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Florence Nightingale

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Jimmy Le

on 29 August 2014

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Transcript of Florence Nightingale

Major Influences
Major Concepts
Florence Nightingale developed five points that she believed were vital to obtaining and maintaining health: “pure air, pure water, efficient drainage, cleanliness, and light” (Nightingale, 1860, p. 18). Nightingale also addressed the metaparadigm concepts of human, environment, health, and nursing when she developed her theory (McEwen & Wills, 2014). Healthy surroundings were believed to be an important part in promoting health and healing of patients; buildings should be made in a way that rooms were properly ventilated to allow in fresh air and had enough openings to allow in light (McEwen & Wills, 2014). Nightingale also stated that health is directly related to how the household is managed, and nurses must take into consideration the house in which the patient lives, and also consider everyone who comes in contact with the patient (McEwen & Wills, 2014).

Nightingale believed that many things in a patient’s environment could directly affect their health. For example, noise was believed to be harmful to patients and had a negative effect on their ability to rest and heal. Nightingale stated that nurses should be mindful of this and avoid excessive noise around patients, including having a heavy footfall, talking within earshot of patients, and asking too many questions (McEwen & Wills, 2014). Although noise was thought to be harmful to patients, Nightingale did encourage social contact and thought it was important to overcoming illness (McEwen & Wills, 2014). Nightingale believed that healthy food, decent beds and bedding and personal hygiene also played a part in a person’s health. The germ theory had also been suggested during her lifetime, although Nightingale never acknowledged it, her theory shows that she realized the importance of cleanliness in preventing illness and maintaining health (McEwen & Wills, 2014).

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In conclusion, Nightingale’s theory is currently being followed in today’s institutions that rely upon HCAHPS feedback for Medicare/Medicaid reimbursement. Patient satisfaction can be a gray area of understanding. Understandably, there are elements of a patient’s care that will fall outside the control of the hospital staff. If the patient is critically ill, unable to eat, or is dependent upon mechanical ventilation, managing the patient’s ability to choose varieties of foods or control their environment will be diminished. The nurse is then charged with being insightful, empathetic and considerate to providing as much comfort as possible without impeding the prescribed care plan. While there are lower scores reflected when patient’s lack understanding of the reasons behind their care plan decisions, the nurse can be instrumental in educating and informing to the best of their ability. Personality differences that negatively affect patient communication can be improved upon if the art of nursing is employed. Artful, thoughtful communication tactics may or may not be able to soothe a disgruntled patient, either from the primary nurse, the nurse manager or nursing supervisor. In essence, Nightingale’s theory has set the standard for optimizing the standards of nursing care today.
Environmental Theory
Florence Nightingale
Christine Vayo
Tammy Dannehl
Gia Ciancanelli
Jamie Laubach
Jimmy Le
Grand Canyon University
NUR-502 Theoretical Foundations for Nursing Roles and Practice
August 27, 2014

Thank you!
Florence Nightingale
Why did we choose her?
Nightingale’s work is the foundation for nursing, hospital administration, public health, and also social services (Blais, Hayes, & Kozier, 2011). Nightingale has been identified as the theorist of choice for more many reasons. One of the most important reasons is the impact on nursing care that is still applicable today. Much like Nightingale, caregivers are charged to provide care to numerous individuals with drug-resistant infections, non-curable diseases, new diseases, and the return of old diseases (Beck, 2010, p. 317). Nightingale’s ideas of nursing care still influences nursing care with utilizing the idea of “Health-Nursing”. Through Nightingale's experience, philosophies, observations, and data collection, she was able to revolutionize health care. Beck (2010) succinctly relayed a global sentiment in stating “Nightingale's call for nurses to apply themselves to helping people stay healthy and regain health” (p.318).
Follow us on an adventure of learning and discovery about Florence Nightingale's and her environmental theory!
Category of the Theorist
Nightingale viewed a person as patients and nurses should care for these patients to help with recovery (McEwen & Wills, 2014).
Nightingale defined the health paradigm in her treatise, Sickness-Nursing and Health-Nursing (1893/1954), as “to be well but to be able to use well every power we have” (McEwen & Wills, 2014, p. 135). Nightingale defined health as more than just the absence of disease (McEwen & Wills, 2014), but also it is the prevention of the disease and to preserve the integrity of health to its highest potential.
The environmental paradigm was one of Nightingale’s major emphases. Nightingale understood that adding variety to the environment could help add life to a monotonous room. Adding colorful objects, décor and flowers would brighten up the room and lift spirits. (Nightingale, 2003, p. 45) Nightingale would also use flowers in the room to freshen the air, as she understood flowers could produce therapeutic aroma and beneficial oxygen that would counter out the tainted air (Nightingale, 2003, p. 46). Nightingale believed that a healing environment is created by a healthy home. She saw five essential points to achieving this: “pure air, pure water, efficient drainage, cleanliness, and light” (McEwen & Wills, 2014, p. 134). These essentials promoted rest and tranquility which aides the patient’s body, mind and spirit in recovery (McEwen & Wills, 2014).
Nightingale stated:

