Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)

Legacy Department

Planning, Design, and the Built Environment

Committee Chair/Advisor

Dr. Matthew Powers

Committee Member

Dr. Stephen Verderber

Committee Member

Prof. David Allison

Committee Member

Dr. Ellen Vincent


Large hospitals are being built in the way that divorces patients from the natural environments (i.e., daylight, natural ventilation and therapeutic landscapes) (Verderber & Fine, 2000). Empirical research on this subject suggests that patients experience physical environment-related stress in such settings due to lack of control and insufficient connectivity with the exterior world (Ulrich et al., 2004). On the other hand, nature has been proven therapeutic in many ways, such as in reducing mental fatigue (Kaplan & Kaplan, 1989), reducing stress (Ulrich, 1999), reducing pain (Vincent, 2009). Although gardens are seeing a revival in hospitals in the recent decade, issues of the inadequate usability of healing gardens in general hospitals are emerging, primarily yields to twofold aspects: low visibility, and difficulties of accessibility (Pasha, 2010; Cooper-Marcus, 2007). This study aimed to reappraise landscape and architectural design patterns that can be used to address the current disconnect existing between therapeutic landscapes and architectural interiors within urban healthcare environments. The theory of transparency, initially presented by architecture theorists (Rowe & Slutzky, 1997; Hoesli, 1997), that expressed a type of continuous space with blurred boundaries between interiors and exteriors, was operationalized in this investigation to describe a continuum of flow between architecture and therapeutic landscapes within healthcare environments. Twelve patterns of design considerations that can encourage such an experience were derived and reshaped from the pattern language of town, buildings and construction (Alexander et al, 1977) and the typology study of hospital outdoor environments (Cooper-Marcus & Sachs, 2013). Then, the stress-reducing effects of one selected pattern, 'therapeutic viewing place', were rigorously tested using Evidence-Based Design strategies. It tested and compared the stress-reducing effects of transparent hospital waiting area with two other typical design patterns - total exclusion of nature, and with limited window views of nature. Methodologically, the study developed an integrative method for exploring and quantifying the stress-reducing effect of transparent spaces by combining psychophysiological measurements, mood states survey and preference study in a quasi-experimental study. Furthermore, the potential links between environmental perception, people's stress levels, and mood states were also explored by using the mixed method. Eventually, this study contributed to a larger body of literature that discussed the people-nature relationship within healthcare environments, and presented preliminary design guidelines in correspondence to the selected design patterns of transparent space.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.