When you are a nurse you know that every day you will touch a life or a life will

touch yours. - Anonymous

Nursing is not just an ART, it has a heART. Nursing is not just a SCIENCE, but it has a conSCIENCE. -

Anonymous

Florence Nightingale

Historical Nursing

Hildegard

Peplau

Florence Nightingales image appeared for many years on the back of a Ten Pound note.

Florence Nightingale
The Lady with the Lamp Mother of modern Nursing

Florence Nightingale
Born in Florence in 1820 Named Florence, after the city she was born in Born to very wealthy, educated parents Traveled extensively, owned multiple estates Father was Cambridge educated, mother was a strong supporter of the abolition of slavery Well Educated Father believed women should have a strong education Florence and her sister learned Italian, Latin, Greek, history and mathematics.

Florence Nightingale
Embley Park, now a school, was one of the family homes of William Nightingale

Lea Hurst.
Childhood home of Florence Nightingale located in the rolling hills of Derbyshire. She returned here after the Crimean War. Now a private residence.

Florence Nightingale

In 1837, when she was 17, she felt a calling to help people

Florence Nightingale
But after a nine-year courtship she rejected him, convinced that marriage would interfere with her ability to follow her calling to nursing

The Lord Houghton

Introduction to Nursing
Florence was visiting a convent where she met two French Sisters of St. Vincent de Paul. She admired the Sisters discipline and organization surmising they made better nurses than women in England She made a visit to the Institute of Protestant Deaconesses at Kaiserwerth in (founded for the care of the destitute and eventually a training school for women teachers and nurses)

Her visit convinced her of the possibilities of making nursing a vocation for ladies

Broadening her horizons and seizing opportunity Florence began visiting the poor, but became interested in looking after the ill. She visited hospitals looking for occupations for women there Side note:
Nursing at that time was seen as employment that needed neither study nor intelligence; nurses were considered to be little less than prostitutes or cooks.

Hospitals in 1830s
Often people who went into hospital died
They were Dirty Nurses didnt know what to do

Introduction to Nursing

Spent three months at Kaiserwerth training as a sick nurse ( In Germany) Upon returning home, she inspected hospitals in London, Edinburgh and Dublin

In 1853, she accepted her first administrative post where she became the Superintendent of the Establishment for Gentlewomen.

South Street, Mayfair - Where Florence died on August 13, 1910.

Florence Nightingale
being responsible for the War Office during the Crimean War,

Sidney Herbert,

Crimean War
Broke out when Florence 34 was years old War Russia vs Turkey(Britain and France) Reports were coming through about terrible conditions in hospitals

known as Barrack Hospital during the Crimean War, was the British army's headquarters and hospital from 1854-1856

Selimiye Barracks

Crimean War 1854

Reports of the sufferings of the sick and wounded in English camps inspired Florence to enlist her services She was offered plenary authority over all nurses and the fullest assistance and cooperation from medical staff.

She got to work

Scrubbed the floors Cleaned the wards

Washed the bedclothes

Made the men comfortable In 1854 assembled party of 38 nurses to serve in Crimean War

A Nightingale Ward

Making a Difference

Florence collected data, kept impeccable records and systematically used statistics to demonstrate the effects of poor sanitation and surgical practices on death rates. Diagram of the Causes of Mortality in the Army in the East (1858) With simple education, she was able to bring down the death rate from 42% to 2% in six months.

Mathematical Contribution

l l l l l l

Developed a Model Hospital Statistical Form for hospitals to collect and generate consistent data and statistics Published statistical graph in 1859 which showed the losses of the British army in the Crimean war Used data to persuade the Government to improve army hygiene Created spectacular graphics designed to show how improvements in hygiene could save many lives First to create a line chart which showed death rates of soldiers in peacetime Credited with inventing the pie chart

In the night she carried a lamp so she was called The Lady with the Lamp

They began to get better Sitting up, cheerful and happier!

