Unit II Nursing Philosophies

1. Chapter 4.
Nightingale's
2.
Chapter 5.
Watson's Philosophy and
Environmental Theory Theory of Transpersonal
Caring

3. Chapter 6.
4.
Chapter 7.

Benner's Stages of Nursing Eriksson's Caritative

Expertise Nursing Philosophies Caring Theory
Environmental
Philosophy
(Modern Nursing)

Chapter 4
Florence Nightingale
"Nursing ought to signify the proper use
of fresh air, light, warmth, cleanliness,
quiet, and the proper selection and
administration of diet — all at the least
expense of vital power to the patient"

-Nightingale, 1969
Contents of this Lecture
 Florence Nightingale:
● History and Background  Critical Thinking with Nightingale's Theory

 Theoretical Sources for Theory Development  Application of Florence Nightingale's

Environmental Philosophy
 Nightingale's Environmental Model
Major Concepts and Definitions  Critique of Nightingale's Environmental Philosophy
Use of Empirical Evidence Clarity
Major Assumptions: Environment Simplicity
Person Generality
Health Empirical precision (Accessibility)
Nursing Derivable Consequences (Importance)

 Nightingale and The Nursing Process  Critical Thinking Exercises on Nightingale's

Environmental Philosophy
Florence Nightingale (mid-1800)
“The Legacy of Caring”
“Notes of Nursing” What is, What is Not”
“In a nurturing environment, the body could repair itself.”

“The most important practical lesson that can be given to nurses is to teach them what to
observe- how-to observe... If you cannot get the habit of observation one way or other,
you had better give up being a nurse, for it is not your calling, however kind and anxious
you may be.”
 History
and
Background
History and Background

Florence Nightingale is the most recognized name in the field or nursing. Her
work was instrumental for developing modern nursing practice, and from her first shift.
She worked to ensure patients in her care had what they needed to get healthy. Her
Environmental Theory changed the face or nursing to create sanitary conditions for
patients to get care.

Florence Nightingale was born in May 12, 1820 in Florence, Italy. She was a
beautiful Victorian lady whose parents were wealthy and well-travelled. She was
expected to behave like every other Victorian lady, filling her time before her marriage
with music, reading, embroidery and learning how to be the perfect hostess.
History and Background

However, Florence Nightingale had other intentions. Even at a young age, she
believed she was called into service by God. She had great compassion and concern for
people of all types. And as she grew older, she believed she had been called to serve
mankind. She yearned to help the poor but suffered in silence for years because it was
socially unacceptable for someone of her upbringing to be involved with physical work.

At the age of 24, Florence Nightingale decided to help the suffering masses
and desired to work in a hospital. This was greatly opposed by her family, and they
fought about it for long, before ultimately allowing her to go to Kaisersworth, Germany
to study nursing from the Institution of Deaconesses. She studied there for 3 months and
then returned to the service of her family. It was another 2 years before she was allowed
to practice nursing (Brown, 1988, Woodham-Smith. 1951).
History and Background

She served the wounded soldiers during the Crimean War. After which, she
wrote what we have come to refer to as her nursing theory. Her writings, which included
philosophy and directions were inspired from a need to define nursing and reform
hospital environments rather than give nursing new knowledge. Nightingale worked
intensely during her lifetime to effect all types of reforms in nursing. Because of her
works in reforming nursing, she was given the title “Founder of Modern Nursing.” She
established a school of nursing at St. Thomas Hospital in England and wrote many
manuscripts about hospital reform and nursing care.
History and Background

Nightingale strongly advocated that “nursing knowledge is distinct from

medical knowledge.” Her philosophy in nursing is environment-oriented. Her work
focuses largely on the patient and the environment, but also includes the nurse and
health.

She believed that the person is a holistic individual and thus had a spiritual
dimension. She advocated that nursing is a spiritual calling, and with that belief, she
assumed that nurses can help those clients who were in spiritual distress. During her
time, it was expected that Christians would help other Christians. She recognized nursing
of the sick (nursing proper) and nursing of the well).
History and Background

Since Florence Nightingale believed in nursing well persons---or health

promotion---it is logical that she assumed her nurses would do some health
teachings as were caring for the sick or for those who already well. In using
Nightingale's theory, the nurse must consider Nightingale’s 13 Canons, health
promotion, and spiritual distress.
Theoretical
Sources
for Theory
Development
Theoretical Sources for Theory
Development
 Many factors influenced the development of Nightingale’s philosophy of nursing

• Her personal, societal and professional values and concerns all were integral to the
development of her beliefs. She combined her individual resources with societal and
professional resources available to her to produce immediate long- term change
throughout the world.