The most important practical lesson that can be given to nurses is to teach them what to observe – how to observe – what symptoms indicate improvement – what the reverse – which are of importance – which are of none which are the evidence of neglect – and of what kind of neglect”. (Nightingale, 2003, p. 88)

Nightingale believed that a nurse should be precise with their observation and to be able to critically think. This in turn would make nurses better at recognizing patterns, signs and symptoms and allow them to accurately collect data. Nightingale’s paradigm of nurse defines anyone who is responsible for the health of a patient. Unlike medicine, she believed that nursing was an art. The art of caring. As part of caring, one must care for the health of the house, the health of those whom comes into contact with the patient and the health of the patient (McEwen & Wills, 2014).
Major Propositions
Nightingale thought the nurses played a large role in patients’ health, and that nurses must conduct precise assessments of patients and report their findings to physicians as soon as possible (McEwen & Wills, 2014). Nightingale also stated that nurses need to use critical thinking skills to determine what care is best for their patients and do what was essential to aid in patients’ healing (McEwen & Wills, 2014). Nightingale believed that nursing was “to put the constitution in such a state that it will have no disease, or that it can recover from disease” (Nightingale, 1860, p.7).
Examples of how her theory was used.
How the theory is integrated into practice.
Nursing theory’s primary focus is to guide nursing practice in a way that health and quality of life is improved (McEwen & Willis, 2014). Integration of theory into nursing practice is of importance to provide a positive impact on patient’s lives. The first step is to identify a theory to be used to influence practice change. In this particular case, Florence Nightingale’s Environmental Theory will be used. The facility should establish a committee, or utilize the quality improvement committee, to identify a problem that may affect patient healing. The next step should be to involve staff members at all levels in the development of a patient survey that’s directed at the problems related to the environment such as lighting, temperature and cleanliness of patient rooms, noise, and such. These surveys should be provided to each patient for a given amount of time. After this amount of time has ended, data should be collected and presented to the committee for review to note problems that exist in the facility. The committee should then identify interventions to minimize these problems. Choosing of these interventions should take place based on research and review of evidence-based practice literature related to environmental changes. Next, each staff member of the facility should be encouraged to become involved in implementation of these interventions to produce changes. After changes have been initiated, a follow up survey should be provided to the patients to assure change has taken place.
Concrete examples of theory integration
Assessment Guide
Healthcare Providers and Systems (HCAPS) scores are used as an assessment of patient satisfaction.
3 goals:
standardized survey produces data that can be measured
public reporting creates new incentives to improve healthcare
public reporting enhances accountability

