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Credit seminarCredit seminar

Therapeutic GardenTherapeutic Garden

SHAMANTH.M.GSHAMANTH.M.GAHM/14-07AHM/14-07FLA DeptFLA DeptDr.Y.S.R.Horticultural University.Dr.Y.S.R.Horticultural University.2014-20162014-2016

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  Name Designation Department/ Major Field

Chairman Dr.R.Nagaraju Assistant professor Horticulture

Member Dr.K.Swarajya lakshmi Associate professor Horticulture

Member Dr.B.Govindarajulu Principal scientist

Pathology

Member Dr.D.Srinivas reddy Assistant professor

Entomology

Case Studies

Design Guidelines

Types of therapeutic gardens

Therapeutic garden

Topic division

History & Introduction

conclusion

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The World Health Organisation defines health as complete physical, mental and social well-being.

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Healing:- •Process that promotes overall well-being (Cooper Marcus & Barnes 1999). •In particular, it is a process that the body restores or recovers both physically or/and mentally. Moreover, it is a multidimensional process which includes physical, mental, spiritual, emotional and social aspects.

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Gardening works on many different levels which makes it a powerful and flexible medium for improving health and quality of life.

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• A Therapeutic Garden is an outdoor garden space that has been specifically designed to meet the physical, psychological, social and spiritual needs of the people

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For a patient, visitor, or member of staff, spending long hours in a hospital can be a stressful experience.

Nearby access to natural landscape or a garden can enhance people’s ability to deal with stress and thus potentially improve health outcomes.

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A therapeutic garden referred to different garden features that have the ability to foster restoration from stress and also have other positive effects on patients staffs and visitors. and “should contain prominent amounts of real nature content such as green vegetation, flowers, and water.”

Ulrich, 1984

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History• “The idea of healing garden is both ancient and modern”(Cooper

Marcus & Barnes, 1999). • Historically, people have always used nature as a powerful healing

source and as a resource for recovery (Cooper Marcus and Barnes, 1999).

• Persian garden, the Japanese Zen garden and the Monastic Cloister gardens are some of examples of a healing environment which appeared throughout history in different parts of the world.

• The Greeks created healing temples for their gods. The temple for the god Aesclepius (god of healing) was built in pastoral settings with mineral springs, bathing pools, gymnasiums, and healing gardens. Here people would come to worship, lodge, recreate, and heal.

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•In the 19th century, Dr. Benjamin Rush was first to document the positive effect working in the garden had on individuals with mental illness.•In US, horticultural therapy blossomed after World War II, with homecoming soldiers in need of restorative therapy.•Since the mid-1980s, research has indicated that gardens, parks and areas with natural greenery have beneficial effects on human health, well-being and capacity (Kaplan,R and Kaplan, S.1989).

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• Friends Asylum - first known example of psychiatric hospitals using gardening activities opening in 1813 in Philadelphia.

• In 1972, foundation teamed with the Horticulture Department at Kansas State University provided first horticultural therapy curriculum in the U.S.

• 1973 – NCTRH (National council for therapy and rehabilitation)

• 1988 – AHTA (American Horticultural Therapy Association)

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Medieval monastic cloister gardenMedieval monastic cloister gardenEarly example of restorative outdoor space for sick patientsEarly example of restorative outdoor space for sick patients

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Raised Beds Raised Beds

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INTRODUCTION

“Quality of life,” “well-being,” and “healing” are phrases that embody concepts being recognized with increasing importance in the 21st-century.

However, over the last 50 years with the rapid growth of medical technology and economic pressure, this ancient concept has been neglected.

Presently, Healthcare costs are climbing. Hence in hospitals and healthcare institutions often keep up extensive gardens and landscapes as an important part of healing.

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Therapeutic Gardens can be found in a variety of settings, including but not limited to hospitals, skilled nursing homes, assisted living residences, continuing care retirement communities, out-patient cancer centers, hospice residences, and other related healthcare and residential environments.

The focus of the thereupetic gardens is primarily on incorporating plants and friendly wildlife into the space near to hospitals and healthcare centers for the better health outcomes of the peoples.

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• The Joint Commission for the Accreditation of Hospitals Organization (JCAHO) has stated, “Patients and visitors should have opportunities to connect with nature through outside spaces, plants, indoor atriums, and views from windows” (1999).

