The Life of Florence Nightingale - PDF

The Life of Florence Nightingale - " 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 - FLORENCE NIGHTINGALE Early Life - Her British fam...

The Life of Florence Nightingale - " 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 - FLORENCE NIGHTINGALE Early Life - Her British family belonged to a rich, upper class, well- connected British Family. 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(24 y.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 at St. Bartholomew's Hospital, firs woman doctor in US - In 1849, 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. - Despite the objections of her parents, Nightingale enrolled as a nursing student in 1844 at the Lutheran Hospital of Pastor Fliedner in Kaiserswerth, Germany. - She was very attractive and charming but she rejected a suitor, Richard Monckton Milnes, 1^st^ 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 Euro 5000roughly euro 25,000/US dollar 50,00 in present terms) during this time allowed her to still live comfortably and pursue her career. 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 Kaserswerth 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 1854. Crimean War - In March, 1853, the Crimean War broke out between Russia and Turkey, with British and French forces aiding Turkish armies in repelling the advance of the Russians. - Soldier began going down with cholera and malaria (around 8,000 men.) - Several nurses offered help but rejected until public protest was made after a news paper was published concern the status of British army. - 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 October 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. - Nightingale and some of the 38 "handmaidens of the Lord ( as she called them) to nurse wounded British soldiers in the Crimean War. - Nightingale arrived early in November 1854 at Selimiye Barracks in Scutari ( modern-day Uskudar in Istanbul). - There were no female 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 common, many of them fatal. - 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 " stiff with dirt" - 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 hospitals defective sewers and lack of ventilation. - 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 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 Russell.) - " She is a Miinistering angel" without any exagegeration in these hospital, and as her slender form glides quietly along each corridor, every poor fellow's face soften 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 prostate sick, she may, be observed alone, with a little lamp in her hand, making her solitary rounds. After the War - Based on her observations in the crimea, Florence nightingale wrote Notes on Matters Affecting the Health, Effeciency and Hospital Adminstration of the British Army, an 830- page report analyzing her experience and proposing reforms for other military hospitals operating under poor conditions - The Nightingale Fund for training of Nurses. - Using the money (\$ 250,000)she got from the british government she funded the establishment of,St. Thomas Hospital, and with in it, the Nightingale Training Schools 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", outlinining principles of nursing, a slim 136 page book that served as the cornerstone of curriculum at the nightingale School (written specially for nursing education) - Considered a classic introduction to nursing - Notes on Hospital, 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. - In the 1870's 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 was erected in her honors - King Eddward 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. - The international Nurses Day is celebrated on her birthday each year.( May) - Became first woman to receive the British order of Merit - Until recently her picture was on the british money 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. - The grave of Florence Nightingale in the Churchyard of St. Margaret's Church, East Wellow, England - The News Paper that published Nightingale's death - Today Nurses take the Florence Nightingale pledge before being formally initiated into the profession of Nursing Florence Nightingale 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 the patient's health - She viewed the manipulation of the physical environment as a major component of nursing - Discussed in her book Notes on Nursing: What it is, what it is Not. Sub-concepts of environmental theory - Health houses - Ventilation and warming - Light - Variety - Bed and bedding - Cleanliness of rooms and walls - Personal cleanliness - Nutrition and taking foods - Chattering hopes and vices - Observation of the sick - Petty management Nightingale's Environmental Theory Conceptual Framework - 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 energy needed for healing. Health of houses - Is closely related to the presence of pure air, pure water, efficient drainage, cleanliness and light. - "badly constructed houses do for healthy what badly constructed hospital do for the sick- Nightingale - Cleanliness outside the house affected the inside. Ventilation and warming - "keep the air he breathes pure as the external air, without chilling him" - Person who repeatedly breathes his/her own would be sick or remain sick. - "noxious air" or "effluvia" or foul odors affects the client's health( excrement, bedpans, urinals) - Emphasized the importance of room temperature( should not be warm or too cold) 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. Nose - Pts. 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 rings. Variety - Affects pts. Recovery - Provide variety in the pts. 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 palnts, rotating 10-12 paintings & engravings) ( presented known as diversional therapy) - Advocated reading, writing, and cleaning to relieve the sick of boredom Bed and Bedding - An adult exhales about 3 pints of moisture through the lungs &skin in 24-hr period. - This matter enters the sheets and stays there unless the bedding is changed and aired frequent. - Beds must be placed in the lightest part of the room. - Care giver must never lean against, sit upon, or unnecessarily shake the bed, wrinkle free bed - Nurses must keep bedding clean, neat, dry, and to position for maximum support. Cleanliness of rooms and wall - 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 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 Nutrition and taking food - Variety foods served to patients - Individuals desire different foods at different times of the day - Frequent small servings maybe more beneficial than a large breakfast or dinner - No business must be done with the patient while are eating (distraction) - Right food at the right time. Chattering hopes and advice - False hopes are depressing to patients - Sick persons should hear good news that would assist them in becoming healthier. Observations of the sick - Nurses must be taught - What to observe - How to observe( what symptoms indicate improvement) - What is the reverse - Which are the important - Which are evidence of neglect - It is important to obtain complete and 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 - The most important practical lesson that can be given to nurses is to teach them what to observed- Florence Nightingale Petty management - Continuity of 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 concept are in balance; that 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 unnecessary energy. Major concepts ( metaparadigm) - A. Environment- anything can be manipulated to place a patient in the best possible condition for nature to act. - Physical components- ventilation, warmth, nutrition, medicine, stimulation, room, temperature and activity. - Psychological- avoid chattering hopes and advices and providing privacy. - B. Person- the one who is receiving and complex being - C. Health- " Healthy is not only to be well , but to be able to use well very power we have. - \- for nightingale, health is " not only to well, but to be able to use us well very 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 systems)- REPARATIVE PROCESS - PREVENTION OF DISEASES AND PROMOTE HEALTH - D. Nursing- a spiritual calling; Nurses were to assist nature to repair the patient responsible to provide physicians with accurate information about patients. Different Type of Nursing a. Nursing proper- nursing the sick b. General nursing- health promotion c. Midwifery nursing d. \- nurses must use their powers of observation in caring for patients e. \- nurse must have educational background, knowledge that were different from those of physicians f. she rallied for nursing education to be combination of clinical experience and classroom learning Application to nursing Process - 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. CHAPTER 2: NURSING THEORETICAL WORKS Lesson 1 Nursing Theorist Theory A green and white chart with text Description automatically generated  A chart of a goal atuitment Description automatically generated with medium confidence  A green and white chart with black text Description automatically generated Nursing Philosophies 1\. Nightingale's Environmental Theory 2\. Watson's Theory of Human Caring 3\. Benner Benner's Stages of Nursing Expertise Nursing Philosophies 4\. Erikson's Caritative Caring Theory Theory of Florence Nightingale - The goal of nursing is "to put the patient in the best condition for nature to act upon him". -- Nightingale Introduction - As the founder of modern nursing, [Florence Nightingale's](https://nursing-theory.org/nursing-theorists/Florence-Nightingale.php) Environment Theory changed the face of nursing practice. She served as a nurse during the Crimean War, at which time she observed a correlation between the patients who died and their environmental conditions. As a result of her observations, the Environment Theory of nursing was born. Nightingale explained this theory in her book, *Notes on Nursing: What it is, What it is Not*. The model of nursing that developed from Nightingale, who is considered the first nursing theorist, contains elements that have not changed since the establishment of the [modern nursing](https://nursing-theory.org/articles/modern-nursing.php) profession. Though this theory was pioneering at the time it was created, the principles it applies are timeless. - Founder of modern nursing. - The first nursing theorist. - Also known as \"The Lady with the Lamp\" - She explained her environmental theory in her famous book Notes on Nursing: What it is, What it is not. - She was the first to propose nursing required specific education and training. - Her contribution during Crimean war is well-known. - She