Bluebells at Wayland Wood, Norfolk, UK. Photo by Nedra Westwater

Jacqueline Fiske Healing Garden, Jupiter Medical Center, Jupiter, FL. Photo courtesy of Studio Sprout

“So never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself.” – Florence Nightingale

Let’s hear it for nurses!

If anyone knew the value of fresh air and access to the outdoors, it was Florence Nightingale (1820-1910); her birthday is on May 12th, and National Nurses Week began on May 6th.

Therapeutic and restorative gardens in hospitals and other healthcare facilities are not just for patients and visitors. Staff can benefit just as much – and sometimes even more. The outdoors is a critical place of respite where people who deal with life-and-death situations can go, by themselves or with colleagues, to take a physical, mental, and/or emotional break. Whenever possible, healthcare facilities should provide separate garden spaces for staff. This separation of space for different users with different needs can be as important as the space itself. Even a view of the outdoors has been found to benefit staff, for example by reducing stress and improving alertness (which, of course, benefits the patients as well!). See for example, Debajyoti et. al.’s article – citation and abstract are  below. Nurses are also invaluable members of the Interdisciplinary Design Team, the team that makes decisions about the design and construction of new and existing spaces. They have the “on the ground” view and usually know the needs of patients, visitors, and other staff, as well as the programmatic and physical needs of the space being considered. For more on the IDT, see this recent TLN Blog post, “EDAC – Why it Matters.”

Please share your thoughts! For nurses and other hospital staff reading this, leave a comment and tell us what outdoor spaces at work mean to you, and how you use them.

Debajyoti Pati, Tom Harvey Jr., Paul Barach (2008). “Relationships Between Exterior Views and Nurse Stress: An Exploratory Examination.” Health Environments Research & Design Journal, Vol. 1, No. 2, pp. 27-38.
Exterior views of nature decreased stress and increased alertness in pediatric nurses.
Abstract:
Objective: Examine the relationships between acute stress and alertness of nurse, and duration and content of exterior views from nurse work areas. Background: Nursing is a stressful job, and the impacts of stress on performance are well documented. Nursing stress, however, has been typically addressed through operational interventions, although the ability of the physical environment to modulate stress in humans is well known. This study explores the outcomes of exposure to exterior views from nurse work areas.
Methods: A survey-based method was used to collect data on acute stress, chronic stress, and alertness of nurses before and after 12-hour shifts. Control measures included physical environment stressors (that is, lighting, noise, thermal, and ergonomic), organizational stressors, workload, and personal characteristics (that is, age, experience, and income). Data were collected from 32 nurses on 19 different units at two hospitals (part of Children’s Healthcare of Atlanta) in November 2006.
Results: Among the variables considered in the study view duration is the second most influential factor affecting alertness and acute stress. The association between view duration and alertness and stress is conditional on the exterior view content (that is, nature view, non-nature view). Of all the nurses whose alertness level remained the same or improved, almost 60% had exposure to exterior and nature view. In contrast, of all nurses whose alertness levels deteriorated, 67% were exposed to no view or to only non-nature view. Similarly, of all nurses whose acute stress condition remained the same or reduced, 64% had exposure to views (71% of that 64% were exposed to a nature view). Of nurses whose acute stress levels increased, 56% had no view or only a non-nature view.
Conclusions: Although long working hours, overtime, and sleep deprivation are problems in healthcare operations, the physical design of units is only now beginning to be considered seriously in evaluating patient outcomes.

Senior hikers cross near a waterfall. Photo by Amriphoto

We’re never too old to play!

Children are not the only ones who reap health benefits from being in nature. Adults of all ages, including the eldest among us, have much to gain by routinely accessing the outdoors in gardens, parks, urban trails, and other green spaces.

For the past four decades, the federal Administration on Aging has promoted May as “Older Americans Month” as a way to encourage communities to sponsor activities and celebrations that keep elders, 62 and older, engaged, active and involved in their lives. “Never Too Old to Play” is this May’s theme.

As we age, access to hospitable, navigable and social environments becomes more important to maintaining overall health – fitness, flexibility, strength and social support. Numerous studies conclude that regular exercise helps elders to prevent falls and fractures; reduce their risk of strokes, heart disease, and some cancers; and lessen cognitive decline.

Read more about the health of  older Americans by visiting the Administration on Aging’s Older Americans  web page.

