Plant Therapy: a Nonpharmacological and Noninvasive Treatment Approach Medically Beneficial to the Wellbeing of Hospital Patients

Abstract

A 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 psychologic symptoms. The current paper reports a therapeutic horticultural study’s findings regarding the effect of indoor foliage plants and flower arrangements on health prospects of surgical patients. Two surgical wards, ward A (with foliage plants and arranged flowers) and ward B (without foliage plants and flowers), were selected for the study. A total of 270 patients were randomly assigned to either ward to give 135 patients in each. Patients admitted to ward A had significantly more optimistic and promising health improvements than those in ward B. Provision of foliage plants and flower arrangements to the patients in ward A resulted in shorter postoperative stays, lower intake of analgesics, lower pain intensity, less stress fatigue, and improved vital signs (blood pressure, heart rate, respiration rate, body temperature) as compared to patients in ward B. Moreover, analyses showed that patients in ward A had a stronger psychologic frame of mind regarding their recovery from surgery and had more positive emotions and feelings regarding their stay in the hospital. They also felt that the ward atmosphere was more calming, pleasant, and satisfactory. Additionally, small group discussions and focal interviews with ward doctors and nurses confirmed the findings of the questionnaire that foliage plants & flower arrangements create a cherished environment in the ward, reduce patients’ stress, improve medical and psychologic status of patients, and also conveye positive messages of the hospital. These findings confirm the therapeutic value of horticultural activities, particularly in surgical patients in a stressed hospital setting.

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ORIGINAL ARTICLE
DOI 10.1007/s10343-016-0377-1
Gesunde Pflanzen
Plant Therapy: a Nonpharmacological and Noninvasive Treatment
Approach Medically Beneficial to the Wellbeing of Hospital Patients
Muhammad Ali Khan1· Noorul Amin2· Arsalan Khan3· Muhamamd Imtiaz1· Farmanullah Khan2,4 ·
Imran Ahmad2·AsadAli
1· Badshah Islam1
© Springer-Verlag Berlin Heidelberg 2016
Abstract A 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 psy-
chologic symptoms. The current paper reports a therapeutic
horticultural study’s findings regarding the effect of indoor
foliage plants and flower arrangements on health prospects
of surgical patients. Two surgical wards, ward A (with
foliage plants and arranged flowers) and ward B (without
foliage plants and flowers), were selected for the study.
A total of 270 patients were randomly assigned to either
ward to give 135 patients in each. Patients admitted to
ward A had significantly more optimistic and promising
health improvements than those in ward B. Provision of
foliage plants and flower arrangements to the patients in
ward A resulted in shorter postoperative stays, lower in-
take of analgesics, lower pain intensity, less stress fatigue,
and improved vital signs (blood pressure, heart rate, res-
piration rate, body temperature) as compared to patients in
ward B. Moreover, analyses showed that patients in ward A
had a stronger psychologic frame of mind regarding their
recovery from surgery and had more positive emotions and
Muhammad Ali Khan and Noorul Amin contributed equally.
Muhammad Ali Khan
aliaup2@yahoo.com
1Department of Agriculture, Abdul Wali Khan University
Mardan, Mardan, Khyber Pakhtunkhwa, Pakistan
2Department of Horticulture, The University of Agriculture
Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
3Agriculture Research Institute Tarnab, The University of
Agriculture Peshawar, Peshawar, Pakistan
4Directorate of Soil Conservation, Government of Khyber
Pakhtunkhwa Peshawar, Peshawar, Pakistan
feelings regarding their stay in the hospital. They also felt
that the ward atmosphere was more calming, pleasant, and
satisfactory. Additionally, small group discussions and fo-
cal interviews with ward doctors and nurses confirmed the
findings of the questionnaire that foliage plants & flower
arrangements create a cherished environment in the ward,
reduce patients’ stress, improve medical and psychologic
status of patients, and also conveye positive messages of
the hospital. These findings confirm the therapeutic value
of horticultural activities, particularly in surgical patients in
a stressed hospital setting.
