Nightingale's environmental theory

Introduction
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Born 12 May 1820 on the trip of Florence, Italy.

Founder of modern nursing.
The first nursing theorist.
Pioneer of the formal nursing concept.
Organized nursing begin in the mid 1800's with leadership of Florence Nightingale.
She Belongs to upper middle class family.
In 1844, Nightingale enrolled as a nursing student at the Lutheran Hospital of Pastor

Fliedner in Kaiserwerth, Germany.

In the early 1850s, Nightingale returned to London, where she took a nursing job in a
Middle sex Hospital. Her performance there was so impressed her employer that

Nightingale was promoted to superintendant within just a year of being hired.

In 1860 she established ST. Thomas' Hospital and the Nightingale Training School for

Nurses.
In 1854, the minister of war appointed her as Nursing Superintendent on War torn

environment.
Her experience in treating sick/injured soldiers in the Crimean war strongly influenced

her philosophy of nursing.

Patient's needs should be prioritized according to Maslow's Hierarchy.
With her lamp, Nightingale traverse the night during the Crimean War. Nightingale
became a heroine in Great Britain as a result of her work in the war. The Lady with the

lamp.
In 1860 Nightingale published Notes on Nursing.
She explained her environmental theory in her famous book Notes on Nursing: what it is,

what it is not.
She was the first to propose nursing required specific education and training.
Her contribution during Crimean war is well known.
She was a statistician, using bar and pie charts, highlighting key points.
International Nurses Day, May 12 is observed in respect to her contribution to Nursing.
Died 13 August 1910.

Assumptions of Nightingale's Theory

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Natural law
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.

Nightingale's Nursing theory

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Nightingale's nursing theory the first published nursing theory in 1860.

Persons are in relation with the environment. Stresses the healing properties of the

physical environment (fresh air, light, warmth, and cleanliness).

Nursing puts patients in the "best conditions" for nature to act upon them.
Health is "the positive of which the pathology is the negative". "Nature alone cures".
When aspects of the environment are out of balance, the client must use energy to counter

these environmental stresses.

Stresses drain the client of the energy needed for healing viewed disease as a reparative

process.
The health of the home/community is critical components in an individual's health.

Nightingale's Environmental theory's Model

1. Physical environment
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Physical environment consists of physical elements where the patient is being treated and
affects all other aspects of the environment. Eg cleanliness, ventilation, air, light, noise,

water, bedding drainage, diet.

Cleanliness of environment relates directly to disease prevention and patient mortality.
Aspects of the physical environment influence the social and psychological environments
of the person.

2. Psychological environment
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It can be affected by a negative physical environment which then causes stress and affect

to the patient's emotional state.

It requires various activities to keep the patient's mind active (ie, manual work, appealing

food, a pleasing environment).

Communication should be therapeutic, soothing and unhurried.
Patient should not be encouraged by false hopes and advice about their illness.

3. Social environment
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Social environment involves collecting data about illness and disease prevention.

It includes components of the physical environment i.e clean air, clean water, and proper

drainage etc.
It consists of a person's home or hospital room, as well as the total community that affects

the patient's specific environment.

Observation of the social environment especially as related to specific data collection
related to illness which is essential to preventing disease.

Nithtingale's theory and Nursing's Metaparadigm

Nursing
Society/Environment
Human or individual
Health/ Disease

1. Nursing
Nursing is different from medicine and the goal of nursing is to place the patient in best
possible condition for nature to act.
Nursing is the activities that promote the health which occur in any care giving situation.
They can be done by anyone.
Nursing provide fresh air, light, warmth, cleanliness, quiet and proper diet.
Facilitates a patient reparative process by ensuring the best possible environment.

2. Environment

Environment is the foundational component of Nightingale's theory.

The external conditions and forces that affect one's life and development includes
everything from a person's food to a nurse's verbal ands nonverbal interactions with the

patient.
Poor or difficult environments led to poor health and disease.
"Environment could be altered to improve conditions so that the natural laws would allow
healing to occur."

3. Person

Person referred to by Nightingale as "the patient".

A human being acted upon by a nurse, or affected by the environment has reparative
powers to deal with disease. Recovery is in the patient's power as long as a safe

environment exists.
People are multidimensional, composed of biological, psychological, social and spiritual
components.

