ARTICLE IN PRESS
International Journal of Nursing Studies 43 (2006) 851–859
www.elsevier.com/locate/ijnurstu
The aesthetic dimension in hospitals—An investigation into
strategic plans
Synnøve Casparia,Ã, Katie Erikssonb, Dagfinn Na˚dena
aOslo University College, Faculty of Nursing, Oslo, Norway
bA˚bo Akademi University, Department of Caring Science, Wasa, Finland
Received 29 March 2006; accepted 8 April 2006
Abstract
Background and rationale: The underlying assumption was that the aesthetics of the hospital surroundings are often
neglected.
Aims: This article is the first part of a larger study into the aesthetics of general hospitals. The aim of the study is to
throw light on the influence of aesthetics on the health and well-being of patients and the professional personnel, and to
examine how aesthetic considerations are dealt with. We present a survey of how the aesthetic dimension is planned and
it is considered important in the strategic plans of Norwegian general hospitals.
Methods: Data were sampled by analyzing the strategic plans of somatic hospitals. Sixty-four of 86 hospitals responded
(74%). Concepts were categorized in a matrix of 11 main categories, each with subcategories. The method was
quantitative, in that the analyzed material was amenable to counting.
Results: Very few concrete guidelines or directions for the aesthetic dimension have been included in written
documents. This indicates that the aesthetic area is a neglected field in the directions for the daily management of
hospitals.
Conclusions: The research available today on the contribution of environmental aesthetics to health, rehabilitation, and
well-being suggests that it is important to have concrete guidelines recorded in strategic plans. This field concerns the
maintenance of high quality in the caring professions.
r 2006 Elsevier Ltd. All rights reserved.
Keywords: Aesthetic environment; Aesthetic research; Hospital aesthetics; Patient environment; Survey
What is already known about the topic?
What this paper adds


There are few concrete guidelines concerning aes-
Aesthetics contributes to health and wellness.

thetics in somatic hospital strategy plans.
The aesthetic dimension is a need for the human
 High quality in nursing care includes the aesthetic
being.
dimension.
1. Introduction
ÃCorresponding author. Tel.: +47 22453844;
fax: +47 22453799.
Our investigation started with an examination of the
E-mail address: Synnove.Caspari@su.hio.no (S. Caspari).
strategic plans of Norwegian general hospitals, to find
0020-7489/$ - see front matter r 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijnurstu.2006.04.011

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whether and how aesthetics are considered important,
and medicine has provided insight into how a healing
and how the instructions that address aesthetic issues are
environment can be created and how it affects the body
formulated. Research has shown that aesthetically
and soul (Dilani and Malkin, 1998). Therefore, aes-
pleasing surroundings can have an important effect on
thetics are an important factor in life, whether one is sick
patient health and well-being. This has been demon-
or healthy, old or young.
strated by the reduced use of medications, fewer
A person continually senses and experiences the
infections, better sleep, improved blood pressure, and
environment consciously, as aesthetic, unaesthetic, or
shorter admissions (Ulrich, 2001). Aesthetic surround-
insignificant. Its beauty, harmony, and balance, or the
ings can also be stimulating for nurses and other health-
lack of these qualities is cognitively assimilated. How-
care professionals, resulting in a higher working
ever, this cognitive awareness is not necessary for
capacity, greater job satisfaction, and fewer sick leaves
aesthetics or their lack to influence health. The aesthetic
(Fjeld, 1998b).
sense need not convert these impulses into words; it has
its own ‘language’ and communicates continually
1.1. Literature review
through all the senses, to every cell of the body and to
the mind, to influence the individual positively or
Aesthetics is, among other things, a philosophical
negatively. ‘‘Dr. Deepak Chopra asserts that every cell
discipline that concerns the fine arts and problems
in our immune system continually listens in on our silent
connected with artistic understanding in general, that is
internal conversation and that one can imagine the cells
art philosophy. The term ‘‘aesthetic’’ is a Germanic form
of the immune system as intelligent small entities similar
of the Greek term ‘‘aisthesis’’. The Latin term ‘‘aesthe-
to brain cells y’’ (Watson, 1988).