Keywords Horticultural therapy · Patients health · Vital
signs · Pain analgesics · Hospitalization days
Pflanzentherapie: ein nichtpharmakologischer
und nichtinvasiver Behandlungsansatz mit
medizinischem Nutzen für das Wohlbefinden
von Krankenhauspatienten
Zusammenfassung Eine grüne Atmosphäre und die In-
teraktion mit Pflanzen (Grünpflanzen und Blumen) kön-
nen die menschlichen Sinne und die mentale Gesundheit
durch Abbau von durch Ängsten, Depressionen, neurotische
Beeinträchtigungen und andere psychologische Symptome
hervorgerufenem Stress beträchtlich verbessern. Der vor-
liegende Artikel berichtet von den Ergebnissen einer Studie
über therapeutische Hortikultur bezüglich der Auswirkun-
gen von Zimmerpflanzen und Blumenarrangements auf die
gesundheitliche Perspektive chirurgischer Patienten. Zwei
chirurgische Stationen, Station A (mit Grünpflanzen und
Blumenarrangements) und Station B (ohne Grünpflanzen
und Blumen) wurden für die Studie ausgewählt. Insgesamt
270 Patienten wurden untersucht, die nach dem Zufallsprin-
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M. Ali Khan et al.
zip so den Stationen zugeteilt wurden, dass in jeder Station
135 Patienten lagen. Die Patienten in Station A zeigten sig-
nifikant optimistisch stimmendere und vielversprechendere
gesundheitliche Verbesserungen als die auf Station B. Die
Ausstattung von Station A mit Grünpflanzen und Blumenar-
rangements für die Patienten führte zu weniger postoperati-
ven Krankenhaustagen, weniger Schmerzmitteleinsatz, ge-
ringerer gefühlter Schmerzintensität, Stress und Müdigkeit
bei verbesserten Vitalparametern (Blutdruck, Puls, Atem-
frequenz und Körpertemperatur) im Vergleich zu den Pati-
enten auf Station B. Außerdem zeigte eine Analyse, dass
die Patienten auf Station A angesichts ihrer Erholung von
der Operation in besserer psychischer Verfassung waren
und dem Krankenhausaufenthalt gegenüber positiver ein-
gestellt waren. Sie fanden die Atmosphäre auf der Station
beruhigend, angenehm und zufriedenstellend. Darüber hi-
naus bestätigten Gespräche in Kleingruppen und fokussierte
Interviews mit Stationsärzten und dem Pflegepersonal die
Ergebnisse des Fragebogens, dass Grünpflanzen und Blu-
menarrangements auf der Station ein Umfeld schaffen, das
wertgeschätzt wird, den Stress der Patienten senkt, den me-
dizinischen und psychologischen Zustand der Patienten ver-
bessert und das Krankenhaus in ein positives Licht rückt.
Diese Ergebnisse bestätigen den therapeutischen Wert von
Aktivitäten der Pflanzenpflege bei chirurgischen Patienten
im stressbehafteten Krankenhausumfeld.
Schlüsselwörter Pflanzentherapie · Patientengesundheit ·
Vitalparameter · Schmerzmittel · Krankenhaustage
Introduction
Life in all forms, including human beings, is essentially
allied with plants (Mattson and Kiyota 1999). In addition
to release of oxygen and absorption of carbon dioxide from
the atmosphere, plants also purify water, provide food, en-
ergy, medicine, materials for shelter, and fibers for clothing
(Lewington 2003). Since prehistoric times, man has been
associated with the natural world. Universally, plants and
flowers are recognized as a symbol for expression of love,
thoughts, affection, feelings, and emotions that cannot be
conveyed through words (Doyle et al. 1994). A hospi-
tal is considered to be a stressful place for patients, as
they are consistently subjected to stresses, trauma, physi-
cal pain, health discomfort, and, as a result, are confronted
with physiologic, psychologic, and physical health compli-
cations. In order to speed up the postoperative recovery of
patients and to improve their life during hospitalization, it
is important to reduce stresses and counter them with pos-
itive distractions in the environment—alongside the best
possible treatment—which would provide a soothing and
stress-reducing effect. Psychologic manipulations, such as
positive distraction, are considered as efficient alternative
cognitive strategies to cope with pain and stress of patients
(Johnson et al. 1998; Lautenbacher et al. 1998). Further-
more, nature, particularly plants and a green environment,
holds a great positive distraction capability, reducing hu-
man worry and ailments (Ulrich 1992). Green atmosphere
due to plants and flowers develops positive emotions that
ameliorate pain and stress, thus distracting patients’ mind-
set from their worries or making them feel more competent
to cope with it (De Wied and Verbaten 2001). Plants and
flowers have a natural soothing and calming effect on the
human psyche. Indoor plants and vegetation create a natural
milieu inside buildings that facilitates a positively enhanc-
ing perception and contributes to wellbeing (Mary and Rice
2008). The presence of foliage plants and flowers not only
changes peoples’ emotions and feelings, but also positively
improves their physiologic responses, such as heart rate,
blood pressure, respiration rate, and muscle tension, and
decreases consumption of analgesics. The blood pressure
and heart rate of schizophrenic patients decrease while star-
ring at the indoor plant “Ficus benjamina” placed in front
of the wall in comparison to a blank wall in a healthcare
center (Son et al. 2004;Wichrowskietal. 2005). Fo-
liage plants can also act as air purifiers and humidifiers in
indoor environments, by absorbing volatile organic com-
pounds and other pollutants from the air (Stanley 2009). It
greatly improves the surrounding environment and affects
the quality of air inside buildings.
