Florence Nightingale s Conceptual Model

“If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault of not of the disease, but of the nursing. I use the word nursing for want of a better” (Nightingale, 1860, p. 8). While Nightingale stressed the impact of one’s environment to promote healing, Virginia Henderson aimed to establish on the fundamental needs as a knowledge base to guide Professional nursing practice. Henderson emphasized on fourteen components required for effective nursing care which includes: breathing normally, eating and drinking adequately, elimination of body wastes, movement and posturing, sleep and rest, select suitable clothes-dress and undress, maintaining body temperature, keeping body clean and well groomed, avoiding dangers in the environment, communication, worship according to one’s faith, work accomplishments, play or participate in various forms of recreation, and learn, discover, or satisfy the curiosity (Fernandes et al., 2015). Her division of the fourteen components acknowledged patient needs with a holistic approach that is applied through the nursing process in a clinical setting.

person as someone with psychological, intellectual, and spiritual components. This is evidenced by her acknowledgment of the importance of variety. For example, she wrote of “the degree . . . to which the nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings” (Nightingale, 1860). A nurse was defined as any woman who had “charge of the personal health of somebody” whether well, as in caring for babies and children, or sick, as an “invalid” (Nightingale, 1860). Above all, nursing was “service to God in relief of man”; it was a “calling” and “God’s work” (Bostridge, 2008). All nursing actions were guided by the nurses’ caring, which was guided by underlying ideas about God. Nightingale placed spiritual needs of the patient right at the top along with caring for the patient. She taught about obedience in relation to nursing and this revealed that she was creating a profession that was based on the role of wife and mother. In her teaching, she tried to concentrate more on the lifestyle and moral conduct of the nurses, rather than their professional skills. The measurement of the art of nursing could not be accomplished

Over the past two decades, EBP has expanded on Florence's theories. EBP constitutes the combination of clinical expertise, patient values, and research evidence when making decisions about patient care. In the 1990's, it was determined that just increasing knowledge was not sufficient for improving patient outcomes. To obtain better patient outcomes "new knowledge must be transformed into clinically useful forms, effectively implemented across the entire care team within a systems context,

“Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles” (ICN 2010)

Kristen M. Swanson may not be as well-known as Florence Nightingale in the nursing field, but she has made great contributions with the Theory of Caring that has been used in many hospitals, even internationally, for their framework to guide patient care. Through the study of her practice, I have realized much of her practice is reflected in mine. This paper will present the basic concept of nursing known as the metaparadigm concepts of person, health, environment, and nursing as presented by Swanson, as well as provide my own philosophy of nursing, which in many ways mirrors Swanson’s.

This paper will examine the origin of the nursing theory in reference to the Florence Nightingale Theory of Positive Manipulation Of the environment. Initially the paper will introduce the theorist and the context in which the theory was developed. Will critique the theory according to nursing theory critique. The paper will further describe the utility of the theory with respect to practice, administration, education and research will also examine the empirical precision of the theory(testability and logical adequacy). Infact the entire paper demonstrates the understanding of the theory.

The concept of environment and its integral role in the delivery of nursing care was among the first identified and documented nursing theory since its early days. Florence Nightingale pioneered the profession of nursing and along with it, pioneered the concept of nursing theory. Her environmental theory was patient focused and incorporated five environmental components needed to promote health. Jarrin (2012) supported that the role of nursing is to promote the best possible environment for the patient to assist in their natural reparative process. According to Rahim (2013), as considered as the profession’s first nurse theorist, Florence Nightingale provided the essential foundation in environmental theory. She believed

Grand theories are relatively abstract concepts and help to provide nursing knowledge in a general way. However, this theory is the most complex and widest in scope of the level of theory have been subdivided into Human needs, Interactive and Unitary process theories (McEwen, & Wills, 2014). For this reason, Nightingale’s Environmental theory is part of the grand theory because it encompasses different areas of nursing care. This theory incorporate knowledge made from observing the patient and critical thinking as contrast to empirical and medical care (McEwen, & Wills, 2014). Between these three subdivisions, Nightingale’s theory is also a Human Need Theory because she based her theory on how the environment cause changes in ill patients. Nightingale used inductive reasoning through observation and experiences to obtain laws of health, disease and nursing (pdf).

The environment theory of nursing is a patient-care theory. The delivery of patient centered care is the best delivery of care a patient can receive. Applying Nightingales environmental care theory of manipulation of the patient environment can affect the patient and assist in the delivery of quality of care. The concept of a clean patient environment has an effect on the patient’s recovery and the prevention of spread of diseases (Harvard Libraries, 2012). Using Florence Nightingales environmental theory and concepts will give a

Naomi Higenbottam, an environmental activist believes, "Nurses have a responsibility to the people of the world to be an environmental health activist and raise awareness of the health implications of environmental changes, to support policies to reduce health vulnerability and to build capacity to adapt to climate change." Nurses begin to teach people about the small changes they can make in their homes that will have a huge impact on the environment. They are cautious of their environmental choices. Nursing education and practice have evolved to adequately deal with the increase in environmental health issues. "Nurses are in an excellent position to provide leadership in implementing the principles of reducing, reuse, recycle, recover and re-educate in the workplace" (Higenbottam). The right to a healthy environment requires a healthy human habitat, including clean water, air, and soil that are free from toxins. By nurses providing leadership, death and disease rates will go down and a cleaner environment will bound to happen; because nurses are providing a safer and disinfected area. Nursing resources will be scarce in many places, such as high-density populations, areas most affected by the environmental changes, and the poor population. "They address the global environment changes because it will have a vast impact on the nursing profession" (Higenbottam).

Florence Nightingale, or as soldiers on the battlefield would call her the “Lady with the Lamp”, was an inspirational women of the nineteenth century that had many aspirations and dreams concerning the care of others. Achieving these dreams by “facilitating the reparative processes of the body by manipulating the patient’s environment” (Potter & Perry 2009, p. 45); Nightingale laid the foundations of modern nursing and gave the country and many others a system that has stood the test and remains timeless. In this, Florence has become one of the most widely known nursing theorist to this day.

The Environmental Theory by Florence Nightingale defined Nursing as “the act of utilizing the environment of the patient to assist him in his recovery” (Alice Petiprin, 2014). It involves the nurse’s initiative to make environmental settings appropriate to aid in the recovery of the patient’s health. According to Nightingale all external factors are somehow associated with the patient and affects their life physically, mentally, and socially (Alice Petiprin, 2014).

I will be summarizing Notes on Nursing: What It Is and What It Is Not by Florence Nightingale. Notes on Nursing: What It Is and What It Is Not was first published in 1860 with the last edition being published in 1969 (Adams-Wending, 2010). Nightingale’s theory addresses the importance of providing an environment that is conducive to the healing process for patients (Nightingale, 1860). Nightingale’s theory of the environment was based off the idea that disease was caused by smell of decomposing matter (Adams-Wending, 2010). The theory is broken down into thirteen “canons” of nursing (Nightingale, 1860). The thirteen topics within this theory are: ventilation and warming, health of houses, petty management, noise, variety, taking food, what food?, bed and bedding, cleanliness of rooms and walls, personal cleanliness, chattering of hope and advices, and observations of the sick. Nightingale (1860) states that ventilation is to make the air the patient breaths as fresh as the air outside. This also goes into detail of removing chamber pots

The concept of environment and its integral role in the delivery of nursing care was among the first identified and documented nursing concept since its early days. Florence Nightingale pioneered the profession of nursing and along with it, pioneered the concept of Nursing Theory. Her Environmental Theory was patient focused and incorporated five environmental components needed to promote health. Jarrin (2012) supported that the role of nursing is to promote the best possible environment for the patient to assist in their natural reparative process. It dates back from the time of ancient Greek philosophers and historians, including Plato, Hippocrates, and Aristotle, whose works are studied by Nightingale in her early years. According to Rahim (2013), as considered as the profession’s first nurse theorist, Florence Nightingale provided the essential foundation in environmental theory. She believed that some laws of nature, when applied and integrated into nursing care, can assist individuals in restoring their health during their illness, and, in those who are already healthy, promote health and prevent illness.

Throughout Notes on Nursing, Florence Nightingale expresses the importance of proper care to patients. Another factor of nursing that was effected by Nightingale is the professionalism of nursing and how nursing is not only a science, but an art. Nightingale states how numerous subjects in nursing should be improved upon. The specific chapters that show how Nightingale has improved nursing within Notes on Nursing were Light, Personal Cleanliness, Chattering Hopes and Advices, and Ventilation and Warming. In chapter 9, Light, Florence Nightingale emphasizes the impact of sunlight on the patient and how it improves their health. Personal cleanliness was reviewed in chapter 11. Nightingale explores the importance cleanliness has on a patient. Within chapter 12, Nightingale states how to properly advise the sick, as well as give hope to patients. In chapter 1, Ventilation and Warming, Nightingale states the need for pure air within a patient’s room. These chapters express the importance of properly taking care of patients. The focus of this paper is how it was applied during Nightingale’s time and how it is still relevant today in nursing practice. The chapters within Notes on Nursing have had a profound impact on the practice of nursing today.