Flowers Rooms

[Robert]

Photographsof the two hospital room treatments. (A) No plants and (B) foliage and flowering plants. The rooms, which were located on the same floor and the same side of the building, were identical except for the presence or absence of plants. The combinations of plants used in each room were identical. Room B contained single plants of arrowhead vine, cretan brake fern, variegated vinca, and yellow star jasmine arranged with two plants each of dendrobium, peace lily, golden pothos, and kentia palm.

Medical and psychological measurements of surgical patients were tested to determine the influence of plants and flowers within hospital rooms. Eighty female patients recovering from a thyroidectomy were randomly assigned to either control or plant rooms. Patients in the plant room viewed 12 foliage and flowering plants during their postoperative recovery periods. Data collected for each patient included length of hospitalization, analgesics used for postoperative pain control, vital signs, ratings of pain intensity, pain distress, anxiety and fatigue, the State-Trait Anxiety Inventory Form Y-1, the Environmental Assessment Scale, and the Patient's Room Satisfaction Questionnaire. Patients in hospital rooms with plants and flowers had significantly shorter hospitalizations, fewer intakes of analgesics, lower ratings of pain, anxiety, and fatigue, and more positive feelings and higher satisfaction about their rooms when compared with patients in the control group. Findings of this research suggest the therapeutic value of plants in the hospital environment as an effective complementary medicine for surgical patients.

Surgery is a threatening experience with multiple stressful components such as physical pain and discomfort, worries about illness, isolation from family and friends, fear of medical procedures, and lack of familiarity with medical personnel, hospital equipment, and the sterile hospital environment. Numerous studies suggested that greater stress or anxiety associated with surgical experience is typically related to more severe postoperative pain and a slower and more complicated postoperative recovery (Cohen and Williamson, 1991; Johnston and Wallace, 1990; Mathews and Ridgeway, 1981). Some of the postoperative problems related to stress can be mediated through intakes of anesthetics and analgesics; however, these drugs have side effects, which can produce postoperative physiological problems (e.g., vomiting, headaches, nausea, and pain at the incision site), drug dependency, and even be fatal if not properly administered (Abbott and Abbott, 1995; Coniam and Diamond, 1994). Therefore, it would be useful to develop nonpharmacological approaches to improving the patient experiences with pain and stress during hospitalization.

Clinical trials concerning the health benefits of viewing indoor plants on stress and recovery of surgical patients within a hospital setting do not exist. This investigation determined if exposing surgical patients to plants influences stress reduction and recovery from surgery using various medical and psychological measurements.

The sample consisted exclusively of patients who had undergone thyroidectomy surgery, which is a comparatively standardized medical procedure with similar postoperative management in the uncomplicated cases. Eighty female patients (mean age, 36.2 10 years) were studied from July 2005 to Jan. 2006 in an 809-bed suburban university-affiliated hospital in Korea. Human research protocols for this study were approved by the Institution Review Boards of both the academic and hospital setting. Patients were informed that their medical history and current medical records would be reviewed and each signed an informed consent form. Patients were randomly assigned to either control or plant rooms (Fig. 1) as they became available. Equal numbers of single and six-patient rooms were used for two treatments. The rooms, which were located on the same floor and the same side of the building, were identical except for the presence or absence of plants. Patient views from the hospital windows were only of the sky with no presence of trees or other buildings. Patients in the plant group were allowed to view plants during their recovery periods after surgery until discharge. Excluded from the study were patients who were younger than 19 years or older than 60 years and those who reported a chronic (e.g., diabetes or high blood pressure) or current acute (e.g., upper respiratory infection) health problem, a history of psychiatric problems (e.g., depression or anxiety), or uncorrected hearing or visual impairments. All were in good health before surgical treatment.

Data collected included the length of hospitalization, analgesics used for postoperative pain control, vital signs, ratings of pain intensity, pain distress, anxiety and fatigue (PPAF), the State-Trait Anxiety Inventory Form Y-1 (STAI-Y1), the Environmental Assessment Scale (EAS), and the Patient's Room Satisfaction Questionnaire (PRSQ).

