Embedding “therapeutic nurturance” in hospitals and care institutions
Hospitals and care institutions are the settings for a unique type of nurturance, one that is therapeutically restoring and has the properties of curing, caring and healing. How does this “therapeutic nurturance” come by? What are its properties and under what preconditions does it instantiate? How is this “nurture” different from the ones that are experienced in the fields of education, hospitality and others? What do leaders of medical institutions need to put in place to achieve therapeutic nurturance of their resident patients? We discuss some of these issues in this article.
It has been well researched, firmly established and adequately emphasised that hospitals and care institutions need to aim beyond the curative aspects of care. While curative interventions aim for physiological care, patient healing requires the redressal and unity of body, mind and spirit. Hospital environments and their constituent elements (i.e., leadership; staff – nursing, clinical and supportive; infrastructure; treatment approaches) need to recognise aspects of care that can bring about mental and emotional well-being, through interventions that are affective, social, spiritual and infrastructural. And this, in essence, is the definition of the goals of “therapeutic nurturance” and the outcomes that it purports to bring about.
Having alluded to the goals of therapeutic nurturance, we turn our attention to the preconditions that must exist for it to instantiate. For this enumeration, we consider important elements of the care setting, the quality of care operations, and the mental states of caregivers.
The first precondition for therapeutic nurturance is the breadth and depth of the healing environment that the hospital provides. This environment needs to be conceived multi-dimensionally, encompassing internal, carative, curative, social and physical elements. The internal environment concerns the patient’s inner being including her epistemology, axiology and ethics, agency, intentionality and spiritual philosophy. The carative environment includes caring relationships, loving presence, caring tasks and a caring organisation. The curative environment goes beyond evidence-based medicine to include the concepts of blended medicine, ‘whole human’ cure, and empowered self-driven cure. The social environment concerns the roles of family and friend. Finally, the physical environment concerns its personalisation and integration with nature.
The second precondition for therapeutic nurturance is focused on the mission, vision and values of the medical institution, that jointly constitute its direction. The direction of hospitals tends to be implicit and assumed, and at times, ambiguous and incomplete. Lack of clarity in this matter will not do. In the absence of an explicit and coherent direction, how are the institution’s leaders and governors, medical staff, the caregiver community, the administrative and support staff, and the families of patients to comprehend and unite behind a common philosophy of caring, a set of expected behaviours, and a set of common goals related to patient outcomes?
The third precondition concerns the philosophy of “patient-centred care”, which is underpinned by the philosophy: “no decision about me, without me”. Research has proven beyond doubt that patient-centric hospitals achieve better performance on operating parameters as well as clinical outcomes. Moreover, employee satisfaction scores tend to be higher. “Patient centricity” is a way of life in a hospital setting, and requires leaders to train employees, modify processes and refurbish infrastructure. Such is the importance of this concept, that we choose to call this out from a milieu of contemporary concepts in healthcare, as a prerequisite for therapeutic nurturance.
The fourth precondition concerns the work climate and occupational health of the nursing community within the hospital. A positive work climate is a must have for nurses to consistently deliver a high standard of holistic and patient-centric care. The philosophy underlying the importance of nursing work climate is that: “it is not possible for a caregiver to care, unless she is adequately cared for”. In poor work climates, nursing organisations suffer from depersonalisation and empathy degradation, and consequent high turnover. Transforming the nursing climate is a significant step towards therapeutic nurturance.
The fifth precondition concerns the nursing community again, but focuses this time on her role, which is a matter that lies at the heart of the hospital’s caring model. Earlier definition of the nurse’s role positioned her as the “person in charge” who would control the external as well as the internal-spiritual environment of the patient. Contemporary philosophies of care have led to a transformation of this role definition, whereby the nurse is now considered more akin to “the coach, strategist and integrator” who unifies the patient’s mind, body and spirit, and enables holistic healing. Anachronistic notions of the role of the nurse go against the conception of therapeutic nurturance.
The final precondition for therapeutic nurturance lies in the area of environment-friendly sustainable approaches. Healthcare is among the sectors that is most prone to systems failure driven by the pressures of unsustainable approaches. While the emphasis on sustainable approaches benefits the healthcare system, it also has immediate impact on the hospital’s operating performance and the patient’s health outcomes. Consider as an example the emphasis on health promotion and prevention. These are marquee examples of sustainable approaches, and are also important ingredients of fostering therapeutic nurturance.
Contemporary philosophies of care such as “patient centric care” and “sustainable approaches”, and humanistic considerations of caregivers such as the “nursing work climate and occupational health”, are strong initiatives that hospital leaders need to implement. However, the whole concept of “therapeutic nurturance” is much larger than the sum of these parts. It is this consideration of “therapeutic nurturance”, with its constituent preconditions mentioned above, that will drive progress of marquee “hospitals of the future”.