Archive for the ‘Bibliography’ Category

Make it Pretty and They Will Come: The Role of Aesthetics in Patient Satisfaction

Thursday, July 8th, 2010
Woodwinds Health Campus

Garden bench at Woodwinds Health Campus, photo courtesy of Woodwinds Health Campus

Like most people, I’ve had my fair share of unpleasant experiences in doctors offices and hospitals. And looking back, I realize that many of my most worst memories had to do with the way the place looked. The one that took the cake was a doctor’s office in a windowless clinic with one potted plant in the waiting room. And that plant, a Poinsettia from Christmas-time (this was in February) was dead. Even if only on a subliminal level, we perceive that something is wrong with this picture: “If they can’t even take care of one houseplant, how the heck are they going to take care of me?” I have heard many people, when talking about the gardens in a hospital, clinic, or nursing home or other place of healing, express the opposite sentiment: “They take such good care of the gardens, and that reassures me that they will take good care of me, too.”

I’m reading an article from an old (2008) issue of Healthcare Environments Research & Design Journal (HERD), titled “Ambulatory Facility Design and Patients’ Perceptions of Healthcare Quality,” which completely reinforces what we all know in our hearts to be true: That places of healing work better when they look and feel like…places of healing. And I’m talking, of course, about a more holistic idea of healing than just “isolate, sterilize, and medicate.” Squeaky white linoleum floors that reflect buzzing fluorescent lights attached to low ceilings in long, windowless corridors is an old model that has been proven to be anything but good for our health.

So, let me just share a few nuggets from this article. First, its conclusion, as stated in the abstract: “This study is consistent with other studies that examined the relationship among the physical attractiveness of healthcare settings, patient satisfaction, and quality of care.” Patients reported better care, service, and staff and doctor interactions in the more attractive waiting rooms. The authors cite several other related studies about patient satisfaction: Leitner and colleagues (1998) found that “patients in hospital units where nurses felt that their work was meaningful were more satisfied with their hospital stay” and that “…patients on units where nurses felt more tired and more frequently expressed their intention to quit were less satisfied with their care.” Mallak, Lyth, Olsen, Ulshafer, and Sardone (2003) found that “…job satisfaction [among healthcare providers] and patient satisfaction were significantly and positively correlated with culture strength and ratings of the built environment.” They also cite interviews with patients and families about what they want. Douglas and Douglas (2004) “found that patients reported the need for personal space, a homey welcoming atmosphere, areas for visitors, access to external areas, and provision of facilities for recreation and leisure.” Gardens in places of healing can fulfill many of these criteria, and a well-designed garden should address all of them.

I once got an email from someone recommending that his local hospital’s healing gardens (Woodwinds Health Campus, pictured above) be added to the TLN’s list of exemplary gardens in healthcare facilities. The gardens made a strong positive impression on him, and influenced how he felt about the entire hospital. And it probably provided a great incentive for him to visit for regular check-ups rather than waiting for emergencies. Think about how much people’s health would improve if they adhered to the preventative care model!

The article mentioned above explores the role of the built environment in influencing patient (consumer) satisfaction. Another article, which I’ll blog about soon, discusses the role of the built environment in influencing patient health and safety. There are so many reasons for healthcare providers to focus not just on the medicines and the machines, but on the places that house what all that stuff is there for: The patients and their families. All of those places have outdoor space – be it a parking lot and drop-off area or a designed “healing garden,” and all of those outdoor spaces could and should be considered as part of the aesthetic package that influences patient satisfaction, health, and well-being.

Full citations:

Becker, Franklin, Bridget Sweeney, and Kelley Parsons (2008). “Ambulatory Facility Design and Patients’ Perceptions of Healthcare Quality.” Healthcare Environments Research & Design Journal (HERD), Vol. 1, No. 4, pp. 35-54.

Douglas, C. H., and M. R. Douglas (2004). “Patient-friendly Hospital Environments: Exploring the Patient’s Perspective.” Health Expectations, Vol. 7, No. 1, pp. 61-73.

Leiter, M. P., P. Harvey, and C. Frizzell (1998). “The Correspondence of Patient Satisfaction and Nurse Burnout,” Social Science Medicine, Vol. 47, No. 10, pp. 1611-1617.

Mallak, L. A., D. M. Lyth, S. D. Olsen, S. M. Ulshafer, and F. F. Sardone (2003). “Culture, the Built Environment and Healthcare Organizational Performance.” Managing Service Quality, Vol. 13, No. 1, pp. 27-38.

Top Ten Gift Books for Healing Garden Inspiration

Wednesday, December 16th, 2009



I realize I’m a little late getting to this, but here are some suggestions for people who are still looking for last-minute gifts (in addition to things from the TLN store, of course!).


