The information in this chapter provides an extensive review of the literature used to identify and address the research gap in this proposed study. The research presented in this literature review explores bodies of literature related to use of nature-based solutions (e.g. indoor plants, window views, or images of nature) in the work environment. The conclusion of this review helped to determine that it is not known how direct support workers describe their experience with indoor nature exposure or how they perceive the restorative value of indoor nature exposure in community care facilities (CCF) in the San Francisco Bay Area, California. Therefore, this qualitative descriptive study seeks to address this gap in research.
The purpose of the literature review is ordered to provide structure and ease of reading.
The first section contains the background to the problem, which provides a better understanding of the purpose of this study. Following this section is the identification of the problem pace, which addresses the need for this study. Next is the theoretical foundation for the study which connects the research to Kaplan’s (1989) Attention Restoration Theory (ART). After the theoretical foundation section is a review of literature, which discusses an assessment of the sources used to identify and address the gap in this research study. Next, there is a review of the problem statement. Lastly, the summary provides an overview of all the information shared in this chapter.
This literature review provides an extensive review of how nature exposure in the workplace has positive benefits for increasing cognitive function, reducing stress, and improving work performance. The online resources include Google Scholar, ProQuest, ProQuest Dissertations, EBSCOhost, ERIC, ABI/INFOR Collection, Emerald Management, SAGE Research Methods, and Education Research Complete. The following terms: Attention Restoration Theory, desk plants, nature exposure in the workplace, hospital gardens, viewing nature in the workplace, psychological benefits of indoor plants in the workplace, creating psychologically healthy workplaces, and restorative elements at the computer workstation were used when searching for scholarly sources to identify and address the gap in research.
Background of the Problem
Healthcare, as an industry, places numerous pressures on healthcare providers, including the challenges of clinical work, time constraints, competing demands, lack of control over work processes, and overlapping roles and responsibilities. The well-being of healthcare professionals and the influence of healthcare professionals on mental health and wellness has an influence on the quality of care a patient experiences (Bridjeman et al. 2018). Crocker and Joss(2016) writes how healthcare providers are always exposed to traumatic experiences of the people they provide services to and are susceptible to psychological fatigue, occupational stress. Ruisoto et al.(2021) adds how healthcare providers become burnout because of the prolonged exposure to stressful work environments related to the job conditions within the healthcare industry.
In California, community care facilities provide specialized care and services for individuals of all ages and with various conditions such as physical, cognitive disabilities, mental illness, psychological, behavioral, and substance abuse disorders etc. Community care facilities can range from group homes, small family homes, adult residential facilities or residential care facilities for the elderly. Direct care workers are responsible for having direct interaction with the clients, providing non-medical residential care, and supervision. Therefore, the job requires a lot of attention-directed focus and psychological resources in providing care to clients (Cox et al.,2018). Cox et al.(2018) argue that direct care employees become burnout and experience psychological fatigue because of the nature of the occupation, long work hours, lack of training, and limited time for self-care. Pageaux and Lepers (2018) adds that prolonged use of directed attention can result in psychological fatigue, a condition that interferes with physical, cognitive, and occupational performance. While researchers have conducted many studies to examine the causes of burnout among direct care workers
A few studies have been done to explore the use of nature exposure in community care facilities as an economical solution for reducing psychological fatigue and occupational stress among direct care workers.
Identification of the Problem Space
Previous research on nature-based solutions in the workplace has indicated health-promoting benefits: attention restoration, improved wellness, and reduced occupational stress (Berg et al. 2021; Bratman et al. 2019; Korpela et al. 2017; Lee et al. 2015; Moran, 2019; Toyoda et al. 2019; White et al. 2019).
According to Dreyer et al.(2018)the integration of nature-based elements (e.g., indoor plants, window views, or images of nature) into the work environment can provide a range of positive benefits for occupational performance, attention restoration, and physical health. In addition, research by Bratman et al.(2019) and Lee et al. (2015) revealed that increasing opportunities to view nature and having desk plants can reduce mental fatigue with attention to hyperactive or demanding workspaces.
Although current empirical and seminal research demonstrates that nature exposure in the workplace has positive psychological, physiological, and organizational benefits, the extent of literature is somewhat limited. A lot of studies have focused on nature exposure in office-based work environments, explore relationships between nature elements (e.g., viewing nature from the work window, nature images, and indoor plants), and have overlooked other occupations(McSweeney et al.,2014; Moran,2019; Moran et al.,2021). Among the many overlooked workplaces are healthcare environments such as community care facilities, which are acknowledged to be highly stressful places, with high levels of job stress and burnout among direct care professionals (Cox et al.,2018).
