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Sample Test

Chapter 3
Key Terms
Scope of nursing practice Choosing
Values and beliefs Nursing situations
Theory-guided practice Connecting values
Creative nursing practice Ways of knowing
Theoretical frames of reference Theory evaluation guides
Empirical knowing Personal knowing
Ethical knowing Esthetic knowing

Chapter 3
Objectives
On completion of this chapter, students will be able to:
1. Describe the significance of nursing theory for nursing practice.
2. Identify questions from practicing nurses about using nursing theory.
3. Compare and contrast five approaches to evaluating nursing theory.
4. Demonstrate the use of study guides to direct the analysis and evaluation of selected nursing
theorists.
5. Articulate a process for implementing theory-guided practice.

Chapter 3
Outline
Significance of Nursing Theory for Nursing Practice
Nursing Practice as Essential for Developing, Testing, and Refining Nursing Theory
Creative Nursing Practice
Theoretical Frames of Reference
Depth and Scope of Nursing Practice
Responses to Questions from Practicing Nurses About Using Nursing Theory
My Nursing Practice
My Personal Interests, Abilities, and Experiences
Resources and Support
The Theorist, Evidence, and Opinion
Choosing a Nursing Theory to Study
Importance and Significance of Choosing
Hope and Anxiety
A Reflective Exercise for Choosing a Nursing Theory for Practice
Enduring Values
Nursing Situations
Connecting Values and the Nursing Situation
Verifying Awareness and Appreciation
Multiple Ways of Knowing and Reflecting on Nursing Theory
Empirical Knowing
Personal Knowing

Ethical Knowing
Esthetic Knowing
Using Insights to Choose Theory
Evaluation of Nursing Theory
Process of Making a Determination About the Value, Worth, and Significance of a
Theory
Addressing the Whole Theory
Level and Scope
Theory Evaluation Guides
Johnson (1974)
Chinn and Kramer (2004)
Fawcett (2000)
Melesis (1997)
Smith (2008)
Implementing Theory-Guided Practice
Gaining Administrative Support
Selecting a Model or Theory to Be Used in Practice
Launching the Imitative
Creating a Plan for Evaluation
Consistent and Constant Support and Education
Periodic Feedback
Re-visioning of the Theory-Guided Practice Model
Summary

Chapter 3
Questions for Classroom Discussion
1. Form small classroom groups (two or three students). After you have completed the
Reflective Exercise described in your text, identify a value that you believe strongly influences
your understanding of nursing. Draw a picture or take a photograph that you believe
demonstrates that value as it is lived in nursing. Share the artwork/photograph with your
groupmates and ask them: What do you think/see when you look at this? After they have shared
their thoughts, discuss the value you were trying to portray. Discuss any shared values that were
depicted within the group.
2. In small groups, share a brief description of a nursing situation. As a group, list as many
values guiding nursing that you can. Write down whatever comes to mind (the goal is to generate
as many listings as you can—do not edit responses at this point). Discuss the responses and edit
the list to consolidate those listings that seem to convey a similar value. Have each group
member individually rate the values in order of their importance with a numerical score. Share
your priorities with the group. Discuss the commonalities and differences. How might practice
be influenced from a set of hierarchical values?

Chapter 3
Multiple-Choice Questions
(Answers appear in bold)
1. The primary purpose of nursing theory is to:
A. Improve nursing practice.
B. Control health care costs.
C. Justify nursing costs.
D. Establish nursing as a discipline.
2. One of the most urgent issues facing the discipline of nursing is the artificial separation of
theory and practice.
A. True
B. False
3. Theories of any professional discipline are useless if they do not have an impact on practice.
A. True
B. False
4. Nursing practice is essential for all of the following except:
A. Developing nursing theory
B. Testing nursing theory
C. Refining nursing theory
D. Discovering nursing theory

5. Historically, nursing has always been distinctly separate from the medical model.
A. True
B. False
6. Nurses working together as colleagues often realize that:
A. Their views of nursing are not compatible.
B. They share the same values and beliefs.
C. The study of nursing theory does not enhance their work.
D. None of the above
7. Responses to guiding questions about theory in practice can be found in the following
resources:
A. Nursing literature
B. Audiovisual sources
C. Electronic sources
D. All of the above
8. How we come to know the science of nursing and other disciplines that are used in nursing
practice was described by Carper as:
A. Empirical knowing
B. Personal knowing
C. Ethical knowing
D. Esthetic knowing

