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Background: There is an increasing interest in the possible healing factors connected to the presence of nature elements in health institutions. Objective: The aim of the present study is to get a deeper understanding of how residents in a residential rehabilitation center experience the views through windows and the indoor plants, and whether and how the view and the plants can impact their recovery process. Methods: In-depth individual and group interviews were conducted among 16 residents at a rehabilitation center in Norway. Results: The participants said that the indoor plants and the view of nature were pleasant to look at and elicited feelings of relaxation and positive emotions which contributed to opportunities for reflection and contemplation. They expressed a feeling of connectedness to nature: a feeling of wholeness and spirituality elicited by the nature elements. They also expressed that the presence of nature elements contributed to a sense of being taken care of. Conclusions: The nature elements, such as a view of nature or indoor plants, seem to enhance opportunities for reflection, feelings of meaningfulness and sense of being taken care of which may strengthen their feeling of well-being and make them more resilient to the stressors in life.
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Health benefits of a view of nature
through the window: a quasi-
experimental study of patients in a
residential rehabilitation center
Ruth Kjærsti Raanaas
, Grete Grindal Patil
and Terry Hartig
Objective: To examine the health benefits of a bedroom window view to natural surroundings for patients
undergoing a residential rehabilitation programme.
Design: Longitudinal quasi-experiment.
Setting: A residential rehabilitation centre.
Subjects: Two-hundred and seventy-eight coronary and pulmonary patients provided data at all measure-
ment points during the programme.
Intervention: Blind, quasi-random allocation to a private bedroom with a panoramic view to natural
surroundings or with a view either partially or entirely blocked by buildings.
Main measures: Self-reported physical and mental health (SF-12), subjective well-being, emotional states,
use of the private bedroom and leisure activities.
Results: For women, a blocked view appeared to negatively influence change in physical health
(time 3view 3gender interaction, F(4,504) ¼2.51, P¼0.04), whereas for men, a blocked view appeared
to negatively influence change in mental health (time 3view 3gender interaction, F(4,504) ¼5.67, P<0.01).
Pulmonary patients with a panoramic view showed greater improvement in mental health than coronary
patients with such a view (time 3view 3diagnostic group interaction, F(4,504) ¼2.76, P¼0.03). Those with
a panoramic view to nature more often chose to stay in their bedroom when they wanted to be alone than
those with a blocked view (odds ratio (OR) ¼2.32, 95% confidence interval (CI) 1.08–5.01).
Conclusion: An unobstructed bedroom view to natural surroundings appears to have better supported
improvement in self-reported physical and mental health during a residential rehabilitation programme,
although the degree of change varied with gender and diagnostic group.
Cardiac rehabilitation, pulmonary rehabilitation, leisure, recreation, psychological factors
Received: 9 May 2011; accepted: 14 May 2011
Department of Plant and Environmental Sciences, Norwegian
University of Life Sciences, A
˚s, Norway
Institute for Housing and Urban Research, Uppsala University,
¨vle, Sweden
Corresponding author:
Ruth Kjærsti Raanaas, Department of Plant and Environmental
Sciences, Norwegian University of Life Sciences, Box 5003, N-
1432 A
˚s, Norway
Clinical Rehabilitation
26(1) 21–32
ÓThe Author(s) 2011
Reprints and permissions:
DOI: 10.1177/0269215511412800
Features of the physical environment can
promote desirable patient outcomes in health
care institutions.
One such feature is the con-
nection between the indoor and outdoor environ-
ment provided by a window in a patient’s
bedroom. Fresh air and sunlight have long been
thought to promote patient well-being,
but until
relatively recently there was little experimental
evidence that what patients could see from their
room also could be beneficial. In a pioneering
study, however, Ulrich
compared recovery
from surgery among patients in hospital rooms
with a view of trees versus a brick wall. Those
with the tree view used less potent analgesics,
received fewer negative comments in nurses’
notes and had shorter postoperative hospital
To explain these benefits, Ulrich
that a view of natural elements serves as a dis-
traction that evokes positive emotions, counter-
acting stress and enhancing pain management.
His study has not been replicated, but several
experiments have addressed components of his
Studies in clinical settings have
reported beneficial effects of indoor interventions
involving nature imagery.
For example,
Diette et al.
reported better pain control
among patients undergoing flexible bronchos-
copy while lying on a bed surrounded by a cur-
tain with a large landscape scene, in comparison
to patients without such a ‘bedscape’.
Experiments with non-clinical samples have
found enhanced psychophysiological stress
reduction with a window view to nature versus
no view
and videotapes of natural settings
versus urban and pedestrian mall settings.
The present study extends this line of research
by assessing the effects of window view contents
on patients in a residential rehabilitation centre.
The focus on residential centres is of interest
because many of them are located in natural
surroundings and offer window views onto those
Even with seemingly easy
physical access to the natural surroundings,
window views may have considerable importance,
particularly if harsh weather conditions and poor
health keep patients indoors.
In general, patients undergoing rehabilitation
are a vulnerable group, with compromised health
presenting a major life crisis.
typically last for multiple weeks and are intended
to help patients restore physical function and
learn about lifestyle change and how to live
with their condition. Participants in a rehabilita-
tion programme have a number of mandatory
activities during the day that may be physically
and mentally demanding. Thus, although the
rehabilitation programme is meant to be restor-
ative in a sense, patients may frequently experi-
ence it as stressful. Withdrawal to a private room
with a view to natural surroundings can support
stress recovery on such occasions. We therefore
hypothesize that availability of a private room
with a window view to natural surroundings
will cumulatively have positive effects on rehabil-
itation patients’ health and well-being.
Given this hypothesis, it is important to mea-
sure how patients actually use their bedrooms,
and in particular the extent to which they use it
when they want to withdraw and be alone versus
using it only for sleeping. We hypothesize that
patients with a window view towards the natural
surroundings will more frequently use their room
as a place for contemplation and waking rest.
There are many possibilities for voluntary leisure
time activities at a rehabilitation centre, such as
social activities, watching TV and going out for
walks. We measured the performance of these
activities as well, to see for example whether
patients in rooms without a window view to
nature would spend more of their spare time
watching television whereas those with such a
view would stay more in their rooms. We also
assessed satisfaction with the window view and
the design of the private room.
We conducted a longitudinal quasi-experiment
at the rehabilitation centre in Røros, Norway.
The main experimental factor comprised three
types of window view from patient rooms,
22 Clinical Rehabilitation 26(1)
which varied in the openness of the view to the
natural surroundings. The study was coordi-
nated with a separate study on the effect of
indoor foliage plants on patient health and
In that study we compared the
self-reported health and well-being of patients
during 11 months before and 11 months after
many large plants were placed in common
areas around the centre in November, 2008.
The present study examined the effects of the
window view from the private bedrooms of the
same patients, where there were no plants either
before or after the plant intervention in the
common areas.
