Nightingale's Contributions to Nursing

Nightingale's Contributions

Infection control: Emphasized cleanliness in hospitals, including top-to-bottom cleaning, clean sheets, and proper hygiene.
Self-care: Encouraged patients to care for themselves to promote healing and independence.
Assessment: Stressed assessing patients and their condition.
Therapeutic Communication: Advocated for offering patients empathy and compassion during rounds and interacting with them to develop care plans.
Spiritual Nursing: Provided comfort to patients nearing death.
Public Health Advocacy: Wrote a report proposing hospital reform and advocated for health teachings in the community.

Nightingale's 12 Canons

Ventilation and Warming: Emphasized the importance of pure air for patients, balanced heating, and an appropriate room temperature to prevent chilling.
Health of Houses: Emphasized the importance of environmental factors and their impact on health, including cleanliness.
Light: Stated that direct sunlight has tangible effects on patients and can help improve their prognosis.
Noise: Recommended assessment and elimination of different types of noise.
Bed and Bedding: Emphasized the importance of a clean bed and sheets to prevent infection.
Taking of food and Type of Food: Highlighted the importance of providing proper food for patients, taking into account their nutritional needs and condition.

How Nightingale's Theory is Applied Today

Turning Patients: Patients are turned regularly in bed for comfort.
Limited Staff in Rooms: Staff numbers are limited in patient rooms to create a less crowded and more conducive environment.
Blinds Opened: Blinds are opened to help wake patients and encourage movement and activity.
Flowers Encouraged: Flowers are encouraged from guests (when allowed) to show care and promote healing.
Trips Outside and Activities: Long-term facilities provide trips outside and create activities for residents.
Handwashing: Handwashing remains a critical hygiene practice for healthcare providers.

Sleep Pattern Diagnosis and Planning

Diagnosis: Impaired sleep pattern due to environmental light and separation from family.
Planning and Implementation: Nursing actions focus on modifying the environment to support a more normal sleep pattern with wakefulness during the day and sleep at night.
Evaluation: After two nights of uninterrupted sleep, normal sounds, and parental encouragement, the patient should demonstrate increased orientation to their location, being able to identify that they are in the hospital.

Judgements in Patient Care

Clinical Judgement: Nurses use clinical judgement to make sound decisions by differentiating between fact and assumption and relating it to cause and effect.
Sound Judgement: Sound judgement develops from disciplined functioning of the mind and emotions and improves with expanded knowledge and increased clarity of professional purpose.

Basis of Nightingale's Theory

Central Purpose: Nurses recognize the essential tasks necessary for their specific discipline.
Prescription: The fulfillments of the central purpose.
Realities: Immediate situations influence the central purpose.

Virginia Henderson's Need Theory

Focus: Emphasizes increasing patient independence and focusing on basic human needs to prevent delays in post-hospitalization progress.
Nursing's Role: Believes nursing is independent and involves acting for patients who lack knowledge, physical strength, or willpower, helping them regain their ability to act for themselves as they would ordinarily in health.

Assumptions of Henderson's Need Theory

Patient Care Until Independence: Nurses care for patients until they can care for themselves again.
Desire for Health: Patients desire to return to health.
Service and Devotion: Nurses are willing to serve and will devote themselves to patients day and night.
Mind-Body Connection: Henderson believes the mind and body are inseparable and interrelated.

Major Concepts of Henderson's Need Theory

Individual: Considered anyone requiring nursing care, not limited to those with illnesses.
Health: Viewed health as a balance in all realms of human life, considering the family and patient as a unit.
Environment: The aggregate of all external conditions and influences affecting life and development.
Nursing: Defined nursing as a function rather than a discipline.

Metaparadigm in Henderson's Theory

Individual: Possesses basic needs that are components of health, requiring assistance to achieve health, independence, or a peaceful death. Mind and body are seen as inseparable and interconnected. Includes biological, physiological, sociological, and spiritual components.
Environment: Settings in which individuals learn unique patterns for living, with relationships to families, providing conducive conditions.
Health: Good health is challenged by age, cultural background, and requires an emphasis on health promotion, prevention, and care. Based on the individual's ability to function independently.

Application of Henderson's Need Theory in Practice

Assessment: Nurses assess patients based on the 14 components of basic nursing care.
Nursing Diagnosis: Nursing diagnoses identify the patient's ability to meet their own needs.
Nursing Plan: Documents how nurses can assist individuals, both sick and well.
Implementation: Nurses align interventions with the 14 basic needs.
Evaluation: Nurses evaluate the effectiveness of care in meeting the goals related to those needs.

