WEEK-5-NIGHTINGALE_S-THEORY.pdf

Unit II Nursing Philosophies 1. Chapter 4. Nightingale's 2. Chapter 5. Watson's Philosophy and Environmental Theory Theory of Tran...

Unit II Nursing Philosophies 1. Chapter 4. Nightingale's 2. Chapter 5. Watson's Philosophy and Environmental Theory Theory of Transpersonal Caring 3. Chapter 6. 4. Chapter 7. Benner's Stages of Nursing Eriksson's Caritative Expertise Nursing Philosophies Caring Theory Environmental Philosophy (Modern Nursing) Chapter 4 Florence Nightingale "Nursing ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet — all at the least expense of vital power to the patient" -Nightingale, 1969 Contents of this Lecture ∙ Florence Nightingale: History and Background ∙ Theoretical Sources for Theory Development ∙ Nightingale's Environmental Model Major Concepts and Definitions Use of Empirical Evidence Major Assumptions: Environment Person Health Nursing ∙ Nightingale and The Nursing Process Florence Nightingale (mid-1800) “The Legacy of Caring” “Notes of Nursing” What is, What is Not” “In a nurturing environment, the body could repair itself.” “The most important practical lesson that can be given to nurses is to teach them what to observe- how-to observe... 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 may be.”  History and Background  History and Background Florence Nightingale born in May 12, 1820 in Florence, Italy. a beautiful Victorian lady whose parents were wealthy and well-travelled. Florence Nightingale is the most recognized name in the field or nursing. Her work was instrumental for developing modern nursing practice, and from her first shift. She worked to ensure patients in her care had what they needed to get healthy. Her Environmental Theory changed the face or nursing to create sanitary conditions for patients to get care.  History and Background She was expected to behave like every other Victorian lady, filling her time before her marriage with music, reading, embroidery and learning how to be the perfect hostess. However, Florence Nightingale had other intentions. Even at a young age, she believed she was called into service by God. She had great compassion and concern for people of all types. As she grew older, she believed she had been called to serve mankind. She yearned to help the poor but suffered in silence for years because it was socially unacceptable for someone of her upbringing to be involved with physical work.  History and Background At the age of 24, Florence Nightingale decided to help the suffering masses and desired to work in a hospital. This was greatly opposed by her family, and they fought about it for long, before ultimately allowing her to go to Kaisersworth, Germany to study nursing from the Institution of Deaconesses. She studied there for 3 months and then returned to the service of her family. It was another 2 years before she was allowed to practice nursing (Brown, 1988, Woodham-Smith. 1951). She served the wounded soldiers during the Crimean War. After which, she wrote what we have come to refer to as her nursing theory. Her writings, which included philosophy and directions were inspired from a need to define nursing and reform hospital environments rather than give nursing new knowledge.  History and Background Nightingale worked intensely during her lifetime to effect all types of reforms in nursing. Because of her works in reforming nursing, she was given the title “Founder of Modern Nursing.” She established a school of nursing at St. Thomas Hospital in England and wrote many manuscripts about hospital reform and nursing care. Nightingale strongly advocated that “nursing knowledge is distinct from medical knowledge.” Her philosophy in nursing is environment-oriented. Her work focuses largely on the patient and the environment, but also includes the nurse and health. She believed that the person is a holistic individual and thus had a spiritual dimension. She advocated that nursing is a spiritual calling, and with that belief, she assumed that nurses can help those clients who were in spiritual distress.  History and Background During her time, it was expected that Christians would help other Christians. She recognized nursing of the sick (nursing proper) and nursing of the well). Since Florence Nightingale believed in nursing well persons---or health promotion---it is logical that she assumed her nurses would do some health teachings as were caring for the sick or for those who already well. In using Nightingale's theory, the nurse must consider Nightingale’s 13 Canons, health promotion, and spiritual distress. Theoretical Sources for Theory Development Theoretical Sources for Theory Development ✔ Many factors influenced the development of Nightingale’s philosophy of nursing Her personal, societal and professional values and concerns all were integral to the development of her beliefs. She combined her individual resources with societal and professional resources available to her to produce immediate long- term change throughout the world. Her education under the tutelage by her well-educated, intellectual father included subjects such as mathematics and philosophy. This education, which was an unusual one for a Victorian girl, provided her with knowledge and conceptual thinking abilities.  