Nursing Theories For Complex Multifaceted Concepts

Environmental Theory of Florence Nightingale

Describe about the Nursing Theories for Complex Multifaceted Concepts.

Throughout the twenty-first century, the responsibility of nurses has advanced considerably. Nurses today not only serves in hospital but they also provide efforts in a range of areas including the community health centers, home-cares, medical classrooms, health business sectors, and research laboratories. Although each of this positions brings different responsibilities, the primary objective of a trained nurse remains the same. The Foremost duty of the nurses is to advocate for their patients and provide the finest care centered upon doctor’s recommendation and clinical reports (Brooker & Waugh, 2013).

Nursing theories can be described as a multipurpose practice framework for identifying a target or aim, inspiring and encouraging patients and their family members and deliver support and motivation towards positivity. These theories teach nurses about remarkable analyzing skills, rational and enthusiastic working ability (Alligood, 2014). The above-mentioned qualities are essential in all domains of the nursing profession. Nursing theories play a vital part in the lives of patients, their families and practice methods of subordinate nurses. Nursing theories also impact on the entire healthcare system. Application of different theories is among the core adeptness for any nurse at all stages of this profession (Blais, 2015).

Nursing theories are complex multifaceted concepts of various types, embracing different descriptions and benefits. In terms of traditional science, a nursing theory can be described as a cluster of established statements or rubrics that are able to be verified (Hall, 2015). It is extremely valuable for the nurses to be competent to ascertain the different theories appropriate for their practice method. Being adept in applying these concepts helps the nurses to enhance their skills to become superior nursing professionals and also enhances the relationship with patients and co-workers (Butts, 2013). Effective use of proper nursing theories is vital for the wellbeing of the patients and superior patient outcome. This essay explores the models and theories of nursing.  Nursing theories are not just to observe the patient as a whole, but to apply nursing knowledge to restore and uphold optimal health of the patients. Ideally, nursing theories should offer the principles that underpin practice (Masters, 2014).

Florence Nightingale is famous as the originator of trained and systematic nursing (Bostridge, 2015). Her initial nursing notes written in “The Lady with the Lamp” turn out to be the foundation of professional nursing practice and research (Hegge, 2013). Her transcripts, known as “Notes on Nursing: What it is, what is not”, includes some of her famous theories that have functioned as the fundamentals of nursing practice in different health care settings, containing the successive theoretical contexts and concepts in the field of nursing (Butts, 2013 and Bostridge, 2015).

Environmental Factors Affecting Health

Florence Nightingale is considered as one of the earliest nursing theorists. One of her well-known theories is the Environmental theory. This theory assimilated the reestablishment of the normal health condition of the patients into the system of health care. The concepts of the environmental theory are still practiced these days. In her environmental theory, Florence Nightingale described the function of nurses as the performance of using the environmental components of the patients to support them in their retrieval. It requires the initiatives of the nurses to construct environmental surroundings beneficial for the steady restoration of the health of the patients and those peripheral aspects linked with the surroundings of the patients can impact on biological and physiological processes and their improvement (Hegge, 2013).

According to Koffi & Fawcett (2016), Nightingale’s concepts are really distinctive. Nightingale stated that what nurses has to do is to place the patients in finest form for nature to act upon them. Human beings are defined in relation to their environmental conditions and environmental impacts upon them (Brooker & Waugh, 2013). Her concept reflects a community health model in which all surroundings of a human being are considered in relation to the state of health. According to Ferris et al. (2016) and many other authors, Nightingale declared that nursing must deliver care to the sick persons along with the healthy and discussed that nurses should engage themselves in health promotion activities.

