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Malcolm Randall Veteran Affairs Hospital, Gainesville, Florida

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Title:
Malcolm Randall Veteran Affairs Hospital, Gainesville, Florida promoting a healing environment through design
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Rooftop healing garden at the Malcolm Randall Veterans Affairs Hospital
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Gust, Stephanie ( author )
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English
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1 online resource (71 pages) : illustrations ;

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veterans -- healthcare -- health care -- healing -- rooftop -- gardens
Landscape Architecture capstone project, B.L.A

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Abstract:
As a veteran of the United States Army, I have experienced first hand how daunting follow up healthcare can be for veterans after completing service. I have a passion for designing gardens in healthcare settings and how it can foster quicker recovery times for patients and lessen the draining visits that occur for patients, family, or friends that travel extensive lengths for care. In addition it is important to help ease the staffs working conditions by providing a place of respite or relaxation and reduce stress levels.
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Includes bibliographical references.
General Note:
landscape architecture capstone project
Statement of Responsibility:
Stephanie Gust.

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University of Florida
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University of Florida
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Copyright creator. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
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035647009 ( ALEPH )
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LD1780.1 2017 ( lcc )

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University of Florida College of Design Construction and Planning School of Landscape Architecture & Planning Spring 2017 Capstone Terminal Project

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1 | PAGE Malcom Randall Veteran Affairs Hospital Gainesville, Florida PROMOTING A HEALING ENVIRO NMENT THROUGH DESIGN STEPHANIE GUST | LAA4358 CAPSTONE PROJECT | SPRING 2017

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2 | PAGE ACKNOWLEDGEMENTS I would like to thank my family and friends for always cheering me on no matter what my challenge is. This has been a long arduous journey, and I have learned much more than I anticipated. I would like to thank Tina Gurucharri for her continued support and efforts to help me reach my goal, she has been a beacon of light when I needed it. I would also like to thank Dr. Gail Hansen with whom I feel is a wonderf ul mentor, teacher and friend I would also like to thank Glenn Acomb for all of his input during this process about green roofs and how to approach this area of my project. Thank you to all of the instructors, professors and classmates that have extended themselves to me, so that I can be successful.

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3 | PAGE PERSONAL INTENT As a veteran of the United States Army, I have experienced firsthand how daunting follow up healthcare visit s can be for veterans after completing service. I have a p assion for designing gardens in healthcare settings and how it can foster quicker recovery times for patients it can lessen the draining visits that occur for patients, family, or friends that travel extensive lengths for care. In addition it is important to help ease the staffs working conditions by providing a pl ace of respite or relaxation as well as help reduce stress levels.

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4 | PAGE

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5 | PAGE TABLE OF CONTENTS Chapters Chapter One: Intro Into Site Photos Site Inventory Site Analysis Sun Study Opportunities and Constrain ts Goals and Objectives Case Studies Chapt er Two: Green Roofs Types of green roofs Green Roof Materials Green Wall Characteristics Benefits of Green Roofs/Walls Structural Loads Chapter Three : Healing Garden What is a healing garden? Users at this site Benefits of nature Specific Patient Needs Design Guidelines Chapter Four: Plans Process Chakras Plant List Concept Perspectives Conceptual Master Plan

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6 | PAGE Chapter One Introduction BACKGROUND John Malcom Randall came to Gainesville in 1966 as the Director of the Veterans Affairs Medical Center which was under construction. This was renamed Malcom Randall Veterans Affairs Medical Center in his honor following his retirement. Currently, it is the only VA Medical Center named after an employee. Upon his retirement in 1998, he had completed 59 years of federal service and held administrative positions with the Department of Veterans Affairs. (Sodek, 2008) This is the oldest VA in the State of Florida, 50 years old The Bed Tower was adde d on in May of 2011 including 226 private rooms with additional specialty clinics needed for this growing population. Previous Studies T here are no previous rooftop garden designs for this Veterans Affairs Hospital. Educational Value Create a mo del for other Veterans Affairs Hospitals to design and install a healing garden on site. Case studies and research will stipulate guidelines that will provide the most suitable environment that responds to soldiers of multiple generations and their diffe rent needs.

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7 | PAGE Provide a separate garden for cancer patients receiving infusion or radiation treatment. DESCRIPTION OF SITE Major Issues: E xplore relocating the HVAC in order to accommodate a rooftop garden and the design and maintenance standar ds needed to support plant material on a roof. Issues to be addressed are maximizing views in the garden, the use of irrigation on this site and compilation of rain water. Surrounding Context: This site is surrounded by three sides of the garden with four story buildings with windows T here is a gla ss bridge that separates two perspective spaces. The bridge and high walls do not promote the venturi effect in this space.