Nightingale family's aristocratic social status provided her with easy access to people of power and influence. Nightingale learned to understand the political processes of Victorian England through the experience of her father during his short-lived political career and through his continuing role as an aristocrat involved in the political and social activities of his community. She most likely relied on this foundation and on her own experiences as she waged political battles for her causes. Nightingale also recognized the societal changes of her time and their impact on the health status of individuals. The industrial age had descended upon England creating new social classes, new diseases, and new social problems.  Finally, Nightingale's religious affiliation and beliefs were especially strong sources for her nursing theory. Reared as a Unitarian, her belief that action for the benefit of others is a primary way of serving God, served as the foundation for defining her nursing work as a religious calling. In addition, the Unitarian community strongly supported education as a means of developing divine potential and helping people move toward Perfection in their lives and in their service to God. Nightingale's Environmental Model Nightingale's Environmental Model ✔ Major Concepts and Definitions: ▪ Nightingale viewed the manipulation of the physical environment as a major component of nursing care (Nightingale used the term surroundings in her writing).  Nightingale's Environmental Model She defined the following aspects as major areas of the physical, social, and psychological environment that the nurse could control: 1. Health of houses 1. Cleanliness of rooms and walls 2. Ventilation and warming 2. Personal cleanliness 3. Light. 3. Nutrition and taking food 4. Noise 4. Chattering hopes and advices 5. Variety 5. Observation of the sick 6. Bed and bedding 6. Petty management Nightingale's Environmental Model ✔ The social and psychological environment that affect the physical environment are: 1. Variety 2. Chattering hopes and advices 3. Petty management ✔ Nightingale believed that when one or more aspects of the environment are out of balance, the client must use increased energy to counter the environment stress. ✔ These stresses drain the client of energy needed for healing. Use of Empirical Evidence ✔ Nightingale's reports describing health and sanitary conditions in Crimea and in England identify her as an outstanding scientist and empirical researcher. ✔ Her expertise as a statistician is evident in the reports that she generated throughout her lifetime on the varied subjects of health care, nursing, and social reform. ✔ Nightingale's carefully collected information that illustrated the efficacy of hospital nursing system and organization during the Crimean War is perhaps her best known work. Use of Empirical Evidence ✔ Her report of her experiences and collected data was submitted to the British Royal Sanitary Commission in “Notes on Matters Affecting the Health Efficiency, and Hospital Administration of the British Army Founded Chiefly on the Experience of the Late War” (Nightingale, 1858b). ✔ This Commission had been organized in response to Nightingale’s charges of poor sanitary conditions. The data in this report provided a strong argument in favor of her proposed reforms in the Crimean hospital barracks. ✔ The observation of social phenomena at both individual and systems level was especially important to Nightingale and served as basis of her writings. ✔ Nightingale emphasized the Concurrent use of observation and performance of tasks in the education of nurses and expected them to continue to use both of the activities in their work.  Major Assumptions Major Assumptions ✔ Environment ✔ Person ✔ Health ✔ Nursing  Environment Nightingale’s concept of environment (surroundings) is anything that can be manipulated to place a patient in the best possible condition for nature to act. She emphasized that nursing was to assist nature in healing the patient. ✔ Her admonition to nurses, both those providing care in the home and trained nurses in the hospitals, was to create and maintain a therapeutic environment that would enhance the comfort and recovery of the patient. ✔ Her treatise on rural hygiene includes an incredibly specific description of environmental problems and their results, as well as practical solutions to these problems for households and communities  Environment ✔ Nightingale's assumptions and understanding about the environmental condition of those days were most relevant to her philosophy. She believed that sick poor people would benefit from environmental improvements that would affect both their bodies and their minds. She believed that nurses could be instrumental in changing the social status of the poor by improving their physical living conditions. ✔ Many aristocrats of the time were unaware of the living conditions of the poor. Nightingale's mother, however had visited and provided care to poor families in the communities surrounding their estates; Nightingale accompanied her on these visits as a child and continued them when she was older. Thus Nightingale's understanding of physical surroundings and their effect on health were acquired through first-hand observation and experience beyond her own comfortable living situations.  