Elsevier

Urban Forestry & Urban Greening

Volume 40, April 2019, Pages 125-132
Urban Forestry & Urban Greening

A systematic review of access to green spaces in healthcare facilities

https://doi.org/10.1016/j.ufug.2018.06.019Get rights and content

Abstract

This article describes experiences of users (staff, patients and visitors) who have had access to green spaces within an urban healthcare setting. A systematic mixed studies review was undertaken to review the quantitative and qualitative evidence on user experiences during passive/quasi passive access to green spaces within a healthcare setting, as well to review the methodological quality of the studies eligible for inclusion. A total of 24 articles met the inclusion criteria and were included in the review. User experiences were classified under three key themes on experiencing "control, choice, escape, privacy and autonomy", "opportunities for socialisation" and "engagement with and stimulation by nature". The findings can be explained by theories of human-nature interaction and are likely to contribute towards generating convincing, credible and usable evidence on the topic. Cohesively, this article highlights the importance of incorporating green spaces into urban healthcare settings and contributes to the evidence base accessible to designers, planners, policy makers and hospital administrators who aim to create and support health promoting settings.

Introduction

Regardless of whether you are a patient, visitor or a staff member, spending long hours in a hospital is a stressful experience (Cooper Marcus, 2007). There appears to be a growing recognition of nature’s role in healing and wellbeing, with a heightened eagerness to incorporate green spaces in, or adjacent to, hospitals. In the majority of cases, hospitals are located in built environments and thus, adjacent green space is ‘designed’ and not considered ‘wilderness’. The increased focus on incorporating green spaces within hospital environments has been reported to have multiple health and wellbeing benefits to users (Hartig and Cooper Marcus, 2006; Curtis et al., 2007; Detweiler and Warf, 2005; Long, 2001; Mroczek et al., 2005; Schweitzer et al., 2004; Tieman, 2001; Ulrich, 1984; Vittori, 2011; Zhao and Mourshed, 2012; Cervinka et al., 2014). This has additionally been recognized as contributing to enhanced levels of satisfaction with the healthcare provider as well as the overall quality of care provided (Ulrich, 2002).

A comprehensive search of the literature indicated that, at present, there does not appear to be any systematically conducted review specifically exploring the experiences of users (staff, patients and visitors) who have had passive/quasi passive access to green spaces within an urban healthcare setting. The working definition of passive/quasi passive access used by Cooper Marcus and Barnes (1999, p.4) which identified viewing or accessing a green space within a healthcare facility for activities such as to observe, listen, explore, sit in and stroll through, was applied in this review (Note: although not specifically identified by the authors of this definition, being wheeled through a green space was also identified within this category as applicable to the context being explored). The aim of this systematically conducted review was to explore how access to green spaces within healthcare facilities contributes towards developing a health promoting setting.

Section snippets

Mixed studies review

A mixed studies review (MSR) of peer reviewed and grey literature was conducted. A set of inclusion and exclusion criteria were applied as follows:

Inclusion Criteria:

  • -

    Articles selected for inclusion were in English and were Full Text;

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    Year of publication was restricted to 1984 onwards, as the first known empirical study on this topic was conducted in this year by Roger Ulrich;

  • -

    Any empirical study published in a peer reviewed journal, book chapter or report outlining a sufficiently detailed

Findings

There were three key themes generated from the MSR. Table 4 below provides insight into the alignment of themes with individual study findings, as well as denotes the strength of the individual themes.

Discussion

This MSR focused on patient, staff and visitor experiences in accessing green spaces within a healthcare setting. The findings reveal that the provision of green spaces within a healthcare facility afforded users various opportunities to utilise and interact with the environment to fulfil certain psychophysiological, social and spiritual needs. The experiences indicate that all user groups benefited from the restorative and coping resources (Ulrich, 1999) afforded by the green spaces. As

Conflict of interest

The authors declare that there is no conflict of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgements

The authors thank Professor Pierre Pluye and Quan Nha Hong of McGill University for the expert technical advice and guidance provided to carry out this mixed studies review. We also thank Dr Amy Shaw for the assistance provided in preparing this paper for submission.

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    This article is part of a special issue entitled “Urban Green Infrastructure – Connecting People and Nature for Sustainable Cities” published at the journal Urban Forestry & Urban Greening 40C, 2019.

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