Florence Nightingale: Care Concept

OBJECTIVES OF THE SESSION

At the end of this session, the B.Sc. Nursing 1st year students will be able to:

Introduce Florence Nightingale State the four major concepts of Nursing Theory

according to Nightingale. Explain 5 major elements of environment affecting

patients’ health according to Nightingale. Discuss the application of nursing process using

Nightingale’s theory. Analyze the strength and weakness of Nightingale’s

theory.

INTRODUCTION OF THEORIST AND THEORY

Born to wealthy English parents on trip to Florence, Italy on 1820 May 12.

Parents- William Edward Nightingale

–Frances Nightingale

Founder of educated and scientific nursing.

The first nursing theorist.

At the age of seventeen, Florence Nightingale felt called by God to become a nurse

Announced her decision to enter nursing in the year 1844

1854 she was requested to care for wounded soldiers during the Crimean War

(“Lady with the Lamp”) was given special attention by Henry Wadsworth Longfellow.

Notes on Nursing: What it is, What is not (1860)

In 1860, Nightingale found the Nightingale’s School and home for nurses at Saint Thomas’s Hospital in London .

The work of her School of Nursing continues today as the Florence Nightingale School of Nursing and Midwifery at King’s Hospital London

By 1896, Florence Nightingale was bedridden: Chronic Fatigue Syndrome

Aug 13, 1910 - Florence Nightingale died in her sleep at the age of 90.

NIGHTINGALE’S CONCEPTS

1. Person Patient who is acted on by nurse Affected by environment Has reparative powers

2. Environment Foundation of theory. All the external conditions and influences

affecting the life and development of an organism and capable of preventing, suppressing or contributing to disease or death.

3. Health Maintaining well-being by using a person’s

powers Maintained by control of environment

4. Nursing Provided fresh air, warmth, cleanliness, good

diet, quiet to facilitate person’s reparative process.

NIGHTINGALE’S ENVIRONMENTAL THEORY OF NURSING The core concept is environment.

She tends to emphasize the physical more than social and psychological environment.

The death rate went from a staggering 42 per 100 to a low of 22 per 1000.

USE OF STATISTICS BY NIGHTINGALE

NIGHTINGALE’S ENVIRONMENTAL CONCEPTMajor Areas of concentration

Examples

Ventilation Fresh air, which is of primarily importance, can be achieved through open windows, corrupt, stagnant and musty air breeds disease. An outlet is needed for impure air. Drafts caused by open windows and doors are to be avoided. Dirty carpets and furniture are a source of impurity in the air.

Warmth Guarding against the loss of vital heat is essential to the patient’s recovery. Chilling is to be avoided. Hot bottles, bricks, and drinks should be used to restore lost heat.

NIGHTINGALE’S ENVIRONMENTAL CONCEPTEffluvia (smells)

Sewer air is to be avoided and care is needed to get rid of noxious body order caused by disease. Chamber utensils should be order free and out of sight. Fumigation and disinfectant should not be used but the offensive substance removed.

Noise Intermittent sudden noise causes greater excitement than continuous noise, especially during the patient’s first sleep. The more the patient sleep peacefully, the greater the patient’s ability to sleep will be. Walking lightly, whispering or discussing a patient’s condition just outside his room is cruel.

Light Beds should be placed in such a position as to allow the patient to see out the window- the sky and sunlight.

NIGHTINGALE’S THEORY OF NURSINGPhysical Environment

Patient Condition and nature

Cleanliness, ventilation. Air, light, noise, water, bedding, drainage, warmth, diet

Communication, advice variety

Mortality data, prevention of disease

Psychological Environment Social Environment

PHYSICAL ENVIRONMENT Cleanliness room should not be dusty, smoky or have close odor. bed must be clean, aired, warm, dry and free from odor. One should provide an environment in which the

patient can be easily cared for by others or self. The width, height, and placement of bed should

facilitate the activities of the patient. bed should be placed in the best lighted spot, away

from sudden noises and the odor of drainage. The position of the patient on the bed should be viewed

in the context of the supporting ventilation.

PSYCHOLOGICAL ENVIRONMENT

The effect of mind on body was fairly well accepted in Nightingale’s time.

Nightingale did recognize that a negative environment could cause physical stress, there by affecting the patient’s emotional climate.

Offering the patient a variety of activities to keep his/her mind stimulated.

The view of sunlight, the attractiveness of food, and offering of manual activities that stimulate the need of labour are all factors that assist the patient to survive emotionally.

Boredom is viewed as painful.

Communication with the patient is viewed in the context of the total environment.

Should not be hurried, it is important to sit down in front of them.

Outside the patient’s room or within the hearing distance is viewed as in appropriate.

Should not encourage the sick with false hopes and advice.

Communicating about the world around them that they miss, or about good news that visitors can share.

SOCIAL ENVIRONMENT

Specific data collections related to illness

Each nurse must use observational power in dealing with specific cases rather than be comfortable with average patients.

Notions as mentioned in physical environment such as clean air, water, and proper drainage and sewage in context of society.

NURSING PROCESS APPLICATION USING ENVIRONMENTAL THEORY

Assessment•Ventilation•Cleanliness of body, cloths, linen, surrounding•Adequacy of light•Noise•Sleep pattern•Odor•Condition of wound and dressing•Communication pattern of relatives and treatment team members•Area of patient placement•Way of offering food

Nursing Diagnosis

• Altered body temperature• Sleep pattern disturbances• Inadequate nutrition• Social Isolation• Risk for infection

Planning Intervention Evaluation

CRITIQUE OF THEORY

Simple and applicable, has caught the basic and important concepts in nursing.

Represents the condition at the time of Nightingale, may not be compatible to the sophisticated environment of modern western hospital.

Emphasized subservience to doctors.

Focused more on physical factors than on psychological needs of patient.

SUMMARY

Environmental Theory is of vital importance.

According to this theory the nurses try to keep the environment of the patient clean and hygienic.

The environment is kept free of germs so that the health of the patient cannot be affected.

Ventilation, warmth, noise, light, effluvia are the most highlighted concept to provide care to the patient who himself possess reparative power.

Lo! in that hour of misery

A lady with a lamp I seePass through the glimmering gloom,And flit from room to room

Thank You

REFERENCES

1. George JB. Nursing Theories: The Base for Professional Practice. Appleton and Lange. Norwalk, 3rd Edition

2. Attewell A. Florence Nightingale. Prospect: the quarterly review of comparative education. UNESCO. International Bureau of Education. Vol XXVIII no 1. March 1998; 153-66

3. Nightingale F. Notes on Nursing: What it is and what it is not. Harrison. 59. Pull Mall. London; 1860. Available from http://books.google.com/