CONCEPT DEVELOPMENT: Florence Nightingale - Influence on Nursing Theory 1. AIM: This assignment gives an abridged account of Florence Nightingale’s life, her education, aspirations and career. It also discusses the development of nursing theory in general, and Florence Nightingale’s influence in later nursing theorists’ work. Florence Nightingale’s philosophy regarding the environment was fundamental to her concept of nursing and health, which was demonstrated through her work on sanitary reform and hospital construction. 2. BACKGROUND: Florence Nightingale was born in 1820 to well-educated, affluent British parents.
Her youthful upbringing brought her into aristocratic society, where she made life-long distinguished friends and acquaintances. These would prove pivotal in her work as the founder of modern nursing. Schooled by her father in mathematics, languages, religion and philosophy (which were put to good use in forming her theories), the young Nightingale began her nursing training in Germany. After returning to England, she became Superintendent of the Hospital for Invalid Gentlewomen 1. During the 1840’s, sanitary reform in the community became a big political issue, which Florence Nightingale zealously embraced.
She utilised plans for eliminating sanitation problems on the army wards during her time in the Crimean War. Although medical care in the army was higher than in the community, conditions were still appalling with blocked latrines, overflowing cesspools and contaminated drinking water. The latter playing an important part in epidemic outbreaks of cholera. 1,2. The soldiers named her as ‘The Lady of the Lamp’ when she carried her lantern through the corridors at night. In 1855, Florence Nightingale became very ill with ‘Crimean Fever ‘ and was not expected to survive. This disease is believed by some to be brucellosis melitensis. Her symptoms subsided and she returned to England, after which, she founded nursing schools at St. Thomas Hospital and at King’s College Hospital. Her achievements have included her many writings, such as ‘Notes on Hospitals’ and ‘Notes on the Sanitary State of the Army in India’. Florence Nightingale also compiled statistics and much evidence for the Royal Commission. Hospitals were set up world-wide financed by the Nightingale Fund. Although bed-ridden for much of her later years, she worked prolifically into her eighties, gathering data and expounding her nursing theories. In 1910, Florence Nightingale died at the age of 90 years. . Development of Nursing Theories and Practices Between 1858, when Florence Nightingale first wrote her ideas for the theory and practice of nursing, and the 1950’s, there was little change to the task orientated, authoritarian concept of nursing practice. The nursing theorists may have started to evolve in order to change this viewpoint. Notable protagonists include Henderson, Peplau, Abdellah and Orem. 4 In addition, reactions to the medical paradigm which was well established and developed, may have prompted the change of nursing, from one of traditional symptom orientation to a nursing paradigm in it’s own right. Figures 3. 1 & 3. 2 refer). [pic] Nursing theories have gone through several changes and ideas that were rejected in one stage of development have been accepted in another. There has been a shift from the early rejection of nursing theories, through the positivistic, quantitative research of the sixties to the recent revival of Florence Nightingale’s concept of nursing of health and environment. Nursing research has shifted towards the phenomenological viewpoint (the meaning of experience and perceived reality) illustrated in Figure 3. 3. [pic] Nursing theories prove that nursing is a profession, not simply an occupation.
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Meleis describes these as being “a systematic, coherent body of knowledge with boundaries”. There are three types of nursing theories, according to Alligood and Chong Choi. 1 The first is nursing philosophy, in which the meaning of nursing is realised through analysis, reasoning and logical argument. Exponents of this type of work were early theorists. Florence Nightingale’s work is a philosophical one. The second or ‘grand theorist’ type gives a conceptual framework in which one can view the world and take into account it’s aspects. (J. Fawcett 1989)1: 6 . Orem and Neuman are examples of this type.
The third type are middle range theories, which are derivatives from other works such as grand theories, philosophy of nursing theories or perhaps from other, related theories. 1 4. Florence Nightingale’s Influence on Nursing Development and Practice Florence Nightingale was the first nursing theorist. She believed her life in nursing to be a calling from God, her chief mission being to improve the environment in which people lived and in which people were cared for. Although an innovator, she was also a product of her time as sanitary reform in the community became a big issue with the educated classes.
Her other philosophies influenced nursing theory and practice. These were: * Nursing as a profession distinct from Medicine. Gathering of statistical data for applied research The establishment of recognised system of nurse training Definition of Health Dichotomy of nurse / patient role. The reparative process of disease 4. 1 Environment Florence Nightingale placed great emphasis on the physical aspects of the care setting. These are namely; clean air, pure water, efficient drainage, cleanliness and sunlight, 7 which are largely taken for granted in our modern hospitals.
She believed these would eradicate the main source of illness, although, Miss Nightingale rejected the theory of bacterial infection on the grounds that she had no empirical evidence to support it. Florence Nightingale believed that building construction, in particular, hospital building, should pay particular attention to sanitation and ventilation. This together with the correct diet would eliminate much current sickness. Her writings on this subject revolutionised hospital construction. 10. In her Notes on Nursing, she admonished nurses who noisily tripped over fire-irons, thus breaching safety standards. Virginia Henderson wrote of Florence Nightingale’s influence on her own work regarding the environment, when she said, “Like Miss Nightingale, I have shared an interest in seeing the environment made safer for people. She put more emphasis on fresh air than I, of course, did. I had more opportunity to learn how to control infection than she did. ” 8. Miss Henderson further enlarged on Florence Nightingale’s theory to say that nurses should recommend the construction of buildings, purchase of equipment and maintenance in order to minimise chances of injury. 1
Kathryn Barnard, speaking in 1966, said that in order for the nurse to assist the patient in promoting and maintaining his / her independence, a change in the patient’s environment may be necessary. 1 Martha E. Rogers (1970) and Betty Neuman (1995) echoed Florence Nightingale’s belief that the provision of an environment which was conducive to healing, such as cleanliness, fresh air and calm, were prerequisites for recovery from illness. Nursing theorists widened the concept to include people’s responses to their immediate and broader environment. 9 Rogers holds that the description of person and environment ‘energy fields’ are inseparable.
