The Creation of a Theory
A nursing theory is a group of concepts that guide a nurse in practice. It gives a specific guideline to view a phenomenon using deductive and inductive reasoning.
The purpose of this assignment is to explore how a nursing theory is created. I will step into the place of a theorist and describe the journey “I” took in developing “my” theory. I will be assuming the role of Florence Nightingale and the development of her Environmental Theory.
Theory Development
First Stage
It is at this time in my life when I need to find meaning in what I do. God has called me into his service, though at the time I was unsure what that service would be, I will serve him by caring for the sick (Snowden, Donnell, & Duffy, 2010) . I have discovered that nursing is achieved through alterations in the environment and furthermore nursing is separate and distinct from medicine. Nursing is not just the administration of medicines and poultices. There is art and science involved in nursing (Theory of Florence Nightingale, 2012).
Second Stage
“In watching diseases, both in private houses and in public hospitals, the thing which strikes the experienced observer most forcibly is this, that the symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different–of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of each or of all of these” (Nightingale, 1860/2017, p. 8).
I believe an alteration in one’s environment is necessary to bring about a change in one’s health or recovery from illness. I have discovered that observation is the key to good nursing care (Snowden, Donnell, & Duffy, 2010). Through observation alone, especially undetected observation, one may discover a multitude of information. Is one truly ill? Are they seeking attention? Are they just in need of rest, and seeking solitude? There are several observations that I have discovered which I believe will aide one in nursing an individual back to health. They are the basic principles, or canons of nursing that are essential to one’s well-being.
Third Stage
Ventilation and warmth. We must keep the patient’s room warm and well ventilated. That is to say a nurse must “keep the air he breathes as pure as the external air, without chilling him” (Nightingale, 1860/2017, p. 11).
Health of houses. This includes five necessary principles for the health of an individual: pure air, pure water, efficient drainage, cleanliness, and light (Butts & Rich, 2018). “Without these, no house can be healthy” (Nightingale, 1860/2017, p. 16).
Petty management. It is ever so important for the continuity of care for the patient in times of the nurse’s absence (Butts & Rich, 2018). No one shall be able to care for the sick or injured as well as the nurse, however it is unfeasible for the nurse to always be there. In these instances, the management of a patient must be carried out by another. “Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done?” (Nightingale, 1860/2017, p. 23).
Noise. Quiet and rest are essential for the betterment of the sick. “Of one thing you may be certain, that anything which wakes a patient suddenly out of his sleep will invariably put him into a state of greater excitement, do him more serious, aye, and lasting mischief, than any continuous noise, however loud” (Nightingale, 1860/2017, p. 25). One must always be aware of noises surrounding a patient and their room. Waking a patient after just mere minutes of sleep does more harm than waking one after several hours of sleep. Remember this always.
Variety. The sick may spend many hours isolated in one room without any relief from their continual surroundings. It is the nurse’s duty to provide variety in a patient’s surroundings to avoid boredom and depression (Butts & Rich, 2018, p. 427). I have seen, in fevers (and felt, when I was a fever patient myself), the most acute suffering produced from the patient (in a hut) not being able to see out of window, and the knots in the wood being the only view” (Nightingale, 1860/2017, p. 32).
Food intake. Maintaining appropriate intake is important in helping the sick to recover. Monitoring the amount of food and liquid intake will help the nurse to determine whether to increase or decrease a person’s nutrition. It is difficult for the very weak to consume any solid food before 11 am. “A spoonful of beef-tea, of arrowroot and wine, of egg flip, every hour, will give them the requisite nourishment, and prevent them from being too much exhausted to take at a later hour the solid food, which is necessary for their recovery” (Nightingale, 1860/2017, p. 35).
Food. Nutrition is important for regaining strength in the sick and weak. Therefore, patient preferences must be taken into consideration when contemplating meals (Butts & Rich, 2018). Essential vitamins should be included to help strengthen the sick, as well as including choices that are pleasing to the palate.
“In laying down rules of diet, by the amounts of “solid nutriment” in different kinds of food, it is constantly lost sight of what the patient requires to repair his waste, what he can take and what he can’t. You cannot diet a patient from a book, you cannot make up the human body as you would make up a prescription, –so many parts “carboniferous,” so many parts “nitrogenous” will constitute a perfect diet for a patient” (Nightingale, 1860/2017, p. 39).
