People, Place, and Process: The Role of Place in Creating Optimal Healing Environments

Abstract

Healing and place are inseparable. (Wilbert Gesler, 2003, p. 1) Florence Nightingale stands out as the first nursing leader to understand the impact of place on the healing process. In her writings she laid the groundwork for a holistic approach to patient care. "Volumes are now written and spoken upon the effect of the mind upon the body. Much of it is true. But I wish a little more was thought of the effect of the body on the mind" (Nightingale, 1860). She also is credited with being one of the first to record this impact in her statistical representation of public health issues. She understood that the element of place (nature, site location, and building design) needs to be integrated with elements of people (spirituality) and with processes (care delivery) to create an Optimal Healing Environment (OHE). Nightingale practiced nursing more than 150 years ago, but her insight into the creation of OHE leaves a legacy for us all. She proposed no formulaic response to the role of place in optimal healing but documented her experiences and observations with her patients as well as the larger community. Our challenge is to discover frameworks to help us identify elements that create optimal healing environments within our own communities. The American Holistic Nurses' Association's Standards of Holistic Nursing Practice (1998) include therapeutic environments as part of their core values. The standards state that "each person's environment includes everything that surrounds the individual, both the external and internal (physical, mental, emotional, and spiritual), as well as patterns not yet understood." This article will introduce systems thinking as a framework for identifying and studying the elements of OHE. Application of this framework also allows subtle patterns, including the interactions between elements, to be made explicit. With billions of dollars of spending anticipated in healthcare construction both nationally and internationally before 2020, it is imperative that means to improve the healthcare environment be explored to ensure optimal work, healing, business and cultural outcomes. (Stickler, 2007, p. 11) DEFINITIONS OF TERMS Optimal Healing Environments The word "healing" comes from the Anglo-Saxon word haelen , which means "to make whole." Healing environments are designed to promote harmony or balance of mind, body, and spirit; to reduce anxiety and stress; and to be restorative (Kreitzer & Zborowsky, 2009). The OHE are created when people, place, and care processes converge at a particular time and within a particular culture. Some of these elements are universal while others may be unique to each community. Systems Thinking Systems theory was developed in the 1940s by biologist Ludwig von Bertalanffy as a reaction against reductionism and the attempt to revive the unity of science (Heylighen & Joslyn, 1992). Von Bertalanffy emphasized that real systems are open to and interact with their environments, and that they can acquire qualitatively new properties through emergence resulting in continual evolution. Rather than reducing an entity to the properties of its parts or elements, systems theory focuses on the arrangement of and relations between the parts that connect them into a whole. Systems theory is applied to many disciplines such as physics, biology and sociology to provide a holistic framework to areas of study (Heylighen & Joslyn, 1992). OHE and Systems Thinking Applying systems thinking to the creation of OHE allows a holistic perspective into their creation. Figure 1 illustrates the relationship between the major elements of OHE. Systems thinking allows a broader, more integrated view of this concept. Rather than focusing on the individual parts, systems thinking allows a perspective of how the parts relate to each other. The elements can be better understood when examined in relation to each other and to the synergy that exists between them. …