Transcript File - Ashley Lundberg

Florence Nightingale’s
Theory of Nursing
As Presented by Kara Derry, Ashley Lundberg, and Lori Nousen
Florence
Nightingale
(1820-1910)
Known as the
founder of modern
nursing
Environmental
Theory of Nursing
Author of
Notes on Nursing:
What It Is and
What It Is Not
The promotion of health as controlled by
external stimuli and environmental factors
(Clements & Averill, 2006)
Before The Crimean
War
Before The Crimean
War
Born to a wealthy
family and educated
intensively by her
father
 Traveled throughout
Europe including to
Kaiserswerth where she
first studied nursing
and was introduced to
poor sanitation in
relation to nursing


1853 Nightingale
accepted the unpaid
position of
superintendent at the
Establishment of
Gentlewomen During
Illness
 Began the practice of
providing quiet and
comfortable recovery
from illness and
surgery
(Baly & Matthew, 2004)
History of Florence Nightingale

Administrative
authority over
nursing during the
war

Improved
unsanitary
conditions for
nursing and
recuperation

Became sick with a
fever which she
would never fully
recover

Named “The Lady of
the Lamp” for
rounding on patients
alone at night
The Crimean War 1854-1856
(Baly & Matthew, 2004)
Written Work and
Accomplishments

Notes on matters
affecting the health,
efficiency, and hospital
administration of the
British army (1858)
◦ Never published
◦ 830 pages
◦ Described unsanitary
conditions that lead to
senseless death amongst
the troops
(Baly & Matthew, 2004)
Written Work and
Accomplishments

Opening of the Nightingale
Training School at St
Thomas Hospital
◦ 1860

Notes on Nursing: What It
Is and What It Is Not
◦ 1860
◦ Text written to guide nurses
(Clements & Averill, 2006)

How people may live and
not die in India
◦ Helped bring attention to
sanitation reform in India
◦ 1863
(Baly & Matthew, 2004)
History of Nightingale’s Work

Florence Nightingale
credited unsanitary
conditions with high
mortality rates

She believed symptoms
which were thought to be
of disease were actually
responses to negative
environmental stimuli

Nursing was as much
about providing fresh air,
clean sheets, appropriate
diet, and decreasing
environmental stimuli as
it was wound
management and drug
administration

During the Crimean war
she tested her
environmental theory by
creating more sanitary
conditions and was
labeled a heroin
(Clements & Averill, 2006)
Basis For Environmental Theory

Nursing Theory

Florence Nightingale described
nursing as a divine calling to
serve others

Her philosophy was about
healing, not just caring for the
sick

Nightingale’s philosophy
reflected a change in nursing
that still persists today

She believed that caring for the
whole person required
integration and collaboration
with medicine, environment,
family, and society
(Payne, 2010)
Global Concepts of Nursing

Florence Nightingale’s theory
focuses on the care of the patient
rather than the nursing process

The nursing model must be
adapted to fit the needs of
individual patients

Improvement in the health of
individuals and families leads to
the improved health of society

People are multidimensional, being
composed of biological,
psychological, social, and spiritual
components
◦ It is important to address each
of these components to create a
holistic person
Nightingale’s Conceptualization of Holism
Human Being (Person)
(Selanders, 2010)

Environment is the
umbrella concept in the
Nightingale theory of
nursing

Environment could be
altered in such a matter
to allow healing to
occur.
◦ Poor or difficult
environments led to
poor health and
disease

Nightingale was
concerned about both,
elements that entered
the body (food, water,
medications) as well as
external elements
(ventilation, light, noise
control, stimulation,
and room temperature)

Nightingale saw
ventilation as the most
important element
(Selanders, 2010)
Environment

Nightingale stated that “health
is not only to be well, but to
be able to use well every
power we have.”

Health is viewed as a relative
state, with ultimate health
being the best you can be at
any given point in time

Individual does not need to be
disease free to be healthy;
rather one must simply
maximize optimal potential to
be in a healthy state

Disease is portrayed as dysease or the absence of comfort

Nightingale stated that disease
was a reparative process,
indicating that symptoms alert
one to the presence of illness,
thus allowing appropriate
interventions to be instituted
(Selanders, 2010)
Health

The goal of nursing is to place the patient in the best possible condition for
nature to act
◦ Accomplished through alteration of the environment

Nightingale states, “If a patient is cold, if a patient is feverish, if a patient is
faint, if he is sick after taking food, if he as a bed-sore, it is generally the fault
not of the disease, but of the nursing.”