Environmental factors affecting health

Florence Nightingale wrote in her nursing theories that nursing is an action of using the environment of the patients to help them in their retrieval (Brooker & Waugh, 2013). According to her, it encompasses the ingenuities of the nurses to arrange environmental backgrounds suitable for the gradual restoration of the health of the patients (Butts, 2013). The conceptual framework of her environmental theory emphasized upon fresh air supply where patients breathe. The air should be pure as possible without chilling the patients. A badly constructed healthcare setting can be very harmful to the patients (Hall, 2015). She stated that patients who frequently breathed their own air would become ill or stay ill. Nightingale was highly alarmed about toxic air or effluvia and filthy smells that originated from excrements. She also disliked fumigations as she believed that not only the smell but also the unpleasant sources of foul odors must be eradicated (Gürler, 2014).

The significance of surrounding temperature was also emphasized by Florence Nightingale. The patients should not be placed in too cold or too hot environment. The temperature could be maintained by the proper equilibrium between aeration from the window and burning fires (Gürler, 2014). She also described the importance of using pure water. When epidemic diseases occur, persons using impure water are nearly certain to suffer (Masters, 2014). A very important part of nursing consists of preserving the cleanliness of healthcare settings. A nurse must rinse her hands often during her duty (Hall, 2015). It is essential to maintain the fresh air supply round the sick persons and frequently take away the morbid discharges or harmful odors from the lungs and skin. It essential to maintain free ventilation and also obligatory to retain pores of the skin unrestricted from the blocking excretions. According to her, light or direct sunlight is very effective in treating disease (Bernhofer et al., 2014). She also believed in active drainage system is a must for any healthcare setting (Gürler, 2014).

As described by Thorne & Sawatzky (2014), Florence Nightingale noted that patients require different diets at according to different times of the day and that regular small meals may be more favorable to the patients than heavy breakfasts or dinners. She advised that no interaction should do with patients while they are eating because it could be distractive. She stated that to misleadingly cheer the patients by creating lightness about their health conditions could be dangerous but not helpful (Hall, 2015). She stimulated the nurses to notice what is being said by their families, considering that patients should receive decent news that would promote them in becoming recovered. Nightingale sustained the significance of observing beyond the patients to the societal environment in which they existed (Masters, 2014).

These aspects had major significance during the time of Florence Nightingale when healthcare establishments had deprived hygiene, health care providers had petite knowledge and training and were often unskilled and unreliable in fulfilling the requirements of the patients (Gürler, 2014). Her most praised concept was manipulation of the environment to the advantage of patients for restoring their health (Katherine Renpenning, 2011). She suggested that one the main cause of respiratory diseases is poor air quality and air pollution which remain a truth today (Escobar, 2014 and Gürler, 2014).

The five vital components (pure water, pure3 air, light, hygiene and effective drainage) to optimal health recovery remain a significant part of global healthcare settings (Zborowsky, 2014). Nightingale always emphasized on the maintaining hygiene. Hand hygiene is still a prominent concern and a leading source of hospital-acquired infections (Gürler, 2014). The five crucial components are the most important aspects of modern nursing care and any lack of them can give rise to various complications and diseases. The ethics and values that her theory incorporates are so valuable that it is sustained to be used today in the training of modern nursing (Selanders & Crane, 2012). As stated by McDonald (2014), her recommendation for continuing education and training for nurses has been proven to be vital for increasing the quality of healthcare system.

But there is some weakness in her beliefs and concepts. She stressed subservience to physicians. She stressed more on physical aspects than on patient’s psychosomatic requirements (Hegge, 2013). Her theory does not discuss the exact procedures for handling extremely needy and reliant patients. This a deterrent for nurses who manage these type of patients (Masters, 2014). According to Hegge (2013), Masters (2014), Hall (2015) and many other authors, Nightingale believed that illness is a cause of miasmas. It means that diseases spontaneously arise due to deprived sanitation and poor ventilation system.

The self-care deficit nursing concept is an outstanding nursing philosophy that was established between Dorothea Orem. It is again well-recognised as the Orem’s model of nursing. It is mainly used in rehabilitation and primary healthcare situations where patients are inspired to be as sovereign as possible. This nursing theory is grounded upon the viewpoint that every individual desire to care for themselves (Shah et al., 2015). Patients can get better more rapidly and effectively if they are allowed to accomplish their personal self-maintenance to the best of their abilities. Orem’s theory emphases on the performance of the doings that persons start and do on their own to maintain health, daily life, and well-being (Hintze, 2011).