● Her education under the tutelage by her well-educated, intellectual father included
subjects such as mathematics and philosophy. This education, which was an unusual
one for a Victorian girl provided her with knowledge and conceptual thinking abilities.
● Nightingale family's aristocratic social status provided her with easy access to people of
power and influence. Nightingale learned to understand the political processes of
Victorian England through the experience of her father during his short-lived political
career and through his continuing role as an aristocrat involved in the political and
social activities of his community. She most likely relied on this foundation and on her
own experiences as she waged political battles for her causes.

● Nightingale also recognized the societal changes of her time and their impact on the
health status of individuals. The industrial age had descended upon England creating
new social classes, new diseases, and new social problems. Dickens’ social
commentaries and novels provided English society with scathing commentaries on
health care and the need for health and social reforms in England. In his serialized
novel (1843-1844), Dickens' portrayal of SaireyGampand Betsy Pregas drunken, filthy,
untrained nurses who stole their patients' food, and intoxicate restless patients with
alcohol, provided an image of the horrors of Victorian practice.
● Nightingale's alliance with Dickens undoubtedly influenced her & definitions of nursing and
health care and her theory for nursing.

● Similar dialogue with political leaders, intellectuals, and social reformers of the day (John
Stuart Mill, Benjamin Jowett, Edwin Chadwick, and Harriet Marirrau) advanced
Nightingale's philosophical and logical thinking, which is evident in her philosophy and
theory of nursing. These dialogues likely inspired her to strive to change the things she
viewed as unacceptable in the society in which she lived.

● Finally, Nightingale's religious affiliation and beliefs were especially strong

sources for her nursing theory. Reared as a Unitarian, her belief that action for the
benefit of others is a primary way of serving God, served as the foundation for
defining her nursing work as a religious calling. In addition, the Unitarian
community strongly supported education as a means of developing divine
potential and helping people move toward Perfection in their lives and in their
service to God.
Nightingale's
Environmental
Model
Nightingale's Environmental
Model

 Major Concepts and Definitions:

 Nightingale viewed the manipulation of the physical environment as a

major component of nursing care (Nightingale used the term
surroundings in her writing).
 Nightingale's Environmental
Model

She defined the following aspects as major areas of the physical, social, and
psychological environment that the nurse could control:

1. Health of houses
2. Ventilation and warming
3. Light.
4. Noise
5. Variety
6. Bed and bedding
Nightingale's Environmental
Model

7. Cleanliness of rooms and walls

8. Personal cleanliness
9. Nutrition and taking food
10. Chattering hopes and advices
11. Observation of the sick
12. Petty management
Nightingale's Environmental
Model

 The social and psychological environment that affect the physical environment are:
Variety, chattering hopes and advices, and petty management.

 Nightingale believed that when one or more aspects of the environment are out of
balance, the client must use increased energy to counter the environment stress.

 These stresses drain the client of energy needed for healing.

Use of Empirical Evidence
 Nightingale's reports describing health and sanitary conditions in Crimea and in England
identify her as an outstanding scientist and empirical researcher. Her expertise as a
statistician is evident in the reports that she generated throughout her lifetime on the
varied subjects of health care, nursing, and social reform.

 Nightingale's carefully collected information that illustrated the efficacy of hospital

nursing system and organization during the Crimean War vis perhaps her best known
work. Her report of her experiences and collected data was submitted to the British Royal
Sanitary Commission in “Notes on Matters Affecting the Health. Efficiency, and Hospital
Administration of the British Army Founded Chiefly on the Experience of the Late War”
(Nightingale, 1858b). This Commission had been organized in response to Nightingale’s
charges of poor sanitary conditions. The data in this report provided a strong argument in
favor of her proposed reforms in the Crimean hospital barracks.
Use of Empirical Evidence

 The observation of social phenomena at both individual and systems level was
especially important to Nightingale and served as basis of her writings. Nightingale
emphasized the Concurrent use of observation and performance of tasks in the
education of nurses and expected them to continue to use both of the activities in
their work.
 Major
Assumptions
Major Assumptions

 Environment

 Person

 Health

 Nursing
 Environment

Nightingale’s concept of environment (surroundings) is anything that can be

manipulated to place a patient in the best possible condition for nature to act. She
emphasized that nursing was to assist nature in healing the patient.

