ArticlePDF Available

Healing and therapeutic landscape design - Examples and experience of medical facilities

Authors:

Abstract and Figures

Healing and therapeutic landscape design proposals are particularly suitable for medical facilities and, in general, facilities for people with health disorders, where they become a major support in difficult situations and can serve as a supplement to treatment. They do not replace medical help and different therapies, and neither do they exclude their need. However, their effects can improve and accelerate the recovery process in patients. In Slovakia, medical facilities do not often meet modern medical care requirements in terms of their technologies and equipment. For this reason, it is necessary to mainly transform hospital facilities and their exteriors in order to create the required natural foundation for patients in the form of healing and therapeutic landscape design. Using the example of the Philippe Pinel Psychiatric Hospital in Pezinok (Slovakia, Central Europe), we present a proposal for a green vegetation-scaping using the existing space, adding elements that highlight and support the therapeutic effect of the proposed space. The aim of the proposal is to create an environment that will bring positive changes for patients while serving as a relaxation space for employees.
Content may be subject to copyright.
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
128
Archnet-IJAR: International Journal of Architectural Research
www.archnet-ijar.net/ -- https://archnet.org/collections/34
HEALING AND THERAPEUTIC LANDSCAPE DESIGNEXAMPLES
AND EXPERIENCE OF MEDICAL FACILITIES
DOI: http://dx.doi.org/10.26687/archnet-ijar.v12i3.1637
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Keywords
Abstract
landscape design; healing
and therapeutic effects;
exterior landscaping of
hospitals
Healing and therapeutic landscape design proposals are
particularly suitable for medical facilities and, in general,
facilities for people with health disorders, where they become
a major support in difficult situations and can serve as a
supplement to treatment. They do not replace medical help
and different therapies, and neither do they exclude their
need. However, their effects can improve and accelerate the
recovery process in patients. In Slovakia, medical facilities do
not often meet modern medical care requirements in terms of
their technologies and equipment. For this reason, it is
necessary to mainly transform hospital facilities and their
exteriors in order to create the required natural foundation for
patients in the form of healing and therapeutic landscape
design. Using the example of the Philippe Pinel Psychiatric
Hospital in Pezinok (Slovakia, Central Europe), we present a
proposal for a green vegetation-scaping using the existing
space, adding elements that highlight and support the
therapeutic effect of the proposed space. The aim of the
proposal is to create an environment that will bring positive
changes for patients while serving as a relaxation space for
employees.
I.Belčáková*
, P. Galbavá & M. Majorošová
I. Belčáková, Faculty of Ecology and Environmental Sciences, Technical University in Zvolen, T.G.Masaryka 24, 960 53
Zvolen
P. Galbavá, ONY Landscape architecture studio, www.ony.sk
M.Majorošová, Faculty of Civil Engineering, Slovak University of Technology in Bratislava, Radlinského 11, 810 05
Bratislava, Slovakia
*Corresponding Author’s email address: belcakova@tuzvo.sk
ArchNet-IJAR is indexed and
listed in several databases,
including:
Avery Index to Architectural
Periodicals
EBSCO-Current Abstracts-Art
and Architecture
CNKI: China National
Knowledge Infrastructure
DOAJ: Directory of Open
Access Journals
Pro-Quest
Scopus-Elsevier
Web of Science
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
129
INTRODUCTION
According to the World Health Organization (WHO), human health is defined as a state of
complete physical, psychological and social well-being, and not only a state without any
disease or physical disorder (Fredrickson, 2013). Talking about health, it is necessary to
consider the interconnection of physical and mental factors that influence each other. On this
principle, the natural environment or an environment with a predominance of natural
elements can influence not only the physical but also the psychological state of a person as a
positive factor in the creation of spaces.
Healing gardens or walks in nature can also serve as prevention against diseases. They are
designed to promote human health in a comprehensive way, both physically and mentally.
Designing and creating gardens is not just a matter of aesthetics, they have a much greater
effect on humans (Jiang, 2014). Healing and therapeutic landscape design has been
experiencing a boom in recent years, particularly in the USA, as well as Great Britain,
Australia and the Scandinavian countries. A healing and therapeutic garden is primarily
composed so as to fulfil its comforting purpose in particular, acting as anti-stress. In addition,
it contains many other aspects with a positive effect on a person (Smidl et al., 2017). Nature
is a natural place for relaxation, which can create some positive effects in humans. It can
serve as a factor supporting a proper mental mood and internal functioning of the body and
preventively reduce susceptibility to diseases (Sachs and Marcus, 2012).
Due to the effects on psyche and health, healing and therapeutic landscape design is
primarily intended for various medical facilities, sanatoriums, healing spas or retirement
homes (where the elderly suffer from various diseases). Of course, its application is not
limited to these spaces in relation to its positive effects in general (Zeisel, 2007; Cooper-
Marcus et al., 2009). The interest in the natural environment and health has again increased
recently, though the creation of gardens for healing purposes goes back a much further than
that. The use of gardens as spaces suitable for treatment has been observed in early
Eastern, Greek and Roman cultures (Warner and Baron, 1993; Chen, 2004).
Gardens in hospitals and monasteries were used as a space for thought, as well as the
cultivation of crops and herbs for medicinal purposes in the Late Middle Ages (Tyson, 1998).
Gardens were also used for therapeutic purposes and therapy by working in a garden,
especially in psychiatric facilities, at the turn of the 18th and 19th centuries (Epstein, 1998).
Pavilion-style hospitals were built during this period. Many sanatoriums emerged in a natural
environment during the 20th century. Gradually, however, natural elements as part of the
treatment receded and high-rise multi-storey hospitals began to be built, the use of terraces
and balconies disappeared, parking requirements increased.
We saw great advances in medical technology over the last decades (50-60 years).
However, a concept of gardens with healing effects was neglected perhaps because of this
trend, coupled with the economic pressure or the political situation of countries (Beal, 2004).
A systematic study of the effects of natural spaces on health dates back to around 1980-90.
Ulrich (1984) documented and demonstrated the relationship between the period of
hospitalization, the use of pain medication and accessible view of external environment in
surgical patients. Patients with a view of nature regenerated faster and required fewer pain
medications.
Wilson (1986) and Kellert et al. (2008) presented a thesis entitled ‘Biophilia Hypothesis’,
assuming that increasing contact with nature has healing effects on a disease. The
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
130
hypothesis draws attention to the existence of an instinctive connection between humans
and other living systems. The design that reflects this thesis is based on 6 attributes:
environmental elements, natural shapes and forms, light, space, local relationships, human-
nature relationships conditioned by development.
ASLA (American Society of Landscape Architects) began sponsoring special meetings on
the topic of healing gardens as part of an annual conference. An American botanical school
in Chicago initiated the first postgraduate program in the USA in 2003 - Healthcare Garden
Design for landscape architects who want to specialize in the field (Cooper Marcus, 2007).
A laboratory for research into the interaction of green vegetation with medicine and healing
design called ‘Nature, Health & Design Laboratory’ was established in Copenhagen,
Denmark in 2014. It is located in the Horsholm arboretum, the largest collection of trees and
shrubs in Denmark. The laboratory team created the Nacadia therapeutic forest garden
project to help people with mental illness and the Octovia healing forest project, which is
used as disease prevention and promotes overall health (Stigsdotter, Randrup, 2008;
Stigsdotter et al., 2014).
In Slovakia (Central Europe), treatment associated with relaxation in a natural environment
was mainly used as part of the treatments in sanatoriums and healing spas in the last
century. The sanatoriums established in the 19th and 20th centuries were primarily built as
facilities for the treatment of tuberculosis and were built in a natural environment. Spas were
built in a natural environment near springs, and spa parks were included as a supplemented
treatment.
Today, sanatoriums located in nature are used to treat other diseases, addictions, or
behavioural disorders and conduct rehabilitations. Some of them have changed their
functions or are not used anymore. Spas and spa parks are still used for rehabilitation
processes by different patients. The main component of a spa treatment in a spa are spa
procedures, especially, contact with water from natural springs that contain healing
substances. The specific treatment options depend on the type of spa.
The green vegetation of hospitals or other medical facilities in Slovakia is not specified in any
Slovak legislation and there are no regulations that would support its fundamentals and use
in practice. When looking at horticulture and urban planning, we can simplify the division of
green vegetation based on its accessibility to the public as public, restricted, and private.
Restricted green vegetation includes the green spaces of hospitals and sanatoriums, i.e.
hospital gardens, green vegetation in the hospital and the surroundings of sanatoriums. In
most cases, hospitals and other healthcare facilities in Slovakia do not have a well-adapted
exterior space to help treat physical and mental illnesses. For this reason, it is necessary to
transform hospital facilities and their exteriors in order to create the natural foundation
required for patients in the form of healing and therapeutic landscape design. An example of
such a facility is the Philippe Pinel Psychiatric Hospital in Pezinok (Slovakia), which we have
considered as a pilot case study for the treatment and therapeutic design.
