FACULTY OF NURSING AND ALLIED HEALTH SCIENCES
SEMESTER MAY / 2018
NURSING THEORIES AN MODELS
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Before discuss the application of nightingale’s environmental theory, it is important to know the history of nursing. It is believed that the first aspect recorded in the nursing home was the beginning of the profession during the height of the Roman Empire, about 300 A.D. It is at this time that the Empire endeavors to locate a hospital in every city under its control. Therefore, there are many ;nurses; at that time who assist in the care of patients in the newly established hospital care, along with the doctor because the Roman Empire became the Byzantine Empire, they continued to innovate in the internal by creating two fully developed hospitals in the great city of Constantinople, which houses both male and female nurses.
The nurse is known as hipourgoi and helps improve nursing on a international standard. However, it is important to note that nursing became more popular in Europe during the Middle Ages, mainly due to its dispersed by the Catholic Church (Sayles, 2016). However, according to Sayles (2016), Florence Nightingale is the main reason to help to change the quality of nursing career forever by introducing the modern nursing in Europe. Around early and late 1900, nursing became more important, as nurses were needed at the forefront of many opposing battles, from the Crimean War to the Civil War. Nurses are sent to take care a sick and wounded army in combat. Florence Nightingale began her career as a nurse in the Crimean War that took place in the mid-1850s, attending injured soldiers on the battlefield.
At present, death from injuries is common, but many deaths that result in this injury due to the lack of general hygiene, . After discovering this, Nightingale asked for help from the British government that allowed better hygiene throughout the battlefields and nearby hospitals, which the outcome was that the rate of death from infections drops drastically over a short period of time. Florence Nightingale is well known for environmental theory of hers, where she identified 5 environmental factors which are fresh air, pure water, efficient drainage, cleanliness or sanitation and light or direct sunlight that will help the patient to recover (Sayles, 2016).
FLORENCE NIGHTINGALE’S ENVIRONMENTAL THEORY
This theory was introduced by Florence Nightingale during the Cremerian war when she notices that the reason of death among the wounded soldiers was the poor hygiene which they applied instead of war wound. The environment is most discussed about in the aspects of Nightingale’s theory. The definition of environmental theory is the act of utilizing the environment to assist him in his recovery according to John (2016). She also emphasized that if a nurse can only do one thing, they should forget everything and ;KEEP THE AIR THE PATIENT BREATHES AS PURE AS THE EXTERNAL AIR, WITHOUT CHILLING HIM;.
According to Ali Pirani (2016), environmental factors included in Nightingale theory are clean air and ventilation, temperature, noise, light, architecture and cleanliness. Nightingale emphasizes almost anything without the pure, clean and warm air, the patient may not improve in health. Nightingale also describes the idea that ;unnecessary noise, or noise that creates the expectation in mind, is painful for the patient.; This noise can be a construction worker outside, or a whispering conversation between a nurse and a doctor. Nightingale describes light as the main element of life. She points out that if you put a withering plant or human being in the sun, they will rise again. Nightingale also eludes the fact that poor architecture can make it difficult for the nurses . She also confirmed that clean rooms, beds, and clothing were important for the recovery of patients (Ali Pirani, 2016).
According to John (2016), environmental manipulation is an important part of nursing care. Nightingale sees different environmental factors that must be controlled so that the health is free from disease because imbalance between these factors can lead to illness. The following factors are as below:
2.1 Health of house – The concept of Nightingale a healthy home is that it has pure air, pure water, efficient drainage, adequate cleanliness, and sufficient light. She also pointed out that the environment outside the home can also affect the interior. Sewers should be kept separate from drinking water, and water should be sanitary and purified to prevent illness. Drainage should drain effectively especially the pipes and sewers to avoid disease like cholera (John, 2016).
2.2 Ventilation and heating- Nightingale assures that the need for clean air is essential in maintaining health. She reached this conclusion when she was in the Crimean War when the hospital barracks were not conducive to the recovery of the injured troop. She is worried about the smell that comes from the dirt, in the hospital environment, this includes the smell of urine, urinals, etc (John, 2016).
2.3 Lights- The light mention by Nightingale is the need to have direct sunlight in the patient’s room or in the hospital room because it can contribute to the patient’s orientation towards day and night cycles. She also states the reason sunlight is needed is because that a sick person tends to lie in front of the window rather towards the door and also that a dark houses are unhealthy and poorly circulated. Sun and light were essential for proper healing of patients (John, 2016).