The most important assumptions of Orem’s self-care deficit theory was described by Alligood (2014), every person holds distinct characteristics. Everyone must be self-reliant and in charge for their own well-being along with other family members who require care. Nursing is a method of accomplishment. It is a dealing between dual and more individual. Fruitfully assembling universal and developmental self-care basics is a vital element primary care and prevention of poor health and diseases. Knowledge of an individual about the probable health jeopardize is vital for upholding self-care activities. Self-care as well as reliant care, both are performances acquired within the social and cultural context.

This model is incorporated three inter-related parts: concept of self-care, the concept of self-care deficit and concept of nursing system. The first part of this theory includes self-care which is the events that a people initiate and perform on their own to preserve regular lifestyle, health, and well-being. Human capacities to engaging in self-care are influenced by developmental stages, social and cultural backgrounds, life experience, age, health, and resources (Orem, & Taylor, 2011). Orem had identified three categories of requirements or necessities. These are called self-care requisites. They are classified into three groups that are universal self-care requisites, developmental self-care requisites and health deviation self-care requisites.

For universal self-care requisites, it is concomitant with life courses and the upkeep of the integrity of structure and function. It includes the maintenance of  ample air intake, ample water intake, satisfactory food intake, the process associated with excretion,  the equilibrium between relaxation and movement, the poise between societal interactions and solitude, deterrence of hazards to life and well-being and advancement of human health. Developmental self-care requisites are either specific expressions of universal self-care fundamentals that have been personalized for developmental method or new conditions consequent from some conditions or connected with an incident. Health deviation self-care requisites are needed during the time of injury, disease, illness or may outcome of medical measures required to analyze and correct the situation. Health eccentricity self-care stipulations incorporates seeking and confirming adequate curative assistance, awareness and attention about the effects and consequences of pathological conditions, awareness about the harmful effects of prescribed medical  measures, modification of the self-image or self-concept in requirement of particular forms of health care and knowledge to cope with the effects of pathological environments and effect of clinical diagnosis and treatment procedures in patient’s lifestyle that encourages sustained personal improvement (Banfield, 2011).

The notion of self-care deficit explains when nursing is required. Nursing is necessary when somebody is unable or restricted in the delivery of uninterrupted operational self-care. Orem identified five effective way of nursing. These are guiding others, acting and doing for others, supporting, teaching and offering an atmosphere encouraging individual development in relation to satisfying future demands (Queirós et al., 2014).

The concept of nursing system designates how self-care requirements of a patient will be maintained by a nurse, the patient himself or by both of them. This system is active when a person’s therapeutic self-care requisitions surpass the available methods, leading to the need for nursing (Desbiens et al., 2012). Orem classified nursing system in three categories. First is the wholly compensatory nursing system. This is represented by a situation when the patients have no active part in the act of their care. The nurse’s act for the patients (Blais, 2015). Here a patient necessitates total nursing care to satisfy self-care requirements and self-care agency of the patients is so limited that they totally depend on the nurses for their well-being. The nurses accomplish therapeutic self-care of the patients, compensate for incapability of the patients to involve in self-care, supports and care for these patients. Some examples are care of a newborn, care after surgery etc. (Banfield, 2011).

Second is the partial compensatory nursing system. This is represented by a state of affairs in which both nurses and patients effort together to do the activities to complete preferred self-care objectives (Blais, 2015). Here the patients can do some self-care activities but desire nurses to support them to meet other self-care measures. It possesses a give and takes association between the nurses and the patients. The nurses compensate for self-care confinements of patients.

 Final category is supportive educative system. This system involves usages of resources and learning equipment to teach the patients and their family to accomplish their own self-care. It shows that the patients contribute mostly in their self-care and the role of the nurses is just to observe & normalize the self-care of the patients (Richard, 2011). The patients accomplish self-care & control the measures & improvement of self-care activity. The patients are capable of performing or can acquire to perform essential methods of satisfying self-care but cannot do so without any support. These patients can complete self-care fundamentals but requires aid in knowledge gaining, decision-making and behavior regulator (Desbiens, 2012).