 Her admonition to nurses, both those providing care in the home and trained nurses in
the hospitals, was to create and maintain a therapeutic environment that would enhance
the comfort and recovery of the patient.

 Her treatise on rural hygiene includes an incredibly specific description of environmental

problems and their results, as well as practical solutions to these problems for households
and communities
 Environment

 Nightingale's assumptions and understanding about the environmental condition of those

days were most relevant to her philosophy. She believed that sick poor people would
benefit from environmental improvements that would affect both their bodies and their
minds. She believed that nurses could be instrumental in changing the social status of the
poor by improving their physical living conditions.

 Many aristocrats of the time were unaware of the living conditions of the poor.
Nightingale's mother, however had visited and provided care to poor families in the
communities surrounding their estates; Nightingale accompanied her on these visits as a
child and continued them when she was older. Thus Nightingale's understanding of
physical surroundings and their effect on health were acquired through first-hand
observation and experience beyond her own comfortable living situations.
 Person
 In most of her writings, Nightingale referred to the person as a “patient”. Nurses
performed tasks to and for the patient and controlled the patient's environment to
enhance recovery.

 For most part, Nightingale described a passive patient in this relationship. However,
specific references are made to the patient performing self-care when possible and, in
particular, being involved in the timing and substance of meals. The nurse was to ask the
patient about his or her preferences, which reveals the belief that Nightingale saw each
patient as an individual. However, Nightingale (1969) emphasized that the nurse was in
control of and responsible for the patient's environmental surroundings.

 Nightingale had respect for persons of various backgrounds and was not judgmental about
social worth.
 Health
Nightingale defined health as being well and using every power (resource) to the
fullest extent in living life. In addition, she saw disease and illness as a reparative process that
nature instituted when a person did not attend to health concerns.

 Nightingale envisioned the maintenance Of health through prevention pf disease by

environmental control and social responsibility.

 What she described led to public health nursing and the more modern concept of health
promotion.

 She distinguished the concept of health nursing as different from-nursing sick patient to
enhance recovery, and from, living better until peaceful death.
 Health

 Her concept of health nursing exists today in the role of district nurses and health
workers in England and in other countries where lay health works are used to
maintain health and teach people how to prevent disease and illness.

 Her concept of health nursing is a model used by many public heal agencies and
departments in various countries.
 Nursing
Nightingale believed that every woman, at one time, in her life, in the sense that
nursing is being responsible for someone else's health.

 Nightingale believed nursing to be a spiritual calling. Nurses were to assist nature to repair
the patient.

 Nightingale wrote “Notes on Nursing.” published originally in 1859, to provide women

with guidelines for caring for their loved ones at home and to give advice on how to “think
like a nurse” (Nightingale, 1969 p.4). Trained nurses, however were to learn additional
scientific principles to be applied in their work and whereto be more skilled in observing
and reporting patient’s health status while providing care as the patient recovered.
 Nursing
 Using Nightingale's philosophy in practice today fits well with the use of the nursing
process. The nurse assesses the patient situation, identifies a need; implements a plan of
care, reevaluates the situation, and finally changes the plan to better serve the patient.

 She expected nurses to use their powers of observation in caring for patients.

 She advocated for nurses to have educational background and knowledge that is different
from those of physicians.

 She believed in and rallied for nursing education to be a combination of clinical

experience and classroom learning.
Nightingale and
The Nursing
Process
Nightingale and The Nursing Process

Assessment
Nightingale recommended two essential behaviors by the nurse in the area of assessment.

1. Ask client what is needed or wanted.

Examples:
a. If the patient is in pain, ask where the pain is located.
b. If the patient is not eating, ask when he or she would like to eat
and what food is desired

 She recommended asking precise questions. She warned against asking leading questions
Nightingale and The Nursing Process
 Correct: “How many hours of sleep did you have? At What hours of the night?”
 Wrong: “Did you have a good night sleep?”

2. Observation

She used precise and specific observations concerning all aspects of

the client's physical health and environment.

Examples:
a. How do light, noise, smells. and bedding affect the client?
b. How much food and drink had the client ingested at every meal or snack?
Nightingale and The Nursing Process

Nursing Diagnoses

 Nightingale believed, data should be used as the basis for forming any
conclusion. The nursing diagnosis is the client's response to the environment
and not the environmental problem. It reflects the importance of the
environment to health and well-being of the client.
Nightingale and The Nursing Process

Outcomes and Planning

 Identifying nursing actions needed to keep clients comfortable. dry, and in the best state
for nature to act on.