2.4 Room and wall cleanliness- cleanliness is very important and serves as a great part in nursing because she believes everything will follow when everything is clean. It is important to keep the cleanliness by opening the windows, clean dust, dispose of waste properly, clean linens, carpets and floors (John, 2016).
2.5 Personal cleanliness- she emphasized the importance of maintaining personal hygiene and the importance of the skin, because she believes that the skin pores should be free of excretion as it is poisonous to the body. She also pointed out the importance of performing nurse hand washing (John, 2016).
2.6 Beds and bedding – She believes that the patient needs a good bed and a clean bedding. Beds should be placed in the room where there is access to sunlight as well the beds should be clean, neat, tidy, and dry to serve maximum comfort for patients(John, 2016).
2.7 Nutrition and food taking – She believes that patients should be offered various foods because one may want different food at different times. Frequent small portion is more useful than serving large amount of food(John, 2016).
2.8 Variety- Nightingale believes that the patient’s environment should accept changes, such as the color and shape, as this can help the patient’s recovery. This can be done by placing flowers or plants in the bedroom. She also encourages the use of activities such as reading, writing and working with needles to reduce the patient’s boredom(John, 2016).
APPLICATION OF ENVIRONMENTAL THEORY ON MANAGING PATIENT.
Practicing nursing is never easy because it is full with challenges due to the dynamic and challenging nature of nursing, several theories and philosophies have advanced to guide nursing practices, education and research. It has been said that daily practice improves the theory and, conversely, both practice and nursing theory are guided by values and beliefs. This theory helps to redesign our thinking about nursing and the use of ideas and techniques. Theories can close the gap between practice and research and illustrate potential(Mughal & Irshad, 2017).
My case study here is about a patient which was having cancer of the ovaries. She was already on 3rd cycle chemotherapy with Carbotaxol and Cisplatin, but during this admission, noted her Neutrophils count was low and she was not suitable for chemotherapy yet. She was planned for reverse barrier nursing with isolation nursing. We treated her according to the Nightingale’s environmental theory and she did recover and her Neutrophil counts increased. She never developed fever or infection as the barrier nursing applied was a success, but not every patient is suitable for this theory. There is a debate saying that we never allow the patient to have a good sleep and we always disturb them every 4 for observation.
3.1 Health of house – a healthy home is that it has pure air, pure water, efficient drainage, adequate cleanliness, and sufficient light. This patient was kept at 5th cubicle which was emptied for her. The environment was clean. The air was also clean but she was asked to wear a mask for protection as she was prone to infection. She was served with clean boiled water by the hospital staffs. There were no pipes or drainage near her bed but the drainage in the toilet was clear without any obstruction. Her bed was just beside the windows where and there were direct sunlight towards her. She was kept there to avoid her from getting infection because her neutrophils count was low and she was prone to infection easily. The area near her bed and the surrounding in cubicle 5 was very clean and was to be clean (Mughal ; Irshad, 2017).
3.2 Ventilation and heating- the patient needs clean air in maintaining health. There were no bad smell or odour coming towards the patient. The environment around her was kept clean so that the patient will feel comfortable with her longer stay. This patient was ambulating well to toilet which was only for her use and she can’t share with other patients. The toilets was cleaned by the cleaner every shift 2 times (Mughal & Irshad, 2017).
3.3 Lights- this patient was placed at the side of the windows so that she get fresh air from outside and also that she gets direct sunlight as the sunlight were necessary for proper healing of patients. She also will acknowledge the time as she always wait for her daughters during visiting hours. The light at cubicle 5 was also bright so that the patient won’t be in darkness as darkness is not healthy and poorly circulated (Mughal ; Irshad, 2017).
3.4 Room and wall cleanliness- the cubicle which the patient was kept was in a very clean condition. The dust was cleaned by the cleaner after each other day. During the cleaning, the patient is asked to sit at the bed which was 2 beds away from her current bed. She was asked to wear mask. The windows was open every day but the cleaning was done along with the dust cleaning as we wanted to limit her visitors. Then we also prepared the biohazard, sharp bin, and domestic waste at the end of the room and it was disposed accordingly. The linen was also changed daily and the patient was not having any ambulation problem so her linen was always clean. she knew cleanliness is very important and serves as a great part in healing her (Mughal ; Irshad, 2017).