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8 | PAGE Sit e Context MALCOM RANDALL VA ME DICAL CENTER The North Florida/South Georgia Veterans Health System serves veterans across a large geographical area in North Florida (33 counties) and South Georgia (19 counties). In addition to our two medical centers in Gainesville and Lake City, we offer a number of services to our patients in several satellite outpatient clinics and community -based outpatient clinics. The North Florida/South Georgia Veterans Health Care System is the VA's largest Health Care System spanning 5 2 counties (40,000 square miles) between North Florida and South Georgia while proudly serving over 130,000 veterans. The Malcom Randall VA Medical Center in Gainesville is a tertiary care facility that also serves as an active teaching hospital wit h an extensive array of specialty services. The Malcom Randall VA Medical Center combines a full range of

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9 | PAGE patient care services with state -of -the -art technology and supported through education and research. We provide between 40,000 and 50,000 outpatient v isits each month Patients from our System of Clinics must travel to Gainesville for most specialty services, and this facility provides some specialty services to 100,000 veterans on a yearly basis. The estimated total number of outpatient visits for fis cal year 2008 approximate 600,000. Combined with a total of 12,000 in patient admissions each year, the Malcom Randall VA Medical Center is easily one of the top five busiest VA medical centers in the country. Specialized services include but are not limit ed to: Traumatic Brain Injury Treatment, Spinal Cord Injury Treatment, Stroke Rehabilitation, Radiation/Oncology, Hospice and Palliative Care, Surgery (Including Surgical Inpatient Care, Cardiothoracic, Neurological, Musculoskeletal, and other) (FisherHouseGainesville, 2014)

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10 | PAGE Surrounding Site Gainesville Alachua County Site located on rooftop Way Finding to VA In the City of Gainesville

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11 | PAGE Population Data (U.S. Department of Veterans Affairs 2016) Florida has the highest veteran population next to Texas and California

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12 | PAGE Veterans Age Data Florida has one of the largest aging populations in the United States. The average age at the Ma lcom Randall VA is 65 and older.

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13 | PAGE Site Photos Looking East from the glass bridge that connects the Bed Tower (North Side) with the Medical Services (South Side). Looking West from the glass Bridge. Priv ate rooms to the left and offices to the right. Looking North towards the Bed Towers.

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14 | PAGE Way Finding Map The red areas are limited to staff only no patients can access these areas. Purple = Bed Tower Orange = Medical Se rvices Sky Blue = Medical Services Aqua = Site Green = Basement (U.S. Department of Veterans Affairs 2016, p. 14) Bed Tower square footage = 240,000. Sq. ft. 226 beds Medical Services Square Foota ge = Estimated 275,000. Sq. Ft. Total Sq. Ft. = 515,000 Sq. Ft. of operational space = 11 Acres

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15 | PAGE HVAC SYSTEM The HVAC unit is proposed to be relocated to other sections of the roof. (G oogle Earth, 2015) Existing Access Points to the roof. A is the proposed main entry from the second floor, while B is a secondary entry point adjacent to elevator B, on the second floor. B

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16 | PAGE MEDICAL SERVICES Site Inventory: This is a federal building and there is currently no access to unauthorized personnel. Safety gear is required upon exiting the building. This is OSHA Occupational Safety & Hazzard Authority recomm endations that limit injury to all personnel in this location. The HVAC system, drain system along the edge of the Bed Towers, poor view sheds looking into this site. The site slopes to the north between 1% 3% guestimate.

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17 | PAGE Site Analysis (Google Earth, 2015) Square Footage for: ( West Garden) Side of Site: 18,000 sq. ft. & the East Side (Garden of Dreams) is approximately 5,500 sq. ft.

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18 | PAGE The Heat Island Effect What is the Heat Island Effect? The term "heat island" describes built up areas that are hotter than nearby rural areas. The annual mean air temperature of a city with 1 million people or more can be 1.8 5.4F (1 3C) warmer than its surroundings. In the evening, the difference can be as high as 22F (12C). Heat islands can affect communities by increasing summertime peak energy demand, air conditioning costs, air pollution and greenhouse gas emissions, heat -related illness and mortality, and water quality. (EPA, 2017) This emphasizes the roads only not including the buildings around this site. It is important to see how much space is not being used, and how changing this space to a garden can have multiple benefits to both patients and maintenance to the rooftop as w ell as reduce the temperature on the site. (Google Earth, 2015)

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19 | PAGE Sun Study JANUARY 9 AM 12 NOON 5 PM Approx. 75% shade During this month.

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20 | PAGE MARCH 9 AM 12 NOON 6 PM MORE FAVORABLE TIME OF YEAR IN THIS SPA CE. MARCH, SEPTEMBER & OCTOBER PARTIAL SUN EXPOSURE.

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21 | PAGE JUNE 8 AM 12 NOON 7 PM FULL SUN FROM APRIL TO AUGUST. THE HOTTEST TIME OF THE YEAR.

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22 | PAGE Sun Analysis & Wind Effects Months SHADE EXPOSURE WIND COMFORT November less Desirable December 50% -75% Less than 10 minutes January SHADE with cold wind. February March Most Desirable April 10% -50% 10 min. 30 min. September SHADE Most Desirable October Moderate Winds May Least Desirable June 10% OR LESS 10 minute duration July SHADE Warm Winds August

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23 | PAGE Opportunities & constraints Opportunities Create b et ter vista s from rooms and offices Central l ocation gives easy access. Collection of Storm water and reuse it. Reduce the heat island affect in this area. Extend the life of the roof. Green walls. Integrated path for all ambulatory care. Add additional access points. Po st supports could be used for tree placement. Add passive and active spaces. Constraints Views into rooms. Storm water Management. Structural loads Accessibility to site from the bed tower. Plant material. Adding additional access points. Echo. Sun/sh ade. Winds.