9. How we come to know the moral component guiding choices within the complexity of health
care that guide day-to-day actions in nursing practice was described by Carper as:
A. Empirical knowing
B. Personal knowing
C. Ethical knowing
D. Esthetic knowing
10. Striving to know the self and to actualize authentic relationships between the nurse and the
one nursed was described by Carper as:
A. Empirical knowing
B. Personal knowing
C. Ethical knowing
D. Esthetic knowing

Chapter 4
Statement of Intent
This chapter explores the life of Florence Nightingale and her contributions to nursing. A
biographical account is provided that addresses her education, travel, spiritual background, and
Crimean War experiences. The medical environment of the 1800s and her views of women
during that time are also presented. An overview is provided for the foundations of Nightingale’s
model of nursing and how it is interpreted today.

Chapter 4
Key Terms
Spirituality
Crimean War
Moral Authority
Atmosphere
Environment
Sickness
Contagionism
Feminism
Expressions of Caring
Laws of Nursing
Laws of Health
Health of Houses
Observation
Personal Cleanliness
Petty Management
Light
Cleanliness of Rooms
Ventilation and Warming
Bed and Bedding
Taking Food
What Food?
Noise
Chattering Hopes and Advices
Variety

Chapter 4
Objectives
On completion of this chapter, students will be able to:
1. Summarize significant events in Nightingale’s life that led her to nursing and influenced
the development of her model of nursing.
2. Discuss the influence of Nightingale’s spirituality on her practice of nursing.
3. Compare and contrast the medical milieu of the 1800s with the medical milieu of today.
4. Discuss the impact of Nightingale’s feminist view within the context of her work.
5. Discuss Nightingale’s conception of nursing and analyze the elements of Nightingale’s
Theory of Nursing.
6. Identify the expressions of caring that are essential components of Nightingale’s Theory
of Nursing.
7. Discuss Nightingale’s assumptions and their relevance and application to nursing today.
8. Identify ways to apply Nightingale’s Environmental Model to the current practice of
nursing.
9. Identify and discuss the application of the four major factors that influenced
Nightingale’s Model (Environmental Model) to current nursing practice.

Chapter 4
Outline
Introduction the Theorist
Foundation of Nursing Practice
Call to Serve
Justice-Making
Early Life and Education
Family
Travel
Kaiserworth
Spirituality
Science and Spirituality
Truth Seeking
War
Crimean War Experience
Breaking Gender Barriers
Battle Front Innovations
Introduction to the Theory
Role of Observation
Defining Disease
The Medical Milieu
19th Century Medicine
Paradigm Shift

Origins of Disease
The Feminist Context of Nightingale’s Caring
Respectable Profession
Moral Role
Cultural Feminism
Ideas About Nursing
Notes on Nursing: What It Is; What It Is Not
Nursing as a Science
Statistics
Nightingale’s Assumptions
Goal of Nursing
Education
Environment
Nightingale’s Legacy for 21st-Century Nursing Practice
Caring
Activism
Applications: Nightingale’s Legacy of Caring

Chapter 4
Questions for Classroom Discussion
1. In Nightingale’s mind a specific function of nursing was to “put the patient in the best
condition for nature to act upon him. What was the meaning of this perpsective? What can nurses
do in contemporary nursing practice to implement this function of patient care?
2. How does Nightingale’s legacy for 21st-century nursing practice create an environment for
evidence-based practice in the current hospital or community setting? Discuss nursing situations
that would validate your thoughts.
3. Discuss how Nightingale’s concepts might decrease hospital-acquired infections and the
impact on patient recovery. Develop one hypothesis statement clarifying the relationship
beween envrionmentally and hospital-acquired infections.

Chapter 4
Multiple-Choice Questions
1. Nightingale proposed nursing as:
A. An extension of the environment
B. An art and a science
C. Empirical science
D. Physician’s handmaiden
2. Nightingale defined a nurse as any woman who had “charge of the personal health of
somebody” whether well, as in caring for babies and children, or sick, as an “invalid”
(Nightingale, 1860/1969). It was assumed that all women:
A. One time or another in their lives, would nurse
B. Needed to know the laws of health
C. Nursing proper, or “sick” nursing, was both an art and a science and required organized,
formal education to care for those suffering from disease.
D. All of the above
3. The goal of nursing as described by Nightingale is:
A. Work collaboratively with the physician to implement the medical orders.
B. Take care of the patient’s environment by maintaining cooking, cleaning, and scrubbing the
floors.
C. Assisting the patient in his or her retention of “vital powers” by meeting his or her
needs, thus putting the patient in the best condition for nature to act upon.
D. Giving the patient medicine when the medicine is due.

