Introduction to Theory and Knowledge PDF

INTRODUCTION TO THEORY AND KNOWLEDGE Module I REGIE P. DE JESUS, RN, PhDNSc Faculty, College of Health Sciences  Nursing as a Profession An occupation is a job or a career, whereas a profession is a learned vocation or occupation that has a status of superior...

INTRODUCTION TO THEORY AND KNOWLEDGE Module I REGIE P. DE JESUS, RN, PhDNSc Faculty, College of Health Sciences  Nursing as a Profession An occupation is a job or a career, whereas a profession is a learned vocation or occupation that has a status of superiority Profession refers to specialized field of practice, which is founded upon the theoretical structure of the science or knowledge of that discipline and the accompanying practice abilities.  All professions are occupations, but not all occupations are professions (McEwen & Wills, 2019).  Characteristics of a Profession (1) defined and specialized knowledge base, (2) control and authority over training and education, (3) credentialing system or registration to ensure competence, (4) altruistic service to society, (5) a code of ethics,  (6) formal training within institutions of higher education, (7) lengthy socialization to the profession, and (8) autonomy (control of professional activities) (McEwen & Wills, 2019).  Nursing as an Academic Discipline Discipline is specific to academia and a branch of education, a department of learning or field of knowledge obeying code of behavior. Nursing’s knowledge base draws from many disciplines (physiology, sociology, psychology, and medicine)  Nursing Philosophy Nursing philosophy refers to the belief system or worldview of the profession and provides perspectives for practice, scholarship, and research (McEwen & Wills, 2019). A philosophy of nursing is a statement that outlines a nurse’s values, ethics, and beliefs, as well as their motivation for being part of the profession.  Nursing Science Nursing science is the development of theories and practical concepts for improving how clinicians and patients administer care and manage conditions. Nursing science is the application of hard sciences with a compassionate aim, and its innovations improve both patient wellbeing and caregiver response. Recent Advancement in Nursing TeleHealth Nursing Informatics Photovoice  Nursing as an Art The art of nursing is more than a great deal of science. It is more than just knowing; it is doing. (Jacobson, 2017). It is the application of all the science known to nursing to give the utmost care the pa It involves the use of compassionate, caring, conscientious, competence, and confidence.  Knowledge Development & Nursing Science Epistemology is the study of the theory of knowledge. Epistemologic questions include: – What do we know? – What is the extent of our knowledge? – How do we decide whether we know? and – What are the criteria of knowledge?  Ways of Knowing Empirics—the scientific form of knowing. Empirical knowledge comes from observation, testing, and replication (i.e. Empiricism) Personal knowledge—a priori knowledge. Personal knowledge pertains to knowledge gained from thought alone.  Ways of Knowing Intuitive knowledge—includes feelings and hunches. Intuitive knowledge is not guessing but relies on nonconscious pattern recognition and experience. Somatic knowledge—knowledge of the body in relation to physical movement. Somatic knowledge includes experiential use of muscles and balance to perform a physical task.  Ways of Knowing Metaphysical (spiritual) knowledge—seeking the presence of a higher power. Aspects of spiritual knowing include miracles, psychokinesis, extra-sensory perception, and near-death experiences. Esthetics—knowledge related to beauty, harmony, and expression. Esthetic knowledge incorporates art, creativity, and values.  Ways of Knowing Moral or ethical knowledge— knowledge of what is right and wrong. Values and social and cultural norms of behavior are components of ethical knowledge. Rationalism - It is the use of the rational senses (reason) in ensuring the truthfulness of a phenomenon  Research Methodology & Nursing Science Quantitative Methods vs Qualitative Methods The quantitative approach has been justified by its success in measuring, analyzing, replicating, and applying the knowledge gained Phenomenology and other methods of qualitative research arose because aspects of human values, culture, and relationships were unable to be described fully using quantitative research methods. Quantitative Methods vs Qualitative Methods It is generally accepted that qualitative research findings answer questions centered on social experience and give meaning to human life. It is repeatedly argued that both approaches are equally important and even essential for nursing science development known as Methodologic Pluralism Nursing as a Practice Science As an applied or practical science, nursing requires research that is applied and clinical and that generates and tests theories related to