Geriatric Care and Nursing Theories of Past and Present … Essay
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Nursing Theories Regarding Geriatric Care
Nursing theories: Geriatric care
The first, foundational theorist of nursing is Florence Nightingale, whose 19th century tract Notes on Nursing was the first attempt to standardize medical practice and an approach to nursing that was professional in a thorough and detailed manner. Nightingale's writings rehabilitated nursing from being regarded as a second-class profession to a respectable one. It also contains many foundational concepts useful to nurses, particularly in the field of geriatric medicine, even today. This paper will review the core concepts of Nightingale's theory, examine how they are still applicable to nursing today (with a specific emphasis on geriatric nursing) and also detail how a modern theorist, Dorothea Orem, advanced concepts that are in many ways resonant with Nightingale's.
In her introduction to Notes on Nursing, Nightingale notes that disease is a reparative process, not something which should be regarded as evil. For example, we know today that unless a fever is extremely high, a fever is actually raising the body's temperature for a specific physiological purpose and should not necessarily be immediately contained. Nightingale believed that nursing had limited itself far too narrowly to simply alleviating diseases rather than creating a health-promoting environment. Providing the patient with fresh air, warmth, and a proper diet, were often more essential than actual medical treatment, so the illness could run its course. That was why Nightingale's first, foundational principle of nursing was the need for ventilation (Nightingale 2010: 10).
The first tenant of Nightingale's theory was the need for clean air, not something which should be taken for granted, given the common state of buildings in cities in the 19 the century. Today, the fact that diseases circulate more easily in winter because of closed rooms is well-known, but that was not the case in Nightingale's day. Then, sick rooms were often closed for fear of the ill person catching a chill in the days before centralized heating and the exterior air was often foul even when windows were open. Nightingale is unsparing in calling it murderous to keep someone who is severely ill with something like scarlet fever in a closed-up room. The objective of nursing is to keep the air pure without as it is within, without chilling the patient (Nightingale 2010: 12). For patients in geriatric care, quite often because of the structure of the facilities there may be little motivation to get the patients outside on a regular basis. However, with proper supervision, based upon Nightingale's principles, it is quite likely that they could benefit from the additional exposure to the out-of-doors.
Nightingale also stressed the importance of the patient's diet. Once again, this resonates with the need for promoting wellness, rather than treating the sickness of the patient alone. More and more patients today are suffering from chronic illnesses such as diabetes and heart disease, the legacy of a rise of lifestyle-related conditions due to obesity. Patients are never too old (or too young) to benefit from a healthier diet. Unfortunately, many hospitals and nursing homes do not have healthy food. Also, encouraging elderly persons to eat can sometimes be difficult and they may lack important macronutrients. Encouraging physical activity can be valuable in helping patients regulate their diet as can the psychological benefits from a nurse's attentiveness. Nightingale notes the extent to which something simple such as 'timing' the food of the patient can have a significant impact upon their responsiveness (Nightingale 2010: 69). Even if someone is not immediately receptive to food at one point in time, they may feel more receptive to dining later on.
Nightingale was also an early advocate of the mind-body link and the body-mind link as well: both were interconnected. People who are ill need mental relief and often lack it: Nightingale urges the nurse to feel compassion for the ailing individual who is denied the traditional comforts of manual labor, walking, or the other things that the healthy take for granted (Nightingale 2010: 62). It is essential that the nurse provide some sort of relief with her demeanor and to do all that she can to alleviate the patient's psychological distress. Similarly, a geriatric nurse today can alleviate considerable mental suffering of a patient simply by taking an interest in his or her welfare. Asking the patient about the patient's past and evaluating the patient's mental state in the here and now can make the physical limitations the patient is experiencing much more bearable. (This concept of caring as a scientific component of nursing, not merely being generalized compassion, would resonate with many later theorists of nursing, including Jean Watson).
Other important caveats Nightingale makes regarding the care of the sick which would have resonance today include the need for appropriate bedding and clean walls and the overall appearance of the sick room. In many nursing homes, pressure ulcers are significantly linked to adverse patient outcomes because of insufficient turning: Nightingale underlines the need for attentiveness to such small issues which can spiral out and become larger ones. A Chief Nursing Officer must institute policies to support such health promotion.
Overall, attentiveness to simple human needs, not strictly medical needs, is at the heart of Nightingale's writings. Although she does not specify a theory which has components defined as 'nursing,' 'patient,' 'health,' and 'environment' like many modern nursing theories, these components are all addressed in Notes on Nursing. The nurse acts as a facilitator of self-efficacy as much as possible by creating an environment conducive to the body healing itself. Although Nightingale's work is not specifically religious in intention, she makes numerous references to allowing God's rehabilitative work to take place by creating such a health-promoting environment.
Nightingale's emphasis on health no doubt came from the fact that she had her origins as a war nurse. During the Crimean War she saw numerous examples of soldiers who were denied all of the things she deemed essential for healing and health promotion in Notes on Nursing. There was often little acknowledgement for the need for sanitation and appropriate care of the soldiers on a regular, daily basis in a manner that made it impossible for the men to get well, even those with relatively minor injuries. Soldiers were often more sickened from the care they received than their actual treatment (Fee & Garofalo: 2009: 1591). Nightingale's insight into the need for appropriate wellness promotion was to be a cornerstone of her training of new nurses as well as her own practice, as can be seen in other classics such as Florence Nightingale to her nurses, in which she exhorts new nurses to be constantly learning from their patients, as well as teaching others how to take better care of the sick (Nightingale 2009).
Another theory with significant applications to geriatric care is that of Dorothea Orem's self-deficit of care concept, which stresses that nurses step in to address care deficits, when patients cannot care for themselves. This concept resonates with the ideas expressed by Nightingale although Orem's theory more formally defines the core components of nursing. Nursing is specifically defined, according to Orem (1995), by making specialized assistance to patients that cannot give care to themselves. Orem's major publication is Nursing: Concepts of practice although she also expanded upon her theory in Concept formalization in nursing: Process and product, a work which she co-authored and edited with the Nursing Development Conference Group. Although Orem places a greater stress upon medical intervention than Nightingale, it must be remembered that when Orem crafted her theory, there was a wider range of potential technology that was life-promoting for patients. Orem, like Nightingale, clearly defines the patient as the center of nursing. However, environment for Orem is located in the biological and chemical realm, not as purely something which exists in the patient's external environment (Gonzalo 2010).
However, perhaps the most unique aspect of Orem's theory is its concept of health with its stress upon being able to care for one's self. Someone who is fully healthy has integrity in mind and body and is able to interact with the outside world in a meaningful way, both in terms of being able to perform actions to maintain well-being and to communicate with others (Gonzalo 2010). There is, however, a certain degree of implied 'self-care' requirements in Nightingale, given that she presumes the sick are unable to take care of their exterior surroundings, provide themselves with food, or to create the balanced state of homeostasis in their external world so they can heal.
This notion of self-care as articulated in Orem is very important because so many nurses on geriatric units have lost the ability to engage in comprehensive self-care because they have lost their physical capacity to feed themselves, engage in the full range of mobility, or do not have the mental capacity to life alone without danger. In all of these components of life the nurse must step in. However, Orem's stress upon the facilitation of self-care also cautions the nurse from providing too much care when… [END OF PREVIEW]
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