Journal of Environmental Protection, 2011, 2, 639-647
doi:10.4236/jep.2011.25073 Published Online July 2011 (http://www.scirp.org/journal/jep)
Landscape Preference Evaluation for Hospital
Environmental Design
Anthopoulos K. Petros1, Julia N. Georgi2
1Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece; 2Hellenic Open Univer-
sity, Patras, Greece.
Received March 20th, 2011; revised May 1st, 2011; accepted June 13th, 2011.
ABSTRACT
This paper examined users’ preferences for landscape design of grounds and spaces surrounding hospitals, in order to
assess how they perceived the landscape facilities so as to make future open spaces of hospitals suitable to users’ needs.
The method of the research was based on quantifying a questionnaire survey of a representative sample of personnel
(doctors, nurses, administrative staff and medical students) by using the stratified sample research programme that was
carried out in March 2007 at the University Hospital of the city of Alexandroupolis, situated in northeastern Greece.
The results of study show that users of hospital cared about footpaths, resting areas, social and public spaces, personal
spaces, water features and a dominant, limited range of colors in landscaping. They also require environment that
supports the principles and specifications of Therapeutic Hospital Gardens. Based on the results of this research, 1)
interventions have been proposed (e.g., footpaths, resting areas, social and public spaces, personal spaces, water fea-
tures and a dominant, limited range of colors in landscaping), and 2) the principles and specifications for the landscape
design of Therapeutic Hospital Gardens have also been evaluated and have been redefined in the light of the study
findings. These results also provide the opportunity for health care decision makers to apply and to incorporate user
considerations into overall landscape design for current and future health care programs.
Keywords: Therapeutic Garden, Horticultural Therapy, Landscape Design, Sample Investigation
1. Introduction and Methods
People that were living in large and dense cities, a good
quality of life depend largely on the quality of the urban
environment [1]. Nearly four out of five European citi-
zens live in urban areas where existing environmental
quality limits are breached.
Public parks and private gardens play a critical role in
supporting biodiversity and providing important ecosys-
tem services in urban areas [2,3]. Especially, green areas
outside hospitals are considered not only to be necessary
but also beneficial. Renewed interest in nature within the
hospital environment has resulted in research document-
ing the benefits of nature for reducing stress, improving
mood, and increasing healthcare satisfaction [4-8]. Stud-
ies described that even a few minutes of visual exposure
to nature can significantly reduce patients stress [9]. The
benefits that individuals can derive from plants and con-
tact with nature have been discussed for thousands of
years. Historical accounts suggest that this belief was an
organizing principle for the exemplary hospitals of the
past, where a primary goal was making patients more
comfortable [10].
The main goal of this study was to investigate users’
attitudes towards landscape design regarding the existing
and future improvements to outdoor grounds and spaces,
by using a case study in order to collect data from the
hospital users. The objectives of the study were: to deve-
lop an understanding of users experience within the land-
scape surrounding the hospital buildings; to investigate
users considerations of landscape design in the impro-
vement and maintenance of the landscape; to recognize
and estimate the characteristics that the users who were
surveyed felt they had contributed towards a sustainable
friendly environment; to outline a set of recommenda-
tions to improve the landscape that surrounds the hospi-
tals; and to consider users’ needs in the planning and
design of hospitals.
1.1. Historic Overview: Integration of Green
Spaces in the Design of Hospitals
Historical data have shown that the design of the spaces
around hospitals was an important consideration in en-

Landscape Preference Evaluation for Hospital Environmental Design
640
suring that patients could feel comfortable, and that land-
scape design played a very important role [10]. The no-
tion of a healing space has its roots back to ancient
Greece. Temples such as the sanctuary at Epidaurus were
built for the god Asclepius, where ill people went in the
hope of having dreams where he would reveal the cures
for ailments [11]. Since the Middle Ages, hospitals with-
in monasteries used the monastery gardens as areas for
therapy and healing [12]. The patients’ rooms had a view
of the hospital gardens, which could provide the patient
with exposure to sunshine, a small lake, seasonal flowers,
rest areas or footpaths. Saragossa hospital in Spain,
which was built in 1409, is one such example that was
used as inspiration from the landscape designers of that
era, particularly with regards to the way patients could
interact with one another. This became known in the ni-
neteenth century as ‘Ethical Therapy’. In the Saragossa
hospitals, patients were not shut in their rooms. Instead,
the hospital’s garden was used for their treatment, and
patients generally communicated with one another
throughout the day in the outdoors [12]. Later, in 1860,
Florence Nightingale extolled ventilation and fresh air as
“the very first canon of nursing,” along with elimination
of unnecessary noise, proper lighting, warmth, and clean
water [11].