• There is significant evidence indicating that environmental exposures, such as contact with plants and animals, viewing landscapes, and participating in wilderness experiences, may have positive impact on mental and physical health (Frumkin, 2001, 2004),

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Table 1: Responses from 143 garden users at four San Francisco Bay Area hospitals

Healing Gardens in Hospitals

Cooper Marcus and Barnes, 1995

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2069

Benefits of therapeutic gardening

• Psychological

• Social

• Physical

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Facilitates stress reduction, helps body reach more balanced state

Helps person summon up own inner healing resourcesProvide a setting where staff can conduct physical

therapy, horticultural therapy, etc. with patientsHelps patient come to terms with incurable medical

conditionProvide a relaxed setting for patient-visitor interaction

away from the hospital interior.Provides needed retreat for staff from stress of work

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• Therapeutic landscape designed for people with vision loss, outside London, England.

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Types of Therapeutic Gardens• Alzheimer's Gardens: adult day care programs and dementia

residences• Healing Gardens: acute care hospitals, skilled nursing facilities

and other healthcare facilities• Rehabilitation Gardens: rehabilitation hospitals• Restorative Gardens: psychiatric hospitals• Senior Community Gardens: assisted living, continuing care

retirement communities and other senior living residences• Cancer Gardens: chemotherapy facilities• Enabling Gardens: vocational schools, arboretum• Meditation Gardens: religious institutions and other faith

based settings

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ElementsElements

Familiar plantings Plants that attract birds and butterflies Ornamental plants Non-toxic and non-injurious plantings Annuals Soil Sunlight and natural shade Wind Precipitation

Natural elementsNatural elements

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PatioPaved walking SeatingsLandscape lightingRaised bedsShadeWater featuresElectrical outdoor

outlet; for music and related activities

Constructed garden elementsConstructed garden elements63

POTENTIAL ACTIVITIES IN

A THERAUPEUTIC

GARDEN

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Views through a windowViews through a window

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Sitting outsideSitting outside

Reading/Reading/doing paper work outsidedoing paper work outside

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Walking & Walking & Rehabilitation Rehabilitation exercisesexercises

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Therapeutic garden characteristicsTherapeutic garden characteristics

1.Scheduled and programmed activities

2.Features modified to improve accessibility

3.Well defined perimeters

4.A profusion of plants and people interactions

5.Supportive conditions

6.Universal design

7.Recognizable place making

AHTA, 2015

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Design Principles in Therapeutic Landscapes

Before starting the design process it is important to know the user groups.

In designing a healing garden the focus should be on the people who are going to use the garden.

Depending on user groups there should be a balance between the physical activities and just being and experiencing the garden passively (Stigsdotter & Grahn 2002).

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The key design principles

• Sustainability

• Orientation

• Accessibility

• Socialisation

• Meaningful activity

• Reminiscence

• Sensory stimulation

• SafetyAHTA, 2012

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Sustainability

Understanding of its therapeutic value,

activity programs and maintenance regime

Garden’s success very much depends

upon the staff’s understanding of the design

AHTA, 2012

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Orientation

•Locate gardens where they can be easily viewed from inside the

building

•Simple path system

AHTA, 2012

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Accessibility

Ensure garden accessible with people by removing the physical and

mental barriers

Ensure there is plenty of shade

Offer a range of garden beds at differing heights for ease of access

AHTA, 2012

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Socialisation

AHTA, 2012

•Enhance the quality of life

•Include elements that encourage interaction between

family members

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Meaningful activity

AHTA, 2012

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•Reminiscence

•Sensory stimulation

•Safety

AHTA, 2012

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Plants used..Plants used..

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Enhancing the sense of smell to relaxScented flowers

Blue bottle (Centaurea cyanus L.)Stock (Mathiola incana L.)

Lavendula angustifolia Rosa damascena

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Scented Climbers

Star Jasmine Rangoon creeper Bower vine

Potato vineMadhvilataHoney suckle

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Glossy Abelia Cape Jasmine

Kamini Arabian Jasmine

Din ka Raja

Night-blooming jasmine

Scented Shrubs46

Lavandula angustifolia Ocimum sanctum Passion flower(Passiflora sp.)

