PHOTOFUSION
ALAMY
Habitat and health: why place matters In their second article on the social sciences, nursing lecturers Richard Kyle and Iain Atherton consider the importance of place in people’s lives
SUMMARY
What on earth has geography got to do with nursing? It is a question we have both been asked from time to time. Bear with us. We have spent much of our working lives thinking about how ideas and insights from geography can be applied to nursing. Thinking about place and space can be useful for the care you provide as a nurse. When you think of geography you may well think back to your Each of us is shaped by the places we spend our lives in. Thinking about your patients in their geographical context – their biogeography – can enable more holistic care. Authors Iain Atherton and Richard Kyle are lecturers in nursing in the school of nursing, midwifery and health at the University of Stirling’s Highland Campus, Inverness
24 september 17 :: vol 29 no 3 :: 2014
school days, and field trips that encouraged you to look at your local area slightly differently. You may also have a hazy memory that geography has two main branches: physical geography, which seeks to understand the features of the natural environment around us and the processes through which they came to be; and human geography, which has at its heart a concern for the interrelationship of people and place – how people shape places, and how places shape people. Counted among the many fields of human geography sits health geography. Among other things, health geographers are interested in how people’s experiences of health and illness, health outcomes and behaviours are shaped by the places where they live, and, conversely, how those places shape the health and wellbeing of
individuals, communities and society at large. Traditionally, biogeography has been a branch of physical geography, interested in the interactions between plants and animals and their wider environment. More recently, cultural geographers Hayden Lorimer and Merle Patchett have used the term to think about how life (biography), interacts with place (geography). Thinking biogeographically, then, is about recognising that the place an individual inhabits has quite likely influenced their life choices and chances as well as their health and wellbeing. The idea can perhaps be summarised in a single phrase: place matters.
Two questions
Putting patients at the centre of their care requires us to understand that place is at the heart of patients’ lives. Through two questions – Where do you live? What places are important to you? – nurses should be able to reveal aspects of patients’ lives
NURSING STANDARD
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trigger an explicit engagement with wider issues such as the effects of poverty. That concern for the wellbeing of others sparks a spirit of engagement.
Real life
The gap between theory and practice causes many of us concern. By bringing ideas from geography together with the practice of nursing, it ensures that theory is made applicable to real life. Research is made relevant and enjoyable, kindling an ongoing spirit of enquiry. We hope this article has inspired you to take geographical ideas further. Perhaps you could spend some time thinking or even writing about your own life story. Chart your own biogeography, and think about how the interplay between you and your place BIOGEOGRAPHY HELPS US changed you. You may then UNDERSTAND THAT PLACE IS want to apply AT THE HEART OF PATIENTS’ LIVES this approach in your nursing practice – to discharge planning, shaped by the places where they to care planning, or even to casual have lived, which may have closed conversations with patients. Think off health opportunities or even about the new connections you been harmful. make that can help you understand In such thinking, simplistic your patients’ situation holistically labels might be challenged or recognise new opportunities and subconscious judgement to provide person-centred, and suspended, enhancing place-centred care NS a continual spirit of empathy. In our experience, nursing The previous article in this series students and qualified nurses alike is free to access on our website. care deeply about social justice. Please go to tinyurl.com/p68t49p Thinking biogeographically can
PHOTOFUSION
PHOTOFUSION
that would otherwise be hidden from view, but which are crucial to care and recovery. For an example of how this can work, see the case study (right) where we again meet Bill, the patient with coronary obstructive pulmonary disease (COPD) who appeared in our first article (Learn to see patients in their own world, Nursing Standard, August 13). We believe that thinking biogeographically can also release three spirits that are vital for nurses: spirit of empathy; spirit of engagement; and spirit of enquiry. Amid the pressures of practice, it is all too easy to slip into thinking that patients are solely responsible for the situation they find themselves in. Thinking biogeographically allows us to consider how individuals have been
CASE STUDY: IS BILL READY TO LEAVE? Bill is a patient with COPD who has been on your ward for a few days after the latest in a series of exacerbations of his condition that have led to several readmissions over the past year. You sit down with Bill to discuss his discharge – and this time, you ask a couple of geographical questions. Where does Bill live? Where Bill lives is important for his recovery. It may, in fact, be contributing to his repeat admissions. It is possible that Bill’s COPD is being exacerbated by his living conditions or the environment around him (for example, exhaust fumes). Or it could be that his opportunities to engage in exercise are constrained because parks to walk in are too far away, or local leisure facilities are too expensive. Opening up conversations about where Bill lives may also reveal his social and family networks, and the attitudes of those close to him which may be beneficial or detrimental to his recovery. What places are important to Bill? Getting to a local church group each week may be an important part of Bill’s social life, and the walk to the bus stop the only real regular exercise he can manage. But now he is anxious about his ability to continue with these activities. You can provide encouragement and reassurance. Conversely, it may be that Bill spends a lot of time at his local pub with friends who smoke and finds it difficult not to smoke when around them. You can provide education and signpost him to appropriate smoking cessation support.
NURSING STANDARD september 17 :: vol 29 no 3 :: 2014 25 Downloaded from RCNi.com by ${individualUser.displayName} on Sep 12, 2016. For personal use only. No other uses without permission. Copyright © 2016 RCNi Ltd. All rights reserved.
