Scientific Evidence

Scientific evidence is clear and convincing. Viewing nature scenes plays a key role in creating a healing environment which can improve patient outcome.  Research suggests that nature art can…

  1. Reduce stress and anxiety.
  2. Lower blood pressure.
  3. Reduce need for pain medication.
  4. Increase patients’ trust and confidence.
  5. Be a positive distraction for patients, visitors, and staff.

The Foundation for Photo/Art in Hospitals relies on the most current research and evidence-based design to develop its projects.  We have participated in research studies in Italy and the USA.  The largest study, “Beyond traditional treatment… establishing art as therapy,” was conducted in collaboration with the Italian Oncology Group of Clinical Research (GOIRC), coordinated by Prof. Francesco Di Costanzo, director of the Oncology Department of Careggi Hospital in Florence, Italy. Three cancer centers in Italy – Ancona, Perugia, and Messina – participated in the research.  345 patients from these centers were tested on their perception of the hospital environment before and after the display of Elaine’s nature photos in the treatment rooms of their Cancer Centers.  The project was sponsored by Eli Lilly.  Results show that the great majority of patients prefer art on the walls of hospitals, instead of white, sterile walls.  The art preferred, in order of preference:

  1. Nature landscapes (most popular)
  2. Animals
  3. Scenes of everyday life
  4. Portraits
  5. Urban landscapes
  6. Abstract (least popular)

The control group’s fiducia (trust or hope) decreased from viewing only white, sterile walls, whereas the experimental group who viewed nature photos for several months, had an increase in fiducia.


Research and Trends

Hospitals are giving artwork a higher priority. “More Hospitals Use the Healing Powers of Public Art” The Wall Street Journal, August 2014

“Art, when appropriately selected and placed, has durability. It engages the viewers, transports them, delights and amuses them, calms and reassures them, day after day.”  Art in HealthcareHealthcare Design Magazine, December 2011

French hospital gets ambient with HP latex ink… January 2010

“Picture of Health – Handbook for Healthcare Art” by Henry Domke, M.D. This 217-page hard bound book includes interviews from designers and leaders in the healthcare field, the latest research on evidence-based design, expert tips on framing, art budget issues, and other subjects that touch on the field of art in healthcare. If you are interested in the book, it can be downloaded for free from the website:  www.henrydomke.comAugust 2009

“Putting Patients First – the essential healthcare art book” www.healthcarefineart.com, February 2009

“The Future of Healthcare Environments and Evidence Based Design (EBD). . . chances are that each of us will probably experience some time spent in a clinic, waiting room, hospital, patient room, or wellness center. . .
As designers, architects and healthcare providers plan for the future they are constantly researching the newest information available to enhance the “healing environment”. At the same time clinics, hospitals and healthcare facilities are striving to create spaces that will comfort and enhance the surroundings of their patients and families.
Evidence Based Design (EBD) has proven to be a key in the partnership between concept, design and creating the “healing environment”. The core of EBD links research and design so that informed design decisions can be made in the planning process. Currently, artwork and/or photographs may become a focal point when designing patient and public areas and consideration needs to be given when selecting the image, content and color.
Great strides are being made in healthcare and creating the “healing environment”. “Exploring Healthcare and Design” published by The Center for Health Design 2008

Last month’s launch of the government’s Report of the Review of Arts and Health Working Group strongly endorsed the fundamental role that the arts performs in the promotion of well-being and improvement of patient outcomes.  Recognizing that the arts in health can deliver “real and measurable benefits”, the report met the high expectations of NHS arts coordinators, artists, arts therapists, clinicians, architects and designers, by backing a movement that has, arguably, been marginalised on the edges of patient care for too long.  “Making the Case” by Marc Sansom, Hospital Development Magazine, May 2007

“Beyond traditional treatment:  Establishing art as therapy”  by Elaine Poggi, Healthcare Design Magazine, November 2006

Just 20 years ago hospitals looked very different.  They were sterile environments focused on promoting cure rather than fostering care.  In the last two decades hospitals have transformed and become “Health-Care” environments in the truest sense, where the role of the environment on healing has been investigated, appreciated and enhanced.  Within this changing climate the role of art has been significant.  Art has been used to enhance the quality of care by positively impacting patient, staff and family perceptions.  Today, almost every hospital invests in Art-programs, because we now have research to show that not only can Art improve the image of the hospital, but it can, in fact, aid in healing.  “Current Research in Evidence-Based Art Programs” by Kathy Hathorn, President,American Art Resources, November 2006

“Oltre le cure tradizionali…  l’arte come terapia”  GOIRC NEWS, November 2005

Based on research, there are several design innovations that every hospital involved in a building project should undertake immediately…provide positive distractions through appropriate art, restful views and access to nature, thus relieving unnecessary stress and improving patient satisfaction.  “No Opportunity Wasted:  The Case for Building Better Hospitals is Stronger Than Ever,” Interiors & Sources, January/February 2005

