Question

All nursing theories are developed in space and time, and are not value free. Select one nursing theorist and explain the factors that influenced development of the theory (history, scientific paradigm, and personal experiences--mentoring, education, practice, other). Provide reference(s) for your response.

Answer 1

Florence Nightingale's Theory

Florence Nightingale (1820–1910), considered the founder of educated and scientific nursing and widely known as "The Lady with the Lamp", wrote the first nursing notes that became the basis of nursing practice and research. Her theories have served as foundations of nursing practice in various settings,including the succeeding conceptual frameworks and theories in the field of nursing. Nightingale is considered the first nursing theorist.

Contemporary authors are begining to explore Florence Nightingale's work as potential theoritical and conceptual model for nursing. Meleis (1997) notes that Nightingale's concept of environmet as the focus of nursing care and her suggestion that nurses need not know all about the disease process are early attempt to diffrentiate between nursing and medicine.

Nightingale did not view nursing as being limited to the administration of medications and treatments but rather as being oriented toward providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition (Nightingale, 1860). Through observation and data collection, she linked the client's health status and with environmental factors and initiated improved hygiene and sanitary conditions during the Crimean War.

Nightingale provided basic concepts and propositions that could be supported and used for practicing nursing. Nightingale's "descriptive theory" provides nurses with a way to think about nursing with a frame of reference that focuses on clients and the environemnt. Nightingale's letters and writting direct the nurse to act on behalf of the client. Her principles were visionary and encompassed the areas of practice, research, and education. Most important, her concepts and principles shaped and delineated nursing practice (Alliigood and Marriner Tomey, 2002). Nightingale taught and used nursing process, noting that "vital observation is not for the sake of piling up micellaneous information or curious facts, but for the sake of saving life and increasing health and comfort".

Goal of Nursing

To facilitate "the body's reparative processes" by manipulating clients environment.

Environmental Effects
She 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), that it involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health, and that external factors associated with the patient's surroundings affect life or biologic and physiologic processes, and his development.

Framework for Practice

Client's environment is manipulated to include appropriate noise, nutrition, hygiene, light, comfort, socialisation and hope.

Environmental Factors Affecting Health

• Pure fresh air- "to keep the air he breathes as pure as the external air without chilling him/her."
• 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."
• 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."
• Cleanliness- "the greater part of nursing consists in preserving cleanliness."
• Light(especially direct sunlight)- "the usefulness of light in treating disease is very important."

Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status.

Nursing Paradigms

Nightingale's documents contain her philosophical assumptions and beliefs regarding all elements found in the metaparadigm of nursing. These can be formed into a conceptual model that has great utility in the practice setting and offers a framework for research conceptualization. (Selanders LC, 2010)

Nursing

• 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 occur in any caregiving situation. They can be done by anyone."

Person

• People are multidimensional, composed of biological, psychological, social and spiritual components.

Health

• Health is “not only to be well, but to be able to use well every power we have”.
• Disease is considered as dys-ease or the absence of comfort.

Environment

• "Poor or difficult environments led to poor health and disease".
• "Environment could be altered to improve conditions so that the natural laws would allow healing to occur."

Theory and Nursing Practice

Application of Nightingale's theory in practice:

• "Patients are to be put in the best condition for nature to act on them, it is the responsibility of nurses to reduce noise, to relieve patients’ anxieties, and to help them sleep."
• As per most of the nursing theories, environmental adaptation remains the basis of holistic nursing care.

Reference:

1. Fundamentals of Nursing 6th Edition, Potter and Perry.
2. Selanders LC, 2010
3. Nursing Theory and Conceptual Framework, Fundamentals of Nursing: Human Health and Function, Ruth F. Craven and Constance J. Hirnle, 2003
4. The Nature of Nursing, Fundamentals of Nursing: Concepts, Process and Practice, Second Edition, Barbara Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder, 2004
5. Nightingale,F.(1860).Notes on nursing:what it is and what it is not.New York:D.Appleton And Company.