Stacie Brown, Julie Ivey, Cassandra Kotlarczyk, & Joella Show

Nursing Theorist Presentation

Florence Nightingale

IntroductionLET ME TELL YOU ALL ABOUT A

NURSING THEORY & MODEL

Theories are composed of concepts, definitions, models , propositions and are based on assumptions.

Models are representations of the interaction among and between the concepts showing patterns.

1. Born in Florence, Italy on May 12, 1820.

2. During the Crimean War, improved the unsanitary conditions at a British base hospital, reducing the death count by two-thirds.

3. Made it her mission to improve hygiene practices, significantly lowering the death rate at the hospital in the process.

4. Have you figured out who this Nurse Theorist is yet???

"the Lady with the Lamp."

Florence Nightingale "the Angel of the Crimea.“

According to www.biography.com, Florence Nightingale was a prolific writer. She lived from 1820 to 1910 in Victorian England. Her ideas, values, and beliefs on a wide range of topics can be identified in her documents. They contain philosophical assumptions and beliefs regarding all elements found in the met paradigm of nursing. In 1859, she was the first to conceptualize nursing’s work into a theoretical framework. She was credited with founding the practice of nursing.

Assumptions and Point of View Origins of the Nursing Model

Nightingale is most remembered as a pioneer of nursing and a reformer of hospital sanitation methods.

She was the first person to link poor hygiene and living conditions to deaths in hospitals.

In this model is Nightingale's “polar-area diagram” to dramatize the needless deaths caused by unsanitary conditions and the need for reform.

Polar-Area DiagramThe areas of the blue, red, & black wedges are each measured from

the centre as the common vertex.

• The red wedges measured from the centre of the circle represent the deaths from wounds.

• The blue wedges measured from the centre of the circle represent area fore the deaths from Preventable or Mitigable Zymotic diseases.

• The black wedges measured from the centre of the circle represent the deaths from all other causes.

Nightingale’s View on Prevention

"The work we are speaking of has nothing to do with nursingdisease, but with maintaining health by removing the thingswhich disturb it . . . dirt, drink, diet, damp, draughts, anddrains” (Monteiro, 1985).

Motivation for Developing the Model and Historical Background

Nightingale served as a nurse during the Crimean war and through that service she learned the effects the environment has on health

(Contagion, n.d.).

She is famous for her work to improve sanitary conditions for her patients during a pre-germ theory era (Contagion, n.d.).

Nightingale’s Model For Nursing Practice

Nightingale’s Philosophic Values About Nursing and Knowledge Development

• Florence Nightingale founded the Nightingale School and Home for Nurses at Saint Thomas's Hospital in London. The opening of this school marked the beginning of professional nursing education.

• “People are multidimensional, composed of biological, psychological, social and spiritual components” (Knutson, 2010).• “Disease is more accurately portrayed as dys-ease or the absence of comfort” (Knutson, 2010).

• “Symptoms alert nurses to the presence of illness, which allows for appropriate interventions” (Knutson, 2010).

• “Breaking the natural laws will cause disease” (Knutson, 2010).

• “Improvement in the health of individuals and families lead to the improved health of society” (Knutson, 2010).

• Nurses are meant to ease suffering, to offer comfort, and most of all to look after the patient's well being (enurse-careplan.com).

• Nursing is a science as well as a profession (enurse-careplan.com).

• Nurses should concentrate on the patient and their needs, not the disease they were afflicted with (enurse-careplan.com).

Nightingale’s Philosophic Values & Knowledge

More Values and Knowledge Development “The nurse whose practice is guided by Nightingale’s philosophy is sensitive to

the effect of the environment on the patient’s health or recovery from illness”(Chitty & Black, 2011, p. 306).

“This philosophy provided the foundational work for theory development that proposed changing patient’s environments to effect positive changes in their health” (Chitty & Black, 2011, p. 306).

Nightingale applied her early education to develop statistics that she used to support her nursing care and her evidence based nursing practice. “Her description of the importance of observing the patient and accurately recording information and her principles of cleanliness still shape hospital-based nursing practice today” (Chitty & Black, 2011, p. 306).

Influence on Nightingale’s PhilosophyHer experience as a nurse in the Crimean war provided her with in site on the conditions such as, filth, inadequate nutrition, dirty water, and inappropriate

sewage disposal, which led to a situation in which more British soldiers died in the hospital than of battlefield wounds.

“Nightingale believed that the health of patients was related to their environment” (“Chitty & Black, 2011, p. 306).

Nightingale’s Metaparadigm

Health, Nursing

Person, Environment

Person The person is referred to by Nightingale as “the patient”. “A human being acted upon by a nurse, or affected by the environment has reparative powers to deal with disease.” “Recovery is in the patient’s power as long as a safe environment exists” (Environmental Theory, 2012).

Environment

• External forces affect one’s life.

• "Poor or difficult environments led to poor health and disease“ (Theory, 2012).

