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
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
the staff himself. If they are coming in
we know the patient has
just managed to fall asleep
and in comes, you know,
our equipment and we are
banging walls or banging doors.
So we have to be mindful
of as we do our work
that how do we sound to the patient.
So these are all things that
we want to try to avoid.
What is our response to these stressors?
We want to avoid excessive lighting
but especially at night. If it's day
time you wanna give the patient
especially in some of these
darker may be buildings.
You do want to give
them some bright light
to indicate yes this is day time.
But as the day goes on
you don't wanna disrupt their perception
of circadian rhythm or their
a psycho. So you
generally avoid excessive
lighting especially at night.
And be cognizant of their needs
prior to the alarm settings. This
is what I was speaking too earlier.
Your IV you see that you only have 200ml
left in the bag. Don't wait to
the alarm be to "I will be come back".
Be prepared to check on
that and change the bag
before it alarms and you know
has the patient worried what's
going on next to them
And again you wanna coordinate your care
needs to include the patient preference
when possible. What
do we mean by this?
What we were talking about
is that if the patient says
"Hey can you get my vital signs at
3 o'clock rather than 10 o'clock?"
Or you know understand where there
sleep patterns may be falling
you want to try to do as
much care as possible create
in one visit with the patient without
coming in disorganized
and "Oh I forget to
get your vital signs"
"Oh now here is your medications". You
you want to be prepared and organized
when you enter the patient's environment.
And include them in when
is the best time for them
to get some tasks done.
And again be aware of
your staff conversations
and disruptive movements
in the patient environment.
The patient environment is not just
their room. Just remember this; because,
out in the hole if you
are sharing information
you really have to be award that
the patient can hear this and
to that fact you also wanna
be aware of people around you.
So we have to be very cautious
about what we say, where
we say and how we say it.
A lot of times at night, I
worked night for many years
and having is that staff may be
carrying on their conversation for
night staff. This is their day
and they end up not
really realizing that how
kind of loud they are speaking
and laughing and things like that.
This really reflex on the patients.
It's very disturbing to them
and they also feel like
nobody is doing anything.
If they hear all this laughter and
things. So take it to break room.
But really the patient
should feel a very calm
and safe environment.
So continuing this nursing and
therapeutic environment which
you can't avoid safety.
And safety is part of
a therapeutic environment; because, it's
one of the patient's concerns. So of-course
as nurses we need to respond and have
a goal for safety at the environment.
So from the patient's perspective
they are now in an unfamiliar environment.
And they may have mobility impairment or
condition and their strains.
So you wanna be aware of that you know
that they just inst to the restroom.
Aware of obstacles. Sometimes we
end up leaving a lot of our own
supplies in the patient environment in
their room which can become a safety
issue. So also, the patient is able to
kind of loose orientation at
times due to their illness.
May be their medications, their length of stay
and they get a loss
of circadian rhythm.
So it's always good
to be aware of this.
And in response to some of
these patient potential problems
you want to provide an orientation of
the environment and the surroundings.
This is actually, mostly
part of almost everyone's
regulations in nursing.
and initially the patient comes in you wanna
make sure that they oriented to the room
that they are aware of
where the restroom is
where is their call light. You wanna
make sure that their call light is very near them.
And be mind for that all patients
are at risk for fallen
and you want to provide
side rails as needed.
And ensure that the
room is free of clutter.
Again I mention here
that Psychosis can develop
in the intensive care unit to
a patient who is a critically ill.
Spending time often in the
intensive care unit, they are
you know the lights are on 24/7
and these patients can develop
basically a Psychosis because
of an extended length of stay.
So keep that in mind because a lot of
nursing interventions if you would see
this developing in
some of your patients.
You may suggest to the doctor,
"You know may be we can find
room that has a brighter view
within the patient's eye sight".
And that helps the patient see
the sunrise, you know, darkness
and it helps them
So for the patient you
want to provide or mimic
natural lighting, as mentioned earlier,
and clocks and calendar are always
good to have in a patient room.
If you notice that in your
organization you don't have may be clocks
often you will see may be a board. So you
want to introduce it with the day, the date
and keep the patient in the aligns of
their line of view. So they can read these
and maintain their orientation
as days, and especially length of
stay days can run together and they can
kind of get out of sort on that.
So when we moving forward
on social support and control
of the environment. Remember,
that there are barriers
to that feeling that
the patient has some control.
Space/staff restrictions to visitors:
Remember the patient is concerned
about their social isolation.
You know "How is my family gonna visit
if there any room filled with clutter?"
They are concerned and they may be not
even be concerned about themselves at this
point than he be concerned
about their spouse
"Where can my spouse be?".
So you wanna
keep your environment and your
the patient's environment clear
and calming and free of
these kind of barriers.
So it also can lack
for the patient to
have input in their care.
Those are also a barrier to an environment.
So again you wanna include
the patient in their care
"What is the best time if
you can adjust a treatment plan
and make it conducive to the patient?"
and this offers the patient some
control of what's going on
around them. They are not just
subjective to who every walks in the
door and says "Now it's time for this.
Right?" So you can say to the patient
"You know this is what your treatments
are? Do you have a preference?".
And that offer you enough
control really promotes
healing and wellness for the patient.
Again uncertainty of staff
response to their needs.
This is a chronic problem
in any institution
where the patient says, "Well, okay I
need something". They ring your bell
and gosh someone says "Oh, I
will be in there in a minute"
and what may seems
five minutes to you
I would just tell you, to the patient
is much longer.
