Think for a moment about the people you know, including yourself, who live or work in a care community, or with in-home care. How often do residents, staff, volunteers, and carers engage Outdoors? How often do you engage Outdoors? How often do your children and grandchildren engage Outdoors?
🚧 Indoor environments are often rife with pollutants and synthetic materials that can negatively impact our health.
🚧 It's concerning that care is primarily practiced indoors, especially considering that:
Americans spend 90% or more of their time indoors.
Australians spend 90% or more of their time indoors.
Canadians spend 90% or more of their time indoors.
Two in five (38%) UK adults spend less than an hour per day outdoors.
Children today spend up to 44 hours per week on their digital devices and less than 10 minutes a day playing outdoors.
Care Outdoors: A Unique Approach to Care
To be valued is a human need that does not go away with a dementia diagnosis, mobility impairment, or when we are receiving care.
To have opportunities to continue making contributions to our world, however large or small, is a human need.
To feel as though your life has meaning, is a human need from the moment we are born until we take our last breath.
In Care Outdoors, reciprocity, interdependence, and Caring With are paramount for health and wellbeing. When our care philosophy is focused wholly on 'giving care', we miss out on the extraordinary power of a Reciprocal Care Relationship.
How does Reciprocal-Shared Care Differ from Person-Centered Care?
In Reciprocal-Shared Care,
individuality, values, preferences, emotional and social needs of the individual are foundational for the care relationship, person-centered care.
Reciprocal-Shared Care expands
Person-Centered Care to include the needs of the carer, community, and natural environment while nurturing contribution, and healthy ecosystems for all.
Reciprocal-Shared Care = ALL
Being an Activities Director was, without a doubt, one of my favorite jobs. This position followed my time in live/work/learn communities, and I eagerly looked forward to working with older adults.
Looking back, I realize I've always been a gerontologist at heart. Growing up with three great-grandmothers who played pivotal roles in my upbringing, I never feared aging. In fact, getting old was something I anticipated. Though very different from one another, each of my great-grandmothers were the most composed and grounded people in my life.
They led slower, more deliberate lives, and I found great comfort in that.
As is true with many aspects of my life, "I often wish I knew then what I know now."
This applies to my time as an Activities Director as well. I worked for a large, profit-driven corporation that did not prioritize sufficient budgets for meaningful engagement.
Leadership was stretched thin, and the care teams were often burned out.
Despite these challenges,
we co-created incredible programs, though it came at the cost of my own wellbeing.
Before long, I, too, became overwhelmed and burned out, watching my physical and mental health deteriorate day by day.
The care environment was heavily focused indoors; residents, leadership, and care teams rarely went outdoors.
But it doesn't have to be this way.
People often say, It's all about the residents. But that's not entirely true.
Residents only receive optimal care with vibrant, healthy leadership and care teams and a healthy environment.
The health and wellbeing of the entire care community are interconnected. It depends on the wellbeing of everyone within the environment—residents, staff, and the spaces they occupy, both indoors and outdoors. Quality food, fresh air, natural surroundings with trees, birds, accessible gardens, comfortable seating areas, and shade all play critical roles in creating a healthy care environment.
Extensive research and case studies highlight the significant role of the Nature experience in promoting wellbeing, enhancing quality of life, and preventing disease. Outdoor care—through both passive and active engagement, caring in, for, and with Nature, fresh air, and sunlight—is vital for the health of everyone, people and Nature.
Our current paradigm of living is often busy, technical, consuming, and grey, with just a few minutes a day spent in green spaces. Yet most people wish modern life could be more straightforward and that the pace of life could slow. —Miles Richardson, Reconnection: Fixing Our Broken Relationship with Nature
How do you feel when you're fully immersed in nature—walking along a forest path, or simply sitting outdoors, listening to the sounds of birds singing?
Imagine how different the care you share, how different your entire care community would feel, if leadership supported a slower care pace
Nature as a Care Ally: The Future of Greening Care Communities
Attention Restoration Theory
Green care and nature-based approaches utilize existing theories as a foundation for practice, such as Attention Restoration Theory. According to this theory, a visual connection to Nature is not only enjoyable, but can also improve mental focus and our ability to concentrate.
In the 1970s, grant funding from the United States Department of Agriculture brought Stephen and Rachel Kaplan to the Upper Peninsula of Michigan to research the effects of an outdoor youth program in a wilderness environment. Their research gave rise to a new generation of environmental psychologists and designers, as the wilderness became their laboratory.
The Kaplans later discovered that an inherent sense of awe and fascination with Nature helps people recover and restore mental clarity; thus, Attention Restoration Theory was born.
