The right healthcare environment can reduce your stress

Patients and healthcare providers both benefit from gardens, natural light, and design elements that offer choice and a sense of control

By Ann Sloan Devlin, PhD - June 8, 2020
Hospital interior
Hospital interior (© istock/JazzIRT)

Daily, we read about the COVID-19 challenges facing healthcare providers and first responders as they battle the pandemic. We also read about their levels of stress. But are there aspects of their surroundings that can help mitigate the negative effects of stress?

Ann Sloan Devlin, PhD, is Professor of Psychology at Connecticut College and editor of <em>Environmental Psychology and Human Well-being: Effects of Built and Natural Settings</em> (Elsevier, 2018).Yes. Environmental psychology is the study of our interactions with these built and natural surroundings and how those interactions impact our well-being. There are other aspects of environmental psychology, such as sustainability and pro-environmental behavior, but our focus here is on stress reduction.

In the book Environmental Psychology and Human Well-being: Effects of Built and Natural Settings (Elsevier, 2018), which I edited, three of the 15 chapters offer useful information on the ways in which stress can be reduced through contact with the environment:

Throughout the book, there is an emphasis on nature and its role in human well-being. Researchers such as Stephen Kaplan (1987, 1995) and Roger Ulrich (1983) provide theoretical frameworks examining the relationships between nature, well-being and the reduction of stress. Both Kaplan’s Attention Restoration Theory and Ulrich’s Stress Reduction Theory (also called Psychoevolutionary theory) provide an evolutionary perspective on the importance of nature in our lives, and the biophilia hypothesis advanced by Edward O. Wilson (Biophilia, 1984) and Stephen R. Kellert and Wilson (The Biophilia Hypothesis, 1993) asserts that humans have an innate preference for nature. Kaplan emphasizes the cognitive aspects of the benefits of nature (i.e., nature helps to restore depleted attention), whereas Ulrich emphasizes the affective aspects (i.e., visual aspects of nature influence preference, enhance mood, and reduce stress).

Healthcare settings

The research presented in these chapters shows that aspects of the environment are related to well-being. For example, Ulrich’s Theory of Supportive Design, discussed in the chapter on healthcare settings, explains that positive distractions, social support and perceived control in healthcare settings can promote well-being. While improving the patient’s environment is usually the focus of the research, the principles can apply to healthcare providers as well.

What aspects of the environment provide these features? One of the most plentiful and effective positive distractions is views of nature, which can occur looking out the window of a patient’s room or into an interior garden in a healthcare setting. Even viewing photographs and other images of natural environments has been shown to be beneficial.

Social support for healthcare providers can come in the form of seating in staff lounge areas that offers multiple niches and differentiated areas (i.e., not simply chairs lined up against the wall), and furnishings that accommodate a range of body types. Perceived control — the belief that you can change aspects of the environment — can be as simple as being able to adjust the thermostat and HVAC and control the amount and source of light.

Therapeutic landscapes

In her chapter “Therapeutic Landscapes,” Cooper Marcus delineates the opportunities in healthcare settings for contact with nature. In her work, one of the points she makes is that outdoor settings such as gardens are appreciated not only by patients and visitors, but also by staff (Cooper Marcus & Barnes, 1995). For all of these groups, gardens not only provide sights and smells but also places to sit for meditation. In this book chapter, Cooper Marcus emphasizes the multi-sensory appeal and year-round interest that well-designed gardens offer, including smell, touch, sound, vision and taste. She also offers principles advanced by Ulrich (1999) for garden designs that have positive effects. These principles include the opportunities for exercise, sense of control, social support, and nature engagement.

Cooper Marcus states that research on these factors demonstrates their ability to “reduce stress, improve mood, strengthen the immune system and, in some cases, reduce pain.” Quoting Ulrich, she writes: “Restorative space should have ‘green plants, spatial openness with scattered trees, and peaceful wildlife’” (pp. 391-392). She notes that a range of gardens, and not a single space, is beneficial, as distance from the garden has the potential to either encourage or discourage use.

Designing mental and behavioral health facilities

In discussing what the authors consider exemplary designs for mental health care facilities, Anthony and McCaffrey identify a variety of features that have as much relevance for staff as they do for patients, in my judgment. These include “natural light and connections with nature, ... residential-like features (e.g., warm material and soft, indirect lighting), … choice in furniture, spaces, activity, and … the removal of barriers and institutional inclinations” (p. 348). As we have seen in the other two chapters, the elements that should be provided for patients and staff (nature, fresh air, daylight) are the same whether the focus is mental or physical health.

While the three chapters mentioned here were recommended in the context of healthcare providers, other chapters in the book (e.g., “Everyday and Nearby Natural Environments” and “Behavioral Impact of Naturalistic and Wilderness Settings”) also remind us of the benefits of nature more generally.

Environmental Psychology coverRead Prof. Devlin's book

Environmental Psychology and Human Well-Being: Effects of Built and Natural Settings (Elsevier, 2018), edited by Ann Sloan Devlin, provides a better understanding of the way in which mental and physical well-being is affected by physical environments, along with insights into how the design of these environments might be improved to support better health outcomes. The book reviews the history of the field, discusses theoretical constructs in guiding research and design, and provides an up-to-date survey of research findings. Core psychological constructs, such as personal space, territoriality, privacy, resilience, stress, and more are integrated into each environment covered.

The book is intended for environmental-behavior academics/researchers, environmental psychologists, environmental psychology students; and researchers in architecture, gerontology, behavioral geography, city and regional planning.

Related stories by Elsevier’s book authors

Find more resources in the Mental and Behavioral Health section of Elsevier’s COVID-19 Healthcare Hub.

woman with mask in loneliness image

Written by

Ann Sloan Devlin, PhD

Written by

Ann Sloan Devlin, PhD

As Professor of Psychology at Connecticut College in New London, Dr. Ann Sloan Devlin teaches courses on cognitive processes, I/O, environmental psychology, and research methods. She frequently writes about evidence-based design. She is a former Woodrow Wilson Fellow, and the recipient of several Mellon Foundation grants.

Dr. Devlin is the editor of the book Environmental Psychology and Human Well-being: Effects of Built and Natural Settings (Elsevier, 2018). She has been published in multiple journals, was the Editor-in-Chief of Environment and Behavior (SAGE) from 2016-18, and authored the book Transforming the Doctor’s Office: Principles of Evidence-Based Design for Routledge in 2015. Since 2001 she has also published two other books on environmental psychology and two on research methods. In 2020, she received the Environmental Design Research Association Career Award.

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