A Brief History of Hospital Gardens

Hey, it’s Kat again. In today’s guest post, I’ll be talking about the history of hospital gardens as we know them today.

Tracing the history of hospital gardens shows us that there is a common thread of belief in the importance of fresh air, sunshine, access to nature and working the land as positive contributions to the healing process.

Healing gardens have long since served as places for recovery; for the restoration of the mind, soul and body. Monastery settings in the Middle Ages were the first instances where a garden was specifically incorporated as a part of the healing environment.

These spaces served as places for contemplation as well as for growing vegetables, fruits and herbs.

The Cloisters in New York City showcase a traditional monastic courtyard garden. Image: Kat Shiffler

A document believed to have been written by a monk in the early part of the ninth century describes a plan of an ideal garden for the Benedictine Monastery of Saint Gall in Switzerland, laying out many of the same formal features that show up in healing gardens today: intersecting paths for contemplative walking, a well or fountain, an herb garden, a green “court” or lawn.

In addition, outside the monastery’s walls there were also several acres of crops to supply necessary food for clergy, workers, visitors and the poor.

The Monastery of St. Gall was an early healing landscape. Image: Alarmy.com

The Church itself was instrumental in the establishment of hospitals during the Middle Ages that have influenced the delivery of healthcare through the centuries.

Later, the religious connection between spiritual healing and the garden began to fade and give way to a much more human-centered built environment. As hospitals developed, the formal cloistered garden features were often replaced by an open area for patients to walk and take in the sunshine and fresh air.

Some progressive hospitals that primarily cared for people with mental illness placed a greater emphasis on the active work of tending to gardens and fields. A prominent example is that of the Hospital at Zaragossa in fifteenth-century Spain. At this hospital, a routine of normal daily activities, including gardening, was encouraged for patients who were able—rather than confining them as was the custom at the time.

German horticultural theorist Christian Cay Lorenz wrote some of the first recommendations for hospital garden design at the end of the eighteenth century:

“The garden should be directly connected to the hospital… A view from the window into blooming and happy scenes will invigorate the patient… [and] encourages patients to take a walk… The plantings should wind along dry paths, which offer benches… The spaces between could have beautiful lawns and colorful flower beds… Noisy brooks could run through flowery fields… A hospital garden should have everything to enjoy nature and to promote a healthy life.”

Classic open-air hospital design at Hospital del Salvador in Santiago, Chile. Image: Wikipedia

Florence Nightingale, the founder of the modern nursing profession, stressed the importance of fresh air and natural sunlight on the well-being and healing of patients in her landmark, Notes on Nursing published in 1859. She described the value of plants and outdoor spaces in the healing process,

“People say the effect is only on the mind. It is no such thing. The effect is on the body too.”

Florence Nightingale, Notes on Nursing

Throughout Victorian and Edwardian periods, green spaces in hospitals were seen as places for healing. But in the decades the followed, priorities in hospital construction changed; the industrial revolution and two World Wars took place. Park areas were replaced by parking lots.

But in 1984 a study by American psychologist Roger Ulrich provoked a renaissance in the hospital garden movement. Ulrich showed that patients with views of the outdoors from their hospital bed recovered faster after surgery, and spent less time in the hospital than those who did not have an outdoor view. Ulrich has gone on to publish widely on the health benefits of nature:

“Just looking at an image of nature could be healing”.

Roger Ulrich, ‘Forest Bathing’: How Microdosing on Nature Can Help With Stress

Today there are many beautiful contemporary examples of outdoor hospital environments that promote healing through a connection to plants. These spaces are once again being seen as critical for health and well-being. Working farms at hospitals, however, continue to be somewhat rare—a growing part of the overall movement to create spaces that heal.

A contemporary courtyard garden at Great Ormond Street Hospital, London designed by Chris Beardshaw. Image: The Telegraph

Hospital gardens provide a natural and calming view, stimulate the senses of therapy patients, provide restoration and relaxation for visitors and staff—and have the potential to grow healthy food for surrounding communities.

Gardens as Antidote to Nurse Burnout

Healthcare practitioners take a break outside. / Photo: Legacy Health

Hey, it’s Kat again. In today’s guest post, I’ll be talking about the timely topic of nurse burnout and research into hospital-based gardens.