METHODOLOGY
The methodology of the interior and exterior revitalisation of the hospital is based on
knowledge of the principles of healing and the design of therapeutic gardens and their
positive influence on the psyche, perception and health of human beings This methodology
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
131
relates to the connection between people and nature, the influence of the nature on the
psychological perceptions of a person, the connection between nature and human health
and, last but not least, the importance of green vegetation as a supplement to a treatment.
Our research included results from foreign studies, publications, and realizations based on
the influence of therapeutic landscape design when used both passively and actively. In the
next step, we focused mainly on the healthcare facilities and the effect of green vegetation
on patients, visitors and employees of facilities abroad as well as in Slovakia. The economic
aspects, the appropriate methodology for the evaluation of therapeutic designs, and the
value of their treatment character are part of our research.
We have applied our research on the design of revitalisation based on the principles of
treatment and therapeutic design mentioned below, an analysis of the facility, consultations
with several stakeholders, and the results of questionnaires with employees and patients.
The design works with existing space, and there are added elements that highlight and
support the treatment effect of the proposed space. The aim of the design is to create a
space that will bring positive changes for patients and it will offer a relaxing space for
employees.
Study area description
The Philippe Pinel Psychiatric Hospital is located on the outskirts of Pezinok town which is
close to the Little Carpathians Mountain Range, in a peaceful natural environment on the
edge of an urbanized landscape that is characterized by low building constructions. It is
accessible from a II. class road (No. 503) called Malacká cesta. There are bus stop and a car
park in front of the complex.
Pezinok is located at an altitude of 156 m above sea level, with its highest point known as
Čertov kopec (752 m above sea level). The town is located 18 km northeast of Bratislava
(the capital) and is surrounded by the districts of Senec, Bratislava, Malacky and Trnava. The
average summer temperature is from 16 to 20 ° C; in winter it is -2 to -4 ° C. The annual
precipitation reaches about 700-740 mm for approximately 90-95 precipitation days. The
town and its surroundings are considered to be an important wine-growing region.
The forests around the town are predominantly Fagus-Quercus and are a part of the
protected landscape of the Little Carpathians Mountain Range. Apart from Fagus and
Quercus, the main species that occur in this are Fraxinus, Acer and Tilia and the non-native
Castanea. In herbaceous communities spring Adonis vernalis, Chrysopogon gryllus, Pulsatila
grandis and Dianthus lumnitzeri can be found. The species that only occur on this mountain
range are: Ruscus hypoglossum, Coronilla eremus and Rhamnus saxatilis. There is a wide
range of animals too. The mountain range has a specific development of crystalline, and
overall it is characterized by the following rocks: granitoid rocks, limestone, slate, phyllites,
amphibolites, etc.
The character of the hospital is mostly pavilion-like and is supported by green vegetation with
aspects of forest park or spa park, spacious lawns and aesthetically developed trees. The
buildings and facades of the buildings are built in various architectural styles, depending on
their construction and additional modifications. The tallest building in the area has 5 floors.
The main entrance to the area is located on its east side and it is accessible also for the cars
of employees, who can park near the main buildings. Another entrance for vehicles is also
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
132
located on the eastern side; it is closer to the southeast, and the gate does not open. On the
west side of the area, there is a free entrance for pedestrians through a little forest. Apart
from the road communication, the complex is complemented by pedestrian communications,
and the entire communication system connects the buildings and main relaxation areas and
forms a good walking route. There is a parking lot and a bus stop in front of the entrance to
the complex, and a bit further on there are two parking lots. At the entrance there is also an
information desk and a buffet. This building is connected by a long ground floor corridor with
a social hall and the patient entry building, along with ambulances and the Physiotherapy
and Rehabilitation Departments. It also leads to the Women's Department via an overhead
interconnecting corridor. Other buildings, i.e., the Male Department, Drug Addiction Clinic,
food service, administration, St. Luke's Chapel, operational and technical buildings and
unused buildings, are standalone. The area also features a bust of Philippe Pinel, several
sculptures, a bell tower, non-functional water features within the smaller architectural works,
as well as sports grounds for volleyball, basketball, tennis and football.
The green vegetation in the area is not specially designed for healing gardens, but it creates
a naturally pleasant and natural healing environment for the hospital. The natural surface
area is large in comparison to the reinforced surfaces. It can be said that green vegetation is
one of the most attractive elements of the complex. It creates a peaceful atmosphere of the
area and inspires calm. It does require some modifications, but overall it works very well.
There are many tree species such as Pinus, Abies, Thuja, Tilia, Fraxinus, Acer Populus,
Aesculus, Morus, Betula, Larix and Prunus (many of them are natural in the area, not all of
them). Their care and maintenance are mainly handled by four exterior workers. The whole
area offers visitors, patients and employees a beautiful view of the forested Little Carpathian
mountains. At the same time, the site is part of an educational walkway due to its historical
background.
The character of the green vegetation and its design differs in various typological areas:
The entrance area in front of the complex – a maintained lawn in front of the entrance
and part of the parking lot;
Entrance garden - formed conifers and a smaller flowerbed with a rocky garden next
to a fountain;
The access part of the area the lawn and conifers;
Park type of hospital garden - free lawn areas and shady areas, groups of trees
forming a forest park;
Atrium of the Male Department - unused area, currently destroyed terrain, stone
cubes and a lawn;
Atrium of the Female Department- stone cubes and lawn, two high Betula trees and
Taxus trees (Taxus is a poisonous plant, whether to let it remain is controversial). The
space is simple and features no complicated gardening. The atrium is accessible;
The atrium of the Rehabilitation Department, with a healing garden element, i.e., an
atrium with a stone pavement and lawn, dominating conifers (among them is the
poisonous Taxus again), young deciduous trees, a therapeutic walkway made from
different materials, a pine cone cover bed between flowers (created as a part of
patient activities), a fountain without water but pebble and fine vegetation decorations
and flower pots. This atrium is maintained the best because the staff creates activities
there and has works with patients recent years. It is accessible and used for the
therapies. Atrium requires minor modifications in design;
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
133
Space without any function - a large area in the northern part of the complex located
behind the buildings, connected through the long corridor and it is not used, the
spacious lawn is mowed by mowing tractors. The area is crossed by pavement
proposed as a walking route but it is not used;
Blatina creek there is a creek in the area that is quite maintained, a short part is
designed as an underground covered canal. Problems with wild vegetation; and
Indoor vegetation - only located in some places in the hospital buildings, in halls,
respectively in corridors some old flower pots with simple indoor plants.
The Philippe Pinel Psychiatric Hospital in Pezinok focuses on psychiatric illnesses and
addictions to psychoactive substances as well as provides outpatient and constitutional
healthcare. It consists of 6 clinics - a psychiatric clinic with a male ward, a psychiatric clinic
with a female ward, a psychosomatic clinic, a drug addiction clinic, a gerontopsychiatric
clinic, a neuropsychiatric clinic. The hospital includes a physiotherapy-rehabilitation unit and
an outpatient department for the public. Currently, the capacity of the hospital is 480 beds,
with around 340 employees.
Philosophy of the healing and therapeutic landscape design
The connection of humans and green vegetation has existed since time immemorial, and the
number of studies focusing on the issue has increased recently. The presence of green
vegetation promotes recovery by inducing positive changes, such as the improvement of
blood pressure, cardiac activity, muscle activity and electrical activity in the brain. These
findings are important not only for hospital complexes, which were primarily addressed in this
work, but in general (Ulrich 1999). An improvement in behaviour, a better pulse, blood
pressure and weight values were demonstrated in patients with Alzheimer’s disease thanks
to the garden, but the nature of medicinal use has not changed (Westphal, 2000). We
perceive certain differences in the character and effect of healing gardens according to their
intended function with respect to the target group of persons and the degree of effect over
time. There may be a difference between the effect of green vegetation on a patient after
surgery and a patient with Alzheimer’s disease, and a difference between regular time spent
in a natural environment and a short visit once in a while. A summary of recommendations
for the creation of healing gardens, complemented with more recent findings is provided for
the best effect possible. Green vegetation is perceived as an important tool for creating
medical facilities people visit because of their current psychological or physical problem,
while patients and staff are exposed to a stressful environment (Cooper Marcus, 2007;
Shackell & Walter, 2012; Ulrich, 2002). Based on the research, it is stated that a person goes
through the following three or four stages in terms of psychology, when the person decides to
visit green spaces (e.g. gardens or park areas) or to a natural environment to feel good
(Cooper Marcus, 1997):
a journey - a change of place or flight from the place where stress has occurred, the
healing garden serves as a sanctuary;
sensory awaking - awakening of the senses, sensory experience based on new
phenomena, sounds, scents, etc.;
personal centering - concentration on internal processes, finding inner strength,
changing the view of problems; and
a deeper perception of a human’s connection to the environment, perception of the
whole, relief.
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
134
Ulrich’s theory of the so-called restorative design is based on the theory and research of
behavioural science and science in areas related to health. It suggests that green vegetation
in medical facilities is an important comforting means for both patients and staff because it
provides the following in humans (Ulrich, 1999):
sociality;
sense of control (person loses control in a hospital, led by the conditions and staff of
medical facility);
physical movement;
access and bond to nature; and
general, various positive distractions.
