TMC PULSE

33 t m c » p u l s e | m a r c h 2 0 1 9 Seeking Nature in the Hospital Real and virtual green space could improve patients' lives B y B r i t n i R . M c A s h a n F or years, dietitian Renee Stubbins, Ph.D., and oncology infusion nurse liaison Ashley Verzwyvelt have dreamed of transforming an unused rooftop space at Houston Methodist Hospital's outpatient center into a lush therapeu- tic garden for patients. "When I first started here six years ago, I saw these signs all over saying there was a rooftop garden on the 21st floor," said Stubbins, a senior research oncology dietitian. "I was really excited and then I found out that there is no garden there—it's just a big open space." Stubbins and Verzwyvelt work with cancer patients at Houston Methodist's infusion center, where some patients will spend up to eight hours a day receiving chemotherapy. Both women have a bit of a green thumb and hoped a garden could reduce their patient's pain and stress. "Oncology patients are in chronic pain. Some of our patients are veterans, on Medicare, they are already stretched thin," Stubbins said. "To get pain medication, it might mean another co-pay for them. They will have to physically go get the prescription in person and they might have trans- portation issues. There are so many barriers and many of our patients want alternatives." Last Fall, Stubbins and Verzwyvelt submitted a proposal for the rooftop garden to the Center for Health & Nature, a new center housed at Houston Methodist that is anchored by the belief that nature is essential to healing and well-being. The center is a partnership between Houston Methodist, Texas A&M University and Texan by Nature, a nonprofit conservation group founded by former first lady Laura Bush. Stubbins and Verzwyvelt wanted to find out if access to a garden would improve their patients' hospital experience, but the committee overseeing the proposals wanted the duo to expand their research beyond literal greenery. The committee introduced Stubbins and Verzwyvelt to two virtual reality experts: Ann McNamara, Ph.D., associate profes- sor and associate head of the department of visualization at Texas A&M, and Xiaohui Xu, Ph.D., department head and associate professor of epidemiology and biostatistics at the Texas A&M School of Public Health. "At first, I was a little skeptical because I thought the whole point was to get people out- side," Stubbins said, "but Dr. McNamara brought up the fact that many people can't go outside and not all of our rooms have windows. So why not bring nature indoors through virtual reality?" McNamara designed a virtual reality program with a 360-degree view of any number of land- scapes—a beach, a waterfall, a forest, and so on. Each interactive landscape will be paired with sounds to fully immerse the patient in the experi- ence of nature while sitting in a hospital room. "It is heartbreaking to see a patient in pain and all you can do is tell them to try this or that or tell them to speak with a social worker," Stubbins said. "There are so many hoops to jump through." If funded, Stubbins and Verzwyvelt's team will conduct a six-cycle trial with 35 oncology patients suffering from different types of cancers. Each patient will have two visits to three different rooms while receiving regular chemotherapy treatments: a room with a view of the proposed rooftop garden; a control room with no windows; and a room where the patient will experience nature via the virtual reality headset. The team plans to examine each patient's pain scale, dis- tress scale, saliva cortisone levels, heart rate and blood pressure to see if having some interaction with nature improved his or her experience. The study would be reviewed by the Institutional Review Board and fully disclosed to all patients participating. At the Center for Health & Nature's inaugural symposium in February, Stubbins and Verzwyvelt were among the finalists who pitched their pro- posal to the audience, which included researchers, doctors, wildlife experts and Laura Bush. "Like many of you, I was inspired by the conservationists and naturalists in my life, includ- ing my mother-in-law [Barbara Bush] who was proud of her cottage garden in Kennebunkport, Maine," Bush said to the symposium audience in February. "In Midland, I learned to enjoy the out- doors from my mother who, if she was not reading, could be found outside. My mother was a knowl- edgeable, self-taught naturalist who remembered the name of every wildflower and was passionate about birds." Bush went on to say that the individuals in attendance at the symposium were leaders in their communities who could help prove "that the con- nection between health and nature truly makes people happier, healthier and more prosperous." Stubbins was heartened by the opportunity to pitch the proposal. She should hear about funding on April 30. "If we get funded—hopefully, we do—it will be a year-long project," she said. "We had several people come up to us at the symposium and offer their help, so hopefully we will get it. But either way, we have ignited a flame and we will pursue it and make it happen for our patients."

• Cover