WELL-BEING IN THE THERAPEUTIC GARDEN

FOR PATIENTS WITH DEMENTIA

1

Stokkeprosjektet

• The Vestfold University college collaborated with the local municipality of Stokke

• The aim was to develop good public health services with high accessibility

• A therapeutic garden for 21 patients with dementia at the nursing home, was one practical answer

• The participatory action research was chosen to balance action and research

2

Action research as practical approach

• To fulfil the local action purpose, an interdisciplinary team was established.

• Action research is experience-based, participant-and action-orientated

• The interdisciplinary team aimed to develop and explore an accessible therapeutic garden to improve the patients well-being

3

Disharmony

• The interdisciplinary team reported that the situation outdoors wasmeaningless, unmanageable and incomprehensible for the patients

• At the same time, the situations were occasionally were unmangeablefor the nurses.

4

This disharmony is interpreted

according to disability in the Gap

model.

The gap between demands of the

outdoor environment,

and the patients capabilities

in the immediate environment,

is not harmonized

GMT v. reversed time

• Patients with dementia re-experience their former life, in bygone times

• At the time, in relation to dementia, they experience a reversed axis of time

• Since their capabilities connected to time, among others, are declining successively …

• the gap between demands of the environment,

• and the person with dementia capabilities declines as time passes …

5

From disharmony to well-being

• To synthesize resources and risk factors, the Soc construct was adapted to achieve well-being

• The therapeutic garden and universal design principles were activated in the planning process

• The principles served as Generalized Resistance Resources in the immediate outdoor environment

• The aim of GRR scaffolding, in the outdoor environment, was to facilitate well-being outdoors, for this vulnerable group

6

Universal design: a paradox?http://www.design.ncsu.edu/cud

• Universal design: The design of products and environments to be usable by all people, to the greatest extent possible, without adaptation or specialized design.

• Universal design guides a wide range of design disciplines including environments, products and communications.

• As a project leader I applied the principles as a guide, in the design process to strengthen comprehensibility and manageability in theoutdoor area

• This is contradictory, because the design should be for everyone, which I consider is valid in theory , but not often performed in practice

7

Universal design principles:

Presentation of principles 1,2,3 and 4

• 1 EQUITABLE USE

• The design is useful and marketable to people with diverse abilities.

• 2 FLEXIBILITY IN USE

• The design accommodates a wide range of individual preferences and abilities.

• 3 SIMPLE AND INTUITIVE USE

• Use of the design is easy to understand, regardless of the user’s experience, knowledge, language skills, or current concentration level.

• 4 PERCEPTIBLE INFORMATION

• The design communicates necessary information effectively to the user, regardless of ambient conditions or the user’s sensory abilities.

8

Presentation of universal design

principles 5,6 and 7.

9

5 TOLERANCE FOR ERROR

The design minimises hazards and the adverse

consequences of accidental or unintended actions.

6 LOW PHYSICAL EFFORT

The design may be used efficiently and comfortably

and with minimum fatigue.

7 SIZE AND SPACE FOR APPROACH AND USE

Appropriate size and space is provided for

approach, reach, manipulation and use,

regardless of user’s body size, posture, or mobility.

Printed 9/06 by J . Woodar

A therapeutic approach in the garden

• Throughout history the garden has contributed to holistic healing: body, mind and spirit

• The most important principle will be presented:

• Utilise plants and other elements that stimulate the memory , conversation and activity ( meaning )

10

FROM ACTION TO RESEARCHThe interdsiciplinary team were focus group interviewed 1, 2 and 3 years after the garden had been

opened, and the interviews served as a fruitful unit of analysis in the hermeneutic-

phenomenological analytic process

• A main result was that when the patients were upset indoors, it was like they were transformed when entering the therapeutic garden

• They slowed down and relaxed, like in an intermediate stage and…

• They transformed from this initial stage and then activated their senses in the therapeutic garden

• They were more satisfied with being outdoors than indoors

11

INTERPRETATION

• In Phenomenoligie de la peception, 1945, Maurice Merleau Ponty, attributed to Heidegger, presentsan existensial theory where, among others:

• The lived body is essential for accessing the world

• Each bodily change, changes the world

• The term Merleau Ponty uses is «etre-au –monde» , which expressesfacing the world

• I have interpreted the transformation entering the outdoor area, to..

• A perceptual field opens to the patient , attributed to the pre-objective phenomena like wind, weather, light, noises and temperature

• Then they perceive objects by hearing the birds singing , taste thestrawberries, smell the thyme, stroke the dog and look at the flowers

12

Results

• A salutogenesic framework, combined withaction research as a method, therapeuticaland universal design principles in theplanning process, resulted in an appropriatedesign with high accessibility for the patientswith dementia.

13

Conclusion

• Well-being was the result, attributed to the possibility of patients to comprehend, manage and experience meaning outdoors

• Thank you for your attention

14