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24 | PAGE Goals and objectives Goal 1. Provide a healing garden to the veterans, family, friends and staff. Objective 1. Enhance view sheds out to this site. Objective 2. Provide interesting focal points within the garden. Objective 3. P rovide passive spaces. Objective 4. Provide active spaces. Goal 2 Provide a garden on the east side of this site for cancer patients. Objective 1 Provide shade and breezes during the hot months. Objective 2 Create a magical element to the gard en. Objective 3. Water feature in closed system to avoid legionaries disease.

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25 | PAGE Case Studies Fisher House Therapeutic Garden in Puget Sound, Washington. By Daniel Winterbottom Located in Puget Sound, Washington this is a wonderful response the type of veterans they service in that region of the country. Fort Lewis is an Army base where many young soldiers came back from Iraq with Traumatic brain Injuries. The fisher house slowly evolved into what it is today. When they saw a need for children to have a play area, they added one, while the service member receives all care necessary for their recovery. The symbolism used in the site gave a sense of peace, unity and movement within the garden. They adapted as this program grew based on the type of users wh ich was critical for me in designing this rooftop healing garden.

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26 | PAGE Case Study Smilow Cancer Center @ Yale T he Betty Ruth & Milton B. Hollander healing garden at the Smilow Cancer Center at YaleNew Haven Hospital in New Haven, Connecticut has some very appealing design aspects. This meandering path gives the user and experiences as they move through the site. I love the dry rock riverbed with minimal water to add white noise, and the use of the nook that gives you some privacy without isolating you in t he garden. One can feel safe they eliminate the ability for someone to s neak up beh i nd them

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27 | PAGE CASE STUDY Jacqueline Fiske Healing Garden Jupiter Medical Center By Studio Sprout This case study has a picture of how the garde n is being used by the staff and I could not think of a better idea tha n sitting or lying down on a seat wall and decompress ing. One of the most remarkable prospects is the generosity made possible by employees and then Guy Fiske made a generous donation in his wifes name along with future funds to maintain this space. I love the idea of connecting nature directly to the hospital through windows, glass walls or immersed in the space itself. The goal of the Jacqueline Fiske Healing Garden is to foster the ph ysical, mental and spiritual restoration of patients, visitors and staff by distracting from the medical setting. A series of garden spaces connected by paths create a tranquil and sheltered environment. The garden can be seen from inside the Cardiopulmona ry Rehabilitation Center exercise room and offers an alternative outdoor route between hospital units. Seating areas for visitors, patients and staff seamlessly i ncorporate elements that can be used in rehabilitation therapy. (Stu dio, 2012)

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28 | PAGE Case Study DELL CHILDRENS MEDICAL CENTER OF CENTRAL TEXAS Austin, Texas There are elements in this garden that I believe transcend all ages. We all have a little kid inside of us and the whimsical nature of chi ldren can be inspired wit h adults. People of al l ages love water features. The movement is relaxing, and the white noise can be distracting in a pleasant way. The garden is completely encapsulated and each level is a room that has its own access point. I love the water wall and ho w is connects this multi -level garden that gives the sensation of Disney and a stream in the mountains crashed into one another.

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29 | PAGE Chapter Two Green Roofs

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30 | PAGE Green Roofs Green roofs have been used throughout history an d are widely used In the U nite d K ingdo m France Singa pore and Germany just to name a few countries. Surprisingly the City of Chicago also has made its name on the top leading cities to add green roofs to its agenda in cooling the cities Heat Island e ffects that can be overwhelm ing in the concrete jungle. Green roofs systems can be added to roof tops where no humans will be walking, keep in mind small maintenance paths should be maintained. There are additional applications in adding green roofs where garden design can change the experience for users in the garden and viewers that can see into this space. Adding gardens to roofs in the urban setting can help reduce the heat island effect at great lengths. People living in these urban settings have their own challenges finding nature in the concrete jungle. Places like Singapore have been able to entwine vegetation into the urban setting so heavily that it appears to be something from a movie. We know it can be done I am unsure why the United States is so far behind with this a pproach.

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31 | PAGE Intensive Green Roof Intensive roof greening is similar to the old -style roof gardens where it is expected that people would use the area much as a conventional garden. Plants tend to be maintained on an individual basis in the same way as th ey would i n a garden at ground level. Soil depth is generally at 15cm (6 in) deep, but now may be composed of lightweight growing media, and is thus more correctly know as substrate Intensive roofs can support the whole range of vegetation types, from tr ees and shrubs through to herbaceous planting and lawns. Substantial pools and water features are also possible. Such roofs are usually intended to be accessible to people, and certainly need to look good.

