Nightingale’s theory and it's application

2. LADY WITH THE LAMP
FLORENCE
NIGHTINGALE

3. NIGHTINGALE’S THEORY
AND IT’S APPLICATION
SUBMITTED TO: PRESENTED BY:
Mrs. POONAM GUPTA MANISH KUMAR
TUTOR M.Sc. NURSING
RAK COLLEGE OF NURSING FIRST YEAR

4. OUTLINE OF THE PRESENTATION
1. Introduction to the Nightingale’s theory.
2. Biography of the Florence Nightingale.
3. Evolution of the theory.
4. Nightingale’s Assumptions.
5. Nightingales’ theory on Environment.
6. Paradigm on nightingale’s environment model.
7. Application of Nightingales’ work in the nursing process.
8. Nightingale’s model, the characteristics of theory
9. Evaluation of theory and
10. Application of nightingale’s theory in nursing practice and education.
11. Strengths and limitations of nightingale’s theory.
12. Review of literature.

5. INTRODUCTION
• Florence Nightingale (1820-1910), considered the founder of education
and scientific nursing and widely known as “The Lady with the Lamp”
wrote the first nursing notes that became the basis of nursing practice
and research.
• Nightingale is considered the first nursing theorist.
• Environmental Theory, which incorporated the restoration of the usual
health status of the nurse’s clients into the delivery of healthcare-it is still
practiced today.

6. BIOGRAPHY OF FLORENCE
NIGHTINGALE
12 May 1820 - Birth of Florence Nightingale (Pioneer of Modern nursing
and Public health)
1851 - She went to Kaiserswerth Germany, for her early nursing training.
1853 - She became superintendent of the Hospital for invalid Gentlewomen
in London.
1854 - Nightingale went to the front of the Crimean war at the request of her
friend, Sir Sidney Herbert, secretary at war. She arrived in Scutari on 5 Nov
1854 accompanied by 38 nurses.
The mortality rate in the hospital dropped to 22% after 6 month.Nightingale
achieved this drop by attending to the environment of the soldiers.

7. BIOGRAPHY OF FLORENCE
NIGHTINGALE
1856 - After war on August 5, she established a teaching institution for nurses at
Thomas Hospital and at King’s College Hospital in London.
Within a few years after its foundation, the Nightingale School began receiving
requests from nurses to establish new schools at hospitals worldwide.
For her efforts, Nightingale received numerous awards, including the order of
Merit from King Edward VII, Germany’s Cros of Merit and France’s Secours aux
Blesses Militaries.
1910 - She died in her sleep at the age of 90 on August 13, in London.

8. EVOLUTION OF THEORY
Many factors influenced the development of Nightingale's theory of
nursing. Individual, societal, and professional values were all integral in
the development of her work.
She used her broad base of knowledge, her understanding of incidence
and prevalence of disease, and her acute powers of observation to
develop an approach to nursing as well as to the management and
construction of hospitals.
Nightingale's main focus was the control of the environment of
Individuals and families, both healthy and ill.

9. • Nursing is separate from medicine.
• Nurses should be trained.
• The environment is important to the health of the patient.
• Sick and well are governed by the same laws of health.
• The disease process is not important to nursing.
• Nursing should support the environment to Assist the patient in healing.
• Research should be utilized through observation and empirics to define the
nursing discipline.
• Nursing is both an empirical science and an Art.
• Nursing’s concern is with the person in the environment.
• The person is interacting with the environment.
• The nurse should be observant and Confidential.
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10. NIGHTINGALE’S THEORY ON
ENVIRONMENT
• Nightingale’s theory focused on the environment. Environment
includes surrounding matters that influence or modify a Course of
development; the system must interest and adjust to its environment.
• Environment which is capable of preventing, suppressing or
contributing to disease, accidents or death, in all the extended
Conditions and influences affecting the life and developments of all
organism.

11. NIGHTINGALE’S THEORY ON
ENVIRONMENT
 Nightingale viewed the manipulations of the physical environment as the
major component of nursing care.
 She identified ventilation and warmth, light, noise, variety, bed and
bedding, cleanliness of rooms and walls, and nutrition as major areas of
the environment the nurse could control.
 When one or more aspects of the environment are out of balance, the
clients must use increased energy to counter the Environmental Stress.

