By Katharina Nieberler-Walker

PhD Scholar, Griffith University, Director, Australian Institute of Landscape Architects (AILA)

Building on a career in landscape architecture, which included the design and establishment of the 11 healing gardens at the Queensland Children’s Hospital, Katharina’s research consolidates her practical expertise by creating a framework to optimise the health-promoting qualities of therapeutic hospital gardens. This will assist patient recovery, support family well-being and improve staff performance and satisfaction.

Gardens as a tool for health and well-being vs the sterile clinical setting

Gardens are a valuable tool for improving health and well-being in the hospital environment and may benefit many people. Health and nature are intrinsically linked and the positive impacts of nature become available when gardens are included in healthcare settings.

Those who build or work in clinical environments, such as hospitals, understandably prioritise infection control. The resulting tightly controlled care settings are inevitably air-conditioned, with inoperable windows, bright lights and smooth, often white and shiny surfaces for easy cleaning. These clinical settings, however, feel and smell unfamiliar and this strangeness is heightened when a patient is vulnerable or ill, or as a carer, concerned for a loved one.

Eastern Gardens and Plaza, Queensland Children’s hospital, Conrad Gargett, Photo Christopher Frederick Jones

Traditional clinical environments can create stress, anxiety, and on occasion, irrational thinking by patients and their families. An explanation for this increased stress may be that human evolution closely parallels that of the natural world. As a result, the amygdala, the ancient part of our brains, may be unable to read the clinical environment quickly and effortlessly in guiding our “flight” or “fight” response. This appears comparable to a malfunctioning computer that gets stuck in a loop because of a missing or incorrect piece of code. The computer cannot process incoming information, and this causes the machine to malfunction.

Green Roof, Queensland Children’s hospital, Conrad Gargett, Photo Christopher Frederick Jones

Creating a design framework for THGs

Hospital gardens are increasingly provided because of their health-promoting qualities. However, the anticipated user experience is rarely achieved, generally because health-promoting hospital gardens are ill-defined, variable in terms of quality and so their impact is also difficult to assess. Negative or unquantifiable outcomes can waste money, time and goodwill, and undermine the value of hospital gardens.

View to the CIty, Queensland Children’s hospital, Conrad Gargett, Photo Christopher Frederick Jones

We need to establish how therapeutic hospital gardens should look and how they may be experienced by patients with varying health conditions and other users including staff. We need to understand how to design these gardens and in doing so, also produce credible, replicable and useful research.

My research investigates the creation of a design framework for therapeutic hospital gardens (THGs). This framework will enable healthcare professionals, policy setters, decision-makers, designers and hospital administrators to purposefully design and integrate THGs successfully into every hospital to benefit many different users.

Secret Garden, Queensland Children’s hospital, Conrad Gargett, Photo Christopher Frederick Jones

The need for transdisciplinary research for THG design

Transdisciplinary research is required due to the complexity of THG design and design processes. Knowledge must be derived from more than “argument and logic”, it must also be drawn from the “art of design” that is, outside the logic paradigm. “Landscape design” which includes technical knowledge and logic is a skill that takes years to master and is hard to perfect.

“Argument and logic” is one source of knowledge, and “skill and practice” is another equally valid foundation for knowledge creation. Being across both camps enables better insight into the complexity of THG design. Both types of knowledge support the creation of purposefully designed and well-integrated THGs, and thence, the optimisation of the health-promoting benefits of THGs. This process of integration is critical to the success of the end product and makes teamwork essential.

Pathways in the Secret Garden, Queensland Children’s hospital, Conrad Gargett, Photo Christopher Frederick Jones

Systematic Literature Review

My scholarly systematic literature review (SLR) examined 28 peer-reviewed academic articles published in the last five years that analysed the reported benefits and values of THGs. The SLR focused on three key terms – “hospital gardens”, “health” and “therapeutic” – establishing a clear scope for a thorough investigation of the topic of THG. While the SLR is one small step towards establishing THGs globally, it is important in that it defines the benefits/ values of THGs and the knowledge base for the rest of the study. The SLR is a substantial resource that demonstrates the status and progress towards creating THGs at this time. It is noteworthy that, over the last 10 years, there has been an exponential increase in the number of scholarly publications that highlight the intrinsic and tangible benefits of linking nature with health in clinical environments .

Conducting the SLR established a baseline in terms of both practice and research related to THGs. It confirmed that this research can make a useful contribution by creating a framework that informs the design and creation of THGs. The SLR is substantially complete and I look forward to sharing the results and findings from this SLR when it is published later this year.

Seating Spaces in the Secret Garden, Queensland Children’s hospital, Conrad Gargett, Photo Christopher Frederick Jones

Next Steps: My primary research and its expected outcomes

I will commence my primary research by asking practitioners and experts in the field of healthcare design, human and environmental health, and healthcare governance about their experiences in establishing THGs. My aim in conducting this primary research is to gather empirical evidence regarding how THGs are currently established in practice and how this evidence can inform the THG framework.

My research is based in the real world. My research will enable practitioners, designers and hospital administrators to create purposefully designed and well-integrated hospital gardens globally, to further human, environmental and organisational health. Ultimately, this will serve the common good.

To learn more about this subject, please contact me.

I acknowledge the traditional owners of the lands on which I work. I pay my respects to Elders past and present.