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KENN S. NUYDA, RN
The Florence Nightingale Pledge
I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.
Who is Florence Nightingale?
Born: May 12, 1820 Villa Colombaia,
Florence, Italy Parents: – William Edward Nightingale – Frances Nightingale née Smith • rich, upper-class well-connected English family (Victorian family)
Residence of Nightingale
Embley Park, now a school, was the
family home of Florence Nightingale Parents were landowners, “class citizens”
Sister: Parthenope Tutored by father in:
childhood to the “poor” and the “sick” mathematics, Visited various languages, religion and philosophy hospitals to see the occupations of Participated in social women there gatherings at Victoria’s social events during her adolescence
Exposed during her
What influenced Nightingale to pursue Nursing?
Personal Professional values
of her family
– Education – Social status – Personal experience – Religion
L U V L I F E???
Courted by politician Rome 1847 – met
and poet Richard Monckton Milnes, 1st Baron Houghton, but she rejected him “Marriage” would interfere with her ability to follow her calling to nursing
Sidney Herbert Secretary of War Crimean War Herbert was already married, but he and Nightingale were immediately attracted to each other and they became lifelong close friends
the works of her government 1837 - Had a strong belief in GOD and she had a “religious calling” – “God spoke to me and called me to his service”
1851 – completed
her training in nursing at KAISERWERTH, GERMANY, stayed there for 3 months
1850 she visited the
instrumental in facilitating her pioneering work in Crimea and in the field of nursing, and she became a key advisor to him in his political career.
Lutheran religious community at Kaiserswerth-am-Rhein where she observed Pastor Theodor Fliedner and the deaconesses working for the sick and the deprived.
She regarded the
1851 - rejected Milnes'
experience as a turning point in her life, and issued her findings anonymously in 1851; The Institution of Kaiserswerth on the Rhine, for the Practical Training of Deaconesses, etc. was her first published work
marriage proposal against her mother's wishes
August 22, 1853 –
hospital facilities, reformatories, charitable institutions after her training
became the superintendent of the HOSPITAL FOR INVALID GENTLEWOMEN (London)
• October 21, 1854 – under the authorization of Sidney Herbert Nightingale and 38 newly recruited nurses were sent to Crimea (Turkey) • She and her nurses found wounded soldiers being badly cared for by overworked medical staff in the face of official indifference • Medicines were in short supply • Hygiene neglected and infections most common
Criteria for Being A Nurse
• Young • Middle class women • Basic general education to nursing care • Needs to address the environmental pxs
• 4077 soldiers died • Cleaned the hospital and equipment • Reorganized patient care • typhus, typhoid, cholera and dysentery
• d/t overcrowding and the hospital's defective sewers and lack of ventilation
• March 1855 – 6 months after she arrived in Scutari: flushed out the sewers and improved ventilation, death rates were reduced
LADY WITH A LAMP
• She is a ‘ministering angel’ without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow's face softens with gratitude at the sight of her.
• When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.
• Immortalized by the poem of Henry Wardsworth Longfellow on “Santa Filomena”
• Lo! in that hour of misery A lady with a lamp I see Pass through the glimmering gloom, And flit from room to room.
• August 7, 1857 • Given honor by Queen Victoria • Awarded with funds which she used in establishing institution for nurses – St. Thomas’ Hospital and King’s College Hospital in London • Was stricken by a fever, probably due to a chronic form of Brucellosis ("Crimean fever") that she contracted during the Crimean war • Home confined
• Played the central role in the establishment of the Royal Commission on the Health of the Army, of which Sidney Herbert became chairman.
• Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army Founded Chiefly on the Experience of the Late War • Notes on Hospitals • Reports on Measures Adopted for Sanitary Improvements in India from June 1869 – June 1870
• Wrote 15000 – 20000 letters to friends, acquaintances, allies and opponents conveying her beliefs, observations and desire for social changes in health care and society
• August 13, 1910 – death of Florence Nightingale at her own home
The grave of Florence Nightingale in the churchyard of St. Margaret's Church, East Wellow
• Blessed with determined motivation, Nightingale was a stern, starchy but gifted organizer. Her success in elevating nursing owed much to her insistence in her 'Notes on Nursing' (1859) on the requirement for nurse recruits to receive a thorough training in nursing theory and practice. She was a great advocate in the power of facts, calling statistics 'the most important science in the world'. Florence believed nursing involved dedication, devotion and discipline, but it was also to be a skilled profession.
