Robert Ryan Ph.D., FASLA, Chair Landscape Architecture and Regional Planning, UMass Amherst Theodore Eisenman Ph.D., Committee Member Landscape Architecture and Regional Planning, UMass Amherst Joanne Westphal, Ph.D., D.O., Committee Member, Michigan State University
Gardens have been used as places for meditation, relaxation, and restoration through the ages. From the earliest times, gardens were used as sanctuaries and restorative places, providing psychological, spiritual, emotional, and physical health care delivery in Western, Eastern, and Asian societies. In the late twentieth century Roger Ulrich’s (1984) scientific investigations showed the tie between nature’s positive effects on human health and the ability of patients to recover from surgery faster. This and other scientific research gave rise to the creation of therapeutic gardens in healthcare facilities. Today, therapeutic gardens are designed to meet medical goals through activities known to improve human health—e.g., walking, socializing, massage therapy, etc. The intent is to support the patient’s recovery in the medical environment, and to provide positive measurable results (Gerlach-Spriggs & Healy 2009). Conventional wisdom suggests that the most effective therapeutic gardens tend to be designed for a specific patient group, and those surrounding the patient—i.e., medical staff, family members, and care givers. Specific activities can be designed into a therapeutic garden that match the standards of care and therapeutic outcomes defined for a patient group. These may include: walking (physical therapy), planting (horticulture therapy), smelling (aroma therapy), viewing flowers and plants (chromotherapy, cognitive therapy), and all other therapeutic treatments aided by nature. Since a therapeutic garden often targets the deficits of specific patient groups, they oftentimes are not designed alike nor do they follow the same guidelines. This project identifies tests the idea that therapeutic gardens should be designed for the primary patient population and/or the secondary support personnel that care for a patient; it uses a hospice garden to test whether this notion of unique design is appropriate within the broader specialty area of therapeutic garden design.
This professional paper is an exploratory study that examines the distinct benefits that a garden provides under hospice conditions. Unlike more traditional therapeutic gardens, the primary user group—i.e., the patient—quickly fades from the program elements, leaving three distinct secondary populations to being served—medical staff, family members, and care givers. Understanding the desired outcomes for these three populations helped the author broaden her knowledge and appreciation of the relationship between, and among, health care delivery, therapeutic garden goals/objectives, and standard treatment protocols. It is for this reason that this study attempted to define when standard therapeutic garden design protocols and goals are appropriate, and when the designer must go to a broader set of goals and objectives that address the health and wellbeing of a secondary “patient” group—i.e., those medical staff, family, and care giver who have been left behind.
This paper is organized into four parts—a literature review, methodology section, data findings, and a conclusions chapter. The literature review section presents a general history of garden use in the treatment of patients and contemporary thoughts on gardens in health care delivery. It also discusses current needs for therapeutic gardens in hospice care, since hospice is the final stage in palliative care delivery. The methodology chapter begins with a typical request for a design project with solution, involving the Lake Superior Hospice Association and their property in Marquette, MI. At that time, a preliminary set of plans were completed, using the typical questions a designer would address with a client. Among the questions to be addressed were what are the specific characteristic of this hospice; what do we know about its users and their needs in terms of garden program? To broaden out an understanding of hospice environments, this preliminary set of plans were set aside to pursue a second and third phase of inquiry involving this evaluation of four other hospice facilities and their users in order to develop baseline data on the similarities and differences in hospices. It allowed the author to define a broader base of personal, professional and/or therapeutic benefits a hospice garden might provide to its users; it also identified other needs that hospices might have that were different from the Lake Superior case study. The chapter on data findings summarizes the investigation into hospice similarities and differences and is applied to the Lake Superior Hospice (LSH)Association) in Marquette, MI in a final set of plans which can be found in the conclusions chapter.
The paper essentially involved studying the pre-construction condition of a site with a narrow perspective on hospice garden design, which was then followed by a broader investigation of hospice facilities operating elsewhere, and using that data to suggest possible improvements (i.e., a metaphoric post-construction evaluation) in the original design that serves the LSHA more appropriately.
This project will contribute to the advancement of landscape architecture as it continues its transition to an evidence-based profession. Findings from the case study and baseline data comparison was used to create a conceptual framework for decisions affecting garden design that serves patients, patient advocates, and hospice staff, who deal with end-of-life circumstances. The appropriateness of certain design elements under different hospice conditions—structurally, environmentally, managerially, and demographically – must be taken into account. This will provide better design outcomes that can be used to compare and analyze the decisions affecting therapeutic gardens in a hospice healthcare system.