title: The effects of presence and influence in nature images in a simulated hospital patient room.
abstract: BACKGROUND
  Nature images are frequently used for therapeutic purposes in hospital settings. Nature images may distract people from pain and promote psychological and physiological well-being, yet limited research is available to guide the selection process of nature images.
  
  
  OBJECTIVE
  The hypothesis is that higher degrees of presence and/or influence in the still photograph make it more effective at holding the viewer's attention, which therefore may distract the viewer from pain, and therefore be considered therapeutic. Research questions include: (1) Is there a significant difference in the level of perceived presence among the selected images? (2) Is there a significant difference in the level of perceived influence among the selected images? (3) Is there a correlation between levels of presence and levels of influence?
  
  
  METHODS
  109 college students were randomly assigned to one of four different image categories defined by Appleton's prospect refuge theory of landscape preference. Categories included prospect, refuge, hazard, and mixed prospect and refuge. A control group was also included. Each investigation was divided into five periods: prereporting, rest, a pain stressor (hand in ice water for up to 120 seconds), recovery, and postreporting. Physiological readings (vital signs) were measured repeatedly using a Dinamap automatic vital sign tracking machine. Psychological responses (mood) to the image were collected using a reliable instrument, the Profile of Mood States.
  
  
  RESULTS
  No significant statistical difference in levels of presence was found among the four image categories. However, levels of influence differed and the hazard nature image category had significantly higher influence ratings and lower diastolic blood pressure readings during the pain treatment. A correlation (r = .62) between presence and influence was identified; as one rose, so did the other. Mood state was significantly low for the hazard nature image after the pain stressor experience.
  
  
  CONCLUSIONS
  Though the hazard image caused distraction from pain, it is nontherapeutic because of the low mood ratings it received. These preliminary findings contribute methodology to the research field and stimulate interest for additional research into the visual effects of nature images on pain.
authors.affiliation: Department of Environmental Horticulture, Clemson University, Clemson, SC 29634-0319, USA. ellenav@clemson.edu
authors.forename: Ellen
authors.initials: E
authors.lastname: Vincent
authors.forename: Dina
authors.initials: D
authors.lastname: Battisto
authors.forename: Larry
authors.initials: L
authors.lastname: Grimes
mesh_terms: D000704:Analysis of Variance; D001288:Attention; D001794:Blood Pressure; D005260:Female; D006339:Heart Rate; D006801:Humans; D007374:Interior Design and Furnishings; D008297:Male; D019368:Nature; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D010362:Patients' Rooms; D010465:Perception; D010781:Photography; D055815:Young Adult