The nature of hospitals

In 1984, Roger Ulrich’s “surgery recovery and view out the hospital window study” set a worldwide standard for research on the health benefits of nature.

Since then, Dr. Ulrich has been a key driver of the still limited body of scientific research on how exposure to gardens and nature in health care settings — like here at Legacy Health, where Dr. Ulrich has consulted for the past fifteen years — can reduce patient pain and stress while improving other outcomes.

This early research is part of why interdisciplinary teams at Legacy’s six hospitals have created eleven therapeutic gardens to serve our patients, families and employees year-round, 24-7.

Now, in his recent Lancet Neurology study “Gardens that take care of us,” Ulrich and fellow researchers state the need for more rigorous study on how gardens provide measurable benefits in patients with specific medical conditions.

We’re ready to break that new ground.

Thanks to a $560,000 grant from the TKF Foundation's Nature Sacred Initiative, we’re launching three new research studies centered on our Terrace Garden, located outside Legacy Emanuel's family birth center and cardiovascular intensive care units. All studies (read more below!) are managed by Legacy Research Institute and scheduled for completion by October 2014.

“We know in our hearts that these gardens are really important,” said Lori Morgan, M.D., Legacy Emanuel’s Chief Administrative Officer, at our recent garden dedication. “Now we have the funding to prove how they help.”

Birthing study (already underway)

This study focuses on 100 low-risk pregnant women recruited from obstetricians and nurse midwives practices based at Legacy Emanuel. Patients randomized to the garden will use a birthing study log for data purposes. Physiological data will be collected on all subjects, as well as subjective data collected via questionnaires.

Families and stress study (scheduled to begin shortly)

Dr. Ulrich's studies have shown that stress, in addition to afflicting patients, is also a burden for both patient families (especially those of acutely ill patients such as those in intensive care units (ICU)) and nurses and other healthcare professionals.

At Emanuel, families of cardiovascular ICU patients will be recruited to take part in a study that observes and measures the effects of time spent in the garden on their emotional state during their family member’s stay in the ICU.

Nurses and green time study (scheduled to begin shortly)

Evidence suggests that access to gardens can reduce stress in health care workers, increase job satisfaction, and may help foster personnel recruitment and retention.

In 1995, post-occupancy studies of hospital gardens concluded that many health care employees used gardens to achieve a restorative break from negative work conditions. In 2008, researchers found that nurses with daily exposure to a nature window view in their work areas had lower stress and reported higher alertness than nurses with no window overlooking nature.

Nurses working in the ICU and Family Birth Center will be invited to participate in the nurse study. RNs will spend time each work shift in the garden and complete a nursing study log each day.

So, why again do our studies break new ground?

Despite the growing research on health care gardens, knowledge gaps and methodological shortcomings remain. Rather than rely on real nature exposure, most investigations to date have used simulations such as video or pictures. And the few studies that used real gardens lacked well-controlled randomized study methodologies.

Additionally, no prior research has examined the effects of gardens or nature on any of Legacy Health's study groups: women in maternity units and their infants; families of long-stay patients in intensive care units; or nurses from Labor & Delivery and Critical Care during 12-hour work shifts.

Because our studies will bring an unparalleled level of scientific rigor to this work, we anticipate that the results will, in the words of Dr. Ulrich, “send a signal to readers of medical reports to take this seriously” and “bring with it a more credible case for nature and sacred spaces.”

Watch for the announcement of the research results in October 2015.