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In 2004, The Center for Health Design published The Healthcare Consumer's Environmental Bill of Rights. The brief introductory paragraph to the Bill of Rights asks, "What are your rights as a healthcare consumer when it comes to the environment in which you receive care?" The center suggests that individuals take this checklist of rights with them the next time they go to the hospital, doctor's office, or visit a loved one in a nursing home. Reviewing the checklist, one realizes that many healthcare facilities are failing in some aspects of their mission to provide healing environments. When institutions and nursing homes fail their constituencies in this regard, they also fail their staff because the environment affects all concerned.


The Center for Health Design states that as a consumer, you are entitled to an environment that


* is easy to find your way around and offers frequent opportunities of orientation to where you are


* has unrestricted access to nature through views, gardens, landscaped patios, terraces, courtyards, atria, and natural elements


* provides reasonable control over your personal environment, including personalization, electrical lighting, day lighting, noise sound reduction, odor elimination, thermal comfort, and visual privacy


* offers you the ability to select positive distractions, including television, games, video, computers, art, telephone, music, access to nature, and reading material


* has activities occur in spaces that are conducive to their purpose


* makes it easy for staff members to bring you food, medicine, and other supplies related to your care


* provides you with access to furniture and equipment that is comfortable and user-friendly


* maximizes opportunities for your regular lifestyle activities


* offers access to a continuous sequence of environments that protect your dignity and the dignity of others


* is clean


* is free from hazards


* provides you with personal safety and security for personal possessions


* is neat and orderly


* inspires your trust and confidence


* symbolizes values appropriate to you and others who use it


* appropriately acknowledges the local cultural backgrounds and diversity of your community


* is appropriate for the various ages, sexes, and physical and mental capabilities of people who use it


* supports interaction with others and care partner participation


* minimizes unnecessary "stressors" for all patients/residents and staff, and


* is aesthetically appealing to you.



It is hoped that reflecting on each of the above rights in relation to healthcare facilities with which the reader is associated produces a myriad of possibilities for creativity and change. Even if one is fortunate to work in an already transformed or newly built facility, there are always more transformations possible. Indeed, as new employees arrive and traverse through orientation programs, instruction on the components of a healing/therapeutic environment should become part of the learning that takes place. In some institutions, it is a responsibility of nurse leaders and managers to support and nurture the healing environment through their leadership and with their staff.


Consumers of healthcare do have access to The Healthcare Consumer's Environmental Bill of Rights. Informed consumers have helped to bring important changes in the way that healthcare is delivered. And, of course, at one time or another, we all have been or will become a healthcare consumer. It is suggested that healthcare practitioners view their practice environment with this checklist in hand just as the consumers have been invited to do. Together, the elements of the environment described in the above Bill of Rights comprise a therapeutic environment that is designed for patient and staff comfort and safety, is humane, provides access to information and knowledge, and provides access to beauty, color, nature, and light. In most healthcare facilities, many of these rights are already in place. Many, if not all, are part of the art and science of nursing. Some are not as easy to provide, the barriers to change seem insurmountabl[horizontal ellipsis]until closely examined. A transformation of the physical, operational, and social environment becomes a unified pursuit, all in the facility and those who use its services realize the crucial necessity of creating and sustaining a healing environment.


Of all the elements aforementioned, it is unrestricted access to nature through views, gardens, landscaped patios, terraces, courtyards, atria, and natural elements that, for many, seems most formidable. And yet, literature shows us that gardens can be installed in most environments. They need not be large atriums to be effective (although atriums are desirable in cold climates). Gardens can be in containers, windows, terrariums, on balconies, rooftops, patios, pathways, walkways, etc. Furthermore, it is known through Wolverton's2 research that a large number of plants can rid the atmosphere of dangerous toxins.


"Patients in a healthcare facility are often fearful and uncertain about their health, their safety, and their isolation from normal social relationships. The large, complex environment of a typical hospital further contributes to the stressful situation. Stress can cause a person's immune system to be suppressed, and can dampen a person's emotional and spiritual resources, impeding recovery and healing."3


In my next column, I will discuss the theory/background of therapeutic environments, highlighting restorative gardens and their positive influence on the human spirit.




1. The Center for Health Design. The Healthcare Consumer's Environmental Bill of Rights. Concord, Calif: Center for Health Design; 2004.


2. Wolverton BC. How To Grow Fresh Air: House Plants to Purify Your Home or Office. New York: Penguin; 2002. [Context Link]


3. Smith R. Therapeutic environments. Paper presented at: Therapeutic Environments Forum, AIA Academy of Architecture for Health; 2004. [Context Link]