Healing Garden

Guest Book Entries from Emanuel Children’s Hospital Garden, Portland, OR

Legacy Emanuel Children’s Hospital Garden, Portland, OR
Photo courtesy Legacy Health System
The guest book in the Emanuel Children’s Hospital Garden at Legacy Health Systems in Portland, OR allows visitors to leave comments and share their experiences. Here are some recent postings. Thanks to Teresia Hazen, their on-staff Horticultural Therapist, for sending the guest book entries and images.

Thank you for the garden!  It really lifted my spirits!  
Abram (10 months) 
 
It is nice to be able to step away from the beeping machines, wires crossing and constant watching and sit in the garden.  Listening to the water, smelling the herbs, watching the birds helps restore a little bit of balance lost here.  Thank you for this beautiful escape for a bit.

The garden was peaceful and soothing during my stay (bed rest).  
Barbara E., Mom to Be (twins) 

Wonderful garden.  Waiting for Daddy to finish PT (Physical Therapy).     
Emily and Grandma 
 
Love all the plants.  We come and visit often.  My girls love this place.  
Love, Danielle, Jada, and Treasure  
 
Thank you for such a beautiful place.  It brings great calm amidst the storms of life.  

Our son Jacob loves the garden.  He loves all the silly animals, especially the cow and turtles. His baby brother is having surgery today so it was a nice treat while we waited. 

Legacy Emanuel Children’s Hospital Garden, Portland, OR
Photo courtesy Legacy Health System

Paynseville Area Hospital Foundation Meditation Garden

Jennifer Shinn, Director and Volunteer Coordinator for the Paynesville Area Health Care System recently wrote in about the hospital’s new Meditation Garden, a wonderful example of grassroots community effort. Here’s what she had to say:


“We are a small healthcare facility that has received such wonderful gifts from community members and our landscape designer to make the first phase of our Meditation Garden possible – all through donations! I would like to share a ‘before’ photo so you can better understand the full transformation that has happened here in Paynesville. 


Our staff, healthcare recipients and visitors use this newly reformed space everyday!  Although our plants are ‘newbies,’ the space provides so much more than the original mission sought out to do!  When you visit you are taken away from wherever you are at in your day and brought into a place where you would envision you could revive your inner soul.  

We are so grateful that philanthropy has created this first phase of our Meditation Garden and we are also grateful for Brian Hamer’s (owner/designer, Rock-Heads MN, Inc., www.rock-heads.net) vision for our space.  The pictures do not fully capture the beauty…  We have postings on our website at http://www.pahcs.com/category.php?disid=130.”

The Paynesville Area Health Care System is located in PaynesvilleMN at 200 West First Street.
You can contact Jennifer Shinn directly for more information at 320-243-7938, or email JShinn@pahcs.com

Open Spaces Sacred Places – New Book from TKF Foundation


So I’m looking on my own blog (this one) and one of the Google ads – “Open Spaces Sacred Places” – catches my eye. I’m not supposed to click on my own Google ads but this one I couldn’t resist, and low and behold, it’s a new book published by the TKF Foundation. This nonprofit’s mission is “to provide the opportunity for a deeper human experience by supporting the creation of public greenspaces that offer a temporary place of sanctuary, encourage reflection, provide solace, and engender peace.” The book is called Open Spaces Sacred Places, by Tom Stoner and Carolyn Rapp, and you can order it from the TKF website. I don’t have a copy yet, but am looking forward to getting my hands on one and reviewing it for this blog. Or if anyone else out there has read it and would like to write a guest review, I’m all for that, too. 


I come across information for this blog and for the Therapeutic Landscapes Database in all sorts of ways. I’m thrilled when people send me stuff, which happens often. But there’s also a lot of internet surfing, following one winding river and taking its many tributaries and just seeing where you end up. Today, I ended up with the TKF’s new book. They’ve been listed on the TLD links page for years now, and I’m glad to see they’re still doing great work.