Identification of Measurable Outcomes from Theory Implementation

how well do the doctors and nurses communicate with the patient during their care?
how responsive is the hospital staff in meeting the patient's needs?
how well was the patient's pain managed?
how well did the hospital staff communicate about new medications?
how well was key information taught at discharge?
how clean and quiet was the patient's room during their stay?
There are a vast number of grand theories, which can be categorized in multiple ways. These grand theories can be categorized based on scope, domains, paradigms and more (McEwen & Wills, 2014). One way Nightingale’s theory is categorized is based on human needs. Human needs theories considers patients as “biopsychosocial beings who are the sum of their parts, who are experiencing disease or trauma, and who need nursing care” (McEwen & Wills, 2014, p. 132). Nightingale’s environmental theory falls under the human needs umbrella because her model of nursing addresses the body, mind, and spirit.
It is this group’s opinion that Florence Nightingale’s focus on environmental effects on the well being of individuals continues to be of value in today’s nursing. As stated by Beck (2010), drug-resistant microbes are on the rise, old diseases are returning, and there is an influx of new diseases. Factors contributing to these continued health concerns are related to economic status, environmental conditions, and social issues (Beck, 2010).

At an unnamed school, students and faculty provided foot care to homeless, migrant farm workers (Howett, Conner, & Downs, 2010). Also, Howett, Conner, & Downs provided discussion of observation of living conditions of these individuals. A lack of protection from the elements of the weather resulting in prolonged exposure to moisture contributed to disease. The nurses’ role was to manipulate the environment to promote healing (Howett, Conner, & Downs, 2010). A plan of care for the diseased individuals based on Nightingale’s environmental theory of sanitation, sunlight, fresh air, cleanliness, and avoidance of dirt was provided (Howett, Conner, & Downs, 2010).

Ultimately, it was discovered that the application of Nightingale’s environmental theory of promoting a clean and dry environment was as applicable today as it was when it was first discovered.

Noise is also an environmental condition that was thought to contribute to poor healing. As stated by Murphy, Bernardo, and Dalton (2013), “The ill effects of noise on patients and the importance of maintaining a quite, restful environment have long been recognized by nurses, beginning with Florence Nightingale” (p. 43). Noise reduction and the assurance of a restful environment became a priority at Beth Israel Deaconess Medical Center (BIDMC) (Murphy, Bernardo, & Dalton, 2013). Beth Israel Deaconess Medical Center gathered information from patient utilizing a 32-question survey regarding the care environment. Literature was reviewed related to noise reduction and nursing staff became involved to initiate strategies for noise-reduction (Murphy, Bernardo, & Dalton, 2013). Changes included but were not inclusive to the following: closing doors, supplying ear plugs to patients, use of mini-flashlights on rounds, and to initiate quite hours for the facility. It was discovered that the critical component of noise reduction was the nurse. Murphy, Bernardo, & Dalton, (2013) acclaimed the following:
Call lights, intercoms, telephones, computers, and staff noise are just of few of the environmental noises encountered today.

The important role of nurses was perhaps best expressed by Nightingale, who shared the following observations in Notes on Nursing: “A good nurse will always make sure no door or window in her patient’s room shall rattle or creak; that no blind or curtain shall, by any change of wind through an open window, be made to flap—especially will she be careful of all this before she leaves her patient for the night. If you wait till your patients tell you, or remind you of these things, where is the use of their having a nurse?” (p. 51).