The Røros Centre offers rehabilitation pro-
grammes for different diagnostic groups. These
include patients with a coronary diagnosis (e.g.
have undergone heart surgery or have a history of
coronary heart disease) and patients with a pulmo-
nary diagnosis (e.g. asthmatic diseases or chronic
obstructive pulmonary disease). Hereinafter we
will refer simply to ‘heart’ and ‘lung’ patients, in
line with the terms used by centre staff.
Patients are referred to the centre by their
regular physician and have been at home prior
to the stay; they typically do not enter directly
from acute care facilities. Rehabilitation pro-
grammes are run with groups of at most 20
heart or lung patients, and the length of the
programme is normally four weeks. The groups
are cared for by teams of staff members from
different professions (physical therapy, occupa-
tional therapy, nutrition, bioengineering, nurs-
ing, medicine).
During 2007–2008, patients preparing for a
stay at the centre were invited to participate in
the study via a letter sent with an initial question-
naire by a secretary at the centre. Potential par-
ticipants were informed that it was a study about
the aesthetics of the centre in relation to health
and well-being among patients there. They were
also informed that participation was voluntary.
No further information was given about the envi-
ronmental factors being measured. We obtained
informed consent from those patients willing to
participate. The study was approved by the
Regional Committee for Medical and Health
Research Ethics and the privacy ombudsman
for research at the Norwegian Social Science
Data Service.
Room assignments were administered by a
secretary at the centre (not the same one who
mailed the invitation to participate in the
study). Following standard procedure at the
centre, allocation was stratified by diagnostic
group, as different sets of rooms were reserved
for the different groups. For each diagnostic
group, incoming patients were allocated to the
rooms according to the alphabetical order of
their last names, starting with the lowest room
number. The few rooms with a totally blocked
view were among the lowest room numbers in
both groups. The secretary who made the alloca-
tion to rooms, as well as the other staff members
who interacted with the patients, were not aware
of the window view factor being measured.
Study site and description of window views
The rehabilitation centre was built in the moun-
tain village of Røros in 2003 for the Norwegian
National Association for Heart and Lung
Disease. The centre has modern architecture,
with large open spaces, large windows, light col-
ours, and extensive use of wood and stone in the
interior. Window views from the common areas
are dominated by grass and low trees, a parking
area, and other parts of the building or neigh-
bouring buildings. In contrast, window views
from the bedrooms encompass the valley and
the mountains, though in some rooms the views
of the landscape beyond the centre are partially
or entirely blocked by sections of the building
itself or by other buildings.
Three view categories were created on the
basis of the best possible (least obstructed) view-
point from inside the room. In the panoramic
view condition, rooms had an unobstructed
view onto the valley and mountains, with no
buildings blocking the view. In the partially
blocked view condition, rooms had a view to
the landscape that was partly blocked by parts
of the centre and/or other buildings. In the
blocked view condition, the view to the landscape
Raanaas et al. 23
was completely blocked by other parts of the
centre. Natural elements such as grass could be
seen outside, but there was no view to the land-
scape surrounding the centre.
Rooms at the centre are furnished with a bed,
sofa, desk, and small table. A chair near the
window can easily be oriented toward the view
the patient considers best. The room interior is
identical for all rooms, although the floor plan of
some of the rooms mirrors that of others. The
heart and lung patients used 52 rooms alto-
gether. On a few occasions, rooms primarily
used by heart patients were used by lung patients
and vice versa, so that the heart patients used a
total of 27 different rooms and the lung patients
used a total of 29 different rooms. Five of the
rooms are somewhat larger than the others and
these were used by patients in both diagnostic
groups. Two of them have panoramic views
and three have partially blocked views.
Measurement procedures and
outcome measures
The participants received questionnaires at five
different time points: with the initial invitation
letter two weeks before arrival at the centre
(T0), at the time of arrival (T1), two weeks
after arrival (T2), at the end of the four-week
programme (T3), and two weeks after returning
home (T4). The secretary who mailed out the
invitation letter with the T0 questionnaires also
maintained the coding key with participants’
names and registration codes, ensuring their ano-
nymity. She was also responsible for mailing out
the last questionnaire (T4). A member of the care
team working with the given group of patients
handed out the questionnaires for T1, T2 and T3
with instructions to fill them out and return them
in a mailbox placed in the centre’s reception area.
The staff were instructed not to inform the par-
ticipants about the interest in specific environ-
mental factors at the centre (which the staff
took to mean the indoor plants). The completed
forms were forwarded to the research team, and
the data were entered by a research assistant
blind to the window view conditions of the
participants. Information about the room
number for all participants who filled in at least
one questionnaire was collected from the secre-
tary holding the coding key after data collection
concluded. Patient assignments to view catego-
ries were derived from knowledge about their
room number. Room numbers were linked with
view categories on the basis of observations
made by the research team on-site.
Measures of health and well-being were
included in the questionnaires administered at
T0 through T4. The 12-item Short Form
Health Survey (SF-12) measures self-perceived
physical and mental health.
Responses were
scored according to the instructions provided in
the SF-12 version 2 manual.
Scores can range
from 0 to 100, with higher scores indicating
better health. Cronbach’s alpha ranged from
0.86 to 0.88 across the measurement points.
Subjective well-being was measured with a
single item: ‘When you look at your life in
general, how happy would you say that you
Responses were given with an 11-point
scale (0 ¼extremely unhappy, 10 ¼extremely
Current emotional well-being was measured
using items from a measure of affect based on
the circumplex model.
We focused on acti-
vated–unpleasant (AUP) and unactivated–
pleasant (UAP) affects. AUP affect was
measured with the adjectives annoyed, fearful,
jittery and anxious. UAP was measured with
the terms relaxed, content, at rest, and calm.
Instructions referred to the degree to which
these emotions were experienced at the moment
(1 ¼not at all; 5 ¼very much). The two measures
AUP and UAP were combined after reversal of
scores on the AUP measure, since analyses
of each separately showed that their results mir-
rored each other. Cronbach’s alpha ranged
from 0.83 to 0.87 across the measurement points.
The T3 questionnaire also included specific
questions about the extent to which the partici-
pant was satisfied with the window view and the
design of the private bedroom. Responses were
given on 5-point scales (0 ¼not at all; 4 ¼very
24 Clinical Rehabilitation 26(1)
The T4 questionnaire included questions
about how many hours the participant spent in
the bedroom during the day and for what
purposes they used the bedroom. Responses to
the latter question were recoded into two catego-
ries: only for sleeping during the night and for
taking a nap during the day (coded 0), and for
withdrawing and being alone as well (coded 1).
The T4 questionnaire also included a question
about how often the participant went out
for walks during the four-week period (0 ¼never,
1¼once or twice during the stay,2 ¼once or twice
every week, 3 ¼every second day, 4 ¼every day).
Responses were recodedinto two categories: up to
twice during the stay at the centre (coded 0), and
more than twice during the stay (coded 1).
