Florence Nightingale 1820-1910 NURS 324 Fall 2012 A presentation by Sara Anderson, Cristin Barnaby, Sherry Brabon and Stephanie Olson

Introduction Crimean War Increased rate of illness in her facility Investigation found standing sewage under hospital Beginning of public health Florence Nightingale was instrumental in the Crimean War by nursing wounded soldiers. It was here that she noticed an increased rate of illness. After an investigation this increased incidence was found to be associated with inadequate sewage drainage under the hospital. Because of this she identified the importance of cleanliness to promote healing. This was the beginning of public health.

Introduction continued Training was focused on: health promotion disease prevention research ethics safe work conditions multi-disciplinary approach nursing autonomy After the war, Florence Nightingale began educating nurses. These nurses were taught hands on, much like diploma programs. Her nurse training program was soon used world wide. There were 6 main topics that she focused on during training. health promotion disease prevention research ethics safe work conditions multi-disciplinary approach nursing autonomy

Pioneer in Nursing Introduced ethical principle 'do no harm' Taught basic hygiene practices Encouraged environmental sanitation Advocated for infection control by promoting sterilization and isolation Introduced evidence-based health care (Letizia, 2012) Nightingale was considered to be a pioneer in nursing. She introduced do no harm ethical principle. Basic hygiene and environmental sanitation for infection control was a big focus of her education. These principles lead us to evidence-based health care that we know today.

Florence Nightingale believed the foundations of good health were: Decent housing Clean water and air Good nutrition Safe Childbirth Good childcare (McDonald, 2007) Here are her 5 foundations of good health. Many of these topics continue to be an area of concern today.

Philosophic Views Client centered with a holistic approach. Biological Psychological Social (Dossey, 2005) Florence Nightingale's theories were client centered with a holistic approach. They focused on the biological, psychological and social needs and problems of clients.

Nightingale believed that nursing interventions and actions could meet, resolve and alleviate the needs and problems of the clients. ( Nightingale, 1860) Nightingale had big dreams for the nursing profession.

Theory Assumptions (Selanders, 2010) Natural laws Mankind can achieve perfection Nursing is a calling Nursing is an art and a science Nursing is achieved through environmental alteration Nursing requires specialized education Nursing is distinct and separate from medicine (Selanders, 2010) Assumptions: accepted truths that are the basic fundamentals of the theory. Lets look at each of these theories in more detail... Natural laws - "The presence of universal natural laws that govern the ways in which the world works is reflective of Nightingale's profound belief in God" (Selanders, 2010, 83). Mankind can achieve perfection - Nightingale was a firm believed in "self-determination, self-realization, and that ultimately mankind does seek self-perfection. The route to perfection is through strict adherence to natural laws" (Selanders, 2010, 83). Nursing is a calling - Nightingale believed that God "called her to His service" (Selanders, 2010, 83). It is believed that Nightingale viewed nursing is as important as a religious vow. Nursing is an art and a science - Nightingale was the first person to provide nurses with formal education. Nightingale believed that nurses should be educated using "current research and methods (science)as well as compassion and common logic (art)" (Selanders, 2010, 83). Nursing is achieved through environmental alteration - "through environmental alteration, one is able to put the patient in the best possible condition for nature to act, thereby facilitating the laws of nature" (Selanders, 2010, 83). Nursing requires a specific educational base - Nightingale's idea that nursing required specialized education was unheard of in England during the 19th-century. Nightingale believed that nurses needed a combination of traditional schooling (books, lectures) and a vast array of clinical experiences (Selanders, 2010, 84). Nursing is distinct and separate from medicine - Nightingale believed that "nursing's focus is caring through environmental alteration, whereas medicine's focus is cure of the disease" (Selanders, 2010, 84). It was important to Nightingale that nursing and medicine worked together.

Environmental Adaptation Theory Nightingale observed that healing and health could not occur in poor environments. "Environment could be altered to improve conditions so that the natural laws would allow healing to occur." - Florence Nightingale (Selander, 2010). Based on Nightingale's assumption that nursing is achieved through environmental alteration. Nightingale observed that healing and health could not occur in poor environments. Furthermore, she believed natural laws would allow healing to occur.