In contrast to that, American hospitals in the 17th cen-
tury were offering bad environments for their patients.
Buildings were small, rooms had no windows, there were
no gardens and the treatment of psychopathic patients
included the “tying of patients on piles” or the use of a
type of “gallows” [13].
The European Romanticism Movement of the 18th
century was the cause of many important changes in the
design of hospital facilities and grounds. The theory
connecting medical therapy with the existence of a natu-
ral environment around hospitals was revived. Romanti-
cism was a “pervading cultural movement, aiming at the
unification of human emotions with morals and nature”
[12].
Cooper Marcus [14] mentioned that in the 18th cen-
tury, Dorothea Linde Dix (1802-1887) was the first to be
interested in amending the patient’s therapy methods and,
by extension, the hospital environment. She proposed
certain basic principles to the American Legislative As-
sembly concerning the arrangement of areas in these in-
stitutions.
However, in the 20th century, the progress in medical
science, urbanization and technological developments
and other economic forces led to the neglect of the ex-
ternal areas of many hospitals [15].
Many hospitals in Europe added a method called “hor-
ticultural therapy” (gardening) to their therapeutic pro-
grams, which was aimed at “keeping the patients’ mind
away from disaster and drive it to creative action” [12].
Horticultural therapy developed from the profession of
occupational therapy and emerged as a distinct profes-
sion in the U.S. in the 1950s. A well-designed hospital
garden offers security, reduces stress, nourishes social
contact and interaction, allows visitors to enjoy nature
and helps in the development of senses, which cannot be
developed within the structural environment of a city [9].
1.2. Benefits of Nature
Findings from several studies of non-patient groups sug-
gest that even brief visual encounters with real or simu-
lated natural settings can elicit significant psycho-phy-
siologic restoration within as little as 3 - 5 min [6,16-18].
This restoration is manifested as reduced negative effects,
and heightened positive effects and changes in physiolo-
gic systems that are indicative of reduced arousal or stress
mobilization (electrocortical, cardiovascular, neuroendo-
crine and musculoskeletal) [17].
Accordingly, Sherman et al. [19] focused on the ac-
tivities of the users in the hospital, and found that 66% of
staff garden usage was in the form of “walk-throughs”
from one place to another. Although this activity does
not fully exploit the gardens to their full capacity, re-
search such as Kaplan’s [20] on micro-restorative ex-
periences suggests that even these brief encounters may
enhance staff’s well-being and job satisfaction, both of
which are predictors of patient healthcare satisfaction
[21].
Furthermore, Douglas and Douglas [22] investigated
patients’ perceptions based on qualitative and quantitative
methodologies. The results from a questionnaire survey
provide suggestions for radical improvements, and found
a sustainable health care environment to be supported of
the patients’ health and recovery.
A number of studies have discussed the relationship
between mental stress and the healing effect of the natu-
ral and urban environment [6, 23-27]. One study supports
the view that the hospital environment is stressful be-
cause it is considered to be complex and not friendly [28].
The authors believe that continuous exposure to such an
environment leads to mental (spiritual) exhaustion. In
such cases, they recommend exposure to a less complex
natural environment, which would enable them to rest,
develop companionship and burden them with a smaller
amount of information.
