FLORENCE NIGHTINGALE ENVIRONMENTAL THEORY (DONE).ppt

Florence Nightingale environment theory

1. Florence Nightngale
Environmental theory
ROSELYN KAMBEWA

2. Objectives
Broad objective
•By the end of the lesson, learners should acquire
knowledge and an understanding of Florence
Nightingale’s environmental nursing theory
Specific objectives
•State the historical background of the theory
•Describe development of the theory
•Define nursing according to F. Nightingale
•Explain the paradigm in Nightingale’s theory

3. Objectives ct…
•Explain other considerations in F.
Nightingale’s theory
•Discuss interrelationships of concepts in F.
Nightingale’s environmental theory
•Mention the major concept in F.
Nightingales’s theory
•List assumptions in F. Nightingale’s
environmental theory

4. Objectives ct…
•Explain understanding of F. Nightingale’s
environmental theory
•Discuss application of F. Nightingale’s
environmental theory to nursing
•Analyze the theory (Strengths & Weaknesses)
•Explain application of the theory to nursing
and midwifery practice, management,
research and nursing education

5. BACKGROUND
•Florence Nightingale was born on 12 May, 1820
in Florence, Italy to a wealthy English family
•She was the founder of modern nursing
•She was the first nursing theorist
•She was also known as "The Lady with the Lamp"
 
•She explained her environmental theory in her
famous book Notes on Nursing: What it is, What
it is not

6. BACKGROUND CT…
•She was the first one to propose that 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
•She died on 13
 August 1910

7. BACKGROUND CT…
•In 1859, she published notes on nursing
•In 1860 she started Nightingale training school
for nurses
•Nightingale improved health laws, reformed
hospitals, recognizes military medical services
and established nursing as a profession by
opening the first nursing training school

8. BACKGROUND CT…
•She was educated in language, phyilosophy
and Liberal arts
•She entered nursing when she was 31 years
old in hope of replacing ‘Sarah Gamp’s of a
bad nurse who was cruel to patients because
sent to nurse patient as punishment since she
was an alcoholic

9. BACKGROUND CT…
• She wanted to change the image of nurses
that well –educated, intelligent women who
are kind nurse could be nurses (Dolan, et al.,
1983)
•She was a superintendent of nurses at Kings
hospital
•She cared for soldiers at Cremean war

10. BACKGROUND CT…
•She reduced mortality rate (death of wounded
soldiers) to 50% at the Crimean war
•She was known as “the lady with a lamp”
because as she made nursing rounds at mid
night, she was carrying her lamp to the
wounded soldiers

11. BACKGROUND CT…
•She was gracious and hard working
•Her contribution continues to influence
nursing today (Dolan, et al., 1983)
•She was the first nurse to introduce the
nursing process when nursing patients
•She was the first nurse to stress the
importance of documenting nursing activities
and evaluating nursing care

12. BACKGROUND
•She was the first nurse to identify the impact of
poor environment to patients’ recovery process
•She was the first nurse to recognize that the
basis of understanding issues in nurses is formal
education
•She was the first one who directed nursing care
to sick people as well as health people by
introducing sick and health nursing

13. Development of Nightingale’s Theory
Motivation
•Florence Nightingale was motivated by:
-her consciousness
-Suffering and pain that sick people were going
through
-Her father’s high education, Dr Ward and Dr
Blackwell the first female doctors
-Her frequent visit to the sick people

14. Development of Nightingale’s Theory
ct…
-Poor conditions of British soldiers during
Crimean war where wounded soldiers wore
bloody uniforms and congested in the
hospital. These facts influenced her to come
up with a theory
Focus of Florence Nightingale’s environmental
theory
- She focused on the manipulation of the
physical environment as a major component
of nursing care

15. Development of Nightingale’s Theory
•She believed that when the is unbalanced, the
client needs to increase energy to encounter
the stress. This drains the client’s energy
needed for healing

16. Definition of nursing according to
Nightingale
•The goal of nursing is “to put the patient in
the best condition for nature to act upon
him”. Nightingale 1859 cited by George, 2002

17. Definition of the paradigms in F.
Nightingale’s theory
1. Nursing
•She defined nursing in her theory as the act of
utilizing the environment of the patient to
assist him/her in recovery. She considered
clean, well ventilated and quiet environment
important to patients’ recovery

18. Definition of the paradigms in F.
Nightingale’s theory ct…
2. Man
•She defined man as recipient of nursing action
ie man may be an individual person, group of
people, family or community
3. Health
Nightingale did not define health but she
believed that health is an innate process and
combined result of environment, physical and
psychological factors

19. Definition of the paradigms in F.
Nightingale’s theory ct…
4. Environment
•Nightingale considered environment as a
setting in which nursing actions occur and also
all that surrounds the human beings in
relation to their health eg she focused on
ventilation, warmth, noise, light and
cleanliness