The theme of therapeutic design and healing gardens has been dealt with by several experts
from different fields over the past 30 years, and a number of studies on the effect of green
vegetation/ the natural environment on humans, whether within a view or within a given
environment, have been carried out. The terms ‘healing gardens’, ‘therapeutic gardens’,
‘restorative gardens’, ‘restorative garden design’, ‘healing landscape design’, etc. and their
definitions have been gradually used. These terms generally represent the creation of
gardens with a healing and therapeutic effect, i.e. with a positive effect on human health;
they should help and accelerate treatment. On the basis of certain views and opinions, any
natural garden or park could be considered as healing, but such a garden is specified in
more detail for the highest efficiency in the use of its healing and therapeutic effects. Some
authors distinguish the terms ‘healing garden’ and ‘therapeutic garden’ in particular
(Eckerling, 1996; Mitrione and Larson, 2007; Cooper Marcus and Barnes, 1999).
The term healing garden can be considered instead as a concept for a garden with an
applied design to recover from a disease, focusing more on mental health and overall well-
being. It approximates the methods of psychoneuroimmunology focusing on the correlation
between stress and health. Eckerling described a healing garden as a healing environment
garden, the influence of which makes a person feel better (Eckerling, 1996). The term
therapeutic garden can refer to a garden that produces a certain effect and a measurable
outcome in the disease process, related to the particular aspect of a disease or healing
process (Mitrione and Larson, 2007). It is less focused on mental health and related more to
allopathic medical systems defined by treatment based on the biological action of medicine,
using medicine that induces a state opposite or incompatible with the course of a disease
(garden elements and activities in the case of a garden). Cooper Marcus and Barnes (1999)
described therapeutic gardens as gardens to improve overall patient and employee moods
that can induce stress relief and alleviate physical symptoms.
The Centre for Health Design (CHD) presents the following types of therapeutic gardens
(Westphal, 2000; Smith, 2007):
healing garden (physical, psychological and mental healing effect, induction of overall
feeling of well-being);
enabling garden (based on psychological effects, aiding physical recovery, improving
physical condition based on possible activities, mental growth based on meaningful
activities);
meditative garden (supports the inner thought process);
rehabilitative garden (primarily based on rehabilitation in the environment); and
restorative garden (regeneration after stressful situations).
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
135
Bengtsson and Grahn (2014) summed up, compared and considered the results of various
studies and the principles of designing healing gardens based on them in their research in
2014 (including, for example, the works by Grahn et al. (2010), Cooper Marcus (1997),
Bengtsson and Carlsson (2013), Rodiek (2008). They selected 6 important qualities of the
environment in medical facilities that enhance comfort: proximity and easy access, entry and
fencing, safety, familiarity, easy orientation, and various possibilities in different weather
conditions. They also selected 13 environmental qualities that support the relationship
between humans and nature as well as access to it: joyful and meaningful activities, contact
with the surrounding life, social possibilities, culture and connection with the past, symbolism
and reflection, outlook, open space, species richness, nature’s influence on the senses,
changes in nature according to the seasons, peace, nature life, and sanctuary.
Figure 1. Mental map of healing garden philosophy (Source: Authors).
In the late 1990s, three publications on the exteriors in nursing homes and hospitals were
published in English (Cooper Marcus and Barnes, 1999; Gerlach-Spriggs et al., 1998; Tyson,
1998), as well as other books on transforming a garden at home into a healing space (for
example, McDowell, 1998; Mintner, 1993; Cooper Marcus, 2007).The philosophy of healing
and therapeutic landscape design is the design of gardens supporting health. This design
combines garden and landscape architecture with psychology and medicine (see Figure 1). It
is based on the theory that nature, green vegetation and a garden have a positive effect on
the human psyche, senses and health. The presence of a healing garden can serve as an
additional part of a treatment.
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
136
The methodology of the solution/design of the healing and therapeutic gardens relies on the
exterior typology in medical facilities and the current recommendations for designing such
spaces. Well-known and published methodological guides (Cooper Marcus and Sachs, 2014;
Sachs and Shepley, 2014) were applied in the example of the Philippe Pinel Psychiatric
Hospital in Pezinok (Slovakia).
According to Cooper Marcus (2007) the exterior spaces of medical facilities are classified in
terms of their character and location to the premises and buildings as follows:
park-style of hospital garden;
access part of the campus;
entry space in front of the campus;
entry garden;
garden inside;
square;
roof garden;
roof terrace;
healing garden;
meditation garden;
vistas garden;
atrium garden;
vistas/walking garden;
semi hidden garden;
borrowed landscape; and
education paths and protected nature.
The principles of creating healing and therapeutic gardens as well as their positive effect on
the human psyche, perception and health are an important part of designing healing and
therapeutic gardens. When designing the outer hospital space, we can follow several groups
of principles. Ulrich (2002) outlined the possibilities for physical movement, selection options,
socialization-supporting elements as well as access to nature and positive distractions as
four main aspects of a medical facility garden. Kaplan and Kaplan (1989) distinguished four
principles that a garden can include as a natural environment: cohesiveness/coherence,
readability - as factors of understanding; and mystery, complexity - as factors of discovery.
Cooper Marcus (2007) defined a successful garden using the following principles: variation of
spaces, the abundance and predominance of green vegetation, movement support, positive
distractions, minimizing interference, minimizing ambiguous elements that can have different
meanings for healthy and ill people.
McDowell and Clark-McDowell (1998) recommended 7 elements of the healing garden
design: a special entrance that welcomes and takes hold of a visitor to the garden; a water
feature for their physical, psychological and mental effects; the creative use of colours and
light that induces emotions and comfort; an emphasis on natural elements; the integration of
art; elements that attract animals to create animal diversity.
Kellert (2005) presented 9 basic environmental values on which the attraction of a person to
nature depends: aesthetics, dominance, humanity, morality, naturality, negativism, science
and scientific knowledge, symbolism and utility.
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
137
RESULTS
The proposed design is based on the principles of the creation of healing gardens and on the
requirements of the staff who work in the facility. It should be adjusted to the target group of
people, i.e., the patients of the facility and their health problems. The design of the healing
garden with a therapeutic influence is intended to support the treatment of patients, increase
the value of the facility, and create a harmonious environment. It is essential to have gardens
and natural elements that represent positive values and that these areas are managed in
harmony with human needs to support and bring about relaxation, a sense of calm, and
psychical and physical energy. There should also be the possibility for physical activities,
selection possibilities, elements supporting socialisation, access to a nature, etc.
Study area analysis
The hospital area has great potential for all prepared therapeutic design proposals. When
comparing the present state of the architecture and greenery of the study area, the
architectural elements represent a major problem. The present state of the buildings and
unused spaces and elements is very negative. A substantial number of buildings in the area
are not utilised nor do they have any function. Furthermore, they are in very bad condition in
terms of safety. Refurbishment must also be undertaken on the garages, water supply station
and transfer station. A majority of the buildings need refurbishment of the facades, windows,
doors, and balconies. Behind the hospital, on its northern side, we can see a great deal of
potential in the unutilised mowed area (see Figure 2).
Figure 2. Study area analysis (Source: Authors).
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
138
A great positive and essential element of the healing character of the complex is its natural
character and its integration into the environment of the Little Carpathians. There are trees
and shrubs, or herbs, many of which have healing properties (Allium ursinum and others)
and can have a positive effect because of their specific scents. The singing of birds is very
pleasant. There is a nice ornamental flower bed at the great fountain. A stream flows through
the complex, with its open visible part being not only aesthetic, but also having a pleasant
sound of flowing water in nature. Furthermore, the entire premises and its continuity to the
forest offer the possibility of healthy walks. Environments suitable for walks, sports areas and
outdoor seating options support socializing. There are plenty of sunny and shady areas
within the premises, as well as a simply developed network of paths that allow a person to
choose the environment and how it suits them (see Figure 3). The choice, one’s own
decision, a sense of control are also promoted by the diversity of sports grounds where one
can choose between football, basketball, volleyball or tennis. In addition to the above-
mentioned features and elements, the positive distractions are enhanced by the presence of
simple art.
Figure 3. Scheme of basic natural elements (Source: Authors).
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
139
According to the categorization of the outdoor areas of medical facilities, the following
typological areas are located in the design area: an entrance area in front of the complex, an
entrance garden, the entrance area of the complex, a park-type hospital garden, one
unoccupied atrium garden, two atrium gardens with the possibility of an entrance (one of
them with a therapeutic garden element), a space without a designated function and without
use, a space for sports areas, an economic and technical space, a leased landscape and, at
the same time, protected nature and an educational trail leading through the premises (see
Figure 4).
The art is in the form of sculptures depicting humans and animals. A symbolic sculpture of
the premises is the bust of Philippe Pinel near the entrances to the complex. Other
sculptures show open arms with doves, birds of prey with caught fish, mythology and
symbolism. A distinctive artistic element is also the facade of the drug addiction ward, the
bell tower, fountains and the composition of wooden blocks. There is a new therapeutic path
for the development of senses, especially touch and sensorimotor function, in the atrium of
the rehabilitation department.
Figure 4. Scheme of therapeutic garden characteristic elements (Source: Authors).