health of human beings within their environments as well as the actions and processes used by nurses in practice. Nursing as a Human Science Nursing discipline has examined issues related to behavior and culture, as well as biology and physiology Characteristics of Carper’s Patterns of Knowing in Nursing  My Nursing Philosophy I chose nursing as my profession because I truly believe that the desire to help people through nursing is a calling, and I feel drawn toward helping those in need. Nursing is an honorable career, and should not be treated as just a job to earn a paycheck. My mission is to proudly provide nonjudgmental care to those in need regardless of race, spiritual beliefs, lifestyle choices, financial status, or disability. My philosophy is that nurses have a responsibility to the public to provide safe, holistic, patient-centered care. I must remember that my patients are not room numbers or medical conditions, but individuals that require and deserve individualized attention and care. Nurses should use clinical judgment to help meet the needs of the patient. As advocates, I should empower patients by encouraging them to become active partners in their own care and engage in mutual goal-setting between ourselves and the patient. I must educate patients and their families on diseases, treatments, and healthy behaviors in order to improve their outcomes. I also have a commitment to keep current in knowledge and skills and seek self-enhancement through perpetual learning  Outcome Requirements Interview a nurse from whatever area of practice and inquire about his/her philosophy in nursing. Summarize his/her philosophy and include how this affects your own philosophy in nursing.  INTRODUCTION TO NURSING THEORY Module II REGIE P. DE JESUS, RN, PhDNSc Faculty, College of Health Sciences  Theory Defined A set of statements that tentatively describe, explain, or predict relationships among concepts that have been systematically selected and organized as an abstract representation of some phenomenon (McEwen & Wills, 2019).  Nursing Theories Nursing theories are organized bodies of knowledge to define what nursing is, what nurses do, and why do they do it. Nursing theories provide a way to define nursing as a unique discipline that is separate from other disciplines (e.g., medicine). It is a framework of concepts and purposes intended to guide the practice of nursing at a more concrete and specific level.  History of Nursing Theories In 1860, Florence Nightingale defined nursing in her “Environmental Theory” In 1952, Hildegard Peplau introduced her Theory of Interpersonal Relations In 1955, Virginia Henderson conceptualized the nurse’s role in assisting sick or healthy individuals In 1960, Faye Abdellah published her work “Typology of 21 Nursing Problems”  In 1962, Ida Jean Orlando viewed the professional function of nursing as finding out and meeting the patient’s immediate need for help. In 1968, Dorothy Johnson pioneered the Behavioral System Model In 1970, Martha Rogers viewed nursing as both a science and an art In 1971, Dorothea Orem - nursing care is required if the client is unable to fulfill needs. In 1971, Imogene King‘s Theory of Goal attainment - nurse-patient relationship in meeting goals  In 1972, Betty Neuman - Stress reduction is the goal In 1979, Sr. Callista Roy - maintain the balance between various stimuli for adaptation In 1979, Jean Watson developed the philosophy of caring highlighted humanistic aspects of nursing  Stages in the Development of Nursing Theory  Components of a Theory Concepts Definition Assumptions Phenomenon  Concepts Concepts are often called the building blocks of theories. They are primarily the vehicles of thought that involve images. Concepts may be abstract or concrete Examples: Noise, Cleanliness, Ventilation, Bed and Beddings, Warmth in Nightingale’s Environmental theory  Definitions It conveys the general meaning of the concepts in a manner that fits the theory. An example in Newman’s theory, she defined stressor as any stimuli that can produce tension and cause instability within the system.  Two Types of Definition Theoretical definition – concepts that are described according to how these concepts are defined in the dictionary or based on the theorist’s perspective. Operational Definition – concepts that are based on how these concepts are used or will be used within the context of the phenomenon being observed or experienced  E.g. Theoretical definition – Temperature is the hemothermic range of a person’s internal environment maintained by the thermoregulatory system of the body. Operational definition – Temperature is the degree of temperature measured by the oral thermometer taken for one minute under the tongue.  