on September 03, 2026
Health cannot be considered exclusively as the absence of disease. The World Health Organization's historical definition describes health as a state of physical, mental, and social well-being, emphasizing the need to consider the person as a whole and not merely through the presence or absence of a specific pathology. The WHO's most recent elaborations on well-being have further expanded this perspective, recognizing the interaction between physical, mental, psychological, emotional, social, spiritual, and environmental dimensions.
In this perspective, the place where a person receives care also plays an important role. The hospital, rehabilitation center, healthcare facility, and any other space dedicated to health are not simply containers in which clinical services are provided. They are environments where the patient spends time, confronts illness, recovers functions, establishes relationships with healthcare workers and family members, and experiences psychological experiences that can be characterized by fear, pain, uncertainty, or loss of autonomy.
From this awareness arises the concept of a green hospital, a design model in which natural elements are not considered merely decorative, but become an integral part of the environmental quality and the care experience. Gardens, trees, natural light, water, outdoor paths, vegetable gardens, and spaces dedicated to contemplation can help create an environment more conducive to well-being.
This approach does not replace diagnosis, pharmacological therapies, surgery, or conventional rehabilitation. The value of environmental design lies rather in creating conditions that can support the person during the care journey and improve the experience of staying in healthcare facilities.
Nature, environment, and health
Scientific interest in the relationship between nature and health has progressively developed across different disciplines, from medicine to environmental psychology, from architecture to urban planning.
The most recent research suggests that exposure to green spaces may be associated with several health and well-being indicators. A systematic review published in 2024 analyzed the relationship between exposure to green and blue spaces and hospitalizations related to non-communicable diseases. The results predominantly suggest favorable associations for exposure to green spaces, while highlighting significant heterogeneity among the studies and important methodological limitations that require further higher-quality research.
Another important research strand concerns the possible effects of the natural environment on stress and mental health. A systematic review with meta-analysis published in 2024 found that access to gardens and natural spaces during the pandemic was associated with a lower likelihood of depression and anxiety, and that spending more time in green spaces was associated with lower stress levels. However, the same authors emphasize that the overall quality of the available evidence was very low, especially due to the high risk of bias in observational studies.
This element is particularly important in scientific communication: nature must not be presented as a universal therapy or as an alternative to medical treatments. The evidence suggests instead that natural environments can constitute a favorable factor within broader health promotion strategies.
The scientific origin of the concept of a healing garden
One of the best-known studies in the field of healthcare design was published by Roger Ulrich in 1984 in the journal Science. Ulrich compared the postoperative course of patients who underwent surgery and had a view of natural elements with that of patients whose window looked primarily onto a wall.
The study suggested that the presence of a natural view could be associated with a more favorable postoperative recovery, with less need for analgesics and fewer negative observations in the clinical course. The historical importance of this research lies above all in having helped shift attention to the possible role of the physical environment as a relevant element of the patient experience.
Decades later, a scoping review published in 2024 analyzed the literature related to exposure to natural elements during hospital stays. After screening nearly 13,000 publications, 41 studies were included. The most common forms of exposure considered included the presence of windows and natural light, the view of natural landscapes, and nature-inspired soundscapes. The authors highlighted a growing interest in biophilic design and the integration of natural elements into the hospital environment, while also emphasizing the need for more rigorous studies to precisely define which interventions are most effective and for which categories of patients.
Stress Reduction Theory
Roger Ulrich later developed a theoretical model according to which natural environments can promote recovery from stress through relatively rapid psychophysiological responses.
According to this perspective, some characteristics of nature can be perceived as positive, reassuring, and non-threatening, promoting a reduction in the psychophysiological activation associated with stress.
A garden designed for a healthcare environment can therefore offer a form of positive distraction. The patient can temporarily shift attention from pain, illness, or the hospital environment toward elements such as trees, water, flowers, natural sounds, and seasonal changes.
The value of this experience does not necessarily lie in the elimination of the clinical problem, but in the possibility of creating psychological pauses within a care journey often characterized by stress and loss of control.
The ability to choose whether to walk, sit, be in company, or seek a more private space can also help restore a certain decision-making capacity to the person. For the hospitalized or institutionalized patient, the loss of control over daily life can represent an important component of the experience of illness.
Attention Restoration Theory and attention recovery
Another important interpretation of the relationship between humans and nature is Attention Restoration Theory, developed by Rachel and Stephen Kaplan.
Contemporary life frequently requires continuous voluntary attention. The hospital environment can further increase this load through noise, communications, procedures, tests, visits, and illness-related worries.
Natural environments can offer forms of stimulation capable of attracting attention without requiring the same level of cognitive effort. The movement of leaves, the presence of water, changes in light, and the variety of natural forms can generate what has been defined as a form of “soft fascination.”
Exposure to nature could therefore contribute to the recovery of attentional resources and the reduction of mental fatigue. This concept is particularly interesting in places dedicated to rehabilitation, disability, and long-term care.
However, in this case too, the theory represents an interpretive framework that must be linked to specific experimental evidence. Not all green spaces automatically produce the same effects, and the quality of design can profoundly change the user experience.