The T4 questionnaire further included items
about whether or not the participant spent time
in the reception area, TV rooms, and corridor
resting areas during daytime, evenings and week-
ends (0 ¼no, 1 ¼yes for each of the nine ques-
tions for the three areas 3three periods). For
each common area, a mean was calculated for
each participant looking across the three differ-
ent periods. The mean scores could range from 0
to 1, where 1 indicates more use of that particular
common area. The common area measures
reflect on the degree of social activity, but the
use of the TV rooms is assumed to reflect on
the amount of TV watching.
A variety of socio-demographic variables
were measured at T0. Those relevant for the pre-
sent study were gender and age in years.
Statistical analyses
Imputations for missing data were made at the
item level using the expectation maximization
with data for other items from the
same questionnaire at the same time point used
for reference.
One-way ANOVA were used to assess the
effects of the window view on satisfaction with
the window view and interior room design.
Repeated-measures ANOVA were used to
assess the effects of the window view on change
in the self-reported health, subjective well-being,
and emotion outcomes from T1 to T3. For all of
these analyses, gender, diagnostic group and
plant intervention period (pre- and post-) were
treated as additional between-subjects factors.
Age and the corresponding measure from T0
were used as covariates. Greenhouse-Geisser
adjusted degrees of freedom and associated prob-
abilities are reported where appropriate for the
repeated measures ANOVA. The type III sum
of squares was used, given unequal cell numbers.
Logistic regression was used to assess the odds
that the patients performed some leisure activi-
ties more often if they had a particular window
view, independent of age, gender, diagnostic
group, and plant intervention.
During the study period, 250 lung and 345 heart
patients (in 16 lung and 20 heart groups) com-
pleted at least three of the four weeks in one of
the centre’s rehabilitation programmes and were
eligible for the study. The flow of patients is
shown in Figure 1. Four hundred and eighty-
one patients consented to participate. Of these,
278 answered all three questionnaires at the
centre (T1–T3) and were included in analyses of
change in the health and other outcomes. The
questions posed at T4 about activities at the
centre were answered by 380 patients. Patients
did not complete all questionnaires because of
unwillingness (e.g. due to fatigue) and on a few
occasions because they did not receive the
questionnaire from centre staff.
The demographic characteristics of the groups
are presented in Table 1. The mean age of the
participants did not differ across the view condi-
tions (P¼0.27). Gender was not significantly
associated with view type (x
¼2.89, P¼0.24).
However, more of the heart than the lung
patients had panoramic views (x
P<0.01). Relatively more of the participating
patients had a panoramic view during the
second year of the study, after initiation of the
plant intervention, whereas fewer had a partially
blocked view during the same period (x
P<0.05). These differences further motivate the
Raanaas et al. 25
Table 1. Baseline demographic data for patients in the different window view conditions
Panoramic Partially blocked Blocked
Age in years, mean (SD) 62 (8.6) 64 (8.6) 62 (9.1)
Male N(%) 83 (73) 86 (64) 18 (60)
Female N(%) 31 (27) 48 (36) 12 (40)
Diagnostic group
Heart N(%) 81 (71) 69 (51) 16 (53)
Lung N(%) 33 (29) 65 (49) 14 (47)
Plant intervention
Without plants N(%) 49 (43) 80 (60) 14 (47)
With plants N(%) 65 (57) 54 (40) 16 (53)
Enrollment, informed
consent and allocation to
n = 472
n = 47
Partially blocked
n = 227
n = 189
invitation to
participate (unknown
room number)n = 165
Complete T1-T3 data
n = 114
Complete T1-T3 data
n = 134
Complete T1-T3 data
n = 30
Unknown room
number n = 9
T4 data n = 151 T4 data n = 191 T4 data n = 38
T1-T3 data
but data
available for
T4 n = 62
T1-T3 data
but data
available for
T4 n = 9
n = 5
n = 1
n = 7
T1-T3 data
but data
available for
T4 n = 44
n = 31
n = 31
n = 8
Figure 1. Flow diagram describing the study design and sample available for analysis of change in the health and
well-being outcomes (T1–T3 data) and activity at the center (T4 data).
26 Clinical Rehabilitation 26(1)
Table 2. Means (standard deviations) for the SF-12 physical (P) and mental (M) health scores, emotional state (E) and subjective well-being (W) outcomes for the
three window view conditions from the start of the rehabilitation programme (T1) to the end of the programme (T3)
Panoramic Partially blocked Blocked
Heart Lung Heart Lung Heart Lung
P Men
T1 48.4 (7.83) 42.6 (9.98) 38.6 (9.48) 33.3 (10.0) 45.0 (8.22) 41.6 (11.27) 37.2 (9.28) 38.5 (7.18) 46.5 (9.96) 51.3 (10.99) 33.8 (7.50) 41.1 (9.61)
T2 51.6 (7.82) 46.4 (9.54) 43.3 (9.81) 36.8 (11.71) 50.5 (7.05) 49.8 (8.34) 38.2 (10.12) 40.4 (9.14) 49.7 (8.12) 51.7 (11.12) 34.8 (3.24) 43.6 (7.82)
T3 52.9 (7.79) 46.8 (9.62) 41.1 (10.71) 38.9 (10.71) 52.2 (6.94) 48.1 (7.75) 40.1 (10.43) 40.9 (9.67) 51.2 (8.19) 47.9 (7.78) 42.0 (8.29) 42.1 (8.69)
T1 40.2 (9.53) 40.5 (9.65) 34.4 (9.45) 32.4 (14.70) 41.7 (8.44) 45.1 (6.44) 37.0 (8.37) 40.4 (8.29) 43.3 (8.29) 33.5 (4.9) 39.4 (9.28) 35.9 (12.13)
T2 42.2 (8.83) 43.3 (7.87) 42.9 (7.35) 41.1 (8.55) 44.3 (6.90) 40.7 (7.00) 39.0 (9.13) 43.8 (7.46) 41.1 (10.35) 43.9 (6.09) 32.8 (9.19) 41.6 (7.17)
T3 44.1 (7.88) 44.0 (5.75) 40.5 (9.35) 41.4 (8.91) 44.8 (7.88) 49.7 (3.07) 39.4 (9.06) 45.2 (6.28) 41.4 (9.09) 44.6 (0.94) 37.3 (7.49) 41.9 (4.89)
T1 4.01 (0.63) 3.89 (0.57) 3.61 (0.63) 3.49 (0.70) 4.09 (0.59) 4.10 (0.37) 3.51 (0.71) 3.78 (0.60) 3.99 (0.61) 4.25 (0.18) 3.53 (0.55) 3.29 (1.03)
T2 4.16 (0.54) 4.05 (0.72) 3.60 (0.71) 3.77 (0.73) 4.22 (0.56) 4.31 (0.33) 3.88 (0.59) 3.98 (0.65) 3.94 (0.65) 4.44 (0.33) 3.48 (0.52) 3.43 (0.91)
T3 4.24 (0.63) 4.19 (0.78) 3.68 (0.76) 3.69 (0.77) 4.28 (0.57) 4.37 (0.23) 3.90 (0.66) 4.16 (0.59) 4.08 (0.67) 4.66 (0.12) 3.72 (0.44) 3.42 (0.51)
T1 6.56 (1.58) 6.83 (1.29) 6.28 (1.94) 5.54 (0.88) 6.96 (1.45) 7.08 (1.16) 6.52 (1.62) 6.31 (1.41) 7.00 (2.17) 7.25 (0.50) 6.33 (1.21) 5.38 (0.92)
T2 7.05 (1.31) 7.17 (1.65) 6.55 (1.28) 6.00 (1.22) 7.23 (1.18) 7.41 (1.09) 6.97 (1.82) 6.97 (1.36) 7.67 (1.30) 7.25 (0.96) 6.00 (1.79) 5.50 (1.41)
T3 7.35 (1.39) 7.28 (1.13) 6.90 (1.48) 6.77 (1.54) 7.46 (1.29) 7.75 (1.14) 6.94 (1.36) 7.11 (1.47) 7.67 (1.23) 7.50 (0.58) 6.17 (0.75) 5.38 (1.77)
inclusion of gender and diagnostic group as fac-
tors in the experimental design.
