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Case Study

Using Nightingales Environmental Theory, What Actions Would the Nurse Take upon the First Assessment? What Are the Five Essential Components?

The nightingale environmental theory is a patient-care theory. This theory focuses on patient care and the relationship between nurses and patients. According to this theory, environmental factors affect patients, therefore, nurses must address these factors on a case by case basis to ensure best possible care ADDIN EN.CITE <EndNote><Cite><Author>Pirani</Author><Year>2016</Year><RecNum>1308</RecNum><DisplayText>(Pirani, 2016)</DisplayText><record><rec-number>1308</rec-number><foreign-keys><key app="EN" db-id="axzrwpxxqvwtw5evsf3xrer2arfwsa5f0e5d" timestamp="1574878428">1308</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pirani, SA</author></authors></contributors><titles><title>Application of Nightingale’s theory in nursing practice</title><secondary-title>Annals of Nursing and Practice</secondary-title></titles><periodical><full-title>Annals of Nursing and Practice</full-title></periodical><pages>1040</pages><volume>3</volume><number>1</number><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>(Pirani, 2016). It includes initiatives of a nurse to configure environmental settings that are appropriate for the gradual restoration of patient health. It also takes into account the external factors and physiologic and biological processes that have an impact on patient recovery. Upon the first assessment, the nurse looks at environment in which patient is living. The environment plays a very important role in maintaining the wellbeing and health of the patient and also promotes recovery. According to this theory, an environment that promotes health allows the patient to retain their vital powers and energy for use towards self-healing.

A nurse will look at 5 environmental factors such as efficient drainage, light or direct sunlight, fresh air, and sanitation or cleanliness ADDIN EN.CITE <EndNote><Cite><Author>Awalkhan</Author><Year>2016</Year><RecNum>1309</RecNum><DisplayText>(Awalkhan &amp; Muhammad, 2016)</DisplayText><record><rec-number>1309</rec-number><foreign-keys><key app="EN" db-id="axzrwpxxqvwtw5evsf3xrer2arfwsa5f0e5d" timestamp="1574878515">1309</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Awalkhan, Afsha</author><author>Muhammad, Dildar</author></authors></contributors><titles><title>Application of Nightingale Nursing Theory to the Care of Patient with Colostomy</title><secondary-title>European Journal of Clinical and Biomedical Sciences</secondary-title></titles><periodical><full-title>European Journal of Clinical and Biomedical Sciences</full-title></periodical><pages>97-101</pages><volume>2</volume><number>6</number><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>(Awalkhan & Muhammad, 2016). According to Nightingale's theory, Mrs. Adam's complaint of pain and draining of fluids from her surgical site can be associated with the environmental condition. In Mrs. Adam's apartment, there is no proper system of ventilation and lighting. The first thing which should be fixed is the ventilation system. As the patient is suffering from different chronic and life-threatening diseases, therefore, the air that is breathed by the patient must be pure, warm and fresh. As there is drainage from her surgical site it is important to maintain cleanliness to avoid any infection. Waste should be disposed of properly and carpets and floors should be cleaned. According to Nightingale, an individual who repeatedly breathes his or her air becomes sick. This patient is already suffering from many diseases and she needs to breathe in clean air. There is also a great importance of room temperature. As stressed on by nightingale, there is a need that temperature should be kept in an appropriate range i.e. not too warm or too cold. As this patient is suffering from cancer and she also had a complaint of pain, therefore this patient must not be waked intentionally during sleep. It is noted that the patient had not changed her dress for last few days. As there is drainage of fluids from her surgical site, therefore, it is very important to maintain the hygiene of the patient to prevent the infection.

What Would Be An Appropriate Plan Of Care Be For Mrs. Adams? How Would You Prioritize The Care Plan? Using Nightingale Environmental Theory To Explain The Above-Stated Scenario

