M.

Sc DEGREE COURSE IN NURSING

ADVANCED NURSING PRACTICE
UNIT – VI
Philosophy and Theories of Nursing

Nightingale’s Theory

DR. T.JAYADEEPA
VICE PRINCIPAL
 OBJECTIVES

 Background of the theorist

 Nightingale’s Theory: Evolution & Introduction
 Nightingale’s Thirteen Canons
 Major concepts of nursing according to Nightingale
 Nightingale’s environmental model
 Analysis of Nightingale’s Environmental model of Nursing
 Nightingale’s Environmental model as a framework for nursing practice
 The nursing process and Nightingale’s Environmental model
 INTRODUCTION
 The goal of nursing is “to put the
patient in the best condition for nature
to act upon him”.
- Nightingale
 Born- 12 May 1820 in Florence, Italy
 Privately educated by father
 Inclined to care for sick
 She attended nursing programs in KaiserWerth, Germany in
1850 and 1851.
 She worked as the Nursing superintendent at the Institution
for care of sick gentlewomen in distressed circumstances,
where she instituted many changes to improve patient care.
 Called to Turkey, during Crimean war.
 Her work proved successful in decreasing the

mortality rate in the war.

 Lady with the lamp
 Begin the Nightingale school of nursing at St.
Thomas hospital, King’s College in London
 Founder of modern nursing and the first nursing theorist.
 Books:

 Notes on Nursing: What it is, what it is not (1860)

 Notes on hospitals (1863)
 Sick-Nursing and Health-Nursing (1893)
 Died:13th August 1910 in London.
 Origins of Nightingale’s Theory for Nursing Practice

• Florence Nightingale was a prolific writer. She lived from

1820 to 1910 in Victorian England.
• Her ideas, values, and beliefs on a wide range of topics can
be identified in her documents.
• They contain philosophical assumptions and beliefs
regarding all elements found in the meta paradigm of
nursing.
• In 1859, she was the first to conceptualize nursing’s work
into a theoretical framework.
• She was credited with founding the practice of nursing.
 EVOLUTION/INTRODUCTION OF
NIGHTINGALE’S THEORY

 Early in her work at the army hospital Scutari,

Nightingale noted that the majority of the soldier’s deaths

was caused by transport to the hospital and conditions in

the hospital itself.

Nightingale found that open sewers and lack of cleanliness,
pure water, fresh air and wholesome food were more often
the cause of soldier’s death than their wounds; she
implemented changes to address these problems.
 Nightingale instituted a system of care that
reportedly cut causalities from 48% to 2%
with in 2 years.
 She adapted a statistical reporting method known as
polar area diagram or Cock’s comb model, to analyse the
data she rigorously collected.
 Major Premises of Environmental Adaptation Theory

• People are multidimensional, composed of biological,

psychological, social and spiritual components.
• Disease is more accurately portrayed as dys-ease or the
absence of comfort.
• Symptoms alert nurses to the presence of illness, which
allows for appropriate interventions.
• Breaking the natural laws will cause disease.
• Improvement in the health of individuals and families lead to
the improved health of society.
 The Environmental
Adaptation Concepts

• Florence Nightingale’s original theory for Six D’s of Dys-ease:

nursing practice was holistic. Dirt
Drink (need clean
• Her concepts included human/individual, drinking water)
society/environment, health/disease and Diet
Damp
nursing. Draughts (Drafts)
• She focused more on physical factors than Drains (need proper
drainage and sewer
on psychological needs of patients because systems)
of the nature of nursing practice during her
time.
 NIGHTINGALE’S THIRTEEN CANONS

1. Ventilation and warmth

9. Light
2. Health of houses
10. Cleanliness of
3. Petty management rooms/walls
4. Noise 11. Personal cleanliness
5. Variety 12. Chattering hopes and
6. Food intake advices
7. Food 13. Observation of the sick
8. Bed and bedding
 1. VENTILATION AND WARMTH

 Keeping patient, patient’s room warm

 Keeping patient’s room well ventilated and free of odors.
 Keep the air within as pure as the air external
air/without noxious smells.
 2. HEALTH OF HOUSES

 This canon includes five essentials of - Pure air, Pure water,

Efficient drainage, Cleanliness, Light

 Examples include:

 removing garbage or standing water

 ensuring clean air and water and free from odour and that
there is plenty of light.
 3. PETTY MANAGEMENT

 Continuity of the when the

care,

nurse is absent
 Documentation of the plan of care

and all evaluation will ensure others give the same care to

the client in your absence.

 4. NOISE
 Avoidance of sudden/startling

noises.

 Keeping noise in general

to a minimum.

 Refrain from whispering

outside the door.

 5. VARIETY

 Provide variety in the patient’s room to help him/her avoid

boredom and depression.
 This is accomplished by cards, flowers, pictures, books or
puzzles (presently known as diversional therapy)
 Encourage significant others to engage with the client.
 6. FOOD INTAKE

 Assess the diet of the client.