A meta-study has found that quiet, single-patient rooms with ventilation, good lighting and nature images significantly improve outcomes.  “The Evidence on Evidence-Based Design,” Hospitals & Health Networks Online, January 2005

Experts find that relaxing pictures, colors and lighting are good medicine for patients and staff.  “Hospitals go for a less clinical look,” The Detroit News, January 2005

Strong studies…have produced additional convincing evidence that viewing nature reduces patient pain as well as stress.  These investigations also support the interpretation that nature serves as a positive distraction that reduces stress and diverts patients from focusing on their pain or distress…  A small number of studies on art in hospitals has yielded findings parallel to those from nature research.  Results suggest a consistent pattern wherein the great majority of patients respond positively to representational nature art, but many react negatively to chaotic abstract art.  Although nature pictures and other emotionally appropriate art elicit positive reactions, there is also evidence that inappropriate art styles or image subject matter can increase stress and worsen other outcomes.  It should not be expected that all art is suitable for high-stress healthcare spaces, as art varies enormously in subject matter and style, and much art is emotionally challenging or provocative.  “The Role of the Physical Environment in the Hospital of the 21st Century” by Roger Ulrich and Craig Zimring, The Center for Health Design, September 2004

If there is one universal truth about hospitals, it is that they are drab, dismal places, not at all designed to soothe and heal…  But a few architects and designers are working to change hospitals by humanizing their design, a concept that is slowly gaining influence in Europe and the United States.  The idea is obvious: Build inviting, soothing hospitals, graced with soft lighting, inspiring views, curved corridors, relaxing gardens and lots of art, and patients will heal quicker, nurses will remain loyal to their employers and doctors will perform better.  The environment of a hospital contributes to the therapy of the patients.  People are mentally vulnerable when they come in and if they are beaten down by an awful, dreadful, concrete, uninteresting, poor building with poor colors, it makes them even worse.  “Design as part of health care,” International Herald Tribune, September 2004

Research shows that even little touches can have a substantial impact.  Patients, for example, feel and do better if the hospital offers pleasant distractions such as soothing artwork on the walls…“Healthy Design” Lancet, July 31, 2004

Patients with nature images have less anxiety and require fewer strong pain medication doses.  However, too much stimulation will have the negative impact of raising anxiety levels.  Abstract art may contribute to less favorable recovery outcomes than viewing no pictures at all and is consistently disliked by patients.  All visual art (paintings, prints, photographs) displayed in patient areas should have unambiguously positive subject matter and convey a sense of security or safety.  When selecting art for stressed patients, Ulrich suggests the following characteristics should be avoided:  ambiguity or uncertainty; emotionally negative or provocative subject matter; surreal qualities; closely spaced repeating edges; forms that are optically unstable or appear to move; restricted depth or claustrophobic-like qualities; close-up animals staring directly at the viewer; and outdoor scenes with overcast or foreboding weather.  Most pictures selected should depict landscapes during warmer seasons when vegetation is verdant and flowers may be visible; avoid landscapes conveying bleakness; include scenes with positive cultural artifacts, such as barns and older house, and garden scenes with some openness in the immediate foreground.  “Healing Spaces:  Elements of Environmental Design That Make an Impact on Health”, by M. Schweitzer, L. Gilpin, and S. Frampton.  The Journal of Alternative and Complementary Medicine, 2004

Anche i luoghi di cura cambiano e diventano piu’ allegri.  Perche’ in un ambiente gradevole la guarigione e’ piu’ rapida e certa.  Oggi la medicina dovrebbe non solo curare i sintomi del male, ma promuovere il benessere.  Fisico e psichico.  Dipinti, decorazioni e colori sono un piccolo investimento di grande aiuto alla terapia.  “L’Ospedale Colorato,” by Vittorino Andreoli. Io Donna, February 2003

Providing patients, families and staff with access to nature by providing indoor and outdoor gardens, views of nature through windows, and artwork of nature scenes can relieve stress, “Healing arts – nutrition for the soul,” by R. Ulrich and L. Gilpin.Putting Patients First, 2003

Hospitals, long a bastion of bad design and dreary décor, are finding that improving their layouts and their looks can translate into better health for their patients.  A calming, healing environment helps patients deal more effectively with their pain. “Healthy Hospital Designs,” The Wall Street Journal, Marketplace, November 2002

More hospital leaders are realizing that a pleasant, efficient environment reduces costs and improves care…  Positive distractions, such as artwork, music, daylight, and water sounds, are built into the environment to help reduce stress.  “A Better Place to Heal,” Health Forum Journal, July/August 2002

The  research findings of  Roger Ulrich, PhD indicate that psychologically appropriate art can substantially affect outcomes such as blood pressure, anxiety, intake of pain medication, and length of hospital stay.  In particular, representational nature art is shown to have a beneficial effect on patients experiencing stress and anxiety.  “The Arts of Healing,” The Journal of the American Medical Association (JAMA), May 19, 1999, Vol.281, No.19