Humans have a natural tendency to prefer the natural
landscape rather than the built-up environment, particu-
larly when the latter presents an absolute lack of vegeta-
tion and water [29,30]. Many people who are under stress
seek solace in the natural environment, which they be-
lieve could make them feel better [13,31].
Cooper-Marcus and Barnes [13] evaluated four hospi-
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Landscape Preference Evaluation for Hospital Environmental Design641
tal gardens in the US with the use of observations and
interviews of patients, visitors and staff. Their findings
showed that from those interviewed 95% experienced a
positive change of mood in the garden. During an inves-
tigation conducted by Cooper-Marcus [32], a sample of
students in California was asked to describe where they
go when they wish to escape from a stressful situation.
The majority (75%) answered that they go outdoors to a
natural or designed environment.
Ulrich [9], of the University of Texas, found that pa-
tients’ views towards natural settings are associated with
shorter hospital stays. Examining medical records, he
found that patients who viewed trees during their recove-
ry period needed fewer strong painkillers and their reco-
very was quicker compared with patients who had a view
of a wall. Furthermore, patients who were able to view
trees more frequently received positive written comments
from staff about their condition in their medical records
(“patient is in good spirits”). Those patients with views
of a wall, however, had far more negative evaluative
comments (“patient is upset”, and “needs much encour-
agement”).
The hospital staff can also benefit from it by having
access to windows that make it possible to view garden
spaces [33]. Indirect proof of the aforementioned is the
satisfaction that patients and staff express when they find
themselves in a natural environment, compared with be-
ing inside the hospital building [13].
2. Methodology
Initially, a team of expert scientists (Landscape architect,
Forester, Medical doctor) edit a questionnaire with ques-
tions including refreshing area, cheerful environment,
scenic view; open space, freedom to play, and a variety
of activities were asked upon the users for the outdoor
space of hospital. The collection of the information was
conducted through questionnaires to 102 users (5% of the
total population occupied in the hospital).
2.1. User Attitude Survey Method
This research was carried out at the new University Hos-
pital of Alexandroupolis (Greece), which is located 6 km
west of the city and is developed along the coastal road
axis. The existing environmental situation surrounding
the hospital is at an early stage and no specific plans have
been applied. The University Hospital in northeastern
Greece (Figure 1) provides local, regional and national
services, has approximately 630 beds, and employs 1,180
staff. It was established in 2002 after the relocation of
Alexandroupolis National Hospital. From the front of the
hospital one can see panoramic views of the coast line
and from the back view the surrounding mountains.
These factors influence the users’ perceptions, their ex-
Figure 1. Map of Greece where it is pointed out the area of
study.
periences and their subsequent view and opinions for the
surrounding environment of the hospital [22].
2.2. Method Description
This research includes the compilation of a questionnaire
with pre-coded questions, so it would be easy for those
being asked to answer them. The answers were collected
through personal interviews, which were given by the
hospital staff face-to-face and were then processed with
the use of a statistic program SPSS V 15.
The questionnaire was developed according to the fol-
lowing principles:
1) limitation of a question to one idea; 2) no ques-
tions accepting multiple complex answers; 3) avoiding
leading questions; 4) simple language; 5) avoiding ne-
gative or conditional answers; and 6) posing only neces-
sary questions [34,35].
The responders were chosen from groups of staff me-
mbers that work in the hospital. Their responses repre-
sented their own preferences and perceptions as well as
their knowledge of the experiences from patients and vi-
sitors. Most efforts with regards to the aesthetics evalua-
tion of the landscape are based on users and not on “spe-
cial estimators” (Landscape architecture, Forester). Ex-
pert scientists accept that the evaluation of each land-
scape depends on human needs, wishes, and, consequ-
ently, human preferences [36]. The method used for the
landscape evaluation on the basis of people’s preferences
is a basic method, which has become more and more
accepted [37,38]. This is because it achieves the direct
participation of the public, which is indeed the group of
people who are directly, interested in “decision taking
while expressing their preferences” [39].

