Healthcare Design - November 2014 - 106

The randomized family birthing study will assess effects on full-term, low-risk expectant mothers who access the garden for walking, sitting, and resting during
early stages of labor, before returning to birthing
rooms for delivery. The researchers will measure the
extent to which access to the garden may lessen their
discomfort, pain, and stress-as well as the impact
on their babies' conditions at birth-compared with
controls. With prior research showing that the mom's
stress level can influence delivery, "We're trying to find
out if gardens are actually helpful and show measurable benefits in early stages of labor," Ulrich says.
The ICU family study could not be randomized
because of ethical concerns about denying garden

Are gardens clinically effective?
It's just common sense that most people will say
a garden makes them feel more peaceful, says Dr.
Alar Mirka, director of clinical research at the Legacy
Research Institute and a member of the Terrace
Garden research team. "But trying to turn that into
scientific questions, with hypotheses that can be
tested, is harder to do. One of the tools we've developed is a questionnaire to translate the complexities
of emotional experience into data"-which utilizes, for
example, the visual analog scale to quantify subjective
measures, such as emotional state.
Ulrich, a professor at the Center for Healthcare
Architecture at Chalmers University (Gothenburg,
Sweden), says there's a growing body of research on
therapeutic gardens, with evidence that well-designed
access to nature for patients and other hospital users can help reduce healthcare costs and increase
customer satisfaction. He was in Portland in June for
research meetings and press events related to the
Terrace Garden research project.
"It's amazing how far things have come and how
quickly," he said at a press conference. "But there's
still a long way to go. We need much more research
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HCDmagazine.com 11.14

to see if the benefits really are there-are gardens
truly effective clinically? Many knowledge gaps
remain, and there have been few controlled trials
measuring outcomes in hospital gardens."
The field needs to carry out scientifically sound
outcomes research with sufficient rigor to qualify
for publication in medical journals, which carry
weight with decision makers, medical administrators, and clinicians, he adds. This kind of
research is costly and requires a multidisciplinary
team collaborating on study design, development, and evaluation.
"There's always a risk that when rigorous randomized controlled trials are carried out, the findings will not be positive. Science allows methods
to disprove researchers' expectations. We hope
that the new garden will show beneficial results,
but there will be some surprises. Whatever we
find will advance the overall knowledge base,"
Ulrich says.
The Legacy garden researchers plan to announce their findings at a public event on-site in
October 2015. HCD
Larry Beresford is an Alameda, Calif.-based
journalist. He can be reached at larryberesford@
hotmail.com.

Top, left: The display of succulents and poppies serves
as a green roof for the
garden's toolshed and a test
of sustainability techniques
for Legacy's therapeutic
gardens program. Above:
A view from a third-floor
rooftop shows the new
second-floor Terrace Garden
overlooking the 17-year-old
ground-level Children's
Garden with its canopy of
deciduous and conifer trees.

LEGACY HEALTH

access to highly stressed family members of ICU
patients. Instead, the researchers designed an observational study to try to identify benefits experienced
by any ICU families who visit the garden. A fourth,
post-occupancy study is also planned, with several
months spent observing people who use the garden
and their patterns of use-what they do in the garden,
where they sit, and which plants and design features
they respond to.

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Healthcare Design - November 2014

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