Natural philosophy


Report on the benefits of giving patients access to nature via design to promote their wellbeing and recovery, and advocates some methods. Article for HD Magazine to be published October 2002

Paradoxically health buildings often have a detrimental effect on the well-being of the user, and clinical spaces in particular are likely to actually inhibit recovery due to their static and often oppressive atmosphere. Natural healing processes can occur given the right conditions.Together with a US mandate for health organisations over the next decade to incorporate contact with nature, there is increasing evidence to show that patients able to view nature have made significantly improved recoveries. Further research in Japan suggests there is a direct relationship between sensory deprivation and decline in health, and recommends the introduction of positive diversions which nourish the senses. To fully address the use of nature as a positive stimulant requires a fundamental reappraisal of healthcare provision. Simply adding piecemeal layers of sensory nourishment is inadequate; nothing less than the dissolution of the mainstream hospital as we know it is required. Medical architecture is not restricted to procurement and construction targets, but is more importantly about the psychology, comfort and feelings of the patient, all of which are within the domain of the designer. To bring nature nearer to the patient¹s experience we must first appreciate that hospitals are not fortresses and the natural world does not end at the front door. And now that the profile of healthcare has become much more comprehensive, the emphasis is shifting to a more integrated and complementary approach.

There are two principle landscape experiences which concern the patient; the general vista of distant and intermediate views, and a relatively more direct relationship with the foreground. The view from the ward across the intermediate grounds and neighbourhood is the classical vista. The window frames the landscape, the view becomes part of one¹s personal domain. Without the pleasure of even visual interaction with the landscapes, rooms with no views lead to feelings of insecurity and disorientation. Although some waiting spaces have reasonable outlooks, the quality of views available to inpatients from most ward accommodation remains extremely unsatisfactory. Currently, most of the middle ground¹ of the estate (areas ripe for landscaping) has been invaded by the hostile paraphernalia of vehicle access. For new developments the hospital curtilage should respect the surroundings, and the access roads should be kept as short and as far away from the building as possible with private cars moved off site altogether. The supremacy given to traffic puts enormous pressure on the remaining green space and makes close-in gardens even more precious and vital. A patient-centred hospital requires a more human-scale grain, the geography broken into smaller clusters of individual units. With the picturesque vista blighted by traffic and car parks, greater importance must be placed on the patient¹s immediate surroundings.

The challenge is to link their sensibilities to external natural phenomena. The patient¹s senses require stimulation brought to the bedside, with organic interaction given preference over static and sterile environments. Experiences should include natural sunlight, the sound of breeze through the leaves and efficient cross ventilation to oxygenate the air within. A combination of transparent and translucent panels can offer a layered threshold, through which the user may appreciate the surrounding garden. Window bays, internal lightwells and rooflights all offer opportunities to penetrate the clinical membrane. Sliding doors and French windows will provide floor-to-patio access and low window sills improve light quality, seating and sightline potential. Glazed solar panels admit light and offer views, and internal planting will offer shade. While this multi-layered "threshold" between indoor and outdoor provides an in-between mediation space, there are other ways to transfer natural phenomena. Water is an excellent reflector and, in certain configurations, can be used to stimulate and animate. Although internal water features have largely been made redundant by legionella scares and ongoing maintenance costs, creative use of water is an extremely effective means of reducing stress levels and contributing to a better quality of life. Research on the presence of water has found that it triggers sensory stimulation, both soothing and stimulating patients*.

While first-hand tactile experience of water and vegetation is essential to successful healthcare design, the world of virtual reality offers another potential layer of interaction with nature. Early comparative tests by the architectural psychologist Roger Ulrich using films of outdoor environments found plummeting stress levels during exposure to parkland scenes. Studies have since confirmed quick relaxation responses to films with sound contributed more significantly to recovery than just a view. With healthcare increasingly moving towards shorter-term treatments, the notion that nature can produce stress recovery within a few minutes has important implications. The inpatient is involuntarily withdrawn from the rhythms and therapeutic effects of nature when they are encased in an alien and clinical white cube, with windows often only providing a very limited access to the outside.

Developments in real time broadcasting technology offer new possibilities of experiencing the delights of nature. Adapting familiar hospital security technology for more creative purposes is an affordable and easily achievable approach to 'bringing the outside in.' Other video media can provide engagement with the elements. Improvements in CCTV now offer excellent video monitoring, and a ready made studio network can downstream an array of images from any location within the hospital estate and beyond. Beautiful and relaxing images of nature can be streamed through to the individual monitors in each bed or waiting space, providing an undemanding experience, natural reassurance and visual interest. These network configurations are in widespread use and it may simply be a matter of reusing existing installations. This 'nature-watch¹ concept enables the patient to interact directly with real-time events around the hospital grounds, and provides an almost subliminal beneficial experience, in complete contrast to attention-grabbing TV.

Case study: Ystradgynlais
Ystradgynlais Community Hospital near Swansea was designed with a strong horizontal emphasis to reduce apparent height to a more human scale. Combined emphasis on energy conservation led to the provision of overhanging eaves, and sinking the building into the slopes on the north side provided protection from the wind. The narrow five-fingered plan enables all rooms, where required, to be naturally lit and ventilated. The landscaping was considered an important factor in striving for a restful, un-institutional environment and it has been enhanced by a building shape that creates attractive enclosures between wings. The large overhanging eaves, banding of brickwork and continuous sill help to link the building elevation to the site, appearing inviting to the community it serves. The core of the plan is a hexagonal court to which all corridors lead, and on to which the main entrance and reception areas face (see pic, left). This provides a recognisable focus without need for intensive sign- posting. The central concourse serves as meeting area and facilitates a relaxed informal atmosphere.

Case study: WEST Dorset
West Dorset Hospital Trust is collaborating on a project with the Dorset Wildlife Trust to provide patients in isolation with access to views of remote and beautiful parts of the Dorset countryside. Patients will be able to access these cameras at any time to watch and listen to live nature. The low key sensory stimulus will provide a soothing and healing experience for patients who are deprived of everyday contact due to their high risk of infection. These virtual windows will be placed in two of four rooms used for cancer patients and an intended research project, to be conducted by a clinical psychologist with the patients, will measure the effect on medical outcomes.


* David Haley: 'Water & Well being¹. Faculty of Arts & design, Manchester Metropolitan University.


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