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Therapeutic Environments for Older Adults: Constituents and Meanings

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Journal of Gerontological Nursing
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David Edvardsson
David Edvardsson
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This article presents the findings of a study that aimed to describe what constitutes therapeutic environments and interpret what it means to be in such environments for older adults. Interview and observational data collected in Swedish health care contexts were subjected to qualitative content analysis. The findings describe therapeutic environments as being constituted by three interacting and interwoven categories: the physical environment, people's doing and being in the environment, and an organizational philosophy of care. The findings are interpreted in light of the existential philosophy of home as a concept, a place, and an existential experience, highlighting that therapeutic environments can support existential at-homeness among patients. The findings of this study can contribute to nursing practice by providing a conceptual basis for reflecting on and evaluating how the physical environment, staff's doing and being, and the organizational philosophy of care cooperate to support well-being among older adults living in long-term care facilities.
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ABSTRACT
This article presents the ndings of a study that aimed to describe what constitutes
therapeutic environments and interpret what it means to be in such environments for
older adults. Interview and observational data collected in Swedish health care contexts
were subjected to qualitative content analysis. The ndings describe therapeutic environ-
ments as being constituted by three interacting and interwoven categories: the physi-
cal environment, people’s doing and being in the environment, and an organizational
philosophy of care. The ndings are interpreted in light of the existential philosophy of
home as a concept, a place, and an existential experience, highlighting that therapeutic
environments can support existential at-homeness among patients. The ndings of this
study can contribute to nursing practice by providing a conceptual basis for reecting on
and evaluating how the physical environment, sta’s doing and being, and the organiza-
tional philosophy of care cooperate to support well-being among older adults living in
long-term care facilities.
Therapeutic Environments
for Older Adults
Constituents and Meanings The environment is one of four
grand concepts of nursing,
but there have been limited
theoretical advances in this domain
(Fawcett, 2005; Kim, 1989). Florence
Nightingale is recognized as the first
nurse theorist to focus on the envi-
ronment’s role in nursing. She stated
that the main function of nursing is to
aid the body’s own means of recovery
by enhancing the therapeutic func-
tion of the environment (Nightin-
gale, 1969; Weiss & Lonnquist, 2000).
In the more recent caring literature,
theorists such as Rogers (1970) and
Watson (1985) have focused on the
interrelationship between human be-
© 2008/Ryan McVay/Photodisc/Getty Images
David Edvardsson, PhD, RN
32 JOGNonline.com
... Physical and psychosocial dimensions of the environment have also been described in relation to the concept of caring environment or person-centredness of the environment. Experiences of caring environments can emerge from an optimal interaction between aesthetic, positive stimuli in the physical environment, people's doing and being in the environment, and their experiences of the place where care is provided (Edvardsson, 2008;Edvardsson et al., 2017). Encompassing a climate of safety, everydayness and hospitality, a caring environment represents an integration of person-centredness of the environment and care to form a general perception of the psychosocial 'climate' of a setting (Edvardsson, 2008;Rasmussen & Edvardsson, 2007), and according to a recent study, relatives of NH residents seem to associate a more person-centred care environment with high quality care ). ...
... Experiences of caring environments can emerge from an optimal interaction between aesthetic, positive stimuli in the physical environment, people's doing and being in the environment, and their experiences of the place where care is provided (Edvardsson, 2008;Edvardsson et al., 2017). Encompassing a climate of safety, everydayness and hospitality, a caring environment represents an integration of person-centredness of the environment and care to form a general perception of the psychosocial 'climate' of a setting (Edvardsson, 2008;Rasmussen & Edvardsson, 2007), and according to a recent study, relatives of NH residents seem to associate a more person-centred care environment with high quality care ). Baxter (2021 argues that the NH environment can be perceived as an intervention and a resource to thriving. ...
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... Their active engagement seemed to play a more crucial role in shaping the outcome than the sheer number of participants [29,52]. When dealing with older persons with cognitive impairment as meaningful interactions, person-centered care, and tailored activities can make a difference [53]. ...
