Stacie Brown, Julie Ivey, Cassandra Kotlarczyk, & Joella Show
Theories are composed of concepts,
definitions, models , propositions and are
based on assumptions.
Models are representations of the
interaction among and between the
concepts showing patterns.
1. Born in Florence, Italy on May 12, 1820.
2. During the Crimean War, improved the unsanitary conditions at a
British base hospital, reducing the death count by two-thirds.
3. Made it her mission to improve hygiene practices, significantly
lowering the death rate at the hospital in the process.
4.
Have you figured out who this Nurse Theorist is yet???
"the Lady with the Lamp."
According to www.biography.com, Florence Nightingale was a prolific
writer. She lived from 1820 to 1910 in Victorian England. Her ideas,
values, and beliefs on a wide range of topics can be identified in her
documents. They contain philosophical assumptions and beliefs
regarding all elements found in the met paradigm of nursing. In 1859,
she was the first to conceptualize nursing’s work into a theoretical
framework. She was credited with founding the practice of nursing.
Origins of the Nursing Model
Nightingale is most remembered as a pioneer of nursing and a
reformer of hospital sanitation methods.
She was the first person to link poor hygiene and living conditions to
deaths in hospitals.
In this model is Nightingale's “polar-area diagram”
to dramatize the needless deaths caused by
unsanitary conditions and the need for reform.
Polar-Area Diagram
The areas of the blue, red, & black wedges are each measured from the centre as the
common vertex.
•
•
•
The red wedges measured from the centre of the circle represent the deaths from wounds.
The blue wedges measured from the centre of the circle represent area fore the deaths from
Preventable or Mitigable Zymotic diseases.
The black wedges measured from the centre of the circle represent the deaths from all other
causes.
Nightingale’s View on Prevention
"The work we are speaking of has nothing to do with
nursing disease, but with maintaining health by
removing the things which disturb it . . . dirt, drink,
diet, damp, draughts, and drains” (Monteiro, 1985).
Motivation for Developing the Model and Historical
Background
Nightingale served as a nurse during the Crimean war and through that service
she learned the effects the environment has on health (Contagion, n.d.).
She is famous for her work to improve sanitary conditions for her patients during a
pre-germ theory era (Contagion, n.d.).
Nightingale’s Model For Nursing Practice
Nightingale’s Philosophic Values About Nursing and
Knowledge Development
• “People are multidimensional, composed of biological, psychological, social and spiritual components”
(Knutson, 2010).
• “Disease is more accurately portrayed as dys-ease or the absence of comfort” (Knutson, 2010).
• “Symptoms alert nurses to the presence of illness, which allows for appropriate interventions” (Knutson, 2010).
• “Breaking the natural laws will cause disease” (Knutson, 2010).
• “Improvement in the health of individuals and families lead to the improved health of society” (Knutson,
2010).
• Florence Nightingale founded the Nightingale School and Home for Nurses at Saint Thomas's Hospital in
London. The opening of this school marked the beginning of professional nursing education.
•
Nurses are meant to ease suffering, to offer comfort, and most of all to look
after the patient's well being (enurse-careplan.com).
•
Nursing is a science as well as a profession (enurse-careplan.com).
•
Nurses should concentrate on the patient and their needs, not the disease they
were afflicted with (enurse-careplan.com).
Influence on Nightingale’s Philosophy
Her experience as a nurse in the Crimean war provided her with in site on the conditions
such as, filth, inadequate nutrition, dirty water, and inappropriate sewage disposal, which
led to a situation in which more British soldiers died in the hospital than of battlefield
wounds.
“Nightingale believed that the health of patients was related to their environment” (“Chitty &
Black, 2011, p. 306).
Nightingale’s Metaparadigm
Person, Environment
Health, Nursing
Person
The person is referred to by
Nightingale as “the patient”. “A
human being acted upon by a
nurse, or affected by the
environment has reparative
powers to deal with disease.”
“Recovery is in the patient’s
power as long as a safe
environment exists”
(Environmental Theory, 2012).
Environment
• External forces affect one’s
life.
• "Poor or difficult
environments led to poor
health and disease“ (Theory,
2012).
• "Environment could be
altered to improve conditions
so that the natural laws would
allow healing to occur”
(Theory, 2012).
Health
Health is, “not only to be well, but to be able to use well every power we have”.
(Theory, 2012).
“Disease is considered as dys-ease or the absence of comfort” (Theory, 2012).
Nightingale believed it was important to control the environment to prevent
disease.
Nursing
Nursing, “Provides fresh air, light, warmth,
cleanliness, quiet, and proper diet” and
also, “facilitates patient reparative process
by environment” and “influences the
environment to affect health”
(Environmental Theory, 2012).
The goal of nursing is, “to put the patient in
the best condition for nature to act upon
him” - Nightingale (Environmental Theory,
2012).
