Question

How did Nightingale's theories impact nursing practice?

Answer 1

INTRODUCTION

Florence Nightingale, 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. Nightingale is considered the first nursing theorist. She served as a nurse during the Crimean War, at which time she observed a correlation between the patients who died and their environmental conditions. As a result of her observations, the Environment Theory of nursing was born. The Environmental Theory, which incorporated the restoration of the usual health status of the nurse's clients into the delivery of health care and it is still practiced today.

FOCUS OF THIS THEORY

The focus of nursing in this model is to alter the patient's environment in order to affect change in his or her health.

The environmental factors that affect health, as identified in the theory, are:

fresh air,

pure water,

sufficient food supplies,

efficient drainage,

cleanliness of the patient and environment, and

light (particularly direct sunlight).

If any of these areas is lacking, the patient may experience diminished health. A nurse's role in a patient's recovery is to alter the environment in order to gradually create the optimal conditions for the patient's body to heal itself.

In cases, this would mean minimal noise and in other cases could mean a specific diet. All of these areas can be manipulated to help the patient meet his or her health goals and get healthy.

The ten major concepts of the Environment Theory, also identified as Nightingale's Canons, are:

Ventilation and warming

Light and noise

Cleanliness of the area

Health of houses

Bed and bedding

Personal cleanliness

Variety

Offering hope and advice

Food

Observation

Nightingale’s four major concepts of nursing theory:

1.Environment:

Physical components of the environment include ventilation and warming, health of houses, light, noise, bed and bedding, cleanliness of rooms and walls, personal cleanliness, taking food and what food. Social and psychological environment addressed as chattering hopes and advices, petty management, observations of the sick .

2.Person

  

Person is the individual who receives the nursing care. Although Nightingale did not define the person specifically, she did conceptualize person as holistic.

3.Health

Health does not mean to be well only but to be able to use every power the individual has. Nightingale believed “nature alone cures”.

4.Nursing

Nursing is viewed in two arenas. The first is defined as general nursing; she carry out the activities mentioned in canons of environment and another one is proper nursing who are educated in the art and the science of nursing. They are able to apply nursing process.

IMPACT OF NIGHTINGALE'S THEORY ON NURSING PRACTICE

The Environment Theory of nursing is a patient-care theory. It focuses on the care of the patient rather than the nursing process, the relationship between patient and nurse, or the individual nurse. In this way, the model must be adapted to fit the needs of individual patients.

The environmental factors affect different patients unique to their situations and illnesses, and the nurse must address these factors on a case-by-case basis in order to make sure the factors are altered in a way that best cares for an individual patient and his or her needs.

Nightingale's model teaches that unsanitary environments contribute greatly to ill health, and that the environment can be altered in order to improve conditions for a patient.

When physical environment of a patient gets ignored, this can push the patient to critical situation. Modification of the patient’s unhealthy environment at the early stage can prevent the patient's condition getting deteriorate

In Nursing practice, Nightingale emphasized that, “the most important practical lesson that can be given to nurses is to teach them what to observe, how to observe, which are the evidence of neglect, and of what kind of neglect”.

Nightingale emphasizes that when one or more aspects of the environment are out of balance, the patient uses his increased energy to balance it; however, this extra effort drains his energy which put delays in his healing.

For Example: In Nursing Practice, Patients with COPD are always instructed to save their energy because, unlike healthy people, because breathing for a COPD patient involves a conscious effort which is extremely challenging and consume more energy.

Next important concepts of Nightingale theory is cleanliness of room and walls. She pointed out, “greater part of nursing consists in preserving cleanliness”. Moreover, Nightingale linked the ventilation with cleanliness. She emphasized, “Without cleanliness, you cannot have all the effect of ventilation; without ventilation, you can have no thorough cleanliness”

In Nursing Practice, if a patient’s room is crowded and windows are closed , there will be no proper ventilation which can make the patient sick. Ensuring good ventilation means keeping the windows open with the alternative intervals and closed them after intervals of time so that room will be adequately fresh aired. This also includes limiting the attendants and giving teaching to patient and his family members regarding importance of proper ventilation. A person who repeatedly breathed his own air would become sick or remain sick.

According to Nightingale, “let the food come at the right time, and be taken away, eaten or uneaten, at the right time” . In Nursing practice, a nurse should realise that though patient’s meal tray usually has more than half food left uneaten most of the time, when patient will feel better he will take it.

Nightingale also instructed nurses that, “have a rule of thought about your patient’s diet; consider, remember how much he has had, and how much he ought to have today” . In practice, a nurse must consider her patient’s food preferences.

According to Nightingale, cleanliness is another important factor which affects the patient’s health.

For example, in Nursing practice, a patient was suffering from COPD and had severe cough so in that situation dust acts as allergen which has exacerbated the patient’s condition. Patient did not open his windows because he thought that dust from outside will affect negative on his health; however, he was not aware of inside dust.

Moreover, a small dustbin was placed beside patient’s bed which was full of garbage. That was also a source of infection and irritant for the patient. In this situation, the nurse should give awareness on importance of environmental hygiene to patient and especially the family members because patient was dependent on them.

Nightingale addressed that proper arrangement of sunlight in the room is beneficial for both health and recovery. Nightingale also has emphasized the importance of looking beyond the individual to the social environment in which he lived.

In Nursing practice a nurse should consider the patient's physical infrastructure, educational status, financial status, awareness on basic health precautions, access to primary health care centre and family background.

The nurse should introduce the principals of environmental hygiene in peoples’ daily routine and convince them on the idea of “prevention is better than cure”. At hospital level, if   checklist regarding environmental factors is attached in patient’s bedside folder then it will compel the nurse for its implementation and hence will result in positive effects on patient’s condition.

At the end of each shift nurse should evaluate and document the effect of favorable or unfavorable environment effects on patient’s health. In this way, nurse would be able to monitor the patient’s environmental.

Thus Florence Nightingale's Environmental theory assist health care professionals to provide unique contribution in caring for their patients. According to Nightingale, if nurses modify patients environment according to her canons, she can help patient to restore his usual health or bring patient in recovery. Hence, Nightingale provided a basis for providing holistic care to the patients and it is still applicable today. It is recommended that awareness regarding basic environmental hygiene should be given at community and hospital level in Nursing.