12. Health of houses
Ventilation and
warming
Bed and bedding
Cleanliness of
Rooms and Walls
Light and noise
Personal
Cleanliness
Nutrition and
Taking Food
Chattering Hopes
and Advices
Social
consideration
Variety
NIGHTINGALE’S CANONS

13. 1. Health of
Houses
• She discussed the importance of the
health of houses as being closely
related to the presence of pure air,
pure water, efficient Drainage,
cleanliness and light.
• She also noted that the cleanliness
outside the house affected the
inside.

14. • The aspect of the environment that
concerned Nightingale most was
providing proper ventilation to a
patient.
• She urged the caregiver to consider
the source of the air in the patient’s
room, as she believed a steady
supply of fresh air was the most
important principle of nursing.
• Nightingale believed that the
person who repeatedly breathed his
or her own air would become sick
or remain sick.
2. Ventilation
and warming

15.  Light, specially direct sunlight has
purifying effect on the air of the room.
 Modern hospital be constructed in
such a way that day light is available
for patients.
 She believed that patient should never
be waked intentionally or accidentally
during the sleep.
 She viewed unnecessary noise
irritating to the patient. So, nurses
responsibility is to assess and stop this
kind of noise.
3. Light and
Noise

16.  She believed that variety in
environment was a critical aspects
of affecting the patient’s recovery.
 She discussed the need for change
in color and form, including
bringing the patient brightly and
colored flowers or plants.
 Nightingale also advocated
reading, needlework, writing, and
cleaning as activities to relieve the
sick of boredom. Now, this is
called Diversion Therapy.
4. Variety

17.  She viewed bedding as an important
part of environment.
 She believed that the bed should be
placed in the lightest part of the
room so that patient could see out
of a window.
 It is important for nurses to keep
bedding clean, neat and dry and to
position the patient for maximum
comfort.
5. Bed and
Bedding

18.  She stated that dirty carpets and
walls containing large quantities of
organic matter provide ready
source of infection, just as dirty
sheets and beds did.
 Nightingale indicated that “the
greatest part of nursing consists in
preserving cleanliness.
 She pointed out that even the best
ventilation cannot freshen a room
that is not first of all clean.
6. Cleanliness
of Rooms and
Walls

19. • The need for cleanliness is
extended to the patient,nurse and
environment.
• She viewed the function of the skin
is important, believing that many
diseases or disorders breaks
through skin.
• She believed that unwashed skin
poison the patient and noted that
bathing and drying the skin
provided great relief to the patient.
7. Personal
cleanliness

20.  She noted their individual desire
for different foods at different
times of the day and the frequent
small services maybe more
beneficial to the patient then a large
breakfast or dinner.
 She also urged that the right food
be brought at right time and be
taken away eaten at right time.
8. Nutrition
and Taking
Food

21.  She considered that false hope was
depressing to patients and caused
them to worry and become fatigued.
 Nightingale encouraged the nurse to
heed what is being said by visitors,
believing that sick persons should
hear good news as that would assist
them in becoming healthier.
9. Chattering
Hopes and
Advices

22. • She supported the importance of
looking beyond the persons to the
social environments in which he or
she lived. She was a role model for
political activities by nurses.
• She believed that the nurse and
hospital related to be well
managed, i.e. organized, clean and
with appropriate supplies show
client and environment in balance
and expending unnecessary energy
being stressed by environment.
10. Social
consideration

23. PARADIGM ON NIGHTINGALE’S
ENVIRONMENT MODEL
NURSING
According to Nightingale, nursing is,
to put the patient on the best
condition for nature to act upon him.
She stated that the nursing “ought to
signify the proper use of fresh air,
light, warmth, cleanliness, quick and
proper selections and administration
of diet, all at the least expense of vital
power to the patient.
HUMAN BEING
Human being is not defined by
Nightingale, but they are defined on
relationship to their environment and
the impact of the Environment upon
them.

