Florence Nightingale's Environmental Theory PDF

**TFN NOTES WEEK 4 AND 5** **WEEK 4** **FLORENCE NIGHTINGALE'S ENVIRONMENTAL THEORY** **FLORENCE NIGHTINGALE** - known as the founder of modern nursing, revolutionized the field with her environmental theory. **FLORENCE NIGHTINGALE'S BACKGROUND AND CONTRIBUTIONS** **EARLY LIFE** - Bor...

**TFN NOTES WEEK 4 AND 5** **WEEK 4** **FLORENCE NIGHTINGALE'S ENVIRONMENTAL THEORY** **FLORENCE NIGHTINGALE** - known as the founder of modern nursing, revolutionized the field with her environmental theory. **FLORENCE NIGHTINGALE'S BACKGROUND AND CONTRIBUTIONS** **EARLY LIFE** - Born in Italy in 1820, Nightingale defied societal expectations and pursued her passion for nursing. **THE CRIMEAN WAR** - Nightingale gained recognition for her work in improving sanitary conditions and reducing mortality rates in military hospitals during the war. **PIONEERING REFORMS** - She established the first professional training school for nurses and advocated for better healthcare practices. **THE ENVIRONMENTAL THEORY** - Nightingale\'s theory emphasizes the impact of the environment on a patient\'s healing process. It focuses on the essential elements of clean air, pure water, efficient drainage, cleanliness, and light. **KEY PRINCIPLES OF THE ENVIRONMENTAL THEORY** **SANITATION** - Creating a clean and hygienic environment to prevent the spread of diseases and infections. **PROPER VENTILATION** - Ensuring sufficient fresh air to promote respiratory health and reduce the risk of airborne pathogens. **NATURAL LIGHT** - Utilizing natural light to positively impact mood, circadian rhythms, and overall well-being. **NOISE CONTROL** - Minimizing noise disturbances to ensure a peaceful and healing environment for patients. **MAJOR ASSUMPTIONS** **NURSING** - Nightingale believed that every woman, at one time in her life, would be a nurse in the sense that nursing is being responsible for someone else's health **HEALTH** - Nightingale defined health as being well and using every power (resource) to the fullest extent in living life. Additionally, she saw disease and illness as a reparative process that nature instituted when a person did not attend to health concerns. **PERSON** - In most of her writings, Nightingale referred to the person as a patient. Nurses performed tasks to and for the patient and controlled the patient's environment to enhance recovery. **ENVIRONMENT** - Nightingale's concept of environment emphasized that nursing was "to assist nature in healing the patient. **APPLICATION OF THE ENVIRONMENTAL THEORY IN NURSING PRACTICE** **CREATING HEALING SPACES** - Nurses contribute to the healing process by designing patient rooms that promote relaxation and recovery. **INCORPORATING NATURE** - Nature-based interventions, such as gardens and green spaces, are integrated into healthcare settings to aid in patient healing and well-being. **NUTRITION AND NOURISHMENT** - Nightgale\'s theory highlights the importance of providing patients with nutritious meals to support their recovery and overall health. **EVIDENCE SUPPORTING THE EFFECTIVENESS OF THE ENVIRONMENTAL THEORY** **REDUCED INFECTIONS** - Studies have shown that implementing Nightingale\'s principles leads to a significant decrease in hospital-acquired infections. **ENHANCED PATIENT OUTCOMES** - Patients in environments adhering to the environmental theory have experienced improved recovery rates and overall well-being. **POSITIVE STAFF SATISFACTION** - Nurses working in environments aligned with the theory report higher job satisfaction and increased morale. **CRITIQUE OF THE ENVIRONMENTAL THEORY** **SUBJECTIVITY** - Some critics argue that the theory lacks scientific objectivity and fails to consider individual patient preferences. **EVOLUTION OF HEALTHCARE** - As healthcare practices and technologies evolve, it is important to adapt the theory to incorporate new advancements and changes. **CONCLUSION AND RELEVANCE OF THE ENVIRONMENTAL THEORY TODAY** - Although Nightingale\'s environmental theory has evolved over time, its principles remain highly relevant in modern nursing practice. Incorporating elements of the theory promotes better patient outcomes