Landscape Preference Evaluation for Hospital Environmental Design
642
This research was carried out using a method referred
as ‘stratified sampling’. The total population was divided
into homogeneous, non-overlapping sub-population groups,
called ‘strata’. This stratified sampling method is indi-
cated for similar research, because it presents smaller
losses in the evaluation of the various parameters com-
pared with the ‘simple random sampling’ method [40].
People were divided into four strata on the basis of their
specialty in the hospital. The strata were as follows: stra-
tum Α: doctors; stratum Β: nurses; stratum C: adminis-
trative Staff; stratum D: medical students.
Responders were selected to provide diversity both in
terms of their length of experience and the type of speci-
alty area across the major clinical divisions of the hospi-
tal. Thus, the researchers sought to interview a variety of
responders comprising the young and middle-aged as
well as males and females.
Consequently, sample size was determined using the
method of “proportional allocation” of the number in
each stratum. The size of each stratum was as follows:
doctors: 350; nurses: 450; administrative staff: 380; and
medical students: 683. The size of each sample was 5%
of the people surveyed. We observed a limitation of n/N
< 0.10 (Ν is the size of people and n is the size of sam-
ple), this is required so that sample taking is considered
to be independent and the sample is considered to be
random. It also enables us to avoid “finite population
correction” [41]. We obtained a final sample of approxi-
mately 6%, which is close to the original target of 5% of
the total population occupied in the hospital. This meets
the aforementioned requirements and additionally gives a
value of n = 102 (doctors 21, nurses 23, administrative
staff 24, and medical students 34), which is also accepted
by the following formula for n-optimum:
 
2
2
2
11 a nNS dzN 
where S2: Dispersion, 1-a: level of trust, and d: area of
error.
For acceptable values of error d departure of estima-
tors from estimated data, as well as trust level 1-a. S
2
factor has been estimated from a first sample [42].
3. Results
From the field survey, an average response rate of 95%
participated and completed the questionnaires from ap-
proximately 6% of the population. For most questions
responses were satisfactorily numerous and provided
sufficiently distinct decisions to make reasonably confi-
dent predictions for the overall population and for com-
parison between the different groups.
The first question in the survey of the selected hospital
staff asked them how satisfied the person was with the
current outdoor space area of the hospital. The majority
of doctors, nurses, administrative staff and medical stu-
dents replied “a little” and “not at all” (Table 1). These
responses are expected because of the current condition
of the hospital outdoor spaces.
The second question asked which part of the outdoor
space of the hospital would the responder would like to
increase its availability. As shown in Table 2, the major-
ity of users of outdoor space prefer “green areas” (50%
nurses to 90% doctors) and “rest areas” (5% doctors to
37.5% nurses). A significant percentage of administrative
staff (18.3%) prefers to increase the “parking areas” even
though currently, the hospital provides parking that ac-
commodates 350 spaces. This response may be because
the staff would like to have more convenient access to
parking spaces, especially after long hours of work.
In the third question, when the responders were asked
whether they would wish for a garden with trees and
bushes in the outdoor space of the hospital, the majority
of doctors, nurses, administrative staff and medical stu-
dents expressed their wish for this type of garden as it
can be seen in Table 3.
The fourth question asked whether the person believes
that landscape design with green areas in the outdoor
space of the hospital would positively affect their psy-
chology. The majority of doctors (95%) gave a positive
answer, compared with nurses (79.2%), whereas the re-
maining 20.8% doubted the effect that greenery would
have on their psychology. Two-thirds (72.7%) of admin-
istrative staff favored the effect of greenery on their
mood, whereas 18.2% had doubts about the effects, and
9.1% considered greenery to have no effect. Table 4
provides shows the findings for question four. The ma-
jority of Students believed that greenery would have a
positive effect on their mood.
Regarding question five, which asked whether the per-
son would wish to spend their rest time in a well-designed
landscape surrounding the hospital, the majority of doc-
tors, nurses, administrative staff and medical students
gave a positive answer. We believe that a high percent-
age of Administrative Staff gave a negative answer be-
cause of too much pressure of work as it can be seen in
Table 5.
