Healing Gardens: Landscape architects designing for children’s wellbeing
G4.1.1
Designing Research 2024
The University of Adelaide
Shivani KandalgaonkarHealing Gardens: Landscape architects designing for children’s wellbeing.
Inspired by the chapter ‘Design of Health’ in Beatrize Colomina and Mark Wigley’s book, ‘Are we Human? Notes on an Archaeology of Design’, this essay is stimulated by the Theory of Design of Health—how design is similar to medicine.1 The chapter ‘Design of Health’ summarises the relationship between the human body, diseases, and the medical institutions that contain them.
Summary
The implications of healing inspired by nature is a broad field of research that has resulted into the design of Healing Gardens within hospitals. Based on the literature that supports the efficacy of Healing Gardens, this essay argues that providing a wide variety of restorative spaces certainly determines the success of a Healing Garden. This essay also contends why the eleven Healing Gardens at the Lady Cilento Children’s Hospital are thriving as a result of thorough landscape designing. In conclusion, this essay argues why a Healing Gardens for children should be extensively designed by landscape architects in every children’s hospital.
Healing gardens for children: Design specific spaces
‘What distinguishes a therapeutic garden from all other gardens?- It is the process of design.’ The design process helps to identify and understand the types of user groups who will be utilising the design and gives the gardens shape and significance. While every healing garden is unique, this essay argues that healing gardens which provide a vast diversity of spaces and functions, are more successful than healing gardens that cater to a specific disease/ function.
With children’s hospitals, there is a tremendous potential to design for children with chronic diseases, disabilities, sensory gardens for children with autism, a garden dedicated to toddlers, and young teenagers.
For each healing garden, the design brief is unique, and the spatial requirement is different. Therefore, this essay contents that there should be a variety of spaces within these Healing gardens for it to become a successful healing garden.
When these different playscapes are hollistically designed, they enhance the Healing gardens within the medical institution. Drawing similarities from the book, ‘Are we human?’ where architects have been described as surgeons of the contemporary cities, this essay argues that Landscape architects are surgeons of the Healing gardens.
Natural Landscapes: Healing inspired by nature
The concept of man seeking comfort in nature dates back to many centuries. Nature in the form of medicinal plants was seen as intrinsic to healing.2 Throughout the epidemics during the nineteenth century, hospitals recognised the impact nature and the importance of natural environment around a recovering human being. By the 1850s, a professional dogma was established that a naturalistic landscape had a direct impact on the mental health of the afflicted patient.2
Dr. Roger S. Ulrich (Professor of Architecture at the Center for Healthcare Building Research at Chalmers University of Technology in Sweden) summarises the impact of nature on diseases and hospitalised patients.3
The research done by Dr. Ulrich in his journal articles ‘View through a window may influence recovery’ and ‘Natural Versus Urban Scenes’, and provides scientific evidence that has proved that access to nature and green spaces has improved the health outcomes and wellbeing of patients within the hospitals.3
The Kaplans and Roger Ulrich have produced a substantial body of work in 1984 that discusses the therapeutic potential of landscapes.
Healing gardens: Therapeutic spaces within hospitals
Healing gardens is a rather contemporary concept within the field of medical research. The subject of healing gardens is now being studied within the landscape architecture discourse. An issue published by the American Society of Landscape Architects in 1995 highlights that out of six healing gardens, only one was designed for children. Marcus C. Cooper & Marni Barnes have discovered that residents of aged care and nursing homes who were in proximity to plants respond positively to their treatment.4 Marcus C. Cooper and Naomi Sachs present noteworthy literature in their book, ‘Therapeutic landscapes: an evidence-based approach to designing healing gardens and restorative outdoor spaces’ the role of horticulture therapy, medicinal plants, and therapeutic healing gardens.