Person ✔ In most of her writings, Nightingale referred to the person as a “patient”. Nurses performed tasks to and for the patient and controlled the patient's environment to enhance recovery. ✔ For most part, Nightingale described a passive patient in this relationship. However, specific references are made to the patient performing self-care when possible and, in particular, being involved in the timing and substance of meals. The nurse was to ask the patient about his or her preferences, which reveals the belief that Nightingale saw each patient as an individual. However, Nightingale (1969) emphasized that the nurse was in control of and responsible for the patient's environmental surroundings. ✔ Nightingale had respect for persons of various backgrounds and was not judgmental about social worth.  Health Nightingale defined health as being well and using every power (resource) to the fullest extent in living life. In addition, she saw disease and illness as a reparative process that nature instituted when a person did not attend to health concerns. ✔ Nightingale envisioned the maintenance of health through prevention of disease by environmental control and social responsibility. ✔ What she described led to public health nursing and the more modern concept of health promotion. ✔ She distinguished the concept of health nursing as different from-nursing sick patient to enhance recovery, and from, living better until peaceful death.  Health ✔ Her concept of health nursing exists today in the role of district nurses and health workers in England and in other countries where lay health works are used to maintain health and teach people how to prevent disease and illness. ✔ Her concept of health nursing is a model used by many public health agencies and departments in various countries.  Nursing Nightingale believed that every woman, at one time, in her life, in the sense that nursing is being responsible for someone else's health. ✔ Nightingale believed nursing to be a spiritual calling. Nurses were to assist nature to repair the patient. ✔ Nightingale wrote “Notes on Nursing.” published originally in 1859, to provide women with guidelines for caring for their loved ones at home and to give advice on how to “think like a nurse” (Nightingale, 1969 p.4). Trained nurses, however were to learn additional scientific principles to be applied in their work and whereto be more skilled in observing and reporting patient’s health status while providing care as the patient recovered.  Nursing ✔ Using Nightingale's philosophy in practice today fits well with the use of the nursing process. The nurse assesses the patient situation, identifies a need; implements a plan of care, reevaluates the situation, and finally changes the plan to better serve the patient. ✔ She expected nurses to use their powers of observation in caring for patients. ✔ She advocated for nurses to have educational background and knowledge that is different from those of physicians. ✔ She believed in and rallied for nursing education to be a combination of clinical experience and classroom learning. Nightingale and The Nursing Process Nightingale and The Nursing Process Assessment Nightingale recommended two essential behaviors by the nurse in the area of assessment. 1. Ask 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?” Nightingale and The Nursing Process 2. Observation She used precise and specific observations concerning all aspects of the client's physical health and 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? Nightingale and The Nursing Process Nursing Diagnoses ✔ Nightingale believed, data should be used as the basis for forming any conclusion. ✔ The nursing diagnosis is the client's response to the environment and not the environmental problem. ✔ It reflects the importance of the environment to health and well-being of the client. Nightingale and The Nursing Process Outcomes and Planning ✔ Identifying nursing actions needed to keep 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. Nightingale and The Nursing Process 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. Nightingale and The Nursing Process Evaluation ✔ Is based on the effect of the changes in the 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  NIGHTINGALE’S 13 NURSING PROCESS AND THOUGHT CANONS Assess the client's body temperature, room temperature, and room for fresh air (or adequate ventilation) and foul odors. Ventilation and warmth Develop a plan to keep the room airy and of odor while maintaining the clients body temperature. Assess the room for adequate light. Sunlight works best. Develop and implement adequate light in the Light client' s room without placing the client in direct light.  NIGHTINGALE’S 13 NURSING PROCESS AND THOUGHT CANONS Assess the room for dampness, darkness, and dust or mildew. Cleanliness of rooms and walls Keep the room free from dust, dirt, mildew and dampness Assess the surrounding environment for pure air, pure water, drainage, cleanliness, and light Examples include removing garbage or Health of Houses garments from the area, removing any standing water (or ensuing that water drains away from the area), and ensuring that air and water are clean and free from odor and that there is plenty of light.  