The Hospital as a Workplace
Healthcare facilities are among the most stressful work environments and burnout–emotional, mental, and physical exhaustion–is a prevalent problem among nurses. Burnout not only affects the health and well-being of nurses but also contributes to high turnover and more medical errors, making it detrimental to patient care and organizational effectiveness. Pati, Harvey, and Barach argue that “patient well-being is a function of caregiver well-being,” and despite scientific publications as far back as the 1980s noting the high-stress nature of nurses’ work environments, healthcare architecture and research has focused primarily on patient conditions (2008, 27). A growing body of research is dedicated to examining the impact of the built environment on patient well-being, resulting in new understandings and approaches to environmental design for the patient and family spaces of healthcare facilities. Comparatively, few studies investigate its impact on the well-being of nurses. In a 2016 study, an interview with a nurse raised the point that attention to environmental design for staff well-being was an important factor in solving the problem of burnout, however, although stress reduction and opportunities for restoration have been shown to be important in the workplace, healthcare facilities often lack respite spaces for nurses (Nejati et al, 2016).
In some industries, recognition of the role of the physical work environment on employee well-being leads to the creation of aesthetically enhanced spaces that aim to increase employee satisfaction. While this is sometimes framed as an attempt to attract a particular generation or type of employee, “the environment can have substantial effects on a wide range of psychological, social, and task-related processes,” among which are job satisfaction, stress reduction, emotional well-being, and the performance of complex cognitive tasks ( Heerwagen et al, 1995, 460). Enhancing the aesthetic quality of the environment can take many forms, among which is increasing visual interest and variety through artwork (Heerwagen et al, 1995, 465). Further studies on the effect of workplace environments on employees demonstrate that enriched environments, particularly those enhanced by art and plants, are more conducive to well-being and productivity, particularly if employees are able to have a degree of control over the appearance of the space. In contrast, aesthetically deprived environments are associated with greater passivity, withdrawal, and negative feelings about work.
Nature, Restoration, and Art
Emerging out of two complementary theoretical positions, one that emphasizes physiological stress and the other mental fatigue, much of the research on nature exposure in workplace settings, including spaces for nurses, posits that it has restorative benefits that counter the negative impacts of demanding environments. In particular, it seems that exposure to nature in high-stress work environments such as healthcare can help reduce symptoms of depression and anxiety and minimize stress (Trau et al, 2016, 49). The idea of restoration derives from Kaplan’s examination of environments that can restore personal resources, such as attention, that become depleted throughout the day, particularly in stressful settings. In the framework of Kaplan’s attention restoration theory, stress is a marker of resource depletion as well as a contributor to its decline. Restorative environments are those in which exposure to the nontaxing stimuli of nature allows for the renewal of personal resources and a shift to more positive emotional, physiological, and cognitive states. In Nejati et al’s study on restorative design for staff break areas, interviews with nurses revealed that access to nature and daylight were perceived to help relieve stress, whether through artwork, indoor plants, a window with a nice view, or access to a garden or other outdoor area with natural features; and many expressed interest in the incorporation of a wide range of these elements (2016).
In light of the evidence pointing to the benefits of exposure to nature, it may be tempting to simply select any artwork depicting nature to help create a restorative break area for nurses. However, differences in how we experience and interact with nature (including how we perceive restorativeness) are shaped by factors such as gender, age, culture/ethnicity, and interests. This diversity of experience and understanding can be better negotiated through a collaborative process of artwork selection. For example, polling for artwork selection in corporate settings is a successful approach that has been shown to not only support an enriched environment but also to allow team members to feel a greater sense of engagement with and ownership of a space.
Collaborative artwork selection also acknowledges different ideas about and tastes in art, and while ‘nature art’ is often limitedly defined as realistic depictions of nature in photography and other media, it can be interpreted as literally or as loosely as individuals choose. For one person, a photograph of a tree may be restorative, for another, an abstract painting evoking the movement of water. The collection below presents different views of nature art.
Views of Ohio
- Berto, R. (2005) ‘Exposure to Restorative Environments Help Restore Attentional Capacity, Journal of Environmental Psychology, 25, pp. 249-259. doi:10.1016/j.jenvp.2005.07.001.
- Berto, R. (2014) ‘The Role of Nature in Coping with Psycho-Physiological Stress: A Literature Review on Restorativeness’, Behavioral Sciences, 4, pp. 394-409. doi:10.3390/bs4040394.
- Fragoso, Z. L. et al. (2016) ‘Burnout and Engagement: Relative Importance of Predictors and Outcomes in Two Health Care Worker Samples’, Workplace Health & Safety, 64(10), pp. 479–487. doi: 10.1177/2165079916653414.
- Heerwagen, J.H. et al. (1995) ‘Environmental Design, Work, and Well Being: Managing Occupational Stress through Changes in the Workplace Environment’, AAOHN Journal, 43 (9), pp. 458-468.
- Kaplan, S. (1995) ‘The Restorative Benefits of Nature: Toward an Integrative Framework’, Journal of Environmental Psychology, 15, pp. 169-182.
- Knight, C. and Haslam, S.A. (2010)’The Relative Merits of Lean, Enriched, and Empowered Offices: An Experimental Examination of the Impact of Workspace Management Strategies on Well-Being and Productivity’, Journal of Experimental Psychology: Applied, 16 (2), pp. 158-172.
- Kotzer, A. M. et al. (2011) ‘Evaluation of the Built Environment: Staff and Family Satisfaction Pre- and Post-Occupancy of the Children’s Hospital’, HERD: Health Environments Research & Design Journal, 4(4), pp. 60–78. doi: 10.1177/193758671100400405.
- Nejati, A., Shepley, M. and Rodiek, S. (2016) ‘A Review of Design and Policy Interventions to Promote Nurses’ Restorative Breaks in Health Care Workplaces’, Workplace Health & Safety, 64(2), pp. 70–77. doi: 10.1177/2165079915612097.
- Nejati, A. et al. (2016) ‘Restorative Design Features for Hospital Staff Break Areas: A Multi-Method Study’, HERD: Health Environments Research & Design Journal, 9(2), pp. 16–35. doi: 10.1177/1937586715592632.
- Panari, Chiara et al. (2019), ‘Emotional exhaustion among healthcare professionals: the effects of role ambiguity, work engagement and professional commitment’, Acta bio-medica : Atenei Parmensis, (90)6-S, pp. 60-67. doi:10.23750/abm.v90i6-S.8481
- Pati, D., Harvey, T. E. and Barach, P. (2008) ‘Relationships between Exterior Views and Nurse Stress: An Exploratory Examination’, HERD: Health Environments Research & Design Journal, 1(2), pp. 27–38. doi: 10.1177/193758670800100204.
- Perzynski, A. T. et al. (2019) ‘Primary Care Practice Workplace Social Capital: A Potential Secret Sauce for Improved Staff Well-Being and Patient Experience’, Journal of Patient Experience, 6(1), pp. 72–80. doi: 10.1177/2374373518777742.
- Timm, S. et al. (2018) ‘Designing for Health: How the Physical Environment Plays a Role in Workplace Wellness’, American Journal of Health Promotion, 32(6), pp. 1468–1473. doi: 10.1177/0890117118779463b.
- Trau, D. et al. (2016) ‘Nature Contacts: Employee Wellness in Healthcare’, HERD: Health Environments Research & Design Journal, 9(3), pp. 47–62. doi: 10.1177/1937586715613585.