What is nursing theory? According to Chitty & Black in the book Professional Nursing Concepts and Challenges, theory is “a general explanation scholars use to explain, predict, control, and understand commonly occurring events” (424).
What is the nursing model? Through the utilization of knowledge and skills in combination with values and beliefs set by a nursing theory a nurse creates a model to provide patient care and define the four key concepts: person, environment, health, and nursing.
Florence Nightingale “A lady with a lamp shall stand, In the great history of the land, A noble type of good, Heroic womanhood.” -Henry Longfellow
Who is Florence Nightingale? Born May 12, 1820 to an affluent British family Received a classical education from her father in German, French, and Italian Nightingale’s parents expected her to marry a “man of means” and join them in climbing the social ladder Nightingale was unhappy and depressed as a teen and sought to do something with meaning Nightingale chose the forbidden path after she turned down a proposal from a “suitable” man and started a journey to pursue a nursing education and becoming what was a lowly labor worker in her parents eyes Became a nurse at a Middlesex hospital caring for ill governesses and was promoted to superintendent after only one year (Florence Nightingale: Biography, 2013).
Florence Nightingale’s Motivation Nightingale believed there to be a direct relationship to the sanitary conditions of the environment and the spread of disease. This focus led to a more broad focus on the effect of every part of the patient’s environment.
The Lady With the Lamp October of 1853 the Crimean War broke out. Per request from the Secretary of War, Nightingale assembled a team of 34 nurses to care for wounded soldiers Upon arrival found the hospital to be over a cesspool contaminating the water and hospital, rodents and insects crawling all around, and patients dying from infections. Nightingale collected scrub brushes and had the healthiest patients scrub the hospital top to bottom while she spent every waking moment caring for the wounded. In the evening she carried her lamp with her while she moved from patient to patient an became known as “the lady with the lamp” and “the angel of the Crimea”. (Florence, 2013)
Nightingale created: a kitchen to cook appealing food for patients with special dietary requirements a laundry so that linens could be cleaned a classroom and a library, for patients entertainment and intellectual stimulation
Nightingale’s Focus The Patient’s Environment
Results of Nightingale’s Involvement in the Crimean War “wound sepsis, cholera, dysentery and 'Crimea fever' were rampant and the mortality rate was an unbelievable 42.7%” before Nightengale “the 'lady with the lamp‘ had the mortality down to 2.7% in a few months” ( Ellis, 2008)
Philosophic Influences “I use the word nursing for want of a better. It has been limited to signify little more that the administration of medicines and the application of poultices. It 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, 1946, p.6).
Philosophic Values as Seen in the Florence Nightingale Pledge “ I solemnly pledge myself before God and presence of this assembly; to pass my life in purity and to practice my profession faithfully (fidelity). I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug (nonmaleficence). I will do all in my power to maintain and elevate the standard of my profession (beneficence) And will hold in confidence all personal matters committed to my keeping and family affairs coming to my knowledge in the practice of my calling (confidentiality). With loyalty will I endeavor to aid the physician in his work (fidelity), And devote myself to the welfare of those committed to my care (justice)” (Chitty, 113).
The Rest of Florence Nightingale’s Life Nightingale saw the importance of the differentiation between the professional nurse and a caregiver. After the Crimean War, Nightingale was given a prize of $250,000 for her work from the British government. The importance of nursing education was so important to Nightingale that she used her prize to create the St. Thomas Hospital which housed the Nightingale Training School for Nurses (Florence, 2013). At age 38 Nightingale became homebound and bedridden for the rest of her life due to contracting the Crimean Fever. She continued her work on health care reform and advocacy from her bed publishing Notes on Hospitals and serving as an authority on public sanitation. She received a merit of honor from King Edward at age 88 and died at age 90. (Florence, 2013)
Florence Nightingale paved the way for modern nursing practice through her Environment Theory. Information and Concepts
Environment Theory The Environment Theory focuses on the patients environment and how it contributes to health. Environmental Factors: Fresh air Pure water Sufficient food Appropriate nutrition Efficient drainage Cleanliness Sunlight Quiet and warmth (“Nightingale’s," 2011)
Environment Theory is Patient Care Theory Nightingale’s Environment Theory is considered a patient- care theory because the primary focus is on the patient and not the nursing process or the patient-nurse relationship (“Nightingale’s," 2011).
