ArticlePDF Available

Abstract

Therapeutic impact of foliage plants and flower arrangements were evaluated on the post-operative recovery of surgical patients in hospital wards. A total of 270 surgical patients were randomly assigned to two hospital wards with plants and without plants representing ward A and ward B, respectively, making a lot of one hundred and thirty five patients in each comparing ward. Data collected includes parameters for evaluating patients’ physiological status, intake of postoperative analgesics, Environmental Assessment Scale, Patient’s personal preferences for plants and flowers. More effective health signs were observed for patients admitted in the ward A than those in the ward B. Patients admitted in ward A had significantly fewer (30%) consumption of strong postoperative analgesic in comparison to ward B (40%) due to more normal psychological and cognitive responses. More Patients in plant group experienced mild intensity of pain (41.5%), anxiety (41.5%), fatigue (49.6%) as compared to patients in ward B, who experienced severe level of pain, anxiety and fatigue. Patients in ward A were observed with an elevated mood and were socially more active and friendly towards other patients and nursing staff, expressing more positive feelings and describe ward atmosphere more calming, soothing and satisfying in contrast to patients in control group i.e., ward B. Additionally, most of the patients (45%) in ward A preferred cut flowers, especially red color roses over the green and variegated foliage plants. Furthermore, small group discussion and focal interviews with nurses and doctors affirm that arrangement of plants and flowers in hospitals is an effective, inexpensive and more productive complementary approach in medical field for surgical patients.
INTRODUCTION
A hospital is thought to be a stressful place for all user groups,
including the medical staff, patients, family members, and
visitors. Among these, patients are considered to be the most
vulnerable segment at the hospital as they are consistently
subjected to stresses, trauma, physical pain, health discomfort
and other negative symptoms of illness or treatments as a
result their equilibrium is disrupted (Rodin and Voshart,
1986). Additionally, patients also have to deal with some
other stresses such as worries about their illness, fear of
medical procedures, and lack of familiarity with medical
personnel, pressure of sterile hospital environment and
hospital equipment (Carpmen and Grant, 1993). All these
major and minor stresses are linked with variety of emotional,
psychological and physical health problems. Stresses require
energy and as a result prolonged stress contributes to fatigue
of human mind (Aistars, 1987; Irvine et al., 1991). Stresses
also results in a number of medical complications like it
weakens the body’s immune system, increase susceptibility to
infectious disease and delay wound repair thus resulting in a
slower and more complicated postoperative recovery
(Marucha et al., 1998; Padgett et al., 1998). Studies show that
greater stress and trauma is associated with surgery patients,
and they typically experience more severe pain and a slower
recovery period. Some of these problems are treated through
the use of anesthetics and analgesics, but, if not properly
administered, these anesthetics, muscle relaxants, and
narcotic drugs can have side effects ranging from vomiting
and headaches to drug dependency or even fatality (Abbott
and Abbott, 1995; Markland and Hardy, 1993). It is therefore
beneficial to patients and care providers to develop
approaches that improve the overall patient experience but
don't rely on pharmaceuticals (Park and Richard, 2009).
Psychological manipulations, such as positive distraction,
have been recognized as effective alternative cognitive
strategies to cope with pain and stress (Johnson et al., 1998;
Lautenbacher et al., 1998). Further Ulrich, (1992) defined a
positive distraction as an element that produces positive
feelings, effortlessly holds attention and interest, and
Pak. J. Agri. Sci., Vol. 53(2), 355-363; 2016
ISSN (Print) 0552-9034, ISSN (Online) 2076-0906
DOI: 10.21162/PAKJAS/16.2431
http://www.pakjas.com.pk
THERAPEUTIC HORTICULTURE: INFLUENCING PSYCHOLOGICAL
RESPONSES OF SURGICAL PATIENTS AND THEIR ENVIRONMENTAL
ASSESSMENT SCALE
Muhammad Ali Khan1,ǂ, Noor ul amin2,*, ǂ, Imran Ahmad2, Muhammad Sajid2, Ibadullah Jan1,
Abdul Mateen Khattak2, Juniad Khan3, Mehboob Alam2, Humaira Wasila2 and Sikandar Hayat2
1Department of Agriculture, Abdul Wali Khan University Mardan, Khyber Pakhtoonkhwa, Pakistan;
2Department of Horticulture, Khyber Pukhtookhwa Agricultural University, Peshawar, Pakistan;
3Department of Agriculture, University of Swabi, Khyber Pakhtoonkhwa, Pakistan.
*Corresponding author’s e-mail: drnoorulamin@yahoo.com
ǂThe authors contributed equally.
Therapeutic impact of foliage plants and flower arrangements were evaluated on the post-operative recovery of surgical patients
in hospital wards. A total of 270 surgical patients were randomly assigned to two hospital wards with plants and without plants
representing ward A and ward B, respectively, making a lot of one hundred and thirty five patients in each comparing ward.
Data collected includes parameters for evaluating patients’ physiological status, intake of postoperative analgesics,
Environmental Assessment Scale, Patient’s personal preferences for plants and flowers. More effective health signs were
observed for patients admitted in the ward A than those in the ward B. Patients admitted in ward A had significantly fewer
(30%) consumption of strong postoperative analgesic in comparison to ward B (40%) due to more normal psychological and
cognitive responses. More Patients in plant group experienced mild intensity of pain (41.5%), anxiety (41.5%), fatigue (49.6%)
as compared to patients in ward B, who experienced severe level of pain, anxiety and fatigue. Patients in ward A were observed
with an elevated mood and were socially more active and friendly towards other patients and nursing staff, expressing more
positive feelings and describe ward atmosphere more calming, soothing and satisfying in contrast to patients in control group
i.e., ward B. Additionally, most of the patients (45%) in ward A preferred cut flowers, especially red color roses over the green
and variegated foliage plants. Furthermore, small group discussion and focal interviews with nurses and doctors affirm that
arrangement of plants and flowers in hospitals is an effective, inexpensive and more productive complementary approach in
medical field for surgical patients.