tica’’ can be translated as perception, sense, feeling,
High-quality holistic health care should have as its
awareness, knowledge of the fine arts, and the standards
goal the maintenance of all areas that influence health.
used to understand them. In this study, the idea is used
‘High-quality’ implies that the aesthetic aspect should
to describe the qualities of the surroundings that might
also be taken into consideration. The abstract, theore-
influence the health and wellness of patients and of the
tical, and ideal are as important as the concrete,
professional health-care personnel. Analysis of the
measurable, and observable in holistic health care.
workplace and the work environment is often domi-
‘‘Art captures expresses and recreates humanity and
nated by traditional scientific evaluations, logical
life, in all its diverse forms. Art is the life’s spirit y the
rational analyses that ignore the aesthetic dimension
soul seeks beauty!’’ (Ulrich, 1984).
(Strati, 1998).
Some hospitals are attentive to the aesthetic aspects of
Aesthetics influence a person’s feelings, both physical
the environment and have a concrete plan to address
and psychological. Both aesthetic and nonaesthetic
them. Others seem to have no understanding of its
surroundings create an impression and affect a person
importance. The decisive factor is not necessarily
consciously or unconsciously (Ulrich, 1991; Beil-Hildeb-
economic. The prevailing philosophy and ideology of
rand, 1992; Ku¨ller and Lindsten, 1992).
the hospital administration and its employees can be
Aesthetically pleasing surroundings will improve a
equally important. There is a great deal of knowledge of
person’s affective condition and contribute to a feeling
and research undertaken today regarding different areas
of well-being (Ulrich, 2001; Fjeld, 1998a; Ulrich, 1991;
of aesthetics. The significance of colors and their
Ku¨ller and Mikellides, 1993). Therefore, aesthetics has
influence on an individual exemplifies an area in which
great importance, perhaps more than we imagine. There
it is important that the decisions made are not arbitrary,
must be a congruence between the person and nature,
but are based on existing research and knowledge.
between the person and his or her surroundings.
In San Francisco in 1978, Angelica Thieriot estab-
Research has shown how important feelings are for an
lished an organization, an expert group consisting of
individual’s physical and mental health. A person’s
architects, doctors, nurses, and people interested in art,
feelings of well-being and happiness, of harmony and
among others, who developed and laid the foundation
balance, directly influence his or her health and counter-
for the ‘Planetree model’. The theoretical basis of the
act destructive stress factors, among other things. Stress
model was developed through the cooperation of the
factors in the environment can have a negative effect on
group and was the result of their reactions to the health
the immune system (Fjeld, 1998a; Dilani and Malkin,
service they had experienced at the hospitals where they
1998; Watson, 1988).
had been patients. They viewed the health service as cold
The aesthetic dimension covers a large range of
and inhuman, and as not giving first priority to the
concepts. It might include colors, art, insufficient day-
patient and his family. The Planetree philosophy is built
light, blinding light, outlook to dull surroundings,
around the idea that health services and hospitals and
limited choices, and restricted personal space, which
the services they provide are for the patient. In other
can all create additional stress and increase the risk of
words, the patient is their principal concern. The
illness. Research in psychology, the health-care sciences,
patients and their families must, as far as possible, feel

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S. Caspari et al. / International Journal of Nursing Studies 43 (2006) 851–859
853
secure and at ease. Openness and freedom, autonomy
hospital surroundings in general. The received material
and the right to be consulted are of prime importance.
was considered representative.