and enhances the overall healing environment. **JEAN WATSON'S PHILOSOPHY AND THEORY OF TRANSPERSONAL CARING** - An in-depth look at Jean Watson\'s influential theory of transpersonal caring in nursing practice, exploring key concepts, applications, criticisms, and future implications. **JEAN WATSON** - Jean Watson is a renowned nurse theorist and professor who developed the theory of transpersonal caring. She believes that nursing is an art and a science that encompasses compassionate care and holistic healing. **MAJOR ASSUMPTIONS** **NURSING** - According to Watson (1988), the word nurse is both noun and verb. To her, nursing consists of "knowledge, thought, values, philosophy, commitment, and action, with some degree of passion" Nurses are interested in understanding health, illness, and the human experience; promoting and restoring health; and preventing illness. **HEALTH** - She defined health as "unity and harmony within the mind, body, and soul"; associated with the "degree of congruence between the self as perceived and the self as experienced" (Watson, 1988) **PERSON** - Watson uses interchangeably the terms human being, person, life, personhood, and self. She views the person as "a unity of mind/body/spirit/nature" (1996), and she says that "personhood is tied to notions that one's soul possesses a body that is not confined by objective time and space..." **ENVIRONMENT** - She has a much broader view of the environment: "The caring science is not only for sustaining humanity but also for sustaining the planet... Belonging is to an infinite universal spirit world of nature and all living things; it is the primordial link of humanity and life itself, across time and space, boundaries and nationalities" **KEY CONCEPTS IN WATSON'S THEORY OF TRANSPERSONAL CARING** **CARING AS THE CENTRAL FOCUS** - Watson emphasizes the importance of engaging in caring relationships to promote healing and well-being. **THE TEN CARATIVE FACTORS** - These factors guide nurses in providing individualized care that considers the physical, emotional, and spiritual needs of patients. **THE TRANSPERSONAL CARING RELATIONSHIP** - This relationship is built on trust, empathy, and understanding, creating a healing atmosphere for both the patient and the nurse. **ORIGINAL 10 CARATIVE FACTORS** **FORMATION OF A HUMANISTIC ALTRUISTIC SYSTME OF VALUES** - Humanistic and altruistic values are learned early in life but can be influenced greatly by nurse educators. This factor can be defined as satisfaction through giving and extension of the sense of self **INSTILLATION OF FAITH-HOPE** - This factor, incorporating humanistic and altruistic values, facilitates the promotion of holistic nursing care and positive health within the patient population. It also describes the nurse's role in developing effective nurse-patient interrelationships and in promoting wellness by helping the patient adopt health-seeking behaviors **CULTIVATION OF SENSITIVITY TO SELF AND OTHERS** - The recognition of feelings leads to self-actualization through self-acceptance for both the nurse and patient. As nurses acknowledge their sensitivity and feelings, they become more genuine, authentic, and sensitive to others. **DEVELOPMENT OF A HELPING-TRUST RELATIONSHIP** - The development of a helping-trust relationship between the nurse and patient is crucial for transpersonal caring. A trusting relationship promotes and accepts the expression of both positive and negative feelings. **PROMOTION AND ACCEPTANCE OF THE EXPRESSION OF POSITIVE AND NEGATIVE FEELINGS** - The sharing of feelings is a risk-taking experience for both nurse and patient. The nurse must be prepared for either positive or negative feelings. - The nurse must recognize that intellectual and emotional understandings of a situation differ. **SYSTEMATIC USE OF THE SCIENTIFIC PROBLEM-SOLVING METHOD FOR DECISION MAKING** - Use of the nursing process brings a scientific problem-solving approach to nursing care, dispelling the traditional image of a nurse as the doctor's handmaiden. The nursing process is similar to the research process in that it is systematic and organized. **PROMOTION OF INTERPERSONAL TEACHING-LEARNING** - This