Keywords: Horticultural therapy, green atmosphere, psychological responses, environment, surgical patients.
Khan, Amin, Ahmad, Sajid, Jan, Khattak, Khan, Alam, Wasila & Hayat
356
therefore may block or reduce worrisome thoughts and
moreover claimed that nature particularly plants and green
environment holds a great positive distractional capability in
reducing human worrisome and ailments.
Green atmosphere and interaction with nature (plants and
flowers) can considerably improve the human senses and
sanity by decreasing the stress associated with anxiety,
depression, neurotic impairment, and other psychological
symptoms (Brown, 2001; Rodin and Voshart, 1986). One of
the simple and cost effective ways to improve patients’
emotional states and to provide relaxation could be simply
providing plants or other natural elements, which provide
ample restorative soothing. Human behavior, mood, emotions
and deeds are affected by experiences from surroundings.
Green environment has a natural soothing and calming effect
on human psyche. The nurturing plants and overall green
atmosphere not only change people’s emotions and feelings,
but also positively influence their physiological responses,
including brainwave, heart rate, blood pressure, and muscle
tension (Wichrowski et al., 2005). A number of other
researchers such as Park and Richard, (2009) also observed
this impact during examining human health benefits of plants.
Close interaction of prison inmates with greenery can
positively affects their self-image and social relationships
(Lewis, 2004). Psycho-physiological studies in horticultural
therapy suggested that a plant environment seems to provide
the preferred form of physiologically measurable stress
reduction (Chang and Chen, 2005; Liu et al., 2003, 2004).
This relaxation occurs remarkably quickly, almost within
minutes (Ulrich, 1992). People in a green environment not
only showed faster physical recovery from stress, but also
improved psychological, emotional and cognitive states
(Kaplan, 2001; Cho, 2002). Positive relationships with plants
can make people feel that they are fully human beings.
Relationships with plants provide a powerful ongoing
connection with life and reconnect human being with daily
routine life’s (Alexandria, 2009). Thus a comprehensive
research activity was conducted by providing green
atmosphere in form of foliage plants and flower arrangements
in order to analyze its impact on the psychological and
cognitive response of surgical patients in hospital. The
research project was conducted using a properly designed
questionnaire for the patients. A wide range of questions were
asked from the patients obtaining data regarding the personnel
socio-economic status of the patients, including length of
hospitalization, analgesics used for postoperative pain
control, ratings of patient’s psychological traits such as pain
intensity, pain distress, anxiety, fatigue, mood, social
behavior (PPAF), Environmental assessment scales (EAS),
Patients Room satisfactory Questionnaire (PRSQ) and
Patients preferences for different ornamental plants and
flowers.
MATERIALS AND METHODS
A therapeutic horticultural related research study was carried
out at Hayattabad Medical Complex Peshawar, Pakistan
during 2010 in perspective to evaluate the therapeutic impact
of foliage plants and flower arrangements on the
psychological and cognitive responses of surgical patients.
Surgical patients were chosen for the reason that they exhibit
greater extent of pain, emotional stress, psychological
depression, anxiety, fatigue and longer stay at the hospital.
Patients exclude from the study were those who were younger
than 20 years or older than 50, so that there must be general
uniformity into the sample and a certain age group be
considered under the study. This specification in the age
limits will minimize the age influence on the data taken for
the parameters and enabling us to concentrate on same age
group people under the experiments. Two hundred and
seventy surgical patients were randomly assigned to two
wards in the same hospital, naming as “ward A”, which was
decorated with indoor foliage plants and flower arrangements
and “ward B” with no foliage plants and flowers representing
control, respectively, thus making a lot of one hundred and
thirty five patients in each comparing ward. The selected
indoor foliage plants and flowers during the course of study
are; Cycus Revoluta, Chlorophytum comosum, Syngonium
podophyllum, Dracaena deremensis, Brassaia actinophylla,
Araucaria beterophylla, Ficus macleilandii “Alii”, Ficus
benjamina, Asparagus sprigeri, Rhapis excelsa,
Chamaedorea Seifrizii, Chamaedora elegans, Epipremnum
aureum, Tujja Orientalis, Canna Plant, Rose hybrida cv.
Cardinal, Gladiolus, Polianthes tuberosa,jasmine and
Marigold. Attractive and eye catching pots and vases were
used for displaying foliage plants and flowers in “ward A”.
Additionally both the hospital wards were completely
identical in all aspects like having the same nursing and
paramedics’ staff and doctors presence, identical ward size
and number of windows with natural views of outside
landscape, same sunlight duration during daytime, presence
of same nursing stuff and doctors except for the presence of
plants. Foliage plants were properly arranged around the ward
A while cut flowers were displayed in eye catching vases
beside the patients on the side table. Selection of foliage
plants was accustomed with less water requirement and
maintenance. Extreme care was exercised to keep both the
wards isolated from each other.
Data collection: Integrated effective approaches’ viz., using
specific patients’ hospital record, personal discussion &
interviews with patients, small group debates among patients
& nurses and also focal interviews with ward doctors were
mechanized for collecting the data regarding the under
studied psychological and environmental assessment
parameters in the presence of foliage plants and flowers
arrangements. Patient’s personal data was also gathered
through discussion with the patients including patients’ name,
Therapeutic horticulture
357
sex, age, occupation, qualification and residence.