Back to School: Healthcare Garden Design Certification Program at Chicago Botanic Garden

When designers and people in health and human services ask me what they can do to get better educated about healthcare garden design, I usually point them to the Chicago Botanic Garden’s Healthcare Garden Design Professional Development Certificate Program. One of my early posts, “Education in Healthcare Design,” listed it, along with other good programs, but CBG is worth mentioning again because registration for 2009 (May 6-13) is now open, and because Anne Hunt, a Chicago-based writer and recent graduate of the program, recently wrote an article about it and has just sent me the pdf, which you can link to HERE. To see more images of the Schwab Rehabilitation Hospital Rooftop Garden mentioned in Hunt’s article, go to the greenroofs.com site.

Here’s a little teaser from Anne Hunt’s article:

CERTIFICATION COURSE OFFERS INSIGHT AND INSPIRATION

The Chicago Botanic Garden’s Healthcare Garden Design certification course offers a unique opportunity to understand the multi-faceted nature of healthcare garden design and expand and improve professional services.

The intensive 8-day program brings together landscape design professionals, architects and interior designers, therapists, nurses and recreation specialists, healthcare marketers, administrators and consultants. Specialists in all of these areas share research, experience, business savvy and a passion for healing gardens with participants, who themselves bring a variety of backgrounds to the table.

Healing Gardens in Prisons

Prison garden at Elmore County Correctional Facility, AL 
Photo courtesy Alabama Department of Corrections
Amy Lindemuth, who submitted her thesis for the Therapeutic Landscapes Database References page (see previous post), also recently published an article in the Journal of Mediterranean Ecology on healing gardens in prisons: “Designing Therapeutic Environments for Inmates and Prison Staff in the United States: Precedents and Contemporary Applications.” This is a really interesting area of the field of landscape and healthcare design that I would like to delve into more, maybe eventually giving it its own page on the TLD. The prison industrial complex, as Angela Davis calls it, has grown astronomically in recent decades, and access to gardens and gardening has been found to have a positive effect on those “inside.” 

Last year, Clare Cooper Marcus wrote a great piece about UC Berkeley Landscape Architecture students’ work on a prison hospice garden in Vacaville, CA (first published in Frameworks, the UC Berkeley College of Enviornmental Design Alumni Magazine, Fall 2006, pp. 10-15) which was reprinted in the ASLA Healthcare and Therapeutic Design Professional Practice Network 2007 Newsletter. Scroll to page 6 to read that article.

After a quick search on the web, I found two interesting articles to include here. 

One is from the Human Flower Project, titled “Flowers in Purgatory,” from July 2006. That’s where the above photo is from. 

The second is from the TKF Foundation website, one of their Sacred Space Locations: The Metropolitan Transition Center in Baltimore, MD.

And finally, if you’re interested in this subject, the book Doing Time in the Garden: Life Lessons Through Prison Horticulture, by James Jiler, should definitely be on your reading list. 

Gainesville Times article on healing gardens

Healing garden at The Oaks at Limestone nursing home, designed and installed by Fockele Garden Co.

Here are some excerpts from the Gainesville Times article, by Debbie Gilbert of Gainesville, GA (link to the article to read the whole thing and to hear a brief interview with Naomi Sachs, Director of the Therapeutic Landscapes Resource Center)

Healthy Monday: Greenery good for patients, health facilities

Sometimes, nature is the best medicine.

More health care facilities are using the outdoor environment as a way to help both patients and visitors feel better. Known as “healing gardens” or “therapeutic landscapes,” these green spaces have proven to be so beneficial that hospitals and nursing homes have begun incorporating them into their construction plans.

Northeast Georgia Medical Center’s two upcoming additions to its main campus, the Women & Children’s Pavilion and the North Patient Tower, both include healing gardens in their design. And at least one local nursing home, The Oaks at Limestone off Limestone Parkway, has been using a therapeutic garden for several years. There’s a bubbling fountain in the interior courtyard, and colorful native flowers planted throughout the grounds. Strategically placed bird feeders almost guarantee a display of wildlife throughout the day.

“The families really, really love it,” said administrator Dorothy Foster. “The water fountain is really soothing. When residents are able to go outside, they love just sitting and enjoying the sound of the water.” Foster said the nursing home’s employees also find it a relaxing place to take a break.