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32 | PAGE Extensive Green Roof Substrate de pths are relatively thin: between 2 and 15 cm (.8 and 6 in) which reduces the amount of extra loading that must be built into the roof construction. Plants are treated as masse, rather as grass plants are in a lawn. Maintenance is generally designed to be minimal (e.g. simple walkovers to remove problem species, or trimming or cutting of the entire vegetation). Extensive roofs are generally much cheaper than intensive roofs, both in construction and maintenance. (Planting Green Roofs and Living Walls, 2008) pg.5

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33 | PAGE Semi extensive Green Roof Semi -extensive roofs have the same low or no -input philosophy as the extensive roof and use similarly lightweight substrates and modern green -roof construction technologies, but they hav e slightly deeper layers of growing medium (10 -20 cm, 4-8 in.) and therefore enable wider and more diverse range of plants to be grown. (Planting Green Roofs and Living Walls, 2008) pg. 7 Pavers This is how paver s are used with this green roof application. Hyrdrotech USA works with Hanover pavers to give clients optimal choices when designing. (Hyrdotech USA, 2017) Sloped Applications

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34 | PAGE This is the material used for sloped applications. By using these metal slates that help hold the dirt in place while adding mounds or hills by layering the Styrofoam material. It is very easy to cut and manipulate to achieve some height in various areas of the garden. (Hyrdotech USA, 2017) Characteristics of a green roof Drainage: Vegetative roof drainage design must both maintain optimum growing conditions in the growth medium and manage heavy rainfall without sustaining damage due to erosion or ponding of water. Plant nourishment and support: The engineered medium must be carefully designed to provide for excellent plant growth, no wind scouring, and proper water holding capacity. Protection of underlying waterproofing systems: Vegetative roof asse mblies must protect the underlying waterproofing system from human activities (including the impact of maintenance) and biological attack, and solar degradation. A capillary break immediately above the membrane is required for most membranes.

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35 | PAGE Waterproofing systems: Waterproofing is critical for protecting the structure from water intrusion. Insulation systems: Insulation is critical for saving energy (National Institute of Building Sciences, 2017) Benefits of a green roof/ gre en walls There are many potential benefits associated with extensive vegetative roofs. These include: Controlling storm water runoff Improving water quality Mitigating urban heat -island effects Prolonging the service life of roofing materials Conserving e nergy Reducing sound reflection and transmission Improving the aesthetic environment in both work and home settings Mitigation of wildlife Cost/benefit. (National Institute of Building Sciences, 2017) Examples: Benefits

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36 | PAGE S tormwater runoff can be managed efficiently with a green roof Vertical Elements Unique way to incorporate vegetation into a design (Planting Green Roofs and Living Walls, 2008) pg. 57, 199, 244,214 57, 214 Cont. Benefits of a green roof/ green walls

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37 | PAGE All Green plant s help to ameliorate the effects of pollution: absorbing noise, trapping dust, recycling carbon dioxide, and absorbing and breaking down many gaseous pollutants. Plants help to reduce negative climatic effects of urbanization, for Example by absorbing some of the heat generated in city environment and absorbing the rainfall that runs off hard surfaces. They can thus contribute to improved urban climates at the microclimatic scale but also at the larger scale, helping to ameliorate the effect of heat island, combat urban flooding and reduce energy costs associated with keeping building cool in hot climates. Plants can help to regulate the interior climates of buildings by ins ulating them against extremes of heat and cold, and they can play a part in physically cooling a building as a result of evaporation of water from their surfaces. (Planting Green Roofs and Living Walls, 2008) PG.11 https://www.linkedin.com/pulse/elmichgreenwalls go international ken hitchcock

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38 | PAGE Structural Loads Dead load the final constructed weight of all built elements and all components associated with the roof or wall assembly, including plants, growing substrate and any water held in the system Live load the weight of people who will use the sp ace, and of any mobile equipment that will be used periodically on the site, for example, maintenance (live load generally applies to green roofs, not facades or walls, however it would be appropriate on a vertical surface if a trafficable maintenance plat form was built into the system) Dead Load of 93lbs was supplied by Hydro tech USA. West Garden this is approximately 18,000 square feet With Dead load of 93 lbs. per cubic ft. this would bring the structural load to 1,664,000 lbs. per cubic ft. Total=1,664,000 Approximation of people in the garden at one time, between 25 50 people, while the length of the visit will vary based on the users. This is only a guestimate based on my own observations at the site.

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39 | PAGE Benches Qty. 5 4 b enches 80lbs. = 400 lbs. 3 6 Benches 115 lbs. = 345 lbs. 4 8 Benches 150 lbs. = 600 lbs. Total=1345 lbs. Movable Table and Chairs 5 9 Diameter Umbrellas 37 lbs. = 185 lbs. 5 42 Diameter Aluminum Tables 25 lbs. = 125 lbs. 25 Chairs w/ arms (aluminum) 4 lbs. =100 lbs. 3 Chess/card tables with seating for two 150 lbs. = 450 lbs. Water Feature Water Wall size (24 tall x 8 Wide) Weight based on stainless Steel Shell with internal pump. Exterior 304 ss Diamond Plate 4 x 8 panel = 7 (total 32 sq. ft.) 224 lbs. each panel Total = 1568 lbs. Water 105 length x 2 width x 1 deep = 210 sq. ft. Stainless Steel Poles for plant growth OD 1.25 x Wall .065 x ID 1.12 Weight/Lineal Foot .8334 x 12 lengths = 10 lbs. each 20 -200 lbs. Total = 200 lbs.

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40 | PAGE Stainless Steel Cable 500 ft. diameter (7x19) 304ss = 59 lbs. for a roll. (E Rigging 2017) Total = 59 lbs. Total dead load on this roof: Total = 1,666,264 lbs. per sq. f t. Live load West Garden Human impact Womens average weight @160 lbs. = 4000 lbs. Mens average weight @ 190 lbs. = 4750 lbs. Total= 8750 lbs. (Center for Disease Control and Prevention, 2016) Wheelchairs 5 35 lbs. average = 175 lbs. IV Stand 5 A typical stand can vary from 2.5 5 lbs. so I will use the heavier of the two. = 25 lbs. Total= 25 lbs. Mobile Scooters 2 Approx. 265 lbs. = 530 lbs. Total= 530 lbs. Walkers 4 Approx.19 lbs. = 76 lbs. Total= 76 lbs. Total live load on this roof: Total= 9,381 lbs.

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41 | PAGE The above information is an example of how many factors are involved when calculated the allowable loads a roof can support. As I was unable to gather any engineering documents for this Federal Building. This exercise was important to understand that all roofs are not engineered to maintain additional loads and this is easier to achieve while designing the building. These estimates are just that this is not steadfast information that can be used to build a green roof, always seek out professionals to mitig ate th is process. After the live load was added the dead load of 93lbs. per cubic ft. the increase load moved to 93.091lbs. Per cubic foot. This exercise is very important to understand all of the value needed to calculate structural loads.

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42 | PAGE Chapter Three The healing Garden & the users of the site

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43 | PAGE What is a healing Garden? Websters Dictionary Heal verb \ h l \ 1 : to restore to health or so undness; make well again. 2. To Cause the cure or recovery of (a wound, injury, etc.) 3. To free from grief, worry, etc. pg328 Garden noun garden \ g r -dn \ 1: A place for the cultivation of flowers, vegetables or small plants. 2. Any fertile or highly cultivated territory. 3. a piece of ground commonly with ornamental plants, trees, used as a public park Pg.292 (Landau, 1997) Healing gardens as they are define d are also known as therapeutic garden, restorative gardens and healthcare gardens. It is important to understand this because a therapeutic is designed specifically to have an output or metrics that can measure the effectiveness to the users that maintai n that garden. The term healing gardens is most often applied to green spaces in hospitals and other healthcare facilities that specifically aim to improve health outcomes. These gardens provide a place of refuge and promote healing in patients, families, and staff. Any environment can promote healing, but gardens are particularly able to do so because humans are hard -wired to find nature engrossing and soothing. W hat makes a healing garden different from any other garden is the intent to provide patient s with a place to be pleasantly distracted with some holistic approaches to the design. (Placeholder2; Clare Cooper Marus, 1999)

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44 | PAGE Benefits of Nature One of the first modern ideas of nature healing people was developed in monasteries. It was through the observation of pati ents that determined reusing the space to create these open courtyards with fresh air, a hall to stroll down and plenty of vegetation f or the patients to observe. A study by Li et al. (2007) found that green exercisephysical movement in a natural setting -increased the activity of natural killer (NK) cells, a part of the immune system that fights cancer. Li attributes some of the stress reduction to the presence of phytoncides (wood essential oils), antimicrobial volatile organic compounds emitted from trees to protect them from rotting and insects. (Clare Cooper Marcus, 2014) Pg18 BIOPHILIA Evolutionary biologist E.O.Wilson (1984) hypothesized tha t human have an affinity to other living things; he called this theory biophilia and suggested it was rooted in our biology, in our evolutionary past. (Daniel Winterbottom, 2015) Pg31 Another term used is Forest Bathing and th at is submerging ones self into a heavily inundated vegetation space where you are completely surrounded by nature or taking a walking in the forest. STRESS REDUCTION THEORY Roger Ulrichs (1999) Theory of Supportive Gardens emphasized positive health o utcomes through stress reduction for two primary reasons. First, most people who are sick, or who

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45 | PAGE are caring for the sick, experience stress. As contact with nature has been shown to reduce stress, then gardens in healthcare make good sense. Second, many p eoplemost who are not aware of the evidence seek out nature dominated setting to reduce stress (Francis and Cooper Marcus 1991, 1992). (Clare Cooper Marcus, 2014) pg. 25 Benefits of exposure to nature or a garden: Revives the staff physical and mental state. Provides Fresh Air. Change in sterile environment. Provide light movable chairs and tables. Plenty of seating. Stunning Vista. Subspaces. Fountains attract birds. Universally accessible. Buffer between patients rooms and Piercing eyes. Lack the people at times appealing. (Clare Cooper Marus, 1999) (pg.173) Users of the site: Aging Veterans 55 years and older. W heelchair s patients need to have access next to a bench or seat so they can appropriately interact wi th family, friends or caregiver along with 6 -8 min. Pathway. Patients with IV stand s can take them outside to enjoy the garden Veterans with PTSD. Cancer patients. The hospitals staff Friends, family and caregivers Disabled A merican Veteran (DAV) O rganiz a tion Special Events for small groups.

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46 | PAGE Important Factors for different patients types: Cancer Patients These are some common issues. Sensitive to heat and cold. Olfactory sensitivity. Lack of energy during treatment. Cannot intera ct with dirt or fertilizer products. Noise sensitivity. Lack of taste buds. Immune deficiencies during treatment. Hair loss. Cannot be in direct sun. Legionnaires Disease from water features. Veterans with PTSD/ Psychological Issues Seating tha t allows a veteran to feel safe, no one can sneak up behind them. Noise sensitivity. Color red is a reminder of death. Need to control their environment. Anti -social may need private spaces. Misinterpret abstract art. A place to socialize and interact with others. Acute Care Needs Seating that has a back and arms to assist p atients and make them feel safe offer in many locations. Seating that is next to the entrance for frail patients. Provide covered area and areas with sun. Create areas with screening from windo w views. Variety of plantings for stimuli.

