By: Megan Cottrell, Karen Theus, Emily Cornell and Elizabeth Klynstra Image from PictureLarge.htm PictureLarge.htm

 “Nightingale’s unique perspective on nursing practice focused on the relationship of patients to their surroundings” (Chitty and Black, 2011)

 Religious inspiration called Florence Nightingale to the nursing profession  She is most remembered for her contributions to nursing during the Crimean War  In 1854, Nightingale received a letter from the Secretary of State at war for the British government requesting her to organize and lead a group of nurses to tend to the soldiers of the Crimean War who were being poorly treated  In six months, Nightingale and her team of nurses greatly improved the mortality rate of the British soldiers

 Nightingale healed through providing a clean environment, personal hygiene, clean linens and dressings, adequate food and housing, and recreation  She turned her observations into statistics and diagrams, using her evidence-based practice to change medicine and nursing  She developed the philosophy that changing patients’ conditions can promote positive changes in their health

 Nightingale described nursing as a divine calling to serve others  Her philosophies on the general nature of nursing include:  Nursing is defined as a unique profession that is both art and science  The basic nursing activity is the alteration of the internal and external nursing environment  Nursing is autonomous within the defined scope of practice  Nursing is collaborative with all other healthcare professions  The goal of nursing is to foster health within the patient  Individuals are complex, holistic beings  The power of nursing comes from decision-making activities based on empirical observation of the patient  The practice of nursing should not be limited by gender, spiritual beliefs, or values  The nurse should be allowed to develop to the maximum of his or her potential  (Selanders, 2012)

Nursing has specialized educational requirements with theoretical and clinical components Nurses should be educated by nurses who specialize in education Nurses should have a grounding in basic sciences Nursing education should be controlled by the school, not the hospital Students are to be regularly evaluated and apprised of this evaluation during the course of the education  (Selanders, 2012)

 Nightingale’s philosophy on utilizing the environment to assist in patient recovery was influenced by her education, experiences, and observations during her nursing career

 Nightingale's philosophy focused nursing on what is known as the metaparadigm of nursing. She looked at the individual in their surroundings and observed how the environment impacted their health. Considered the founder of modern nursing, Florence Nightingale lead a team of nurses appointed to help at an unsanitary British military hospital. The wards were overcrowded, unsanitary, they had poor lighting, the water was contaminated, the food inedible not to mention the general filth, from bloody rags on the floor to dead animals in the courtyard. Florence Nightingale led a team of nurses to improve the health of the individuals and relieve suffering in a healing environment that consisted of a cleanliness, fresh water, sunlight and a caring attitude of the nurses who worked there.  (Winklestein,2009)

 Human: The patient is the focus of care  Environment: Making sure patients have clean air, water,linens, proper ventilation, and sunlight.  Health: Positive changes in health.  Nursing: Florence Nightingale set the foundation for nursing that is still relevant today.

 Nightingale’s model describes the four global concepts;  providing rest and an environment to allow for proper healing for  allowing for rest  hand washing, maintaining a sterile field  providing patients with proper supply's for care.

 Through her discipline and determination, Nightingale earned respect for women as nurses.  philosophy shaped nursing into the profession it is today.  Created the first documentation of nursing because of the notes she took.  She started a training school for nurses and this educational model influenced nursing education in both the US and England.  provided a basis for nursing theories and an impact on the future of nursing

Origin of Theory Evaluation of Theory Florence nightingale felt that God had influenced her, and nursing was her calling. The poor reputation for nurses and the lack of occupations for women. The unsanitary conditions and spread of disease in patients

Education and distinction between nurses in physicians Sanitation in hospitals Metaparadigm of nursing Recording of information and statistical data The relationship of patients in their surroundings. Chitty, K. K., & Black, B. P. (2011). Professional nursing concepts & challenges (6th ed.). Maryland Heights, MO: Saunders Elsevier

Florence’s model consisted of the four global concepts. Person- Florence viewed patients as multidimensional and needed to be treated holistically Health- Florence did not view health as only the absence of disease. Environment- This is the foundation of Florence's nursing philosophy; nurses need to adjust the environment to the patient to promote health and good outcomes. Nursing- Florence described “ what nursing is and what nursing is not” and gave nursing a whole other dimension. Before Florence, nursing was viewed as work of the servants or working class. Selanders LC. The power of environmental adaptation: Florence Nightingale's original theory for nursing practice..J Holist Nurs Mar; 28(1):81-8.