24. PARADIGM ON NIGHTINGALE’S
ENVIRONMENT MODEL
HEALTH
It is also not specifically defined. She
stated “we know nothing of health, the
positive of which pathology in the
negative, except from observation and
experience. She believed nature alone
cures.
She believed the nursing should provide
care to the healthy as well as the ill and
discussed health promotions as an
activity in which nurses should engage.
ENVIRONMENT
The physical environment is stressed by
nightingale in her writings.
Her writings reflect the community
health model in which all that surrounds
human beings is considered in relation to
their state of health. She synthesized
immediate knowledge of disease with the
existing sanitary conditions in the
Environment.

25. NORMAL
(NURSE,OBSERVER,
PRACTIONER)
MANIPULATION OF
ENVIRONMENT

26. Theories can interrelate
concepts
Theories must be Logical
in Nature
Theories must be
Relatively Simple yet
Generalizable
Theories can be basis for
Hypothesis
NIGHTINGALE’S
MODEL & THE
CHARACTERISTICS
OF THEORY

27. Theories Constitute to and
Assist in Increasing
Theories can be Used by
Practitioner to Guide and
Improve their Practice
Theories must be
Consistent with Validated
Theories
NIGHTINGALE’S
MODEL & THE
CHARACTERISTICS
OF THEORY

28. NIGHTINGALE AND NURSING
PROCESS
1. ASSESSMENT
• In this stage, Nightingale advocated two essential behaviors by the nurses.
The first is to ask the client what is needed or wanted, i.e. ask many
questions to know the actual status of the client.
• The second area of assessment she advocated was the use of observation.
She used precise observations concerning all aspects of the client’s
physical health and environment. First one is subjective data and second is
objective data that are used to present nursing process.

29. NIGHTINGALE AND NURSING
PROCESS
2. NURSING DIAGNOSIS
Nursing diagnosis are based on an analysis of the conclusion
gained from the information to the assessment. Nightingale
believed that data should be used as the basis for drawing any
conclusion. Nursing diagnosis reflects the importance of the
environment to the health and well-being of the client.

30. NIGHTINGALE AND NURSING
PROCESS
3. PLANNING
It includes identifying the nursing actions needed to keep clients
comfortable, dry and in the best state for nature to work on
Planning focused on modifying the environment to enhance the
client’s ability to respond to the disease process.

31. NIGHTINGALE AND NURSING
PROCESS
4. IMPLEMENTATION
• Implementation takes place on the environment that affects out
client and involves taking action to modify that environment.
• All factors of the environment should be considered, including
noise, air, odors, beddings, cleanliness, and light-all the factors
that place clients in the best positions for the nature to work
upon them.

32. NIGHTINGALE AND NURSING
PROCESS
5. EVALUATION
Evaluation is based on the effects of the changes in the
environment on the client’s ability to regain their health at the
least expense of energy. Observation is primary method of data
collection based to evaluate the client’s response to the
intervention.

33. EVALUATION OF THEORY
1. Nightingale’s Theory Contains Three Major Relationships
Environment to patient, nurse to environment, and nurse to
patient. She viewed environment as the main factor acting on the
patient to produce an illness state and regarded disease as “the
reactions of kindly nature against the conditions in which we have
placed ourselves.”

34. EVALUATION OF THEORY
2. Nightingale’s Theory Attempts to Provide General
Guidelines for all Nurses in all Times
Although Many of her specific direction are no longer applicable
general concepts such as relationship between nurse patient and
environment are still pertinent. Generality is criterion met by
Nightingale’s theory.

35. EVALUATION OF THEORY
3. Concepts and Relationships within Nightingale’s Theory
Concepts and relationships within Nightingale’s theory are frequently
stated implicitly and are presented as established truths rather than as
tentative, testable statements. Little or no provision Is made for
empirical examination. Indeed, Nightingale Suggested that the practice
of Nursing should be built on individual observation rather than
systematic research when the advised. “let experience, not theory,
decide upon this as upon all other things”.

36. EVALUATION OF THEORY
4. Nightingale’s Writings, to an Extraordinary Degree
Nightingale’s writings, to an extraordinary degree, direct the nurse to
action on behalf of her patient and herself. These directives encompass
the areas of practice, research and education. most specific are her
principles attempted to shape nursing practice. Her encouragement of a
measure of independence and precision previously unknown in nursing
may still guide and motivate us today as nursing continues to evolve.