Being in and gazing at Nature generates effortless focus, a process I refer to as tapping in by tapping out and tapping out by tapping in. When immersed in Nature, our attention and senses are engaged rather than strained, resulting in a restorative and energizing effect.
Stress Reduction Theory
Roger Ulrich, a leading environmental psychologist, is renowned for his pioneering work in healthcare design and the development of Stress Reduction Theory (SRT).
This theory posits that exposure to natural environments can reduce stress by activating the parasympathetic nervous system, leading to both physiological and emotional relaxation. Rooted in evolutionary biology, SRT suggests that humans have an innate connection to nature, which helps lower stress and anxiety levels when individuals spend time in natural settings.
The theory emphasizes that Nature can alleviate stress and promote mental wellbeing, facilitating quicker recovery from stress than urban or built environments.
Ulrich first publicized SRT in 1984 through his influential paper, View Through a Window May Influence Recovery from Surgery, which highlighted the benefits of natural views for patients recovering from surgery and laid the groundwork for further research into the positive effects of nature on stress and wellbeing.
The Importance of Nature-Based Approaches in Care Communities
In today's fast-paced and digital world, holistic approaches to organizational wellbeing are vital for care communities. Nature-based care is not just a healing art; it is an essential approach that benefits everyone involved, providing practical solutions to the challenges of modern care and living.
By integrating nature-based approaches into the core of your care philosophy, you can enhance the mental health and overall wellbeing of your entire community, including residents, carers, all levels of your organization, as well as their families and the wider community; while growing the biodiversity of your landscape.
Care communities have an enormous opportunity to become places that promote wellness for all—people and Nature. This mutual, reciprocal benefit is one of the most significant advantages of Nature-based approaches.
Recent research underscores the profound impact of nature-based interventions on employee wellness, making them essential for fostering a healthy workplace environment. In care communities, where residents come to receive care and support, it is vital to prioritize the wellbeing of leadership, care teams and the whole environment.
Unfortunately, burnout continues to run rampant and leaving teams little time or organizational support to nurture their own wellbeing.
Why Care Outdoors is a Healing Art that Benefits Every Organization
Highlights from The Harris Poll on behalf of the American Psychological Association's 2024 Work in America Survey reveal that workplace stress and burnout are significant concerns, with nearly two in five employees (43%) feeling tense or stressed during their workday.
Additionally, 67% of workers experienced at least one symptom of burnout in the past month, such as low energy, lack of motivation, or feelings of isolation. These findings underscore the urgent need to address employee wellbeing.
Moreover, mental health issues like depression are becoming increasingly common in the workplace, yet they are often preventable. One promising approach to improving mental health in organizational settings is through nature-based interventions (NBIs). These interventions harness the well-documented benefits of exposure to Nature to enhance mental wellbeing and reduce workplace stress.
A recent study emphasizes the effectiveness of Nature-Based Interventions in promoting employee health and wellbeing by encouraging time spent in Nature or integrating Nature into the work environment.
The review of scientific evidence indicates that workplace nature-based interventions are a cost-effective and proactive means to improve mental health, reduce stress, and increase overall employee satisfaction and productivity.
These nature-based interventions, rooted in positive psychology, aim to cultivate a flourishing work environment by focusing on strengths, resilience, and mental health. Nature can serve as an ideal context for mental restoration, enabling employees to recover from job-related stressors and thereby reducing the risk of burnout.
Through psychological detachment and relaxation, Nature exposure allows everyone to reset and regain personal resources critical for thriving in high-demand care environments. Ultimately, NBIs not only address mental illness but can foster optimal functioning by enhancing positive emotions within the care community.
Implementing such interventions aligns with a broader organizational health psychology approach, which seeks to balance job demands and personal resources, creating a healthier, more vibrant care environment.
A Nature-Connected Care Community Promotes
Holistic Wellbeing for Everyone
The study Associations between Nature Exposure and Health: A Review of the Evidence provides a comprehensive examination of the myriad benefits of Nature exposure, drawing from a wealth of experimental and observational research conducted over the past decade to demonstrate its significant positive effects on various aspects of health and wellbeing,
for all ages.
I will now showcase key findings from this research, highlighting the specific ways in which exposure to Nature can enhance mental health, cognitive function, and overall quality of life and wellbeing, for all ages.
Stress Reduction through Nature Exposure
A systematic review of over 40 experimental studies reveals compelling evidence that spending time in natural environments significantly reduces perceived stress levels, heart rate, and blood pressure.
