Florence Nightingale (Environmental Theory)
Florence Nightingale (Environmental Theory)
Florence Nightingale (Environmental Theory)
Florence Nightingale
(Environmental theory)
Florence nightingale, OM, RRC, dstj (12 may 1820 – 13 august 1910)
was an english social reformer and statistician, and the founder of
modern nursing.
Nightingale came to prominence while serving as a manager and trainer
of nurses during the crimean war, in which she organised care for
wounded soldiers.[3] she gave nursing a favourable reputation and
became an icon of victorian culture, especially in the persona of "the
lady with the lamp" making rounds of wounded soldiers at night
Florence Nightingale
(Environmental theory)
She stated in her nursing notes that nursing "is an act of
utilizing the environment of the patient to assist him in his
recovery" (nightingale 1860/1969),[3] that it involves the nurse's
initiative to configure environmental settings appropriate for
the gradual restoration of the patient's health, and that
external factors associated with the patient's surroundings
affect life or biologic and physiologic processes, and his
development
Florence Nightingale
(Environmental theory)
Pure fresh air- "to keep the air he breathes as pure as the external air without
chilling him/her."
Pure water- "well water of a very impure kind is used for domestic purposes. And
when epidemic disease shows itself, persons using such water are almost sure to
suffer."
Effective drainage- "all the while the sewer maybe nothing but a laboratory from
which epidemic disease and ill health is being installed into the house."
Cleanliness- "the greater part of nursing consists in preserving cleanliness."
Light(especially direct sunlight)- "the usefulness of light in treating disease is very
important."[5]
Any deficiency in one or more of these factors could lead to impaired functioning
of life processes or diminished health status.[6]
Nurse
The nurse is functioning human being.
The nurse no only acts, but thinks and feels as well.
Knowledge
Knowledge encompasses all that has been percieved and grasped by
the human mind.
Knowledge may be :
• Factual
• Speculative or
• Practical
Judgment
Clinical judgment represents the nurse’s likeliness to make sound
decisions.
Sound decisions are based on differentiating fact from assumption and
relating them to cause and effect.
Sound judgment is the result of disciplined functioning of mind and
emotions, and improves with expanded knowledge and increased
clarity of professional purpose.
Nursing skills
Nursing skills are carried out to achieve a specific patient-centered
purpose rather than completion of the skill itself being the end goal.
Skills are made up of a variety of actions, and characterized by harmony
of movement, precision, and effective use of self.
Person
Each person (whether nurse or patient), is endowed with a unique
potential to develop self-sustaining resources.
People generally tend towards independence and fulfillment of
responsibilities.
Self-awareness and self-acceptance are essential to personal integrity
and self-worth.
Whatever an individual does at any given moment represents the best
available judgment for that person at the time.
Key elements
Wiedenbach proposes 4 main elements to clinical
nursing.
A philosophy
A purpose
A practice and
The art.
The philosophy
The nurses' philosophy is their attitude and belief about
life and how that effected reality for them.
Wiedenbach believed that there were 3 essential
components associated with a nursing philosophy:
• Reverence for life
• Respect for the dignity, worth, autonomy and
individuality of each human being and
• Resolution to act on personally and professionally held
beliefs.
The purpose
Nurses purpose is that which the nurse wants to
accomplish through what she does.
It is all of the activities directed towards the overall good
of the patient.
The practice
Practice are those observable nursing actions that are
affected by beliefs and feelings about meeting the
patient’s need for help.
The art
The art of nursing includes
• Understanding patients needs and concerns
• Developing goals and actions intended to enhance patients ability and
• Directing the activities related to the medical plan to improve the patients condition.
The nurses also focuses on prevention of complications related
to reoccurrence or development of new concerns.
Jean Watson
( Philosophy and Science of Caring)
Jean Watson is an American nurse theorist and
nursing professor who is best known for her
Theory of human caring. She is the author of
numerous texts, including Nursing: The
Philosophy and Science of Caring. Watson's
research on caring has been incorporated into
education and patient care at hundreds of
nursing schools and healthcare facilities across
the world
She refers to the human being as "a valued
person in and of him or herself to be cared for,
respected, nurtured, understood and assisted;
in general a philosophical view of a person as a
fully functional integrated self. Human is
viewed as greater than and different from the
sum of his or her parts."
Dorothea Orem
( Self-Care Deficit theory)
The Self-Care Deficit Theory developed as a result of Dorothea E. Orem
working toward her goal of improving the quality of nursing in general
hospitals in her state. The model interrelates concepts in such a way as
to create a different way of looking at a particular phenomenon. The
theory is relatively simple, but generalizable to apply to a wide variety
of patients. It can be used by nurses to guide and improve practice, but
it must be consistent with other validated theories, laws and principles.
Orem's approach to the nursing process provides a method to determine the self-
care deficits and then to define the roles of patient or nurse to meet the self-care
demands. The steps in the approach are thought of uas the technical component
of the nursing process. Orem emphasizes that the technological component
"must be coordinated with interpersonal and social pressures within nursing
situations.
The nursing process in this model has three parts. First is the assessment, which
collects data to determine the problem or concern that needs to be addressed.
The next step is the diagnosis and creation of a nursing care plan. The third and
final step of the nursing process is implementation and evaluation. The nurse sets
the health care plan into motion to meet the goals set by the patient and his or
her health care team, and, when finished, evaluate the nursing care by
interpreting the results of the implementation of the plan.