Psychological & cognitive responses and environmental
assessment parameters were collected from each patient of
both the comparing wards. Outcome data related to patient’s
analgesic intakes was extracted from patient charts while data
regarding the psychological and emotional status of patients
(patient's, pain intensity, anxiety, fatigue, mood and social
behavior), environmental assessment scale of patients’ and
patients’ preferences for specific indoor foliage plants and
flowers present in wards were collected directly through a
preplan verbal discussion with the patients by using properly
prepared patients’ questionnaire. The data and results were
also analyzed and debated in group discussions discussed
with nursing staff and focal interviews with ward doctor. The
data was statistically analyzed through Statistical Package for
Social Studies (SPSS) specifically using chi-square test and
presented in a graphically pattern.
Analgesics consumption was classified in three categories on
the basis of the type of drug (oral or injection) and whether
the drug was narcotic or not;
Weak Analgesics: oral administered medication ( Brufen,
Paracitamal).
Moderate Analgesics: Combine usage of oral medication and
small amount of drugs through injection (Maloxicam,
Piroxicam, Voren inj.)
Strong Analgesics: Included injection of “Tramal” or
“Nalbin” only or doses combination with “Voren” doses.
The analgesics used in weak and moderate category were
Non-steroidal anti Inflammatory drugs/ Non- opoidal
analgesics (NSAID); whereas analgesics used in strong
category were “opoid” analgesics (Lippncott, 2004).
RESULTS AND DISCUSSION
Patient profile: Table 1 describes overall patient’s personal
information/ data which can signify the personal status and
level of patients involved in the current research study. These
information not subjected to any further statistical analysis as
the aim is to describe the general standings of patients under
study.
Physiological responses of patients: Involuntary feelings and
emotions in form of patient’s pain, anxiety, fatigue, mood,
depression and social interaction describes the overall
psychological status of a patient. Impact of foliage plants and
flowers arrangement on psychological status of patients is
evaluated in this section.
Patient's pain intensity and distress: Data regarding patient
experiences with regard to pain intensity and distress are
shown in Figure 1. Patients considered for the study in both
the comparing wards were all subjected to minor surgeries, so
the level of pain intensity was high at admittance to the wards.
Pain intensity was significantly different (P≤0.05) between
the two studied wards; A and B. Patients in ward A which was
decorated with indoor foliage plants and flowers arrangement
experience less pain intensity and exhibit high pain tolerance
as compare to ward B which was not furnished with plants
and flowers. According to the Figure 1, high percentage of
patients (41.5%) in ward A experienced mild pain as compare
to that of ward B (25.9%) while patients experienced
moderate pain were 25.9% and 31.1% in ward A & ward B,
respectively. However, 32.6% of patients experienced severe
pain intensity in ward A in comparison to 43.0% in ward B.
Grinde and Patil (2009) suggested that the cheering, pleasant
and attention holding, positively distracting properties of
plants might keep away a person from focusing on pain and
discomfort. A combination of studies have shown that
patients, while undergoing painful procedures reported less
pain and display a higher pain tolerance when they were
exposed to nature scenes with or without sounds (Tse et al.,
2002a,b). Another study reported that plants had greater
attention holding power and gave greater relief from pain
compared to other aesthetic objects such as a designer lamp
or an abstract picture (Lohr and Pearsons-Mims, 2000). Diette
et al. (2003) concluded with the notion that views of nature
may provide relief from pain.
Chi-Square= 7.404 P= 0.025
Figure 1. Patient pain intensity and distress as influenced
by foliage plants and flower arrangement.
Table 1. Patient’s profile.
Cases
Gender
Age
Education level
Male
Female
Range
(20-50) years
Secondary School
Higher education
Middle class
Upper class
190(70)
80(30)
94(35)
176(65)
204(75)
66(25)
Total
270(100)
270
270(100)
Values in parenthesis shows percentages
Khan, Amin, Ahmad, Sajid, Jan, Khattak, Khan, Alam, Wasila & Hayat
358
Patient anxiety intensity levels: A significant (P≤0.05)
difference in anxiety level was found among patients in two
comparing wards (Fig. 2). Intensity of anxiety was
considerably less in patients stayed in ward A which was
provided with foliage plants and flower arrangement as
compare to patients admitted in ward B with no plants and
flowers. It is evident from Figure 2, that higher percentage of
patients (41.5%) stayed at ward A experienced mild anxiety
intensity in comparison to 28.9% of patients in ward B;
Whereas less percentage of patients (27.4%) in ward A
reported severe anxiety intensity as compared to 26.7% of
patients in ward B. Furthermore, patients experienced
moderate anxiety intensity were 31.1% and 26.7% in ward A
and ward B, respectively. It’s been evidence from research
that while looking at a landscape and green environment, the
previously held negative feelings and thoughts, may be about
the illness, wounds other worries in a patient’s mind are
replaced by positive feelings such as interest, cheerfulness
and calmness (Hartig et al., 1999). Research studies indicate
that nature and green settings reduce stress, promote peace,
tranquility, enhanced self-esteem, and sense of mastery of the
environment (Lewis, 2004). Nature has been reported to have
psychological benefits by reducing stress, improving
attention, by having a positive effect on mental restoration
(Van den Berg et al., 2007). Likewise, Cackowski and Nasar
(2003) observed that green environment and pleasant
landscape contributes to higher frustration tolerance and less
anxiety status of patients.
Chi-Square= 8.957 P= 0.011
Figure 2. Comparisons of control and plant groups in
patient anxiety intensity levels.