According to Marcus C. Cooper, who’s six literature sources have been perused for this essay, ‘The healing garden is both a process and a place. It is a concept at the meeting point of medicine and design’.5 Unanimously, researchers in the field of pediatrics and health, concur that the holistic aim of the healing garden is to provide a reduction in stress and cortisol levels, and not hope for curing the illness or any physical pain. It is accepted that these gardens themselves cannot cure a person of chronic diseases or injury, however, healing gardens can potentially offer healthcare services in the most despairing cases.6 With contemporary literature in the book ‘Children’s Hospice Gardens’ by Elizabeth Read, it is established with evidence that healing gardens immensely impact children and younger patients in a children’s hospital. It is observed that children who have access to healing gardens show a decrease in cortisol levels, quicker recovery, positive social behaviour, and possess active movements.7
Figure 2: Rooftop Healing garden for children at Boston Children’s Hospital. (Source: Mikyoung kim design, 2024. Overlay by author) Figure 3: Indoor healing garden and thematic planting for children’s wellbeing at GHS Children’s HospitalHealing gardens for children: a vital space for recovery
Healing gardens are required for children to experience nature as restorative and recreational spaces.8 Literature in books written by Elizabeth Read, Marcus C. Cooper & Marni Barnes, and Dr. Roger S. Ulrich gives a broader understanding of the benefits of having nature/ healing gardens within medical institutions. Samira Pasha in her article ‘Research Note: Physical Activity in Paediatric Healing Gardens’ elaborates that healing gardens for adults and the elderly predominantly cater to spaces that can offer maximum relaxation, comfort and recollection. Children’s healing gardens comprise more of playscapes, interactive elements and a different anthropometric altogether.9 The literature by Sandra A. Sherman (affiliated with University of Texas MD Anderson Cancer Center) summarises that children’s anxieties and imagination can be studied thorough their behaviour at a themed playscape or via fantasy play. Her article ‘‘Post-occupancy Evaluation of Healing Gardens in a Paediatric Cancer Centre’, describes how healing gardens in paediatric hospitals have been designed to engage children with exercises and playful equipment that makes hospital visits memorial for them.10 The possibility to ‘play’ within a stressful environment of a hospital or medical institution differentiates a children’s healing garden with other traditional healing gardens. Healing gardens for children facilitate expression and exploration which is vital for their cerebral development particularly in daunting hospital environments and operational wards.11 There has been considerable evidence supporting the need for a healing garden in pediatric hospital.
Playscapes: The more the better for Healing Gardens
Marcus C Cooper in his book, Healing Gardens, describes the different types of therapeutic methods adopted within healing gardens. Play therapy, horticultural therapy, wildlife therapy, and nature as therapy are
some of the restorative therapies that add value to the healing garden.13 Healing gardens for children are spaces where their personalities are meant to participate with the physical world, where recovering children can discover a sense of solace, and response to stimuli. British child psychiatrist and pediatrician Donald Winnicott emphasises that through play, a child can navigate its inner turmoil, fears, and express its desires.14 This notion reinforces that a playful landscape has the potential to perform as a therapeutic space for children, their families, and hospital employees. Through playscapes at the healing gardens, children are able to reframe hospitalisation as a pleasant experience rather than a painful one, giving them a sense of comfort and control in an unfamiliar environment.14 A significant strategy associated with play therapy is to allow children to have a sense of control within the healing garden. Healing gardens have a positive impact on children when they are exposed to situations where the child can control their environment and thus seek restoration from their stressful medical treatments.14 This strategy in landscape planning is extremely important as healing gardens are the only spaces within the medical institutions that provide this kind of freedom for the children, as against to the dreadful hospital wards where they have no control over things that are done to them.
Figure 4: Mounds for an interactive playscape at Comer Children’s Hospital (Source: Mikyoung kim design, 2024. Overlay by author)
Lady Cilento Children’s Hospital: Eleven healing gardens exclusively for children
Landscape Architect Katharina Nieberler-Walker (Principal Architect at Conrad Garett Lyons) with Griffith University and Queensland University of Technology conducted a survey to record experiences at the Lady Cilento Children’s Hospital. The survey conducted by the researchers relied on benchmarking diaries/ feedback quotes written by patients, visitors, and staff across different levels within the hospital.