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
140
Questionnaire survey results
77 persons took part in the questionnaire survey out of which 41 persons were hospital
employees, 18 were patients staying at the hospital, 1 was a patient completing a one-time
medical control and 17 were visitors. They responded to the questionnaire points as follows:
8"#$
%9#$
'#$
%%#$
I am:
(mark one option) :;<=20))$2>$-.)$.2*<?-,=$
@,A?)1-$7.2$?*$.2*<?-,=?B)5$?1$
-.)$.2*<?-,=$
@,A?)1-$7.2$A,;)$>2/$,$21)C
D;)$;)5?A,=$)E,;?1,D21$
F?*?-2/$
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
141
!9$
"G$
%8$
%"$
''$
"%$
'&$
&$
'"$
&$ '&$ %&$ "&$ 9&$ 8&$ G&$ !&$ H&$
I/))*J$*./KL*J$<=,1-*J$1,-K/,=$A.,/,A-)/$2>$-.)$
,/),$
M<)1$=,71$,/),$
N),D1O$,/),*$
P/-$,15$*AK=<-K/)*$
Q,=6?1O$/2K-)J$<,R);)1-*$
N<2/-$,/),*$
SK?=5?1O*$
MK-522/$,ADR?D)*$
:E-)/?2/$,ADR?D)*$
M-.)/T$
O0;$
What%do%you%like%the%most%in%the%complex%?%%
(you can mark more than one option )
32U$2>$/)*<21*)*$
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
142
'H$
"8$
"H$
%8$
%9$
'"$
H$
8%$
%"$
%!$
%9$
V$
%9$
'H$
%G$
9!$
'V$
%8$
9!$
%!$
&$ '&$ %&$ "&$ 9&$ 8&$ G&$
I/))*J$*./KL*J$<=,1-*T$,55$;2/)$*<)A?)*$
I/))*J$*./KL*J$<=,1-*T$,55$W27)/?1O$*<)A?)*$
I/))*J$*./KL*J$<=,1-*T$,55$;2/)$W27)/L)5*$
I/))*J$*./KL*J$<=,1-*T$1?A)/$,//,1O);)1-J$
A2;<2*?D21J$,)*-.)DA$)1R?/21;)1-$
I/))*J$*./KL*J$<=,1-*T$L)X)/$;,?1-)1,1A)$
M<)1$=,71$,/),*T$*))5?1O$<=,1-*$
M<)1$=,71$,/),*T$5?Y)/)1-$K*)$2>$,/),*$
41A/),*)$-.)$1K;L)/$2>$*),D1O$,/),*$
Z)*?O1$2>$-.)$*),D1O$,/),*$
S?1*$
N?O1*J$?1>2/;,D21$-,L=)*$
+,?=?1O*$
P/-J$*AK=<-K/)*T$;25?[A,D21$2>$)E?*D1O$
)=);)1-*$
P/-J$*AK=<-K/)*T$,55?1O$1)7$)=);)1-*$
Q,-)/$)=);)1-*T$5)A2/,D1O$2>$-.)$>2K1-,?1*$
7?-.$W27)/*$\2/$2-.)/$5)A2/,D21$7?-.2K-$
Q,-)/$)=);)1-*T$/)R?)7$-.)$>K1AD21$2>$-.)$
>2K1-,?1*$\;25?[A,D21$L0$K*?1O$7,-)/]$
Q,=6?1O$/2K-)J$<,R);)1-*T$,55?1O$1)7$
<,R);)1-*$
Q,=6?1O$/2K-)J$<,R);)1-*T$;25?[A,D21$2>$
-.)$)E?*D1O$<,R);)1-*$
^,A,5)*$2>$-.)$LK?=5?1O*$
S,//?)/C>/))$)=);)1-*J$;25?[A,D21$>2/$K*?1O$,$
7.))=A.,?/$)-AU$
M-.)/$
O0;J$[-1)**$
What would you recommend improving in the area?
(you%can%mark%more%than%one%op7on)%
32U2>$/)*<21*)*$
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
143
G"#$
%&#$
!#$ 8#$ 8#$
%
Would you like to have small areas set apart for planting herbs, fruits
and vegetables?
()*$
+,-.)/$0)*$
+,-.)/$12$
32$
4$52$12-$6127$
8!#$
%'#$
'"#$ 9#$ 8#$
Would you welcome simple revitalisation through the use of interior
plants in the buildings?
()*$
+,-.)/$0)*$
+,-.)/$12$
32$
4$52$12-$6127$
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
144
G8$
'H$
%$
'$
G$
9$
%$
8$
'$
9$
%$
"$
'$
'$
%$
8$
%$
"$
%$
'$
'$
'$
'$
%$
%$
'$
'$
'$
&$ '&$ %&$ "&$ 9&$ 8&$ G&$ !&$
<),A)$
)1_20;)1-$
.,/;210$
*0;L?2*?*$L)-7))1$;,1$,15$1,-K/)$
;2DR,D21$
,ADR?-0$
A2K/,O)$
/)=,E$
)Y2/-*$-2$?;</2R)$7,.-$7)$.,R)$127$
A2;>2/-$
A,=;$
<2*?DR)$);2D21*$
26$
<=),*K/)$
5K=A?[A,D21$
R,A,1A0$
>/))52;$
)1)/O0$
>))=?1O*$2>$L),K-0$
*,D*>,AD21$
O225$;225$
1?A)$,-;2*<.)/)$
1)/R2K*1)**$
,1O)/$
/,-.)/$*,51)**$
*,51)**$
,1E?)-0$
>),/$
32-)*$,15$A2;;)1-*$
How do you perceive the natural environment of the area?
(peace, anxiety, anger, motivation, activity, courage,
nervousness, other...)
32U$2>$/)*<21*)*$
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
145
Design proposals
Taking into account the large hospital area, we have firstly divided the revitalisation
proposals into units or categories (from the point of view of both landscape architecture and
building architecture). After a detailed analysis of the hospital premises, the adjustments of
unused buildings, small architecture, paths, roads, building facades, entrances and interiors
were proposed in terms of architectural elements in an effort for wheelchair accessibility and
a reflection of the questionnaire survey results (see Figure 5).
Figure 5. Renovation of architectural elements scheme (Source: Authors).
As already mentioned, a lot of buildings in the area do not have any use and/or function and
they are in very bad condition. They could potentially have a bad impact on patients walking
along or observing them from a greater distance. They are perceived as a damage of current
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
146
landscape scenery, and at the same time, they can result in negative emotions when thinking
about the hospital management. The patient may feel that when area management is so
poor the patient management may also be very bad. We have proposed a detailed analysis
of the unused buildings, the evaluation of their present state and, accordingly, we have
created a detailed proposal for the whole hospital area.
The previous architectural and landscaping designs are aimed at improving the healing and
therapeutic character of the environment. The complex currently has a great potential for
implementing nature therapy. They partially meet almost all the major aspects of healing
gardens that only need to be taken to a higher level to provide the desired effect.
The landscape adjustment design focused on the adjustment of atriums and unused areas,
completing the environment with natural elements and management measures for exterior
areas (see Figure 6).
The main therapeutic elements that should be added to the exterior of the hospital are:
the possibility of working in the garden in the form of growing plants - horticultural
therapy, and the possibility of growing medicinal herbs and edible plants;
completing the environment in the spirit of a sensory garden, that is, with elements
that engage touch, smell, sight, taste, hearing;
adding harmonic colours in the form of plants, water features, flower beds, plants with
interesting textures, nesting boxes;
singing birds (their introduction to the premises of the hospital in question is currently
planned in the foreseeable future), edible plants; the smells of plants are of great
importance;
wheelchair accessibility, universal design; and
therapeutic exterior elements according to the character of patient treatment
requirements, elements supporting movement, motor skills, concentration, thinking,
etc.
In relation to the healing gardens, we propose a reconstruction of the building with green
houses. Its function should be renewed. In the past, the green house had everything that one
could need for herb growing. It could also be utilised during winter time. After renovation,
patients can cultivate healthy fruits and vegetables suitable for nutrition there. Fig trees or
citrus plants can also be cultivated along with different kinds of herbs having a variety of
smells and tastes (for example basil, horsemint, bee balm, basil thyme, chive, or meadow
sage). While growing herbs, the patients can improve their management and responsibility
skills and also their interest in the natural environment. These activities can also result in
better social skills and communication in a team. Additionally, such activity makes patients
less stressed during their therapy, and they can feel themselves to be more efficient and
successful.
Several unused fountains are in the hospital area. Their renovation is financially very difficult,
so the hospital management does not plan to repair them. However, we have proposed to
improve their aesthetic function. The hospital has already started the repair of the stone
mosaics that are part of the fountains. We have also proposed some reconstructions that
include vegetation that can bring vital material” to the fountains (for example Bacopa
speciosa, Campanula betulifolia, Fragaria vesca, Tulipa gregii etc.). At the same time, we
recommend a reconstruction that will not have a negative effect on future fountain utilisation.
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
147
Figure 6. Landscape therapeutic design scheme (Source: Authors).