Assumptions These are statements that describe concepts or connect two concepts that are factual. These are the “taken for granted” statements that determine the nature of the concepts, definitions, purpose, relationships and structure of the theory  Example of Assumption For example, in Neuman’s systems model the assumptions include the following: patients are dynamic  Phenomenon A phenomenon is the term, description, or label given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations. Examples of phenomena of nursing include caring, self- care, and patient responses to stress.  Conceptual Framework A set of interrelated concepts that symbolically represents and conveys a mental image of a phenomenon. Conceptual models of nursing identify concepts and describe their relationships to the phenomena of central concern to the discipline: person, environment, health and nursing  Hypothesis It is an educated guess based upon observation. Can be supported or proven false by experimentation or continued observation Theoretical Model Theoretical models are representations of the interaction among and between the concepts showing patterns. Models are typically accompanied by a pictorial representation of the variables and their interrelationships Example of Theoretical Model  Classification of Nursing Theories Based on scope (complexity and degree of abstraction) Based on types of Purpose According to Meleis Types of Theory Based on Scope  a. Metatheory These are theories whose subject matters are some other theories (theories about theories) It describes the philosophical basis of the discipline (a.k.a. Nursing Philosophies) The highest level of theory in terms of abstraction thus very difficult to for practical application  Example of Metatheory Ray and Turkel, Theory of Relational Caring Complexity, regarded “the caring relationship as the complexity in nursing science” with multidisciplinary focus and “spiritual-ethical caring at the center of complex relational caring practice of nursing in healthcare organizations” (Van Sell, 2017).  b. Grand Theory It describes the describe the comprehensive conceptual frameworks (a.k.a. Nursing Conceptual Models) Are broad in scope and complex and therefore requires further specification through research before they can be tested. Focus on broad, nonspecific, and general areas and concepts They lack operational definitions  Examples of Grand Theories Roy’s Adaptation Model, Self-Care Theory by Orem, Philosophy and Theory of Transpersonal Caring - Jean Watson, King’s Goal Attainment Theory, Nightingale’s Environmental Theory  c. Middle-Range Theories They have more limited scope, less abstraction, address specific phenomena or concepts and reflect practice (e.g. pain, stress, adaptation). They more precise and highly specific in nursing  They exhibit “best of both worlds” – i.e. easy applicability in practice and abstract enough to be scientifically interesting They are easier to apply as frameworks for research studies Examples of Middle- Range Theories Benner’s Skill Acquisition Model, Leininger’s Cultural Care Diversity and Universality Theory, Pender’s Health Promotion Model, Mercer’s Conceptualization of Maternal Role Attainment/Becoming a Mother  d. Practice Theory They are also called situation- specific theories, prescriptive theories and are the least complex and “action-oriented” They are more specific than middle range theories and produce specific directions for practice They are usually limited to specific populations or fields of practice Examples of Practice Theories Examples of practice theories developed and used by nurses are theories of postpartum depression, infant bonding, and oncology pain management. Types of Purpose of Theory 1. Factor-isolating theories (descriptive theories) These describe, observe, and name concepts, properties, and dimensions but does not explain how or why the concepts are related. It is generated and tested by descriptive research techniques (case studies, literature review phenomenology, ethnography)  Example of Descriptive Theory Theoretical model describing the experience of caring for a dying spouse  2. Factor-relating theories (explanatory theories) They relate concepts to one another, describe the interrelationships among concepts or propositions They attempt to tell how or why the concepts are related and may deal with cause and effect and correlations or rules that regulate interactions. They are developed by correlational research Example: Theory of spirituality-based nursing practice by Nardi & Rooda  3. Situation-relating theories (predictive theories or promoting or inhibiting theories) This predicts occurrence of a phenomenon when the cause is present Experimental research is used to generate and test them in most cases. Example: The relationship between spirituality and health status among adults living with HIV by Cobb  4. Situation- producing theories (prescriptive theories) Prescriptive theories address nursing therapeutics and consequences of interventions. “Prevents” occurrence of the phenomenon by controlling or eliminating possible causes Example: A prescriptive theory explaining medical acupuncture to reduce stress and enhance well-being  Nursing Theories Classification According to Meleis (2011) "Needs "theories. "Interaction" theories. "Outcome "theories. A. "Needs" theories These theories are based around helping individuals to fulfill their physical and mental needs. Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position.  B. "Interaction" theories These theories revolve around the relationships nurses form with patients. Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs.  C. "Outcome" theories These portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health (Roy 1980). Outcome theories have been criticized as too abstract and difficult to implement in practice (Aggleton and Chalmers 1988).  Examples of Nursing Theories According to Meleis (2011) Needs Theories Interaction Outcome Theories Theories Dorothea Imogene King Dorothy Orem Jean Watson Johnson Virginia Hildegard Martha Rogers Henderson Peplau Sister Callista Faye Glenn Ernestine Roy Abdellah Weidenbach Myra Levine Joyce Travelbee  BASIC PROCESSES IN THE DEVELOPMENT OF NURSING THEORIES 1. General Systems Theory 2. Adaptation Theory 3. Developmental Theory A. General System Theory: It describes how to break whole things into parts and then to learn how the parts work together in " systems". These concepts may be applied to different kinds of systems, e.g.. Molecules in chemistry , cultures in sociology, organs in Anatomy and health in Nursing.  B. Adaptation Theory It defines adaptation as the adjustment of living matter to other living things and to environmental conditions. Adaptation is a continuously occurring process that effects change and involves interaction and response. Human adaptation occurs on 3 levels: – the internal ( self ) – the social (others) – and the physical ( biochemical reactions )  C. Developmental Theory It outlines the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death. The progress and behaviors of an individual within each stage is unique. The growth and development of an individual are influenced by heredity , temperament, emotional, and physical environment, life experiences and health status. Nursing Defined What is Nursing? Nursing comes from the Latin word “nutrix” which means “to nourish.” Nursing encourages people to live healthy lives, cultivate a caring and healthy attitude among them, and foster mutually beneficial relationships with each other International Council of Nurses Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.  Royal College of Nursing UK The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death."  American Nurses Association Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.  Virginia A. Henderson The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.  Purposes of Theories A. In Practice – Assist nurses to describe, explain, and predict everyday experiences – Serve to guide assessment, intervention, and evaluation of nursing care – Provide rationale for collecting reliable and valid data above the health status of clients, which are essential for effective decision making and implementation  Help to establish criteria to measure the quality of nursing care Help build a nursing terminology to use in communicating with other professional Enhance autonomy (independence and self- governance) of nursing by defining its own independent functions  B. In Education – Provide a general focus for curriculum design – Guide curricular decision making C. In Research – Offer framework for generating knowledge and new ideas – Assist in discovering knowledge gaps in specific field of study – Offer a systematic approach to identify questions for study, select variables, interpret findings and validate nursing interventions  Nursing Metaparadigm There are four major concepts that are frequently interrelated and fundamental to nursing theory: person, environment, health, and nursing. These four are collectively referred to as metaparadigm for nursing.  Four Major Concepts (Metaparadigms) of Nursing Theories 1. Person – refers to all human being or clients – People are the recipients of nursing care – They include individuals, families, communities, and groups  2. Environment Environment (or situation) is defined as the internal and external surrounds that affect the client. It includes all positive or negative conditions that affect the patient, the physical environment, such as families, friends, and significant others, and the setting for where they go for their healthcare.  3. Health Health is defined as the degree of wellness or well-being that the client experiences....state of complete physical, mental, emotional, social, and spiritual well-being and not necessarily the absence of disease or infirmity – World Health Organization  4. Nursing It is central to all nursing theories Definitions of nursing describe what nursing is, what nurses do, and how nurses interact with clients NURSING PROCESS the nursing process is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate the outcomes of the care provided.  