What happens in the mind of man is always reflected in the diseases of his body. —Rene Dubos
While it may seem intuitive that calming nature scenes would be preferable to abstract or provocative artwork in a hospital environment, Roger Ulrich was the first person to actually measure the effects of patient’s surroundings on the healing process. Ulrich’s 1984 study focused on patients who could see trees, rather than a brick wall, through their patient-room window. The study found these patients required less narcotic pain medications, experienced a shorter hospital stay, and had fewer negative evaluative comments in nurses’ notes (Sternberg, 2009).
Since Ulrich’s original research hundreds of studies have been conducted related to the effect of design elements in healthcare. This field of study is called Evidence-based Design (EBD) and is defined as “the process of basing decisions about the built environment on credible research to achieve the best possible outcomes” (The Center for Health Design, 2008). Workflow, patient privacy, noise reduction, and the prevention of hospital acquired infections are a few examples of the other design features studied in addition to artwork. Artwork studies have used physiological measures like blood pressure, heart-rate, and cortisol levels to show a reduction in the body’s stress response when exposed to calming nature scenes (Ulrich, 1999).
Stress leads to many serious and often deadly health problems. “It [stress] slows healing, predisposes the body to more severe and frequent infections, and compounds the effects of illness. A hospital environment, whose goal is to heal, should do what it can to eliminate stress,” according to Esther M. Sternberg, M.D. (2009), a prominent researcher on brain-immune interactions and the effects of the brain’s stress response on health. “It takes less stress to turn on the body’s stress response when we don’t feel in control. Our perception of stress, and therefore our response to it, is an ever changing thing that depends a great deal on the circumstances and settings in which we find ourselves.”
I felt immensely vulnerable, hoping the strangers prodding and prying would help me, not hurt me.
In healthcare environments the stress response in patients is far more likely to be triggered by seemingly benign triggers, like abstract art or noise. For example, a patient getting prepped for surgery relinquishes more than a little bit of control. She places herself in the hands of strangers in an environment that often feels sterile and impersonal. When you imagine an anxious and vulnerable patient, it is easy to understand how little things can feel like big things; a kind word, the caring touch of a nurse, a serene nature scene. Patients on gurneys viewings ceiling mounted scenes of nature had systolic blood pressure levels 10 to 15 points lower than patients exposed to either esthetically pleasing “arousing” images or a control condition of no image (Nanda, 2010).
Studies show waterscapes featuring calm, non-turbulent water can lower blood pressure.
“While viewing art in healthcare settings, particularly in high stress areas (procedure rooms, ICU’s, pre-surgery rooms etc.), our flight or fight response will kick in before any higher level of aesthetic judgment is made. In other words, our ‘museum brain’ and our ‘hospital brain’ function differently,” according to renowned researcher in the field of evidence-based healthcare art, Upali Nanda, Ph.D. (2010).
Characteristics of Healing Artwork
The most appropriate artwork for healthcare is representative nature art. Representative art is concerned with the authentic representation of nature and living things. Its chief characteristic is that the subject matter is immediately recognizable. Natural elements like water, mountains, trees, grass, the sky and the sun are universally understood and require no interpretation.
“Nature holds the key to our aesthetic, intellectual, cognitive and even spiritual satisfaction,” said E.O. Wilson, a biologist who theorized that humans have an innate love for nature. “Biophilia” is the term he coined to describe this affinity. While most of us would rather be in nature as opposed to gaze at an image of nature, a quiet hike in the woods, a walk on the beach, or sitting in a park listening to the birds is not always possible. Sometimes circumstances, like being ill, prevent us from experiencing nature directly. However, when we are unable to go outside, representative artwork can trigger memories and can serve as a vehicle for our imagination that allows us to take a mental vacation from our present circumstances.
Having land and not ruining it is the most beautiful art that anyone could ever want.—Andy Warhol
Not everyone is enamored with nature art. To describe a work of representative nature art as “beautiful” or worse, “sublime” is a kiss of death in the art world. On the other hand, to describe a work of art as “provocative” or “destabilizing” is high praise. But aspects of artwork that are highly valued in the art world are irrelevant in the business of caring for patients. Studies have shown abstract or ambiguous art increases anxiety in patients. In one study, ambiguous art requiring an interpretation was significantly more likely to be interpreted negatively when viewed by patients than the same artwork when viewed by students (Nanda, 2010). Patients are challenged enough by their health and do not need to be challenged further. Allegiance in healthcare art is to the patient, not to the artist or the field of arts.
It is not necessary for the public to know whether I am joking or whether I am serious. —Salvador Dali
Healthcare art should console patients, not confront or confuse them. Representative nature art most appropriate for healthcare environments has at least one or more of the following characteristics (Vincent, 2011).
1. Open prospect or depth of field
2. Refuge or place of shelter or safety
3. Lack of ambiguity or hazard
These characteristics serve as guidelines in the selection of healthcare art but they still leave room for artistic freedom when it comes to the selection of size, subject, composition, materials, and placement. (See Why Choose Us)
The statement “form follows function” is an architectural principle that means the design of the building or object is determined by its function or purpose. Artwork in healthcare should support the function or purpose of each space. For example, the artwork most appropriate for end-of-life care in a hospice center will be different from the artwork selected to support the function of a orthopedic and sports rehabilitation center, in which patients are being encouraged to re-engage with life.
The mountains are calling and I must go.—John Muir
The greatest weapon against stress is our ability to choose one thought over the other.—William James
Benefits of EBD Artwork
1. Promotes healing by reducing stress.
Patients with views of nature requested less pain medication, complained less to staff, and left the hospital earlier than patients without views of nature in Roger Ulrich’s groundbreaking 1984 study. Subsequently, many studies have been conducted that substantiate that views of nature, even in artwork, alleviate stress and promote healing. (Sternberg, 2009).
2. Improves staff efficiency and morale by providing a positive distraction for patients.
Staff efficiency and morale improved when patient stress was reduced by providing patients the opportunity to focus on nature artwork. Placing calming artwork in patient waiting rooms resulted in a significant decrease in the following behaviors: 1) front desk queries, 2) out-of-seat behavior, pacing, talking, noise, and 3) people watching (Nanda, 2010).
3. Enhances the image and reputation of the organization.
Representative nature art softens and humanizes institutional environments by making them less intimidating. All people can relate to nature regardless of age, race, gender, or culture.
a. Increases Perception of Care and Competence.
Physicians and staff received higher competency ratings from patients the nicer the surroundings and the more positive distractions. (Heerwager, 1990).
b. Enhances Way-finding.
Artwork programs can serve as landmarks for patients and visitors.
4. Improves HCAP scores.
All of the above benefits are positively correlated to higher HCAP scores (Ulrich, 2001).
Study nature, love nature, stay close to nature. It will never fail you.—Frank Lloyd Wright
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