Green space in hospital built environment. A literature review about therapeutic gardens in acute care healthcare settings before Covid-19.

Green space in hospital built environment. A literature review about therapeutic gardens in acute care healthcare settings before Covid-19.

Authors

  • Andrea Brambilla a:1:{s:5:"en_US";s:39:"Politecnico di Milano, Dipartimento ABC";}
  • Matilde Del Pio School of Architecture Urban planning and Construction Engineeringg (AUIC), Politecnico di Milano
  • Roberto Ravegnani Morosini Department of Architecture and Urban Studies (DASTU), Politecnico di Milano, Italy
  • Stefano Capolongo Design&Health Lab. Department of Architecture, Built Environment and Construction Engineering (DABC) Politecnico di Milano

Keywords:

healing garden, hospital building, therapeutic green space, evidence based design, literature review

Abstract

 

Background and aim

Hospital facilities are one of the most stressful environments and there is evidence that during Covid-19 having outdoor and green spaces helped medical staff and nurses to decrease the stress and anxiety level. Nevertheless, knowledge about the type of green space is limited. The aim of the study is to systematize the existing scientific literature on the topic in a specific time period.

 

 

Methods

Scopus, Pubmed, and Cochrane library databases have been explored in a systematic way. Following the Prysma diagram 25 studies have been included. Descriptive statistics and content analysis have been performed to highlight green typologies, users and functional area involved, spatial focus, relationship between users and space and vegetation typology. The different topics have been clustered according to Kellert’s biophilic framework.

 

 

Results

Articles reviewed included studies from the 2000 to 2020. The selection led to the analysis of 25 documents; it was significant to understand the major areas of application (pediatrics, ma-ternity, oncology, hospitalization, etc) and forms of green (images, furniture, healing gardens, vegetable gardens, etc).

 

Conclusions

The present review highlight the main characteristics of green space in hospital built environment with specific focus on pre-pandemic situation.

 

 

References

Muhamad Robat R, Mohd Fauzi MF, Mat Saruan NA, Mohd Yusoff H, Harith AA. Why so stressed? A comparative study on stressors and stress between hospital and non-hospital nurses. BMC Nurs. 2021;20(1): 2. doi: 10.1186/s12912-020-00511-0.

Tanja-Dijkstra K, Andrade CC. Healthcare Settings. In: Environmental Psychology and Human Well-Being. Elsevier; 2018. p. 313–334. doi: 10.1016/B978-0-12-811481-0.00012-3.

Connellan K, Gaardboe M, Riggs D, Due C, -Reinschmidt A, Mustillo L. Stressed Spaces: Mental Health and Architecture. HERD. 2013;6(4): 127–168. doi: 10.1177/193758671300600408.

Dendaas N. Environmental Congruence and Work-Related Stress in Acute Care Hospital Medical/Surgical Units: A Descriptive, Correlational Study. HERD. 2011;5(1): 23–42. doi: 10.1177/193758671100500103.

Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med. 1997;44(7): 1017–1022. doi: 10.1016/S0277-9536(96)00227-4.

Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702): 1714–1721. doi: 10.1016/S0140-6736(09)61424-0.

Williams ES, Skinner AC. Outcomes of Physician Job Satisfaction: A Narrative Review, Implications, and Directions for Future Research: Health Care Management Review. 2003;28(2): 119–139. doi: 10.1097/00004010-200304000-00004.

Wilson-Barnett J. Stress in Hospital Patients. In: Bittles AH, Parsons PA (eds.) Stress. London: Palgrave Macmillan UK; 1996. p. 152–158. doi: 10.1007/978-1-349-14163-0_9.

Aguglia A, Amerio A, Costanza A, et al. Hopelessness and Post-Traumatic Stress Symptoms among Healthcare Workers during the COVID-19 Pandemic: Any Role for Mediating Variables? Int J Environ Res Public Health. 2021;18(12): 6579. doi: 10.3390/ijerph18126579.

