The Impact of Simulated Nature on Patient Outcomes: A Study of Photographic Sky Compositions

Debajyoti Pati, Patricia Freier, Michael O’Boyle, Cherif Amor, Shabboo Valipoor

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


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. Result: 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. Conclusion: Salutogenic benefits of photographic sky compositions render them better than traditional ceiling tiles and offer an alternative to other nature interventions.

Original languageEnglish
Pages (from-to)36-51
Number of pages16
JournalHealth Environments Research and Design Journal
Issue number2
StatePublished - Jan 1 2016


  • access to nature
  • acute care
  • biophilia
  • environmental design
  • experimental
  • interior design


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