Burnout among nurses was on the rise even before COVID-19. In a 2017 survey, 63% of registered nurses employed in hospitals self-reported workplace burnout.

Characterized by symptoms of emotional exhaustion, depersonalization, and loss of personal efficacy, burnout has far-reaching negative consequences for individual wellbeing, quality of patient care and costs to the healthcare system. One study estimated that nurse burnout adds up to $14 billion annual

In 2019, the World Health Organization included burnout in the 11th Revision of the International Classification of Diseases as “an occupational phenomenon” rather than a medical condition, saying burnout “is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

Research indicates that hospital gardens are one way we can lessen the fatigue and stress that lead to burnout.

For a study in 2018, a team of researchers that included legendary healthcare designer Roger Ulrich, looked at indoor and outdoor break environments and their effect on nurse burnout.

Time outdoors can help reduce symptoms of burnout. Photo: Legacy Health

Nurses at Legacy Emanuel Medical Center in Portland, Oregon were randomly assigned to 6 weeks of a daily work break in the garden and 6 weeks of indoor-only breaks. Researchers had the nurse-participants complete the Maslach Burnout Inventory-Human Services Survey (MBI), a tool used to measure burnout in healthcare workers, at the start and end of each 6-week period.

The nurses also recorded the immediate psychological impact of a break in both environments using another tool that asked them to rate feelings of anxiety, sadness, anger, worry, fatigue and pain on a defined scale.

What they found was that for the nurses who took their 20-minute break outside, the garden provided greater reduction in burnout.

They concluded that taking daily work breaks in a garden may be beneficial in mitigating burnout among nurses working in high-stress hospital environments.

The research setting was featured the Portland news recently, highlighting the positive response to the garden in light of COVID-19. One nurse said of the Legacy Health garden,

“It takes you to such a different place that it’s so refreshing to your spirit and your soul and your psyche.”

Gardens provide respite for practitioners, patients and their families. Photo: Legacy Health

Another nurse said of the garden,

“It is transformational for me. It really is. Just to even get five minutes in the garden, you shift your paradigm. You’re no longer thinking about the hospital. You’re looking at the plants, you’re smelling the herbs that are growing here, you’re seeing the sunshine.”

Providing spaces for respite is more important than ever—in hospital environments and public spaces alike. What’s good for the mental health and wellbeing of nurses is good for us all.

In the next blog post, I’ll be exploring best practices for designing restorative spaces, according to prominent thinkers in environmental psychology.

Guest post by Kat Shiffler, collaborator with The Farm at St. Joe’s and graduate student in Landscape Architecture at the University of Michigan.

Update on Plans for a New Farm at St. Joseph Mercy

by Kat Shiffler, graduate student in landscape architecture at the University of Michigan.

The word is out. The Farm at St. Joseph Mercy is a national model of the “green care” movement, pioneering a new approach to health care by connecting the hospital system with fresh, local food(read this great article about “How the Farm at St Joe’s Transforms its Health System“. But did you know that The Farm at St. Joe’s is working on replicating the model at the nearby St. Joseph Mercy Oakland in Pontiac?

Amanda looking over a proposed site plan at St. Joseph Mercy Oakland in Pontiac, MI

In January, I began working with The Farm’s Amanda Sweetman to envision and design the 1.3 acre site at St. Joseph Mercy Oakland. When I jumped on board, she had completed soil tests, installed drainage, imported tons of topsoil and planted covercrops, bushes and flower bulbs.

To get into design mode, Amanda and I started with an analysis of the Pontiac location, looking into site conditions like sun and shade, topography, access and walking routes. We spoke with farm staff to compile the strengths and weaknesses of layout of the Ann Arbor site, compiling ideas for best practices for the new Pontiac farm design. And I looked into examples of outdoor healthcare environments and worked to summarize relevant research in environmental psychology and evidence-based design.

Process diagrams on top of early iteration of the Pontiac site plan

As a result, I created several proposals for the space that would combine a working farm, community gardens and specific areas for reflection and therapy. I did research on materials and starting getting into specifics regarding pathways, seating areas, accessible garden beds and gathering spaces. With an eye on ecological design, I began locating and defining appropriate varieties of trees, shrubs, herbaceous perennials and annuals. 