Patient fatigue intensity levels: Patients fatigue intensity
were significantly (P≤0.05) different for the ward A (plant
group) as compared to the ward B (control) (Fig. 3). Patients
admitted in ward A reported more mild fatigue and lesser
severe fatigue intensity while patients in ward B experienced
lesser mild and more severe fatigue intensity. It’s been depict
from the Figure 3 that at 49.6% of patients in ward A reported
mild fatigue intensity in comparison to 35.6% in ward B; In
addition in ward A few patients (21.5%) experienced severe
fatigue intensity as compared to 31.9% patients in ward B.
Further, patients experienced moderate fatigue intensity were
28.9% and 32.6% in ward A and B, respectively. The
restorative effects of natural scenes and green spots attract
human attention, resulting in positive changes in emotional
states and improve their mental exertion. Presence of indoor
plants may help restore attention by relaxing the subjects and
help them recover from mental fatigue (Grinde and Patil,
2009). Furthermore, Fjeld (2000) reported that addition of
foliage plants and full spectrum lamps in a clinical settings
results in a 25% decrease in typical ‘sick building’ symptoms,
such as fatigue, headache, dry throat and dry or itchy hands of
patients. In support, Berto (2005) observed that visual
confrontation with pictures of natural landscapes had a
restorative effect on mental fatigue in students.
Chi-Square= 6.163 P= 0.046
Figure 3. Comparisons of patient fatigue intensity levels in
plant and control groups.
Patients mood: Statistical analysis describes a significant
effect (P≤0.05) of foliage plants and flowers on the mood of
patients at ward A. Patients staying in the ward with foliage
plants and flowers were found with an elevated mood whereas
patients in ward without greenery were observed with a
depressed mood. It is evident from Fig. 4 that, a high
percentage of patients (39.6%) was observed with an elevated
mood in ward A as compared to ward B (29.6%). Similarly
Patients showing depressed mood were higher (48.5%) in
ward B in comparison to ward A (37.8%). An almost equal
percentage of patients (22.6%) and (21.9%) in both the wards
responded no change in their mood. Restorative effects of
natural scenes attract human attention resulting in positive
changes in emotional states (Kuo and Sullivan, 2001b).
Furthermore, green environment predominantly green foliage
plants increases positive feelings like pleasantness, calmness,
peace and harmony in human mind (Ulrich, 2002).
Therapeutic horticultural activities improve mood state of
patients, suggesting that it may be a useful tool in reducing
stress (Wichrowski et al., 2005). Likewise, a recent study of
Therapeutic horticulture
359
a garden in a children’s hospital identified mood
improvement and restoration from stress as primary benefits
for users (Whitehouse et al., 2001)
Chi-Square= 8.574 P= 0.014
Figure 4. Influence of foliage plants and flowers
arrangement on patient’s mood.
Social behavior: Figure 5 depicted a significant (P≤0.05)
impact of planting arrangements on the social behavior of
patients during their stay at hospital. Patients stayed in ward
A with provision of foliage plants and flowers were observed
with improved social interaction and positive responses to
other patients, family members and nursing staff in
comparison to patients staying in the absence of greenery. A
higher percentage of patients (52.2%) were recorded for
friendly behavior in plant group as compared to control group
(41.5%); likewise patients find with an indifferent behavior
were less in plant group (47.8%) in contrast to control group
(58.5%). An atmosphere with greenery and plants allows the
patients to have more opportunity to be relaxed and become
more open in discussion about their problems, thus
encouraging patients to feel a greater sense of self-worth.
Nature creates a positively enhancing perception and
improves self-esteem of patients, enabling them to interact
with normal world (Hartig, 2004). A study demonstrated that
viewing nature, imagining nature, visiting hospital healing
garden positively influence healing, alleviate stress, increase
well-being and promote participation in social life (Soderback
et al., 2004). Moreover, Smith (1998) demonstrated that
horticultural (plants) activities in psychiatric units at a
hospital are beneficial not only to patients with chronic mental
illnesses to improve social skills and self-esteem, but also
nursing students and mental health unit staff to build positive
relationship with their patients.
Amount of analgesics: Data regarding the quantity of
analgesics consumed by patients during hospital stay is
presented in Figure 6 elaborating a significantly different
(P≤0.05) in rate of analgesics intake for the patients in both
comparing wards. Patients in ward A had consumed low
quantity of analgesic than patients in ward B. More
percentage (39.3%) of patients in ward A consumed weak
analgesics dose in comparison to patients (28.9%) in ward B.
Patient’s percentage using moderate analgesic dose were
slightly higher in patients in ward A (36.3%) than in ward B
(31.1%). Similarly, lesser percentage (30.0%) of patients
consumed strong analgesics dose in ward A in comparison to
ward B (40.0%). Analgesics and anesthetic besides having
side effects that results in various postoperative behavioral
complications (e.g., vomiting, headaches, nausea), are
sometimes indispensable for some of the postoperative
problems related to stress as they keep the patient calm and
tranquil (Abbott and Abbott, 1995). This indicates a direct
relation between high stress level and intake of analgesics. So
for low analgesic consumption, it is important to keep the
patients in a tranquil and serene atmosphere.
Chi-Square= 6.539 P= 0.011
Figure 5. Evaluation of patient social behavior in the
presence of indoor plants and flower
arrangements.
Chi-Square= 7.738 P= 0.021
Figure 6. Impact of flowers arrangements and indoor
plants on analgesics consumption of patients.
A study reported that patients exposed to nature scenes (with
or without sounds) feel positive about their ailment and
discomforts, reporting less pain and tenderness and display a
higher pain tolerance while undergoing painful procedures
(Schneider et al., 2003, 2004). Different studies reported
Khan, Amin, Ahmad, Sajid, Jan, Khattak, Khan, Alam, Wasila & Hayat
360
patients exposed to the trees/green views suffered less severe
pain, as evidenced by the fact they shifted faster from strong
narcotic pain drugs to moderate strength analgesics. The
studies further portrayed that patients who assigned to rooms
with a view of nature after their surgery required fewer strong
painkillers compared to those who were assigned a room with
a view of a brick wall with no nature, suggesting that views
of nature may act as a natural painkiller (Ulrich, 1984 and
2002).
