Children's Hospitals Take Healing Outside

As healthcare continues to be a polarizing national topic and obesity remains a growing epidemic, there is an increasing emphasis on employing preventive measures to attack the problem that is America’s collectively expanding waistline. And while obesity rates across the board are disconcerting, the most dismaying aspect is the increasing percentage of obese children, who are establishing a solid foundation for heart disease, diabetes, and a host of other maladies later on in life.

At the root of this pediatric healthcare problem is the lost connection between children and nature. For many reasons, children today fail to spend enough time outdoors in natural environments, which is an ideal setting for childhood development, social interaction, and recreation.

Fortunately, there are entities, like the Natural Learning Initiative (NLI), a research and design assistance program within North Carolina State University’s College of Design, that are making great strides to reverse the trend and bring nature back into children’s daily lives. NLI promotes the importance of the natural environment in the daily experience of all children through environmental design, action research, education, and  dissemination of information.

NLI has overseen a number of projects related to natural play, including 60 demonstration sites for its Preventing Obesity by Design (POD) program, as well as the development of an ongoing project launched in 2009, known as the Nature Play and Learning Area Guidelines project.

Robin Moore, a North Carolina State professor of landscape architecture and director of the Natural Learning Initiative, explains that while the majority of his team’s research has been focused on child development facilities like schools and daycare centers, there is great value, from a therapeutic perspective, in providing natural environments for children in the context of healthcare institutions.

“We talk about the child’s need for release from the stress of indoors, where medical procedures impinge on the child in highly structured environments,” Moore says, adding, “Walls confine the patient the whole time. Outside in the garden, conditions are reversed. The child gains a sense of freedom and stress is relieved.”

This contrast in experience between indoors and outside reflects what researchers Rachel and Stephen Kaplan have termed “directed attention” versus “voluntary attention.” For patients inside hospital rooms, the focus is on what’s being done to them; however, when outside, patients are free to let their minds and bodies wander.

“There’s a clear argument, supported by evidence, that we all should be spending more time outdoors, especially children,” Moore says. “But how? At NLI we say environments have to be compelling. Our design response focuses on natural diversity and the intrinsic interest that nature provides for a child, creating settings that offer something different every day. A hospital healing garden can become a type of special friend for a sick child and provide a positive relationship very different than that of a hospital ward. For the sick child meeting with a sibling or friend, nature provides a vehicle for close social contact. There’s always something new to observe and talk about.”

Appreciating the view
Kathy Harper, RN, MBA, EDAC, is the director of clinical planning at Parkland Hospital, a facility founded in 1894 that serves as Dallas County’s public hospital. She has a unique perspective from working for years on the clinical side of healthcare before moving to the institutional side, first with Children’s Medical Center of Dallas and now Parkland.

“When I was working in a clinical setting, land was there to be built on and not for anything else,” Harper says. “As long as the patient had a view of sunlight, it was great. That was pretty much the extent of it. Now, nature is an active part in the healing care of the patient; rather than just looking out the window, you go into nature.”