Introduction
The concept that will be presented in this paper is extracted from Virginia Henderson’s Nursing Need Theory (Ahtisham & Jacoline, 2015). This theory emphasizes the fact that the patient’s independence directly influences the successes that they make after their hospitalization. The core idea is that any patient must realize their potential to overcome their disease and successfully recover from it after they are released from the hospital. Many components form this theory and concepts that provide the direction that it takes to develop and improve. One of these concepts is the environment. It describes the setting in which the patient is put and the conditions that this setting must meet to increase their recovery chances and rates. Numerous factors are contributing to the healthy environment including families, equipment, nurses’ attention, and care, etc. This paper will analyze the concept of environment in seven separate parts. These parts are explanation, literature review, the definition of attributes, presentation of an antecedent and consequence, empirical referents, model, and alternative cases.
Explanation of the Concept
The concept itself is rather simple to grasp. The environment, according to the Theory of Needs author, Virginia Henderson, is the setting in which the patient resides. However, the author did not explicitly state what the environment represents focusing more on what the role of the nurse is and what are the primary needs of any patient (Smith & Parker, 2015). Nevertheless, the essentials of this concept are provided. These are the state of premises in which the patient is put, the amount of attention provided to them, the quality of used equipment, and the ability of caring personnel to make sure that the patient’s needs are satisfied and their condition is always monitored and improved.
The role of this concept did not stand out from other important concepts of the time when it was offered by Henderson. However, as Florence Nightingale’s theory received more and more recognition, the environment as a concept of nursing began to experience new growth, thus pushing the development of the general nursing theory. The earlier dominating focus on diseases and means of their prevention and elimination was at least partially replaced by the goal of creating a healthier and more supportive environment. These achievements gave birth to what now is known as nursing and care.
It is hard to overestimate environment as an independent concept; it is substantially harder to cast aside the impact that it has on the nursing of the modern-day. After all, the primary goal of nursing now is to create an environment in which the treatment proceeds, while also providing support, care, and possibilities to soothe the patient’s discomfort. All of these elements form a healthy and positive environment that is necessary for a quick and efficient recovery. Furthermore, an adequately established environment provides the patient with a possibility to realize that their future recovery mostly depends on how well they can re-create the environment in which they resided in the hospital. Thus, the importance of the concept is established.
Literature Review
The concept of patient environment is often referred to in the framework of patient safety. This concept is also influenced by several different factors. For example, Tella et al. (2014) provide research on the impact that nursing education has on patient safety and, therefore, the environment in which they are placed. Kirwan and Matthews (2013) also state that “The importance of ward-level nurse factors such as nurse education level and the work environment should be recognized and manipulated as important influences on patient safety” (p. 253). However, it is also often stated that the patient safety climate (and the environment they are in) do not result in better patient outcomes (Ausserhofer et al., 2013).
As already stated, this concept only received a somewhat decent coverage on its own much earlier in the development of nursing theory. As of now, the concept of environment is mostly used in a framework of other theories, practices, and concepts. It is interesting to notice that the environment as a concept began to shift from focusing on the patient to focusing on nurses and other health care institutions’ staff. The examples of this emphasis on the practicing and working environment are provided above.
However, the patient environment was not completely abandoned and is mostly reviewed by researchers in the framework of Nightingale’s theory. For example, the fifth chapter of the book Nursing Theory: Utilization & Application by Bolton (2013) dwells on the topic of the impact that Nightingale’s theory had earlier and the legacy it left. It is important to understand why the concept of the environment was so significantly covered by Nightingale and did not receive as much attention from Henderson. Florence Nightingale’s Environmental Theory provides a significant number of details explaining what the environment is when it is safe and healthy, and what factors influence its state (Medeiros, Enders, & Lira, 2015). It is important to note that the primary component of this theory is the environment, which was not the case for Henderson’s work. This partly explains why the environment is not represented in the modern nursing research literature on its own all that well.
Finally, another important part of the representation of this concept in scientific literature is its application and the benefits it provides. An article by Karim (2015) provides a concise description of the possibilities that the application of Nightingale’s Environmental Theory has to offer. The author concludes that “This scholarly application was an eye-opening opportunity for me to appreciate how this great nursing leader has combined knowledge of her empirics, arts, and ethics to develop such a simple but so general and easy to apply theory with basic concepts in nursing. Today, however, advances have been achieved, but the reality and the importance of Nightingale’s theory are at the highest rank, and if followed religiously nurses and other caretakers at home can easily prevent several diseases from occurring” (Karim, 2015, p. 227). This example demonstrates just how important the theory was earlier and how much of an impact it still has both on nurses personally and the nursing theory in general.
Thus, it becomes evident that, although the separate concept of environment did not receive excellent coverage, it is often referred to in various frameworks and theories to support statements or push the nursing theory’s development further. Also, this concept did not receive as much recognition based on the work of Henderson. However, the idea of the environment as a separate term in nursing theory was significantly promoted and complemented by Florence Nightingale that based her whole theory around this possible asset.
Defining Attributes
Based on what the sources mentioned earlier described as the environment in the framework of Henderson’s theory, it is possible to determine the following defining characteristics:
- Support;
- Promotion of a healthy lifestyle;
- Nurses’ cooperation (Ahtisham & Jacoline, 2015).
The support here means that a patient must be provided with the attention that is focused on their well-being and recovery. The more support a patient receives from nurses and the close ones, the higher the motivation and chances to successfully recover are. Thus, support may be regarded as the most important attribute of the concept.