The hospital area is very large and old and requires a number of serious renovations (step by
step based on hospital resources). From landscape point of view, the area is very valuable,
having the potential for therapeutic landscape design. In principle, one just needs to add
several vegetation types as well as elements supporting therapy. The management of the
greenery that is already on site is also very important. For renovation purposes we propose
to organise volunteer garden activities involving patients and using available financial grants.
In our proposal, we have mostly focused on the hospital atriums. There are three of them:
one is not utilised, one is half utilised and one is utilised for therapeutic purposes. As a part
of a building, an atrium can serve as a nice enclosed space while also serving as a natural
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
148
vista for hospital rooms and a space for relaxing. The already utilised atrium has a so called
touch path and touch fountain” made from cones and other materials. A lot of greenery can
be observed there. The atrium was brought to life and managed with a minimum of financial
sources. On the other hand, the non-utilised atrium is a space where patients throw garbage
out of windows. The atrium where only ruderal vegetation can be observed is perceived by
patients as a non efficient space suitable only for damaging activities“. That is why hospital
management has started their renovation activities right there. That space is suitable for
patients unable to walk. Based on the needs of patients we have recommended the
renovation of the sport field areas. One such space has already been reconstructed.
Throughout the whole hospital area, we have recommended focusing on green area
management and adding some isolated greenery, ornamental flowers, greenery having an
impact on human senses (Lavandula, Geranium, Sedum, etc). For outdoor activities
drawing, music, working with wood and others natural materials can be very positive. The
renovation of interior spaces using vegetation elements is also very important. They can
eliminate harmful substances from furniture, walls and air. At the same time, they can serve
as an aesthetic design element resembling nature. For that purpose, interior vegetation
elements are very useful (Chlorophytum comosum, Spathiphyllum, Sansevieria trifasciata,
Zamioculcas, Aspidistra elatior, Philodendron scandens, Hedera helix, Ficus elastica,
Nephrolepis exaltata, etc). From the time we began the preparation of our study for the
hospital, several renovations have already taken place (both outdoor and indoor).
CONCLUSION
The topic of healing and therapeutic landscape design is extensive, but it is built on simple
principles. It is important to be aware of the effects of green vegetation and the associated
therapies on the mental and physical state of persons. In Slovakia, this issue is currently of
interest and has a great potential for further development. In recent decades, there has been
no interest in investing in healing gardens and no funds have been expended on this issue.
Medical centres are often just centres designed in the old functional style of socialist
medicine, regardless of the unpleasant or depressing perception of visiting them from the
point of view of a patient.
The proposed design is based on the principles of the creation of healing gardens and on the
requirements of the staff who work in the facility. It should be adjusted to the target group of
people, i.e., the patients of the facility and their health problems. The proposed design with a
therapeutic influence is intended to support the treatment of patients, increase the value of
the facility, and create a harmonious environment.
The case study on the premises of the Philippe Pinel Psychiatric Hospital in Pezinok,
together with questionnaires, demonstrates the positive effect of green vegetation on people,
the need for green vegetation and its re-cultivation. It also points to the advantages and
disadvantages of the complex and suggests a solution. The hospital complex in Pezinok is
extensive, with potential for nature treatment, and would be a wonderful therapeutic area for
patients, visitors and employees if adjusted.
Nowadays, based on the design schemes presented, the individual works are being done in
the interior and exterior of the hospital with the help of the patients. The patients are doing
such activities as a part of their therapy, which is under the supervision of the healthcare
personnel and volunteers. Landscape therapeutic design provides some considerable
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
149
financial costs, but according to surveys, the creation of healing gardens in medical facilities
reduces healthcare expenses.
The economic aspect of healing gardens should be considered from the beginning of their
design. Resources for creating a therapeutic garden should be used reasonably. For
example, Sedum creates an area covered by green vegetation and reduces the use of lawns,
i.e. lawn care costs (reducing regular mowing, etc.). Using plants with less need for water
and houseplants easier to grow in a given environment will facilitate care and reduce
expenses. Solar lights and water features that use recycled rainwater can also help financial
efficiency and sustainability.
The purpose of the low-budget design of the interior hall was to transform the space through
simple changes that require a minimum of expenditures and bring about a positive effect.
The design is based on the hospital's requirements and ideas. The proposed design for
Philippe Pinel Hospital can be presented as a positive example for other healthcare facilities
in Slovakia.
ACKNOWLEDGEMENTS
This research was supported by the Scientific grant Agency of the Ministry of Education,
Science and Sport of the Slovak Republic (VEGA 1/0096/16).
REFERENCES
Beal, H. (2004). Natural Healing. Architecture Minnesota, 30, 48-53.
Bengtsson, A., & Grahn, P. (2014). Outdoor environments in healthcare settings: A quality evaluation
tool for use in designing healthcare gardens. Urban Forestry & Urban Greening, 13, 878-891.
http://dx.doi.org/10.1016/j.ufug.2014.09.007.
Benngtsson, A., & Carlsson, G. (2013). Outdoor environments at three nursing homes: qualitative
interviews with residents and next of kin. Urban Forestry & Urban Greening, 12 (3), 393-400.
Chen, L. (2004). On the construction of healthcare garden. J. Shaoyang Univ. (Natural Science), 1(4),
108109, 114.
Cooper Marcus, C., & Sachs, N. A. (2014). The salutogenic city. World Health Design, 7(4),18-25.
Cooper Marcus,C., Luo,H., & Jin, H. (2009). Healing gardens in hospitals. Chin.Lands.Archit., 7, 1–6.
Cooper Marcus, C. (2007). Healing Gardens in Hospitals. Interdisciplinary Design and Research-
Journal, 1(1: Design and Health), 1-27.
Cooper Marcus, C. (1997). Nature as Healer: Therapeutic Benefits in Outdoor Places. Nordisk
Architekturforsking, 1, 9-20.
Cooper Marcus, C., & Barnes, M. (1999). Healing Gardens: Therapeutic Benefits and Design. New
York: John Wiley & Sons.
Eckerling, M. (1996). Guidelines for Designing Healing Gardens. Journal of Therapeutic Horticulture,
8, 21-25.
Epstein, M. (1998). The Garden as Healer. Seattle Daily Journal of Commerce. from
http://www.djc.com/news/co/11184021.html.
Fredrickson, B. L. (2013). Updated thinking on positivity ratios. American Psychologist, 68(9), 814-
822. doi: 10.1037/a0033584.
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
150
Gerlach-Spriggs, N., Kaufman, E.R., & Warner, S. M. Jr. (1998). Restorative Gardens: The Healing
Landscape. New Haven, CT and London: Yale University Press.
Grahn, P. et al. (2010). Using affordances as a health-promoting tool in a therapeutic garden. In C.
Ward Thompson, P. Aspinall & S. Bell (Eds.), Innovative Approaches to Researching
Landscape and Health: Open Space: People Space 2 (pp.116-54). New York: Routledge.
Jiang, S. (2014). Therapeutic landscapes and healing gardens: A review of Chinese literature in
relation to the studies in western countries. Frontiers of Architectural Research, 3, 141-153.
Kaplan, R., & Kaplan, S. (1989). The experience of Nature: A psychological perspective. New York:
Cambridge University Press.
Kellert, S. R., Heerwagen, J., & Mador, M. (2008). Biophilic Design: The Theory, Science, and
Practice of Bringing Buildings to Life. New Jersey: John Wiley.
Kellert, S. R. (2005). Building for Life: Designing and Understanding the Human-Nature Connection.
Washington D.C.: Island Press.
McDowell, C. F., & McDowell, T. C. (1998). The Sanctuary Garden. New York: Fireside Books.
Mitrione, S., & Larson, J. (2007). Healing by Design: Healing Gardens and Therapeutic Landscapes.
Informe Design: Where Research Informs Design. from
https://www.informedesign.org/_news/nov_v02.pdf
Mintner, S. (1993). The Healing Garden. London: Headline Book Publishing.
Rodiek, S. (2008). A new tool for evaluating senior living environments. Senior Housing and Care
Journal, 16 (1), 3-10.
Sachs, N. A., & Shepley, M. M. (2014). Book Review: Australian Healthcare Design 2000-2015: A
Critical Review of the Design and Build of Healthcare Infrastructure in Australia. Health
Environments Research & Design, 7(3), 152-153.
Sachs, N., & Marcus, C.C. (2012). Are healing gardens becoming too popular? Medical Construction
& Design, 8(5), 68-70.
Shackell, A., & Walter, R. (2012). Practice Guide Greenspace design for health and well being.
Edinburgh: Forestry Commission.
Smidl, S., Mitchell, D.M., & Creighon, L.C. (2017). Outcomes of a Therapeutic Gardening Program
in a Mental Health Recovery Center. Occupational Therapy in Mental Health, 33(4), 374-
385. doi: 10.1080/0164212X.2017.1314207.
Smith , J. (2007). Health and nature: The influence of nature on design of the environment of care. A
Position Paper for the Environmental Standards Council of The Center for Health Design
(pp.20). The Hague: The Center for Health Design.
Stigsdotter, U.K., & Randrup, B.T. (2008). A Conceptuel Model for therapy gardens and horticultural
therapy for people sufferingg from stress, Frederiksberg: University of Copenhagen.
