Hospitals are critical sites for addressing the health and well-being of surrounding populations. Unfortunately time spent in the hospital is usually associated with high stress levels, whether you or a loved one is getting ready for a surgical procedure, having labor contractions or you’re keeping a vigilant eye on patients with a variety of different needs. Dr. Roger Ulrich is working with the team at Legacy Emanuel Medical Center in Portland, OR, to provide relief for these stressed groups through access to nature.
A Nature Place and the corresponding research conducted on three different groups’ use of a beautiful new and accessible garden at the medical center is drawing on Dr. Ulrich’s expertise in healthcare design. Dr. Ulrich is a professor of architecture at the Center for Healthcare Building Research at Chalmers University of Technology in Sweden, and is adjunct professor of architecture at Aalborg University in Denmark.
We had the opportunity to talk with Dr. Ulrich about the planning behind A Nature Place.
Open Voices: Can you go into a little more detail about your role with the project in Portland?
Roger Ulrich: I played a key role in developing the focus of each of the studies and the methods, and remain involved on a steady basis. But the details and more heavy lifting has been done by a team at Legacy… This is not your usual laboratory research, and their clinical knowledge all comes into play in a multidisciplinary effort to do rigorous research and learn more about how nature and gardens benefit human health. I’ve been involved in a lot of collaborative research projects, and I have to say the level of collaboration and connectedness is about the best I have experienced in many years.
Open Voices: Why did you choose these three particular studies to focus on in your research?
Ulrich: The garden had been located strategically where you had some high need groups, particularly family members of patients in intensive care. They are known to experience serious stress. The current research shows if a family member has a loved one in intensive care for 3-5 days, after a period of 6 months, 10-15% of family members show symptoms of post-traumatic stress disorder traceable to that episode. Nature is generally healing, but here’s a group where the stakes were very high, and nature could potentially be particularly important.
Then there were obvious advantages to including maternity patients, although birthing mothers have never been researched in this sense. There were a lot of normal births where we could pursue a randomized clinical trial. We could ethically randomly assign people either the standard of care, which is very good at Legacy, which is to spend time prior to delivery in interior space, or a very nice garden. There’s evidence that stress has negative effects on the baby and the labor curve. If we are successful with the garden and improving the birthing experience and improving the labor curve, we would expect lower blood pressure in moms during delivery, and we might expect to see a healthier baby born. That would shed important new light, and generate important new knowledge and lead to better environments and better experiences for millions of moms, but also point the direction for other patient groups how nature could improve different health outcomes.
There is a pattern of evidence that suggests that well designed gardens can reduce stress, lower blood pressure, and relax people. Also there is research that shows experiencing nature and looking at gardens reduces pain. Nature seems to reduce pain by blocking stress and reducing the extent to which patients focus on themselves and their discomfort.
Nurses are also a high need group. They are under great strain and high stress internationally. They are being asked to do more and learn more. The pressures are on… Anything that can be done that is a cost effective way to improve staff morale and help them cope with intense job demands and stresses of high level clinical care is very important and can potentially help hospitals and other healthcare providers deliver better quality care.
Open Voices: How do you plan to use the results to help improve healthcare design?
Ulrich: The studies on mothers and staff members will have unprecedented scientific rigor. It will send a signal to readers of medical reports to take this seriously. On one level our first goal is to do high quality research and publish the material in peer reviewed research journals. That puts a quality seal on the evidence, no matter how it turns out. Once we have it published, it will enable many media to then use that research and bring it to people’s attention.
Our second obligation is to write more articles based on the more technical scientific reports that are more readily understandable. We’re trying to shed light and deepen understanding, and it will inevitably bring with it a more credible case for nature and sacred spaces.