The patient is 5 days’ post-op from a right-sided mastectomy. Mrs. Adam is in need of nursing care that aims to maintain a safe environment that protects her from infection and helps in her social and spiritual wellness. The patient is presented with postoperative vital signs and there is drainage from the surgical site. Pain-relieving measures should be adopted to manage pain associated with surgery. According to the verbal statement of Mrs. Adam, it is noted that the room in which she is living is injurious to her health and she is not able to care for herself independently. The care plan for the management of pain includes assessing the pain of patients at regular intervals, determine factors that increase or decrease pain, supporting her during daily activities such as changing clothes and cooking food, using both nonpharmacological and pharmacological pain-relieving interventions, administering pain killers to patient and reassessing pain after administration of medicines. The care plan for the management of drainage from the surgical site includes interventions that prevent bleeding and complications associated with surgery. Patient vital signs should be checked every 2 hours. Surgical sites should be checked for bleeding. Patient breathing patterns should be assessed. As she is living in a room with no proper ventilation, she can suffer from severe coughing and pain during breathing. She should be kept in a room where there is a proper ventilation system. The patient had no food in department which shows that she has not eaten anything. Her weight should be checked and body mass index should be calculated. The patient must get nutrients that are needed for her metabolic needs. Interventions include assessing the weight of patients daily; the nutritional requirements of a patient should be calculated with dieticians; discussing the importance of food with the patient. It is noted from initial assessment that the patient has not changed clothes for the last few days. In this case, patient personal hygiene and dressing is very important. She should be given clean and comfortable dress to wear. The patient must be provided with information on wound care and hand washing. The patient should be taught about cautions while moving the arm on the operated site. The patient lives alone in her home, therefore social activities for a patient should be planned and she should also be encouraged to express her feelings regarding mastectomy. Fluorescent light should be turned off and for the patient comfort, natural light and lamps should be used.

Apply Nightingale’s Environmental Theory to an Area of Your Nursing Practice? What Patient Population Would Benefit From This Approach? Support This Practice Change With At Least One Evidenced-Based Article.

The environment plays an important role in maintaining the health of the patient. Nurses should manipulate their surroundings to promote the recovery of patients. For this, nurses should be vigilant, skillful and confidential, and their practice should be evidence-based. Pure water, cleanliness, pure air, nutrition, noise, light, personal cleanliness, and bedding are important concepts in nightingale environmental theory. Bedding that is used for patients should be clean. Nurses should frequently wash their hands. Nightingale's environmental theory also stressed on individual cultural and ethnic backgrounds. It also focuses on patient beliefs and values. Nightingale's idea of disease prevention and sanitation is also valued concerning the importance of public health nursing. Nightingale's environmental theory also analyzed the relationship between environment and health status. The hospital environment should be such that it promotes patient recovery from illness. Nurses play an important part in controlling hospital environment according to the need of the patients. Cleanliness and proper handwashing should be conveyed in writing for daily nurse practice ADDIN EN.CITE <EndNote><Cite><Author>Calhoun</Author><Year>2018</Year><RecNum>1311</RecNum><DisplayText>(Calhoun, 2018)</DisplayText><record><rec-number>1311</rec-number><foreign-keys><key app="EN" db-id="axzrwpxxqvwtw5evsf3xrer2arfwsa5f0e5d" timestamp="1574878619">1311</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Calhoun, Susan</author></authors></contributors><titles><title>A Baccalaureate Community Health Nursing Course Grounded in Nightingale’s Environmental Action Theory of Nursing Practice</title></titles><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>(Calhoun, 2018). The mutual relationship should be developed between nurses and patients to build confidentiality and trust for sharing information about patient health status. Nurses should also measure outcomes as an important aspect of her practice. The method of quality improvement should be based on the observation of nurses. The nurse should note the patient comfort level and his sleep and rest time. According to the nightingale theory, the patient took rest when the nurse switches off the light on the patient's bedside ADDIN EN.CITE <EndNote><Cite><Author>Awalkhan</Author><Year>2016</Year><RecNum>1309</RecNum><DisplayText>(Awalkhan &amp; Muhammad, 2016)</DisplayText><record><rec-number>1309</rec-number><foreign-keys><key app="EN" db-id="axzrwpxxqvwtw5evsf3xrer2arfwsa5f0e5d" timestamp="1574878515">1309</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Awalkhan, Afsha</author><author>Muhammad, Dildar</author></authors></contributors><titles><title>Application of Nightingale Nursing Theory to the Care of Patient with Colostomy</title><secondary-title>European Journal of Clinical and Biomedical Sciences</secondary-title></titles><periodical><full-title>European Journal of Clinical and Biomedical Sciences</full-title></periodical><pages>97-101</pages><volume>2</volume><number>6</number><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>(Awalkhan & Muhammad, 2016). According to the nightingale theory, the diet plan plays a very important role in patient recovery. A patient has no knowledge that which diet is important for his health therefore in consultation with the dietician nurses should made diet plan and pasted it in front of the patient bed. The nurse should also guide patients about diet which best manages his disease symptoms. All admitted patients will get benefit from this approach.

References

ADDIN EN.REFLIST Awalkhan, A., & Muhammad, D. (2016). Application of Nightingale Nursing Theory to the Care of Patient with Colostomy. European Journal of Clinical and Biomedical Sciences, 2(6), 97-101.

Calhoun, S. (2018). A Baccalaureate Community Health Nursing Course Grounded in Nightingale’s Environmental Action Theory of Nursing Practice.

Pirani, S. (2016). Application of Nightingale’s theory in nursing practice. Annals of Nursing and Practice, 3(1), 1040.