Florence Nightingale's Nursing Theory PDF

# Theorists on Nursing Theory ## 1. Florence Nightingale (1860) - Also known as The Lady with the Lamp. - Born on May 12, 1820 in Florence, Italy. - Nursing Education: Trained in Kaiserwerth, Germany at a Protestant religious community with a hospital and after 3 months she was declared trained as...

# Theorists on Nursing Theory ## 1. Florence Nightingale (1860) - Also known as The Lady with the Lamp. - Born on May 12, 1820 in Florence, Italy. - Nursing Education: Trained in Kaiserwerth, Germany at a Protestant religious community with a hospital and after 3 months she was declared trained as a nurse (1851). - One day she visited a hospital and that CHANGED HER LIFE. - Defined nursing as: "the act of utilizing the environment of the patient to assist him in his recovery", that involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health, and that external factors associated with the patient's surroundings affect life or biologic and physiologic processes, and his development. - **Hospitals in 1830's** - Often people who went into hospital died - They were Dirty - Badly run - Nurses didn't know what to do - Turned down several offers of marriage to pursue her career. - Harry Nicolson - Richard Monckton Milnes - Harry Verney - **Crimean War** - Broke out when Florence was 34 years old - War Russia vs Turkey (Britain and France) - Reports were coming through about terrible conditions in hospitals - Florence left London with 38 nurses - **Scutari Barrack Hospital** - Mortality rate at the hospital was 42.7% of those treated - Mortality rate dropped to 2.2% - She got to work - Scrubbed the floors - Cleaned the wards - Washed the bedclothes - Made the men comfortable - In the night she carried a lamp, so she was called "The Lady with the Lamp" - Soldiers kissed her shadow - They began to get better - Sitting up, cheerful and happier. - **Letter from Queen Victoria to "Miss Nightingale and her ladies" for all their hard work.** - **Notes on Nursing: What it is and What it is Not was a book first published by Florence Nightingale in 1859.** - "On the purpose of nursing." "...the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet- all at the least expense of vital power to the patient” - "On the empowering partnership with clients in the community.” “We must not talk to them or at them but with them" ## **Origins of Nightingale's Theory for Nursing Practice** - Prolific writer. - Her ideas, values, and beliefs on a wide range of topics can be identified in her documents. - In 1859, she was the first to conceptualize nursing work into a theoretical framework. ## **Assumptions of Florence Nightingale's Theory:** 1. **Law - "thoughts of God"** - This is reflective of Nightingale's profound belief in God. She defined a law as "the thought of God" and discussed the predictability of nature. 2. **Natural laws** - Natural Laws are universal natural laws that govern the ways in which the world works. 3. **Mankind can achieve perfection** - Mankind can achieve perfection relates to her strongly held beliefs in self-determination, in self-realization, and that ultimately, mankind does seek self-perfection, which means perfect health. The route to perfection is through strict adherence to the natural laws. - The role of the nurse was to alter the environment in such a way as to obey the natural laws, and thus provide the environment in which perfection might be achieved. 4. **Nursing is a calling** - She defined a calling as doing work in such a way as to do what is right and best. 5. **Nursing is an art and a science** - By identifying nursing as having components of art and science, she provides the profession with the expectation that nursing will be practiced by educated individuals using current research and methods as well as compassion and common logic. 6. **Nursing is achieved through environmental alteration** - Environmental alteration-see canons (which are laws or rules). ## **Nightingale's Canons** | Canons | Major Concepts | |---|---| | Ventilation and Warming | Physical Environment | | Light, noise | | Cleanliness of rooms/wall | | Health of houses | | Bed and bedding | | Personal cleanliness | Psychological Environment| | Chattering hopes and advices | | Taking food | Nutritional Status | | Petty management/observation | Nursing Care Plan & Management | 7. **Nursing requires a specific educational base** - Nursing cannot be taught by books alone. Nurses need a combination of clinical and theoretical training. ## **8. Nursing is distinct and separate from medicine** - Although the physician and nurse may deal with the same population, nursing is not to be viewed as subservient to medicine, as the purposes of the two are distinctly different. - Nursing's focus is on caring through environmental alteration, whereas medicine's focus is cure of the disease. - Nursing and medicine are most effective when working in a collaborative manner. ## **ENVIRONMENTAL THEORY: Major Concepts and Definitions** - **Environment** - concepts of ventilation, warmth, light, diet, cleanliness and noise. - She focused on the physical aspects of the environment. - She believed that "Healthy surroundings were necessary for proper nursing care." - She stated that “Nursing is an act of utilizing the environment of the patient to assist him in his recovery"  _"Configure external factors associated with the patient's surroundings that affect life or biologic and physiologic processes, and his development."_ ## **5 Essential Components of a Healthy Environment:** 1. **Pure fresh air** - "to keep the air he breathes as pure as the external air without chilling him. " 2. **Pure water** - "well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer. " 3. **Effective drainage** - "all the while the sewer may be nothing but a laboratory from which epidemic disease and ill health is being installed into the house." 4. **Cleanliness** - "the greater part of nursing consists in preserving cleanliness. " 5. **Light (especially direct sunlight)** - "the usefulness of light in treating disease is very important. " - Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status. - The factors posed great significance during Nightingale's time, when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients. ## **How are the issues public hospitals now?