The patient is at the center of the Nightingale model which incorporates a holistic view of the
person as someone with psychological, intellectual, and spiritual components. The laws of
health, as defined by Nightingale, were to keep the person and the population, healthy. This
was dependent upon proper environmental control, such as sanitation. The environment was
what the nurse manipulated. Nightingale isolated five environmental components essential to
an individual’s health: clean air, pure water, efficient drainage, cleanliness, and light
(www.enurse-careplan.com).
Person, Environment, Health & Nursing
.
Refuge for the Destitute-Female Workhouse Ward, 1873
 Florence Nightingale is the mother of nursing.
 Her philosophy is the basis for contemporary nursing
theory.
l
Image Retrieved from http://theedwardians.blogspot.com/2011/12/nursing.htm
 Florence Nightingales philosophy is over one hundred
years old.
 Her philosophy is still relevant today.
Image retrieved form the University of Virginia Art Museum. "Surely We Essential: Images of Nursing in the Twentieth Century"
Evaluation of the Nursing Model
Clarification of Origins
Nightingale heard, “of the
horrible conditions suffered by
the sick and wounded British
soldiers in Turkey during the
Crimean War. (She) took a
small band of untrained women
to the British hospital in Scutari”
(Chitty & Black, 2011, p. 29).
Interpretation & Inference and Implications & Consequences
Clarification of Origins Continued
They arrived November 4,
1854 and the description she
gave was,
“There were no vessels for
water or utensils of any kind;
no soap, towels, or clothes, no
hospital clothes; the men lying
in their uniforms, stiff with gore
and covered with filth to a
degree and of a kind no one
could write about; their
persons covered with vermin”
(Bloy, 2012, para. 7).
Clarification of Origins Continued
This visual travesty
influenced her philosophy
that a patient’s health is
directly related to their
environment, it is the
nurses’ responsibility to
protect patients’ because
positively changing a
patient’s environment
positively changes their
health (Chitty & Black,
2011, p. 306).
Evaluation of the Nursing Model
Content
Humanitarian work was how Nightingale
saw nursing. “For her, nursing was
holistic, bringing body, mind, and spirit
together. Caring for the whole person
required integration and collaboration
with medicine, environment, family and
society” (Payne, 2010, p. 10).
According to Chitty & Black (2011),
“Nightingale focused the profession on
what has become known as the
metaparadigm of nursing: person
(patient), health (as opposed to illness),
environment (how the environment
affects health and recovery from illness),
and nursing (as opposed to medicine) (p.
306).
Content Continued
Nightingale worked on, “visual displays of
quantitative information, which she believed
were more effective in conveying statistical
significance…she was a pioneer in a specific pie
graphic display” (Kudzma, 2006, p. 62).
This display and her statistics from the Crimean
War she showed to the Queen of England so
that hospitals would change their current
practice and that a standardized nursing school
should be implemented.
This is not a narrow view. With any patient, on
any floor (OB, OR, ED), their environment can
be altered to promote healing and comfort.
Evaluation of the Nursing Model
Her Influence
According to Chitty & Black (2011), “the Nightingale Pledge
can be considered nursing’s first code of ethics. It is presented
here not only for its historic value but also because it
established the roots for our current code (of ethics)” (p. 68).
She, “revolutionized and professionalized nursing by stressing
that nursing was not a domestic, charitable service but a
respected occupation requiring advanced education” (Chitty &
Black, 2011, p. 147). Our current education system originates
from her work.
Her philosophy that, “proper use of fresh air, light, warmth,
cleanliness, quiet, and the proper selection and administration
of diet… (Influenced) contemporary nursing’s focus on the
therapeutic milieu” (Chitty & Black, 2011, p. 128).
Nightingale’s philosophy was the foundation for theory
development on environmental impact on patient health (Chitty
& Black, 2011, p. 306).
What practice situations can/has this model been used?
Surgery/OR: During surgery sterile
environment, sterile tools, taking a
timeout, and calm music are utilized.
Hospice houses: There are places for families to sleep,
eat and socialize with patients, large windows in rooms,
and the ability for beds to go outside.
Fall risk patients in the hospital: Bed
alarms, chair alarms, falling star signs,
and red socks are used on patient’s who
are a fall risk.
Agitated patients: calming music, lights dimmed,
decreased visual stimuli
Nursing homes/extended care facilities:
Llive birds in cages, windows in every
room, decks for residence, and family
rooms are provided.
Pediatrics: playrooms, beds for parents
to sleep in, and colorful, kid friendly
rooms and hallways are provided.
ICUs/step-downs: Sterile cleaning of invasive lines
(chest tubes, central lines, art lines, tracheotomies) are
utilized.
We have one person to thank for these positive
changes………….