Nursing Process A- ssessment D- iagnosis P- lanning I- mplementation/ Intervention E- valuation  Outcomes Requirements 1. Create your own Conceptual Model/Framework using the four nursing metaparadigms 2. Write a reflection paper on “Lessons from Nursing to the World” from this link https://www.youtube.com/watc h?v=Qh4HW3yx00w by Kathleen Bartholomew FLORENCE NIGHTINGALE: THE MOTHER OF MODERN NURSING Module III REGIE P. DE JESUS, RN, PhDNSc Faculty, College of Health Sciences  “Nursing is the art of utilizing one’s environment for his or her own recovery.” Nightingale is the first nurse theorist well-known for Florence Nightingale developing the 12 May 1820 – 13 August  Florence Nightingale EARLY LIFE Known as the “Mother/ Founder of Modern Nursing” “The Lady with the Lamp” Born in Florence, Italy on the 12th day of May 1820 and was named after the city of her birth the younger of two children, her older sister is Frances Parthenope. Her mother, Frances (Fanny) Nightingale, hailed from a family of merchants and took pride in socializing with people of prominent social standing.  Her British family belonged to a rich, upper-class, well-connected British family. Her father, William Nightingale, a wealthy landowner who had inherited two estates—one at Lea Hurst, Derbyshire, and the other in  Nightingale’s Education Her father provided her with a classical education, including studies in German, French and Italian. She is also excellent in Mathematics From a very young age, Nightingale was active in philanthropy, ministering to the ill and poor people  Inspired by what she took as a call from God in February 1837 (17 y/o), Florence announced her decision to enter nursing in 1844 (24y/o), despite the intense anger and distress of her mother and sister. Rebelled against the expected role for a woman of her status (become a wife and mother) Motivated by Elizabeth Blackwell  Despite the objections of her parents, Nightingale enrolled as a nursing student in 1844 at the Lutheran Hospital of Pastor Fliedner in Kaiserswerth, Germany.  Nightingale’s Personal Life She was very attractive and charming but she rejected a suitor, Richard Monckton Milnes, 1st Baron Houghton, because she was convinced that marriage would interfere with her ability to follow her calling to nursing. The income given to her by her father of £500 (roughly £25,000/US$50,000 in present terms) during this time allowed her to still live comfortably Richard Monckton Milnes Works and Appointment She regarded the experience in the Lutheran Hospital in Germany as A TURNING POINT IN HER LIFE, and issued her findings anonymously in 1851; The Institution of Kaiserswerth on the Rhine, for the Practical Training of Deaconesses, etc. was her first published work  In 1853, Florence Nightingale accepted the position of superintendent at the Institute for the Care of Sick Gentlewomen (Invalid women) in Upper Harley Street, London. She held this position until October  Crimean War In March, 1853, the Crimean War broke out between Russia and Turkey, with British and French forces aiding Turkish Several nurses armies in repelling the offered help but advance of the rejected until public Russians. protest was made after a newspaper Soldiers began going was published  Florence Nightingale's most famous contribution came during the Crimean War, which became her central focus when reports began to filter back to Britain about the horrific conditions for the wounded. On 21 October 1854, she and a staff of 38 women volunteer nurses, trained by Nightingale and including her aunt Mai Smith, were sent (under the authorisation of Sidney Herbert, the Secretary of War) across the Black Sea from Balaklava in the Crimea,  Nightingale and some of the 38 “handmaidens of the Lord” (as she called them) to nurse wounded crimean-peninsula-map-coca-cola-stirs-outrage-with-map-showing-crimea-as-part-of-russia-640-x-359-pixels.jpg …………..  Nightingale arrived early in November 1854 at Selimiye Barracks in Scutari (modern-day Üsküdar in Istanbul). There were no female nurses stationed at hospitals in the Crimea She and her nurses found wounded soldiers being badly cared for by overworked medical staff in the face of official indifference. Medicines were in short supply, hygiene was being neglected, and mass infections were  There was no equipment to process food for the patients. Rats and insects crawled the floor and walls Wounded soldiers still wearing their army uniform  During her first winter at Scutari, 4,077 soldiers died there. Ten times more soldiers died from illnesses such as typhus, typhoid, cholera and dysentery than from battle wounds. Conditions at the temporary barracks hospital were so fatal to the patients because of  Through her tireless efforts the mortality rate among the sick and the wounded was greatly reduced (from 42% to 2%) she advocated sanitary living conditions as of great importance Consequently, she reduced deaths in the army during peacetime and turned attention to the sanitary design of hospitals.  