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What are the critical trends in tri state s environment

Natal - RN, Brazil. To analyze the environmental theory of Florence Nightingale based on the model proposed by Johnson and Webber. Theoretical and reflective study conducted in the months of November and December 2012.

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Theory analysis based on eight criteria: We conclude that the environmentalist theory of Florence Nightingale has concepts that serve today's parameters, and its relevance is considered a landmark in the history of nursing. The disease is considered, in this theory, a restoring health process and the nurse's function is to balance the environment, in order to save the patient's life energy to recover from the disease, prioritizing the delivery of an stimulating environment for the development of the patient's health 12.

Here lies, then, the conception of the human-being as a member of nature, an individual whose natural defenses are influenced by a healthy or unhealthy environment 1. Nightingale believed that providing a suitable environment was the difference in the recovery of patients, and in this perception underlies the Environmentalist theory. Thus, Nightingale became known for her actions that have brought innovative results to treatment of patients 2. In her writings, Nightingale addresses the provision of factors for maintaining an environment that is favorable to the facilitation of the healing and healthy living processes such as: In nursing, such concern about the environment has existed since the foundation of professional nursing in the second half of the nineteenth century.

It can found on the present days, in a humanized care, based on environmental control around the patient, which is seen as a being that is part of relationships and interactions with the environment in which this one can be found 3. It should be noted also that the ambience is just one of the devices for the development of humanized care, but it can be added, among such devices: Thus, the goal of the nursing field is to provide assistance for patients in maintaining their vital capacity, satisfying their needs.

Therefore, Nightingale shows that nursing is a non-healing practice, in which the patient is what are the critical trends in tri state s environment in the best condition for the action of nature 1. In this perspective, the focus of nursing care is on environmental hygiene, the most basic concept and characteristic of her works.

In those, Nightingale lists the tasks that nurses must perform to assist sick individuals, and many of them are relevant even nowadays 5.

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The use of nursing theories is of great importance due to the practice foundation. It provides the appreciation of the knowledge of the profession and its relation with the performance of the nurses. Therefore, it is important to make a critical analysis about the theory in focus, bearing in mind that carrying out a critical analysis study of a theory assists in ensuring the validity of such and its correct use, providing relevant information for its development.

Analysis or evaluation theory is the process of examining systematically a theory by using criteria that vary depending on the authors that propose methods of analysis, which are: The primary purpose of the analysis of a theory is to determine its potential contribution to the scientific knowledge.

It also contributes by adding knowledge, to the perspective of practices, providing its greater solidification, and allowing the identification of faults and inconsistencies as for the use of the theory in practice 56. In order to critically analyze a theory, many authors have proposed methods to conduct this process such as: Walker and Avant 6Meleis 7 and Johnson and Webber 8.

The what are the critical trends in tri state s environment of critical analysis of these last ones were used in this study to examine the Environmental Theory of Florence Nightingale 1. Based on the critical model based on criteria that was proposed by Johnson and Webber 8it will be discussed in this article the following: Thus, the aim of this study is to analyze the Environmental Theory by Florence Nightingale through the model proposed by Johnson and Webber. It was used as a primary source for the critical analysis of the Environmentalist Theory by Florence Nightingale, its most widespread work, the book "Notes on Nursing - what it is and what it is not" written in 1859, translated into Portuguese in 1989 1.

Secondary sources on the Environmental Theory 2 - 49 - 11 were also used, which contributed significantly in the preparation of this reflection. Secondary sources were used as subside for the discussion of the critical analysis made from the primary source.

Such sources comprised books and scientific articles found in online databases and sectorial libraries where the study was developed and it appears a base for the adherence to the theme of reflection.

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In order to analyze this theory, it was used the model of critical analysis based on criteria by Johnson and Webber 8when examining the intent, concepts and propositions of the theory and the construction of judgments about the usefulness of it at its practice, demonstrating how the theoretical knowledge is embedded in the nursing practice.

This model is intended to help make judgments about the theoretical value and the use of the theory in order to identify connections between the nursing practice and the theory, assuring the achievement of its own examination 8. The criteria set forth by the authors 8 to critically analyze a theory are: To facilitate the presentation of some of the criteria, five-point scales were used, proposed by the authors 8to their measure along with the contribution of the literature concerning the matter.

