Nursing Theorist

Florence Nightingale
Presented by Patti Adams, Amy Lewis, Ronda Mott & Maira Perez

Nursing

One Woman. One Calling. One Mission.

Introduction
Florence Nightingale's nursing theory can be considered a 'descriptive
theory', by providing nurses a way to think about patients and their
environment.
Florence Nightingale's theory was the initial model for nursing and was
focused on manipulating the client's environment to improve their health.
She based her theory on health maintenance and restoration. Her spiritual
philosophy prompted her nursing views.

Assumptions and Point of View

Florence Nightingale's theory was the initial model for nursing. She collected
data and observed clients, linking their health status to factors in the
environment.
Nursing practice was influenced by her belief in the provision of fresh air,
light, warmth, cleanliness, quiet, and adequate nutrition
Defined differences between nursing and the practice of medicine
Encouraged nurses to act on behalf of the client
Pioneer in nursing in the Crimean War, 1853
Initiated major reforms in hygiene, sanitation and nursing practice
Assisted with decreasing mortality rate in Turkish hospital from 42.7% to
2.2% by improving the quality of the sanitation facilities
Established St. Thomas's Hospital in London in 1960

(Bloy, 2012)

Information and Concepts

Human Beings
Environment
Health
Nursing

Interpretation, Influence,
Implications & Consequences
Shaped nursing
Notes on Nursing: What It Is and What It
Is Not
Nursing education model for the United
States
Basis of several nursing theories

Evaluation of the Nursing Model

Nightingale is unique to nursing
Her work represents the beginning of
professional nursing.
She set forth principles that remain
relevant to nursing practice today.
Her model was influenced by her passion
to serve others.

Does this model adequately describe

the four global concepts?
Human: The patient is the focus
Environment: Providing clean air, water,
proper ventilation, and sunlight.
Health: Positive changes in health.
Nursing: She set the foundation in nursing
and remains relevant today.

Can it be used in OB or OR?

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Other Theories Generated From or

Influenced by Nightingale's Holistic
Concept
1. Roy's Adaptation Model
2. Levine's Conservation Theory
3. Modeling and Role Modeling Theory
4. Watson's Theory of Transpersonal Caring

Roy's Adaptation Model

Adaptation -- goal of nursing

Person -- adaptive system

Environment -- stimuli
Health -- outcome of adaptation
Nursing-- promoting adaptation
and health
(Chitty & Black, 2011)

Levine's Conservation Theory

Adaptation
Wholeness
Conservation

(Levine, 1973)

Modeling and Role Modeling

Theory
This theory draws concepts from:

Maslow's theory of hierarchy of needs

Erikson's theory of psychosocial stages
Piaget's theory of cognitive development

According to the theory the roles of nursing are:

Facilitation
Nurturance
Unconditional Acceptance

(Sappinton, 1996 June)

Watson's Theory of Transpersonal Caring

Indicates that Nightingale's blueprint for
transpersonal meanings and models of caring
transcend history.
It called forth the full use of self, connecting
the divine within and without as a source of
inspiration as well as the foundation for a
professional code.
(Watson, 1998)

The reviewed
theories differ in
environmental
influences and
other aspects of
nursing but share
holistic concepts.

Examples
Wash in wash out
Florence Nightingale's belief about cleanliness remains
important in healthcare today for the purpose of limiting the
spread of resistant organisms. "Wash In, Wash Out". We now
use isolation precautions to attempt to block the spread of
organisms, and also to protect the patients from the
introduction of harmful organisms while they are in a
compromised state.

Rest
Encouraging rest, so the body can heal and better deal with
the stress of being in an altered state of health, was also a
belief of Florence Nightingale. In the ICU's at Spectrum Health,
we have a two hour block of time each afternoon when we
limit noise, turn down the lights and minimize patient care
activities when possible.

Examples
Reducing the spread of infection
Nightingale promoted the view that nurses primary responsibility
was to protect patients by careful management of their surroundings
(Chitty & Black, 2011). In our radiation oncology clinic, upon entering
the front doors, patients are directed to a special station to utilize facial
masks and hand sanitizer. Nurses help patients and family members
decrease the potential of spreading unwanted infectious illnesses.

Clean water
Nightingale promoted clean water. One of the most important parts
of dialysis is the water quality. Reverse osmosis systems for water
purification are used to reduce the risk of infection and exposure to
toxins.

Examples
Providing a positive environment
Nightingale recognized the effect of the environment on the patient's
health or recovery(Chitty & Black, 2011). In practice I practice this by
having a positive attitude with the patient. Providing natural sunlight,
cleanliness, and personalizing their space as they wish.

