Outdoor Environments at Crisis Shelters in Denmark
Victoria L. Lygum, Ulrika K. Stigsdotter, Cecil C. Konijnendijk, and Henriette Højberg

Studies on gardens investigating positive health outcomes have focused on various groups and settings. This study investigates the current status and explores the potential of outdoor environments to support health and well-being at crisis shelters for women and children survivors of domestic violence in Denmark. This is a type of setting where not much research has been done but which services a very vulnerable group. Through a questionnaire distributed by e-mail and targeted crisis shelter staff, the extent, general satisfaction, characteristics, and use of outdoor environments were examined. Out of the 38 Danish crisis shelters, 31 responded. Responses were analyzed by means of univariate and bivariate analysis. Responses to open questions were grouped into categories. Furthermore different outdoor environment types were identified and defined. 

Results show that all of the crisis shelters in the study have an adjacent outdoor environment. They are used by residents and staff and the general satisfaction with the outdoor environments is high. At most of the crisis shelters members of the staff carry out maintenance of the outdoor environment and at a few crisis shelters the residents contribute as well. The aspects of the outdoor environments rated with both very satisfied and dissatisfied scores are presented, and preferences for type, size, demarcation and level of screening from surroundings are reported. The findings indicate that the outdoor environment should be closed to public use and accommodate passive and active as well as social and private activities for both children and adults. Furthermore, findings suggest that facilities should strive to make garden use possible in all kinds of weather and that the staff play a role when it comes to taking the initiative for organizing outdoor activities.

The results from this study can be used as a starting point for optimizing outdoor environments at crisis shelters. Even though the general satisfaction is high, the findings show that the full potential of the outdoor environments is not being realized. Findings, however, indicate great opportunities to improve the setting and develop the activities taking place to take further advantage of the therapeutic qualities of nature in supporting the women, children, and staff at crisis shelters.

A Review of Design Recommendations for Outdoor Areas at Healthcare Facilities
Shureen Faris Abdul Shukor, Ulrika K. Stigsdotter, and Kjell Nilsson

This systematic review examines literature that discusses design recommendations for health supportive outdoor areas at children’s hospitals, psychiatric hospitals, hospices, acute care hospitals, and nursing homes. The review includes design recommendations for each type of healthcare facility based on the following categories: 1) location and view; 2) accessibility; 3) layout and space; 4) seating arrangement; 5) planting; 6) design details; and 7) practical services. The current review found a lack of evidence-based design recommendations and additional research, including post occupancy evaluations, is recommended. The reviewed literature has a strong focus on the benefits for patients and less on the benefits for visitors and staff. Finally, a list of common design recommendations identified in several of the reviewed documents is presented, which may be of inspiration for health policy-makers, hospital administrators, designers, and others involved in the design and management of healthcare facilities.

Engaging Clients Through the Therapeutic Use of Self
Barbara Kreski

Horticultural therapists use themselves as a therapeutic agent as well as their technical skills. By learning to label their interactions with clients as representative of a mode or type, therapists can become more intentional in their choice of how to approach each client. Developing competency in additional modes expands the repertoire of successful therapeutic interactions that a therapist can employ.