factor is an important concept for nursing in that it separates caring from curing. It allows the patient to be informed and shifts the responsibility for wellness and health to the patient. The nurse facilitates this process with teaching-learning techniques that are designed to enable patients to provide self-care, determine personal needs, and provide opportunities for their personal growth **PROVISION FOR A SUPPORTIVE, PROTECTIVE, AND CORRECTIVE MENTAL, PHYSICAL, SOCIOCULTURAL, AND SPIRITUAL ENVIRONMENT** - Nurses must recognize the influence that internal and external environments have on the health and illness of individuals. Concepts relevant to the internal environment include the mental and spiritual well-being and sociocultural beliefs of an individual. **ASSISTANCE WITH GRATIFICATION OF HUMAN NEEDS** - The nurse recognizes the biophysical, psychophysical, psychosocial, and intrapersonal needs of self and patient. Patients must satisfy lower-order needs before attempting to attain higher-order needs. **ALLOWANCE FOR EXISTENTIAL-PHENOMENOLOGICAL FORCES** - Phenomenology describes data of the immediate situation that help people understand the phenomena in question. Existential psychology is a science of human existence that uses phenomenological analysis. **APPLICATION OF WATSON'S THEORY IN NURSING PRACTICE** **CREATING A HEALING ENVIRONMENT** - Nurses can create a healing environment by fostering a sense of safety, comfort, and tranquility for patients. **ENHANCING NURSE-PATIENT CONNECTIONS** - Nurses can establish meaningful connections through active listening, empathy, and genuine presence. **PROMOTING HOLISTIC CARE** - By considering all aspects of a patient\'s well-being - physical, emotional, social, and spiritual - nurses can provide comprehensive care. **CRITICISM AND LIMITATIONS OF WATSON'S THEORY** **ETHICAL CONCERNS** - Some argue that the theory\'s emphasis on subjective experiences may lead to biased care and neglect of objective medical evidence. **LACK OF EMPIRICAL EVIDENCE** - Critics argue that there is a lack of scientific research supporting the effectiveness of Watson\'s theory in improving patient outcomes. **FUTURE IMPLICATIONS AND RESEARCH IN TRANSPERSONAL CARING THEORY** **INCORPORATING TECHNOLOGY** - Exploring how technology can enhance and maintain the humanistic aspects of caring in a rapidly evolving healthcare landscape. **CULTURAL CONSIDERATIONS** - Further investigating how cultural values and beliefs influence the transpersonal caring relationship and tailoring care accordingly. **MARILYN RAY'S THEORY OF BUREAUCRATIC CARING** - Discover the visionary theory of Marilyn Anne Ray that revolutionizes the concept of caring in bureaucratic healthcare settings. **MARILYN ANNE RAY** - Marilyn Anne Ray is a renowned nursing scholar and author, best known for her groundbreaking Theory of Bureaucratic Caring. **BUREAUCRATIC CARING** - Bureaucratic Caring refers to the integration of attentive and caring practices within bureaucratic systems, transforming them into compassionate and empathetic environments. **KEY CONCEPTS IN MARILYN RAY'S THEORY** **AUTHENTIC PRESENCE** - Being fully engaged, attentive, and emotionally present in interactions with patients and colleagues. **ENABLEMENT** - Empowering individuals to make informed decisions and promoting their active participation in their own care. **CARING MOMENT** - A unique opportunity for authentic connection and shared understanding that enhances the healing process. **TRANSCENDENCE** - Embracing the human experience beyond illness or ailment, valuing the individual\'s journey. **MAJOR ASSUMPTIONS** **NURSING** - Nursing is holistic, relational, spiritual, and ethical caring that seeks the good of self and others in complex community, organizational, and bureaucratic cultures. **HEALTH** - Health provides a pattern of meaning for individuals, families, and communities. In all human societies, beliefs, and caring practices about illness and health are central features of culture. Health is not simply the consequence of a physical state of being. **PERSON** - A person is a spiritual and cultural being. Persons are created by God, the Mystery of Being, and