20. Other considerations in F.
Nightingale’s theory
Environmental effects
•F. Nightingale believed that it involves the
nurse’s initiative to configure environmental
settings appropriately for the gradual
restoration of the patient’s health and that
external factors associated with the patient’s
surrounding affect life or biological and
physiological processes and development

21. Other considerations in F.
Nightingale’s theory ct…
Physiological environment
Health and houses
•She related health of houses closely to the
presence of pure air, efficient drainage,
cleanliness and light
•She stated that what badly constructed
houses could do to for health is the same as
badly constructed hospitals could do for
patients admitted in those hospitals

22. Other considerations in F.
Nightingale’s theory ct…
•She also stated that adequate ventilation is a
factor contributing to changes of patient’s
process of illness recovery
•The following factors are defined in her
environmental theory which are present in
patient’s environment and could affect the
patient’s illness recovery if not taken care
properly namely:

23. Other considerations in F.
Nightingale’s theory ct…
-Pure or flesh air
-Pure water (e safe water)
-Sufficient food supplies
-Cleanliness and light (especially sun light)
•Any deficiency in one of the above factors
could lead to impaired functioning of life
process or diminishing health status

24. Conceptual f. work of F. N
Diagram of Conceptual Framework
See plain paper

25. Other considerations in F.
Nightingale’s theory ct…
•She also stated that cleanliness of the
surrounding of the house affects the inside. In
her times the buildings were sealed in such a
way that fresh air was difficult to enter and a
new problem called building sickness erupted

26. Other considerations in F.
Nightingale’s theory ct…
Ventilation
•She believed that it is important to keep the air
we breath as pure as the external air without
chilling. She urged the care givers to consider
the source of air which patients breathe
•She believed that the patient who repeatedly
breath his own air (polluted air) would become
sick

27. Other considerations in F.
Nightingale’s theory ct…
•Provision of care by environmente factors
stated in F. Nightingale’s environmental
theory posed great significance during her era
because when institutions (hospitals) had
poor sanitation and health workers had little
education and training and were frequently
incompetent and unreliable in attending to
the needs of the patient. t

28. Other considerations in F.
Nightingale’s theory ct…
•She also emphasized in her environmental
theory the provision of quiet or noise free and
warm environment and attending to patient’s
dietally needs by assessing, documenting time
of food intake by patients and evaluating the
effect of the food on the patient
Warming
- She believed that the room in which patients are
sleeping should not be too warm or cold

29. Other considerations in F.
Nightingale’s theory ct…
•He urged the care givers to control room
temperatures depending on the weather and
the needs of patients by warming (heating)
and cooling (fanning or aircorning)
Bed and beddings
•Beds and beddings were seen as an important
part of the environment for the quick
recovery of patients

30. Other considerations in F.
Nightingale’s theory ct…
•Aerating and frequent changing of beddings
helps to get rid of organic matter and moisture
within beddings hence microorganisms could
not grow and multiply and cause infection to
the patient
•She noticed that it was important for the
nurses to keep the beddings clean, neat and
dry to keep the patient in a comfortable
position

31. Other considerations in F.
Nightingale’s theory ct…
•Care givers should never lean against, sit
down or unnecessarily shake beds of patients
in order to prevent disturbing the patients’
comfort
•Bed sheets should be free of wrinkles and
unnecessary bed appliances disturbs the
patient’s comfort

32. Other considerations in F.
Nightingale’s theory ct…
•Nightingale emphasized removing dust from
the rooms by dump dusting opposed to dry
dusting because dry dusting transfers dust from
one place to another
•Nightingale emphasized the importance of
cleaning the floor rather than covering it with
carpets, fabric or wall paper because they
harbor dust which is a reservoir for
microorganism which causes diseases

33. Other considerations in F.
Nightingale’s theory ct…
Light
•Nightingale observed the need for direct
sunlight which acts as a stimulant for quick
recovery
Social environment
•She supported the idea for interacting with
patients and those involved in caring for the
patient

34. Other considerations in F.
Nightingale’s theory ct…
Description of the nursing process
1.Assessment
2.Nursing diagnosis
3.Planning and outcome
4.Implementation
5.Evaluation

35. Other considerations in F.
Nightingale’s theory ct…
Nightingale encouraged care givers to:
1. Assess patients
- For a nurse to attend to the need of the
patient, she will first assess what the patient’s
needs are eg This was evidenced when she
encouraged care givers to observe/assessing
how much the patient has eaten when feeding
patients

36. Other considerations in F.
Nightingale’s theory ct…
2. Nursing diagnosis
•It is the establishment or conclusion which has
been made by the nurse after assessment
3. Planning and outcome
- After the nurse has made the nursing diagnosis,
the nurse then plans nursing activities to be
done to the patient and imagines the
anticipated outcome of the nursing activities
she will perform to the patient