was a statistician, using bar and pie charts, highlighting key points. - International Nurses Day, May 12 is observed in respect to her contribution to Nursing. - Died - 13 August 1910 Assumptions of Nightingale\'s Theory - Natural laws - Mankind can achieve perfection - Nursing is a calling - Nursing is an art and a science - Nursing is achieved through environmental alteration - Nursing requires a specific educational base - Nursing is distinct and separate from medicine - Nightingale's Canons: Major Concepts 1\. Ventilation and warming 2\. Light 3\. Noise 4\. Cleanliness of rooms and walls 5\. Health of houses 6\. Bed and bedding 7\. Personal cleanliness 8\. Variety 9\. Chattering hopes and advices 10.Taking food. What food? 11\. Petty management 12\. Observation of the sick 1\. Ventilation and Warming Nightingale believed that it was essential to "keep the breathes as pure as the external air without chilling him. she believe that the person who repeatedly breath his/her own air would be sick or remain sick. Nightingale also believed that " noxious air" or "effluvia" or foul odors affect the client's health. This come from raw, sewage, ditches, excrement, bedpans, urinals and other utensils used to discard excrement. She believed that the offensive source, not the smell must be removed. So she criticized " fumigations" Nightingale also emphasized the importance of room temperature. The patient should not be too warm or too cold. 2\. Light Nightingale advocated that the sick needs both fresh and light- direct sunlight was what clients wanted. She noted that light has" quite real and tangible effects upon the human body" She noted that the sick rarely lie with their face toward the wall but are much more likely to face the window , the source of the sun. In these modern times it is still noted that luck of environmental stimuli like isolation rooms, NICU, ICU, etc. , can lead to confusion or " intensive care psychosis: related to the lack of the usual cycling of day and night. 3\. Noise Nightingale believed that patients should never be waked intentionally or accidentally during the first part of sleep. She averred that whispered or long conversations about patients are thoughtless and cruel, especially when held so that the patient knows ( or assumes) the conversation is about him. In these modern times, 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, radios, TV's, telephones ringing, machines that beep or alarm, etc. 4\. Cleanliness of rooms and walls Nightingale emphasized that " the greater part of nursing consists in preserving cleanliness. She urges the removal of dust with the used of damp clothe rather than a feather duster. Floors should be easily cleaned rather than being covered with dust trapping carpets. Furniture and walls should be easily washed and not damaged by coming in contact with moisture. In modern times, the concept that a clean room is a healthy room continues to be relevant. 5\. Health of houses Is closely related to the presence of pure air, pure water, efficient drainage, cleanliness and light. According to nightingale, " badly constructed houses do for the healthy what badly constructed hospitals do for the sick. One stagnant air is stagnant, sickness is certain to follow"( Nightingale , 1859, p.15) She also noted that the cleanliness outside the house affected the inside. Nightingale's advocacy is still applicable in these modern times, because families can be still affected by toxic wastes, contaminated water and polluted air. 6\. Bed and bedding Nightingale postulated that an adult exhales about three pints of moisture through the lungs and skin in a 24 hour period. This organic matter, she said, enters the sheets and stays there unless the bedding is changed and aired frequently. She believed that the bed should be placed in the lightest part of the room and placed so the patient could see out of the window. She reminded the caregiver never to lean against, sit upon, or unnecessarily shake the bed of a patient. Even in the modern times, it remains important for the nurse to keep bedding clean, neat, and dry and to position the patient for maximum comfort. 7\. Personal cleanliness Nightingale viewed the function of the skin as important. She believed that unwashed skin poisoned the patient and noted that bathing and drying the skin provided great relief to the patient. 8\. Variety Nightingale stressed that variety in the environment was a critical aspect affecting the patient's recovery. She believed in the need for changes in color and form, including bringing the patient brightly colored flowers or plants. She also advocated rotating 10 to 12 paintings and engravings each day, week, or month to provide variety for the patient. She agreed that the mind greatly affects the body. She also advocated reading, needlework, writing and cleaning activities to relieve the sick of boredom. 9\. Chattering hopes and advices Nightingale perceived that to cheer the sick by making light of their illness and its danger is not helpful. She considered it stressful for a patient to hear opinions after only brief observations had been made. False hope was depressing to patients, she felt, and caused them to worry and become fatigued. Nightingale encouraged the nurse to heed what is being said by visitors, believing that sick person should hear good news that would assist them in becoming healthier. 10.Nutrition and Taking food. What food? Nightingale addressed the importance of variety in the food served to patient. She has proven that the attention given to the patient affected how the patient ate. She has observed that individuals desire different foods at different times of the day and that frequent small servings maybe more beneficial to the patient has a large breakfast or dinner. She urged that no business be done with patient while they are eating because this was distraction. She also urged that the right food be brought at the right time and " be taken away, eaten or eaten, at the right time." 11\. Petty management Nightingale discussed " petty management' or ways to assure that "what you do when you are there, shall be done when you are not there" She believed that the house and the hospital needed to be well-managed- that is organized, clean, and appropriate supplies. 12\. Observation of the sick According to Nightingale " at most important practical lesson that can be given to nurses is to teach them - what to observe - how to observe - what symptoms indicate improvement - what is the reverse - which are of importance - which are one - which are evidence of neglect\-\-\--and what kind of neglect"( Nightingale, 1859, p.59) Nursing Paradigms - Nightingale\'s documents contain her philosophical assumptions and beliefs regarding all elements found in the metaparadigm of nursing. These can be formed into a conceptual model that has great utility in the practice setting and offers a framework for research conceptualization. (Selanders LC, 2010) Nursing - Nursing the best possible condition for nature to act, is different from medicine and the goal of nursing is to place the patient in the best possible condition in order 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.\" Person - People are multidimensional, composed of biological, psychological, social and spiritual components. Health - Health is "not only to be well, but to be able to use well every power we have". - Disease is considered as disease or the absence of comfort. Environment - \"Poor or difficult environments led to poor health and disease\". - \"Environment could be altered to improve conditions so that the natural laws would allow healing to occur.\" Nightingale's Theory and Nursing Practice Application of Nightingale\'s theory in practice: - \"Patients are to be put in the best condition for nature to act on them, it is the responsibility of nurses to reduce noise, to relieve patients' anxieties, and to help them sleep.\" - As per most of the nursing theories, environmental adaptation remains the basis of holistic nursing care. Criticisms - She emphasized subservience to doctors. - She focused more on physical factors than on psychological needs of patient. Applications of Nightingale\'s Theory - Nightingale theory and intentional comfort touch in management of tinea pedis in vulnerable populations. - Incorporating Florence Nightingale\'s theory of nursing into teaching a group of preadolescent children about negative peer pressure. - Conclusion - Florence Nightingale provided a professional model for nursing organization. - She was the first to use a theoretical foundation to nursing. - Her thoughts have influenced nursing significantly. - According to Nightingale, nursing is separate from medicine. The goal of nursing is to put the patient in the best possible condition in order for nature to act. Nursing is "the activities that promote health which occur in any caregiving situation." Health is "not only to be well, but to be able to use well every power we have." Nightingale's theory addresses disease on a literal level, explaining it as the absence of comfort. - The environment paradigm in Nightingale's model is understandably the most important aspect. Her observations taught her that unsanitary environments contribute greatly to ill health, and that the environment can be altered in order to improve conditions for a patient and allow healing to occur. - [Nightingale's Modern Nursing Theory](https://nursing-theory.org/theories-and-models/nightingale-modern-nursing-theory.php) also impacted nursing education. She was the first to suggest that nurses be specifically educated and trained for their positions in healthcare. This allowed there to be standards of care in the field of nursing, which helped improve overall care of patients. Nightingale and the Nursing Process *Assessment* - Nightingale recommended two essential behaviors by the nurse in the area of assessment. 1\. Ask the client what is needed or wanted. Examples: a\. If the patient is in pain, ask where the pain is located. b\. If the patient is not eating, ask when he or she would like to eat and what food is desired. - She recommended asking precise questions. She warned against asking leading questions. Correct: " How many hours of sleep did you have? At what hours of the night? Wrong: 'Did you have a good night sleep? 2\. *Observation.