An aesthetic environment and a comfortable milieu are
sought, so that an atmosphere conducive to well-being is
2.2. Method of analysis
created. Hospitals that are designed and run in
accordance with the Planetree philosophy have had
Before the work with the material could start a
many positive responses in many countries.
formulary, a matrix was constructed that was suitable
for the numeric recording of all occurrences of the word
Late twentieth-century neuropsychological theory
‘aesthetic’ and similar words that are related to the
suggests that the human forebrain can best be
aesthetic domain. After reading and analyzing other
considered as a limbic system and a frontal neocor-
studies by Beil-Hildebrand (1992), Ulrich (1984, 1991,
tex. The limbic system is the seat of the emotions; it
2001), and Wikstro¨m (1997), it was decided to focus on
deals with the nonrational. In contrast the neocortex
11 main categories, with subcategories. Although this
is the thinking brain, but is itself divided into lateral
study deals with aesthetic categories, ‘aesthetic’ and
hemispheres with rather different functions. In short,
‘quality’ themselves are included as categories because
the left hemisphere is Apollonian: verbal, mathema-
we were interested to know if these words were
tical, logical, deductive and orientated towards the
mentioned, and the contexts in which they were included
external environment, whereas the right hemisphere
in the strategic plans. Some of the tactics used by Miles
is Dionysian: holistic, intuitive, spatial, pattern-
and Hubermans (1984) to generate meaning were used
recognizing, and concerned with inner spaces y We
to draw conclusions from the material: counting, noting
have a psychological need to satisfy all three systems’
patterns, clustering, etc. Principally, we undertook to
demands for input, and individual wellness depends
find words that showed how aesthetics were addressed in
on the balance of input to all three areas (Ulrich,
the strategic plans and how each hospital followed these
1985)
directions. In this way, it was possible to determine the
intentions behind these strategies and to quantify the
The literature leads us to conclude that the aesthetic
aesthetics-related words in the strategic plans for further
dimension has great importance for human health, in
statistical analysis.
recovery and well-being when sick, and is a positive
All documents and hospitals were registered numeri-
factor in the care of terminally ill patients.
cally, and all documents were analyzed for words from
the main categories or subcategories. The frequencies of
1.2. Purpose and research question
occurrence were noted, but in this context, were
recorded only once for each hospital. Table 1 illustrates
The purpose of this article is to report the results of a
the categories and subcategories that were considered in
study into whether and how aesthetics are prioritized in
analyzing the strategic plans. The main categories are
the strategic plans of Norwegian general hospitals. The
shown in the upper line (Z), and the subcategories in
research question is: To what degree are the aesthetics of
lines A–I.
hospital surroundings addressed in the strategic plans of
general hospitals in Norway?
3. Results
The strategic plans were analyzed to determine
2. Methods
whether and in what way aesthetics were addressed.
This graphic Fig. 1 illustrates the results of the
2.1. Data sampling
analysis. Each column represents the total findings for
the main categories (including subcategories) in the
Hospitals were requested to supply their strategic
documents, according to their occurrences in the
plans concerning the aesthetic domain for the past 2
strategic plans.
years. A second request was sent to those who did not
In presenting the results, important factors will be
respond. In the request letter, the project was described
indicated in relation to each category.
and a short summary of the investigation was given.
Category 1: Harmony. Subcategories are properness
Sixty-four of 86 hospitals (74%) answered, providing
considered as tidiness, balance, harmony, hygiene,
information and copies of their strategic plans. Two
laughter, humor, play, and entertainment.
hospitals submitted information by telephone and
These words/ideas were recorded in the documents
another two hospitals supplied information by letter,
from 12 hospitals in different contexts.
with no strategic plan enclosed. Our intention was to
Category 2: Food. Subcategories are appearance,
survey the plans for establishing the aesthetics of
color, and service. Food was mentioned in only one

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S. Caspari et al. / International Journal of Nursing Studies 43 (2006) 851–859
Z
A
B
C
D
E
F
G
H
I
document, in a supporting letter that stated: ‘‘The
z
kitchen is renowned for serving delicious and nutritious
as
food’’. There were no further specifications.