Baseline (T1) data for the measured outcomes
are presented in Table 2. At the start of their
programme, the participants in the different
view groups were similar on all the outcome mea-
sures (all F-values <2.56, all P-values >0.08).
Change in self-reported physical health during
the time at the centre (T1–T3) was modified by
window view and gender together (Tables 2
and 3). Men had similar increases in all view con-
ditions across the three measurement points,
whereas women in the partially and fully blocked
view conditions showed declines during the latter
part of the programme, after initially making
gains (Table 3 and Figure 2 a,b). The change
was also modified by window view and diagnos-
tic group together. Among heart patients, those
with the blocked view showed the least improve-
ment, particularly from T2 to T3. Among lung
patients, those with the panoramic view showed
the greatest improvement from T1 to T2, but
then no further improvement, while the two
other groups continued to improve (Table 3
and Figure 2c,d).
Improvement in mental health during the time
at the centre was also sensitive to the window view,
but the effect was again modified by both gender
and diagnostic group (Tables 2 and 3). A blocked
window view appears to have had a negative effect
on mental health during the period of the rehabil-
itation for men but not for women (Table 3 and
Figure 3). Heart patients with the blocked view
showed the least improvement, while among the
lung patients, those with the panoramic view
showed the greatest improvement from T1 to
T2, but then no further improvement, while the
two other groups continued to improve.
Change in the emotional state and subjective
well-being reports was not modified by window
view. For both variables, all F-values for inter-
actions involving window view were less than
1.07 and all P-values were larger than 0.37.
There were no significant interactions between
window view and the plant intervention condition
for any of the health and well-being measures (all
P-values >0.13). Nor did the window view and
plant intervention together interact with either
gender or diagnostic group (all P-values >0.14).
Patients in the three window view categories
spent about the same number of hours in their
rooms during the daytime (blocked: M¼2.15,
SD ¼1.58; partially blocked: M¼2.12,
SD ¼1.42; panoramic: M¼2.30, SD ¼1.43).
However, more of those who had a panoramic
window view chose to stay in the room when
they wanted to withdraw and be alone in
comparison to those who had a blocked view
(odds ratio (OR) ¼2.32, 95% confidence interval
(CI) ¼1.08–5.01). Those with a partially blocked
view did not have significantly higher odds of
withdrawing to their rooms for solitude than
those in the fully blocked view condition
(OR ¼1.39, 95% CI ¼0.65–2.97). The other
variables in the logistic regression model (age,
gender, diagnostic group, plant intervention
condition) did not contribute to prediction (all
P-values >0.05). Thus, it would appear that,
while spending the same amount of time in the
room during the day, patients with panoramic
views were less likely to spend it in napping.
There were no significant associations between
window view and the measured leisure activities,
including going out for walks and using the cor-
ridor seating areas, seating areas in the reception
and TV rooms (all correlation coefficients <0.09).
In keeping with the health and behavioural
data, patients with a panoramic view to the
surrounding landscape were quite satisfied with
the view, and more so than those who had a
partially blocked view, who were themselves
more satisfied than those with a totally blocked
view (Table 4). Post-hoc tests (Bonferroni)
showed that ratings of each of the view condi-
tions differed significantly from the others
(P<0.03). Satisfaction with the design of the
patient room of itself was high overall and unaf-
fected by the window view (Table 4).
The relationship between type of window view
and satisfaction with the view showed a clear
gradient. Patients with a panoramic window
28 Clinical Rehabilitation 26(1)
Table 3. Effects of time at the centre (T1–T3) on self-reported health as moderated by window view, gender and
diagnostic group
FP-value Partial eta
SF-12 Physical Time 3view 0.93 0.45 0.01
Time 3view 3gender 2.51 0.04 0.02
Time 3view 3group 2.64 0.03 0.02
SF-12 Mental Time 3view 3.50 0.01 0.03
Time 3view 3gender 5.67 <0.01 0.04
Time 3view 3group 2.76 0.03 0.02
For the physical health outcomes, the Greenhouse–Geisser adjusted degrees of freedom are (3.39, 490.5). For the mental health
outcomes, the Greenhouse–Geisser adjusted degrees of freedom are (3.61, 454.2).
T1 T2 T3
Mean SF-12 Physical Health
Partially blocked
T1 T2 T3
(c) (d)
Figure 2. Change in mean SF-12 physical health during the rehabilitation programme (T1–T3) as a function of the
window view, for men (a) and women (b) and for heart patients (c) and lung patients (d). Error bars show 61 SE.
Raanaas et al. 29
view to nature were most satisfied, and those
with a blocked view were least satisfied. This
result conforms with a large body of findings
that scenes of nature and natural elements are
preferred over scenes dominated by build-
Patients with a panoramic view to nature also
reported using the room as a place to withdraw
to a greater extent. Patients at a rehabilitation
centre are taxed by the demands of a diffi-
cult health situation,
in addition to the
demands of the rehabilitation programme itself.
Table 4. Satisfaction with window view and room design reported by patients in the three window view conditions
Panoramic Partially blocked Blocked FP-value
Window view 3.34 (0.71) 2.44 (0.99) 1.97 (0.89) 28.04 <0.01
Room design 3.56 (0.58) 3.47 (0.66) 3.50 (0.51) 0.33 0.72
For the window view F-test, df are 2 and 251. For the room design F-test, df are 2 and 252.
Values in the first three columns are means (SDs).
Mean SF-12 Mental Health
T1 T2 T3
Partially blocked
T1 T2 T3
(c) (d)
Figure 3. Change in mean SF-12 mental health during the rehabilitation programme (T1–T3) as a function of the
window view, for men (a) and women (b) and for heart patients (c) and lung patients (d). Error bars show 61 SE.