Stigsdotter, U.K., et al. (2014). Conceptual model Health Forest Octovia. A model for designing green
spaces with perceived sensory dimensions that promote good health. Frederiksberg: University
of Copenhagen.
Tyson, M. M. (1998). The Healing Landscape: Therapeutic Outdoor Environments. New York:
McGraw-Hill.
Ulrich, R. S. (1984). View Through a Window May Influence Recovery from Surgery. Science, 224 (2),
420.
Ulrich, R. S., (2002). Communicating with the healthcare community about plant benefits. In:
Proceedings of the Sixth International People Plant Symposium. Chicago: Chicago Botanical
Garden.
International Journal of Architectural Research
Ingrid Belčáková, Pavla Galbavá, Martina Majorošová
Archnet-IJAR, Volume 12 - Issue 3 - November 2018 - (128-151) Regular Section
Copyright © 2018 | Copyrights are granted to author(s), Archnet-IJAR, and Archnet @ MIT under the terms of the "CC-BY-NC-ND" License.
151
Ulrich, R. S. (1999). Effects of gardens on health outcomes: Theory and research. In C. Cooper
Marcus & M. Barnes (Eds.), Healing gardens: Therapeutic Benefits and Design
Recommendations (pp. 27-86). New York: John Wiley & Sons.
Warner, S.B., & Baron, J.H. (1993). Restorative gardens. British Medical Journal, 306 (6885), 1080-
1081.
Westphal, J., (2000). Hype, Hyperbole, and Health: Therapeutic site design. Urban Lifestyles: Spaces,
Places, People. Rotterdam: A.A.Balkema.
Wilson, E. (1986). Biophilia: the Human Bond with Other Species. Cambridge: Harvard University
Press.
Zeisel, J. (2007). Creating a therapeutic garden that works for people living with Alzheimer’s. Journal
of Housing for the Elderly, 21(1-2),13-33.
... Both the built environment and AT could potentially have a positive effect on promoting health when they use the means of design for therapy. Based on the analysis results of the built environment and AT, this paper finds that TD is mainly divided into two areas of research application: the first one comprises therapeutic environment [51][52][53], architecture [54][55][56], and space [57][58][59]; whilst the second is a garden-based therapeutic landscape design [60][61][62]. The following sections carry out micro qualitative analysis from these two research application fields. ...
... The related research progressively appeared from 2002 to 2018. In terms of the research method, the research of TD in the garden-based landscape design field mainly adopts a case study [61,82,83] and a mixed research method based on literature review and case study [84][85][86]. In terms of the research subject, the studies mainly take the general public as the research group to analyze the therapeutic characteristics and effects of landscape design. ...
... A therapeutic landscape refers to a green public space that is beneficial to people's physical health, mental health, and social health, as well as a therapeutic activity space that provides people with meditation, alleviates stress, and encourages social interaction [88]. When the landscape design is aimed at rehabilitation and curativeness, creating the natural foundation for patients, such as green plants, can bring positive changes to patients and provide employees with a relaxing space [61]. In addition, daylighting is an important factor that promotes health in the design of therapeutic landscape [89]. ...
Article
Full-text available
At present, a smart city from the perspective of the United Nations Sustainable Development Goals (SDGs) emphasizes the importance of providing citizens with promising health and well-being. However, with the continuous impact of coronavirus disease 2019 (COVID-19) and the increase of city population, the health of citizens is facing new challenges. Therefore, this paper aims to assess the relationship between building, environment, landscape design, art therapy (AT), and therapeutic design (TD) in promoting health within the context of sustainable development. It also summarizes the existing applied research areas and potential value of TD that informs future research. This paper adopts the macro-quantitative and micro-qualitative research methods of bibliometric analysis. The results show that: the built environment and AT are related to sustainable development, and closely associated with health and well-being; the application of TD in the environment, architecture, space, and landscape fields promotes the realization of SDGs and lays the foundation for integrating digital technologies such as Building Information Modeling (BIM) into the design process to potentially solve the challenges of TD; and the principle of TD can consider design elements and characteristics from based on people’s health needs to better promote human health and well-being.
... When the landscape style changes, it will inevitably lead to discussions about endowing the landscape with healing properties or maintaining the healing properties of the place. Examples include exploring and understanding the creation of restorative and therapeutic spatial places for refugees or dislocated farmers in urban distribution and resettlement planning [9,11,12], exploring longevity villages as tourist destinations as the health tourism industry grows [8], and exploring design strategies for healing and therapeutic gardens in senior communities or medical buildings as we move toward a healthy aging society [13]. It is worth noting that as urban economies develop, populations grow, and the quality of life improves, cities at all levels in many regions experience varying degrees of expansion, and the landscape of former suburban areas will evolve significantly under the influence of multiple factors. ...
... He explored the role of smell within Community Supported Agricultural projects. Belčáková et al. [13] proposed a strategy for greening hospital facilities and external spaces and adding elements that highlight and support the therapeutic effects of the spatial environment, creating specific therapeutic landscape design forms that create the required physical environmental base for patients. ...
Article
Full-text available
Under the influence of economic, environmental, and social structural changes, urban space expands and contracts to varying degrees and the everyday urban landscape changes in response. Over the past 20 years, a large number of cities in China have undergone a brief but rapid urban expansion and are moving toward shrinking cities. Most of these cities are now facing social problems such as an aging population and a high prevalence of chronic diseases. Therefore, the “therapeutic” role and impact of everyday landscapes in these cities need to be examined in the context of urban development processes through appropriate assessment methods. Therefore, this study applies the ANP-mV model to examine the therapeutic nature of everyday urban landscapes in different development periods, with the aim of enhancing the health and well-being of people with chronic diseases. Firstly, this study uses the city of Jinzhou in Northeast China as an example to develop a framework for assessing the therapeutic nature of everyday urban landscapes based on the health care needs of people with chronic diseases; secondly, it examines the therapeutic nature of the former Jinzhou Suburban Riverfront Forest Park as it has developed and evolved over the past 16 years; finally, it explores place-making and regeneration strategies for therapeutic landscapes from the perspectives of dynamic impact and sustainable development to enhance chronic illness patients’ well-being. At the theoretical level, this study contributes by providing a methodology and research ideas for examining the “therapeutic” nature of everyday urban landscapes and proposing further development plans for renewal, constructing a framework for assessing therapeutic landscapes, and elucidating the relationship between networks of influence and the relative importance of various assessment dimensions/elements. At the practical application level, the contribution of this study is to provide local policymakers with a key decision basis for the future development planning of the East Lake Forest Park. The aim is to explore landscape creation and regeneration strategies for the East Lake Forest Park in the context of Jinzhou's progressive move toward a shrinking city, in order to sustain the well-being of the chronically ill. 1. Introduction Previous research has repeatedly documented the restorative effects of place on health and well-being [1, 2] and has developed a number of framework concepts such as the biophilia hypothesis, the Attention Restoration Theory, and the concept of healing landscapes [3]. Under the concept of therapeutic landscapes, scholars have examined many types of landscapes associated with healing or rehabilitation, including natural landscapes such as villages, mountains, and lakes that have a reputation for healing [4, 5]. There are also everyday landscapes, such as places and residential areas where medical services are provided, and libraries [6, 7]. Then, there are urban landscapes, such as urban public green spaces and streets, and social networks [8, 9]. In humanist and cultural ecology theories, the formation of therapeutic landscapes is dynamic and the landscape can be seen as an evolving process where “therapeutic” is examined in the context of changing environmental, social, and economic conditions [10]. Yan and He [8] argue that it is important to explore the evolution of therapeutic landscapes, i.e., how therapeutic landscapes change over time. Realistic experience shows that the development of local productivity, changes in social structure, and the introduction of macrogovernance policies can have a vital impact on the evolution of the urban landscape. When the landscape style changes, it will inevitably lead to discussions about endowing the landscape with healing properties or maintaining the healing properties of the place. Examples include exploring and understanding the creation of restorative and therapeutic spatial places for refugees or dislocated farmers in urban distribution and resettlement planning [9, 11, 12], exploring longevity villages as tourist destinations as the health tourism industry grows [8], and exploring design strategies for healing and therapeutic gardens in senior communities or medical buildings as we move toward a healthy aging society [13]. It is worth noting that as urban economies develop, populations grow, and the quality of life improves, cities at all levels in many regions experience varying degrees of expansion, and the landscape of former suburban areas will evolve significantly under the influence of multiple factors. For local urban dwellers, villages, green spaces, forests, and parks in the suburbs are often seen as therapeutic and healing landscapes that combine physical and nonphysical levels [14, 15]. Due to the economic downturn of cities, industrial transformation, and an aging population, the rate of urban expansion into suburban areas has generally slowed down in recent years, and more emphasis has been placed on the planning concept of “transformation” rather than “new construction/rebuilding,” with more emphasis on the inner development of cities, microrenewal, and adaptive improvement of urban space. Even in China, where the built-up area has grown exponentially over the past 30 years, spatial expansion is no longer the dominant form of urban development, and many cities are facing a shift from “incremental planning” to “stock planning” [16]. In China, in particular, a large number of small and medium-sized cities are now moving toward shrinking cities after urban expansion, with serious urban population loss and an increasing trend toward aging [17]. Concerned with the development of these cities, scholars and practitioners have proposed