Florence Nightingale and Environment Theory
According to most nursing historians, Florence Nightingale is the leading figure in the development of modern nursing. As an early innovator in the field, Nightingale would pioneer many of the ideologies and approach which are still in circulation today. In particular, nursing professionals in her wake would coin the term Environment Theory in order to describe the mode of care that would be her contribution to modern medicine. As the discussion hereafter denotes, this theoretical model would be driven by Nightingale's view that health and treatment outcomes are directly related to the context and conditions within which a patient received care.
Description of Environment Theory:
This is underscored by a basic conceptualization of the Environment Theory. The text by Tomey & Alligood (2005) provides a useful preliminary understanding of this mode of treatment, specifying that during the 19th century that served as a backdrop to Nightingale's work, she never actually used to the term 'environment' to describe her approach. Moreover, it is not sufficient to limit the meaning of environment to modern expectations that this describes one's surroundings. To the contrary, Tomey & Alligood report that "although Nightingale never used the term environment in her writing, she did define and describe in detail the concepts of ventilation, warmth, light, diet, cleanliness, and noise -- components of surroundings that have come to be known as environment in discussions of her work." (p. 75)
The text by Tomey & Alligood goes on to remark that for Nightingale, the nature of this environment hinged significantly on factors beyond just these physical ones. As Nightingale viewed it, the patient's health and the treatment outcomes would be directly impacted by a host of conditions that included but could not be limited to such external conditions. Accordingly, Tomey & Alligood report that "although Nightingale defined concepts precisely, she did not distinguish aspects of the patient's environment as physical, emotional, or social." (p. 75) This should be considered an important point of consideration as we move into a more detailed discussion on the concepts related to her environment theory, particularly as we hone in on the ways that Nightingale both conceptualized and treated the patient. The notation of emotional and social realities as part of the treatment environment would denote an intuitive and innovative recognition of the more abstract human qualities that impact a treatment experience and the likely set of health outcomes.
In spite of the considerable opportunities afforded Nightingale by her aristocratic upbringing, her work as a nursing professional would also drive her personal development. Specifically, the educator, philosopher and field nurse would expose herself without reservation to risk and sacrifice in order to achieve goals impacting large groups of people. As Attewell (1998) explains through the words of a close colleague to Nightingale, we can see that the willingness of one to give of herself to such a cause would be tantamount to her ultimate influence on the field and the world as a whole. Accordingly, the colleague would ponder of Nightingale, "how many thousand soldiers […] are now alive owing to your forethought and diligence; how many natives of India in this generation and in generations to come have been preserved from famine and oppression and the load of debt by the energy of a sick lady who can scarcely rise from her bed." (Attewell, 166) For Nightingale, the call of her life's work would constitute a sufficient cause to withdraw from many demands and opportunities in her personal life, where she would fend off such traditional notions as marriage, motherhood and female secondary status in order to serve as a nurse and care provider with total devotion. Many of the emotional attachments that other women might have reserved for the extension of a personal support system or social circle she dedicated to those for whom she provided critical treatment.
During the Crimean War, she would be sent to Turkey to lead a troop of nurses to a soldier hospital where she found conditions to be deplorable. Overcrowding, poor ventilation, improper working spaces and a total lack of sanitation had caused extremely high mortality rates, prompting her dispatch. When there, according to Cook (1913), Nightingale would be noted for her tireless efforts, which in application to the 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." (Cook, 237). Again, the theme of personal sacrifice emerges as important in identifying her as a nurse, a leader and a figure of great importance in the history of her profession. Likewise, we are given an indication that her service would, importantly, be a point of inspiration, for her great status in the profession would be paralleled by her great tenacity in performing the rigorous duties there implied.
Concepts in Nursing Practice/Education:
In light of the extensive dedication shown by Nightingale in the treatment of soldiers, we come to understand her view of the person in the process of treatment. Many modern theories tend to address the patient as a person and to emphasize the treatment of an individual rather than of a sickness. In Nightingale's time, this view is in its fledgling states. Therefore, from a Nursing Practice perspective, her emphasis seems less on empowering the patient and more on providing the patient with a powerful advocate. Accordingly, we define patient advocacy most essentially as the manner in which nurses work to protect patient needs, priorities, preferences and desires as they are moved through the healthcare system. Where individuals are otherwise incapable either physically or because they lack the wherewithal to do so, this role of advocacy can be the only force ensuring that the patient's wishes are not violated or determining that the patient is receiving the appropriate care. As Beyea (2005) indicates, "since the time of Florence Nightingale, nurses have served in this important role, advocating for health care improvements related to infection control, practice and patient care environments, and access to care. Regardless of the practice setting, every encounter a nurse has with a patient provides an opportunity for that nurse to serve as a patient advocate." (p. 1)
This denotes that in a certain regard, the relationship established between the nurse and the patient is likely to be among the most personal and intimate forged during a hospital or healthcare facility stay. Therefore, it is incumbent upon the nurse to use this relationship as a way of promoting the patient's interest, even as interests such as hospital administration, cost control and procedural normalcy may come into opposition of these interests. That said, Nightingale would also provide in her role as a nurse educator for the importance of some level of patient empowerment through training in self-care and through effective consultation in learning the patients wishes and needs. These steps would help to shape the view of the patient as a person rather than as a collection of symptoms.
With respect to nursing practice, Nightingale viewed health as the primary and shared goal between the patient and the professional. In other words, it would fall upon the practicing nurse to use every means including the will and emotional dedication of the patient in order to help bring about a positive remission of illness or injury. Accordingly, "Nightingale defined health as being well and using every power (resource) to the fullest extent in living life." (Tomey & Alligood, 77)
This would promote the notion in nursing education of nursing as being centered on the improvement of health prospects, life-expectancy and quality of life. Tomey & Alligood suggest that, in fact, the emergence of public health as a concept and through various agencies is a function of this idea that nurses are inherently responsible for improving the short- and long-term health prospects of all potential patients.
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