TaneT LETICIA SUAREZ RN TANESHA HIPPOLYTE RN SOFIA WARREN RN GROUP 3 Born: 1820

 Florence Nightingale was a pioneer in the nursing field.  Despite parental objections Florence decide to become a nurse.  Nightingale went to Kaiserworth in Prussia to study nursing. Even then her views were being noticed.  By 1853 she became the unpaid superintendent of London’s Institute for the Care of Sick Gentlewomen.  From Florence Nightingale became a patient advocate by establishing more sanitary conditions in patient care settings.  Florence started focusing on nursing administration. She always made time to make nightly visits to the wards. She was called “The Lady of The Lamp”.  The mortality rate at the military hospital decreased from sixty percent to two percent six months after her arrival. 2

 Florence Nightingale was the first “Nursing Theorist”.  Nightingale began collecting information about her theory by her experiences in the Crimean War. She maintained written documentation (statistical analysis).  1860 Nightingale’s theory was published.  Nightingale laid the foundation for professional nursing.  Notes on Nursing summarized the principals of nursing.  1869 Nightingale along with Dr. Blackwell opened the Women’s Medical College.  1870 Nightingale mentored Linda Richard, “America’s First trained nurse”.  1883 Nightingale was awarded the Royal Red Cross by Queen Victoria.  1907 The first women to be awarded the Order of Merit.  1908 Nightingale was given the Honorary Freedom of the City of London.  1857 Although Nightingale became bedridden due to illness, she continued pioneer work in the field of hospital planning. 3

CRIMEAN WAR

 The environmental theory, which incorporated the restoration of the unusual health status of the nurse’s client into the delivery of heal care – is still practiced today. (Wikipedia)  She viewed the environment as controllable to enhance a patient recovery.  The nurse was responsible for planning environmental factors appropriate for restoration of health.  Factors that were included in the environment theory were: ventilation, warmth, light, noise, bed & bedding, cleanliness of rooms & patients, nutrition, hope, observation of the sick, and social consideration. 5

VENTILATIONLIGHTWARMTH CONTROL NOISE CONTROL ODOR 6

7 THE HEALING ENVIRONMENT

Person Environment NursingHealth 8

 The person exists in their environment.  The patient interrelates with the family and their community.  Nursing performs tasks for the patient, aiding in their recovery by controlling and enhancing the environment.  Patient independence is also promoted.  Nightingale believed nursing was responsible for a patients’ personal choices and behavior.  Nightingale viewed her patients with respect, regardless of religion, race or wealth. 9

 The environment is the foundation of Nightingale’s Theory.  Nurses enhance natures healing powers by manipulating the environment.  Nurses promote a therapeutic environment increasing the patient’s health.  Nursing promotes the healing process by providing an environment that is clean, warm, odorless and full of light. 10

 Nightingale views health as a patients well being.  She viewed illness and disease as occurring when a person did not attend to their health issues.  The prevention of disease related to environmental control and social responsibilities.  Nightingale promoted public health nursing and health prevention and promotion. 11

 Nursing assist patients in achieving their best physical condition for natural healing to occur.  Notes on Nursing is a guide for nursing principles and care for patients at home.  Nurses need to assess, implement, evaluate and document their patients’ health status.  Nursing induces the health of a patient by promoting an adequately controlled environment 12

13 NIGHTINGALE’S LATER YEARS Died: 1910

 Nightingale describes the nursing role in optimizing the environment for healing.  The model demonstrates Nightingale’s recognition of human nature, the environment, and the biological and social aspects of care.  Nightingale focused on the reformation of hospital sanitation.  Nightingale integrated data collection, use of statics and mathematical data in evaluation and decision making.  The phenomenon of environment in nursing practice has impacted the expanding nursing knowledge in the realm of human health. 14

15 Polar-Area Diagram

 Ventilation  Warmth  Light  Cleanliness  Diet  Noise

 Proper ventilation was one of the greatest concerns of Nightingale.  As quoted “ keep the air he breathes as pure as the external air, without chilling him” (Nightingale, 1969, p.12)  Nightingale recognized and placed great emphasis on proper ventilation as a source of disease and recovery (Marriner, 2010, p. 75)  According to Nightingale, the nurse is to control or manipulate the environment continually to maintain ventilation and patient warmth by using good fire, opening windows and proper positioning of the patient in the room(Marriner, p. 75) 17

 One of Nightingale’s concepts for measuring the patient’s body temperature was through palpation of the extremities to check for heat loss (Marriner,2010, p 75)

 Nightingale identified direct sunlight as a need of patient.s  As quoted by Nightingale “light has quite as real and tangible effects upon the human body…Who has not observed the purifying effect of light, upon the air of a room?” (Nightingale, 1969, pp84-85)  Beneficial effects of sunlight are achieved if nurses move and position patients to expose them to sunlight, according to Nightingale. 19

 Cleanliness is a critical component of Nightingale’s environmental theory (Nightingale,1969).  According to Nightingale, dirty floors, carpets, bed linens,walls etc… are a source of infection through the organic matter it contained (Marriner, p.75).  Proper handling and disposal of bodily excretions and sewage are required to prevent contamination of the environment, as noted by Nightingale (Marriner, p. 75).  Nightingale advocated frequent handwashing, which is now known as the # 1 prevention of infection. 20

 Nightingale noted that the nurse is required to assess the need for quietness (Marriner, p.76).  According to Nightingale, noise created by physical activities in area’s around a patients room could be harmful to the patient and should be avoided (Marriner, p. 76). 21