Environmental assessment scales: General ward atmosphere
was evaluated with the addition of foliage plants and flowers
arrangement in regards to patient’s responses. Environmental
assessment scale includes few parameters such as ward
cleanliness & beautification, light quality in ward and
patient’s quality of stay in ward which would describes ward
atmosphere in patient’s views.
Ward beautification and its aesthetic value: Patient’s
opinions concerning general beautification and aesthetic
value of wards are presented in Figure 7. The presence of
flowers and foliage has developed a highly significant impact
(P≤0.05) on the overall beautification and cleanliness of ward
A as compare to ward B. An overwhelming percentage of
patients (68.9%) in ward A has described the ward as
attractive and beautiful in comparison to ward B (26.7%);
whereas patients considering ward B as unattractive and dull
were more (59.3%) as compare to that in ward A (18.5%).
Furthermore, about 12.6% and 14.1% of patients give no
response in ward A and B respectively. Plants and flowers
always stimulate the aesthetic sense of human mind.
Provision of more vegetation develops patient’s connection
with plants resulted in positive impact as well as improves the
aesthetic value of the ward. Nature and living things tend to
make most people feel happy and attract them (Kellert and
Wilson, 1993; Maller et al., 2002).
Chi-Square= 54.107 P= 0.00
Figure 7. Patient’s view regarding ward beautification in
the presence of indoor plants and flower
arrangement.
Light quality in wards: Data about patient’s opinion
regarding light quality in both the wards are reported in Figure
8. A significant difference (P≤0.05) was recorded for
preferred light quality by patients among the two comparing
wards (A & B). Patient’s judging light as bright and vivid
were more (53.3%) in ward A than in ward B (38.4%);
whereas 36.3% of patients in ward A and 45.9% of patients in
ward B reported light as dull and tedious in their wards.
Patients with percentages of 10.4% and 15.6% in ward A &
ward B respectively give no response for the intervention. The
green foliage of plants shines and buff when sunlight and
normal room light falls of them, which creates a brighter and
vivid environment and the patients respond for improved light
quality and more brightened atmosphere. The presence of
plants and flowers helps to brighten any human setting and
creates an attractive and restorative atmosphere. So basically
the difference was not in the light intensity in both the
comparing wards, but actually reflection of sunlight and
normal room light from green leaves creates an extra
brightness and vividness, thus resulting in a more pleasant and
cheering environments, and patients described it as a more
brighter and lively indoor condition.
Chi-Square= 6.148 P= 0.046
Figure 8. Impact of foliage plants and flower arrangement
on the perception of patient regarding the light
quality in wards.
Quality of stay in hospital : Data concerning the patient’s
overall quality of stay at the hospital wards is described in
Figure 9. Impact of flowers and foliage on patients’ quality of
stay in ward A was significant (P≤0.05). Presence of flowers
and foliage plants in ward A, make the patients feel much
calm and relaxed as compare to patients in ward B with no
plants and flowers. Patients reporting for a calming and
soothing stay in the hospital were higher (57.0%) in ward A
than in ward B (43.9%); in the same manner, 33.3% of
patients in ward A and 50.4% of patients in ward B portrayed
an irritating and frustrating stay at the hospital respective. An
almost equal percentage of patients from both the wards give
no response in this regard. Plants and green surrounding
Therapeutic horticulture
361
prominently contributed to the psychological and social well-
being of the residents, stimulated residents’ senses, created
positive emotions, and offered opportunity for rewarding
activity (Rappe and Linden, 2004). Likewise, plants stimulate
a greater variety of sight, touch, smell, taste, and hearing
sensations (Caplan, 2006). Horticulture therapy (greenery and
nature) mediates emotional, cognitive and/or sensory motor
functional improvement, increased social participation,
health, well-being and life satisfaction, thus improving the
patients stay (Soderback et al., 2004).
Chi-Square= 8.254 P= 0.016
Figure 9. Impact of indoor foliage and flowers
arrangement on the perception of patients
regarding their quality of life in the hospital.
Patient's preferences for plants and flowers: Foliage plants
and flowers arrangements were only provided to patients
admitted in ward A. So patients’ personal preferences for
specific indoor plants and cut flowers on basis of their
appearance and fragrance were asked only from patients in
ward A.
In context of the graphs presented in Figures 10-12, it has
been concluded that about 38.5% of patients preferred cut
flowers in comparison to green and variegated foliage plants
(Fig. 10). It’s been observed that interacting with flowering
plants appeared to have a stronger positive effect on human
emotions than non-flowering plants (Yamane et al., 2004).
Similarly, maximum percentage of patients (45%) like rose
cut flower for its appearance, overwhelming bloom and
considerable amount of fragrance, followed by gladiolus
preferred by 25% of patients’ (Fig. 11). Rose due to its
glooming and bright outlook and noticeable fragrance creates
a positive distraction in patients mind and divert its mind from
pain and anxiety towards brighter and healthy side of the
surrounding. Rose being comparably less pronounced
fragrant flower than other cut flowers used during the study,
but its gloom and vibrant appearance can easily overcome this
less fragrance factor and turn it as the most preferred cut
flower for patients. Furthermore, more patients (48.9%) like
red color appearance in flowers and foliage plants, followed
by yellow color (22.6%) and then white color (14.8%) (Fig.
12). Rose flower with red color is the most fascinating and
preferred flower of people of Peshawar, Pakistan .
