Nightingale and Orem Nursing Theories in Geriatric Care

Introduction

The first foundational theorist of nursing is Florence Nightingale, whose 19th-century tract Notes on Nursing was the first attempt to standardize medical practice and to approach nursing in a thorough and professional manner. Nightingale's writings rehabilitated nursing from being regarded as a second-class profession to a respectable one. Her work also contains many foundational concepts useful to nurses, particularly in the field of geriatric medicine, even today. This paper reviews the core concepts of Nightingale's theory, examines how they remain applicable to nursing today — with a specific emphasis on geriatric nursing — and details how a modern theorist, Dorothea Orem, advanced concepts that are in many ways resonant with Nightingale's.

Nightingale's Core Principles and Their Geriatric Applications

In her introduction to Notes on Nursing, Nightingale notes that disease is a reparative process, not something to be regarded as evil in itself. For example, we know today that unless a fever is extremely high, it actually raises the body's temperature for a specific physiological purpose and should not necessarily be immediately suppressed. Nightingale believed that nursing had limited itself far too narrowly to simply alleviating disease rather than creating a health-promoting environment. Providing the patient with fresh air, warmth, and a proper diet was often more essential than medical treatment alone, so that the illness could run its natural course. That is why Nightingale's first foundational principle was the need for ventilation (Nightingale, 2010, p. 10).

The first tenet of Nightingale's theory was the need for clean air — something that could not be taken for granted given the common state of buildings in 19th-century cities. Today, the fact that diseases circulate more easily in winter because of closed rooms is well understood, but that was not the case in Nightingale's day. Sick rooms were often kept shut for fear that the patient would catch a chill in an era before centralized heating, and exterior air was frequently foul even when windows were open. Nightingale was unsparing in calling it murderous to confine someone severely ill with scarlet fever in a closed room. The objective of nursing, she argued, is to keep the air indoors as pure as it is outdoors, without chilling the patient (Nightingale, 2010, p. 12). For patients in geriatric care, the structure of many facilities often provides little motivation to take patients outside on a regular basis. However, with proper supervision, regular exposure to fresh outdoor air would likely benefit them in line with Nightingale's principles.

Diet, Mental Well-Being, and Environmental Attentiveness

Nightingale also stressed the importance of the patient's diet. Once again, this resonates with her emphasis on promoting wellness rather than treating illness alone. More and more patients today suffer from chronic conditions such as diabetes and heart disease — the legacy of lifestyle-related factors associated with obesity. Patients are never too old, or too young, to benefit from a healthier diet. Unfortunately, many hospitals and nursing homes do not consistently provide nutritious food. Encouraging elderly persons to eat can be difficult, and they may lack important macronutrients. Encouraging physical activity can also help patients regulate their dietary intake, as can the psychological benefits derived from a nurse's attentiveness. Nightingale notes that something as simple as timing a patient's meals can have a significant impact on their responsiveness (Nightingale, 2010, p. 69). Even when a patient is not immediately receptive to food, they may feel more willing to eat at a later time.

Nightingale was also an early advocate of the mind-body connection. People who are ill need mental relief and often lack it. Nightingale urges nurses to feel compassion for ailing individuals denied the traditional comforts of manual labor, walking, and the other activities that healthy people take for granted (Nightingale, 2010, p. 62). It is essential that the nurse provide relief through her demeanor and do all she can to alleviate the patient's psychological distress. Similarly, a geriatric nurse today can alleviate considerable mental suffering simply by taking a genuine interest in a patient's welfare. Asking about the patient's past and evaluating their mental state in the present can make the physical limitations they are experiencing much more bearable. This concept of caring as a scientific component of nursing — rather than merely generalized compassion — would resonate with many later nursing theorists, including Jean Watson.

Other important observations Nightingale makes regarding the care of the sick include the need for appropriate bedding, clean walls, and a well-maintained overall appearance of the sick room. In many nursing homes, pressure ulcers are significantly linked to adverse patient outcomes due to insufficient repositioning of patients. Nightingale underlines the need for attentiveness to such small issues, which can escalate into larger ones. A Chief Nursing Officer must institute policies that actively support such health promotion.

Overall, attentiveness to fundamental human needs — not strictly medical needs — is at the heart of Nightingale's writings. Although she does not specify a formal theory with components explicitly defined as "nursing," "patient," "health," and "environment" in the manner of many modern nursing theories, all of these components are addressed throughout Notes on Nursing. The nurse acts as a facilitator of self-efficacy by creating an environment conducive to the body healing itself. Although Nightingale's work is not specifically religious in intention, she makes numerous references to allowing God's rehabilitative work to take place through such a health-promoting environment.