Nursing Paradigms NURSING Nightingale believed nursing is separate from medicine She felt nursing should focus on health rather than illness (Chitty et al, 2011). Nightingale felt nurses should provide the patient with optimal conditions in order for nature to act (“Nightingale’s," 2011).
Nursing Paradigm PERSON An individual is multifaceted, making up physical, psychological social, cultural and spiritual layers. The nurse must include all aspects of the individual when providing care and makes changes to the theory to accommodate the patient (Nightingale’s," 2011).
Nursing Paradigm ENVIRONMENT Nightingale believed that environment played a large role in the positive or negative outcomes of patient recovery. She felt the nurse should incorporate the proper environmental factors into the patient's care so the body can heal itself (Nightingale’s," 2011).
Nursing Paradigm HEALTH Nightingale believed disease is the absence of discomfort. She took a holistic view of health and stressed the importance of health promotion and disease prevention. She realized that one’s health was closely related to their living conditions (McDonald, 2006).
Interpretation Nightingale Activist for health promotion Holistic focus on the patient Health closely related to the environment Developed modern nursing practice Helped improve sanitation Took close notes of her patients
Inference and Implications Nightingale’s theory has been relied on for years. She was a pioneer that lead the way for other nurses to form their own theories, philosophies and models which has helped to shape nursing. Her work has been closely studied and researched. It remains just as pertinent today, as it did years ago and the implications of her untiring work is still seen throughout healthcare today.
Consequences Proper hygiene of patient and nurse (clean linens, baths) Hand washing (Infection control) Environmental services (housekeeping) Food and nutrition (dietary) Patient charting Provide patient comfort (positioning, warmth) Maintaining patient safety (medication, falls, etc.) Holistic nursing approach (social work, Chaplin, family/friends) Health promotion (education )
Evaluation of Nightingale’s Nursing Model
Origins: Florence Nightingale’s ideas originated from her social and historic environment. Born to wealthy family in 1820 Nursing was considered appropriate only for working class women at the time Trained for nursing in Kaiserswerth, Germany Wanted to demonstrate that academically trained nurses could impact health care in a manner beyond the care offered by household servants at the time
Influences: Florence Nightingale’s idea was significantly influenced by her experiences serving in Crimean War field hospitals. She noted the relationship between lack of cleanliness and infection As hospitals were better cleaned and organized patient health improved and mortality rates declined.
Content: Florence Nightingale developed the metaparadigm philosophy of nursing. Meaning the “person as a patient, health as opposed to illness, environment (how the environment affect health and the recovery from illness), and nursing (as opposed to medicine)” (Chitty and Black, p.306)
Content: Beliefs about Human Beings: Florence Nightingale’s primary focus was to advocate for a patient’s wellbeing and to be in a healthy environment where one could obtain their optimal health. She recognize that patients are holistic in nature, with biological, psychological, social and spiritual components. Saw the benefit of protecting patients from unwanted visitors Protected them from excess fatigue, inappropriate advice, and anxiety producing misinformation
Content: Beliefs about Environment: She believed that one’s environment could have a profound effect on a person’s health. That clean air, water, adequate ventilation, and sunlight could have a positive impact on your health. Adequate amounts of sleep, nutrition, and decreasing noise would provide peace and healing.