 According to Nightingale’s concept of diet, the nurse is to not only assess the dietary intake of, but also the meal schedule and the effect of the food on the patient. (Marriner, p.76)  Nightingale also noted, “intelligent nurses were those who were successful in meeting their patient’s nutritional needs”. (Marriner, p. 76) 22

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Through evidenced based practices, this model can be used in clinical practices today with focuses on  Internal and external components of the environment  Ventilation  Food  Water  Light  Temperatures  Medications  Sanitation 24

 Individuals receiving nursing care.  Conceptualizing that the improvement of health in individuals and families can lead to a improved health of society. 25

 Dirt-refers to general hygiene, and interpersonal contact  Drink—cleanliness of drinking water and the importance of drinking water  Diet—refers to proper and balanced diet  Damp—refers to a need for a dry, warm environment  Draughts--refers to drafts can precipitate a disease episode  Drains—refers to proper drainage and sewage systems 26

 Evaluating and assessing the patients needs based upon the individualized care needed.  Nursing Process  Education  Family centered care 27

 Nightingale noted that “training is to teach not only what is to be done, but why it is done”.  Having a balance of hands on experience as well as knowing the theoretical reasoning is very important according to Nightingale.  According to Nightingale, nurses must be excellent observers and were to be trained specifically to provide care for the sick person. (Marriner, p. 79) 28

 Development of evidenced-based-practice (EBP) for nursing with current and best research findings being used to deliver healthcare.  This model according to current research, has been building sound knowledge base for nursing practice through quantitative and qualitative research.  Outcome research is conducted to examine both short-term and long-term results of patient care.  Use of intervention research, which examines the effectiveness of nursing actions in promoting healthy outcomes for patients and families. 29

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Strengths of Model

 Universal  Simplistic  Logical  Timeless  Foundational 32

Florence Nightingale’s philosophy of nursing was derived from working in varied conditions. Nightingale had been an examiner of hospital facilities, reformatories, and charitable institutions as well as caring for the sick in hospital and on the battlefield, the conditions of these various environments often deplorable. Nightingale recognized that ones environment was universally important to health and well-being (Alligood and Tomey, 2010, p. 72). 33

“Nightingale recognize the potential harmfulness of an environment, and she emphasized the benefit of a good environment in preventing disease” (Alligood & Tomey, p. 82). Thus the goal being to manipulate the environment to promote health as well as prevent disease, by promoting cleanliness, good sanitation and proper ventilation. 34

Nightingale’s philosophy of nursing care addressed the basic concepts of air quality, cleanliness and sanitation. Using inductive reasoning she deduced that a contaminated, dirty, dark environment breed disease( Alligood & Tomey, p.79). Through her experiences and observations she recognized that not only could disease be prevented from flourishing, by controlling the environment, but that disease could be prevented by manipulating the environment (Alligood & Tomey p. 79). 35

Nightingale’s philosophy of nursing care is foundational to modern nursing theory and nursing practice. The tenants of environmental control are as relevant today as they were 150 years ago. As the founder of modern nursing Nightingale has laid the ground work for modern nursing theorists. 36

Florence Nightingale is recognized as the founder of modern day nursing. Her Environmental Model is based on the idea that healing lies within the individual and the focus of care is to place the individual in an environment that fosters the healing process. This basic concept has been the impetus for the foundation of modern nursing theory. 37

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Limitations

One only needs to read Nightingale’s Notes on Nursing, to deduce the concepts that she intended to promote. The concepts that are written about are most often principles that are derived from anecdotal situations to their meaning and support their claims (Alligood & Tomey, p. 81). Nightingale’s writings lack the testing and complexity of modern nursing theory, but there is no doubt that these early concepts have served as the basis for modern research (Alligood & Tomey, p. 81). 40

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 Ventilation and Warming  Health of Houses  Petty Management  Noise  Variety  Taking food  What food?  Bed and Bedding  Light  Cleanliness of Rooms and Walls  Personal Cleanliness  Chattering Hopes and Advices  Observation of the Sick 42

Florence Nightingale is recognized as the founder of modern day nursing. Her basic ideas about the care of the patient and the environment are directly or indirectly represented in the works of many nursing theorists. The environment and care of the environment will continue to be relevant far into the future as our world is ever changing. Although Nightingale’s theory lacked in complexity and testing it has proven to be foundational in the development of subsequent nursing theories. 43

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 On-line Florence Connection  Florence Nightingale’s Museum website  Woodham-Smith, C. (1983). Florence Nightingale. New York: Atheneum.  Cohen, I. B. “Florence Nightingale,” Scientific American, (March 1984),  Tomey, A. M., & Alligood, M. R. (2010). Nursing theorists and their work. (6th ed.). St. Louis, MO: Mosby Elsevier.  Nightingale, F. (1969). Notes on Nursing. New York, NY: Dover Publications, Inc.  Barnham, Kay. (2003). Florence Nightingale: The Lady of the Lamp. Austin, TX: Steck- Vaughn.  Small, Hugh. (1998) Florence Nightingale Avenging Angel. New York, NY: St. Martins Press. 73

 Group #3  How does Nightingale’s concept of the environment impact human health?  How did Nightingale’s contributions move nursing into a profession?  Nightingale is considered the first nursing theorist. How can you apply her environmental theory in your nursing practice? Give an example. 74