Florence Nightingale Theory Case Study

Clinical Application of Florence Nightingale Theory (Paper)

• Amber Hussain

Overview of Theory

Everything in this world that has been created by God has some meaning attached to it and has to perform some role in this world. Similarly[M1] Florence Nightingale developed modern nursing based on her life experiences. She was the pioneer who gave the concept of nursing education and was considered as the first nursing theorist. It was a Crimean war where serving as nurse and observing dead patients forced her to develop an environmental theory. Her first theory was termed as “environmental theory” and was published in 1860. The theory describes the relationship of people with their environment. According to her, disease is a reparative process, which is not always the cause of sufferings but nurses ought to modify the environment for nature to act upon[M2]. Selanders (2010) comments that “The principle of environmental alteration has served as a framework for research studies” (P.88). Nightingales’ environmental theory reflects a great consideration in providing holistic approach to the patients by inculcating four major metaparadigms which consist of individual, environment, health and Nursing. All four concepts are interlinked with each other. An individual is a human being who is effected by the environment and acted upon by a nurse. Environment is a way which a nurse can manipulate for natural laws to act in order to make the human body healthy or vice versa. Health is viewed as a holistic level of wellness which is maintained by the customized environmental factors and facilitated by the nurses to maintain it. In the same way, for Florence, nursing is a separate entity in the field of medicine and the vital role of a nurse is to keep the patient in an environment where they remain healthy and where the maximum healing takes place. “The nurse is responsible for maintaining the environment in such a manner as to maintain the health of the patient” (Selanders, 2010, p.87)

These environmental alterations are represented as the canons of Florence Nightingale environmental theory which are classified into 13 sub concepts. These canons includes ventilation and warming, health of houses, noise, light, nutrition, bed & bedding, personal cleanliness, variety ,taking food, petty management, chattering hopes and observation of the sick. She believed that this is the responsibility of nurse to alter the environment in a manner that it can help the patient to have a better recovery. She emphasized that air a person breaths should be clean, odor free and room temperature should be moderate. Houses should be clean and well-constructed. A good sunlight and calm surroundings should also be considered as they create tangible effects on body. Patient and a nurse should practice hand hygiene as a Personal cleaning. Bed should be dry, wrinkle free and placed at the lowest portion. Individual should be preferred to eat small frequent meals without any distractions. Patient should be provided hopes and all his concerns should be listened and addressed. Lastly, nurse should keenly observe patient and his environment. All these will help to provide patients with patient centered care.

Clinical Scenario

This theory can be applicable in different clinical scenarios with different context but I can best relate it to a clinical scenario related to my life experience, which stunned me during my student life. It was one of the government hospitals where I was assigned in a pediatric ward with 4 years old patient suffering from pneumonia. Next to my assigned bead was a 3years old baby boy who came with the complaint of dehydration. Child was on intravenous fluids and antibiotics.

While nurse was taking history from the mother, I realized that he belongs to a poor family and has recurrent history of cough since after his birth. Child was recovering well and was advised to discharge. Few hours before his discharge, he developed small red scaly spots on the back which within 3-4 hrs increased in size and spread to the extremities. Mother shared the concern with nurse, to which she said that these are just heat rashes which can probably be due to hot weather. In order to provide comfort to baby, mother started applying heat powder on child’s whole body butbaby became restless due to itching and burning of rashes. After few hours, the rashes appeared on whole body including chest and face due to which child was presented with respiratory distress. Mother started hue and cry due to which the nurse and doctors arrived. Nurse started to perform vital signs and she observed that baby’s respiration and pulse were high. Doctor diagnosed these as anaphylactic reaction which were a result of urticarian rashes. The child was kept on triple regimen therapy including prednisolone and was suggested for allergy test and Complete Blood Count (CBC). Laboratory diagnosis reveled that WBCs was high and baby was reported as severely allergic to dust.

After this incident, I was stressed up as a baby who was about to discharge, suddenly developed allergy which converted to anaphylaxis. I did a root cause analysis and identified the following possible reasons: i) baby was not bathed since 3 days, ii) there was no bedding changed and iii) the room was full of dust heaps, eatables and wet clothes.

