Which Type Of Theorist Is Most Likely To Explore The Ways In Which Registered Nurses Display
Louise C. Selanders, RN, EdD, FAAN
Patrick C. Crane, MSN, RN
Abstract
Modernistic nursing is circuitous, e'er changing, and multi focused. Since the time of Florence Nightingale, nonetheless, the goal of nursing has remained unchanged - namely to provide a safe and caring environment that promotes patient health and well being. Effective use of an interpersonal tool, such as advocacy, enhances the care-giving environs. Nightingale used advocacy early and often in the development of modernistic nursing. By reading her many messages and publications that accept survived, it is possible to identify her professional goals and techniques. Specifically, Nightingale valued egalitarian human rights and developed leadership principles and practices that provide useful advancement techniques for nurses practicing in the 21st century. In this article nosotros will review the accomplishments of Florence Nightingale, discuss advocacy in nursing and show how Nightingale used advancement through promoting both egalitarian human rights and leadership activities. We will conclude by exploring how Nightingale's advocacy is every bit relevant for the 21st century as it was for the 19th century.
Citation: Selanders, 50., Crane, P., (January 31, 2012) "The Vox of Florence Nightingale on Advocacy" OJIN: The Online Journal of Issues in Nursing Vol. 17, No. ane, Manuscript i.
DOI: 10.3912/OJIN.Vol17No01Man01
https://doi.org/x.3912/OJIN.Vol17No01Man01
Cardinal words: Florence Nightingale, advancement, nursing, profession
Nursing has never been simple. Early care stressors included exposure to the elements and a lack of knowledge as to how to treat serious injuries or diseases. Through ensuing generations, environmental conditions have improved and scientific discipline has provided constructive treatment pathways. Still, other complexities, including societal acceptance of the profession, gender bigotry, and educational and regulatory disarray, have created a multifaceted and complicated properties confronting which nurses continue to provide the most basic of human interventions: caring.
One of the near effective tools that [Nightingale]employed was advocacy, both for individuals and for the nursing collective. In the nineteenth century, ane woman, considering of her religious convictions and profound vision of the potential of nursing, contradistinct the status of nursing from that of domestic service to that of a profession (Nightingale, 1893/1949; Nightingale, 1895a). This adult female, Florence Nightingale, utilized intellect, personal motivation, available opportunities, and the strength of her ain persona to create a permanent professional transformation (Bostridge, 2008; Cook, 1913; Dossey, 2000). 1 of the virtually effective tools that she employed was advocacy, both for individuals and for the nursing collective. The purpose of this article is to explore Nightingale's utilise of advocacy as a tool and to place the continuing value of her conceptual and practical advocacy strategies for the nursing profession in the 21st century. In this article we will review the accomplishments of Florence Nightingale, hash out advancement in nursing, and show how Nightingale advocated both through promoting egalitarian human rights and through her leadership activities. We will conclude by exploring how Nightingale'due south advocacy is every bit relevant for the 21st century every bit it was for the 19th century.
Who Was Florence Nightingale?
On May 12, 1820, Florence Nightingale was born as the second of two daughters to English parents. As a immature woman, she displayed infrequent intellect, learning multiple languages and beingness particularly capable in mathematics (Bostridge, 2008). Nightingale seemed to be most comfy in the solitary activities of reading, writing in her journals, and attempting to discern purpose in her life. She deeply believed that she had a God-given purpose to improve flesh, but the route to achieving this goal was unclear (Calabria & Macrae, 1994; Melt, 1913).
...her lifetime of work and her passion for improving healthcare provided nursing with a foundational philosophy for practice. Equally a young woman, Nightingale wished for meaningful work and began to imagine herself caring for others, defying her parents' desire that she marry into a socially prominent family. On at least 3 occasions she declined proposals, indicating that she could not pursue her own goals as a married woman (Gill, 2004; Nightingale, 1859a/1978). By the historic period of 17 she had discerned that she had a Christian duty to serve humankind. By the age of 25 she had identified nursing as the means to fulfill this mandate (Gill, 2004). When she was 30 years onetime, she was permitted ii brief periods of instruction in nursing at Kasiserswerth, a Protestant institution in Germany (Bostridge, 2008; Nightingale, 1851). This experience helped her to understand the essential components of basic nursing, hospital design, and personnel administration. Of even greater issue was Nightingale's perception that formalized education was a necessary component of nurse preparation (Nightingale, 1851).
