I believe that nursing is caring. In my ‘Notes on nursing’, I explained my beliefs in nursing. In this paper, I will discuss my purpose for writing the book “Notes on nursing”. I will explain my assumptions, nursing concepts, my key sources of information, and relevance of my beliefs to modern nursing. I will conclude this paper by stating what modern nursing needs to serve the patient.
My purpose for writing “Notes on Nursing”.
My purpose was to give caregivers and nurses some hints or thoughts on how to teach themselves how to nurse by optimizing the environment so that the person requiring care will have no disease, can recover from disease or maintain his or her well being(Nightingale, F. Notes on Nursing, 1969 . P.3, Dover Publications Inc. New York, U.S.A).Through this writing I intend to generate enough awareness on how the nurse could help a physically, socially or psychologically weak person to utilize his vital powers in promotion of self recovery. Secondly, I intend to impress upon the nurse the necessity of putting the person in the best condition for nature to act on (Nightingale, 1969).Thirdly, I intend to make aware the importance of providing care to clients as prescribed in the ‘Nursing Practice Standard’ (.Nightingale,.1969; College of Nursing Ontario, (CNO), Nursing Practice Standard, 2009).
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In my opinion, the nurse should provide prompt, adequate care and enabling environment to a person (sick or well), who at the particular time was not able to help himself or herself, but would have helped him or herself, if he or she had strength, will and knowledge (Slusarska, B and Zarzycka, D. Understanding of the concept of nursing care- inductive analysis. Annales Universitatis Mariae Curie-Sklodowska. Vol.LXIII, N1, 35, 2008). For the nurse to fulfill this assignment, the nurse must exhibit the desire, intent, and obligation to apply relevant knowledge, skills, values, meanings and experience to support repair that will empower the person to return to a state of health where he or she can adapt positively to changes occurring in his or her live (Johnson, B and Webber. An introduction to theory and reasoning in nursing, 3rd edition. Wolters Kluwer/ Lippincott Williams and Wilkins, New York, 2010, P. 60).
My assumptions about nursing.
I began notes on nursing with assumptions about nursing care. These assumptions proffered answers to what nursing is and what is not. It is with these assumptions that I defined the concept of nursing as providing enabling environment to a person so that the individual will regain his or her vital energy to permit nature to work on him or her (Nightingale, 1969). I assumed that care is fundamental and pertinent to nursing and that for proper care to be provided that the nurse must recognize environment as a determinant of health. This means that the nurse can achieve better patient outcome by manipulating environmental factors in preparation for nature to act on the patient (Slanders, L.C.The power of environmental adaptation: Florence Nightingale’s original theory for nursing practice. Journal of holistic nursing, Vol.28, pp.181-188, 2010.
Doi: 10.117708980109360257).
I believe in the existence of natural laws. I believe that the law of life is defined through research and experiences. Therefore, nurses should find their place in scientific observation, collection and investigation of data. It is through these means (obtaining and retention) of health information that patients’ recovery will be enhanced (Salenders, 2010).
I believe individuals can achieve perfection (self actualization) through self realization and determination to obey natural health laws. It is the duty of the nurse to manipulate the environment in a way that will bring about renewal of patients vital powers (Nightingale, 1969; Salenders 2010).
I believe that nursing is both an art and a science. The nursing profession requires practitioners to be educated in the art and science skills of nursing. This means that the educated nurses will be expected to demonstrate use of current research, science, common logic and composition as evidence based and best nursing practice (Salenders, 2010).
I believe that nursing is separate from medicine. The purpose of nursing is to provide care to patients through environmental variation while medicine focuses on cure of disease (Salenders, 2010). Therefore, I believe that nursing will require a specialized education base that will emphasize blending of theoretical and clinical experiential knowledge (Nightingale, 1969; Salenders, 2010).
I believe that nursing is a calling that should be done with utmost devotion. Nursing should not be done because of monetary benefit but with zeal and intention of doing what is right and best for patient’s recovery (Salenders, 2010; Nightingale, 1969).
My concepts of nursing
I believe that a person is multidimensionally made of biological, physical, social, spiritual and intellectual components. This was why I set my goals on four most important concepts: (a) Person. (b) Health and disease (c) Environment (d) Nursing.
