Therapeutic Landscapes

"The active physical use of gardens needs greater study as design professionals seek to create gardens for different patient populations.. Landscape architects and architects in particular need a greater understanding of healthcare and the hospital environment to be able to design for specific patient populations (Davis 15)."

Brad E. Davis, Assistant Professor at the College of Environment and Design at the University of Georgia, Athens, conducted research on a rooftop garden built in 1995 at the Fort Sanders Regional Medical Center in downtown Knoxville, Tennessee.  Designed to provide patients with a convenient (and scenic) outdoor option for physical therapy or gathering with friends, the purpose of Davis' study on the specific rooftop garden was to discover what patients and hospital staff found beneficial in the garden, and what improvements they would make.

Gardening as therapy is not a new concept.  Therapeutic Landscapes are making a comeback in the healing arts, but have a rich history spanning back over 3,000 years, particularly in Persia and the Orient, many of which are still thriving today.

Knoxville's rooftop garden was one of the first to be implemented for hospital therapy in the United States as a way of imitating different terrain for patients in the physical therapy program.  The budget for the gardens is approximately $8,500.00 per year, and the budget is dictated by the lead therapist for the hospital (Davis 23).  This budget includes hiring a landscape architect who can come up with creative ways of maintaining the garden, particularly as the use of pesticides and insecticides is forbidden under hospital regulations.  

Davis' study found some downsides besides the pesticide issue.  There is not the additional finances needed to develop a greenhouse for the rooftop that would keep the garden lush year-round (Davis 23).  While patients were observed to have interest in the garden, it was not diverse enough to keep their attention, and the group setting of benches and other sitting areas in the garden didn't appear to be conducive to private conversation (Davis 25).

A survey of 25 participants in the nursing and therapy staff found interesting results.  The therapy staff had largely positive views of the garden and frequently visited it with their patients.  Nurses had a less positive view of the garden and were "too busy" to spend any time there.   Less than 25% of the staff interviewed used the garden for their own personal use (breaks, lunches) but all touted the therapeutic benefits the garden had with their patients, including activities like basketball, putting on the golf green, Easter egg huts, barbecues and concerts that allowed their patients to have normalcy in their hospital stay or have breakthrough moments re-learning an activity (Davis 27).

Patients were also surveyed to gauge their personal feelings toward the garden.  The average length of stay for the patients chosen for the study was 3.5 weeks.  Only one patient of the 13 participants said they had read about the garden in a hospital brochure; the rest had been told about the garden by staff.  All participants gave the garden high rankings in the following areas:

• an option different from indoors
• to have as a view while inside
• to use in good weather and when feeling well
• to use with family and friends
• to have some private time
• for physical therapy
• to be outside and relax and to feel the sun and wind

Patients used the garden not only for therapy, but just as a way to get outside during their stay, citing the benefits of maintaining a sense of self, well-being and positive outlook (Davis 29).

Original plans had the garden on the main level of the hospital, but it was later moved to the fourth floor of the therapy wing to keep the space contained and accessible to patients without outside influence (Davis 33). A main feature of the garden, the gazebo, offers shelter on bright days and allows patients a view of the entire garden.

Keeping plants healthy has been a constant issue for the garden; observations in 2001 revealed that most of the trees planted in the garden were beginning to die away.  Constant shifting of plants is necessary to maintain a living space in the garden (Davis 35).

While there are positives and negatives at Tennessee's rooftop garden, it is far from decline and has been used as a way to expand ideas for other garden designs that focus on Fort Sanders' strengths while trying to phase out its weaknesses.

This layout for Chicago's Schwab Rehabilitation Hospital, designed by Douglas Hills Associates, Inc., offers a space for patients to relax and rehabilitate while staying safe.  

Other hospitals implementing rooftop gardens for therapeutic use include San Diego's Sharp Memorial, the Betty Cameron Women's & Children's Hospital in Wilmington, North Carolina and The Children's Hospital of Philadelphia.  

We will re-visit the concept of rooftop gardens in hospital as the relate to specific therapeutic causes other than physical therapy in later posts.  We've only just begun to explore the rehabilitation benefits patients experience when they are reconnected with nature during their convalescence.  

Unlinked Source:

Davis, Brad E.  "Rooftop Hospitap Gardens for Physical Therapy: A Post-Occupancy
     Evaluation."  Herd Journal 4.2 (2011): 14-43.  ProQuest.  Accessed March 21, 2014.