a range of urban regeneration and development strategies that can be summarized in three main development planning directions: regrowth, urban islands, and dedensification and greening [18]. Regardless of the development strategy, what needs to be acknowledged is the irreversibility of urban shrinkage, and that urban growth and decline, like life cycles, are seen as natural processes of urban change, requiring planning managers to shift a commonly accepted perception [19]. Scholars have suggested that local policymakers should examine whether sprawling urban landscapes meet the real needs of the current population and improve urban green space networks to increase the livability and attractiveness of cities, thereby mitigating population loss and enhancing economic vitality [20–22]. In contrast to China's Tier 1-2 cities, there is a large demand for healthcare in small and medium-sized cities that have undergone a brief and rapid urban expansion and are now gradually shrinking. Perhaps due to its unique natural environment and dietary habits, Northeast China has long been a region with a high prevalence of chronic diseases such as cardiovascular disease, diabetes, and gout [23, 24]. In many cities in Northeast China, there is widespread and strong awareness of the need for chronic disease patients to go outdoors for physical, mental, and spiritual healing [25]. Through ongoing observations and interviews over many years, this study considers that people with chronic illnesses in the region value rely more on outdoor blue, green, and white spaces for healing and therapy in appropriate seasonal and climatic conditions. In the cities of Jinzhou in Liaoning Province and Jiamusi in Heilongjiang Province, for example, outside of the extreme weather days in the northeast, large numbers of people regularly enter urban squares, parks, and waterfront streets where people can gather and relax on an almost daily basis to enjoy the healing and therapeutic effects of the landscape through a variety of health behaviors and activities. Therefore, as cities shift from sprawl to contraction and respond to the current needs of the population to continue to enhance the health and well-being of people with chronic diseases, the former suburban landscape needs to be reexamined not only for its therapeutic qualities but also for new place-making strategies in urban regeneration. However, much of the previous research has focused on examining the positive effects of landscape environments on patients [26, 27] and explaining the formation and evolution of therapeutic landscapes. Few scholars have integrated urban development and planning concepts in a public health context, examining the therapeutic nature of an evolving landscape and exploring how to shape therapeutic landscapes for sustainable well-being in urban regeneration. In summary, this study uses the city of Jinzhou in Liaoning Province, China, as a case study. The city has experienced a brief and rapid urban expansion and is now shifting to a shrinking city with significant population loss and an aging trend. The city has a high prevalence of chronic diseases in the northeast and is generally representative of healthcare resources and the development of the built-up areas. The purpose of this study is to develop a framework for assessing the therapeutic nature of everyday urban landscapes based on the health care needs of people with chronic diseases, examine the therapeutic nature of the former Jinzhou Suburban Riverfront Forest Park as it has developed and evolved over the past 16 years, and explore strategies for place-making and regeneration of therapeutic landscapes for the well-being of people with chronic diseases from a dynamic impact and continuous development perspective. The design of this study is shown in Figure 1. Firstly, this study uses a literature review to initially extract the elements of therapeutic assessment for everyday urban landscapes and then, through focus group interviews, constructs a framework for assessing the therapeutic landscape of the East Lake Forest Park in Linghe District, Jinzhou City, based on the health care needs of people with chronic illnesses. Secondly, a network analysis method (ANP) was applied to assign weights to the assessment elements based on expert opinion, and a modified VIKOR technique was applied to examine the therapeutic landscape of Jinzhou City's Donghu Forest Park for people with chronic diseases over the past 16 years, in conjunction with interviews and questionnaires administered by the public. Finally, based on the results of the assessment and analysis, strategies for the creation and renewal of the therapeutic landscape of the East Lake Forest Park are explored in the context of Jinzhou's progressive move toward a shrinking city, in order to sustain the well-being of people with chronic diseases.
... The design of the elements comprising the physical environment that result in sensory stimulation, such as buildings, equipment, furniture, signboards, colors, art, landscapes, and clothing, is perceived to indicate a hospital's quality of care and can positively influence patient healing [35]. Since patients experience the patient clothing design directly, the aesthetics that can inspire positive emotions in them, such as images representing optimism, vitality, and humor, should be considered to improve the healing system [36]. Feodoroff, a designer who developed a functional patient suit "Original Healing Threads" for women with cancer, emphasized the importance of design considering the aesthetic sensitivity of patients by commenting that when you feel like you look good, you will get better [37]. ...
... The third design direction is aesthetics. Designs that aesthetically apply humor or vitality can improve healing by creating positive emotions in the patient [36]. In pattern design, the angle at which a motif is placed can affect the patient's psychological vitality. ...
Article
Full-text available
Patients’ emotional responses to the hospital environment can be considered as important as medical technology and equipment. Therefore, this study investigated their experiences to determine whether the pattern using hospital identity (HI) elements, a widely used design method for patient clothing in university hospitals, can affect their emotional response and contribute to healing. It aimed to identify whether controlling the motif characteristics, arrangement, and spacing in this pattern design, and the direction between motifs, could be a method to design patient clothing for healing. To investigate patients’ emotional response and suggestions for patient clothing design, an interview-based qualitative approach was used. In-depth interviews were conducted with 12 patients discharged from Kyung Hee University Hospital Medical Center (KHUMC), Seoul. The interview questions consisted of two parts. One part featured questions about participants’ emotional responses to the medical environment and their latest patient clothing experience, and the other featured questions about their emotional response to, and suggestions for, the healing expression of pattern design using HI. The results confirmed that the motif characteristics, arrangement, and spacing, and the direction between motifs, influenced patients’ positive emotions and contributed to the healing effect. Therefore, when the HI elements of a medical institution are applied in the design of patient clothing with the characteristics of a healing design, patients perceive this as providing stability and comfort. The design of patient clothing becomes a medium that not only builds the brand image of medical institutions, but also enhances the quality of medical services centered on patient healing.
... there were many studies in this field like (Belcakova et al. 2018) which discussed the effect of healing gardens in support patient treatment, socialization, gives a sense of control, engorge the physical movement; access and bonding with nature; in general, a variety of pleasant distractions. The study depended on questionnaire survey [6]. Another study of (van den Bosch and Bird 2018). ...
Conference Paper
Full-text available
This research examine the role of physical design elements for healing gardens in promoting the psychological health for the patients. Many studies had presented the role of the landscape in enhancing the psychological aspects of human, and its connection with outdoor environment. Previous studies also provided a definition of healing gardens design and components, but the study of the effect of physical components within healing gardens in promoting human psychological health, was not adequately addressed. This represented the research problem. As for the research hypothesis, it states that the physical components (natural and artificial components) for healing gardens will support the psychological environment and improve the quality of life for the patients. The research adopted descriptive analytical approach for a number of hospitals healing gardens, and their positive impact on the psychological health.
... there were many studies in this field like (Belcakova et al. 2018) which discussed the effect of healing gardens in support patient treatment, socialization, gives a sense of control, engorge the physical movement; access and bonding with nature; in general, a variety of pleasant distractions. The study depended on questionnaire survey [6]. Another study of (van den Bosch and Bird 2018). ...
Article
Full-text available
This research examine the role of physical design elements for healing gardens in promoting the psychological health for the patients. Many studies had presented the role of the landscape in enhancing the psychological aspects of human, and its connection with outdoor environment. Previous studies also provided a definition of healing gardens design and components, but the study of the effect of physical components within healing gardens in promoting human psychological health, was not adequately addressed. This represented the research problem. As for the research hypothesis, it states that the physical components (natural and artificial components) for healing gardens will support the psychological environment and improve the quality of life for the patients. The research adopted descriptive analytical approach for a number of hospitals healing gardens, and their positive impact on the psychological health.
... Environmental Elements for End-of-Life. There are many elements in an environment that can contribute to or hinder comfort and quality of life, such as colours, sounds, access to nature, and furniture (Zadeh et al., 2018;Belcakova et al., 2018). Presently, in most environments where end-of-life occurs, these elements have been overlooked or not optimized, and thus the environment remains an area with potential that can be addressed through design. ...
Article
End-of-life (EoL) care is often a difficult period for all involved: the person who is dying, their family and friends, and care providers. A review and analysis of literature on design for end-of-life care led to identifying common themes that may influence end-of-life experience, design categories which aim to support EoL care, and continuing challenges that may undermine EoL experience. An additional review researched impacts of the COVID-19 pandemic on EoL experiences. The results of both reviews are presented here, as well as some suggestions for future directions in EoL design.
... The healing function of vegetation has been underestimated on many occasions. Healing landscape designs were known in the ancient Chinese, Greek, and Roman cultures (Belčáková et al., 2018). The earliest known list of healing plants, which is from China, is around 5000 years old. ...