• "Environment could be altered to improve conditions so that the natural laws would allow healing to occur” (Theory, 2012).

Health

Health is, “not only to be well, but to be able to use well every power we have”. (Theory, 2012).

“Disease is considered as dys-ease or the absence of comfort” (Theory, 2012).

Nightingale believed it was important to control the environment to prevent disease.

NursingNursing, “Provides fresh air, light, warmth, cleanliness, quiet, and proper diet” and also, “facilitates patient reparative process by environment” and “influences the environment to affect health” (Environmental Theory, 2012).

The goal of nursing is, “to put the patient in the best condition for nature to act upon him” - Nightingale (Environmental Theory, 2012).

The Relationship The patient is at the center of the Nightingale model which incorporates a holistic view of the person as someone with psychological, intellectual, and spiritual components. The laws of health, as defined by Nightingale, were to keep the person and the population, healthy. This was dependent upon proper environmental control, such as sanitation. The environment was what the nurse manipulated. Nightingale isolated five environmental components essential to an individual’s health: clean air, pure water, efficient drainage, cleanliness, and light (www.enurse-careplan.com).

Person, Environment, Health & Nursing

.

Refuge for the Destitute-Female Workhouse Ward, 1873

Interpretation & InferenceFlorence Nightingale is the mother of

nursing.Her philosophy is the basis for contemporary

nursing theory. l

Image Retrieved from http://theedwardians.blogspot.com/2011/12/nursing.htm

Implications & ConsequencesFlorence Nightingales philosophy is over one

hundred years old. Her philosophy is still relevant today.

Image retrieved form the University of Virginia Art Museum. "Surely We Essential: Images of Nursing in the Twentieth Century"

Evaluation of the Nursing ModelClarification of Origins

Nightingale heard, “of the horrible conditions suffered by the sick and wounded British soldiers in Turkey during the Crimean War. (She) took a small band of untrained women to the British hospital in Scutari” (Chitty & Black, 2011, p. 29).

Interpretation & Inference and Implications & Consequences

Clarification of Origins Continued

They arrived November 4, 1854 and the description she gave was, “There were no vessels for water or utensils of any kind; no soap, towels, or clothes, no hospital clothes; the men lying in their uniforms, stiff with gore and covered with filth to a degree and of a kind no one could write about; their persons covered with vermin” (Bloy, 2012, para. 7).

Clarification of Origins Continued

This visual travesty influenced her philosophy that a patient’s health is directly related to their environment, it is the nurses’ responsibility to protect patients’ because positively changing a patient’s environment positively changes their health (Chitty & Black, 2011, p. 306).

Evaluation of the Nursing ModelContent

Humanitarian work was how Nightingale saw nursing. “For her, nursing was holistic, bringing body, mind, and spirit together. Caring for the whole person required integration and collaboration with medicine, environment, family and society” (Payne, 2010, p. 10).

According to Chitty & Black (2011), “Nightingale focused the profession on what has become known as the metaparadigm of nursing: person (patient), health (as opposed to illness), environment (how the environment affects health and recovery from illness), and nursing (as opposed to medicine) (p. 306).

Content Continued

Nightingale worked on, “visual displays of quantitative information, which she believed were more effective in conveying statistical significance…she was a pioneer in a specific pie graphic display” (Kudzma, 2006, p. 62).

This display and her statistics from the Crimean War she showed to the Queen of England so that hospitals would change their current practice and that a standardized nursing school should be implemented.

This is not a narrow view. With any patient, on any floor (OB, OR, ED), their environment can be altered to promote healing and comfort.

Evaluation of the Nursing ModelHer Influence

According to Chitty & Black (2011), “the Nightingale Pledge can be considered nursing’s first code of ethics. It is presented here not only for its historic value but also because it established the roots for our current code (of ethics)” (p. 68).

She, “revolutionized and professionalized nursing by stressing that nursing was not a domestic, charitable service but a respected occupation requiring advanced education” (Chitty & Black, 2011, p. 147). Our current education system originates from her work.

Her philosophy that, “proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet… (Influenced) contemporary nursing’s focus on the therapeutic milieu” (Chitty & Black, 2011, p. 128).

Nightingale’s philosophy was the foundation for theory development on environmental impact on patient health (Chitty & Black, 2011, p. 306).

What practice situations can/has this model been used?

Surgery/OR: During surgery sterile environment, sterile tools, taking a timeout, and calm music are utilized.

Fall risk patients in the hospital: Bed alarms, chair alarms, falling star signs, and red socks are used on patient’s who are a fall risk.

Nursing homes/extended care facilities: Llive birds in cages, windows in every room, decks for residence, and family rooms are provided.

Pediatrics: playrooms, beds for parents to sleep in, and colorful, kid friendly rooms and hallways are provided.

Hospice houses: There are places for families to sleep, eat and socialize with patients, large windows in rooms, and the ability for beds to go outside.

