Research in biophilia — the notion that humans experience an instinctive bond with nature and other living things — as well as the effects of daylighting has greatly increased our understanding of and appreciation for the ways in which access to nature and nature views enhance the experience of occupants in built environments.

The findings of this research now inform the architecture and design of most major healthcare facilities and many smaller ones. As several recent studies show, when these practices are applied across the board, they create a synergy that produces multiple benefits for all occupants — patients, visitors and staff.

As the cost of healthcare continues to escalate, the focus in medicine and public health has been shifting toward prevention and wellness. A team of researchers led by Jennifer DuBose, a research associate in the School of Architecture at Georgia Tech, conducted a literature review of research on the health impacts of spatial design to learn how those findings might be applicable to the design of spaces that foster healing.

Healing spaces, posit the researchers, "evoke a sense of cohesion of the mind, body, and spirit. They support healing intention and foster healing relationships."

Their study identified six key environmental variables found to directly affect or facilitate healing, among them light and access to views and nature. (The others are homelike environment, noise control, barrier-free environment, and room layout.)

When incorporated into the physical setting, these elements can help to alleviate stress and anxiety as well as induce feelings of well being, which have been shown to promote healing and wellness.

New research has found additional evidence of the importance of daylight in healing spaces. A study recently conducted at Georgetown Medical Center has revealed yet another reason why adequate daylighting is so important in built environments.

Research has shown that daylighting improves occupants' mood and productivity. And it has long been established that sunlight is essential to the production of vitamin D and melatonin in the human body. Unexpectedly, the researchers discovered that low levels of blue light, found in sun rays, make T-cells move faster, thus improving the body's immune system.

Research shows that, in addition to reducing stress and anxiety, nature images and views can also help distract patients from pain.

Thus, healthcare design expert Debajyoti Pati, professor of interior design at Texas Tech University, and colleagues studied the impact of nature images on women's labor and delivery experience. Women who watched Nature TV during their labor had a more positive experience overall, including a lower mean heart rate.

These women also reported a higher level of satisfaction on the Quality of Care From the Patient's Perspective (QPP) questionnaire. The more Nature TV they watched, the higher the rating. In addition, their infants had a higher Apgar score.

Of course, access to plants or landscaping can irritate or distress patients with allergies or other environmental sensitivities.

Sarah Blaschke, a landscape architecture and cancer-experiences researcher based at the Peter MacCallum Cancer Centre in Melbourne, and colleagues sought to evaluate the response of patients and staff in an oncology clinic to the use of artificial plants, since live plants were not an option.

Although about two-thirds of the respondents said they prefer living plants, 8 in 10 said they liked the green features and noticed them immediately upon entering the waiting room. Three-fourths said having the artificial plants was much better than having no plants at all.

The presence of nature views and images benefits more than just patients. An investigation led by Adeleh Nejati of the Center for Health Systems & Design in the College of Architecture at Texas A&M University examined how nature images and views might prove restorative for hospital staff.

The study tested a range of access to nature in hospital staff break rooms, from paintings of natural landscapes to the presence of indoor plants to views of nature through a window to direct access to the outdoors through a balcony. Staff were provided with sets of nature visualizations and asked to rate them according to how restorative they found them to be.

The findings showed that ratings increased significantly based on higher levels of nature content, with direct access to the outdoors receiving the highest ratings. Break rooms lacking nature content, in contrast, were deemed to be nonrestorative. Interestingly, the landscape paintings were perceived as more restorative than indoor plants.

Taken together, these studies show that incorporating nature images, nature views and access to the outdoors throughout healthcare facilities — not just to waiting rooms or patient rooms — can provide a wide range of benefits that contribute to the health and wellness of all occupants and greatly improve the overall experience of being in a healthcare setting.