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Aim This review will identify, evaluate and synthesize the literature related to evidence‐based design of healthcare environments and to identify impacts of the built environment on the outcomes and experiences of patients, significant others and staff. Design A mixed‐method systematic review of literature 2010–2018. Methods Database searches for evidence in peer‐reviewed journals will be conducted electronically using CINAHL, Medline, SCOPUS and Web of Science. Abstract, full‐text screening and data extraction will be completed independently by the reviewers. Quality assessment will follow Swedish Agency for Health Technology Assessment and Social Services Assessment. Results This review will offer knowledge for informed decisions about the design of the healthcare environment. The review is comprehensive, includes a large volume of literature various research designs and will highlight the knowledge gap in evidence‐based design and provide a breadth of knowledge about the built environments and its impact on health and well‐being.

Background Nurses working in hospital environments are at risk for burnout. Exposure to nature has psychological benefits, but the effect of hospital gardens on nurse burnout is less understood. Objective To compare the effect on nurse burnout of taking daily work breaks in a hospital-integrated garden with the effect of indoor-only breaks. Methods A prospective crossover trial was conducted of nurses assigned to either 6 weeks of a work break in an outdoor hospital garden or 6 weeks of indoor-only breaks. After a 1-week washout period, break assignments were switched for a subsequent 6 weeks. The Maslach Burnout Inventory was administered at the beginning and end of each 6-week period, and a Present Functioning Visual Analogue Scale was completed at the start and end of each break to capture immediate psychological symptoms. Change scores were analyzed by using generalized estimating equations. Results For 29 nurses, for garden compared with indoor breaks, significant improvement was apparent in scores on the Maslach Burnout Inventory subscales for emotional exhaustion (4.5 vs -0.2; P < .001) and depersonalization (1.8 vs 0.0; P = .02) but not for personal accomplishment (-0.6 vs -0.0; P = .55). Compared with indoor breaks, total symptom scores on the Present Functioning Visual Analog Scale improved significantly when nurses took a break in the garden (garden vs indoor breaks, 4.0 vs 2.4; P = .04). Conclusions Taking daily work breaks in an outdoor garden may be beneficial in mitigating burnout for nurses working in hospital environments.

Drawing on international research and practice, this chapter highlights how designing with nature improves care and health for ageing. We outline the benefits of nature and outdoors to care settings, architecture’s crucial role in ‘edge spaces’ and site design, plus give brief UK design examples from extra-care housing, dementia nursing care and hospice. Furthermore, we identify tools to assess and improve care settings to better support dementia green care. Scientific evidence is driving a resurgence in nature-enhanced hospital design. Gardens with pleasant views and other sensory stimulation provide psychological and physiological restoration from stress and clinically significant reduction of pain. Well-designed gardens can entice patients into movement, physical activity or rehabilitation by providing access to social support, privacy, and positive nature distraction. Families as well as patients report reduced stress, enhanced emotional well-being, and higher satisfaction with care quality, while hospital staff experience lowered work-related stress and burnout. The chapter ends with evidence-informed guidelines for designing hospitals with nature.

The article describes a conceptual model proposing that aggression in psychiatric facilities may be reduced by designing the physical environment with ten evidence-grounded stress-reducing features. The model was tested in a newer hospital in Sweden having wards with nine of the ten features. Data on two clinical markers of aggressive behavior, compulsory injections and physical restraints, were compared with data from an older facility (replaced by the newer hospital) that had only one stress-reducing feature. Another hospital with one feature, which did not change during the study period, served as a control. The proportion of patients requiring injections declined (p