After realizing its root cause, I changed bedding and gave bath to the child. I also taught mother the importance of giving regular bath, its proper techniques and also emphasized on personal hygiene.

Analysis of Clinical Scenario by Applying Florence Nightingale Theory

Keeping all the views into considerations, the above case I experienced is now to be related to the theory of Florence Nightingale. In Nightingales four metaparadigm, Individual is a 3 years old baby who required proper environment. Dehydration is a disease due to which patient was admitted. Unchanged bedding, dirty area and lack of patient care are the environmental factors due to which the baby suffered from anaphylaxis and also other patient, staff and relatives were at risk. The nurse is the one who was assigned with baby, and did not pay attention on the environment. If a nurse having skills and knowledge, could have altered the baby’s environment, then baby would have not suffered with sever anaphylactic reaction. According to Florence Nightingale (1996) “If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault not of the disease, but of the nursing” (p. 6).

By taking environmental theory into account, the major canons which suits in above clinical scenario are ventilation and warming, health of houses, bed & bedding, personal cleanliness and observation of the sick. Ventilation and warmth is the most important concept without which other concepts are nothing. The area where baby was present was dirty and full of the foul smell due to the presence of food and damp cloths. The damp cloth which dries in patient room can go into the air where patient is present. The eatables which were present without cover/lid, the moisture of that evaporates in patient area and can spoil the air. The nurse and mother were so insensitive that they were unable to recognize that patient is being treated in an unhygienic environment. “The more that is known about your child’s environmental exposures and experiences, the more accurately one can predict the risk of immune dysfunction and immune-related disease” (Dietert, Rodney & Janice, 2010, p.15). However, Nightingales strongly emphasized on the presence of fresh and clean air as well as avoidance of foul smell and fumigations. It is the air we breathe which purifies the blood. This impure air if provided with untidy room can be a disaster for the patient as he can develop numerous diseases. Nightingale explains the above factor in her concept Health[M3] of houses. The room in which the baby was admitted was full of dust and there was no one, including a nurse who noticed and rectified this factor. Therefore, dust heap was the source of environmental impurity and patient’s allergic factor. This factor was coupled with the allocation of beds in the room. The beds were so congested that there was no such corner where outer atmosphere find its way for providing clean and fresh air. The patient care was further compromised by the bedding that was available for the patient. It is well explained in the cannon bed and bedding. The nurse was aware of the fact that the bedding that is offered to patient hasn’t changed since few days. The child, who was already sick and was depositing his exhaled sick breath and body’s unsafe flora into the bed, had exaggerated his sickness due to the unchanged and old wrinkle full bedding provided to him. According to Nightingale, the large amount of moisture of exhaled air goes into bedding which contains organic matter and is noxious for health. Beita (2013) also emphasized that “It’s a chore, but washing all bedding weekly in hot water is a sure way to get rid of dust mites”

Personal cleaning, be one of the important canon is also nicely related to the baby’s health. Baby has not bathed since 3 days which made him more prone to infection and allergies. Nightingale in her theory intensely advised nurses to pay attention to patients’ personal hygiene. She also gave consideration to sponging methods, usage of soft water and hand washing. Last but not the least, observation of the sick is also a very essential canon to be integrated with the case. In this scenario nurse did not had a sound observation and she neglected patient care. Even, when mother of the baby made her realize that baby is having rashes, she ignored and gave falsify reason of having heat rashes. She did not observe that the environmental factors has became a cause of patient sufferings. While, according to Florence Nightingale,

The most important practical lesson that can be given to nurses is to teach them what to observe—how to observe—what symptoms indicate improvement—what the reverse—which are of importance—which are of none—which are the evidence of neglect—and of what kind of neglect.

Due to all these environmental factors the baby in this scenario ended up with anaphylactic reaction which could have been prevented if all above measures would have taken care.

Let us consider the impact of local context which affect the critical incident of the case. Primarily, the age of baby (3years old), his present complaint (dehydration) and his history of recurrent cough made him susceptible to acquire infection and allergies. “Children, because of

their smaller bodies are more vulnerable to the impacts of bad indoor air” (Beita, 2013).

