Environment

An important consideration for teaching nursing students how to thrive as an innovative trailblazer is the environment. The environment encompasses much more than the setting where we practice; it includes the physical space, participants, and resulting interactions.

The environment begins with the physical space. For optimal encounters, nurses must assess the space:

• Is the lighting appropriate?
• Is there sufficient seating or space for all people that need to be present?
• Is the temperature neutrally comfortable?
• Can privacy be created as appropriate?
• Are distractions removed? For example, turn off the television, shut the cellphone,  and close the computer so that all parties can focus their attention where needed.
• Can all participants adequately see and hear all that is occurring?
• Is one person creating a position of power over another? For example, is everyone seated or is one person displaying authority by standing when everyone else is seated?
• Can the space be considered neutral and safe? 

The participants should include those pertinent to the situation:

• The person with the message to deliver needs to be included in the environment.
• Those the message is being delivered to must be present.
• If the interruption by others into the environment will prove distracting, take steps to ensure the environment is uninterrupted (close the door, post a sign, etc.).
• If others need to be present to observe or another tangential reason, ensure this presence is acceptable by all parties.
• Everyone present in the environment needs to be familiar with everyone else in the environment. Time should be taken to complete introductions and reason for being in the environment, as appropriate.

The interaction is the actual events that take place:

• A respectful tone should be set.
• Each party should agree to be open and listen to one another. No person should be planning their next statement while the other person is talking.
• Before closing the environment, all participants should ensure that everyone has the same understanding of what was accomplished within the environment.    

Reflection:

Questions and exercises to consider with classmates and/or colleagues:

• Reflect on a time when you were involved in a difficult conversation. What was the environment like during that conversation? What could have been changed in the environment to make it more appropriate for the conversation taking place?
• Describe the environment in which you last provided nursing care. What about the environment was appropriate and inappropriate and why?
• Using a pen and paper, or a computer program for interior architecture, design an ideal environment for holding difficult conversations with patients/clients.
• Which part of the nursing environment is most concerning for you?

Helpful Resources

Healthy Work Environment
American Nurses Association

Health Work Environments
American Association of Critical-Care Nurses

Creating a Positive Nurse Working Environment
Nursing Center Blog by Christina Gresh (February 4, 2020)

Recommended Readings

Bailey, S. (2021). Seven steps for having difficult conversations: This simple guide can facilitate interactions. American Nurse Today, 16(4), 14–16.

Manning, J., & Jones, N. (2021). Improving healthy work environments through specialty nursing professional development. Journal of Radiology Nursing, 40(3), 241–245. https://doi.org/10.1016/j.jradnu.2021.05.006

Williamson, K. (2020). Fostering an environment for difficult conversations. APCO Worldwide. https://apcoworldwide.com/blog/fostering-an-environment-for-difficult-conversations/