Florence Nightingale’s

Nursing Theory and Its

Application
Theorist Background
• Florence Nightingale was born on May 12, 1820, while
her parents were on an extended European tour.
• Much attention has been to the “Calling” that
Nightingale recorded in her diary in 1837, when she
wrote that “ God spoke to me and called me to his
service”.
• Florence Nightingale began her nursing training in
1851 in Germany.
• She pioneered the concept of formal
education for nurses.
• Known as the Lady with the Lamp
• She served the injured soldiers during the
Crimean war which strongly influenced her
philosophy of nursing.
• She wrote the first nursing notes “Notes on
Nursing: What it is, What is not” (1860) that
became the basis of nursing practice and
research.
• She is considered the first nursing theorist.
• She stated in her nursing notes that nursing “is
an act of utilizing the environment of the patient
to assist him in his recovery.”
• Her contribution during Crimean war is well-
known.
• She was a statistician, using bar and pie charts,
highlighting key points.
• International Nurses Day, May 12 is observed in
respect to her contribution to Nursing.
• She died 13 of August 1910
A rare photograph of Nightingale in
1910, by Lizzie Caswall Smith
Description of Theory
• The Environmental Theory by Florence
Nightingale defined Nursing as:
“the act of utilizing the environment of the patient to
assist him in his recovery.”
• It involves the nurse’s initiative to configure
environmental settings appropriate for the gradual
restoration of the patient’s health, and that external
factors associated with the patient’s surroundings
affect life or biologic and physiologic processes, and
his development.
• The foundation of Nightingale’s theory is the
environment- all the external conditions and
forces that influence the life and development of
an organism.
• According to her, external influences and
conditions can prevent, suppress, or contribute
to disease or death.
• Her goal was to help the patient retain his own
vitality by meeting his basic needs through
control of the environment.
 Major Assumptions of Nightingale
Theory
• Health and sickness are governed by natural laws.
• Nursing is a distinct field and is not like medicine. It is a
science and also an art.
• Disease process is not important for nursing rather nurses
concern is with the individual in the environment.
• Environment plays important role in patients’ health.
• Nurses should manipulate the surrounding to promote
sufferer recovery.
• Furthermore, nurses should be skillful, vigilant and
confidential, and their practice should be evidence base.
There are three types of environments:
Physical, Psychological and Social Physical
Environment:
Types of Environment
• Physical Environment consists of physical elements
where the patient is being treated.
• It affects all other aspects of the environment.
Cleanliness of environment relates directly to disease
prevention and patient mortality.
• Aspects of the physical environment influence the
social and psychological environments of the person
Types of Environment
• Psychological Environment:
• Psychological environment can be affected by a
negative physical environment which then causes
STRESS.
• It requires various activities to keep the mind active.
• It involves communication with the person, about the
person, and about other people.
Types of Environment
• Social environment
• It includes components of the physical environment -
clean air, clean water, proper drainage.
• It consists of a person’s home or hospital room, as well
as the total community
 Metaparadigm of
Nightingale Environmental
Theory
Nursing
• “What nursing has to do… is to put the patient in the
best condition for nature to act upon him”
(Nightingale, 1859/1992)
• Nightingale stated that 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.” She reflected the art of nursing in her
statement that, “the art of nursing, as now practiced ,
seems to be expressly constituted to unmake what
God had made disease to be, viz., a reparative
process.”
Person
• Nightingale referred person as a patient. Person is
affected by environment.
• Person is multidimensional, composed of biological,
psychological, social and spiritual components.
• He has a vital reparative power to deal with disease,
recovery is within the person’s power as long as a safe
environment for recuperation exists.
Health/Disease
• Health is “not only to be well, but maintaining well-
being by using a person’s power to the fullest extent”.
• Health is maintained by controlling the environmental
factors to prevent disease.
• Disease is considered as DYS-EASE or the absence of
comfort.
• Health and disease are the focus of nurse, who helps a
person through the healing process.
Environment
• "Poor or difficult environments led to poor health and
disease".
• "Environment could be altered to improve conditions
so that the natural laws would allow healing to occur."
Health of houses
• “Badly constructed houses do for the healthy what
badly constructed hospitals do for the sick. Once insure
that the air is stagnant and sickness is certain to
follow.”
• The importance of the health of houses as being
closely related to the presence of pure air, pure water,
efficient drainage, cleanliness and light.
• Cleanliness outside the house effected the inside.
 Ventilation and warming
• “Keep the air he breathes as pure as the external air,
without chilling him.”
• Nightingale believed that the person who repeatedly
breathed his or her own air would become sick or remain
sick. She was very concerned about “noxious air” or
“effluvia” and foul odors that came from excrement. She
also criticized “fumigations,” for she believed that the
offensive source, not the smell, must be removed.
• The importance of room temperature was also stressed by
Nightingale. The patient should not be too warm or too
cold. The temperature could be controlled by appropriate
balance between burning fires and ventilation from
windows.
Light
• Nightingale believed that second to fresh air, the sick
needed light.
• She viewed that direct sunlight was what patients
wanted.
• Although acknowledging a lack of scientific rationale
for it, she noted that light has “ quite real and tangible
effects upon the human body”.
 Noise
• She stated that patient should never be waked intentionally
or accidentally during the first part of sleep.
• She asserted that whispered or long conversations about
patients are thoughtless and cruel.
• She viewed unnecessary noise, including noise from female
dress, as cruel and irritating to the patient.
• Nurses responsibility is to assess and stop different kinds of
noise.