Article
Full-text available
The aim of this article is to point out the potential of urban spaces that have not been primarily meant to be barefoot parks. The stimulation of bare feet is used as a part of therapy or for the prevention of plantar problems. The high number of research papers or blogs available about bare feet shows the interest in this topic among scientists, doctors and the broader population. People are usually shod in a city environment. An analysis of some existing barefoot/sensomotoric spaces compares 3 different projects located in Italy, Germany, and Colombia. The paper shows the common and different approaches in information systems and the amount, variability, and spatial arrangement of stimulation surfaces of these projects. The same method of categorization is used in the analysis of a newly reconstructed park in Slovakia, which was built without a request for a barefoot space. A comparison of these analyses shows the high potential for a regular park having a barefoot area. This research proves that barefoot places in urban areas could be instituted without any significant financial or construction interventions.
... Taking into account the historical and cultural traditions of Kazakhstan, modern researchers recommend the active use of ethnic themes in landscape architecture designs: "The symbolism as a characteristic feature of ancient nomads art can be considered as one of the leading attributes in determining the future development of regional landscape architecture" (KOZBAGAROYA, 2010).There are 9 values that influence the connection and attraction between a person and a natural landscaped area: aesthetics, dominance, humanity, morality, natural-ity, negativism, science and scientific knowledge, utility and finally symbolism (KELLERT, 2012, BELČÁKOVÁ et al., 2018. It can be said that symbolism is a characteristic feature of nomads. ...
Article
Full-text available
This study investigated the emerging progressive use of ornamental art in the landscape architecture of Kazakhstan and determined the influence of symbolism on the quality of new urban environments. The study analysed the existing recreational facilities in Kazakhstan in order to establish their symbolic meaning, the level of utilisation of symbolic ornaments, and the socio-economic factors that influence the design structure of landscape elements. The results revealed that symbolic meanings of the ornaments stem from historic, legal and cultural traditions of different ethnic groups in Kazakhstan. Therefore, the form depends on not only the topography of the area, but also the traditional symbolism and numerology. This study categorised the studied places according to their size: large gardens, small squares and small landscape forms. Taking into account the natural and climatic features of Kazakhstan, small landscape forms acquire the quality of arid zone gardens. However, lack of identity and consistency appears to be a major problem in design of larger scale landscapes. This article posits that coordination between socio-economic and historical-cultural factors will open new creative opportunities for the development of an original landscape architecture in Kazakhstan, yet balance between environmental construction and contextually meaningful urban planning will still be needed.
Article
Full-text available
Egyptian cities have faced several challenges since the start of this new millennium; rapid population growth, urban decay at the expense of available shelter, and services, degradation of infrastructure and land, the downgrade of the environment, social structure and the economy in general, are all factors that have led to unsustainable living. The Burullus region, located in the Northern part of the Egypt delta, is an active commercial and administrative hub. It is one of the five protectorate lakes of Egypt which accommodates both a recreational summer resort and a poorer all year residence. The lake has faced, across time, several changes in respect to the surrounding cities, which in turn impacted dramatically the shore. The changes that happened to the land use and land footprint have changed the shoreline, and will, eventually, lead to many environmental and urban problems as well. Many actions should be taken when thinking about future extensions of cities that have natural edges like Lake Burullus and huge agricultural lands, the aforementioned challenges will face existing communities, as well as, extend with respect to the surrounding areas leading consequently to the change of the identity of the area at large. This paper focuses on the importance of urban development and urban solutions of the cities surrounding Lake Burullus as well as the shoreline protection and implementation policies to optimize deterioration of shoreline, taking into consideration the importance of rural regeneration and its impact on this area. It also highlights a list of actions for successful lake upgrading steps based on the experiences reviewed and concludes that the success of the development of shoreline depends on several factors and that metropolitan planning should cover problems across urban and peri-urban areas and address multijurisdictional issues.
Article
Full-text available
This article presents the first outline of a quality evaluation tool (QET) to be used in the process of designing outdoor environments in healthcare settings, e.g. healthcare gardens. Theory triangulation is used to integrate theories and evidence from selected research on people's health/wellbeing and the outdoor environment. The results first present the theoretical principles underlying the tool and justifying its practical construction. Then, 19 environmental qualities constituting the backbone of the practical tool are presented, including six qualities based on the need to be comfortable in the outdoor environment and 13 qualities based on the need for access to nature and surrounding life. Furthermore, this work presents suggestions of how the tool might include concepts dealing with how users can become involved in the design process, as well as general design guidelines corresponding to the various needs and wishes users may have. The paper ends with a discussion that, among other things, relates the QET to evidence-based design, salutogenesis and pathogenesis.
Article
Full-text available
3 This report describes the development of a new tool that objectively evaluates senior living environments. The principles were based on the established psychosocial needs of residents, using the concept of environmental "affordances" (the actions or behaviors supported by a given environment). The 63-item instrument, developed from the existing environmental design literature, received validity testing in a recent multiregional study conducted at 68 randomly selected assisted living facili-ties (1,569 respondents). Researchers' environmental ratings significantly correlated with resident questionnaire responses on most items. The environmental evaluation tool also found high rates of inter-rater and test-retest reliability in preliminary test-ing. By making environmental evaluations more quantifiable and reliable, it becomes possible to compare health-and satisfaction-related outcomes associated with physical environments. This instrument may serve as a useful example for developing future tools to assess physical environments for seniors. ABSTRACT
Article
Full-text available
The paper deciphers the Chinese literature to English speaking scholars and bridges the gap between China and the western countries on the topics of therapeutic landscapes and healing gardens. Three parts of contents are included in the paper. Firstly, four schools of theories explaining how and why nature can heal, are introduced based on the studies in western countries with the examination of terminology used. In the second part, 71 publications in Chinese are systematically reviewed, with 19 significant studies analyzed in details, including focus areas, the research method, and major findings. In the final part, Chinese studies are evaluated in relation to the theories in western countries.
Article
This study evaluated outcomes of a therapeutic gardening project in a community mental health center. The authors worked with 20 adults with severe mental illnesses, to plan, build, and care for raised-bed gardens. Targets for recovery-oriented outcomes related to personal responsibility, emotional and physical well-being, and socialization, were established in advance. Achievement of outcomes was measured using quantitative and qualitative methodology. Results indicated that the program supported recovery. Participants demonstrated significant improvement in mood and markedly higher levels of involvement and spontaneity, when engaged in gardening. Positive changes in diet and social interaction were also reported.
Article
In July, 2013, the International Academy for Design & Health held the 9th World Congress in Brisbane, Australia. Australia's proposal to host the Congress evolved into the book, Australian Healthcare Design 2000-2015, which was then published to coincide with the event. Alan Dilani, Founder and CEO of the International Academy for Design & Health, states in the book's preface, "Australia's successful bid to host the event reflects the huge amount of new healthcare building that is taking place across the region, and the body of research and knowledge that has developed there as a result...this book aims to communicate to the rest of the world that the region has some of the most advanced healthcare buildings of our time" (p. 12).This richly illustrated book appeals to visually-oriented designers, but offers valuable information for scholars and healthcare administrators as well. Many compelling contemporary international healthcare projects are featured in journals and books, but rarely do we get to see so many projects collected together focused on a specific geographic region, as is done in Australian Healthcare Design 2000-2015. The book serves as both a compendium and snapshot of the latest research, practice, and design in a large and diverse country. While Australia faces some unique challenges such as the vast distances between cities and the large number of rural community facilities, most issues are those facing every country and society: rising healthcare costs, patient and worker safety, an aging population, and rapidly advancing technology.The World Health Organization defines health as "... a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (1948). Most medical care, and healthcare design, in the second half of the twentieth century followed the "pathogenic" and "biomedical" model, in which mind and body were viewed as separate rather than inextricably linked, and diseases were addressed primarily with pharmaceutical drugs and/or surgery. Healthcare practice and design is now moving in the direction of care that does not just treat the sick after the fact, but instead uses a more holistic preventive care model, encouraging health and wellness in all aspects and through all stages of life. The term "salutogenesis," first coined by Aaron Antonovski in 1979, has begun to be adopted by members of the healthcare design community as an expression of this belief. This approach promotes health and well being-not just for buildings, but for all scales of design (cities, communities, landscapes). Salutogenic design and biophilic design are closely linked to concepts associated with evidence-based design.The book is organized into two sections: Essays and Projects. Following the Introduction, which includes a preface by Alan Dilani, and Forewords by the editor and the sponsors, are 15 essays by a mix of researchers and professionals, all of whom have practiced in Australia. …
Article
This article presents my response to the article by Brown, Sokal, and Friedman (2013), which critically examined Losada's conceptual and mathematical work (as presented in Losada, 1999; Losada & Heaphy, 2004; and Fredrickson & Losada; 2005) and concluded that mathematical claims for a critical tipping point positivity ratio are unfounded. In the present article, I draw recent empirical evidence together to support the continued value of computing and seeking to elevate positivity ratios. I also underscore the necessity of modeling nonlinear effects of positivity ratios and, more generally, the value of systems science approaches within affective science and positive psychology. Even when scrubbed of Losada's now-questioned mathematical modeling, ample evidence continues to support the conclusion that, within bounds, higher positivity ratios are predictive of flourishing mental health and other beneficial outcomes. (PsycINFO Database Record (c) 2013 APA, all rights reserved).