Theoretical Foundation of Nursing (NCM 15 – 100)
1st semester, s.y. 2023-202
INTRODUCTION
Nursing has made phenomenal achievement in
the last century that has led to the recognition of
nursing as an academic discipline and a profession. A
move towards theory-based practice has made
contemporary nursing more meaningful and significant
by shifting nursing’s focus from vocation to an
organized profession. The need for a knowledge-based
to guide professional nursing practice has been
realized in the first half of the twentieth century and
many theoretical works have been contributed by
nurses ever since, first with the goal of making nursing
a recognized profession and later with the goal of
delivering care to patients as professional.
Florence Nightingale – Environmental Theory
Florence Nightingale (12
May 1820 – 13 August 1910)
was a nurse who contributed
to developing and shaping the
modern nursing practice and
has set examples for nurses
who are standards for today’s
profession. Nightingale is the
first nurse theorist well-
known for developing the
Environmental Theory that revolutionized nursing
practices to create sanitary conditions for patients to
get care. She is recognized as the founder of modern
nursing. During the Crimean War, she tended to
wounded soldiers at night and was known as “The
Lady with the Lamp.”
The Environmental Theory by Florence
Nightingale defined Nursing as “the act of utilizing the
environment of the patient to assist 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 surrounding affect
life or biologic and physiologic processes, and his/her
development. Nightingale discussed the Environmental
Theory in her book Notes on Nursing: What it is, What
it is Not. She is considered as the first theorist in
nursing and paved the way in the foundation of the
nursing profession we know today.
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MAJOR CONCEPTS OF FLORENCE
NIGHTINGALE’S THEORY
1. HUMAN BEING OR PERSON
 Referred to by Nightingale as the
“patient” in the most of her writings.
(Not specifically defined by
Nightingale)
 Person is a human being acted upon
by a nurse or affected by anything.
 Nightingale envisioned the person as
comprising physical, intellectual,
emotional, social, and spiritual
components.
 Person has reparative powers to deal
with disease; recovery is within the
patient’s power as long as a safe
environment for recuperation exists.
2. NURSING
 “What nursing has to do… is to put
the patient in the best condition for
nature to act upon him.” (Nightingale,
1859/1992)
 Nursing is the “activities that promote
health which occur in any caregiving
situations. They can be done by
anyone.”
 Defined three types of nursing:
“Nursing Proper (nursing the sick),
“General Nursing (health promotion),
and “Midwifery Nursing.”
 Nightingale believed nursing to be
spiritual calling. She saw nursing as
the “science of environmental
management.”
 Aims to provide fresh air, light,
warmth, cleanliness, quiet, and a
proper diet.
3. ENVIRONMENT
 Environment serves as the foundation
of nightingale’s theory.
 The physical environment is stressed
out by Nightingale in her writing.
 It reflects a community health model
in which all surrounds human beings
is considered in relation to their state
of health.
 Defined as anything that can be
manipulated to place a patient in the
Theoretical Foundation of Nursing (NCM 15 – 100)
1st semester, s.y. 2023-202
best possible condition for nature to
act.
 Involve those external conditions that
affect life and development of the
individual. The focus is on ventilated,
warmth, odors, noise, and light.
 Environment includes everything from
person’s food to a nurse’s verbal and
non-verbal interactions in the person.
4. HEALTH
 Health is maintained by controlling
environmental factors to prevent
disease; health and disease are the
focus of the nurse, who helps a person
through the healing process.
 Nightingale wrote “Health is not to be
well, but to be able to use very well
every power we have.”
 Disease is considered as the absence
of comfort.
CONCEPTUAL FRAMEWORK OF
NIGHTINGALE’S ENVIRONMENTAL
THEORY
The client, the nurse, and the major environment
concepts are in balance; that is; the nurse cam
manipulate the environment to compensate for the
clients’ response to it. The goal of nurse is to assist the
patient in staying in balance. If the environment of a
client is out of balance, the client expends the
unnecessary energy.
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SUB-CONCEPTS OF FLORENCE
NIGHTINGALE’S ENVIRONMENTAL
THEORY
1. HEALTH OF HOUSES:
“Badly constructed houses do for the healthy
what badly constructed hospitals do for the
sick. Once ensure that the air is stagnant then
sickness is certain to follow.”
2. 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. The importance of room
temperature was also stressed by Nightingale.
The patient should not be kept too warm nor
too cold. The temperature could be controlled
by burning fire and ventilation from window.
3. LIGHT:
Nightingale believed that second to fresh air,
the sick needed light. She noted that direct
sunlight was want patients wanted.
4. NOISE:
She stated that patients should never be waked
intentionally or accidentally during the first
part of sleep. She asserted that whispered or
long conversation about patients are
thoughtless and cruel. She viewed unnecessary
noise, including noise from female dress, as
cruel and irritating to patients.
5. VARIETY:
She discussed the need for changes in color
and form, including bringing the patient
brightly colored flowers or plants. She also
advocated rotating 10 or 12 paintings and
engraving each day, week or month to provide
variety to patient. Nightingale also advocated
reading, needlework, writing, and cleaning
activities to relieve the sick of boredom.