This survey demonstrates positive feedback by patients who spent their time in the healing gardens during the treatment.6 Landscape design is an essential aspect that can determine the productivity of a healing garden. The hospital comprises of eleven healing gardens specific to different users. The architect has explained that having eleven gardens within the children’s hospital enables the children to have a varied access to nature and natural sunlight which reflects on children throughout their treatment.6
This provides an insight as to how landscape architecture can promote healing, how landscape architects can utilise this feedback to create efficient healing gardens. The landscape design by Conrad Garett is coherent to the hospital’s massive built form. This staggered landscape through various levels provides on opportunity for the children to interact with nature across different zones.
The landscape architecture discourse across the hospital’s Secret Garden, Adventure Garden and Babies Garden provides opportunities for outlook, restorative exercise, play, socializing, respite and retreat for children.6 The Adventure Garden includes a collection of play and rehabilitation activities including a climbing wall, a basketball hoop and a wheelchair training ramp, all of which assist with building coordination, strength and confidence amongst children.6 This project combines the peripheral roads and plazas with the expansive roof gardens to ensure that nearly 80 percent of the site can be classified as public open space, which is remarkable for a children’s hospital.
Figure 5: Tropical garden for children at Lady Cilento Children’s Hospital (Source: Christopher Frederick Jones, 2024. Overlay by author) Figure 6: Aerial view of the Lady Cilento Children’s Hospital (Source: Christopher Frederick Jones, 2024. Overlay by author)Since children associate reality through fantasy play, play is a form of action adopted by the child to initiate relationships, and engage with their surroundings. Their fascination towards nature is the reason why gardens are responsible for healing of children. Garden spaces targeted specifically to children are distinct, temporal, multisensory and aesthetically appealing. Healing Gardens provide these children a wide scale of sensory action, activating their responses to stimuli.15
The therapeutic benefits of wildlife therapy for kids have been adopted for the design of healing gardens.
Gardens help foster animal contact by giving wildlife a place to live. Some of the small interventions for wildlife therapy include planting for birds and creating butterfly gardens. The concept of human growth and development being anchored in childhood and the relationship with the landscape is expressed via healing gardens at the LCCH. The child develops a stronger understanding of who they are in the universe via their tactile connections with plants, rocks, and water.
Ninety per cent of the adults (including doctors, hospital staff, and patient families) have recorded a sense of calmness and peace in the healing garden, which they didn’t expect in a conventional medical institution. Adults who were presented with a facility like a healing garden demonstrated higher levels of satisfaction with the hospital Design strategies that encourage the plantation of contrast/ accent trees, tactile pathways, and interactive water features are crucial components of landscape design that have inspired children to engage with their surrounding environment. In addition, healing gardens providing acoustic diversity and visual appeal have nurtured children positively.15
At the healing gardens, children enjoy a break from the impersonal medical setting, have more flexibility, and engage in imaginative play in the explorative, open-ended realm of nature.
Figure 7: Sensory garden for children at Lady Cilento Children’s Hospital (Source: Christopher Frederick Jones, 2024. Overlay by author)
Figure 8: Adevnture garden the rooftop of Lady Cilento Children’s Hospital
(Source: Christopher Frederick Jones, 2024. Overlay by author)
Landscape architects: Designers of Health
The field of horticultural therapy has grown significantly in the last several years, serving a diverse clientele that includes kids with potential special needs. Helping kids develop their social skills improves their sense of achievement and boosts their self-esteem. It also gives off a nurturing vibe. The final design by the landscape architect must meet the demands of the user. Healing gardens need to be vibrant, brimming with people, activity, development, and change. Such healing spaces require careful planning and research. Landscape architect Katharina Nieberler-Walker explains that this process of landscape design consists of four phases. Investigating and defining the users’ therapeutic objectives is the first stage. The creation of concepts and the final plan constitute the second phase. Successfully integrating people into the construction process is the third phase. Making adjustments and evaluating the design are necessary for the fourth and final phase.
