Brure

Introduction

Florence Nightingale and Dorothea Orem are two nurse theorists who made significant contributions to the field of nursing. Nightingale is known for her Environmental Theory, which emphasizes the importance of a clean and safe environment for the promotion of health and the prevention of disease. She believed that the role of the nurse was to manipulate the environment to facilitate the body's natural healing process. On the other hand, Orem's Self-Care Deficit Theory focuses on the patient's ability to perform self-care activities to maintain their health and wellbeing. She believed that the role of the nurse was to identify the patient's self-care deficits and provide assistance to promote independence. While Nightingale and Orem's theories differ in their approach to nursing practice, they both share a common goal of promoting health and wellbeing through nursing interventions. Nightingale's Environmental Theory emphasizes the importance of the physical environment in promoting health and preventing disease. Nightingale believed that the role of the nurse was to manipulate the environment to facilitate the body's natural healing process. For example, by maintaining a clean and well-ventilated environment, the nurse can reduce the risk of infection and promote healing. Evidence-based practices that are derived from Nightingale's theory include infection prevention practices like wearing personal protective equipment and practicing good hand hygiene. It has been demonstrated that these procedures lower the danger of infections linked to healthcare and enhance patient outcomes.

Evaluation

Orem's Self-Care Deficit Theory focuses on the patient's ability to perform self-care activities to maintain their health and wellbeing. Orem believed that the role of the nurse was to identify the patient's self-care deficits and provide assistance to promote independence. For example, in patients with diabetes, the nurse can provide education on proper foot care to prevent foot ulcers. Evidence-based practices that are derived from Orem's theory include patient education and self-management interventions. These practices have been shown to improve patient outcomes and reduce healthcare costs. While Nightingale and Orem's theories differ in their approach to nursing practice, they both share a common goal of promoting health and wellbeing through nursing interventions. Evidence-based practices derived from their theories have been shown to improve patient outcomes and reduce healthcare costs.

Points of Comparison and Contrast

When you hear QSEN competencies, the first thing that comes up is, what is that? “QSEN stands for Quality and Safety Education for Nurses and the goal of this project is to meet all challenges of the current nurses and future nurses who could improve the safety of healthcare as well as quality of healthcare. The QSEN has six different competencies which are: patient-centered care, teamwork and collaboration, evidence-based practice (EBP), quality improvement (QI), safety, and informatics.” (Sherwood 2021).

Patient -Centered Care

Comparing and contrasting Florence Nightingale and Dorothea Orem’s theories based on these 6 different competences is so interesting because both heroes in nursing existed in different eras but maintained almost the same philosophy. Florence Nightingale's philosophy and teachings emphasize that the nurse must use her brain, heart, and hands to create healing environments to care for the patient's body, mind, and spirit (Riegel et, al 2021). As we know, Ms. Nightingale theory was based on her experience on wounded soldiers during the Crimean War of October 1853 to February 1856. This era was the time when the healthcare and nursing profession was still in the incubator stage; nursing was seen as an act of kindness not a profession. Hence, Nightingale urged us to use “our brain, heart and hands.” Patient centered care was the key component of Nightingale as reflected in her empathy and sympathy for the wounded and helpless soldiers, who were dying because of poor nutrition and hygiene in the hospitals. While Dorothea Orem’s theory of 1959 and 2000 comprised three related parts: theory of self-care; theory of self-care deficit; and theory of nursing system. “The theory of self-care includes self-care, which is the practice of activities that an individual initiates and performs on his or her own behalf to maintain life, health, and well-being and self-care deficit that specifies when nursing is needed. (Petiprin, 2023). Orem’s self-care deficit theory suggests patients are better able to recover when they maintain some independence over their own self-care. According to Orem, nursing is required when an adult is incapable or limited in the provision of continuous, effective self-care. Orem’s model was patient-oriented since it implied educating patients on how to manage their condition through appropriate practices. (Petiprin, 2023).

Teamwork and Collaboration

The second QSEN competency “Teamwork and collaboration” is very paramount in nursing education, it is critical that pre-licensure graduates understand their role and responsibility in healthcare with emphasis on their relationship to the other healthcare providers. Nurses must learn to respect the value of the other disciplines recognizing where the various scopes of practices intersect or are different. Teamwork refers to the efforts within one team to produce the highest quality and most efficient results. While Collaboration refers to joint efforts between various independent teams or groups. For example, if a pregnant psychiatric patient shows signs of a heart issue, a cardiac team will be called to work together with those in the maternity ward. Nightingale’s Teamwork and collaboration cannot be overemphasized, that in the middle of the war she “intuitively and wisely influenced local stakeholders by building onsite multinational teams whose collaborations were essential. The myriad individuals on the teams included her nurses; military medical officers and wives of soldiers; diplomats and their wives; local men of business and laborers; and religious sisters and clergy.” (Matthews at el, 2020). Orem’s model is useful for the practice setting because it provides nurses with the basis for educating patients to care for themselves through collaboration with healthcare providers. Training nurses on how to address the needs of different patients, improve the efforts of collaboration, and identify challenges that still require addressing, especially with regards to interdisciplinary teamwork.

