Theoretical Foundation of Nursing

Florence Nightingale’s Environmental Theory

 History and Background

Florence Nightingale is known as the Mother of Modern Nursing, Founder of
Modern Nursing, The Lady with the Lamp. She is the most recognized name in the
field of nursing. Her work was instrumental for developing modern nursing practice.
Her Environmental Theory changed the face of nursing to create sanitary conditions
for patients to get care.

Nightingale was born in Florence, Italy on May 12, 1820. She is the daughter of the
wealthy landowner, William Nightingale of Embley Park, Hampshire, England, a
respected Unitarian and a Whig who was actively involved in the anti-slavery
movement.By the age of seventeen, Florence believed that she was called by God to
do some unnamed cause. At the age of 24, she told her parents she wanted to
become a nurse. Her parents greatly opposed her idea because they viewed nursing
as associated with working class women.In 1851, at the age of 31, Florence’s father
gave her permission to train as a nurse. She went to Kaiserswerth, Germany and
studied nursing at the Institute of Protestant Deaconesses. Two years later, she was
appointed resident lady superintendent of a hospital for invalid women in Harley
Street, London.She served the wounded soldiers when Crimean War broke out in
March, 1853 between Russia and Turkey (British and French forces aiding Turkish
armies).

Nightingale published two books, Notes on Hospital (1859) and Notes on Nursing
(1859). In 1860, she established the Nightingale School and Home for Nurse at St.
Thomas Hospital.Nightingale strongly advocated that “Nursing knowledge is distinct
from medical knowledge”. Her philosophy in nursing is environment-oriented. In
later life Florence Nightingale suffered from poor health. She went blind in 1895.
Soon afterwards, the loss of other faculties meant she had to receive full-time
nursing. Although a complete invalid she lived another fifteen years before her death
in London on the 13th day of August 1910.

Nightingale’s Theoretical Sources for Theory Development 

Many factors influenced the development of Nightingale’s philosophy of nursing: her
personal, societal and professional values and concerns; her education from her
father that include mathematics and philosophy; her societal status as Victorian lady,
that provided her with  easy access to people of power and influence-----this paved
the way for her to effect her cause  on the improvement and reforms of on health
care; and finally her religious affiliation and beliefs – that action for the benefit of
others is a primary way of serving God. In addition, her religious affiliation strongly
supported education as a means of developing divine potential and helping people
move toward perfection.

Major Concepts and Definition of Nightingale’s Theory

Nightingale in her “Environment Theory” viewed the manipulation of the physical
environment as a major component of nursing care. Nightingale identified the
following aspects as major areas of the physical, social, and psychological
environment that the nurse could control:
1. Health of houses
2. Ventilation & warming
3. Light
4. Noise
5. Variety
6. Bed and Beddings
7. Cleanliness of rooms & walls
8. Personal cleanliness
9. Nutrition and taking food
10. Chattering Hopes and advices

Use of Empirical Evidence

Nightingale used empirical evidence in the conceptualization of her philosophy
based on her description of health and sanitary condition in Crimea and England.

Major Assumptions

Environment: can be defined as anything that can be manipulated to place a patient

in the best possible condition for nature to act. It is both physical and psychological
components. Physical refers to ventilation, warmth, light, nutrition, medicine,
stimulation, room temperature, and activity while psychological components include
avoiding chattering hopes and advices and providing variety.
Person: the receiver of care; a dynamic and complex being which Nightingale
envisioned the person as comprising physical, intellectual, emotional, social, and
spiritual components.
Health: Nightingale wrote, “Healthy is not to be, well but to be able to use well every
power we have.” She believed in the prevention and health promotion in addition to
nursing patients from illness to health.
Nursing: Nightingale believed nursing to be a spiritual calling. Nurses were to assist
nature to repair the patient. She defined different types of nursing as “nursing
proper” (nursing the sick), “general nursing” (health promotion), and “midwifery
nursing.” Nightingale viewed nursing as the “Science of environmental
management.” Nurses were to use common sense, observation, and ingenuity to
allow nature to effectively repair patient. Nightingale believed, “Observation may
always be improved with training---will seldom be present without
training;forotherwise the nurse does not know what to look for.” 