* She used precise and specific observations concerning all aspects of the client's physical health environment. - Examples: a\. How do light, noise, smells, and bedding affect the client? b\. How much food and drink had the client ingested at every meal or snack? *Nursing Diagnoses* - Nightingale believed data should be used as the basis for forming any conclusion. The nursing diagnosis is the client's response the environment and not the environmental problem. It reflects the importance of the environment to health and well-being of the client. *Outcomes and Planning* - Identifying the nursing actions needed to keep the clients comfortable, dry, and in the best state for nature to act on. - Planning is focused on modifying the environment to enhance the client's ability to respond to the disease process. - The desired outcomes are derived from the environmental model\-\-\-- for example, being comfortable, clean, dry, in the best state for nature to work on. *Implementation* - Takes place in the environment that affects the client and involves taking action to modify that environment. - All factors of the environment should be considered, including noise, air. Odors, bedding, cleanliness, light\-\-- - All the factors that place clients in the best position for nature to work upon them. *Evaluation* - Is based on the effect of the changes in environment on the client's ability to regain his/her health at the least expense of energy. - Observation is the primary method of data collection used to evaluate the client's response to the intervention. Critical Thinking with Nightingale's Theory  A green and black text on a green background Description automatically generated  A green and white background with text Description automatically generated  A green and black text Description automatically generated Nurse Observer Practitioner (Client and Environment in Balance) - Ventilation - Nutrition - Chattering hopes - Cleanliness - Bedding - Light - Variety - Health of Houses - Noise - Air Application of Florence Nightingale's Environmental Philosophy - Case History of Angel Gonzaga Miss Angel Gonzaga is a 25 year old female who had been admitted to the medical unit with the chief complaint of frequent, watery stools since last night. This is accompanied by abdominal cramps, nausea and vomiting. Her vital signs are as follows: Temperature- 38.6 C, Pulse- 98bpm, Respiration- 23 bpm, BP- 100/70 mm Hg. She complains of weakness, thirst and dryness of mouth. Her skin is warm, flushed, and dry. Her urine is dark yellow in color. - Miss Gonzaga claims, she had eaten oysters for dinner. She lives in a crowded community close to a landfill and shares toilet with 4 other families. Their source of drinking water is from pump well in the community. She does not practice good hand washing after using the toilet. Stool examination revealed salmonellosis. - Miss Gonzaga is extremely tearful. She expresses great concern over her health and expenses for hospitalization. - In Nightingale's environmental theory, Miss Gonzaga is the Person seeking care. She needs nature's reparative process. - The nursing process and Nightingale's theory can be used together to provide care for Miss Gonzaga. This care involves " nursing the sick", review of the environment and the client's lifestyle. Nursing the Sick - Assessment Assess the client for the following problems: 1\. Fluids and electrolyte losses related to frequent, watery stools, nausea and vomiting as manifested by changes in the VS; weakness, dryness of mouth; warm, flushed, dry skin; dark colored urine. 2\. Pain related to abdominal cramps. 3\. Inadequate fluid intake related to nausea and vomiting. 4\. Fever ( T- 38.6 C) related to infection( Salmonellosis) and dehydration. - Plan 1\. Fluid and electrolyte losses. - Provide fluid and electrolyte replacement. - Administer medications to relieve frequent, watery stools and nausea and vomiting as prescribed. - Provide good oral care for dryness of mouth. - Promote rest to relieve weakness. - Monitor intake and output. To assess fluid balance status. - Provide good perianal care. 2\. Pain related to abdominal cramps. - Provide low fiber diet. To reduce peristalsis - Promote rest. To reduce peristalsis and promote comfort - Avoid gas- forming foods. Flatulence worseness abdominal pain. - Administer anti cholinergic as prescribed. To relieve abdominal cramps. 3\. Inadequate food intake related to nausea and vomiting. - Provide small, frequent feedings. This is better tolerated by patients with nausea. - Provide ice chips to relieve nausea. - Administer anti emetic as prescribed. To relieved nausea and vomiting. 4\. Fever related to infection and dehydration. - Provide adequate room ventilation. - Keep the room airy and free of odor. To promote rest. - Increase fluid intake. To reduce fever, relieve dehydration, and promote excretion of microorganism. - Administer antibiotic and antipyretic as prescribed. - Render tepid sponge bath. To reduced fever by evaporation and conduction. - Keep the skin clean and dry. To promote comfort. - Change gowns and bedding as needed to prevent dampness from perspirations. - Observation of the sick. Observe everything about the client. Record all observations which are factual and not merely opinions. B. Physical Environment - Home, community/ neighborhood and workplace Assessment 1\. Pure water. Assess for adequate working water system and storage that is free from contamination. 2\. Cleanliness. Assess for sanitation conditions of food sources and preparation and hygienic practices. 3\. Assess for the means to maintain sanitation conditions of the toilets. To keep Food and water supply free from contamination. Home, community/neighborhood and work place plan 1\. Water - Have water checked for contamination in coordination with local Department of Health Personnel. - Educate the client on water purification and storage methods. - Keep garbage and other, refuse away from water supply or any parts of the water system. 2\. Cleanliness - Educate the client on proper food handling; the importance of hand washing especially when preparing foods and before and after using the toilet; proper waste disposal and personal cleanliness. Home and Workplace Assessment 1\. Light. Assess for adequate windows and working light sources. 2\. Pure Air. Assess for ventilation, offensive odors, (e.g. odor of garbage in the landfill). 3\. Water. Assess for working system that is free from contamination. 4\. Drainage. Assess the area for drainage of water from washing dishes and laundry ; drainage of rain water away from the home. 5\. Cleanliness. Assess the home and workplace for means to keep the areas clean, and freedom from excessive dust, molds, mildew, pet droppings ( from cats and dogs), offensive odors, " dust catcher" things ( files of papers, unused jars, plastic container, unused old clothes, etc.) 6\. Bed and bedding. Assess the bed for space and comfort. Assess the bedding for Cleanliness and availability of areas for laundry and drying of bedding( for home Environment only). 7\. Noise. Assess the area for loud, offensive and unnecessary noise. Psychological Environment - Assessment and Plan Miss Angel Gonzaga has several psychological concerns. She is worried over her absence from her job, her health, and expenses for hospitalization. 1\. Variety. Assess the client's activities before illness. Attempt to stimulate variety in the Room and with the client during her hospital stay- with cards, flowers, magazines, books Music. Encourage visits of relatives and friends. 2\. Chattering hopes and advices. Refrain from giving the patient your opinion. Provide factual information about health. Allow her to verbalize her fears, feelings and concerns. Summary: - Nightingale's Theory in Nursing is timeless. Her writings are as meaningful today as they were in the nineteenth century. Her 13 canons ( see Critical Thinking with Nightingale's Theory) may differ in the specifics of application today, but the underlying principles provided by Nightingale remain sound and relevant. - Nightingale's theory applies in all situations that nursing care is provided. Jean Watson\'s Philosophy of Nursing: Theory of Transpersonal Caring - Jean Watson ) an American nurse theorist and nursing professor who is well known for philosophy and Theory of Transpersonal Caring and "Caring Science" - Her study on caring has been integrated into education and patient care to various nursing schools and health care facilities all over the world Her concept of nursing - Nursing involves the application of ART and \`human Science through Transpersonal Transactions in order to help the person achieve mind , body and soul harmony Introduction - Theorist - Jean Watson was born in West Virginia, US - Educated: BSN, University of Colorado, 1964, MS, University of Colorado, 1966, PhD, University of Colorado, 1973 - Distinguished Professor of Nursing and Chair in Caring Science at the University of Colorado Health Sciences Center. - Fellow of the American Academy of Nursing. - Dean of Nursing at the University Health Sciences Center and President of the National League for Nursing - Undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and PhD in educational psychology and counseling. - Six (6) Honorary Doctoral Degrees. - Research has been in the area of human caring and loss. - In 1988, her theory was published in "nursing: human science and human care". - 1997-, she experienced an accidental injury that resulted In the lost of her left eye. - In 1998, her husband, whom she considers as her physical and spiritual partner, and her best friend passed away. - Watson states that she is " attempting to integrate these wounds into my life and work. One of the gifts through the suffering was the privilege of experiencing and receiving my own theory through the care from my husband and loving nurse friend and colleagues. Seven Assumptions 1\. Caring can be effectively demonstrated and practiced only interpersonally. 2.Caring consists of carative factors that result in the satisfaction of certain human needs. 3\. Effective caring promotes health and individual or family growth. 4\. Caring responses accept person not only as he or she is now but as what he or she may become. 5\. A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself or herself at a given point in time. 6\. Caring is more " healthogenic" than is curing. 7\. A science of caring is complementary to the science of curing. - The practice of caring is central to nursing. Major Elements of Caring Theory 1. Transpersonal caring relationship - How the nurse goes beyond an objective assessment, showing concerns toward the person's subjective and deeper meaning regarding their own health care situation. 2\. Caring Occasion/ Moment - Moment when the nurse and another person come together in such a way that an occasion for human caring is created. 3\. Carative Factors Ten Carative Factors - The ten primary carative factors, - guide for the core of nursing, need to be addressed by nurses with their patients when in caring role. - Carative term to contrast with curative - It honors the human dimensions of nursing work and the inner life world and subjective experiences of patients. - Watson offered a translation of the original carative factors into clinical caritas processes that suggested ways to apply the 10 carative factors.  