The criteria mentioned are organized and analyzed in three phases: It should be noted that the critical analysis of a theory proposed by these authors is based on a judging process, which determines the utility theory to the practice of nursing. Criterion 1 - The significance of the theory is clear and understandable The first criterion focuses on the significance of the theory and the classification of its clarity and understanding 8. Therefore, Nightingale advocated essential factors that would ensure the sanitation of dwellings such as clean air, clean water, efficient drainage, cleanliness, lighting, prevention of infection, among others 1.

The care in the rehabilitation process of the wounded soldiers in combat or the ones coming from surgeries, during the Crimean War, was the crucial fact that led Nightingale to develop innovative thoughts to the context of care provided to individuals.

Her experience enabled the comprehension about what was effective and what was hindered this process. These ideals are part of the context of the practice experienced by nursing professionals in different areas 2. In her work, Nightingale succinctly stated what she believed to be important in the care of the sick person 5. The Environmental Theory, with its message of valuing the environment as an essential tool to the healing process of people, highlights the importance of ventilation, heating, sanitary conditions of housing, as for the housing hygiene 19.

Other factors for the patient's care are also presented by Nightingale, such as noise, the varied, nutritive and punctual eating habits. In addition, the analyzed theory includes information about the appropriate buildings in which patients should be treated in and about the management of hospitals 5.

  1. It's possible to verify that most of the criteria present score scale given for each criterion, however, the criteria 2 - Limits are consistent with the practice of nursing - and 6 - variables and hypothesis help understand and interpret propositions- do not use scales for their analysis.
  2. Before what has been presented and based on the characterization proposed by Johnson and Webber 7 , it's possible to identify that in order to promote the criterion in of the matter, the theory has a high consistency, and its limits are clearly identified. Walker and Avant 6 , Meleis 7 and Johnson and Webber 8.
  3. Nightingale believed that providing a suitable environment was the difference in the recovery of patients, and in this perception underlies the Environmentalist theory. Criterion 8 - Theoretical knowledge influences the nursing practice The methods used in Nightingale's works served as a basis for the teaching of nursing for more than a century, and as a matter of fact, they still exist in nursing programs nowadays.

Johnson and Webber 8 show a form of measurement for this criterion with a five-point scale, which was assigned value 5, indicating that the theory has clear ideas in meaning, given that the reader does what are the critical trends in tri state s environment need to have a vocabulary too far-fetched for the full understanding of the work into focus.

Criterion 2 - Limits are consistent with the practice of nursing The second criterion leads to the judgment as to the limits of the theory, if they are consistent for the practice of nursing. Among the limits are included: Nightingale's work was written for caregivers at home, with methods and guidelines to improve the health of patients, aiming to support the work of these professionals.

She directed her teachings to women, because they are those who were primarily responsible for family care 10. The main scenario addressed by Nightingale in her theory was the home environment. She taught how to create favorable environments to the recovery of the patient's health at their home and later proposed modifications in the way of building hospitals and manage them 10.

Nightingale sparked a revolution in the concept of the nurses back then, specially considering the foundation of nursing as a profession by offering professional training for nurses, which came to be seen as responsible for putting the individual in the best condition to the action of nature, which occurs primarily through the impact on the environment 2. To Nightingale, caring was minimum among the tasks for which she had been driven to 1. Other health professions were responsible for analyzing situations and making judgments about the patient's health.

Therefore, the caregiver, the main subject besides the patient, in this theory, must know how to communicate effectively with these professionals, because upon this relied the efficiency of the care and the patient's welfare 10.

Before what has been presented and based on the characterization proposed by Johnson and Webber 7it's possible to identify that in order to promote the criterion in of the matter, the theory has a high consistency, and its limits are clearly identified. Criterion 3 - Understandable language and includes minimum jargon Throughout her work, Nightingale tells true and experienced stories by herself, often demonstrating her opinion about them 11. This format substantially facilitates understanding of the information that the author intends to pass on to their readers.

Responding to the third criterion, an understandable language could be verified in all her work, especially in the chapters added to the end of it, where weaving comments on the meaning of being a nurse and behaviors that it must provide assistance in the various types of patients can be found. The very alphabet of a nurse is to be able to read every change which comes over a the patient's countenance, without causing him the exertion of saying what he feels.