Figure 10. Patient preferences for various plants and
flower arrangement types placed inside wards.
Figure 11. Patient preferences for different type of flower
arrangement in relation to their appearance
and fragrance.
Figure 12. Patient preferences for different type of flower
arrangement in relation to flower color.
0
5
10
15
20
25
30
35
40
Cut Flowers Green Foliage Cut flowers &
Green foliage Variegated
Foliage
Planta in Wards
Patients Respondance %age
0
5
10
15
20
25
30
35
40
45
50
Rose Gladiolus Tuberose Marigold jasmine
smabax
Flower Preferences
Patients Respondence %
0
10
20
30
40
50
60
Red Yellow White Pink Orange
Flower Color Prefrence
Patients Respondance %age
Khan, Amin, Ahmad, Sajid, Jan, Khattak, Khan, Alam, Wasila & Hayat
362
Color therapy is an area of holistic healing which uses color
in an attempt to affect our mood, emotions, feelings and
eventually our health. Colors are capable of influencing many
aspects of our lives, including mental state and energy level,
frame of mind, wellbeing, influence mood and cause
psychological and cognitive responses (Kendra, 2012). As the
most outrageous color, red represents power and strength to
stimulate the body and mind and to increase blood circulation.
It's thought to rouse and boost physical energy, strengthen
willpower, vitality, increase blood circulation, clear
congestion, overcoming negative thoughts, gives a sense of
power, self-confidence, settled-ness, appetite stimulate and
sense of power (Brian and Argisle, 2005). Beside the
chromatheraphic effect of red cut rose flower, it’s also
considered as a symbol of love and harmony in our society
and generally people holds a natural affection for rose flower,
that’s why it’s known as ‘king of flowers”.
Conclusion: Foliage plants and flowers arrangement has
helped to improve psychological and cognitive of patients by
decreasing their anxiety, fatigue and tranquility levels.
Environmental Assessment Scale responses indicated that
patients were of the view that in the presence of indoor foliage
plants and flowers, their rooms were more satisfying,
relaxing, comfortable, colorful, calm and attractive as
compared to those in the control group. So, therapeutic
Horticulture is a non-pharmacological and noninvasive
treatment approach and is medically beneficial and cost-
effective to patients as well as hospital administration.
REFERENCES
Abbott, J. and P. Abbott. 1995. Psychological and
cardiovascular predictors of anesthesia induction,
operative and postoperative complications in minor
gynecological surgery. Brit. J. Clin. Psychol. 34:613-625.
Aistars, J. 1987. Fatigue in the cancer patients: A conceptual
approach to a clinical problem. Oncol. Nurs. Forum 14:
25-30.
Alexandria, V.A. 2009. Fresh flowers and plants promote
innovation and ideas, 2nd Ed. Southern Botanical, Inc.
Dallas.
Berto, R. 2005. Exposure to restorative environment of
patients helps to restore attentional capacity. J. Environ.
Psychol. 25:249-259.
Brian, B. and B. Argisle. 2005. Light Years Ahead: The
Illustrated Guide to Full Spectrum and Colored Light in
Mindbody Healing, 2nd Ed. Celestial Arts Press.
California, USA.
Brown, J.R. 2001. Gardening for the senses. In: M.R. DeHart
and J.R. Brow (eds.), National Garden Clubs: St. Louis,
pp.179-182.
Cackowski, J.M. and J.L. Nasar. 2003. The restorative effects
of roadside vegetation implication for automobile driver
anger and frustration. Environ. Behav. 35:736-751.
Caplan, L. 2006. Gardening for the sense: The sensual garden.
Purdue Extension Service, Purdue University, USA.
Carpman, J.R. and M.A. Grant. 1993. Design that cares:
Planning health facilities for patients and visitors, 2nd Ed.
Chicago: American Hospital Publishing.
Chang, C.Y. and P.K. Chen. 2005. Human responses to
window views and indoor plants in the workplace.
HortScience 40:1354-1359.
Cho, H. 2002. The influence of social or task-oriented
horticultural classes on adrenal immune axis responses,
emotions, and common cold symptoms in female
university students. Ph.D. Dissertation, Kansas State
University, Manhattan, Kansas.
Diette, G.B., N. Lechtzin, E. Haponik, A. Devrotes and H.R.
Rubin. 2003. Distraction therapy with nature sights and
sounds reduces pain during flexible bronchoscopy: A
complementary approach to routine analgesia.
Chest.123: 941-948.
Fjeld, T. 2000. The effect of interior plantings on health and
discomfort among workers and school children.
HortTechnology 10: 46-52.
Grinde, B. and G.G. Patil. 2009. Does visual contact with
nature impact on health and well-being? Int. J. Envir.
Res. Public Health 6:2332-2343.
Hartig, T. 2004. Toward understanding the restorative
environment as a health resource. In: Open space: People
space. Engaging with the environment. OPENspace
Research Centre, Edinburgh. Available online at
http://www.openspace.eca.ac.uk/conference/proceeding
s/summary/Hartig.htm.
Hartig, T., M. Barnes and C.C. Marcus. 1999. Conclusions
and prospects. In: C.C. Marcus and M. Barnes (eds.),
Healing gardens: Therapeutic benefits and design
recommendations. John Wiley & Sons: New York,
pp:571-596.
Irvine, D.M., L. Vincent, N. Bubela, L. Thompson and J.
Graydon. 1991. A critical appraisal of the research
literature investigating fatigue in the individual with
cancer. Cancer Nursing 14:188-199.
Johnson, M.H., G. Breakwell, W. Douglas and S. Humphries.
1998. The effects of imagery and sensory detection
distractors on different measures of pain: How does
distraction work? Brit. J. Clin. Psychol. 37:141-154.
