Introduction
Nursing theories guide practitioners in identifying patients’ needs and providing personalized support. Practitioners can apply diverse frameworks depending on the reported health problems, individual responsiveness, and anticipated outcomes. Florence Nightingale’s environment nursing theory is designed to guide clinicians in using the available environmental attributes to transform patient recovery. Involved professionals should configure the available settings and surroundings to match the individual’s medical expectations. This framework falls under the grand theory category due to its applicability in numerous areas of medical practice. Mishel’s uncertainty in illness model differs significantly from Nightingale’s framework since it describes how people suffering from various chronic conditions structure schemas for interpreting uncertainty with the available treatment options and the anticipated outcomes. Such a result describes the return to the earlier functioning or adaptation level. Professionals describe it as middle-range since it is applicable to patients in various disease phases. While these two theories present unique differences and similarities, practitioners can apply the presented ideas to meet the health needs of patients in different medical settings.
Background of the Theories
The life experiences of Nightingale could shed some light regarding her desire to develop environmental nursing theory. Having been involved as a practitioner in the infamous Crimean War, the professional observed that most injured people died due to poor conditions. She was convinced that a strong correlation existed between the quality of the immediate environment and the healing process. These insights encouraged her to develop the environment nursing theory, a framework that continues to transform nursing practice today (Riegel et al., 2021). Her key observations revealed that five aspects were critical for improving the healing processes. These included the presence of a healthy dwelling, proper sanitation, clean water, adequate lighting, and cleanliness. These attributes would deliver a healthy environment capable of improving a patient’s health outcome.
Unlike Nightingale’s experiences during the Crimean War, Mishel’s academic dissertation developed the uncertainty of illness theory. In terms of background, the scholar was interested in the subject matter following her personal observations and experiences with her father, who had colon cancer (Fernandez-Araque et al., 2020). She was keen to note that the patient struggled to cope with or control a wide range of attributes in his life. With such insights, Mishel presented a new framework for guiding patients and caregivers to address health-related uncertainties. She revealed that most people with terminal conditions recorded ambiguous experiences (Fernandez-Araque et al., 2020). Being less abstract, Mishel’s theory would be classified as a middle-range that is applicable in clinical settings to guide nursing practice.
Philosophical Underpinnings
The development of nursing models is largely based on the personal philosophies, views, expectations, and knowledge of their respective authors. Being one of the founders of the nursing profession, Nightingale had become passionate about caring and the ability to transform patients’ health experiences. Her philosophies and values revolved around compassion, healing, empathy, and humility. Nightingale’s experiences with war victims compelled her to reexamine the role of the environment in the healing process (Riegel et al., 2021). She would later develop a philosophy that reshaped her view of nursing practice. Specifically, she asserted that healthy surrounding was necessary if the targeted beneficiaries were to record positive medical outcomes. This philosophical underpinning would support the creation and promotion of the environment theory of nursing.
The successful development and promotion of the uncertainty of illness framework emerged from Mishel’s willingness to complete a dissertation targeting hospital patients. She relied on an empirical approach to understand the thoughts and expectations of the participants. She borrowed the concept of thought or information processing from the theories of Warburton and stress coping by Lazarus and Folkman (Fernandez-Araque et al., 2020). She identified uncertainty within the context of terminal conditions. She identified it as a source of stress for most affected individuals. Such a mental status arose from the absence of adequate cues whereby someone lacked internal schema and cognitive knowledge of an event. She combined these attributes with her observations of her father, who struggled with colon cancer. Consequently, she developed a practical framework for supporting the needs of individuals with terminal conditions.
Assumptions, Concepts, and Relationships
Most of the available nursing theories were informed by their respective authors’ unique assumptions and viewpoints. For Nightingale, the key suppositions that led to the formulation of the environment framework revolved around the surrounding environment (Riegel et al., 2021). According to the caregiver, patients require clean surroundings characterized by pure air and water, proper drainage systems, and the presence of natural light. Similarly, Mishel was able to present several assertions to support the development of her theory (Bora, 2020). Specifically, she argued that uncertainties during illnesses emerged due to patients’ inability to predict some of the possible outcomes (Fernandez-Araque et al., 2020). This challenge existed due to the absence of adequate cues. She also hypothesized that doubts could take divergent forms, including inconsistency, complexity, and ambiguity.