they engage co-creatively in human organizational and transcultural relationships to find meaning and value **ENVIRONMENT** - Environment is a complex spiritual, ethical, ecological, and cultural phenomenon. This conceptualization environment embodies knowledge and conscience about the beauty of life forms and symbolic (representational) systems or patterns of meaning **APPLICATION IN HEALTHCARE SETTINGS** **PATIENT-CENTERED CARE** - Ensuring the well-being and satisfaction of patients by recognizing and addressing their individual needs and preferences. **EFFECTIVE COMMUNICATION** - Fostering open and transparent communication among healthcare professionals, patients, and their families. **COLLABORATIVE DECISION-MAKING** - Involving patients as partners in their own care and fostering shared decision-making processes. **BENEFITS OF IMPLEMENTING THE THEORY** **IMPROVED PATIENT SATISFACTION** - Enhanced patient experiences and increased satisfaction rates leading to improved healthcare outcomes. **ENHANCED EMPLOYEE ENGAGEMENT** - Increased job satisfaction, motivation, and overall well-being of healthcare professionals. **POSITIVE ORGANIZATIONAL CULTURE** - Promotion of a caring and compassionate work culture that positively impacts the overall organization. **CHALLENGES AND LIMITATIONS** **TIME CONSTRAINTS** - Allocating sufficient time for meaningful interactions and incorporating caring practices in busy healthcare settings. **RESISTANCE TO CHANGE** - Overcoming resistance to adopting new approaches and values within traditional bureaucratic systems. **EVALUATION AND MEASUREMENT** - Develop effective methods to evaluate and measure the implementation and impact of the theory. **SUCCESSFUL EXAMPLES OF UTILIZING THE THEORY** **HEALTHCARE ORGANIZATION A** - Implemented Bureaucratic Caring principles and witnessed improved patient outcomes and staff satisfaction. **NURSING EDUCATION PROGRAMS** - Integrating the theory into nursing curriculum, creating future caregivers equipped with compassionate skills. **RESEARCH INSTITUTIONS** - Conducting extensive studies to further explore the application and effectiveness of Marilyn Ray\'s Theory of Bureaucratic Caring. **CONCLUSION AND FUTURE DIRECTIONS** - As Marilyn Ray\'s Theory continues to gain recognition, it presents a promising avenue for transforming healthcare systems into compassionate and caring environments. Further research and implementation are needed to expand its impact worldwide. **WEEK 5** **PATRICIA BENNER: NOVICE TO EXPERT THEORY** - Introduced in 1984 - Explains how nurses develop skills and acquire clinical expertise over time. - Drawing from the Dreyfus Model of Skill Acquisition, Benner identifies five stages of nursing competence, focusing on the importance of experiential learning in clinical practice. - Offers a structured approach to understanding the progression of nursing skills and is widely used in both nursing education and practice. **MAJOR CONCEPTS AND DEFINITIONS** **NOVICE** - Ex. Student Nurses - Definition: Beginners with no experience in the clinical situations they are expected to perform. - Characteristics: Follows strict rules and guidelines, unable to exercise discretionary judgment. - 1^st^ level means zero experience **ADVANCED BEGINNER** - Ex. Fresh Graduates - Learner has enough real-world situations but still needs support - Definition: a nurse with some experience who begins to recognize patterns in clinical situations. - Characteristics: relies on guidelines but starts using experiences to handle recurring situations, though still needs support. **COMPETENT** - Ex. 3 years OR Nurse then change your department (Considered as a novice when it comes to another department/role) - Definition: A nurse with typically 2 to 3 years of experience in the same role. - Characteristics: Demonstrates efficiency, organized care, and can make decisions based on more comprehensive analysis of a situation. **PROFICIENT** - Ex. 3 to 5 years of experience - Definition: A nurse who perceives clinical situations in a holistic manner. - Characteristics: Uses intuition and experience to guide decision-making, anticipates needs, and focuses on long-term