Born to a wealthy family in May of 1820
Noted for her selflessness and her caring heart.
Nightingale opted to proceed with the occupation of nursing-at the time considered a low-ranking occupation to improve health care.
Known for her service as a nurse in the Crimean War
Nightingale believed that nurses are to be more concerned with health as opposed to illness, thus stressing the importance of preventive care.
Nightingale’s work influences nursing practice by creating a foundation for the development of nursing theories.
Florence Nightingale was a pioneer in the field of nursing and is responsible for the transformation of nursing from a domestic service to a profession.
Nightingale was the first nurse to develop a philosophy for nursing practice.
Nightingale was acknowledged for her scholarly works, passion for nursing, advocacy for patients, and advocacy for the profession as a whole.
Nightingales theories transcend time and her promotion of patient rights and nurse education are still a basis for nursing practice today (Selanders, & Crane, 2012).
Florence Nightingale was a pioneer in the field of nursing and is responsible for the transformation of nursing from a domestic service to a profession. Selanders and Crane (2012) have noted that Nightingale was the first to develop a philosophy for nursing practice. Nightingale was acknowledged for her scholarly works, passion for nursing, advocacy for patients, and advocacy for the profession as a whole (Selanders & Crane, 2012). Nightingale’s theories transcend time and her promotion of patient rights and nurse education are still a basis for nursing practice today (Selanders & Crane, 2012).
Nightingale’s environmental theory stressed the importance of diet, cleanliness, ventilation, warmth, and quiet, which is still used today by many health care organizations (Alligood, 2010). In this theory, Nightingale incorporated the restoration of the usual health status of the nurse’s clients into the delivery of health care (Alligood, 2010). Nightingale stated in her nursing notes that nursing “is an act of utilizing the environment of the patient to assist him in his recovery” (Nightingale,1860/1969, p.11 ). Utilization of the environment involves the nurse’s intervention to configure environmental setting appropriate for the gradual restoration of the patients health, and that external factors associated with the patient’s surroundings affect life, the biologic and physiologic processes, and development. Nightingale observed “that people were inseparable from their physical environments, either flourishing or deteriorating in relation to their living conditions” (Hegge, 2013, p. 212). Nightingale’s theory follows the human needs metaparadigm because Nightingale believed that social contact promoted healing (McEwen & Wills, 2014). As Nightingale trained young nurses to work, she instructed them to be highly aware of their patient’s condition, changes in their condition, and that pertinent information should be reported to the physicians (McEwen & Wills, 2014).
During the Crimean war-era, Nightingale observed hospital conditions; she noted epidemics that were prevalent in dirty environments congested with people, which placed people’s health in danger (Hegge, 2013). Nightingale’s concepts were important as she cared for the sick and injured soldiers from 1854-1856. According to Nightingale, the environmental factors affecting health are:
Each patient should have pure fresh air: “to keep the air he breathes as pure as the external air without chilling him.” (Nightingale, 1860, p. 3). Each patient should have pure water: “well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer.” (p. 7) Each patient’s room should have effective drainage: “all the while the sewer maybe nothing but a laboratory from which epidemic disease and ill health is being installed into the house.” (p. 7). Each patient’s room should have adequate cleanliness: “the greater part of nursing consists in preserving cleanliness.”(p.7). Each patient’s room should have adequate light (especially direct sunlight): “the usefulness of light in treating disease is very important.” (p. 7).

Nightingale (1860) continued to emphasize that if one is lacking in one or more of these environmental factors could delay the ill person’s return to normal health status. Beck (2010) that these factors were quite important during Nightingale’s time when health institutions had poor sanitation and health workers were uneducated in how to assist ill patients.
Nightingale brought 38 nurses to the war and taught them the importance of caring and communication (Hegge, 2013). Nightingale brought in healing herbs, clean water, healthy foods, and created well-ventilated healing areas full of light and quiet (Hegge, 2013).
Nightingale taught her nurses the importance of caring communication, and brought in healing herbs, clean water, healthy foods, and created well-ventilated healing areas full of light and quiet (Hegge, 2013). Nightingale also emphasized in her environmental theory the provision of an environment that was quiet, noise-free, and warm. She also attended to the patient’s dietary needs by examining their food consumption, their consumption routine and evaluating its effects on the patient (Hegge, 2013). Nurses can witness elements of her environment theory at work today when hospitals renovate units to offer noise-reduction upgrades to hallways and private rooms, as well as the steps employed in a care plan for patients with seizure disorders when rooms are kept dark and quiet to avoid seizure stimulating stimuli.

Nightingale’s theory adheres to the nursing paradigm of supporting health needs because she believed that nurses must use every skill they have in doing the best they can in nursing health by providing “optimally clean air, environment, light, food, linen, and overall cleanliness” (McEwen & Wills 2014, p.135). Because Nightingale believed nursing is an art, her theory adhered to the paradigm of nursing needs, as she saw nursing as “a way to put the constitution in such a state as that it will have no disease, or that it can recover from disease, which will put us in the best possible condition for nature to restore or to preserve health-to prevent or to cure disease or injury” (McEwen & Wills, 2014, p.135).

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