A green and white chart with black text Description automatically generated  Application Theory - Her model of nursing reflects & embodies the TRUE ESSENCE of the Nursing profession to this day - It viewed the patient as the mind, body and spirit entity that needs holistic nursing care. - One major implication of the theory is in the realm of BEDSIDE NURSING , where nurses of today have pacticularly begun to neglect, - The essence of nursing is in the caring aspect and caring is taking the wholeness the totality of the patient into consideration. - It is every nurse's duty & obligation to care for his patient not by merely looking into and caring for his physical disease but try to care for the patient for who he is. The first three carative factors form the "philosophical foundation" for the science of caring. The remaining seven carative factors spring from the foundation laid by these first three. 1. The formation of a humanistic- altruistic system of values Begins developmentally at an early age with values shared with the parents. Mediated through ones own life experiences, the learning one gains and exposure to the humanities. Is perceived as necessary to the nurse's own maturation which then promotes altruistic behavior towards others. 2\. Faith-hope Is essential to both the carative and the curative processes. When modern science has nothing further to offer the person, the nurse can continue to use faith-hope to provide a sense of well-being through beliefs which are meaningful to the individual. 3\. Cultivation of sensitivity to one's self and to others - Explores the need of the nurse to begin to feel an emotion as it presents itself. - Development of one's own feeling is needed to interact genuinely and sensitively with others. - Striving to become sensitive, makes the nurse more authentic, which encourages self-growth and self-actualization, in both the nurse and those with whom the nurse interacts. - The nurses promote health and higher level functioning only when they form person to person relationship. 4\. Establishing a helping-trust relationship - Strongest tool is the mode of communication, which establishes rapport and caring. - Characteristics needed to in the helping-trust relationship are: - Congruence - Empathy - Warmth - Communication includes verbal, nonverbal and listening in a manner which connotes empathetic understanding. 5\. The expression of feelings, both positive and negative - "Feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring relationship". - Awareness of the feelings helps to understand the behavior it engenders. 6\. The systematic use of the scientific problem-solving method for decision making - The scientific problem- solving method is the only method that allows for control and prediction, and that permits self-correction. - The science of caring should not be always neutral and objective. 7\. Promotion of interpersonal teaching-learning - The caring nurse must focus on the learning process as much as the teaching process. - Understanding the person's perception of the situation assist the nurse to prepare a cognitive plan. 8\. Provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment - Watson divides these into external and internal variables, which the nurse manipulates in order to provide support and protection for the person's mental and physical well-being. - The external and internal environments are interdependent. - Nurse must provide comfort, privacy and safety as a part of this carative factor. 9\. Assistance with the gratification of human needs - It is based on a hierarchy of need similar to that of the Maslow's. - Each need is equally important for quality nursing care and the promotion of optimal health. - All the needs deserve to be attended to and valued. - Watson's ordering of needs - Lower order needs (biophysical needs) - The need for food and fluid - The need for elimination - The need for ventilation - Lower order needs (psychophysical needs) - The need for activity-inactivity - The need for sexuality - Higher order needs (psychosocial needs) - The need for achievement - The need for affiliation - Higher order need (intrapersonal-interpersonal need) - The need for self-actualization 10\. Allowance for existential-phenomenological forces - Phenomenology is a way of understanding people from the way things appear to them, from their frame of reference. - Existential psychology is the study of human existence using phenomenological analysis. - This factor helps the nurse to reconcile and mediate the incongruity of viewing the person holistically while at the same time attending to the hierarchical ordering of needs. - Thus the nurse assists the person to find the strength or courage to confront life or death. Watson's theory and the four major concepts: 1\. Human being - Human being refers to "..... a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. He, human is viewed as greater than and different from, the sum of his or her parts". 2\. Health - Watson adds the following three elements to WHO definition of health: - A high level of overall physical, mental and social functioning - A general adaptive-maintenance level of daily functioning - The absence of illness (or the presence of efforts that leads its absence) 3\. Environment/society - According to Watson, caring (and nursing) has existed in every society. - A caring attitude is not transmitted from generation to generation. - It is transmitted by the culture of the profession as a unique way of coping with its environment. 4\. Nursing - "Nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health". - It focuses on health promotion and treatment of disease. She believes that holistic health care is central to the practice of caring in nursing. - She defines nursing as....."a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human transactions". Watson's Theory and Nursing Process Nursing process contains the same steps as the scientific research process. They both try to solve a problem. Both provide a framework for decision making. 1\. Assessment - Involves observation, identification and review of the problem; use of applicable knowledge in literature. - Also includes conceptual knowledge for the formulation and conceptualization of framework. - Includes the formulation of hypothesis; defining variables that will be examined in solving the problem. 2\. Plan - It helps to determine how variables would be examined or measured; includes a conceptual approach or design for problem solving. It determines what data would be collected and how on whom. 3\. Intervention - It is the direct action and implementation of the plan. - It includes the collection of the data. 4\. Evaluation - Analysis of the data as well as the examination of the effects of interventions based on the data. - Includes the interpretation of the results, the degree to which positive outcome has occurred and whether the result can be generalized. - It may also generate additional hypothesis or may even lead to the generation of a nursing theory. Watson's theory and the characteristic of a theory - Logical in nature - Relatively simple - Generelizable - Based on phenomenological studies that generally ask questions rather than state hypotheses. - Can be used to guide and improve practice. - Supported by the theoretical work of numerous humanists, philosophers, - developmentalists and psychologists. Strengths: - This theory places client in the context of the family, the community and the culture. - It places the client as the focus of practice rather than the technology. - Limitations - Biophysical needs of the individual are given less important. - The ten caratiive factors primarily delineate the psychosocial needs of the person. - Needs further research to apply in practice. - Research related to Watson's theory - The effectiveness of Watson\'s Caring Model on the quality of life and blood pressure of patients with hypertension. J Adv Nurs. 2003 Jan;41(2):130-9. Conclusion: - Watson provides many useful concepts for the practice of nursing. - She ties together many theories commonly used in nursing education. - The detailed descriptions of the carative factors can give guidance to those who wish to employ them in practice or research. Patricia E. Benner\ From Novice to Expert Introduction - Dr. Patricia Benner introduced the concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences. - She proposed that one could gain knowledge and skills (\"knowing how\") without ever learning the theory (\"knowing that\"). - She further explains that the development of knowledge in applied disciplines such as medicine and nursing is composed of the extension of practical knowledge (know how) through research and the characterization and understanding of the \"know how\" of clinical experience. - She conceptualizes in her writing about nursing skills as experience is a prerequisite for becoming an expert. Introduction: - Dr. Patricia Benner introduced the concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences. - She proposed that one could gain knowledge and skills (\"knowing how\") without ever learning the theory (\"knowing that\"). - She further explains that the development of knowledge in applied disciplines such as medicine and nursing is composed of the extension of practical knowledge (know how) through research and the characterization and understanding of the \"know how\" of clinical experience. - She conceptualizes in her writing about nursing skills as experience is a prerequisite for becoming an expert. - About the theorist - Patricia E. Benner, R.N., Ph.D., FAAN is a Professor Emerita at the University of California, San Francisco. - BA in Nursing - Pasadena College/Point Loma College - MS in Med/Surg nursing from UCSF - PhD -1982 from UC Berkeley - 1970s - Research at UCSF and UC Berkeley - Has taught and done research at UCSF since 1979 - Published 9 books and numerous articles - Published 'Novice to Expert Theory' in 1982 - Received Book of the Year from AJN in 1984,1990,1996, 2000 - Her web address is at: http://www.PatriciaBenner.com - Her profile can be obtained at LEVELS OF NURSING EXPERIENCE She described 5 levels of Nursing Experience as: 1\. Novice 2\. Advanced beginner 3\. Competent 4\. Proficient 5\. Expert - Novice - Beginner with no experience - Taught general rules to help perform tasks - Rules are: context-free, independent of specific cases, and applied universally - Rule-governed behavior is limited and inflexible - Ex. "Tell me what I need to do and I'll do it." - Advanced Beginner - Demonstrates acceptable performance - Has gained prior experience in actual