Rev. Connie Madden MDiv, BCC Chaplain Coordinator St. Louis Children’s Hospital.

Rev. Connie Madden MDiv, BCC Chaplain Coordinator St. Louis Childrens Hospital

Sacred Spaces: Learning Objectives 1. To understand what elements are common to sacred spaces in the pediatric hospital setting 2. To view research surrounding what aspects of our sacred spaces are most helpful for family coping 3. To create our own sacred space design

Definition of a Sacred Space in a Hospital Setting A therapeutic space for a designated purpose Intention is to help patients and families connect with meaning, to provide restoration, to connect with faith resources To liberate families and patients, if only temporarily, from the captivity of the health care environment

History of Healthcare Setting (Whitehouse, Varni, Seid, et. al, 2001) In the Middle Ages, monasteries offered patients courtyards bordering rooms, seasonal plants, and places to sit or walk. (Warner, 1995)

History of Healthcare Setting (Whitehouse, Varni, Seid, et. al, 2001) Germ Theory of Illness of Louis Pasteur and Claude Bernard in the 19 th century changed focus of disease treatment and hospital function to sterile, contained environment, with patient comfort as a low priority. (Lindheim & Syme, 1983)

History of Healthcare Setting (Whitehouse, Varni, Seid, et. al, 2001) Increased healthcare competition and focus on patient satisfaction in the United States in the 1990s with new research on psychology of architecture changed priorities for space utilization. (Horsburgh, 1995)

Movement to Family Centered Care (www.ipfcc.org) The Institute for Family-Centered Care was established in 1992 to advance the understanding and practice of family- centered care in all settings where individuals of all ages and their families receive care and support. In every encounter, health and human service professionals will seek to build on the strengths of patients and families, enhancing their confidence and competence. The health care delivery system will recognize and encourage patient and family strengths, choice, and independence. www.ipfcc.org/about/index.htm

Environment and Design: Family Centered Care http://www.ipfcc.org/advance/topics/keyconsiderations.html Family Support Art Play Areas Spiritual Support Information and Education Nature and the Out of Doors

A true hospital should be a place where any of us would love to go as to a vacation. TF Hanlin (Hanlin, 711)

What to consider for creating a Sacred Space (Horsburgh, 738) 1. Purpose and intention for space- -Meditation -Stress relief -Interaction -Familiarity -Resources for participants -Specific space needs

What to Consider for Creating a Sacred Space 2. Research Driven Designs (Whitehouse, et. al., 302) 3. Budget (Whitehouse et. al., 302) 4. Connection to Local Resources and History (Lindheim & Syme, 352)

Types of Sacred Spaces in Hospital Settings Gardens Chapels Bereavement Rooms

Efficacy of Integrating Nature in Healthcare Settings Gardens can reduce stress and health related complaints among patients (Cooper-Marcus & Barnes, 1999; Ulrich, 1984; Verderber, 1986) Gardens increase patient and staff satisfaction (Paine & Francis, 1990; Cooper-Marcus and Barnes, 1995) Gardens are important for hospitalized children and parents (Strain & Grossman, 1975; Horsburgh, 1995; Carpman & Grant, 1993)

How Gardens Impact Differing Age Groups Adults prefer natural to urban landscapes (Ulrich, 1977; Balling and Falk, 1982; Orians & Heerwegen, 1995; Schroeder, 1995) Adults prefer scenes with trees, grass, water, visible sky, rocks, flowers and birds (Olds, 1989) During stress, going to nature helped adults mood improve (Cooper-Marcus, 1995)

Important Aspects of Gardens for Children Children love functional elements of nature, such as climbing, throwing, touching (Gibson, 1979; van Andel, 1990) Children love places of refuge and hiding (van Andel, 1990; Kirkby, 1989) Children need outdoor play, opportunities for play leadership, connections between the indoors/outdoors (Cooper-Marcus and Barnes, 1999)

Study at Childrens Hospital and Health Center, San Diego, of the Leichtag Family Healing Garden (Whitehouse et. al., 2001) 52 adults, 12 children were surveyed, including staff, patients and families Adults most enjoyed : -Sound of running water (33%) -Bright colors (25%) -Being outside in a garden (23%) -Flowers, trees, plants and greenery (23%) -Artwork (19%)

Study at Childrens Hospital and Health Center, San Diego, of the Leichtag Family Healing Garden (Whitehouse et. al., 2001) Children most enjoyed: -Artwork (83%) -Fountain, sound of running water (83 %) -Being outside in a garden (33%) -Flowers, trees, plants, greenery (33%)

Family comments about the St. Louis Childrens Hospital Garden Even though I dont have it in me (to come), I want you all to know how important it is to me that A. is mentioned in the garden. We spent a lot of time here in the garden during all of her treatmentsThe first circle window, she would get in there, sit and look out. It was peaceful for her as bad as she felt through all of her chemo. She loved to be outsideI thank all of you for the garden - note from As mom for the memorial service last year

Uses for Hospital Gardens Visits by Family, Patients and Staff Interactions and Discovery Craft Projects by Patients to Decorate

Uses for Hospital Gardens (continued) Connection with Community, concerts, celebrations, diversity awareness, artwork Extubations, bereavement services Connection with the Seasons in a Timeless Setting

Chapels In the past, chapels have been designed according to the affiliation of the healthcare setting (ie: faith-based, military specifications, etc.) or donor preferences

Chapels Problems of Past designs Static faith elements often excluded certain faith groups Static furniture impeded sense of privacy and limited possibilities for use Generalized space became like a waiting room versus sacred space

