The 6,800 square-foot-garden was built on an underutilized second-floor roof space located just outside the cardiovascular ICU and near the family birthing center, facing the hospital\u2019s interior courtyard. The garden, adjacent to a long hallway offering clear garden views even in inclement weather, includes benches, chairs, and tables (some movable to a variety of configurations); user-friendly pathways; a children\u2019s playhouse; and a water feature. But more than half of the space is devoted to a profusion of greenery planted around the four seasons.<\/p>\n
Work on the garden was completed in 2014 with a $558,000 grant from a program of the TKF Foundation (Annapolis, Md.), which guides communities in the creation of public green spaces. The grant supported both the garden\u2019s construction\u2014including some structural reinforcement of the terrace\u2014and the medical research, led by co-principal investigator Roger Ulrich, a pioneer of evidence-based design in healthcare and since-retired visiting professor in the department of architecture and Center for Healthcare Building Research at Chalmers University of Technology (Gothenburg, Sweden).<\/p>\n
The goal was to measure and document clinical outcomes from nature access in the garden for three distinct populations: family visitors whose loved ones were having extended stays in the ICU; critical care nurses, who may be prone to job stress and burnout; and expectant mothers in the birthing center and their partners. But the researchers faced significant methodologic challenges. For example, both the nurses and the expectant mothers resisted participation in randomized controlled trials because that meant they could be assigned to the non-garden-access control group. Sufficient sample size was another challenge.<\/p>\n
\u201cWe had a lot of discussions (about research methods), from pretty rigorous measures like the level of cortisol in saliva down to observational studies,\u201d says Makayla Cordoza, a nurse and now a postdoctoral fellow in the department of psychiatry at the University of Pennsylvania Perelman School of Medicine (Philadelphia). Cordoza joined the research team as a representative of clinical practice nursing and brought her interest in health and burnout of working nurses.<\/p>\n
Because the Legacy researchers could not do randomized controlled trials, considered the gold standard of medical research, the team adopted self-reported qualitative studies using validated measures on voluntary subjects asked to fill out questionnaires and observational studies by researchers watching from a distance how the gardens were being used.<\/p>\n
Studies were conducted between 2011 and 2019 and the results have started to appear in medical journals. For example, one finding from the research was that access to an unlocked garden with abundant nature located close to the ICU significantly mitigated the stress experienced by family visitors<\/a>, which has been compared to post-traumatic stress disorder. Critical care nurses who took daily work breaks in the gardens had reduced rates of sadness, anger and fatigue<\/a>. And full-term, low-risk expectant mothers at the hospital\u2019s birthing center\u2014and their partners who utilized the garden during the hospital stay\u2014found the garden beneficial and increased their satisfaction with their care.<\/a><\/p>\n \u201cThe research confirmed what we already knew anecdotally\u2014that the garden space is beneficial to all\u2014staff, patients, and visitors who spend time there,\u201d says Bridget Martin, a nurse leader in the neurotrauma ICU at Legacy Emanuel and a member of the research team. \u201cInterestingly, it didn\u2019t require spending a lot of time in the garden to gain its benefit. Just passing through the garden for a few minutes can decrease stress levels.\u201d<\/p>\n A fourth study, in review for publication, used behavioral mapping techniques to observe what people were actually doing in the garden, including meditating, looking at plants, eating, talking, or just sitting. Whether these different activities might affect the restorative benefits of the garden is a target for future research, Cordoza says.<\/p>\n
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Larry Beresford is a freelance medical journalist based in Oakland, Calif. He can be reached at larryberesford@hotmail.com.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"