Agitated patients: calming music, lights dimmed, decreased visual stimuli

ICUs/step-downs: Sterile cleaning of invasive lines (chest tubes, central lines, art lines, tracheotomies) are utilized.

We have one person to thank for these positive changes………….

Conclusion

Florence Nightingale’s journey to becoming a nurse started in the early 1840s, but she didn’t make her mark until the Crimean War in 1854. Nightingale was dedicated to her work, even in spite of her parent’s disapproval. At the barrack hospital at Scutari during the war, she was often on her feet for 24 hours a day. She was also the only woman allowed in the soldier’s ward at night where she affectionately got the name, “Lady of the Lamp” (Bloy, 2012, para. 8). Nightingale was a pioneer in the nursing field. Due to her experience during the war her practice focused on the relationship between a patient and their surroundings. These principles have been the foundation for nursing and are still relevant and practiced today (Chitty & Black, 2011, p. 306).

Young Florence Nightingale and Injured Collie Dog

Case Study1 A 76 year-old male presents to the Emergency Department with increased headache, blurry vision, confused to event and mild agitation. It has been confirmed by the physicians and CT scan that he has suffered a hemorrhagic stroke. Family is currently out in the waiting room and is very upset and distraught. Due to the bleeding in his brain, the Stroke team doesn’t want the patient to have any pain medications or any medications to calm him down. As a nurse working with this patient, what can you do following Florence Nightingale’s philosophy to make this patient more comfortable?

Case Study2

A Dementia/Alzheimer’s patient was just admitted to a neuro step-down unit for increased confusion. She has become increasingly agitated after her daughter has left and keeps getting out of bed. The staff is concerned that she may wander or fall. Taking Florence Nightingale’s philosophy into consideration, what can the nursing staff do to calm and protect the patient?

CASE STUDY3

You are a nurse at an extended care facility that is undergoing construction work. A result of the contraction work is extra noise throughout the day. There are sheets of plastic hung from the wall where the work is being done. Construction workers walk up and down the hall frequently throughout the day. According to Florence Nightingales nursing philosophy, will this construction work affect the patients’ health and wellbeing? If yes, how?

Case Study 4

You are a nurse on a medical-oncology unit. One of your oncology patients desperately misses her pet dog. You are trying to arrange for this patient to have her pet brought in to see her. She is not in any form of isolation precautions and her white blood cells and neutrophils are within normal limits. According to Florence Nightingale’s nursing philosophy is it appropriate for her pet to be brought into her?

ReferencesBloy, M. (2012). Florence Nightingale (1820-1910). The Victorian web. Retrieved from: http://www.victorianweb.org/history/crimea/florrie.html

Chitty, K.K., Black, B.P. (2011). Professional nursing: Concepts and challenges (6th ed.) Maryland Heights, MO: Saunders

Contagion. (n.d.). Florence Nightingale, 1820-1910. Retrieved from http://ocp.hul.harvard.edu/contagion/nightingale.html

eNurse care plan (2011). Nursing theory and theorist: Florence Nightingale. Retrieved from http://www.enurse-careplan.com/2010/04/nursing-theory-theorist-florence.html

Florence Nightingale: Biography (2012). Retrieved from http://www.biography.com/people/florence-nightingale-9423539?page=2 Florence Nightingale: Environmental Theory (2012). Retrieved from http://nursinglibrary.info/florence-nightingale/

Knutson, M.B. (2010). Original nursing theories of Florence Nightingale. Retrieved from http://id3i.one.pl/erWA

References ContinuedKudzma, E.C. (2006). Florence Nightingale and healthcare reform. Nursing Science Quarterly 19(1): 61-61. doi: 10.1177/0894318405283556

Payne, K. (2010). Science, healing, and courage: The legacy of Florence Nightingale. The Alabama Nurse, 10

Riddle, L. (2012). Biographies of women mathematicians. Florence Nightingale May 12, 1820 - August 13, 1910. Retrieved from https://www.agnesscott.edu/lriddle/women/nitegale.htm

Boehm, H. & Morast, S. (2009). Quiet time. American Journal of Nursing, 109(11): 29-32. Retrieved from http://www.nursingcenter.com/lnc/journalarticle?Article_ID=940560

Theory of Florence Nightingale (2012). Retrieved from http://currentnursing.com/nursing_theory/Florence_Nightingale_theory.html

References ContinuedPavlac,tml B. (2005). Florence Nightingale. Retrieved from http://departments.kings.edu/womans_history/florence.html

Seymor, L.R. (1954). Florence Nightingale, selected writings of Florence Nightingale (pp. 38287). New York, NY: The Macmillan Co

Rehmeyer, J. (Nov. 2008). Florence Nightingale: The passionate statistician. Retrieved from http://www.sciencenews.org

Monteiro, L.A. (1985). Florence Nightingale on public Health nursing. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1645993/pdf/amjph00278-0075.pdf