Objectives: Measure the immediate change in intensive care unit (ICU) family members’ state stress levels from the beginning to the end of a person’s visit to a hospital garden and compare the changes produced by the garden with those associated with spending time in indoor hospital environments intended for respite and relaxation. Background: No previous research has compared the efficacy of different physical environments as interventions to foster stress reduction in family members of ICU patients, a group of hospital visitors known to experience high levels of distress. Method: A convenience sample of 42 ICU patient family (from 42 different families) completed the Present Functioning Visual Analogue Scales (PFVAS) before and after each visit (128 total visits) to a garden, an atrium/café, or ICU waiting room. Results: Stress scores significantly declined (i.e., improved) from the start to the end of a break on all PFVAS subscales ( p < .0001) in both the garden and indoors locations. However, it is noteworthy that garden breaks resulted in significantly greater improvement in the “sadness” scale than breaks in indoor locations ( p = .03), and changes in all five other PFVAS scores showed somewhat more reduction of stress for breaks spent in the garden than indoors, although these differences were not statistically significant. Conclusion: Creating an unlocked garden with abundant nature located close to an ICU can be an effective intervention for significantly mitigating state stress in family members of ICU patients and can be somewhat more effective than indoor areas expressly designed for family respite and relaxation.

ObjectiveHealthcare-oriented design in hospitals can promote better clinical outcomes. Creating optimal facilities may increase treatment effects. We investigated the influence of the treatment room on effects of exercise therapy.MethodsIn a mixed-method randomised controlled double-blind trial, middle-aged individuals reporting knee or hip pain performed 8 weeks of exercise therapy in (1) a newly built physically enhanced environment, (2) a standard environment or (3) were waitlisted, receiving no intervention. Participants and therapists were blind to study aim. Primary outcome was participants’ Global Perceived Effect (GPE; seven-point Likert scale). Six nested focus group interviews with participants (n=25) and individual interviews with therapists (n=2) explored experiences of the environments.Results42 people exercised in the physically enhanced environment, 40 in the standard environment, 21 were waitlisted. Contrary to our hypothesis, the treatment response seemed greater in the standard environment for GPE (0.98, 95% CI0.5 to 1.4) than for the physically enhanced environment (0.37, 95% CI −0.2 to 0.9), between-group difference (0.61, 95% CI −0.1 to 1.3) did not reach statistical significance (p=0.07). Waitlist group reported no improvement (−0.05 95% CI −0.5 to 0.4). In interviews, participants from the standard environment expressed greater social cohesion and feeling at home. Qualitative themes identified; reflection, sense of fellowship and transition. Secondary patient-reported outcomes and qualitative findings supported the primary finding, while improvements in muscle strength and aerobic capacity did not differ between exercise groups.ConclusionResults suggest that the physical environment contributes to treatment response. Matching patients’ preferences to treatment rooms may improve patient-reported outcomes.Trial registration numberClinicalTrials.gov identifier: NCT02043613.

Introduction American nurses report sleeping an average of 6.8 hours per night on workdays, which is less than the recommended 7-9 hours. Burnout, which is comprised of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA), is common among nurses and may contribute to insufficient sleep quantity and sleep disruption. We aimed to investigate if burnout, measured using the Maslach Burnout Inventory (MBI), predicted self-report of trouble sleeping for nurses working in the hospital. Methods This is a secondary report of a prospective crossover trial of nurses assigned to either 6 weeks of daily work-breaks in an outdoor hospital garden or 6 weeks of indoor-only breaks. After a 1-week washout period, break assignments were switched for an additional 6 weeks. Nurses completed the MBI at the beginning and end of each 6-week period. Each workday, nurses completed a visual analog scale reporting no trouble sleeping to much trouble sleeping immediately following a break. For this analysis, we used initial MBI subscale score (EE, DP, PA) as a predictor of mean trouble sleeping over the subsequent 6-week period regardless of break location using generalized estimating equations. Results A total of 29 nurses (27 females, mean age 42.8 years) participated. Most (n=20) worked dayshift, and 9 worked night shift. Initial MBI subscale score, regardless of break location, was predictive of mean self-report of trouble sleeping over the subsequent 6-week period for EE (p

One of my greatest pleasures (and a potent stress reliever) is to walk in the Japanese gardens near my home in Portland, Oregon. When I heard about the work being done at a local hospital with the use of a healing garden for mothers and their families, I was so impressed I had to share it. Today&#39