situations to recognize recurring meaningful components - Principles, based on experiences, begin to be formulated to guide actions - Competent - Typically a nurse with 2-3 years experience on the job in the same area or in similar day-to-day situations - More aware of long-term goals - Gains perspective from planning own actions based on conscious, abstract, and analytical thinking and helps to achieve greater efficiency and organization - Proficient - Perceives and understands situations as whole parts - More holistic understanding improves decision-making - Learns from experiences what to expect in certain situations and how to modify plans - Expert - No longer relies on principles, rules, or guidelines to connect situations and determine actions - Much more background of experience - Has intuitive grasp of clinical situations - Performance is now fluid, flexible, and highly-proficient - Different levels of skills reflect changes in 3 aspects of skilled performance: - 1\. Movement from relying on abstract principles to using past concrete experiences to guide actions - 2\. Change in learner's perception of situations as whole parts rather than in separate pieces - 3\. Passage from a detached observer to an involved performer, no longer outside the situation but now actively engaged in participation Significance of the theory - These levels reflect movement from reliance on past abstract principles to the use of past concrete experience as paradigms and change in perception of situation as a complete whole in which certain parts are relevant - Each step builds on the previous one as abstract principles are refined and expanded by experience and the learner gains clinical expertise. - This theory changed the profession\'s understanding of what it means to be an expert, placing this designation not on the nurse with the most highly paid or most prestigious position, but on the nurse who provided \"the most exquisite nursing care. - It recognized that nursing was poorly served by the paradigm that called for all of nursing theory to be developed by researchers and scholars, but rather introduced the revolutionary notion that the practice itself could and should inform theory. Conclusion - Nursing practice guided by the human becoming theory live the processes of the Parse practice methodology illuminating meaning, synchronizing rhythms, and mobilizing transcendence - Research guided by the human becoming theory sheds light on the meaning of universal humanly lived experiences such as hope, taking life day-by-day, grieving, suffering, and time passing. Theory of Carative Caring: Katie Eriksson\ Biography and career of Katie Eriksson - Katie Eriksson is a Finland-Swedish nurse. After taking nursing in 1965 to be able to practice nursing, she became a nursing instructor at Helsinki Swedish Medical Institute. She currently works as a professor of health sciences at Abo Akademi University in Vaasa, where she built a master's degree program in health sciences, and a four-year postgraduate studies program leading to a doctoral degree in health sciences. Credentials of the theorist - Katie Eriksson is one of the pioneers of caring science in the Nordic countries. When she started her career 30 years ago, she had to open the way for a new science. We who followed her work and progress in Finland have noticed her ability from the beginning to design caring science as a discipline, while bringing to life the abstract substance of caring. - Eriksson was born on November 18, 1943, in Jakobstad, Finland. - She belongs to the Finland-Swedish minority in Finland, and her native language is Swedish. - She is a 1965 graduate of the Helsinki Swedish School of Nursing, and in 1967, she completed her public health nursing specialty education at the same institution. - She graduated in 1970 from the nursing teacher education program at Helsinki Finnish School of Nursing. - She continued her academic studies at University of Helsinki, where she received her MA degree in philosophy in 1974 and her licentiate degree in 1976; - she defended her doctoral dissertation in pedagogy (The Patient Care Process---An Approach to Curriculum Construction within Nursing Education: The Development of a Model for the Patient Care Process and an Approach for Curriculum Development Based on the Process of Patient Care) in 1982 (Eriksson, 1974, 1976, 1981). In 1984, Eriksson was appointed Docent of Caring Science (part time) at University of Kuopio, the first docentship in caring science in the Nordic countries. - She was appointed Professor of Caring Science at Åbo Akademi University in 1992. - Between 1993 and 1999, she held a professorship in caring science at University of Helsinki, Faculty of Medicine, where she has been a docent since 2001. - Since 1996, she has also served as Director of Nursing at Helsinki University Central Hospital, with responsibilities for research and development of caring science in connection with her professorship at Åbo Akademi University. Major Concepts and Definitions - Caritas - Caritas means love and charity. In caritas, eros and agapé are united, and caritas is by nature unconditional love. Caritas, which is the fundamental motive of caring science, also constitutes the motive for all caring. It means that caring is an endeavor to mediate faith, hope, and love through tending, playing, and learning. - Caring communion Caring communion constitutes the context of the meaning of caring and is the structure that determines caring reality. Caring gets its distinctive character through caring communion (Eriksson, 1990). It is a form of intimate connection that characterizes caring. Caring communion requires meeting in time and space, an absolute, lasting presence (Eriksson, 1992c). Caring communion is characterized by intensity and vitality, and by warmth, closeness, rest, respect, honesty, and tolerance. It cannot be taken for granted but pre-supposes a conscious effort to be with the other. Caring communion is seen as the source of strength and meaning in caring. Eriksson (1990) writes in Pro Caritate, referring to Lévinas: - Entering into communion implies creating opportunities for the other---to be able to step out of the enclosure of his/her own identity, out of that which belongs to one towards that which does not belong to one and is nevertheless one's own---it is one of the deepest forms of communion (pp. 28--29). - Joining in a communion means creating possibilities for the other. Lévinas suggests that considering someone as one's own son implies a relationship "beyond the possible" (1985, p. 71; 1988). In this relationship, the individual perceives the other person's possibilities as if they were his or her own. This requires the ability to move toward that which is no longer one's own but which belongs to oneself. It is one of the deepest forms of communion (Eriksson, 1992b). Caring communion is what unites and ties together and gives caring its significance (Eriksson, 1992a). -  The Theory of Caritative Caring was developed by Katie Eriksson. This model of nursing distinguishes between caring ethics, the practical relationship between the patient and the nurse, and nursing ethics. Nursing ethics are the ethical principles that guide a nurse's decision-making abilities. Caritative caring consists of love and charity, which is also known as caritas, and respect and reverence for human holiness and dignity. According to the theory, suffering that occurs as a result of a lack of caritative care is a violation of human dignity. - "Caritative nursing means that we take 'caritas' into use when caring for the human being in health and suffering \[...\] Caritative caring is a manifestation of the love that 'just exists' \[...\] Caring communion, true caring, occurs when the one caring in a spirit of caritas alleviates the suffering of the patient." - The ultimate goal of caring is to lighten suffering and serve life and health. - Inspired many in the Nordic countries, and used as the basis of research, education, and clinical practice. The Act of Caring -The act of caring contains the caring elements - faith - hope - love - tending - Playing - learning involves the categories of infinity and eternity, and invites to deep communion. - The act of caring is the art of making something very special out of something less special. Carative Caring Ethics - Caritative caring ethics comprises the ethics of caring, the core of which is determined by the caritas motive. Eriksson makes a distinction between caring ethics and nursing ethics. She also defines the foundations of ethics in care and its essential substance. - Caring ethics deals with the basic relation between the patient and the nurse---the way in which the nurse meets the patient in an ethical sense. It is about the approach we have toward the patient. - Nursing ethics deals with the ethical principles and rules that guide my work or my decisions. Caring ethics is the core of nursing ethics. The foundations of caritative ethics can be found not only in history, but also in the dividing line between theological and human ethics in general. Eriksson has been influenced by Nygren's (1966) human ethics and Lévinas' (1988) "face ethics," among others. - Ethical caring is what we actually make explicit through our approach and the things we do for the patient in practice. An approach that is based on ethics in care means that we, without prejudice, see the human being with respect, and that we confirm his or her absolute dignity. - It also means that we are willing to sacrifice something of ourselves. The ethical categories that emerge as basic in caritative caring ethics are human dignity, the caring communion, invitation, responsibility, good and evil, and virtue and obligation. In an ethical act, the good is brought out through ethical actions (Eriksson, 1995, 2003). Dignity - Dignity constitutes one of the basic concepts of caritative caring ethics. - Human dignity is: - partly absolute dignity - partly relative dignity. - Absolute dignity is granted the human being through creation, while relative dignity is influenced and formed through culture and external contexts. - A human being's absolute dignity involves the right to be confirmed as a unique human being (Eriksson, 1988, 1995, 1997a). Invitation -refers to the act that occurs when the career welcomes the patient to the caring communion. The concept of invitation finds room for a place where the human being is allowed to rest, a place that breathes genuine hospitality, and where the patient's appeal for charity meets with a response (Eriksson, 1995; Eriksson & Lindström, 2000). Suffering -is an ontological concept described as a human being's struggle between good and evil in a state of becoming. Suffering implies in some sense dying away from