Ulrich 1984: 23 Surgery Patients Looked at Trees, 23 at a Brick Wall

“The ‘built’ view in this study was a comparatively monotonous one, a largely featureless brick wall.” Roger Ulrich wrote that sentence himself, in the discussion of his 1984 paper in Science, as a warning against over-reading his own result. It is the most useful line to carry into any conversation about what you should see when you wake up.

So does the view from your bed change how your day goes? One small hospital study found that a view of trees went with a shorter recovery than a view of a blank wall. No study has shown that the first thing you see after an alarm changes how fast you get up.

What did Ulrich actually measure?

The setting was a 200-bed suburban Pennsylvania hospital. One side of a three-story wing looked out on a small stand of deciduous trees, the other on a brown brick wall. The rooms were double occupancy and nearly identical in size, window and layout, and patients were assigned to rooms as they became vacant.

Ulrich pulled the records of cholecystectomy (gallbladder) patients from 1972 to 1981 and built 23 matched pairs, 46 patients in all (15 female and 8 male). Pairs were matched on sex, age within five years, smoking, obesity, previous hospitalization, year of surgery and floor. A nurse who did not know which view each patient had extracted the records.

Measure	Tree view	Brick wall	Gap
Days in hospital	7.96	8.70	0.74 days (8.5%)
Negative nurses’ notes per patient	1.13	3.96	2.83 fewer (3.5 times as many on the wall side)

The percentage and the ratio are the author’s own arithmetic from Ulrich’s two reported averages. Ulrich’s own tests gave P = 0.025 for length of stay and P < 0.001 for negative notes. For days 2 through 5 after surgery, he also reported that wall-view patients took more moderate and strong analgesic doses and tree-view patients more weak ones (P < 0.01).

What does the evidence not establish?

Ulrich lists his own cautions. The conclusions “cannot be extended to all built views, nor to other patient groups,” and he suggests that a chronically understimulated patient might do better with a lively city street than with many natural views. The sample is 23 pairs from one hospital, all one operation, all in summer-to-autumn months.

Two design details matter more than the sample size. Patients were not randomized; they got whichever room was free. And Ulrich notes that the nurses’ stations sat somewhat closer to the wall-view rooms, so staff contact could differ. Nurses’ notes are also written by staff who could see which room a patient was in, so that measure is the easiest to bias.

The paper is about surgical patients lying in bed with little else to look at. It says nothing about whether a healthy adult gets up faster because of what the window shows.

Did later research confirm that nature restores attention?

Partly. The Kaplan lineage proposes that natural scenes hold attention gently and let the effortful kind recover. In Berman, Jonides and Kaplan’s 2008 paper in Psychological Science, 38 University of Michigan students did a backward digit-span task before and after a walk in an arboretum or downtown Ann Arbor. Mean span rose from 7.90 to 9.40 digits after the nature walk and from 7.90 to 8.40 after the urban walk. By the author’s subtraction, that is a gain of 1.50 against 0.50 digits. A second experiment, with 12 students and pictures, pointed the same way.

The 2016 systematic review by Ohly and colleagues in the Journal of Toxicology and Environmental Health, Part B gives the wider picture. It included 31 studies, and only three of its 13 meta-analyses (Digit Span Forward, Digit Span Backward and Trail Making Test B) showed significant positive effects of exposure to natural environments. The authors blamed small numbers of studies, small samples and uneven reporting.

For windows specifically, Soga and Gaston’s 2025 meta-analysis in BioScience pooled 28 studies and 104 results and reported consistently positive effects of viewing nature through windows, with publication bias detected but not enough to change the conclusion. Only its abstract was available for this post, so effect sizes are not quoted here.

Control over your surroundings matters at work too, as the Whitehall civil-servant studies found.

What can a bedroom borrow from the brick-wall result?

Treat these as sensible guesses rather than findings. The research compares nature with blank or urban views, so the cheapest reading is to avoid giving yourself the blank wall.

• Leave the blind or curtain partly open if street light allows, so the first thing in view is outdoors and not a ceiling or a screen.
• Clear the sightline from the pillow. The clothes-first KonMari pass treats a chair of clothes as a visible to-do list, and nobody has tested whether removing it changes sleep.
• If the window faces a wall, a plant or a picture of a landscape sits closer to Berman’s picture condition than to the wall.
• Decide where the phone charges. The argument about phones in bedrooms cuts both ways, since a phone can be both the thing that scrolls and the thing that rings.

Daylight is a different lever from a pleasant view. An open window helps the circadian side that morning light research describes, but sunlight alone does not decide whether you stand up when the alarm fires.

Whatever the window shows, standing up still happens with nobody watching, and that is the gap how DontSnooze works targets: a 30-second video check-in, with a random camera-roll photo sent to friends if it never arrives.