Two types of nursing
◦ General nursing: activities that promote health. These are carried out in all
care-giving situations, regardless of whether the individual is educated in
healthcare
◦ Proper nursing: individuals who are educated in the are and science of
nursing. The nurse is able to implement problem solving in a logical manner
(known today as the nursing process)

Nursing
(Selanders, 2010)

Nightingale’s nursing
model is a four-step
process
◦ Observation
◦ identification of the needed
environment alteration
◦ implementation of the
alteration
◦ identification of the current
health state

This process is repeated
as frequently as necessary
to achieve the overall goal
of the improved health
state

The model includes health
promotion, illness
prevention, health
restoration, and
rehabilitation as
appropriate states in
which the model can be
implemented
(Selanders, 2010)
Nightingale’s Nursing Model

Nightingale’s basic tenets of
nursing practice have served the
profession well for one and a half
centuries

Most nurses today practice nursing
while following Nightingale’s
principles

Nightingale included in her theory,
what we know today as the nursing
process

Nightingale’s model is
philosophically consistent with
Maslow’s Hierarchy of Needs that
we use today

Her theory of environmental
alteration has served as framework
for many research studies
Maslow and Nightingale
(Selanders, 2010)
Clarification of Origins
Founder of Modern Nursing
 The First Nursing Theorist
 She explain her Environment Theory in her famous book
~Notes on Nursing~
What It is and What It is not (1859)
She was the first to propose nursing required specific education
and training


Selanders LC.(2010)
Evaluation of the Nursing Model
Nightingale’s Philosophy
Nightingale had a unique perspective on nursing
practice it focused on the relationship of her
patients and their surroundings
• Her philosophy’s are the foundation of Nursing
practice as we know it today
• It also provided the foundational work for
theory development
• Her focus on the profession became known as
the metaparadigm of nursing: Person,
Health, Environment and Nursing
Chitty & Black (2011)
Nightingale’s Philosophy
Content
•
•
•
•
•
•
•
•
•
•
•
•
Ventilation and sunlight
Clean air and water
Light, Noise
Cleanliness of rooms/walls
Health of houses
Bed and bedding
Personal cleanliness
Balance diet
Observing the patient and
accurate recording
information
Monitoring noise level
Providing adequate rest
Protecting from possible
harm
Chitty & Black(2011)
Nursing Metaparadigm of
Nursing
Person


Patient
People are multidimensional, composed of biological, psychological, social and spiritual
components
Health


As opposed to illness
Health is “not only to be well, but to be able to use well every power we have”



How the environment affects health and recovery from illness
“Poor or difficult environments led to poor health and disease”
“Environment could be altered to improved conditions so that the natural laws would
allow healing to occur”
Environment
Nursing



As opposed to medicine
Nursing is different from medicine and the goal of nursing is to place the patient in the
best possible condition for nature to act.
Nursing is the “ activities that promote health which occurs in any caregiving
situation”
Chitty & Black(2011)
Selanders LC(2010)
View and Concept
Florence Nightingale’s Environmental Nursing Philosophy
•
Holistic nursing care
• Nurses who have been guided by her philosophy are
sensitive to the effect to the environment and it’s
impact on the patients health and recovery of illness
• Her philosophy provide the foundation for other theorist
to develop their philosophy’s and theories
• She was the first nurse theorist. She continues to pave
the way for those who followed and those will continue
to come to this profession
Chitty & Black(2011)
Infection
Control
Confidentiality
HIPAA
Practice
Situations
Evidence
Base
Practice
Nurse
Researcher
www.nursing2011critcalcare.com

A home health nurse is visiting a new mom for the first time. Mom
states that she and the new baby have not been sleeping well. The
nurse notes that the house is a mess and that all the blinds are
closed, the house is very dark. Mom also has another child who is
watching a very loud TV show in the next room.
◦ 1. The home health nurse includes Nightingale’s 4-step nursing process in
her care. What are these steps?
◦ 2. According to Nightingale, what changes need to be made to improve the
health of mom and her baby?
◦ 3. Using Nightingale’s theory, what 4 components need to be addressed to
create a holistic person?
◦ 4. What did Nightingale see as the most important element that affects
healing in a patient’s environment?
Case Study
References
Baly, M. E, & Matthew, H. C. G. (2004). Nightingale, Florence.
Oxford Dictionary of National Biography.(Online Ed. 2011).
doi:10.1093/ref:odnb/35241
Chitty, K. K., & Black, B. P. (2011). Professional Nursing Concepts
and Challenges (6th ed). Maryland Heights: Saunders
Clements, P. T., & Averill, J. B. (2006). Finding the patterns of
knowing in the works of Florence Nightingale. Nursing Outlook,
268-274. doi:10.1016/j.outlook.2006.06.003
Lim Fidelindo, L.M. (2011). Why Florence Nightingale still matters.
retrieved www.nursing 2011critcalcare.com
Payne, K. (2010). Science, healing, and courage: the legacy of Florence Nightingale.
Alabama Nurse, 37(3), p. 10.
Selanders, L. C. (2010). The power of environmental adaptation: Florence Nightingale’s
original theory for nursing practice. Journal of Holistic Nursing, 28(1), 81-87.
doi:10.1177/0898010109360257