Keeping in view the role of foliage plants and flowers,
and their positive effect on patients’ health, a research study
was formulated to analyze the role of foliage plants and
flower arrangements. Green atmosphere in form of foliage
plants and flower arrangements was provided to the patients
and their various medical, physiologic, and psychologic pa-
rameters were examined.
Materials and Methods
The current research study was carried out at Hayattabad
Medical Complex Peshawar, Pakistan, during 2014 and
2015. The objective was to evaluate the therapeutic effect
of foliage plants and flower arrangements on the psycho-
logic and cognitive responses of surgical patients. Sur-
gical patients were chosen for the reason that they ex-
hibit a greater extent of pain, emotional stress, psychologic
depression, anxiety, fatigue, and longer stay at the hos-
pital. Patients excluded from the study were those who
were younger than 20 or older than 50 years. A total of
270 surgical patients were randomly assigned to two hospi-
tal wards: “ward A”, decorated with indoor foliage plants
and flower arrangements, and “ward-B”, with no foliage
plants or flowers, representing the control; thus making
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Plant Therapy: a Nonpharmacological and Noninvasive Treatment Approach Medically Beneficial to the Wellbeing of Hospital Patients
Tab l e 1 Vital signs of patients
Observations Units Low Normal High
Blood pressure mmHg <Normal 120/80 >Normal
Heart pate Beats/min <Normal 72 >Normal
Respiratory rate Breaths/min <Normal 16–18 >Normal
Temperature ºF <Normal 98 >Normal
135 patients in each comparing ward. The selected in-
door foliage plants and flowers during the course of study
were; Cycus Revoluta, Chlorophytum comosum, Syngonium
podophyllum, Dracaena deremensis, Brassaia actinophylla,
Araucaria beterophylla, Ficus macleilandii “Alii”, Ficus
benjamina, Asparagus sprigeri, Rhapis excelsa, Chamae-
dorea Seifrizii, Chamaedora elegans, Epipremnum aureum,
Tujja Orientalis, Canna Plant, Rose hybrida cv. Cardinal,
Gladiolus, Polianthes tuberosa, jasmine, and marigold. At-
tractive and eye-catching pots and vases were used for dis-
playing foliage plants and flowers in ward A. Additionally,
both the hospital wards were completely identical in all as-
pects except for the presence of plants, such as having a
similar size and number of windows with natural views of
the outside landscape, and the same daytime sunlight dura-
tion. Foliage plants were properly arranged around ward A
while cut flowers were displayed in vases beside the pa-
tients on the side table. The selection of foliage plants was
customized, with less water and maintenance requirements.
Extreme care was exercised to keep both the wards isolated
from each other.
Vital Signs of Patients
Vital signs of patients consisted of systolic and diastolic
blood pressures (mm Hg), heart rate (beats per minute),
respiratory rates (breaths per minute), and body temperature
(0F). All these vital signs were categorized into low, normal,
and high ranges as suggested by Guyton and Hall 2005 and
Kumar et al. 2006, and indicated in Table 1.
Patients’ Hospitalization Days
Patients’ stay in hospital was considered as “total number of
days patient stayed at the hospital”. Patients were adjusted
into three appropriate groups, according to number of days
he/she spent in the hospital:
●Group 1: (1–4 days),
●Group 2: (5–7 days),
●Group 3: (≥8days).
Analgesics Consumption
Patients’ consumption of analgesics was classified into
three categories based of the type of drug (oral or injec-
tion) and whether the drug was narcotic or not:
●Weak analgesics: orally administered medication (Brufen
“Ibuprofen”, Paracetamol).
●Moderate analgesics: combined usage of oral medi-
cation and small amount of drugs through injection
(Maloxicam, Piroxicam, Voren injections “Diclofenac
Sodium”).
●Strong analgesics: included injection of “Tramal-Tra-
madol” or “Nalbin-Nalbuphine” only or doses combina-
tion with “Voren” doses.
The analgesics used in the weak and moderate category
were non-steroidal anti-inflammatory drugs (NSAID)/non-
opioid analgesics; whereas analgesics used in the strong
category were “opioid” analgesics (Lippncott 2004).