The nursing profession offers a system in determining self-care deficits and to describe the function of nurses and patients to reach the ultimate self-care demand (Chen et al., 2014). Assessment requires diagnosis and explanation about why nursing is desirable, analysis and interpretation by making judgments concerning care, designing of nursing systems and plans to deliver optimal patient care, production, and management of the nursing system (White et al., 2011). The assessment process involves the following steps:

Step one: Collection of data in six sections

Current health status of the patient, viewpoint of the doctors about the health status of the patient, outlooks of the patient about his or her health condition, the health objectives within the background of health status, lifestyle and life history, requirement of self-care of the patient and ability of the patient to perform self-care

Step two: Nursing plans and diagnosis

A nurse should design a system which is totally or partially compensatory or supportive educative, bringing out a decent association of the constituents of therapeutic self-care demand and an assortment of ways to aid effectively and efficiently in compensating the self-care deficit of the patient.

Step three: implementation and evaluation

Nurses assist the patients and families in self-care difficulties in attaining identified and defined health and health-related outcomes. A collection of evidence in the evaluation of results attained against results specified in nursing structure plan. Here the activities are directed by etiological components of nursing analysis.

Orem’s theory is frequently used by registered nurses in their practice, administration, nursing education, curriculums and research (Riegel et al., 2012). It offers nursing practitioner with a comprehensive base. It is a contemporary self-care approach with the notions of health elevation and healthiness conservation. Orem’s theory identifies when nursing is required and emphases not only on personalized self-care but also to multiple person-units. It encompasses continuous education and training for nurses in their individual endeavor in nursing practice.

Like every nursing theory, Orem’s self-care deficit theory has some limitations. Her theory makes it appear illness-oriented instead of wellness-oriented (Alligood, 2014). In the present day, health and nursing system are viewed as dynamic and frequently fluctuating components (Blais, 2015). However, Orem described the nursing system as constant and static, suggesting that there are merely three standing situations regarding health (Alligood, 2014 and Blais, 2015).

Mrs. Smith is a 58 years old Christian homemaker. She has no proper education, lives with husband and son. She was admitted due to rheumatoid arthritis.

Universal self-care requisites

The universal self-care requisites are described in the Appendix 1.

Developmental self-care requisites

Maintenance of developmental environment for her difficulties such as incapability of self-feeding, difficulty in dressing and toileting and inhibition of threatening conditions for normal development as she feels responsible for her deprived health condition.

Health deviation self-care requisites

Adherence to medical regimen includes reports problem to the doctor, cooperative with the nurses, not much aware of medicines and their mode of action. Awareness of potential problems in association with the regimen are not cognizant about the disease progression, not compliant with the diet and prevention of hazards. Modification of self-image to incorporate changes in health status and accepted mobility restriction. Modification of lifestyle to accommodate variations in the health conditions and clinical regimen for adjusting with the disabilities. Pain easiness not achieved.

Application of Orem’s theory

There are cases in which patients are stimulated to elicit the best in them in spite of being ill for a period of time. This is very certain in rehabilitation settings, in which patients are becomes more self-regulating after being cared for by doctors and nurses. Mrs. Smith is also required such strategies which incorporates Orem’s theory. Although Orem’s concept significantly impacts the independence of every patient, the definition of self-care cannot be directly applied to those who necessities comprehensive attention or help with self-care events such as the babies and the elderly. A nursing upkeep strategy for Mrs. Smith could be arranged according to Appendix 2. The nursing plan uses the concept of Orem’s theory to improve her health outcomes concerning food, activity, pain control, prevention of hazards and awareness about the disease process and management.

Conclusion

Nursing theories help health care professionals to deliver exceptional contributions in caregiving for their patients. Both the discussed theory played major roles in the development of the modern nursing concept.

