title: Rethinking the intensive care environment: considering nature in nursing practice.
abstract: OBJECTIVE
  With consideration of an environmental concept, this paper explores evidence related to the negative impacts of the intensive care unit environment on patient outcomes and explores the potential counteracting benefits of 'nature-based' nursing interventions as a way to improve care outcomes.
  
  
  BACKGROUND
  The impact of the environment in which a patient is nursed has long been recognised as one determinant in patient outcomes. Whilst the contemporary intensive care unit environment contains many features that support the provision of the intensive therapies the patient requires, it can also be detrimental, especially for long-stay patients.
  
  
  METHODS
  This narrative review considers theoretical and evidence-based literature that supports the adoption of nature-based nursing interventions in intensive care units.
  
  
  METHODS
  Research and theoretical literature from a diverse range of disciplines including nursing, medicine, psychology, architecture and environmental science were considered in relation to patient outcomes and intensive care nursing practice.
  
  
  CONCLUSIONS
  There are many nature-based interventions that intensive care unit nurses can implement into their nursing practice to counteract environmental stressors. These interventions can also improve the environment for patients' families and nurses.
  
  
  CONCLUSIONS
  Intensive care unit nurses must actively consider and manage the environment in which nursing occurs to facilitate the best patient outcomes.
authors.affiliation: School of Nursing, Massey University, Palmerston North, New Zealand.
authors.forename: Claire
authors.initials: C
authors.lastname: Minton
authors.affiliation: Research Centre for Maori Health and Development, Palmerston North, New Zealand.
authors.forename: Lesley
authors.initials: L
authors.lastname: Batten
mesh_terms: D003422:Critical Care / Q000523:psychology*; D064648:Critical Care Nursing; D006749:Hospital Design and Construction; D006801:Humans; D007362:Intensive Care Units; D009741:Nursing Staff, Hospital / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: ICU environment; biophilia hypothesis; nature; patient outcomes; stress