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1Scan for outdated or missing drivers - takes under a minute2Repair Windows errors before they cause bigger problems3Fix the driver behind crashes, sound loss and screen glitchesEarth and Sky Garden is a small therapeutic courtyard at the Puget Sound Veterans Affairs Hospital in Seattle, designed as a refuge for veterans, patients, families, and staff. University of Washington Design/Build students created and installed it in spring 2017, and the American Society of Landscape Architects (ASLA) recognized the project with a 2017 Student Community Service Honor Award.
The garden is not a therapy program, a public botanical attraction, or a retail product. It is a site-specific hospital courtyard whose planting, circulation, seating, screens, and views were shaped with veterans and hospital staff. Its therapeutic value is expressed through design intent—calm, privacy, social connection, nature contact, and dignity—not through published clinical measurements. The available project documentation does not establish current public access, present-day condition, or reductions in PTSD symptoms or other diagnoses.
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What the Earth and Sky Garden is
The project occupies a courtyard beside the hospital’s main entrance and emergency department. Its location makes the garden part of the hospital experience for people arriving for care, accompanying a veteran, working a shift, or looking out from an interior room. The designers described it as a respite and a green refuge, including for people with PTSD and other diagnoses.
Its name expresses the central concept. “Sky” refers to openness, light, and the Pacific Northwest horizon; “earth” refers to soil, vegetation, stone, and grounded sensory experience. Native plants, wood, basalt, and steel screens connect those ideas. The screens draw on images of mountains and rivers, while the planting and materials were selected to relate the hospital interior to the courtyard outside.
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That symbolism is architectural rather than a claim of treatment. The project account explains why the team believed the setting could support comfort and recovery, but it does not report controlled observations, symptom scores, usage totals, or other clinical outcomes.
How veterans and staff shaped the design
The student team did not begin with a finished concept and ask the hospital to approve it. They gathered information through surveys, visual-preference boards, and focus groups with veterans and hospital staff. Participants discussed desired activities, aesthetics, needs, and meaningful symbols. Occupational-therapy students and hospital therapists advised the team on human scale and accessibility.
The ASLA award jury summarized the process this way: “What we see here was not a vision imposed on the clients, but the outcome of information gathered from focus groups of veterans and staff.” That distinction matters in a healthcare courtyard. A designer can produce an attractive space that is difficult to approach, overstimulating, or emotionally uncomfortable. Consultation helped the team identify what users wanted to do, see, touch, and avoid.
Documented goals included a calming refuge, opportunities for meditation and social interaction, privacy, and a pleasant view from hospital interiors. The designers also considered elements that could trigger traumatic emotional responses. Those considerations are not described as a clinical protocol; they are evidence of trauma-aware decision-making during design.
Three rooms, three ways to use a compact courtyard
The courtyard is organized into three areas with distinct roles. Together they address different preferences without pretending that every visitor needs the same kind of retreat.
| Area | Primary experience | Design response |
|---|---|---|
| Sky Room | Group activity and social interaction | Movable tables and chairs allow small gatherings and flexible layouts. |
| Earth Room | Immersion in vegetation, soil, and stone | Planting and hardscape create a grounded, tactile garden setting. |
| Forest Room | Viewing and visual contact with planting | A viewing garden is positioned to be seen from inside the hospital. |
Sky Room: gathering without a fixed program
The Sky Room supports conversation, group activity, and informal time outside. Movable furniture is important in a hospital setting because the same area may need to accommodate a pair of visitors, a staff conversation, or a larger gathering. Tables and chairs can be rearranged rather than forcing every user into one social pattern.
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Earth Room: material and sensory grounding
The Earth Room emphasizes vegetation, soil, and stone. This is the most literal expression of the garden’s grounded side: living material and regional geology provide texture and visual weight within a constrained atrium. The project account also records a desire for lush planting and running water, although the documentation does not provide an operating specification or current status for a water feature.
Forest Room: a garden for people who stay indoors
The forest room functions as a viewing garden. Its value is not limited to people who can enter the courtyard; hospital occupants can see planting from inside. That indoor connection was one of the documented goals and helps explain why sightlines, screens, and the composition of the planting mattered as much as circulation.
Accessibility was built into ordinary details
Universal-design principles informed paths, furniture, handrails, and structures. The intent was to make participation possible for people using wheelchairs, canes, or crutches, rather than treating accessibility as a late adjustment.
Transfer-friendly seating
Curving benches were reclined and shaped to make wheelchair transfers easier. Their form also supports social participation: a person transferring from a chair can remain part of a conversation instead of being positioned apart from it. The project description presents this as a design response to user needs, not as a guarantee that every transfer or body type will be accommodated in the same way.
Reachable planting
A green wall was designed so a wheelchair user could roll underneath and reach aromatic herbs while facing the plants. This changes the usual expectation that a vertical garden is primarily for viewing. Reach, posture, and orientation were considered together, allowing a visitor to interact with living material rather than simply pass it.
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Safe movement and legibility
Illuminated screens, path lighting, and handrails help define routes through the courtyard. These elements can support people with low vision, balance concerns, or fatigue, while also making the space easier to understand at different times of day. The documentation does not provide illumination levels, slope measurements, turning radii, or a current accessibility inspection, so those details should not be inferred from the project narrative.