30 Clinical Rehabilitation 26(1)
As suggested by Ulrich,
by supporting restora-
tion when needed, passive visual contact with the
natural environment may help patients receiving
care to cope better with the demands engendered
by ill-health.
Even though patients at the centre were not in
their bedrooms during the day to the same extent
as in the studies by Ulrich
and Park and
their self-reported health varied
with the type of window view. The effects were
contingent, however, on gender. A blocked
view appears to have negatively affected the
mental health of men but not women during
their stay. On the other hand, a panoramic
view had a more continuously positive effect on
physical health among women. The indoor
plant intervention in the Røros centre also
found gender differences,
as did earlier studies
involving indoor nature interventions in other
The effects of the window view over time also
were contingent on diagnostic group. A view
to the surrounding natural landscape appeared
to have a more positive effect on the mental
health of lung patients than of heart patients.
We can only speculate about reasons for the dif-
ferences between the diagnostic groups. The lung
patients generally have more constraints, given
difficulty in breathing and rapid onset of fatigue;
they may therefore need to relax indoors to a
larger extent, and a window view to nature may
therefore have a larger potential for improving
their health. The results of the logistic regres-
sion analysis suggest that the different diagnos-
tic groups did not differ in their use of the
private room, but this does not mean that
they benefitted similarly from the time spent
in the room.
We did not find effects of the window view on
either emotional states or subjective well-being.
This may reflect on the temporal scope of the
measures; the former prompts for emotional
experience at the moment, while the latter asks
the respondent to look back over his or her life.
In contrast, the SF-12 measures place most
emphasis on health as perceived during the
preceding week.
The study has some limitations. Although
we are confident that the allocation procedures
disallowed self-selection, we did not have formal
randomization to view conditions. The outcome
measures were self-reports, and results from
these may not align with objective measures
indicative of the success of the rehabilitation
programme. The analyses here only concern the
experience of the patients while they were at
the centre; long-term health effects cannot be
Together with similar studies, the findings
have practical implications. Those designing
health institutions can consider ways to site the
building so that the rooms have pleasing views.
Those responsible for room allocation
can take care to allocate especially vulnerable
persons to rooms with particularly good views.
Clinical messages
.An unobstructed window view to nature
from a private patient room promotes
improvement in self-reported health
during a residential rehabilitation pro-
gramme; however, the strength of the
effect appears to vary as a function of
gender and diagnosis.
.A patient room with an unobstructed
window view to nature may find more use
as a setting to be alone during a challenging
residential rehabilitation programme.
Such withdrawal can help patients cope
emotionally with the demands of their
This project was financed with EXTRA funds
from the Norwegian Foundation for Health
and Rehabilitation. It was further supported by
the Norwegian Gardener’s Union, the Bank of
Røros, Tropisk Design, and Primaflor. In addi-
tion to the funders, we thank Tina Bringslimark
for help in planning the study, Tropisk Design
for help in implementing the plant intervention,
Raanaas et al. 31
the staff at the Røros Rehabilitation Centre for their
diligent assistance in conducting the study, and Ellen
Zakariassen for help with data entry.
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32 Clinical Rehabilitation 26(1)
... Other studies create a green space and use this manufactured setting as the green space variable. Raanaas, Patil, and Hartig (2011) and Raanaas, Patil, and Alve (2016) used this method when evaluating a patient's perceived health. The authors in these studies defined a participant's exposure to green space as either a panoramic view, or a blocked view. ...
... In a similar study conducted by Raanaas, Patil, and Alve (2016) a phenomenological study approach was utilized in an attempt to find the meaning that nature had on a patient's recovery. Again, the patient's perceived health was the focus of the study and is therefore not measurable. ...
... Natural elements were shown to trigger health promotion activities and mentally prepare patients for partaking in rigorous physical rehabilitation activities. In summary, Raanaas, Patil, and Alve (2016) found that it was difficult to separate mental health from physical health because the one is dependent upon motivating the other. White et al. (2019) conducted a longitudinal study in England that examined the relationship between time spent outdoors and self-reported physical health and wellbeing. ...
Environmental greenness is often associated with improved psychological outcomes, but the use of green space as a protective factor for maintaining physiologic health is understudied. However, growing evidence exists on the benefit of greenness on physiologic health. The purpose of this systematic review was to evaluate the effect of green space on the physiologic function of the adult. Cohort studies were searched for that had all elements of inclusion criteria. Six final studies were included in this systematic review utilizing PRISMA guidelines and CASP tool for cohort studies. Data from the studies was collected and a cross study analysis was conducted to compare all studies and assess for themes in study outcomes. Results of this review demonstrate that green space has a protective effect on physiologic health. Areas with higher levels of greenness are associated with lower prevalence of central obesity, diabetes mellitus, and self-reported rates of cardiovascular disease and stroke as well as decreased rates of mortality from cancers, and kidney and respiratory diseases. Implications of this study include the importance in understanding risk factors for development of disease. Awareness of a patient’s environment that includes natural spaces should be identified as a potential risk factor for the development of cardiovascular illness, obesity, and diabetes mellitus.
... Window views of nature have shown a strong relationship with shorter length of stay [11], reduced perception of pain [4], relaxation and positive emotions [12], and patient satisfaction with their view [5]. A study of ICU patients concluded that patients with views of nature had a reduced length of stay compared to patients with urban views [11]. ...
... A study of rehabilitation center residents explored the impact of view through windows and indoor plants on recovery and found a strong relationship between the type of window view and view pleasantness. Patients with a panoramic window view to nature found their view calming, and those with a blocked view to the outdoors were dissatisfied with the view [12]. Participants in a study by Gharaveis et al. (2016) emphasized that the view content was important to them, with view of nature and other people's activities noted as their preferred type of view [8]. ...
Full-text available
Hospital ratings reflect patient satisfaction, consumer perception of care, and create the context for quality improvement in healthcare settings. Despite an abundance of studies on the health benefits of the presence and content of window views, there is a gap in research examining how these features may impact patient satisfaction and consumer perceptions of the quality of care received. A quantitative exploratory study collected data from 652 participants regarding their previous stay in the hospital, their perception of windows in their room, and their perception of their room, the hospital, and the quality of care received. On a scale of 0–10, participants with access to windows gave a 1-unit higher rating for the hospital. Access to window views from their bed provided a 1-unit increase, and having a view to green spaces resulted in a 2-unit increase in hospital ratings. Statistically significant results were also found for room ratings and care ratings. Windows in the patient rooms impact the key patient satisfaction measures and patient experience during the hospital stay. Patient room design, bed set up, and quantity and quality of window views may play an important role in shaping the patient’s experience.