Kaplan, R. 2001. The nature of the view from home:
Psychological benefits. Environ. Behav. 33:507-542.
Kellert, S.R. and E.O.Wilson. 1993. The Biophilia
Hypothesis. Washington, DC: Island Press.
Kendra, C. 2012. Color Psychology: How color impact
moods, feelings and behaviors. An article on About.
Com. Psychology. NewYork Times Company.
Therapeutic horticulture
363
Kuo, F.E. and W.C. Sullivan. 2001b. Aggression and violence
in the inner city: Effects of environment via mental
fatigue. Environ. Behav. 33:543-571.
Lautenbacher, S., P. Pauli, M. Zaudig, and N. Birbaumer.
1998. Attentional control of pain perception: The role of
hypochondriasis. J. Psych. Res. 44: 251- 259.
Lewis, C.A. 2004. Human Health and Well-Being: The
psychological, physiological and sociological effects of
plants on people: Horticulture in human life, culture and
environment. Acta Hort. 391:31-40.
Liu, M., E. Kim and R.H. Mattson. 2003. Physiological and
emotional influences of cut flower arrangements and
lavender fragrance on University students. J. Therap.
Hort. 14:18-27.
Liu, M., R.H. Mattson and E. Kim. 2004. Influences of
lavender fragrance and cut flower arrangements on
cognitive performance. Int. J. Aromatherapy 14: 169-
174.
Lohr, V.I. and C.H. Pearson-Mims. 2000. Physical discomfort
may be reduced in the presence of interior plants.
HortTechnology 10: 53-58.
Maller, C., M. Townsend and P. Brown. 2002. Healthy parks
healthy people. Melbourne: Deakin University and Parks
Victoria.
Markland, D. and L. Hardy. 1993. Anxiety, relaxation, and
anesthesia for day-case surgery. Brit. J. Clin. Psych. 32:
493-504.
Marucha, P.T., J.K. Kiecolt-Glaser and M. Favagehi. 1998.
Muscular wound healing is impaired by examination
stress. Psychosomatic Med. 60: 362-365.
Padgett, D.A., P.T. Marucha and J.F. Sheridan. 1998. The role
of LGL/NK cells in surgery induced promotion of
metastasis and its attenuation by morphine. Brain Behav.
Immunity 8: 241-250.
Park, S.H. and H.M. Richard. 2009. Ornamental indoor plants
in hospital rooms enhanced health outcomes of patients
recovering from surgery. J. Alternat. Complem. Med. 9:
975-980.
Rappe, E. and L. Linden. 2004. Plants in health care
environments: Experiences of the nursing personnel in
homes for people with dementia. Acta Hort. 639:75-81.
Rodin, G. and K. Voshart. 1986. Depression in the medically
ill: An overview. Amer. J. Psychiatry 143:696-705.
Schneider, S.M., M. Ellis, W.T. Coombs, E.L. Shonkwiler
and L.C. Folsom. 2003. Virtual reality intervention for
older women with breast cancer. Cyber Psych. Behav.
6:301-307.
Schneider, S.M., M. Prince-Paul, M.J. Allen, P. Silverman
and D. Talaba. 2004. Virtual reality as a distraction
intervention for women receiving chemotherapy. Oncol.
Nursing Forum 31: 81-88.
Smith, D.J. 1998. Horticultural therapy: The garden benefits
everyone. J. Psych. Nursing Mental Health Services 36:
14-21.
Soderbacka, I., S. Marianne and S. Elisabeth. 2004.
Horticultural therapy: the ‘healing garden’ and gardening
in rehabilitation measures at Danderyd hospital
rehabilitation clinic, Sweden. Pediatric Rehabilitation 7:
245-260.
Tse, M.M.Y., J.K.F. Ng, J.W.Y. Chung and T.K.S. Wong.
2002a. The effect of visual stimuli on pain threshold and
tolerance. J. Clin. Nursing 11: 462-469.
Tse, M.M.Y., J.K.F. Ng, J.W.Y. Chung and T.K.S. Wong.
2002b. The effect of visual stimulation via the eyeglass
display and the perception of pain. Cyber psych. Behav.
5: 65-75.
Ulrich, R.S. 2002. Health benefits of gardens in hospitals.
Paper for conference, Plants for People International
Exhibition Floriade. Center for Health Systems and
Design, Colleges of Architecture and Medicine Texas
University College State, Texas.
Ulrich, R.S. 1984. View through a window may influence
recovery from surgery. Sci. 224:420-421.
Ulrich, R.S. 1992. How design impacts wellness. Healthcare
Forum J. 35:20-25.
Van den Berg, A.E., T. Hartig, and H. Staats. 2007.
Preference for nature in urbanized societies: Stress,
restoration, and the pursuit of sustainability. J. Social
Issues 63: 79-96.
Whitehouse, S., J.W., Varni, M. Seid, C. Cooper-Marcus,
M.J. Ensberg, J.J. Jacobs and R.S. Mehlenbeck. 2001.
Evaluating a children’s hospital garden environment:
Utilization and consumer satisfaction. J. Environ.
Psychol. 21: 301-314.
Wichrowski, M., J. Whiteson, F. Haas, A. Mola and M.J. Rey.
2005. Effect of horticultural therapy on mood and heart
rate in patients participating in an inpatient
cardiopulmonary rehabilitation program. J. Cardiopulm
Rehabil. 25: 270-274.
Yamane, K., M. Kawashima, N. Fujishige and M. Yoshida.
2004. Effects of interior horticultural activities with
potted plants on human physiological and emotional
status. Acta Hort 639:37-43.
