Theoretical Foundations of Nursing

“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.

In nursing, many theories have emerged that highlight the role of nurses in health care. Of these, Henderson’s Definition of Nursing became influential as Virginia Henderson brought it to the forefront in her 1955 Textbook of the Principles and Practice of Nursing (Abrams, 2007, p. 382). Per Renece Waller-Wise (2013), Henderson’s Definition of Nursing is “primarily helping people (sick or well) in the performance of those activities contributing to health, or its recovery (or peaceful death) that they would perform unaided if they had the necessary strength, will, or knowledge” (p. 31). Waller-Wise (2013) also pinpointed that the aforesaid would be carried out in a manner that would promote gaining independence (p. 31). Therefore, this nursing process is geared towards “helping patients attain, retain, or regain optimum health” (Schmieding, 1990, p. 464). In order to make improved health possible, it requires understanding what the patient’s needs are (Abrams, 2007, p. 383). Once identified, the nurse can respond to the patient’s self-care deficit and work towards patient autonomy (Risjord, 2014, p. 36).

The application of nursing theories to the nursing care practice promotes the structure of care. It intensifies the importance of an individual in need and facilitates the environment of healing. By integrating the major nursing theories into the daily nursing routine in the hospitals or the community, and understanding their meaning, nursing profession flourishes as a unique science separate from the discipline of law. One of the theories looked at is humanbecoming by Rosemarie Rizzo Parse. As Smith & Parker, (2015) explains, humanbecoming nurses’ involvement in the care of the patient is influenced by the utmost importance that arise from the point of view of their patient at that particular time. The nurse then and recognizes the wishes, benefits and desires of the patient and prioritizes her care in such a way.

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

According to the American Nurses Association, “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (ANA, 2010b). Nursing has come a long ways. From primitive times when caring for the sick was predominantly the rule of medicine-men who acquired the skills from their ancestors, to the era when it was viewed as a mean profession for prostitutes and nowadays when it is considered a noble profession with trained and skilled personnel.

In this paper I will explore the elements of nursing theory and how I believe they are all tied together. I believe that a man’s health will be directly affected by his environment and his nursing care.

A metaparadigm is a concept that is extremely general, one that serves to define an entire world of thought. The metaparadigm of nursing is comprised of four parts: person, health, nursing and environment. This concept is important to nursing theory, because those are the key areas of focus when it comes to patient care. In this metaparadigm, the ‘person’ can refer to the patient, the patient’s family members, friends, communities, and groups. The nurse’s goal when dealing with the ‘person’ is to nurture the patient and empower him or her to manage their own health to the best of their abilities. The next part of the metaparadigm is ‘health’. It generally addresses the person’s state of well-being and their availability to healthcare. The other metaparadigm ‘environment’ includes factors that affect individuals internally and externally. A positive therapeutic interaction creates an environment that is essential for patient recovery. The final concept in the metaparadigm of nursing is ‘nursing’. In general, this refers to any hands-on medical treatment from nurse to patient.

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).

In my opinion, Environment englobes all the nursing’s needs. Thus, I highly follow Nightingale’s theory where her

Virginia Henderson, one of many nursing theorists, is the one who has defined nursing as “the unique function to assist the individual, sick or well, in the performance of contributing to health and recovery or to peaceful death with having the necessary strength, will, and knowledge” (Eichelberger & Sitzman, 2011, p. 35). Virginia Henderson applied skills to help the individual gain knowledge as quickly as possible (Eichelberger & Sitzman, 2011, p. 35). Henderson was able to express her views in order to explain the importance of following a patient's chart and the plan of care for the patient’s overall health. Henderson defined fourteen components of basic needs for nursing care, that I one day hope to provide to my own patient. I am

Upon completing my undergraduate studies and beginning my nursing career, I was quick to follow a very empirical based philosophy of nursing. I often chose objective over subjective findings (McEwen, 2014, p. 11) to mark my next move in patient care. I was focused on lab values and ventilator settings, and less focused on my overall perception of the patient and his or her illness. As I have developed as a practicing nurse, my views, and consequently my actions, have shifted to represent a more interpretive view of nursing.

In any job there are many roles to fill. Bartenders always say they double as therapists. Teachers are educators, role models, advocates for children, and often provide family and community support. Mothers are everything short of miracle workers. So what roles does a nurse fulfill? Everyone knows that nurses care for patients, but Hildegard Peplau focused on the nurse-patient relationship and defined the roles nurses take on when working with patients. Since most nursing students have entered the field of study because they want to help people, looking at the nurse-patient relationship and the roles they fulfill provide a benefit.

Florence Nightingale is considered one of the first nursing theorists. Even though she never formally formulated a theory, her scholarly writings and written opinions on environmental manipulation for the promotion of health is well known to anyone studying nursing. Nightingale combined spirituality with nursing to give her patients the best possible care possible. Florence Nightingale began following her mother when she made rounds to the poor areas within their communities (Heggae, 2013). She later professed receiving a call to serve others. As part of her Environmental Model, she has thirteen essential points that must be addressed to promote wellness amongst the sick (Butts & Rich, 2011). These points are continually addressed in today’s nursing practice during initial assessment and ongoing assessment. Florence Nightingale points focuses on cleanliness, food, shelter, observation, and documentation. According to Heggae (2013), Nightingale focused on nurses being very observant and the ability to document accurately. Florence Nightingale was adamant in nurses being willing to challenge social policies that will impede one’s ability to heal (Heggae, 2013). Nightingale believed that nurses must have the ability to “manipulate the physical and social factors that affect health and illness so as to enhance patient recovery” (Butts & Rich,

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.

Florence Nightingale developed the environmental model theory of nursing. Nery, (2015) states that Florence Nightingale’s environmental theory of nursing, “focus primarily on the environment, interpreted as all external conditions and influences that affect the life and development of an organism, that are able to prevent, suppress or contribute to disease and death.” The four metaparadigm concepts of this theory consist of person, environment, nursing, and health. Within this theory, the patient is being cared for by the nurse, has been influenced by the environment, and has reparative powers (“Nursing Theories, 2011). Nightingale’s theory does not have a clear definition of the person; however, it can be inferred that the person correlates “in relation to the environment and the impact of the environment on the person’s health status” (Butts & Rich, 2018). The highlight of Nightingale’s theory is the environment. Both the external and internal environment needs to be in sanitary conditions. The environment concept of this theory contains “physical, psychological, and social” factors (“Nursing Theories, 2011). The goal of the nurse is the control the patient’s environment to achieve ideal health for the patient. Nightingale’s theory did not define health; however, she stated that nature itself can heal ailments (Butts & Rich, 2018). Nightingale (1859) stated that health is ‘not only to be well, but able to use well every power we have to use it.”