Holistic nursing is based on nursing knowledge, theories, research, doing mediated by experience, as well as intuition and creativity(66 American Holistic Nurses Association (AHNA). What is Holistic Nursing. [Internet]. 2020. [cited 2020 Jul 5]. 1(1)-1-2. Available from:
). In this perspective, nursing practice incorporates theory, practice and subjective aspects, as well as intuition and creativity, which are decisive in how this care model will be constituted.
Validating outcomes with data. Nightingale was familiar with the medical advances and current evidence of the time, such as contagion of disease and its proximity to unsanitary conditions. She noted these associations through her first independent assignment with actual nursing and leadership at Middlesex Hospital during a cholera epidemic (Steward & Austin, 1962). She was a proponent of the early sanitarian movement that created the 1848 British Public Health Act (Gill & Gill, 2005). She implemented into practice what would be the first tenets of germ theory in disease prevention by emphasizing the values of cleanliness and antisepsis, clean air, water, and nutrition. Her hygiene practices and isolation of infected patients to prevent spread of disease are forerunners of current infection prevention practices (Gill & Gill, 2005).
The factors posed great significance during Nightingale's time, when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients. Also emphasized in her environmental theory is the provision of a quiet or noise-free and warm environment, attending to patient's dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient.[7]
Nightingale's theory was shown to be applicable during the Crimean War when she, along with other nurses she had trained, took care of injured soldiers by attending to their immediate needs, when communicable diseases and rapid spread of infections were rampant in this early period in the development of disease-capable medicines. The practice of environment configuration according to patient's health or disease condition is still applied today, in such cases as patients infected with Clostridium tetani (suffering from tetanus), who need minimal noise to calm them and a quiet environment to prevent seizure-causing stimulus.
Florence Nightingale was born into a prominent English family and received excellent training in mathematics from both her father and James Sylvester, an important English mathematician and contributor to matrix and number theory. Nightingale would go on to frequently use statistics in her work.
When the germ theory was developed after about 1870, Nightingale was skeptical of its importance, and remained convinced that hygienic practices were more valuable for health than knowledge of bacteriology.
Florence Nightingale is remembered as the heroine of the Crimean War and acknowledged for her contributions to nursing, hospital reform and statistics. This paper presents her as a scholar, showing the range of her theoretical interests and linking the theory with her practical activities as a social reformer.
That Nightingale wrote what sociologists have called grand theory has scarcely been realized in social science, although this material has now been published and studied by people interested in religion.5 Still the only books on sociological theory to treat Nightingale as a significant contributor are my own Early Origins of the Social Sciences and Women Founders of the Social Sciences.6 The purpose of this paper is to present Nightingale as a serious contributor to the development of social science theory and methodology, in the case of the latter one who had an important impact at the time. This work is part of the preparation for a collected works of Florence Nightingale, to be published by Wilfrid Laurier University Press.
This meant that Nightingale believed that people who did not take care of their personal environments properly would be more susceptible to disease. Here are some examples of this from her environmental theory of nursing.
Richard Bates works on the project 'Florence Nightingale Comes Home for 2020' (www.florencenightingale.org) at the University of Nottingham, headed by Professor Paul Crawford and Dr Anna Greenwood, funded by the Arts and Humanities Research Council.
Earlier this year, I did a quick caricature of Florence Nightingale for a Fundamentals of Nursing practice course reflection paper. It got me thinking on how it was her environmental theory that defines the Nursing profession today as we combat #Coronavirus.
She was born into a rich British family of high social status in Florence, Italy (hence her name Florence). Her mother was against her choices to pursue Nursing School, since at that time they believed Nurses to be the jobs of slaves and housewives. Florence chose a life that would serve humankind and end the suffering of others - she became a nurse. Through her efforts, she saved countless lives of wounded soldiers in the times of the Crimean war. She developed a theory in which the health of an individual is as important as the health of the environment. Clean air quality, healthful diets, and nurturing places - Florence was ahead of her time in sustaining the lives of people.
I too am a school nurse with many years of experience. Glad to see an article on school nursing! I went for a quick walk daily (when I could get out of my office) to "blow off the germs" so I know where you are coming from regarding the fresh air theory ?
I adore your article....I too use the Nightingale theory to help guide my practice. Her book is a quick and interesting read. .even Queen Victoria read it. Because of all she did, Florence was a great celebrity in the UK. Staffordshire figurines were very popular to have on our fireplace mantel.
Due to the changing and challenging nature of nursing, various theories and philosophies have been advanced to guide nursing practice, education and research. It has been said that everyday practice enriches theory and vice versa as both practice and nursing theories are guided by values and beliefs [1] . Theory helps to reframe our thinking about nursing and guides use of ideas and techniques. Theory can close the gap between practice and research and envision potentialities. While proposing her idea of practice theory, [1] provided the following concise description for a substantive theory:
The objective for the development of a theory is to illustrate, define, or systematize knowledge in a professional field of study. Theory can be utilized in all facets of nursing and promotes the advancement of education, knowledge and care in the profession.
Person :Nightingale's theory approach to patient-centered care emphasizes approaches that seek to reduce human suffering through compassionate care, which focuses on patient needs. The theory advocates for innovation that dignifies service delivery to patients to enhance their comfort at the hospital (Hartweg & Metcalfe, 2022). Similarly, Oren's theory emphasizes the nurse-patient relationship and views Nursing as an art to help patients meet their self-care needs. It focuses on environmental aspects such as the patient's family, culture, community, and personal practices that patients employ to maintain their health and well-being. Both theories are vital contributors to the nursing practice; however, Orem focuses on fostering patient independence and their education process, while Nightingale's theory hubs engage nurses in continuous learning .
Orem's theory approach to health employs a collaborative approach for nurses and patients in administering care. Patients learn and practice self-care to ensure good health, while nurses use the systems approach to deliver healthcare services (Yip, 2021). Nightingale's theory views health as being in an environment without disease or one that supports recovery. It emphasizes the need for nurses' continuous learning to provide quality care, apply critical thinking, and effectively serve patients under their care.
Orem's theory emphasizes creating a conducive environment for individuals to meet their self-care needs and thrive in all areas. Its methods for helping others emphasize creating communities that help others through action on their behalf, guiding and supporting them, besides creating an environment to foster personal development. Similarly, Nightingale's theory emphasizes a healthy environment to promote overall well-being. It emphasizes the physical environment factors such as basic sanitation, clean water, air light, and sufficient nutrition. The theory also recommends appropriate bedding, personal hygiene, and a quiet environment to promote peaceful rest. According to Riegel et al. (2021), the overall environment paradigm seeks to place people in a surrounding that can preserve and promote recovery from illness. The theory centers on social justice and respect for humanity. Both theories view the physical environment as essential to human well-being. However, Orem's concept incorporates social and psychosocial aspects in the ecological paradigm.
According to Meleis (2012), objective evaluation and critique of theories is usually complex and therefore requires simplification by breaking down the theory into various components. According to Chinn and Krammer (2004), there is a set of questions which are necessary for guiding the evaluation of theories. The questions guide the reviewer in theory description as well as in the critical reflection of the theory. The questions as per Chinn and Krammer include; What is the purpose of the theory? What are the concepts of the theory? What are the relationships in theory? What is the theory structure? And what are some of the assumptions of the theory?
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