 Planning is focused on modifying the environment to enhance the client's ability to

respond to the disease process.

 The desired outcomes are derived from the environmental model-----for example, being
comfortable, clean, dry, in the best state for nature to work on.
Nightingale and The Nursing Process

Implementation

 Takes place in the environment that affects the client and involves taking action to
modify that environment.

 All factors of the environment should be considered, including noise, air odors,
bedding, cleanliness, light,----- all the factors that place clients in-the best position for
nature to work upon them.
Nightingale and The Nursing Process

Evaluation

 Is based on the effect of the changes in the environment on the client's ability to regain
his/her health at the least expense of energy.

 Observation is the primary method of data collection used to evaluate the client’s
response to the intervention.
 Critical
Thinking
with
Nightingale’s
Theory
 Nightingale’s 13 Canons Nursing Process and Thought

Assess the client's body temperature, room

temperature, and room for fresh air (or
adequate ventilation) and foul odors.
Ventilation and warmth Develop a plan to keep the room airy and of
odor while maintaining the clients body
temperature.

Assess the room for adequate light. Sunlight

works best. Develop and implement adequate
light in the client' s room without placing the
Light client in direct light.
 Assess the room for dampness, darkness, and
dust or mildew. Keep the room free from dust,
dirt, mildew and dampness
Cleanliness of rooms and walls

Light
 Assess the room for dampness, darkness, and
dust or mildew. Keep the room free from dust,
Cleanliness of rooms and walls dirt, mildew and dampness

Assess the surrounding environment for pure

air, pure water, drainage, cleanliness, and light

Examples include removing garbage or

Health of Houses garments from the area, removing any
standing water (or ensuing that water drains
away from the area), and ensuring that air and
water are clean and free from odor and that
there is plenty of light.
Asses the noise level in the client’s room and
surrounding area. Attempt to keep noise level
to a minimum, and refrain from whispering
Noise outside the door
 Asses the bed and bedding for dampness,
wrinkles, and boiling, and check the bed for
Bed and bedding height. Keep the bed dry, wrinkle-free, and at
the lowest height to ensure the client’s
comfort.

Attempt to keep the client dry and clean all

times. Frequent assessment of the client’s skin
Personal cleanliness is needed to maintain adequate skin moisture.

Attempt to stimulate variety in the room and

with the client. This is accomplished with
cards, flowers, pictures, books, or puzzles.
Variety
Encourage friends and relatives to engage the
client in some sort of stimulating conversation.
 Avoid talking without reason or giving advice
that is without fact. Continue to talk to the
client as a person, and continue to stimulate
Chattering hopes and advices the client’s mind. Avoid personal talk.

Assess the diet of the client. Take note of the

amount of food and drink ingested by the client
Taking food at every meal or snack.

Continue with the assessment of the diet to

include type of food and drink the client likes or
dislikes. Attempt to ensure that the client
What food always has some food or drink available that he
or she enjoys.
 Petty management ensures continuity of care.
Documentation of the plan of care and all

Petty management Evaluation will ensure others give the same

care to the client in your absence.

Observe everything about your client. Record

all observations. Observations should be
factual and not merely opinions. Continue to
Observation of the sick observe the client’s surrounding environment,
and make alterations in the plan of care when
needed.
 Critique:
Nightingale's
Environmental
Theory
Clarity

 Nightingale's work is clear and easily understood. It addresses

three major relationships:

1. Environment to patient
2. Nurse to environment
3. Nurse to patient
Clarity

 Nightingale believed that the environment was the main factor

that created illness in a patient and regarded disease as “the
reactions of kindly nature against the conditions in which we
have placed ourselves”

 She recognized the potential harmfulness of an environment

and emphasized the benefit of a good environment in
preventing disease.
 Clarity
 The nurse's practice includes manipulation of the environment in a
number of ways to enhance patient recovery. Elimination of contamination
and exposure to fresh air, light, warmth. and quiet were identified as
elements to be controlled or manipulated in the environment.