The patients are expected to recover not only when residing in a health care institution. As much as the hospitals can achieve, it is often impossible for a patient to completely recover solely by undergoing certain procedures. It is also crucial that the patient works their hardest to regain their health after they are released from the institution. This is where the promotion of a healthy lifestyle takes its part. The more attention the nurses and physicians provide to motivating their patients to improve their health and well-being, the healthier the environment gets. At the same time, the chances of a complete recovery are drastically increasing. This component is closely related to the support that the medical personnel can provide.
Finally, it is important to understand that no medical worker can achieve what it takes to ensure complete and rapid recovery. Instead, nurses and physicians must be motivated to work in a constant collaboration. This will provide a significant number of possible achievements, while also negating potential risks and threats. Henderson explicitly stated that it is important to encourage nurses to take cooperative actions and make shared decisions so that they would achieve better results. Furthermore, the motivation that is so crucial to the patient will also be multiplied by the joint efforts that the medical personnel may demonstrate.
Antecedent and Consequence
Following the nature of the concept, the antecedent must be chosen from the nursing meta-paradigm presented by Henderson (Smith & Parker, 2015). Since the environment is supposed to create a setting promoting recovery, the factor that precedes the creation of such a setting must be the condition of a patient’s health. This means that the environment is only established when the patient requires assistance and treatment and most probably would not have been created otherwise.
The consequence, then, is easy to determine. If the adverse health condition precedes the environment, the positive state of being and general improvement of well-being are the consequences. It is only natural that a proper environment that combines the indicated attributes causes an enhancement of the patient’s health.
Thus, both of these factors represent the cause and effect of the implementation of the environment concept in medical practice.
Empirical Referents
As stated by Medeiros et al. (2015), “the disease is considered, in this theory, a restoring health process and the nurse’s function is to balance the environment, to save the patient’s life energy to recover from the disease, prioritizing the delivery of a stimulating environment for the development of the patient’s health” (p. 519). Thus, it is up to the patient to determine whether or not a nurse is performing her functions well (or if at all). The patient may determine whether or not the proper environment had been established by continuously monitoring their health state. If they are feeling progressively better, it is most likely that a favorable environment is set. If not, it is possible that either there is no proper environment for the patient to recover, or the patient’s disease is more severe than expected. However, most of the diseases treated in medical institutions do not result in immediate complications. Therefore, the lack of a proper environment may be the most possible answer.
Model and Alternative Cases
An assumed patient reports to the hospital with a severe case of the flu. The nurses assume that the potential complications (antecedent) may affect the patient’s life even after hospital procedures are concluded. The nurses then proceed to act following the mentioned defining attributes of the theory (Ahtisham & Jacoline, 2015). Working in collaboration, they establish a healthy environment in which the patient quickly recovers (consequence). However, they also encourage the patient to take possible measures to negate any potential complications and lead a healthy lifestyle. The patient, in turn, realizes that there are a lot of things they may improve to increase their well-being, which represents the empirical referent.
If one or more of the mentioned components are missing, it will become progressively harder for medical personnel to achieve positive results. For example, the lack of support may lead to excessively prolonged recovery, while not promoting a healthy lifestyle may cause further complications that may potentially ruin every achieved result. On the other hand, recovery may be attained even in the most lackluster environment lacking collaboration or encouragement of any kind. After all, any patient may already be motivated enough to fight off their disease and successfully recover.
Conclusion
To summarize, the concept of the environment represents the healthy setting in which the focus is on providing every possible measure for a patient to recover well and not develop any complications. The Needs Theory by Virginia Henderson, in turn, is a theory that determines the aspects necessary to ensure the fastest and most efficient recovery. The application of this theory may be found almost in any medical facility. Ideally, each health care institution strives to achieve the greatest possible improvement in its patients’ health. Therefore, taking into account the components and concepts provided by Henderson may result in much less time and effort required to achieve greater medical results.
References
Ahtisham, Y., & Jacoline, S. (2015). Integrating nursing theory and process into practice; Virginia’s Henderson Need Theory. International Journal of Caring Sciences, 8(2), 443-450.
Ausserhofer, D., Schubert, M., Desmedt, M., Blegen, M. A., De Geest, S., Schwendimann, R. (2013). The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: A cross-sectional survey. International Journal of Nursing Studies, 50(2), 240-252.
Bolton, K. (2013). Nightingale’s philosophy in nursing practice. In Aligood, M. R. (ed.), Nursing theory: Utilization & application (pp. 84-95). St. Louis, MO: Elsevier.
Karim, H. N. (2015). Clinical application of Nightingale theory. International Journal of Innovative Research & Development, 4(11), 225-227.
Kirwan, M., & Matthews, A. (2013). The impact of the work environment of nurses on patient safety outcomes: A multi-level modelling approach. International Journal of Nursing Studies, 50(2), 253-263.
Medeiros, A. B. A., Enders, B. C., & Lira, A. L. B. C. (2015). The Florence Nightingale’s Environmental Theory: A critical analysis. Escola Anna Nery, 19(3), 518-524.
Smith, M. C., Parker, M. E. (2015). Nursing theories and nursing practice. Philadelphia, PA: Davis Company.
Tella, S., Liukka, M., Jamookeeah, D., Smith, N., Partanen, P., & Turunen, H. (2014). What do nursing students learn about patient safety? An integrative literature review. Journal of Nursing Education, 53(1), 7-13.