outcomes. **EXPERT** - "Takes 10 thousand practices before you perfect the skill." - Definition: A nurse with extensive experience who has an intuitive grasp of clinical situations without needing to rely on rules or guidelines. - Characteristics: Rapid, accurate decision-making with a deep understanding of patient needs and situations. **NURSING METAPARADIGM IN BENNER'S MODEL** **PERSON** - Both the patient and the nurse - Emphasizes the nurse's development as an individual, growing through experiences and interactions with patients. **HEALTH** - Understood not just in terms of the absence of disease but as the patient's lived experience. - Nurses at different levels of expertise interpret health differently, with experts focusing on the patient's holistic health rather than just treating symptoms. **SITUATION** - Benner and Wrubel (1989) use the term situation rather than environment because situation conveys a social environment with social definition and meaningfulness. - They use the phenomenological terms being situated and situated meaning, which are defined by the person's engaged interaction, interpretation, and understanding of the situation. **NURSING** - Practice-based profession that evolves around through experience. - Ability to provide effective care grows as nurses gain more experience, moving from rule-based care to intuitive, expert-level care. **APPLICATION TO NURSING THEORY** - Patricia Benner's Novice to Expert model provides a comprehensive understanding of how nurses develop expertise over time. - By emphasizing experiential learning and mentorship, the model outlines a clear path for the development of nursing competence. - This framework is essential for clinical practice, education, and leadership, helping to ensure that nurses provide high-quality care as they progress in their careers. **KARI MARTINSEN: PHILOSOPHY OF CARING** - Kari Martinsen is a Norwegian nurse and philosopher whose work focuses on the philosophy of care, emphasizing the moral, practical, and relational aspects of care. - Her philosophy revolves around the idea that care is fundamental not only to nursing but to life itself. She critiques modern healthcare's focus on efficiency and objectivity, advocating for a return to the moral foundation of care. **MAJOR CONCEPTS AND DEFINITIONS** **CARE** - Definition: The foundation of nursing and a fundamental precondition for life. Three Dimensions of Care: - *RELATIONAL --* care is about relationships between individuals. - *PRACTICAL --* care is rooted in actions and practices. - *MORAL --* care is a moral imperative directed outward, towards the other. **PROFESSIONAL JUDGMENT AND DISCERNMENT** - Concept: Judgment is learned through concrete clinical experiences and developed through professional practice. - Sensory and Moral: Involves the ability to "see, listen, and touch clinically in a good way." - Link to Perception: Perception in nursing is analog and subjective, involving the integration of professional knowledge and previous experience. **MORAL PRACTICE IS FOUNDED ON CARE** - Concept: Empathy and reflection must work together in moral practice. - Empathy and Reflection: Empathy is the foundation of moral action, and it involves recognizing what the patient needs most. **PERSON -- ORIENTED PROFESSIONALISM** - Focus: Person-oriented professionalism demands that nurses see the patient as a suffering person, protecting their integrity. - Engagement: Nurses must invest themselves in caring encounters, obligating themselves to do their best for the patient. **SOVEREIGN LIFE UTTERANCES** - Concept: These are pre-cultural phenomena fundamental to all societies, including openness, mercy, trust, hope, and love. - Relation to Care: Without these qualities, life disintegrates. Care helps to realize these utterances in both personal and professional interactions. - Caring Actions: Through caring actions, nurses can help patients experience love, trust, hope, and mercy. **THE UNTOUCHABLE ZONE** - Definition: A protective boundary that nurses must not cross in caring encounters, ensuring professionalism and impartiality. - Duality: While respecting this zone, care must also involve openness and vulnerability