Rosemarinus officinalisBalm mint

(Melissa officinalis)Chamomile

(Matricaria recutita)

Anti-stress herbs45

Trees for shade (Tropical region)

Indian devil tree(Alstonia scholaris)

Indian Beech Tree (Pongamia pinnata)

Neem (Azadirachta indica)

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Healing garden entrance with arbor at Cortesia’s HealingSanctuary in Oregon.

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• View of raised beds and work tables

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Case studies..Case studies..

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“EFFECT OF HEALING GARDEN USE ON STRESS EXPERIENCED BY PARENTS OF PATIENTS IN A PEDIATRIC HOSPITAL”

Toone (2008)

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• Dell Children’s Medical Center in Austin.• To test the hospital healing garden had an effect on

the on stress levels of parents of pediatric hospital patients.

• 27 participants, equating 9 to group.• Data was collected in the form of surveys and

behavioral observation.

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Dell Children’s Medical Center in Austin.Dell Children’s Medical Center in Austin.

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Table 1- All Pre/Post Total Symptom Score and Emotional Distress Summery Scores

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Total Symptom ScoreSetting N Range Minimum Maximum MeanGarden 9 22.83 -1.67 21.17 7.3332 North 9 34.67 -28.17 6.50 -1.796Surgery 8 8.83 -3.33 5.50 1.222

Emotional Distress Summery ScoreSetting N Range Minimum Maximum MeanGarden 9 30.75 -6.50 24.25 5.7222 north 9 30.25 -24.00 6.25 -2.361Surgery 8 10.50 -3.50 7.00 1.055

Table 2- Descriptive Statistics of Change Scores Within Groups

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Table 3- Wilcoxon Signed Ranks Test

Total symptom

scoreP

Emotional Distress

Summery Score

P

Garden .015 Garden .214

2 North .678 2 North .953

Surgery .161 Surgery .514

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Conclusion

participants experienced a greater decrease in stress when sitting in the Healing Garden Courtyard than when in either of the interior spaces.

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Healing at a Hospital Garden: Integration of Physical and Non-Physical Aspects

Asano, 2008

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Fig. 1. The garden design layout of the Kansai Rosai Hospital, Japan.

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Fig. 2. Minutes spent visiting the Kansai Rosai Hospital garden.

Fig 3: Frequency of visits to the Kansai Rosai Hospital garden

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Fig. 4. Reported use of the Kansai Rosai Hospital garden by respondents of a survey (multiple answers).

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Table 1. Changes reported by patient visitors to a hospital garden.

N=142 nRelaxed 43Refreshed 24Enjoyable 8Healed 5Other (feels like my own garden, let children play with peace, able to be private )

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Unaware 1No change 3No answer 59

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Fig 5: Frequency of visit and if the hospital staff ever recommended the garden responses by hospital staff

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Fig. 6. Kansai Rosai Hospital nurses response to the possibility of rehabilitation or therapeutic use of the hospital garden

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Fig 7: A model demonstrating the design elements, purpose, and programming of a healing landscape.

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Landscape preference evaluation for hospital environmental design

Petros and Georgi. 2011

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The main goal of this study was to investigate user’s attitudes towards landscape design regarding the existing and future improvements to outdoor grounds and spaces,

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Table 1: How satisfied are you with the current outdoor space area of the hospital? (%)

A lot A little Not at allDoctors 5 45 50Nurses 12.5 75 12.5

Administrative staff 13.6 63.7 22.7Medical students 8.3 75 16.7

Table 2: Which part of the outdoor space of the hospital would you wish to increase? (%)

Green areas

Parking areas

Rest areas Isolated areas

Water formations

Doctors 90 5 5 0 0Nurses 50 4.2 37.5 8.3 0

Administrative staff

63.6 18.3 13.6 0 4.5

Medical students

52.8 13.9 25 8.3 0

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Table 3: Would you like a garden with trees and bushes in the outdoor space of the hospital to exist? (%)

A lot A little Not at allDoctors 90 10 0Nurses 70.8 29.2 0

Administrative staff

77.3 18.2 4.5

Medical students 80.6 16.6 2.8

Table 4: Do you believe that landscape design with green areas in the outdoor space of the hospital would positively affect your psychologic status? (%)