Question six asked what kind of vegetation the person
would wish to be planted in the hospital’s garden. The
majority of users wished for a combination of trees and
bushes because the variation of trees and bushes can pro-
vide a natural character to the garden (Table 6). A sig-
nificant percentage of nurses seem also to prefer medium
and small trees.
Question seven asked whether the person would wish
for water features in the outdoor space of the hospital. As
shown in Table 7, a high percentage (70%) of doctors
and 91.7% of nurses, and 80.6% of students wished for
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Landscape Preference Evaluation for Hospital Environmental Design
643
Table 1. How satisfied are you with the current outdoor space area of the hospital? (%).
a lot a little not at all
Doctors 5 45 50
Nurses 12.5 75 12.5
Administrative Staff 13.6 63.7 22.7
Medical Students 8.3 75 16.7
Table 2. Which part of the outdoor space of the hospital would you wish to increase? (%)
Green areas Parking areasRest areas Isolated areas Water formations
Doctors 90 5 5 0 0
Nurses 50 4.2 37.5 8.3 0
Administrative Staff 63.6 18.3 13.6 0 4.5
Medical Students 52.8 13.9 25 8,3 0
Table 3. Would you like a garden with trees and bushes in the outdoor space of the hospital to exist? (%)
a lot a little not at all
Doctors 90 10 0
Nurses 70.8 29.2 0
Administrative Staff 77.3 18.2 4.5
Medical Students 80.6 16.6 2.8
Table 4. Do you believe that landscape design with green areas in the outdoor space of the hospital would positively affect
your psycho logic status? (%)
Yes Maybe No
Doctors 95 5 0
Nurses 79.2 20.8 0
Administrative Staff 72.7 18.2 9.1
Medical Students 91.7 8.3 0
Table 5. Do you want to spend your r est time in a well-designed landscape surr o unding the hospital? (%)
Yes No
Doctors 85 15
Nurses 95.8 4.2
Administrative Staff 81.8 18.2
Medical Students 94.4 5.6
Table 6. What kind of vegetation would you like to be plante d in the hospital’s gar den? (%)
High trees Medium height treesSmall trees Bushes Combination of trees and
bushes
Doctors 5 15 15 15 50
Nurses 4.2 29.2 20.8 8.3 37.5
Administrative Staff 9.2 4.5 13.6 0 72.7
Medical Students 11.1 22.2 11.1 0 55.6
Table 7. Do you wish for water features in the outdoor space of the hospital? (%)
Yes No
Doctors 70 30
Nurses 91.7 8.3
Administrative Staff 50 50
Medical Students 80.6 19.4

Landscape Preference Evaluation for Hospital Environmental Design
644
water features, while only 50% of administrative staff
gave a positive answer.
Question eight asked what combination of colors
would the person wish to see prevail in the hospital’s
garden. As shown in Table 8, a monochromatic color
character received low preferences from the responders:
10% of doctors, 8.3% of nurses, 4.5% of administrative
staff, and 8.3% of students. The preference responses
increased for a garden with color: variegated character
garden (40% of doctors, 50% of nurses, 31.8% of admin-
istrative staff and 44.4% of students; while preference for
a limited number of colors in a garden received medium
range responses: 50% of doctors, 41.7% of nurses, 63.7%
of administrative staff and 47.3% of students.
In question nine which asked what kind of activities
would the person wish to have to exercise in the hospi-
tal’s garden; the results vary between the responders. The
detailed responses are shown in Table 9. Where 50% of
doctors, 41.7% of nurses, 36.4% of administrative staff
and 61.1% of students would wish to use the garden to
rest, 10% of doctors, 8.3% of nurses and 9.1% of admin-
istrative staff would wish to be able to observe the land-
scape from inside the buildings. Furthermore, the garden
as a place for having lunch received a preference of 10%
from doctors, 8.3% from nurses, 22.7% from administra-
tive staff, and 19.4% from students; while the garden as a
place to go to avoid stressful work situations was pre-
ferred by 30% of doctors, 29.2% of nurses, 31.8% of
administrative staff and 16.7% of students. In addition,
12.5% of nurses and 2.8% of students would wish to be
able to have a garden to walk in.
