Florence Nightingale's Environmental Theory PDF

1 DIFFERENT VIEWS OF PERSON, HEALTH, ENVIRONMENT AND NURSING BY VARIOUS NURSING THEORISTS FLORENCE NIGHTINGALE MAY 12,1820-AUGUST 13, 1910 Environmental Theory and Modern Nursing  “Nursing is the art of utilizing one’s environment for his or her own recovery.”...

1 DIFFERENT VIEWS OF PERSON, HEALTH, ENVIRONMENT AND NURSING BY VARIOUS NURSING THEORISTS FLORENCE NIGHTINGALE MAY 12,1820-AUGUST 13, 1910 Environmental Theory and Modern Nursing  “Nursing is the art of utilizing one’s environment for his or her own recovery.” –Florence Nightingale Nightingale is the first nurse theorist well- known for developing the Environmental Theory  EARLY LIFE Known as the “Mother/Founder of Modern Nursing” and “The Lady with the Lamp” Born in Florence, Italy on the 12th of May 1820 and was named after the city of her birth (international Nurses Month) Younger of the two children, her older sister is Frances Parthenope Her mother, Frances Nightingale, hailed from a family of merchants and took pride in socializing with people of prominent social standing  EARLY LIFE Her British family belonged to a rich, upper-class, well- connected British family. Her father, William Nightingale, a wealthy landowner who inherited two estates- one at the Lea Hurst, Derbyshire and the other one in Hampshire, Embley Park (now a school) when Nightingale was 5 years old.  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.  EDUCATION Inspired by what she took as a call from God in February 1837, Florence announced her decision to enter nursing in 1844, 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 a mother). Motivated by Elizabeth Blackwell at St. Bartolomew’s Hospital, first woman doctor in US.  EDUCATION In 1848, Blackwell graduated first in her class. She continued her training at several hospitals in London and Paris but found most doctors were not willing to accept her.  EDUCATION Despite the objection of her parents, Nightingale enrolled as a nursing student in 1844 at the Lutheran Hospital of Pastor Fliedner in Kaiserswerth, Germany.  PERSONAL LIFE She was very attractive and charming but she rejected a suitor, Richard Monckton Milnes, first 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 500pounds- during this time allowed her to still live comfortably and pursue her career.  WORKS AND APPOINTMENTS 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. WORKS AND APPOINTMENTS In 1853, Florence Nightingale accepted the position of superintendent at the Institute for the Care of the Sick Gentlewomen (invalid women) in Upper Harley Street, London. She held this position until October 1854.  CRIMEAN WAR In March 1853, the Crimean War broke out between Russia and Turkey, with British and French forces aiding Turkish armies in Several nurses repelling the advance of offered help but rejected until public the Russians. protest was made Soldiers began going down after a newspaper was published with cholera and malaria concerning the (around 8,000 men) status of British army.  CRIMEAN WAR 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 of the wounded. On October 21, 1854, she and a staff of 38 women volunteer nurses, trained by Nightingale and including her aunt, Mai Smith were sent (under the authorization of Sidney Herbert, the Secretary of War) across the Black Sea from Balaklava in the Crimea, where the main British camp was based.  CRIMEAN WAR Nightingale and some of the 38 “Handmaids of the Lord” (as they call them) to nurse wounded British soldiers in Crimean War.  CRIMEAN WAR Florence Nightingale arrived early in November 1854 at Selimiye Barracks in Scutari (Uskudar in Istanbul). There were no female nurses stationed at hospital in Crimea. She and her nurses found wounded soldiers being badly cared for by overworked medical staff in the face of official indifference. Medicines were short in supply, hygiene was being neglected, and mass infections were common, many of them fatal.  CRIMEAN WAR There were no equipment to process for the patients. Rats and insects crawled the floor and walls. Wounded soldiers still wearing their army uniform “stiff with dirt”.  CRIMEAN WAR 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 overcrowding and the hospital’s defective sewers and lack of ventilation.  CRIMEAN WAR 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 designs 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 Russell.  “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 a little lamp in her hand, making her solitary rounds.”  Based on her observations in the Crimea, Florence Nightingale wrote “Notes on Matters Affecting Health, Efficiency and Hospital Administration of the British Army” an 830-page report analyzing her experience and proposing reforms for the 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 it.  POST WAR CONTRIBUTIONS The Nightingale Fund for the training of Nurses. Using the money 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  POST WAR CONTRIBUTIONS 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 Religious Truths, she argued strongly for the removal of restrictions that prevented women having careers.  POST WAR CONTRIBUTIONS In the 1870s, Nightingale mentored Linda Richards, “America’s First trained nurse”, a great 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  AWARDS AND HONORS International Nurses Day is celebrated on her birthday each year. AWARDS AND HONORS  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 at 2pm, Saturday, August 13 at her home in London.  NIGHTINGALE’S DEATH The grave of Florence Nightingale in the churchyard of St. Margaret’s Church, East Wellow, England. AT PRESENT…. Today the Nurses take the Florence Nightingale pledge before being formally initiated into the profession of Nursing. Were you inspired by the life of Florence Nightingale?  NIGHTINGALE’S ENVIRONMENTAL THEORY 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 patient’s health She viewed the manipulation of the physical environment as a major component of nursing care Discussed in her book Notes in Nursing: What it is, What it is not  SUB CONCEPTS OF ENVIRONMENTAL THEORY 1. Health of houses 7. Cleanliness of rooms 2. Ventilation and and walls warming 8. Personal Cleanliness 3. Light 9. Nutrition and taking 4. Noise food 5. Variety 10. Chattering hopes and advices 6. Bed and Beddings 11. Observation of the sick 12. Petty management  NIGHTINGALE’S ENVIRONMENTAL THEORY  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 repeatedly breathes his/her own, would be sick or remain sick “noxious air” or “effluvia” or foul odors affect the client’s health (excrement, bedpans, urinals, etc) 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 real and tangible effects upon the human body Lack of environmental stimuli (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, telephone 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 (bringing brightly colored flowers or plants, rotating 10-12 paintings and engravings – diversional therapy Advocated reading, writing and cleaning to relieve the sick of boredom  6. BED AND BEDDINGS An adult exhales about 3 pints of moisture through the lungs and skin in a 24-hour period. This matter enter 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 Nurses must keep bedding clean, neat and dry and to position for maximum support.  7. CLEANLINESS OF ROOMS AND WALLS The greater part of nursing consists of 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 and 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). Right food at the right time.  10. CHATTERING HOPES AND ADVICES False hopes are depressing to the patients Sick persons should hear good news that should 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 evident of neglect  11. OBSERVATION OF THE SICK It is important to obtain complete and accurate information about patients. “if you cannot get the habit of observation one way or the other, you had better give up being a nurse, for it is not your calling, however kind and anxious you maybe” -Nightingale  11. OBSERVATION OF THE SICK “The most important practical lesson that can be given to nurses is to teach them what to observe.” -Florence Nightingale  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 staying in balance. If the environment of the client is out of balance, the client expends unnecessary energy.  METAPARADIGM 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 privacy  PERSON The one who is receiving care; a dynamic and complex being  HEALTH “Healthy 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 system)- a REPARATIVE PROCESS Prevention of disease and health promotion  NURSING – is a spiritual calling. Nurses were to assist nature to repair the patient; responsible to provide physicians with accurate information about patients 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 and knowledge that were different from those of the physicians She rallied for nursing education to be combination of clinical experience and classroom learning  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 practitioners od today. THANK YOU