The physical facilities in which healthcare services are performed play an important role in the healing process. Evidence-based design in healthcare is a developing field of study that holds great promise for benefiting key stakeholders: patients, families, physicians, and nurses, as well as other healthcare staff and organizations. In this paper, the authors present and discuss a conceptual framework intended to capture the current domain of evidence-based design in healthcare. In this framework, the built environment is represented by nine design variable categories: audio environment, visual environment, safety enhancement, wayfinding system, sustainability, patient room, family support spaces, staff support spaces, and physician support spaces. Furthermore, a series of matrices is presented that indicates knowledge gaps concerning the relationship between specific healthcare facility design variable categories and participant and organizational outcomes. From this analysis, the authors identify fertile research opportunities from the perspectives of key stakeholders.

Objective:This report surveys and evaluates the scientific research on evidence-based healthcare design and extracts its implications for designing better and safer hospitals.Background:It builds on a literature review conducted by researchers in 2004.Methods:Research teams conducted a new and more exhaustive search for rigorous empirical studies that link the design of hospital physical environments with healthcare outcomes. The review followed a two-step process, including an extensive search for existing literature and a screening of each identified study for the relevance and quality of evidence.Results:This review found a growing body of rigorous studies to guide healthcare design, especially with respect to reducing the frequency of hospital-acquired infections. Results are organized according to three general types of outcomes: patient safety, other patient outcomes, and staff outcomes. The findings further support the importance of improving outcomes for a range of design characteristics or interventions, including single-bed rooms rather than multibed rooms, effective ventilation systems, a good acoustic environment, nature distractions and daylight, appropriate lighting, better ergonomic design, acuity-adaptable rooms, and improved floor layouts and work settings. Directions for future research are also identified.Conclusions:The state of knowledge of evidence-based healthcare design has grown rapidly in recent years. The evidence indicates that well-designed physical settings play an important role in making hospitals safer and more healing for patients, and better places for staff to work.

Anger and stress management have become important issues in the modern workplace. One out of four American workers report themselves to be chronically angry, which has been linked to negative outcomes such as retaliatory behavior, revenge, interpersonal aggression, poor work performance, absenteeism, and increased turnover. We hypothesized that people who work in office environments decorated with aesthetically engaging art posters would experience less stress and anger in response to task-related frustration. Two hundred and ten college students were randomly assigned to different office conditions where abstract and nature paintings were hung on the walls. Participants performed four mild anger-provoking computer tasks and then reported their levels of state anger and stress. Results indicate that different office conditions had a significant influence on state anger and stress for males but not for females. Males experienced less state anger and stress when art posters were present. Through mediation analysis, we found that increased proportions of nature paintings decreased state anger because of decreased levels of stress.

INTRODUCTION: Context effects are described as effects of a given treatment, not directly caused by the treatment itself, but rather caused by the context in which treatment is delivered. Exercise is a recommended core treatment in clinical guidelines for musculoskeletal disorders. Although moderately effective overall, variation is seen in size of response to exercise across randomised controlled trial (RCT) studies. Part of this variation may be related to the fact that exercise interventions are performed in different physical environments, which may affect participants differently. The study aims to investigate the effect of exercising in a contextually enhanced physical environment for 8 weeks in people with knee or hip pain.METHODS AND ANALYSIS: The study is a double-blind RCT. Eligible participants are 35 years or older with persisting knee and/or hip pain for 3 months. Participants are randomised to one of three groups: (1) exercise in a contextually enhanced environment, (2) exercise in a standard environment and (3) waiting list. The contextually enhanced environment is located in a newly built facility, has large windows providing abundant daylight and overlooks a recreational park. The standard environment is in a basement, has artificial lighting and is marked by years of use; that is, resembling many clinical environments. The primary outcome is the participant's global perceived effect rated on a seven-point Likert scale after 8 weeks exercise. Patient-reported and objective secondary outcomes are included.ETHICS AND DISSEMINATION: The Regional Scientific Ethical Committee for Southern Denmark has approved the study. Study findings will be disseminated in peer-reviewed publications and presented at national and international conferences.TRIAL REGISTRATION NUMBER: NCT02043613.

