Health Sciences - Medicinal Gardens / Deborah Franklin

It turns out that ornamental gardens in hospitals have medical benefits

To get a faint idea of ​​what a carefully planned hospital garden can mean to a sick child, watch the home video uploaded to YouTube in August 2011, showing Aidan Schwalbe, a three-year-old toddler who received a heart transplant, curiously exploring the winding paths of the garden. The sunlight-dappled grass and the thick roots of a wide-view tree in the Prouti Gardens at Children's Hospital in Boston (http://youtu.be/gea7au2CL9Y). "He loves being out in the garden and feeding the birds and the squirrels," Aiden's grandmother wrote on her blog in August. "They'll literally fatten us up by the time we get out of here!"

The garden that Aidan loves so much, with its green vegetation, its shady corners, where you can sit or walk, and the small animal sculptures that are hidden in it and intrigue children as well as adults, is "one of the most successful hospital gardens in the United States," says Claire Cooper Markus, professor emeritus of landscape architecture at the University of Berkeley in California.

Gardens, which were neglected and considered a secondary factor in medical treatment for most of the 20th century, are coming back into vogue, and are part of the construction plans of most new hospitals today, according to the American Society of Landscape Architects. In a recent survey of 100 managers and architects of nursing homes, 82% of them agree that "the design of the exterior spaces should be a factor of utmost importance in the planning phase." But can the genes encourage healing? It turns out that most of the time it is. Scientists around the world are currently sifting through their data to find out which of the gene's properties are responsible for this beneficial effect.

Logic in the test

The notion that a fresh breeze, sunshine and the scent of vegetation may help us fight disease comes to us from ancient traditions and common sense. But in an article published by the environmental psychologist Roger Ulrich (now at the University of Texas AM) in the journal Science in 1984, and which has been widely cited since then, he proved for the first time that looking at the garden may speed up the rate of recovery from surgery, infections and other illnesses. In his research, he adhered to the standards of modern medical research, meaning experiments with strict control and quantifiable medical results.

Ulrich and his team went through the medical files of patients recovering from gallbladder surgery at a hospital in suburban Pennsylvania. Although all other data were the same, patients who slept in beds next to a window facing green trees recovered on average a day sooner, needed far fewer painkillers, and suffered fewer complications after surgery compared to patients whose window faced a brick wall.

Esther Sternberg, a physician and neuroimmunologist at the American Institute of Mental Health says that Ulrich's work was a "breakthrough." At the time, studies were just beginning to be published showing that noise, non-continuous sleep and other chronic stressors could lead to serious medical consequences. "In 1984 we all thought it was obvious that hospitals were confusing, noisy and smelly mazes," says Sternberg, who reviews this history in her book "Healing Spaces: Science of Place and Good Feeling". "But it didn't occur to us that stress could harm the patients' recovery, or that we could prevent it."

Fortunately, while more and more evidence has emerged that hospitals are a source of stress, so has evidence that gardens and planted corners are helpful for recovery. Three to five minutes of looking at the scenery of a garden with lots of trees, flowers or water is enough to reduce anger, anxiety and pain, and to give a feeling of calmness. This figure emerges from several studies conducted among healthy people, in which physiological changes in blood pressure, muscle tension or the electrical activity of the heart or brain were measured.

Indeed, the benefits of staying in or observing nature are so evident that even pictures of nature may be helpful. In 1993 Ulrich and his colleagues at the University Hospital of Uppsala in Sweden admitted 160 heart patients randomly to one of six conditions: a simulated "window view" of a large natural picture (an open stream with trees on its banks, or a shady forest), one of two abstract paintings, a white board or A wall without decorations. Subsequent surveys proved that patients who lay next to the picture of water and trees suffered less anxiety and needed less strong painkillers than those who viewed the dark forest picture, the abstract art or the wall without a picture.

"Let's be clear," explains Marcus. "The relationship with nature in a properly planned garden will not cure you of cancer or a severe burn. But there is evidence that it can reduce the pain and tension you will feel, thereby strengthening the immune system in a way that will allow your body to heal, in combination with other treatments."

Grow insights

But studies show that not all genes are equally effective. In 1995, Cooper Marcus and landscape architect Marnie Burns received a grant from the "Center for Medical Planning" association to study the physical layout and day-to-day use of several hospital gardens in Northern California. After 2,140 visits to write detailed lists and interviews with the visitors to the gardens and 32 hours of observation, the researchers noticed some patterns that returned and emerged even in later studies and in other places.