Image: Medical University of South Carolina; an existing example of hospital farm/garden

As we began to set in motion the construction we’d hoped would happen this Spring, COVID-19 changed the world. And we are now beginning to reassess the original plan in light of overall changes to healthcare environments.

Access to plants and nature seem to be a universal pressure release valve—important for the mental wellbeing of healthcare workers as well as the general public. In this new context, we are also certain that the demand for fresh, local vegetables will persist and even expand. But what will community gardening look like months from now? Will hospital seating areas be necessarily different? How will the public interact with healthcare settings in the future?

As we investigate these questions, we want to share our thoughts and our process; the process of designing a farm serving a post-COVID healthcare community—and what exactly that means.

For the next couple weeks, I will be sharing some of that research right here on the blog.

I hope you enjoy! Be Well.

Spring Emerges at The Farm at St. Joe's

We can’t wait to grow seedlings in our new propagation house!

Happy Spring and social solidarity through spacial distancing! It’s been a whirlwind, but despite the uncertainty swirling around us, there is so much spring goodness coming our way. We have a hoop house full of greens that are being harvested and we will be giving this life-giving food to our front-line colleagues and to our community partners. We are determined to find safe ways to continue to provide healthy nutritious food to our community members and support our local farmers!

Fun Farm Updates!

Salad greens harvest – March 23, 2020

Now on to the business…

The Farm at St. Joe’s current priorities are:

  1. Doing our part to contain any spread and mitigate the effects of COVID-19 —both physically and mentally— for staff, volunteers, and community members.  
  2. Planning how The Farm will safely provide nourishing food from local farms that will be essential this season.

This is how the Farm Share Program will be providing safe access to healthy food:

  1. Curbside pick up – Wednesday-Friday (schedule TBD).
  2. Using single-use packaging (brown bags instead of boxes).
  3. Strict sanitation of surfaces protocol is in place throughout The Farm.
  4. Staff who handle produce and food-contact surfaces practice strict hand washing and hospital health assessment standards.

In the meantime, on behalf of our entire Farm team, we are truly appreciative of all of you and we are working hard to keep the essential service of providing nutrious food to Farm Share members and the community at large.

We still have spots open to join this season, please register HERE.

Questions we’ve been getting:

What is The Farm Doing To Stay Safe?

To keep our workplace healthy, we are following stringent precautionary measures like frequent hand washing, sterilizing our work environments, use of gloves, and social distancing.

Can I Come Volunteer?

At this time, in order to reduce the spread of COVID-19, we are not accepting volunteers at The Farm. As this changes, we will let you know.

I’m Struggling To Access Food Right Now. Where Can I Go?

If anyone finds themselves in need of emergency food resources, they can dial 2-1-1 to connect to United Way’s 211 call center. The operator will be able to provide info on the nearest food distribution location.

Can I Donate? Where? How?

Yes! We are working hard to provide food and assistance to food insecure families. Please consider donating – https://stjoesfarm.org/donate/

I’ve Got Another Question!

Send us an email at  FarmShare@stjoeshealth.org or call us at (734) 712-0501. We’re in and out of the office, so please feel free to leave a message. We will get back with you. Thank you for your patience!

How to help the hospital during this challenging time?

Community Donation of Needed Supplies for St. Joe’s Ann Arbor

In response, the hospital has organized a Donation Center at the Towsley Building, on the campus of St. Joseph Mercy Ann Arbor. The following unopened (click here) items can be dropped off.

Hours for donations will be 8 a.m. – 4 p.m. seven days a week (Hours may change due to availability of staffing). Read more.

Farmers Market

Dear Friends,

To protect the health and well-being of our community, the St Joe’s Farmers Market will be closed until further notice.

As we all slow down and step back from physical contact with one another, let us lean in and connect emotionally with one another. Please reach out if you are in need physically or emotionally. You can reach me at Amanda.Sweetman@stjoeshealth.org.

Poodle sitting at computer desk.
Everyone is helping right now.

Community Resources: check out the Washtenaw County COVID-19 Essential Services Update page(https://www.washtenaw.org/3100/COVID-19-Essential-Service-Updates). There is a comprehensive list of resources for things like food, housing, utility support etc.