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47 | PAGE ADA Accessibility Accessible Route A continuous unobstructed path connecting all accessible elements and spaces of a building or facility. Automatic Door. A door equipped with a power operated mechanism an d controls that open and close the door automatically upon receipt of a momentary actuating signal. The switch that begins the automatic cycle may be a photoelectric device, floor mat, or manual switch (see power assisted door). Circulation Path. An exter ior or interior way of passage from one place to another for pedestrians, including, but not limited to, walks, hallways, courtyards, stairways, and stair landings. Public Facility. A facility or portion of a facility constructed by, on behalf of, or for the use of a public entity subject to title II of the ADA and 28 CFR part 35 or to title II of the ADA and 49 CFR 37.41 or 37.43. Public Use. Describes interior or exterior rooms or spaces that are made available to the general public. Public use may be provided at a building or facility that is privately or publicly owned. These are all important to be familiar with when designing to meet ADA Standards. Design responses such as providing safe and comfortable places to walk and sit, creating opportuni ties for choice and a sense of control, enabling interaction with plants, and creating opportunities for social connection and support all facilitate physical and emotional comfort. (Clare Cooper Marcus, 2014) pg.57 Develop ment and maintenance, ecological methods of stormwater management, and other strategies all contribute to the Triple Bottom Line of social, environmental, and economic responsibility. (Clare Cooper Marcus, 2014)pg. 58

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48 | PAGE DESIGN GUIDELINES IN A HEALTHCARE SETTING P rovide physical and emotional security while in the garden. Provide a central location if site allows Allow for privacy without creating isolation. ADA Accessibility P hysical comfort where people can find na ture and nurture. This will increase the length of stay in the garden. Engagement with Nature. (biophilia) Maintenance and aesthetics. Sustainability (LID) Low Impact Design. Create pathway to allow for two wheelchairs to pass at the same time. Minimum 6 -8 wide. Provide seating close to the entrance Provide a covered area. Provide for small groups. Provide active/ passive spaces for users.

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49 | PAGE Chapter Four Process

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50 | PAGE Process My concept is to combine Mind, Body & Spirit in a way that Is not evident to the user as they enter the garden, however I hope the experience will evoke positive emotions or feelings that are intended in the deliberate design choices. It was during Analysis that I realized the additional space that could be used specifically by cancer patients CONCEPT MIND BODY SP IRIT

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51 | PAGE 1. Values 2. Branches of Services 3. Directions 4. 7 motivating words for cancer patients

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52 | PAGE Military Values Army Airforce Navy/Marines Coast Guard Loyalty Duty Respect Honor Integrity Personal courage Integrity Service before self Excellence in all we do Honor Courage Commitment Honor Respect Devotion to duty Inspirational Words to use the Garden of Dreams Renewed Calmness Reinvigorate Hopeful Exhilara tion Optimism Restored A study released on August 26, 2013 confirms that language has the power to reshape our knowledge and expectations of the world we see. Interestingly, another study released the same day found that ones dispositional attitude is what makes some people love everything they see and others to hate everything. Put toget her, this new research offers clues on ways that someone can change his or her explanatory style to be happier and more optimi stic (Psychology Today, 2017)

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53 | PAGE Feelings associated with color. Blue Order, freedom, trust, loyalty & Piety Violet Creativity, Devotion, Balance, Royalty & Wisdom Green Calmness, Relaxation, Nature, Growth & Sincerity Yello w Friendship, Laughter, Happiness, Stimulation & forgiveness. Orange Security, Coziness, Generosity, Humor & Encouragement. MILITARY VALUES Army Airforce Navy/Marines Coast Guard Loyalty Duty Respect Honor Integrity Personal courage Integrity Servi ce before self Excellence in all we do Honor Courage Commitment Honor Respect Devotion to duty These are values that all soldiers are swor n to uphold and live by each day. Soldiers never forget these values as they are engrained into a daily routine t hroughout their careers. I would like to add these elements to the garden.

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54 | PAGE CHAKRAS Chakra also spelled Cakra, Sanskrit C akra (wheel), any of a number of psychic -energy centers of the body, prominent in the occult physiological practices of certa in forms of Hinduism and Tantric Buddhism The chakras are conceived of as focal points where psychic forces and bodily functions merge wit h and interact with each other. Among the supposed 88,000 chakras in the human body six major ones located roughly along the spinal cord and another one located just above the crown of the skull are of principal importance. Each of these seven major chakras (in Buddhism four) is associated with a specific colour, shape, sense organ, natural element, deity, and mantra (monosyllabic prayer formula). Root Chakra Located near the coccyx, or tailbone area, the root chakra is home to basic primal foundational needs such as survival. The innate urge for flight or fight is said to originate here. The color linked with the root chakra is red If you are having trouble manifesting things or situations in your life, its likely that your root chakra is blocked and needs to be cleared, especially of any fear -based beliefs. To balance and re ground yourself, including feeling safe, protected and centered, meditate upon your root chakra and visualize the color red reverberating there. Since many people unfortunately associate red with the emotion anger, its