** - Pure Water? - Pure fresh air? - Effective drainage - Light? - Control of noise? ## **FIVE MAJOR COMPONENTS OF A HEALING ENVIRONMENT** 1. Ventilation 2. Light 3. Warmth 4. Control noise 5. Control odor - Also emphasized in her environmental theory is the provision of a quiet or noise-free and warm environment, attending to patient's dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient. - Nightingale's theory was shown to be applicable during the Crimean War when she, along with other nurses she had trained, took care of injured soldiers by attending to their immediate needs, when communicable diseases and rapid spread of infections were rampant in this early period in the development of disease-capable medicines. - The practice of environment configuration according to patient's health or disease condition is still applied today, in such cases as patients infected with Clostridium tetani (suffering from tetanus), who need minimal noise to calm them and a quiet environment to prevent seizure-causing stimulus. ## **Concerns of Environmental Theory** - **Proper ventilation** focuses on the architectural aspect of the hospital. - **Light has quite as real and tangible effects to the body.** Her nursing intervention includes direct exposure to sunlight. - **Cleanliness and sanitation.** She assumes that dirty environment was the source of infection and rejected the "germ theory". Her nursing interventions focus on proper handling and disposal of bodily secretions and sewage, frequent bathing for patients and nurses, clean clothing and handwashing. - **Warmth, diet and quiet environment.** She introduced the manipulation of the environment for patient's adaptation such as fire, opening the windows and repositioning the room seasonally, etc. - **Unnecessary noise is not healthy for recuperating patients.** - **Dietary intake.** - **Petty management** proposed the avoidance of psychological harm, no upsetting news. Strictly war issues and concerns should not be discussed inside the hospital. - She includes the use of small pets of psychological therapy. ## **NITHANGLE'S NURSING METAPARADIGM** - **Nursing** - Nursing is different from medicine and the goal of nursing is to place the patient in the best possible condition for nature to act. - Nursing is the "activities that promote health (as outlined in canons) which occur in any caregiving situation. They can be done by anyone." - Major component of nursing: manipulation of physical environment - Nursing "ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of vital power to the patient." - **Person** - People are multidimensional, composed of biological, psychological, social and spiritual components. - The patient is the focus of the environmental theory. The nurse should perform the task for the patient and control the environment for easy recovery. She practices nurse-patient passive relationship. - **Health** - Health is "not only to be well, but to be able to use well every power we have". - A healthy body can recuperate and undergo reparative process. - Environmental control uplifts maintenance of health. - Disease is considered as dysease or the absence of comfort. - **Six D's of Dys-ease:** - Dirt - Drink - Diet - Damp - Draughts - Drains - **balance between human and his/her environment** - **being well and using every power (resource) to the fullest extent in living life** - **disease and illness** – reparative process that nature instituted when a person did not attend to health concerns - **health maintenance through prevention of disease via environmental control and social responsibility** - **Environment** - Major areas of environment that can be controlled by the nurse: - health of houses - presence of pure air - pure water - efficient drainage - **light** - light - direct sunlight - purifying effect of direct sunlight upon room air - **ventilation and warming** - breathe air that is as pure as external air; without chilling - source of the air in the patient's room - proper room temperature - patient's body temperature - can harm the patient - **bed and bedding** - Bed should be placed in the lightest part of the room and placed so the patient could see out a window. - Care giver should never lean against, sit upon, or unnecessarily shake the bed of a patient. - clean, neat, and dry - positioning the patient for maximum comfort - **variety** - need for changing color and form - reading, needlework, writing and cleaning as activities to relieve boredom - **cleanliness** - personal (patient, nurse) - physical environment - dirty environment as source of infection - **nutrition** - dietary intake - variety of food - no distraction while eating - right food brought at the right time - **chattering hopes and advices** - False hope can be depressing. - Heed what is being said; sick persons should hear good news. - **Logical Form** - She used inductive reasoning from her experiences and observation which is addressed with logical thinking and philosophy. ## **Importance of Environmental Theory** 1. **Practice** - Disease control - Sanitation and water treatment - Utilized modern architecture in the prevention of "sick building syndrome" applying the principles of ventilation and good lighting. - Waste disposal - Control of room temperature. - Noise management. 2. **Education** - Principles of nursing training. Better practice result from better education. - Skills measurement through licensing by the use of testing methods, the case studies. 3. **Research** - Use of graphical representations like the polar diagrams. - Notes on nursing. 4. **Critique** - Simplicity - simple and logical; tends toward description and explanation rather than prediction - Generality - provides general guidelines for all nurses - Empirical Precision – Little or no provision is made for empirical examination; individual observation rather than systematic research - Derivable Consequences – to extraordinary degree, direct the nurse to action on behalf of patient and herself; These directives encompass the areas of practice, research and education