Secondly unidentified allergies were present during his admission which badly effected baby’s health. Then the misperception of the nurse that the red spots are heat rashes due to warm weather, ended baby with anaphylaxis. Also, the nurse’s lack of knowledge regarding environmental influence and her busy schedule, compromised baby’s hygiene care, which leads baby to severe life threatening condition

The impact of this scenario is not only on the individual baby, but it can also be on all the patients admitting to the particular ward/ hospital, due to unfavorable environment. It is also evident in the scenario that client belong to the poor family, which contributes to the economic burden to the family and consequently on the community.

Hypothesis Derived from Theory to Test Nursing Interventions

If Government will invest more in the infrastructure of hospitals, it will decrease the chances …

If nursing training is being provided up to the mark in every nursing institution, then patient recovery would be fast

If infection control educations have been done continuously in media, then it will decrease chances of infection & allergies

If hospitals would develop their policies and procedures, then it will reduce nosocomial and other infections

If signs of specific allergies/ infections have been posted in hospital as a guide for nurses, they would easily rectify the problem and patient complication would be less.

Summarization

To summarize, integrating Nightingale’s theory in the clinical scenario, has increased my knowledge regarding this particular theory and it helped me to view nursing as discipline. This assignment has basically given me theoretical concepts for understanding my own experienced observation, in a more meaningful way. I have never thought about this unpleased clinical scenario but through this assignment and integration of theory I did analysis of my observation which pointed out to specific outcomes. Also it helps me to make connections while considering options for interventions. For this theory I now realize that though this theory was developed in early century, however its implication is still consistent with modern era and many health care professionals are consistently following it in some way or the other. I will also apply this theory whenever and wherever it would be pertinent, as it helps to prevent from many diseases and infections.

References:

Beita,B.(2013). Home breathable home. The Environmental Magazine. 24 (3): 28-9

Dietert, Rodney R., & Janice. (2010). Strategies for protecting your child’s immune system: Tools for parents and parents -to-be. Singapore: W.S: Hackensack

Nightingale, F. (1992). Notes on Nursing: what it is and what it is not. Philadelphia PA: J.B. Lippincott Company

Selanders, L.C. (2010). The Power of Environmental Adaptation: Florence Nightingale’s Original Theory for Nursing Practice. Journal of Holistic Nursing.28 (1), 81-88.

The Power of Environmental Adaptation: Florence Nightingale’s Original Theory for Nursing Practice 2010 Louise C. Selanders, EdD, RN, FAAN Journal of Holistic Nursing

American Holistic Nurses Association

Volume 28 Number 1

March 2010 81-88

© 2010 AHNA

10.1177/0898010109360257

http://jhn.sagepub.com

Becker, E. (2001, August 27). Prairie farmers reap conservation’s rewards. The New York

Times. Retrieved from http://www.nytimes.com

Strunk, W., Jr., & White, E. B. (1979). The guide to everything and then some more stuff.

New York, NY: Macmillan.

Gregory, G., & Parry, T. (2006). Designing brain-compatible learning (3rd ed.). Thousand

Oaks, CA: Corwin.

The interactions between the body and environmental factors generally

follow very simple rules. Some exposures are useful and may play a

critical role in promoting good health. Others are problematic and can

damage the health of our children.

Title:Strategies for Protecting Your Child’s Immune System : Tools for Parents and Parents -to-be

Author:Dietert, Rodney R., Dietert, JaniceDate:2010

Source:E: The Environmental MagazineDate:May 1,2013. Home breathable home by beita belli

The general definition of environment is anything

that, through manipulation, assists in putting

the individual in the best possible condition

for nature to act. Therefore, the environment has

internal and external components . (P.8)

Journal of Holistic Nursing

The Power of Environmental Adaptation: Florence Nightingale’s Original Theory for Nursing Practice 2010 Louise C. Selanders, EdD, RN, FAAN

Journal of Holistic Nursing

American Holistic Nurses Association

Volume 28 Number 1

March 2010 81-88

© 2010 AHNA

10.1177/0898010109360257

http://jhn.sagepub.com

[M1]Helen keller

[M2]Did not understand

[M3]Connectivity is missing