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.
of the viewer and their state of mind
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.
that welcome the viewer. Consider the implied socio-cultural messages about education,
wealth, and class that an image may convey.
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:
in the immediate foreground. Openness gives the viewer room to breathe and explore, rather than a
feeling of being “crowded.”
cultural artifacts. Scenes with positive cultural artifacts, such as barns and older houses,
provide viewers with a sense of familiarity and comfort.
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.
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.
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
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.
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.
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
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
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.
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?”
by S. McDonnell, M. Healy, K. Roosa.
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.
of Iowa: Study about Art Cart and patient preferences
communication S. McDonnell
R. Why zebras don’t get ulcers
on chronic stress.