Reconnecting at the End: The Healing Power of Nature in Hospice and Palliative Care

By Dr. Owen Wiseman

When I think about comfort at the end of life, I picture difficult moments buffered by a sense of softness. Small moments that remind us that we’re part of something bigger.

One of the most profound sources of comfort is nature. The feeling of sunlight warming our skin, the sound of birds outside a window, or that first breath of fresh air. In hospice and palliative care, every moment is important, and these connections to the world around us offer something no medicine or machine can.

Why Nature Matters

Humans are wired to feel better in nature.

We feel calmer when we see the colour green or hear water flowing from a stream nearby. Even something as simple as watching leaves rustle in the wind. Evidence shows that simply viewing nature can reduce pain, anxiety, and stress.

In one of the most-cited studies, patients recovering from surgery who had window views of nature used 21% fewer pain medications and shortened hospital stays. They also wrote fewer negative nurse evaluations.^1,2

A systematic review of biophilic design found that incorporating nature – whether through views, natural light, or indoor plants – has a positive effect. The review showed that incorporating this design strategy reduced patient mortality and pain while improving psychological well-being for patients and caregivers alike.³ The ripples go beyond the patient and provider though. Environmental elements support the caregivers. Nature-inspired spaces help to reduce caregiver burnout and improve their overall satisfaction.^4,5

A Personal Connection

I’ve had a front-row seat to the power of nature in palliative care, both professionally and personally.

My mother, towards the end of her career, worked in pediatric palliative care at Roger’s House in Ottawa (part of CHEO). Through our conversations, she would talk about how much the kids enjoyed a warm summer breeze drifting through an open window. During her rounds, she’d often catch them looking out towards the gardens, taking in the sights of bees and butterflies at work on a cluster of echinacea or purple-stemmed asters.

More recently, my family experienced the other side of this care when my grandmother spent her final days at the Brockville General Hospital. After a thoughtfully designed and LEED certified redevelopment, the space is filled with natural light and natural materials. Beautiful cedar stripping brings warmth to the nurses stations as bio-swales collect rain water on the rooftop gardens.

Small Ways to Bring Nature In

Not every hospice or palliative care space has access to large gardens or forests. That said, nature can still find a way in:

• Views and bird feeders: Simply seeing swaying trees or an active bird feeder brings life to a patient’s room.
• Plants and flowers: Even a single potted plant reduces feelings of stress and pain. One study found that the presence of indoor plants reduced patient fatigue and improved their energy.²
• Nature sounds and imagery: Bringing in landscape art is another way to make nature accessible to those with limited mobility. Even gentle sounds of nature playing in a waiting room led to reduced heart rate and muscle tension.⁶
• Outdoor visits: When possible, even five minutes can make a difference.

These practices are being championed by organizations like Root in Nature, a Canadian leader in therapeutic horticulture. Founder and CEO Alexis Ashworth shares:

“Therapeutic horticulture aligns closely with the goals of hospice and palliative care by reducing anxiety and agitation, enhancing quality of life, and supporting both patients and caregivers through meaningful, accessible engagement with plants. Activities such as watering, arranging flowers, or simply viewing greenery can improve emotional regulation, stimulate memory, and foster calm, even in the final days of life. These interventions are easily adapted to physical and cognitive abilities and can be delivered at bedside, in clinical settings, or in the home.”

It’s a reminder that nature-based care doesn’t have to be complicated.

Supporting Caregivers and Staff

Consider how much caregivers give of themselves. They are often emotionally exhausted and at risk of burnout. Compassion fatigue is a reality for so many. Access to nature can be a lifeline in those moments where we’re asked more than we have to give.

Designing staff break areas with natural light, views of green space, or even the sounds of nature has been shown to help staff recover faster from emotional strains. Some data reports reductions in stress as high as 30%.^7,8

Overcoming Barriers

Bringing nature into the workplace can be…challenging. Access can often be difficult in urban or resource-limited settings when budgets are tight. But even small touches like nature-inspired art or a single plant can benefit both patients and staff.

If you are supporting someone at the end of life, consider:

• Can they see the sky or trees?
• Can we introduce any gentle sounds or artwork into their room?
• Are caregivers able to find moments to step outside and recharge?

A Final Reflection

In hospice and palliative care, it’s often the small things that stay with us. Holding a hand, even when we don’t feel a response. Catching a glimpse of a bird flying by the window.

Even a small smile from one of the nurses that tells you, “It’s going to be alright.”

My mother’s dedication to families and my grandmother’s final few days showed me that by inviting nature in, we have a chance to feel a little more connected to the very end.

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References:

1. Ulrich, Roger S. “View through a window may influence recovery from surgery.” science 224.4647 (1984): 420-421.
2. Park, S. H., & Mattson, R. H. (2009). Ornamental indoor plants in hospital rooms enhanced health outcomes of patients recovering from surgery. The Journal of Alternative and Complementary Medicine, 15(9), 975-980.
3. Al Khatib, I., Samara, F., & Ndiaye, M. (2024). A systematic review of the impact of therapeutical biophilic design on health and wellbeing of patients and care providers in healthcare services settings. Frontiers in Built Environment, 10, 1467692.
4. McCoy, Janetta Mitchell, and Gary W. Evans. “The potential role of the physical environment in fostering creativity.” Creativity Research Journal 14.3-4 (2002): 409-426.
5. Tekin, B. H., Corcoran, R., & Gutiérrez, R. U. (2023). A systematic review and conceptual framework of biophilic design parameters in clinical environments. HERD: Health Environments Research & Design Journal, 16(1), 233-250.
6. Largo-Wight, E., O’Hara, B. K., & Chen, W. W. (2016). The efficacy of a brief nature sound intervention on muscle tension, pulse rate, and self-reported stress: Nature contact micro-break in an office or waiting room. HERD: Health Environments Research & Design Journal, 10(1), 45-51.
7. Gola, Marco, et al. “Influence of nature at the time of the pandemic: An experience-based survey at the time of SARS-CoV-2 to demonstrate how even a short break in nature can reduce stress for healthcare staff.” HERD: Health Environments Research & Design Journal 14.2 (2021): 49-65.
8. Tekin, Bekir Huseyin, and Rosa Urbano Gutiérrez. “Human-centred health-care environments: a new framework for biophilic design.” Frontiers in Medical Technology 5 (2023): 1219897.