Getting to Today's Nursing Care, Started with Florence Nightingale's Struggles

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The focus of this course paper is to link the ideas of Florence Nightingale, a woman known as being the founder of modern nursing, and how her ideas have influenced the way nursing is practiced today. She spent a majority of her life taking care of the sick and trying to promote health as well as healthy environments for the sick to heal more rapidly and more effectively. The chapters from Nightingale’s book that will be the focus of this paper are chapters one, 11, and 12. Chapter one is titled “Ventilation and Warming”. It discusses appropriate ways to heat and ventilate rooms in which sick patients are residing and the best ways to do so while simultaneously improving the patient's health as well as keeping other patients safe. Chapter 11 is “Personal Cleanliness” and is about how keeping patients clean is significant and can impact their health and recovery. Finally, chapter 12 is “Chattering Hopes and Advices”. It is about how the author believes that if patients hear good news about other life events, they are more likely to get better, without giving them false hope about their illness. Many ideas from Nightingale have been passed down through generations of nurses and are now integrated into curriculums in nursing schools today.

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In chapter one entitled “Ventilation and Warming”, the author talks about how the air movement through the hospitals was conducted and how heat was deposited into rooms that were too cold for the patients. Although most windows in hospitals and other health care facilities are kept shut, there is still sufficient ways to assure patient safety. One of Nightingale’s biggest stresses was that a patient's breathing air needed to be as pure and clean as if they were outside breathing, while at the same time keeping it so it’s not making him/her cold. Ventilation was a very controversial topic in Nightingale’s time and was not a very thought out problem. They would open the inside doors that went throughout the hospital, letting in mustiness, gas fumes, open sewers, as well as other unfriendly odors.

Ventilation is commonly defined as removing polluted air and replacing it with clean air. Some doctors would want to keep the windows closed and others wanted to keep them open. Nightingale mentions that the purest of air comes in at night, making it the best time to have windows open. During the day civilians are driving their cars, smoking their cigarettes and cigars, along with other activities that cause pollutants being emitted into the air. At night, all of these activities have ceased or at least lessened making the air the purest of the 24 hour time period of day and night (Nightingale, 1860). Although there are still issues, we have made many improvements with ventilation. We now know that it is extremely important to keep air ventilated and clean to improve a patient’s health. Today hospitals have ventilation systems commonly places on ceilings, walls, and floors to keep the air clean and pure for inhalation. We know that many pathogens can be airborne and keeping air pure through ventilation decreases the odds of one of these pathogens roaming the halls of the facility and cross infecting another patient (Melikov, 2015).

Hospitals today still have room for improvement with ventilation. When using the same centralized air system for all individual rooms, there are still pathogens being moved from room to room without are removed from the air. The next step in assuring pure air for everyone and no problems with cross contamination is to provide personal air purifiers for each patient and person in the hospital. One idea is to have personal wearable systems to do the purifying, heating, and cooling all in one (Melikov, 2015). Heating or warming of patient rooms used to be achieved during Nightingale’s era by burning an open fire or keeping all doors and windows shut to lock in the heat of the sick bodies (Melikov, 2015). Nightingale’s perspective on these warming practices was that it was just asking for trouble. More patients would get sicker and spread their illnesses more rapidly as well as have a harder time recovering. Today warming is achieved in a much more sanitary way, which also uses the ventilation system resulting in clean air for the patient without contamination from other patients.

When thinking about personal cleanliness, the most common thing that comes to mind is personal hygiene acts including showering and brushing teeth. Nightingale made it clear in her paper that if a patient is not kept clean and their surrounding are not kept clean, then it is doing them no good and is most likely making them more ill (Nightingale, 1860). What this means is that if a patient remains unbathed and their clothes and linens aren’t changed accordingly, the patient is still holding on to all of their illness and the possibility of them getting better is lower. Think of an infection. If a patient has an infection and it is never debrided, or cleaned out, the infection will continuously get worse, will not heal, and the patient will not recover. Nightingale also mentions that it is much more beneficial to use hot water with soap than cold water with soap. In her time, the rationale was that the dirt could be physically seen using hot water versus cold water. Today we know that hot water kills more bacteria which results in a more efficient cleaning of the patient.

It is a patient’s right to get bathed and their linens changed as often as needed so they are not sitting in filth. In hospitals today, nurses are supposed to ask patients if they would like to shower every day or every shift, and while the patient is getting washed, it is customary to change their linens so they will not be clean then lying on dirty linens. Bathing is a good way for nurses today to assess the skin of patients and the treatments can be catered to the needs of the specific patient (Musuuza, Roberts, Carayon, and Safdar, 2017). Specific individual needs for bathing can include cleaning PICC lines and IV lines, and having assistive equipment like a chair, walker, or other device to help position a patient with an amputated limbs, weight issues, and balance issues (Musuuza, Roberts, Carayon, and Safdar, 2017).

Chapter 12, “Chattering Hopes and Advices”, is mainly about being honest with patients about their situation and how it is important for family and friends of the patients to be present and bring good news that can be a distraction from their current situation. Sometimes patients would rather talk about anything other than their health situation (Nightingale, 1860). Another thing that Nightingale mentions is that trying to make light of the patient's situation also does not seem to help. For example, if a patient has a broken leg and a visitor says something along the lines of it could be worse and be both legs or it could be worse and be a spiral fracture instead of a greenstick, it does not help. Some patients get into a depressed state and feel very alone even if they are surrounded by family and or friend at the time. That being said, positive personal relationships including the patient are helpful (Broadhurst and Harrington, 2015).

Having someone present with the patient during hard times gives the patient a feeling of comfort without going over the line as to give the person false hope. Positive relationships with professionals can also encourage patients without making them focus on their health. A positive relationship with a professional can include helping with spiritual issues (Broadhurst and Harrington, 2015). Another thing that family and friends do to help but just causes more issues is when they try to come up with solutions and insist that is the issue, or that they know more about what is going on than medical professionals. That may be true, but the medical professionals have more experience with the ill and there is a good chance they have seen the patient's ailment previously in their career, which gives them much more knowledge about the present issue.

Nightingale mentions in her paper that it was not uncommon for family and friends both in the medical field and those who are not, to enter the patient's room and make suggestions about care, not always knowing what the diagnosis is and what would be safe and unsafe for the patient to do. She gives an example of family members coming in and suggesting the patient go out and exercise, not knowing he had a broken leg (Nightingale, 1860).

Nursing today and in Nightingale’s time is very different however there are some similarities. Nightingale’s thoughts and ideas about nursing were advanced for her time. She thought a lot more about safety and results of actions than many other nurses. Her ideas about personal cleanliness, the importance of ventilation and warming, and the way we as nurses encourage patients have immensely impacted the way nursing is performed today. We are more particular about safety and what is best for the patient versus what is easiest for us. There are no longer huge rooms filled with patients with all different issues (Nightingale, 1860), but a majority of patient rooms house one or two patients only. Thanks to Nightingale and her thoughts about nursing and methods she implemented, our practice has evolved to become much safer, more hygienic, and more considerate of each individual patient’s physical and emotional needs.

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