Data Collection
Integrated effective approaches, namely using specific pa-
tients’ hospital records, personal discussion & interviews
with patients, small group debates among patients & nurses,
and focal interviews with ward doctors, were mechanized
for collecting data regarding the various aspects of human
health, such as medical vital signs (blood pressure, heart
rate, respiration rate, temperature), analgesics consump-
tion, patients’ pain intensity, and days of hospitalization
in both study wards. Patients’ personal data were gathered
through discussion with the patients and included patients’
name, age, occupation, qualification, and residence (data
not shown). Outcome data related to patients’ blood pres-
sure, heart rate, respiration rate, temperature, and analgesic
intake were extracted from patient charts, while data re-
garding the psychologic and emotional status of patients
(patients’ pain intensity and anxiety) were collected di-
rectly through a preplan verbal discussion with the patients
using a properly prepared patient questionnaire. The data
and results were also analyzed and debated in group dis-
cussions with nursing staff and focal interviews with ward
doctors. The data were statistically analyzed with the Sta-
tistical Package for Social Scientists (SPSS; IBM Corp.
Released 2012. IBM SPSS Statistics for Windows, Version
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M. Ali Khan et al.
Tab l e 2 Patients’ profile
Cases Gender Age Education level Income level
Male Female Range Secondly School Higher education Middle class Upper class
190 (70 %) 80 (30 %) 20–50 years 94 (35 %) 176 (65 %) 204 (75 %) 66 (25 %)
Total 270 (100 %) 270 (100 %) 270 (100 %) 270 (100 %)
21.0. Armonk, NY: IBM Corp.), specifically using chi-
square tests, and presented in a graphical pattern.
Results
Patient Profile
Table 2describes patients’ overall personal data, which sig-
nify the personal status and level of patients involved in the
current research study. This information was not subjected
to any further statistical analysis, as the aim is to describe
the general standing of the patients under study.
Fig. 1 Patient response to indoor foliage plants and flower arrange-
ments with regard to their blood pressure (BP). (Chi-square = 6.610,
P= 0.037)
Fig. 2 Influence of indoor foliage plants and flower arrangements on
patient heart rate (HR). (Chi-square = 8.996, P= 0.011)
Patients’ Vital Signs
Vital signs are the basic medical parameters for assessing
the health status of a patient. They are regularly exam-
ined throughout the patient’s hospital stay. The findings
of present study with regard to each vital sign of surgical
patients are presented and discussed under the subheadings
below:
Patients’ Blood Pressure
Data regarding patients’ blood pressure (BP) is presented
in Fig. 1. Statistical analysis of the data showed that the
blood pressures of patients were significantly different (PÄ
0.05) between patients in ward A (plants group) and ward B
(control). A higher percentage (41.5 %) of patients with
normal blood pressure was found in ward A as compared
to ward B (26.7 %). Similarly, lower percentages of patients
with low BP (23.7 %) and high BP (34.8 %) were recorded
in ward A as compared to ward B (30.4 and 43.0 %, respec-
tively). Patient’s blood pressure tended more towards nor-
mality in ward A, which was provided with foliage plants
and flowers arrangements, compared to ward B, where no
plants and flowers were provided (control). The human
mind is enriched with positive feelings (pleasantness, tran-
quility, calmness) in the presence of nature and a green
environment, and, as a result, this reduces negatively toned
emotions such as fear, depression, and anguish; thus dimin-
ishing stressful thoughts & feelings and acting as a source
of pleasant distractions.
Patients’ Heart Rate
Patients’ heart rates were significantly different (PÄ0.05)
between patients in ward A and those in ward B during
hospitalization (Fig. 2). According to the figure, a higher
percentage (48.1 %) of patients with a normal heart rate was
recorded in ward A as compared to ward B (30.4 %). Pa-
tients with lower heart rater were fewer (16.3 %) in ward A
in comparison to ward B (20.7 %). Similarly, 35.6 % of
patients were suffering with a high heart rate in ward A as
compared to ward B which was (48.9 %). Findings revealed
that patients’ heart rates were normal in ward A where fo-
liage plants and flower arrangements were provided, while
a great variation in patients’ heart rates were noticed in
ward B (control group). Generally, green and natural set-
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Plant Therapy: a Nonpharmacological and Noninvasive Treatment Approach Medically Beneficial to the Wellbeing of Hospital Patients
Fig. 3 Influence of indoor plants and flower arrangements on patient
respiration rate (RT). (Chi-square = 7.397, P= 0.025)
Fig. 4 Effect of indoor plants and flower arrangements on patient
body temperature (Te mp). (Chi-square = 6.181, P= 0.045)
Fig. 5 Patient pain intensity and distress as influenced by foliage
plants and flower arrangements. (Chi-square = 7.404, P= 0.025)
tings reduce stress, promote peace and tranquility, enhance
self-esteem, create a positively enhancing perception, and
contribute to wellbeing. Therefore, to the extent that stress
contributes to coronary heart disease, the role of plants and
green environment is indispensable as an effective compo-
nent of cardiac rehabilitation.
