Homework: Florence Nightingale’s Environmental Theory.

Florence Nightingale (1820–1910)

• known as the Lady with the Lamp, providing care to wounded and ill soldiers during the Crimean War

• considered the founder of educated and scientific nursing

• wrote the first nursing notes “Notes on Nursing: What it is, What is not” (1860) that became the basis of nursing practice and research.

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• considered the first nursing theorist.

• One of her theories was the Environmental Theory, which incorporated the restoration of the usual health status of the nurse’s clients into the delivery of health care which is still practiced today.

Theoretical Sources

of the Environmental

Theory

Theoretical Sources of the Environmental Theory

• Education: Nightingale is a very good mathematician (a nurse statistician) and a philosopher.

• Literature: Dicken’s novel “The Adventures of Martin Chuzzlewit”, a novel that portrays a victorian drunken, untrained and inexpert nurse causes a stigma and bad impressions about nurses. The novel greatly affects her beliefs about being a nurse and pursue the battle to change the negative stigma about nurses.

• Intllectuals: Political leaders greatly affected and influenced her beliefs of changing things as she viewed as unacceptable to society.

• Religious Beliefs: For Nightingale, an action for the benefit of others is called “God’s Calling”. DUM VIVIMUS, SERVIMUS.

Theoretical Sources of the Environmental Theory

• Use of Empirical Evidence: She uses the polar diagram (statistical diagram) in her reports, books and letters.

• She highlighted the use of observation and the performance of tasks in the nursing education.

Theoretical Sources of the Environmental Theory

Environmental

Theory

– Philosophy or Metatheory

Environmental Theory: Major Concepts and Definitions

• Environment – concepts of ventilation, warmth, light, diet, cleanliness and noise. She focused on the physical aspects of the environment.

• She believed that “Healthy surroundings were necessary for proper nursing care.”

“Nursing is an act of utilizing the environment of the

patient to assist him in his recovery”

gradual

restoration

of health

INITIATIVE

NURSE

Configure

environmental

settings

appropriate for



PATIENT

Configure external factors associated with the patient’s surroundings

that affect life or biologic and physiologic processes, and his development.

5 Essential Components of

A Healthy Environment:

1. pure air

2. pure water

3. efficient drainage

4. cleanliness

5. light

 Pure fresh air – “to keep the air he breathes as pure as the external air without chilling him.“

2. Pure water – “well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer.“

3. Effective drainage – “all the while the sewer maybe nothing but a laboratory from which epidemic disease and ill health is being installed into the house.”

4. Cleanliness – “the greater part of nursing consists in preserving cleanliness.“

5. Light (especially direct sunlight) – “the usefulness of light in treating disease is very important.“

• Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status.

• The, factors posed great significance during Nightingale’s time, when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients.

• Also emphasized in her environmental theory is

the provision of a quiet or noise-free and warm environment, attending to patient’s dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient.

Conerns of Environmental Theory

1. Proper ventilation focus on the architectural aspect of the hospital.

2. Light has quite as real and tangible effects to the body.

3. Cleanliness and sanitation. She assumes that dirty environment was the source of infection and rejected the “germ theory”. Her nursing interventions focus on proper handling and disposal of bodily secretions and sewage, frequent bathing for patients and nurses, clean clothing and handwashing.

4. Warmth, diet and quiet environment. She introduced the manipulation of the environment for patient’s adaptation such as fire, opening the windows and repositioning the room seasonally, etc.

5. Unnecessary noise is not healthy for recuperating patients.

6. Dietary intake.

7. Petty management proposed the avoidance of psychological harm, no upsetting news. Strictly war issues and concerns should not be discussed inside the hospital. She includes the use of small pets of psychological therapy.

Nursing Metaparadigm

Nursing • Nursing is different from

medicine and the goal of nursing is to place the patient in the best possible condition for nature to act.

• Nursing is the “activities that promote health (as outlined in canons) which occur in any caregiving situation. They can be done by anyone.”

Person • People are

multidimensional, composed of biological, psychological, social and spiritual components.

• The patient is the focus of the environmental theory. The nurse should perform the task for the patient and control the environment for easy recovery. She practices nurse-patient passive relationship.

Health • Health is “not only to be

well, but to be able to use well every power we have”.

• A healthy body can recuperate and undergo reparative process. Environmental control uplifts maintenance of health.

• Disease is considered as dys-ease or the absence of comfort.

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.

Theoretical Assertions

• Prevention of interruption is very vital in the reparative process of the patient.

• Nursing Practice is the application of common sense, observation, perseverance and ingenuity.

• “If the person wants to recuperate, he needs to cooperate with the nurse.”

• Disease came from the organic materials from the patient and environment not on the germ theory.

Theoretical Assertions cont’d

• Sanitation means the manipulation of the environment to prevent diseases.

• Nursing is the commitment to the nursing works.

• She gives a little focus on the interpersonal relationship and nurse caring behavior.

• She believed that the nurse should be moral agents. “Think and act like a nurse.”

• Professional relationships, principles of confidentiality and care for the poor to improve health and social condition were the focus of her nursing care.

Logical Form

• She used inductive reasoning from her experiences and observation which is addressed with logical thinking and philosophy.

Importance of Environmental Theory

Practice

1. Disease control

2. Sanitation and water treatment

3. Utilized 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 polar diagrams.

2. Notes on nursing.

Critique

• Simplicity – simple and logical; tends toward description and explanation rather than prediction

• Generality – provides general guidelines for all nurses

Critique

• Empirical Precision – Little or no provision is made for empirical examination; individual observation rather than systematic research

• Derivable Consequences – to extraordinary degree, direct the nurse to action on behalf of patient and herself; These directives encompass the areas of practice, research and education

Homework: Florence Nightingale’s Environmental Theory.

References

• www.wikipedia.com

• http://slsu- coam.blogspot.com/2008/08/nightingales- environmental-theory.html

• www.currentnursing.com

• Tomey, A.M., (1994). Nursing Theorists and Their Work. 3rd ed. Missouri: Mosby