NIGHTINGALE’S

ENVIRONMENTAL
THEORY
Prepared by :
Godoy, Shaina Kassandra
Gonzales, Jen Khryzteen Charise
of BSN 1-11
FLORENCE NIGHTINGALE
 Florence Nightingale 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. She is given
the title “Founder of Modern Nursing”
because of her work in reforming nursing.
 Nightingale strongly advocated that “nursing
knowledge is distinct from medical
knowledge”. Her philosophy is environment-
oriented.
FLORENCE NIGHTINGALE
 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 social status as Victorian Lady,
that provide 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 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.
FLORENCE NIGHTINGALE
 Nightingale’s Environmental Theory meet the criteria that are used for
analysis of nursing conceptual models and theories as follows:
1. Clarity. Nightingale’s work is clear and easily understood. She believed and
emphasizes that environment is the main factor that created but also treating
disease.
2. Simplicity. Nightingale’s objective for setting forth general rules for the
practice and development was meth through simple theory. Her theory focuses
on the manipulation of the environment to promote good nursing care.
3. Generality. Her theory applies in all situations that nursing care is provided.
The universality and timeliness of her concepts remain pertinent. The relation
concepts (nurse, patient and environment) remain applicable in all nursing
settings today.
4. Emperical Precision (Accessibility). Concepts and relationships within
Nightingales’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 experience.
5. Derivable Consequences (Importance). The directives given by Nightingale
to nurses in her writings encompass areas of practice, research, and education.
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,
howerver kind or anxious you may be”. Furthermore, she believed in a creative
universal humanity with the potential and ability for growth and change.
FLORENCE NIGHTINGALE
 Nightingale’s concepts of environmental
manipulation and care of the patient can be applied
in contemporary nursing settings. Her theory and
her principles are relevant to the professional
identity and practice of nursing. Her works have
great significance for the world of nursing today.
 In summary, Nightingale’s Theory in nursing is
timeless. Her writings are as meaningful today as
they were in the 19th century.
 Nightingale’s theory applies in all situations that
nursing is provided up yo these generations and in
the future generations of nurses.
APPLICATION OF
FLORENCE
NIGHTINGALE’S
ENVIRONMENTAL
PHILOSOPHY
CASE HISTORY OF EVA D.
Miss Eva D. Is a 25 year old female who had been
admitted to the medical unit with the chief complaint of
frequent, watery stools since last night. This accompanied by
abdominal cramps, nausea and vomiting. Her vital signs are as
follows: T=38.6℃, P=98bpm, R=23/min., BP=100/70mmHg.
She complains of weakness, thirst and dryness of mouth. Her
skin is warm, flushed and dry. Her urine is dark yellow in
color.
Miss D. claims, she had eaten oysters for dinner. She
lives in a crowded community close to a landfill and shares
toilet to four other families. Their source of drinking water is
from pump well in the community. She does not practice good
handwashing after using the toilet. Stool examination
revealed salmonellosis.
Miss D. is extremely tearful. She expresses great
concern over her absence from her job in a garment factory
and over her health and expenses for hospitalization.
NURSING CARE OF MISS EVA D. WITH
NIGHTINGALE’S THEORY
In Nightingale’s environmental theory, Miss D is
the person seeking care. She needs nature’s reparative
process. The nursing process and Nightingale’s theory
can be used together to provide care for Miss D. This
care involves “nursing the sick”, review of the
environment and the client’s lifestyle.
A. Nursing the Sick
- Assesment
Assess the client for the following problems:
1. Fluid anf electrolyte losses related to frequent, watery stools, nausea
and vomiting as manifested by changes in the VS; weakness; dryness
of mouth; warm, flushed, dry skin; dark-colored urine.
2. Pain related to abdominal cramps.
3. Inadequate food intake related to nausea and vomiting.
4. Fever (T=38.6℃) related to infection (salmonellosis) and
dehydration.
NURSING CARE OF MISS EVA D. WITH
NIGHTINGALE’S THEORY
- Plan
1. Fluid and electrolyte losses.
- Provide fluid and electrolyte replacement.

- Administer medications to relieve frequent, watery stools as

prescribed.
- Administer medications to relieve nausea and vomiting as prescribed.

- Provide oral care for dryness of mouth.

- Promote rest to relieve weakness.

- Monitor intake and output to assess fluid balance status.

- Provide good perianal care to promote comfort.

2. Pain related to abdominal cramps.

- Provide low fiber diet. To reduce peristalsis.

- Promote rest. To reduce peristalsis and to promote comfort.

- Avoid gas forming foods. Flatulence worsens abdominal pain.

- Administer anticholinergic as prescribed. To relieve abdominal cramps.

NURSING CARE OF MISS EVA D. WITH
NIGHTINGALE’S THEORY
3. Inadequate food intake related to nausea and vomiting.
- Provide small, frequent feedings. This is better tolerated by patients
with nausea.
- Provide ice chips to to relieve nausea.

- Administer antiemetic as prescribed. To relieve nausea and vomiting.

4. Fever related to infection and dehydration.

- Provide adequate room ventilation.

- Keep the room airy and free of odor. To promote rest.

- Increase fluid intake. To reduce fever, relieve dehydration, and promote

excretion of microorganisms.
- Administer antibiotic and antipyretic as prescribed.

- Render tepid sponge bath. To reduce fever by evaporation and

conduction.
- Keep the skin clean and dry. To promote comfort.