Hospitals Changing Chapel Design and Use (Kaiser unveils meditation room, Roseville Press-Tribune, 2/5/11, Christian, Sena.) Kaiser Roseville Medical Center had no official chapel or meditation space --Meditation room became like a waiting lounge because of lack of purpose and design --New space includes stained glass window with nature symbols, chairs arranged for privacy but not sleeping, prayer bowl for prayer requests, kneeling stools, various religious sacred texts, prayer rugs

Hospitals Changing Chapel Design and Use (Kaiser unveils meditation room, Roseville Press-Tribune, 2/5/11, Christian, Sena.) UC Davis Medical Center in Sacramento -move to an all faith chapel Sutter Health Womens and Childrens Center -40 seat meditation room for 2013 Kansas City Childrens Mercy- -chapel design decided by Interfaith local community clergy council

Photos of Pediatric Chapels Kosair Childrens Hospital

St. Louis Childrens Hospital

Cincinnati Childrens Hospital http://www.cincinnatichildrens.org/svc/alpha/p/pastoral/tour.htm

Texas Childrens Hospital http://www.texaschildrens.org/AllAbout/ VisitingTheHospital/SpiritualCare.aspx

Pediatric Chapel Design Considerations Honor Diversity in design, elements, spiritual item offerings-yet preserve some familiarity to location Think of common themes- prayer, community connection, privacy, nature Integrate Child friendly elements-art, interaction, water sounds

Pediatric Chapel Design Considerations Have movable elements to transition use Utilize local faith leaders and their specific ideas of the needs of their people Remember setting specific goals of the chapel-What does our hospital want and need?

St. Louis Childrens Hospital Bereavement Room Private space for grieving families, families awaiting funeral home pickup, or for extubations Includes home-like dcor, refrigerator, blanket warmer, bathroom, phone, adjustable lighting, privacy doors, sound proof walls, security button Small refrigeration unit allows children to stay in our hospital until pickup versus transition to adult hospital morgue

St. Louis Childrens Hospital Bereavement Room

Create your Own Sacred Space!

References Balling, J. D. & Falk, J. H. (1982). Development of visual preference for natural environments. Environment and Behavior, 14, 5-38. Carpman, J. R. & Grant, M. A. (1993). Design that Cares: Planning Health Facilities for Patients and Visitors (2 nd edition). Chicago: American Hospital Publishing. Cooper-Marcus, C. & Barnes, M. (1995) Gardens in Healthcare Facilities: Uses, Therapeutic Benefits, and Design Recommendations. Martinez, CA: The Center for Health Design. Cooper-Marcus, C. & Barnes, M. (1999) Healing Gardens: Therapeutic Benefits and Design Recommendations. New York: John Wiley & Sons. Pp. 323-384. Gibson, E. J. (1979). The Ecological Approach to Visual Perception. Boston: Houghton-Mifflin. Hamlin, T.F. Architecture of Hospitals, Pencil Points, 1940:21 (11): 711-20. Horsburgh, C.R. Jr. (1995). Healing by design. The New England Journal of Medicine, 333, 735-740. www.healinglandscapes.org/resources-related-organizations.html www.ipfcc.org Kaiser unveils meditation room, Roseville Press-Tribune, 2/5/11.

References Kirkby, M. (1989). Nature as a refuge in childrens environments. Childrens Environments Quarterly, 6. 7-12. Lindheim, R. & Syme, S. L. (1983) Environments, people and health. Annual Review of Public Health, 4, 335-339. Making hospital chapel welcoming to all faiths. Bay Citizen, reprinted in the New York Times, 10/21/10. Orians, G. & Heerwegen, H. (1995). Evolved responses to landscapes. In Barkow, J., Cosmides, L. & Tooby, J. (Eds), The Adapted Mind: Evolutionary Psychology and the Generation of Culture. Oxford: Oxford University Press. Olds, A. R. (1989). Nature as healer. Childrens Environments Quarterly, 6, 27-32. Paine, R. & Francis, C. (1990). Hospital outdoor spaces. In C. C. Marcus & C. Francis (Eds.), People Places: Design Guidelines for Urban Open Spaces. New York: Van Nostrand Reinhold. pp. 263-290. Schroeder, H. W. (1995). Preference and meaning for arboretum landscapes: Combining quantitative data. In A. Sinha (Ed.), Readings in Environmental Psychology and Landscape Perception. San Diego: Academic Press. Strain, J. J. & Grossman, S. (1975). Psychological reactions to medical illness and hospitalization. In Strain, J. J. & Grossman, S. (Eds.) Psychological Care of the Medically Ill: a Primer in Liaison Psychiatry. New York: Appleton- Century-Crofts. pp. 23-26.

References Ulrich, R. S. (1984) View through a window may influence recovery from surgery. Science, 224, 420-421. Ulrich, R. S. (1977) Visual landscape preference: A model and application. Man-Environment Systems, 7, 279-293. van Andel, J. (1990). Places children like, dislike, and fear. Childrens Environments Quarterly, 7, 24-21. Verderber, S. F. (1986) Dimensions of person-window transactions in the hospital environment. Environment and Behavior, 18, 450-466. Warner, S.B. Jr. (1995). The periodic rediscoveries of restorative gardens: 1100-present. In M. Francis, P. Lindsey & J.S.Rice (Eds), The Healing Dimensions of People-plant Relations: Proceedings of a Research Symposium. Davis, CA. University of California, Davis, Center for Design Research, pp. 5-12. Whitehouse, Sandra, et. Al. (2001) Evaluating a Childrens Hospital Garden Environment: Utilization and Consumer Satisfaction. Journal for Environmental Psychology, 21, 301-314.

Rev. Connie Madden MDiv, BCC Chaplain Coordinator St. Louis Children’s Hospital.

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