Kritek P B
University of Texas Medical Branch, School of Nursing at Galveston, 301 University Blvd., Galveston, TX 77555-1029, USA.
AACN Clin Issues. 2001 Aug;12(3):336-44. doi: 10.1097/00044067-200108000-00002.
Rethinking the critical care environment, an implicit call to change, can catalyze a return to nursing's intellectual roots. Healing environments, as envisioned by Florence Nightingale, involve system-level changes that require effective negotiations on behalf of our patients and ourselves. The nurse-patient relationship is central to the patient's environment and requires a comprehensive understanding of healing. Only nurses can articulate the changes necessary to ensure quality nursing care, and our collective "silencing" must be confronted if it is to change. Nurses' tendency to avoid, accommodate, or compromise when faced with conflict also must change. Giving voice to nursing concerns itself becomes a call to excellence, and those unwilling to change are best excluded. Although all of this is difficult, it is no more difficult than the nonhealing environments where we now work, and at least gives promise of more positive outcomes.
重新思考重症监护环境，这一隐含的变革呼声能够促使护理回归其知识根源。正如弗洛伦斯·南丁格尔所设想的，疗愈环境涉及系统层面的变革，这需要我们代表患者和自身进行有效的协商。护患关系是患者环境的核心，需要对疗愈有全面的理解。只有护士能够阐明确保优质护理所需的变革，如果要实现变革，就必须正视我们集体的“沉默”。护士在面对冲突时倾向于回避、迁就或妥协的情况也必须改变。表达护理方面的关切本身就成为追求卓越的呼声，而那些不愿改变的人最好被排除在外。尽管所有这些都很困难，但并不比我们现在工作的非疗愈环境更困难，而且至少有望带来更积极的结果。