... Espaços ao ar livre, com diversos tipos de vegetações e área de lazer, podem promover bem-estar (15,33) , pois favorecem novas amizades, a socialização e o encontro de subjetividades entre os hospitalizados e a equipe de saúde. Nesse sentido, esses espaços podem amenizar os efeitos adversos da hospitalização (36) . ...
Article
Full-text available
Objective: to identify, through the contributions of hospitalized children and adolescents, the characteristics they consider necessary for a hospital that promotes well-being and development. Method: descriptive and exploratory study, with qualitative data analysis, carried out with a total of 30 hospitalized children and adolescents. Data were collected through semi-structured interviews, mediated by drawing, and analyzed by inductive thematic analysis, supported by the theoretical framework of the humanization of health care and the Florence Nightingale’s Environmental Theory. Results: the designed hospital takes up the principles of Florence Nightingale’s Environmental Theory, as well as one of the guidelines of the National Humanization Policy, the environment, from two perspectives: elements and material resources from the physical environment; elements of comfort and well-being environment. Final considerations: hospitals such as the projected institution corroborate what is recommended in public policies, as they qualify health care.
Article
Full-text available
This study documents nursing personnel's observations regarding plants in homes for people suffering from dementia. Based on a survey of 65 nursing staff from ten homes it could be concluded that both indoor and outdoor plants were used as tools in the care work and staff believed that it had a beneficial impact on the environment of the homes. Plants created a lush, homelike atmosphere and improved the quality of indoor air according to the survey respondents. They reported that the contribution of the plants to the psychological and social well-being of the residents was prominent. Their reported observations included: plants stimulated residents' senses, created positive emotions, and offered opportunity for rewarding activity. The main problems identified were residents' eating of plants and soil and damaging plants. The residents were interested especially in colorful plants and berries. Although the nursing personnel considered plants and gardening to be therapeutic to the residents, they often disapproved of residents' actions regarding the plants, including positive actions. They might regard as negative if the residents moved plants from place to place, picked flowers, or watered plants. The nursing personnel interested in gardening had used horticulture in care work more than those not interested in gardening. Education about plants and growing methods adapted for the elderly was felt to be necessary for the personnel. This study provides evidence that professionals in the field of eldercare believe that plants do not cause any major problems in care environment but can contribute significantly to the well-being of individuals with dementia.
Article
Full-text available
A well-known research report showed that being in a hospital room with a view of trees rather than a view of a building was linked to the use of fewer pain-reducing medications by patients recovering from surgery. The experiment reported here was designed to further examine the role of plants in pain perception. We found that more subjects were willing to keep a hand submerged in ice water for 5 min if they were in a room with plants present than if they were in a room without plants. This was found to be true even when the room without plants had other colorful objects that might help the subject focus on something other than the discomfort. Results from a room assessment survey confirmed that the room with colorful, nonplant objects was as interesting and colorful as the room with plants present, but the presence of plants was perceived as making the air in the room fresher.
Article
The purpose of this paper was to report the effects of window views and indoor plants on human psychophysiological response in workplace environments. The effects of window views and indoor plants were recorded by measuring participant's electromyography (EMG), electroencephalography (EEG), blood volume pulse (BVP), and state-anxiety. Photo Impact 5.0 was used to simulate the environment in an office, where six conditions were examined: 1) window with a view of a city, 2) window with a view of a city and indoor plants, 3) window with a view of nature, 4) window with a view of nature and indoor plants, 5) office without a window view, and 6) office without a window view and indoor plants. Participants were less nervous or anxious when watching a view of nature and/or when indoor plants were present. When neither the window view nor the indoor plants were shown, participants suffered the highest degree of tension and anxiety.
Article
The physiological and emotional effects of working with plants were studied in students. Subjects (119 in total, 52 males and 67 females, mean age = 21) were assigned to one of three groups: filling pots with soil (control), transplanting nonflowering pansy plants (Viola x wittrockiana 'Sakura sakura') (NF-P), or transplanting flowering plants (F-P). Subjects were given 10 minutes to complete the activity. At the start of the experiment and again after ten minutes, electroencephalogram (EEG) and electromyogram (EMG) recordings were taken from the subject's forehead, the number of eye blinks per minute were counted, and Profile of Mood States (POMS) data were collected . The ratio of alpha waves to beta waves with the eyes closed significantly increased in the NF-P and the F-P groups but not in the control. Beta wave amplitudes with eyes opened decreased in F-P group significantly more than in the control. EMG significantly decreased in the NF-P (P<0.001) and F-P (P<0.05) groups but not in the control group. Eye blink rate declined in F-P group significantly more than in the control group. The "Fatigue" score from POMS of the F-P group was significantly lowered compared with the other groups. These results suggest that activities with plants promoted physiological relaxation. Working with flowering plants appeared to have a stronger positive effect on human emotions than non-flowering plants.
Article
ADDITIONAL INDEX WORDS. benefits of plants, foliage plants, fluorescent lighting, full-spectrum lighting, human–horticulture relationships, human issues in horticulture, human well-being, mucus membrane symptoms, neuropsychological symptoms, people–plant interactions SUMMARY. Plants are widely used in building environments; however, studies reporting the health and discomfort symptoms of people in response to indoor foliage plants are few. The objective of the presented studies was to assess the effect of foliage plants or a combination of foliage plants and full-spectrum fluorescent lamps on self-reported health and discomfort complaints in three different work environments: an office building, an X-ray department in a Norwegian hospital, and a junior high school. Health and discomfort symptoms were found to be 21% to 25% lower during the period when subjects had plants or plants and full-spectrum lighting present compared to a period without plants. Neuropsychological symptoms, such as fatigue and headache, and mucous membrane symptoms, such as dry and hoarse throat, seemed to be more affected by the treatments than skin symptoms, such as itching skin.