A landscape architect may be a great asset in designing the garden and choosing the appropriate components to make it a unique space. The factors taken into account while designing other areas have a distinct meaning when creating healing gardens. It is essential that the garden work and take into account the space users’ restrictions. This essay has emphasised the value of therapeutic gardens in medical institutions and the growing body of research showing the positive effects of nature interaction on people’s health and happiness at irrespective of age.. Healing Gardens are the spaces that distract the children, and restore their innocence. Thus, for many children, healing gardens within hospitals help them recover/ regain their health that they have lost due to their illness, or medical condition.17 It is easier to understand and establish an understanding of how to build a healing garden in the outdoors, as well as start restoring these children’s gardens with the guidelines set out in this essay.
Figure 9: Buffer spaces with green walls at the Lady Cilento Children’s Hospital (Source: Christopher Frederick Jones, 2024. Overlay by author)1. Beatriz Colomina & Mark Wigley, 2016, Are we human? : Notes on an archaeology of design (Zürich, Switzerland: Lars Muller Publishers).
2. Jenny Donovan, 2013, Designing to heal (Collingwood, Vic: CSIRO Publication).
3. Roger S. Ulrich, 1984, ‘View through a window may influence recovery,’ Science 224 (4647), p. 420–421.
4. Marcus C. Cooper & Marni Barnes, 1999, Healing gardens : Therapeutic benefits and design recommendations (New York: John Wiley & Sons).
5. Marcus C. Cooper & N Sachs, 2013, Therapeutic landscapes : an evidence-based approach to designing healing gardens and restorative outdoor spaces (Hoboken, New Jersey: John Wiley & Sons).
6. A. Reeve, K. Walker-Nieberler & C. Desha, 2017, ‘Healing gardens in children’s hospitals: Reflections on benefits, preferences and design from visitors’ books’, Urban forestry & urban greening 26, p. 48–56.
7. Elizabeth Read, 2019, Children’s Hospice Gardens: Using Nature to Enhance Well-Being, (Llangibby, UK: Elizabeth Read).
8. Marcus C. Cooper & T. Hartig, 2006, ‘Essay: Healing gardens—places for nature in health care’, The Lancet (British edition) 368(1), p. S36–37.
9. Samira Pasha and Mardelle M. Shepley, 2013, ‘Research Note: Physical Activity in Paediatric Healing Gardens’, Landscape and Urban Planning 118, p. 53–58.
10. Sandra A. Sherman, James W. Varni, Roger S. Ulrich & Vanessa L. Malcarne, 2005, ‘Post-occupancy Evaluation of Healing Gardens in a Paediatric Cancer Centre’, Landscape and Urban Planning 73(2), p. 167–183.
11. Marcus C. Cooper & Marni Barnes, 1995, Gardens in Healthcare Facilities: Uses, Therapeutic Benefits, and Design Recommendations (Concord, CA, USA: The Centre for Health Design, Inc.).
12. Marcus C. Cooper, 2016, ‘The Future of Healing Gardens’, HERD 9(2), p. 172–174.
13. Roger S. Ulrich, 1991, ‘Stress recovery during exposure to natural and urban environments’, Journal of Environmental Psychology 11, p. 210-230.
14. Catherine Ward Thompson, 2011, ‘Linking Landscape and Health: The Recurring Theme’, Landscape and Urban Planning 99 (3), p. 187–195.
15. Sandra Whitehouse, James W. Varni, Michael Seid, Marcus Cooper, Mary Jane Ensberg, Jenifer R. Jacobs & Robyn S. Mehlenbeck, 2001, ‘Evaluating a Children’s Hospital Garden Environment: Utilization and Consumer Satisfaction’, Journal of Environmental Psychology 21 (3), p. 301–314.
16. Roger S. Ulrich, 1981, ‘Natural Versus Urban Scenes: Some Psychophysiological Effects’, Environment and Behaviour 13 (5), p. 523-553.
17. Marcus C. Cooper, 2001, ‘Hospital Oasis’, Landscape Architecture 91(10), p. 36-39, 99.
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