Evidenced-Based Practice (EBP)

Evidence-based practice (EBP) Nightingale was a disciplined pioneer of evidence-based practice. Less well-known than her contributions to hospital and nursing practice was her pioneering work in medical statistics; her painstaking efforts to chart infection and death rates among soldiers at Scutari gave weight to her demands for improved sanitary conditions first at military hospitals, and later in civilian institutions. (Tye, J. 2015). She observed a direct correlation between the sanitary conditions of patients and their health and recovery. Patient cause of death was primarily due to poor hygiene rather than their wound. Nightingale worked to create sanitary conditions for patients, medical tools, clean bed linens, and the health care professionals and hospital environment. Based on Orem’s nursing theory, self-care is considered as activities that people engage in to maintain, restore, or improve their health. Nurses do not consider patients as inactive and mere recipients of health services; rather, they consider patients as strong, reliable, responsible, and capable of decision-making who can take care of their health appropriately (Khademian, 2020).

Quality Improvements (QI)

According to Nightingale's idea, it's critical to create a setting that encourages recovery and supports the patient's innate capacity for healing. This includes access to clean water, fresh air, and nutritious food. The core of Orem's theory is the idea that everyone has the capacity to engage in self-care practices that sustain their health and wellbeing. In order to encourage good self-care, the approach highlights the significance of comprehending the patient's capabilities and limitations. Both theories advocate for the application of fact-based knowledge to enhance patient outcomes and the standard of treatment.

Safety

According to Nightingale's idea, it's critical to give patients a clean and safe environment. She underlined the value of handwashing and other infection control procedures while acknowledging the significance of limiting the spread of infection. The need for nursing intervention when a person is unable to sustain their own self-care is acknowledged by Orem's hypothesis. Taking care of safety issues like fall prevention or ensuring medication compliance might be part of this. Both theories acknowledge the significance of patient safety as well as the necessity of addressing risky behaviors and mistakes.

Informatics

The application of technology or informatics in nursing practice is not expressly covered by Nightingale's philosophy. The relevance of technology in fostering successful self-care is acknowledged by Orem's hypothesis. The approach highlights the necessity of utilizing technology to improve communication and decision-making. The significance of technology in increasing patient safety and minimizing medical errors is more explicitly acknowledged in Orem's view.

Contrasting the Two Nursing Theories

While Orem's theory highlights the value of encouraging effective self-care, Nightingale's theory places a strong emphasis on establishing an atmosphere that promotes the patient's innate ability to recover. Orem's theory prioritizes the unique requirements and skills of each patient, whereas Nightingale's theory lays more attention on the physical environment and how it affects patient outcomes. While Orem's theory acknowledges the use of technology in encouraging successful self-care and improving decision-making and communication, Nightingale's theory is less clear in addressing the use of technology and informatics in nursing practice.

Metaparadigms: Person

Nightingale’s theory approach to patient-centered care emphasizes approaches that seek to reduce human suffering through compassionate care, which focuses on patient needs. The theory advocates for innovation that dignifies service delivery to patients to enhance their comfort at the hospital (Hartweg & Metcalfe, 2022). Similarly, Oren’s theory emphasizes the nurse-patient relationship and views Nursing as an art to help patients meet their self-care needs. It focuses on environmental aspects such as the patient’s family, culture, community, and personal practices that patients employ to maintain their health and well-being. Both theories are vital contributors to the nursing practice; however, Orem focuses on fostering patient independence and their education process, while Nightingale’s theory hubs engage nurses in continuous learning.

Health

Orem’s theory approach to health employs a collaborative approach for nurses and patients in administering care. Patients learn and practice self-care to ensure good health, while nurses use the systems approach to deliver healthcare services (Yip, 2021). Nightingale’s theory views health as being in an environment without disease or one that supports recovery. It emphasizes the need for nurses’ continuous learning to provide quality care, apply critical thinking, and effectively serve patients under their care.

Environment

Orem’s theory emphasizes creating a conducive environment for individuals to meet their self-care needs and thrive in all areas. Its methods for helping others emphasize creating communities that help others through action on their behalf, guiding and supporting them, besides creating an environment to foster personal development. Similarly, Nightingale’s theory emphasizes a healthy environment to promote overall well-being. It emphasizes the physical environmental factors such as basic sanitation, clean water, air light, and sufficient nutrition. The theory also recommends appropriate bedding, personal hygiene, and a quiet environment to promote peaceful rest. According to Riegel et al. (2021), the overall environmental paradigm seeks to place people in surroundings that can preserve and promote recovery from illness. The theory centers on social justice and respect for humanity. Both theories view the physical environment as essential to human well-being . However, Orem’s concept incorporates social and psychosocial aspects in the ecological paradigm.

Nursing

Ultimately, the idea of metaparadigms proposed by Florence Nightingale and Orem offers a framework for nurses to consider while giving care and highlights the significance of teamwork and evidence-based practice. It is possible for nurses to build a holistic approach to care that is individualized to the person who is getting care if they have a thorough grasp of the four components of the theory and how they connect to one another. This will assist in ensuring that the individual receives the greatest possible quality of care from the nurses, as well as that their individual requirements and preferences are addressed.

Conclusion

In conclusion, the theories of Nightingale and Orem have made significant contributions to nursing practice. They emphasize the importance of patient-centered care and creating a healthy environment for patients to promote recovery and healing. Theories are essential in providing nurses with the skills, knowledge, and strategies required to deliver quality care to patients. The two theories have helped shape the nursing profession and are essential in providing nurses with the necessary skills, knowledge, and strategies required to provide quality care to patients.