Overview of the Theory
Florence Nightingale is arguably one of the prominent nursing theorists of all time. Her theory focuses on four significant concepts; environment, person, health, and nursing. Nightingale held that the environment dramatically impacts the outcomes of a patient. She emphasized proper nursing care requires looking beyond the patient’s social environment. In her theory, Nightingale depicts the correlation between the three types of environment and the patient’s behavior and recovery. These environments include physical, psychological and social. The physical environment comprises of the physical elements surrounding the patient. The considerations made at this point are essential as physical environment affects all other settings. Nightingale emphasized the cleanliness of patient’s rooms, which is also a significant concern insofar as the patient’s physical environment is concerned. Conversely, the psychological environment derives directly from the physical environment in that a negative physical environment can lead to stress. On the hand other, the social environment entails the essential components of the physical environment. It comprises of the patient’s home or hospital room and the community at large. The Nightingale theory takes an evaluative approach to a patient’s environmental conditions and how they impact on the overall patient’s performance and improvements. The theory holds that good surroundings are vital determinants of proper nursing care.
Selection of Theory
The Nightingale theory was selected as it reflects on the significant problems that nurses encounter in delivering quality to patients. Providing excellence in modern nursing has proved to be a challenge, which revolves around the workplace conditions. While various models have been adopted have been adopted to curb the insurgence of nursing issues, key nursing issues, especially those involving the patient’s environment remain unsolved. The environment-related nursing issues include, but are not limited to, workplace violence and hazards. Such environmental drawbacks have a significant impact on nursing care and the overall patient’s behavior to treatment. The Nightingale theory provides a useful model that nurses can employ to minimize issues, thereby improving nursing care and the patient’s outcome.
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Seven Step Practice in Translating Theory into Practice
The analysis of the theory will employ the seven-step sequence of translating theories into evidence-based assessments tools. Various studies show that evidence-based practice (EBP) leads to the higher quality care of nursing and improved patient outcome (Harris, McBride, Ross & Curtis, 2002). Evidence-Based practice is an essential problem-solving approach employed in the delivery of quality healthcare. An effective EBP involves the translation of medical theories from various healthcare providers.
Nilsen (2015) finds that theory and practice in advanced practice nursing are equivalent. Further, Nilsen (2015) suggests that obtaining evidence from theory is in itself translational research, which helps one transform research findings into practical actions. In essence, there is a considerably slight discrepancy between theory and practice whereby, theories are basically formulations that are not relevant to practice. Nonetheless, theory-based practices correlate significantly with evidence-based practices. Thus, transforming theories into evidence requires a translational research in which the researcher carries out an in-depth analysis on a given model or theory. Afterwards, the researcher identifies the necessary conditions that need to be put in place to actualize the theory.
Translation research will be employed in this paper to derive practical measures that can help improve nursing quality and patient care.
Problem
In the recent past, several nursing institutions have put in place measures to see to improve nursing care. However, patients’ satisfaction has proved to be a major challenge in most hospitals and health facilities. The well-being of patients is still a problem to health providers including nurses and doctors. Patient’s satisfaction is complex as measuring satisfaction depends on one’s past healthcare experience. Various factors inhibit the provision of patient satisfaction: poor systems, financial problems, hostile working environments and uncordial nurse-patient relationship. The American Society of Healthcare Engineering (ASHE) estimates that in green hospitals, patients are discharged 2.5 days earlier compared to traditional hospitals. The determinants of patients’ satisfaction vary with some factors. A recent survey conducted in German shows that patients satisfaction in health institutions are deteriorating (Schoenfelder, Klewer & Kugler, 2011). Table 1 shows the levels of patient satisfaction in the hospital where the study was carried out.
Table 1 : Levels of Global Patient Satisfaction (Schoenfelder, Klewer & Kugler, 2011)
| Abbreviated item content | Grouped median |
| Global satisfaction with hospital stay | 5.04 |
| The kindness of the hospital's physicians | 5.36 |
| The kindness of the hospital's nurses | 5.38 |
| The efficiency of admitting procedure | 5.23 |
| Outcome of treatment | 5.17 |
| Clear reply to inquiries by physicians | 5.14 |
| Individualized medical care | 5.10 |
| Organization of procedures and operations | 5.04 |
| Physician's knowledge of patient anamnesis | 4.85 |
| Clear information about undergoing operations | 4.74 |
| Discharge procedures and instructions | 4.66 |
| Clear information about anesthesia | 4.64 |
| Performance of service | |
| Cleanliness | 5.34 |
| Accommodation | 5.14 |
| Quality of food | 4.98 |
This paper will seek applicable models from the Nightingale theory that can help improve patients’ satisfaction.
Research Question
The research employed the PICOT format to develop practical research questions. The following research questions were adopted using the PICOT format and were applied in guiding the research key objectives.
The following are the research questions developed for this research.
Q1. Of what significance is healthcare satisfaction to patients?
Q2. How does the Nightingale theory depict patient satisfaction?