Affective State
Research indicates that exposure to natural environments positively influences self-reported affective states, enhancing emotional wellbeing. Studies show that individuals who engage with Nature experience increased positive emotions and decreased negative emotions.
For example, a study involving a 50-minute walk found that participants in a natural setting reported significant reductions in anxiety and negative affect while preserving positive emotions, in contrast to those who walked in urban environments.
Additionally, forest bathing (shinrin-yoku) has been linked to lower levels of hostility, depression, and anxiety, highlighting its potential for health promotion and stress reduction.
Notably, forest walks consistently yield the most significant improvements in psychological states, emphasizing the therapeutic role of Nature in emotional wellbeing.
Anxiety and Depressive Mood
Exposure to natural environments has been shown to significantly reduce anxiety and rumination, both of which are linked to adverse mental health outcomes, including depression.
A study conducted in Gloucestershire, UK, evaluated a wetland NBI aimed explicitly at individuals diagnosed with anxiety and depression.
The findings revealed that engaging with the wetland environment offered participants a much-needed escape from their daily surroundings, leading to increased relaxation and reduced stress levels.
Furthermore, a systematic review and meta-analysis confirmed that short-term exposure to natural settings is associated with a notable decrease in depressive mood, highlighting the therapeutic potential of Nature in fostering mental health and wellbeing.
Cognitive Function
Research has demonstrated that brief experiences in natural environments positively influence cognitive function among adults, aligning with findings in school-aged children.
Numerous studies indicate that spending time in natural settings, as opposed to urban environments, enhances attention, executive function, and perceived restoration. These studies reveal statistically significant improvements in cognitive outcomes even after relatively short durations in Nature.
Brain Activity
Exposure to natural environments has been linked to significant changes in brain activity, particularly within the prefrontal cortex, which is crucial for emotional regulation.
In a compelling experimental study conducted among female university students in Japan, researchers examined both physiological and psychological responses to viewing real plants versus images of those same plants.
While participants reported feelings of comfort and relaxation after observing both real and virtual plants, physiological responses were exclusively noted when participants viewed real plants.
Specifically, this interaction resulted in increased oxy-hemoglobin concentrations in the prefrontal cortex, indicating that engaging with real plants elicits physiological benefits for brain activity that are not achieved through mere visual representation. This highlights the unique impact of direct nature exposure on cognitive and emotional functioning.
Blood Pressure
Numerous studies, including two comprehensive meta-analyses, have demonstrated a strong association between exposure to natural environments and reduced blood pressure levels.
In a review of 52 studies on the physiological effects of nature therapy in Japan, researchers found compelling evidence that participants experienced significant decreases in both systolic and diastolic blood pressure when in natural settings.
These reductions were observed in diverse populations, from young, healthy individuals to those with hypertension, indicating that activities like forest walking promote a state of physiological relaxation.
Furthermore, a systematic review analyzed 20 trials involving 732 participants, including high school and college-aged youth, revealing that blood pressure measurements taken in forest environments were notably lower compared to those taken in urban or non-forest settings.
This underscores the potential of Nature exposure as a therapeutic intervention for managing blood pressure and enhancing overall cardiovascular health.
Immune Function
Research from Japan has highlighted the positive effects of forest bathing on human immune function.
In one notable study, participants engaged in a 3-day/2-night forest bathing experience, with blood and urine samples collected on the second and third days.
Results showed a significant increase in natural killer (NK) cells—crucial components of the immune system—during the forest bathing days compared to control days.
This enhancement in NK cell activity was not only observed during the trip but also persisted for 30 days afterward indicating a lasting impact on immune health.
A potential mechanism for this effect may be the exposure to phytoncides, natural substances released by trees and plants to defend against pests and diseases. These compounds may reduce stress hormones in the body, thereby boosting NK cell activity.
Moreover, the study revealed that even a single day trip to a forest park could elevate levels of intracellular anti-cancer proteins, further suggesting that regular interaction with natural environments may support and strengthen the immune system.
Mental Health
Access to green space correlates with improved mental wellbeing, cognitive development in children, and reduced psychological distress in teens. For instance, U.S. students who actively engaged with green spaces for at least 15 minutes four or more times a week reported better quality of life and lower stress levels.
Similarly, the Growing Up Today Study (GUTS) indicated that greater exposure to greenness around the home was associated with lower depressive symptoms.
Research in European cities revealed that adults with low levels of childhood nature exposure reported worse mental health compared to those with higher exposure.
Furthermore, a study of one million Danes found that continuous green space during childhood was linked to a lower risk of psychiatric disorders in adulthood.