Andrade CC, Devlin AS, Pereira CR, Lima ML. Do the hospital rooms make a difference for patients’ stress? A multilevel analysis of the role of perceived control, positive distraction, and social support. J Environ Psychol 2017;53: 63–72. doi: 10.1016/j.jenvp.2017.06.008.

Pati D, Harvey TE, Barach P. Relationships between Exterior Views and Nurse Stress: An Exploratory Examination. HERD. 2008;1(2): 27–38. doi: 10.1177/193758670800100204.

Spano G, D’Este M, Giannico V, et al. Association between indoor-outdoor green features and psychological health during the COVID-19 lockdown in Italy: A cross-sectional nationwide study. Urban For Urban Greening. 2021;62: 127156. doi: 10.1016/j.ufug.2021.127156.

Kellert SR, Heerwagen J, Mador M, [eds.]. Biophilic design: the theory, science, and practice of bringing buildings to life. Hoboken, N.J: Wiley; 2008.

Kellert SR, Wilson EO. The Biophilia Hypothesis. Bulletin of Science, Technology & Society. 1995;15(1): 52–53. doi: 10.1177/027046769501500125.

Appleton J. The experience of landscape. Nachdr. d. Ausg. von 1975. Chichester: Wiley; 1978.

Kaplan S. The restorative benefits of nature: Toward an integrative framework. J. Environ. Psychol. 1995;15(15): 169–182. doi: 10.1016/0272-4944(95)90001-2

Marcus CC, Barnes M, [eds.]. Healing gardens: therapeutic benefits and design recommendations. New York Chichester: Wiley; 1999.

Nightingale F. Notes on hospitals. London: Longman, Roberts, and Green; 1863.

Ulrich R. View through a window may influence recovery from surgery. Science. 1984;224(4647): 420–421. doi: 10.1126/science.6143402.

Ulrich RS, Zimring C, Zhu X, et al. A Review of the Research Literature on Evidence-Based Healthcare Design. HERD. 2008;1(3): 61–125. doi: 10.1177/193758670800100306.

Ulrich RS. Visual landscapes and psychological well-being. Landscape Research. 1979;4(1): 17–23. doi: 10.1080/01426397908705892.

Kaplan R, Kaplan S. The experience of nature: a psychological perspective. Cambridge: Cambridge Univ. Pr; 1989.

Chawla L. Benefits of Nature Contact for Children. Journal of Planning Literature. 2015;30(4): 433–452. doi: 10.1177/0885412215595441.

Ward Thompson C. Linking landscape and health: The recurring theme. Landscape and Urban Planning. 2011;99(3–4): 187–195. doi: 10.1016/j.landurbplan.2010.10.006.

Ward Thompson C, Roe J, Aspinall P, Mitchell R, Clow A, Miller D. More green space is linked to less stress in deprived communities: Evidence from salivary cortisol patterns. Landscape and Urban Planning. 2012;105(3): 221–229. doi: 10.1016/j.landurbplan.2011.12.015.

Buffoli M, Rebecchi A, Gola M, Favotto A, Procopio GP, Capolongo S. Green SOAP. A Calculation Model for Improving Outdoor Air Quality in Urban Contexts and Evaluating the Benefits to the Population’s Health Status. In: Mondini G, Fattinnanzi E, Oppio A, Bottero M, Stanghellini S (eds.) Integrated Evaluation for the Management of Contemporary Cities. Cham: Springer International Publishing; 2018. p. 453–467. doi: 10.1007/978-3-319-78271-3_36.

Gianfredi V, Buffoli M, Rebecchi A, et al. Association between Urban Greenspace and Health: A Systematic Review of Literature. Int J Environ Res Public Health. 2021;18(10): 5137. doi: 10.3390/ijerph18105137.