Faye Glenn Abdellah's Needs Theory

Shift in Focus: Abdellah's theory shifted nursing's focus from disease-centered to patient-centered care.
Typology of Nursing Problems: Created a typology of 21 nursing problems to promote professional status and autonomy in nursing.
Problem-Solving Approach: Used a problem-solving approach as the basis for her typology.

Abdellah's Typology of 21 Nursing Problems

Basic to All Patients: Focuses on maintaining hygiene; promoting optimal activity, exercise, rest, and sleep; ensuring safety through the prevention of accidents, injuries, and infection; and maintaining good body mechanics to prevent and correct deformities.
Sustenance Care Needs: Emphasizes facilitating oxygen supply to body cells (as ordered by a doctor); facilitating the maintenance of nutrition; facilitating the maintenance of elimination; facilitating the maintenance of fluid and electrolyte balance; recognizing physiological responses to disease conditions; facilitating the maintenance of regulatory mechanisms and functions; and facilitating the maintenance of sensory functions.
Remedial Care Needs: Focuses on identifying and accepting positive and negative reactions from the patient; identifying and accepting the interrelatedness of emotions and organic illness, encouraging the verbalization of feelings and release of tension; facilitating effective verbal and nonverbal communication; promoting healthy interpersonal relationships; facilitating progress towards personal and spiritual goals; creating and maintaining a therapeutic environment; and facilitating self-awareness and the understanding of varying physical, emotional, and developmental needs.
Restorative Care Needs: Emphasizes accepting the optimum possible goals given limitations, both physical and emotional; utilizing community resources to aid in resolving problems arising from illness; and understanding the role of social problems as influential factors in the cause of illness.

Metaparadigm in Abdellah's Theory

People/Patients: Have physical, emotional, and social needs. Emphasis is on prevention and rehabilitation. Overt needs are those that are visible, while covert needs may be hidden.

Dorothy Johnson's Behavioral Systems Model

Foundation: Advocates for fostering a patient's behavioral system.
Patient as System: Defines the patient as a behavior system composed of seven subsystems.

Nursing in Johnson's Theory

External Regulatory Force: Nursing is seen as an external regulatory force that preserves the organization and integration of patients' behaviors at an optimal level, especially when those behaviors pose a threat to physical or social health or when illness is present.

Goals of Nursing Within Johnson's Model

Adherence to Social Demands: Assisting patients whose behavior aligns with social demands.
Behavior Modification for Biological Needs: Helping patients modify their behavior in ways that support biological needs.
Benefit from Physician Knowledge and Skills: Assisting patients to benefit to the fullest extent from physician knowledge and skills during illness.
Prevention of Trauma: Assisting patients whose behavior does not show evidence of unnecessary trauma as a consequence of illness.

Purposes of Johnson's Model

Balance Between Client and Environment: Nurses work to create a balance between the client and the environment.
Protection from Threats: Providing protection from noxious stimuli that threaten the survival of the behavioral system.
Nurturance for Sustainability: Offering adequate nurturance to sustain behavior.
Stimulation of Growth: Encouraging the continued growth of the behavioral system.

Assumptions Behind Johnson's Model

Interdependency of Behaviors: The behaviors that make up a patient's system are organized, interdependent, and integrated.
System Balance: The system aims to achieve balance among the forces operating within and upon it.
Behavioral System Regularity: Behavioral systems require and produce regularity in behavior, essential for human functioning.
System Balance and Adaptation: System balance reflects successful adjustments and adaptations.

Subsystems in Johnson's Behavioral Systems Model

Attachment or Affiliative Subsystem: Focuses on social inclusion, intimacy, and forming strong social bonds to ensure survival and security.
Dependency Subsystem: This subsystem involves relying on others for care, support, and protection.
Ingestive Subsystem: Relates to food intake, eating behaviors, and related activities.
Eliminative Subsystem: Deals with excretory functions and related behaviors.
Sexual Subsystem: Encompasses sexual behaviors and the need for sexual expression.
Aggressive Subsystem: Covers behaviors related to asserting oneself, defending against threats, and expressing anger.
Achievement Subsystem: Concerns activities and behaviors aimed at achieving goals and fulfilling one's potential.