Abstract
As a young woman, Nightingale often accompanied her mother when she visited the sick. This inspired her to want to be a nurse, and against her parents’ wishes she entered a nurses’ training program. During the Crimean war she was asked by a family friend to come and care for the British soldiers at the army hospital. While there she witnessed filth, vermin, and death. Upon seeing the unsanitary conditions and the health risk to the soldiers she began her crusade to establish an environment that would promote health and healing. Thus: The Environmental Theory.
Florence Nightingale’s Environmental Theory and How it relates to Mans’ Health
The Environmental Theory focuses on how the environment: physical, psychological, and
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Nightingale believed health of the patient was a process affected by nursing, the environment, and human conditions (Torres, 1985, p. 41). Filth, vermin, dirty water, stagnant air, and raw sewage were a breeding ground for diseases and infection. With conditions such as these even a healthy person in a poor environment would soon experience a decline in health. Nightingales theory showed how the environment could inhibit or promote health for man.
Chitty (2011) stated “Nightingale promoted the view that nurses’ primary responsibility was to protect patients by careful management of their surroundings” (p. 306). Nightingale saw nursing as placing the patient in an environment where nature can assist in providing optimum health conditions. According to Gillette “Nursing functions influence the human environment to affect health” (1996, p. 264). While Nightingale understood the importance of medicine she emphasized the importance of environment on health. Nursing was not just for the patient but the environment and its relationship to the patient.
Nursing has made much advancement since Nightingale Environmental Theory but the focus on a healthy environment has remained the same. Pulliam (1997) noted in her article that Nightingales’ theory formed a solid foundation for nursing: fresh air, cleanliness, clean water, warmth, proper drainage, plenty of light, and stress free environment provided an optimum environment for healing.
Nightingales’ theory
“If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault of not of the disease, but of the nursing. I use the word nursing for want of a better” (Nightingale, 1860, p. 8). While Nightingale stressed the impact of one’s environment to promote healing, Virginia Henderson aimed to establish on the fundamental needs as a knowledge base to guide Professional nursing practice. Henderson emphasized on fourteen components required for effective nursing care which includes: breathing normally, eating and drinking adequately, elimination of body wastes, movement and posturing, sleep and rest, select suitable clothes-dress and undress, maintaining body temperature, keeping body clean and well groomed, avoiding dangers in the environment, communication, worship according to one’s faith, work accomplishments, play or participate in various forms of recreation, and learn, discover, or satisfy the curiosity (Fernandes et al., 2015). Her division of the fourteen components acknowledged patient needs with a holistic approach that is applied through the nursing process in a clinical setting.
Nightingale’s theory has made a difference in healthcare over the years and still has an impact on healthcare today.
This paper will examine the origin of the nursing theory in reference to the Florence Nightingale Theory of Positive Manipulation Of the environment. Initially the paper will introduce the theorist and the context in which the theory was developed. Will critique the theory according to nursing theory critique. The paper will further describe the utility of the theory with respect to practice, administration, education and research will also examine the empirical precision of the theory(testability and logical adequacy). Infact the entire paper demonstrates the understanding of the theory.
Those two theories are Florence Nightingale’s theory of the important of the environment and Katharine Kolcaba’s theory of comfort. Both of these theories are lacking in the emergency room because of the lack a therapeutic environment for these patients. The goal for most emergency room physician is to keep the patient safe until the patient can be moved to an inpatient pscyharitic unit (Nicks & Manthey, 2012, p. 2). By the physicians having this mentality, it does not allow the patient to start his or her healing process in the emergency room while the patient is boarding waiting for an inpatient bed to become available. With the implementation of both of the nursing theories mentioned above this writer believes that it will change the environment that the patient is in and will teach the physicians to start to treat these patients and in turn, it will provide the patients with the quality care that he or she
The concept of environment and its integral role in the delivery of nursing care was among the first identified and documented nursing theory since its early days. Florence Nightingale pioneered the profession of nursing and along with it, pioneered the concept of nursing theory. Her environmental theory was patient focused and incorporated five environmental components needed to promote health. Jarrin (2012) supported that the role of nursing is to promote the best possible environment for the patient to assist in their natural reparative process. According to Rahim (2013), as considered as the profession’s first nurse theorist, Florence Nightingale provided the essential foundation in environmental theory. She believed
Grand theories are relatively abstract concepts and help to provide nursing knowledge in a general way. However, this theory is the most complex and widest in scope of the level of theory have been subdivided into Human needs, Interactive and Unitary process theories (McEwen, & Wills, 2014). For this reason, Nightingale’s Environmental theory is part of the grand theory because it encompasses different areas of nursing care. This theory incorporate knowledge made from observing the patient and critical thinking as contrast to empirical and medical care (McEwen, & Wills, 2014). Between these three subdivisions, Nightingale’s theory is also a Human Need Theory because she based her theory on how the environment cause changes in ill patients. Nightingale used inductive reasoning through observation and experiences to obtain laws of health, disease and nursing (pdf).
A quote from Nightingales early writings defined “nursing is the act of utilizing the environment of the patient to assist in recovery” this is not only true in a patient’s recovery but is also true for the well being and the health of the patient and family included (Harvard Libraries, 2012). Nightingales theory of environment is the responsibility of the nurse this in essesence make the nurse in control of the patient’s environment, she has the ability to identify the environmental deficits and apply Nightingale’s concepts directs the nurse to make adjustments and advocate for the patient .(Harvard Libraries, 2012).