D’Alessandro D, Buffoli M, Capasso L, et al. Green areas and public health: improving wellbeing and physical activity in the urban context. Epidemiol Prev. 2015;39(4 Suppl 1): 8–13. PMID: 26499409

Capolongo S, Rebecchi A, Buffoli M, et al. COVID-19 and Cities: from Urban Health strategies to the pandemic challenge. A Decalogue of Public Health opportunities. Acta Biomed. 2020;91(2): 13–22. doi: 10.23750/abm.v91i2.9615.

Kondo M, Fluehr J, McKeon T, Branas C. Urban Green Space and Its Impact on Human Health. Int J Environ Res Public Health. 2018;15(3): 445. doi: 10.3390/ijerph15030445.

Mygind L, Kjeldsted E, Hartmeyer R, et al. Effects of Public Green Space on Acute Psychophysiological Stress Response: A Systematic Review and Meta-Analysis of the Experimental and Quasi-Experimental Evidence. Environment and Behavior. 2021;53(2): 184–226. doi: 10.1177/0013916519873376.

Ward Thompson C. Activity, exercise and the planning and design of outdoor spaces. Journal of Environmental Psychology. 2013;34: 79–96. doi: 10.1016/j.jenvp.2013.01.003.

Wendelboe-Nelson C, Kelly S, Kennedy M, Cherrie J. A Scoping Review Mapping Research on Green Space and Associated Mental Health Benefits. Int J Environ Res Public Health. 2019;16(12): 2081. doi: 10.3390/ijerph16122081.

Gascon M, Triguero-Mas M, Martínez D, et al. Mental health benefits of long-term exposure to residential green and blue spaces: a systematic review. Int J Environ Res Public Health. 2015;12(4): 4354–4379. doi: 10.3390/ijerph120404354.

Zagnoli F, Filippini T, Jimenez MP, Wise LA, Hatch EE, Vinceti M. Is Greenness Associated with Dementia? A Systematic Review and Dose-Response Meta-analysis. Curr Environ Health Rep. 2022;9(4): 574–590. doi: 10.1007/s40572-022-00365-5.

Cooper Marcus C. Therapeutic Landscapes. In: Environmental Psychology and Human Well-Being. Elsevier; 2018. p. 387–413. doi: 10.1016/B978-0-12-811481-0.00015-9.

Winterbottom D, Wagenfeld A. Therapeutic gardens: design for healing spaces. First edition. Portland, Oregon London: Timber Press; 2015.

Ulrich RS. Effects of gardens on health outcomes: Theory and research. In: Marcus CC, Barnes M (eds.) Healing Gardens: Therapeutic Benefits and Design Recommendations. New York: Wiley; 1999.

Brambilla A, Maino R, Mangili S, Capolongo S. Built Environment and Alzheimer. Quality Evaluation of Territorial Structures for Patients with Dementia. In: Bevilacqua C, Calabrò F, Della Spina L (eds.) New Metropolitan Perspectives. Cham: Springer International Publishing; 2020. p. 178–186. doi: 10.1007/978-3-030-52869-0_15.

Marsh P, Courtney-Pratt H, Campbell M. The landscape of dementia inclusivity. Health Place. 2018;52: 174–179. doi: 10.1016/j.healthplace.2018.05.013.

Uwajeh PC, Iyendo TO, Polay M. Therapeutic gardens as a design approach for optimising the healing environment of patients with Alzheimer’s disease and other dementias: A narrative review. Explore(NY). 2019;15(5): 352–362. doi: 10.1016/j.explore.2019.05.002.

Mangili S, Capolongo S. Healthcare Facilities and Dementia Development of a Framework to Assess Design Quality. In: Garofolo I, Bencini G, Arenghi A (eds.) Studies in Health Technology and Informatics. IOS Press; 2022. doi: 10.3233/SHTI220856.

Mangili S, Brambilla A, Capolongo S. Long-term care Facilities and Dementia. Development of a framework to assess design quality in healthcare structures for people with dementia. Alzheimer’s & Dementia. 2022;18(S8). doi: 10.1002/alz.065844.

