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Critical thinking activities

1. Your community is at risk for a specific type of natural disaster (e.g., tornado, flood, hurricane, earthquake). Use Nightingale’s principles and observations to develop an emergency plan for one of these events. Outline the items you would include in the plan.

2. Using Nightingale’s concepts of ventilation, light, noise, and cleanliness, analyze the setting in which you are practicing nursing as an employee or student.

3. You are participating in a quality improvement project in your work setting. Share how you would develop ideas to present to the group based on a Nightingale approach

Florence Nightingale’s
Environmental

Theory

Josephine Ann J. Necor, RN

Florence Nightingale (1820–1910)

• known as the Lady with
the Lamp, providing care to
wounded and ill soldiers during the
Crimean War

• considered the founder of
educated and scientific
nursing

• wrote the first nursing notes
“Notes on Nursing: What it is,
What is not” (1860) that became
the basis of nursing practice and
research.

• considered the first
nursing theorist.

• One of her theories was
the

Environmental

Theory, which
incorporated the
restoration of the usual
health status of the
nurse’s clients into the
delivery of health care
which is still practiced
today.

Theoretical
Sources

of the
Environmental

Theory

Theoretical Sources of the Environmental Theory

• Education: Nightingale is a very good
mathematician (a nurse statistician) and a
philosopher.

• Literature: Dicken’s novel “The Adventures of
Martin Chuzzlewit”, a novel that portrays a
victorian drunken, untrained and inexpert nurse
causes a stigma and bad impressions about
nurses. The novel greatly affects her beliefs
about being a nurse and pursue the battle to
change the negative stigma about nurses.

• Intellectuals: Political leaders greatly affected
and influenced her beliefs of changing things as
she viewed as unacceptable to society.

• Religious Beliefs: For Nightingale, an action for
the benefit of others is called “God’s Calling”.
DUM VIVIMUS, SERVIMUS.

Theoretical Sources of the Environmental Theory

• Use of Empirical Evidence: She uses the
polar diagram (statistical diagram) in her
reports, books and letters.

• She highlighted the use of observation and
the performance of tasks in the nursing
education.

Theoretical Sources of the Environmental Theory

Environmental
Theory

– Philosophy or Metatheory

Environmental Theory:
Major Concepts and Definitions

• Environment – concepts of ventilation,
warmth, light, diet, cleanliness and noise. She
focused on the physical aspects of the
environment.

• She believed that “Healthy surroundings
were necessary for proper nursing care.”

“Nursing is an act of utilizing
the environment of the

patient to assist him in his
recovery”

gradual

restoration

of health

INITIATIVE

NURSE

Configure

environmental

settings

appropriate for



PATIENT

Configure external factors associated with the patient’s surroundings

that affect life or biologic and physiologic processes, and his development.

5 Essential Components of

A Healthy Environment:

1. pure air

2. pure water

3. efficient drainage

4. cleanliness

5. light

1. Pure fresh air – “to keep the air he breathes
as pure as the external air without chilling
him.“

2. 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.“

3. Effective drainage – “all the while the sewer
maybe nothing but a laboratory from which
epidemic disease and ill health is being
installed into the house.”

4. Cleanliness – “the greater part of nursing
consists in preserving cleanliness.“

5. Light (especially direct sunlight) – “the
usefulness of light in treating disease is very
important.“

• Any deficiency in one or more of these factors
could lead to impaired functioning of life
processes or diminished health status.

• The, factors posed great significance
during Nightingale’s time, when health
institutions had poor sanitation, and health
workers had little education and training and
were frequently incompetent and unreliable in
attending to the needs of the patients.

• Also emphasized in her environmental theory is

the provision of a quiet or noise-free and
warm environment, attending to patient’s
dietary needs by assessment,
documentation of time of food intake, and
evaluating its effects on the patient.

Concerns of Environmental Theory

1. Proper ventilation focus on the architectural
aspect of the hospital.

2. Light has quite as real and tangible effects to
the body.

3. Cleanliness and sanitation. She assumes that
dirty environment was the source of infection
and rejected the “germ theory”. Her nursing
interventions focus on proper handling and
disposal of bodily secretions and sewage,
frequent bathing for patients and nurses, clean
clothing and handwashing.

4. Warmth, diet and quiet environment. She
introduced the manipulation of the environment for
patient’s adaptation such as fire, opening the
windows and repositioning the room seasonally, etc.

5. Unnecessary noise is not healthy for recuperating
patients.

6. Dietary intake.

7. Petty management proposed the avoidance of
psychological harm, no upsetting news. Strictly war
issues and concerns should not be discussed inside
the hospital. She includes the use of small pets of
psychological therapy.

Nursing Metaparadigm

Nursing
• 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. They can be
done by anyone.”

Person
• People are

multidimensional,
composed of biological,
psychological, social and
spiritual components.

• The patient is the focus of
the environmental theory.
The nurse should perform
the task for the patient and
control the environment for
easy recovery. She practices
nurse-patient passive
relationship.

Health
• Health is “not only to be

well, but to be able to use
well every power we
have”.

• A healthy body can
recuperate and undergo
reparative process.
Environmental control
uplifts maintenance of
health.

• Disease is considered as
dys-ease or the absence
of comfort.

Environment
• 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.

Theoretical Assertions

• Prevention of interruption is very vital in
the reparative process of the patient.

• Nursing Practice is the application of common
sense, observation, perseverance and ingenuity.

• “If the person wants to recuperate, he needs to
cooperate with the nurse.”

• Disease came from the organic materials from
the patient and environment not on the germ
theory.

Theoretical Assertions cont’d

• Sanitation means the manipulation of the
environment to prevent diseases.

• Nursing is the commitment to the nursing works.

• She gives a little focus on the interpersonal relationship
and nurse caring behavior.

• She believed that the nurse should be moral agents.
“Think and act like a nurse.”

• Professional relationships, principles of confidentiality
and care for the poor to improve health and social
condition were the focus of her nursing care.

Logical Form

• She used inductive reasoning from her
experiences and observation which is addressed
with logical thinking and philosophy.

Importance of
Environmental Theory

Practice

1. Disease control

2. Sanitation and water treatment

3. Utilized modern architecture in the prevention
of “sick building syndrome” applying the
principles of ventilation and good lighting.

4. Waste disposal

5. Control of room temperature.

6. Noise management.

Education

1. Principles of nursing training. Better practice
result from better education.

2. Skills measurement through licensing by the
use of testing methods, the case studies.

Research

1. Use of graphical representations like the polar
diagrams.

2. Notes on nursing.

Critique

• Simplicity – simple and logical; tends toward
description and explanation rather than
prediction

• Generality – provides general guidelines for all
nurses

Critique

• Empirical Precision – Little or no provision is
made for empirical examination; individual
observation rather than systematic research

• Derivable Consequences – to extraordinary
degree, direct the nurse to action on behalf of
patient and herself; These directives encompass
the areas of practice, research and education

References

• www.wikipedia.com

• http://slsu-
coam.blogspot.com/2008/08/nightingales-
environmental-theory.html

• www.currentnursing.com

• Tomey, A.M., (1994). Nursing Theorists and
Their Work. 3rd ed. Missouri: Mosby

http://www.wikipedia.com/

http://slsu-coam.blogspot.com/2008/08/nightingales-environmental-theory.html

http://www.currentnursing.com/

THANK YOU!