Yes May be No Doctors 95 5 0Nurses 79.2 20.8 0

Administrative staff

72.7 18.2 9.1

Medical students 91.7 8.3 0 22

Table 5. Do you want to spend your rest time in a well-designed landscape surrounding the hospital? (%)

Yes NoDoctors 85 15Nurses 95.8 4.2

Administrative staff 81.8 18.2Medical students 94.4 5.6

Table 6. What kind of vegetation would you like to be planted in the hospital’s garden? (%)

High trees

Medium height trees

Small trees

Bushes Trees+bushes

Doctors 5 15 15 15 50Nurses 4.2 29.2 20.8 8.3 37.5

Administrative staff

9.2 45 13.6 0 72.7

Medical students

11.0 22.2 11.1 0 55.6

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Table 7. Do you wish for water features in the outdoor space of the hospital? (%)

Yes NoDoctors 70 30Nurses 91.7 8.3

Administrative staff 50 50Medical students 80.6 19.4

Table 8. What combination of colors would you like to see prevailing in the hospital’s garden? (%)

Monochromatic Limited number of colors

Variegation

Doctors 10 50 40Nurses 8.3 41.7 50

Administrative staff

4.5 63.7 31.8

Medical students 8.3 47.3 44.4

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Table 9. What kind of activities would you wish to exercise in the hospital’s garden? (%).

Rest Landscape observation

Picnic Avoidance of stressful

environment

Walking

Doctors 50 10 10 30 0

Nurses 41.7 8.3 8.3 29.2 12.5

Administrative

staff

36.4 9.1 22.7 31.8 0

Medical

students

61.1 0 19.4 16.7 28

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Table 10. Do you believe a garden would help the patients to recover? (%).

Conclusion

All doctors responded to the survey gave a possibility of improving the physiologic status of the patients with outdoor gardens.

The staff understood to a large extent, the importance of having a green landscape for improving the psychology and healing of patients.

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Impact of Gardening Activities on Special Children: a Case Study

Riaz et al., 2012

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Table: 1- Distribution of children according to age, gender and living place.

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Figure: 1. Nature of impairment in special children.

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Figure: 2. Places to be used by children for gardening activities.

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Figure: 3. Opinion of respondents about gardening as a means for a closer relationship between parents and children.

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Figure: 4. Opinion of special children about having fountains around.

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Figure: 5. Kinds of plants in which special children were interested at school and home.

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Figure: 6. Suggestion of respondents about gardening to be used as part of a school curriculum.

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Figure: 7. Teachers having discussion of gardening with students in class.

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Figure: 8. Mode of involvement of children in garden activities.

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Figure: 9. Satisfaction level of parents about gardening facilities at school.

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Conclusion

The results of this study show the positive impacts of gardening for the children with special needs in respect to mental, social and all allied benefits and outcomes that are needed for their betterment.

Teachers and parents of such children observed gardening as a very important activity for their physical and psychological health along with the other trainings and education at schools.

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Organizations

American horticulture therapy association www.ahta.orgCanadian horticultural therapy association www.chta.orgCity farm www.resourcecentrechicago.orgGardening leave www.gardeningleave.orgFarming for health www.farmingforhealth.comGarden partners www.gardenpartners.orgGerman association for horticulture and therapy Horticultural therapy institute www.htinstitute.orgHuman issues in horticulture- horticultural therapy, HawaiiMichigan horticultural therapy association www.michiganhta.orgThrive www.thrive.org.ukTrellis www.trellisscotland.org.ukUrban meadows www.urbanmeadows.orgASHA foundation trust www.ashafoundation.org

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The therapeutic garden is a preceding concept, it is being revived in modern times because of the comprehensive therapeutic benefits.

It is a natural method to reduce stress, tension, fatigue, pain, sadness, depression and anxiety. It increases positive mood, energy and feeling of calm and encourage human-nature interactions.

The significance of the discipline and the contribution it can make to advancing health and well being has just begun to be understood. Continued research studies will help contribute to evidence based research and further implementation of best practices. 

3Conclusion

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Doubts…???Doubts…???

“We are not ourselves when nature being oppressed, commands the

mind to suffer with the body”Shakespeare

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