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55 | PAGE suggested you try instead to allow the red flowing to your root chakra to represent courage, pioneering spirit and strength. Toning the chakras (using vocalization) while visualizing them as healthy and whole can be extremely beneficial. Some toning sounds for each chakra can be found below this section. 2nd or Sacral Chakra One step above the root, the second chakras color is orange It deals with the libido sexual energy as well as creativity It is also the foundation of our emotions Should you feel an imbalance in your sexual desires or orientation, or perhaps be dealing with emotions such as low self -esteem, listlessness, lack of passion for life, etc., then this chakra will most definitely benefit from some healing and clearing. Visualize filling this chakra with a clear, beautiful orange light, while taking slow, steady, deep breaths and sending them to your second chakra. 3rd or Solar Plexus Chakra Located at your core the solar plexus chakra links with the color yellow Gut instinct or intuition often kicks in at this point of the body, and should be honored to the best of ones ability in particular, going with your first intuitive impression rather than letting your logical left brain cause you to ove rthink things and create self -doubt. Also, if this chakra is imbalanced, you may be more likely to take on projects or jobs that dont advance your goals, or you may feel like a victim and that you are out of control. This chakra is extremely important to keep clear and balanced in order to experience a healthy, happy, fulfilled life.

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56 | PAGE Heart Chakra Logically, the heart chakra is located in the center or your upper chest, and is where love flows to and from. If you feel happy and loved in your relations hips, including the one with yourself, your heart chakra is in balance and functioning properly. However, if you are dealing with a lot of discord in your relationships, it is likely blocked. The traditional color used to heal and open the heart chakra is green though in recent years many people have found that breathing in the energy of rose quartz pink (the vibration of unconditional love) works equally well. Choose the color that most appeals to you and has the best outcome. Throat Chakra Not surpris ingly, this chakra is all about communication The color linked to it is blue If you feel that you cannot speak your heart and mind properly, your throat chakra could stand some clearing and balancing. When it is open, you are never afraid to voice your o pinion. However, an abundance of unnecessary talking can also cause your throat chakra to become imbalanced. Third Eye Chakra Located in the center of your forehead, exactly between your eyes and a bit above the top of your nose is your third eye chakr a. It is where your psychic and intuitive messages enter, and it serves as a portal to higher dimensions and beings when in a meditative state. You may be able to accurately predict future events. When your third eye is closed, you are completely focused o nly on earthly events and your physical body, and have no desire to tune into or explore spiritual topics. The color used to access and enhance your third eye is indigo

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57 | PAGE Crown Chakra At the top of your head, smack dab in the center is your crown chakra Universal energetic connectivity is achieved through meditating on this chakra, and when it is open properly, its a portal through which you can learn to astral project. Visualize pure incandescent white light pouring into your crown chakra to cleanse a nd open it; some people prefer to imagine the white light infused with strands of gold or silver this is completely your choice. If your crown chakra is closed, you feel cut off from others and any source of guidance or direction. If you are going throug h a rough time, feeling deep depression and overall unhappiness, you can try meditating upon your crown chakra; flood it with beautiful, divine light as you breathe deeply all the way in, then all the way out. If you feel a bit of pressure on the top of your head, dont worry this is just additional proof that you are successfully connecting with ascended, advanced energy/beings.

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58 | PAGE Suggested Plant List COMMON NAME SCIENTIFIC NAME Creeping Juniper Juniperus horizontalis and cvs. Crinum Lily Crinum spp. Mondo Grass Ophiopogon japonicus Cast Iron Aspidistra elatior Hydrangea Hydrangea macrophylla Rosemary Rosmarinus spp. Liriope Liriope muscari African Iris Dietes iridiodes Autumn Fern Dryopteris Bracken Fern Pteridium aqu ilinum Philodendron Philodendron spp. Aloe Aloe spp. Century Plant Agave spp. Euro Fan Palm Chamaerops humilis Star Anise Illicium spp. Bromeliads Bromeliaceae genera Muhly grass Muhlenbergia capillaris Crape myrtle Lagerstroemia Indica (single trunk) Lily of the Nile Agapanthus africanus Confederate Jasmine Trachelospermum jasminoides Shell Ginger Alpinia spp. Coontie Zamia floridana (Vertical foliage) Morning glory Ipomoea spp. Climbing Hydrangea Decumaria barbara Climbing Aster Aster carolinianus Passion Vine Passiflora incarnata Cross Vine Bignonia capreolata Creeping Fig Ficus pumila

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59 | PAGE Concept This Concept is to create rooms within the garden, allow that color to influence what program elements occur in th at space.

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60 | PAGE CONCEPTUAL PLAN GARDEN OF DREAMS PROGRAM ELEMENTS N

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61 | PAGE PERSPECTIVE GARDEN OF DREAMS This view is looking west towards the glass bridge. I wanted to show some of the details like shadows and cables used to create screens or shaded areas. This area could be used for small groups or for private seating. The waterwall in the back is a closed system with a dry riverbed that flows off to the left wher e additional seating is PROVIDED

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62 | PAGE PERSPECTIVE This shot shows the improvement made to this space by adding a garden. The space is aesthetically unpleasing from all view points.