Variety
• She believed that variety in the environment was a
critical aspect of affecting the patients recovery.
• She discussed the need for changes in colour and
form, including bringing the patient brightly coloured
flowers or plants.
• She also advocated rotating 10 or 12 paintings and
engravings each day, week, or month to provide
variety for the patient. Nightingale also advocated
reading, needlework, writing, and cleaning as activities
to relieve the sick of boredom.
Bed and bedding
• Nightingale noted that an adult in health exhales
about three pints of moisture through the lungs and
skin in a 24-hour period. This organic matter enters the
sheets and stays there unless the bedding is changed
and aired frequently.
• She believed that the bed should be placed in the
lightest part of the room and placed so the patient
could see out of a window. She also reminded the
caregiver never to lean against, sit upon, or
unnecessarily shake the bed of the patient.
• She stated that dirty carpets and walls containing large
quantities of organic matter and provided ready
source of infection, just as dirty sheets and beds did.
Personal cleanliness
• The need for cleanliness is extended to the patient,
the nurse and the environment.
• Nightingale viewed the functions of the skin is
important, believing that many disease “disorders” or
caused breaks in the skin.
• “Just as it is necessary to renew the air round a sick
person frequently to carry off morbid effluvia from
the lungs and skin, by maintaining free ventilation, so
it is necessary to keep pores of the skin free from all
obstructing excretions.”
• “Every nurse ought to wash her hands very frequently
during the day.”
Nutrition and taking food
• Nightingale addressed the variety of food presented to
the patients and discussed the importance of variety in
the food presented.
• Nightingale noted that individuals desire different
foods at different times of the day and that frequent
small servings may be more beneficial to the patient
than a large breakfast or dinner. She urged that no
business be done with patients while they are eating
because this was distraction.
Chattering hopes and advices
• False hope was depressing to patients, she felt and
caused them to worry and become fatigued.
• She believed that sick persons should hear good news
that would assist them in becoming healthier.
• Nightingale wrote that to falsely cheer the sick by
making light of their illness and its danger is not
helpful.
• She encouraged the nurse to heed what is being said
by visitors, believing that sick persons should hear
good news that would assist them in becoming
healthier.
Social considerations
• Nightingale supported the importance of looking
beyond the persons to the social environments in
which he or she lived.
• She observed that generations of families lived and
died in poverty.
Relevance of theory in
nursing practice,
education and research
Nursing Practice
1. Disease control
2. Sanitation and water treatment
3. Utilized by modern architecture in the prevention
of "sick building syndrome" applying the principles
of ventilation and good lighting.
4. Waste disposal
5. Control of room temperature
6. Noise management.
Education
1. Principles of nursing training. Better practice result
from better education.
2. Skills measurement through licensing by the use of
testing methods, the case studies.
Research
1. Use of graphical representations like the bar, pie
diagrams.
2. Notes on nursing.
 Application of
nightingale's theory in
nursing process
Assessment
The following information
should be adequate:
• Adequacy of ventilation
• Cleanliness of environment
• Presence of draft
• Sudden noises
• Amount of sunlight and
artificial light
• Variety of dietary offerings
• Odors present in
throughout ward
• Methods of disposal of
human waste and sputum
• Opportunity to
communicate with others
• Insufficient warmth
• company from family and
other patient
• Insufficient knowledge
regarding disease
Nursing Diagnosis
• Non-stimulating environment
Implementation
• Provide adequate ventilation by opening doors and
windows.
• Keep the surrounding environment clean (linen, bed,
utensils)
• Keep the patient in warm and comfortable room, avoid
unnecessary noise.
• Increase stimulus through a greater exposure to sunlight
and fresh air.
• Provide nutritious diet and encourage for liquid diet
frequently.
• Proper disposal of sputum, human excreta and other waste
to remove odors.
Implementation
• Proper dress-up, maintain room temperature and
wear warm clothes.
• Isolate the patient from the children from the other
patients but keep in touch and interaction with limited
visitors.
• Keep in stimulating environment such as listening to
radio, reading magazines and newspapers.
• Provide sufficient advice, information about disease,
it’s prognosis, course of treatment to the patient and
family members.
Evaluation
• It is based on observation on the effect of a changing
environment on the health of a person specially focus
on the vital signs and adequate knowledge about
disease condition.
Application of Nightingale’s work in the
nursing process (Case Analysis)
• Assessment: Nancy Smith, a 10 yrs old was injured in
an accident related to farm machinery. She had head
injury then she was admitted to PICU. Because of PICU
envt., she had interrupted sleep and she became
increasingly confused. Her leg has become infected.
• Analysis of data: includes data gap
• Nursing Diagnosis: Impaired sleep pattern related to
environmental light and noise and separation from
family.
• Planning and implementation: nursing actions focus on
changing the environment to support more normal
sleep patterns, that is, being awake during the day and
sleeping at night.
• Evaluation: After two nights of uninterrupted sleep,
normal sounds, and parental encouragement, Nancy
will demonstrate increased orientation to place being
able to identify that she is in the hospital.
Conclusion
• The Environmental Theory of Nursing is a patient-care
theory. It focuses in the alteration of the patient’s
environment in order to affect change in his or her
health. Caring for the patient is of more importance
rather than the nursing process, the relationship
between patient and nurse, or the individual nurse.
• In this way, the model must be adapted to fit the
needs of individual patients. The environmental
factors affect different patients unique to their
situations and illnesses, and the nurse must address
these factors on a case-by-case basis in order to make
sure the factors are altered in a way that best cares for
an individual patient and his or her needs.