Category 3: Art. Subcategories are painting, sculpture,
stered
nel
pictures, tapestries, decor, mosaics, and water decor. Art
Pa
is mentioned in four documents, paintings in three,
regi
`
ing
sculpture in three, pictures in three, tapestries in none,
lity:
petance
lity
ialists
mite
decor in seven, mosaics in two, and water decor in two.
Qua
Com
descid
Qua
Spec
Com
Holism
Among the documents received, in which references to
n
these subcategories were quite spare, one hospital
reported that it had engaged a color designer, a qualified
interior decorator, who planned the use of color and the
ility
perceptio
aesthetics of the hospital surroundings. She had been
tiful
ly
thetics
e
eption
steful
engaged together with the architects, right from the
Aes
Beau
Love
Nic
Ta
Sense
Perc
Sensib
Sense
start, and the results were very satisfying for both the
patients and the professional staff. Otherwise, very few
ion
references were found in the documents. Letters
re
wers
es
attached to the received documents stated: ‘‘It is a pity,
ants
iew
entilat
but we have written very little about how we want to
Natu
Pl
Flo
Tre
V
Air
V
address aesthetics.’’; another stated: ‘‘Unfortunately, we
have very little in print about this aspect of the hospital
sounds
environment. Aesthetics is very important in hospital
nds
surroundings. In earlier times, the aesthetics were a
sou
natural part of daily tasks and duties. Today, this
d
re
ise
pleasant
function receives less attention and it has become more
usic
Soun
No
Song
M
Natu
Un
the exception than the rule to attend to the aesthetics of
the surroundings.’’
ure
ns
Category 4: Rooms. Subcategories are patient rooms,
living rooms, external rooms (medical rooms, group rooms,
plans
Design
Furnit
Curtai
cleaning rooms, and linen rooms), corridors, staff rooms,
ic
and bathrooms (W.C. and shower). There was nothing in
ns
r
iture
the documents concerning the aesthetics of these rooms;
strateg
nothing concerning the guidelines for choosing colors,
in
Colors
Walls
Ceiling
Floo
Textiles
Curtai
Furn
textiles, designs, etc.; and nothing on the existing criteria for
nce
decision making or the expected influence on patients and
atur
ht
mps
staff. When these areas are mentioned, it is in reference to
a
occurre
Lig
Sun
Electric
L
Arm
technical or maintenance procedures.
r
s
Category 5: Light. Subcategories are sun, daylight,
thei
electrical or artificial light,fittings and lamps. Only two
for
room
room
hospital documents contained any reference to these
om
r
ed
n
idor
room
.
areas. One hospital mentioned bad ventilation, lack of
ient
ingroom
daylight in working rooms, narrow and small rooms for
analyz
Room
Pat
Liv
Ekster
Corr
Staff
Bathro
Showe
W.C
working routines, etc. in the context of health, milieu
g
and security (HMS). Offices were cited as having very
terms
ture
es
stries
r
ics
little access to daylight and insufficient ventilation.
the
Category 6: Colors. Subcategories are walls, ceilings,
f
Art
Paintin
Sculp
Pictur
Tape
Deco
Mosa
Water
o
floors, textiles, curtains, and furniture. Very few
references were found to these areas and no concrete
arance
e
philosophy has been given as guidelines. Colors are
tegories
mentioned in documents from seven hospitals.
subca
Food
Colour
Appe
Servic
Category 7: Design. Subcategories are furniture and
curtains. Design is mentioned in three of the strategic
and
s
plans. ‘Design’ refers to and concerns everything in the
1
room: all forms, patterns, sizes and dimensions, etc. It
mony
iness
lance
iene
tertainment
mor
ile
might also include the design of materials, or of
ble
ategorie
operly
ughter
ay
Ta
C
Har
Pr
Tid
.Ba
En
Hyg
La
Hu
Pl
Sm
furniture and utensils.