A. Person
The person is the individual we describe as the patient or client. The person is multidimensional (has biological, psychological, intellectual and spiritual components). The patient is center of my care planning and I have a holistic view of him or her. The patient is affected by disease and is the one who needs recovery. His or her recovery is directly affected by the environment and the interventions of the nurse. However, the patient has vital powers to deal with disease as long as enabling environment is provided for nature to act (Nightingale, 1969; Knutson.M.B. Original Nursing theories of Florence Nightingale.
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Health and disease.
Health deals with the health status of the person. Health is more than not having disease; it is a preservative process resulting from a mixing of environmental factors and nursing interventions on the individual (Nightingale, 1969 p.12). My emphasis on health is about keeping the person and the population healthy. To achieve good health requires that proper environmental manipulation and control is implemented by the nurse so that the patient is empowered to utilize his or her vital powers. Maintenance of good health and prevention of disease should be the focus of the nurse. It is through these ways that the nurse helps the patient in his or her recovery process (Nightingale, 1969; CNO, Infection prevention and control, Practice standard, 2009; CNA, 2008,).
Environment
The environment is where care is given to the patient. The environment includes every condition that will assist in putting the patient in the best condition for nature to act. Environmental conditions include the physical, psychological and the social aspects of living. The physical environment includes the building (where the patient receives care), air, light, water, ventilation noise level and odors (Nightingale, 1969, pp.12-24; Salenders, 2010).
I made the environment the center of my advocacy for nursing intervention, because I believe that the provision of good quality environment for the sick and healthy is possible. I plead that the nurse should be aware of the effect of nature on the mind and body to help pain perception in the patient (Nightingale, 1969, p.24; Hong, The Nightingale Principles -19th century thinking for 21st century sustainable practice, 2009).
In order to generate a sustainable milieu for patient’s comfort, the nurse must advocate for the integration of outdoor views and vistas (Nightingale, 1969,p.20; Hong, 2009).The reason is that “since patients spend most of their recovery time in the hospital units, the designs must include warm interiors, comfortable furniture, art works, lightings and reduced noise levels (Hong, 2009).
Also, I advocate for the opening of windows at both night and day to promote circulation of fresh air at all times. The same thing I say of home ventilation and aeration, “Households require pure air, pure water, efficient drainage, cleanliness and light as well” (Nightingale, 1969).
Nursing
I believe that nursing can manipulate the environmental resources to help the patient utilize his vital powers and permit nature to act on the patient (Nightingale, 1969). The nurse will assist the patient through assessment, observation, planning, implementation and evaluation of the patient’s health condition (nursing process) (Nightingale, 1969; College of nurses Ontario (CNO) Professional standard of practice, 2002). This is because the goal of nursing is to place the patient in the best possible condition for nature to act (Nightingale, 1969). Therefore, the nurse must advocate and promote patient’s hygiene, cleanliness (of rooms, walls, bed, beddings and water), proper drainage systems, ventilations, adequate lightings, sufficient warmth, control of noise, odor, variety, minor supervision and provision of nutrition and diets (Nightingale,1969). These activities are considered sanitary nursing. The professional nurse must also have the skills and knowledge of wound dressing and medication administration, because, “a patient may be left to bleed to death in a sanitary place” Hence, professional nursing is reserved for those individuals who are educated in the art and science of nursing (Nightingale, 1969).
Again, the nurse must demonstrate leadership capability by not straining herself to extra working hours, but by demonstrating entrustment to ensure good care when he or she was not there (Nightingale, 1969, pp. 35-39).
Furthermore, the nurse must communicate with the patient in a manner that shows partnership with the patient (Nightingale, 1969; CNA, 2008). “I say, we (nurses) must not talk to them, or at them but with them in a soothing and unhurried manner”(Nightingale, 1969).
My key sources of information.
The sources of information that I used to create my beliefs about nursing were greatly influenced by my “profound sense of connectedness with God” (Dossey, B. Nursing as a spiritual practice: The Mystical legacy of Florence Nightingale. http://www.altjn.com/perspectives/spiritual_practice.htm). My religious insight made me to focus on the unmet needs and health of people around me: On seeing human sufferings and the effects of poverty and disease on the England’s misery caused by the great depression, I was overwhelmed. This human tragedy made me to write in my notes “my mind is absorbed with the idea of the sufferings of men…All the people I see are eaten up with care and disease” (Baly, M. Florence Nightingale: Founder of modern nursing Part I the Crimean Experience. Humane medicine, Healthcare, Vol.2 (1), 2002).
