Florence Nightingale

By: Megan Cottrell, Karen Theus, Emily Cornell and Elizabeth Klynstra

Image from http://todayinsci.com/N/Nightingale_Florence/NightingaleFlorence-PictureLarge.htm

Introduction

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

Historical Background

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

Historical Background (continued)

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

Philosophic Views About Nursing

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)

Philosophical views on Knowledge Development

• 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)

What Influenced Nightingale’s Philosophy?

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

Information and Concepts

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)

Use of Four Global Concepts

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.

Does the model define the four global concepts?

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.

Interpretation, Influence, Implications & Consequences

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

Evaluation of the Nursing Model

Evaluation of Theory

• Origin 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.

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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

Practice situations of Florence Nightingale’s approach

Florence’s model consisted of the four global concepts.

Person- Florence viewed

patients as multidimensio

nal 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. 2010 Mar; 28(1):81-8.

Nursing Theories emerging from Florence’s model

Holistic nursing care

Disease management and

sanitation

Professional nursing

Proper training

and education for nurses

Nursing is separate

from medicine

Nursing is a art and a science

Practice Examples

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.

Practice Examples

Positive Environment PromotionMaintaining 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).

Conclusion

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.

Case Study

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.

Case Study

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.

Case Study Continued

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

Case Study Question

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

References

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 http://www.britannica.com/EBchecked/topic/415020/Florence-Nightingale/280687/Nursing-in-peace-and-war

Nightingale, F. Notes on nursing: What it is and what it is not. 1860.

Payne, K. (2010). Science, healing, and courage: the legacy of Florence Nightingale. Alabama Nurse, 37(3), 10 Retrieved from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/pdfviewer/pdfviewer?vid=3&sid=bc11d590-8d29-4a3c-9360-e74455d2417b%40sessionmgr104&hid=103

Selanders LC. The power of environmental adaptation: Florence Nightingale's original theory for nursing practice. .J Holist Nurs. 2010 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 http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/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: 10.1097/EDE.0b013e3181935ad6 & (Chitty & Black, 2011).