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Mrs. Adams, a 68-year-old widow who was referred to case management upon discharge from the hospital based on her physician’s recommendation that she is not able to care for herself independently. Her diagnosis is diabetes, hypertension, and breast cancer. She is 5 days’ post-op from a right sided mastectomy. Mrs. Adams apartment is located in a low income area of the city where crime is prevalent. Upon assessment by the Community Health Nurse, Mrs. Adams apartment was in disorder with minimal airflow or light. Her cloths appeared unchanged and she had no food in the apartment. The small apartment also housed 3 cats and a small dog who Mrs. Adams considers family since the death of her husband 1 year ago. Mrs. Adams complains of pain and draining from her surgical site and a broken air conditioner.
- Using Nightingales Environmental Theory, what actions would the nurse take upon the first assessment?
- What are the five essential components of Nightingales Theory?
- Prioritize an appropriate care plan for Mrs. Adams?
- 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 (this means current EBP of 5 years of less for the article.)
The assignment should be completed in APA format, as an essay of between 1000 and 1500 words. The paper should include at least 2 outside references and the textbook. The paper should be in APA format with a title page, level headings, and reference page, please see the Shell that I have included in this module. 1st person is not acceptable in APA papers, make sure to keep this is 3rd person.
Expert Answer and Explanation
The plan of the recovery of a chronic patient involves several interventions, with one of the main ones being the configuration of the environment or setting of the patient to make it friendlier. Florence Nightingale, the founder of modern nursing, also called ‘The Lady with the Lamp’ from her service during the Crimean war had several views about the implication of sanitation to the nursing field (Idrees & Shah, 2017). Applying her environmental theory in the care of Mrs. Adams, a 68-year-old woman with hypertension, cancer of the breast, and diabetes can guide in the development of the best practice from her situation.
Actions the Nurse would take upon the First Assessment Nightingale’s Environmental Theory
Mrs. Adams is referred to case management upon discharge from hospital, but upon assessment of her living conditions, there are numerous elements that show that her current home is not the ideal place of care. Besides living with four animals, three cats and one dog, Mrs. Adam’s apartment shows that there is minimal light flow, limited food, and the clothes are barely changed. Also, the air conditioner is broken, and the place she lives in is a high crime area. The first action that the nurse in charge would take would be the assessment of the possibility of changing the environment, or her chances of moving to a better place. The following are some of the environmental factors that the nurse would consider as pointed out in the environmental theory by Florence Nightingale.
Pure Fresh Air
The air that the patient breaths should be made as clean as possible. Stuffy environments increase the chances of chilling, which could limit the chances of recovery. Also, to maintain the right concentrations of oxygen required in the body, the patient would have to ensure that the external environment is completely sanitized (AliSher et al., 2019).
Pure water serves almost the same purpose as pure fresh air- making sure that the patient’s circulation is not contaminated with too much concentrations of unwanted substances. Impure water that is used for drinking purposes could lead to the absence of the right elements that would help in proper patient hydration (Mughal & Irshad Ali, 2017). In worse case scenarios, this impure water could lead to the addition of undesired elements to the body of the patient.
Effective drainage in the patient environment helps to ensure that their waste material is removed constantly from their residence. Lack of proper waste removal can lead to the build-up of undesired bacteria that could contribute to patient re-infection. Effective drainage can also help the patient feel more mentally comfortable with their environment.
Nursing mainly entails preserving cleanliness of both the patient and their environment. According to the environmental theory, clean environments have a large mental implication to ensuring patient wellness (Couto et al., 2020). Cleanliness also prevents chances of re-infection and re-admissions.
This is the last factor that should be considered in nursing according to the environmental theory. Direct sunlight has numerous health benefits such as helping in bone growth and development. Lighting up the room of a patient can also increase their mental alertness and wellness.
Appropriate Plan of Care for Mrs. Adams
In the plan of care for Mrs. Adams, the first step would be making suitable environmental adjustments that would contribute to improving her environment. For the patient to achieve a healing state, the introduction of a healthy environment is paramount. Having four pets could be disadvantageous to her given her economic conditions, as she would probably not be able to feed them well. These pets could roam around the streets and bring her a fourth disease, which would be problematic to her health. The plan of care should therefore include elimination of three of the pets to leave her with possibly a male cat. Also, general cleaning of her environment should be made to ensure that the surroundings are clean and safe for her to live in.
In the plan of care, the possibility of moving to a new apartment where lighting, security, and clean water is in plenty should be made. Changing the environment could also help her make new friends and hence contribute to her overall mental wellness (Thanattheerakul, 2018). Lastly, in the plan of care, there should be constant assessment of her surgical wound as well as the vitals which would guide in the progress of the other two conditions she faces, and corrective action done in case of abnormalities.
Applying Nightingale’s Environmental Theory to my Nursing Practice Area
Nightingale’s environmental theory holds to the fact that nature alone has the power to cure people from their illnesses. Medical plans in my nursing practice area, however, do not put much emphasis on the effect of altering the environment for positive changes. As a nurse leader, I would ensure that I advocate for policies in which nurses constantly assess the environment of patient as part of the wellness enhancement plan. Also, I would be sure to implement relevant applications of the nursing theory such as improving the five elements highlighted in the theory to ensure proper work outputs.
An implementation of the environmental theory in a nursing practice area would involve the recognition of nature as one of the healing elements, and hence improving aspects of nature such as light, ventilation, cleanliness, drainage, and water. The plan of care of Mrs. Adams is best designed through elimination of undesirable elements in her environment as well as through the introduction of elements that foster environmental wellness. Improving drainage and the lighting in her area should be part of the courses of action a nurse should take in her care, where the suitability of moving to a better location should also be assessed.
AliSher, A. N., Atta, S., Yasin, I., & Sohail, M. A. (2019). Clinical application of nightingale’s theory. International Journal of Nursing Care, 7(1), 13-16.
Couto, J. F., Tyrrel, M. A. R., de Araújo, S. T. C., Tonini, T., Machado, W. C. A., & de Figueiredo, N. M. A. (2020). Bringing Nightingale into the 21st century: Retrospective of Nursing care from the Environmental Theory perspective. Research, Society and Development, 9(5), 77953122.
Idrees, S., & Shah, N. B. Z. (2017). Bridging gap between Theory and Practice. Int. J. Endorsing Health Sci. Res, 5(4), 1-6.
Mughal, F. B., & Irshad Ali, B. H. (2017). Enhancing patient well-being: Applying environmental theory in nursing practice. Annals of Nursing and Practice, 4(3), 1085.
Thanattheerakul, C. (2018). Florence Nightingale: modern nursing theory forever. Journal of Nursing Science and Health, 41(1), 149-157.
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