 The nurse-patient relationship may be the least well-defined in

Nightingale’s writings. Yet cooperation and collaboration between the
nurse and the patient are suggested in her discussion of a patient's eating
patterns and preferences, the comfort of a beloved pet to the patient, the
protection of the patient from emotional distress, and conservation of
energy while allowing the patient to participate in self-care
Clarity

 Finally, it is interesting to note that Nightingale discussed the

concept of observation extensively, including its use to guide the
care of patients and to ensure improvement or lack of response to
nursing interventions.
Simplicity

 Nightingale provides a descriptive, explanatory theory. Its environmental

focus, along with its epidemiological components, has predictive
potential.

 Nightingale could be said to have tested her theory in an informal

manner by collecting data and verifying improvements. She used brief
case studies possible exemplars, to illustrate a number of concepts that
she identified in “Notes in Nursing” (1969). Her intent was to provide
general rules and explanations that would result in good nursing care
for patients.
Generality

 Nightingale’s theory has been used to provide general guidelines for all
nurses since she introduced them more than 150yenrs ago. Although
some activities that she described are no longer relevant, the
universality and timelessness of her concepts remain patient.

 Nurses are increasingly recognizing the role of observation and

measurement of outcomes as an essential component of nursing
practice.
Empirical Precision (Accessibility)

 Concepts and relationships within Nightingale’s Theory typically are

stated implicitly and are presented as truths rather than as tentative,
testable statements.

 In contrast to her quantitative research on mortality performed in

Crimea, Nightingale advised the nurses of her time that their practice
should be based on their observations and experiences. Her concepts
are amenable to studies with the qualitative approaches of today as well
as quantitative methods.
Derivable Consequences (Importance)

 To an extraordinary degree, Nightingale's writings direct the nurse to

take action on behalf of the patient and the nurse. These directives
encompass the areas of practice, research, and education. Her principles
to shape nursing are the most specific.

 She urges nurses to provide physicians with “not your opinion, however,
respectfully given, but your facts”

 Similarly, she advises that “if you could not get the habit of observation
one way or other, you had better give up being a nurse, for it is not your
calling, however kind or anxious you may be”
Derivable Consequences (Importance)

 Nightingale’s basic concepts of environmental manipulation and care of

the patient can be applied in contemporary nursing settings. Although
subjected to some criticisms, her theory and her principles are relevant
to the professional identity and practice of nursing.

 The statements and observations made by Nightingale in “Notes in

Nursing” can have great significance for the world of nursing today.
Application of
Florence
Nightingale’s
Environment
Philosophy
Case History of Eva D.
Miss Eva D. is a 25-year-old female who had been admitted to the medical
unit with the chief complaint of frequent, watery stools since last night. This is
accompanied by abdominal cramps, nausea and vomiting. Her vital signs are as
follows: T=38.6°C, P=98bpm, R=23/min., BP=100/70mmHg. She complains of
weakness, thirst and dryness of mouth. Her skin is warm, flushed, and dry. Her urine
is dark yellow in color.

Miss D. claims, she had eaten oysters for dinner. She lives in a crowded
community close to a landfill and shares toilet with 4 other families. Their source of
drinking water is from pump well in the community. She does not practice good hand
hygiene after using the toilet. Stool examination revealed salmonellosis.

Miss D. is extremely tearful. She expresses great concern over her absence
from her job in a garment factory and over her health and expenses for
hospitalization.
 Nursing care of Miss Eva D. with
Nightingale’s Theory

In Nightingale’s environment theory, Miss D. is the person seeking care.

She needs nature’s reparative process.

The nursing process and Nightingale’s theory can be used together to

provide care for Miss D. This care involves “nursing the sick”, review of the
environment and the client’s lifestyle.
 Nursing care of Miss Eva D. with
Nightingale’s Theory
A. Nursing the Sick

• Assessment
Assess the client for the following problems:

1. Fluid and electrolyte losses related to frequent, watery stools. nausea and vomiting as
manifested by changes in the VS (Vital Signs); weakness. Dryness of mouth; warm. flushed.
dry skin; dark-colored urine.

2. Pain related to abdominal cramps.

3. Inadequate food intake related to nausea and vomiting.

4. Fever ('1-38.60C) related to infection (Salmonellosis) and dehydration.

 Nursing care of Miss Eva D. with
Nightingale’s Theory
● Plan
1. Fluid electrolyte losses

 Provide fluid and electrolyte replacement.

 Administer medications to relieve frequent, watery stools as prescribed.

 Administer medications to relieve nausea and vomiting as prescribed.

 Provide good oral care for dryness of mouth.

 Promote rest to relieve weakness.