Gola M, Botta M, D’Aniello AL, Capolongo S. Influence of Nature at the Time of the Pandemic: An Experience-Based Survey at the Time of SARS-CoV-2 to Demonstrate How Even a Short Break in Nature Can Reduce Stress for Healthcare Staff. HERD. 2021;14(2): 49–65. doi: 10.1177/1937586721991113.

Iqbal SA. COVID-19 and the Need for More Accessible and Designed Hospital Outdoor Spaces in Developing Countries. HERD. 2021;14(2): 368–372. doi: 10.1177/1937586721993767.

Iqbal SA, Abubakar IR. Hospital Outdoor Spaces as Respite Areas for Healthcare Staff During the COVID-19 Pandemic. HERD. 2022;15(4): 343–353. doi: 10.1177/19375867221111530.

Brambilla A, Morganti A, Lindahl G, Riva A, Capolongo S. Complex Projects Assessment. The Impact of Built Environment on Healthcare Staff Wellbeing. In: Gervasi O, Murgante B, Misra S, Garau C, Blečić I, Taniar D, et al. (eds.) Computational Science and Its Applications – ICCSA 2020. Cham: Springer International Publishing; 2020. p. 345–354. doi: 10.1007/978-3-030-58814-4_24.

Yang Y, Ro E, Lee TJ, Aet al. The Multi-Sites Trial on the Effects of Therapeutic Gardening on Mental Health and Well-Being. Int J Environ Res Public Health. 2022;19(13): 8046. doi: 10.3390/ijerph19138046.

Sachs N. Access to Nature Has Always Been Important; With COVID-19, It Is Essential. HERD. 2020;13(4): 242–244. doi: 10.1177/1937586720949792.

Capolongo S, Brambilla A, Girardi A, Signorelli C. Validation Checklist for Massive Vaccination Centers. Ann Ig. 2021; doi: 10.7416/ai.2021.2460.

Gola M, Brambilla A, Barach P, Signorelli C, Capolongo S. Educational Challenges in Healthcare Design: Training Multidisciplinary Professionals for Future Hospitals and Healthcare. Ann Ig. 2020;32(5): 549–566. doi: 10.7416/ai.2020.2375.

Mead M, Ibrahim AM. Strategies to evaluate the quality of hospital design with clinical data. J Hosp Med. 2022; jhm.12987. doi: 10.1002/jhm.12987.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6(7): e1000097. doi: 10.1371/journal.pmed.1000097.

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; n71. doi: 10.1136/bmj.n71.

Beukeboom CJ, Langeveld D, Tanja-Dijkstra K. Stress-Reducing Effects of Real and Artificial Nature in a Hospital Waiting Room. J Altern Complement Med. 2012;18(4): 329–333. doi: 10.1089/acm.2011.0488.

Park SH, Mattson RH. Effects of Flowering and Foliage Plants in Hospital Rooms on Patients Recovering from Abdominal Surgery. HortTechnology. 2008;18(4): 563–568. doi: 10.21273/HORTTECH.18.4.563.

Pearson M, Gaines K, Pati D, Colwell M, Motheral L, Adams NG. The Physiological Impact of Window Murals on Pediatric Patients. HERD. 2019;12(2): 116–129. doi: 10.1177/1937586718800483.

Gonzalez MT, Hartig T, Patil GG, Martinsen EW, Kirkevold M. A Prospective Study of Existential Issues in Therapeutic Horticulture for Clinical Depression. Issues Ment Health Nurs. 2011;32(1): 73–81. doi: 10.3109/01612840.2010.528168.

Raanaas RK, Patil GG, Hartig T. Health benefits of a view of nature through the window: a quasi-experimental study of patients in a residential rehabilitation center. Clin Rehabil. 2012;26(1): 21–32. doi: 10.1177/0269215511412800.

