Nature and Inpatient Mental Health - Annals of Internal Medicine: Fresh Look Blog


Wednesday, June 15, 2022

Nature and Inpatient Mental Health

Patient comfort volunteers spend their time conversing with inpatients, which vastly improves their well-being and builds human connection. Why not also connect with nature? We often take nature for granted given that we have the capacity and ability to go outside and seek out nature whenever we want to. Inpatients, on the other hand, do not.

A recently published cohort study in Annals of Internal Medicine by Jain and colleagues (1) examined socioeconomically disadvantaged patients who are at risk for mental health decline and function after intensive care unit hospitalization. They noted that there was “nearly 10-fold greater odds of transitioning to probable dementia” among socioeconomically disadvantaged persons. This is not surprising considering that Alzheimer disease is expected to more than double by 2050 to 13.8 million Americans (2). What is interesting is the effect of being socioeconomically disadvantaged and having a greater risk for developing dementia. They noted that further investigations on factors leading to this disparity are warranted. I say 1 factor to consider includes assessing the effect of nature during one's hospitalization stay, such as the effect of green space window views and access to nature. Access to nature has a great effect on mental health and overall well-being during and after one's hospital stay (3).

A study found that “participants who received care in patient rooms with windows and agreed that they viewed green spaces outside their window rated the hospital higher than participants who disagreed with viewing green spaces outside their window… Participants in the patient rooms with views to green spaces rated the quality of care significantly higher than the participants in the patient room with view to no green spaces” (3). Elderly patients with neurodegenerative diseases like Alzheimer or patients with cancer who are stuck in long length of stay units are often “jailed” in the hospital system, not being able to leave the floor and constantly surrounded by hospital alarms and white coats—“…loud and frequent noises (e.g., alert system) which was associated with sleep disruption, panic, and the wish to escape, particularly at night” (4). There comes a point where watching television becomes mundane and is the last thing one would want to do. Why not spend an hour or so a day immersing oneself in activities other than watching television and sitting in the bed or chair, which is often something we seek to prevent for our patients so that they can live happy, active lives because as health care professionals, we understand the effects of a sedentary lifestyle? The solution seems simple. Allow these patients to remove themselves from the hospital atmosphere and connect with nature. Allow them to take care of plants and gardens and to build hobbies outside of being an inpatient and sustain their roots to life.

To improve overall inpatient health care, let us seek to change how our health care system is designed and to advocate for hospital rooftop gardens or secured outdoor spaces for patients to interact with and observe nature outside the hospital noise. It is time to work on improving inpatient mental health well-being and literally think outside the box. Let patient care volunteers interact with patients in nature and do activities outside, whether that be gardening, painting, or simply talking. Systemic hospital changes, such as building hospitals with rooftop green spaces or designated secure green spaces for patients, can make a vast difference in patient health care and may close some of the patient disparity gap of socioeconomic differences and mental health decline.


  1. Jain S, Murphy TE, O'Leary JR, et al. Association between socioeconomic disadvantage and decline in function, cognition, and mental health after critical illness among older adults. A cohort study. Ann Intern Med. 2022;175:644-655. [PMID: 35254879] doi:10.7326/M21-3086
  2. 2020 Alzheimer’s disease facts and figures. Alzheimers Dement. 2020;16:391-460. [PMID: 32157811] doi:10.1002/alz.12068
  3. Mihandoust S, Joseph A, Kennedy S, et al. Exploring the relationship between window view quantity, quality, and ratings of care in the hospital. Int J Environ Res Public Health. 2021;18. [PMID: 34682419] doi:10.3390/ijerph182010677
  4. Weber C, Monero Flores V, Wheele TP, et al. Patients' health & well-being in inpatient mental health-care facilities: a systematic review. Front Psychiatry. 2021;12:758039. [PMID: 35046849] doi:10.3389/fpsyt.2021.758039

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