We’re not usually in the habit of referring people to business websites, but Must Have Play is a company that focuses on play and playground for elders, and they have some good information on the why’s and how’s: www.musthaveplay.com. And here’s a guest blog post by Must Have Play’s founder, Michael Cohen, on the Aging in Place website: “Have you heard? A playground for elders!“

Head Start Preschool Play Yard, Seattle, WA. Photo by Filiz Satir

Community Built Association Conference: May 30-June 2, 2012

The Community Built Association (CBA) will hold its annual conference in Portland, OR, May 30 – June 2. The interdisciplinary gathering is open to all those interested in community engagement through the lenses of art, play, nature, and the built environment.  The conference features presentations and panel discussions related to play environments, gardens and green spaces, public art, and community-engaged architecture. The conference at Portland’s Tabor Space, 5441 S.E. Belmont Street will  include:

• Presentations and discussions from leaders in the field of community-based practice;

• Hands-on workshops that will engage participants’ creativity while they contribute something of lasting value to the local community;

• Tours of local “place-making” sites around Portland, where volunteers have shaped community spaces with their own hands over time; and

• Informal networking and sharing sessions with inspirational community builders from Portland and around the country.

Artists, architects, builders, organizers, gardeners, planners, and others are all welcome. To learn more and register for the conference, visit the CBA Web site: http://communitybuilt.org/conference/portland_2012.

It has been over 135 years since J. Sterling Morton founded Arbor Day. His simple idea of setting aside a special day for tree planting is now more important than ever. – Arbor Day Foundation

The New York Times just published a great opinion piece by Jim Robbins, titled “Why Trees Matter.” I never know which articles non-subscribers can access, so please accept my apologies if access is restricted. Below are some excerpts, just in case.

We have underestimated the importance of trees. They are not merely pleasant sources of shade but a potentially major answer to some of our most pressing environmental problems. We take them for granted, but they are a near miracle. In a bit of natural alchemy called photosynthesis, for example, trees turn one of the seemingly most insubstantial things of all — sunlight — into food for insects, wildlife and people, and use it to create shade, beauty and wood for fuel, furniture and homes.

This paragraph on “forest bathing” is particularly appropriate for our Network:

In Japan, researchers have long studied what they call “forest bathing.” A walk in the woods, they say, reduces the level of stress chemicals in the body and increases natural killer cells in the immune system, which fight tumors and viruses. Studies in inner cities show that anxiety, depression and even crime are lower in a landscaped environment.

Below are some past TLN Blog posts about the role of trees in restorative landscapes:

If you can plant one thing, plant a tree

Planting the healing garden: Trees, please!

Forget the chocolate, gimme a tree

Plant a tree: A truly “green” gift

See the Arbor Day Foundation’s website for more information and ideas about how to celebrate this day: www.arborday.org/arborday

Photo by Henry Domke, www.henrydomke.com

Two-Day Workshop Focuses on Horticultural Therapy for Elders

Planting Seeds for Culture Change is a workshop taking place in early May and late June in Grand Rapids, MI and Prescott, AZ, respectively (see below for dates).

The two-day training focuses on the use of horticultural therapy (HT) with elder populations from the “culture change” perspective.  In the hands-on workshop, attendees will gain skills to incorporate HT into care plans and learn strategies to enable elders’ full participation and gardening success. Instructor Pamela Catlin, has more than 30 years of experience providing  HT to elders. For more information regarding workshop content, registration deadlines and enrollment, visit www.htinstitute.org or call 303.388.0500. 

Locations and dates for Planting Seeds for Culture Change:

Friday and Saturday, May 4-5, 2012, 8 a.m. to 4 p.m.
Porter Hills Retirement Community
Grand Rapids, MI

Friday and Saturday, June 22-23, 2012, 8 a.m. to 4 p.m.
Margaret T. Morris Center
Prescott, AZ

Fee:  $290 (includes all materials and lunches)

Tulip fading. Stonecrop Gardens, Cold Spring, NY. Photo by Naomi Sachs

I posted this photo on the TLN Facebook page, with the following thought: “In nature, even the end can be beautiful. Perhaps because it’s not really the end? Perhaps that’s what gives people solace – a reminder that nothing ever really ends.”

Here are some responses:

It’s not the end. It’s not even the beginning of the end – but it might be the end of the beginning…

…and that spring will always be back next year.

Tulips have the most graceful way of passing on!

There is solace in knowing you can let go – that things don’t need to be held perfect – that it all keeps flowing.

What do you think? Please share with a comment!

The retention pond at Jupiter Medical Center in Jupiter, FL also serves as large water feature, viewable from the Cancer Treatment Center. Photo by Michiko Kurisu, courtesy of Studio Spout.

Happy Earth Day!

Human health cannot be treated separately from the natural environment.
- Hippocrates, 4th Century BCE

We at the Therapeutic Landscapes Network believe that the best landscapes for health are those that benefit people and the planet. In the most recent issue of Research Design Connections, an article by Naomi Sachs titled “Landscapes for Health: Therapeutic AND Sustainable Landscapes in the Healthcare Setting,” is featured in the Expert’s Corner.  If you subscribe to RDC, you can log in and read the full article on their website. This article will also become a chapter in a book on therapeutic landscapes by Naomi Sachs and Clare Cooper Marcus, to be published by Wiley in 2013.