In 1852 Nightingale was offered the superintendency of a pocket-sized hospital on Harley Street in primal London (Verney, 1970). During her twelve months in this position, she developed effective administrative skills, identified appropriate qualifications for those employed equally nurses, and affirmed her belief that egalitarian and competent care were basic human being rights for all people (Selanders, Lake, & Crane, 2010; Verney, 1970).
As Nightingale was preparing to leave the Harley Street position, she was appointed past the Victorian government to lead a grouping of xxx-eight women to Ottoman Turkey, to provide nursing treat British soldiers fighting the Crimean State of war (Bostridge, 2008; Woodham-Smith, 1983). Nightingale's atypical motivation was to improve the plight of the wounded. She stated, "...I did not retrieve of going to give myself a position, simply for the sake of mutual humanity" (every bit cited in Goldie, 1987, p.21). Her administrative skills allowed her to negotiate the male worlds of both the armed services and medicine. She successfully solved the problems of supply purveyance, resolved interpersonal squabbles betwixt nursing factions, and designed care modalities in the face of massive overcrowding, incompetence, uncaring physicians, and a armed services structure that was outdated and inept. In a letter to her uncle, Nightingale stated that the Purveyor had intentionally withheld supplies for his ain gain, noting, "This little Fitzgerald [Purveyor] has starved every infirmary when his shop was full- & not, equally it appears from ignorance, like some of the honorable men who have been our murderers, but from malice prepense." (Nightingale, March 6, 1856, as cited in Goldie (1987, p. 225).
On her return from the Crimea, Nightingale worked tirelessly to develop nursing as an essential and educated component of healthcare. On her return from the Crimea, Nightingale worked tirelessly to develop nursing equally an essential and educated component of healthcare. Her establishment of the Nightingale School in London in 1860, and the distribution of trained nurses away established the basis for nursing educational activity worldwide (Baly, 1986; Godden, 2010). Through the support of Queen Victoria and Prince Albert she was able to design improvements for the British military machine and establish public health standards in India (Dossey, 2000; Mowbray, 2008). Additionally, her lifetime of work and her passion for improving healthcare provided nursing with a foundational philosophy for do (Selanders, 2005a).
Nightingale remained actively concerned with the development and behavior of the Nightingale nurses educated at the Nightingale School until her death in 1910 at historic period 90. Between 1872 and 1900, she wrote a series of thirteen messages to the Nightingale nurses that both documented the progress nursing made in the late nineteenth century and warned nurses that they must remain electric current, competent, and caring. In 1897, she wrote of the danger of relying on words over actions:
"There is no doubtfulness that this is a disquisitional time for nursing... ...There is a curious onetime legend that the nineteenth century is to be the age for women and has it not been and so? Shall the twentieth century be the age for words? God forbid." (Dossey, Selanders, Beck, & Attewell, 2005, p. 283).
Advocacy in Nursing
...advocacy has not e'er been a clear expectation in nursing...Early nursing education emphasized conformity and a position subservient to the medico. Advocacy has been defined as an active process of supporting a crusade or position (Illustrated Oxford Dictionary, 1998). However, advancement has non e'er been a clear expectation in nursing. Seminal documents in the development of the American nursing curriculum, such equally Nursing and Nursing Educational activity in the Us (Goldmark, 1923) and A Curriculum Guide for Schools of Nursing (National League of Nursing Education, 1937), practise not explicitly mention advocacy. Early nursing education emphasized conformity and a position subservient to the physician. Isabel Hampton Robb, an early leader in the development of American nursing didactics, encouraged obedience as the principal activeness of the nurse. In 1900 Robb stated:
Above all, let [the nurse] call up to do what she is told to do, and no more than; the sooner she learns this lesson, the easier her work will exist for her, and the less likely she volition be to autumn nether severe criticism. Implicit, unquestioning obedience is one of the start lessons a probationer must learn, for this is a quality that will be expected from her in her professional capacity for all future time.... (Hamric, 2000, p. 103).
