Page 166 - Nursing: The Philosophy and Science of Caring

Fr om carative Fa c t o r 8 t o C ar it as ProC e s s 8
work (1992), Quinn identified several ways of examining environment
within nursing practice:
• First, by acknowledging that both the nurse and the patient are
in the physical environment, both looking out into a shared
physical space. The nurse in this framework attends to the
most basic essentials of environment, such as privacy, comfort,
lighting, safety, cleanliness, aesthetics, and so forth, including
acknowledging spiritual needs. These are foundationally impor-
tant aspects of the caring process in nursing and one of the core
Carative Factors.
• Second, however, we go beyond the basic Carative essentials as
we expand our disciplinary and theory-guided practice. Now we
are invited to consider environment at a theory-guided prac-
tice level. Were we to consider Rogers’s (1970, 1994) view of the
human-environmental field and an expanded view of nurse and
patient as integral within the environment, affecting the entire
field, we then must rethink environment and the nurse’s role and
place in the space.
• This second evolved view builds on the first, but in addition to
considering the nurse and patient as sharing the physical space
and the nurse as altering that space to meet the patient’s basic
needs, the nurse now has to consider self as part of the environ-
mental field. This view introduces concepts such as patterning/
re-patterning of the environment to promote healing and deeper
caring.
• Furthermore, in considering environmental field at this deeper
level, the nurse working within a holistic caring consciousness
would consider introducing caring-healing modalities, such as
music, intentional touch, sound, art, aromatherapy, visualiza-
tion, relaxation, and other nursing arts, as well as healing arts
approaches to enhance healing and help the patient “be-in-right-
relation” (Quinn personal communication, 1986).
• While Quinn did not necessarily locate her ideas within a Caring
Science context, as I do here, she nevertheless invited a third
level of consideration of environment. This third view is consis-
tent with Caring Science and the Caritas Nursing consciousness
proposed throughout this text. This deeper conceptualization of
environment takes into consideration the subtle environment

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