NURSING THEORIES

WEEK 4
NURSING PHILOSOPHIES
ENVIRONMENTAL
THEORY
FLORENCE NIGHTINGALE
ENVIRONMENTAL PHILOSOPHY

• “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”
HISTORY & BACKGROUND OF
FLORENCE NIGHTINGALE
• Born on May 12, 1820 in Florence, Italy
• A beautiful Victorian lady whose parents were wealthy
and well-travelled
• Young age: believed that she was called into service by
God
• As she grow older: she believed that she had been
called to serve mankind
• Age of 24: decided to help the suffering masses and
desired to work in the hospital
• Studied nursing from the Institution of Deaconesses
HISTORY & BACKGROUND OF
FLORENCE NIGHTINGALE
• Studied nursing from the Institution of
Deaconesses in Kaiserwerth, Germany for 3 years
• Served the wounded soldiers with a team of nurses
during the Crimean War & known as “The Lady
with the Lamp”.
• In 1854, she lead an expedition of 38 women to
take over the management of the barrack hospital
at Scutari where she observed where she observed
the disastrous sanitary condition
INSPIRATION TO DEVELOP THE
THEORY
• Her writings which included philosophy & directions
inspired her from a need to define nursing and reform
hospital environments rather than give nursing new
knowledge.
• She worked entirely during her lifetime to effect all
types of reforms in nursing.
• Because of her works in reforming nursing, she was
given the title “Founder of Modern Nursing” .
• Established a School of Nursing at St. Thomas Hospital
in England and wrote many manuscripts about hospital
reform and nursing care.
INSPIRATION TO DEVELOP THE
THEORY
• Strongly advocated that “nursing knowledge is distinct from medical
knowledge”. Her philosophy in nursing is “environment oriented”.
• Her work focuses on patient and environment and also includes
nurses and health
• Believed that person is a holistic individual and thus had spiritual
dimension
• Advocated that nursing is a spiritual calling; with that belief, she
assumed that nurses can help those clients who were in spiritual
distress.
• Believed in nursing well persons or health promotion: it is logical
that she assumed that nurse would do some health teachings as
they were caring for the sick or well clients.
• Died on August 13, 1910
MAJOR CONCEPTS OF NIGHTINGALE`S
THEORY
HUMAN BEING/PERSON
• Not specifically defined by Nightingale
• Person: as the one receiving care
• Persons: defined in relation to their environment &
the impact of environment upon them
• People: are multidimensional, composed of biological,
psychological, social and spiritual components
MAJOR CONCEPTS OF NIGHTINGALE`S
THEORY
HEALTH
• Did not defined health specifically
• Stated: “we know nothing of health, the positive of which
pathology is negative except for the observation and
experience”
• She wrote: health “is not only of being well, but to be able to
use well every power we have”
• Disease is considered the absence of comfort
• Disease & illness is a reparative process instituted by mother
nature if the person will not attend to his personal health
concerns.
MAJOR CONCEPTS OF NIGHTINGALE`S
THEORY