If you’re a gardener like me and you live somewhere cold where gardening in winter isn’t much of an option, then one of your favorite pastimes is sitting by the fire, poring over gardening books and dreaming of spring. And if you’re a designer, what better way to get your clients excited about doing more than planting shrubs in front of their house’s foundation?

These are all books that I own and refer to again and again for inspiration when designing and consulting about healing gardens (including my own). There are more academic and educational books out there, one of which I recommended in the last blog post, and many more of which are listed on the TLN’s References page. We’re working on an “If You Only Read Five” page (still in development) that will list books in categories (inspiration, evidence-based design, horticultural therapy, specific populations, etc.), so stay tuned for that.

These ten books are sure to inspire you, or those receiving them as gifts, to create spaces that are truly nurturing to body and soul. And as a bonus, when you buy from any of the links on this post, you’ll be nurturing the Therapeutic Landscpaes Network, too. Through the Amazon Associates program, the TLN receives a percentage of each book sale. Of course, if you can find the books locally, all the better. But if you must order by mail, please shop through this post! Just click on the title to link to Amazon.com. So, here we go. My top ten books for healing garden inspiration:

Peaceful Gardens: transform your garden into a haven of calm and tranquillity by Stephanie Donaldson – A very sweet little book (it really is little, measuring 5.5 x 6.5″) with hundreds of beautiful photographs and great ideas. I like the mixture of garden styles in this book – everything from traditional cottage-type gardens to wild meadows to very modern, spare, contemplative spaces.

The Healing Garden: A Natural Haven for Body, Senses and Spirit by Sue Minter – This was one of my first “healing gardens” books. I really like Minter’s first chapter, “The Healing Arts: A marriage of botany and medicine” for its overview of the history of healing gardens and the therapeutic use of plants and nature. In general, her scope is broad, touching on a lot of aspects of healing gardens, from herbs and organic vegetables to Feng Shui and color theory. A delightful buffet for those who like a little bit of everything. There’s another book by Sue Minter called The Healing Garden: A Practical Guide for Physical & Emotional Well-Being. I’m not sure how it differs from the one above, and I’m sorry to say I don’t have it…yet.

The Healing Garden: Gardening for the Mind, Body and Soul by Gay Search – After a short overview, Search delves into more detail with herbs, both culinary and medicinal; flowers, especially as used for color and scent; water in the garden; and low-allergen gardens. She includes some good plant lists and suggestions for each category, and even a few garden plans.

The Healing Garden: Natural Healing for the Mind, Body and Soul by David Squire (I know, it’s confusing that three different books have the same main title. What are you gonna do.) – Squire, too, starts with a nice chapter that gives some historical perspective, including the Garden of Eden, Islamic gardens, monastery gardens, and tea gardens. His next chapter is something of a surprise: “Does Soil Have a Soul?” He’s got a good point here, which is that everything comes from the soil, so that had better be healthy first. I appreciate this, since nothing is more depressing – and less nurturing – than a garden that doesn’t thrive. After that, each chapter is devoted to one of the five senses: touch; scent; taste; sound; taste; and sight – color, patterns, shapes, and textures.

Sanctuary: Gardening for the Soul by Lauri Brunton and Erin Fournier – This book is all about nature and gardens as sanctuary, and how to find and create sanctuary in your life. I have to say, though I love all of my book-children equally, there’s something particularly inspiring about this one. Perhaps because it’s more than just a garden how-to book, or perhaps because the photos are just so darn scrumptious. As another indication that this is something special, here are the chapter titles: Peace; Change; Passion; Mystery; and Contemplation. It’s one of the few books, along with Derek Jarman’s Garden (below) that calls attention to and embraces death as a part of the garden’s cycle. There’s also a nice section on labyrinths at the end of the book.

A Child’s Garden: 60 Ideas to Make Any Garden Come Alive for Children by Molly Dannenmaier – Wonderful ideas for creating and embellishing spaces that nurture young people. A must-have if you’ve got kids or clients with kids. Or just for the kid in you.

Healing Gardens by Romy Rawlings – I’d say that “holistic gardening” is the main thrust of this book – that to create a garden that is healing for us, we must create a healthy garden. In other words, be good to the earth and she will reward you. After an overview of this concept, Rawlings focuses on the following topics: Feng Shui (a whole chapter, looking at the various schools); color therapy; herbalism, with both culinary and medicinal herbs; aromatherapy; and styles of gardens, including meditation and Zen.

Gardens for the Soul: Designing Outdoor Spaces Using Ancient Symbols, Healing Plants and Feng Shui by Pamela Woods – This book (not surprising, given the title) delves a little more into the spiritual. Woods, who is a dowser as well as an artist and landscape designer, begins with a chapter on garden energy. The next chapter focuses on ancient symbols like labyrinths, medicine wheels, mandalas, and spirals. Woods also talks about how using universal patterns can make us feel more connected to nature the earth.


by Peg Streep – This book, more than any of the others, is about creating sacred space and a place where you connect with your spirit, or soul, though nature. Streep touches on myriad different spiritual gardens, including Zen, Gaia, Celtic, and Biblical, and several different methods of connecting with nature including aromatherapy, Feng Shui, and labyrinths. For those who are more spiritual or even religious, this book more than the other ten will speak to you. But even if you’re not, it’s a good pithy read with lots of great pictures and quotes.


