Horticulture for healing

Tim Howell of Mitie Landscapes discusses the health and well-being benefits of interior and exterior landscaping for healthcare facilities

Traditionally, interior planting or garden design for hospitals has been mostly decorative. However, there has been a growing awareness of the positive effect that plants and gardens have on patients.

Healthcare facilities, like hospitals, care homes and clinics are utilising access to greenery as part of their patient after-care strategy, whether its interior planting or accessible gardens.  The research shows that greens are good for you, even when you’re not eating them.

A room with a view

In 1984, Professor Roger S. Ulrich conducted ground-breaking studies in the United States that showed how window views of gardens and vegetation from hospital rooms had a healthy impact on the resident patients. Ulrich’s evidence-based design studies have been much quoted sources of research in the relationship between healing and green environments.  They showed that hospital patients recovering from major operations had fewer negative post-operative effects if they were able to have an outside view of greenery instead of buildings, through their window. [1]

Furthermore, patients with access to such ‘green’ views were discharged from hospital sooner. While in hospital they required fewer and less aggressive painkillers and were not as dependent on nursing staff attention.

Subsequently in 2012, case studies carried out by the Forestry Commission in Scotland cemented these views in their design guide ‘Green Space Design for Health and Wellbeing’. The guide illustrates the beneficial healing and therapeutic effects of interior and exterior green spaces from the perspective of patients, clinicians, healthcare employees and visitors. Through their testimonials, the case for greener spaces is strengthened and shows that contact with nature in planted form, whether physical or visual has the following positive effects on patients and visitors:

• Reduction of patients’ blood pressure, muscle tension, pulse rate, and a subtle effect on their experience of pain.
• Patients and families who use hospital gardens have reported positive mood changes and reduction in stress. Visual settings dominated by ‘nature’ reduce stress and improve patient performance – especially where stress is accompanied by feelings of anxiety.
• Stress reduction, which helps the immune system to function better, facilitating the healing process.

A breath of fresh air

In addition to his studies on a room with a green view, Professor Ulrich found that just being able to see a plant in a hospital room has been proven to improve recovery, lessen pain and boost emotional well-being of patients. There really is something positive to be said about the healing effects of giving a beautiful bunch of flowers or plant to a patient in hospital, providing there’s no restriction on having plants in the room. Plants may be prohibited in intensive care units or high dependency units (HDUs).

However, we know that trees and plants are the lungs of the planet, therefore, on a smaller scale, plants have the same function in a contained space. Internal air quality is often lower than external air quality because of the restriction of fresh air exchange. Furthermore, Volatile Organic Compounds (VOCs) emitting from paints, furniture and equipment can have a negative impact on our health.  This means that spending the vast majority of the time inside means inhaling mould, carbon monoxide, nitrogen dioxide, formaldehyde, dust mites, chemicals and even pesticides. This even applies in hospitals.

Opening the windows to ventilate the space helps, when possible. However, in winter, when you need to keep the windows closed and VOCs accumulate in intensity, the air exchange rate is greatly reduced and people don’t benefit so much from fresh air as they would in warmer months.

The good news is that plants have the ability to act like filters, feeding off these toxic substances and producing oxygen as a by-product that helps to purify our internal environment.  According to research by NASA (their report “Indoor Landscape Plants for Indoor Pollution Abatement”), certain plants can remove up to 77% of VOCs every 24 hours. In modern air-tight or climate controlled buildings, VOCs are likely to be trapped inside.  NASA discovered that plants purify that trapped air by pulling contaminants into the soil, where the micro-organisms around the roots convert VOCs into food for the plant.

Some plants are more effective when it comes to removal of these chemical compounds. Depending on the hospital room or space, planting could be tailored to help improve air quality needs.

Feel good factor

It’s not just on physical well-being where plants make an impact, but psychologically too. Ulrich found that having plants in work spaces can improve the psychological well-being of healthcare employees specifically.

Healthcare employees work in highly stressful conditions, making critical decisions in daily emergency situations. Being in a work environment that helps to decrease those stress levels and improve positivity in the face of tremendous work challenges can transform mental wellness while on the job.

In his 1995 paper, Health Benefits of Gardens, Professor Ulrich cites that stressed hospital employees visited hospital gardens just as much as stressed patients. Through interviews with the staff, it was confirmed that they depend on the positive influence of green spaces as much as recovering patients.

Interactive gardens and green spaces are now considered a vital part of patient aftercare. Being able to walk or sit in a garden while recovering provides a gentle means of exercise as well as help to reduce anxiety. At Mitie, we have helped to design gardens specifically aimed at providing a peaceful and stress free outdoor environment for long and short term patients. One such example is the garden at Mountwood Care Home in Andover, specially designed for use by its residents who suffer from dementia.  The garden is a safe and peaceful space with a figure-of-eight, fluid layout without any abrupt walls, dead-ends or disruptions that might cause agitation in dementia sufferers.

We also deliver a more unique service across the Southern Health NHS Foundation Trust estate.  This involves the maintenance of special, therapeutic gardening areas at each hospital that patients and visitors can design and cultivate using plants and, or garden ornaments donated by friends and relatives. Mitie are required to treat these special garden areas with the same care as the rest of the common green areas across the Trust’s estate.

Over two decades, several studies have been carried out to illustrate the positive relationship between good health and horticulture.  The findings have inspired hospital designers and administrators to make significant changes to improve the patient and visitor experience.  Newer healthcare facilities that include well planted interiors and user-friendly gardens, have been shown to accelerate patient recovery, reduce staff burnout symptoms and increase staff morale.  This makes the case for the benefits of working with nature rather than leaving it out of the equation.

[1] ‘View through a window my influence recovery from surgery’. 27 April 1984. R. Ulrich.

Published in Healthcare Design Management – September 2016