The Anatomy of a Healing Garden from The Journal of Healthcare Design 1998


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A collection of writings from the proceedings of the Tenth Symposium of the Health Care Design. My article focused on the Resident Orientated Support and Evaluation System (ROSES). A way of measuring the effectiveness of the horticultural therapy programming for seniors in a healthcare facility.

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The Anatomy of a Healing Garden from The Journal of Healthcare Design 1998

  2. 2. THE ANATO].4Y OF A HEALI NG GARDEN rated, but also that different parts of the body were PAUL CARL ALLISON treated by different specialists. Hospital architec- J'IARNI BARNES, J'|.L.A., LCSW ture became characterized by towers on a podium. JA]'|ES BURNETT, ASLA BARBARA CRISP The chapel was tucked away out of sight. ln the '1 960s, business moved into healthcare. The garden, if considered at all, became curb appeal or TOPHER DELANEY entry landscaping as cosmetics, DAI/ID IG]'|B ASLA, LF JEAN tfiVANAGH, ASLA DEBORAH LeFRANK CLARE COOPER ]'IARCUS, M.A., ]'lCP ROGER S. ULRICH, Ph.D. arcus: The earliest healers were shamans and priests who had links with other worlds and brought in the spirits of plants and animals to assist in healing. The earliest healing places were nearly always in nature - a healing spring, a sacred grove, a special rock or cave. The earliest hospitals in the Western world were attached to monasteries, where medicinal herbs and prayer were components of healing. The cloistered garden was an essential part of the healing environment. With the start of the scientific era, priests and healers separated. Hospitals became places of scientific treatment, although in the era of Florence Nightingale-inspired pavilion hospitals, some attention was still paid to the outdoors as a source of fresh air and sunlight. By the 20th century, medical technology began to dominate healthcare, except in the case of TB patients in sanitoria, where the outdoors was still seen as an important part of healing. By the '1 940s, the rise of specialists within medicine meant not only that the body and spirit sepa- Direct contact with the outdoors all but disappeared. Yet all is not lost. Studies are beginning to appear that indicate that access to nature is highly valued by patients and staff and that it can increase positive medical outcomes. ln certain healthcare facilities, the garden and nature are still present. This is true in the care of the dying in hospices, in the care of the mentally ill, and in the care of long-term patients, such as those with Alzheimer's disease and those in some Veterans Administration hospitals. Those precedents and the emerging interest in what is being called a "healing garden" bode well for the return of accessible nature in all medical facilities. The healing garden movement is intimately linked with an overall paradigm shift in society as we move from a mechanistic and technical world view to one that is more holistic, embracing spirit as well as science. The interest in healing gardens is one facet of health that looks at healing rather than treatment, and sees that healing as a combination of the body and mind. Healing gardens are part of a movement that also encompasses, among other things, the opening of clinics in Arizona and Washington State that combine allopathic and complementary medicine; and the enormous popularity of the work of medical doctors who embrace complementary practices, such as Andrew Weil and Deepak Chopra. The huge number of American people who spend a total of $15 billion a year on alternative medicine is further evidence that something is changing. Clearly, these people are not satisfied with what mainstream medicine has to offer. a 101
  3. 3. e an: scape that harnesses the powers of nature into a design of simplicity and order, thereby allowing a mair- focused environment for personal healing. The order of the Texarkana pine forest is found ishes ons imainI wel,There 'toxic expe- ld be f abii;e the ]s. lr- I patories nove- cape meni rtext. n the rique >le to ther- e the n ical vork. . into SUC- I the ; the SUC- ,ings nita>lop- oors nent bed te is ana, >vel- lural ious )are sing ril. arity ealrnd- lbv rnd- home of this celebration in October each year by the Sisters, staff members, and community. The amphitheater has over-scaled steps, which are designed at seat height and focus on the center throughout the site in the form of bosques and allees that enrich the quality of the built areas. The courtyard areas near the building are heavily developed water feature. lt can accommodate a large group for with special paving, seating, fountain f eatures, tuated with a water feature that adds sound and potscapes, and landscape planting. The courtyards are designed as break areas so that people can experience an outdoor environment more healthy than typical medical institutions. A path system further unifies the site, reaching from the buildings to the pond edge and throughout many of the natural preserve areas. The two-acre pond near the entry also functions as an irrigation reservoir. The edge detail was a site-adapt idea whereby we trenched a pond line and backfilled with concrete. The soil was clayey enough to work as a form and hold the concrete together. Upon curing, the pond side of the trench was excavated, leaving a four-inch pond wall intact. The natural soil color helped to stain the concrete, making it blend in with the natural landscape. The complement to the pond is a decomposed granite gravel path that winds through the woodlands, providing a porous walking path that does not damage the tree root systems. At the main entry to the hospital we worked very visual interest to the court. The edge of the garden of balance is designed with pear trees that provide shade and seasonal color for the benches that line the garden edge. Committing resources and time to the proper execution is critical to the success of the hospital garden. Gardens, unlike buildings, are living things and take on a life of their own. Strategies should be developed for proper implementation as well as long-range maintenance programs that support the original design concepts over time. Allison: The Oxford Dictionary describes evaluation as "assessment and appraisal." To help healing gardens reach their full potential, creative techniques for an evaluation process have been developed to provide information about materials, closely with architect Kirk Hamilton to keep the parking out of the way of the entry auto court. The centerpiece of this entry garden is a series of crushed gravel paths and a fountain that offers a cool place for people to enjoy. ln areas where we lost existing trees for the construction