Statue of Florence Nightingale. The statue is in Waterloo Place, London SW1
NIGHTINGALE’S APPROACH TO NURSING
• Focused on the Environment • Environment = all the ext’l conditions and influences affecting the life and dev’t of an organism and capable of preventing, suppressing or contributing to disease, accidents or death. (Murray and Zentner)
COMPONENTS OF ENVIRONMENT
• VENTILATION • WARMTH • LIGHT • DIET • CLEANLINESS • NOISE
• She integrated the physical, emotional and social aspects of the environment, that they are interrelated with each other in the role of attaining health of man. • But her NOTES ON NURSING gave emphasis on the PHYSICAL aspect of the env’t
5 ESSENTIAL COMPONENTS OF ENVIRONMENTAL HEALTH
1) 2) 3) 4) 5) Pure air Pure water Efficient drainage Cleanliness Light
“ Badly constructed houses do for the healthy what badly constructed hospitals do for the sick. Once insure that the air is stagnant and sickness is certain to follow.”
PROPER VENTILATION and WARMING
• Greatest concern of Nightingale • “Keep the air he breathes as pure as the external air, without chilling him.” • Asked the caregiver to consider the source of air in the pt’s room • If he keeps on breathing his/her own air he would become sick
• Concerned pretty well in “noxious air” or EFFLUVIA (foul odor from excrement) • Urinals, bedpans, utensils • Criticized “fumigations” – coz it just treats the offensive smell, not the source • Room Temperature – not too warm or too cold
• Direct sunlight • “light has quite as real and tangible effects upon the human body… who has not observed the purifying effect of light, and especially of direct sunlight, upon the air of the room?” • Move and expose cts to sunlight • Decreases confusion and psychoses
• Dirty environment (floors, carpets, walls and linens) is a source of infection through the organic matter in it • Nurse, patient & environment • Proper handling and disposal of body secretions and sewage • Daily bathing of the pt was advocated • Clothes of the pt must be clean • Handwashing = pt and the nurse
• Believed that many diseases were caused by breaks in the skin • Unwashed skin poisoned the pt • Bathing:
– Just as it is necessary to renew the air round a sick person frequently, to carry off morbid effluvia from the lungs and skin, by maintaining free ventilation, so is it necessary to keep pores of the skin free from all obstructing excretions.”
BED AND BEDDINGS
• Bed should be placed at the lightest part of the room and pt must be able to see the window • Nurse must maintain its cleanliness, dryness and neatness at all times
• Affects the recovery of the pt • Change in color and form – plants and flowers • 10 – 12 paintings be rotated each day, week or month • Advocated reading, needlework, writing and cleaning to relieve boredom
• Measure the pt’s temperature by palpating the extremities to assess heat loss • Nurse must manipulate the env’t to maintain both ventilation and patient warmth by using good fire, opening windows and properly positioning the pt in the room
• Noise must be avoided ‘coz it could harm the patient • Example:
– Jarring noises – Pt should be waked intentionally or accidentally during the 1st part of sleep – Whispering and long conversations about pts are thoughtless and cruel * Nurses must stop these noises
• Assess dietary intake, meal schedule and effect on the pt • There must be variety of foods served to the pt • Noted:
– Individualization of foods per person – Frequent small feedings were beneficial to clients – Patterns of eating (breakfast) at lunch
– Chronically ill may be starved to death because of their incapacitation can make them unable to feed themselves – No business should be done while patient is eating to avoid distractions
CHATTERING HOPES AND ADVICES
• Means what is said to the patient • To cheer the sick by making light of their illness • False hopes are depressing to the clients making him more fatigued • Nurse must heed what is being said by the visitors • Sick persons must hear good news that would make them healthier
• She observed that generations of families lived and died in poverty • Wrote letters and sent them to improve the undesirable living conditions • Started the political activism by nurses
• Pet visits may bring comfort to the patient • Protect the patient from upsetting news, visitors who affect the recovery
Believed that every woman, at one time in her life, would be a nurse in the sense that nursing is having the responsibility for someone else’s health Provided guidelines to women in the care of their loved ones at home and to give advise on how to “think like a nurse” – NOTES ON NURSING (1859)
“What nursing has to do… is to put the best condition for nature to act upon him” Viewed medicine and surgery as removing obstructions to health to allow nature to return the person to health
“Nursing ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet and the proper selection and administration of diet – all at the least expense of vital power to the patient.” “The art of nursing as practiced, seems to be expressly constituted to unmake what God has made disease to be, a reparative process.”