Davis BE. Rooftop Hospital Gardens for Physical Therapy: A Post-Occupancy Evaluation. HERD: Health Environments Research & Design Journal. 2011;4(3): 14–43. doi: 10.1177/193758671100400303.

Gonzalez MT, Hartig T, Patil GG, Martinsen EW, -Kirkevold M. Therapeutic horticulture in clinical depression: a prospective study of active components: Therapeutic horticulture in clinical depression. J Adv Nurs. 2010; no-no. doi: 10.1111/j.1365-2648.2010.05383.x.

Lohr VI, Pearson-Mims CH. Physical Discomfort May Be Reduced in the Presence of Interior Plants. Hort Technology. 2000;10(1): 53–58. doi: 10.21273/HORTTECH.10.1.53.

Vincent E, Battisto D, Grimes L, McCubbin J. The Effects of Nature Images on Pain in a Simulated Hospital Patient Room. HERD. 2010;3(3): 42–55. doi: 10.1177/193758671000300306.

Trau D, Keenan KA, Goforth M, Large V. Nature Contacts: Employee Wellness in Healthcare. HERD. 2016;9(3): 47–62. doi: 10.1177/1937586715613585.

Aburas R, Pati D, Casanova R, Adams NG. The Influence of Nature Stimulus in Enhancing the Birth Experience. HERD. 2017;10(2): 81–100. doi: 10.1177/1937586716665581.

Ali Khan M, Amin N, Khan A, et al. Plant Therapy: a Nonpharmacological and Noninvasive Treatment Approach Medically Beneficial to the Wellbeing of Hospital Patients. Gesunde Pflanzen. 2016;68(4): 191–200. doi: 10.1007/s10343-016-0377-1.

Reeve A, Nieberler-Walker K, Desha C. Healing gardens in children’s hospitals: Reflections on benefits, preferences and design from visitors’ books. Urban Forestry & Urban Greening. 2017;26: 48–56. doi: 10.1016/j.ufug.2017.05.013.

Tinner M, Crovella P, Rosenbaum PF. Perceived Importance of Wellness Features at a Cancer Center: Patient and Staff Perspectives. HERD. 2018;11(3): 80–93. doi: 10.1177/1937586718758446.

Paraskevopoulou AT, Kamperi E, Demiris N, et al. The impact of seasonal colour change in planting on patients with psychotic disorders using biosensors. Urban Forestry & Urban Greening. 2018;36: 50–56. doi: 10.1016/j.ufug.2018.09.006.

Adrian L. Post-occupancy Evaluation. In: Roaf S (ed.) Benchmarking Sustainable Building Performance. RIBA Publications; 2003. https://www.usablebuildings.co.uk/UsableBuildings/Unprotected/AdrianLeamanPost-OccupancyEvaluation.pdf [Accessed 29th March 2023]

Brambilla A, Capolongo S. Healthy and Sustainable Hospital Evaluation—A Review of POE Tools for Hospital Assessment in an Evidence-Based Design Framework. Buildings. 2019;9(4): 76. doi: 10.3390/buildings9040076.

Cooper BA, Ahrentzen S, Hasselkus BR. Post-occupancy evaluation: an environment-behaviour technique for assessing the built environment. Can J Occup Ther. Revue Canadienne D’ergotherapie. 1991;58(4): 181–188. doi: 10.1177/000841749105800406.

Paraskevopoulou AT, Kamperi E. Design of hospital healing gardens linked to pre- or post-occupancy research findings. Frontiers of Architectural Research. 2018;7(3): 395–414. doi: 10.1016/j.foar.2018.05.004.

Naderi JR, Shin WH. Humane Design for Hospital Landscapes: A Case Study in Landscape Architecture of a Healing Garden for Nurses. HERD. 2008;2(1): 82–119. doi: 10.1177/193758670800200112.

Cooper Marcus C, Valente R. Healing gardens: design processes and realizations of beneficial environments. TECHNE - Journal of Technology for Architecture and Environment. 2015; 180-190 Pages. doi: 10.13128/TECHNE-16120.