The Lady with the Lamp During the Crimean War, Florence Nightingale gained the nickname "The Lady with the Lamp", deriving from a phrase in a report in The Times: (by William Howard  “She is a ‘ministering angel’ without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow's face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with  Based on her observations in the Crimea, Florence Nightingale wrote Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army, an 830-page report analyzing her experience and proposing reforms for other military hospitals operating under poor conditions. Letter from Queen Victoria Thanking “Miss Nightingale and her ladies” for all their hard work She was given a diamond brooch with ‘Blessed are the merciful’ engraved on “Nightingale Jewel”  Post-War Contributions The Nightingale Fund for the training of nurses. Using the money ($250,000) she got from the British government, she funded the establishment of St. Thomas’ Hospital, and within it, the Nightingale Training School for Nurses, now part of the King’s College London First Batch of Nursing Graduates  In 1860, her best authored works was published, “Notes on Nursing,” outlining principles of nursing, a slim 136-page book that served as the cornerstone of the curriculum at the Nightingale School (written specifically for nursing education) considered a classic introduction to nursing Notes on Hospitals, which deals with the correlation of sanitary techniques to medical facilities Suggestions for Thought to Searchers after The First nursing Book  In the 1870s, Nightingale mentored Linda Richards "America's first trained nurse”, a great nursing pioneer in the USA and Japan.  Awards and Honors Crimean Monument in Waterloo Place, London was erected in her honor King Edward VII bestows the Order of Merit; it is the first time that the Order is given to a woman Became a Fellow of the Royal Statistical Society because of her “Nightingale Rose Diagram” Honorary member of the American Statistical Association  Became first woman to receive the British Order of Merit The International Nurses Day is celebrated on her birthday each year.  Crimean Monument in Waterloo Place, London was erected in her honor Until recently her picture was on our British £10 note “Nightingale Rose Diagram”  Nightingale’s Death Despite being known as the heroine of the Crimean War, Florence Nightingale felt ill in August 1910. She seemed to recover but she developed an array of troubling symptoms a week later, on the evening of Friday, August 12, 1910. She died peacefully unexpectedly in her sleep The grave of Florence Nightingale in the churchyard of St. Margaret's Church, East Wellow, England The Newspaper that published Nightingale’s death  Today the Nurses take the Florence Nightingale pledge before being formally initiated into the profession of  Nightingale’s Environmental Model defined Nursing as “the act of utilizing the environment of the patient to assist him in his recovery.” It involves the nurse’s initiative to configure environmental settings appropriate for the gradual restoration of the patient’s health She viewed the manipulation of the physical environment as a major component of nursing care. Discussed in her book Notes on Nursing:  Sub-Concepts of Environmental Theory 1. Health of Houses 7. Cleanliness of Rooms & Walls 2. Ventilation & 8. Personal Cleanliness Warming 9. Nutrition and Taking food 3. Light 10.Chattering hopes and Advices 4. Noise 11.Observation of the Sick 5. Variety 12.Petty Management 6. Bed and Bedding  Nightingale believed that when one or more aspects of the environment are out of balance, the client must use increased energy to counter the environmental stress. These stresses drain the client of energy needed for healing.  1. Health of Houses Is closely related to the presence of pure air, pure water, efficient drainage, cleanliness, and light. “badly constructed houses do for the healthy what badly constructed hospitals do for the sick – Nightingale” Cleanliness outside the house affected the inside  2. Ventilation and Warming “keep the air he breathes pure as the external air, without chilling him” person who repeatedly breathes his/her own air would be sick or remain sick “noxious air”, or “effluvia” or foul odors affect the client’s health( excrement, bedpans, urinals) Emphasized the importance of room temperature (should not be too warm or too cold)  3. Light The sick needs both fresh air and light – direct sunlight was what the clients wanted. Has quite real and tangible effects upon the human body Lack of environmental stimuli (e.g isolation, NICU, ICU) can lead to confusion or “intensive care psychosis” related to the lack of the usual cycling of day and night.  