They are at the forefront in preventing hospital-acquired conditions (e.g., pressure injuries, bloodstream infections, ventilator-associated pneumonia), promoting improved patient outcomes, and reducing healthcare costs (Delp et al., 2016; Duffy et al., 2014; Fulton et al., 2019; Heitkemper & Bond, 2004). Enhances patient testimonial, and offers information relevant to the patient. CNSs demonstrate their influence and impact on systems of care delivery, which resonates with Nightingales vision of healthcare. and barriers to promoting health in practice were included in the review. For the past 12 years she has worked as a psychotherapist, manager, staff educator, patient and family advocate and nurse consultant in long term care and dementia nursing. Health professionals still celebrate her life and work, and her theories about patient care and public health remain influential. doi: 10.1590/0034-7167-2020-1306. She surveyed the organizations human resources, determined the members for the interdisciplinary teams, and assigned them accordingly to set projects in motion to support the wellbeing of the patients. Nightingales beliefs about nursing standards and practice, advocacy and training; and impact within systems of care delivery are reflected in the CNS principles and spheres of impact: direct patient care; nurses and nursing practice; and healthcare environment, systems, and organizations (NACNS, 2019). Elsevier Saunders. Clinical Nurse Specialist, 12(1), 3-5. Dr. Phyllis Whitehead is a clinical ethicist and clinical nurse specialist with the Carilion Roanoke Memorial Hospital Palliative Care Service and Associate Professor at the Virginia Tech Carilion School of Medicine. CNS leaders cultivate power and influence cumulatively from their attributes, intentionality, supportive relationships, communication skills, coalition building, and rational persuasion (Adams & Natarajan, 2016; Fulton et al., 2019). (1998). Marion Kyner has been practicing nursing for over 38 years and has been a Board Certified Clinical Nurse Specialist since 1993 following graduation in 1990 from UVA’s Master’s Program in Psychiatric Mental Health Nursing. At the completion of their training, the orderlies were required to demonstrate competencies to receive their qualification certificates from nurse matrons. Pediatric Intensive Care Unit: reflection in the light of Florence Nightingale's Environmental Theory. What is nursing professionalism? The role of the CNS in achieving and maintaining Magnet status. Jennifer H. Matthews, PhD, RN, A-CNS, FAANEmail: jmatthewsrn@comcast.net, Jennifer Matthews is a clinical nurse specialist in Adult Health. This theory was proposed in 1968 by Dorothy Johnson. In the era that we are in today, we are faced with environmental conditions beyond what ought to be natural and nurturing. Cardoso SB, Oliveira ICDS, Souza TV, Carmo SAD. Clinical application of Nightingales environmental theory By individualizing each environment, healing could be created and deeper relationships between the patient and nurse could form. She is the current president of the Virginia Association of Clinical Nurse Specialists, and is also a member of the National Association of Clinical Nurse Specialists, Academy of Medical-Surgical Nurses, and Sigma Theta Tau. endobj She didnt even attempt to define what good health would actually be. 359 391). Nightingale believed that there were many natural elements that could help a patient begin to have their health restored. Advances in Nursing Science, 39(3), E40-E56. Nightingales belief that disease is caused by miasmas, meaning they spontaneously occur due to dirty and ill-ventilation, is not accurate. The Queen rewarded Nightingales work by presenting her with an engraved brooch that came to be known as the Nightingale Jewel and by granting her a prize of $250,000 from the British government. Nightingale theory conceives of the patient as a central agent in his own healing. "Nursing Theories & Practice"; Marilyn Parker; 2006. The ultimate goal is to optimize patient care and individualize care delivery to attain health for men, women, children, and the family in the context of their communities, just as Nightingale role modeled improvements and holistic care for soldiers at Scutari (Chan & Cartwright, 2014; Fulton et al., 2019; Heitkemper & Bond, 2004; McDonald, 2018; Miracle, 2008). To see the Lady with the Lamp, or her shadow cast by its glow, gave them hope and a sense of belonging (Cohen, 1984). Views the individual as an adaptive system their environment and health. She was adamant that the nurse was not just an assistant to the physician (Baly, 1997) and that training embodied teaching the nurse to help the patient live well (McDonald, 2018). Articulations of antimicrobial resistance in trade union financed journals for nurses in Scandinavia - A Foucauldian perspective. Results: Nightingale analyzed the proposals (with the accompanying background politics) and felt state registration: would exclude working class nurses; was dependent solely on a written examination, with no account for compassion and skills; lacked adequate controls to prevent medical men from controlling the profession, making nursing a legal profession inseparable from medicine (Helmstadter, 2007, p. 160); and, finally, the intent of the leaders lacked professional ethics (Helmstadter, 2007). She asserted that whispered or long conversations about patients are thoughtless and cruel. . However, there is no one "universal" nursing theory. Nightingale states there are five basic concepts to consider which must all be present for houses to provide a healthy environment: pure water, pure air, efficient drainage, cleanliness and light. Illustrated by Tables and Diagrams (for which she was credited). Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BCEmail: cwward@carilionclinic.org, Marion Kyner, MSN, RN, CNSEmail: mkyner@kinex.net. As a result of these onsite sanitary reforms, the hospital mortality dropped an unprecedented rate, from 42.7% to 2.2% (McDonald, 2014; Miracle, 2008; Neuhauser, 2003). Federal government websites often end in .gov or .mil. This model postulate that the primary role of nursing is to assist the individual to adjust to changes in self-concepts, physiological needs and interdependent relations. Citation: Matthews, J.H., Whitehead, P.B., Ward, C., Kyner, M., Crowder, T., (May 31, 2020) "Florence Nightingale: Visionary for the Role of Clinical Nurse Specialist" OJIN: The Online Journal of Issues in Nursing Vol. In McEwen, M. and Wills, E. Applied in the nursing process of pattern manifestation and knowing appreciation. Cook (1913a), a contemporary of Nightingale who exalted her extraordinary abilities, revealed from her letters to him, I work in the wards all day and write all night (p. 234). Her mother and sister were against her chosen career, but Nightingale stood strong and worked hard to learn more about her craft despite societys expectation that she become a wife and mother. As a change agent she helps families and care partners learn positive care skills for coping with the disease of dementia and to raise professional and community awareness of dementia and available resources. Clipboard, Search History, and several other advanced features are temporarily unavailable. She encouraged nurses to wash their hands frequently throughout the day as a way to fend of illness. She is certified in pain management and as an advanced practice hospice and palliative care nurse. This author extracts the environmental theory from Florence Nightingale's writings and recorded experiences. I am proud to be a nurse! Nightingale became known as The Lady with the Lamp. During the Crimean War, she initially made her rounds on horseback and at night used an oil lamp to light her way, then reverted to a mule cart and finally a carriage with a hood and curtains. Nightingales critical thinking and problem analyses; implementation of interventions and positive outcomes; advancement of nursing practice based on evidence; detailed documentation and statistical analysis; and tenacious political advocacy to reform healthcare systems resembles the role of the CNS as an expert clinician, nurse educator, researcher, consultant, and leader in healthcare systems and policy creation. Judd, D., & Sitzman, K. (2014). She died unexpectedly at 2 pm the following day, Saturday, August 13, at her home in London. Careers. Dr. Matthews has worked at the national level for the American Nurses Association and continues policy work with that organization. Requires many healthcare personnel which may not be possible since the shortage of healthcare personnel in a phenomenon not only experienced in the United States but also other parts of the world In this way, the best care possible could be provided. As a change agent she helps families and care partners learn positive care skills for coping with the disease of dementia and to raise professional and community awareness of dementia and available resources. She was a proponent of the early sanitarian movement that created the 1848 British Public Health Act (Gill & Gill, 2005). By 1859, Nightingale had spent many hours contemplating what nursing is and what it is not, described in her famous writing Notes on Nursing (Baly, 1997; Cook 1913a; 1913b; Nightingale, 1859). The theory is most based in the values such as concern and love for other individuals, kindness and honour for the personal spiritual dimension. She is recognized as the founder of modern nursing. ii. AcknowledgementThe authors gratefully acknowledge Kimberly Carter, PhD, RN, NEA-BC for her thoughtful review and critique of this manuscript. Prior to working in geriatrics, she worked for over 25 years in addictions nursing as a consultant, counselor, educator and coach. It illuminates patients choices and addresses noncompliance, thus nurses become more compassionate, reverence and more joyful in their job. Nightingale remained at Scutari for a year and a half. i. Nightingale supported the importance of looking beyond the individual to the social environment in which they lived. 12 0 obj Florence Nightingale is well known as the mother of nursing, aptly recognized as Lady in Chief, immortalized as the Lady with the Lamp, and revered as a visionary and a catalyst for healthcare reform. 