The topic of this month’s blog has been on my mind for… well, almost nine months. My second baby is due in a few weeks! Beyond all of the regular preparations for our new arrival, I have been thinking academically about the design of my local hospital. Given my experience with the building during the birth of my first child, how will the spaces and places in the hospital impact the upcoming emotions, expectations, and stress I will soon experience? What aspects do I wish were different?

These are natural questions. No really – they are, in fact, questions about nature. The theory of biophilia proposes that exposure to natural elements and sufficient daylight can reduce stress, improve health outcomes, and even assist in pain management (Ulrich, 2008). It makes sense that nature-based features have begun to be integrated into the designs of many hospitals and other healthcare settings over the last decade (Jones, 2007). 

Perhaps, where you live, designers and administrators working with hospitals, retirement communities, or hospices have used natural attributes in lobbies, patient rooms, and care units. This is the case in my city… to a point. Despite strong evidence-based research supporting the health benefits of nature views, large windows, outdoor gardens, and visual art in healthcare sites, these considerations cost money. One might argue that funds ought to be put toward medical research or assistive technology instead of aesthetics, however potentially restorative they might be.

Nevertheless, environmental and architectural psychologists, designers, and planners often consider how architecture, art, sculpture, and other interior design features can facilitate health and wellbeing by way of diminishing stress (Ulrich, 1991). In general, social design practices implemented in health care settings can reduce negative experiences with wayfinding, as well as anxiety or overstimulation caused by crowding, poor lighting, temperature, or noise. Hospital design strategies that emphasize frequent social interaction can also benefit patients, staff, and visitors by taking into account their needs in relation to comfortable seating, privacy, and so on.

However, given my current state of mind, I find myself wishing there was more of a balance between nature, function, and the necessary sterility inside the hospital my growing family and I are about to spend some time in.

Biophilia research indicates that maximizing natural light and allowing nature into buildings in other ways, like playing the sound of moving water or planting a garden for patients to passively look at through their windows, can reduce stress and other negative outcomes felt by patients (Ulrich, 1999). Other, more expensive options exist, too – especially if a new building or wing is being constructed where broader-scale plans can be implemented. Large windows can be built to offer wider views of the nearby landscape, and aquariums can be installed in common areas. Another neat concept is a green wall (also known as a biowall), where living vines, leaves, and flower species bloom and climb along a vertical surface. Green walls provide a calming visual and tactile experience (although, I suppose such advantages must balance with the cost of irrigation and maintenance).

What brought on this train of thought is my upcoming Cesarean section, during which I will be conscious and, undoubtedly, tense. I wonder at what point some of the stress-reducing biophilic design strategies will be put into practice inside operating rooms. It seems as though some procedures are now done less invasively, while patients are awake, using a local anesthetic or some other form of low-grade sedation. This trend affords the argument that ‘green’ design elements could extend into operating spaces typically set up for optimal medical performance (and not for the complex psychological needs of a patient mindful of their own surgery). This means there are new opportunities to manage patients’ stress levels using nature, but with different constraints than those present in a hospital lobby, waiting room, or recovery area.  

Perhaps, in operating rooms, patients could choose to listen to natural sounds during their procedure (through head phones if the sound stood to distract staff). Or, because a person would likely focus their gaze upward during a procedure, ceiling materials could be painted with a nature-themed mural, or a screen could be installed to cycle still or live nature scenes. Certainly, a range of green, patient-centered care options could be put into place with respect to surgical spaces if more patients undergo procedures without general anesthesia. 

So, wish me luck next month. Arguably, users of hospitals and other health care settings are those most likely to be affected by emotional stress and benefit from whatever combined power architecture and nature have to heal, support, and motivate. This is why I believe that, as ironic as it may seem, these environments could become some of the most inspiring and relaxing places in the coming years. Looking forward to it.


Jones, H. (2007). FMI’s construction outlook: First quarter 2007. Raleigh, NC: FMI Corporation.  

Ulrich, R. S. (1991). Effects of interior design on wellness: Theory and recent scientific research. Journal of Health Care Interior Design, 3, 97-109.

Ulrich, R. S. (1999). Effects of gardens on health outcomes: Theory and research. In C. C. Mearns, & M. Barnes (Eds.), Healing gardens. New York, NY: Wiley.

Ulrich, R. S. (2008). Biophilic theory and research for healthcare design. In S. R. Kellert, J. H. Heerwagen, & M. L. Mador (Eds.), Biophilic design: The theory, science, and practice of bringing buildings to life. Hoboken, NJ: Wiley.

About the Author

Lindsay J. McCunn

Lindsay J. McCunn, Ph.D., is an assistant professor in environmental psychology at the University of Washington Tacoma.

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