Below are some excerpts from the article:

Complementary Approaches
Sustainable and therapeutic landscapes complement each other in myriad ways. Facilities have the opportunity to “feed two birds with one seed” by meshing the two design philosophies. Landscape architects are the architect’s and engineer’s best friend here, because they are trained to see the “big picture” as well as details that will best benefit the site and the people served. In many cases, one strategy comes first and the other follows.

Regardless of which comes first—therapeutic or sustainable—below are examples of how the two design strategies can work together and reinforce each other:

• Window views of designed gardens and surrounding nature also bring natural daylight into buildings (or to look at it the other way, providing access to natural light creates an opportunity to allow views of nature).
• Therapeutic gardens, landscaped grounds, and detention and retention ponds dovetail with stormwater management and other low-impact development (LID) practices.
• Green roofs reduce stormwater runoff and the heat island effect.
• Green facades help cool buildings and reduce the heat island effect.
• Trees help shade buildings and pavement, reducing need for AC and reducing the heat island effect.
• Gardens that are varied and support biodiversity encourage beneficial insects and wildlife.
• Using integrated pest management practices also encourages biodiversity and a healthy ecosystem.
• Using native and adaptive plants puts the “right plant, right place” model into practice, reducing the need for chemical fertilizers and pesticides.
• Native plants also provide a sense of place.
• Condensate from air conditioners, roof runoff, and grey water can be used to irrigate gardens.
• Growing or offering healthy food on-site encourages good nutrition, healthy eating, and sustainable farming practices (local, organic, non-GMO, hormone-free). Kaiser Permanente in California is one of several hospitals to offer onsite farmers’ markets for hospital visitors and staff as well as members of the community. At Changi General Hospital, in Simei, Singapore the roof is planted with cherry tomatoes (that yield an average of 440 lbs/year) and herbs for use in the kitchen. In addition to cooling the roof and providing the most local food possible, a composting program uses kitchen and landscaping waste as a natural fertilizer that helps to remediate previously damaged soil.

Potential conflicts, and possible resolutions
Whenever possible, we should strive to merge sustainable landscapes and therapeutic landscapes to create an environment for health that serves both people and planet. The ways in which they intersect and support each other far outweigh potential conflicts, but the conflicts are real, and therefore cannot be ignored. I believe very strongly that in those times when we must choose between one and the other, our #1 priority is to “do no harm” by choosing what supports the patients, visitors, and staff first. In healthcare, this is an ethical imperative. Conflicts and potential resolutions are discussed in the article. 

Where do we go from here?
This is an exciting time for designers and healthcare providers. Both the sustainability movement and the movement toward landscapes that support human health and well-being, emotionally and physiologically, are trickling down to healthcare, an industry that has been, ironically, slow to embrace what would seem to be in everyone’s best interest. For whatever reason, landscape architects who specialize in healthcare design and landscape architects who focus on sustainability have, until recently, stayed in their respective camps. Fortunately, people are realizing that the two usually complement and support each other, and the twain seem to finally be meeting. Next steps are to hone the business case, and to delve deeper into research about what types of landscapes best support people in stressful, harsh environments like hospitals, and to address possible conflicts between best practices for human health and best practices for environmental responsibility. I firmly believe that it can be done, and that we will be all the stronger, healthier, and smarter for trying.

As always, your thoughts and comments are welcome! Happy Earth Day.

Photo by Henry Domke, www.henrydomke.com

Portland Memory Garden Founders Day Weekend, June 2-3, 2012

In celebration of the Portland Memory Garden’s 10-year Anniversary, the Friends of the Portland Memory Garden will sponsor an educational panel discussion at Good Samaritan Hospital, Saturday, June 2 from 8:30 a.m. to 5:30 p.m.  Susan Rodiek, Associate Director of the Center for Health Systems & Design at Texas A&M University, will present the keynote address.

The Friends also plan a “garden” open house, June 3, noon to 3 p.m. The event will include guided tours, free nature crafts, music, and refreshments. The seminar and garden celebration are open to the public, though registration is required for the Saturday seminar. All seminar proceeds will go to support annual maintenance of the Portland  Memory Garden, located off S.E. Powell at 104^th Avenue in Ed Benedict Park.

The garden is designed to meet the special needs of those with memory disorders such as Alzheimer’s disease, and to provide respite for their caregivers. The garden is one of eight “memory gardens” in the U.S., and one of only two built on public land.

For more information contact Brian Bainnson at 503-256-8955 or visit www.portlandmemorygarden.org/PMG/Events.

Recruiting Garden Volunteers: If you’d like to get your hands dirty in the Memory Garden they have two teams that meet on the first and third Saturday of every month, 9:30-11:30 a.m. Contact Patty Cassidy (1st Saturday) 503-239-9174 and Julie Brown (3rd Saturday) 503-367-5188.