37. Other considerations in F.
Nightingale’s theory ct…
4. Implementation
- This is the doing (performing ) of nursing
activities. In Nightingale’s theory this was
evidenced by encouraging care givers to
attend to patient’s needs. When a nurse is
performing nursing activities to attend to the
need of the patient she is implementing care

38. Other considerations in F.
Nightingale’s theory ct…
5. Evaluation
- Nightingale emphasized that nurses must
observing the effect of the food which the
patient has eaten. When nurses are observing
the effect of the food which the patient has
eaten, the nurse is performing an evaluation

39. Interrelationship among concepts
1.Environment and man
•Nightingale believed that there must be an
equilibrium (balance) between the patient
and the environment
•The environment must also be safe for the
patient

40. Interrelationship among concepts
•The nurse when nursing patients in the
environment, she must manipulate the
environment to speed up recovery of patients.
This is important because when there is
imbalance between the patient and the
environment the patient is affected and
recovery is delayed

41. Interrelationship among concepts
2. Nursing and man
•It is the responsibility of the nurse to follow
the nursing process when providing nursing
care in order to maintain nutritional status of
patients to promote healing and recovery

42. Major concept
•It must be noted that the major concept in
Nightingale’s theory is the environment

43. Assumptions of her theory
•Natural laws (eg let nature act on the patient)
•Mankind can achieve perfection if the
environment is manipulated to suit him/her
•Nursing is a calling (spiritual calling)
•Nursing is an art and a science
•Nursing is achieved through environmental
alteration (manipulation of environment)
•Nursing requires a specific educational base
(nursing education)
•Nursing is distinct and separate from medicine

44. Understanding of the theory
•The theory states that, when there is an
imbalance in the environment man uses a lot
of energy to correct the situation instead of
directing the energy to quicken recovery.
• Therefore the active role of nurses must be
directed towards manipulation of the
environment of patients in favour of the
patient in order to quicken recovery

45. Understanding of the theory ct…
•The theory further states that nurses must put
patients in the best environmental condition
for nature to act upon them (utilizing natural
laws, let nature take charge)

46. Application of the theory…
•Patients are to be put in the best condition for
nature to act on them
•It is the responsibility of nurses to reduce
noise, to relieve patients’ anxieties and to
help them sleep in order to quicken recovery
•Environmental adjustment remains the basis
of holistic nursing care

47. Application of the theory ct…
• Attending to the immediate needs of the
patient prevents complications
•Manipulating the environments in hospitals
and communities prevents infections to the
patient

48. Application of the theory ct…
•The nursing process, cleaning of the
environment and maintaining adequate
supplies at the hospital assist in quickening
recovery of patients is still in practice up to
date

49. Application of the theory ct…
•Importance of maintaining adequate nursing
staffing levels, record keeping, documenting
patient care, report writing and nurses being
patients’ advocators/collaborators, change
agents and providers of health education to
patient and clients are important roles of
nurses up to date
•Nursing education is one of the qualities which
has made nursing to be a profession

50. Application of the theory ct…
•Nursing activities have to be independent.
This has set boundaries between nursing and
other health disciplines
•Research in nursing is an important element in
order for nurses to be able to provide nursing
care to patients that is evidence based

51. Application of the theory ct…
•F. Nightingale did research on mortality rate of
soldiers and presented results statistically
•Based on F. Nightingale’s hard work nurses to
day are inquisitive to know why things happen
the way they do or to find solutions and
improve understanding and develop knowledge
base
•Nursing education is up to date provided in
independent education institution

52. Analyze F. Nightingale’s
environmental theory
Strength of the theory
•It is the first theory in nursing from which other
nursing theorists developed their theories
•The theory is still used in nursing profession
•The theory which aimed at teaching nurses the
art of nursing
•The theory which emphasized on infection
prevention which is still an important element in
nursing care as well as other health related fields

53. Analyze F. Nightingale’s
environmental theory ct…
•The nursing theory which focused on both
hospital and community nursing (sick and
health nursing)

54. Analyze F. Nightingale’s
environmental theory ct…
Weakness of the theory
•F. Nightingale concentrated on the
environment and overlooked other sources of
infections
•She was not gender sensitive because she
maintained the profession to women only
•She did not have scientific base on many of her
assumptions eg light
•She focused more on physical factors than on
psychological needs of patient

55. Conclusion
•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 and
nursing education significantly

56. Reference
•http://
currentnursing.com/nursing_theory/Florence_
Nightingale_theory.html
•Alligood, M., A. (2010). Nursing Theorist and
Their Work. Mosby, Inc., an affiliate of
Elservier Inc.
•Potter A., P. & Perry G., A. (2005)
Fundamentals of nursing: Human health and
function (6
th
Ed.).
•Philadelphia : Lippincott Co