Annotations on Nursing Theories

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ANNOTATION ON THE IDEAS OF SOME NURSING THEORISTS IN PRACTICE, EDUCATION AND RESEARCH

1. Florence Nightingale’s Environmental Theory
She stated in her nursing notes that nursing "is an act of utilizing the environment of the patient to assist him in his recovery" (Nightingale 1860/1969), that it involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health, and that external factors associated with the patient's surroundings affect life or biologic and physiologic processes, and his development. She defined in her environmental theory are the following factors present in the patient's environment: pure or fresh air, pure water, sufficient food supplies, sufficient drainage, cleanliness, light (especially direct sunlight). Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status. The factors posed great significance during Nightingale's time, when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients. Also emphasized in her environmental theory is the provision of a quiet or noise-free and warm environment, attending to patient's dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient. Nightingale's theory was shown to be applicable during the Crimean War when she, along with other nurses she had trained, took care of injured soldiers by attending to their immediate needs, when communicable diseases and rapid spread of infections were rampant in this early period in the development of disease-capable medicines. The practice of environment configuration according to patient's health or disease condition is still applied today, in such cases as patients infected with Clostridium tetani (suffering from tetanus), who need minimal noise to calm them and a quiet environment to prevent seizure-causing stimulus.

2. Dorothy Johnson Behavioral System Model

Johnson was an early proponent of nursing as a science as well as an art. She also believed nursing had a body of knowledge reflecting both the science and the art. From the beginning, Johnson (1959) proposed that the knowledge of the science of nursing necessary for effective nursing care included a synthesis of key concepts drawn from basic and applied sciences. In 1961, Johnson proposed that nursing care facilitated the client's maintenance of a state of equilibrium. Johnson proposed that clients were "stressed" by a stimulus of either an internal or external nature. These stressful stimuli created such disturbances, or "tensions," in the patient that a state of disequilibrium occurred. Johnson identified two areas that nursing care should be based in order to return the client to a state of equilibrium. First, by reducing stressful stimuli, and second, by supporting natural and adaptive processes. Johnson's behavioral system theory springs from Nightingales belief that nursing's goal is to help individuals prevent or recover from disease or injury. The "science and art" of nursing should focus on the patient as an individual and not on the specific disease entity. Johnson used the work of behavioral scientists in psychology, sociology, and ethnology to develop her theory. The model is patterned after a systems model; a system is defined as consisting of interrelated parts functioning together to form a whole. Johnson states that a nurses should use the behavioral system as their knowledge base; comparable to the biological system that physicians use as their base of knowledge (Lobo, 1995). The reason Johnson chose the behavioral system model is the idea that "all the patterned, repetitive, purposeful ways of behaving that characterize each person's life make up an organized and integrated whole, or a system" (other). Johnson states that by...
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