Patients’ Respiration Rate
Respiration rates of patients in both wards are presented
in Fig. 3. The analyzed data show a prominent variance
between respiration rates of patients in ward A, furnished
with foliage plants and flowers arrangements, and ward B
(control). Patients in ward A were observed to have im-
proved and more normal respiration rates in comparison to
those in ward B. Frequencies illustrate the effect of green
atmosphere on patients, indicating that normal breath rate
patients were more numerous (56.3%) in ward A as com-
pared to ward B (40.0%). Furthermore, lower percentages
of patients with low (15.6%) and increased (28.1 %) res-
piration rates were observed in ward A in comparison to
those in ward B (23.7 and 36.3 %, respectively). Presence
of foliage plants and flowers can greatly improve the vital
signs of patients and provide them with a more stable health
condition during their hospital recovery period.
Patients’ Temperature
Patients’ body temperature was considerably altered for pa-
tients in ward A (plant group) compared to those in ward B
(control) during hospitalization (Fig. 4). Data presented in
Fig. 4revealed that a substantial difference was observed
in the percentage of admitted patients recorded for nor-
mal and high body temperatures in ward A and ward B,
whereas slight difference was observed in the patients per-
centage recorded for low body temperature. Patients with
low body temperature were fewer in ward A (14.8%) as
compared to ward B (17.8%). Normal body temperature
patients were more numerous (48.9%) in ward A in con-
trast to ward B (34.1 %). Furthermore, a low percentage
(36.3 %) of patients with a high temperature was observed
in ward A as compared to ward B (48.1 %). A uniform
and stable blood pressure and heart rate helps to stabilize
patients’ temperature.
Patients’ Pain Intensity and Distress
Data regarding patient experiences with regard to pain in-
tensity and distress are shown in Fig. 5. Patients consid-
ered for the study in both comparing wards had all received
surgery, so the level of pain intensity was high at admittance
to the wards. Pain intensity was significantly different (PÄ
0.05) between the two studied wards, A and B. Patients in
ward A, decorated with indoor foliage plants and flowers
arrangements, experienced less pain intensity and exhibited
high pain tolerance as compared to ward B, which was not
furnished with plants and flowers. A high percentage of
patients (41.5 %) in ward A experienced mild pain as com-
pared to that of ward B (25.9%), while the proportions of
patients experiencing moderate pain were 25.9 and 31.1 %
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M. Ali Khan et al.
Fig. 6 Impact of flower arrangements and indoor plants on patients’
consumption of analgesics. (Chi-square = 7.738, P= 0.021)
Fig. 7 Patients hospitalization days as influenced by foliage plants
and flower arrangements. Chi-square = 9.091, P= 0.011
in wards A & B, respectively. However, 32.6 % of patients
experienced severe pain intensity in ward A in comparison
to 43.0 % in ward B. Plants and a natural environment have
a cheering, pleasant, and attention-holding property, thus
positively distracting patients’ minds away from focusing
on its pain and discomfort.
Amount of Analgesics
Data regarding the quantity of analgesics consumed by pa-
tients during their hospital stay are presented in Fig. 6.
Foliage plants and flower arrangements show a positive ef-
fect on analgesic intakes of patients when comparing plant-
group and control-group patients. Patients in ward A con-
sumed a low quantity of analgesics as compared to patients
in ward B. It is evident from data that 39.3% of patients in
ward A consumed a weak analgesics dose in comparison
to patients in ward B (28.9 %). The percentage of patients
using a moderate analgesic dose was slightly higher in pa-
tientsinwardA(36.3%)thaninwardB(31.1%). Sim-
ilarly, fewer patients (30.0 %) consumed strong analgesics
in ward A in comparison to ward B (40.0 %). In cases of
higher pain and discomfort conditions, patients mostly re-
quire larger amounts of analgesics, but as medical science
suggests that every analgesic has some side effects on hu-
man health, they should be consumed in lesser quantities.
Taking of fewer analgesics in ward A indicates that foliage
plants and flowers can help in distracting patients’ minds
from pain, resulting in minimum use of analgesics.