4. Noise Patients should never be waked intentionally or accidentally during the first part of sleep Noises that may irritate patients are jewelries worn by nurses, keys that jingle, snapping of rubber gloves, the clank of the stethoscope against metal bed rails, telephones ringing  5. Variety Affects patients’ recovery Provide variety in the patient’s room to help him/her avoid boredom and depression. Encourage significant others to engage with the client. Need for changes in color and form (e.g. Bringing brightly colored flowers or plants, rotating 10-12 paintings & engravings) (presently known as diversional therapy)  6. Bed and Bedding An adult exhales about 3 pints of moisture through the lungs & skin in a 24-hr period This matter enters the sheets and stays there unless the bedding is changed and aired frequently Beds must be placed in the lightest part of the room Caregiver must never lean against, sit upon, or unnecessarily shake the bed, wrinkle free bed  7. Cleanliness of Rooms and Walls The greater part of nursing consists in preserving cleanliness Removal of dust with a damp cloth rather than feather duster Floors should be easily cleaned Furniture and walls be easily washed Clean room is a healthy room  8. Personal Cleanliness Unwashed skin poisons the patient Bathing & drying the skin provide great relief to the patient “keep the pores of the skin free from all obstructing excretions” “every nurse ought to wash her hands very frequently during the day” - Nightingale  9. Nutrition and Taking Food Variety of foods served to patients Individuals desire different foods at different times of the day Frequent small servings may be more beneficial than a large breakfast or dinner No business must be done with the patient while they are eating (distraction)  10. Chattering Hopes and Advices False hopes are depressing to patients Sick persons should hear good news that would assist them in becoming healthier  11. Observation of the Sick Nurses must be taught - what to observe – - how to observe (what symptoms indicate improvement) – - what is the reverse – - which are of importance – - which are evidence of neglect -  It is important to obtain complete & accurate information about patients “ If you cannot get the habit of observation one way or other, you had better give up being a nurse, for it is not your calling, however kind and anxious you maybe.”  12. Petty Management Continuity of the care, when the nurse is absent Documentation of the plan of care and all evaluation will ensure others give the same care to the client in your absence. Ways to assure “what you do when you are there, shall be done when you are not there.”  Note that the client, the nurse, and the major environment concepts are in balance; that is; the nurse can manipulate the environment to compensate for the client’s response to it. The goal of the nurse is to assist the patient in staying in balance. If the environment of a client is out of balance, the client expends  Major Concepts (Metaparadigms) A. Environment – anything can be manipulated to place a patient in the best possible condition for nature to act Physical components –ventilation, warmth, light, nutrition, medicine, stimulation, room temperature, and activity Psychological – avoid chattering hopes and advices and providing  B. Person – the one who is receiving care: a dynamic and complex being C. Health – “Healthy is not only to be well, but to be able to use well every power we have.” – For nightingale, health is “not only to be well, but to be able to use well every power we have”. – Disease is considered as dys-ease or the absence of comfort. [Six D’s of Dys-ease are: Dirt, Drink (need clean drinking water), Diet, Damp, Draughts and Drains (need proper drainage and sewer D. Nursing – a spiritual calling; Nurses were to assist nature to repair the patient – Different Types of Nursing a) Nursing Proper – nursing the sick b) General Nursing – health promotion c) Midwifery Nursing – Nurses must use their powers of observation in caring for patients – Nurses must have educational background & knowledge that were different from those of physicians – She rallied for nursing education to be a combination of clinical experience and classroom  Application to Nursing Practice With the advent of technology, and with it, globalization, comes threats from the environment Global warming, industrial noise, air pollution, nuclear radiation threats, man-made environmental calamities, and fad diets continue to pose challenges to the nurse practitioner of today.  Outcome Requirements 1. Write a Movie Review including your reflection on Animated Hero Classics - Florence Nightingalefrom this link https://www.youtube.com/watch? v=sW0IvNlxUjw 2.  Outcome Requirements 2. Graphic Applications (Illustration) focusing on how nursing changed from Nightingale’s period to present condition of nursing – (Put a title and caption that reflects the outcome and post it online – facebook/instagram)  Outcome Requirements 3. Using the following case scenario, make a plan of care for Mr. SanaAll (See TFN Module page 34)