Promotion of Health and Healing Starts Here

Conclusion
Florence Nightingale was a leader in the the nursing profession
far before her times. Willing to sacrifice her own personal life to
serve others, she founded the nursing profession, and will always be
know as a prominent part of the nursing profession. Her practices
continue to provide a basis for modern nursing theories. Focused on
the environment and its impact on health, she paved the way for the
modern metaparadigm of nursing. Health maintenance and
restoration was promoted through her own spiritual values.
Nightingale used critical thinking to promote nursing as a profession
and through her personal contribution delineated nursing from
medicine while gaining respect for nursing as a profession. Through
careful observation and note taking, she introduced evidence-based
practice into nursing to promote change and improve patient
outcomes. Florence Nightingale pioneered nursing education and her
theories continue to have a marked influence even today.
Many resources are available regarding Florence Nightingale's
nursing theories and some of these are found in our reference list for
you to explore further.

Questions?

Case Study
Mrs. Smith is a patient on a med-surg floor, and has been in the hospital for 11
days. She was admitted with pneumonia, but has since developed a UTI after having a
urinary catheter in place for 7 days. She has been on several different antibiotics
during this hospitalization, and yesterday was diagnosed with Clostridium Difficile (C.
Diff.) in her stool and has been placed in enteric isolation precautions.
As Mrs. Smith was being placed in isolation precautions yesterday,the nurse
discussed with the patient and her family about the new diagnosis of C. Diff., and the
need for strict adherence to isolation precautions as well as the rationale behind these
precautions. Today you notice some things that need to be addressed with the family
and some neighbors who have come to visit. The family continues to bring food from
the cafeteria into the patient room (for themselves to eat), they aren't wearing
isolation gowns in the room, and they frequently don't wash their hands when leaving
the room.
Additionally, Mrs. Smith frequently has verbalized to the nurse about how
exhausted she is, and that she is not able to get any rest while "there is a parade of
family and friends going in and out of my room". Her daughter and 3 grandchildren
have been staying in the hospital room around the clock and have had the TV on quite
loud all night long. When the nurse has requested that there be some 'quiet time' for
Mrs. Smith so that she may sleep at night, as well as have some naps during the day,
she is met with resistance from the family. They have made statements such as "well,
Mom has the TV on all the time at home so she should be used to it" and "how else can I
keep the grandkids quiet in here if I can't have the TV on with cartoons for them?"

Case Study Questions

1. Using Florence Nightingale's philosophy, what can you
suggest to the family and neighbors that will promote
rest? List three.
2. After reading the case study, what portions of Florence
Nightingale's theory could be integrated in the
teaching of Mrs. Smith and her family regarding her
care during this hospitalization? List three.

Resources and Web Links

Bloy, M. (2012 January). Florence Nightingale (1820-1910). The
Victorian Web. Retrieved June 24, 2013, from
http://www.victorianweb.org/history/crimea/florrie.html
Chitty, K. K., & Black, B. P. (2011). Profession nursing:
Concepts and challenges (6 ed.). Maryland Heights, MO:
Saunders Elsvier.
Levine, M. E. (1973). Introduction to clinical nursing.
Philadelphia, PA: F.A. Davis Company.
Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed.).
St. Louis, MO: Mosby.

Resources and Web Links

Retrieved from http://www.commons.wikimedia.org/wiki/file:Fl
orence_Nigtingale.png
Sappinton, J. K. (1996 June). Modeling and role-modeling
theory: A case study of holistic care. Journal of Holistic
Nursing, 14(2), 130-141.
Selanders, L. C. (2010 March). The power of environmental
adaptation: Florence Nightingale's original theory for nursing
practice. Journal of Holistic Nursing, 28(1), 81-88.

Resources and Web Links

Watson, J. (1998). Florence Nightingale and the enduring legacy
of transpersonal human caring. Journal of Holistic Nursing,
16(2), 292-294.
Winklestein, W. (2009). Florence Nightingale: Founder of
modern nursing and hospital epidemiolgoy. Epidemiology,
20(2), 311. doi:10.1097/EDE.0b013e3181935ad6

Key to Case Study

1.a. A restful environment will help promote healing based on
Nightingale's theory.
b. Turning the TV off during the night will help to promote a
sleep/wake cycle.
c. Allowing for some uninterrupted rest during the day will be
beneficial for Mrs. Smith.
2.a. The need for cleanliness is crucial both for the patient's health
and for the prevention of the spread of organisms.
b. Providing a clean environment in the patient's hospital room is
beneficial according to Nightingale's theory.
c. Allowing and encouraging adequate rest will help promote
healing as described in Nightingale's theory.