Florence Nightingale’s Theory of Nursing

1. Florence Nightingale’s Theory of Nursing As Presented by Kara Derry, Patricia Howell, Ashley Lundberg, and Lori Nousen

2. 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)

3. Before The Crimean War Before The Crimean War • Born to a wealthy family and educated intensively by her father • Traveled throughout Europe including to Kaiserswerthwhere 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

4. 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)

5. Written Work and Accomplishments 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) • 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

6. 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

7. 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

8. 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 (Selanders, 2010) Human Being (Person)

9. 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

10. 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 dys-ease 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

11. 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) • (Selanders, 2010) Nursing

12. 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

13. 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)

14. 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

15. 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

16. 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)

17. 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” Environment • 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” 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) Nursing Metaparadigm of Nursing

18. 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) View and Concept

19. Confidentiality HIPAA Infection Control Practice Situations Evidence Base Practice Nurse Researcher www.nursing2011critcalcare.com

20. 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 (6thed). 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 References