Therapeutic Environment

by Anne Vanderputten

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    Hi, I am Anne Vanderputten and welcome to the Therapeutic Environment and Security. I wanted to start with an overview of the environment for the patient and therapeutic environment. Florence Nightingale: - put forth the environmental theory which stressed the use of environment to assist in patient recovery. So this is one of the nursing paradise is including the environment in the care of the patient. So what are the goals of therapeutic environment? Firstly and in foremost is to facilitate the promotion of healing. It supports the psycho-social needs of the patient and family. And then thirdly it provides and promotes safety of the patient. It seem like very basic things. When a patient comes into a healthcare system they have the number of concerns and no. 1 is their health and their safety. And again when they are isolated from their family or their support systems this is create anxiety. And then the lack of control of their own environment. When they in their home they can do as they choose. But now they are in different environment and it can create anxiety for the patient. So some of the stressors that are included in the environment. These non-therapeutic environmental stressors include: Excess of bright lighting which disrupts sleep cycles or underlying disease process such as excessive stimulation. Again equipment alarms things in the healthcare environment that we all may be become use to. and absorb the [inaudible 0:01:39.080] because it's just part of our day. But you can image for a patient to have an IV just beep beep beep beeping next you. It's constantly distracting them and they don't know if it's an alarm or should they be concerned. So we wanna be aware of the perception of the patient of their environment. Other non-therapeutic environmental...

    About the Lecture

    The lecture Therapeutic Environment by Anne Vanderputten is from the course Psychosocial Integrity. It contains the following chapters:

    • Therapeutic Environment and Safety
    • Stressors
    • Safety
    • Social support and control
    • Definition of Security
    • Definition of Security
    • Principles of Security
    • Nursing Summary

    Included Quiz Questions

    1. Provide reorientation to the patient, lower TV volume, dim lighting to promote less stimulation of the environment
    2. Contact the physician for an order for medication
    3. Determine if the patient is hard of hearing
    4. Sit with the patient for one hour and allow patient time to verbalize anxiety
    1. Assess the immediate environment for safety risk, keep the patient in close proximity for observation, follow institution policy and procedure
    2. Restrain the patient
    3. Contact security officer to watch the patient
    4. Allow family members to stay with the patient
    1. Discuss with the physician and suggest moving the patient to a room with a window view.
    2. Ensure a family member is with the patient 24 hours a day
    3. Reorient the patient and provide pain medication
    4. Turn on all the lights and television to keep the patient in touch with reality.
    1. Assess the patient’s need for extra warmth, educate the patient and family about fall risks, and ask family to bring home items not needed by the patient
    2. Requesting the family to leave and return during regular visiting hours
    3. Contact security to remove items
    4. Inform the patient’s spouse the rules of the hospital
    1. Safety is the highest concern in providing nursing care.
    2. Safety is an important need but self-actualization is higher.
    3. Safety is a basic human need provided outside the healthcare environment.
    4. Security is responsible for all safety in the hospital.
    1. Discuss fall risk education with the patient and suggest area rugs be removed.
    2. Tell the family it is better to have smooth clean floors.
    3. Look for other environmental hazards.
    4. Request an occupational therapist consult to provide the patient with a walker.
    1. “It is stressful to have so many interruptions to your sleep. If you would like, we can discuss with your doctor about ordering testing and labs during the day time hours.”
    2. “If you do not want care, it is your patient right to refuse.”
    3. “You could have died from your heart attack and we have to monitor your heart condition.”
    4. “I understand but we are here to do our job.”
    1. Reorient the patient to date and be sure to have a calendar posted in patient view
    2. Suggest the physician discharge the patient
    3. Ask the patient if they are frequently confused
    4. Adjust plan of care to include frequent reorientation for the patient
    1. Reassure the patient, staff will answer the call light and the nurse will check on the patient every hour or sooner if needed.
    2. Tell the patient the unit is short staffed and it is difficult to answer the call light so frequently.
    3. Consult respiratory therapy
    4. Dim the lights in the room
    1. Able bodied patients will evacuate first
    2. Nursing should secure windows
    3. Community providers will evacuate patients.
    4. Nursing staff should check in at home to ensure their family is safe.

    Author of lecture Therapeutic Environment

     Anne Vanderputten

    Anne Vanderputten

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