6. BED AND BEDDING:
Nightingale noted that an adult in health
exhales about three pints of moisture through
the lungs and skin in a 24 hours period. This
organic matter enters the bed sheets and stays
Theoretical Foundation of Nursing (NCM 15 – 100)
1st semester, s.y. 2023-202
there unless the bed sheets is changed and
aired frequently. She believed that the bed
should be kept in the lightest part of the room
and placed beside the window so that patient
could see out of it.
7. PERSONAL CLEANLINESS:
Just as it is necessary to renew the air around
the 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 secretions. She stated that “every
nurse ought to wash her hands very frequently
during the day."
8. NUTRITION AND TAKING FOOD:
Nightingale noticed that individual desired
different food at different times of the day and
that frequent little 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.
9. CHATTERING HOPES AND ADVICES:
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 the good news
that would help them become healthier.
10. SOCIAL CONSIDERATION:
Nightingale supported the importance of
looking beyond the individual to the social
environment in which he or she lives.
ENVIRONMENTAL FACTORS IDENTIFIED
BY FLORENCE NIGHTINGALE
Florence Nightingale identified five environmental
factors as follows:
 PURE FRESH AIR: “To keep the air he
breathes as pure as the external air without
chilling him.”

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 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.”
 EFFECTIVE DRAINAGE: “All the while
the sewer may be nothing but a laboratory
from which epidemic disease and ill health is
being installed into the houses.”
 CLEANLINESS: “The greater part of nursing
consists in preserving cleanliness.”
 LIGHT (especially sunlight): “The
usefulness of light in treating disease is very
important.” “Direct sunlight, not only daylight,
is necessary for speedy recovery, except,
perhaps, in certain ophthalmic and a small
number of other cases.”
NIGHTINGALE DISCUSSED THREE TYPES
OF ENVIRONMENT
1. Physical environment
2. Psychological environment
3. Social environment
PHYSICAL ENVIRONMENT
Consists of physical elements where the patient is
being treated, such as ventilation, warmth, cleanliness,
light, noise, and drainage.
A patient’s bed must be clean, aired, warm, dry and
free from odor. One should provide an environment in
which patients can be easily cared by others or self.
The width, height, placement of bed should facilitate
the activities of the patient. The bed should be placed
in the best lighted spot, away from sudden noises and
the odor from drainage. The position of the patient on
the bed should be viewed in the context of supporting
ventilation.
PSYCHOLOGICAL ENVIRONMENT
Theoretical Foundation of Nursing (NCM 15 – 100)
1st semester, s.y. 2023-202
The effect of the mind on the body was fairly well
accepted in Nightingale’s time. nightingale recognized
that a negative environment could cause physical
stress, thereby affecting the emotional climate.
Therefore, emphasis is placed on offering the patient a
variety of activities to keep his mind stimulated. The
view of sunlight, the attractiveness of the food and the
offering enable the patient to survive emotionally.
Boredom is viewed as painful.
SOCIAL ENVIRONMENT
Social environment involves collecting data on illness
and disease prevention. It includes components of the
physical environment as clean air, water, and proper
drainage. It may consist of a person’s home or a
hospital room, as well as the total community that
affects the patient’s specific environment.
ASSUMPTIONS OF ENVIRONMENTAL
THEORY
 Natural laws
 Mankind can achieve perfection
 Nursing is a calling
 Nursing is an art and a science
 Nursing is achieved through environmental
alteration
 Nursing requires a specific educational base
 Nursing is distinct and separate from medicine
 Florence Nightingale believed that five points
were essential n achieving a healthful house:
“pure air, pure water, efficient drainage,
cleanliness, and light.”
 A healthy environment is essential for healing.
She stated that “nature alone cures.”
 Nurses must make accurate observations of
their patients and be able to report the
physician in an orderly manner.
 Nursing is an art, whereas medicine is a
science. Nurses are able to be loyal to the
medical plan but not servile.
APPLICATIONS OF ENVIRONMENTAL
THEORY
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“Patients should be put in the best condition for nature
to act on them.” It is the responsibility of the nurses to
reduce the noise, to relieve patient’s anxieties and to
help them sleep.
As most of the nursing theories, environmental
adaptation remains the basis of holistic nursing.
a. Patients should have clean air and a
temperature-controlled environment.
b. Patients should have direct access to sunlight
and not be subjected to unnecessary noise,
especially when sleeping.
c. Rooms should be kept clean.
d. Hospital facilities should be well-constructed.
e. Beddings should be changed and aired
frequently.
f. Patients should be kept clean and nurses
should wash hands frequently.
g. Patients should be offered a variety of scenery
such as new books or flowers to prevent
boredom.
h. Nurses should be positive but not offer false
hope to the patients or make light of their
illness.
i. Offer a variety of small meals instead of large
ones and do not do patient’s care while the
patient is eating as it is distracting.
j. Consider not only the individual patient but
the context of where he/she lives.
“Nursing out 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.”
~ Florence Nightingale
Theoretical Foundation of Nursing (NCM 15 – 100)
1st semester, s.y. 2023-202 kmdv - 021105