A new book – intended as a textbook for students in horticultural therapy, social services, design and other disciplines – highlights the therapeutic benefits of onsite gardens in hospitals, and prominently features Legacy's Gardens in Healthcare program, which includes 12 gardens in its six hospitals.
Therapeutic Landscapes, co-written by Clare Cooper Marcus and Naomi A. Sachs, focuses both on what research says about access to gardens in hospitals, and offers advice for landscape architects on how to design gardens for healthcare settings, as well as how to incorporate views of nature.
“We've been at this 23 years,” said Teresia Hazen, coordinator of the therapeutic gardens and horticultural therapy program for Legacy. When Hazen started at Legacy, she worked at the Bishop Morris Care Center, a Legacy nursing home that included a healing garden.
Now every hospital in Legacy's system has at least one garden, and the therapeutic benefit of nature is taken into consideration at many levels, Hazen said – from ensuring that hospital rooms have a view of nature, to incorporating gardening work into rehabilitation therapy.
“The healing garden is integral to our rehab,” said Peg Bodell, a speech and language pathologist who also manages the Legacy Rehabilitation Institute of Oregon. The average stay in Legacy Good Samaritan's rehabilitation unit is 12 to 14 days, and 95 percent of patients who stay there – most recovering from strokes or traumatic brain injuries – return to living in community settings.
Patients are taken to the garden, for instance, for range of motion, balance exercises and walking practice, since many stroke and traumatic brain injury patients need to learn to walk again before they can go home. Hazen said about 500 patients visit the the rehabilitation unit every year, and the average census is 22 to 25 patients at a time.
“This hallway is not what the real world is,” Bodell said. In addition to learning to walk on less even terrain, the garden can be a place to focus on cognition and social skills – such as gardening together with family members, and also reciting the names and colors of plants as a memory exercise.
Even patients who aren't yet ready to go outside get some of the benefits of garden therapy. The rehabilitation unit includes not just a view of nature but dozens of large potted plants, and some patients assist in transplanting or re-potting plants rather than working outside.
“They're kind of a practice for the other goals,” Bodell said. “We teach practical skills.”
The Gardens in Healthcare program has a $140,000 annual maintenance budget from Legacy Foundation to maintain its gardens and horticultural therapy program. In addition to the work of staff members like Bodell, as well as occupational and physical therapists, the program employs three paid patient gardeners and relies on 22 volunteers, who provide 3,000 hours of labor every year in the gardens.
Melissa Berman, who volunteers and works as a horticultural therapist and contract gardener, is also working on a master's degree in healthcare management,. She helps psychiatric patients at the hospital, many of whom stay for three or four months, and who are so acutely mentally ill they must have a doctor's pass to visit the garden.
Legacy has also received a $560,000 grant from the TFK Foundation to turn the concrete courtyard at Legacy Emanuel Medical Center into a therapeutic garden, and will participate in a research study to investigate the garden's effect on three groups of people: nurses from the cardiovascular intensive care unit, pregnant women on the verge of delivery, and families of people staying in the cardiovascular intensive care unit. The study, led by Kathleen Wolf at the University of Washington, will assess whether visits to the garden have a measurable impact on stress levels in those groups.
“If it does help, it's going to be cheap help,” Hazen said. She said the movement to improve healthcare design and incorporate more gardens in healthcare settings was spurred by a 1986 study by Roger Ulrich showing that gall bladder surgery patients who have a view of nature from their hospital room have a faster, less stressful recovery than those who don't.
Ulrich wrote the introduction to Therapeutic Landscapes and will speak at an April conference on Gardens in Healthcare in Portland.
“There's a foundation for this,” Hazen said. “There is evidence.”
Christen can be reached at [email protected].