something, and through reconciliation, the wholeness of body, soul, and spirit is re-created, when the human being's holiness and dignity appear. Suffering is a unique, isolated total experience and is not synonymous with pain (Eriksson, 1984, 1993). Suffering related to illness, to care, and to life - These are three different forms of suffering. - Suffering related to illness is experienced in connection with illness and treatment. - When the patient is exposed to suffering caused by care or absence of caring, the patient experiences suffering related to care, which is always a violation of the patient's dignity. - Not to be taken seriously, not to be welcome, being blamed, and being subjected to the exercise of power are various forms of suffering related to care. In the situation of being a patient, the entire life of a human being may be experienced as suffering related to life (Eriksson, 1993, 1994a; Lindholm & Eriksson, 1993). The Suffering Human Being - The suffering human being is the concept that Eriksson uses to describe the patient. The patient refers to the concept of patients (Latin), which means "suffering." The patient is a suffering human being, or a human being who suffers and patiently endures (Eriksson, 1994a; Eriksson & Herberts, 1992). Reconciliation - Reconciliation refers to the drama of suffering. A human being who suffers wants to be confirmed in his or her suffering and be given time and space to suffer and reach reconciliation. Reconciliation implies a change through which a new wholeness is formed of the life the human being has lost in suffering. In reconciliation, the importance of sacrifice emerges (Eriksson, 1994a). Having achieved reconciliation implies living with an imperfection with regard to oneself and others but seeing a way forward and a meaning in one's suffering. Reconciliation is a prerequisite of caritas (Eriksson, 1990). Caring Culture  - Caring culture is the concept that Eriksson (1987a) uses instead of environment. It characterizes the total caring reality and is based on cultural elements such as traditions, rituals, and basic values. Caring culture transmits an inner order of value preferences or ethos, and the different constructions of culture have their basis in the changes of value that ethos undergoes. If communion arises based on the ethos, the culture becomes inviting. Respect for the human being, his or her dignity and holiness, forms the goal of communion and participation in a caring culture. The origin of the concept of culture is to be found in such dimensions as reverence, tending, cultivating, and caring; these dimensions are central to the basic motive of preserving and developing a caring culture (Eriksson, 1987a; Eriksson & Lindström, 2003). Major Assumptions - Eriksson distinguishes between two kinds of major assumptions: axioms and theses. She regards axioms as fundamental truths in relation to the conception of the world; theses are fundamental statements concerning the general nature of caring science, and their validity is tested through basic research. Axioms and theses jointly constitute the ontology of caring science and therefore also are the foundation of its epistemology (Eriksson, 1988, 2001). - The caritative theory of caring is based on the following axioms and theses, as modified and clarified from Eriksson's basic assumptions with her approval (Eriksson, 2002). The axioms are as follows: -  The human being is fundamentally an entity of body, soul, and spirit. - The human being is fundamentally a religious being. - The human being is fundamentally holy. Human dignity means accepting the human obligation of serving with love, of existing for the sake of others. - Communion is the basis for all humanity. Human beings are fundamentally interrelated to an abstract and/or concrete other in a communion. - Caring is something human by nature, a call to serve in love. -  Suffering is an inseparable part of life. Suffering and health are each other's prerequisites. -  Health is more than the absence of illness. Health implies wholeness and holiness. - The human being lives in a reality that is characterized by mystery, infinity, and eternity. The theses are as follows: - Ethos confers ultimate meaning on the caring context. - The basic motive of caring is the *caritas* motive. - The basic category of caring is suffering. - Caring communion forms the context of meaning of caring and derives its origin from the ethos of love, responsibility, and sacrifice, namely, caritative ethics. - Health means a movement in becoming, being, and doing while striving for wholeness and holiness, which is compatible with endurable suffering. - Caring implies alleviation of suffering in charity, love, faith, and hope. Natural basic caring is expressed through tending, playing, and learning in a sustained caring relationship, which is asymmetrical by nature. The Human Being - The conception of the human being in Eriksson's theory is based on the axiom that the human being is an entity of body, soul, and spirit (Eriksson, 1987a, 1988). She emphasizes that the human being is fundamentally a religious being, but all human beings have not recognized this dimension. - The human being is fundamentally holy, and this axiom is related to the idea of human dignity, which means accepting the human obligation of serving with love and existing for the sake of others. Eriksson stresses the necessity of understanding the human being in his ontological context. - The human being is seen as in constant becoming; he is constantly in change and therefore never in a state of full completion. He is understood in terms of the dual tendencies that exist within him, engaged in a continued struggle and living in a tension between being and nonbeing. - Eriksson sees the human being's conditional freedom as a dimension of becoming. She links her thinking with Kierkegaard's (1843/1943) ideas of free choice and decision in the human being's various stages---aesthetic, ethical, and religious stages---and she thinks that the human being's power of transcendency is the foundation of real freedom. The dual tendency of the human being also emerges in his effort to be unique, while he simultaneously longs for belonging in a larger communion. - The human being is fundamentally dependent on communion; he is dependent on another, and it is in the relationship between a concrete other (human being) and an abstract other (some form of God) that the human being constitutes himself and his being (Eriksson, 1987a). - The human being seeks a communion where he can give and receive love, experience faith and hope, and be aware that his existence here and now has meaning. - According to Eriksson (1987b), the human being we meet in care is creative and imaginative, has desires and wishes, and is able to experience phenomena; therefore, a description of the human being only in terms of his needs is insufficient. When the human being is entering the caring context, he or she becomes a patient in the original sense of the concept---a suffering human being (Eriksson, 1994a). 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. The *caritas* motive can be traced through semantics, anthropology, and the history of ideas (Eriksson, 1992c). The history of ideas indicates that the foundation of the caring professions through the ages has been an inclination to help and minister to those suffering (Lanara, 1981). - *Caritas* constitutes the motive for caring, and it is through the caritas motive that caring gets its deepest formulation. This motive, according to Eriksson, is also the core of all teaching and fostering growth in all forms of human relations. In caritas, the two basic forms of love---eros and agapé (Nygren, 1966)---are combined. When the two forms of love combine, generosity becomes a human being's attitude toward life and joy is its form of expression. The motive of caritas becomes visible in a special ethical attitude in caring, or what Eriksson calls a caritative outlook, which she formulates and specifies in caritative caring ethics (Eriksson, 1995). Caritas constitutes the inner force that is connected with the mission to care. A career beams forth what Eriksson calls *claritas,* or the strength and light of beauty. - Caring is something natural and original. Eriksson thinks that the substance of caring can be understood only by a search for its origin. This origin is in the origin of the concept and in the idea of natural caring. The fundamentals of natural *caring* are constituted by the idea of motherliness, which implies cleansing and nourishing, and spontaneous and unconditional love. - Natural basic caring is expressed through tending, playing, and learning in a spirit of love, faith, and hope. The characteristics of tending are warmth, closeness, and touch; playing is an expression of exercise, testing, creativity, and imagination, and desires and wishes; learning is aimed at growth and change. To tend, play, and learn implies sharing, and sharing, Eriksson (1987a) says, is "presence with the human being, life and God" (p. 38). - True care therefore is "not a form of behavior, not a feeling or state. It is to be there---it is the way, the spirit in which it is done, and this spirit is caritative" (Eriksson, 1998, p. 4). Eriksson brings out that caring through the ages can be seen as various expressions of love and charity, with a view toward alleviating suffering and serving life and health. - In her later texts, she stresses that caring also can be seen as a search for truth, goodness, beauty, and the eternal, and for what is permanent in caring, and making it visible or evident (Eriksson, 2002). Eriksson emphasizes that caritative caring relates to the innermost core of nursing. - She distinguishes between caring nursing and *nursing care.