What are therapeutic gardens
The term Healing Garden, or therapeutic garden, is used to describe a natural space designed with the goal of promoting the physical, psychological, and social well-being of the people who use it.
The concept does not necessarily indicate a place where a specific therapy takes place. A healing garden can be used simply to rest, contemplate the landscape, meet other people, walk, or spend time outdoors.
Some gardens, on the other hand, are designed for specific therapeutic and rehabilitative activities. In these cases, they can be used for motor paths, raised beds, sensory areas, spaces for occupational therapy, and surfaces designed to promote accessibility for people with disabilities.
Contemporary literature therefore distinguishes several possible functions of green spaces in healthcare settings: passive exposure to nature, active use of the space, horticulture and gardening activities, sensory stimulation, and support for socialization.
A recent review dedicated to hospital healing gardens highlighted the need for more widely shared definitions and design criteria. The goal is to make these spaces truly functional for the needs of patients, family members, and healthcare workers, preventing the concept of a therapeutic garden from remaining merely an architectural label.
Passive use: observing and staying
The simplest form of relationship with a garden is passive enjoyment.
A person can sit, observe the landscape, listen to natural sounds, or simply spend time outdoors. This type of use is particularly important for people with reduced mobility, frail elderly people, or patients undergoing treatments that limit the possibility of performing physical activity.
Design should therefore include comfortable rest points, shaded areas, protection from unfavorable weather conditions, and good visibility of natural elements.
The view from the window can also be considered a form of passive exposure to nature. After all, not all patients can physically reach a garden. For some people, especially during acute phases of illness, the relationship with the outside environment can occur primarily through natural light and sight.
This represents one of the fundamental principles of biophilic design: connection with nature can be fostered not only through physical presence in a green space, but also through visual contact with natural elements.
Active use: movement and rehabilitation
The garden can also become a space for physical activity and rehabilitation.
Walking in a safe outdoor environment can contribute to mobility and autonomy. In rehabilitation pathways, the possibility of performing some exercises outdoors can positively change the patient experience compared to traditional therapy carried out exclusively in indoor spaces.
However, a therapeutic garden intended for rehabilitation must be designed with particular attention to safety. Paving, slopes, handrails, rest areas, and lighting must be appropriate for the users' abilities.
The presence of paths with different difficulty levels can allow the activity to be adapted to the person's functional conditions.
Universal design takes a central role in this context. A therapeutic green space must be accessible not only to young and independent people, but also to individuals with motor difficulties, visual impairments, wheelchair needs, or walking aids.
The sensory experience of nature
A therapeutic garden can be designed to engage different sensory systems.
Sight can be stimulated through the variety of forms, shades, and seasonal changes. Hearing can be engaged through the wind in the leaves, birdsong, or the controlled presence of water.
Touch can be stimulated through different plant surfaces and materials. Smell can be engaged through aromatic plants and selected blooms.
Sensory design, however, requires particular attention to vulnerable people. Intense fragrances, excessive noise, or a large amount of stimuli can be unpleasant for some patients. The goal is not to create sensory overload, but to offer stimuli that can be chosen and modulated by the person.
Horticulture and plant activities
The active use of vegetation can also take on a rehabilitative dimension.
Horticultural therapy and gardening activities are used in different socio-healthcare contexts as complementary tools to care, educational, and rehabilitative activities.
Sowing, watering, pruning, harvesting, and caring for plants requires a sequence of actions. These activities can involve movement, coordination, attention, memory, and planning abilities.
Gardening can also promote the perception of temporal continuity. The person observes a progressive transformation: the seed sprouts, the plant grows, changes with the seasons, and requires repeated care.
In socio-healthcare contexts, the vegetable garden can also represent a shared activity. Working with plants can become an opportunity for collaboration, communication, and social participation.
The available evidence suggests potential benefits of horticultural therapy and nature-based activities, but the quality of the studies varies and does not allow all practices to be attributed the same results. Horticultural therapy should therefore be considered a possible complementary tool and not a replacement for therapies validated for specific pathologies.
The possible biological mechanisms
The relationship between nature and health can be interpreted through different mechanisms, which probably act simultaneously.
One first mechanism concerns stress reduction. Spending time in an environment perceived as safe and pleasant can influence the neuroendocrine response to stress.
A second mechanism concerns physical activity. The availability of accessible green spaces can promote movement and reduce sedentary behavior.
A systematic review and meta-analysis that included 38 studies and over 5 million participants found associations between greater exposure to green space and lower average blood pressure, as well as a lower likelihood of hypertension in some analyses. However, the authors emphasize that longitudinal and experimental studies are needed to better define the causal relationship.
A third possible mechanism is social interaction. A garden can become a meeting place for patients, family members, and healthcare workers. Social connection can be an important resource, especially in long-term care and inpatient settings.
A fourth element concerns air quality, reduced exposure to certain environmental stressors, and the opportunity to create more favorable microclimates. However, these aspects depend heavily on location, design, and the urban context.
The most recent reviews therefore suggest that the effects of green spaces are probably multifactorial and cannot be attributed to a single biological mechanism.
