Returning from the Beryl Institute’s Patient Experience conference last week, my thoughts run from the obligations of the caregiver community, to the responsibility of the patient to engage, and to the environment in which care is delivered almost being forgotten. I say this in the most positive light because the conference brought great weight to the meaning of the patient experience and the impact of the culture of the hospital.
What needs more ongoing discussion is the role of context — the power of the environment to inform, if not control, the therapeutic relationship.
More specifically, HCAHPS questions address cleanliness, noise, pain management, and communication. Each of these factors are informed by the environment. For example, an unclean, cluttered hospital room or a waiting area in disarray communicates and represents a lack of attention to detail by the staff and a disregard for the circumstances of the patient and family.
Out of control noise levels threaten speech privacy, are the number one contributor to sleep deprivation, and communicates lack of consideration. In fact, if the background noise is high enough, nurses, patients, and family members will unintentionally wind up raising their voices to each other. Noise triggers PTST responses, agitates the elderly, and stresses the staff.
Like Dorothy when she enters the wonderful world of OZ, patients experience their own, “We are no longer in Kansas” moment — the sudden realization that something is different. They start asking themselves, “Where am I? What is happening?”
The environment communicates. It speaks for the quality of care continuously over the full 24-hour admission day. It speaks for the staff when no one is in the room. This approaching Nursing Week and the birthday of Florence Nightingale, it is timely to remember that healing environments began with nursing. Nightingale put forth that it is our job to manipulate the environment to “put the patient in the best possible position for nature to act upon him.”