Naomi Sachs, executive director of the Therapeutic Landscapes Resource Center in New York, said studies have shown that when patients have a view of the outdoors, they need less pain medication and have shorter hospital stays. This knowledge has brought about a revolution in health care design, Sachs said. “In the 1960s, when hospitals got air conditioning and began closing their windows, they kind of turned their backs on the outdoors,” she said. “(But) a lot of research has been done by environmental psychologists, starting in the mid-1970s. It shows that people respond to a wealth of greenery, a really lush environment (rather than to just a few boxed plants).”

“In a hospital setting, where people are very much not in control of their own bodies and their own routines, and there is a huge lack of privacy, naturalistic settings can be an antidote to that,” Sachs said. “It’s a distraction to whatever problem the patient or visitor or caregiver may have.”

While the gardens are beautiful, they’re far more than just a pleasant amenity. “Savvy hospitals are realizing that it helps their bottom line,” Sachs said. The environment also may play a role in why people choose one facility over another. If they had a positive experience, whether as a patient or as an employee, they’re likely to recommend that place to others. “The fact that people are happier can become a marketing tool,” Sachs said. “More and more health care centers are starting to catch onto that.”

“Isn’t every garden a healing garden?” Part II

Healing Garden at Good Samaritan Cancer Center, Puyallup, WA 

KMD Architects; photo by Michael O’Callahan 

Click here for Healthcare Design Magazine’s write-up of this project. 


“A healing garden is an outdoor (and sometimes green indoor) space designed to promote and improves people’s health and well-being. A true healing garden must be successful in fulfilling the design intent.” Naomi Sachs and the Therapeutic Landscapes Resource Center’s working definition of “healing gardens.”  


In my post yesterday, I gave my very broad definition of “Landscapes for Health,” (recap: A Landscape for Health is defined as any landscape that promotes and facilitates health and well-being). And I left you with a cliffhanger, promising to define “healing gardens” today. And none too soon, as I seem to have already caused confusion, as evidenced by Henry’s comment on yesterday’s post and a friend’s email to me:

“So is a playground a healing garden??  (Slightly joking/slightly serious.)  The best way to get my daughter to forget she has teething pain is to take her to the playground and the best way to help mom forget she is tired and overwhelmed is to take her to the playground – her joy makes us both forget the owie.” – K.W.

Is a playground a Landscape for Health? Absolutely, according to my definition and my friend’s experience. But is it a healing garden? Maybe. Depends who designed it, for whom, and why. I agree with Henry that we need a more narrow and specific definition for healing gardens, one that refers to outdoor (and some green indoor) spaces that are designed, preferably with Evidence-Based Design (EBD), to have healing effects on the people using them.

I have a confession: I started the Therapeutic Landscapes Database in 1999, and have been avoiding coming up with a simple, one-or-two-sentence definition for “healing gardens” ever since. I find it to be extremely daunting, and others must, too, because nine years later, there is still no agreed-upon, industry-standard definition that I can blithely quote. Maybe that’ll happen someday soon, but for now there’s a lot of confusion around the terminology. The American Horticultural Therapy Association (AHTA) just recently issued a Position Paper with helpful definitions of some terms including “healing gardens,” “therapeutic gardens,” and “restorative gardens,” among others. I’ve included some of those definitions below, along with other discussions, but today I’ve finally come up with my own working definition, which means that it is still very much subject to discussion and change. I hope people will leave comments and constructive criticism about what I’ve got so far. 

I have a pet peeve about people’s overzealous use of dictionary definitions, but in this case I think that’s a good starting point: 

1. Healing: The Oxford English Dictionary gives four definitions for the verb “heal”:

a. To become sound or healthy again;

b. To cause (a wound, a disease, or a person) to heal or be healed;

c. To put right (differences, etc.);

d. To alleviate (sorrow, etc.).

So “healing” implies making someone well, or at least improving the health of someone who is or was not well.  

Garden: The OED’s definitions for garden are just too darn long for this already-too-long posting, so I’ll just paraphrase: A garden is a designed, or at least cultivated, space, usually outdoors and usually including vegetation. A garden doesn’t have to be gardenesque, but it does have to be designed or cultivated by someone instead of having just evolved that way. So whereas the Grand Canyon might be a Landscape for Health, it would not fit my definition of a healing garden. 