The concepts supporting Nightingale’s theory are described in accordance with the four nursing metaparadigms. Nursing is the best approach for putting individuals in their best conditions (Riegel et al., 2021). Clinicians need to analyze and study human beings based on their relationships with their surroundings. The environment is a key determinant of a person’s health status. Its sub-concepts include air, cleanliness, increased hope, ventilation, nutrition, reduced noise, and proper bedding. Health is the best experience emerging when patients live in favorable environments. For Mishel’s theory, three primary concepts exist that support its practicability and applicability. The antecedents of uncertainty would refer to the stimuli frame and structure providers (Fernandez-Araque et al., 2020). Such forces work either negatively or positively to affect the patient’s perception of uncertainty. The concept of cognitive capacity describes “individuals’ ability to process information that allows understanding conditions in which an illness occurs, and to recognize or assess uncertainty in illness” (Bora, 2020, p. 72). Social support describes that information, care, and interest arising from family members to support the coping process.
The assumptions and concepts described for each theory work synergistically to support the development of practical theories. Nightingale succeeds in defining the environment from a philosophical viewpoint that makes it a primary determinant in the healing process. The underpinning guides the author to use the four nursing metaparadigms as the supporting concepts for the framework. The theory defines health outcomes based on the available conditions and the willingness of practitioners to embrace them. In her theory, Mishel offers a unique relationship between the philosophical underpinning and the outlined concepts (Fernandez-Araque et al., 2020). The presence of social support dictates the overall process of adaptation. When adequate support and guidance are available, the beneficiary might eventually record a new perspective or approach to possible uncertainties.
Clinical Applications: Extending Nursing Science Testability
The selected theories offer unique attributes and guidelines that make them appropriate in the fields of clinical care and nursing. Within the field of nursing science, researchers can begin by applying Nightingale’s environment theory to test the practicability of the outlined concepts and viewpoints. Gilber (2020) observes that the environment forms an integral aspect when it comes to the provision of personalized medical services and care. In the study “Florence Nightingale’s Theory and her Contributions to Holistic Critical Thinking in Nursing,” Riegel et al. (2021) indicated that the elements of the environment could impact people’s health outcomes. Specifically, pure air, proper diet and sanitation, and clean water could improve people’s medical experiences, thereby improving the speed of recovery. These attributes show conclusively that the ideas evident in theory are useful and practical in nursing. The framework is testable because it denotes a wide range of attributes that remain applicable in numerous research investigations.
Just like Nightingale’s model, Mishel’s theory has remained instrumental and applicable in cases whereby the targeted patients report chronic conditions. The outlined concepts can prevent powerful guidelines for engaging most of these individuals and equipping them with the relevant competencies. In their study, Bora and Buldukoğlu (2020) apply this theory to support and empower patients with chronic conditions. These attributes make the model practical and testable to extend nursing science (Bora, 2020). The emerging insights can guide future practitioners in addressing most of the illness-associated uncertainties and support more patients in recording positive health outcomes.
Use in Nursing Practice
Nightingale’s theory of environment remains practical and applicable in nursing practice to improve patient’s overall experiences. This grand theory can make it possible for practitioners to create the best environment that remains supportive of the identified patients’ medical needs. During care delivery, nurses can provide rooms with adequate air circulation and natural sunlight (Gilber, 2020). The ideas could encourage them to remove their respective patients from congested environments. They can apply the model whenever designing new approaches for personalizing patients’ dietary intakes. Beddings, continuous care, and timely interventions are critical in the provision of high-quality medical services.
As described in the above sections, Mishel’s uncertainty of illness theory presents a powerful approach for guiding caregivers in analyzing and interpreting the uncertainties their respective patients encounter. Irrespective of the illness, the involved caregivers will find the available attributes influential and capable of supporting the introduction of desirable interventions. For example, nurses can rely on the theory to collaborate with psychotherapists and clinical management experts to provide personalized coping strategies (Bora & Buldukoğlu, 2020). Nurse practitioners can embrace the framework to offer additional support and guide the select patient to record positive behavioral responses. Researchers recommend the application of diverse coping strategies to guide individuals whenever they experience uncertainties.
From these two analyses, it becomes clear that each framework presents unique opportunities for application in diverse nursing situations. While the environmental nursing theory offers guidelines for promoting favorable conditions to address patients’ needs, Mishel’s model remains practical in responding to uncertainties that might arise due to the recorded condition. The uncertainty in illness theory could benefit from the attributes Nightingale presents to offer the best environment for promoting desirable coping techniques (Bora & Buldukoğlu, 2020). Both theories provide room for working with other professionals to ensure that more patients receive timely, culturally competent, and personalized support throughout the healing process.