37. EVALUATION OF THEORY
5. Nightingale’s View of Humanity.
Nightingale’s view of humanity was consistent with her theories of
nursing. She believed in creative, universal humanity with the potential
and ability for growth and change. Deeply religious, she viewed
nursing as a means of doing the will of her God. Although the lack of
patient involvement in health seems to be a gap in Nightingale’s views,
it may be accounted for by the historical period in which she lived and
wrote.

38. APPLICATIONS OF NIGHTANGALE’S
THEORY
IN PRACTICE
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”
As per most of the nursing theories,
environmental adaptation remains the
basis of holistic nursing care.
IN EDUCATION
Nightingale’s nursing education
emphasized the need to blend a mixture of
theoretical and clinical experiences.
Schools of nursing were established on her
model throughout the world.
They emphasized the moral qualities of
nursing and introduced humanitarian,
patient-centered values that are still
relevant today.

39. STRENGTHS OF NIGHTINGALE’S
THEORY
1. Nightingale’s theory is logical in nature.
2. Her writings are simple, easy to understand.
3. It increases the general body of knowledge.
4. It can be used by the practitioner as guide to improve their
practice.

40. LIMITATIONS OF NIGHTINGALE’S
THEORY
1. Professional Distance
• The close patient-nurse relationship that Nightingale theory stresses helps create
a nurturing, emotionally supportive environment, but it also risks violating the
boundaries of professional distance that health professionals are expected to
maintain. The kind of devotional care the theory encourages can be considered
unprofessional or even emotionally counterproductive to both patient and nurse.
• Emotional bonds that become too intimate can make it difficult for a nurse to
perform her job objectively while causing the patient to become overly attached.

41. LIMITATIONS OF NIGHTINGALE’S
THEORY
2.Patient Incapacitation
• Nightingale’s theory conceives of the patient as a central agent in his own
healing. This may be effective in some cases, but is limited in cases in
which the patient is incapacitated or otherwise incapable of working
toward his own healing.
• Some patients may be physically in capable of engaging to the degree that
theory advocates, while others may be psychologically incapable, or may
be overwhelmed by the pressure of taking such an active role.

42. LIMITATIONS OF NIGHTINGALE’S
THEORY
3. Emphasis on Environmental Measures
The theory’s emphasis on environmental measures, clean air and water, drainage,
light and warmth, may be effective to an extent but is inherently limited. Healthy
environmental conditions can only go far in treating disease and illness. It says little
about the application of medical technology, which was rudimentary but
nonetheless existent in Nightingale’s time:
1. She emphasized subservience to doctors.
2. She focused more on physical factors than on psychological needs of patient.

43. REVIEW OF LITERATURE
Health in environment: reduce surgical site infections by applying
Florence nightingale's environmental theory
AUTHOR: Anna Rana. J Pak Med Assoc. 2021 Feb.
Surgical site infection is one of the most common causes of readmission in
hospitals and it also leads to an overall increased burden. This can be decreased by
applying basic concepts of Nightingale (1860) "Environmental Theory" while
giving care to the patients. Keeping in view Nightingale's environmental theory, this
paper aims to discuss the case of a patient suffering from a surgical site infection. It
will help readers to understand the environmental factors which affect the patients'
health and provide a way to promote healing and fast recovery by modifying their
environment.

44. CONCLUSION OF THEORY
The Environmental Theory of Nursing is a patient-care theory. it
focuses in the alteration of the patient's environment in order to
affect change in his or her health. Caring for the patient is of more
importance rather than the nursing process, the relationship
between patient and nurse, or the individual nurse.

45. BIBLIOGRAPHY
1. Parker E. Marilyn, Nursing theories and nursing practice, Florence nightingale’s legacy of
caring and its applications, Jaypee brothers medical publishers (P) Ltd, Second edition, Page
no. 39-54.
2. Brar kaur Navdeep and rawat H C, Textbook of advanced nursing practice, Nursing
theories, The health sciences publisher, First edition, 2015, page no. 562-570.
3. A redesign of Florence Nightingale's Rose Chart created by Jeffrey A. Shaffer |
DataPlusScience.com
4. https://assignology.com/conceptual-model-in-nursing-analysis-florence-nightingales-
theory/
5. https://www.scielo.br/j/rgenf/a/FCtdhW9CT3k47gJS9KTSXkk