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855
70
Serie1
60
50
40
30
Hospials
20
10
0
Art
Food
Room
Light
Colours Design Sound Nature
Quality
HospitalsHarmony
Aesthetics
Categories
Fig. 1. Occurrence in documents of words from each category.
Category 8: Sounds. Subcategories are noise, song,
aesthetics
of
hospital
surroundings
are
finding
music, nature sounds, and irritating or unpleasant
their way into today’s strategic plans. Even though
sounds. This category appears in five documents.
aesthetics are considered important, there are very few
Category 9: Nature. Subcategories are plants, flowers,
directions given. To ensure that this area receives
trees, view, air, and ventilation. These categories were
attention, it is necessary to have clear and concise
found in 10 documents.
guidelines in strategic plans, on what to do and how to
Category 10: Aesthetics. Subcategories are beautiful,
do it.
lovely, nice, tasteful, sense, perception, and sensibility. These
To illustrate how the ideas were used in the
words were found in nine documents or strategic plans. A
documents, a few examples from the strategic plans
few comments from the letters attached are included:
are given, to show their relevance or otherwise to
‘‘When analyzing our strategic plans, we found that very little
aesthetics. One document stated: ‘‘Surroundings shall be
has been written concerning our thoughts and priorities in
designed so that the patient is comfortable, feels safe, is
aesthetic areas in the hospital. To do better in this field, we
rested and attains well-being’’. However, no specifica-
hope to obtain a copy of your investigation, when finished’’;
tions on how these feelings could be achieved and no
another letter stated: ‘‘You are investigating a neglected area.
further instructions are given. Another document states:
In our hospital, we have no philosophy concerning the
‘‘The prosperity, well-being and competence of the
importance of aesthetics in hospitals, but as we are now
professionals are the most important contributions to
building a new hospital, I will, as a leading director, personally
meeting the patient’s needs’’.
see that this theme is included in the project’’.
One letter refers to a positive experience in a
Category 11: Quality. Subcategories are competence,
psychiatric ward: ‘‘y we are happy that you are
committee, panel, specialists/professionals, and holism.
working on a project concerning aesthetics in the general
Words from this category was found in documents from
hospitals of Norway. Firstly, I wish to point out that
36 hospitals. This might be due to the Hospital Law of
aesthetics is more an attitude that depends on the
1994 (Helsedirektoratet), which requires that all hospi-
individual than one that is found in the guidelines of
tals establish a quality control group. The law does not
strategic plans. In our experience, when aesthetic
include specific details on the group’s responsibilities,
standards are improved, patients cause less damages to
nor any definition of the word ‘quality’ in the context of
furniture,
bric-a-brac
etc.
y’’.
Another
letter
hospitals or patients. ‘Quality’ is defined as a degree of
states: ‘‘Your letter has prompted us to include, as soon
excellence, relative nature, general excellence, attribute,
as possible, concrete guidelines concerning the aesthetics
trait, faculty, social standing.
at
our
hospital.
Your
investigation
has
already
caused the inclusion of guidelines concerning aesthetics
4. Discussion
in the hospital strategic plan y’’. These two examples
underline the need for aesthetics and the importance of
By analyzing the received material, we have drawn the
producing guidelines for the best way to address these
conclusion that very few guidelines concerning the
issues.

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4.1. Harmony
4.5. Light
Harmony and its subcategories are all important in
One letter that accompanied the documents stated
the context of the patient’s recovery and well-being.
that our request had been presented to the technical
Harmony relates to the wellness of the soul and has
leader and to the domestic economy coordinator at their
psychosomatic effects. The antiseptic effects of hygiene
hospital. They regretted to say that there was very little
are most evident. However, hygiene also influences the
found in their documents specifically concerning aes-
patient’s sense of comfort and well-being.
