DESIGNING A HEALING GARDEN FOR THREE PATIENT POPULATIONS BASED ON RESEARCH, THEORY, OBSERVATION AND INTERVIEWS by HAYES ROGERS FAIRCHILD (Under the Direction of Brad Davis) ABSTRACT This thesis explores types of healing gardens suited for three patient populations: dementia, catastrophic, and psychiatric. It addresses the features that need to be included for each of these patient populations, and why different features need to be emphasized for each type of patient. It presents historical information on healing gardens, including prior research, theory, and design methods, as well as conclusions the researcher reached by observing patient behavior in gardens, and by conducting focused interviews with patients and unstructured interviews with garden directors. The researcher examines the results of these efforts through the prism of theoretical structures offered by environmental psychologists and landscape designers. The researcher then creates a prototype garden for each of the three patient populations. INDEX WORDS: healing gardens, nature preference, stress reducing factors, evidence-based design, post occupancy evaluation, patient population, Roger Ulrich, Steven and Rachel Kaplan, clinical studies and physiological measurements with plants, supportive design theory, healing garden features DESIGNING A HEALING GARDEN FOR THREE PATIENT POPULATIONS BASED ON RESEARCH, THEORY, OBSERVATION AND INTERVIEWS by HAYES ROGERS FAIRCHILD B.A., Psychology, Mercer University, 2002 A Thesis Submitted to the Graduate Faculty of The University of Georgia in Partial Fulfillment of the Requirements for the Degree MASTER OF LANDSCAPE ARCHITECTURE ATHENS, GEORGIA 2011 © 2011 Hayes Rogers Fairchild All Rights Reserved DESIGNING A HEALING GARDEN FOR THREE PATIENT POPULATIONS BASED ON RESEARCH, THEORY, OBSERVATION AND INTERVIEWS by HAYES ROGERS FAIRCHILD Major Professor: Brad Davis Committee: David Spooner Marguerite Koepke Neal Weatherly Electronic Version Approved: Maureen Grasso Dean of the Graduate School The University of Georgia August 2011 DEDICATION To the ones I love. iv TABLE OF CONTENTS Page DEDICATION ............................................................................................................................... iv LIST OF TABLES ........................................................................................................................ vii LIST OF FIGURES ..................................................................................................................... viii CHAPTER ONE INTRODUCTION ..............................................................................................................1 TWO THEORY AND RESEARCH OF HEALING GARDENS ............................................3 BRIEF HISTORY OF HEALING GARDENS ...................................................................3 RESEARCH, THEORY AND DESIGN FOR THE MODERN HOSPITAL SETTING.10 THREE METHODOLOGY ...................................................................................................34 DIRECT OBSERVATION ................................................................................................35 FOCUSED INTERVIEWS ................................................................................................38 UNSTRUCTURED INTERVIEWS WITH PROGRAM DIRECTORS ...........................40 FOUR CASE STUDY SITES ....................................................................................................41 CASE STUDY ONE: DEMENTIA GARDENS AT WESLEY WOODS ........................42 CASE STUDY TWO: CATASTROPHIC HEALING GARDEN AT SHEPHERD CENTER…………………………………………………………………………………50 CASE STUDY THREE: PSYCHIATRIC HEALING GARDEN AT SKYLAND TRAIL ............................................................................................................52 v FIVE RESULTS AND DISCUSSION…….……………………………………...................54 WESLEY WOODS ............................................................................................................54 SHEPHERD CENTER .....................................................................................................60 SKYLAND TRAIL ...........................................................................................................64 SUMMARY ......................................................................................................................71 SIX IMPLICATIONS FOR DESIGN....................................................................................77 PREFACE TO PROTOTYPE DESIGNS ..........................................................................77 PROTOTYPE THERAPEUTIC GARDEN ONE: DEMENTIA HEALING GARDEN..................................................................................79 PROTOTYPE THERAPEUTIC GARDEN TWO: CATASTROPHIC HEALING GARDEN………………………………………….