Florence Nightingale, born in 1820, revolutionized nursing as it is today. Throughout her time working with the wounded soldiers during the Crimean War, she noted that more soldiers were dying of infections than from wounds. Therefore, she worked to ensure sanitation as well as sufficient health and healing practices amongst her patients. From care to prevention, Nightingale’s practices were able to set the foundation for nurses today. Nightingale distinguished that a healthy environment is essential to one’s health and thus her tenets of ventilation, cleanliness, light, as well as nutrition set the bases of the City of Toronto’s tuberculosis program for the under-housed, homeless, and the correctional population.
“In these conditions, it was not surprising that in army hospitals, war wounds only accounted for one death in six. Diseases such as typhus, cholera, and dysentery were the main reasons why the death rate was so high amongst wounded soldiers” (Spartacus, 2011, ¶ 10). Nightingale went on to establish sanitary guidelines to improve nursing quality, statistical ways of obtaining data, and most importantly environmental factors to improve patient quality. What we know of Florence Nightingale is that although she was born into a wealthy family, she had a different drive in her life towards helping other humans. Nightingale demonstrated pure altruism, but why? What constitutes for her behaviors and traits, there must be a key to unlocking the personality development of Florence Nightingale.
Using her calculations she determined that an improvement in sanitary conditions would lead to a decrease in deaths. During her time this was the first time a woman had came up with such a productive theory to reduce the mortality rate. Florence was dedicated to improving the health and living conditions of the British army, the sanitary and administration of hospitals, and the way women were looked at if they wanted to pursue a profession in nursing.
Florence Nightingale, or as soldiers on the battlefield would call her the “Lady with the Lamp”, was an inspirational women of the nineteenth century that had many aspirations and dreams concerning the care of others. Achieving these dreams by “facilitating the reparative processes of the body by manipulating the patient’s environment” (Potter & Perry 2009, p. 45); Nightingale laid the foundations of modern nursing and gave the country and many others a system that has stood the test and remains timeless. In this, Florence has become one of the most widely known nursing theorist to this day.
The Environmental Theory by Florence Nightingale defined Nursing as “the act of utilizing the environment of the patient to assist him in his recovery” (Alice Petiprin, 2014). It involves the nurse’s initiative to make environmental settings appropriate to aid in the recovery of the patient’s health. According to Nightingale all external factors are somehow associated with the patient and affects their life physically, mentally, and socially (Alice Petiprin, 2014).
I will be summarizing Notes on Nursing: What It Is and What It Is Not by Florence Nightingale. Notes on Nursing: What It Is and What It Is Not was first published in 1860 with the last edition being published in 1969 (Adams-Wending, 2010). Nightingale’s theory addresses the importance of providing an environment that is conducive to the healing process for patients (Nightingale, 1860). Nightingale’s theory of the environment was based off the idea that disease was caused by smell of decomposing matter (Adams-Wending, 2010). The theory is broken down into thirteen “canons” of nursing (Nightingale, 1860). The thirteen topics within this theory are: ventilation and warming, health of houses, petty management, noise, variety, taking food, what food?, bed and bedding, cleanliness of rooms and walls, personal cleanliness, chattering of hope and advices, and observations of the sick. Nightingale (1860) states that ventilation is to make the air the patient breaths as fresh as the air outside. This also goes into detail of removing chamber pots
The concept of environment and its integral role in the delivery of nursing care was among the first identified and documented nursing concept since its early days. Florence Nightingale pioneered the profession of nursing and along with it, pioneered the concept of Nursing Theory. Her Environmental Theory was patient focused and incorporated five environmental components needed to promote health. Jarrin (2012) supported that the role of nursing is to promote the best possible environment for the patient to assist in their natural reparative process. It dates back from the time of ancient Greek philosophers and historians, including Plato, Hippocrates, and Aristotle, whose works are studied by Nightingale in her early years. According to Rahim (2013), as considered as the profession’s first nurse theorist, Florence Nightingale provided the essential foundation in environmental theory. She believed that some laws of nature, when applied and integrated into nursing care, can assist individuals in restoring their health during their illness, and, in those who are already healthy, promote health and prevent illness.
Throughout Notes on Nursing, Florence Nightingale expresses the importance of proper care to patients. Another factor of nursing that was effected by Nightingale is the professionalism of nursing and how nursing is not only a science, but an art. Nightingale states how numerous subjects in nursing should be improved upon. The specific chapters that show how Nightingale has improved nursing within Notes on Nursing were Light, Personal Cleanliness, Chattering Hopes and Advices, and Ventilation and Warming. In chapter 9, Light, Florence Nightingale emphasizes the impact of sunlight on the patient and how it improves their health. Personal cleanliness was reviewed in chapter 11. Nightingale explores the importance cleanliness has on a patient. Within chapter 12, Nightingale states how to properly advise the sick, as well as give hope to patients. In chapter 1, Ventilation and Warming, Nightingale states the need for pure air within a patient’s room. These chapters express the importance of properly taking care of patients. The focus of this paper is how it was applied during Nightingale’s time and how it is still relevant today in nursing practice. The chapters within Notes on Nursing have had a profound impact on the practice of nursing today.