* She means that nursing care is based on the nursing care process, and it represents good care only when it is based on the innermost core of caring. - Caring nursing represents a kind of caring without prejudice that emphasizes the patient and his or her suffering and desires (Eriksson, 1994a). - The core of the caring relationship, between nurse and patient as described by Eriksson (1993), is an open invitation that contains affirmation that the other is always welcome. The constant open invitation is involved in what Eriksson (2003) today calls the act of caring. - The act of caring expresses the innermost spirit of caring and recreates the basic motive of caritas. The caring act expresses the deepest holy element, the safeguarding of the individual patient's dignity. In the caring act, the patient is invited to a genuine sharing, a communion, in order to make the caring fundamentals alive and active (Eriksson, 1987a) (i.e., appropriated to the patient). - The appropriation has the consequence of somehow restoring the human being and making him or her more genuinely human. In an ontological sense, the ultimate goal of caring cannot be health only; it reaches further and includes human life in its entirety. Because the mission of the human being is to serve, to exist for the sake of others, the ultimate purpose of caring is to bring the human being back to this mission (Eriksson, 1994a). Environment - Eriksson uses the concept of ethos in accordance with Aristotle's (1935, 1997) idea that ethics is derived from ethos. In Eriksson's sense, the ethos of caring science, as well as that of caring, consists of the idea of love and charity and respect and honor of the holiness and dignity of the human being. Ethos is the sounding board of all caring. Ethos is ontology in which there is an "inner ought to," a target of caring "that has its own language and its ow - n key" (Eriksson, 2003, p. 23). Good caring and true knowledge become visible through ethos. Ethos originally refers to home, or to the place where a human being feels at home. It symbolizes a human being's innermost space, where he appears in his nakedness (Lévinas, 1989). - Ethos and ethics belong together, and in the caring culture, they become one (Eriksson, 2003). Eriksson thinks that ethos means that we feel called to serve a particular task. This ethos she sees as the core of caring culture. - Ethos, which forms the basic force in caring culture, reflects the prevailing priority of values through which the basic foundations of ethics and ethical actions appear. - At the beginning of the 1990s, when Eriksson reintroduced the idea of suffering as a basic category of caring, she returned to the fundamental historical conditions of all caring, the idea of charity as the basis of alleviating suffering (Eriksson, 1984, 1993, 1994a, 1997a). This meant a change in the view of caring reality to a focus on the suffering human being. Her starting point is that suffering is an inseparable part of human life, and that it has no distinct reason or definition. - Suffering as such has no meaning, but a human being can ascribe meaning to it by becoming reconciled to it. Eriksson makes a distinction between endurable and unendurable suffering and thinks that an unendurable suffering paralyzes the human being, preventing him or her from growing, while endurable suffering is compatible with health. - Every human being's suffering is enacted in a drama of suffering. Alleviating a human being's suffering implies being a co-actor in the drama and confirming his or her suffering. A human being who suffers wants to have the suffering confirmed and be given time and space to become reconciled to it. - The ultimate purpose of caring is to alleviate suffering. Eriksson has described three different forms: suffering related to illness, suffering related to care, and suffering related to life (Eriksson, 1993, 1994a, 1997a). Health - Eriksson considers health in many of her earlier writings in accordance with an analysis of the concept in which she defines health as soundness, freshness, and well-being. The subjective dimension, or well-being, is emphasized strongly (Eriksson, 1976). In the current axiom of health, health implies being whole in body, soul, and spirit. - Health means as a pure concept wholeness and holiness (Eriksson, 1984). In accordance with her view of the human being, Eriksson has developed various premises regarding the substance and laws of health, which have been summed up in an ontological health model. She sees health as both movement and integration. The health premise is a movement comprising various partial premises: health as movement implies a change; a human being is being formed or destroyed, but never completely; health is movement between actual and potential; health is movement in time and space; health as movement is dependent on vital force and on vitality of body, soul, and spirit; the direction of this movement is determined by the human being's needs and desires; the will to find meaning, life, and love constitutes the source of energy of the movement; and health as movement strives toward a realization of one's potential (Eriksson, 1984). - In the ontological conception, health is conceived as a becoming, a movement toward a deeper wholeness and holiness. As a human being's inner health potential is touched, a movement occurs that becomes visible in the different dimensions of health as *doing, being,* and *becoming* with a wholeness that is unique to human beings (Eriksson, Bondas-Salonen, Fagerström, et al., 1990). - In doing, the person's thoughts concerning health are focused on healthy life habits and avoiding illness; in being, the person strives for balance and harmony; in becoming, the human being becomes whole on a deeper level of integration. Theoretical Assertions - Eriksson's fundamental idea when formulating theoretical assertions is that they connect four levels of knowledge: the meta-theoretical, the theoretical, the technological, and caring as art. The generation of theory takes place through dialectical movement between these levels, but here deduction constitutes the basic epistemological idea (Eriksson, 1981). The theory of science for caring science, which contains the fundamental epistemological, logical, and ethical standpoints, is formed on the meta-theoretical level. Eriksson (1988), in accordance with Nygren (1972), sees the basic motive as the element that permeates the formation of knowledge at all levels and gives scientific knowledge its unique characteristics. - A clearly formulated ontology constitutes the foundation of both the caritative caring theory and caring science as a discipline. The caritas motive, the ethos of love and charity, and the respect and reverence for human holiness and dignity, which determine the nature of caring, give the caritative caring theory its feature. This ethos, which encircles caring as science and as art, permeates caring culture and creates the preconditions for caring. The ethos is reflected in the process of nursing care, in the documentation, and in various care planning models. - Caring communion constitutes the context of meaning from which the concepts in the theory are to be understood. Human suffering forms the basic category of caring and summons the carer to true caring (i.e., serving in love and charity). In the act of caring, the suffering human being, or patient, is invited and welcomed to the caring communion, where the patient's suffering can be alleviated through the act of caring in the drama of suffering that is unique to every human being. Alleviation of suffering implies that the carer is a co-actor in the drama, confirms the patient's suffering, and gives time and space to suffer until reconciliation is reached. Reconciliation is the ultimate aim of health or being and signifies a reestablishment of wholeness and holiness (Eriksson, 1997a). - Logical form - Meta-theory has always had a fundamental place in Eriksson's thinking, and her epistemological work is anchored in Aristotle's theory of knowledge (Aristotle, 1935). Searching for knowledge, which is intrinsically hermeneutic, and which takes place within the scope of an articulated theoretical perspective, is understood as a search for the original text in a historical-hermeneutic tradition, that which in the old hermeneutic sense represents truth (Gadamer, 1960/1994). To achieve the depth in the development of knowledge and theory she has consistently striven for, Eriksson has used various logical models for the hypothetical deductive method and hermeneutics guiding principles. Lesson 2 Nursing Conceptual Model - Nursing Conceptual Model - Roger's Science of Unitary Human Beings Nursing Conceptual Model - Orem's Self-care Deficit Model - King's General Systems Model - Neuman's System model - Roy's Adaptation Model - Johnson's Behavioral System Model Martha E Rogers\ Science of Unitary Human Beings Nursing Conceptual Model Introduction - Theorist - Martha E Rogers - Born :May 12, 1914, Dallas, Texas, USA - Diploma : Knoxville General Hospital School of Nursing(1936) - Graduation in Public Health Nursing : George Peabody College, TN, 1937 - MA :Teachers college, Columbia university, New York, 1945 - MPH :Johns Hopkins University, Baltimore, MD, 1952 - Doctorate in nursing :Johns Hopkins University, Baltimore, 1954 - Fellowship: American academy of nursing - Position: Professor Emerita, Division of Nursing, New York University, Consultant, Speaker - Died : March 13 , 1994 Publications of Martha Rogers - Theoretical basis of nursing (Rogers 1970) - Nursing science and art :a prospective (Rogers 1988) - Nursing :science of unitary, irreducible, human beings update (Rogers 1990) - Vision of space based nursing (Rogers 1990) Overview of Rogerian Model - Rogers conceptual system provides a body of knowledge in nursing. - Rogers model provides the way of viewing the unitary human being. - Humans are viewed as integral with the universe. - The unitary human being and the environment are one, not dichotomous - Nursing focus on people and the manifestations that emerge from the mutual human /environmental field process - Change of pattern and organization of the human field and the environmental field is propagated by waves - The manifestations of the field patterning that emerge are observable events - The identification of the pattern provide knowledge and understanding of human experience - Basic characteristics which describes the life process of human: energy field, openness, pattern, and pan dimensionality - Basic concepts include unitary human being, environment, and homeodynamic principles Nursing Conceptual Models Chapter 2: Lesson 2 Introduction Theorist - Martha E Rogers Born :May 12, 1914, Dallas, Texas, USA Diploma : Knoxville General Hospital School of Nursing(1936) - Graduation in Public Health Nursing : George Peabody College, TN, 1937 - MA :Teachers college, Columbia university, New York, 1945 - MPH :Johns Hopkins University, Baltimore, MD, 1952 - Doctorate in nursing :Johns Hopkins University, Baltimore, 1954 - Fellowship: American academy of nursing - Position: Professor Emerita, Division of Nursing, New York University, Consultant, Speaker - Died : March 13 , 1994 Publications of Martha Rogers - Theoretical basis of nursing (Rogers 1970) - Nursing science and art :a prospective (Rogers 1988) - Nursing :science of unitary, irreducible, human beings update (Rogers 1990) - Vision of space based nursing (Rogers 1990) Overview of Rogerian Model - Rogers conceptual system provides a body of knowledge in nursing. - Rogers model provides the way of viewing the unitary human being. - Humans are viewed as integral with the universe. - The unitary human being and the environment are one, not dichotomous - Nursing focus on people and the manifestations that emerge from the mutual human /environmental field process - Change of pattern and organization of the human field and the environmental field is propagated by waves - The manifestations of the field patterning that emerge are observable events - The identification of the pattern provide knowledge and understanding of human experience - Basic characteristics which describes the life process of human: energy field, openness, pattern, and pan dimensionality - Basic concepts include unitary human being, environment, and homeodynamic principles Concepts of Rogers Model - Energy field - The energy field is the fundamental unit of both the living and nonliving - This energy field \"provide a way to perceive people and environment as irreducible wholes\" - The energy fields continuously varies in intensity, density, and extent. - Openness - The human field and the environmental field are constantly exchanging their energy - There are no boundaries or barrier that inhibit energy flow between fields Pattern - Pattern is defined as the distinguishing characteristic of an energy field perceived as a single waves - \"pattern is an abstraction and it gives identity to the field\" Pain Dimensionality - Pan dimensionality is defined as \"non-linear domain without spatial or temporal attributes\" - The parameters that human use in language to describe events are arbitrary. - The present is relative, there is no temporal ordering of lives. Homeodynamic Principles - The principles of homeodynamic postulates the way of perceiving unitary human beings - The fundamental unit of the living system is an energy field - Three principle of homeodynamics \> Resonancy \> Helicy \> integrality Resonance - Resonance is an ordered arrangement of rhythm characterizing both human field and environmental field that undergoes continuous dynamic metamorphosis in the human environmental process. Helicy - Helicy describes the unpredictable, but continuous, nonlinear evolution of energy fields as evidenced by non -repeating rhythmicities. - The principle of Helicy postulates an ordering of the humans evolutionary emergence. Integrality - The mutual, continuous relationship of the human energy field and the environmental field. - Changes occur by the continuous re-patterning of the human and environmental fields by resonance waves - The fields are one and integrated but unique to each other Nursing Paradigms Unitary Human Being (Person) - Unitary Human Being (person) - A unitary human being is an \"irreducible, indivisible, pan dimensional (four-dimensional) energy field identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from knowledge of the parts\" and \"a unified whole having its own distinctive characteristics which cannot be perceived by looking at, describing, or summarizing the parts\" Environment - The environment is an \"irreducible, pan dimensional energy field identified by pattern and integral with the human field\" - The field-coexists and is integral. - Manifestations emerge from this field and are perceived. Nursing - Two dimensions Independent science of nursing 1\. An organized body of knowledge which is specific to nursing is arrived at by scientific research and logical analysis 2\. Art of nursing practice: - The creative use of science for the betterment of the human - The creative use of its knowledge is the art of its practice - Nursing exists to serve people. - It is the direct and overriding responsibility to the society - The safe practice of nursing depends on the nature and amount of scientific nursing knowledge the individual brings to practice.......the imaginative, intellectual judgment with which such knowledge is made in service to the man kind.  Rogerian Theories-Grand Theories - The theory of paranormal phenomena - The theory of rhythmicities - The theory of accelerating evolution Theory of Paranormal Phenomena - This theory explains precognition, déjàvu, clairvoyance, telepathy, and therapeutic touch - Clairvoyance is rational in a four dimensional human field in continuous mutual, simultaneous interaction with a four dimensional world; there is no linear time nor any separation of human and the environmental fields Theory of Accelerating Evolution - Theory postulates that evolutionary change is speeding up and that the range of diversity of life process is widening. - Higher wave frequencies are associated with accelerating human development Theory of Rhythmicity - Focus on the human field rhythms (these rhythms are different from the biological, psychological rhythm) - Theory deals with the manifestations of the whole unitary man as changes in human sleep wake patterns, indices of human field motion, perception of time passing, and other rhythmic development. Theories derived from the science of unitary human beings - The perspective rhythm model (Patrick 1983) - Theory of health as expanding consciousness (Neuman, 1986) - Theory of creativity, actualization and empathy (Alligood 1991) - Theory of self- transcendence (Reed1997) - Power as knowing participation in change (Barrett 1998) Conceptual Model C:\\Users\\Guest\\Desktop\\rogers-diagram.png Dorothea Orem\ Self- Care Deficit Model Introduction: - Theorist : Dorothea Orem (1914-2007) - Born 1914 in Baltimore, US - Earned her diploma at Providence Hospital -- Washington, DC - 1939 -- BSN Ed., Catholic University of America - 1945 -- MSN Ed., Catholic University of America - She worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant. - Received honorary Doctor of Science degree in 1976. - Theory was first published in *Nursing: Concepts of Practice* in 1971, second in 1980, in 1995, and 2001. Major Assumptions - People should be self-reliant and responsible for their own care and others in their family needing care - People are distinct individuals - Nursing is a form of action -- interaction between two or more persons - Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health - A person's knowledge of potential health problems is necessary for promoting self-care behaviors - Self -care and dependent care are behaviors learned within a socio-cultural DEFINITIONS OF DOMAIN CONCEPTS Nursing - is art, a helping service, and a technology - Actions deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change conditions in themselves or their environments - Encompasses the patient's perspective of health condition ,the physician's perspective , and the nursing perspective - Goal of nursing -- to render the patient or members of his family capable of meeting the patient's self- care needs. - To maintain a state of health. - To regain normal or near normal state of health in the event of disease or injury. - To stabilize ,control ,or minimize the effects of chronic poor health or disability. Health - health and healthy are terms used to describe living things... - It is when they are structurally and functionally whole or sound... wholeness or integrity..includes that which makes a person human,...operating in conjunction with physiological and psychophysiological mechanisms and a material structure and in relation to and interacting with other human beings. Environment - environment components are enthronement factors, enthronement elements, conditions, and developed environment - Human being -- has the capacity to reflect, symbolize and use symbols - Conceptualized as a total being with universal, developmental needs and capable of continuous self- care - A unity that can function biologically, symbolically and socially - Nursing client - A human being who has \"health related /health derived limitations that render him incapable of continuous self- care or dependent care or limitations that result in ineffective / incomplete care. - A human being is the focus of nursing only when a self --care requisites exceeds self -care capabilities - Nursing problem deficits in universal, developmental, and health derived or health related conditions - Nursing process a system to determine (1)why a person is under care (2)a plan for care ,(3)the implementation of care - Nursing therapeutics deliberate,  systematic and purposeful action, Orem's General Theory of Nursing - Orem's general theory of nursing in three related parts:- - Theory of self -care - Theory of self- care deficit - Theory of nursing system Theory of Self Care This theory Includes: A. Self -care -- practice of activities that individual initiates and perform on their own behalf in maintaining life ,health and well being B. Self -care agency -- is a human ability which is \"the ability for engaging in self care\" -conditioned by age developmental state, life experience sociocultural orientation health and available resources C. Therapeutic self care demand -- \"totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions\" D. Self care requisites - action directed towards provision of self care. 3 categories of self care requisites are- a. Universal self care requisites b. Developmental self care requisites c. Health deviation self care requisites 3 Categories of Self Care - 1\. Universal self care requisites - Associated with life processes and the maintenance of the integrity of human structure and functioning - Common to all , ADL - Identifies these requisites as: - Maintenance of sufficient intake of air ,water, food - Provision of care associated with elimination process - Balance between activity and rest, between solitude and social interaction - Prevention of hazards to human life well-being and - Promotion of human functioning - 2\. Developmental self-care requisites - Associated with developmental processes/ derived from a condition.... Or associated with an event - E.g. adjusting to a new job - adjusting to body changes - 3\. Health deviation self-care - Required in conditions of illness, injury, or disease.these include:\-- - Seeking and securing appropriate medical assistance - Being aware of and attending to the effects and results of pathologic conditions - Effectively carrying out medically prescribed measures - Modifying self-concepts in accepting oneself as being in a particular state of health and in specific forms of health care - Learning to live with effects of pathologic conditions B. Theory of Self-Care Deficit - Specifies when nursing is needed - Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision of continuous effective self-care. Orem identifies 5 methods of helping: - Acting for and doing for others - Guiding others - Supporting another - Providing an environment promoting personal development in relation to meet future demands - Teaching another C. Theory of Nursing Systems - Describes how the patient's self-care needs will be met by the nurse , the patient, or both - Identifies 3 classifications of nursing system to meet the self-care