Research has shown many direct and indirect health benefits related to views of nature and access to nature. As hospitals begin to integrate ecological sites, it becomes imperative to understand the interconnection between future users’ attitudes and preferences, intended health outcomes, and the design features within the natural environment.
This study was developed to identify design principles and features that would assist in designing a courtyard that would provide restorative experiences of renewal and stress relief for nursing staff and provide the basis for creating a baseline for a future post-occupancy evaluation.
A standard landscape architecture ecological site design process was integrated with a qualitative empirical study of staff characteristics and landscape preferences for this study. Two distinct proposed designs for the new courtyard were developed utilizing the standard landscape architecture site design process. Nurse surveys were then used to evaluate the two proposed plans. Insights generated from the nurse surveys were used to develop design principles that informed the final design proposal of the new courtyard.
The ecological site assessment was used to gain understanding into the following areas: (1) ecology of the site, (2) desired program, and (3) intention of the owner. This was done through a physical assessment of geometry, views, existing landscape features, access and entrances, movement patterns, climate, and proximity. The underlying quality of the space was assessed through observing how others used the space and by spending time in the space. Discussions with hospital administration were used to gain insight into the owner’s objectives, the target user, and user needs.
Surveys were developed to gain insight into the following areas: (1) nurse attitude towards the outside and (2) nurse input on proposed design concepts and their perceived ability to reduce stress. The survey consisted of two parts and took approximately 15 minutes to complete; they were distributed during the nurses’ monthly staff meetings. The first section was composed of multiple-choice questions relating to the nurses’ attitude towards being outside in general and being outside during work. The second section used perspectives of two different proposed designs of the courtyard. The first design represented a more formal style; the second proposed design represented a more personal style. Participants were asked to answer each question by evaluating pairs of perspectives from each of the proposed plans. Participants were asked to give both positive and negative feedback on the design concepts within the perspectives to ensure a data-driven outcome. A total of 61 nurses participated in this study. Analysis of the multiple-choice questions was done using descriptive statistical analysis. Written comments were analyzed through thematic content analysis.
Results from the landscape architectural site analysis revealed a 1:2 geometry that influenced the ratio for the development of subspaces. Proximity of the chapel influenced the spiritual dimension of the program. Visual access from interior rooms at ground level was predominately on the south, and axonometric views from above occured on all four sides from the second, third, and fourth floors. Open breezeways between the POB and the old hospital offered views into the courtyard. Grass, ivy, small Chinese hollies, a few shrub bamboos, Asian jasmine, and a couple dozen small crape myrtles made up the existing plant material. The existing ground surface was concrete with brick trim, and the current tables and benches were also concrete. Access on the north side was ambiguous, and access on the south was much more direct. Overhead breezeways created thresholds on both the north and south entrances. Observation of movement patterns revealed that due to lack of visual cues, use of the formal entrance was discouraged. The climate in Bryan, Texas is hot and humid. Since the courtyard did not offer opportunities for shade, during the summer months conditions in the courtyard can become difficult to endure. The location of the courtyard among the other buildings also hindered drainage, limited breezes, and provided constant shade in certain areas. Due to proximity, it was discovered that the nurses most able to take advantage of the courtyard for breaks would be the nurses from ER and Oncology. Through an examination of the physical attributes of the space and the intuitive sense gained by spending time in the space, the potential for creating a healing space was realized. Through this assessment, an oasis was chosen to be the appropriate archetype for creating a place of sanctuary. Discussions with hospital administration determined that the primary users of the new garden would be nurses and visitors and that careful attention should be paid to ensure all views from existing hallways and patient rooms were able to reflect the healing benefits of nature.
One limitation to this study was its small sample size within a specific geographic location. Also, this study was designed to address the renovation of an existing courtyard that was underused and was developed due to hospital expansion. This courtyard may not be generalizable to landscape projects that are planned to fit strategically into the overall design of a new hospital campus. Another limitation was that user input was integrated only into the design review process. While user input was used to redirect the planning, it was not incorporated in the initial data assessment. Findings were also limited in that this study only focused on the impact of nature in relation to the factors of stress and renewal.