Do Hospice Gardens Need a Guide? Comparing Guided and Unguided Forest Bathing for Wellbeing, Nature Connectedness and Heart Rate Variability: A Pilot Study

Nature-based interventions may support health and wellbeing, but evidence directly comparing guided and less-resource-intensive formats in clinical populations remains limited. This non-randomised pilot study examined one-hour guided forest bathing and a matched, lightly facilitated unguided nature walk in hospice gardens. Seventeen adult hospice service users selected either the guided (n = 8) or unguided (n = 9) session. The Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS), Inclusion of Nature in Self (INS) scale, and heart rate variability, indexed by the standard deviation of normal-to-normal intervals (SDNN), were assessed before and immediately after the sessions. In 2 × 2 mixed analyses of variance, WEMWBS and INS scores improved significantly over time, but neither outcome showed a significant group-by-time interaction. SDNN showed neither a significant time effect nor a group-by-time interaction; its significant between-group effect was consistent with baseline differences. Exploratory Reliable Change Index analyses identified improvement for some individuals, although these findings require cautious interpretation. Both formats were associated with short-term improvements in self-reported wellbeing and nature connectedness, but the design does not establish causality or equivalence. A lightly facilitated nature walk may warrant evaluation as an accessible, lower-resource addition to palliative-care programmes.