……84 PROTOTYPE THERAPEUTIC GARDEN THREE: PSYCHIATRIC HEALING GARDEN………………………………………………….88 SEVEN CONCLUSIONS……………………………………………………………………92 REFERENCES…………………………………………………………………………………96 APPENDICES…………………………………………………………………………………103 A PATIENT INTERVIEW CONSENT FORM………………………………………103 B PATIENT QUESTIONNAIRE ..................................................................................104 C LETTER OF PERMISSION TO CONDUCT RESEARCH AT SKYLAND TRAIL ...................................................................................................105 D OPPORTUNITIES FOR EDGE TREATMENTS IN EACH OF THE THREE GARDENS……………… .........................................................................................106 vi LIST OF TABLES Page Table 2.1: Types of Post Occupancy Evaluations .........................................................................12 Table 2.2: Number of Doses of Analgesic Meds Given Two Patient Groups (Ulrich, 1984) .......15 Table 2.3: Kaplans’ Environmental Preference Matrix .................................................................21 Table 2.4: Kellert’s Typology of Values in Nature .......................................................................22 Table 2.5: Evidence-Based Design Process ...................................................................................30 Table 2.6: Advantages of Evidence-Based Supportive Design .....................................................32 Table 4.1: Three Case Study Sites and Their Patient Population’s Disease ..................................41 Table 5.1: Patient Answers to Questionnaire at Wesley Woods ...................................................56 Table 5.2: Patient Answers to Questionnaires at Shepherd Center….…………………………..62 Table 5.3: Patients Answers to Questionnaires at Skyland Trail ...................................................67 Table 5.4: Garden Features and Their Affects in Each Garden .....................................................71 Table 5.5: Roger Ulrich’s Four Factor Model Related to Three Case Study Sites ........................74 Table 5.6: Kaplans’ Four Factors of Preference Theory Related to Case Study Sites ..................75 Table 6.1: Kaplans’, Ulrich’s, and Others Factors in Dementia Healing Garden .........................83 Table 6.2: Kaplan’s, Ulrich’s, and Others Factors in Catastrophic Healing Gardens ...................87 Table 6.3: Kaplan’s and Ulrich’s Factors as they relate to Psychiatric Healing Garden ...............91 vii LIST OF FIGURES Page Figure 2.1: St. Paul’s Cloister Garden, 1208-1235 ..........................................................................4 Figure 2.2: Plan of Brislington House Showing Airing Courts, 1804 .............................................7 Figure 2.3: Original 1912 Olmsted Site Plan for Butler Hospital, Rhode Island ............................8 Figure 2.4: Buffalo State Hospital for the Insane, 1916 ..................................................................9 Figure 2.5: Hospital Room Views from Ulrich’s Study ................................................................14 Figure 2.6: View from Patient Rooms in Ulrich’s Study...............................................................14 Figure 2.7: Results from Ulrich’s Study Showing Decrease in Stress when Exposed to Nature ..17 Figure 2.8: Evidence-Based Design Process .................................................................................31 Figure 4.1: Satellite Image of Wesley Woods Dementia Facility .................................................42 Figure 4.2: Angela Pappas’ “Alzheimer’s Garden” (2006) ...........................................................44 Figure 4.3: Wesley Woods Psychiatric Garden Water Feature……………….…………………45 Figure 4.4: Crepe Myrtles, Wesley Woods Psychiatric Garden………………………………... 46 Figure 4.5: Psychiatric Garden Raised Vegetable Planter……….……...……………………….47 Figure 4.6: Wheelchair Accessible Planter ....................................................................................47 Figure 4.7: Planters Covering Grate ..............................................................................................48 Figure 4.8: Wesley Woods Outdoor/ Greenhouse Areas ...............................................................49 Figure 4.9: Path with Boundaries: Greenhouse, Railing, and Shrubs ............................................49 Figure 4.10: The Shepherd Center, Atlanta, GA ...........................................................................51 viii Figure 5.1: Patient in Wheelchair by Raised Bed ..........................................................................61 Figure 5.2: Debi Cziok shows how to use adaptive garden tools ..................................................61