thetics. However, thanks to conscientious colleagues, a
pleasant milieu had been achieved for patients, staff, and
relatives. There was no mention of the design of light
4.2. Food
sources, but it appears that an electrician was consulted
for this purpose. Research clearly indicates that light is
The serving of the food is important to tempt the
of great importance to both the recovery and rehabilita-
patient’s appetite. The portion itself must be adjusted
tion of patients, and also affects the health and well-
for the individual patient. The way the food is cut,
being of staff. This area is a field with potential for
arranged on the dish so that the colors are in harmony,
improvement (Ulrich, 2001; Ku¨ller, 1987, 1981).
and of course the freshness of the food and how well it is
prepared are all important if a patient has little or no
4.6. Colors
appetite. The food must be aesthetic and tempting,
served and presented in a stimulating way. None of these
Colors are an important part of our daily existence,
issues is mentioned in any of the strategic plans. In a
and of our surroundings. Colors imprint the aesthetic
well-composed meal, colors will be used intentionally.
environment and scientific research shows that colors
Colors signal the nutritional value of the product, and
have a great effect on individuals. The patient’s room
can in themselves influence the appetite. For instance,
should be comfortable and pleasant to stay in, and
yellow/orange can be stimulating and green products
colors are important in that context. The same is true for
can give renewed strength.
other rooms. Dark and gloomy colors can lead to an
analogous state of mind, whereas gaudy colors can lead
to irritability, aggressiveness, increases in blood pres-
sure, and general feelings of unpleasantness. A patient
4.3. Art
who must remain on his back, day after day, will not be
positively affected by a view of a grayish ceiling with
Different
artistic
experiences
can
stimulate
the
glaring neon lighting from metal boxes. Colors send
patient; they can also be distracting, entertaining, and
energy impulses to the body that influence it in a positive
restful. The outside world can be brought into the
or negative way. Research has shown that the chromatic
hospital. Art can also be provocative and challenging. In
strength of the color and its nuance are more effective
perceiving art, the viewer is also a cocreator in that he
than the color itself (Ku¨ller and Lindsten, 1992; Ku¨ller
interprets and shapes the art according to his own
and Mikellides, 1993; Mikellides, 1988; Cold, 1998).
experience. Art reveals another reality. It might be a
‘‘Introduction of the Natural Colour System (NCCS)
manifestation of the human longing for something
has made it possible to interpret the world of colors,
‘higher’, because art can confer a feeling of being part
even from a phenomenological perspective’’ (Ku¨ller and
of a higher reality.
Mikellides, 1993, p. 299). Colors can be aesthetically
pleasant in themselves and can also be part of an
aesthetic wholeness. Only one hospital had a structured
4.4. Room
plan for the use of colors in patient environments.
The apparently opposite words ‘sound’ and ‘silence’
The proportions and lines, the architecture and the
can be united in the essential meaning of ‘to listen’. The
colors of rooms must be harmonious. For instance, a
body registers and reacts not only to the sounds that are
very high ceiling in a small room can give a feeling of
audible to the ear. Sound is made by molecular
being in a shaft, or if too low, might be perceived as
oscillations that procreate. Animals often have much
‘getting a ceiling in the head’. It is also important that
better hearing than humans. There is great variability in
colors are used in accordance with the results of research
the auditory senses and in the pain thresholds affected
and scientific knowledge to influence human needs and
by sound. Communication is not sound dependent, even
reactions. Rooms should be at a comfortable tempera-
if language is an important part of communication and
ture, with sufficient ventilation to avoid unpleasant
words are largely transmitted by sounds. The sound or
smells and odors, which may derive from other patients
sounds that express words often convey more than the
in the room.
word itself. The sound or tonal value can often say

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857
something else, even contrary to the etymological
4.9. Plants
meaning of the word. Not everyone is lucky enough to
have pleasant speech. It is often said that ‘‘each bird
Plants have a favorable effect on the indoor climate. It
sings with his own beak’’. The same is true of talking.