So you put those two definitions together and you get “a designed or cultivated outdoor space that heals people or at least makes them feel better than they did before they encountered the garden.” But we want to also include something about intent, that these gardens were designed specifically to elicit positive outcomes of improved physical, psychological, and/or emotional health. And we also want to say that these gardens were not only designed to be healing, but they actually are (believe me, I’ve seen plenty of examples of designed “healing gardens” that couldn’t possibly be salutary). How about this? 

A healing garden is an outdoor (and sometimes green indoor) space designed to promote and improve people’s health and well-being. A true healing garden must be successful in fulfilling the design intent of healing. Positive outcomes can be achieved through passive experience of the garden (viewing of or presence in the garden) and/or active involvement in and with the garden (gardening, rehabilitative therapy, and other activities).

And then there are all the other terms, like restorative landscapes, and wellness gardens, and therapeutic gardens, but I’m going to save that for another day. 

If you feel like reading more, I would suggest:

1. The American Horticultural Therapy Association (AHTA) recently-released Position Paper on Definitions and Positions:

Types of Gardens 

Healing Gardens 

Healing gardens are plant dominated environments including green plants, flowers, water, and other 

aspects of nature.  They are generally associated with hospitals and other healthcare settings, 

designated as healing gardens by the facility, accessible to all, and designed to have beneficial effects on 

most users.  A healing garden is designed as a retreat and a place of respite for clients, visitors, and 

staff and to be used at their desire.  Healing gardens may be further divided into specific types of 

gardens including therapeutic gardens, horticultural therapy gardens, and restorative gardens.  These 

garden types are likely to have overlap and the following definitions should be regarded as guidelines 

since no two gardens are the same. 

 

Therapeutic Gardens 

A therapeutic garden is designed for use as a component of a treatment program such as occupational 

therapy, physical therapy, or horticultural therapy programs and can be considered as a subcategory of a 

healing garden.  A garden can be described as being therapeutic in nature when it has been designed to 

meet the needs of a specific user or population.  It is designed to accommodate client treatment goals 

and may provide for both horticultural and non-horticultural activities.  It should be designed as part of a 

multi-disciplinary collaborative process by a team of professionals.  A therapeutic garden may exist on its 

own as an extension of an indoor therapeutic program area or it may be part of a larger healing garden. 

 

Horticultural Therapy Gardens 

A horticultural therapy garden is a type of therapeutic garden; it is designed to accommodate client 

treatment goals, but it is designed to support primarily horticultural activities.  A horticultural therapy 

garden is also designed in such a manner that the clients themselves are able to take care of plant 

material in the garden. 

 

Restorative Gardens 

A restoration or meditation garden may be a public or private garden that is not necessarily associated 

with a healthcare setting.  This type of garden employs the restorative value of nature to provide an 

environment conducive to mental repose, stress-reduction, emotional recovery, and the enhancement of 

mental and physical energy.  The design of a restorative garden focuses on the psychological, physical, 

and social needs of the users. 




2. Annalisa Gartman Vapaa has a nice discussion of the definition of healing gardens on page three of her masters thesis, Healing Gardens: Creating Places for Restoration, Meditation, and Sanctuary,”  MLA thesis for Virginia Polytechnic Institute and State University, 2002.


3. Clare Marcus and Marni Barnes on pages 3-4 of Healing Gardens: Therapeutic Benefits and Design Recommendations (see this recent post for more on this book).


4. Jain Malkin in her fabulous new book A Visual Reference for Evidence-Based Design, on pages 4-6, and 132.


5. Henry Domke suggested this definition: “A healing garden is created using design informed by credible research to achieve the best possible health outcomes,” a modification of the recently revised definition of “Evidence-Based Design” from the Center for Health Design

“Isn’t every garden a healing garden?” Part I


According to my definition, a Landscape for Health could be a garden designed specifically for healing, like for a hospital or nursing home (see above), and it could also be any number of other landscapes, designed or “natural,” as long as they make people feel good (in technical terms, Landscapes for Health bring “positive outcomes” that reduce negative factors like stress, high blood pressure, and anti-social behavior, and instead encourage positive and restorative factors like fascination, wonder, healthy social interaction, relaxation and/or physical activity, and a general sense of well-being). A stretch of beach; a clearing in the woods; a park in a city (Central Park being a supreme example); a community garden; a backyard sanctuary; Francie’s fire escape in Betty Smith’s A Tree Grows in Brooklyn; a memorial; an indoor atrium that stays green and lush even when it’s -30 degrees and sleeting outside. Get the picture?  