Research by Van Esch et al.(2019) explored how viewing nature or representations of nature, plants, images, or other green spaces in the workplace can have health-promoting benefits. There is a gap in the research by Van Esch et al.(2019) which called on further research to explore viewing nature in other work environments. The proposed study seeks to address this gap by exploring how direct support professionals describe their experience with indoor nature exposure and its perceived restorative value in community care facilities (CCF) in the SF Bay Area. California.
Theoretical Foundations
Attention Restoration Theory (ART). ART argues that perceiving natural stimuli will allow infinite cognitive capacities, such as focusing attention, to restore, alleviating the individual from cognitive fatigue that is experienced when these capacities are overused (Kaplan,1989).
Directed Attention fatigue can cause decreased concentration, performance, and stress (Kaplan,1989).
Nature restores by holding attention effortlessly and having high compatibility (Kaplan,1989).
Review of the Literature
*A paragraph needs to be added connecting these themes with community care facilities
*These studies don’t look like they directly relate to my study(community care facilities), so you can make that connection for the reader.
Theme 1: Nature Exposure and Occupational Mental Health
Research by Cordoza et al. (2018) explored the relationship between nurse burnout and taking walks inside the hospital garden during breaks. Cordoza et al.(2018) found that nurses who took their breaks inside the garden were less stressed.
Research by Berg et al. (2021) examined whether greening a geriatric ward may reduce the hospital-induced decline in the independent functioning of elderly patients. Berg et al. (2021) found that adding indoor nature exposure (INE) helped improve elderly patients’ hospital decline and wellbeing. In addition, Berg et al. (2021) noted that hospital staff also benefited from the plants; the staff reported feeling less stress.
Research by Toyoda et al. (2019) examined how adding desk plants could decrease office workers’ stress and improve the workplace conditions . Toyoda et al. (2019) research indicated that desk plants could be an economical solution for reducing occupational stressT
Theme 2: Nature Exposure and Physical Health
Research by White et al.(2019) explored the relationship between direct exposure to natural environments rather than residential proximity, using data from a large nationally representative sample in England. White et al.(2019) found that research participants who spent at least 120 minutes a week in nature had reported good health.
Research by Korpela et al. (2017) explored the relationship between nature exposure at work, home, and employee well-being. Korpela et al. (2017) concluded that spending time in nature could improve employee’s health.
Research by Dahlkvist et al. (2020) focused on the positive benefits of gardens in two residential care facilities. Dahlkvist et al. (2020) concluded that gardens in residential care facilities could provide therapeutic benefits to the residents by being a location that fosters increased social interactions and increases cognitive abilities.
Theme 3: Nature Exposure and Occupational Social Health
These studies don’t look like they directly relate to my study(community care facilities), so you can make that connection for the reader.
Research by Nadkarni et al.(2017) explored the effects of vicarious nature experiences (nature videos) on prisoners at Snake River Correctional Institution (SRCI) in Ontario, Oregon. Nadkarni et al.(2017) concluded that prisoners who had watched the nature videos reported feeling significantly calmer, less irritable, and more empathetic. In addition, prison staff reported a 26% decrease of inmates engaging in aggressive or violent infractions who saw the nature video than inmates who did not watch nature videos.
Research by Moran (2019) explored prisoners’ experiences with nature exposure inside a medium-security men’s prison in the UK. Moran (2019)study concluded that prisoners who had opportunities to view nature reported feelings of calmness, self-reflection, and imagination.
Research by Moran et al. (2021) explored the relationship between nature exposure and staff call-offs in the UK prison system. Moran et al. (2021) found that jails with nature exposure had a significantly lower staff call-off rate than jails without any nature contact. Furthermore, Moran et al. (2021) noted that this was the same pattern across different prison systems: low, medium, and maximum security.
Chapter 2
This chapter provides a substantial literature review to identify and deal with the research gap in nature exposure in community care facilities. The literature review presented in this research evaluates literature bodies related to the use of solutions based on nature, like indoor plants, indoor gardens, and providing window views of nature (Bratman et al., 2021). From the findings of this review, we were able to determine that how workers take their experiences with nature exposure and their therapeutic value in various community care facilities is not well understood. Nature exposure has excellent benefits to direct care professionals and patients within a community care facility working environment.