... Striving toward wholeness is a vital component of health and well-being that integrates into multiple aspects of life. The idea of wholeness emerges in various forms throughout the literature including: addressing wholeness prenatally, parental self-care, spirituality and religiosity for individuals in the military, awareness of how a patient's rehabilitation environment impacts wholeness, the connection of wholeness and exercise, as well as providing a whole-person care approach within palliative care, (Freeman, 2016;Greenwood & Delgado, 2013;Kluny & Dillard, 2014;Raanaas et al., 2016). Regardless of the specific wholeness element examined, all lead to the same conclusion. ...
... Though a publication dating back to the 1990s has discussed indoor plants and the feeling of satisfaction (Talbot and Kaplan, 1991), the possible relationship between indoor plant exposure and psychological effects or mental health outcomes remains unclear. Some survey studies found that various types of participants, including elderly individuals (Talbot and Kaplan, 1991), patients (Raanaas et al., 2016), employees (Han and Hyun, 2019), and university members/students (van den Bogerd et al., 2018), showed a positive attitude towards having greenery window views or indoor plants. Some experimental studies in succession explored the effect of exposure to indoor plants and mental health-related outcomes. ...
Background Increasing numbers of epidemiological studies are investigating the association between outdoor greenery and various health outcomes. However, in the case of indoor plants, although experimental studies seem relatively abundant, epidemiological studies remain scarce, and research considering the mental health effects is even more limited. Thus, we aim to identify and summarise the relevant epidemiological studies on indoor plant exposure and mental health via this scoping review, thereby presenting the current state of knowledge and research niches. Methods PubMed and PsycINFO were systematically searched for epidemiological studies on indoor plant exposure and mental health, including mental and behavioural disorders, quality of life, and cognitive function. The publication period was from the inception of these two databases to 22nd June 2022. We extracted information on the relevant studies on exposure to indoor plants and mental health-related outcomes. Results The systematic search yielded 1186 unique results. Six studies met the inclusion criteria and were finally included in this scoping review. All included studies were Europe-based cross-sectional studies on mental and behavioural disorders. One study was conducted in 2015 and investigated the office environment, whereas the other five were conducted during the COVID-19 pandemic and focused on the home environment. Despite considerable heterogeneity in outcome assessments and indoor plant exposure metrics, all six studies generally reported beneficial associations between having indoor plants and mental health, such as reducing stress, depressive symptoms, and negative emotions. Conclusions Epidemiological evidence on exposure to indoor plants and mental health is currently limited. In general, favourable effects of indoor plants are supported, although most relevant studies were conducted in the context of COVID-19. Before conducting more studies to explore the associations, data collection methods must be refined with more elaborate designs that allow for the measurement of more comprehensive metrics of indoor plants. Registration Open Science Framework,
... Access to daylight and views through windows has proven critical for fostering a therapeutic and supportive healing environment (1)(2)(3)(4), ultimately manifesting in better patient outcomes such as shortened length of stay and reduced pain medication use (5)(6)(7)(8)(9)(10)(11). Although the relevance of these design factors from an experience and clinical quality perspective are clear, less is understood about how these factors make a hospital a more competitive choice for patients seeking care. ...
Full-text available
Evidence-based design has been fundamental to designing healthcare environments for patient outcomes and experience, yet few studies have studied how design factors drive patient choice. 652 patients who recently received care at hospitals across the United States were administered an online discrete choice survey to investigate the factors playing into their choice between hypothetical hospitals. Discrete choice models are widely used to model patient preferences among treatment alternatives, but few studies have utilized this approach to investigate healthcare design alternatives. In the current study, respondents were asked to choose between hypothetical hospitals that differed in patient room design, window features of the room, appointment availability, distance from home, insurance coverage, and HCAHPS ratings. The results demonstrate that patient room design that allowed unobscured access to daylight and views through windows, in-network insurance coverage, closer distance from home, and one-star higher patient experience rating increased the likelihood of a patient's hospital choice. The study broadly explores discrete choice model's applicability to healthcare design and its ability to quantify patient perceptions with a metric meaningful for hospital administrators.
... A long line of empirical evidence has shown that natural settings can promote stress reduction and ease physiological arousal (Laumann et al., 2003;Stigsdotter and Grahn, 2004;Tyrväinen et al., 2014). Placing natural elements in urban areas has been shown to improve mental health (Tzoulas et al., 2007), and natural elements indoor has been shown to promote psychological well-being (Raanaas et al., 2016). In addition, viewing nature from a window helps faster recovery from physical exercise (Engell et al., 2020). ...
Full-text available
Various lines of evidence have shown that nature exposure is beneficial for humans. Despite several empirical findings pointing out to cognitive and emotional positive effects, most of the evidence of these effects are correlational, and it has been challenging to identify a cause-effect relationship between nature exposure and cognitive and emotional benefits. Only few of the published studies use psychophysiological methods to assess the biological correlates of these positive effects. Establishing a connection between human physiology and contact with natural settings is important for identifying cause-effect relationships between exposure to natural environments and the positive effects commonly reported in connection to nature exposure. In the present study, we recorded physiological indexes of brain activity (electroencephalography) and sympathetic nervous system (electrodermal activity), while the participants were presented with a series of videos displaying natural, urban, or neutral (non-environmental, computerized) scenes. Participants rated the scenes for their perceived relaxing value, and after each experimental condition, they performed a cognitive task (digit span backward). Participants rated natural videos as the most relaxing. Spectral analyses of EEG showed that natural scenes promoted alpha waves, especially over the central brain. The results suggest that experiencing natural environments virtually produces measurable and reliable brain activity markers which are known to be related to restorative processes.
... When direct access to nature is not available on a regular basis, researchers and healthcare practitioners have turned to supplementary approaches for obtaining some of its benefits, such as window views (Chang & Chen, 2005;Kaplan, 2001;Raanaas et al., 2016), nature-oriented artwork and murals (Diette et al., 2003), nature videos (Kahn et al., 2008), and virtual reality (VR) immersion (Gorini et al., 2010;Moyle et al., 2018). Like all such approaches, the use of VR has liabilities, particularly in regard to its lack of tactile engagement and its inability to fully replicate the deep complexity and material interconnectedness of actual organic environments. ...
Full-text available
Background and Objectives Exposure to nature and nature-based imagery has been shown to improve mood states and stave off cognitive decline in older adults. Even “micro-doses” of natural scenery can provide beneficial effects in situations where more extensive interactions with nature are not feasible. In the current study we evaluated the use of virtual reality (VR) for delivering interactive nature-based content with the goal of prompting active engagement and improving mood states in older adults. Research Design and Methods The researchers developed a novel VR environment that combined 360-degree videos of natural areas and botanical gardens with interactive digital features that allowed users to engage with aspects of the environment. We recruited 50 older adults to try out this VR environment, and measured changes in mood states and attitudes toward VR from before vs. after the sessions. We controlled for variables such as age, education level, and exposure to nature in everyday life, and we looked for differences in responses to the VR among participants with cognitive impairments vs without, and participants with physical disabilities vs. without. Results The findings indicated significant improvements in “good” mood and “calm” mood dimensions after exposure to the VR, as well as improvements in attitudes toward the technology. These positive outcomes were significantly greater for participants with physical disabilities compared to those without disabilities. No differences were found in the responses of participants with cognitive impairments vs. those without. Exit interviews provided a variety of helpful suggestions about ways to improve the VR equipment design and content to meet the needs of an older adult population. Discussion and Implications The study demonstrates that VR can provide a cost-effective, non-invasive, and non-pharmaceutical approach for improving the lives of older adults in both clinical and recreational settings, particularly when real-world access to nature is limited.