While Nightingale expected obedience in following the rules and medical management, her intent was to allow nurses the autonomy of purpose to advocate for patients and the profession (Nightingale, 1893). It is likely that she would take disapproved of Robb's emphasis on obedience.
The term 'advocacy' was first utilized in the nursing literature by the International Council of Nurses in 1973. The term 'advocacy' was get-go utilized in the nursing literature by the International Council of Nurses in 1973 (Vaartio & Leino-Kilpi, 2004). Today the American Nurses Association (ANA) states that high quality do includes advancement equally an integral component of patient safety (ANA, n.d.). Advancement is at present identified both as a component of ethical nursing practice and equally a philosophical principle underpinning the nursing profession and helping to assure the rights and safety of the patient. Nurses are seen as advocates both when working to achieve desired patient outcomes and when patients are unable or unwilling to advocate for themselves.
Since 1973 advocacy has been considered a major component of nursing practice - politically, socially, professionally, and academically. Despite the seeming lack of a professional focus on advancement before the early 1970s, it is argued that Nightingale implicitly laid the foundation for nurse advocacy and established the expectation that nurses would abet for their patients.
Nightingale and Advocacy
Nursing is at present recognizing how [Nightingale'southward] ideas and techniques can exist useful in the 21st century. The telescopic of Nightingale's consequence on nursing and her utilization of advocacy as a functional principle, like the profession itself, is complex. Nightingale did non directly accost the concept of advocacy. She did, however, demonstrate advancement in exceptional ways throughout her lifetime. We know of Nightingale'south actions, thoughts, and motivations through her correspondence. At least thirteen,000 letters remain in public archives and private collections. She was the shadow writer for a number of official regime documents relating to healthcare in the armed services and the subcontinent of India (Bostridge, 2008; Mawbray, 2008). Some of her most insightful writings, such as those establish in Suggestions for Idea (Calabria & Macrae, 1994), were published privately, thus controlling the distribution to friends and colleagues. Even so, they are at present publically available. The volumes Nightingale published for public consumption, including Notes on Hospitals (1859b/1982) and Notes on Nursing: What information technology is and what information technology is not (1860/1982), specifically outline the role of the nurse and the environment in which intendance should occur (Selanders, 2005b).
Nightingale was a atypical force in advocating for as opposed to with individuals, groups, and the nursing profession. Her expressions of advocacy grew with age, experience, and public acceptance of her every bit both nurse and expert. Her significant contributions include her advocacy for egalitarian human rights and for advocacy in her leadership roles. Nursing is now recognizing how her ideas and techniques tin be useful in the 21st century.
Advocacy Through Promotion of Egalitarian Human Rights
Every bit a young woman, Nightingale became acutely aware of the unequal condition and opportunity provided to men as compared to women in English guild. Stark (1979) described the social structure:
Victorian England was a land in the grip of an ideology that worshipped the woman in the home. Women were viewed as wives and mothers, every bit potential wives and mothers, or as failed wives and mothers. The woman who was neither wife nor mother was chosen the "odd woman" or the "redundant woman" (p. 4).
In Nightingale'southward frustration, she wrote the lengthy essay Cassandra (1859/1979), named after the tragic Greek mythological figure who, although able to predict the future, was not believed, and therefore, was powerless. As a part of this diatribe, she compares the perceived value of a woman's activity to that of a homo:
At present, why is it more ridiculous for a homo than a woman to exercise worsted piece of work and bulldoze out everyday in a carriage?... Is man's time more than valuable than woman'due south? or is it the difference betwixt man and woman this, that woman has confessedly nothing to practice? (Nightingale, 1859a/1979, p. 32).