 Documentation of amount of foods and liquids ingested at

every meal.
 7. FOOD

 Instructions include trying to

include

patient’s food preferences.

 Attempt to ensure that the client always has some

food or drink available that he/she enjoys.

8. BED AND BEDDING

 Comfort related
measures
to keeping the bed dry,

wrinkle-free and at the

lowest height to ensure the

client’s comfort.
9. LIGHT

 Assess room for

the
adequate light.
 Sunlight works best.

 Develop and implement

adequate light without in
placing the client direct
light.
 10. CLEANLINESS OF ROOMS/WALLS

 Assess the room for dampness,

darkness and dust or mildew.
 Keeping the environment clean
(free from dust, dirt, mildew and
dampness)
 11. PERSONAL CLEANLINESS

 Keeping the patient clean and dry at

all

times

 Frequent assessment of client’s skin

is needed to maintain adequate moisture.

 12. CHATTERING HOPES AND ADVICES

 Avoidance of talking without reason or

giving advice that is without fact.
 Continue to talk to the client as a person. And to stimulate
the client’s mind
 Avoid personal talks.
 13. OBSERVATION OF THE
SICK
 Making and documenting observations.

 Continue to observe the client’s surrounding

environment.
METAPARADIGMS OF NURSING ACCORDING TO
NIGHTINGALE

There are four metaparadigms:

Person

Environment

Heath

Nursing
Person
Recipient of nursing care.
People are composed of biological,
multidimensional,
psychological, social and spiritual components.
Environment
Environment can be external as well as internal.
Poor or difficultenvironments led to poor health
and disease.
Environment could be alteredto improve
conditions so that the natural laws would allow healing to
Health
For nightingale, health is “not only to be well, but to be
able to use well every power we have”.
Disease is considered as dys-ease or the absence of
comfort. [Six D’s of Dys-ease are: Dirt, Drink (need clean
drinking water), Diet, Damp, Draughts and Drains (need
proper drainage and sewer systems)]
Nursing
Nursing to nightingale was above all, “Service to God in the
relief of man”
To alter or manage the environment to implement the natural
laws of health.
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.
NIGHTINGALE’S ENVIRONMENTAL MODEL
NIGHTINGALE’S ENVIRONMENTAL MODEL
ANALYSIS OF NIGHTINGALE’S ENVIRONMENTAL MODEL OF
NURSING

1. Assumptions:
Philosophical assumptions:
Nursing is a calling.
Nursing is both art and science.
People can control the outcomes of their
lives to pursue perfect health.
Nursing requires a specific educational base.
Nursing is distinct and separate from medicine.
Additional assumptions:

Maintaining a clean room, bedding and clothing

aids in patient recovery.

Noise can be harmful to patients.

Managing the environment improves the health of

the patient.
2. Propositions:
The person is desirous of health, so that the nurse,
nature and the person will co-operate; so that all
reparative process occur.
The nurse’s role is to prevent the reparative process
from being interrupted and to provide conditions to
optimize the reparative process.
 BRIEF CRITIQUE
 The model is a simple one, characterized by only three
major relationships:
1)Environment to patient
2)Nurse to environment
3)Nurse to patient
 Nightingale’s model was developed inductively
 Major concepts are clearly defined, and the
relationships among the concepts flow logically
 She focused more on physical factors than on
psychological needs of patient.
 Although, some of the Nightingale’s rationales have been
modified or disproved by advances in medicine and
science, many of the concepts in her theory have not only
endured but have been used to provide guidelines for
nurses for more than 150 years.
 In particular, her model remains relevant to illness
prevention and health promotion.
 NIGHTINGALE’S ENVIRONMENTAL MODEL AS A
FRAMEWORK FOR NURSING PRACTICE

 Nightingale expected nurses to use their skills of

observation in caring the patients.

 Nursing observations and documentation should focus on

the assessment of the patient in relation the 13 canons

identified by Nightingale when nursing care is provided

that is framed by Nightingale’s environment model.

THE NURSING PROCESS AND NIGHTINGALE’S
ENVIRONMENTAL MODEL
HOW TO APPLY THIS THEORY IN TO
PRACTICE?
 CONCLUSION

• Recovery rate of patients would be greatly enhanced by

reduction of noise stress.
• If, as Nightingale stated, the patients are to be put in the
best condition for nature to act on them, it is the
responsibility of nurses to reduce noise, to relieve patients’
anxieties, and to help them sleep.
 Reference
Attewell, A. (1998) Florence Nightingale’s relevance to nurses. Journal
of Holistic Nursing, 16 (2), 281-291

McDonald, L. (2001). Florence Nightingale and the early origins of

evidence-based nursing, EBN Notebook 4(3), 68-9

McCarthy D, Ouimen M, Daun J. (1991) Shades of Florence Nightingale:

Potential impact of noise stress on wound healing. Holistic Nursing
Practice. 5(4) 39-48

Nightingale, F. (19690. Notes on nursing: What it is and what it is not.

New York: Dover. (original work published