The main focus of levine’s conservation model is to promote the physical and
emotional well being of a patient, by addressing the four areas of conservation
she set out. By aiming to address the conservation of energy, structure, and
personal and social integrity, levine's model helps guide nurses in provision of
care that will help support the client's health.[3] though conservation of physical
and emotional well being is the most vital part of attaining a successful outcome
for patients, two additional concepts, adaptation and wholeness, are also
extremely important in a patient's health;
Adaptation- adaptation consists of how a patient adapts to the realities
of their new health situation- the better a patient can adapt to changes
in health, the better they are able to respond to treatment and care.
Martha Rogers
(Science of Unitary Human
Beings)
Martha Elizabeth Rogers (May 12, 1914 – March 13, 1994) was an American
nurse, researcher, theorist, and author. While professor of nursing at New York
University, Rogers developed the "Science of Unitary Human Beings", a body of
ideas that she described in her book An Introduction to the Theoretical Basis of
Nursing.
She was born in Dallas, Texas, the oldest of four children of Bruce Taylor Rogers
and Lucy Mulholland Keener Rogers. She began college at the University of
Tennessee, studying pre-med (1931-1933) and withdrew due to pressure that
medicine was an unsuitable career for a woman. She received a diploma from the
Knoxville General Hospital School of Nursing in 1936. The following year she
received an undergraduate degree in public health nursing at George Peabody
College in Nashville, Tennessee.<ref[1] She received an M.A. in public health
nursing from Teachers College, Columbia University in 1945, an M.P.H. in 1952
and a Sc.D. in 1954, both from Johns Hopkins School of Public Health.
The mind plays a role in Rogers’s nursing model, and it seems to be part of what
she sees as being the driving force to do good work in the field. Every nurse, much
like every doctor, must reconcile within themselves why they do their work and
why it is important to continue. Rogers’s offers that humans are more complex
than the parts nurses interact with when endeavouring to cure or mend them.
Therefore, nurses’ efforts are amplified when they endeavor to help save a life
since that life is more valuable than the body that the nurse helped save. In this
way, a nurse can find strong motivation to do this work to the best degree
possible (Alligood, 2014).
This observation on Rogers’s part has two implications. One is that an individual’s
health is inherently linked to those around that individual and cannot be entirely
understood in a vacuum. This is a common theme, explored by other nursing
theorists as well. More unique is the way Rogers uses this concept to connect
nursing to the sciences, arguing that an individual’s impact on and influence by
their environment makes nursing a naturally scientific field. Koffi & Fawcett (2016)
point out that Rogers’s theories helped spark a new era of scientific thought
within the nursing community.
Dorothy Johnson
(Behavioral system model)
Johnson’s Behavioral System Model is a model of nursing care that advocates the
fostering of efficient and effective behavioral functioning in the patient to prevent
illness. The patient is identified as a behavioral system composed of seven
behavioral subsystems: affiliative, dependency, ingestive, eliminative, sexual,
aggressive, and achievement. The three functional requirements for each
subsystem include protection from noxious influences, provision for a nurturing
environment, and stimulation for growth. An imbalance in any of the behavioral
subsystems results in disequilibrium. It is nursing’s role to assist the client to
return to a state of equilibrium.
Johnson (1980) views human beings as having two major systems: the biological
system and the behavioral system. It is the role of medicine to focus on the
biological system, whereas nursing’s focus is the behavioral system.
The concept of human being was defined as a behavioral system that strives to
make continual adjustments to achieve, maintain, or regain balance to the steady-
state that is adaptation.
Environment is not directly defined, but it is implied to include all elements of the
surroundings of the human system and includes interior stressors.
Health is seen as the opposite of illness, and Johnson defines it as “some degree
of regularity and constancy in behavior, the behavioral system reflects
adjustments and adaptations that are successful in some way and to some
degree… adaptation is functionally efficient and effective.”
Nursing is seen as “an external regulatory force which acts to preserve the
organization and integration of the patient’s behavior at an optimal level under
those conditions in which the behavior constitutes a threat to physical or social
health, or in which illness is found.”
Behavioral system
Man is a system that indicates the state of the system through behaviors.
System
That which functions as a whole by virtue of organized independent interaction of
its parts.
Subsystem
A minisystem maintained in relationship to the entire system when it or the
environment is not disturbed.
Subconcepts
Structure
The parts of the system that make up the whole.
Variables
Factors outside the system that influence the system’s behavior, but which the
system lacks power to change.
Boundaries
The point that differentiates the interior of the system from the exterior.
Homeostasis
Process of maintaining stability.
Stability
Balance or steady-state in maintaining balance of behavior within an acceptable
range.
Stressor
A stimulus from the internal or external world that results in stress or instability.
Tension
The system’s adjustment to demands, change or growth, or to actual disruptions.
Instability
State in which the system output of energy depletes the energy needed to
maintain stability.
3. Ingestive subsystem – fulfills the need to supply the biologic requirements for
food and fluids
Set
The predisposition to act. It implies that despite having only a few alternatives
from which to select a behavioral response, the individual will rank those options
and choose the option considered most desirable.
Function
Consequences or purposes of action.
Functional requirements
Input that the system must receive to survive and develop