- Change gown and bedding as needed to prevent dampness from

perspiration.
⃘ Observation of the sick. Observe everything about the client. Record
all observations which are factual and not merely opinions.
NURSING CARE OF MISS EVA D. WITH
NIGHTINGALE’S THEORY
B. Physical Environment
- Home, Community/Neighborhood and Workplace Assessment
1. Pure water. Assess for adequate working water system and storage that is
free from contamination.
2. Cleanliness. Assess for sanitation conditions of food sources and
preparation and hygienic practices.
⃘ Assess for the means to maintain sanitation condition of toilets. To keep
food and water supply free from contamination.
- Home, Community/Neighborhood and Workplace Plan
1. Water
- Have water checked for contamination in coordination with local
Department of Health personnel.
- Educate the client on water purification and storage methods.

- Keep garbage and other refuse away from water supply or any parts of the
water system.
2. Cleanliness
- Educate the client on proper food handling; the importance of handwashing
especially when preparing foods and before and after using the toilet; proper
waste disposal and personal cleanliness.
NURSING CARE OF MISS EVA D. WITH
NIGHTINGALE’S THEORY
- Home, Community/Neighborhood and Workplace
Assessment
1. Light. Assess for adequate windows and working light sources.
2. Pure air. Assess for ventilation, offensive odors.
3. Water. Assess for working system that is free from contamination.
4. Drainage. Assess the area for drainage of water from washing
dishes and laundry; drainage of rain water away from home.
5. Cleanliness. Assess the home and workplace for means to keep
the areas clean, and freedom from exessive dust, mold, mildew, pet
droppings, offensive odors, “dust-catcher” things.
6. Bed and Bedding. Assess the bed for space and comfort. Assess
the bedding for cleanliness and availabilityof areas for laundry
and drying of bedding.
7. Noise. Assess the area for loud, offensive and unnecessary noise.
NURSING CARE OF MISS EVA D. WITH
NIGHTINGALE’S THEORY
C. Psychological Environment
- Assessment and Plan
Miss Eva D. Has several psychological concerns. She is
worried over her absence from her job, her health, and
expenses for hospitalization.
1. Variety. Assess the client’s activities before illness.
Attempt to stimulate variety in the room and with
the client during her hospital stay – with cards,
flowers, magazines, books, music. Encourage visits
from relatives and friends.
2. Chattering hopes and advices. Refrain from giving
the patient your opinion. Provide factual
information about health. Allow her to verbalize her
fears, feelings and concerns.
NIGHTINGALE’S ENVIRONMENTAL THEORY
 Nightingale in her “Environmental Theory” viewed the
manipulation of the physical environment as a major component
of nursing care. She also 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 and warming
3. Light
4. Noise
5. Variety
6. Bed and bedding
7. Cleanliness of rooms and walls
8. Personal cleanliness
9. Nutrition and taking food
10. Chattering hopes and advices
11. Observation of the sick
12. Petty management
NIGHTINGALE’S ENVIRONMENTAL
THEORY
 The major assumptions of Nightingale’s
Environmental Philosophy on: Environment, Person,
Health, and Nursing are as follows:
A. Environment: can be defined as anything that can
be manipulated to place a patient in the best
possible condition for nature to act.
B. Person: the one who is receiving care; a dynamic
and complex being.
C. Health: Nightingale wrote, “Healthy is not only to be
well, but to be able to use well every power we
have.”.
D. Nursing: Nightingale believed nursing to be a
spiritual calling. Nurses were to assist nature to
repair the patient.
NIGHTINGALE’S ENVIRONMENTAL THEORY

 Florence Nightingale’s Environmental Theory defined

Nursing as “The act of utilizing the patient’s
environment to assist him in his recovery.”.

 She identified 5 environmetal factors:

1. Fresh air
2. Pure water
3. Efficient drainage
4. Cleanliness and sanitation
5. Light or direct sunlight
 THE END!!
ACTIVITY ON NEXT
SLIDE 
 ACTIVITY
 IDENTIFICATION/FILL IN THE BLANKS (5 ITEMS)
1. “Nursing knowledge is distinct form medical
knowledge.”. Her philosophy is _______-oriented.
2. She is given the title ________ because of her work in
reforming nursing.
3. What theory changed the face of nursing to create
sanitary conditions for patients to get care?
4. What is the social status of Florence Nightingale?
5. Nightingale’s theory in nursing is timeless. Her
writings are as meaningful as they were in the ____
century.
 ACTIVITY
 ENUMERATION

a) 5 criterias that is met by the Environmental Theory.

b.) 5 environmental factors.

c.) 3 Steps of Nursing care with Nightingale’s Theory.

d.) 12 aspects as major areas of the physical, social,

and psychological environment that the nurse could
control.
 CRITICAL THINKING EXERCISE ON
NIGHTINGALE’S ENVIRONMENTAL PHILOSOPHY
 Case history of Sarah G.
Sarah G., a 35 year old female had consulted the health
center because of fever since 3 days ago. This accompanied by
loss of appetite to eat, body malaise, headache, abdominal pains,
dizziness. Her VS are as follows: T=38.7℃, PR=86bpm,
RR=21/min., BP=90/60mmHg. She claims that she had lost
weight because of her fever and loss of appetite to eat. She lives in
a crowded community which is constantly submerged in water
due to floods. This causes severe problems in sanitation and
source of water supply. Laboratory test and physical examination
revealed dengue hemorraghic fever (DHF).
Sarah is extremely worried because she had a neighbor who
died because of DHF few months ago. In addition, she is
concerned over financial expenses for her illness and for her
absence from her job as a crew in a fast-food center. She also
verbalized difficulty of sleeping in unfamiliar environment like the
USE THE FOLLOWING FORMAT FOR APPLYING
NIGHTINGALE’S PHILOSOPHY OF ENVIRONMENT.
 Nursing the sick
1. Assessment

2. Plan
 Physical environment

1. Home, Community/Neighborhood and Workplace

Assessment
2. Home, Community/Neighborhood and Workplace
Plan
 Psychological environment

1. Assessment and Plan