4. Nightingale isolated five environmental components essential to an individual’s health. Select
the correct grouping from the following:
A. Calming colors, quiet, comfortable temperature, clean air, pure water
B. Clean air, pure water, efficient drainage, cleanliness, and light
C. Light, color, sound, smell, temperature
D. Pure food, clean water, cleanliness, quiet, calming color
5. In Nightingale’s mind, the specific “scientific” activity of nursing that was the central element
in health care, without which medicine and surgery would be ineffective is which of the
following:
A. Preparing nutritious meals
B. Maintaining an aesthetic environment
C. Maintaining hygiene
D. Sustaining a quiet environment
6. In the mid-19th century , there were two competing theories regarding the nature and origin of
disease. These competing thoeries were:
A. Localization and specificity
B. Contagionism and quarantine
C. Vectorism and pollution
D. Atmosphere and environment
7. According to Nightingale, a nurse is defined as:
A. The handmaiden of the physician
B. A member of the moral majority

C. Any woman who had charge of the personal health of somebody, whether well or sick.
D. An individual who felt a calling to take charge of the sick
8. The patient is at the center of the Nightingale model and incorporates:
A. A holistic view of the person
B. Psychological, intellectual, and spiritual components
C. A unique individual filled with chttering hopes and advice
D. A & B
E. All of the above.
9. According to Nightingale, health is viewed as:
A. An additive process
B. The result of environmental, physical, and psychological factors
C. The absence of illness
D. A & B
E. All of the above
10. Cultural feminism is defined as:
A. Women are a product of the culture.
B. A belief in inherent gender differences
C. The emancipation of women as a cultural fad.
D. The corruption of women by masculine politics .

Chapter 4: Florence Nightingale’s Legacy of Caring and Its Applications
Instructions: Read the case study and answer the questions that follow.
The Community Health Nurse knocked softly before entering Isabel’s bedroom. On this home
visit Isabel was holding her 3-week-old baby girl, Pearl, while 2-year-old Jerry was sitting on the
floor playing with a cat. In one corner, a full litter box sat on the floor next to the changing table.
The nurse noted two half- empty 4-oz formula bottles on the changing table, an empty box of
baby wipes, and three soiled cloth diapers. Looking into Pearl’s sleeping face, Isabel said “She’s
finally fell asleep…I am so tired…Jerry stop teasing Freckles (the cat) and come over here and
hold Pearl while I get something to drink…do you want something to drink?” The nurse quickly
scanned the room, seeing an unmade bed with a bassinet wedged against the wall. Jerry’s bed,
also unmade, was in the corner opposite the litter box. The small bedroom was stifling hot, the
ceiling fan was not on, and the windows were closed. A table in the middle of the room had
plates with partially eaten sandwiches and half-finished cans of soda.
1. Based on this case study how would the nurse practicing from Nightingale’s theory
begin her home visit? What would be the priority for the nurse in this situation?
2. How might Nightingale’s understanding of sanitation and environment guide the nurse
in her home visit?
3. How could the nurse develop a relationship with Isabel and return as a welcomed
visitor in Isabel’s “home”?
Guided Response (Answer) for Instructors:
1. Nightingale focuses on the concepts of the patient in relationship with the
environment, sanitation or hygiene, observation skills, and empirical knowledge. The priority
for the nurse would be the safety of the patient in this environment. This requires the nurse to

draw upon empirical knowledge and experience to place the patient “in the best condition for
nature to act upon” (Nightingale, 1860/1969).
2. According to Nightingale, important things to consider include:
Sanitation—litter box, formula bottles, soiled diapers, food and drink left in the
open
Environment—the above with the addition of ventilation, light, pleasant
surroundings
Empirical knowledge
a. Isabel—postpartum health, hydration, nutrition and personal cleanliness, and
follow-up health care provider visits
b. Pearl—hydration, weight gain, number of diapers soiled per day, color of
skin, stool and urine. Physical evaluation for reflexes/responses
c. Jerry—general health, mental and physical development and nutrition
3. Nightingale reminds us the nurse is a guest in someone else’s environment. Consistent
with Nightingale’s assertion of nurse as guest, the community nurse might begin the visit
with a simple question such as “How may I help you?” This question opens the door for
communication and would give Isabel an opportunity to begin the visit by expressing her
needs first. Ask students to consider how Isabel might respond to this open-ended
question, what follow-up questions they might ask, and what nursing activities might be
useful from Nightingale’s perspective.