The role of nursing was greatly influenced by the work of Florence Nightingale. Due to Nightingale’s research the nursing profession has taken huge strides toward improving patient care, thus yielding maximum healing capability and decreased death rates. I am interested in learning how much Nightingale’s developmental theories changed the role of nursing and practice implications today. Through my clinical experience I truly believe that the cleaner the environment and complete, nurturing care of the nurse provides for a healing environment. The purpose of this paper is to identify reasoning behind Florence Nightingale’s developmental theories of practice and how it shaped nursing into the profession it is today.
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Review of Literature
The role of nursing as a profession is defined by Florence Nightingale’s principles of health maintenance and restoration. Nightingale believed that the nurse was in “charge of somebody’s health” in light of knowing exactly how to position a patient so that they may heal the best way possible (Potter & Perry, 2009). Nightingale’s upbringing allowed for her to achieve the knowledge and expertise needed to advance and develop her theories of practice. Her theories are still being taught in school today, but the implementation in clinical experience seems to be diminishing due to the lack of time by the nursing staff. The purpose of this literature review is to determine whether the evidence supports, or does not support, that Nightingale’s theories improve the overall healing and well-being of the patient.
Educational Background
Nightingale believed that she was not any ordinary girl set to live a ‘conventional life’. Through her educational opportunities as an adolescent she maintained her independent mindset. According to Attewell (1998), Nightingale longed for a college education, but could not find any particular subject to channel her thoughts. In 1848, she was allowed the chance to work with poor children, which really opened her eyes to the others outside her world. Nightingale came away with a good feeling, and gratitude, something she had been longing for. A critical turning point in her life was visiting the Lariboisiere Hospital in Paris in 1853 which she noted the favorable environment which enticed the human body’s natural senses to healing. She began to develop her basis of theory for practice while at Lariboisiere, noting that the filthy enclosed spaces encompassed disease and allowed for the diseases to spread (Attewell, 1998). This opened her eyes to the idea that cleanliness lead to the prevention of disease.
Crimean War
Later in 1853, Nightingale ventured to accept her first job responsibility in a London hospital until the war broke out in 1854. The war created chaos and major concern for the wounded soldiers, as the death tolls continued to increase. Nightingale was appointed to lead a group of nurses into the battlefield front to help fight the mortality rate by implementing her principles of health maintenance and restoration (Attewell, 1998). Upon arrival she noted that everything about the quality of living was poor. There was a dire need for improved nutrition, sanitation, and living facilities, thus reestablishing them was her responsibility (Potter & Perry, 2009).
Influence on Reform
Through her experience with statistics as an epidemiologist, Nightingale was able to link the poor quality of human life and living to the development of disease and numerous deaths in the war. According to Kudzma (2006), after returning from the Crimean War Nightingale compiled extensive reports and letters of her statistical data, which helped her gain recognition for her reforms in patient care. Nightingale successfully completed her goal of improving the qualities of living, reducing the “mortality rate from 42.7% to 2.2% in 6 months” (Potter & Perry, 2009). These results established Nightingale’s works and confirmed her development of theories of health maintenance and restoration, which is why she is known as a founder of modern nursing (Stanley, 2007). During this time, it was very uncommon for women to excel in mathematics, much less statistical analysis of data. Nightingale was assisted by William Farr, a medical statistician, who mentored her in publishing many reports on her work in the Crimean War and in other London hospitals (Kudzma, 2006).
Nightingale Metrics Project
Nightingale’s influence on reform has shaped the practice of nurse’s today. In a recent study performed at Children’s Hospital in Boston, the nursing staff researched client behavior and outcome based on the principle of putting the client ‘in the best condition for nature to act’ (Curley & Hickey, 2006). Essentially it is the responsibility of the nurse to provide the healing environment for the patient and their family. In this study, the nurses identified specific interventions which they believed were crucial in the client’s healing process. The interventions were collected then classified into sets for each unit, called “Nightingale Metrics.” Those specific interventions were then characterized as principles of care on those units and measured carefully (Curley & Hickey, 2006). One of the most beneficial interventions was limited the number of nurses assigned to each patient, attempting to increase the continuity-of-care index (CCI). According to data provided by the report, the higher the continuity-of-care, the more educated the nursing staff is of the patient, consequently an increased quality of care provided for the patient and their family (Curley & Hickey, 2006). Every three months the studies were analyzed and interventions were adjusted as necessary, until the benchmark goal of 100% patient/family assessment satisfaction was reached. This study by Curley & Hickey (2006) implements the importance of the Nightingale’s theories by ensuring the maximum healing process by placing the client ‘in the best condition for nature to act.’
Synthesis of Information
Based on the information provided, there appears to be experiential evidence which supports the practice and implantation of Florence Nightingale’s theories of health maintenance and restoration in clinical practice. The variety of statistical data provided throughout the literature review all supported the basis that nursing care linked with a clean environment leads to advancement in the well-being and healing process of the patient. Nightingale’s interest began at an early stage in her life while working with poor children, then lead to the development of the nursing profession through her studies on the factors relating cleanliness to the growth and spread of disease. The evidence supports that Nightingale’s theories improve the overall healing and well-being of the patient.
Implications for Practice
The fundamental theories of Nightingale have been discussed and reinforced not only in lecture, but also in skills lab, and our clinical experiences outside of the classroom. Being in the hospital setting has opened my eyes to many things about the nursing profession that I never knew. Nightingale’s theories of health maintenance and reformation remain the driving force for nurses and the care they provide. When patients are in the hospital the one person they can depend on is the nurse because ideally the nurse should be providing the care and support for them to heal to their maximum potential. Nurses not only dispense medications, prep for surgery, and educate, but also provide emotional support, therapeutic care, hygiene care, and many other interventions which all impact the overall quality of care for the patient.
With the increased demands on nurses today due to the economy, the fundamental teachings of providing emotional support, clean environment, and a caring nature are being overlooked due to the increased patient to nurse ratio. I found that the nurses on my clinical unit did not have the time or means to provide the emotional or basic hygiene care that Nightingale focused on, yet depend on the nursing assistants to complete the tasks. I believe that providing the personal care allows the patient and nurse to bond, thus provided for a more therapeutics and more positive healing environment, as the Curley & Patricia (2006) study found. Nurses should take pride in providing the best care and emotional support for their patients to ensure the most adequate condition for healing to take place.
Conclusion
