In our blog, we share insight from leaders in our communities who are advancing what it means to have sacred, open green spaces in our cities. This month we take a moment to examine the real, lived experience of an open, sacred green space.
This week we talked with Teresia Hazen, MEd, HTR, GMHP, Coordinator of the Therapeutic Garden Program at Legacy Health in Portland, OR. Hazen is one of our Nature Sacred National Award team members, a leader in her field, and someone who deeply experiences the healing power of nature in her everyday life.
Nature Sacred: In the past decade, there have been many online articles about Legacy’s Gardens and your esteemed career history. The interviews and features over the past few years typically focus on the gardens themselves or the science of health and nature access. Although the science and history of the therapeutic gardens is central to our talk today, I am also interested in hearing about your interaction with patients and your own time spent in a garden or green space. You have an amazing story. You were an educator and gardener for 20 years before learning about horticultural therapy in the late 1980s. And you began working with Legacy in the early 1990s. Since then you have had so much more experience and time to learn and grow. How have your interests progressed professionally or personally in the field of therapeutic horticulture?
Teresia Hazen: Something that has stimulated me, that I wouldn’t have imagined 30 years ago, is that I have become much more interested in research and evidence-based therapy. Most agencies have limited resources. We need to have compelling evidence for best practice in spending money. I am so thankful for all the researchers and doctors here. Dr. Mirka, Dr. Perkins, Dr. Neilson, and Roger Ulrich on our team. Very collaborative. We work in a real lab setting with real people, real hospitals. Our research is not just looking at pictures of nature or imagining one is there any more. Real garden settings. Real patient and employee needs. I am extremely re-invigorated, especially about employee wellness. Dr. Cleveland, the Legacy Health Vice President of Employee Health, supports and is interested in piloting new programs. We keep learning about caring for employees. Legacy has 10,000 employees. This (learning about new research on nature and health) has helped me rise to a new level. I do literature reviews about employee health and nature. We have 11 gardens, let’s see how we can improve and measure employee health! How can we offer a restorative setting for 10,000 employees!? Employees can spend just a few minutes in the gardens and then go back to their work and be more thoughtful, more careful, more relaxed. And when they go home they will have a little bit left to offer their families. What I tell our employees often is to take a break in the garden. We want to support our employees in taking a break.
NS: Employee’s personal experiences and memories are such an important part of understanding green space and health. Do you have a garden or green space you like to visit? What are your experiences there?
Hazen: Portland and the Northwest is so nature rich. We just turn around and we have wonderful nature places. One of my favorite places is our Japanese garden. Our Japanese garden is one of the top 3 in the world. I tell people it provides that sense of being away. It doesn’t mean you have to go to Europe. It means you go somewhere else when you are there.
I also enjoy the nature views. We have Mount St. Helens, Mount Hood, green every where we look. At home I have a garden that is my own joy. And I always talk to my patients about how gardens can be joy and my leisure, not a chore. If you are weeding for 7 hours and you complain that you hurt, then it isn’t a good choice. They have chosen a system that is too much or not enough of something else. I want to be happy with my choices. I want to have a peaceful zen experience. I can just imagine and feel my peaceful place when I am in the garden. My work role is to help employees and patients have a nearby nature place. That is important.
NS: There are currently eleven therapeutic gardens in the Legacy network, answering needs among children, mothers, burn victims, cancer patients, and elders. Over the last decade there has been a strong growth of therapeutic gardens across the country and internationally. What conversations and changes have you witnessed among health practitioners and managers?
Hazen: Each of the Legacy therapeutic gardens is in a ‘clinical cost center’. Each garden has to help the team and department meet clinical concerns and outcomes. The funding has fluctuated with the economy, and if we are going to spend money on this we rightly need to know why and how. Purchasing ventilators and life flight helicopters are important, but I have been impressed by the nurses (who are part of the design process for new gardens) who advocate for gardens. For example, a small garden near an emergency center was being planned and someone on the team said we can’t afford this (new garden). But, someone else said we need a helicopter costing millions, the garden is a few hundred thousand, and we can do it. In another similar experience with a children’s garden, a concerned and dedicated pediatric clinician said we need ventilators (more than a garden). But another design team member said we need to find a way to support this because it will also help people cope with their stressors, breathe and live. Gardens are designed as part of our supportive healing environments of care. Our gardens require a high level of maintenance and benefit from garden volunteers and a focused team of staff and supporters.
NS: How are the gardens integrated into patient care?
Hazen: We have specific event programming. Coming up on June 15th in the new terrace garden is “Summer in the Garden”. This includes a musician, a pet therapist, nature activities and garden tours. All the other gardens have specific events too.
