Designing Outdoor Spaces To Fit Specific Patient Populations

April 1, 2014
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Comfortable, moveable furniture allows people to choose where to sit, what to look at, and whether to be in the sun or the shade at Don Allen Memorial Garden at Sharp Mesa Vista Hospital in San Diego, designed by Schmidt Design Group. Photo: Naomi Sachs. A meditation garden at Banner Gateway Medical Center in Gilbert, Ariz., designed by PDSA and Steve Martino, offers staff an outdoor space to unwind, as even short periods of time in nature can reduce stress. Photo: Clare Cooper Marcus. A view of nature, as seen at the Hulda B. and Maurice L. Rothschild Enabling Garden at Levy Senior Center in Evanston, Ill., designed by Garth Wemmer, Ted Wolff, and Joanne Westphall, can provide a restorative experience for those inside. Photo: Naomi Sachs. “This is the first place I’ve worked where I felt like I'm outside in a garden all the time,” commented a nurse at Smilow Cancer Hospital at Yale-New Haven Hospital in New Haven, Conn., designed by Towers Golde. Photo: Naomi Sachs.  An attractive garden that offers a variety of places to walk and sit encourages patients to exercise and spend time outdoors at The Graham Garden at Saanich Community Hospital in Victoria, British Columbia, Canada, designed by Deborah Lefrank and Associates. Photo: Clare Cooper Marcus. A garden at memory care facility Serenades by Sonata in Longwood, Fla., designed by Baker Barrios, is easily accessible from several different segments of the campus. Photo: Clare Cooper Marcus. The lush planting and meandering pathway at Santa Rosa Memorial Hospital in Santa Rosa, Calif., invite staff and visitors to explore the healing garden. Photo: Clare Cooper Marcus.
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It’s been 30 years since the publication of Roger Ulrich’s seminal article “View Through the Window May Influence Recovery from Surgery,” which kick-started the incorporation of access to nature as an essential component of the healing environment. Much has happened in these three decades. Gardens are now less likely to be seen as cosmetic extras and eliminated through value-engineering.

Award-winning projects in Healthcare Design magazine and elsewhere frequently feature “healing gardens” and/or views to nature. The Chicago Botanic Garden offers a certification course on healthcare garden design, and the American Society of Landscape Architects’ annual conference includes sessions on healthcare design research and practice, as well as field trips to local exemplary sites. And a growing number of researchers are studying the effects of contact with nature on human health and well-being.

Useful and practical guidelines, many based on empirical research and best practices from the industry as a whole, can help designers make educated decisions with their healthcare clients. So much is now known about the needs of patients, staff, and visitors in outdoor healthcare spaces that it’s incumbent upon decision makers to focus attention on who, exactly, is likely to use that space.

While landscape designers must follow general design guidelines for all healthcare garden users, specific populations often need specific design considerations. Below, we outline design practices that are important for all populations, as well as those that address the needs of three specific patient types: the frail elderly, people with Alzheimer’s and other forms of dementia, and people with mental and behavioral health disorders.

Acute care hospitals
In acute care hospitals, the patient population is incredibly varied, including people who may also be treated at more specialized facilities. Thus, design must accommodate a wide range of users, with the needs of the most vulnerable patients coming first. Patients using the garden could include a person awaiting minor surgery; someone recovering from a hip replacement who is urged to walk and seeks smooth pathways with frequent places to stop and rest; a person who has received outpatient chemotherapy and needs to recuperate—in the shade—before driving home; or a sick child being wheeled through a garden as respite from frightening medical procedures.

Overarching considerations for gardens in all healthcare facilities include safety, security, and privacy, visual and physical accessibility to and within the garden, physical and emotional comfort, and proper maintenance. It should go without saying that gardens must feel like gardens, with a high ratio of greenery to hardscape and a great variety of vegetation appealing to all the senses. Other important design elements include plenty of choices as to where to walk, sit, or look at a view; places to sit with a family group, and places to be alone; ample shade for those who need to stay out of the sun; and walking paths of varying lengths. All of these requirements also apply to visitors and staff using the garden, the latter often being the largest group present. Unless the designer takes into account these pragmatic needs, and avoids the temptation to push the envelope with flashy design statements, the garden may fail to meet the needs of those it could help most.

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