THEORETICAL FRAMEWORK

This study was anchored in the Environmental model by Florence Nightingale (1860). In her model, nursing contributes to the ability of the person to maintain and restore health directly or indirectly through managing the environment. Her work and contributions altered the public health status of many public hospitals until the modern times. Her environmental theory of sanitation had greatly influenced and developed the roles of nurses worldwide. Nightingales most effective approach and strategy to be able to improve the health conditions of the patients were to focus on the clean and good condition of the environment. She believed that good sanitation had a great impact to a person health. As a result, she had advocated for health promotion and disease prevention through building decent housing project. In addition she also made an effort to create clean water supplies for the communities; for she knew many deaths were caused by water and airborne diseases. She also managed to improved peoples nutrition, safe birthing practices for mothers and infants, as well as good child caring and rearing. She believed that there were 5 essential elements in hospital practice that include; pure air, pure water, good drainage, cleanliness and light. Her theory deals with the importance of clean environment and everything that people need in order to live in a healthy way. In a metaphoric sense, Florence Nightingales work can be viewed as the base root and trunk of a tree, and modern environmental scholars as branches from that tree leading into various areas of nursing practice. Florence Nightingale's book, Notes on Nursing (1946), first published in 1860, offers specific information on how environmental factors impact health. Air quality, water quality, noise, light, and nutrition were her priorities. Many of Nightingale's implications of the importance of a clean environment, derived from her experience in nursing, have been substantiated in contemporary work by public health researchers, occupational health professionals, and industrial hygienists (Centers for Disease Control, 2005; Pimentel et al., 1998; Steingraber, 1997). Nightingale's attention to air quality represented some of the first modern thinking about the relationship of environmental conditions to human health status. In her Notes on Nursing (1946) she discussed how in the 1800s England was plagued with poor air quality from the heavy use of coal as a fuel for home heating. She was concerned with indoor, as well as outdoor air quality. Nightingale was so adamant about the importance of indoor air quality and ventilation that she prioritized it in Notes as the "first cannon of nursing." Today poor air quality is still a health-related concern. In 1994, the U.S. Environmental Protection Agency (EPA) documented that citizens in the United States were spending as much as 90% of their lives in indoor environments, settings over which there is little or no federal regulation or standards for air quality. In work places and schools poor air quality has been cited as a significant contributor to the increase in asthma, a disease that is a leading cause of absenteeism (American Academy of Allergy, Asthma, & Immunology, 2004). Hospitals are emerging as the most common work site for reported cases of occupational asthma through the exposure to commonly used toxic materials such as glutaraldehyde (Di Stefano, Siriruttanapruk, McCoach, & Sherwood Burge, 1999) and latex (LaMontagne, Radi, Elder, Abramson, & Sim 2006). Nightingale (1946) also wrote about the need for pure and clean water to promote health and healing. Nurses are often taught about the importance of hydration for patients, but are seldom taught how to protect and secure a clean water source in health care facilities and at home. There is an increasing need to attend to the safety of our water supply especially as the number and types of contaminants often found in water increase. There are now more than 80,000 synthetic chemicals available in the commercial marketplace that can contaminate the water supply. Few of these chemicals are tested for health effects in humans, and even fewer tested for health effects in the developing fetus (Centers for Disease Control and Prevention, 2005; Steingraber, 1997). In the current health care setting Nightingales focus on the environment can be lost as nurses are pressured to focus on the myriad technologies surrounding them, and the numerous administrative and documentation tasks they must complete. Fortunately contemporary nurse theorists, such as Jean

Watson (2004), are taking up Nightingales charge and addressing the importance of creating a healing environment, recognizing that the workplace environmental design should promote healing of patients and protection of the environment rather than degrading the environment. Another theorist used in this study is Imogene Kings Goal Attainment theory. King (1981) refined concepts into a nursing theory that consisted of the following bases: 1. An open systems framework as the basis of goal attainment. 2. Nursing as a major system within the health care system. 3. Nursing process emphasis on the interpersonal process. King (1990, 1997) developed her Conceptual System to identify concepts that are important to the nursing profession, to help in developing the scientific base for nursing knowledge, and to provide a potent tool to systematize nursing curricula as well as guides to nursing practice that support quality care in all nursing settings. Kings nursing paradigmwhich seeks to integrate the personal, interpersonal and social systems that influence a patients healthis an important model for health care in the present and beyond (Whelton, 1999). Her interacting conceptual system for nursing and her theory of goal attainment have been included in every major nursing theory text, are taught to millions of nursing students throughout the world, outline the basis of nursing education programs, and are implemented in various nursing service settings (Frey et al., 2002). Kings Goal Attainment Theory (Client-Centered Theory) is indeed what we are practicing in the daily routine in the hospital and in any other clinical setting. Applying Kings concept of Man as a reactive being, thus, make this awareness to respond in the environment.

CONCEPTUAL FRAMEWORK

Health Institution A

Level of Solid Waste Management Practices

Quality of nursing care outcomes

Health Institutuion B

- years of experience - work over load -lack of knowledge - availability of resources/ equipments

Figure 1

Conceptualization refers to the process of refining general or abstract ideas D. Polit, (1995). This conceptual model is based on Florence Nightingales Environmental Theory. The model outlines staff nurses from two tertiary health institutions (A, B) where their level of compliance to the solid waste management practices are assessed as part of their responsibilities as nurses. The level of SWM practice each institution may vary due to the different factors that may influence their practice. Since Nightingale (1860) stated that the environment utilized by a nurse in rendering service greatly affect the recovery of the patient, the quality of nursing care outcomes may depend on the level of SWM practices.