Content: Beliefs about Health: She believed that health and environment were intrinsically interconnected. She believed health is “not only to be well, but to be able to use well every power we have” and that disease is “dys-ease or the absence of comfort” (Nursing Theories, A companion to nursing theories and models)
Content: Beliefs about Nursing: Believed that nursing is a calling. Nursing is an art and a science Success is achieved through environmental alteration Requires professional and educational training Role of nurse is distinctly separate from the practice of medicine Recognized that a nurse’s role should extend into advocating and protecting patients Nursing is based on a theoretical foundation
Content: Versatility of Nightingale’s philosophy: Nightingale’s holistic view of patients and environmental focus continue to be utilized in every healthcare setting. Her ideas on the value of academic and professional training for nurses are now basic assumptions for preparation of nurses. Her thoughts provided a professional model for nursing organization
Others Influenced by Nightingale Holistic approach taken by other theorists Neuman’s System Model Roy’s Adaptation Model Levine’s Conservation Theory (Knutson, n.d. )
Conclusion: Florence Nightingale is often considered the founder of modern nursing. As the first nursing theorist, her philosophy regarding the interconnectedness of the environment and the wellness of patients sets a standard for how nurses are trained. While the details and techniques of modern nursing may differ from those of her times, her influence remains. Her philosophy covers each of the four global concepts, and are generalizable to all nursing disciplines.
Florence Nightingale Advice to Nursing Students (1873) “Nursing is most truly said to be a high calling, an honourable calling. But what does the honour lie in? In working hard during your training to learn and to do all things perfectly. The honour does not lie in putting on Nursing like your uniform. Honour lies in loving perfection, consistency, and in working hard for it: in being ready to work patiently: ready to say not "How clever I am!" but "I am not yet worthy; and I will live to deserve to be called a Trained Nurse.“” (Florence Nightingale: Biography, 2013)
Case Study 1. While at work on your unit you notice that one of your new admissions is your next door neighbor, Mrs. Smith. That night upon returning home, your husband mentions that he heard Mrs. Smith was in the hospital for surgery. By not sharing any information with your husband, which of the philosophical values outlined in Florence Nightingale’s pledge are you honoring? 2. What philosophical value was Florence Nightingale referring to when she stated in her pledge that, “I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug.”
Case Study 3. After receiving report in the morning, you enter your patient’s room and notice the following: the shades are pulled tight, last night’s dinner tray is still on the bedside table, and the nurses out in the hall are being extremely loud and disruptive. What would Florence Nightingale say about this scenario? 4. Which of the following nursing tasks can be attributed to Florence Nightingale and her theory? (Select all that apply) A. Documentation B. Changing a patient’s soiled linens C. Assisting a physician with a bedside procedure D. Consulting social work for a patient with concerns about their home environment.
Chitty, K. K., & Black, P. B. (2011). Professional nursing concepts and challenges (6th ed.). Maryland Heights, MO: Saunders Elsevier. Ellis, H. (2008). Florence Nightingale: creator of modern nursing and public health pioneer. Journal of Perioperative Practice, 18(9), Retrieved from go.galegroup.com.libcat.ferris.edu/ps/i.do?id=GALE%7CA &v=2.1&u=lom_ferrissu&it=r&p=AONE&sw=w Florence Nightingale. (2013). The Biography Channel website. Retrieved from Florence Nightingale: Biography. (2013). Spartacus Educational website. Retrieved from: McDonald, L. (2006). Florence Nightingale and public health policy: theory, activism and public administration. Retrieved from / ~cwfn/ nursing/ theory.html Nightingale F: Notes on Nursing: what it is and what it is not, Philadelphia, 1946, JB Lippincott, reprint (originally published in 1859). Nightingale’s environment theory. (2011). Retrieved from Nursing Theory Web site: / nursing-theory.org/ nursing-theorists/ Florence-Nightingale.php Theories of Florence Nightingale. Retrieved from Nursing Theories, a companion to nursing theories and models Web site:. Reference
References Knutson, M. B. (n.d.). Original nursing theories of Florence Nightingale [PowerPoint Slides]. Retrieved from Healthvista,freehosting.net.Presentations2/ Florence%20Nig htingale.ppt