Dorothea Orem’s ‘Universal self-care requisites’ (1980) lists the maintenance of air, water, food, rest and solitude, as being required by all human beings and adding to these; social interaction, elimination, activity, social interaction, prevention of hazards and promotion of human functioning. 4. 2 The Profession of Nursing and Health. The idea that there would be a professional body of exclusively female nurses (Miss Nightingale believed women were natural nurturers) was revolutionary in the last century. The exception was in psychiatric nursing, where men’s’ physical strength was valued. This view is largely discounted today, of course. She was also passionate about the uniqueness of nursing, existing alongside but not incorporated into, other related disciplines, such as medicine. Adherence to signs, symptoms, surgery, medication and disease prevailed in this era of health care. 5 She was suspicious of ‘new’ scientific thinking, which would turn nurses into ‘medical women’. 10 The training of young, more educated nurses in the new progressive schools like St. Thomas Hospital, included Florence Nightingale’s own concept of health: hygiene, environment and care. Her belief was that health was a state of wellness, desired by the patient and gained by using all power available, to the fullest extent. 1:10 Miss Nightingale combined both health education with sick nursing in her teachings, a practice which is very much in evidence today. Hildegard Peplau, followed Florence Nightingale, in 1952, and pioneered a knowledge-based nursing practice, which included education and research; distinguishing it from medicine-based health care. 1, 11 In 1987, Rosemarie Rizzo Parse echoed the need for nursing to move away from the medical model in order to evolve. 4. 3 Concept of Nursing and Statistical Data Gathering In 1970, Martha Rogers took Miss Nightingale’s concept of nursing and redefined it as a constant human interaction with the environment. 5 She lauded Miss Nightingale’s ability to place the person “within the framework of the natural world”, by her vision of health and by supporting this with statistical data. 1 Rosemarie Rizzo Parse was greatly influenced by Martha Rogers. She believed that, since Florence Nightingale’s time, nursing owed it’s existence to Man and Health. 1 4. 4 Nurse/ Patient Role and her Model of Nursing
Florence Nightingale believed disease to go through a reparative process Her model of nursing reflected her belief that nature would cure the patient by the actions of the nurse’s control on the environment, 12 the patient’s role was a passive one, with little or no say in the way in which he or she was treated by the health care team. Few would argue that nursing theories has taken a more holistic approach than was the case in Florence Nightingale’s time. A legacy of the Nightingale School is the military terminology used by Miss Nightingale from her time spent in army nursing.
Phrases such as; ‘on duty’, ‘off duty’ and ‘sick leave’ are still in use today. 10 5. Conclusion Florence Nightingale saw nurses as women who were not only professionals in their own right, (a revolutionary concept for Victorian England, when most women were subservient to male domination) but were to be instrumental in bringing about changes in order to improve the environment in it’s broadest sense. By this token, she was also the first health educator. Miss Nightingale presented her own empirical evidence i. e. based on her own experiences and observations, as established facts. She was a believer in research. Her gathering of statistical data was used to give credence to her hypotheses on her epidemiological studies. She laid the foundations for a recognised system of nurse training, not only in this country, but abroad. However, those nurse educators, who followed in Florence Nightingale’s footsteps in teaching young (and from an increasingly higher social class) women in the art of nursing, failed to differentiate between the goals and focus of nursing and of medicine. The medical model tended to neglect the patient as a human being. Furthermore, nursing creativity would be stifled (at least in the U. K. ) under a regimented, task-orientated regime until the early 1950’s until the emergence of new nursing theorists, such as Peplau (1952), Henderson (1955) and Orem (1958). Some of Florence Nightingale’s practices and beliefs have been largely discontinued or discounted today, such as the pathology of dirt and dampness, her disregard to the germ theory, and the fact that the patient was non-participative of his/her method of care. This lack of holism was perhaps in keeping with her time. 1.
Her vision of nurses as innovators for social health reform, continues to inspire us today. - End of Assignment – REFERENCES: | | | |1. | Marrinner-Tomey, A. (1994). Nursing Theorists and their Work. St. Louis, Missouri: Mosby. | |2 |Dingwall, R. , Rafferty, A. M. , Webster, C. (1988). An Introduction to the Social History of Nursing. London: Routledge | |3 |Baly, M. E. (Nov. 13. 1996). Different history for Nightingale illness, Letters.
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London: Scutari Press. | |8 |Smith, J. P. (1989). Virginia Henderson: The First 90 years. London: Scutari Press. | |9 |Pearson, A. , Vaughan, B. , Fitzgerald, A. (1991). Nursing Models for Practice. London: Heiman | |10 |Baly, M. E. (1986). Florence Nightingale and the Nursing Legacy. New York: Croon Helm. | |11 |Fitzpatrick, J. and Whall. A. (1983) Conceptual Models of Nursing. Prentice Hall Publishing Co. | |12 |Kershaw, B. and Salvage, J. (1994) Models for Nursing. Great Britain. John Wiley & Sons Ltd. |
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