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Privacy, social contact, and the limits of a small atrium
A compact enclosed courtyard cannot provide the same choices as a large public park. The design therefore uses spatial contrast. Some areas support conversation; others allow a person to sit quietly or look at planting from inside. Curved benches, screens, layered vegetation, and the separation of the three rooms help create degrees of enclosure without eliminating visibility.
This balance addresses three tensions that often appear in healthcare landscapes:
- Private refuge versus social gathering: Users can seek quiet or join others instead of being assigned one mode of use.
- Indoor views versus outdoor immersion: The forest room serves people looking from hospital interiors, while the earth and sky rooms reward entering the courtyard.
- Accessible participation versus tight dimensions: Universal-design details expand participation, but the courtyard’s small footprint still limits how many people can gather and how much equipment can be accommodated.
These are design goals, not measured outcomes. The available account does not state how often each area is used or whether one arrangement is preferred by particular clinical groups.
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Pacific Northwest materials and symbolism
Native plants, wood, and basalt anchor the garden in its region. Steel screens reference mountains and rivers, translating local landscape imagery into architectural elements. The combination gives the courtyard a recognizable sense of place without relying on a generic decorative theme.
Regional materials also support the project’s conceptual link between earth and sky. Basalt and soil provide weight and texture; planting introduces seasonal change; screens and openings frame light and distant forms. The project team’s consultations identified regionally appropriate materials as a stakeholder priority, so the material palette was both symbolic and responsive to users.
Construction and installation
Students fabricated and installed the garden over ten weeks during the spring quarter. They used hand tools and fabrication equipment, combining design-build education with a working hospital project. Local contractors donated concrete cutting, irrigation, and lighting work, allowing the student team to complete specialized tasks within the schedule.
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For construction teams, the project illustrates the coordination required when a courtyard must function as architecture, landscape, and accessible infrastructure at once. Furniture placement affects transfer space. Lighting affects wayfinding and views. Irrigation and soil choices affect maintenance. Screens must provide privacy without making the courtyard feel closed. Those relationships are easier to resolve when users, therapists, fabricators, and facilities staff participate before installation.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Maintenance and the role of the VA facilities department
After installation, the VA facilities department maintained the garden using a maintenance manual created by the students and supplied by the studio. The project narrative states: “The garden is being maintained by the VA facilities department using the maintenance manual created by the students and supplied to the VA by the studio.”
A manual is especially important for a small therapeutic landscape because the intended experience depends on details that can disappear through neglect: clear paths, functioning lights, healthy aromatic plants, usable seating, and legible views. The available documentation does not establish whether the original planting, furniture, screens, or lighting remain unchanged today. It also does not describe current inspection intervals, replacement cycles, or operating costs.
What evidence exists—and what it does not show
The strongest documented evidence concerns process and design decisions. Veterans and staff participated through surveys and focus groups; occupational-therapy students and hospital therapists advised on accessibility and scale; and ASLA recognized the completed project in 2017.
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One free scan finds every outdated or missing driver and matches the right update for your exact hardware.Free scan · exact hardware matchThe project page says the team hoped to work with the VA on future evidence-based studies of user impressions. That statement is a future intention, not a reported result. The reviewed documentation contains no named numerical statistics on garden use, clinical outcomes, symptom change, or comparative effectiveness.
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Accordingly, it is accurate to call Earth and Sky Garden a therapeutic garden in the sense of a healthcare landscape intentionally designed for respite, calm, nature contact, privacy, and social connection. It is not accurate to claim that the project has demonstrated treatment effects or that it replaces clinical care.
What a visitor can and cannot assume
The courtyard was designed for veterans, patients, families, and staff, but the available project record does not establish current visitor rules or public opening hours. A person planning a visit should confirm access with VA Puget Sound rather than assuming that an award-winning hospital courtyard is open like a public park.
Likewise, photographs or descriptions from 2017 should not be treated as proof of present condition. Hospital landscapes change as facilities, planting, accessibility features, and safety requirements are updated. The project’s documented intent remains useful for understanding the design, while current operation requires direct confirmation from the facility.
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Why the project matters to construction and landscape practice
Earth and Sky Garden demonstrates how a constrained healthcare site can produce several kinds of use without becoming visually complicated. Its most transferable lesson is not a particular bench shape or plant list. It is the sequence: listen to users, define contrasting experiences, integrate accessibility into the form of the work, coordinate specialized construction, and leave facilities staff with practical maintenance guidance.
The project also shows why therapeutic language should be handled carefully. A landscape can be designed to support calm, dignity, orientation, and social choice. Those qualities are worthwhile even when a project has not measured symptom reduction. Clear distinctions between intention, user experience, and clinical evidence make the design easier to evaluate and maintain honestly.
Quick Recap
Key takeaways
- Earth and Sky Garden is a specific hospital courtyard at the Puget Sound Veterans Affairs Hospital, not a general therapy program.
- University of Washington Design/Build students created and installed it over ten weeks in spring 2017.
- Veterans, staff, occupational-therapy students, and hospital therapists informed the design through surveys, visual-preference boards, and focus groups.
- The Sky Room supports group activity, the Earth Room emphasizes vegetation and stone, and the forest room provides a planted view from inside.
- Universal-design details include accessible paths, handrails, lighting, transfer-friendly benches, and a reachable aromatic green wall.
- ASLA gave the project a 2017 Student Community Service Honor Award.
- Published documentation does not establish current access, current condition, usage statistics, or clinical effectiveness.
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