Derek Jarman’s Garden by Derek Jarman – It’s funny how many of the above-listed books refer to Derek Jarman’s garden and have at least one picture of it from this book. It’s one of my personal favorites, too. Not your garden-variety garden book, but truly beautiful, inspiring. and life-affirming.

Did I miss any? Leave a comment and let me know! Always looking for more great inspiration books to add to the list…and to my bookshelf!

‘Re-Creating Neighborhoods for Successful Aging’ – Excellent New Book

Monday, December 14th, 2009


This from a recent New York Times article:

“In two years, baby boomers will start to retire [if they haven’t been forced to already due to the recession!], and by 2030 the number of American’s elderly is expected to reach 72 million, more than double the number in 2000. Demographers expect the suburbs to age particularly quickly, as residents retire close to home, or as those who have already moved to the Sun Belt return to live near relatives as they grow frail.”*

Those are some pretty astonishing numbers. It’s what some people have referred to as “the baby-boomer tsunami,” and we as a culture need to start planning and designing now. Luckily, some people have been already.


Re-creating Neighborhoods for Successful Aging edited by Pauline S. Abbott, Nancy Carman, Jack Carman (who serves on the Therapeutic Landscapes Network’s Advisory Board), and Bob Scarfo, is a timely new book that addresses these issues and highlights interesting and creative solutions. Drawing from the fields of gerontology, health sciences, community planning, landscape architecture, and environmental design, the book provides an in-depth examination of current elder housing practices and strategies, alongside goals for the future.


Housing models, such as continuing care retirement communities (CCRCs), shared housing, and co-housing, are evaluated, and best practice recommendations are presented. Expert contributors also incisively explore interdisciplinary issues including

  • the causal relationship between health and the environment
  • challenges posed by America’s automobile-dependent suburban communities
  • elder-friendly design principles, including universal design and defensible space
  • restorative benefits of nature and green environments
  • assistive technology that can support older adults’ independence
  • retrofitting of naturally occurring retirement communities (NORCs)
The book closes with an inspiring look at opportunities for future collaboration of the health sciences and the planning and design professions for the realization of supportive, life-affirming communities that will result in healthy aging, active living, and continued social participation for older adults.

*”Suburbs See a Challenge as Residents Grow Old,”
New York Times ‘Metropolitan’ section, December 6, 2009, pp. 1 & 8.

Picture of Health – Great new book on healthcare art, with many references to nature

Wednesday, July 22nd, 2009

My friend and colleague Henry Domke recently sent me a hard copy of his new book, Picture of Health: Handbook for Healthcare Art. If you think that the subject of art for healthcare may not seem all that closely related to the subject of therapeutic landscapes, think again!

After serving his community in Missouri as a family physician for almost thirty years, Henry decided in 2007 to pursue his passion as a nature photographer full-time. You can see his beautiful images on his website, Henry Domke Fine Art, and if you’re a follower of this blog, you will see some familiar pictures. Henry has always been generous with allowing me to use his images since he believes in what we’re doing here at the TLN. He also has his own excellent blog, Healthcare Fine Art, in which he explores the connection between art and healthcare. The two years of blog entries form the basis of this very informative book; I’ve already referred to it several times, and I refer to the blog often.

Henry believes strongly in a few things. One is the power of nature, and nature imagery, to make people feel good and to to even help sick people feel better. Second is the importance of being a steward of nature: His parents started the Prairie Garden Trust, a 500-acre restoration project on their own land, in the 1970s, and Henry and his wife are dwellers and caretakers of the land and the Trust. Many photographs are taken on the Trusts’ grounds. And last but not least, Henry believes in making decisions that are based not just on intuition, but on facts. This is called Evidence-Based Design (EBD), in which researched and documented evidence about such things as patient outcomes, staff turnover, and hospital safety are used to inform design decisions such as the healthcare facility’s architecture, gardens, programming, and artwork. Many of Henry’s posts deal with this issue, and his blog (and now book) is one of the best resources for healthcare art. It’s also a pretty darn good resource for all designers, artists, and healthcare providers who are trying to introduce more nature into healthcare.

Here’s one quote that illustrates Henry’s motivation for his artwork and his writing:

“As a doctor, I’ve spent a lot of time in hospitals, and I know how stressful they can be. Even in the best of circumstances, such as having a baby, it can be a scary and anxious time. But when you’re experiencing something truly life-threatening, being in a clinical environment can make you feel even worse. What if, instead of that cold space, you could look at images that triggered thoughts of happy times in nature, scenes that transported you mentally to a better place?”