And when someone is in pain or they need
something. May be they need to restroom
you have to be mindful that
when the patient calls
and uses that call light
that they need that security
that someone is coming.
A good tip is that when you enter
a room and say to a patient. You give them
a ton of expectation when they will return
so even if the patient calls
and they need something you say
"I can get you this right
now it may take me 5 minutes
but I will be back in 5 minutes".
This is a reassurance to the patient.
So they have the information. They know
what to expect and then they can trust
that people are there to
help them if they need it.
Again continuing the
that is you want to ensure the patient environment
supports the social needs as I discussed.
You know having a space for
spouse and family to visit.
Allow the patient that input into
when their treatments occur.
Sometimes you can't because it's the
schedule scan or something like
that you can help them
the patient by saying,
"Your scan is scheduled
for 10:30 tomorrow morning".
This information is
very helpful to the patient.
Providing the call light
and the prompt response
and provide the information
at the level for the
So when we talk about
security of the patient
This is an overlap. Let's look at the definition
and there is 3 that I have listed here.
The first 1 is a freedom for
danger, or risk and safety.
This is a basic human need, you have
to remember that. This is very basic.
Every other aspect of the
patient's life is compromised
This becomes a very
They also defines as it "Freedom
from care or anxiety or doubt
and well-founded confidence."
The 3 definition is "Something that secures
or makes safe; protection or defense."
So in essence you are
saying that you as the nurse
can provide security for the patient.
Most organizations have
but you as the nurse are responsible
for everything around your patient.
So you also are a level
of security to that patient.
So what does security affect? It
affects the individual, the patient.
It affects the environment and again
emergency preparedness would
be included in security.
Because it affects everything
around the patient.
So some of the principles of
security for the individual.
It includes their personal information.
This is really very important
special with laws and
regulations now surrounding
patient privacy and their information.
again if you are out the hall and
your talking really gotta be aware
of sharing their information.
And again the individual
creates a vulnerability
and their ability to
care for themselves.
And safety of others, it affects this
and the developmental risk
factors. What are we mean by this?
What we mean is a child
you would not leave them near the top of
the stairs; because their developmental age
is a risk factor. So I
hope that makes sense.
And then elderly person may be
with a weaken sight or few health
patient who may be has
recently injured their legs.
You have to be aware
of these risk factors as well.
So some principles of security in
the environment. A security of access.
Almost everyone is aware of this
know but your organization will have
you know locked doors so that only
certain people can pass through.
The environment again includes
I can't stress that enough and their patient privacy.
So if the patient is waving in the morning,
you know, be aware. Close the door.
This environmental privacy is very
important to human dignity.
And really again where the
patient can trust you.
So if you may be getting
your patient a bass
you don't wanna leave
the door open and
everybody walking by
the hall, you know.
So these are the things you have to be aware
of in regard to the security of environment.
Now emergency management. Every
organization has their own
plan of emergency management. But
there are some underline principles.
When we talk about
we want to remember that
in a true emergency if you have an
evacuation going on or something.
That the principles are the same as
if you in an airline and they say,
"You put your oxygen masks first
and then assist someone who
might need you next to you".
You have to remember that you
are not helping anyone if you
if you pass out or
you are injured. So
the able bodied evacuate first in
a healthcare environment.
And then of-course the immobile
would be a transported out next.
In emergency management
communication is very important.
All lines of communication
have to be open and
you need to be aware
of that as well.
and procedure really drive
organizations plan. But these
are the principles. So if you
working in a institution
you should review you
organizations policies on the emergency
management so that you are prepared.
This also includes
multiple trainings as well.
So in summary when we look
at the therapeutic environment
it should be patient focused.
It of-course should promote
healing so if the environment is
dirty and things like that, you know there
is potential for nosocomial infections.
You want to be aware of that and
use your organizations resources to
support that patient environment.
You wanna support their human
needs which again is their social
needs. What are the
family needs? We say
you should be therapeutic as a nurse
and try to get them what they need.
Again providing safety,
this is can be stress
enough actually in nursing
and then promote trust and
in the environment.
So in nursing summary of security
You want to make sure
you remember that.
It includes the patient privacy
And it is very individualized to the patient
and the safety of the environment
includes that security.
This is a very overlapping
principle. And emergency preparedness
is all part of security.
Your organizations security department
you should become familiar
with that and rely on them.
If you have patient's family that may
be is becoming disruptive.
You as the nurse are
not indented to be the sole
security for the environment.
So use your hospital
or organization resources to support
the nurse. So that the nurse
can support the patient.
And some tips for success as you
take your test and get ready for this.
You wanna make sure that you think
assessment when you cut your choices
of answer. You think assessment before
taking action or implementation.
So even if you were to
find a patient not breathing
you answer would not be begin CPR
before you did an
assessment. Right? Because
it will make sense. But
just keep that in mind.
Use your critical thinking skills
to choose the best answer.
Almost invariably the
answers would be correct
but for that situation
based on most principles of nursing
you wanna choose the best answer.
You can reduce your choices if you are
not sure which would be the best answer
just kinda rule out
the choices by eliminating the may be obvious
And then prioritize
your choices by safety
if you are down to the last 2.
Think about that
assessment and safety
and then do a double check.
When you read your question
your answer should make sense.
It should make sense to you.
So Thank you this is
Anne Vanderputten for
therapeutic environment and
security and Good Luck.