With love,

Amanda and the Farm Team

Volunteers needed!

Hi Everyone,

It may not feel like it yet, but spring is right around the corner! We’re gearing up for a big year at the Farm and we need your help!

We were awarded almost $25,000 to refresh the handicap accessible hoop house by the Christopher and Dana Reeve Foundation! We are so excited to be able to offer even more innovative ways for patients to receive care in our beautiful space!

To get started we need to remove the existing raised beds, so bring your muscles and your friends and we’ll get this project off on the right track.

February dates:

February 8 9am-12pm

February 15 9am-12pm

Sign up HERE or email FarmVolunteers@stjoeshealth.org with questions.

Register today for the 2020 Farm Share!

Get farm-fresh produce this year by participating in the St Joe’s Farm Share program! Register before Jan 31st to lock in the 2019 prices!

REGISTER HERE

Learn more about the program here.

A spring share

The 2020 Farm Share Program will have:

Three 12 week seasons (Spring, Summer, Fall)

There are two membership types: Whole and Half

We offer subsidized shares to families who are experiencing food insecurity. Learn more here.

We will work with 8 partner farms and are on track to generate $150,000 of revenue for those small, sustainable growers.

Beets Help Beat High Blood Pressure, Improve Blood Vessel Health

Beets.png

Fun Facts

Beets are an incredible vegetable! Both the roots and greens can be eaten and both are unbeatably nutritious. Beets come in all shapes and sizes. Did you know that the traditional red beet is not the only variety available? Heirloom varieties can be golden yellow, white, pink and white ringed, and even oblong shaped! They belong to the family Amaranthaceae, and are related to other leafy vegetables such as swiss chard, amaranth, spinach, and quinoa. The wild ancestral origin of beets is believed to be sea beets, which have been alive for thousands of years. Some of the earliest records of sugar beet domestication are thought to be traced back to both the ancient Egyptian Empire and the Roman Empire. Ancient Assyrian texts have also described cultivation of beets in the Hanging Gardens of Babylon. You may not be aware of this but, once harvested, the entirety of the beet plant can be consumed, including the stems and leaves. [1]

Nutrition Information

These colorful root vegetables contain phytonutrients called betalains that give beets their rich red or yellow color. Betalains have been shown to provide antioxidant, anti-inflammatory, and detoxification effects in the body. Beets are also a source of dietary nitrate, which increases production of nitric oxide in the body and helps to lower blood pressure and improve the health of blood vessels.

One cup of raw beets provides about 35% of your recommended daily value of folate, and are also a good source of manganese, fiber, potassium, and vitamin C. [1]

Growing Season /Storage Tips

  • In Michigan, fresh beets are generally available from July to October but they can be grown, harvested and/or stored well into the winter.
  • Choose small to medium sized beets. Pick beets with fresh, unwilted greens.  Avoid beets with spots, bruises, or soft areas which may indicate spoilage.
  • Do not wash beets before storing. Put beets in a plastic bag and wrap it tightly around the beets to get rid of air. Beets will keep in the fridge for up to 3 weeks. Cooked beets may be frozen.

Request Beets in Your Salad at St. Joe’s Market Cafe

In Michigan, fresh beets are generally available from July to October but they can be grown, harvested and/or stored well into the winter. They come in a variety of colors, and they can be prepared in a variety of ways – roasted, steamed, pickled, juiced, boiled or eaten raw on salads or with dips. And be sure to use those greens, which are delicious braised or raw in salads! [2]

References

[1] The Farm at St Joe’s Ann Arbor – https://stjoefarm.wordpress.com/veggie-pages/beets/

[2] Cultivate Michigan – https://www.cultivatemichigan.org/featured-foods/foods/beets

Register NOW for the Summer Farm Share

Eat well all summer by registering for the St Joe’s Farm Share program! Get a box of fresh, local produce every week or every other week! This program is convenient, fun, and a great way to support local farmers.

Summer: July 3-Sept 18 Get the best of the hot weather crops: blueberries, peaches, tomatoes, eggplant, zucchini, corn, and melons! 

Summer Full

Summer Half

A summer share