2015 Oct;26(4):156-62. doi: 10.1111/2047-3095.12059. On the architectural aspect of the hospital, the proper ventilation applies. (Com. The model was sourced from research and has been used over the years to postulate nurses research, practice and education. application/pdf Additionally, Nightingale is celebrated as an administrator, patient advocate, hospital reformer, and pioneer in the use of statistics which she used to support her political activism. Within ten days, at her direction, the engineers created two extra dietary kitchens and established three supplementary boilers (Andrews, 1929) which were used to make broths and a nutritious arrowroot supplement. Methods: this is a theoretical reflection, for which scientific productions on Florence Nightingale's environmental theory, as published in national and international journals, were based. In 2020 she was elected as a Distinguished Practitioner Fellow in the National Academy of Practice in Nursing. The greatest barrier to effective application of any nursing theory is trying to employ the wrong type of theory, or model, in a particular nursing situation. Water pollution and poor air quality remain to be the greatest barriers to nightingale theory. Womens History Review, 19(5), 721740. This acts as a deterrent for nurses who are caring for these patients because it can cause psychological drainage which can affect other patients who are receiving care (Dennis & Prescott, 1985). Healthy environmental conditions can only go so far in treating disease and illness. Cook, E. T. (1913b). Florence Nightingales Environmental Theory defined Nursing as the act of utilizing the patients environment to assist him in his recovery.. According to Lee, Clark, and Thompson,The Nightingale Initiative for Global Health aims to rekindle awareness of Florence Nightingales work and aims to have a healthy world by 2020 (2013). The greatest barrier to effective application of any nursing theory is trying to employ the wrong type of theory, or model, in a particular nursing situation. Nightingales model for education laid the foundation in the 1960s for advanced practice nursing and expanded graduate level education (Judd & Sitzman, 2014). She also created roles for her staff that reflected patient need.Sphere #1: Direct Patient CareNightingale independently developed her role, an unprecedented and pioneering feat. She has a Masters in Nursing from Virginia Commonwealth University and a Masters in Business Management from Troy State University in Alabama. Florence Nightingale: Part I. Strachey, Lytton. Patients enjoy a better healing environment as the theory enhances and nurtures nurses caregivers role. Fulton et al. This lack of understanding may point to an inadequate educational background and lead to unsatisfactory patient care. Spiritual Self-Care Management for Nursing Professionals: A Holistic Approach. Notes on nursing: What it is and what it is not. Unauthorized use of these marks is strictly prohibited. The patients have the potential and knowledge to comprehend what has made them sick. Nightingale is the first nurse theorist well-known for developing the Environmental Theory that revolutionized nursing practices to create sanitary conditions for patients to get care. 8600 Rockville Pike And environment of patient is achangeable thing. Deficiencies in these five factors produce illness or lack of health, but the body could repair itself with a nurturing environment. She was a member of the ANA Moral Resilience Advisory Committee. The theory through its step allows self-reflection for patients. doi: 10.1590/0034-7167-2020-0139. Dr. Cindy Ward received her initial RN education at the Virginia Baptist Hospital School of Nursing in Lynchburg, VA. She received a BSN and MSN from the University of Southern Indiana and DNP from Radford University. An official website of the United States government. Rev Gaucha Enferm. With the idea of providing light, the light emitted by the sun today is proven to be harmful already because of the destruction of the Earths ozone layer. 146-147). Epub 2022 Dec 24. The five essential components to optimal healing remain a vital part of global health and these include pure air, pure water, efficient drainage, cleanliness, and light (Lee, Clark, & Thompson, 2013). Nearly a century after the death of Florence Nightingale (1820-1910), historians continue to debate her legacy. Dimensions of Critical Care Nursing, 27(1), 2123. Careers. Florence Nightingale was raised on the family estate at Lea Hurst, where her father provided her with a classical education, including German, French, and Italian studies. 2022 Jun 28;61(3):181-190. doi: 10.2478/sjph-2022-0024. She arrived in Constantinople, Turkey, with a company of 38 nurses. (Vol 2). CNS clinical expertise competencies are assured by the specialty standards of practice and care within the nurse and nursing practice sphere. Existing food preparation was inadequate and there was often no fuel for cooking fires. and transmitted securely. National Library of Medicine Angelo aims to build a good foundation for aspiring nurses. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Angelo Gonzalo earned his Nursing degree in the year 2010 and continued his studies at St. Paul University Manila taking up Masters of Arts in Nursing Major in Clinical Management. doi: 10.1590/1983-1447.2021.20200228. The following section is an abbreviated review of Nightingales work at Scutari includes topics noted that reflect todays CNS spheres of impact. PMC In her theory, Nightingales writings reflect a community health model in which all that surrounds human beings is considered concerning their health state. She is a clinical nurse specialist at Carilion Roanoke Memorial Hospital in Roanoke, VA, providing consultation and analysis of nursing practice issues related to the medical-surgical specialty area, with a focus on improving outcomes and decreasing the incidence of venous thromboembolism. She is member of the National Association Clinical Nurse Specialists, Virginia Association of Clinical Nurse Specialists, American Association of Critical Care Nurses, and Greater Fredericksburg Area Chapter-AACN. A history of nursing: From ancient to modern times, a world view(5th ed.). iii. In A. official website and that any information you provide is encrypted Marion is a member of the American Psychiatric Nurses Association, the National Association of Clinical Nurse Specialists, the Virginia Association of Clinical Nurse Specialists, and the Virginia Nurses Association. Pediatric Nursing, 40(2), 87-90. She noted that direct sunlight was what patients wanted. Nightingales theory can be applied in order to help control the severity of fungal growth and decrease the risk of secondary infections (Howett, Connor, & Downes, 2010). As the low to middle income countries become more industrialized, these diseases are predicted to increase. In 1860, her best-authored works were published, Notes on Nursing, outlining nursing principles. iii. A healthy environment indeed heals, as Nightingale stated. 2022 Feb 22;65(1):1-22. doi: 10.1192/j.eurpsy.2022.9. Bethesda, MD 20894, Web Policies To achieve her outcomes, she secured and channeled resources as she revised workflows and created new systems in a way similar to a CNS practice. (Original publication 1859). Nightingale identified two major barriers to the implementation of her theory. Federal government websites often end in .gov or .mil. An official website of the United States government. The US Navy launched a namesake troop transport during World War II, USS Florence Nightingale, which served gallantly during the course of the war, receiving four battle stars. Perceived Barriers and Enablers of Nursing Research in the Italian Context: Findings from a Systematic Review. Florence Nightingale: A CNS role model. Prior to working in geriatrics, she worked for over 25 years in addictions nursing as a consultant, counselor, educator and coach. By configuring the environment of a patient so that it best meets their needs at that moment, it would assist in the healing process. Using immediate funds and her newly devised requisition system, Nightingale shortened the 2,000-mile supply chain from England to buy many goods and staples from local vendors (Cook, 1913a). Unable to load your collection due to an error, Unable to load your delegates due to an error. Florence Nightingale (1820-1910), considered the founder of educated and scientific nursing and widely known as "The Lady with the Lamp", [1] wrote the first nursing notes that became the basis of nursing practice and research. Nightingale wanted meat de-boned and gristle removed before serving, a request that caused medical officers to complain about giving too much indulgence to soldiers; they overruled her for that moment (Andrews, 1929, p. 149). The concepts of Nightingale's theory are the metaparadigm of nursing, that is person, health, nursing, and environment are very strongly connected to each other. After her convalescence in England, she began 50 years of documenting her observations and proposals for policy changesNotes for Healthcare Policy. At seventeen, she decided to dedicate her life to medical care for the sick resulting in a lifetime commitment to speak out, educate, overhaul and sanitize the appalling health care conditions in England. Clinical nurse specialists number more than 70,000 advanced practice registered nurses (APRN) (NACNS, 2019) with clinical expertise in defined areas of nursing knowledge. endobj Florence Nightingale wrote in her Environmental Theory that to falsely cheer the sick by making light of their illness and its danger is not helpful. 42 0 obj Her stance was registration should be centered on clinical competence and expertise evaluated by nurse experts currently working or training nurses (Helmstadter, 2007). 