Citation: Ríos-Rodríguez, M.L.; Testa Moreno, M.; Moreno-Jiménez, P. Nature in the Office: A Systematic Review of Nature Elements and Their Effects on Worker Stress Response. Healthcare 2023, 11, 2838. https:// doi.org/10.3390/healthcare11212838 Academic Editors: Gianpiero Greco, Giuseppe Messina, Filip Kuki´ c and Luca Poli Received: 26 September 2023 Revised: 19 October 2023 Accepted: 25 October 2023 Published: 27 October 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). healthcare Systematic Review Nature in the Office: A Systematic Review of Nature Elements and Their Effects on Worker Stress Response María Luisa Ríos-Rodríguez *, Marina Testa Moreno and Pilar Moreno-Jiménez Department of Social Psychology, Social Work, Social Services and Social Anthropology, University of Málaga, 29016 Málaga, Spain; marinatesta@uma.es (M.T.M.); mpilar@uma.es (P.M.-J.) * Correspondence: mlurios@uma.es Abstract: Work-related stress is a significant problem in many work environments and can have negative consequences for both employees and organisations. This review aimed to identify which elements of biophilic design in the workplace affect workers’ stress response. To enable this, a literature search was conducted using PsycINFO, Scopus, and Medline. The search was limited to articles published from 2012 to June 2023. This review only integrated quantitative data, incorporating twelve records for qualitative synthesis. The selected studies suggest that strategies such as access to outdoor environments or the creation of outdoor areas are effective in reducing stress in the workplace. If these are not feasible, the examined research advocates the use of virtual means to recreate such relaxation or break spaces. Furthermore, aspects of interest for future research were identified, such as multisensory stimulation, including the sense of smell, the exploration of views with natural elements, the creation of shelters, or the study of biomorphic forms. Keywords: biophilic design; stress; worker; systematic review 1. Introduction Awareness of the importance of mental health in the workplace has led to the identifica- tion of emerging psychosocial risks, among which work-related stress has been recognized as one of the most pressing challenges in terms of occupational health and safety. [1]. As for its definition, work-related stress encompasses the physical and emotional response resulting from the mismatch between work demands and the resources and capabilities perceived by individuals to cope with those demands [2]. Simultaneously, reports such as the one presented by the WHO [3] have highlighted the relevance of workplaces as spaces of influence on mental health, urging the imple- mentation of strategies that ensure psychological well-being, such as psychosocial risk prevention and promoting well-being in the workplace. This correlation between adverse working conditions and mental health repercussions is supported by empirical evidence and underscores the need for interventions that directly address this issue, especially in the wake of the recent health crisis [2,4,5]. In order to address this challenge, studying the interactions between contact with nature and its effects on mental health is an encouraging and growing perspective [6,7]. According to Markevich et al. [8] the potential pathways linking natural spaces to health emphasize three functions: damage reduction, capacity restoration, and capacity development. Consequently, understanding which forms of contact with nature have a greater impact on mitigating work-related stress can provide specific guidelines for the planning and design of work environments, offering benefits that will be addressed below. Benefits of Biophilic Design In the field of environmental psychology and occupational health, increasing atten- tion has been paid to the influence of urbanization and the reduction in contact with Healthcare 2023, 11, 2838. https://doi.org/10.3390/healthcare11212838 https://www.mdpi.com/journal/healthcare