Nightingale's first pregnant demonstration of advocacy for individuals came every bit she was superintendent of the Hospital for Gentlewomen in Distressed Circumstances. On ane manus, assuming the superintendency of this institution had to accept been extremely daunting for a woman of 32 inbound her get-go employment. The hospital was a newly caused facility in poor condition with inadequate furnishings and a poorly trained staff. She reported that in the first month of occupancy she had experienced a gas leak with small explosions, a fight between workmen in the drawing room, a drunken foreman, and the death of 5 patients (Verney, 1970). On the other hand, information technology was the opportunity to participate in a healthcare state of affairs under her command that allowed her to create and utilise environmental and patient care standards that were to become foundational to the evolution of mod nursing (Selanders, 2005a).
Nightingale did have the general support of the Ladies' Commission, the body to whom she reported. Her first major concern, however, was a policy held past the Commission stating that only individuals who were members of the Church of England would be admitted to the institution. Nightingale could not take this position, perchance because of her liberal Unitarian upbringing and her deeply rooted beliefs in the value of individuals without respect to religious preference. In a private notation to her close friend and ally, Mary Clarke Mohl, she airs her frustration, indicating she would exit the mail service if this disagreement could non exist resolved:
From committees, charities, and schism, from the Church building of England, from philanthropy and all deceits of the devil, good Lord evangelize u.s.a.. My commission refused me to take in Catholic patients; whereupon I wished them skilful morning, unless I might take Jews and their Rabbis to nourish to them. (Verney, 1970, p. eight).
Eventually, she won the boxing with the Committee so that patients of all faiths – or no religion – were equally admitted to the hospital (Verney, 1970). The importance of this event cannot be disregarded in Nightingale's development every bit a social reformer and healthcare abet. She won this see partially through logical persuasion, only as well because of her status as a 'lady' – a person of the upper class. This allowed her to meet the committee members on equal social footing. Use of personal position and social acquaintances, logic and debating skills, and the development of statistical show were tools she would refine and employ over the next fifty years. This firsthand victory helped her to retain her moral convictions and to move forward every bit an advocate for women and nursing (Selanders, Lake, & Crane, 2010).
Nightingale next turned her attention to the development of care standards for patients, including the right to a peaceful decease. The chronically and the mentally ill were often ignored past staff. Those determined to be 'malingerers' and the dying did non meet the criteria for admission (Scott, 1853). Nightingale, all the same, accustomed these patients and allowed them to remain as long every bit she believed that they were benefiting from care despite staff objections. For a staff member to decline to work to Nightingale's standard resulted in dismissal, signaling the application of authoritative standards of care. This is explicitly demonstrated in her May 15, 1854, report to the Governors when she wrote, "I have changed i housemaid on account of her love of clay and inexperience, & one nurse, on account of her love of Opium & intimidation" (Verney, 1970, p. 28).
...Nightingale never wavered from the idea that a basic homo correct was loftier-quality patient intendance provided by a dedicated nursing staff. Nightingale advocated for patients on a larger stage during her 20 months in Scutari and the Crimea. These nurses were individually selected for their power to nurse, the likelihood that they would accept authority, and the expectation that they would remain for the duration of the conflict. Ultimately, many of those selected did not fulfill these criteria. However, Nightingale never wavered from the idea that a basic homo right was high-quality patient care provided by a dedicated nursing staff.
Following her return to England she established like operating principles at The Nightingale School at St. Thomas' Hospital. Nightingale again insisted that probationer students be admitted without respect to religious preference (Bostridge, 2008). The development of educational standards in a tightly controlled surroundings began to elevate nursing equally a respectable profession that provided women with meaningful employment (Adern, 2002).
Advocacy Through Leadership
Leadership was one of Nightingale's innate qualities. During her fifty productive years, she continually benefited from the cumulative experiences of Harley Street, Scutari, the Crimea, and her interactions with regime officials in determining the potential of nursing. Her education, social stature, extensive range of acquaintances, and international travel provided essential context, opportunity, and a public voice. Her major contributions to the profession had evolved from leadership of a few at Harley Street and in the Crimea to the professional person commonage. She was able to explore the potential of a refocused nursing, every bit opposed to remodeling the status quo.