Green hospitals and evidence-based design
The design of a therapeutic garden should not be limited to the selection of ornamental plants.
A truly health-oriented project should begin with an analysis of the needs of the people who will use the space.
A garden intended for a pediatric ward has different needs than one for a dementia center, an orthopedic rehabilitation ward, or an oncology facility.
Design should therefore involve different expertise: architecture, landscape architecture, medicine, physiotherapy, psychology, nursing, occupational therapy, and facility management.
This interdisciplinary approach allows for a shift from purely aesthetic design to an evidence-based design model, in which design decisions are formulated based on the best available knowledge and subsequently verified through the actual use of the space.
Post-occupancy evaluation, or Post-Occupancy Evaluation, can help determine whether the garden is actually used and which features prove most useful.
A space designed for therapeutic purposes should be monitored over time using indicators such as frequency of use, user satisfaction, accessibility, safety, and compatibility with clinical and rehabilitative activities.
Safety, privacy, and a sense of control
Above all, a therapeutic garden must be an environment in which people feel safe.
Safety involves the absence of hazards, but also the ability to navigate the space easily. Clear pathways, recognizable landmarks, and adequate signage can be particularly important for older people or those with cognitive impairments.
Privacy is another fundamental element. Not everyone wants to experience nature in a shared space. A good garden should offer both areas dedicated to social interaction and more secluded spaces.
A sense of control can have significant psychological value. The ability to choose where to sit, which path to follow, or whether to be alone or with others restores a degree of autonomy to the individual.
In healthcare settings, where many decisions must necessarily be entrusted to healthcare professionals, the availability of small spaces that offer choices can help improve the overall experience.
Accessibility and disability
A green hospital cannot be truly therapeutic if some users cannot access natural spaces.
Accessibility must be considered from the design phase. Wheelchair-accessible pathways, safe surfaces, ergonomic seating, accessible tables, and raised garden beds can enable people with different functional abilities to use the garden.
Nature can also become an important tool for the rehabilitation and social participation of people with disabilities.
However, design must avoid the idea that a single universal solution exists. The needs of a person with limited mobility differ from those of a person with visual impairments, cognitive disorders, or sensory hypersensitivity.
For this reason, accessibility should be understood as the space's ability to accommodate a diversity of people and needs.
The role of green space in social and healthcare facilities
The potential benefits of therapeutic gardens are particularly relevant in facilities where people spend extended periods.
In residential care facilities for older adults, the garden can provide one of the main links to the changing seasons. Institutional life can otherwise reduce spontaneous contact with the outdoors.
In rehabilitation centers, green space can offer opportunities for movement and functional activity. In services for people with disabilities, it can become a space for learning practical skills and participating in activities.
In hospitals, it can offer a psychological break for patients, family members, and healthcare workers.
Healthcare staff can also benefit from the availability of quality outdoor spaces. The well-being of those who work daily in emotionally intense environments is an important component of the overall quality of healthcare organizations.
Maintenance as part of the therapeutic project
A therapeutic garden does not end with its opening.
Maintenance is essential to its value over time. Neglected vegetation, damaged pathways, unsafe areas, or deteriorated furnishings can quickly turn a space designed for well-being into an unused environment.
The selection of plant species should therefore consider the climate, water availability, maintenance requirements, and safety.
Environmental sustainability can become an integral part of the project through the selection of appropriate species, efficient water management, reduced unnecessary use of chemicals, and the integration of the garden with local ecosystems.
Involving users in caring for the space can also help strengthen their connection to the place. Where appropriate and safe, shared gardening activities can transform green space from a purely decorative element into a truly lived-in space.
From the traditional hospital to a place of health
The concept of a green hospital calls for a cultural shift in the design of healthcare facilities.
Technology and high levels of clinical specialization remain indispensable elements of modern medicine. However, technological efficiency does not necessarily mean that environments should lack identity, natural light, and connection to the outside world.
A place of health can be technologically advanced while also being designed to promote comfort, orientation, privacy, and connection with nature.
Therapeutic gardens are one of the most concrete examples of this integration. They are not simply decorative parks located next to a hospital, but can be designed to meet psychological, physical, and social needs.
Available scientific evidence supports the growing interest in integrating nature into healthcare settings, while highlighting the need for balanced communication and further high-quality studies to more precisely define the clinical effects and mechanisms involved.
The most compelling perspective, therefore, is not to claim that a garden can cure a disease on its own, but to recognize that people do not experience care solely through medications, procedures, and tests.
The quality of the environment, the opportunity to move, contact with light, the presence of nature, quiet, social interaction, and a sense of control can all contribute to the overall experience of health.
The green hospital thus embodies a form of medicine in which the treatment of illness and the care of the person go hand in hand. Nature does not replace medicine, but it can help make medical settings more humane, accessible, and consistent with a view of health as a dynamic balance between body, mind, relationships, and environment.
Note: The information in this article is for informational and educational purposes only. Therapeutic gardens, exposure to nature, and horticultural activities can complement efforts to promote well-being and support care and rehabilitation pathways, but they are not substitutes for diagnoses, medical treatments, pharmacological therapies, or rehabilitation programs prescribed by healthcare professionals.
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