Nursing Theories emerging from Florence’s model

 Cleanliness- Hospitals prioritize “wash in, wash out” method. Making sure to wash hands when going in or out of a patients room to prevent the spread of infection among patients.  Nightingale promoted the view that nurses primary responsibility was to protect patients by careful management of their surroundings (Chitty & Black, 2011).  Rest- quiet environment is promoted to allow for quicker healing times. Clustering work together throughout night to allow for less interruptions and more sleep.

 Positive Environment Promotion Maintaining a positive environment promotes optimal healing. Maintain a positive attitude with patients. Nightingale recognized the effect of the environment on the patient's health or recovery (Chitty & Black, 2011).

 Florence Nightingale was a pioneer to modern nursing and her practices is currently still being used.  first to use theoretical foundation in nursing.  Provided a professional nursing model for nursing organizations.

 Florence Nightingale was a pioneer in nursing in the 19th century. Her focus on environment and its impact on health is still relevant in today’s nursing practice. She taught us how to promote health and to focus on the improvement of healthy environments in all practice settings (Beck, 2010). The following case study seeks to assist us in focusing on healthy environments and how to change the environment for the good of the patient. Answers include a nursing diagnosis and interventions.

 Mr. Jones has recently evaluated by a home care nurse after being requested by the patients wife. Mr. Jones has recently had an increased number of falls. Three weeks ago Mr. jones got a hip fracture with an ORIF following a fall.  Mr. Jones has a hx of Parkinson's disease, BPH, HTN, falls and recent ORIF.  Medication Mr Jones takes is Carbidopa/levodopa 10/100mg QID, Diovan (valsartan) 160mg QD, Multi vit QD, Flomax 0.4mg QD and Norco 5/325 1 or 2 q6h PRN (has been taking 2 as prescribed)  Lives with wife, has two children who live in town and assist when necessary.  Former machinist, woodworking as a hobby.

 Pt is being evaluated for home care services r/t recent fall and disease progression. Wife is struggling to care for him r/t unsteady gait, need for support while ambulating.  Nurse inspects home for potential danger zones. She notices rugs on the hardwood floor, a sunken living room where the pt and his wife are sitting. Dimly lit hallway, heavy drapes pulled in the bedroom (wife states to keep the summer heat out) stairs at exits, no hand rails. Bathtub not handicap accessible.  Wife states she leaves pt alone sometimes to run errands

 1. Based on Nightingale’s theory what can be changed to Mr Jones’ care to promote a safety?  2. What teaching needs to be completed to the patient and wife to promote a safer living environment? List three

 Chitty, K. K., Black, B. P. (2011). Professional Nursing: Concepts and Challenges. Maryland Heights, MO. Saunders Elsevier.  Florence Nightingale. (2013). In Encyclopedia Britannica. Retrieved from peace-and-war peace-and-war  Nightingale, F. Notes on nursing: What it is and what it is not  Payne, K. (2010). Science, healing, and courage: the legacy of Florence Nightingale. Alabama Nurse, 37 (3), 10 Retrieved from web.ebscohost.com.libcat.ferris.edu/ehost/pdfviewer/pdfviewer?vid=3&sid=bc11d590-8d29-4a3c e74455d2417b%40sessionmgr104&hid=103http://0- web.ebscohost.com.libcat.ferris.edu/ehost/pdfviewer/pdfviewer?vid=3&sid=bc11d590-8d29-4a3c e74455d2417b%40sessionmgr104&hid=103  Selanders LC. The power of environmental adaptation: Florence Nightingale's original theory for nursing practice..J Holist Nurs Mar; 28(1):81-8.  Selanders, L. (2012). The voice of florence nightingale on advocacy. The online journal of issues in nursing, 17 (1), Retrieved from ontents/Vol /No1-Jan-2012/Florence-Nightingale-on-Advocacy.html ontents/Vol /No1-Jan-2012/Florence-Nightingale-on-Advocacy.html  Winklestein, W. (2009). Florence Nightingale: Founder of modern nursing and hospital epidemiology. Epidemiology, 20 (2), 311. doi: /EDE.0b013e ad6 & (Chitty & Black, 2011).