The first part of the literature review is the background of the problem, which aims to explain the study’s whole purpose. A literature review generally gives the study structure and makes the study easier to read for the readers. The next phase after the background of the problem is the theoretical foundation of the study. The theoretical foundation section shows the connection between the study to the Attention Restoration Theory (ART). After the theoretical foundation, the review of the literature section evaluates all the sources used to identify and address the research study gap. After the literature review is the review of the problem statement followed by a summary which gives an overview of all the information in this chapter.
This literature review provides an extensive review of how nature exposure in the workplace has positive benefits for increasing cognitive function, reducing stress, and improving work performance. From the studies, nature exposure presents various positive benefits to a community care facility workplace, like reducing stress, increasing cognitive function, and improving the working morale and overall performance. Online resources used in this research were from Google Scholar, Emerald Management, Education Research Complete, ProQuest, and others. Some of the terms focused on in searching for online resources include Attention Restoration theory, Nature exposure at the workplace, hospital gardens, psychologically healthy workplaces, and benefits of indoor plants.
The healthcare industry presents several challenges to healthcare providers. Some of the most common challenges direct care providers face in community care facilities includes competing demands, time constraints, overlapping responsibilities, clinical challenges, and lack of control over the work processes. These impacts further result in heath provider burnouts and exhaustion which may affect the care provided to patients. The well-being of healthcare professionals at the workplace is as vital as that of the patients because they go hand in hand and depend on each other. The well-being of these healthcare providers directly impacts the quality of care and the patients’ overall well-being. For instance, when direct care professional is not in their best state, they are less likely to provide quality care. Several healthcare providers undergo tragic experiences at the workplace and other work-related issues like occupational stress and psychological fatigue. The prolonged workplace pressure becomes overwhelming at some point for the healthcare providers draining them and eventually sending them to a burnout state. The burnout state is not suitable for direct care professionals to be working in because they are highly expected to cause errors that may threaten the safety of patients and the overall performance of the facility.
In most states of the US like California, community care facilities offer exceptional care and services to everybody in all age brackets and address most health conditions ranging from mental disorders, psychological disorders, cognitive and physical disabilities, behavioral and drug abuse. The community care facilities come in various forms ranging from tiny family homes, group homes, residential care facilities, and adult residential facilities. At these facilities, essential services like providing non-medical residential care, supervision, and direct interactions with the clients are done by direct care workers. Various psychological resources and attention-directed focus are required in providing this care at the community care facilities, which explains why most direct care providers are often burned out and experience psychological fatigue. It is explained by the long working hours, nature of the occupation, lack of training, and inadequate time allowed for self-care. Psychological fatigue is further associated with interferences with occupational, physical, and cognitive performances within the workplace. The study has it that nature exposure within the working environments of community care facilities impacts the economic status of the community care facilities by minimizing occupational stress and psychological stress amongst the direct caregivers, which positively affects the overall outcomes.
Based on previous research, there are various health-promoting benefits associated with using nature-based solutions at the workplace. Some of these benefits directed to the direct care providers include reduced occupational stress, reduced psychological fatigue, improved state of well-being, and attention restoration. Nature-based elements that can be applied as solutions like indoor plants at the workplace increase the morale of working and promote physical attention. Demanding work environments like community care facilities can benefit much from nature-based solutions. For instance, having a good window view at the workplace or having a plant on your desk can help divert your mind from the hyperactive working environment for a short while and reduce mental fatigue. Reduced mental fatigue is associated with the well-being of the care providers and the delivery of quality care.
Based on the current seminal and empirical research, nature exposure at a community care facility is associated with positive physiological, psychological, and organizational benefits. However, the sources that talk about these benefits are somewhat limited. Most of these sources focus on the benefits of nature exposure in office environments and the relationships between the various elements of nature. These studies have failed to talk about the benefits of nature exposure in other occupations and environments. Considering the nature-based solutions aim to reduce occupational stress, healthcare facilities like community care facilities are very stressful work environments that highly benefit from nature exposure. However, there is still minimal study focusing on the benefits of nature-based solutions in such environments. Direct care professionals are highly susceptible to job stress and burnout and could benefit from nature exposure solutions at the workplace.
Looking at nature, plants, images, or vegetation in community care facilities is associated with health-promoting benefits. The study seeks to understand the experiences of direct support professionals with nature-based solutions at the various community care facilities. The research gap in this study is looking at nature exposure in different occupational environments.