Letter from Queen Victoria

Thanking Miss Nightingale and her ladies for all their hard work

END OF THE CARIMEAN WAR

Nursing Contributions
Founded the Nightingale School and Home for Nurses at Saint Thomas Hospital in London Wrote Notes on Nursing, the first textbook for nurses
Notes on Nursing: What Nursing Is, What Nursing Is Not (1860)

Notes on Nursing
ventilation and warming health in houses petty management (how things are done by others when you must be away) noise variety (environment) taking food and what kinds of food bed and bedding light cleanliness of rooms personal cleanliness chattering hopes and advices (the false assurances and recommendations of family and friends to the sick) observation of the sick

A. NIGHTANGLES THEORY (mid-1800) : Focuses on the patient and his environment. Developed and described the first theory of nursing. She focused on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act. Clients environment is manipulated to include appropriate noise, nutrition, hygiene, socialization and hope.

 1907 Royal Red Cross

Fr: Queen Victoria

Order of Merit
Fr: King Edward VII

She was given a diamond brooch with Blessed are the merciful engraved on it

Tidbits
Florence inspired Jean Henri Dunant , one of five founders of the International Committee of the Red Cross (Geneva Switzerland) which in turn inspired Clara Barton to form the American National Red Cross aka American Red Cross . There is a psychological effect named after her called The Nightingale Effect, whereby nurses and doctors fall in love with their patients.

In a Nutshell
Florence was:
A pioneer of nursing The Founder of Modern Nursing A reformer of hospital sanitation methods

Credited with proving that nursing could be a respectable profession

Florence Nightingale
Florence died of old age She was buried near to her parents home in Hampshire. died in 1910, age 90

 She was famous all over the world She changed hospitals all over the world There is a museum in London which celebrates her life and work

2 pounds: 100th anniversary of the death of Florence Nightingale and the 150th anniversary of publication of Notes on Nursing Series: United Kingdom: Commemorative 2 pounds coins

Hildegard E. Peplaus (1909-1999) Mother of Psychiatric Nursing

Hildegard Peplau was born in Reading,Pennsylvania on September 1st, 1909. Second daughter born of six children. As a child, she witnessed the devastating flu epidemic of 1918, a personal experience that greatly influenced her understanding of the impact of illness and death on families.

Peplau began her career in nursing in 1931 as a graduate of the Pottstown, PA, School of Nursing.

After graduating from the Pottstown, Pennsylvania Hospital School of Nursing in 1931 she worked as an operating room supervisor at Pottstown Hospital.

. A summer position as nurse for the New York University summer camp led to a recommendation for Peplau to become the school nurse at Bennington College in Vermont.

At Bennington and through field experiences at Chestnut Lodge, a private psychiatric facility, she studied psychological issues with Erich Fromm, Frieda FrommReichmann, and Harry Stack Sullivan.

During World War II, Hildegard Peplau was a member of the Army Nurse Corps and worked in a neuropsychiatric hospital in London,

From 1943 to 1945 she served in the Army Nurse Corps

was assigned to the 312th Field Station Hospital in England, where the American School of Military Psychiatry was located.

AFTER THE WAR

they worked to reshape the mental health system in the United States through the passage of the National Mental Health Act of 1946 Peplau developed and taught the first classes for graduate psychiatric nursing students at Teachers College.

Peplau held masters and doctoral degrees from Teachers College, Columbia University. Peplau created the first graduate level program for the preparation of clinical specialists in psychiatric nursing

AFTER THE WAR

During the 1950s and 1960s, she conducted summer workshops for nurses throughout the United States, mostly in state psychiatric hospitals. In these seminars, she taught interpersonal concepts and interviewing techniques, as well as individual, family, and group therapy. Peplau was an advisor to the World Health Organization and was a visiting professor at universities in Africa, Latin America, Belgium, and throughout the United States.

A strong advocate for graduate education and research in nursing She served as a consultant to the U.S. Surgeon General, the U.S. Air Force, and the National Institutes of Mental Health.

She served as president of the American Nurses Association from 1970 to 1972 and a second vice president from 1972 to 1974

After her retirement from Rutgers, she served as a visiting professor at the University of Leuven in Belgium in 1975 and 1976

Interpersonal Model Defined nursing as a therapeutic, interpersonal process which strives to develop a nurse- patient relationship in which the nurse serves as a resource person, counselor and surrogate.