Conclusion
Young Florence Nightingale and Injured Collie Dog
Florence Nightingale’s journey to becoming a nurse started in the early 1840s, but she
didn’t make her mark until the Crimean War in 1854. Nightingale was dedicated to her
work, even in spite of her parent’s disapproval. At the barrack hospital at Scutari during the
war, she was often on her feet for 24 hours a day. She was also the only woman allowed in
the soldier’s ward at night where she affectionately got the name, “Lady of the Lamp” (Bloy,
2012, para. 8). Nightingale was a pioneer in the nursing field. Due to her experience during
the war her practice focused on the relationship between a patient and their surroundings.
These principles have been the foundation for nursing and are still relevant and practiced
today (Chitty & Black, 2011, p. 306).
Case Study
1
A 76 year-old male presents to the Emergency Department with increased
headache, blurry vision, confused to event and mild agitation. It has been
confirmed by the physicians and CT scan that he has suffered a hemorrhagic
stroke. Family is currently out in the waiting room and is very upset and
distraught. Due to the bleeding in his brain, the Stroke team doesn’t want the
patient to have any pain medications or any medications to calm him down.
As a nurse working with this patient, what can you do following Florence
Nightingale’s philosophy to make this patient more comfortable?
Case Study
2
A Dementia/Alzheimer’s patient was just admitted to a neuro step-down
unit for increased confusion. She has become increasingly agitated
after her daughter has left and keeps getting out of bed. The staff is
concerned that she may wander or fall. Taking Florence Nightingale’s
philosophy into consideration, what can the nursing staff do to calm and
protect the patient?
CASE STUDY
3
You are a nurse at an extended care facility that is
undergoing construction work. A result of the contraction
work is extra noise throughout the day. There are sheets
of plastic hung from the wall where the work is being
done. Construction workers walk up and down the hall
frequently throughout the day. According to Florence
Nightingales nursing philosophy, will this construction
work affect the patients’ health and wellbeing? If yes,
how?
Case Study
4
You are a nurse on a medical-oncology unit. One of your
oncology patients desperately misses her pet dog. You are trying
to arrange for this patient to have her pet brought in to see her.
She is not in any form of isolation precautions and her white
blood cells and neutrophils are within normal limits. According
to Florence Nightingale’s nursing philosophy is it appropriate
for her pet to be brought into her?
References
Bloy, M. (2012). Florence Nightingale (1820-1910). The Victorian Web. Retrieved from:
http://www.victorianweb.org/history/crimea/florrie.html
Chitty, K.K., & Black, B.P. (2011). Professional nursing: Concepts and challenges (6th ed.)
Maryland Heights, MO: Saunders
Contagion. (n.d.). Florence Nightingale, 1820-1910. Retrieved from
http://ocp.hul.harvard.edu/contagion/nightingale.html
eNurse care plan (2011). Nursing Theory and Theorist: Florence Nightingale. Retrieved
from http://www.enurse-careplan.com/2010/04/nursing-theory-theorist-florence.html
Florence Nightingale: Biography (2012). Retrieved from
http://www.biography.com/people/florence-nightingale-9423539?page=2
Florence Nightingale: Environmental Theory (2012). Retrieved from
http://nursinglibrary.info/florence-nightingale/
Knutson, M.B. (2010). Original Nursing Theories of Florence Nightingale. Retrieved from
http://id3i.one.pl/erWA
References Continued
Kudzma, E.C. (2006). Florence Nightingale and Healthcare Reform. Nursing
Science Quarterly, 19, 1, 61-61. doi: 10.1177/0894318405283556
Payne, K. (2010). Science, Healing, and Courage: The Legacy of Florence
Nightingale. The Alabama Nurse, 10
Riddle, L. (2012). Biographies of Women Mathematicians. Florence Nightingale
May 12, 1820 - August 13, 1910. Retrieved from
https://www.agnesscott.edu/lriddle/women/nitegale.htm
Boehm, H. & Morast, S. (2009). Quiet Time. American Journal of Nursing, 109(11), 2932. Retrieved from
http://www.nursingcenter.com/lnc/journalarticle?Article_ID=940560
Theory of Florence Nightingale (2012). Retrieved from
http://currentnursing.com/nursing_theory/Florence_Nightingale_theory.html
Pavlac,tml B. (2005). Florence Nightingale. Retrieved from
http://departments.kings.edu/womans_history/florence.html
Seymor, L.R. (1954). Florence Nightingale, Selected writings of Florence
Nightingale (pp. 38287). New York, NY: The Macmillan Co
Rehmeyer, J. (Nov. 2008). Florence Nightingale: The Passionate Statistician.
Retrieved from http://www.sciencenews.org
Monteiro, L.A. (1985). Florence Nightingale on Public Health Nursing. Retrieved
from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1645993/pdf/amjph002780075.pdf
Chitty, K. K. & Black, B.P. (2011). Professional Nursing: Concepts & Challenges (6th
ed.). Maryland Heights, MO: Saunders Elsevier
Nursing Theorist Group Presentations-- Due October 14th at 11:59 pm
Nov 2, 2012 5:10 PM
99.00/100 Grade