... When direct access to nature is not available on a regular basis, researchers and healthcare practitioners have turned to supplementary approaches for obtaining some of its benefits, such as window views (Chang & Chen, 2005; R. Kaplan, 2001;Raanaas et al., 2016), nature-oriented artwork and murals (Diette et al., 2003), nature videos (Kahn et al., 2008), and virtual reality immersion (Gorini et al., 2010;Moyle et al., 2018). Like all such approaches, the use of virtual reality (VR) has liabilities, particularly in regard to its lack of tactile engagement and its inability to fully replicate the deep complexity and material interconnectedness of actual organic environments (Kalantari & Neo, 2020). ...
Full-text available
Engaging with natural environments and representations of nature has been shown to improve mood states and reduce cognitive decline in older adults. The current study evaluated the use of virtual reality (VR) for presenting immersive 360 degree nature videos and a digitally designed interactive garden for this purpose. Fifty participants (age 60 plus), with varied cognitive and physical abilities, were recruited. Data were collected through pre/post-intervention surveys, standardized observations during the interventions, and post-intervention semi structured interviews. The results indicated significant improvements in attitudes toward VR and in some aspects of mood and engagement. The responses to the environment did not significantly differ among participants with different cognitive abilities; however, those with physical disabilities expressed stronger positive reactions on some metrics compared to participants without disabilities. Almost no negative impacts (cybersickness, task frustration) were found. In the interviews some participants expressed resistance to the technology, in particular the digital garden, indicating that it felt cartoonish or unappealing and that it could not substitute for real nature. However, the majority felt that the VR experiences could be a beneficial activity in situations when real-world contact with nature was not immediately feasible.
... Many of the interviewees emphasized nature that can be viewed, listened to, touched, smelled, or taken care of from their residence: in the garden or on the terrace, or inside the home. In line with previous research demonstrating the health-enhancing benefits of exposure to and interaction with nature elements indoors, through windows, or in one's garden (Ambrose et al. 2020;Raanaas, Patil, and Alve 2016), such domestic natural environments may be equally regarded as a significant source of health-enhancement for this subgroup of women. This may be of particular relevance for those living in urban areas where access to nature in the neighborhood is lower. ...
Full-text available
The role of nature in potentially improving people’s health – including immigrant women, who are particularly prone to health challenges – has been highlighted. Success in this public health arena requires an adequate understanding of the target group’s current practices and preferences. However, knowledge in this field is lacking, and is nearly non-existent in the Norwegian context. The present study therefore aims to explore practices regarding interactions with nature among immigrant women in Norway. Data were gathered through individual interviews with 14 immigrant women from Iran (2), Poland (2), Palestine, Afghanistan, Congo, Kenya, Thailand, Russia, Portugal, Latvia, Colombia, and Bulgaria. The qualitative content analysis revealed a relatively comprehensive and mixed use of natural environments, which took place in three distinct types of locales: 1) local natural environments, e.g. neighboring wooded areas, sites by the water, playing fields, and school yards; 2) domestic natural environments, e.g. indoor and garden plants; and 3) distant natural environments, e.g. mountains and fjords requiring driving and often overnight visit. Nature outings often included passive recreational pursuits, such as eating a meal and enjoying the scenery, with a few close friends or family members. Walking emerged as a common local nature-based physical activity. Study findings also portray a complex ‘image of nature’ among the women, reflecting their valuing of both more managed and more pristine nature. Findings therefore suggest that future public health practices targeting immigrant women may apply a broad definition of ‘interaction with nature’, incorporating various geographical locales as well as types of nature.
Objectives This article aims to describe users’ perspectives about the impact of hospital outdoor spaces on the patient experience in a postacute setting. Background Hospital outdoor space is an important element in healthcare facility design. There is growing evidence that access to green space within hospital outdoor spaces facilitates healing. However, limited studies have explored the users’ perspective regarding how hospital outdoor spaces impact the patient experience. Methods As part of a hospital preoccupancy evaluation, users (patients, family, and staff) were invited to participate in a semi-structured interview to describe their experiences in the hospital’s outdoor spaces. Data were analyzed using inductive thematic analysis. Results Seventy-four individuals participated in this study: 24 inpatients, 15 outpatients, 11 family, 23 staff, and one volunteer. Three themes were identified: (1) outdoor space benefits healing by helping patients focus on life beyond their illness, (2) design of healthcare spaces facilitates patients’ access to outdoor space to benefit healing, and (3) programming in the outdoor space promotes healing and recovery. Conclusions This study describes the users’ perspective regarding the value of outdoor spaces and the design elements that influence the patient experience.
Full-text available
A job satisfaction survey was posted on the Internet and administered to office workers in Texas and the Midwest. The survey included questions regarding job satisfaction, physical work environments, the presence or absence of live interior plants and windows, environmental preferences of the office workers, and demographic information. Approximately 450 completed responses were included in the final sample. Data were analyzed to compare levels of job satisfaction of employees who worked in office spaces with live interior plants or window views of exterior green spaces and employees who worked in office environments without live plants or windows. Statistically significant differences (P < 0.05) were found regarding perceptions of overall life quality, overall perceptions of job satisfaction, and in the job satisfaction subcategories of "nature of work," "supervision," and "coworkers" among employees who worked in office spaces with live interior plants or window views and those employees who worked in office environments without live plants or windows. Findings indicated that individuals who worked in offices with plants and windows reported that they felt better about their job and the work they performed. This study also provided evidence that those employees who worked in offices that had plants or windows reported higher overall quality-of-life scores. Multivariate analysis of variance comparisons indicated that there were no statistically significant differences among the categories of "age," "ethnicity," "salary," "education levels," and "position" among employees who worked in offices with or without plants or window views. However, there were gender differences in comparisons of males in that male participants in offices with plants rated job satisfaction statements higher when compared with males working in offices with no plants. No differences were found in comparisons of female respondents.