Question ten asked whether the responder believes that
a garden would help the patients to recover. The review
of the responses in Table 10 show that the majority of
doctors, nurses, administrative staff and students replied
“a lot”. It is worth noting that a significant number of
administrative staff (27.3%) replied “a little”. It appears
that the administrative staff’s response maybe due to the
fact that the majority of the staff has only secondary level
education as it can be seen in Table 10.
In question eleven, which asked what type of physical
improvements would the responder wish to be carried out
in the outdoor spaces of the hospital, the majority of the
responders would wish for footpaths (55.6% - 72.7%); a
place to have lunch in the open air is preferred by doctors
(10%), by nurses (16.7%), by administrative staff (9.1%),
and by students (27.8%). Other improvements included
shade areas where people could rest and observe (5% of
doctors, 8.3% of nurses, 4.5% of administrative staff and
2.8% of students); and a playground for the pediatrics
division and for the young visitors to the hospital (5% of
doctors, 9.1% of administrative staff and 5.6% of stu-
dents (Table 11).
4. Discussion
The results of this research project are revealing and give
us insight on the views and preferences of the staff at the
Alexandroupolis University hospital, with regards to
open space associated with the hospital. The majority of
respondents were not satisfied with the current situation
of the open space surrounding the hospital. With the ex-
ception of the installation of some hard surfaces and
parking lots, no other open space and green space impro-
vements were made since the hospital was constructed.
The staff expressed a strong desire for a well-designed
landscape that surrounds the hospital, and it felt that this
would make for a positive contribution to its mood and
well being, and would offer the opportunity to spend part
of their free time there. Similar results were found in a
study about the behavior of consumers in a children’s
hospital in U.S. [8].
The results of this research demonstrate that people
prefer a well-designed landscape that includes a variety
of plant materials. However, if we examine the results
from question three we observed an indifference to the
presence of a garden by the nursing staff (29.2%), ad-
ministrative staff (22.7%), and medical students (19.4%).
The respective percentage of the medical staff is particu-
larly low (10%). A possible explanation for the afore-
mentioned results is that nurses and administrative staff
have a high workload, which directly results in not al-
lowing them to spend much time outside of the hospital
buildings. They prefer to spend their free time in places
that allow for more social interaction and entertainment.
Similar studies have been carried out by Cooper-Marcus
and Barnes [16], in which they used a combination of
behavioral observations and interview methods to evalu-
ate four hospital gardens in California. They found that
restoration from stress, including improved mood, was
by far the most important category of benefits derived by
nearly all users of the gardens - patients, family and em-
ployees. Similarly, another study of a garden in a chil-
dren’s hospital identified mood improvement and resto-
ration from stress as primary benefits for users [8].
Most people working in the hospital would wish for
additional planting of various types of plants, and for
certain areas to be defined at their perimeter with tall
trees. The majority of staff (54%) would wish to see new
trees and shrubs of a variety of sizes and height. This
variation in size of trees and shrubs can give a natural
character to the garden, creating the feeling of a ran-
domly planted natural environment. Planting design of
these open areas should be sensitive to views afforded
from inside the hospital buildings, so that views from se-
lected areas to the outdoor spaces can remain unobstructed,
and contribute to the mood of both patients and vistors.
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Landscape Preference Evaluation for Hospital Environmental Design645
Table 8. What combination of colors would you like to see prevailing in the hospital’s garden? (%).
Monochromie Limited number of colours Variegation
Doctors 10 50 40
Nurses 8.3 41.7 50
Administrative Staff 4.5 63.7 31.8
Medical Students 8.3 47.3 44.4
Table 9. What kind of activities would you wish to exercise in the hospital’s garden? (%).