This study evaluates three healing gardens surrounding a pediatric cancer center. All gardens contained seating, flowers and plants, but varied in size, features, and in user groups’ access to them. A post-occupancy evaluation (POE) yielded a dataset of 1400 garden-users for whom demographic information, activities, and length-of-stay were recorded. Results indicate differential usage patterns across gardens, user category (patient, visitor, or staff), and age (adults and children). The largest garden with most direct patient access was the most used. Staff mostly used the gardens to walk-through or to sit and eat, rarely interacting with features intended for active engagement. Despite patient and child-friendly designs, the overwhelming majority of visitors were adults who mostly engaged in sedentary activities. Children who did use the gardens interacted with garden features significantly more than adults. Although patient rooms are situated at ground-level around the gardens to promote window views of the gardens, the findings suggest an inverse relationship between patient window use and the number of people in the gardens. Finally, preliminary data suggest that emotional distress and pain are lower for all groups when in the gardens than when inside the hospital. Provisional design implications of these findings are discussed.

People have cultivated plants and other natural elements in urban environments virtually since the advent of the earliest human cities. Recent research in the social sciences suggests that passive interactions with large scale natural environments may have health benefits. These early fmdings with large scale natural environments are consistent with enduring beliefs about the beneficial effects of natural environments, which in turn echo beliefs about the positive effects of horticultural pursuits. This paper describes two general classes of research methods that have been used to investigate the mtential health effects of oassive exmures to natural envikmmen6, methods that have direci applicabfiity to the investigation of similar issues in horticultural environments. The fmt set of methods have been used in the field of environmental aesthetics to measure perceived environmental quality. Several of these specific methods are described and their ap licabiity to horticultural research is highlighted. The s...

Two studies were done comparing the preferences of high and low sensation seekers for nature paintings representing different styles. The paintings had been previously rated for qualities of complexity and tension. Factor analyses established five stylistic categories among the paintings. In both studies high sensation seekers had a relatively greater liking for high tension paintings whereas the lows had a relatively greater liking for low tension paintings. In both studies high sensation seekers had a relatively greater liking for expressionist style paintings, and in the second study the lows had a greater preference for the realistic, low tension pastoral scenes than the high sensation seekers. Men liked complex, high tension, realistic paintings more than women did. Complexity did not interact with personality, but was subordinate to other qualities of the paintings. High sensation seekers like tension evoking paintings and are more tolerant of ambiguity in style than low sensation seekers.

Literature on healthcare architecture and evidence-based design has rarely considered explicitly that patient outcomes may be worsened by intra-hospital transport (IHT), which is defined as transport of patients within the hospital. The article focuses on the effects of IHTs on patient complications and outcomes, and the implications of such impacts for designing safer, better hospitals. A review of 22 scientific studies indicates that IHTs are subject to a wide range of complications, many of which occur frequently and have distinctly detrimental effects on patient stability and outcomes. The research suggests that higher patient acuity and longer transport durations are associated with more frequent and serious IHT-related complications and outcome effects. It appears no rigorous research has compared different hospital designs and layouts with respect to having possibly differential effects on transport-related complications and worsened outcomes. Nonetheless, certain design implications can be extracted from the existing research literature, including the importance of minimizing transport delays due to restricted space and congestion, and creating layouts that shorten IHT times for high-acuity patients. Limited evidence raises the possibility that elevator-dependent vertical building layouts may increase susceptibility to transport delays that worsen complications. The strong evidence indicating that IHTs trigger complications and worsen outcomes suggests a powerful justification for adopting acuity-adaptable rooms and care models that substantially reduce transports. A program of studies is outlined to address gaps in knowledge.Key WordsPatient transports, transports within hospitals, patient safety, evidence-based design, hospital design, healthcare architecture, intra-hospital transport complications, acuity-adaptable care, elevators, outcomes.