Patients’ Postoperative Stay
Patients’ postoperative stay in the hospital is illustrated in
Fig. 7. Data reveal that patients admitted to ward A (plant
group) had significantly (PÄ0.05) shorter hospitalizations,
spending 4.84 days on average, as compared to patients
admitted to ward B (control group) who spent on aver-
age 5.80 days. Patients in ward A showed a speedy re-
covery from surgery in comparison to patients in ward B.
Comparing the frequencies, a higher percentage of patients
in ward A (47.4%) stayed for 1–4 days in hospital, as
compared to 29.6 % in ward B. Patients who stayed for
5–7 days in the hospital were less in ward A (39.3%) than in
ward B (51.1 %). Likewise, the number of patients spend-
ing ≥8 days hospitalized were low in ward A (13.3 %) in
contrast to ward B (19.3 %). This shows that the intro-
duction of a green environment to the hospital setup might
improve the overall health conditions of patients and thus
promote faster patient recovery.
Findings of Group Discussions & Focal Interviews
Group discussions and focal interviews were arranged with
the nursing staff and doctorsof ward A, where foliage plants
and flower arrangements were provided. The discussion
portrayed the diversity of the interests, preferences, and
views of nursing staff, and of doctors with regards to effects
of foliage plants and flowers on patients’ health, as well as
nursing attitudes. The debates with ward nurses and doctors
were classified into following main themes:
Patients’ Health and Psychologic Status
The findings with regard to the outcome of foliage plants
and flower arrangements resulting from questionnaire sur-
vey were strongly supported in the group discussion and
focal interviews. Both nurses and doctors concluded that
foliage plants and flower arrangements had positively im-
proved the medical and psychologic status of patients.
Plants created a lush green atmosphere which resulted in
an optimistic effect on patients’ psychology as well as
emotional status. Nurses revealed that a number of patients
had shared that green plants helps with relaxation. One of
the patients said in his interview:
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Plant Therapy: a Nonpharmacological and Noninvasive Treatment Approach Medically Beneficial to the Wellbeing of Hospital Patients
I like the green plants. They put me at ease. I was
just relaxed.
While another pointed out that:
Having plants were unexpected happiness. I appreci-
ate hospital for this opportunity. Plants make a room
homelike and easy feeling. They make me feel better.
The discussion further explains that foliage plants and
flowers stimulated patients’ senses, created positive emo-
tions, elevates patients’ moods, decreased anxiety & de-
pression, and developed a more cooperative environment
for patients’, nurses’, and doctors’ interactions. This means
that provision of plants and flowers prominently contributed
to the psychologic and social wellbeing of the patients. A
couple of patients quoted in their personal interviews that:
Plants and flowers make a room feel much more alive,
beautiful, and less ugly, and reduces their worries and
anxieties.
Debate further revealed that patients in the presence of
plants and flowers had recorded fewer negative comments
towards other patients and relatives, as well as nursing staff.
It was prominently discussed during the group discussion
that the presence of greenery (plants and flowers) in wards
considerably decreased the pain intensity of patients, as
they get involved in observing colorful arrangements of
flower and plants, which divert their attention from pain
and anxiety and make them more soothed and composed.
During discussion, nurses concluded that
Patients in the presence of flowers and plants experi-
enced less pain intensity and thus demand for compar-
atively less analgesics. Color display of cut flowers
and plants gave them a focus and calming attitude. Al-
though some patients’ pain was severe, but it seemed
to be gone at the moment when they see greenery in
ward.
Patients’ Behavior
As patients recovered from surgery and regained mobility,
nursing and medical staff reported increased interaction of
patients with foliage plants and flowers. This included re-
moving dead leaves, touching them, demands for fresh cut
flowers, and requests for watering plants and moving them
for better view. Most of the patients prefer plants to be
the most positive quality/attribute of the ward. One of the
relatives of a patient shared during the patient’s interview
that:
It’s quite rare to get such lovable and cheering ac-
tivities in hospitals. I think the environment created
because of these plants and flowers greatly improved
the hospital atmosphere, since last time I visited this
hospital. It’s great to have. Really good.
Through group discussion, it was concluded that most
of the patients consider flower arrangements more attrac-
tive and pleasing than green foliage plants. Furthermore,
roses, particularly red, were the most promising and catch-
ing flowers. A couple of patients quoted in their personal
interviews that the
Fragrance of rose flower is really good and had over-
come the typical hospital smell.
Another one says:
I want to know flowers and plants’ name, so that I can
grow them in my home.