Full-text available
Medical environments such as hospital waiting rooms can affect a client's anxiety level as well as psychological and physiological responses to his or her situation. The aim of this research was to evaluate the use of environmental design, specifically the design which incorporates elements of nature, in clinics and hospitals to decrease anxiety, blood pressure and pulse rates of waiting clients. Representations of nature and the natural environment are known to recover a dynamic union between an environment and its user, therefore the effects of environmental design on subjects' responses are measured and analyzed. In order to examine these hypotheses a sample of 145 people were chosen as subjects for the experiment. They were divided into control and experiment groups, both of which included males and females. The designed environment was applied for the experiment group which included elements of nature, green plants, sounds of waterfall and birds. Both control and experiment groups were pre tested and then post tested. The findings showed that being in the designed hospital's waiting room was clearly effective at decreasing a client's level of anxiety (p< 0.001), blood pressure (p< 0.001) and pulse rate (0.001). We propose that using an environmental design for medical treatment centers can reduce levels of anxiety in clients and can effectively foster a sense of wellbeing.
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Background: Improving social support, and providing nature contact at work are potential health promoting workplace interventions. Objective: The objective was to investigate whether nature contact at work is associated with employee's health and participation, and to study whether the possible associations between nature contact and health can be explained by perceived organizational support. Method: Data were collected through a web-based, cross-sectional survey of employees in seven public and private office workplaces in Norway (n = 707, 40% response rate). Multiple linear and logistic regression analysis were performed on 565 participants fulfilling inclusion criteria. Results: A greater amount of indoor nature contact at work was significantly associated with less job stress (B = -0.18, CI = -0.318 to -0.042), fewer subjective health complaints (B = -0.278, CI = -0.445 to -0.112) and less sickness absence (B = -0.061, CI = -0.009 to -0.002). Perceived organizational support mediated the associations between indoor nature contact and job stress and sickness absence, and partly mediated the association with subjective health complaints. Outdoor nature contact showed no reliable association with the outcomes in this study. Conclusions: Extending nature contact in the physical work environment in offices, can add to the variety of possible health-promoting workplace interventions, primarily since it influences the social climate on the workplace.
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This study used an experimental design and multiple measures to ascertain whether stress in healthcare consumers undergoing a procedure known to be stressful - blood donation - would be affected by modest changes in a clinic environment. Four different environmental conditions were presented to 872 blood donors (68% males; 32% females; mean age = 40.4 years) using wall-mounted television monitors: a videotape of nature settings (Nature); a tape of urban environments (Urban); daytime television (Television); or a blank monitor (No Television). Findings from physiological measures (blood pressure, pulse rate) provided a pattern of evidence that the environmental conditions had significantly different effects on donor stress. Consistent with arousal/stimulation theory, the blood-pressure and pulse-rate findings converged to indicate that stress was lower during No Television than Television, and during Low Stimulation (No Television + Nature) than High Stimulation (Television + Urban). In line with evolutionary theory, pulse rates were markedly lower during Nature than Urban. An important clinical implication of the findings is that the common practice of playing uncontrollable daytime television in healthcare waiting areas where stress is a problem may actually have stressful. not stress-reducing, influences on many patients/consumers. Healthcare environments should tend to be more restorative and supportive for stressed outpatients when Nature is prominently present, and environmental stimulation levels are low rather than high and intrusive.
Over the past decades, a number of empirical studies have documented that nature or elements of nature in both outdoor and indoor settings can be beneficial for human health and well-being. Wood is a natural product and it is therefore relevant to investigate whether interior wood use might have some of the same beneficial effects. The aim of the present study is therefore to investigate whether interior wood use might be psychologically beneficial by reviewing studies that have investigated psychological responses toward wood. The study also provides a general introduction to theories that can help explain why wood might be psychologically beneficial. Studies related to psychological responses toward interior wood use have generally focused on three different outcomes: 1) perception of wood, including both visual perception and tactile sensation; 2) attitudes and preferences (aesthetic evaluation) of various wood products; and 3) psychophysiological responses toward wood. The review posits that there seem to be similarities in preferences for wood and that people prefer wood because it is natural. In addition, affective responses toward wood seem to be measurable, giving indications of psychological beneficial effects. However, caution should be made in concluding from the review that interior wood use is psychologically beneficial. Thus, theoretical, methodological, and practical implications are discussed and research needs identified.
Effects of an indoor plant intervention in a Norwegian rehabilitation center were assessed in a quasi-experiment. During a 2-year period, coronary and pulmonary patients (N = 282) completed self-report measures of health, subjective well-being, and emotion on arrival, after 2 weeks, and at the end of a 4-week program. The intervention involved the addition of indoor plants for the second year. On average, patient physical and mental health improved during the program, but the addition of plants did not increase the degree of improvement. Subjective well-being did, however, increase more in patients who went through their program after the addition of plants, although the effect was only apparent in the pulmonary patients. The patients reported more satisfaction with indoor plants and the interior generally after the intervention. Room for the intervention to affect outcomes may have been limited by the well-designed interior and the center's location in a scenic mountain area, but these favorable features of the context apparently did not negate the potential for indoor plants to contribute to patient well-being.
Using various medical and psychological measurements, this study performed a randomized clinical trial with surgical patients to evaluate if plants in hospital rooms have therapeutic influences. Ninety patients recovering from an appendectomy were randomly assigned to hospital rooms with or without plants. Patients in the plant treatment room viewed eight species of foliage and flowering plants during their postoperative recovery periods. Data collected for each patient included length of hospitalization, analgesics used for postoperative pain control, vital signs, ratings of pain intensity, pain distress, anxiety, and fatigue, the State-Trait Anxiety Inventory Form Y-1, the Environmental Assessment Scale, and the Patient's Room Satisfaction Questionnaire. Patients in hospital rooms with plants and flowers had significantly fewer intakes of postoperative analgesics, more positive physiological responses evidenced by lower systolic blood pressure and heart rate, lower ratings of pain, anxiety, and fatigue, and more positive feelings and higher satisfaction about their rooms when compared with patients in the control group. Findings of this research suggested that plants in a hospital environment could be noninvasive, inexpensive, and an effective complementary medicine for patients recovering from abdominal surgery.
The study presented in this article represents an initial attempt to generate indepth information about how ornamental plants in real-life office workplaces interact with workplace characteristics, thus influencing working environment and well-being of the employees. Using a qualitative, explorative, and inductive case-study design, the study provides an example of how a cross-disciplinary unit engaged in administrative office work at a Danish institution applied ornamental plants. The results document that ornamental plants are an integrated part of the workplace. The employees used ornamental plants in numerous ways to either actively manipulate different aspects of the surroundings or more passively cope with demands from the surroundings. Furthermore, the use of the ornamental plants was structured by a number of factors: culture and traditions, provisional orders, organizational structures, practices, values and history, company policies, and characteristics of the indoor architectural environment. Ornamental plants were perceived as affecting many aspects of the working environment (e.g., the physical surroundings, the social climate, image of the workplace, etc.), the individual's well-being (e.g., mood, general well-being, emotions, self confidence, etc.), and to some degree the workplace's competitiveness. However, the actual effects were the results of a complex interaction among the way the ornamental plants were applied, characteristics of the present ornamental plants (e.g., size, species and condition), and characteristics of the individual employee (e.g., personal experiences, preferences, and values).