One of Nightingale'south central themes was the importance of nursing'southward role in the management of the patient environment. One of Nightingale's primal themes was the importance of nursing's office in the management of the patient environment (Nightingale, 1859b/1982). For much of Nightingale's life she believed in miasmatism, the idea that foul odors caused disease (Selanders, 2005c). While this was an inaccurate theory, it did focus attention on the office of the environment in relation to illness. The deplorable weather condition at Scutari reinforced this viewpoint, and led to her advocating for the importance of an appropriate environment for the patient both internally and externally. She began her Notes on Nursing (1860/1982) by stating that the incidence of affliction is related to "...the want of fresh air, or of low-cal, or of warmth, or of quiet or of cleanliness..." (p. 5). All of these factors are viewed as existence within the purview of nursing. Although there is dispute as to the degree that the death rate was reduced in the Crimea, information technology is undeniable that there was a specific link between the state of the surround and the death rate (Small, 1998). Nightingale was also a supporter of the sanitation movement in London. She joined forces with reformers, such as Farr and Chadwick, in advocating for permanent improvements in public health (Selanders, 2005c). This emphasis was later on extended to her environmental piece of work in India (Mowbray, 2008).
...she envisioned the extension of nursing every bit the essential strength which would encounter the growing healthcare needs in sectors outside of the hospital. A 2d major outcome/theme of Nightingale's leadership was the establishment of the Nightingale School at St. Thomas' Infirmary in London. She advocated for educated nurses who had a noesis base and a specific part in healthcare. Further, she envisioned the extension of nursing as the essential force which would meet the growing healthcare needs in sectors outside of the hospital. This resulted in the development of nursing in the military, midwifery, poor police nursing (intendance of paupers), and nurse visiting (public health nursing) (Baly, 1986). This part expansion created a full range of services in and out of the hospital and across the life span, thus further expanding the role and autonomy of the nurse.
Nightingale'due south continuing complaint from adolescence and into adulthood concerned the strict social mores relative to women and work outside of the home. Nursing actually served to begin to modify the location of women's work from the habitation into a formal workplace. Two factors contributed to the success of this change. The kickoff was that nursing education under the Nightingale model took place in a tightly controlled environment that included a nurses' dwelling house with a matron who functioned as parent and guardian (Baly, 1986). This immune families to concur to send their daughters to nursing school, every bit nursing education was deemed to be in safe environment. The second factor was that nursing was initially viewed every bit domestic work that had been transplanted into the hospital, thus extending the typical woman's sphere (Selanders, 2005d).
Nightingale, Advocacy, and 21stCentury Leadership
Nightingale's lasting legacy is a composite of her accomplishments and her vision of what tin can and should be undertaken past the profession. She wrote prolifically and demonstrated methods that were constructive. Her lessons accept become the roadmap for future generations.
Perhaps the most significant and enduring of Nightingale's contribution to nursing is learned not by reading one certificate, only rather by synthesizing the entire body of literature that she wrote regarding nursing. From this trunk of literature tin be extracted nursing'southward foundational philosophical base (Selanders, 2005a). The Table summarizes the major referents defined by Nightingale as essential to nursing practice, education, and research.
| Table: Nightingale's Philosophical Referents for Professional person Nursing |
The full general nature of nursing: The nature and value of nursing pedagogy: The nature of nursing research: |
Nightingale understood the value of and the methods for achieving visionary leadership. She repetitively utilized techniques which take been adult every bit the stairstep leadership evolution model (Figure). This image blends the ideas of Nightingale with the current leadership terminology of Burns (1978, 2003), who identified the relative merit of leadership outcomes, with the 'novice-to-expert' concept of Benner (2000) which focuses on the necessity of building leadership skills.