Different conceptual perspectives converge to predict that if individuals are stressed, an encounter with most unthreatening natural environments will have a stress reducing or restorative influence, whereas many urban environments will hamper recuperation. Hypotheses regarding emotional, attentional and physiological aspects of stress reducing influences of nature are derived from a psycho-evolutionary theory. To investigate these hypotheses, 120 subjects first viewed a stressful movie, and then were exposed to color/sound videotapes of one of six different natural and urban settings. Data concerning stress recovery during the environmental presentations were obtained from self-ratings of affective states and a battery of physiological measures: heart period, muscle tension, skin conductance and pulse transit time, a non-invasive measure that correlates with systolic blood pressure. Findings from the physiological and verbal measures converged to indicate that recovery was faster and more complete when subjects were exposed to natural rather than urban environments. The pattern of physiological findings raised the possibility that responses to nature had a salient parasympathetic nervous system component; however, there was no evidence of pronounced parasympathetic involvement in responses to the urban settings. There were directional differences in cardiac responses to the natural vs urban settings, suggesting that attention/intake was higher during the natural exposures. However, both the stressor film and the nature settings elicited high levels of involuntary or automatic attention, which contradicts the notion that restorative influences of nature stem from involuntary attention or fascination. Findings were consistent with the predictions of the psycho-evolutionary theory that restorative influences of nature involve a shift towards a more positively-toned emotional state, positive changes in physiological activity levels, and that these changes are accompanied by sustained attention/intake. Content differences in terms of natural vs human-made properties appeared decisive in accounting for the differences in recuperation and perceptual intake.

Art is assumed to possess therapeutic benefits of healing for children, as part of patient-focused design in health care. Since the psychological and physiological well-being of children in health care settings is extremely important in contributing to the healing process, it is vitally important to identify what type of art supports stress reduction. Based on adult studies, nature art was anticipated to be the most preferred and to have stress-reducing effects on pediatric patients. Nature art refers to art images dominated by natural vegetation, flowers or water. The objective of this study was to investigate what type of art image children prefer, and what type of art image has potentially stress-reducing effects on children in hospitals. This study used a three-phase, multi-method approach with children aged 5—17 years: a focus group study (129 participants), a randomized study (48 participants), and a quasi-experimental study design (48 participants). Findings were evaluated from three phases.

Psychophysiological approaches to studying leisure use physiological measures to assess stress, attention, emotions, and other responses. These methods are discussed from the standpoint of their ca...

Stress, strain, and fatigue at the workplace have previously not been studied in relation to acoustic conditions.To examine the influence of different acoustic conditions on the work environment and the staff in a coronary critical care unit (CCU).Psychosocial work environment data from start and end of each individual shift were obtained from three shifts (morning, afternoon, and night) for a one-week baseline period and for two four-week periods during which either sound reflecting or sound absorbing tiles were installed.Reverberation times and speech intelligibility improved during the study period when the ceiling tiles were changed from sound reflecting tiles to sound absorbing ones of identical appearance. Improved acoustics positively affected the work environment; the afternoon shift staff experienced significantly lower work demands and reported less pressure and strain.Important gains in the psychosocial work environment of healthcare can be achieved by improving room acoustics. The study points to the importance of further research on possible effects of acoustics in healthcare on staff turnover, quality of patient care, and medical errors.

Aim of the study: To evaluate the possible role of room acoustics on patients with coronary artery disease and to test the hypothesis that a poor acoustics environment is likely to produce a bad work environment resulting in unwanted sound that could adversely affect the patients. Methods and results: A total of 94 patients admitted to the intensive coronary heart unit at Huddinge University Hospital for evaluation of chest pain were included in the study. Patient groups were recruited during bad and good acoustics, respectively. Acoustics were altered during the study period by changing the ceiling tiles throughout the CCU from sound-reflecting tiles (bad acoustics) to sound-absorbing tiles (good acoustics) of similar appearance. Patients were monitored with regard to blood pressure including pulse amplitude, heart rate and heart rate variability. The patients were asked to fill in a questionnaire about the quality of the care, and a follow-up of rehospitalization and mortality was made at 1 and 3 months, respectively. There were significant differences between good and bad acoustics with regard to pulse amplitude in the acute myocardial infarction and unstable angina pectoris groups, with lower values during the good acoustics period during the night. The incidence of rehospitalization was higher for the bad acoustics group. Patients treated during the good acoustics period considered the staff attitude to be much better than during the bad acoustics period. Conclusion: A bad acoustics environment during acute illness may have important detrimental physiological effects on rehabilitation. D 2004 Elsevier Ireland Ltd. All rights reserved.