According to the Attention Restoration Theory (ART), perceiving natural stimuli gives room for infinite cognitive capacities like restoration, focusing on attention, and relieving individuals of cognitive fatigue when these capacities are overused (Ohly et al., 2016). Concentration and mental fatigue are likely to be improved based on the time spent interacting with nature. Decreased concentration, poor performance, and occupational stress are all caused by directed attention fatigue. Based on ART, natural exposure enables effortless brain function, giving the brain room to recover and restore its directed attention levels. Kaplan argues that four properties are necessary for the natural environment to have a therapeutic effect. These properties are: Extent, providing a way out of habitual activities, features of the environment that seizure attention without effort, and compatibility. Of the four properties, soft fascination is the primary property because the other three factors sustain or enhance the fascination. It is important to note that although the attention restoration theory is widely cited, there is still no substantial empirical support for this theory. Nature is likely to play a vital role through the ability to hold attention effortlessly and being highly compatible.
Someone said that being outside makes us feel better and accessible. How we perceive and relate to nature has a significant impact on our mental health and stress. Nature generates positive vibrations like calmness’ happiness, creativity and increases levels of concentration. A study confirmed that direct care professionals who walked in the community care facility gardens during their breaks were less stressed than their counterparts who did not. Connection to nature within the workplace is associated with stress reduction, emotional restoration and promotes general well-being. Although including views of nature in the architecture of these facilities may be costly, its benefits cannot be overlooked because they reduce burnout. Reduction of burnout in healthcare professionals is in turn associated with positive outcomes. Desk plants, for example, are associated with reducing occupational stress and can be viewed as an economical solution because it reduces the time offs taken by direct care professionals due to stress and burnout. Apart from the direct care professionals, patients also benefit from nature exposure as it boosts their well-being and improves air circulation.
Theme 2: Nature Exposure and Physical Health
Exposure to nature does more than bring emotional well-being. Exposure to nature adds to physical well-being, reduces blood pressure, controls the heartbeat rate, reduces muscle tension, and generates stress hormones. The feeling of being refreshed upon stepping outside of the working environment to nature extends further than just our heads. Introducing the elements of nature to the working environment reduces stress and increases productivity. Proximity to natural elements like green spaces promotes physical activities because there is room to walk around and stay sharp while at it (Twohig-Bennet & Jones, 2018). Walking in nature increases focus because while at it, observing the surrounding is inevitable. Nature exposure enhances creativity, and the outside is being brought into working environments architectures. Based on a report to determine the benefits of natural exposure compared to residential proximities, people who spend at least two hours a week in nature have good health (White et al., 2019). From the study, we concluded that people living in more natural neighborhoods were less likely to have diabetes, cardiovascular conditions, or obesity. Nature exposure is associated with therapeutic benefits as it encourages social interactions within the workplace. Although in current community care facilities, gardens are incorporated in the architecture, being in the garden feels like being outside the workplace, according to most direct care professionals. The outside increases the cognitive abilities of direct care professionals. On top of that, the study claims that working out or practicing in green environments is more effective than physical activities in other locations.
Nature exposure is associated with promoting a safe and healthy working environment for direct care professionals. Though enhancing the physical and mental states of these professionals, their occupational social health is also protected. Healthcare providers require to be physically and mentally stable to be in a position to help patients. Nature exposure does not have to be directly looking at the elements of nature like vegetation. Even watching documentaries based on nature can have the same effect as observing indoor plants. Based on the nature of the work of direct care professionals, they are likely to be faced with various occupational health concerns like chronic consequences of stress and overworking. However, nurses can afford to encounter effects like these because they have patients counting on their services. Nature exposure can help in minimizing the occupational health concerns associated with healthcare provision. Nature is known to reduce stress and divert the mind from the stressful aspects of the occupation. These destructions are necessary to ensure that the direct care professional stay focused and do not commit any errors that may threaten the safety of the patients. Exposure to nature can help direct care professionals to restore their capabilities and become more creative in dealing with their patients.
Bratman, G. N., Olvera‐Alvarez, H. A., & Gross, J. J. (2021). The affective benefits of nature exposure. Social and Personality Psychology Compass.
Ohly, H., White, M. P., Wheeler, B. W., Bethel, A., Ukoumunne, O. C., Nikolaou, V., & Garside, R. (2016). Attention Restoration Theory: A systematic review of the attention restoration potential of exposure to natural environments. Journal of Toxicology and Environmental Health, Part B, 19(7), 305-343.
Twohig-Bennett, C., & Jones, A. (2018). The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes. Environmental research, 166, 628-637.
White, M. P., Alcock, I., Grellier, J., Wheeler, B. W., Hartig, T., Warber, S. L., … & Fleming, L. E. (2019). Spending at least 120 minutes a week in nature is associated with good health and well being. Scientific reports, 9(1), 1-11.
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