Other studies suggest that moving to greener areas improves mental health.
Emerging research also highlights green outdoor settings as potential treatments for mental and behavioral disorders like ADHD.
A systematic review found a significant inverse relationship between green space exposure and emotional problems in children and adolescents. Moreover, natural features near schools are associated with enhanced early childhood development.
For adults, exposure to greenness consistently shows protective effects against depression, especially in women and younger individuals.
Physical Activity
A substantial body of literature documents the impact of access to green spaces and surrounding greenness on physical activity in both children and adults.
Proximity to green spaces may enhance physical activity by providing venues for walking, running, cycling, and other forms of exercise. Studies show children and adults exhibit higher levels of physical activity in areas with greater access to green space.
For instance, a study in Bristol, UK, examined the relationship between green space accessibility and the likelihood of respondents achieving a recommended 30 minutes or more of moderate activity five times a week; those living closest to formal parks were more likely to meet this physical activity guideline.
Another study involving adults in the UK found that individuals residing in the greenest areas were more likely to meet the recommended daily physical activity levels.
Researchers in California discovered that greenness was associated with higher odds of moderate to vigorous physical activity, particularly when comparing those in the 90th and 10th percentiles of greenness.
Their findings indicated that children exposed to green space for more than 20 minutes daily had nearly five times the daily rate of moderate to vigorous physical activity compared to those with minimal exposure.
Additionally, a study of Australian children demonstrated that time spent outdoors at baseline positively predicted physical activity levels three years later.
Sleep
In Australia, adults residing in areas with more than 80% green space experienced a lower risk of short sleep duration, even after accounting for other predictors of sleep.
Among U.S. adults in the Behavioral Risk Factor Surveillance System survey, access to natural amenities, such as green space, lakes, and oceans, correlated with lower reports of insufficient sleep, particularly among men and individuals over 65.
Cardiovascular Disease
Exposure to green space may affect physical activity levels, stress, and blood pressure, all of which contribute to cardiovascular disease risk.
Recent reviews indicate a consistent association between residential green space exposure and decreased incidence of cardiovascular disease.
Individuals living in areas with less greenness have higher mortality rates following strokes, as well as increased mortality from cardiovascular disease and coronary heart disease.
Diabetes
Evidence regarding the association between green space and type 2 diabetes suggests a potential pathway for diabetes prevention.
Several cross-sectional studies have reported an inverse relationship between green space exposure and type 2 diabetes among adults.
Conclusion: Embrace Nature for Holistic Care
Having explored the compelling research supporting Greening Care and Living for All Ages,
it is time to take action.
Care Outdoors: A Healing Art for Every Care Community
In a world where care is often practiced within the confines of four walls, Care Outdoors offers a transformative approach to holistic wellbeing, benefiting not only care recipients but also carers, leadership, and the wider community.
The science is clear: integrating Nature into our care environments fosters mental clarity, reduces stress, and enhances emotional and cognitive health. Whether through active engagement or passive immersion, outdoor spaces provide essential healing for everyone.
Reciprocal-Shared Care, rooted in the connection between people, community, and the natural world, extends beyond the individual. It nurtures all who engage in care, creating vibrant and healthy ecosystems where people and Nature can thrive together.
RSC shifts us away from the traditional “giving care” paradigm and embraces a reciprocal relationship that is regenerative and healing for all—residents, staff, carers, and the whole environment =
Sharing Care.
As we continue to face rising levels of stress, burnout, and disconnection from Nature in care environments,
Care Outdoors offers a solution that is both practical and profound.
By weaving Nature into the fabric of our care communities, we foster a healthier, more vibrant approach to care that honors the interconnectedness of all living things.
From the leadership level to the day-to-day interactions of care teams and residents, Care Outdoors provides a foundation for healing that extends far beyond the individual, creating ripples of wellbeing that benefit the entire ecosystem.
In embracing Care Outdoors as a healing art, we open the door to a future where care communities are not just places of maintenance but thriving environments of regeneration—for people and the planet.
"When we open the door and go out into the fresh air, we can be immediately in touch with the air and the Earth and all the elements around us.
When we walk, we know we're not stepping on something inanimate. The ground we're walking on is not inert matter.
Understanding the Earth in this way, we can walk on the planet with as much respect and reverence as we would walk in a house of worship or in a sacred space.
We can bring our full awareness to each step.
Steps like these have the power to save our lives".
–Thich Nhat Hanh
Are You Ready?
Join Us and Together we can live, learn, grow and green care for all!
Visit: The Care Outdoors Program
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