Plants and Patient Health
Most of the ward doctors illustrated a keen personal inter-
est in the discussion and highly appreciated the provision of
foliage plants and flower arrangements in the wards. Con-
centrating on the positive effect of foliage plants and flower
arrangements, it can be concluded that watching and tend-
ing plants is of therapeutic value to patients, both medically
and psychologically. They can improve patients’ physio-
logic processes controlling their major vital signs; decrease
the consumption of analgesics in surgical patients.
One of the doctors explained that when a patient sees
a flower or a plant, an electric stimulus passes through
eyes to the specific portion of the brain which is meant for
feelings like happiness and partiality. He further elaborated
that when the stimulus reaches to that particular portion
of brain, it secretes specific hormones which activates that
brain portion and an involuntary liking and pleasure for
flowers and plants is created in human psyche.
Plant Therapy as an Acceptable Modality in Hospitals
Horticultural therapy (green environment and patients’
healing) is a very efficient procedure for patients’ treat-
ment in hospitals, because it improves physical features of
a body, relaxes mind and spirit, improves quality of life and
overall satisfaction with the treatment procedure, and thus
promotes the wellbeing of patient. A reasonable suggestion
given by doctors was that the hospital must be provided
with plants in all stages of growth so that the patients can
see the complete cycle of plant life, as observing plants
growing features/processes encourages a positive strength.
Properly maintained indoor plants provide a great opportu-
nity for patients to experience nature in all seasons when
outdoor scenery is unable to provide such opportunity due
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M. Ali Khan et al.
to an inappropriate season. Furthermore, they can provide
meaningful outcomes, as patients spend much of their time
indoors while recovering from painful surgery.
Discussion
A hospital is thought to be a stressful place for all user
groups, including the medical staff, patients, family mem-
bers, and visitors. Among these, patients are considered
to be the most vulnerable segment at the hospital, as they
are constantly 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).
A green atmosphere created in hospitals due to foliage
plants and flowers not only improves patients’ emotions
and feelings, but also their physiologic responses, includ-
ing brainwaves, heart rate, blood pressure, and muscle ten-
sion (Chang and Chen 2005). Blood pressure and pulse of
blood donors were considerably lower while in a green and
natural atmosphere setting. Secondly, patients’ blood pres-
sure normalizes while inhaling purified and healthier air;
it would improve the blood chemistry and other biochem-
ical mechanisms of the human body concluding in an en-
couraging effect on human health (Ulrich et al. 2003). In
addition, the concentration of volatile organic compounds
such as formaldehyde and ethylene emitted by materials
such as paints, furniture, and carpets was decreased up
to 60 % by the presence of potted indoor plants (Oyabu
et al. 2004). The presence of vegetation tends to reduce
blood pressure and heart rate, help in speedy recovery from
surgery, and reduce other forms of stress such as anxiety,
fatigue, depression etc., thus enhancing a sense of wellbe-
ing (Lewis 2004). Systolic blood pressure and heart rate
of schizophrenic patients show a significant decrease while
looking at plants instead of at the walls, indicating that
green plants in horticultural therapy could be one of the ef-
fective alternative therapies for schizophrenic patients (Son
et al. 2004). The green atmosphere provided in ward A
facilitated the normal respiration rate of patients as foliage
plants and flowers positively improve the respiration rate
by reducing the mental stress and fatigue of the human
mind, which plays a crucial role in disturbing normal phys-
iologic processes of a human body. Additionally, healthy
and fresh air, which was perceived to be present in ward A
due to the natural ability of indoor plants to absorb volatile
organic compounds and other pollutants from the air, had
also improved the respiration rate of patients. Plants have
been proven to absorb toxic substances present inside build-
ings, thus providing much purer and healthier air to breathe
(Stanley 2009). Furthermore, abnormal body temperature
is described as a symptom of a particular disease or in-
fection, and the presence of foliage plants can purify the
indoor air of toxic substances due to its natural ability to
absorb these; thus decreasing the impurities and infectious
materials and hence reducing the chances of any kind of
infection. The current findings contradict Park 2006,who
reported that indoor plants and flowers results in no positive
effect on patients’ body temperature when equating patients
from plant and control groups.