ENVIRONMENT
• The physical environment is stressed out by Nightingale in
her writing
• In her Theory: it reflect a community health model in
which all that surrounds human beings is considered in
relation to their state of health
MAJOR CONCEPTS OF NIGHTINGALE`S
THEORY
NURSING
• “What nursing has to do– is to put the patient in the best
condition for nature to act upon him”
• Nursing is the “activities that promote health (outlined in
Canons) which occur in any caregiving situations. They can be
done by anyone”.
• Defined different types of nursing:
“Nursing proper (nursing the sick)”
“General nursing (health promotion)”
 “Midwifery nursing”
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
1. HEALTH OF HOUSES
 Closely related to the presence of pure air, pure water, efficient
drainage, cleanliness & light
Badly constructed houses do for the health; Badly constructed
hospitals do for the sick. Once stagnant air is stagnant, sickness is
certain to follow
She also noted that cleanliness outside the house affected the
inside
Her advocacy is still applicable at present because families can be
still be affected by toxic wastes, contaminated water and polluted
air.
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
2. VENTILATION & WARMING
Believed that it is essential to “Keep the air he breathes as
pure as the external air, without chilling him”
Believed that the person who repeatedly breathed his/her
own air would become sick or remain sick
She was concerned about “noxious air or effluvia” and foul
odor that came from excrement, raw sewage, bedpans,
urinals & other utensils used to discard excrement
She also criticized “fumigations” for she believed that the
offensive source, not the smell, must be removed.
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
2. VENTILATION & WARMING
The importance of room temperature was also stressed
out by Nightingale. “The patient should not be too warm
or too cold
The temperature can be controlled by an appropriate
balance between burning fires and ventilation from
windows.
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
3. LIGHT
Nightingale believed that the sick needs both fresh air & light –
direct sunlight was what the clients wanted.
Noted that light has “quite real and tangible effects upon the
human body”.
She also noted that the sick rarely lie with their face towards the
wall but are much more likely to face the window, the source of sun.
Modern times: it is still noted that the lack of environmental stimuli
like in isolation rooms, NICU, ICU, etc. can lead to confusion or
“intensive care psychosis” related to the lack of the usual cycling of
day and night.
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
4. NOISE
Nightingale believed that patients should never be waked
intentionally during the 1st part of sleep
She affirmed that long conversations about patients are
thoughtless & cruel, especially when held so that the patient
knows or assumes the conversation is about him
Modern times: noises that may irritate patients are jewelries
worn by nurses, keys that jingle, snapping of rubber gloves,
the clank of the stethoscope against metal bed rails, radio`s,
TVs, telephones ringing, machines that beep or alarm & etc.
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
5. VARIETY
 Nightingale stressed that variety in the environment was a
critical aspect affecting the patient`s recovery
She believes in the need for changes in color & form, including
of bringing the patient brightly colored flowers & plants.
She advocated rotating of 10-12 paintings and engravings
each day, week or month to provide variety for the patient.
She agreed that the mind greatly affects the body
Also advocated reading, needlework, writing and cleaning as
activities to relieve the sick of boredom
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
6. BED & BEDDING
Nightingale postulated that adult 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.
Believed that the bed should be placed in the lightest part of the room
and place so the patient could see a window.
She also reminded that caregivers never to lean against, sit upon, or
unnecessarily shake the bed of the patient.
Modern times: it remains important for the nurse to keep the beddings
clean, neat & dry and to position the patient for maximum comfort.
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
7. CLEANLINESS OF ROOMS & WALLS
Nightingale emphasized the “great part of nursing consists in
preserving cleanliness”
She urges the removal of dust with the use of damp cloth rather
than a feather duster.
Floors should be easily cleaned rather than being covered with dust
trapping carpets.
Furniture's & walls should be easily wash & not damaged by
coming in contact with moisture
Modern times: the concept of having a clean room is a health room
continues to be relevant
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
8. PERSONAL CLEANLINESS
Nightingale viewed the function of the skin as important
She believed that unwashed skin poisoned the patient & noted
that bathing & drying the skin provided great relief to the patient
She strongly stated that “just as it is necessary to renew the air
around a sick person frequently, to carry off morbid effluvia from
the lungs & skin by maintaining free ventilation, so it is necessary
to keep the pores of the skin free from all obstructing excretions”
(Nightingale, 1859)
She also advocated that personal cleanliness extended to the
nurse and that “every nurse ought to wash their hands very
frequently during the day”
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
9. NUTRITION & TAKING FOOD
Nightingale addressed the importance of variety in the food
served to patients
She has proven that the attention given to the patient affected
how the patient ate
She has observed that individuals desire different foods at
different times of the day & that frequent small servings may be
more beneficial to the patient than an large breakfast or dinner
She urged that no business be done with patient while they are
eating because this was a distraction. She added that the right
food be brought at the right time & “be taken away, eaten or
uneaten, at the right time”.
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
10. CHATTERING HOPES & ADVICES
Nightingale perceived that to falsely cheer the sick by
making light of their illness & it`s danger is not helpful
She considered it stressful for a patient to hear opinions
after only brief observations had been made. False hope
was depressing to patients, & caused them to worry &
become fatigued.
Nightingale encouraged the nurses to be mindful what is
being said by visitors, believing that sick persons should
hear good news that would assist them in becoming a
healthier individuals.
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
11. OBSERVATION OF THE SICK
According to Nightingale “the most important practical lesson that can be
given to nurses is to teach them:
1)What to observe
2)How to observe
3)What symptoms indicate improvement
4) What is the reverse
5) Which are of important
6) Which are of none
7) Which are evidence of neglect
8) What kind of neglect
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
11. OBSERVATION OF THE SICK
She felt strongly about the importance of obtaining a complete
& accurate information about the patients. She added “if a nurse
cannot get the habit of observation in one way or another, they
better have to give up nursing for it is not their calling”.
She urges, a precise, specific and individualized questions &
observations & warns against failure to observe & the use of
averages to describe expectations of the individual.
She likewise urges that observation are not be an end unto itself
but a means for assuring that appropriate actions are taken.
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
12. PETTY MANAGEMENT
Nightingale discussed “petty management” or ways
to assure that “what a nurse do when they are there,
shall be done when they are not there”.
She believed that the house and the hospital needed
to be well-managed that is organized, clean & with
appropriate supplies.
KEY CONCEPTS OF NIGHTINGALE`S
THEORY

