Born May 12, 1820 to a wealthy family, well educated
In 1837, she wrote about her “calling from God” to become a nurse. She became a nurse after only 3 months of training.
In 1854 she was requested to care for wounded soldiers during the Crimean War.
Notes on Nursing (published in 1859). Nightingale’s writings define and describe her ideas and beliefs on how these six environmental components can be manipulated by the nurse to provide an optimal environment for the patient.
Nurse - is “any person [female] in charge of the personal health of another” (Nightingale, 1957, p 79).
Nursing - “It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet - all at the least expense of vital power to the patient” (Nightingale, 1957, p. 6).
Petty Management - “knowing how to manage that what you do when you are there, [and what] shall be done when you are not there” (Nightingale, 1957, p. 20).
Patient - assumed to be an individual in need of care.
Disease - “The reparative process which Nature has instituted.” (Nightingale, 1957, p. 5)
Health - Nightingale defined health as “being well, but to be able to use well every power we have to use” (Nightingale, 1954).
Environment - assumed to be fresh air, light, warmth, diet, quiet, and cleanliness.
Fresh Air - ventilation, purest air possible
Light - Expose patient to light during the day and vary the environment
Warmth - dry and warm, but not too warm, comfortable and dry.
Chang, J., Wood, J., Bergeran, A., McBride, L., Ball, B., Yu, Q., et. al. (2004, August). Effects of Low Temperature on Shear-InducedPlatelet Aggregation and Activation.
Diet - no bad milk, meat, or vegetables, tailor to the patient, variety, don’t leave food around all the time, time limit for meals.
Quiet - reduce noise around a sick patient so the patient may rest.
Stoppler, M. (2004). The Relaxation Response.
Cleanliness - clean room and bedding. Cannot have a clean room without a clean house. Pure water and efficient drainage.
Problem - A 51 year old hypertensive male presents to the clinic for a follow up visit. His weight is 240, height 5'11", BP 148/94. Previous lab showed a cholesterol of 256, HDL 30, LDL 160, Triglycerides 180. His medications include Norvasc 10 mg daily, which he takes “most of the time”.
The problem is that the patient needs a manipulation of certain elements in his environment to reduce obesity, blood pressure, increase activity, and be compliant with his medications.
Quotes in the presentation are from Nightingale’s Notes on Nursing (Nightingale, 1957) unless otherwise stated.
Assess:
We see a need to reduce obesity. “A rule of thought about your patient’s diet; consider, remember how much he has had, and how much he ought to have”.
We see the need to get outside and do activity and as the “first canon of nursing, . . .[is] to keep the air he breathes as pure as the external air. . . .”
We see a need to increase quiet times to reduce stress and thus reduce BP because “unnecessary noise, . . . is that which hurts a patient.”
We see a need to address cleanliness as “having a healthy house” to place patient’s medication in a way where he will see them and take them as scheduled. “People are so unaccustomed from education and habits to consider how to make a home healthy, . . . or if they ever entertain the idea of preserving the health of their household as a duty, they are very apt to commit all kinds of ‘negligences and ignorances’ in performing it.”
Keeping in mind the need to do “. . . whatever a patient can do for himself, it is better, i.e. less anxiety, for him to do for himself. . . .”
Plan:
We would provide education about diet including going into the home and talking with the patient and his wife, mother, or caretaker. And we would instruct them on reducing portions, varying the foods, choosing healthy foods like milk, meat, and vegetables, and arranging foods to not have it lying around where the patient could eat as he fancied.
We would plan an outdoor exercise program. The patient must get outside to breath the purest air possible and to be exposed to the light all the while keeping warm.
We would plan quiet times of rest in a patient’s day to relax and pray.
We would inspect the house, and arrange the medicines in a way as the patient can best think of taking it and remembering it.
Plus we would plan on frequently visiting the patient or seeing that the patient had a female care-taker/nurse and provide “petty management” so the patient will follow through with all our plans.
Intervention:
We went to the house and saw it in utter disarray. We had a very long talk with the caretaker of the house in the matters of petty management and diet. We stayed with the family for several weeks until the woman of the house understood the concept taking care of her husband in diet and medicines and could prepare the proper portions of the diet. We also made the family take walks outside in the day light. We did this until it was a habit for the family. We emphasized over and over the role of the wife to make sure these concepts were kept even in her absence.
Evaluation:
We evaluated the family a month after our initial visit and found that the husband was taking his medicines properly, his weight and BP were down and Nature was acting upon him to make him feel better.
We continued to correspond to the family sending thirty letters of advice and checking the progress. We found that at times the wife as a nurse would need assistance. When we found this, we stayed a couple of weeks to give her a hand or found some family or friends to help out.
References
Chang, J., Wood, J., Bergeran, A., McBride, L., Ball, B., Yu, Q., et. al. (2004, August). Effects of Low Temperature on Shear-Induced Platelet Aggregation and Activation. The Journal of Trauma, Injury Infection, and Critical Care, 57, 2, 216.
Dermody, C. (2004, October). Healthy Hospital Story. Reader's Digest Association.
Nightingale, F. (1957). Notes on Nursing reprinted from facsimile of first edition in 1859. Philadelphia and Montreal: J. B. Lippincott Company.
Nightingale, F. (1954). Selected writings. Compiled by Lucy R. Seymer. New York:
Macmillan.
Stoppler, M. (2004, October 12). The Relaxation Response. Stress Management. Health and Fitness. Stress Management. Retrieved October 15, 2004 from http://stress.about.com/cs/relaxation/a/aa090900.htm