2.5 Personal cleanliness – this patient knew the importance of maintaining her personal hygiene with the skin as well. She use to bath 2 to 3 times in a day. She was a very clean patient. There were no wounds on her. As a neutropenic patient, she is at risk for getting wounds in her mouth while brushing or her skin when she lie own, so observation will be done by doctors every morning to detect any abnormalities and to treat it immediately She was not allowed to be pricked simply by any doctor and she will be pricked by medical officer when they ordered for full blood count to check on the neutrophils level. We as nurses applied the reverse barrier nursing for her and also the hand washing. We applied the 5 steps of hand washing which was 2 before and 3 after. She never had fever during her stay in the isolation cubicle(Mughal ; Irshad, 2017).
3.6 Beds and bedding – for this patient, her bed was kept near the window where by it was easier for her to get sunlight access. Her bed was done by hospital staff with new clean bedding. It was very clean, neat and tidy. The patient was feeling comfortable with her stay an happy as well (Mughal ; Irshad, 2017). Patient was asked to stand a little far when we are changing her bed so that the dust from the bed making doesn’t cause her to fall sick or get infected. She was asked to wear mask so that she doesn’t fall sick.
3.7 Nutrition and food taking – as this patient was neutropenic, she was referred to a dietition for food intake advise. She was on neutropenic diet. She can’t eat food which is half cook. She needs fully cooked meat and eggs. She should not drink hot water. She needs to cool it first. We did offer her variety of food but according to dietition’s order. We gave her small amount in different time like yogurt, banana, and the routine meals 6 hourly because she was hardly eating her meals(Mughal ; Irshad, 2017).
3.8 Variety- this patient was a little bored sitting alone at a corner and she was not allowed to talk to other patient because of the risk of getting infected. We offered her to bring her favourite story books for killing her time. We also ask her to write her diary like what she did today and who came visiting. First she was reluctant but then her daughter brought her laptop with her movies which she can watch and she was looking more happy then usual. As this patient was at risk of being infected, so we never had flowers or anything colourful near her. We just wanted less the item so that she doesn’t develop fever or any infection and help her in the recovery (Mughal & Irshad, 2017).
As a conclusion, today, however improvement have been achieved, but the reality and the importance of Nightingale’s theory is at the highest rank. Florence Nightingale’s theory is purely relevant in clinical setting and it guides health care professional to increase patient’s well being and restore health by making change in the surrounding. Nurses are the change agents who can make a difference in patient’s health. This writing has encouraged me to understand Florence Nightingale’s theory in detail. I knew this knowledge was there but, it is very sad to say that I had not applied that. After this I will apply the theory at my clinical area so that the patients will recover well. Florence nightingale theory is very suitable for utilization to the care of such patients, an the fact that theory is more than a century old it is still alive, easy to apply in the basic undertaking of nursing interventions. Although nursing science is progressively advancing with higher degree of learning, research and invention of suitable technology, but Nightingale’s caring model is functional in the era worldwide because her belief fits to the basics of nursing remains the same.
Ali Pirani SS (2016) Application of Nightingale’s Theory in Nursing Practice. Ann Nurs Pract 3(1): 1040.
John, M. (2016). FOUNDATIONS IN NURSING: Nursing Theories of FLORENCE NIGHTINGALE Retrieved from HYPERLINK ;https://www.scribd.com/doc/39926848/FOUNDATIONS-IN-NURSING-Nursing-Theories-of-FLORENCE-NIGHTINGALE-Environmental-Theory-Jean-Watson-Theory-of-Caring-Virginia-Henderson-Need-the; https://www.scribd.com/doc/39926848/FOUNDATIONS-IN-NURSING-Nursing-Theories-of-FLORENCE-NIGHTINGALE-Environmental-Theory-Jean-Watson-Theory-of-Caring-Virginia-Henderson-Need-the
Mughal FB, Irshad Ali BH (2017) Enhancing Patient Well-Being: Applying Environmental Theory in Nursing Practice. Ann Nurs Pract 4(3): 1085.
Sayles, N. (2016). The History of Nursing. Retrieved from https://www.nursingschoolhub.com/history-nursing/
Wayne, G. (2014). Florence Nightingale – Environmental Theory – Nurseslabs. Retrieved from HYPERLINK ;https://nurseslabs.com/florence-nightingales-environmental-theory/; https://nurseslabs.com/florence-nightingales-environmental-theory/