Florence Nightingale’s theory played a significant part to enhance nursing care when communicable disease and quick spread of infection were widespread in that initial phase in the advancement of disease curing medicines. The exercise of the environmental structure according to the health of the patients or disease conditions is still useful these days. Her theory is effective in cases as such as tetanus where patients are infected with Clostridium tetani, who requires the least sound and a noiseless atmosphere to avoid seizure-causing stimuli. She gave a detailed description of each aspect. Her foremost elements embrace aeration, light, sound, diet, purity of rooms and personal hygiene. According to Nightingale, if a nurse modifies the environment of the patient, she can support the patients to re-establish their standard health. Nightingale shaped a root for offering holistic upkeep to the patients.

Orem’s self-care deficit concept is comparatively modest, but comprehensive to apply to an extensive range of patients. It describes the meanings of self-care, self-care deficit and nursing systems which are very crucial to nurses to develop nursing strategies. Furthermore, this concept indicates that every human being desires to care for himself. Patients are capable of recovering more rapidly by accomplishing their own self-care as much as possible. This model is chiefly applied in primary care and rehabilitation settings in which patients are stimulated to be self-regulating.

Appendix

Appendix 1

Air	Breaths devoid of any trouble, no pallor cyanosis
Water	Sufficient liquid intake, presence of edema over ankles, normal turgor according to age
Food	Hb- 9.6m%, BMI = 15. Food consumption is not satisfactory or the diet is not nutritive
Elimination	Eliminates bowel without difficulties
Activity/rest	Frequent rest due to pain, lower activity rate
Social interactions	Interacts positively will neighbors and calls husband and son for any health need
Prevention of hazards	Needs guidance on joint cares, fall prevention and diet.
Promotion of normalcy	Has decent understanding with husband and son

Appendix 2

Clinical self-care deficit areas	Nursing diagnosis	Goals	Objectives	Outcomes	Design of the nursing system	System of assistance	implementation
Food	Inability to maintain proper diet due to inadequate intake and knowledge deficit	To attain ideal level of nutrition	Mrs. Smith will be able to tell the significance of healthy nutrition and list healthy foodstuff items	Improved nutrition and maintenance of balanced iron-rich diet	Supportive educative	Support, guidance, teaching and delivery of developmental environment	Mutually identified and planned targets and the patient was made to comprehend the mandatory alterations
Activity	Self-care deficit in toileting and dressing due to delimited joint function	To attain ideal level of capability for self-care	Mrs. Smith will do her dressings within confinements, use the substitute methods of toileting and do the regular actions of day-to-day living with nominal support	Improved self-care	Partly compensatory	,,	,,
Pain control	Ineffective pain control	Reduction of pain	Description of the total pharmacological pain relief plan	Improved self-control of pain and pain reduction	Supportive educative	,,	,,
Prevention of hazards	Risk of fall and fractures	Fall prevention	She will remain free from injury, expiations of fall prevention methods	Absence of fall	Supportive educative	Support	,,
Awareness about the disease process and management	Potential for complications due to knowledge deficit	Improvement of knowledge	Description of the various complications and their prevention measures, changes due to the disease process and action and side effects of therapeutic drugs	Improved awareness and absence of complications	Supportive educative	Guidance, teaching and promotion of developmental environment	,,

 

References

Alligood, M. R. (2014). Nursing theorists and their work. Elsevier Health Sciences.

Banfield, B. E. (2011). Environment. A Perspective of the Self-Care Deficit Nursing Theory. Nursing science quarterly, 24(2), 96-100.

Bernhofer, E. I., Higgins, P. A., Daly, B. J., Burant, C. J., & Hornick, T. R. (2014). Hospital lighting and its association with sleep, mood and pain in medical inpatients. Journal of advanced nursing, 70(5), 1164-1173.

Blais, K. (2015). Professional nursing practice: Concepts and perspectives. Pearson.

Bostridge, M. (2015). Florence Nightingale: the woman and her legend. Penguin UK.