Q3. What is the correlation between the nursing care aspects described in the Nightingale theory, and those affecting customer satisfaction?
Q4. What are models as illustrated in the Nightingale theory applicable to improving Patient satisfaction?
Q5. What time are factors to be considered in ensuring patients’ satisfaction?
Application of Theory
The Nightingale theory captures fundamental nursing care aspects that most scholars comprehend, which are relative to the impact of nursing care to patients and their recovery. As such, the Nightingale theory can help improve patients’ satisfaction through the various aspects learned from the theory, and which are the ten crucial elements highlighted in the Nightingale theory. They are;
Clean air and temperature environment
Access to direct sunlight and free from disturbances such as noise
Clean rooms
Well-constructed hospital facilities
Frequently aired and changed beddings
Proper nurses’ hygiene when handling patients
Provision of various sceneries such as artifacts to prevent boredom
Positivity by nurses which excludes giving false hopes to patient
Provision of various short meals and minimum distractions when having meals
Extension of nursing care to the patient’s family and friends
In essence, the aspects highlighted above are essential in ensuring that nursing care is satisfactory to patients. These aspects can go a long way to enduring that patients are satisfied by the nursing care provided to them, which in turn, improves their performance and recovery. The models described in the theory focus on the environment and how it impacts on the quality of healthcare provided to patients.
Interpretation of Literature Findings
The theory is widely recognized for its elaborateness and Nightingale’s clear standpoint. Harris, McBride, Ross & Curtis (2002) point out that the Nightingale’s theory is undoubtedly clear and easy to comprehend. The approach is significantly understandable and practicable. Additionally, the limits depicted in theory are at large consistent with nursing practice. As such, the suggested models are readily applicable in nursing at homes, hospitals and other health institutions. Also, the theory identifies and defines essential concepts, which makes it a convenient model for nurse practitioners. The theory delineates essential health, illness, nursing and environment concepts, and gives a concise understanding of each one of them. In a nutshell, the critical concerns of the Nightingale theory apply to patients under various forms of medication. These include patients admitted at home and in health facilities. The approach, therefore, can be said to cut on all occasions where patients require nursing care. For those patients admitted to their homes or receiving nursing care at their homes, Nightingale holds that nurses should see to it that they are well taken care of. Her work was written for nurses at home, which aimed at improving the health of patients, which in turn leads to patient satisfaction.
Recommendations to Address the Problem
There is evidently much to borrow from Nightingale theory, insofar as improving customer satisfaction is concerned. The recommended practices in the approach to enhancing health are in line with those that can help improve the satisfaction of patients as health improvements have a direct impact on patients’ satisfaction. The recommended practices to improve patients’ comfort are broadly categorized into two: environment and nursing care.
Environment, in this case, entails the surrounding factors to a patient during the delivery of nursing care. Nightingale theory focuses on the environment and proposes appropriate measures that nurses should implement to improve nursing care. A conducive patient environment will make patients satisfied with the nursing care they get. Such favorable environmental conditions include pure fresh air and purified water. Also, patients should have sufficient light and should have access to sunlight. Additionally, patients should have a proper, timely and frequent diet. The theory also proposes that patients should not be subjected to any form of distraction whatsoever.
Consequently, nursing care is a fundamental tool that can help improve patient’s satisfaction. Nurses should at all times act with utmost care and professionalism when handling patients. The theory holds that nurses should ensure that they have a cordial relationship either patients, which will enable patients to communicate their complaints more easily.
Plan to Evaluate the Innovative Action Outcomes
The plan suggested to evaluate the effectiveness of the innovative action comprises of both home-based nursing care and nurses at hospitals. The program includes various health stakeholders such as patients and nurses as well as other healthcare providers. Additionally, the plan initiating environment improvement activities at homes and health institutions.
Plan to Disseminate the Outcomes of the Innovation
Patient satisfaction is in itself a positive nursing outcome. Therefore, the general feedback obtained from patients will be a valid measure of outcome. Such feedback will be collected through patient surveys which will demonstrate the impact of improvements in the patients’ environment on their satisfaction. A typical survey entails a questionnaire to patients whose environments have been improved significantly.
Conclusion
Patients’ satisfaction requires the improvement of the environment within which nursing care is administered. Nursing care is an essential practice that every patient needs throughout the treatment process. Nurses are thereby mandated to seek environmental improvements, which will help them establish a cordial relationship with patients. The upgrades are inherent with the aspects highlighted in the Nightingale theory. Therefore, the various recommended practice that Nightingale suggests will play a vital role in improving the level of satisfaction of patients.
References
Harris, P. B., McBride, G., Ross, C., & Curtis, L. (2002). A place to heal: Environmental sources of satisfaction among hospital patients. Journal of Applied Social Psychology , 32 (6), 1276-1299.
Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science , 10 (1), 53.
Schoenfelder, T., Klewer, J., & Kugler, J. (2011). Determinants of patient satisfaction: a study among39 hospitals in an in-patient setting in Germany. International journal for quality in health care , 23 (5), 503-509.