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Background Integrating art in residential care settings aims to create meaningful experiences and enhance the facility’s aesthetic as a home. However, the literature shows a gap, as the voices of older persons are largely absent. This study aimed to explore the views of older persons in residential care facilities specialised in dementia care regarding art and expressions of home. Older persons with cognitive impairments are frequently depicted as lacking meaningful contributions, limiting their opportunities to voice their opinions and influence their environment. Methods This study used a qualitative explorative design with focus group method, allowing older persons with dementia to discuss their views of art in relation to expressions of home. Eleven older persons participated in four focus groups. This method encourages interaction between participants, shedding light on a collective understanding. Results The study found that the residential care facility was perceived as a home by the participants, based on their descriptions of how both private and shared collective spaces in the facility fostered a dynamic sense of belonging. Art owned by the older persons often held personal value and they valued art for its intrinsic qualities, such as beauty, meaning, and expression. The perception of art differed between the private and collective spaces, and the discussions centered on aligning the artistic design with the participants’ notions of home to foster a socially engaging environment. Conclusion Clearly defined private and collective spaces seem to be crucial for fostering self-determination and a sense of belonging for older persons living in residential care facilities specialised in dementia care. A balance between private and collective spaces boosted social engagement, with art playing a key role in reflecting older persons’ previous lives, shared interests and experiences, with co-creation of artistic design ensuring a dynamic environment.
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... In the past three decades, the alternative living arrangements (e.g., small-household model, green care farm, shared housing, and dementia villages) have sought to modify and integrate the physical, social, and organisational environments of residential care to achieve a better person-environment fit in later life (Brouwers et al., 2023;Chaudhury et al., 2018;de Boer et al., 2021), ultimately developing a therapeutic environment that promotes residents' QoL and functioning (Day et al., 2000;Edvardsson, 2008;Regnier, 2003). These models focus on creating small-scale and/or homelike settings, community involvement, and incorporating natural environments to provide responsive and personcentred environmental support (Brouwers et al., 2023). ...
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... Person-centred care climate has been described in terms of the physical environment, people's doing and being, and the organisation's philosophy of care (Edvardsson, 2008). Thus, person-centredness highlights the climate of safety, a climate of everydayness and a climate of community, to support full life and life-situation in the LTC settings of older people, and individuals living there. ...
Person-centred care competence and person-centred care climate described by nurses in older people's long-term care-A cross-sectional survey
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Background: Person-centred care requires that nurses are competent in this approach to care. There may be an association between person-centred care competence and person-centred care climate, but it has not been demonstrated in the literature. This is the justification for the survey study to gain staff's perceptions of such a relationship. Objectives: The aim of this study was to analyse the levels and associations between person-centred care competence and the person-centred care climate as assessed by professional nurses in long-term care settings for older people. Methods: A descriptive cross-sectional survey design with cluster sampling was used to recruit professional nurses of different levels from six long-term care institutions for older people. Data were collected using the Patient-centred Care Competency scale (PCC) and the Person-centred Climate Questionnaire staff version (PCQ-S) in September 2021 and analysed with descriptive and inferential statistics. Results: The mean score on the PCC was rated at a good level of 3.80 (SD 0.45), and the PCQ-S was rated at a good level of 3.87 (SD 0.53). The correlation between PCC and PCQ-S total scores (r = .37, p < .001) indicated that person-centred care competence and person-centred care climate were associated. No associations were detected between nurses' educational levels and PCC (p = .19) or PCQ-S (p = .13) or in terms of age or work experience. Conclusions: The results provide insights into competence and climate levels of person-centred care and preliminary evidence of an association between nurses' assessed competence in person-centred care and the perceived person-centred care climate in long-term care. Nurses' individual characteristics did not appear to affect the level of person-centred care competence or climate. In the future professional nurses of different levels could benefit from effective continuing education in person-centred care. This study design serving for the future intervention study registered to the ClinicalTrials.goc NCT04833153.
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... B. stationäre Langzeitpflegeeinrichtung) zu messen. Die originale schwedische Version wurde im Rahmen von empirischen Studien, die sich mit der Förderung eines Personzentrierten Klimas beschäftigen [7][8][9], sowie aus vorhandener Literatur zur Person-zentrierten Pflege entwickelt. Die originale Version sowie die englische Übersetzung bestehen aus drei Subskalen ("Sicherheit", "Alltagsleben", "Gemeinschaft") und zeigten zufriedenstellende testtheoretische Eigenschaften [1]. ...
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Supporting Aging-in-Place: Drivers and Desired Outcomes of a Healing Environment for Older Adults in Block Spaces of High-Density Cities
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