Wellness health care and the architectural environment

The Influence of Exposure to Nature on Inpatient Hospital Stays: A Scoping Review

AIM

To summarize the existing literature surrounding the influence of natural elements on course in hospital and to introduce clinicians to the concept of biophilic design and the potential for incorporation of nature into the hospital environment as a component of a therapeutic hospitalization.

BACKGROUND

For decades, architects and designers have espoused the benefits of incorporating natural elements into the healthcare environment for therapeutic purposes. The benefits of this "biophilic" design philosophy has been investigated predominantly in long-term care or rehabilitation settings; however, some of the most appealing opportunities lie in the acute care setting.

METHODS

This scoping review surveyed the literature surrounding the influence of exposure to nature on course in acute hospitalizations. After screening 12,979 citations, 41 articles were included. Exposures were divided into seven categories, the most common of which were the presence of a window/natural light, a natural scene through a window, and nature soundscapes. These articles were reviewed in a narrative fashion and thematic analysis was conducted.

RESULTS

Studies were extremely heterogeneous in their design, research questions, and reported outcomes. Types of exposure to nature studied were exposure to a real natural scene through a window, presence of a window/nature light, nature in the healthcare environment, art depicting nature, direct contact with nature, nature soundscapes, and nature experienced through virtual reality (VR).

CONCLUSIONS

Exposure to nature during an acute hospital admission appears to have a real but small therapeutic effect, predominantly on psychological metrics like anxiety/depression, pain, and patient satisfaction. Greater beneficial effects are seen with greater durations of exposure to nature and greater degrees of immersion into nature (e.g., creating multisensory experiences using emerging technology like VR).

Effectiveness of Horticultural Therapy in People with Schizophrenia: A Systematic Review and Meta-Analysis

Horticultural therapy is increasingly being used in the non-pharmacological treatment of patients with schizophrenia, with previous studies demonstrating its therapeutic effects. The healing outcomes are positively correlated with the settings of the intervention. This review aimed to evaluate the effectiveness of horticultural therapy on the symptoms, rehabilitation outcomes, quality of life, and social functioning in people with schizophrenia, and the different effectiveness in hospital and non-hospital environments. This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. We researched studies through PubMed, Embase, the Cochrane Library, Science Direct, and the China National Knowledge Infrastructure. We included randomized controlled trials (RCTs) and quasi-experimental studies about horticultural therapy for people with schizophrenia, from January 2000 to December 2020, with a total of 23 studies involving 2024 people with schizophrenia included in this systematic review. This study provided evidence supporting the positive effect of horticultural therapy. This review demonstrated that non-hospital environments have a better therapeutic effect on all indicators than hospital environments. The results also demonstrated the effectiveness of horticultural therapy on symptoms, rehabilitation outcomes, quality of life, and social functioning in patients in hospital and non-hospital environments, providing further evidence-based support for landscape design.