“Human Flourishing with Dignity”: A Meta-Ethnography of the Meaning of Gardens for Elderly in Nursing Homes and Residential Care Settings

Abstract

This study aims to identify and synthesize qualitative research regarding residents’ experiences of gardens while living in nursing homes and residential care facilities. To provide an optimal nursing environment inspired by nature, we need to derive knowledge from the residents’ perspective. An interpretive meta-synthesis approach, a meta-ethnography, was chosen for this study. Altogether, six articles representing three continents and comprising 124 participants were included. The six articles that fulfilled the inclusion criteria were analyzed and synthesized according to Noblit & Hare’s seven phases of meta-ethnography and the recent eMERGe guidelines. Four themes were identified: (1) The garden—a place to feel a connection with life, (2) the garden—a place to sense and find comfort, (3) the garden—a place to feel healthy and alive, and (4) the garden—a place to relate past and present. An overarching metaphor, “human flourishing with dignity,” offers a deeper understanding of the meaning of the garden for older people in nursing homes and residential care. This meta-ethnography provides a reflective, systematic, data-driven synthesis based on literature spanning ten years. Rather than simply relying on retelling, the narration of experiences according to the primary researcher’s descriptions and interpretations results in new knowledge. The significance of gardens for older people’s health and well-being needs to be given greater attention and space in nursing practice, education, and health policies.

Quality criteria of nature-based interventions in healthcare facilities: a scoping review

“…Several studies refer to sensory stimulation by the natural environment or landscaped garden, ( 8 , 41 , 43 , 45 , 52 ). Examples include the possibility to enjoy visual stimuli ( 41 , 43 , 45 ), smells ( 41 , 43 , 45 , 47 ), sounds ( 13 , 43 , 45 ), tactile interactions with plants ( 41 , 43–45 , 47 , 50 ) and beauty ( 8 , 43 , 52 ).…”

“…Several studies refer to sensory stimulation by the natural environment or landscaped garden, ( 8 , 41 , 43 , 45 , 52 ). Examples include the possibility to enjoy visual stimuli ( 41 , 43 , 45 ), smells ( 41 , 43 , 45 , 47 ), sounds ( 13 , 43 , 45 ), tactile interactions with plants ( 41 , 43–45 , 47 , 50 ) and beauty ( 8 , 43 , 52 ). One study speaks about ‘sensory gardens” ( 52 ), in which sensations and beauty can be experienced with different senses, such as esthetically experiencing of colors and smells, and touching the plants and the soil ( 8 , 13 , 45 ).…”

“…In a literature review of qualitative studies, a study describes the garden adjacent to residential care homes “as a place where connection can be made with life” ( 52 ). This finding was based on the following experience of the participants: ‘ being able to have close contact with their self, contact with others, organized or not; connection with nature by being able to experience the seasons and by doing activities in the garden.…”

“…Finally, the garden was also seen as a place where past and present come together, by revisiting past memories of nature, and as an opportunity to break a daily routine by being able to visit or work in the garden. Based on the findings of their research, they speak of ‘human flourishing in dignity’, and this through the inclusion of and contact with nature in healthcare facilities ( 52 ). A qualitative study in a psychiatric ward found that patients found it important to care and cultivate plants, as a metaphor for their own healing ( 41 ).…”

Healthy by Nature: Policy Practices Aimed at Maximizing the Human Behavioral Health Benefits of Nature Contact

“…Simply being present in nature can be therapeutic to those with severe physical and cognitive limitations. Incorporating therapeutic elements of design in nursing homes has been described as a “silent partner in caregiving,” and when these elements include nature, significant effects on health and wellbeing are observed (Magnussen et al, 2021; Noell, 1995). For those able to engage to a greater degree with nature, horticultural therapy has been shown to have positive effects on healthy and pathologically aging older adults and caregivers (Ascencio et al, 2019).…”