Brooker, C., & Waugh, A. (2013). Foundations of nursing practice: Fundamentals of holistic care. Elsevier Health Sciences.

Butts, J. B., Bandhauer, D., & Rich, K. L. (2013). Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers.

Chen, A. M., Yehle, K. S., Albert, N. M., Ferraro, K. F., Mason, H. L., Murawski, M. M., & Plake, K. S. (2014). Relationships between health literacy and heart failure knowledge, self-efficacy, and self-care adherence. Research in Social and Administrative Pharmacy, 10(2), 378-386.

Desbiens, J. F., Gagnon, J., & Fillion, L. (2012). Development of a shared theory in palliative care to enhance nursing competence. Journal of advanced nursing, 68(9), 2113-2124.

Escobar, C. (2014). Evidence-based healthcare design: A theoretical approach to a substance abuse treatment facility interior design. MICHIGAN STATE UNIVERSITY.

Ferris, L. J., Jetten, J., Johnstone, M., Girdham, E., Parsell, C., & Walter, Z. C. (2016). The Florence Nightingale Effect: Organizational Identification Explains the Peculiar Link Between Others’ Suffering and Workplace Functioning in the Homelessness Sector. Frontiers in psychology, 7.

Gürler, B. (2014). Holistic approach to infection control and healing: the Florence Nightingale story. Microbiology Australia, 35(3), 174-176.

Hall, C. (2015). Introduction to Nursing Theory. Essentials of Nursing Practice, 157.

Hegge, M. (2013). Nightingale’s environmental theory. Nursing science quarterly, 26(3), 211-219.

Hintze, A. (2011). Orem-based nursing education in Germany. Nursing science quarterly, 24(1), 66-70.

Katherine Renpenning, M., & Taylor, S. G. (2011). Self-care science, nursing theory and evidence-based practice. Springer Publishing Company

Koffi, K., & Fawcett, J. (2016). The Two Nursing Disciplinary Scientific Revolutions Florence Nightingale and Martha E. Rogers. Nursing science quarterly, 29(3), 247-250.

Masters, K. (2014). Nursing theories: A framework for professional practice. Jones & Bartlett Publishers

McDonald, L. (2014). Florence Nightingale and Irish nursing. Journal of clinical nursing, 23(17-18), 2424-2433.

Orem, D. E., & Taylor, S. G. (2011). Reflections on Nursing Practice Science. The Nature, the Structure, and the Foundation of Nursing Sciences. Nursing science quarterly, 24(1), 35-41.

Queirós, P. J. P., Vidinha, T. S. D. S., & Almeida Filho, A. J. (2014). Self-care: Orem’s theoretical contribution to the nursing discipline and profession. Revista de Enfermagem, 4(3), 157-63.

Richard, A. A., & Shea, K. (2011). Delineation of Self?Care and Associated Concepts. Journal of Nursing Scholarship, 43(3), 255-264.

Riegel, B., Jaarsma, T., & Strömberg, A. (2012). A middle-range theory of self-care of chronic illness. Advances in Nursing Science, 35(3), 194-204

Selanders, L., & Crane, P. (2012). The voice of Florence Nightingale on advocacy. Online J Issues Nurs, 17(1).

Shah, M., Abdullah, A., & Khan, H. (2015). Compare and Contrast of Grand Theories: Orem’s Self-Care Deficit Theory and Roy’s Adaptation Model. INTERNATIONAL JOURNAL OF NURSING, 5(1)

Thorne, S., & Sawatzky, R. (2014). Nursing and Quality of Life. In Encyclopedia of Quality of Life and Well-Being Research (pp. 4399-4402). Springer Netherlands.

White, M. L., Peters, R., & Schim, S. M. (2011). Spirituality and Spiritual Self-Care Expanding Self-Care Deficit Nursing Theory. Nursing Science Quarterly, 24(1), 48-56.

Zborowsky, T. (2014). The legacy of Florence Nightingale’s environmental theory: Nursing research focusing on the impact of healthcare environments. HERD: Health Environments Research & Design Journal, 7(4), 19-34