ALAMY
Habitat and health: why place matters In their second article on the social sciences, nursing lecturers Richard Kyle and Iain Atherton consider the importance of place in people’s lives
SUMMARY
What on earth has geography got to do with nursing? It is a question we have both been asked from time to time. Bear with us. We have spent much of our working lives thinking about how ideas and insights from geography can be applied to nursing. Thinking about place and space can be useful for the care you provide as a nurse. When you think of geography you may well think back to your Each of us is shaped by the places we spend our lives in. Thinking about your patients in their geographical context – their biogeography – can enable more holistic care. Authors Iain Atherton and Richard Kyle are lecturers in nursing in the school of nursing, midwifery and health at the University of Stirling’s Highland Campus, Inverness
24 september 17 :: vol 29 no 3 :: 2014
school days, and field trips that encouraged you to look at your local area slightly differently. You may also have a hazy memory that geography has two main branches: physical geography, which seeks to understand the features of the natural environment around us and the processes through which they came to be; and human geography, which has at its heart a concern for the interrelationship of people and place – how people shape places, and how places shape people. Counted among the many fields of human geography sits health geography. Among other things, health geographers are interested in how people’s experiences of health and illness, health outcomes and behaviours are shaped by the places where they live, and, conversely, how those places shape the health and wellbeing of
individuals, communities and society at large. Traditionally, biogeography has been a branch of physical geography, interested in the interactions between plants and animals and their wider environment. More recently, cultural geographers Hayden Lorimer and Merle Patchett have used the term to think about how life (biography), interacts with place (geography). Thinking biogeographically, then, is about recognising that the place an individual inhabits has quite likely influenced their life choices and chances as well as their health and wellbeing. The idea can perhaps be summarised in a single phrase: place matters.
Two questions
Putting patients at the centre of their care requires us to understand that place is at the heart of patients’ lives. Through two questions – Where do you live? What places are important to you? – nurses should be able to reveal aspects of patients’ lives
NURSING STANDARD
Downloaded from RCNi.com by ${individualUser.displayName} on Sep 12, 2016. For personal use only. No other uses without permission. Copyright © 2016 RCNi Ltd. All rights reserved.
trigger an explicit engagement with wider issues such as the effects of poverty. That concern for the wellbeing of others sparks a spirit of engagement.
Real life
The gap between theory and practice causes many of us concern. By bringing ideas from geography together with the practice of nursing, it ensures that theory is made applicable to real life. Research is made relevant and enjoyable, kindling an ongoing spirit of enquiry. We hope this article has inspired you to take geographical ideas further. Perhaps you could spend some time thinking or even writing about your own life story. Chart your own biogeography, and think about how the interplay between you and your place BIOGEOGRAPHY HELPS US changed you. You may then UNDERSTAND THAT PLACE IS want to apply AT THE HEART OF PATIENTS’ LIVES this approach in your nursing practice – to discharge planning, shaped by the places where they to care planning, or even to casual have lived, which may have closed conversations with patients. Think off health opportunities or even about the new connections you been harmful. make that can help you understand In such thinking, simplistic your patients’ situation holistically labels might be challenged or recognise new opportunities and subconscious judgement to provide person-centred, and suspended, enhancing place-centred care NS a continual spirit of empathy. In our experience, nursing The previous article in this series students and qualified nurses alike is free to access on our website. care deeply about social justice. Please go to tinyurl.com/p68t49p Thinking biogeographically can
PHOTOFUSION
PHOTOFUSION
that would otherwise be hidden from view, but which are crucial to care and recovery. For an example of how this can work, see the case study (right) where we again meet Bill, the patient with coronary obstructive pulmonary disease (COPD) who appeared in our first article (Learn to see patients in their own world, Nursing Standard, August 13). We believe that thinking biogeographically can also release three spirits that are vital for nurses: spirit of empathy; spirit of engagement; and spirit of enquiry. Amid the pressures of practice, it is all too easy to slip into thinking that patients are solely responsible for the situation they find themselves in. Thinking biogeographically allows us to consider how individuals have been
CASE STUDY: IS BILL READY TO LEAVE? Bill is a patient with COPD who has been on your ward for a few days after the latest in a series of exacerbations of his condition that have led to several readmissions over the past year. You sit down with Bill to discuss his discharge – and this time, you ask a couple of geographical questions. Where does Bill live? Where Bill lives is important for his recovery. It may, in fact, be contributing to his repeat admissions. It is possible that Bill’s COPD is being exacerbated by his living conditions or the environment around him (for example, exhaust fumes). Or it could be that his opportunities to engage in exercise are constrained because parks to walk in are too far away, or local leisure facilities are too expensive. Opening up conversations about where Bill lives may also reveal his social and family networks, and the attitudes of those close to him which may be beneficial or detrimental to his recovery. What places are important to Bill? Getting to a local church group each week may be an important part of Bill’s social life, and the walk to the bus stop the only real regular exercise he can manage. But now he is anxious about his ability to continue with these activities. You can provide encouragement and reassurance. Conversely, it may be that Bill spends a lot of time at his local pub with friends who smoke and finds it difficult not to smoke when around them. You can provide education and signpost him to appropriate smoking cessation support.
NURSING STANDARD september 17 :: vol 29 no 3 :: 2014 25 Downloaded from RCNi.com by ${individualUser.displayName} on Sep 12, 2016. For personal use only. No other uses without permission. Copyright © 2016 RCNi Ltd. All rights reserved.
