Question

Identify the similarities and differences in client focus, nursing actions, and client outcomes of these The Nuemans Systems Model and Florence Florence Nightengales model

Answer 1

Theories are ways of looking at discipline, such as nursing, in clear, explicit terms that can be communicated to others.

Nursing theories address & specify relationships about 4 major ideas. These four Concepts are central to nursing.

1. Nursing-the attributes, characteristics, and actions of the nurse providing care on behalf of or together with the client
2. Person or Client-the recipient of nursing care(includes individuals, families, and communities)
3. Health-the degree of wellness or well-being that the client experiences.
4 Environment-the internal & external environment that affect the client, including people.

“Florence Nightingale, often considered the first nurse theorist, defined nursing over 100 years ago as "the act of utilizing the environment of the patient to assist him in his recovery". She linked health with five environmental factors: pure or fresh air pure water efficient drainage cleanliness light, especially direct sunlight Nightingale set the stage for further work in the development of nursing theories. Her general concepts about ventilation, cleanliness, quiet, warmth, and diet remain integral parts of nursing and health care today.”

*Nightingale's Philosophy of Nursing

PERSON :

Nightingale focused on the person as " the recipient of nursing care" (Selanders, 1993). She believed that nurses should concentrate on the patient and their needs, not the disease they were afflicted with. She knew that people were multidimensional and wrote about their biological, psychological, social and spiritual requirements. Nightingale emphasized that people had reparative powers and that the nurses' duty was to assist these powers as the means of returning people to health. (Selanders, 1993)

ENVIRONMENT :

The environment was the main emphasis on Nightingales nursing beliefs. She clearly emphasized that clean environment, fresh air, warmth, noise control and management of wastes and odors were ways that the "environment could be altered in such a way as to improve conditions so that nature could act to cure the patient." (Selanders, 1993) She realized that internal and external environment controls were both important to the progress of the patient's health. While she stressed the importance of fresh air and ventilation and an environment free of odors and waste, she knew that properly prepared food and clean water was also necessary.

HEALTH :

Nightingale describes health as a "state of being well and using one's powers to the fullest" (Creasia, Parker, 1996) Nightingale saw health as an absence of disease, with illness a physical state. By controlling the environment and taking care of the body, health was achieved.

NURSING :

Florence Nightingale's Philosophy was based on the idea that nursing was a calling from God. Nurses were meant to ease suffering, to offer comfort, and most of all to look after the patient's well being. Further, Nightingale believed that nursing was science as well as a profession -- a noble profession -- and worked very hard to raise it to the level of respectability by teaching technical skills and techniques. Nurses were responsible for the day to day care of the patient and were limited to that function.

*Application of Nightingale's Theory to the Nursing Process

1. Assess :

Florence Nightingale stressed the importance of observation of the patient by the nurse. In her book, Notes on Nursing, she writes: "The most important practical lesson that can be given to nurses is to teach them what to observe howto observe-what symptoms indicate improvement- what the reverse-which are of importance-which are of none-which are the evidence of neglect- and what kind of neglect." ( p. 105) In this statement, Nightingale was teaching the first step of what we now refer to as assessment in the nursing process.

2. Diagnose/Plan :

After the observation, the nurse was to record the findings and be able to "support conclusions regarding prescribed care". (Selander, 1993). While the concept of nursing diagnosis was not present in Nightingale's time she did identify and address particular needs and problems presented by the patient. Through her emphasis on observations, nurses were able to title the problems such as diarrhea, lack of appetite, difficulty of breathing so that these problems/condition were addressed immediately. In this manner, nurses were able to plan their care, basing their plans on prioritization of patient needs.

3. Implement :

The plan of care that the nurse would implement, in Nightingales time, including actions that directly related to Nightingales environmental theory of proper sanitation, improved personal hygiene and clean, warm environments. During this time period, nurses were not only responsible for personal care of the patient which included bathing, wound dressing, treatments but were also required to wash the floors, windows, walls and continue maintenance of the stove to provide warmth for the environment. All these actions and many more were part of the plan of care implemented to provide the proper environment for healing.

4. Evaluate :

Since Nightingale's teachings strongly promoted observation the patient's progress could be evaluated and reassessed. While she did not believe in questioning the patient about their own observations and feelings she did "determine that the evaluation of client status was critical to the process of providing adequate care. Only then could it be determined if the care should be continued or altered."(Selander, 1993) .

*Dr. Betty Neuman is a contemporary theorist whose “Health Care Systems Model” builds on Nightingale’s original theory to include issues of the psyche such as emotions and feelings, expectations and issues of personal life such as finances, relationships, etc.

*The Neuman Systems Model provides a comprehensive, system-based conceptual framework. Originally designed to be used in nursing it can be used by other health professions.

*The model represents the client within the system perspective, holistically and multi-dimensionally. It illustrates the components of five interacting client variables; physiological, psychological, developmental, socio-cultural and spiritual in relation to environmental influences upon the client as a system consisting of a basic structure, lines of resistance and lines of defense. The environment is broadly defined as all internal and external factors or influences surrounding the identified client or client system. Environment consists of three dimensions: internal environment, external environment and created environment.”

*We can now compare Nightingale’s 4 point philosophy of nursing with Neuman’s 3 point plan. Neuman’s Nursing Plan:

1. PERSON :

Neuman sees the person as being a multidimensional, whole, dynamic system, but primarily with interrelationships between five variables or factors: physical/physiological psychological socio-cultural developmental spiritual. The person has a basic 'core structure', comprised of survival mechanisms, including organ function, temperature control, genetic structure, response patterns, ego, and what are termed 'knowns and commonalities'. This core is protected by flexible 'lines of defense' and 'lines of resistance'. The 'person' may, in fact, be an individual, a family, a group, or a community in Neuman's model. The person is seen as being in a state of constant change, or as an open system in reciprocal interaction with the environment (ie affecting, and being affected by it).

2. HEALTH :

Neuman sees health as being equated with wellness. She defines health/wellness as "the condition in which all parts and subparts (variables) are in harmony with the whole of the client". As the person is in constant interaction with the environment, the state of wellness (and by implication any other state) is in DYNAMIC equilibrium, rather than in any kind of steady state. Neuman envisages a wellness-illness continuum, with the person's position on that continuum being influenced by their interaction with the variables and the stressors they encounter.

3. ENVIRONMENT:

The environment is seen to be the totality of the internal and external forces which surround a person and with which they interact at any given time. These forces include the intrapersonal, interpersonal and extrapersonal stressors which can affect the person's normal line of defense and so can affect the stability of the system.

*” Application of Neuman’s Theory to the Nursing Process:

NURSING:

Neuman sees nursing as 'a unique profession' which is concerned with all of the variables which influence the response a person might have to a stressor. The person is seen as a whole, and it is the task of nursing to address the whole person. Neuman defines nursing as actions which assist individuals, families, and groups to maintain a maximum level of wellness, and the primary aim is the stability of the patient/ client system, through nursing interventions to reduce stressors. Neuman states that, because the nurse's perception will influence the care given, then not only must the patient/client's perceptions be assessed, but so must those of the caregiver (nurse).

*Neuman sees a 3-stage nursing process: nursing diagnosis - based of necessity in a thorough assessment, and with consideration given to five variables in three stressor areas (Neuman developed her own assessment and intervention tool) nursing goals - these must be negotiated with the patient, and take account of patient's and nurse's perceptions of variance from wellness nursing outcomes - considered in relation to five variables, and achieved through primary, secondary and tertiary interventions.