Rest Landscape
observation picnic Avoidance of a stressful environment Walking
Doctors 50 10 10 30 0
Nurses 41.7 8.3 8.3 29.2 12.5
Administrative Staff 36.4 9.1 22.7 31.8 0
Medical Students 61.1 0 19.4 16.7 2.8
Table 10. Do you believe a garden would help the patie nts to recover ? (%).
A lot A little
Doctors 100 0
Nurses 83.3 16.7
Administrative Staff 72.7 27.3
Medical Students 88.9 11.1
Table 11. What constructions would you wish to be carried out in the outdoor space of the hospital? (%).
Footpaths Picnic areas Playgrounds Gymnastic areasVegetation Indoor areas
Doctors 70 15 5 0 5 5
Nurses 70.8 20.8 0 0 4.2 4.2
Administrative Staff 63.6 18.2 9.1 0 9.1 0
Medical Students 58.3 36.1 2.8 2.8 0 0
The results of the study show that the majority of the
responders (92.2%) wished for a landscape scheme that is
multi-colored as opposed to monochromatic plantings.
This was also true for the students who prefer plant spe-
cies that provide good shade during summer and could
create an improved microenvironment. Native species of
local origin should generally be preferred [43] and non-
indigenous plants should be avoided [44]. The selection
of trees and shrubs should be done carefully, with special
attention to the mix of color of foliage and flower as ex-
pressed by responders.
In addition, the responders seemed to favor the con-
struction of footpaths, rest areas, social and public areas,
and water features. A “garden” is expected to provide
people with the convenience to walk, stand, and rest in
areas that are especially arranged for this purpose, and
where people have the possibility to enjoy their lunch or
the cool breeze.
Finally, the staff understood, to a large extent, the im-
portance of having a green landscape for improving the
psychology and healing of patients. They understand that
the presence of a planted landscape would compliment
conventional therapy methods, ensuring faster and better
results. It should be pointed out that all doctors who re-
sponded to the survey (100%) gave a positive reply for
the possibility of improving the psycho logic status of the
patients with the use of outdoor gardens. Evidence from
studies of a number of different hospitals and diverse
categories of patients (adults, children, and elderly pa-
tients; ambulatory or outpatient settings; and inpatient
acute care wards) strongly suggests that the presence of
nature—indoor and outdoor gardens, plants and window
views of nature—increases both patient and family satis-
faction [8,13,45].
5. Conclusions
While the healing garden is a preceding concept, it is
being revived in modern societies because of the com-
prehensive therapeutic benefits such places can offer.
These benefits have high implication for hospital staff

Landscape Preference Evaluation for Hospital Environmental Design
646
and students who are at a critical stage of development of
their bodies and minds. In similar finding conclude the
research by English et al. [46] where they suggest a strong
interplay between emotions and place such that emo-
tional geographies, which appear to be embedded within
places of healing, play an important role in shaping and
maintaining therapeutic landscapes.
Furthermore, the research suggests a strong interplay
between emotions and place such that emotional geogra-
phies, which appear to be embedded within places of
healing, play an important role in shaping and maintain-
ing therapeutic landscapes.
All the groups of the users of the case study hospital
gave their considerations for the external design of the
hospital, so the profession of expert scientists of land-
scape planning will be easier and more properly. Users of
hospital cared about footpaths, resting areas, social and
public spaces, personal spaces, water features and a do-
minant, limited range of colors in landscaping. Users re-
quire environment that supports the principles and speci-
fications of Therapeutic Hospital Gardens.
This study of hospital gardens demonstrates the feasi-
bility of objective and landscape guidelines from which
valid design implications can be drawn. When designing
a hospital garden, these findings suggest that designers
should include design features that enable the patient to
sit and socialize or to relax, as well as being able to enjoy
the water features and the paths around the garden. These
results also provide the opportunity for health care deci-
sion makers to apply and to incorporate user considera-
tions into overall landscape design for current and future
health care programs.
6. Acknowledgements
The authors wish to thank Professor Menelaos Trianta-
fillou (Harvard University Graduated) at University of
Cincinnati for his pre-review of the paper. The authors
wish also to thank the users of the hospital that took place
and agreed to be interviewed.
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