1. Chapter Twelve
Environments of Care

2. Environmental Management
As far back as Florence Nightingale nurses were aware of the environment and the impact it had on patients
The goal of environmental assessment is to promote independence
Assess all aspects of an older adult’s living situation that can be seen, heard, touched, or smelled.
Assess how well the older person functions in the living areas. For example:
Is the environment as barrier-free as possible?
Can the older person walk unencumbered or wheel a wheelchair through the entire setting?

3. Environmental Management (cont’d)
Transpersonal Caring-when the nurse relates to the older adult in a holistic way based on caring
Climate of caring
People in the environment
Family members, neighbors, friends, paid caregivers
Environmental tone and atmosphere
Includes being positive, respectful, caring, privacy, encouragement, involvement, independence
Safety
In any setting, safety for the older person is a primary concern.
Assess for environmental hazards.
Keep environment free of fall risks.

4. Environmental Management (cont’d)
Stimulation and personalization
Personalized items maintain a sense of identity.
A caring climate facilitates optimal independence and autonomy.
Personal space territoriality
Personal space is important to everyone.
Personal space varies from person to person.
Viewed as an intrusion when someone comes into it
Territory space is used by a person and seen
as owned by the person.

5. Environmental Management (cont’d)
Privacy
Provide opportunities for privacy.
Respect right to privacy.
Activity and involvement
Provide multiple and diverse opportunities for activity and involvement.

6. Which would be an example of personalization?
Creating new routines
Photos of family members
Turning on the radio
Encouraging activities

7. Answer
B. Photos of family members

8. What is the term for the return to a space out of habit?
Privacy
Activity
Territory
Relocation

9. Answer
C. Territory

10. Relocation Trauma
Moving from one environment to another can be stressful to older adults.
Transitional Stress- refers specifically to the emotional stress that occurs during the time a person is changing from one phase of life to another
Orient to new surroundings slowly.
Incorporate personal furniture and objects into the environment.

11. Environments of Care
Various settings where older adults may receive health-care services
Adult day services
Provide supervised activities for older adults
Provide specific services to meet physical, psychiatric, and social needs
Ongoing assessments of participants are important.

12. Environments of Care (cont’d)
Home care
Provide services for older adults in their homes
Provide nursing services, therapy services, medical supplies, and equipment
Care is provided on a daily basis or intermittently.
Community-based care
Community clinic, dialysis center, or physician’s office

13. Environments of Care (cont’d)
Hospice
Provide care for the dying patient and the family
Care given by interdisciplinary team approach
Allows nurses to give direct patient care to patient and family members

14. Environments of Care (cont’d)
Assisted living
Provide services for older adults with physical care needs
Person must be ambulatory and fairly independent.
Environment is home-like.
Nursing homes
Area of practice that has been available to
practical nurses for many years

15. Environments of Care (cont’d)
Nursing Home (cont’d)
Two categories
Skilled and nursing facility
Licensed by state
LPNs supervise nursing assistants and give medications and treatments.

16. Environments of Care (cont’d)
Acute care
40% to 65% of hospital admissions are older adults.
Patients are admitted for a short period of time.
Difficult to develop trusting relationships with patients
Requires all the basic skills the practical nurse possesses

17. Acute care Skilled care Assisted living Community-based care
Which environment of care involves the services to help achieve more independence for safe return home?
Acute care
Skilled care
Assisted living
Community-based care

18. Answer
B. Skilled care

19. Which type of environment is a wound clinic?
Acute care
Skilled care
Assisted living
Community-based care

20. Answer
D. Community-based care