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63 | PAGE West garden CONCEPTUAL PLAN

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64 | PAGE WEST GARDEN PERSPECTIVE Looking North Green Room This is the proposed garden entrance from the second floor into the garden. This space provides private seating, a water fountain, yoga/meditation p latform, big ass fan, shade sails and plenty of benches close to the entry for patients that require a point of rest.

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65 | PAGE Looking East Freindship Room This is the central location within the garden, this is strong connection point. This area allows for people to sit and eat lunch, socialize, people watch, or even read a book. The overhead vines provide shade as well as screening for some privacy. Hanging baskets with perennials give a spark of color that can be alternated throughout the year.

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66 | PAGE West Blue Room This is a view from the glass bridge that connects the bed tower to the medical services side of the VA. This room has a water wall with a stream that is flush and under Plexiglas so it is visible to the users. This space has Century plants, aloes, bromeliads, ferns, statues, boulders, grasses, cast iron, windmill palms and philodendrons. This room allows the users to site and listen the water wall while reading or people watching, I want this area to reflect how impactful water can be for the users.

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67 | PAGE LOOKING EAST Violet Room This area of the garden provides a second entry point. This space is designed with puzzles to help veterans with dexterity and cognitive skills that aging populations struggle with. There are hidden elements within the garden to spark awareness like: statues, words painted on rocks along with plant signage. There is a covered space where small groups can meet along with plenty of seating along the path with private spaces to feel safe while enjoying the open view to the sky.

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68 | PAGE THANK YOU! THE END

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69 | PAGE Works Cited Clare Cooper Marcus, N. A. (2014). Therapeutic Landscapes An Evidence Based Approach to Designing Healing Gardens and R estoritive Outdoor Spaces. Hoboken, New Jersey, United States: Wiley & Sons, Inc. Retrieved 2014, from www.wiley.com/go/permissions. Clare Cooper Marus, M. B. (1999). Healing Gardens Therapeutic Benefits and Design Recommendations. Hoboken: Wiley & Sons, I nc. Daniel Winterbottom, A. W. (2015). Design for Healing Spaces Theraputic Gardens. Portland, Oregon: Timber Press, Inc. Diane Chun. (2010, July 16). Retrieved April 11, 2017, from The Gainesville Sun: http://www.gainesville.com/news/20100716/once-complete new -va -tower -will revolutionize-care Encylopedia Britanica (2017). Retrieved April 1, 2017, from Encylopedia Britanica: https://www.britannica.com/topic/chakra EPA (2017, January 19). Retrieved from Environmental Protetion Agency: https://www.epa.gov/h eat -islands E Rigging (2017). Retrieved from E -Rigging: http://www.e-rigging.com/ FisherHouseGainesville (Ed.). (2014). Gainesville Fisher House Foundation Retrieved March 5, 2017, from Gainesville Fisher House Foundation: http://www.gainesvillefisherho use.org/2012 09 08 18 -34 -59/malcom-randall -va medical -center Google Earth. (2015, December 15). Google Earth Retrieved from Google Earth : www.googleearth.com Hyrdotech USA (2017). Retrieved from Hyrdotech. Landau, S. I. (Ed.). (1997). The new Internatio nal Webster's Student Dictionary Of The English Language. J.G. Ferguson Publishing Company. Retrieved April 2017 Naomi Sachs. (2017). Therapeutic Landscape Network Retrieved from http://www.healinglandscapes.org/blog/ National Institute of Building Scienc es. (2017). Whole Building Design Guideline Retrieved from Whole Building Design Guideline: www.wbdg.org/resources/greenroofs.php Planting Green Roofs and Living Walls. (2008). In N. Dunnett, Planting Green Roofs and Living Walls (Revised and Updated Edit ion ed., p. 328). Portland: Timber Press. Retrieved 2017

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70 | PAGE Psychology Today. (2017). Retrieved from https://www.psychologytoday.com/blog/the athletes -way/201308/scientists -find -single -word -can -alter -perceptions Sodek, V. M. (2008, March 8). Find A grave Ret rieved from Find A Grave: https://www.findagrave.com/cgi -bin/fg.cgi?page=gr&GRid=25558708 Studio, L. D. (2012). Studio Sprout Retrieved March 8, 2017, from Studio -Sprout: http://studio -sprout.com/2012/09/jacqueline -fiske -healing garden/ TBG (n.d.). (Land scape Architect Services) Retrieved January 15, 2017, from TBG Partners: http://www.tbgpartners.com/project/dell -childrens-medical -center -austin -tx/ Therapeutic Landscape. (2014). Hoboken, New Jersey, United States of America: John Wiley and Sons, Inc. Ret rieved 2017 U.S. Department of Veterans Affairs (2016, April 15). U.S. Department of Veterans Affairs Retrieved April 2, 2017, from U.S. Department of Veterans Affairs: https://www.va.gov/vetdata/veteran_population.asp University Of Minnisota (2016). Retrieved from Taking Charge of Your Health & Wellbeing: (https://www.takingcharge.csh.umn.edu/explore-healing practices/healing -environment/what -are -healing -gardens