has been shown that patients with a view to vegetation
The human voice carries information about age, sex,
or green areas from their sickbeds have shorter
mood, etc., of the speaker. Most people can learn clear
convalescences, fewer complications, and less painkilling
diction, with which words are formulated and spoken
or sleep-inducing medications. Normal blood pressure is
clearly, and sound levels can be modulated to suit the
also more prevalent in this patient group than in the
situation. A patient might jump in his bed if a shrill
control group (Ku¨ller and Laike, 1998). A similar
voice yells ‘‘good morning’’! Similarly, whispering can
project was undertaken by Ulrich in a hospital in
be annoying and distracting. A pleasant well-modulated
Pennsylvania in 1984, with similar positive results
voice can be soothing and calming, and create an
(Ulrich, 1991).
atmosphere of security and pleasure. Sounds can be very
dominating, especially if a patient is very sensitive and
4.10. Quality
alert to sounds. Irritating noises like scrambling,
rustling, slamming doors, and clacking shoes in the
In the strategic plans examined, the notion of quality
corridors at night can be very annoying and disturbing
was found in many combinations, but on closer analysis,
for a patient. Can song and other noises be used as
there was no mention of it in the context of aesthetics.
positive modes of treatment in the same way music can?
Quality specification and quality assurance are both
Sounds can be used as a method of communication and
necessary in the health services in the care of patients
positive results have been achieved in the treatment of
and the working environment of staff. Good working
pain. Different sounds, such as song and music, can add
conditions and surroundings are important for the work
beauty to surroundings, but can also induce anxiety,
effort, pleasure, and the capacity to offer a high
fear, and agitation (Robertson, 2001; Pope Spies, 1995).
standard of nursing care. High-quality working condi-
tions reduce stress factors, strengthen immunity, and
4.7. Design
heighten the contentment factor. This confirms how
important it is to be aware of and address the aesthetic
The way furnishings are shaped and molded, the
dimension in hospitals and we maintain that quality
materials used, and so on, all influence the comfort and
concerns all areas physical, psychological, ethical,
appeal of interiors. The architecture of the room is also a
aesthetic, intellectual, mental, and spiritual.
matter of design, the harmony between the height and
In training student nurses, it should be emphasized
breadth of the patient’s room, windows that embrace the
how important it is that patients receive holistic care
outside world, give light and variation. The arrangement
that individuals are taken care of in physical and
of furnishings should be pleasant to look at, to touch,
psychological ways, socially and spiritually, in terms of
and to handle (Porteous, 1982). Their functionality is
material culture, body, and soul. The human being, sick
also important (Ulrich, 2001; Dilani and Malkin, 1998;
or healthy, is a whole living organism, each part of
Watson, 1988).
which interacts continuously with the other parts; no
part is unaffected by inner or outer influences. One can
4.8. Nature
distinguish the parts, but the whole being is in fact one,
like a coin that has two sides but is still one. The demand
Contact with nature has a positive effect on man and
for quality must be comprehensive if patients are to
leads to better health and well-being. Nature is in many
receive optimal care. The positive effects of pleasant and
ways a person’s right or can be seen as an archetypical
aesthetic surroundings indicate the importance of
element. A research report from an X-ray ward
focusing on and emphasizing the achievement of first-
evaluated the health and contentment of the staff who
class care. Aesthetic surroundings also have a positive
undertook their daily work in the ward, where the main
influence on relatives and others visiting patients and
occupation was the examination of radiographs. The
hospitals. Since 1987, the Picker Institute in Boston has
staff had suffered a bad climate for a long time, and the
been involved in research regarding patient satisfaction
sick-leave rate was high. The ward installed full-
with hospitals and institutions. Two hundred thousand
spectrum daylight bulbs and 25 groups of green plants
patients have been interviewed from 500 different
in the 80 m2 premises. There was a significant reduction
hospitals or institutions regarding their well-being and
in health problems and sick leave was reduced by 25%.