We design the gardens for independent therapeutic needs. Each space has potential for independent, self-directed activities. There is a bird identification and plant pollinator program. Patients who enter the garden can act on their own needs, interests, and abilities so when they leave they may have new goals and skills.
Our doctors and nurses can give referrals to use the gardens. Our occupational therapists, speech pathologists, physical therapists can use the gardens with patients. We advertise in rooms and lounges that the gardens are available to patients and visitors. We recommend using the gardens across different platforms, for as many patient therapies as possible. They must be well designed to address many needs. Visitors do not have to know the gardens are therapeutic to actually receive benefit when using them. Restoration can occur without directed attention.
NS: Can you give an example of how a therapeutic garden may be used with children?
Hazen: The pediatric nature stations run every Wednesday afternoon all year. On days when there is too extreme weather we meet in a wonderful hallway that looks out into the garden. Last month every station centered around Ladybug Days; this June is about insect investigations. Butterfly days in July. August is “Dog Days in Summer”. For Ladybug Days, children would learn what is a ladybug, what do they do, why are they beneficial, why must we protect them… We are teaching care and reducing fright and insecurity about bugs and environments. We made fun popup cards about ladybugs. These are examples of children’s play activities.
NS: There are so many ways we can use these spaces! As you know, research on spending time in green spaces reveals many complex emotions and thoughts that occur in those spaces. People report feelings of happiness, peace, feeling calm, feeling refreshed. People feel like they have had a moment to reflect on a life issue. Could you tell us about how a patient has shared such a moment or feeling with you?
Hazen: A most profound thing happens several times a month. Patients will come out (into a garden) after being in trauma for a few weeks, sometimes life-threatening trauma, and almost always life changing. They will say they feel human again. They will say it’s the first time they have breathed fresh air in 17 days. And they will know the number of days. They will say they feel hope. They will use the word hope. They will say I can, instead of I can’t. It is easy for patients to grab on to. So simple. I hate to say its simple, but it is. Most people are familiar with outdoors. Most people are familiar with plants, the outdoors. All of the sudden they can see, they can interact and not feel so disabled.
The experience could be called magical, it’s the cycle of the seasons. If we just pay attention we see we don’t have to be in charge. Nature carries us. We have to be responsible, but don’t have to be in charge. The cycles of the seasons carry us along.
Several weeks ago a family chose to withdraw life support for their loved one in the terrace garden. This gave the family power to choose. We closed the garden only for the nurses and the family. It was a meaningful experience. It is a profound story of the value of these sacred places. I personally think these spaces are defined differently for different people. Sustainable and personal places can be used beyond our expectations. A nurse can walk out and see so many options and opportunities they can use or offer to help their patients. It may be a nurse told this family about this place. The return on investment has to be amazing. Can you imagine the story this family can tell about their experience and choices?! We have to change the conversation about the whole life span. Death is a part of process. Birth, childhood, adolescence, middle age, older adulthood. It is one of the life stages. We need to increase the cultural talk about the life process. We do this by talking about options and experiences.
NS: Another cultural conversation around health care is how we can be pro-active and responsible for our health.
Hazen: Well there is Health, and Care, and Healthcare. There is the healthcare professional role to assist the patient. But the individual responsibility is different. The big package is about healthy choices, healthy lifestyles. Care transformation is one way to talk about taking personal responsibility for health. We are spending time talking to people about choices they could make. People see others feeling good, being happy, doing fun activities. The gardens are a good place for others to see people doing activities and having fun. Good, nature-based therapeutic horticulture programming and garden design includes framing words and activities so that it is accessible to all. Dr. George Brown, Legacy Health President and CEO noted in a Wall Street Journal interview how most hospitals have well landscaped grounds, but at Legacy, patients are out in them as part of their clinical program for recovery and supports green spaces as one avenue for this.
NS: Thank you for sharing all of this today. Is there anything else you would like to share about personal experiences or emotions in these spaces?
Hazen: Yes, one of the most profound pieces of my work is knowing that spending time in a garden has the potential to help employees, community members, and patients improve without them even knowing they are improving (Research shows our mood and physiological health markers can improve even if we are not seeking improvement). When families visit their loved ones and are so stressed, they don’t even have to know why the garden is there (to benefit). It can help with their coping. And we haven’t even mentioned how these gardens benefit birds and the whole community of living beings! People can just walk in to these spaces and know that this is for them.
Talking about our real experiences in these gardens is normalizing, like home, like community, like our wider nature environment. We are enveloped in nature. When we come to the hospital we need a way to connect to cope with the grief and the trauma.