NIGHTINGALE’S 13 NURSING PROCESS AND CANONS THOUGHT Asses the noise level in the client’s room and surrounding area. Noise Attempt to keep noise level to a minimum, and refrain from whispering outside the door Asses the bed and bedding for dampness, wrinkles, and boiling, and check the bed for height. Bed and bedding Keep the bed dry, wrinkle-free, and at the lowest height to ensure the client’s comfort. NIGHTINGALE’S 13 NURSING PROCESS AND THOUGHT CANONS Attempt to keep the client dry and clean all times. Personal cleanliness Frequent assessment of the client’s skin is needed to maintain adequate skin moisture. Attempt to stimulate variety in the room and with the client. This is accomplished with cards, flowers, pictures, books, or puzzles. Variety Encourage friends and relatives to engage the client in some sort of stimulating conversation.  NIGHTINGALE’S 13 NURSING PROCESS AND THOUGHT CANONS Avoid talking without reason or giving advice that is without fact. Chattering hopes and advices Continue to talk to the client as a person, and continue to stimulate the client’s mind. Avoid personal talk. Assess the diet of the client. Taking food Take note of the amount of food and drink ingested by the client at every meal or snack. Continue with the assessment of the diet to include type of food and drink the client likes or dislikes. What food Attempt to ensure that the client always has some food or drink available that he or she enjoys.  NIGHTINGALE’S NURSING PROCESS AND THOUGHT 13 CANONS Petty management ensures continuity of care. Petty management Documentation of the plan of care and all evaluation will ensure others give the same care to the client in your absence. Observe everything about your client. Record all observations. Observations should be factual and not Observation of the merely opinions. Continue to observe the client’s sick surrounding environment, and make alterations in the plan of care when needed.  Critique: Nightingale's Environmental Theory Clarity ✔ Nightingale's work is clear and easily understood. It addresses three major relationships: 1. Environment to patient 2. Nurse to environment 3. Nurse to patient Clarity ✔ Nightingale believed that the environment was the main factor that created illness in a patient and regarded disease as “the reactions of kindly nature against the conditions in which we have placed ourselves” ✔ She recognized the potential harmfulness of an environment and emphasized the benefit of a good environment in preventing disease. Clarity ✔ The nurse's practice includes manipulation of the environment in a number of ways to enhance patient recovery. Elimination of contamination and exposure to fresh air, light, warmth. and quiet were identified as elements to be controlled or manipulated in the environment. ✔ The nurse-patient relationship may be the least well-defined in Nightingale’s writings. Yet cooperation and collaboration between the nurse and the patient are suggested in her discussion of a patient's eating patterns and preferences, the comfort of a beloved pet to the patient, the protection of the patient from emotional distress, and conservation of energy while allowing the patient to participate in self-care Clarity ✔ Finally, it is interesting to note that Nightingale discussed the concept of observation extensively, including its use to guide the care of patients and to ensure improvement or lack of response to nursing interventions. Simplicity ✔ Nightingale provides a descriptive, explanatory theory. Its environmental focus, along with its epidemiological components, has predictive potential. ✔ Nightingale could be said to have tested her theory in an informal manner by collecting data and verifying improvements. She used brief case studies possible exemplars, to illustrate a number of concepts that she identified in “Notes in Nursing” (1969). Her intent was to provide general rules and explanations that would result in good nursing care for patients. Generality ✔ Nightingale’s theory has been used to provide general guidelines for all nurses since she introduced them more than 150yenrs ago. Although some activities that she described are no longer relevant, the universality and timelessness of her concepts remain patient. ✔ Nurses are increasingly recognizing the role of observation and measurement of outcomes as an essential component of nursing practice. Empirical Precision (Accessibility) ✔ Concepts and relationships within Nightingale’s Theory typically are stated implicitly and are presented as truths rather than as tentative, testable statements. ✔ In contrast to her quantitative research on mortality performed in Crimea, Nightingale advised the nurses of her time that their practice should be based on their observations and experiences. Her concepts are amenable to studies with the qualitative approaches of today as well as quantitative methods. Derivable Consequences (Importance) ✔ To an extraordinary degree, Nightingale's writings direct the nurse to take action on behalf of the patient and the nurse. These directives encompass the areas of practice, research, and education. Her principles to shape nursing are the most specific. ✔ She urges nurses to provide physicians with “not your opinion, however, respectfully given, but your facts” ✔ Similarly, she advises that “if you could not 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 or anxious you may be” Derivable Consequences (Importance) ✔ Nightingale’s basic concepts of environmental manipulation and care of the patient can be applied in contemporary nursing settings. Although subjected to some criticisms, her theory and her principles are relevant to the professional identity and practice of nursing. ✔ The statements and observations made by Nightingale in “Notes in Nursing” can have great significance for the world of nursing today. Application of Florence Nightingale’s Environment Philosophy Case History of Eva D. Miss Eva D. 