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Restorative Environment: Caregivers Evaluation of Hosptitalized Childrens Preference Towards Garden

Restorative Environment: Caregivers Evaluation of Hosptitalized Childrens Preference Towards Garden

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Published by: Karagianni9581 on Sep 20, 2011
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11/04/2013

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RESTORATIVE ENVIRONMENT: CAREGIVERS’ EVALUATION ON HOSPITALIZSEDCHILDREN’S PREFERENCE TOWARDS GARDEN VERSUS WARD IN MALAYSIANHOSPITALSIsmail SaidMohd Sarofil Abu BakarDepartment of Landscape Architecture, Faculty of Built EnvironmentUniversiti Teknologi Malaysia, 81310, Sekudai, Johor, Malaysiab-ismail@utm.my 
Proceedings of the 6
th
International Symposium for Environment-Behavior Studies EBRA, Tianjin, China, Oct. 22-25, 2004
Abstract
Hospitalization often erodes the feelings of toddlers and young children that cause regressive behaviors andstress resulting to reduced cognitive performance, helplessness, restlessness, crying, anxiety, and elevatedblood pressure. Having the children experiencing a garden setting, either in passive or active mode, canarouse their senses that nurture their inductive and deductive, motor-impulses development and reflectivethinking capabilities and thus reduce the stress that would foster their recovery. This study investigates theimpact of garden on the psychological well-being of pediatric patients, toddlers and young children aged 2to 12 years, by determining their preferences toward the domains (properties and attributes) of a garden andward in two Malaysian hospitals. It uses two sets of administered questionnaires evaluated by thecaregivers, Set A for mothers as surrogate respondents, and Set B for ward nurses. Univariate analysis of the data found that 94% of the pediatric patients (n=360) preferred the garden than the ward. Bivariateanalysis on the mother’s evaluation data found that the mean preference scores of the garden are greaterthan the ward in all domains except one. The domains are refreshing smell, fresh air, full with light,cheerful environment, pleasant sound, scenic view, open space, free to play, not confined, home feeling,and place for variety of activities. Moreover, 71% to 93% of the nurses viewed that the garden affords thepatients to (1) play freely and safely either alone or with peers, (2) escape from the confined wardenvironment into an open space where they can observe animals, and (3) gain control on their movement.As a result the patients feel cheerful and agile to the garden setting suggesting theirs cognitive functioningare restored.
****Keywords
: pediatric patients, hospitalization, garden, restoration, cognitive functioning
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 Introduction: Hospitalization and Garden Restorative Effects
Research in nursing, healthcare management, health psychology, pediatric psychology and childpsychiatry found that most children view hospitalization as a threat, and thus they experience illeffects from being hospitalized (Cooper Marcus and Barnes, 1999; Hart, 1995; Johnson, 1994; LaGreca and Bearman, 2000; Lindheim et al. 1972; Rubin et al. 1998; Zahr, 1998). Some of the illeffects are caused by regulated medication, confined space, loss of habitual control due to theclinical treatment, alien smells, and staying with strangers, and way-finding difficulties incomplex and unfamiliar hospital settings (Cooper-Marcus, 1999; La Greca and Varni, 1993; LaGreca and Bearman, 1999; Lau, 2002; Lindheim et al., 1973; Moore, 1999). Thus the children seethe hospital environment as an unfamiliar and strange setting with conditions that inflicts pain andsegregation from their families and favorite places. This is the environment which they have nocontrol on their bodies and behaviors (Lindheim et al., 1972; La Greca and Bearman, 2000). Suchunfamiliar and strange settings are common because design of most late twentieth centuryhospital “concentrate on creating healthcare buildings that would reduce infection risks and serveas functionally efficient settings for new medical technology” (Ulrich, 2002). The design left theoutdoor space such as garden as peripheral landscape which not intended for the healing processof the patients (Copper Marcus & Barnes, 1999). As a result, hospitalization often erodes thefeelings of toddlers and young children causing stress (Lau, 2002) resulting to reduced cognitiveperformance, helplessness, restlessness, crying, anxiety, and elevated blood pressure (Lindheim etal., 1972; Olds, 1987; Oremland and Oremland, 1973; Korpela, 2001; Zahr, 1998). Eventually,the patients react regressively such as excessive fears, anxiety, increased clinging to anddependence on parents, loss of bowel and bladder, intensified thumbsucking, or low self-esteem(Johnson, 1994; Lau, 2002; Lindheim et al., 1972).Creating garden as playspace in the hospital environment generates sense of familiarization to thechildren (Olds, 1987) toward their home and school environments (e.g. Proshanky & Fabian,1987) and thus would calm them (Ulrich, 2002). The children can experience many similarlandscape features such as vegetation and animals, landscape factors including rain, sunlight andshadow, temperature and wind, and man-made features particularly play equipment andbuildings. Vegetation, animals and microclimatic factors are ubiquitous natural elements thatchildren have experienced in their homes and schools before being admitted to the hospital.Natural elements stimulate their perceptual functioning because they perceive them as (1) endless
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diversity, (2) dynamic elements, and (3) elements not made by man (Prescott, 1987). Vegetationand animals in a garden environment come in a variety of shapes, colors and textures. Viewingthe garden or playing in it nourishes the children feelings because nature provide a balance of multi-sensory stimulation as opposed to the overload or deprivation found in the builtenvironment such as hospital (Vernolia, 1994).In contrast to the confined ward environment, the garden allows pediatric patients to move freely.Motion, cycle and scale are three factors that nourish the children intellectual development(Vernolia, 1994). Anita Olds (1989) posits “motion permits a child to locate himself freely inspace, assume body postures, create his own boundaries, have access to diverse territories,manifest power, and explore his abilities.” Apart from the vegetations, animals and microclimaticfactors, the children attentions are also on the play equipment (Stoecklin & White, 1998). This isbecause the garden space, its equipment and other accessories (e.g. pavilion) afford the children avariety of locomotion such as walk, run, hop, jump, roll, ride, sit, hide, dig, mould, pull, pick,bend, grasp, scratch, throw, climb, crawl, swing, slide, and look-out (Kytta, 2003; Heft, 1999).Allowing the patients to perceive and to play with the garden contents is a dynamic experience inan ecological setting (Kytta, 2003). Playing and moving in the garden space from an equipmentor a tree to another develop sensorimotor skills (Hartle & Johnson, 1993); an essential step inchildren development. Consequently, the locomotion shifts the mood of the patients fromregressive to progressive ones (Olds, 1989). It affects the cognitive and affective domains of thechildren behavior (Gallahue, 1993). Hartig and Staats (2003) posit that shifting in mood is arestorative effect because it renews diminished functional and perceptual capabilities of thepatients.Another progressive development that patientscan attain by playing in the garden is socialization.Through play the patients communicate and socialize with their peers in various activitiesincluding sharing, turn-taking and resolving conflicts (Hartle & Johnson, 1993). They feel morecomfortable and secure playing in a group because one would assimilate and accommodate thebehaviors of others (McDevitt & Ormrod, 2002). In addition, they would perceive the garden as acomfortable playspace when the garden provides moderate and varied levels of stimulation fortheir senses (Olds, 1989). This is achieved when they play in rhythmic patterns of movement thatcombine predictable sameness with moderate diversity (Olds, 1989). Proper layout andappropriate composition of the garden contents that help maintain optimal levels of responsivityand alertness. Thus having a garden beside the pediatric ward allows the patients to engage with
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