The environment and quality of care in long-term care institutions.

It is alarming that a basic need such as fluids and nutrition can be so neglected when caring for elderly patients. Dennis & Prescott (1985) found when asking nurses around the country to describe good nursing practice that dietary concerns were not commonly identified as an activity comprising good nursing. Kayser-Jones (1981) found, when comparing the quality of care in a Scottish and an American institution, that the greatest difference between the two facilities was the environment. In the Scottish institution, the environment was patient centered while, in the American institution, little attempt was made to consider the needs of the elderly residents (Andreasen, 1985). To provide quality care to the elderly, the nurse must be involved in all aspects of the environment--the physical, the organizational, the personal, and the psychosocial milieu. While all components are important, the nurse's involvement in the organizational aspects of long-term care facilities is essential for quality nursing care. Florence Nightingale emphasized that the nature of the hospital authority (e.g., policy issues) was critical. "For unless an understanding is come to on this point, the very existence of good nursing is an impossibility" (Nightingale, 1859, 1980). There are many environmental factors that will promote well being for the institutionalized elderly, such as color, lighting, the physical arrangement of furniture, personal belongings, the administrative philosophy, and the absence of irritating noises. Nothing, however, is more important than the characteristics of the nursing staff. Human relationships--the bond between nurse and patient--are more important than the physical surroundings. Nurses must be involved in planning an environment that will promote and enhance the nurse-patient relationship. Furthermore, we must emphasize the value of the nurse-patient contact and be involved in the design of facilities and the development of policies that will increase this contact and promote the development and maintenance of a strong nurse-patient bond.