What would many a nurse do otherwise than she does if her patients were a valuable piece of furniture or a sick cow? I do not know. Yet a nurse must be something more than a lift or a broom. A patient is not merely a piece of furniture to be kept clean and what are the critical trends in tri state s environment against the wall, saved from injury and breakage - though to judge from what many a nurse does and does not do 1: In this, Nightingale shows her hurtful mood, showing a clear language, which was sometimes harsh 12.

We are confident that this little book will delight all who read it, for its historicity and actuality, the clear and elegant style, sometimes openly ironic, so well captured by its translator, and the mixture of passion and thought that runs through its pages 11: The jargons - enunciation of unintelligible words, professional slangs 13 - were not identified in her writings as well as new words that could be added to our vocabulary were not displayed.

Criterion 4 - Important concepts are identified and defined According to Johnson and Webber 8there are two categories of concepts: In the Environmental Theory, the concepts are presented and explained in detail.

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Nightingale addresses the concepts of health, illness, nursing and environment, as concepts that belong into the first category. For Nightingale, health goes beyond the absence of disease, it is to be well, being able to use well all the powers one has. A disease is an effort of nature to restore health. Nursing is the way to put the structure of the individual in such a state that there is no disease or that may allow one recover from the disease, ie, the individual must be kept in the best possible conditions for the nature to preserve or restore health, prevent or cure the disease or injury 15.

The concept of environment in this theory is included in both categories of concept, since it is the Environmentalist Theory. Besides the one about environment, some non-common concepts are presented: Moreover, among the concepts are also presented: The variety is also inserted within these concepts, specifically in the context of changing furniture location, placement of paintings or different portraits and flowers that can be enjoyed by the patient, leading them to diversify their thoughts.

Nutritious and punctual feeding, appropriate beds and linen and individual's personal hygiene were also concepts presented by Nightingale 1. Nightingale brings in her work, the concept of nurse: To analyze the criteria in question, a rating scale of the consistency of the concept is what are the critical trends in tri state s environment by Johnson and Webber 7. The concepts presented for current and future practice such as "moderate consistency" value of 2 for the scalebefore the presence of some definitions that have been modified over time are characterized, as set forth below.

The Environmental Theory was presented by Nightingale in 1859. The fact it has been written over 150 years ago can be regarded as a limitation on the consistency of the its own concepts, because even though it endorses many current actions, some factors may be identified as outdated.

Among them we can mention the fact that only women used perform nursing care and nursing was seen as an art not science. Nursing practice was a female domain, but an independent practice of their own right, since the nurses acted according to doctors whose prescriptions they should faithfully follow, even though they were not subservient to them. Nursing was therefore seen as an art, while the medicine was seen as science 1. Nursing has feminine traits, to the extent that this genre has a close relationship with the gift and sacrifice, represented by the virtuous self-denial of Nightingale, and the provision of care at all times 14.

However, even though, over the years, the number of women in nursing continue growing much higher when compared to men, they are present in this occupation and have gradually increased their admission number in undergraduate courses in nursing and consequently there is the training of new nurses, who seek the profession because of the wide field of action 14. Another concept that is little consisting if the fact nursing is seen as art and not as science.

Therefore, there should be considered the historical background throughout its more than 150 years since its foundation as a profession dedicated to the art of caring by Nightingale, in the nineteenth century, to the investments that have been undertaken, gradually and systematically, in building a scientific practice 15. Science consists of a set of descriptive information, explanatory and predictive of reality, resulting from the observation and the experience over the phenomena.

Through the attempt of renovation or expansion of the nursing knowledge, there is the emergence of theories, in which purposes, limits and possibilities are evidenced in the care and allow reflection on nursing care 5.

Criterion 5 - Concepts stimulate the formulation of propositions As already mentioned, the legacy left by Nightingale has the environment as a fundamental principle for the practice of the profession.

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The ideals concerning this principle were grounded in the concepts referred in the Environmental Theory and were considered essential to the success of the theoretical work, managing to reduce the deaths of wounded soldiers infection and promoting the recovery of patients 2.

The above-mentioned concepts led to the development of several propositions identified throughout the work studied 1. Among all of them some of them are pointed: