FLORENCE NIGHTINGALE Environmental Theory • Born on Florence, Italy on FLORENCE NIGHTINGALE (May 12, 1820-August 13, 1910) May 12, 1820 • Became a heroine in Great Britain as a result of her work in the Crimean War • Known as The Lady with a Lamp and the mother of modern nursing. • Studied nursing in Fliedner School of Nursing (Kaiserwerth, Germany) • First nurse researcher NIGHTINGALE’S APPROACH TO NURSING • Main focus was the control of the environment of individuals and families, both healthy and ill. • The need for ventilation and light in sickrooms, proper disposal of sewage and appropriate nutrition NOTES ON NURSING Give hints for thought to women who have personal charge of the health of others Is a thought provoking essay on the organization and manipulation of the environment of those persons requiring nursing care. “Everyday sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or it can recover from disease.” ENVIRONMENTAL MODEL • Environment • The surrounding matters that influence or modify a course of development (Webster) • The system must interact and adjust to its environment (Miller, 1978). • Ventilation & warmth, light, noise, variety, bed & bedding, cleanliness of rooms and walls, and nutrition as major areas of the environment the nurse could control (Nightingale). • When one or more aspects of the environment are out of balance, the client must used increased energy to counter the environmental stress. These stresses drain the client of energy needed for healing. • Physical environment are also influenced by the social and psychological environment of the individual. Health of Houses • Being closely related to the presence of pure air, pure water, efficient drainage, cleanliness and light. • Stagnant air and sickness is certain to follow. • Cleanliness outside the house affected the inside. • Dung heaps affected health in her time, so too can modern families be affected by toxic waste, contaminated water, and polluted air. Ventilation & Warming • “Keep the air that he breathes as pure as the external air, without chilling him.” • Source of air • Person who repeatedly breathed his/her own air would become sick or remain sick • Importance of temperature Light • “quite real tangible effects upon the human body.” • Sick people rarely lie with their face forward the wall but are much more likely to face the window, the source of the sun. Noise • Patients should never be waked intentionally or accidentally during the first part of sleep • Nurse’s responsibility to assess and stop annoying noises • Modern noises • Snapping of gloves, clank of stethoscope, radios & TVs. Alarms, beeps and other noises that startle a patient from sleep to wakefulness Variety • Changes in color or form • Bringing flowers or plants, • Reading, needlework, writing and cleaning as activities to relieve the sick of boredom Bed & Bedding • Bed should be place in the lightest part of the bedroom and placed so the patient could see out of a window. • Caregiver should never lean against, sit upon, or unnecessarily shake the bed • It remain important for the nurse to keep bedding clean, neat and dry and to position the patient for maximum comfort. Personal Cleanliness • Just as it is necessary to renew the air around a sick person frequently, to carry off morbid effluvia from the lings or skin, by maintaining ventilation, so it is necessary to keep pores of the skin free from all obstructing excretions • Every nurse ought to wash her hands very frequently during the day Nutrition & Taking Food • Variety of food • Individuals desire different foods at different times of the day and that frequent small servings may be more beneficial to the patient. • No business be done with patients while eating Chattering Hopes & Advices • …but that to falsely cheer the sick by making light of their own illness and its danger is not helpful. • False hope was depressing to patients, and caused them to worry and become fatigued Environmental Model and Nursing’s Metaparadigm • Nursing • What nursing has to do … is to put the patient in the best condition for nature to act upon him.” • Medicine & surgery as removing obstructions to health allow nature to return the person to health. • “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet and the proper selection of administration of diet – all at the least expense of vital power to the patient.: • Human Beings • Defined in relationship to their environment and the impact of the environment upon them • Environment • Focused on ventilation, warmth, noise, light and cleanliness • Health • Nightingale believed that pathology teaches the harm disease has done, and nothing more. • “unmake what God had made disease” • Goal of all nursing activities should be client health Client & the environment in balance Client expending unnecessary energy by being stressed by environment