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: T=38.6°C, P=98bpm, R=23/min., BP=100/70mmHg. She complains of weakness, thirst and dryness of mouth. Her skin is warm, flushed, and dry. Her urine is dark yellow in color. Miss D. 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 hygiene after using the toilet. Stool examination revealed salmonellosis. Miss D. is extremely tearful. She expresses great concern over her absence from her job in a garment factory and over her health and expenses for hospitalization.  Nursing care of Miss Eva D. with Nightingale’s Theory In Nightingale’s environment theory, Miss D. 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 D. This care involves “nursing the sick”, review of the environment and the client’s lifestyle.  Nursing care of Miss Eva D. with Nightingale’s Theory A. Nursing the Sick Assessment Assess the client for the following problems: 1. Fluid and electrolyte losses related to frequent, watery stools. nausea and vomiting as manifested by changes in the VS (Vital Signs); weakness. Dryness of mouth; warm. flushed. dry skin; dark-colored urine. 2. Pain related to abdominal cramps. 3. Inadequate food intake related to nausea and vomiting. 4. Fever ('1-38.60C) related to infection (Salmonellosis) and dehydration.  Nursing care of Miss Eva D. with Nightingale’s Theory Plan 1. Fluid electrolyte losses ✔ Provide fluid and electrolyte replacement. ✔ Administer medications to relieve frequent, watery stools as prescribed. ✔ Administer medications to relieve nausea and vomiting as prescribed. ✔ Provide good oral care for dryness of mouth. ✔ Promote rest to relieve weakness. ✔ Monitor intake output to fluid balance status. ✔ Provide good perianal care to promote comfort.  Nursing care of Miss Eva D. with Nightingale’s Theory Plan 2. Pain related to abdominal cramps ✔ Provide low fiber diet. To reduce peristalsis. ✔ Promote rest. To reduce peristalsis and to promote comfort. ✔ Avoid gas-forming foods. Flatulence worsens abdominal pain. ✔ Administer anticholinergic as prescribed. To relieve abdominal cramps.  Nursing care of Miss Eva D. with Nightingale’s Theory Plan 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 antiemetic as prescribed. To relieve nausea and vomiting.  Nursing care of Miss Eva D. with Nightingale’s Theory Plan 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 microorganisms. ✔ Administer antibiotic and antipyretic as prescribed.  Nursing care of Miss Eva D. with Nightingale’s Theory Plan 4. Fever related to infection and dehydration. ✔ Render tepid sponge bath. To reduce fever by evaporation and conduction. ✔ Keep the skin clean and dry. To promote comfort. ✔ Change gowns and bedding as needed to prevent dampness from perspiration Nursing care of Miss Eva D. with Nightingale’s Theory Observation of the sick. Observe everything about the client. Record all which are factual and not merely opinions.  Nursing care of Miss Eva D. with Nightingale’s Theory B. Physical Home, Community/Neighborhood and Workplace Assessment 1. Pure water. Assess for adequate working water system and storage that is free from contamination. 1. Cleanliness. Assess for sanitation conditions of food sources and preparation and hygienic practices. Assess for the means to maintain sanitation conditions of toilets: To keep food and water supply free from contamination.  Nursing care of Miss Eva D. with Nightingale’s Theory B. Physical Home, Community/Neighborhood and Workplace Plan 1.Water ✔ Have water checked for contamination in 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 handwashing especially when preparing foods and before and after using the toilet; waste disposal and personal cleanliness.  Nursing care of Miss Eva D. with Nightingale’s Theory B. Physical Home and Workplace Assessment 1. Light. Assess for adequate windows and working light sources. 2. Pure Air. Assess tor ventilation, offensive odors, e.g. odors 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.  Nursing care of Miss Eva D. with Nightingale’s Theory B. Physical Home and Workplace Assessment 5. Cleanliness. Assess the home and workplace for means to keep the areas clean, and freedom from excessive dust, mold, mildew, pet droppings (from cats and dogs), offensive odors, “dust-catcher” things (files of papers, unused jars, plastic containers, 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.  Nursing care of Miss Eva D. with Nightingale’s Theory C. Psychological Environment Assessment and Plan Miss Eva D. 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.  Reference Quiambao-Udan, J. (2020). Theoretical Foundation in Nursing (2nd Ed.). Manila: APD oretical Foundation in Educational Publishing House. Nursing (2nd Ed.) thanks!