A couple of studies have shown that patients undergo-
ing painful post-surgery procedures reported less pain and
displayed a higher pain tolerance when they were exposed
to nature scenes with or without sounds (Tse et al. 2002a,
2002b). As already reported, the addition of plants and
flowers immensely reduced the pain level of patients ad-
mitted to ward A as compared to ward B. Plants and green
atmosphere had a natural attention-holding power and gave
greater relief from pain compared to other esthetic objects
such as a designer lamp or an abstract picture (Lohr and
Pearsons-Mims 2000; Diette et al. 2003). Most of the
time, patients experiencing stress and depression require
analgesics and painkillers to make them calm and soothed,
indicating the direct relationship between high stress levels
and intake of analgesics. So for low analgesic consump-
tion, it is important to keep the patients in a tranquil and
calm atmosphere, and foliage plants strengthen more pos-
itive feelings and emotions in the human mind, thus con-
tributing to the wellbeing of patients (Mary and Rice 2008);
thus, a green environment reduces the mental stress of pa-
tients, consequently contributing to lesser use of drugs. In
the current study, patients in ward A were observed to have
lesser pain intensity and anxiety as compared to patients in
ward B, and, simultaneously, the use of analgesics was also
considerably reduced. Patients staying in a hospital room
with plants and landscape views and higher sunlight inten-
sity (brighter side) experienced less pain and took 22% less
analgesic medication per hour than patients on the dim side
of the hospital with no plants and landscape views (Walch
et al. 2005). Patients exposed to the green environment
quickly changed from use of strong narcotic pain drugs to
moderate-strength analgesics, describing a decrease in pain
severity (Ulrich 1984 and 2002).
Nature has an overall positive and healthy impact on
patients’ psychologic status, improves their emotions and
feelings, and also strengthens physiologic traits such as
blood pressure, heart rate, and respiration rate (Chang and
Chen 2005). Likewise, green environment intervenes in
emotional and cognitive responses, stress recovery, in-
creased social interaction, and injury healing (Soderback
et al. 2004). All these improvements and developments
in human health are acquired with the presence of plants
and green environment in hospital conditions, which ba-
sically strengthens the wellbeing and life satisfaction and
thus enhances quality of life, ultimately resulting in faster
K

Plant Therapy: a Nonpharmacological and Noninvasive Treatment Approach Medically Beneficial to the Wellbeing of Hospital Patients
recovery of patients from surgery. A study also reported
that patients in hospital rooms with plants and flowers had
significantly shorter hospitalizations and fewer intakes of
analgesics (Park and Mattson 2009). Thus, the present
study demonstrates some encouraging outcomes to sup-
port the notion that foliage plants and flower arrangements
should be maintained as an essential element in hospital
settings for the overall betterment and health benefits of
patients.
Conclusion
Based on the findings of current studies at various hospitals
in Peshawar, Pakistan, the following conclusions can be
made:
Foliage plants and flower arrangements helped in im-
proving the psychologic and cognitive status of patients
regarding their surgeries. Plants proved to be of great help
in developing a positive frame of mind for patients, caus-
ing an optimistic mind with reduced distraction effect from
the worries, stress, and trauma of the surgery. Patients
subjected to the green atmosphere were healthier and had
a more stable physiologic status, as patients’ vital signs
(blood pressure, respiration rate, heart rate, and tempera-
ture) were rated improved. Analgesic intake for pain relief
was low for patients subjected to green environment, due
to less stress and anxiety level. Green plants and flower ar-
rangements caused psychologic and physiologic improve-
ments, resulting in minimizing the overall patients’ stay in
hospitals. A ward decorated with indoor foliage plants and
flowers provides a more satisfying, relaxing, comfortable,
colorful, calm, and attractive atmosphere as compared to a
control ward.
Recommendations
Therapeutic horticulture needs to be adopted at an appropri-
ate stage by hospital administration, as it is a nonpharma-
cological and noninvasive treatment approach that is med-
ically beneficial as well as cost-effective to both patients
and hospital administration.
Acknowledgements Authors are greatly thankful to The University of
Agriculture Peshawar for funding the project and Dr. Ma Nan, Asso-
ciate Professor, Department of Ornamental Horticulture, China Agri-
culture University Beijing for his technical proof reading and revision
of the manuscript.
Compliance With Ethical Guidelines
Conflict of Interest M.A. Khan, N. Amin, A. Khan, M. Imtiaz,
F. Khan, I. Ahmad, A. Ali, and B. Islam declare that they have no
conflict of interest regarding publishing this manuscript.
All procedures performed in studies involving human participants
were in accordance with the ethical standards of the institutional
and/or national research committee ethical standards and with the
1964 Helsinki declaration and its later amendments or comparable
ethical standards. Informed consent was obtained from all individual
participants included in the study.
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Dr. Muhammad Ali Khan is
assistant Professor at Horticulture
Section, Department of Agriculture
Sciences, Abdul Wali Khan Univer-
sity Mardan, Khyber Pakhtoonkhwa.
He works there since march 2016
till today. His responsibilities are:
Teaching graduate and post grad-
uate students, research activities,
academic curriculum settlement,
various academic responsibilities.
K