4 Phases of nurse-patient relationship

Orientation-client seeking assistance, meeting of nurse-patient, identifying the problem and services needed ( interview process), and guidance. Identification- identifying who is best to support needs, patient addresses personal feelings about the experience and is encouraged to participate in care to promote personal acceptance and satisfaction.

Phases cont.
Exploitation- patient attempts to explore, understand and deal with the problem, and gains independence on achieving the goal Resolution- termination of the therapeutic relationship to encourage emotional balance for nurse and patient ( difficult for both patient and nurse as psychological dependence persists)

Roles of Nurses
Stranger Teacher Resource person Counselor Surrogate Leader

Roles of Nurses
Additional Roles include: 1. Technical expert 2. Consultant 3. Health teacher 4. Tutor 5. Socializing agent 6. Safety agent 7. Manager of environment 8. Mediator 9. Administrator 10. Recorder observer 11. Researcher

Roles of Nurses
Stranger role: Receives the client the same way one meets a stranger in other life situations; provides an accepting climate that builds trust. Resource role: Answers questions, interprets clinical treatment data, gives information. Teaching role: Gives instructions and provides training; involves analysis and synthesis of the learner's experience. Counseling role: Helps client understand and integrate the meaning of current life circumstances; provides guidance and encouragement to make changes. Surrogate role: Helps client clarify domains of dependence, interdependence, and independence and acts on clients behalf as advocate. Active leadership: Helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way. Technical expert role: Provides physical care by displaying clinical skills; Operates equipment

 Identified four sequential phases in the interpersonal relationship: 1. Orientation 2. Identification 3. Exploitation 4. Resolution

Orientation phase Problem defining phase Starts when client meets nurse as stranger Defining problem and deciding type of service needed Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of past experiences Nurse responds, explains roles to client, helps to identify problems and to use available resources and services

Factors influencing orientation phase

Identification phase Selection of appropriate professional assistance Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness

Exploitation phase Use of professional assistance for problem solving alternatives Advantages of services are used is based on the needs and interests of the patients Individual feels as an integral part of the helping environment They may make minor requests or attention getting techniques The principles of interview techniques must be used in order to explore, understand and adequately deal with the underlying problem Patient may fluctuates on independence Nurse must be aware about the various phases of communication Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step

Resolution phase Termination of professional relationship The patients needs have already been met by the collaborative effect of patient and nurse Now they need to terminate their therapeutic relationship and dissolve the links between them. Sometimes may be difficult for both as psychological dependence persists Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals

 An article in Current Nursing evaluated using the theory in nursing practice

Assessment= Orientation phase Nursing diagnosis Planning=Identification phase Implementing=Exploitation phase Evaluation=Resolution phase

Application of Interpersonal Theory in Nursing Practice

(the theory allowed clients needs to be assessed. Application of the theory helped provide comprehensive care to the client)

This theory would be useful with our newly diagnosed cancer patients and their family. Resistance is met when trying to educate them about the treatment, encouraging enrolment in studies, and education about how to care for the patient in their home setting.
Orientation-patient gets admitted to the unit, nurse helps the patient to recognize and understand that they have cancer and the importance of treatment. Identification-Patient takes the time to internalize the diagnosis, the nurse participates in helping the patient to do so. -- Exploitation-the nurse works to have the patient explore what help is needed to meet goals, incorporating other disciplines to problem solve (oncologists, therapists, alternative medicine, etc.).Patient test the limits of the nurses availability, and the nurse encourages patient to evaluate ways to meet their final goals. -- Resolution-when in-patient treatment is complete, the nurse has to evaluate feelings and remove themselves from the bond that is made, allowing the patient and family to move on and regain balance in their own lives.

Application of theory in nursing practice

She retired in 1974. On March 17th, 1999, Hildegard Peplau died peacefully at her home in Sherman Oaks California after a brief illness. She was 89 years old.

Thank you!