This is a time of enormous investment in new healthcare buildings. The UK plans to create upwards of a hundred hospitals and thousands of primary-care clinics and surgery centres. In the USA, more than $200 billion will be spent on new hospitals over the next decade. This wave of construction provides an opportunity to create better buildings by use of the emerging science of evidence-based design, in which the design process is guided by an empirical understanding of the eff ects of health-care physical environments on safety, effi ciency, and clinical outcomes. The scientifi c foundation for evidence-based healthcare design is already large and surprisingly strong. A joint project at Texas AM infection rates are lower when patients are in single rather than multi-bed rooms and air quality is very good. Single rooms have advantages over multi-bed rooms in reducing airborne transmission through ventilation and the possibility of such air quality measures as fi ltration, air changes, creation of positive air pressure to protect an immunocompromised patient from airborne pathogens in adjacent spaces, or creation of negative room pressure to prevent a patient with an aerially spread infection from infecting others. Other evidence suggests that single rooms also help to decrease risk of infections spread by contact. Single rooms are easier than multi-bed rooms to clean thoroughly after a patient leaves, lessening the problem of contaminated environmental surfaces remaining as pathogen reservoirs that can spread infection through hand contact. Single rooms also enable separation or isolation of patients on admission, so that those with unrecognised infections can be identifi ed and assignment to multi-bed rooms with uninfected patients avoided. A major source of contact transmission of infection is unwashed staff hands, and low hand-washing rates among staff are well documented. Evidence suggests that hand-cleaning compliance is worse when sinks and dispensers of alcohol hand gel are positioned several paces away from staff work or movement paths, or behind doors or in other locations outside the visual fi elds of busy nurses and physicians. There are encouraging indications that installation of wash basins and gel dispensers close to staff work paths in visually prominent locations near the point of care leads to sustained increases in hand washing. Floor layouts can be designed to reduce staff fatigue and increase time for care. Conventional fl oor layouts for patient-care units generally provide corridors organised around a central nursing station, where medications and charts are located, and a central location for supplies. Nurses therefore spend much of their time walking up and down halls engaged in wasteful activity, such as fetching supplies, thereby increasing fatigue and shrinking the time available for observing patients and delivering direct care. By contrast, fl oor layouts with decentralised nurse charting or observation stations and supplies dispersed to be close to patients’ rooms cut staff time spent walking and fetching and greatly increase time for observation and care of patients. Properly designed Roger Ulrich is Professor of Architecture at Texas A&M University and a faculty fellow of the Center for Health Systems and Design, housed jointly in the colleges of architecture and medicine at Texas A&M University. He is currently Visiting Professor to the Bartlett School of Architecture, University College London. He has previously served as Senior Adviser on the Environment for Patient Care to the UK National Health Service.

Background unstable coronary disease is a stressful situation and environmental influences may increase stress mechanisms important for the cardiovascular status. Aim to evaluate acoustic influence on patients with coronary artery disease and to test if the effects of poor sound absorption on work environment affects quality of care and medical status of patients. Methods 94 patients admitted to the intensive coronary heart unit for chest pain evaluation participated. Patient groups were recruited during bad and good acoustic conditions respectively. Blood pressure, pulse amplitude, heart rate and heart rate variability were monitored. Patients were asked to fill in a questionnaire about the quality of the care and a follow up of rehospitalisation and mortality was made at 1 and 3 months. Results good and bad acoustics differed significantly with respect to pulse amplitude in acute myocardial infarction and unstable angina pectoris groups, with lower values at night during the good acoustics period. Re‐hospitalisations were higher for the bad acoustics group. During the good acoustics period patients considered the staff attitude much better than during the bad acoustics period. Conclusion, bad acoustics environment during acute illness may have important physiological effects of importance for rehabilitation.