Personal Clinical Setting
The studied theories provide unique ideas for meeting the needs of patients in different clinical settings. Nurses working in geriatric care units will find the frameworks plausible and capable of improving patients’ medical experiences. In such a clinical setting, professionals have to provide continuous care, support, and guidelines to individuals with divergent needs. Some of them experience increased episodes of depression, chronic conditions, and mobility complications. The diversity of the diseases most of these individuals face explains why practitioners should combine different theories (Gilber, 2020). Nightingale’s model offers several strategies that clinicians can consider to maximize the quality of elderly care. For example, the model could guide caregivers to begin by making the environment favorable for the patients. Key issues to consider include the provision of hearing and mobility aids. These devices will reduce the chances of recording sentinel events and falls. The theory will make it possible for clinicians to offer the best diet, proper air conditioning, and personalized support. The customization of the surrounding environment will meet patients’ diverse needs.
Mishel’s model remains practical and capable of supporting the process of care delivery in geriatric units. Specifically, nurses can apply the framework to study and identify people experiencing negative perceptions about their health outcomes. Through the power of the theory, clinicians can offer personalized counseling sessions by collaborating with other professionals. Patients with dementia could receive timely support and drugs to cope with their conditions. Clinicians can utilize the theory to introduce focus groups whereby patients elate with each other and embrace new coping strategies (Bora & Buldukoğlu, 2020). Additionally, nurses will devise appropriate mechanisms to intervene and empower elderly patients to record positive health experiences.
Parsimony
In terms of parsimony, the author of the theory appears to present and state it in the most appropriate way. The professionals were keen to use a few concepts, ideas, and assumptions in an effort to describe the anticipated phenomena. Nightingale’s framework relies on the four metaparadigms to define human beings, health, environment, and nursing (Ortiz, 2019). These concepts support the formulation of favorable environments capable of improving the overall health outcomes of the intended patients. These observations reveal that Nightingale’s theory is concise, brief, and comprehensive. Such attributes make the framework explainable and applicable in different clinical settings.
Mishel’s theory proves to meet the threshold of a simple and concise framework that is capable of empowering nurses to provide personalized services. The author states the model in an economical manner without losing ignoring the necessary concepts. The use of three concepts makes it possible for users of the theory to apply it in different settings (Bora & Buldukoğlu, 2020). Analysts find it testable and capable of promoting scientific inquiry in nursing. Consequently, the framework remains understandable, practical, and capable of informing a wide range of practices in care delivery.
Conclusion
Nursing theories present practical procedures and ideas for providing personalized and timely medical services. The completed discussion has revealed that Nightingale developed a grand theory of environment that remains applicable in a wide range of clinical settings and cases to improve patient outcomes. Medical practitioners need to focus on the four metaparadigms of nursing to improve the environment by providing clean water, adequate air supply, bedding, diet, and sanitation. Mishel’s uncertainty of illness falls under the middle-range category of theories, thereby making it useful in various medical cases requiring proper nursing care and support. These theories meet the test of parsimony, a requirement that makes them appropriate and applicable in a wide range of healthcare settings.
References
Bora, S. T., & Buldukoğlu, K. (2020). Using the Uncertainty in Illness Theory to provide care for the caregiver: A case report. Journal of Psychiatric Nursing, 11(1), 70-77.
Fernandez-Araque, A., Gomez-Castro, J., Giaquinta-Aranda, A., Verde, Z., & Torres-Ortega, C. (2020). Mishel’s model of uncertainty describing categories and subcategories in fibromyalgia patients, a scoping review. International Journal of Environmental Research and Public Health, 17(11), 3756-3768.
Gilber, H. A. (2020). Florence Nightingale’s Environmental Theory and its influence on contemporary infection control. Collegian, 27, 626-633.
Ortiz, M. R. (2019). Patient-centered medical (health) home: Nursing theory-guided policy perspectives. Nursing Science Quarterly, 33(1), 91-96.
Riegel, F., Crossetti, M. G. O., Martini, J. G., & Nes, A. A. G. (2021). Florence Nightingale’s theory and her contributions to holistic critical thinking in nursing.Revista Brasileira de Enfermagem, 74(2).