contentedness, and their ability to control their sur-
The best result was a 32% reduction in tiredness, a 33%
roundings in patient rooms—light, noise, temperature,
reduction in ‘heavy head’, a 45% reduction in head-
contact with nature, etc. The results showed that, when
aches, and a 31% reduction in sore throats (Fjeld,
patients could choose, they selected a hospital/institu-
1998a, b).
tion based on criteria other than medical and profes-

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ARTICLE IN PRESS
858
S. Caspari et al. / International Journal of Nursing Studies 43 (2006) 851–859
sional ones, which are taken for granted. Parameters
tion that aesthetics are given a low priority in many
that mattered in making patients and their relatives feel
hospital strategic plans. No concrete goals or directives
secure were the quality of their physical surroundings,
regarding the aesthetics of the environment are included,
whether their requests and preferences were considered,
or are only very sparsely documented.
personal control, respect, manners, and the climate of
It is an ethical duty to attend to this area, for both
communication (Fjeld, 1998b). The results from the
patients and staff, because it concerns and affects human
present study show that patients at Norwegian hospitals
dignity (Kant, 1790; Pope Spies, 1995; Na˚den and
do not have many choices if they value a high aesthetic
Sæteren, 2006).
standard. This does not reduce the value of these
findings. On the contrary, it confirms the importance of
focusing on this dimension. These results are valuable
5. Conclusion
concerning the economic cost savings that can be
achieved by emphasizing the aesthetics as mentioned.
The intention of this research was to determine the
Man has an almost unbelievable ability to adapt and
degree to which the aesthetic dimension is addressed in
survive, but if he is to perform his best and not be
the strategic plans of Norwegian general hospitals. The
exhausted, aesthetic factors must be considered. ‘‘Scien-
aim was to find which directions and decrees the
tists at John Hopkins Medical Center report that they
professional caring personnel and the daily management
have found relatively few reports concerning this area
has, accordingly how to attend to the aesthetic
(70 published articles), but still considerable evidence
surroundings.
that aspects of the aesthetics of the environment have a
We concluded that references to the 11 categories,
considerable effect on patient recovery’’ (Sandelowski,
into which the aesthetic dimension was divided to
1986).
analyze the strategic plans, were almost absent from
When hospitals are built or rehabilitated, it seems that
the strategic plans. Study of the literature and research
aesthetics are considered and considerable amounts of
shows the importance of this sphere to both patients and
money are often allocated to art and decor. This is very
employees (Ulrich, 1991, 2001; Fjeld, 1998b; Wikstro¨m,
positive, but it is critically important that professionals
1997).
from different areas are engaged and that patients are
The results of this study confirm the need to explore
consulted. It is important that research results are taken
the degree to which patients are comfortable and how
into consideration and used, and that the importance of
they evaluate the aesthetics of the hospital environment,
how colors, light and air, space and lines, design, nature,
their thoughts about their influence on their health, well-
etc. influence health, well-being, and rehabilitation is
being, and recovery. The same is true for the profes-
recognized. It must remembered that the patient is the
sional staffs which in this project were nurses.
person who is most affected, but the aesthetics of the
surroundings also influence the staff. A hospital requires
different artistic decorations from those of other
buildings. A sculpture or a painting, for instance, can
Acknowledgement
have quite other connotations for a patient than it has
under different circumstances. Research has shown that
Thanks to Oslo University College, Faculty of
contact with nature and vegetation confers better health
Nursing, for financing this research.
and greater well-being (Ulrich, 1984, 1985; Fjeld,
1998b).
The prophylactic influence of aesthetics on the
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Document Outline

• The aesthetic dimension in hospitals--An investigation into strategic plans
  • What is already known about the topic?
  • What this paper adds
  • Introduction
    • Literature review
    • Purpose and research question
  • Methods
    • Data sampling
    • Method of analysis
  • Results
  • Discussion
    • Harmony
    • Food
    • Art
    • Room
    • Light
    • Colors
    • Design
    • Nature
    • Plants
    • Quality
  • Conclusion
  • Acknowledgement
  • References

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