Summary and Discussion The findings suggest that stressed individuals feel significantly better after exposure to nature scenes rather than to American urban scenes lacking nature elements. Compared to the influences of the urban scenes, the salient effect of the nature exposures was to increase Positive Affect — including feelings of affection friendliness, playfulness, and elation. The increase in positive affect produced by the nature scenes is consistent with the finding that the nature exposures also significantly reduced Fear Arousal. According to psychological theories, a reduction in arousal or activation produces pleasurable feelings if an individual is experiencing stress or excessive arousal (Berlyne, 1971, pp. 81–82). In contrast to the nature scenes, the urban views tended to work against emotional well‐being. The major effect of the urban scenes was to significantly increase Sadness. There was also a consistent but non‐significant tendency for the urban scenes to‐aggravate feelings of Anger/...

The rapidly expanding research record concerning aesthetic, emotional and physiological response to visual landscapes is summarized, with emphasis on aesthetic preferences for views containing trees and other vegetation. The survey is set within a conceptual perspective suggesting that affective responses such as aesthetic preference are central to a landscape observer's thoughts, conscious experience and behavior. Substantial progress has been made in developing models that relate aesthetic responses to specific visual properties of environments. When aesthetic preferences are compared for urban and unspectacular natural views, American and European adult groups evidence a strong tendency to prefer nature. However, liking for urban scenes usually increases when trees and other vegetation are present. Views of nature, compared to most urban scenes lacking natural elements such as trees, appear to have more positive influences on emotional and physiological states. The benefits of visual encounters with vegetation may be greatest for individuals experiencing stress or anxiety. Recent research demonstrates that responses to trees and other vegetation can be linked directly to health, and in turn related to economic benefits of visual quality.

The lack of research concerning psychological benefits of urban parks has prevented their full evaluation as environmental amenities. In this study, psychological as well as active recreation benef...

Subjects viewed sixty color slides of either (1) nature with water, (2) nature dominated by vegetation, or (3) urban environments without water or vegetation. The information rates of the three slide samples were equivalent. Measurements were taken of the effects of the slide presentations on alpha amplitude, heart rate, and emotional states. Results revealed several significant differences as a function of environment, which together indicate that the two categories of nature views had more positive influences on psychophysiological states than the urban scenes. Alpha was significantly higher during the vegetation as opposed to urban slides; similarly, alpha was higher on the average when subjects viewed water rather than urban content. There was also a consistent pattern for nature, especially water, to have more positive influences on emotional states. A salient finding was that water, and to a lesser extent vegetation views, held attention and interest more effectively than the urban scenes. Implications of the findings for theory development in environmental aesthetics are discussed.

Affect is central to conscious experience and behavior in any environment, whether natural or built, crowded or unpopulated. Because virtually no meaningful thoughts, actions, or environmental encounters occur without affect (Ittelson, 1973, p. 16; Izard, 1977; Zajonc, 1980), an affective state is an important indicator of the nature and significance of a person’s ongoing interaction with an environment (Lazarus, Kanner, & Folkman, 1980, p. 190). Research concerning affective and aesthetic response, therefore, may have a central role in advancing our understanding of human interactions with the natural environment and could prove pivotal in the development of comprehensive theories. Further, this area of research relates to important questions in environmental planning and design, including, for instance, visual landscape assessment, the provision of vegetation and parks in cities, and issues of wilderness management and recreation. Concerning the latter, it appears that aesthetic and emotional experiences are the most important benefits realized by many recreationists in the natural environment (Rossman & Ulehla, 1977; Shafer & Mietz, 1969).

Records on recovery after cholecystectomy of patients in a suburban Pennsylvania hospital between 1972 and 1981 were examined to determine whether assignment to a room with a window view of a natural setting might have restorative influences. Twenty-three surgical patients assigned to rooms with windows looking out on a natural scene had shorter postoperative hospital stays, received fewer negative evaluative comments in nurses' notes, and took fewer potent analgesics than 23 matched patients in similar rooms with windows facing a brick building wall.