title: The Impact of Simulated Nature on Patient Outcomes: A Study of Photographic Sky Compositions.
abstract: OBJECTIVE
  To examine whether incorporation of simulated nature, in the form of ceiling mounted photographic sky compositions, influences patient outcomes.
  
  
  BACKGROUND
  Previous studies have shown that most forms of nature exposure have a positive influence on patients. However, earlier studies have mostly focused on wall-hung nature representations. The emergence of simulated nature products has raised the question regarding the effects of the new product on patient outcomes.
  
  
  METHODS
  A between-subject experimental design was adopted, where outcomes from five inpatient rooms with sky composition ceiling fixture were compared to corresponding outcomes in five identical rooms without the intervention. Data were collected from a total of 181 subjects on 11 outcomes. Independent sample tests were performed to identify differences in mean outcomes.
  
  
  RESULTS
  Significant positive outcomes were observed in environmental satisfaction and diastolic blood pressure (BP). Environmental satisfaction in the experimental group was 12.4% higher than the control group. Direction of association for diastolic BP, nausea/indigestion medication, acute stress, anxiety, pain, and environmental satisfaction were consistent with a priori hypothesis. A post hoc exploratory assessment involving patients who did not self-request additional pain and sleep medication demonstrated confirmatory directions for all outcomes except Systolic BP, and statistically significant outcomes for Acute Stress and Anxiety-Acute Stress and Anxiety levels of the experimental group subjects was 53.4% and 34.79% lower, respectively, than that of the control group subjects.
  
  
  CONCLUSIONS
  Salutogenic benefits of photographic sky compositions render them better than traditional ceiling tiles and offer an alternative to other nature interventions.
authors.affiliation: Department of Design, Texas Tech University, Lubbock, TX, USA d.pati@ttu.edu.
authors.forename: Debajyoti
authors.initials: D
authors.lastname: Pati
authors.affiliation: Quality Management, Covenant Health, Lubbock, TX, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Freier
authors.affiliation: Department of Human Development and Family Studies, Texas Tech University, Lubbock, TX, USA College of Human Sciences, Texas Tech University, Lubbock, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Boyle
authors.affiliation: Department of Design, Texas Tech University, Lubbock, TX, USA.
authors.forename: Cherif
authors.initials: C
authors.lastname: Amor
authors.affiliation: Department of Design, Texas Tech University, Lubbock, TX, USA.
authors.forename: Shabboo
authors.initials: S
authors.lastname: Valipoor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D001794:Blood Pressure; D005260:Female; D006801:Humans; D007374:Interior Design and Furnishings; D008297:Male; D008875:Middle Aged; D019368:Nature; D010146:Pain; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology; D010781:Photography; D012890:Sleep
keywords: access to nature; acute care; biophilia; environmental design; experimental; interior design