Furthermore, my formal education in nursing shaped my observation skills and hands-on experiences which immensely contributed to the enrichment of my values and beliefs.
My beliefs about nursing were formulated over a long period of time, through years of working with hospitals, charities and the British army. I gained experiential knowledge during my nursing tours of Europe and Crimea; indeed I was not impressed with their nursing style. Thus, I had to conclude that good nursing cannot be achieved by devotion alone. From then going forward, I made observations and took notes. “By the time I returned from Crimea I had seen the best and worst of things in nursing” (Baly, 2002).
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In fact, from my Crimean experience I was convinced that filth, inadequate nutrition, dirty water and inappropriate sewage disposal system led to the death of more British soldiers than battle field (Cohen. B. Nightingale Florence. Scientific American, Vol.250 (3) 1984. pp.128-137). Then, I deduced from my empirical observation and statistical documentation that poor environment caused disease. On the other hand, if environmental factors are positively manipulated, health and living conditions could improve to a point where natural laws will prevail (Cohen,1984; McDonald, L. Florence Nightingale and early origins of evidence-based nursing. Evidence-based nursing, Vol.4 (3) P68, 2001). These were the reasons I based my ideas on human being, community and professional nursing values.
Relevance of my beliefs to nursing
My model for nursing practice remains useful in modern nursing and my environmental adaptation pronouncements on the proper use of fresh air, light, warmth, cleanliness and proper selection of nutrition and diet remains relevant to professional nursing. I will not be overstretching the fact if I claim that my environmental adaptation theory was transpersonal about human caring and relevant in the 21st century nursing. Watson Jean had this to say. ” She (Nightingale) called forth and made explicit the connections between and among all aspects of self, other, humanity, the environment, nature, and the cosmos as a means of learning, understanding, and connecting health, caring and learning” (Watson,J. Reflections: Florence Nightingale and the enduring legacy of transpersonal human caring, Journal of holistic nursing, 1998 Vol.16 (2)P.292. DOI: 10.1177/089801019801600218).
As we all know that the goal of nursing is to place the patient in the best possible conditions for nature to act (patient centered care), the nurse remains in charge of manipulating the environment to benefit the patient. In order to achieve harmony in healthcare, I advocated for nursing to be a discipline separate from medicine and have a hierarchy under the authority of the matron. Today, the nursing profession is recognized as member of healthcare inter-professional team distinct from medicine.
I appealed for nursing education to incorporate theoretical learning and clinical experiences. These returned a sense of calling to nursing and enhanced passion, competency and moral activity. They connected the unity of person, nature and environment: a union noticed in the delivery of modern nursing care (Watson, 1998).
My use of statistical data and expression of clinical facts in bar and pie charts, is adopted in nursing research and education (Cohen, 1984; Kopf, E.W. Florence Nightingale as Statistician. Publications of the American Statistician Association, Vol. 15(116), 1916. http://www.jstor.org/stable/2965763 ).
Conclusion
In my conclusions of the “Notes on nursing” I affirmed that “The most important practical lesson that can be given to nurses is to teach them to observe…what symptoms indicate improvement or…and of what kind of neglect” (Nightingale, 1969, p.105). The nurse must have observation skills and demonstrate recognition of the spiritual nature of beings, the environmental, biological, psychological and social aspect of care (Shanner.H. Environment as a phenomenon in nursing: Reflections from nurse theorists. The Nightingale institute for health and environment, 2006).
Self evaluation
This paper’s strengths lie in the authenticity of references used in its writing. The references were mostly from professional nursing journals, whose authors were verifiable and the journals were reviewed before they were published.
In the paper, I stated what professional nursing requires as prescribed by Ms. Nightingale. The paper was arranged in a simple easy to read format (subject by subject and point by point) with corresponding references. The paper defended professional nursing concept. In doing so, the paper defended the place of research in nursing, observation skills, critical thinking, and reflective practice in nursing process.
The paper also had its limitations. I did not present examples of nursing statistical data and graphs in this paper; although Ms. Nightingale’s knowledge and use of statistics in nursing was discussed. Therefore to further strengthen my paper I will include diagrams and graphs as considered necessary in future writings. Again the paper had more pages. I will make sue that my next papers do not exceed required number of pages.
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