process, we created an allee of pear trees marching along the arcade, responding to the structural grid of the building Along this walk we notched stopping areas with teak benches for small groups to visit or wait under the canopy of the pear trees. The garden of balance for the hospital is located between the medical office buildings and the medical/surgical bed tower. lt is a large garden area with a raised earth court and an amphitheater court as centerpieces for the space. The amphitheater represents the carving out of earth, while the raised earth is built with the carved earth, which completes the balance one strives for when recovering from an illness. The raised earth offers a seat wall surround that provides a place to look outward to the other garden areas. The earth berm is intersected with a black granite wall that extends to the edge of the seat wall. The wall is a sundial marker that marks the date of the Sisters' arrival on the Texas coast from lreland some 130 years ago. This garden is the special events (poetry reading, musical performance, or hospital gathering). The center is punc- methods, and the functionality of design. While evaluation is also done at predesign, design, and postconstruction phases, I have developed ROSES, the Resident Orientated Support and Evaluation System, as a postoccupancy evaluation for therapeutic gardens to help me assess the horticultural therapy program for seniors living at The Lodge at Broadmead, a long-term care facility in Victoria, British Columbia, Canada. Some of the outcome measures I look for are a decrease in depression, a reduction in aggression toward other residents or staff members, a decrease in medication requirements, as well as a measure of people's overall well-being. ROSES is a way of bringing all this data together in one system. Part of this system is the gardening profile. I visit with each resident about a week after he or she first comes to the facility, approaching each person with a basket of flowers, perhaps from the garden that is nearest to his or her room. We talk about the kinds of things the resident likes in the garden and I ask questions such as, "Did you ever have a garden before? Was it small or large? Did you grow up on a farm? Did you have an orchard? What gardens or parks did you visit?" Paying attention to detail helps in developing an element in the garden that could be important to the therapeutic goals, like a piece of sculpture created by a resident. The resident's gardening profile can enhance the development of therapeutic gardens. For example, an elderly woman told me, "l've always had THE ANATOMY OF A HEALING GARDEN .(} 111
  4. 4. 9 r+ n -^ Y.-r- ens.lre :.- -, '-'- : -' ? -^='aC:-: C gafdenS Marcus: Rcge | .-,,'c' arc others have ceria taught us a lot about tne therapeutic value of natu': But there is still much that we need to know, such as what kinds of nature and what forms work best. D: people with different kinds of disease and physica problems want different kinds of gardens? We knor', -. Sa'::-, ss-es ancj aiiergies are also inrportant : - - s l:'a: o.s in the residents' gardening prof iles, ,', z^: :3 maKe sure that the gardens are cus.= ?.cessicle, which rneans that the garden can be - rlc's as well as out. Perhaps this means having : a-:s in the roorns or having a view. Frail residents ^ -s: ce able to open the doors to the garden, There s^o;rd be raised beds and containers that residents ra^ reach, Paths should be wide enough for two .', ^eeichairs to go side by side without clanking into =ac^ other. Fvaiuation can be done in a number of different ,', a)is including the following: o Ocservatron is crucial, with documentation by ther- aoists and residents in a garden journal. that the information gathered soecific and usable. The information can come 's 'rorn question boxes, mailed-out questionnaires, and educational workshops, and can be input into a computer to create databases. Anecdotal information gives clues to the value of :ne garden to the staff and residents and can be used for fund-raising or promotion. Fhotography and vrdeo production can provide a nistorical record of changes in the gardens. , Surveys can ensure . , Evaluations should include input from residents, friends, and volunteers, as the garden affects all of them. The assessments can be used to staff , family, improve the garden's therapeutic quality, to enhance safety and security, for administrative accountability, to provide marketing material, and to establish a historical context. The gardens at The Lodge at Broadmead are a symbol of the quality of care the community gives the elderly residents. The gardens are well loved by the residents and bring contentment and joy to many people. A comprehensive multidisciplinary evaluation looking at resources, resident strengths, service needs, and coordinated care plans can help to focus . Bl( - quite a lot now about design for people wit' Alzheimer's, both interior design and garden desigr^ We know something about hospice garden desigr, What about psychiatric problems and the garden? What do children want when stressed or ill? Whar kind of healing garden will be most therapeutic for people on dialysis or undergoing chemotherapy? How do different culture groups respond to a healing garden? We certainly need more postoccupancy evaluations, We are beginning to see gardens called healing gardens But how do we know if they are healing? We cannot assume just because a designer says they are healing, or the client expects them to be healing, that they really are. But on the other hand, how do we test for healing? I don't think we will be able to test for spiritual upliftment or a sense of hope Finally, how do we encourage hospital administrators to understand that the garden is important and indeed necessary? lf staff members are the prime users of the garden, we need to look at absenteeism, health problems, and staff turnover before and after the addition of a garden. We need to be telling hospital CEOs that having gardens affects whether or not staff members take a job. lt may certainly affect their health The garden can be as important, or more so, for staff members than for patients in certain medical facilities such as acute care hospitals where the patients are in and out so fast that they barely know there is a garden there. Finally, we need lots more stories, as well as more data. Tell people about the presentations at this Symposium. Use research and patient satisfaction findings to convince them that a garden is development ciation and th an active mer the American has been invc out Can ada t lnstitute of At Clare Coope Health Desig Therapeutic really important cutting-edg impact their develops pt ing with toJ Fortune 10[ 112 r ' JOURNAL OF HEALTHCARE DESIGN, VOL X