Environmental Theory Continued... * Ventilation and warming * Variety * Light * Chattering hopes and advices * Noise * Taking food - What food? * Cleanliness of rooms * Petty management * Health of houses * Observation of the sick * Bed and bedding * Personal cleanliness These are referred to as Nightingale's 13 Canons (Nightingale, 1860) Nightingale believed that it was necessary for the nurse to control the environment in order to provided the best care possible for the individual. Nurses can control the following: * Ventilation and warming * Variety * Light * Chattering hopes and advices * Noise * Taking food - What food? * Cleanliness of rooms * Petty management * Health of houses * Observation of the sick * Bed and bedding * Personal cleanliness These are referred to as Nightingale's 13 Canons (Nightingale, 1860)

Nursing Paradigms Nightingale's documents contain her philosophical assumptions and beliefs which regard all elements that are found in the metaparadigm of nursing. (Selanders LC, 2010) Nightingale's documents contain her philosophical assumptions and beliefs which regard all elements that are found in the metaparadigm of nursing. These can be formed into a conceptual model that has great utility in the practice setting.

Four Global Concepts Nursing: 2. Person: Nursing is the "activities that promote health (as outline in canons) which occur in any caregiving situation. They can be done by anyone." (Nightingale, 1860) Extended outside of hospital and into environmental settings (Chitty & Black, 2011) 2. Person: People are composed of biological, psychological, social and spiritual components. All these components affect the patient and how they will achieve health. 1. Nursing: Nightingale believed that the goal of nursing is to place the patient in the best possible condition for nature to act. The act of caregiving can be done by anyone. It was also believe that the nurse's responsibility for the patients did not end when the nurse is off duty, instead it was to continue outside the hospital setting to help promote careful management of their surroundings. 2. When looking at the patient Nightingale concluded that people are multidimensional, composed of biological, psychological, social and spiritual components. All these components affect the patient and how they will achieve health again.

Global Concepts Continued 3. Health: Health was focused on "not only to be well, but to be able to use well every power we have." (Nightingale, 1860) 4. Environment: 13 canons influence 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 3. Health: Health was focused on "not only to be well, but to be able to use well every power we have." (Nightingale, 1860) Nightingale also stated that rest is very important for the patient in order to restore health. 4. Environment: Nightingale believed that the patients health was related to the patients environment, and how all 13 canons (see slide 10, ex. include ventilation, sun, cleanliness) influenced their environment. Nightingale's theory claimed the following: "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."

Nightingale's Theory & Nursing Practice Nightingale's philosophy is influenced around the the effects of the environment and how it relates to the patient's health or recovery of their illness. Nightingale's philosophy is influenced around the the effects of the environment and how it relates to the patient's health or recovery of their illness. This ground work provided the foundation which proposed changing the patient's environment positively thereby promoting patient healing and wellness

Consequences More focus on physical factors rather than on psychological needs Current practice understands the psychological needs required for health Nightingale focused on physical factors rather than on psychological needs of the patient. We now know that to obtain holistic care of the patient we need to not only look at Nightingale's work on the physical factors but also on the psychological needs in order to maintain health. If a patient psychologically believes they will not get better then they probably will not. Believing that one is psychologically in good health will also benefit the patient. Nightingale lack this concept to a certain degree.

First of Her Kind Informed Observation Innovative and Reflective Kept Journals Developed Practice Defined the Profession Completely Unique According to the text, Professional Nursing Concepts and Challenges, "Florence Nightingale was the first person to recognize the complexities of nursing that led to difficulty in defining it" (Chitty 128). As a nurse she saw how multifaceted nursing truly was. She often journaled and reflected upon her observations while in the field. Through this journaling, she was able to make inferences about disease and disease process. In addition, when we look back to her writing we are able to see how she struggled to define nursing. But ultimately, she was able to come up with her own definition of nursing.

Influences on her Theory Observations Crimean War Soldiers Metaparadigm of Nursing Person and Health Environment and Nursing (Chitty 305-306) Florence Nightingale was strongly influenced by her own observations. For example, when nursing during the Crimean War she noticed that soldiers she was caring for were not getting well. She made a correlation between environment and health care during this time. She "understood well the elements of a healthful environment in which restoration and preservation of health and prevention of disease and injury were possible" (Chitty 277). She also developed "the metapardigm of nursing" (Chitty 306).

Author of Global Concepts Human Being Environment Health Nursing As we have emphasized throughout the presentations, Florence Nightingale was a pioneer. She does not just adequately describe the global concepts of nursing, but she also developed these concepts into actual theory! Her Environmental Theory of Nursing eventually rolled out of this paradigm. In this paradigm she focuses on 4 topic--"Person (instead of patient), health (as opposed to illness), environment ([specifically] how the environment affects health and recovery from illness) and nursing (as opposed to medicine)" (Chitty, 306).