Levels of the PPAF were measured using a 101-point numerical rating scale (NRS-101). The validity of the NRS-101 and its sensitivity to treatment effects have been well documented (Jensen and Karoly, 1992; Jensen et al., 1986). The NRS-101 (rating from 0 to 100) is reported to have several advantages over the other rating scales and to be more sensitive to treatment effect than the NRS-11 (rating from 0 to 10) as a result of a large number of response categories (Jensen et al., 1986).

The STAI-Y (Spielberger, 1983) is comprised of a self-report measurement of anxiety and has been used extensively in research and clinical practice. The STAI consists of two scales. The STAI-Y1 scale includes 20 statements intended to measure transitory feelings of tension, nervousness, apprehension, and worry, whereas the STAI-Y2 section evaluates the stable personality trait of anxiety proneness. This study used the STAI-Y1 because it was designed to measure changes in anxiety resulting from situational stress. Psychometric properties of the STAI-Y and studies supporting its construct validity and reliability are presented in the STAI-Y manual (Spielberger, 1983).

To measure patients' feelings in response to their hospital room, the modified EAS was used (Rohles and Milliken, 1981). The EAS consists of 13 adjective pair semantic differential scales. The EAS has been used in previous studies to evaluate the affective characteristics of the environment and various features it contains (Laviana, 1985; Laviana et al., 1983).

To assess patient satisfaction with the hospital room, patients were asked to complete the PRSQ, which indicated three positive and three negative qualities of their room environments. Patients were further asked about their willingness to return to their room during any future hospitalization. Space was provided so the patient could add comments.

A meeting with the hospital doctors and nurses was held before the beginning of the research. Research objectives were explained that included their need to treat patients similarly. In addition, nurses were assigned to help patients in both the control and plant rooms and were urged not to be influenced by the content of the rooms. Patients were hospitalized a day before surgery to be given preparatory information about surgical procedures. On the day of admission, after obtaining the informed consent agreement from the patient and after health screening, patients completed the PPAF, STAI-Y1, and EAS in the hospital room.

During the recovery period, the PPAF and the STAI-Y1 were administered on the first, third, and fifth days after surgery. The second trial of the EAS and the initial trial of the PRSQ were administered on the last day of hospitalizations. All measurements were taken by the researcher except demographics, analgesic intakes, and vital signs, which were recorded by medical staff.

Analysis of covariance (ANCOVA) (Littell et al., 2006) using SAS PROC GLM (version 8.0; SAS Institute, Cary, NC) was completed for data of hospitalization and the EAS to test for differences between groups. Age was used as the covariate for ANCOVA. A repeated-measures ANCOVA (Littell et al., 2006) using SAS PROC MIXED was done for data of vital signs and the PPAF and the STAI-Y1 to test for differences between groups at each day of hospitalization and to compare trends for groups over postoperative recovery periods. Because of the differences in age and preoperative score, the patient's age and preoperative score were used as the covariates for a repeated-measures ANCOVA. The exact χ2 test (Higgins, 2004) using SAS PROC FREQ was performed for analgesic intake to test for differences between groups at the day of surgery and first day after surgery, Days 2 through 3 after surgery, and Days 4 through 5 after surgery. Alpha level was set at 0.05.

The mean length of hospitalizations for the plant group was 6.08 d and was significantly different from that of the control group at 6.39 d. These records provide evidence that patients who viewed plants had significantly shorter hospitalizations than those patients without plants (P = 0.034). Analgesic intake (Fig. 2) was significantly different for the plant group compared with the control group at Days 4 through 5 after surgery (P = 0.04). Patients exposed to plants were less frequently given weak and moderate analgesics compared with patients in the control group. No significant day-by-group interactions and no significant group differences were found for vital signs during the recovery periods.

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