Nightingale and the Nursing Process • Nursing Process – it is a scientific method used by nurses to ensure the quality of patient care. • ASSESSMENT • DIAGNOSIS (Nursing; not medical) • PLANNING • IMPLEMENTATION • EVALUATION Assessment - the nurse gathers information about a patient's psychological, physiological, sociological, and spiritual status. This data can be collected in a variety of ways: patient interview, Physical examinations, patient's health history, obtaining a patient's family history, and general observation. • Nightingale advocated two essential behaviors by the nurse • To ask the client what is needed or wanted • The use of observation (what to observe – how to observe – what symptoms indicate improvement – what is the reverse – which are of importance – which are of none – which are evident of neglect – and what kind of neglect) Nursing Diagnoses - The diagnosing phase involves a nurse making an educated judgment about a potential or actual health problem with a patient. The diagnoses phase is a critical step as it is used to determine the course of treatment. *NANDA- North American Nursing Diagnosis Association • Nightingale believed data should be used as the basis for forming any conclusion • The diagnosis be the client’s response to their environment and not the environment problem. • It reflect the importance of the environment to the health and well-being of the client. Planning - Each problem is assigned a clear, measurable goal for the expected beneficial outcome. For this phase, nurses generally refer to the evidence-based Nursing Outcome Classification, which is a set of standardized terms and measurements for tracking patient wellness. • Includes identifying the nursing actions needed to keep clients comfortable, dry and in the best state for nature to work on. • Planning is focused on modifying the environment to enhance the client’s ability to respond to the disease process. Implementation - is where the nurse follows through on the decided plan of action: monitoring the patient for signs of change or improvement, directly caring for the patient or performing necessary medical tasks, educating and instructing the patient about further health management, and referring or contacting the patient for follow-up. • Implementation takes place in the environment that affects the client and involves taking action to modify the environment • All factors of the environment should be considered: noise, air, odors, bedding, cleanliness, light, etc. EVALUATION - Once all nursing intervention actions have taken place, the nurse completes an evaluation to determine of the goals for patient wellness have been met. The possible patient outcomes are generally described under three terms: patient's condition improved, patient's condition stabilized, and patient's condition deteriorated, died, or discharged. • Based on the effect of the changes in the environment on the client’s ability to regain their health at the least expense of energy. • Observation is the primary method of data collection used to evaluate the client’s response to intervention APPLICATION • Assessment • Kathy Neil, a 10-year-old female from the rural area, was injured in an accident r/t farm machinery. She had a head injury and although she was “conscious,” she was not oriented to place and time. She had multiple abrasions, multiple bruises, and deep leg wound containing dirt and debris from the farm equipment that injured her. She was transported to the regional hospital. After triage in the ER and surgery, she was admitted to a crowded pediatric intensive care unit (PICU). The lights were on 24hrs, noises from equipment permeated the unit & visits by her parents were restricted. Today, after 2 days & nights of uninterrupted sleep, Kathy has become increasingly confused & her leg has become infected, requiring increased IV antibiotics and dressing changes 2x a day. • Analysis of Data • Data gaps include: • Family structure; who lives in the household; who was present when injury occurred; Kathy’s school performance; economic resources; nutritional status; growth & development. • Primary concern: • lack of sleep and the infected wound • Nursing Diagnoses • Sleep pattern disturbance r/t environmental light and noise and separation from family • Planning & Implementation • Nursing actions focus on: • Changing the environment to support normal sleep patterns • Encouraged to listen to her favorite music / watch favorite TV shows • Encourage parents to visit more often • Teaches dressing change • At night sleep is supported by dimming the lights, reducing noise, and keeping to minimum activities and procedures • Evaluation • After two nights of uninterrupted sleep, normal sounds and parental encouragement, Kathy will demonstrate increased orientation to place by being able to identify that she is in the hospital.
