Careggi Hospital, Florence, Italy
I couldn't understand why an important hospital like Barnes Jewish Hospital in St. Louis would hang abstract art in its halls, waiting rooms, and patient rooms. I was confused by it, and so was my 85-year-old mother, who had been admitted for Non-Hodgkin's lymphoma. I had left my family in Florence, Italy, to assist with her almost three-month stay. After the first month, I decided to take action.

I gathered from my mother's home my enlarged photographs of nature, which I had given to her over the years. I placed them on the white walls and over the abstract art in her room. Immediately, we both felt more relaxed and comforted. The hospital staff and other patients also came to enjoy the photos. As it turned out, my photos were the last colorful images of beauty that my mother saw before passing away in the hospital.

In response to my experience, I created The Foundation for Photo/Art in Hospitals (, an American nonprofit organization. The Foundation's mission is to place large, framed photographs of nature and beautiful places from around the world in hospitals to give comfort and hope to patients and their families, visitors, and caregivers. In almost four years of activity, we have placed nearly 1,500 nature photos in more than 50 healthcare facilities on four continents (and almost 200 of those photos are now hanging in Barnes Jewish Hospital).

Presently, the Foundation is participating in an Italian research project titled “Beyond traditional treatment… Art as therapy,” promoted by the Italian Oncological Group of Clinical Research (Il Gruppo Oncologico Italiano di Ricerca Clinica [GOIRC]), and sponsored by Eli Lilly Italia. It is being coordinated by a Florentine research group, consisting of myself; Francesco Di Costanzo, MD, Director of the Oncology Department, Massimo Rosselli, MD, Director of Psycho-oncology, and Laura Bellotti and Roberta Perfetto, psychologists at Careggi Hospital in Florence; and Franco Pasti, Professor of Architecture at the University of Florence.

The purpose of this study—the first of its kind in Italy—is to appraise cancer patients' perceptions of the hospital environment before and after the placement of 30 nature photographs in their treatment area. The photos, donated by the Foundation for Photo/Art in Hospitals, are images of landscapes, Tuscan hillsides, marine life, tropical beaches, flowers, and animals. The supposition is that the viewing of nature photography can have a positive impact on patients.

The first phase of the research was the construction and validation of “The Test of Perception of the Hospital Environment,” created expressly for this research. The test is a 23-item questionnaire, with reference to five images of hospital rooms, with and without art displayed on the walls; six nature images; and six abstract images. To analyze the test's validity and reliability, the pilot questionnaire was administered to 120 patients at Careggi Hospital—60 experimental cancer patients and 60 internal medicine controls. The first exploratory phase, which took over a year to complete, has confirmed the initial supposition that naturalistic images can have a positive impact on patients.

The second phase of the research is currently underway. This consists of testing 600 cancer patients from five cancer centers throughout Italy—Ancona, La Spezia, Messina, Perugia, and Terni—while they are receiving treatment; half will be the control group. In addition to the newly constructed questionnaire, three other psychological tests will be administered: SF-36 (Health Survey Questionnaire), TCI-R (Temperament and Character Inventory), and HADS (Hospital Anxiety and Depression Scale).

An abstract of the research has been accepted for presentation at the IPOS 8th World Congress of Psycho-Oncology in Venice, Italy, October 18-21, 2006 and will be published in the Journal of Psycho-Oncology.

In Italy, there was once a relationship between hospital structures and visual arts occurring throughout the history of great hospital institutions of the Renaissance, such as Santa Maria Nuova in Florence, Santa Maria della Scala in Siena, the hospital of Ceppo in Pistoia, and San Carlo in Milan. Works of art have been placed mainly in the sacred spaces of the hospitals. Always there was a sense of collaboration between architects and artists, and the value of art as a cure was recognized implicitly.

Today, unfortunately, most Italian hospitals reflect a lack of attention to art. They tend to be cold, sterile, and impersonal. Hospital budgets do not include funding for art. In this context, our research has been very well received by the staff and patients of the five cancer centers.

When the Foundation was created four years ago, most of our photo projects were in the United States and Italy. Since then, there has been a great expansion to hospitals in other areas of the world, including Haiti, Malawi, Kenya, Poland, Japan, the Maldives, Switzerland, Brazil, and Canada. From my interactions with physicians, nurses, and administrators, I've found that although the physical structures and designs of the hospitals vary, the people are the same. The patients are seeking relief from their illnesses and the staff are seeking to provide such relief. It is my belief, which we are now attempting to document, that nature photography can contribute to that effort.

As the Chief Operating Officer of the Hospital Albert Schweitzer in Haiti said, “Whether it be the proud mothers of newborns, malnourished children, or patients of all ages recuperating from accidents or being treated for AIDS or tuberculosis, I know that viewing these photos cannot help but lift their spirits and give them a few moments away from their pain and suffering. If that is the case, then they will have been provided a good dose of ‘medicine’ that even the best-trained doctor would not be able to provide.” HD

Elaine Poggi, originally from Southern Illinois, moved to Florence, Italy, after college to pursue studies in classical piano. After giving concerts throughout the United States and Italy for several years, she married and began a family in Florence and took up nature photography.