The goal of this stairstep leadership development model is to identify a progression of stages through which individuals accomplish positive leadership behaviors over time. This model does not assume that an individual holds a formal leadership position in order to demonstrate leadership; rather, it assumes that all nurses are leaders by virtue of assuming the role of nurse. The ultimate goal of this model is that leaders and followers achieve a mutually defined goal with collective purpose and long-term effectiveness (Selanders, 2005d).
...transformational leaders seek to create long-term or permanent change through the mutual identification of goals between individuals and the organization. The first three steps of the model identify the progression from novice nurse to someone who is experienced in a specific realm of nursing. This is consequent with Benner'due south (2000) model. This progression may be repeated multiple times as the nurse moves from position to position. Additionally, it supports the idea that leaders are adult rather than the conventionalities that some have innate leadership capabilities while others exercise non (Broome, 2011).
Expected outcomes of the model are that an individual ultimately volition assume the characteristics of either a transvisionary or transformational leader. Burns (1978, 2003) has defined these levels. Transactional leaders tend to exchange valued commodities, such as exchanging piece of work for pay. This is oft coercive in nature, and while perchance constructive for the short term, does not achieve long-term results. Conversely, transformational leaders seek to create long-term or permanent change through the common identification of goals betwixt individuals and the organization. This is constructive in achieving change that has lasting value.
Transvisionary leadership is an appropriate goal when the leader...envision[south] a new or unusual change that may not exist fully understood by constituents. Transvisionary leadership is an appropriate goal when the leader is able to envision a new or unusual modify that may non be fully understood by constituents. This is effective in setting insightful goals within an organisation that is experiencing new initiatives and outcomes. This is the way that Nightingale innately chose to use out of necessity when moving nursing from a disorganized and ill-conceived occupation to a profession. A transvisionary leader relies on both expert power and opportunity to attain results. Equally the leader attains effective outcomes and the goals go recognized as sound and accepted, the leadership mode may motion from the transactional to the transformational mode (Selanders, 2005d).
Summary
Nightingale demonstrated that advocacy is what gives power to the caring nurse. Nursing has never been simple, nor is serving as a patient advocate. Nevertheless, nursing has embraced advancement as a professional person construct. Advocacy includes a complex interaction between nurses, patients, professional colleagues, and the public. Nightingale'southward experiences in nursing demonstrated to her the value of advocating for nurses and patients. She embraced an egalitarian value organization and utilized leadership techniques to create change in nursing. Nightingale demonstrated that advocacy is what gives power to the caring nurse.
Authors
Louise C. Selanders, RN, EdD, FAAN
E-mail: selander@msu.edu
Dr. Louise C. Selanders is a professor in the College of Nursing at Michigan State Academy (MSU) and Director of the MSU Nursing Master's Program. She has extensive didactics experience in undergraduate, graduate, and lifelong education programs. Each summer, she coordinates and teaches a study away programme in England which emphasizes the historical origins of modern, western nursing equally applicable to modernistic do. Dr. Selanders is internationally recognized as a Nightingale historian and scholar. She is co-author of Florence Nightingale Today: Healing, Leadership, Global Action, which received the 2005 American Periodical of Nursing Volume of the Yr Award. She holds degrees from MSU, East Lansing, MI; Adelphi Academy, Garden City, NY; and Western Michigan University, Kalamazoo, MI.
Patrick C. Crane, MSN, RN
E-mail: Patrick.crane@hc.msu.edu
Patrick Crane is an instructor at the Michigan State Academy (MSU) Higher of Nursing in East Lansing, MI. He currently teaches both in the MSU undergraduate nursing curriculum and in a written report abroad class in London, England. This grade focuses on the history of nursing, equally well equally the teaching and regulation of nurses in the U.k. as compared to nurses in United States. He has earned both his BSN and MSN from MSU and is currently a Doc of Nursing Practise student at Wayne State University in Detroit, Michigan. He has addressed the office of Nightingale in the development of gimmicky nursing practice through publications and presentations at national and international conferences.
References
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© 2012 OJIN: The Online Periodical of Issues in Nursing
Article published January 31, 2012
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