2023 Leaf Group Ltd. / Leaf Group Media, All Rights Reserved. In . In this way, the best care possible could be provided. i. She grounded her persuasive narratives in statistical evidence. She mobilized collaborators, shaped public awareness, and . In regards to cleanliness, hand hygiene is still a leading concern and is primarily responsible for hospital-acquired infections. She believed that nurses who attempted to falsely cheer up a patient were not creating an appropriate environment. Having close family or friends near to the patient, although it could sometimes be a hindrance, would ultimately improve the environment for the patient. Human beings are not defined by Nightingale specifically. Nursing "grand theories" are general concepts that pertain to the overall nature and goals of professional nursing. Terri continues part-time practice at Mary Washington Hospital as a clinical ICU nurse; as Adjunct Faculty- University of Mary Washington, RN-BSN program; and as Adjunct Faculty- Aspen University, RN-BSN program. The theory makes nurses to nurture and care for every patient with prior knowledge of and respect to individuals differences. Although her ideas met official resistance, they inspired the volunteer body of the United States Sanitary Commission. Clipboard, Search History, and several other advanced features are temporarily unavailable. endobj Terri is currently Secretary for VaCNS and GFAC-AACN associations. She is a Board of Director member of the National Association of Clinical Nurse Specialist and co-lead of the Virginia Nurses Foundation/Virginia Action Coalition. Theory enhances interpersonal relationship in nursing caring behavior as it portrays nurses as moral agents. Nightingale also encouraged nurses to look at the importance of a patients social networks. Bainbridge Books. She was a prolific writer and often was the silent author for Blue Books, official investigation reports from Royal Commissions that were presented to Parliament and the Queen. Environment The environment plays a very vital role in maintaining health andwellbeing and promoting recovery. (n.d.). She continues to be an advisor on the editorial board for the Online Journal of Issues in Nursing. Hospital-acquired infections are one of the . Nightingale noted many waterborne diseases such as cholera, dysentery and typhoid during her time, and these diseases are still responsible for many deaths today. In 1856, Nightingale was sickened by amoebic dysentery which caused her to be an invalid until her death in 1910. Nightingales Environmental Theory has broad applicability to the practitioner. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Your email address will not be published. Thanks, Florence Nightingale, for curing human lives it encourages me to become a good professional nurse. She is a founding member and Board of Director member of the Virginia Association of Clinical Nurse Specialists. Theory is applied in addressing the increasing challenge in nursing burnout. It was reported that she was happiest during the time spent with patients (Gill & Gill, 2005). US title Florence Nightingale. She discussed the need for color and form changes, including bringing the patient brightly colored flowers or plants. They also serve as frameworks for research. official website and that any information you provide is encrypted Dr. Whitehead has done numerous presentations on pain and symptom management, opioid induced sedation, moral distress, and patients end of life preferences locally, regionally, nationally and internationally. This included things as simple as ventilation and clean water, to now modern evidence-based practices utilized by nursing today. Nightingale challenged nurses to create environments where population health is a realistic expectation. In this way, the model must be adapted to fit the needs of individual patients. Cao H, Song Y, Wu Y, Du Y, He X, Chen Y, Wang Q, Yang H. BMC Nurs. Putnams Sons. She is recognized as the founder of modern nursing. Nightingales model for education laid the foundation in the 1960s for advanced practice nursing and expanded graduate level education. Jennifer H. Matthews, iD https://orcid.org/0000-0002-9713-6910, Phyllis B. Whitehead, PhD, APRN/CNS, ACHPN, RN-BC, FNAPEmail: pbwhitehead@carilionclinic.org. ed.). doi: 10.1590/0034-7167-2020-1306. Clinical Infectious Diseases, 40(12),1799-1805. doi: 10.1086/430380, Heitkemper, M. M., & Bond, E. F. (2004). Dr. Phyllis Whitehead is a clinical ethicist and clinical nurse specialist with the Carilion Roanoke Memorial Hospital Palliative Care Service and Associate Professor at the Virginia Tech Carilion School of Medicine. i. Facilitation- the nurse helps the patient take steps toward health, including providing necessary resources and information, ii. Cohen, I. Copyright 2023 Leaf Group Ltd. / Leaf Group Media, All Rights Reserved. Given her definition that the art of nursing is to unmake what God had made disease, then the goal of all nursing activities should be client health. While at Scutari, she mentored her nurses so their expertise would broaden, especially in wound care, and as she rotated her expert nurses to other area military hospitals. Online ahead of print. She valued the experiences she learned in these army hospitals and later, when designing the curriculum for nurses, she ensured that basic practices of hygiene and germs as infectious agents were taught to the students (McDonald, 2010). ), Advanced practice nursing: An Integrative approach (5th ed., pp. Key Words: Florence Nightingale, clinical nurse specialist; CNS; spheres of impact.
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