 Monitor intake output to fluid balance status.

 Provide good perianal care to promote comfort.

 Nursing care of Miss Eva D. with
Nightingale’s Theory
● Plan
2. Pain related to abdominal cramps
 Provide low fiber diet. To reduce peristalsis.

 Promote rest. To reduce peristalsis and to promote comfort.

 Avoid gas-forming foods. Flatulence worsens abdominal pain.

 Administer anticholinergic as prescribed. To relieve abdominal cramps.

 Nursing care of Miss Eva D. with
Nightingale’s Theory
● Plan
3. Inadequate food intake related to nausea and vomiting.

 Provide small, frequent feedings. This is better tolerated by patients with nausea.

 Provide ice chips to relieve nausea.

 Administer antiemetic as prescribed. To relieve nausea and vomiting.

 Nursing care of Miss Eva D. with
Nightingale’s Theory
● Plan
4. Fever related to infection and dehydration.
 Provide adequate room ventilation.

 Keep the room airy and free of odor. To promote rest.

 Increase fluid intake. To reduce fever, relieve dehydration, and promote excretion of
microorganisms.

 Administer antibiotic and antipyretic as prescribed.

 Nursing care of Miss Eva D. with
Nightingale’s Theory
● Plan
4. Fever related to infection and dehydration.

 Render tepid sponge bath. To reduce fever by evaporation and conduction.

 Keep the skin clean and dry. To promote comfort.

 Change gowns and bedding as needed to prevent dampness from perspiration

Nursing care of Miss Eva D. with
Nightingale’s Theory

• Observation of the sick. Observe everything about the client.

Record all which are factual and not merely opinions.
 Nursing care of Miss Eva D. with
Nightingale’s Theory
B. Physical
Home, Community/Neighborhood and Workplace
Assessment

1. Pure water. Assess for adequate working water system and storage that is free
from contamination.

2. Cleanliness. Assess for sanitation conditions of food sources and preparation

and hygienic practices.
● Assess for the means to maintain sanitation conditions of toilets: To keep
food and water supply free from contamination.
 Nursing care of Miss Eva D. with
Nightingale’s Theory
B. Physical
Home, Community/Neighborhood and Workplace Plan

1.Water
 Have water checked for contamination in in coordination with local
 Department of Health personnel.
 Educate the client on water purification and storage methods.
 Keep garbage and other refuse away from water supply or any parts of the water system.

2. Cleanliness
 Educate the client on proper food handling; the importance of handwashing especially when
preparing foods and before and after using the toilet; waste disposal and personal
cleanliness.
 Nursing care of Miss Eva D. with
Nightingale’s Theory
B. Physical
Home and Workplace Assessment

1. Light. Assess for adequate windows and working light sources.

2. Pure Air. Assess tor ventilation, offensive odors, e.g. odors of garbage in
the landfill.
3. Water. Assess for working system that is free from contamination.
4. Drainage. Assess the area for drainage of water from washing dishes
and laundry; drainage of rain water away from the home.
 Nursing care of Miss Eva D. with
Nightingale’s Theory
B. Physical
Home and Workplace Assessment

5. Cleanliness. Assess the home and workplace for means to keep the areas clean,
and freedom from excessive dust, mold, mildew, pet droppings (from cats and
dogs), offensive odors, “dust-catcher” things (files of papers, unused jars, plastic
containers, unused old clothes, etc.)

6. Bed and Bedding. Assess the bed for space and comfort. Assess the bedding for
cleanliness and availability of areas for laundry and drying of bedding (for home
environment only).

7. Noise. Assess the area for loud, offensive and unnecessary noise.
 Nursing care of Miss Eva D. with
Nightingale’s Theory
C. Psychological Environment

Assessment and Plan

Miss Eva D. has several psychological concerns. She is worried over her
absence from her job, her health, and expenses for hospitalization.

1. Variety. Assess the client's activities before illness. Attempt to stimulate variety in the
room and with the client during her hospital stay — with cards, flowers, magazines, books,
music. Encourage visits of relatives and friends.

2. Chattering hopes and advices. Refrain from giving the patient your opinion. Provide factual
information about health. Allow her to verbalize her fears, feelings and concerns.
 Reference

Quiambao-Udan, J. (2020).
Theoretical Foundation in
Nursing (2nd Ed.). Manila: APD
tical Foundation in Nursing Educational Publishing House.
(2nd Ed.)
thanks!