Broad Spectrum Environmental Theory in ALL Settings Holistic Nursing Are YOU Interested in Learning More About Holistic Nursing? Nightingale's Environmental Theory can be applied to all patient care settings and situations. Her theory focuses on the broad global concepts that mold nursing care. Nightingale viewed nursing care as holistic, and paved the way for this shift in thinking. According to the American Holistic Nursing Association, "Florence Nightingale, who believed in care that focused on unity, wellness, and the interrelationship of human beings and their environment, is considered to be one of the first holistic nurses" (www.AHNA.org).

How Can I Use This Theory? Focus on Health Observe Your Patient Collaborate with a Multidisciplinary Team Intersectoral Collaboration Take Action! (Arseneault,26) You might be wondering how you can use this theory in your modern day practice, but don't worry it's quite simple. First, focus on the health of your patient. In whatever setting you are in talk with your patient and assess their current health status. Through the initial intake and interview process one can obtain a lot of information--spoken and unspoken. The nurse must then document appropriate interventions to take to improve the patient's health. This documentation will allow the whole healthcare team to collaborate on the interventions that are perceived necessary. As a nurse it is also important to get involved in "intersectorial collaboration. Nightingale acknowledged that health and wellness are related to economic and social policies. Various disciplines collaborate interdependently. This collaboration includes being involved in public policy development, planning, and healthcare services delivery and assessment" (Arseneault 26). This means that as a nurse you need to stay current with local and national public policy that affects your patients, your job and your profession. Some things you can do are: join professional organizations, help write policy at your work place, become involved in local (or larger) government, write letters, and vote. Arseneault, A.-M. (2011, Winter). Florence Nightingale's beliefs and Primary Health Care (PHC). Info Nursing, 42(3), 25+. Retrieved from http://0-go.galegroup.com.libcat.ferris.edu/ps/i.do?id=GALE%7CA276353110&v=2.1&u=lom_ferrissu&it=r&p=AONE&sw=w

Case Study Nightingale placed great value on altering the environment to promote health. What are some current issues where Nightingales theory may be applied? Explain. Nightingale placed great value on altering the environment to promote health. What are some current issues where Nightingales theory may be applied? Explain.

References Arseneault, A.-M. (2011, Winter). Florence Nightingale's beliefs and Primary Health Care (PHC). Info Nursing, 42(3), 25+. Retrieved from http://0- go.galegroup.com.libcat.ferris.edu/ps/i.do?id=GALE%7C A276353110&v=2.1&u=lom_ferrissu&it=r&p=AONE&sw =w Chitty, K. & Black, B.(2011). Professional nursing: concepts & challenges. Maryland Heights, MO: Saunders Elsevier Dossey, B. (2005). Florence Nightingale and holistic nursing. NSNA Imprint, Feb/March 2005, 56-58. Retrieved from: http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Imprint_F ebMar05_feature_Nightingale.pdf

References Letizia, Marilo. (2012). Infection prevention and control, starting with Flo. MedSurg Nursing, 19(6), 315-316. Retrieved from: http://0- go.galegroup.com.libcat.ferris.edu/ps/retrieve.do?sgHitCoun tType=None&sort=DA- SORT&prodId=ITOF&tabID=T002&subjectParam=Q1&resul tListType=RESULT_LIST&searchId=R1&displaySubject=Nig htingale%2C+Florence&searchType=SubjectGuideForm&co ntentSegment=&currentPosition=16&subjectAction=VIEW_S UBDIVISIONS&searchQueryId=Q1&inPS=true&userGroupN ame=lom_ferrissu&contentSet=GALE%7CA246717209&&d ocId=GALE|A246717209&docType=GALE&role= McDonald, L. (2007). The collected works of Florence Nightingale. Retrieved from: http://www.uoguelph.ca/~cwfn/nursing/theory.html

References Nightingale, F. (1860). Notes on nursing: What it is and what it is not. London: Harrison. Retrieved from: http://books.google.com/books?id=YxIDAAAAQAAJ&printse c=frontcover&dq=Notes+on+Nursing#v=onepage&q=Notes %20on%20Nursing&f=false Selanders, L.C. (2010). The power of environmental adaptation: Florence Nightingale's original theory for nursing practice. Journal of Holistic Nursing, 28(1), 81-89. doi: 10.1177/0898010109360257 Theory of Florence Nightingale. (2012). Retrieved from: http://currentnursing.com/nursing_theory/Florence_Nighting ale_theory.html