Landscape architects and designers agree with this statement 100%, and we work hard to get real gardens into the healthcare setting. If a picture can make someone feel better, imagine what an escape into a real garden can do! Henry discusses “real vs. represented” in at least two posts, Nature vs. Virtual, and Real Nature vs. Pictures of Nature, which are also published in the book.

I recently discovered another way that Healthcare Fine Art and Picture of Health can useful to landscape designers: Art in the garden. Many healing gardens integrate artwork – tiles, or sculptures, or murals – and it’s often up to the landscape architect/designer to figure out how the art, the hardscape, and the plant material will interact. Henry’s work serves as an excellent guide. Stay tuned for a blog posting on this very subject coming soon to a Therapeutic Landscapes Network Blog near you.

You can order a hard copy, or download a free pdf version, of the book from the Henry Domke Fine Art website.

"Can Pastoral Beauty Heal the Mind?" Therapeutic Landscapes in Psychiatric Hospitals

Saturday, July 4th, 2009

Image of Naumkeg Orchard courtesy Henry Domke Fine Art

Jane Roy Brown’s article, “Can Pastoral Beauty Heal the Mind” in this year’s Library of American Landscape History‘s annual journal, View, caught my eye last week. In two pithy pages (pp. 11-12), Brown provides an overview of the history of Northern State Hospital in Washington, a psychiatric hospital built at the turn of the twentieth century. The 227-acre hospital campus, as well as the adjacent 720-acre farm, were designed by John Charles Olmsted (yes, son of Frederick Law) and James Frederick Dawson of the Olmsted Brothers firm between 1910 and 1913.

The landscape architects designed several institutional landscapes, and Northern State Hospital was but one example of the ethos of the time in sanitoria and psychiatric institutions, when fresh air, proximity to and contact with nature, and gardening and farming were thought to be not only beneficial to the patient but in many cases a vital part of treatment. Brown says that “…the property is a rare intact example of an institutional landscape that reflected a Reform-era therapeutic approach to illness and disability, emphasizing the spiritual and moral benefits of nature,” (p. 12).

In researching the historic section of my chapter on psychiatric hospitals for Clare Cooper Marcus and Marni Barnes’ Healing Gardens: Therapeutic Benefits and Design Recommendations, I came across many such examples, and was intrigued by the cyclical nature of how people view, value, and utilize “nature.” Fortunately, we seem to be in another age where people see nature, and the environment (hello, green movement) as something worth working with and fighting for. I do worry sometimes that history will repeat itself and we’ll one day turn out backs on nature again, but I’m hoping that perhaps for once, history will not repeat itself, or if it does, it won’t be for a long, long time.

In addition to the chapter above, here are a few more good resources; some are already on the Therapeutic Landscapes Network‘s site (re-launch of new site coming soon!) and some will be added in the near future:

Barnhart, S., N. H. Perkins, and J. FitzSimons (1998). “Behavioural and Setting Preferences at a Psychiatric Hospital.” Landscape and Urban Planning, Vol. 42, Nos. 2-4, pp. 147-157.

Gerlach-Spriggs, Nancy, Richard Enoch Kaufmann and Sam Bass Warner, Jr. (1998). Restorative Gardens. See especially the chapter on Friends Hospital

Frangipani’s fascinating and beautifully illustrated Flickr post on the Oriental Gardens at Callan Park (or Rozelle Hospital, near Lilyfield, Australia – see this Wikipedia entry for more information).

Hickman, Clare (2006). “Therapeutic Gardens: An Overview of the History of Hospital Gardens in England from 1800.” Bristol University, UK. Paper Presented at the Forum UNESCO University and Heritage 10th International Seminar “Cultural Landscapes in the 21st Century.”

Kovary, Myra M. (1999). “Healing Landscapes: Design Guidelines for Mental Health Facilities.” Master of Landscape Architecture Thesis, Cornell University.
A similar version of Kovary’s thesis was published with the same title as Chapter 12 of Shoemaker, Candice A. (Ed.) (2002). Interaction by Design: Bringing People and Plants Together for Health and Well-Being. Ames, Iowa: Iowa State Press.
If you’d like an electronic copy of this thesis, contact the author: mmk29@cornell.edu.

Neuberger, Konrad R. “Horticultural Therapy in a Psychiatric Hospital: Picking the Fruit.” Note: I found this pdf on the web, and it’s Chapter 34 of ??? Need to do a little digging – no pun intended – to find out what it’s Ch. 34 of. If anyone knows, please help me out!

Regnier, Victor (2002). Design for Assisted Living: Guidelines for Housing the Physically and Mentally Ill. New York: John Wiley & Sons, Inc.

And as always, if you know of other good references or resources, please leave a comment.