Information and Concepts

Renee Lark, Nichole Kraai, Julie Sullivan, & Adrianne TozerFlorence Nightingale Theory PresentationWhat 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 NightingaleA 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 familyReceived a classical education from her father in German, French, and ItalianNightingales parents expected her to marry a man of means and join them in climbing the social ladderNightingale 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 eyesBecame a nurse at a Middlesex hospital caring for ill governesses and was promoted to superintendent after only one year(Florence Nightingale: Biography, 2013).

Florence Nightingales MotivationNightingale 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 patients environment.

The Lady With the LampOctober 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 soldiersUpon 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 cleaneda classroom and a library, for patients entertainment and intellectual stimulation

Nightingales FocusThe Patients Environment

Results of Nightingales Involvement in the Crimean Warwound sepsis, cholera, dysentery and 'Crimea fever' were rampant and the mortality rate was an unbelievable 42.7% before Nightingale the 'lady with the lamp had the mortality down to 2.7% in a few months ( Ellis, 2008)

Philosophic InfluencesI 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 dietall 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 Nightingales LifeNightingale 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 TheoryThe Environment Theory focuses on the patients environment and how it contributes to health.Environmental Factors:Fresh airPure waterSufficient foodAppropriate nutritionEfficient drainageCleanlinessSunlightQuiet and warmth(Nightingales," 2011)

Environment Theory is Patient Care TheoryNightingales 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 (Nightingales," 2011).

Nursing ParadigmsNURSINGNightingale 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 (Nightingales," 2011).

Nursing ParadigmPERSONAn 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 (Nightingales," 2011).Nursing ParadigmENVIRONMENTNightingale believed that environment played a large role in the positive or negative outcomes of patient recovery. She felt thenurse should incorporate the proper environmental factors into the patient's care so the body can heal itself(Nightingales," 2011).

Nursing ParadigmHEALTHNightingale believed disease is the absence of discomfort. Shetook a holistic view of health and stressed the importance of health promotion and disease prevention. She realized that ones health was closely related to their living conditions (McDonald, 2006).

InterpretationNightingaleActivist for health promotionHolistic focus on the patientHealth closely related to the environment Developed modern nursing practiceHelped improve sanitationTook close notes of her patients

Inference and ImplicationsNightingales 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. Itremains just as pertinent today, as it did years ago and theimplications of her untiring work is still seen throughout healthcare today.

ConsequencesProper hygiene of patient and nurse (clean linens, baths)Hand washing (Infection control)Environmental services (housekeeping)Food and nutrition (dietary) Patient chartingProvide patient comfort (positioning, warmth)Maintaining patient safety (medication, falls, etc.)Holistic nursing approach (social work, Chaplin, family/friends)Health promotion (education )

Evaluation of Nightingales Nursing Model

Origins:Florence Nightingales ideas originated from her social and historic environment.Born to wealthy family in 1820Nursing was considered appropriate only for working class women at the timeTrained for nursing in Kaiserswerth, GermanyWanted 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 Nightingales idea was significantly influenced by her experiences serving in Crimean War field hospitals.She noted the relationship between lack of cleanliness and infectionAs 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 Nightingales primary focus was to advocate for a patients 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 visitorsProtected them from excess fatigue, inappropriate advice, and anxiety producing misinformation

Content:Beliefs about Environment:She believed that ones environment could have a profound effect on a persons 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 scienceSuccess is achieved through environmental alterationRequires professional and educational trainingRole of nurse is distinctly separate from the practice of medicineRecognized that a nurses role should extend into advocating and protecting patients Nursing is based on a theoretical foundation

Content:Versatility of Nightingales philosophy:Nightingales 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 NightingaleHolistic approach taken by other theoristsNeumans System ModelRoys Adaptation ModelLevines Conservation Theory(Knutson, n.d. )Conclusions

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 Study1. 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 Nightingales 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 Study3. After receiving report in the morning, you enter your patients room and notice the following: the shades are pulled tight, last nights 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. DocumentationB. Changing a patients soiled linensC. Assisting a physician with a bedside procedureD. 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), 404+. Retrieved from http://www.afpp.org.uk/books-journals/journal_archiveFlorence Nightingale. (2013). The Biography Channel website. Retrieved from http://www.biography.com/people/florence-nightingale-9423539.Florence Nightingale: Biography. (2013). Spartacus Educational website. Retrieved from: http://www.spartacus.schoolnet.co.uk/REnightingale.htm

ReferenceKnutson, M. B. (n.d.). Original nursing theories of Florence Nightingale [PowerPoint Slides]. Retrieved from: Healthvistafreehosting.net.Presentations2/Florence%20Nightingale.pptMcDonald, L. (2006). Florence Nightingale and public health policy: theory, activism and public administration. Retrieved from http://www.uoguelph.ca/~cwfn/nursing/theory.htmlNightingale F: Notes on Nursing: what it is and what it is not, Philadelphia, 1946, JB Lippincott, reprint (originally published in 1859).Nightingales environment theory. (2011). Retrieved from Nursing Theory Web site: http://nursing-theory.org/nursing-theorists/Florence-Nightingale.phpTheories of Florence Nightingale. Retrieved from Nursing Theories, a companion to nursing theories and models Web site: http://currentnursing.com/nursing_theory/Florence_Nightingale_theoory.html

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