CPNRE® Comprehensive Review Series: Part 9





Continuing where we left off last week with the serialization of the CPNRE® Comprehensive Review eBook, today’s post is all about the environment in which we work – and how we can make it psychologically safe for the people we care for. To bring you up to speed, here’s part 1, part 2, part 3, part 4, part 5, part 6, part 7 and part 8.

Nurse-client interactions: Environment

When we’re busy and overwhelmed, it’s easy to overlook the decisions we make about the environment surrounding our clients and their families.

But before we talk about how we can make the environment safe, I think it’s important to examine the potential consequences when we fail to consider the environment in which we work.

The best teachable moments are the ones where people screw up, so I’m going to share a few examples of how the environment can help or harm the psychological safety of the people we care for.

A few years ago, I started seeing a new physician. The first few times I saw her, I noticed that she left the exam room door wide open during our visits. At first, I remember thinking to myself, “this is weird, but maybe there’s a reason”. But after several months of seeing her, I realized this is what she does. Regardless of the reasons why she leaves the exam room door open during client visits, it’s important to recognize that this lack of regard for privacy and dignity undoubtedly makes people feel uneasy about sharing personal information when they know other people can easily listen. I know it makes me feel uncomfortable and far more hesitant to open up knowing that someone is across the hall, listening to what I say. It seems as though this physician doesn’t understand the perspective of her clients and how the environment is influencing her interactions and care.

Here’s a different example – an example of what happens when we pay close attention to the needs of the people we care for, and how the environment plays a role in meeting their needs.

A few years ago, my father underwent a liver resection for metastatic colorectal cancer. After his surgery, the surgeon brought my family into a quiet, private space to talk. At first I thought the surgeon did this because he was about to share bad news, but I quickly understood that he did this so my family could have a place to talk without spectators. There were lots of tears and emotions felt during that discussion, and I cannot imagine what it would have been like to do that in the hallway or a busy waiting room where other people could watch and listen. It was clear that this physician appreciated that the environment in which we communicated had a tremendous impact on our psychological safety.

While our ability to create quiet, safe, respectful and private environments depends on the setting and situation, there are simple things we can do to improve the influence of the physical space for our clients and their families.

Practical nurses can create a respectful, safe and private environment by:

  • Drawing curtains to create privacy in a hospital room
  • Knocking before entering through a closed door
  • Finding a private space, free of noise and distraction especially in sensitive situations
  • Paying attention to lighting in a room
  • Using neutral spaces
  • Limiting the use of chapels or religious spaces unless a client or family specifically requests it


Here’s an example of a question about the environment:

Question: Mrs. Reiker is a 73 year old client living in a long-term care facility. Recently the nursing staff have noticed that Mrs. Reiker is more agitated in the evenings, and at times physically aggressive towards her roommate. Her family is upset and requesting to discuss the situation. As the nursing team leader, where should the practical nurse arrange a meeting with Mrs. Reiker’s family? 

  1. Mrs. Reiker’s bedroom
  2. Chapel
  3. Nursing station
  4. Conference room

 Correct answer:  4.

The conference room is the most appropriate environment in this situation for the simple reason that it’s the most quiet, private and neutral space amongst these answer options.

Nursing stations don’t offer a lot of confidentiality and they can be noisy. Chapels aren’t appropriate spaces to hold meetings for a few reasons. One reason is that other people may want to use the chapel for prayer and the other reason is that not everyone is comfortable in a chapel. Client rooms also aren’t the most appropriate environments to hold meetings because there may be other clients sharing the room, and some meetings are held about clients – without them.


Exam tactic

You may see questions on the CPNRE® asking you to choose ‘Which environment is the most appropriate?’ or ‘Where should the practical nurse arrange a meeting?’ When answering these kinds of questions, try to think about the above ways in which we can provide a dignified space for clients and their families. Ask yourself: what kind of environment would provide this client or family the most privacy and respect for their beliefs, values and preferences?