Nightingale's

Environmental
Model
Background:
Nightingale became a heroine in Great Britain as a
result of her work in the Crimean War. Her depiction
of the very poor sanitary conditions in the hospital
wards at Scutari is overwhelming. She fought the
bureaucracy for food, bandages, fresh bedding, and
cleaning supplies for the soldiers. At times she bought
supplies with her finances.
Background:
She showed concern for the comfort of the English soldier
- well, injured, or sick, including supporting the
establishment of a laundry, library, assistance with letter
writing, a banking system so the soldiers could save their
pay, and a hospital for the families who go with the
soldiers to war. Also, she provided comfort and security to
the seriously sick and dying. Her skills in decision-making
were often better than those of many officers in the army.
She spent the years after the Crimea establishing schools
of nursing and influencing public policy by lobbying her
acquaintances about several of her concerns.
Background (Alligood, M., 2014):
Lady with the Lamp
Mother of Modern Nursing
First Nurse Researcher
First Nurse Theorist
Approach to Nursing (George, J., 2011):
Main focus was the control of the environment of
individuals and families, both healthy and ill
“Notes on Nursing”: manipulation and organization of
the environment of those persons requiring nursing
care
Influence of the environment on the human being and
the critical nature of balance between the human and
his or her environment
Nightingale's Environmental Model
Main Theoretical Assertion: Health is the critical
nature of balance between the human and his or her
environment. When one or more aspects of the
environment are out of balance, the person must use
energy to counter the environmental stress. These
stresses drain the energy of the person for healing.
Nightingale's "Canons"
1. Health of houses – “Badly constructed houses do for
the health what badly constructed hospitals do for the
sick. Once insure that the air is stagnant and sickness
is certain to follow” (Nightingale, F., 1992)
Check surrounding environment for fresh air, pure
water, drainage, cleanliness and light
Remove garbage, stagnant water and ensure clean
water and fresh air.
Nightingale's "Canons"
2. Ventilation and warmth – “Noxious air… effluvia”,
“essential to keep the air he breathes as pure as the
external air without chilling him” (Nightingale, F., 1992)
Check the patient’s body temperature, room
temperature, ventilation and foul odour.
Create a plan to keep the room well-ventilated and free
of odour while maintaining the patient’s body
temperature
Nightingale's "Canons"
3. Light – “Light… has quite real and tangible effects
upon the human body” (Nightingale, F., 1992)
Direct sunlight
Check room for adequate light. Sunlight is beneficial
to the patient.
Create and implement adequate light in the room
without placing the patient in direct light
Nightingale's "Canons"
4. Noise – Patients should never be wakened
intentionally or accidentally during the first part of
sleep
Noise is thoughtless, cruel and irritating to the patient
Check noise level in the room and surroundings
Attempt to keep noise level in minimum
Nightingale's "Canons"
5. Variety – need for changes in color and form, including bringing
the patient brightly colored flowers or plants, rotating painting
and engravings each day, week, or month to provide variety
Reading, needlework, writing and cleaning as activities to relieve
the sick of boredom
Attempt to accomplish variety in the room and with the client
This is done with cards, flowers, pictures and books. Also
encourage friends or relatives to engage in stimulating activities
Nightingale's "Canons"
6. Bed and Bedding – “an adult in health exhales about three pints
of moisture through the lungs and skin in a 24-hr period… enters
the sheets and stays there unless the bedding is changed and aired
frequently… placed in the lightest part of the room and placed so
the patient could see out of the window.” (Nightingale, F., as cited in
George, J., 2011)
Check bed and bedding for dampness, wrinkles and soiling
Keep the bed dry, wrinkle-free and lowest height to ensure comfort
Nightingale's "Canons"
7. Cleanliness of rooms and walls – “the greater part of
nursing consists in preserving cleanliness.” (Nightingale,
F., as cited in George, J., 2011)
Removing dust using damp cloth; restrictions against
carpet, fabrics and wallpapers; floors and furniture should
be easily washed
Check room for dust, dampness and dirt
Nightingale's "Canons"
8. Personal Cleanliness – “…so it is necessary to keep pores
of the skin free from all obstructing secretions. Every nurse
ought to wash her hands very frequently during the day”
(Nightingale, F., as cited in George, J., 2011)
Attempt to keep the patient dry and clean at all times
Frequent assessment of the patient’s skin is essential to
maintain good skin integrity
Frequent hand washing
Nightingale's "Canons"
9. Nutrition and taking food– importance of variety of
food presented
Noted that individuals desire different foods at different
times of the day; frequent small servings maybe more
beneficial to the patient than a large breakfast or dinner;
no business be done with patients while eating
Check the diet of the patient. Note the amount of food and
fluid ingested by the patient at every meal.
Nightingale's "Canons"
10. Chattering hopes and advices – to falsely cheer the
sick by making light of their illness and its danger is
not helpful
Avoid talking without giving advice that is without a
fact
Respect the patient as a person. Communicate
therapeutically
Nightingale's "Canons"
…On Petty management – “what you do when you are there, shall be
done when you are not there”
Document the plan of care and evaluate the outcomes to ensure
continuity
Continuity of care
…On Observation of the sick – “the most important practical lesson
that can be given to nurses is to teach them what to observe – how to
observe – what symptoms indicate improvement – what is reverse –
which are of importance – which are of none – which are evidence of
neglect – and what kind of neglect.” (Nightingale, F., 1992 p. 59, as
cited on George, J., 2011)
Nightingale and the metaparadigm
Person - referred to the person as a patient; a person with vital
reparative powers to dealk with the disease and is responsive to
the environment
Health - being well and using every power that the person has to
the fullest extent; focus is on the reparative process of getting well
Environment - those elements external to and which affect the
health of the sick and healthy person; all external conditions that
affect the life and development of the individual
Nursing - every woman, at one time in her life, would be a nurse ;
goal is to place the individual in the best condition for nature to
act by basically affecting the environment; nurse performs the
task to and for the patient