• • •
Apply scientific principles Observe and report pt’s status Performing interventions
• • • • •
PERSON = PATIENT In relationship with the environment and the impact of the environment upon them N performs tasks to and for the pt N must manipulate the environment for the pt Patient’s self – care should be encouraged
Ask the client about his/her preferences (individualization) Must have respect for persons of any background, be non-judgmental about social worth
Health – “being well and using every power (resource) that the person has to the fullest extent in living his/her life” Disease – “reparative process that nature instituted when a person did not attend to health concerns”
• • •
“nature alone cures” Nursing should provide care to the healthy as well as the ill Discussed health promotion as an activity in which a nurse should engage
MAINTENANCE OF HEALTH
• Environmental control • Social responsibility
• PHN • Modern concept of health promotion (BHWs)
“elements external to and which affect the health of the sick and healthy person” “everything from the patient’s food and flowers to the patient’s verbal and non-verbal interactions” Nurses must create and maintain a therapeutic env’t to enhance pt’s comfort and recovery
• • • •
Describe specific environmental problems and their results Practical solutions to these problems for households and communities Believed that “sick poor people” would benefit from environmental improvements Nurses are instrumental in changing the social status of the poor by improving their physical and psychological living conditions
Noise NURSE Air
H of houses Chattering Hopes
Nurse Observer Practitioner
• • •
Believed that disease was a reparative process Disease was nature’s effort to remedy a process of poisoning Or decay or a reaction against the conditions in which a person was placed
Believed that nursing's role was to prevent an interruption of the reparative process and to provide optimal conditions for its enhancement She was totally committed to nursing education – NOTES ON NURSING
• • •
She also felt the need that nurses must be excellent observers Must make use of their common sense Must be persevering Must have ingenuity
She believed that people who desires good health must cooperate with the nurse and nature to allow the reparative process They should also alter their environment to prevent the disease
• • •
Observing patients at night Sitting with them during the dying process Standing beside them during surgery Writing letters for them Providing reading materials during recuperation
• • •
Wrote letters to their families following death Nurses must be moral agents Must have professional relationship with the patients Maintain confidentiality Nurses must have clear, concise decision making
Nurse is in control of the environment both physically and administratively To protect the patient from both physical and psychological harm
ACCEPTANCE BY THE NURSING COMMUNITY
• • • • • Remains to be integral in nursing care Modern sanitation and water tx Environmental concerns Controlled room temperature and noise to client’s room Suffrage movement – FEMINIST THEORY dev’t – influenced the upper class women of the society to be useful/contributory members of the community
Scientific principle instructions and practical mastery of skills
St. Thomas’ Hospital and Kings’ College Hospital in London US – based hospitals
• • • Bellevue Hospital, NY New Haven Hospital, Connecticut Massachusetts Hospital, Boston
• • • •
The art of nursing could not be measured by licensing examinations Instead, use case studies Good education = good practice “Training is to teach a nurse to know her business… Training is to enable the nurse to act for the best… like an intelligent and responsible being.
• • •
Nightingale’s theory defines the scientific inquiry used in nursing research Gathering and analyzing the data Graphic illustrations Lack the complexity and testability found in modern nursing theories
Considered to be a grand theory (explains the totality of behavior, vague, w/o specific definitions of terms and concepts and w/o full dev’t of relationships b/w concepts Also classified as lower level theory
CHARACTERISTICS OF NIGHTINGALE’S THEORY
• 3 major relationships (Env’t – pt, N – env’t, N – pt) • Environment is the main factor creating illness (harm and benefits) • Environmental manipulation and elimination of contagion • NPR was not well-defined
2. Generality * still applicable today (N – P – E) * applied in all hospital settings (ICU, wards), home, community
3. Empirical Precision * Nurses must practice based on their observations and experiences * May be used to formulate another nursing theory
1. Florence Nightingale’s major writing on nursing is: A. Managing the Environment B. Nature of Nursing C. Notes on Nursing D. Theory of Nursing
2. In using Florence Nightingale’s theory in the assessment phase of the nursing process, data to be collected would include: A. The patient’s ability to be mobile B. Skin turgor C. Family relationships D. Light and ventilation in the room
3. Nightingale’s canon that relates most closely to continuity of care is: A. Chattering hopes and advices B. Cleanliness C. Health of houses D. Petty management
4. Florence Nightingale’s practice of nursing was based on the belief that: A. Germs cause disease B. Proper nutrition is primary to healing C. Suffering humans can heal themselves D. Whispering and quiet movements enhance sleep
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