Florence Nightingale was the founder of modern nursing and supported the ideas that are basic to nursing. Nightingale focused on altering the environment, person, health, and nursing to promote optimal healing of the patient. This included things as simple as ventilation and clean water, to now modern evidence-based practices utilized by nursing today. In the book, Notes on Nursing, Nightingale discusses ventilation, pure water, light, cleanliness, decreased stimuli, and variety for the patient (Nightingale, 1969). All of these things improved the quality of care and treatment the patient received, further improving their outcomes. As a nurse today, we subconsciously provide these things to patients to help promote a more comfortable setting for healing. For example, if a patient feels nauseous, we give them a cool, wet towel or if they are cold, we give them a warm blanket. Even in the critical care setting, where changing the patient’s environment is not always as easy as taking them outside for fresh air, we find a way to provide them with a fan. It is these small details that can truly improve the patient’s ability to heal, which in turn, promotes positive outcomes.
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Applying Nightingale’s four concepts of nursing to my practice as a bedside nurse happens much more often than I had ever imagined. To relate, one of the most impactful experiences I have had with a patient and family during my years of nursing is one that not everyone gets to have. I was open for an admission in the intensive care unit (ICU) and received a respiratory failure/meningitis patient that was intubated from the emergency department. Later, I found out that the patient, as well as his family, were from Mexico and spoke no English. After contacting an interpreter, I further discovered that this patient was an illegal immigrant. This prevented the patient from being considered at any long-term care facility, or rehabilitation center. The patient remained with us in the ICU for months until something was figured out by the social workers and he was able to transition out of the hospital. It was during these months of patient care that I discovered how much, we as nurses, mattered to this patient and family. As Alligood (2014) explains, the care of the sick is based on knowledge of the person and their surroundings. Their inability to communicate with the staff did not affect the amount or quality of care that was given to them. I was able to figure out ways to communicate with the patient even without the interpreter for needs, such as water, warm blankets or a fan. Every day they became more comfortable with us and eventually learned some English just to communicate how appreciative they were of us. This showed me that despite how standardized and protocol-based nursing has become, we are still able to treat human beings with the respect and care that they deserve.
During my time caring for this patient, many ideas and nursing theories came into action. The theory that I believed help me the most through this difficult case, however, was her concept of person. As an ICU nurse, you must possess the ability to look at the patient as a “multidimensional person” so you can provide the most optimal care (Nightingale, 1969). Doing this included paying attention to the things that the patient and family both needed during this stay. To do this, we consulted different members of the multidisciplinary team to assist in their care. All of the team members including, pastoral care, case management, the physicians, and the nurses spent time educating and counseling the family about what was most important for their son. These discussions led to the decision that would give the patient the best quality of life long-term. Having the ability to recognize the theories that Nightingale has established for us as nurses allowed me to remove the extra factors, such as family emotions, and focus on the patient and family that I am caring for in a different way (Alligood, 2014).
Carper’s Four Ways of Knowing
Barbara Carper identified four different patterns of knowing in her expanded view of nursing as an art and a science. These four patterns include empirics (the science of nursing), ethics (moral knowledge of nursing), personal (nurse-patient relationship), and aesthetics (the art of nursing) (Reed & Shearer, 2012). All of these patterns of knowing function together in every nurses practice and will continue to be present as I transition as an advanced practice registered nurse.
When we are able to connect Carper’s patterns of knowing into our practice, patient’s will receive optimal care. All of the pathophysiology taught throughout nursing school and as I have practiced as a bedside nurse is the empirical knowledge that Carper discusses. This knowledge allows me to perform the best care and treat a person for optimal health as Nightingale describes (Alligood, 2014). I was able to use my gained experience to assist in caring for my critically ill patient described earlier. As important as it is to treat an illness, it is equally as important for me to be able to treat the person. This stems from the personal knowledge, the patient-nurse relationship, and it enables me to develop a trusting bond with my patient. We spend so much time caring for our patients and always hope to form the most therapeutic relationships. When I continue on as a psychiatric nurse practitioner, this will continue to be of utmost importance to me as I gain more responsibility in their care (Alligood, 2014).
Once a relationship has been developed with a patient, we will learn more deeply about the patient. This leads us to the aesthetic, or art of nursing. At this point I would determine a plan of care for my patient. For example, this could include something as simple as contacting the respiratory therapist when I know something is going wrong with the patient’s ventilator. This plan will allow me to decide the most appropriate interventions, with hope that the first two patterns of knowing will facilitate patient compliance. An intervention could be something as simple as altering the environment for a patient that allows natural healing like Nightingale has discussed before (Alligood, 2014). Finally, the ethical knowledge helps us in determining the best actions to take for a patient and what steps we need to achieve their optimal health (Reed & Shearer, 2012).
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There is a fifth pattern of knowing, sociopolitical or emancipatory knowing (Alligood, 2014). This pattern of knowing takes a broader look at the ethical situations in nursing, the environment in which we practice, and what we are lacking during our providing (Alligood, 2014). As a future nurse practitioner is important for me to notice that my decisions will facilitate a series of actions and determining the barriers of optimal patient care is necessary in my practice.
Carper and Nightingale: Application to Practice
As a nurse practitioner, I want to be able to incorporate each aspect of the Nightingale and Carper concepts of nursing into every patient encounter. By leaving out certain concepts, I could potentially harm the relationship that I have formed with my patient. I plan to utilize these concepts to create a therapeutic environment for my patients so they will feel safe and comfortable. After learning much more about these theories I have been astonished with how often I actually utilize these on a day to day basis. I truly look forward to learning more in depth knowledge of these concepts so I can continue to apply them to my practice in the future.
References
- Alligood, M. (2014). Nursing theory: Utilization & application, 5th Edition. [Vitalsource]. Retrieved from https://bookshelf.vitalsource.com/#/books/9780323091893/
- Nightingale, F. (1969). Notes on Nursing What it is, and what it is not. Mineola: Dover Publications.
- Reed, P.G. & Shearer, N.B.C. (2012). Perspectives on nursing theory. Philadelphia: Kluwer Health: Lippincot Williams & Wilkins.
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