Therapeutic Environment

No 17. To create and / or maintain a therapeutic environment 

By: Ella Rose Mamaril

What is an environment? What is a therapeutic environment?

We may have different answers to those questions. However, I believe that each and every individual wanted to be placed in an environment they consider as healthy.

Environment, for me, is composed of both the internal and the external. Likewise, it encompasses the physical and psychological aspects. A therapeutic environment, in my viewpoint, is something that promotes a normal process of growth and development, as well as of maturation.

Let’s take this one by one.

The physical aspect of internal environment refers to maintenance of homeostatic processes within our bodies. Example is a normal thermoregulation. The psychological aspect of internal environment refers to one’s thoughts, feelings and perceptions regarding self and all that affects him. The physical aspect of external environment refers to the physical surroundings of the person – his home, his workplace, his school, the air around him, etc. The psychological aspect of external environment refers to man’s relationship with others.

In creating or maintaining a therapeutic environment, one should consider all these aspects.  Furthermore, man can adapt to a certain degree of change. However, should the man’s adaptive mechanisms no longer adapt to the changes, the nurse should intervene.

Here are varied examples.  A patient who has impaired vision and memory can no longer adapt to a change in the external aspect of the physical environment, therefore, his room should not be re-arranged.  We do not totally remove the vernix caseosa in the newborn because it helps the newborn maintain a normal body temperature, a physical aspect of the internal environment. As nurses, we allow clients to participate in the care and to make decisions regarding their treatments in order to maintain a healthy internal psychological environment, by preventing powerlessness. Also, we encourage client’s significant others in participating in patient care by educating them.

Could you cite more examples? I’m sure that in our everyday dealings with our clients or patients, we unconsciously help in maintaining a therapeutic environment for them.