Bed and bedding. Comfort of the sick should be maintained to facilitate recovery. The bed should be kept dry and wrinkle free (Butts & Rich, 2018). If you take into consideration the amount of moisture released by the lungs and skin of the healthy individual, consider then how much is released by the ill, by the feverish. Then one must think where does this moisture go? Into the bedding, because there is nowhere else to go (Nightingale, 1860/2017).
Light. “It is the unqualified result of all my experience with the sick, that second only to their need of fresh air is their need of light; that, after a close room, what hurts them most is a dark room” (Nightingale, 1860/2017, p. 46). Sunlight improves one’s mood, one’s humor, and most of all one’s health. The windows should be kept open to let the natural light in.
Cleanliness of rooms and walls. This particular principle can really stand for itself. Dirt breeds germs and illness. Dirty walls and floors bring forth illness and infection. It is of utmost importance to keep these surfaces clean.
Personal cleanliness. It is not necessary to educate the nurse to keep herself clean or, therefore, to keep her patient clean “seeing that the greater part of nursing consists in preserving cleanliness” (Nightingale, 1860/2017, p. 48).
Chattering hopes and advice. One must avoid talking without a reason or, for that matter, avoid giving advice that is not supported by fact (Butts & Rich, 2018). “I would appeal most seriously to all friends, visitors, and attendants of the sick to leave off this practice of attempting to “cheer” the sick by making light of their danger and by exaggerating their probabilities of recovery (Nightingale, 1860/2017, p. 53).
Observation of the sick. One must continually assess, observe, and document behaviors of the patient.
“The most important practical lesson that can be given to nurses is to teach them what to observe–how to observe–what symptoms indicate improvement–what the reverse–which are of importance–which are of none–which are the evidence of neglect–and of what kind of neglect” (Nightingale, 1860/2017, p. 58).
Fourth Stage
Evidence. How can Florence Nightingale’s environmental theory tie in with evidence-based practice? According to Lim (2017), “In her most famous work, Notes on Nursing: What It Is and What It Is Not, she advised readers, ‘Let experience, not theory, decide upon this as upon all other things.’ Evidence-based practice is the offspring of experience and critical analysis. In both areas, Nightingale excelled.”
In nursing today, nurses are overwhelmed by policies and procedures, protocols and “bundles” to assure patient safety. Despite this, there is still an astonishing number of adverse events and serious safety events. “The challenge isn’t the lack of an evidence base, but lack of commitment by some healthcare providers to practice to the full extent of their education and training” (Lim, 2017, para. 7). For Nightingale, it wasn’t enough to know. ‘I think one’s feelings waste themselves in words,’ she wrote. ‘They all ought to be distilled into action, and into actions which bring results.’ (as cited in Lim, 2017).
Without knowing at the time, Florence Nightingale was developing evidence for evidence-based practice. She expressed the importance of cleanliness, sanitation, and avoidance of germs. She indicated that patients healed faster if the materials used to treat them were clean and if physicians washed their hands. As she worked to guide the medical practices of her day, her idea remained that “What you want are facts, not opinions” (Nightingale, 1860/2017).
Conclusion
Florence Nightingale was the founder of modern nursing and, therefore, began the creation of nursing theories. Nightingale’s environmental theory of nursing was the result of her trying to describe nursing and outline general rules for nursing practice.
“I need hardly here repeat the warning against any confusion of ideas
between cold and fresh air. You may chill a patient fatally without giving him
fresh air at all. And you can quite well, nay, much better, give him fresh air
without chilling him. This is the test of a good nurse” (Nightingale, 1860/2017, p. 68).
References
Butts, J. B., & Rich, K. L. (2018). Philosophies and theories for advanced nursing practice (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Lim, F. (2017). American Nurse Today. Retrieved from American Nurse’s Association: https://www.americannursetoday.com/florence-nightingale-moments-of-interface-between-past-and-present/
Nightingale, F. (1860/2017). Notes on nursing: What it is and what it is not. [Kindle version]. Enhanced Media. Retrieved from Amazon.com
Snowden, A., Donnell, A., & Duffy, T. (2010). Pioneering theories in nursing (Kindle version ed.). London, England: MA Healthcare Ltd. Retrieved from Amazon.com
Theory of Florence Nightingale. (2012). Retrieved from Nursing theories: A companion to nursing theories and models: http://currentnursing.com/nursing_theory/Florence_Nightingale_theory.html