in appropriate ways. **VOCATION** - Concept: Vocation is a call to care for others, grounded in the law of neighborly love. - Professional and Personal Refinement: Nursing requires personal growth alongside professional knowledge. **THE EYE OF THE HEART** - Concept: Stemming from the parable of the Good Samaritan, the \"eye of the heart\" refers to the ability to be moved by the suffering of others. - Holistic Understanding: Seeing the patient with the \"eye of the heart\" combines perception and understanding. **THE REGISTERING EYE** - Definition: The registering eye is concerned with objectifying the patient and classifying clinical situations. - Critique: Martinsen warns that a one-sided focus on this perspective can remove compassion from nursing, reducing the patient\'s will to live. **NURSING METAPARADIGM** **NURSING** - Caring goes beyond nursing but is fundamental to it. True care involves relational, practical, and moral elements. **PERSON** - Individuals are shaped by their social and communal environments. A person cannot be separated from these contexts. **HEALTH** - Health is understood in both classical and modern terms, involving both the body's condition and medical competence. **ENVIRONMENT** - Space and situation are important in nursing. Time, architecture, and interactions create the ambiance of care. **APPLICATION TO NURSING THEORY** **PRACTICAL IMPLICATIONS** - Martinsen's philosophy emphasizes that nursing is not just a set of tasks, but a moral and relational practice. **EDUCATION** - Nurses must be trained not only in technical skills but also in moral discernment and empathetic care. **CLINICAL PRACTICE** - The philosophy of caring demands that nurses treat patients as whole persons, recognizing their dignity and suffering. **KATIE ERIKSSON: THEORY OF CARITATIVE CARING** - Overview: Katie Eriksson is a Finnish-Swedish nurse and theorist whose Theory of Caritative Caring is rooted in the idea of caring as a human science with a deep ethical and spiritual foundation. **MAJOR CONCEPTS AND DEFINITIONS** **CARITAS** - Love and charity; the foundation of caring. **CARING COMMUNION** - Deep, intimate connection that defines the caring reality. **THE ACT OF CARING** - Involves faith, hope, love, and creative actions. **CARITATIVE CARING ETHICS** - Distinction between caring ethics (moral relation with the patient) and nursing ethics (rules guiding nursing decisions). **DIGNITY** - Absolute and relative human dignity; respect for the patient's uniqueness. **INVITATION** - Welcoming the patient to the caring communion. **SUFFERING** - The ontological concept involving human struggle; three types: illness, care, and life. **RECONCILIATION** - Achieving peace and new wholeness after suffering. **CARING CULTURE** - The caring environment shaped by values, traditions, and rituals **NURSING METAPARADIGM** **HUMAN BEING** - Entity of body, soul, and spirit, fundamentally religious and striving for communion. **HEALTH** - Movement towards wholeness and holiness, involving a balance between suffering and health. **NURSING** - Love and charity, or Caritas, as the basic motive of caring has been found in Eriksson (1987b, 1990,2001) as a principal idea even in her early works **ENVIRONMENT** - Caring culture as a context of love, charity, and ethical interaction **APPLICATION TO NURSING THEORY** **CLINICAL PRACTICE** - Nurses are called to offer caritative care, focusing on alleviating suffering, preserving dignity, and supporting the patient's overall well-being. - The nurse-patient relationship is sacred and central to the healing process. **NURSING EDUCATION** - Nursing education should focus on developing nurses who embody Caritas---compassion, love, and mercy in their care. - Emphasizes the importance of ethical discernment, spiritual care, and the moral responsibility of caring. **CARING ETHICS** - Eriksson\'s theory provides a moral and ethical framework for nursing practice, where the nurse's role is to alleviate suffering through compassionate, dignified care. **HOLISTIC CARE** - Caritative caring integrates physical, mental, and spiritual care, ensuring that nursing addresses the whole person, not just their illness.