DRAFT Adapted Guidelines for Selecting Art for Health Care Settings (1, 2)

According to research and expert opinion, the viewers’ state of mindand the images’ attributes are priorities when selecting images for use in health care settings. State of mind includes how people “feel” in health care settings, how they emotionally and physiologically experience visual images, and how this experience affects their well-being and resilience. The literal and symbolic message conveyed by an image is as important as its subject matter.

I. Attributes of the viewer and their state of mind

State of mind or level of alertness. Select images separately for settings in which people may be semi-conscious, confused, or disoriented. These images must address different needs than those intended for people who are alert and oriented.

Messages that welcome the viewer. Consider the implied socio-cultural messages about education, wealth, and class that an image may convey.

II. Attributes of the image

Select representational art that promotes the intended viewer experience. Below are examples of recommended image composition and symbolism and the type of experience they typically promote. Preferred types of subject matter follow these examples.

Composition and symbolism:

    Openness in the immediate foreground. Openness gives the viewer room to breathe and explore, rather than a feeling of being “crowded.”

    Positive cultural artifacts. Scenes with positive cultural artifacts, such as barns and older houses, provide viewers with a sense of familiarity and comfort.

    Clear visual orientation. Images with the presence of a horizon, a clear depth of field, or other orienting features are particularly useful for settings that include patients with an altered level of consciousness.

    Calming, non-threatening situations. Scenes that depict a safe environment or are associated with concepts of home, coziness, or protection reduce the sense of estrangement and unfamiliarity that may be present in a health care setting. Consider the normal size and scale of what is being depicted and the viewer’s level of energy.

    Optimism. Upbeat images with positive associations that convey a sense of optimism are more likely to improve a viewer’s outlook than bleak, complex, or despairing images.  

    Inviting environment. Environments that are familiar and realistic provide a safer, more reassuring experience than cartoon, fantasy, or otherworldly images.

    Humor. Good-natured humor that promotes laughing at the human condition or oneself tends to lift the spirits and encourages relaxation.

Natural settings:

    Waterscapes. Select images with calm or non-turbulent water, but not stormy conditions. (Note: If the health care setting typically involves fluid restriction or a full bladder for a procedure, water should be avoided.)

     Landscapes. Select landscapes that depict warmer seasons, when vegetation is verdant and flowers are visible; landscapes that convey non-threatening or calming situations; or landscapes that contain wildlife, such as birds or deer. Landscapes with low hills and distant mountains are also recommended.

    Flowers and gardens. Select images of flowers and gardens that appear healthy and fresh, rather than wilted or dead, and that contain flowers and foliage that are generally familiar to patients, rather than novel or strange.

Social Themes:

    Positive relationships. Select people, settings, or friendly animals at a normal scale that depict relationships and connection. For example, things in “twos,” such as two chairs in a garden, symbolize relatedness and companionship. (4) Depicted relationships and interactions should be friendly, nurturing, or caring.

    Relaxation. Select images depicting relaxation or leisure in places with prominent natural surroundings, for example, people enjoying a picnic in a field rather than harried people sailing on a stormy ocean.

    Positive facial expressions. Select emotionally positive facial expressions, gestures, and body language that are caring and friendly.

    Acceptance. Select images with generational, cultural, and social diversity that welcome everyone, but without doing so gratuitously.

Engaging Images:

    Interaction. Select images and scenes that pose a question or engage the viewer, such as finding hidden characters or playing with an idea. (6)

    Expression. Select images that encourage input or involvement, and include a place and materials to draw, respond, write, or imagine. For example, invite the viewer to write comments on a white board or turn a pointer towards the image that best reflects how they feel or what they would rather be doing.

    Reflection. Select a series of images that reflects change, such as the seasons or a series of actions, and encourages storytelling and reflection over time.

In summary, the selection and placement of images is an intentional process that includes ongoing research and evaluation. Our goal is to create an environment that more completely engages patients, family, and staff and promotes recovery and well-being.  This process is distinct from criticism or subjective preferences about art.  Instead, the emphasis is on the general viewer; asking “How would most people respond to this picture?”


(1)          Adaptations by S. McDonnell, M. Healy, K. Roosa.

(2)          Ulrich RS. (2008). “Effects of viewing art on health outcomes.” In: Susan A. Frampton, et al., Putting Patients First: Best Practices in Patient-Centered Care 2nd ed. (pp. 129-149) San Francisco, CA: Jossey-Bass.

(3)          University of Iowa: Study about Art Cart and patient preferences

(4)          Personal communication S. McDonnell

(5)          JAMA

(6)          Sapolsky R. Why zebras don’t get ulcers

(7)          References on chronic stress.