4. Health

Health maintained by using a person's healing powers to their fullest extent.

It maintained by controlling the environmental factors so as to prevent disease.
Disease is viewed as a reparative process instituted by nature.
Health and disease are the focus of the nurse.
Health is "not only to be well, but to be able to use well every power we have".

Application of Nightingale's theory in the nursing process

Situation: Miss. Samjhana Dahal, age 48 years, has admitted in female medical ward of Gandaki
Medical College & Teaching Hospital, Pokhara for a diagnosis of fever. She had complaints of
fever with headache, chills, rigor malaise and anorexia. She was in hospital for 5 days. Her
laboratory report shows plenty of WBCs in urine RE and waiting for blood and urine culture
report, chest X- ray shown normal.

Assessment
1.
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Physical environment
Presence of enough window & proper ventilation.
Presence of fowl smelly dumping site outside the window.
Having proper light but no direct sun light to the bed.
Well facility for hot water twice a day but without purification.
Ward toilet drainage system is good but presence of food particles and dust in the pan and

around the pan.

Room environment is clean and ward is swiped frequently.
Presence of water leakage around the sink.
Having only one pieces of biscuits with milk, one full cup of dal and 1 glass of plain

water during 6 hours period.

Bed is clean and tidy but presence of food particles and cover of medicines, pieces of

papers and dust inside the locker.

Cool room temperature.
Patient covered with 2 blankets but still feeling cold.
Hospital is located centrally near to the main city so there is noises of horn, loudspeakers.

2.
3.
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Psychological environment
Patient has never been admitted in hospital before.
Feeling uncomfortable and unable to sleep well.
Patient felt noise because of presence of nursing station near to the patient bed.
She is very active women and feels her time is wasted since the admission.
Social Environment
Patient told that her home environment is clean.
They use to drink boiling water.
Her room is small but with enough ventilation and sunlight.
No h/o illness like her in the family or neighborhood.

Nursing Diagnosis
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Imbalanced nutrition less than body requirement R/T inadequate intake of food.

Impaired comfort measures R/T strange, noisy, and cold environment.

Risk for infection R/T unsafe drinking water, dust from locker, dirt from sink and outside
of the room (Poor environment sanitation)

Risk for injury R/T wet floor.

Nursing Goal
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The client's nutrition level will be maintained as evidence by constant weight till
hospitalization.

The client will feel comfortable as evidence by absence of noise near to the nursing
station and increase room temperature.

The client will be free from infection during hospital stay as evidence by normal WBC's
range, no diarrhea and vomiting.

The client will be free from injury as evidence by not slip on the floor.

Intervention
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Provide purified & boiling water for drinking according to patient demand.
Clean the locker routinely and keep all medicines in small paper box or medicine bag.
Inform to the incharge for maintenance of sink, waste disposal.
Keep the surrounding clean.

Provide adequate diet by encouraging small frequent and nutritious feeding.

Maintain temperature by proper dress up and provide extra blanket.
Dispose waste properly.
Keep the patient in calm and comfortable position and avoid unnecessary stimulation,

noise.
Provide sufficient support and advice related to disease process, diet therapy.

Evaluation
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She told that she is getting boiled and purified water.

She said that she has no vomiting and loose motion.
She has gained a weight and no feeling of weakness and increased appetite.
Locker is cleaned and no presence of dust around the sink.

Bed seems to be cleaned, absence of dust, piece of papers, medicines.

Absence of crowd near to the nursing station so she felt comfortable and felt asleep.
She said that she is not feeling cold.
Her laboratory test result shows normal WBCs and no evidence of fever so no risk for
infection.

Strengths of Nightingale's theory

Nightingales theory has broad applicability to the practitioner. Her model can be applied
in most complex hospital intensive care environment, the home, a work site, or the
community at large.

Limitation
There is scant information on the psychosocial environment when compared to the
physical environment.
It says little about the application of medical technology, which was rudimentary but
nonetheless existent in nightingale's time.

Conclusion

Florence Nightingale's theory is one that every nurse should strive to achieve by

maintaining a healthy environment not only for their patients, but also for themselves.
Florence Nightingale provided a professional model for nursing organization.
She was the first to use a theoretical foundation to nursing.
Her thoughts have influenced nursing significantly.