Central Park, NY, NY

Couldn’t that be just about any landscape, the slightly vexed reporter asked? This is similar to my most-frequently-asked question, which is “isn’t every garden (or landscape) a healing garden?” to which I unfortunately have to answer no. There are plenty of landscapes, both designed and undesigned, that are not conducive to our health and well-being. A few examples that spring to mind would be (see below) most parking lots; many urban and suburban landscapes, including streetscapes; most quarries, clear-cut sections of forests, superfund sites, and other damaged landscapes (brownfields); most of New Mexico in March when the juniper pollen renders anyone even slightly allergic into a tired, sniffling, eye-watering, blubbering mess; and, sadly, many designed gardens, sometimes even ASLA award-winning, magazine-published spaces (yup, just because it looks good in print doesn’t mean it feels good to be there). 



Photo of California foothills housing by Alex Maclean – 

There are plenty of landscapes, and even gardens, that at best are not salutary, and at worst are actually harmful to our physical, emotional, and even spiritual health. So, smarty-pants, you may be wondering, how do you differentiate Landscapes for Health from “healing gardens?” Stay tuned, I’ll try to answer that one tomorrow.

“Healing Environment” vs. “Healthy Environment”

Okay, I know it was three months ago, but I just came across this interesting discussion on the terminology of “healing environments” vs. “healthy environments” from the Center for Health Design Bloghttp://www.healthdesign.org/blog/234.phpPlus it gives me the excuse to post another picture from Maine:) 

Substituting the word “garden” for “environment” (“healing gardens” vs. “healthy gardens”) helped to clarify it for me. We in the landscape architecture and healthcare design community are still searching for one overarching term and definition for outdoor spaces that promote and facilitate health and well-being. I often use the term “Landscapes for Health” because 
1. It is broad enough to cover any outdoor (and even some indoor) spaces; 
2. It can mean a designed or totally “natural” landscape; and 
3. It can include both passive and active enjoyment of and benefit from contact with nature (e.g., just sitting on the rocks above, breathing in the fresh air and salt water, or gardening at a hospital as part of a horticultural therapy program). 

What say you, dear reader? Healing garden, restorative landscape, landscape for health – what term do you think best sums it all up?

Information needed, and a favorite children’s and rooftop garden

I got a request recently from someone who is looking for examples of children’s hospital gardens with rooftop conservatories (in other words, an enclosed space on a rooftop at a children’s hospital). I’ve found many examples of children’s gardens, rooftop gardens, and conservatories, but so far haven’t found all three in one. Anyone out there know of an example? If so, please share by posting a comment! 


In the meantime, here’s an image of one of my favorite children’s gardens that is also one of my favorite rooftop hospital gardens, the Olson Family Garden at the Children’s Hospital, St. Louis, MO (got the image from the Waymarking website: http://www.waymarking.com/waymarks/WM3NPR).

Landscape Architecture Magazine did a nice article on the garden in 2002, which you can read online: http://www.asla.org/lamag/lam02/may02/feature2.html.

Also, here’s a video clip about it: http://uk.youtube.com/watch?v=7GrAsJnY2ww&feature=user.  

I visited this garden a few years ago during the ASLA annual meeting with Roger Ulrich, Virginia Burt, Jack Carman, and other colleagues and we were all so impressed. While we were there, a nurse led a small child–who was recovering from severe burns–around the garden. We were moved to see this young patient, wrapped in bandages, maneuvering about the garden, touching the fountains, looking at the flowers, and generally interacting with the world despite the pain. For me, it was one of those “ah-hah” moments when what you do moves beyond the realm of the theoretical and academic. Yes, gardens really are important, especially in hospitals, and they really do make a difference in people’s lives.

I’ll be in Maine for a week starting Monday, with limited internet access, so this is my last post until next week. When I return, I hope to see lots of comments in response to this blog post!