In the findings: visitors to the gardens mostly visited them to relax and recover from mental and emotional exhaustion. The most popular landscapes were landscapes that had fountains or other bodies of water surrounded by trees, as well as healthy, multi-layered vegetation, including mature trees and flowers. These results are consistent with Ulrich's findings regarding the healing power of landscape images, as well as with theories of evolutionary biologists, according to which humans prefer landscapes similar to the savannah where humanity evolved. Throughout human history, trees and water have signified an oasis, and flowering vegetation has hinted at a source of food. Open landscapes provided sufficient warning from predators, and shady corners served as safe shelter.

The higher the ratio between the vegetation and the hard surfaces, the better. "We found that a ratio of 7 to 3 works best," says Cooper Marcus. When there is only little vegetation, it resembles a shopping center and the garden is not very relaxing.

The activities offered by the garden are just as important as the view. The results that emerge from "behavioral maps" that follow the actions of visitors to the garden, point to the need for areas for private conversations, smooth paths decorated with trees that invite the visitor to walk along them but do not interfere with the movement of wheelchairs and infusion poles, light furniture that can be dragged into the shade or sun, as well as a natural landscape who invites animals and birds to shelter him.

One of the findings that surprised Cooper Marcus and Barnes was that about half of the visitors to the hospital garden are hospital employees themselves, who are also under the same pressure as their patients. From the interviews it emerged that the staff members also depend on the vegetation. "I feel like a mole," a worker from the radiology department in the basement of the hospital in Berkeley, California, told the researchers. According to her, she comes to sit among the trees of the garden on the roof of the hospital every day, to relax and reflect. "It's a huge mental and emotional help."

It seems that members of different generations value the same factors in kindergarten, but the study revealed differences here as well. In 2005, psychologist Sandra A. Sherman and her colleagues conducted a study in three kindergartens at a center for the treatment of children with cancer in San Diego to try and understand what was working and what wasn't. Some of the findings made sense on an intuitive level. For example, a mosaic turtle sculpture that small children can climb on would be more appealing than a crane sculpture that children can only watch. But there were also more surprising results. A river-like facility where parents and children can wade and boat together was twice as popular with children as a child-sized dollhouse, which parents cannot enter.

On the other end of the age scale, Susan Roddick of the University of Texas AM studied 68 randomly sampled long-term care facilities. In her research published in 2009, she spoke with 1,100 tenants and 430 employees. "Older people," she reported, "need the space outside and the vegetation and benefit from it just as much as the young."

But the adults need other facilities. Menopausal people tend to seek peace and quiet in the park, while older people tend to seek interest. In one of the new nursing homes studied by Roddick, the architect created a beautiful, sheltered lawn with a small lake behind the apartment building. But the researcher noticed that every day at about the same time, the elderly residents dragged their chairs to the front of the building, to feel like they belonged to the pedestrian community that passed in front of the building. "There is a limit to how much you can observe the lake," Roddick says. "And the grass isn't very entertaining either."

In search of a standard

To make sure that the spaces outside will promote the recovery of the patients as much as possible, Roddick created a list, based on her findings, according to which directors of nursing homes and other institutions can evaluate the design of the garden in their institution. She is also working on a list that would be specific to hospitals, so that agencies that fund hospitals could set a standard for it.

An orderly standard is needed today because therapeutic genes are becoming more and more popular. "New hospitals today compete with each other through the existence of a therapeutic garden," says Cooper Marcus. "But when they come to check the garden, many times it's nothing more than a couch and a few pots on the roof." According to her, planning a good garden in a medical institution "is not as complicated as nuclear physics." But if the planning is based on scientific findings and not on whims, this strengthens the therapeutic value of the garden.

_______________________________________________________________________________________________________________________________________________

on the notebook

Deborah Franklin (Franklin) lives in San Francisco and reports on science and medicine for NPR radio, the New York Times, and Fortune and Health Magazine

What makes the healing garden?

The following list, based on scientific research, shows what should be observed:

Let it be green

Green landscapes arranged in layers, with shade trees, flowers and bushes of different heights should make up about 70% of the area. paths and squares only about 30%.

Be realistic

Abstract sculptures do not soothe sick and anxious people.

Let it be interesting

Mature trees that attract birds, as well as chairs that can be moved to allow conversation in privacy, encourage more interaction.

engage several senses

Gardens where you can see, smell, hear and touch are the most relaxing. But strongly scented flowers and other odors that disturb chemotherapy patients should be avoided.

Pay attention to the paths

Wide, winding and dark paths, to avoid glare, allow patients with vision problems or those in wheelchairs to get closer to nature. The flooring seams must be narrower than 3 mm so that patients carrying infusion poles do not trip.

Water carefully

Sprinklers and drippers that sound like a leaky faucet, a helicopter or a urinal are not soothing, as is the strong smell of algae.

Easy entry

The garden should be close and not closed behind heavy doors that the sick and elderly cannot open.