13. SOCIAL CONSIDERATIONS

Nightingale supported the importance of looking
beyond the individual to the social environment in
which he or she lived
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
14. ENVIRONMENTAL FACTORS
In Florence Nightingale`s environmental Theory, she
identified 5 environmental factors:
1. Fresh air
2. Pure water
3. Efficient drainage
4. Cleanliness or sanitation
5. Light or direct sunlight
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
14. ENVIRONMENTAL FACTORS
FRESH AIR:
“to keep the air he breathes as pure as the external
air without chilling him”
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”
KEY CONCEPTS OF NIGHTINGALE`S
THEORY
14. ENVIRONMENTAL FACTORS
EFFECTIVE DRAINAGE:
“all the while the sewer maybe nothing but a laboratory
from which epidemic disease & ill health is being installed
into the house ”
CLEANLINESS:
“the greater part of nursing consists in preserving
cleanliness”
LIGHT (ESPECIALLY DIRECT SUNLIGHT):
The usefulness of light in treating disease is very important”
ASSUMPTIONS OF ENVIRONMENTAL
THEORY
Florence Nightingale believed that 5 points were
essential in achieving a healthful house: “pure air, pure
water, efficient drainage, cleanliness & light.
A healthy environment is essential for healing. She
added that the “nature alone cures”
Nurses must make accurate observations of their
patients & be able to report the state of the patient to
the physician in an orderly manner
Nursing is an art, whereas medicine is a science. Nurse
are to be loyal to the medical plan but not servile.
ASSUMPTIONS OF ENVIRONMENTAL
THEORY
STREGTH:
• The language that Florence Nightingale used to write her
books was cultured & flowing, logical in format 7 elegant in
style.
• Her Environmental Theory has broad applicability to the
practitioner
• Her model can be applied in most complex hospital`s
intensive care environment, the home, a work site, or the
community at large.
• Reading her theory raises consciousness for nurses about
how the environment influences client outcomes.
ASSUMPTIONS OF ENVIRONMENTAL
THEORY

WEAKNESSES:
• In Nightingale`s Environmental Theory, there is a scant
information on the psychosocial environment when
compared to the physical environment.
• The application of her concepts in the 20th century is
in question
ASSUMPTIONS OF ENVIRONMENTAL
THEORY
APPLICATION OF NIGHTINGALE`S THEORY IN PRACTICE:
• “patients should be put in the best condition for nature to
act on them. It is the responsibility of the nurses to reduce
noise, to relieve patient`s anxieties & to help them sleep.
• As per most of the nursing theories, environmental
adaptation remains the basis of holistic nursing care.
1. Patients should have clean air & a temperature controlled
environment
2. Patients should have direct access to sunlight & not be
subjected to unnecessary noise, especially when sleeping
3. Rooms should be kept clean
ASSUMPTIONS OF ENVIRONMENTAL
THEORY
APPLICATION OF NIGHTINGALE`S THEORY IN PRACTICE:
4. Hospital facilities should be well-constructed
5. Beddings should be changed & aired frequently
6. Patients should be kept clean & nurses should wash
hands frequently
7. Patients should be offered a variety of scenery such
as new books or flowers to prevent boredom
8. Nurses should be positive but not offer false hope to
the patients or make light of their illness
ASSUMPTIONS OF ENVIRONMENTAL
THEORY
APPLICATION OF NIGHTINGALE`S THEORY IN PRACTICE:
9. Offer a variety of small meals instead of large ones &

do not do patient`s care while patient is eating as it is

distracting.
10. Consider not only the individual patient but the
context of where he or she lives