Guglielmetti Mugion R, Menicucci E. Understanding the benefits of horticultural therapy on paediatric patient’s well-being during hospitalisation. The TQM Journal. 2021;33(4): 856–881. doi: 10.1108/TQM-04-2020-0078.

Blaschke S, O’Callaghan CC, Schofield P. Cancer Patients’ Recommendations for Nature-Based Design and Engagement in Oncology Contexts: Qualitative Research. HERD. 2018;11(2): 45–55. doi: 10.1177/1937586717737813.

Khan MA, Amin N ul, Ahmad I, et al. Therapeutic Horticulture: Influencing Psychological Responses Of Surgical Patients And Their Environmental Assessment Scale. Pakistan Journal of Agricultural Sciences. 2016;53(02): 355–363.doi: 10.21162/PAKJAS/16.2431.

Allah Yar M, Kazemi F. The role of dish gardens on the physical and neuropsychological improvement of hospitalized children. Urban Forestry & Urban Greening. 2020;53: 126713. doi: 10.1016/j.ufug.2020.126713.

Whitehouse S, Varni JW, Seid M, et al. Evaluating a children’s hospital garden environment: Utilization and consumer satisfaction. Journal of Environmental Psychology. 2001;21(3): 301–314. doi: 10.1006/jevp.2001.0224.

Wang CH, Kuo NW, Anthony K. Impact of window views on recovery—an example of post-cesarean section women. Int J Qual Health Care. 2019;31(10): 798–803. doi: 10.1093/intqhc/mzz046.

Feng H, Hewage KN. Economic Benefits and Costs of Green Roofs. In: Nature Based Strategies for Urban and Building Sustainability. Elsevier; 2018. p. 307–318. doi: 10.1016/B978-0-12-812150-4.00028-8.

Oh JW. Pollen Allergy in a Changing Planetary Environment. Allergy Asthma Immunol Res. 2022;14(2): 168. doi: 10.4168/aair.2022.14.2.168.

Wilson EO. Biophilia: the human bond with other species. Cambridge, Mass.: Harvard Univ. Press; 1984.

Rebecchi A, Brambilla A, Botta M, Casino A, Basta S, Capolongo S. Therapeutic Architecture. Assessment Tools and Design Strategies for Healing Gardens Implementation. In: Capolongo S, Botta M, Rebecchi A (eds.) Therapeutic Landscape Design. Cham: Springer International Publishing; 2023. p. 47–56. doi: 10.1007/978-3-031-09439-2_5.

Gonzalez MT, Kirkevold M. Benefits of sensory garden and horticultural activities in dementia care: a modified scoping review. J Clin Nurs. 2014;23(19–20): 2698–2715. doi: 10.1111/jocn.12388.

Ishii M, Iwasaki Y. A Study of User Behaviors in a Green Space at a General Hospital for Acutely Ill Patients in Downtown Tokyo. Jpn J Appl IT Healthc. 2010. doi: 10.11204/ithc.4.102.

Shaabani Y, Vafaee Najar A, Shafiee MN, Meraji M, Hooshmand E. Designing a green hospital model: Iranian hospital. Int J Healthc Manag. 2020;13(sup1): 427–433. doi: 10.1080/20479700.2019.1572265.

Nieuwenhuijsen M, Khreis H. Green space is important for health. Lancet. 2017;389(10070): 700. doi: 10.1016/S0140-6736(17)30340-9.

Downloads

Additional Files

Published

30-08-2023

How to Cite

1.
Brambilla A, Del Pio M, Ravegnani Morosini R, Capolongo S. Green space in hospital built environment. A literature review about therapeutic gardens in acute care healthcare settings before Covid-19. Acta Biomed [Internet]. 2023 Aug. 30 [cited 2024 Jul. 17];94(S3):e2023137. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/14286