Critique: Nightingale’s Environmental Theory

Clarity. Nightingale’s work is clear and easily understood. She believed that the
environment was the main factor that created illness in a patient. She emphasized
the benefit of a good environment in preventing disease. She advocated that nurse’s
practice includes manipulation of the environment in a number of ways to enhance
patient recovery. Nightingale discussed the concept of observation, on     its use to
guide the care of patient and to measure improvement or lack of response to
nursing interventions.
Simplicity. Nightingale’s objective of setting forth general rules for the practice and
development of nursing was met through her simple theory. Nightingale’s theory
focuses on the manipulation to promote good nursing care.
Generality. Nightingale’s theory applies in all situations that nursing care is provided.
The universality and timeless of her concepts remain pertinent.Nurses are
increasingly recognizing the role of observation and measurement of outcomes as an
essential component of nursing practice. The relation concepts (nurse, patient, and
environment) remain applicable in all nursing settings today. Therefore, Nightingale’s
theory met the criterion of generality.
Empirical Precision (Accessibility). Concepts and relationships within Nightingale’s
theory typically are presented as truths rather than as tentative, testable
statements. In her theory, 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 both qualitative and quantitative methods.
Derivable Consequences (Importance). The directives given by Nightingale to nurses
in her writings encompass areas of practice, research, and education. She
emphasized that “nursing knowledge is distinct from medical knowledge.” She had
emphasized to nurses, “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.” Furthermore, she believed in a creative universal humanity
with the potential and ability for growth and change.
In summary, Nightingale’s Theory in nursing is timeless. Her writings are as
meaningful today as they were in the nineteenth century. Her 13 Canons may differ
in the specifics of application today, but the underlying principles provided by
Nightingale remain sound and relevant.
Nightingale’s Theory applies in all situations that nursing is provided up to these
generations and in the future generations of nurses.

Critical Thinking with Nightingale’s Theory

Ventilation and warmth

Assess the client’s body temperature, room temperature, and room for fresh air and
foul odors. Develop a plan to keep the room airy and free of odor while maintaining
the client’s body temperature.
Light 
Assess the room for adequate light. Sunlight works best. Develop and implement
adequate light in the client’s room without placing the client in direct sunlight.
Cleanliness of rooms and walls
Assess the room for dampness, darkness, and dust or mildew. Keep the room free
from dust, dirt, mildew, and dampness.

Health of houses
Assess the surrounding environment for pure air, pure water, drainage, cleanliness,
and light.
Noise 
Assess the noise level in the client’s room and surrounding area. Attempt to keep
noise level to a minimum, and refrain from whispering outside the door.
Bed and beddings
Assess the bed and beddings for dampness, wrinkles, and soiling, and check the bed
for height. Keep the bed dry, wrinkle-free, and at the lowest height to ensure the
client’s comfort.
Personal cleanliness
Attempt to keep the client dry and clean at all times. Frequent assessment of the
client’s skin is needed to maintain adequate skin moisture.
Variety 
Attempt to stimulate variety in the room and with the client. This is accomplished
with cards, flowers, pictures, books, or puzzles. Encourage friends and relatives to
engage the client in some sort of stimulating conversation.
Chattering hopes and advices
Avoid talking without reason or giving advice that is without fact. Continue talking to
the client as a person, and continue to stimulate the client’s mind. Avoid personal
talk.
Taking food
Assess the diet of the client. Take note of the amount of food and drink ingested by
the client at every meal or snack.
What food
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 always has some food or drink
available that he or she enjoys.
Petty management
Petty management ensures continuity of care. Documentation of the plan of care
and all evaluation will ensure others give the same care to the client in your absence.
Observation of the sick
Observe everything about your client. Record all observations. Observations should
be factual and not merely opinions. Continue to observe the client’s surrounding
environment, and make alterations in the plan of care when needed.