nightingle theory

1. • Florence Nightingale theory
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2. Presentation outline
• Introduction nursing theory
• Background florence nightingale
• Major Concepts of the theory
• Assumption of the theory
• Meta-paradigm
• Purpose of theory evaluation
• Evaluation and critique
• Conclusion
• Acknowledgment
• References
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3. OBJECTIVES
• At the end of this session we are expected to:-
 Know the purpose of Florence Nightingale theory
 List Assumptions of theorist
 Identify major Concepts of theory
 Discuss Meta-paradigm
 Describe the Applications of Florence Nightingale theory
 List the Strength and weakness the theory
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4. Introduction
Nursing theory
• Is a conceptualization of some aspect of reality (invented or
discovered) that pertains to nursing.
• The conceptualization is articulated for the purpose of
describing, explaining, predicting, or prescribing nursing care
(Meleis, 1997).
• Florence Nightingale is one of the nursing theorists who have
developed the environmental theory.
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5. Cont…
• Florence Nightingale’s environmental theory describes a
healthy environment as fundamental for healing.
• It focuses on altering the patient’s environment to affect
change in his or her health.
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6. BACKGROUND OF THE
THEORIST
 Nightingale was born in 1820 in
Florence, Italy—the city she was
named for.
 She attended nursing programs in
Kaiserswerth, Germany , in 1850 and
1851 , where she completed what was
at that time the only formal nursing
education available.
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7. Cont…
 Nightingale was from a wealthy family, yet she chose to work
in the field of nursing, although it was considered a “lowly”
occupation.
 She believed nursing was her call from God, and she
determined that the sick deserved civilized care regardless of
their station in life (Nightingale, 1860/1957/1969).
 Although her mother wished her to lead a life of social grace,
Nightingale preferred productivity, choosing to school herself
in the care of the sick.
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8. Cont…
• During the Crimean War:
 she was urged by Sidney Herbert, Secretary of War for
Great Britain to assist in providing care for wounded
soldiers.
 At Herbert’s request Nightingale and a group of 38 skilled
nurses were transported to Turkey to provide nursing care
to the soldiers in the hospital at Scutari Army Barracks.
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9. Cont…
 Early in her work at , she noted that the majority of soldiers’
deaths was caused by;-
 transport problem to the hospital and
conditions in the hospital itself.(open sewers , lack
of cleanliness, pure water, fresh air, and wholesome
food ) than their wounds
she implemented changes to address these
problems
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10. ... • At Scutari, she became known
as the “The Lady with the
Lamp” from her nightly
excursions through the wards
to review the care of the
soldiers.
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11. Her accomplishment at Crimean
• Mortality rate reduced drastically (from
48% to 2%)
• She established cleanliness and
sanitation rules
• Patients received special diets and plenty
of food
• Improved water supply
• Patients received proper nursing care
• Established a reputation which allowed
her to improve nursing standards at
home.
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12. Her contributions to nursing
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• Founded many Schools of Nursing with theoretical and
practical basis in the care of the sick.
• First to stress on aseptic precautions while caring for the
patient.
• Her favorite dictum “Do the Patient no harm”
• The founder of modern nursing
• The first nursing theorist

13. Cont…
Nightingale consider Nurse as:
• The domain of women
• An independent practice in its own right
• Nurses were, however, to practice in accord with physicians,
• Nightingale did not believe that nurses were meant to be
subservient to physicians.
• Rather, she believed that nursing was an independent
profession or a calling in its own right.
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14. Purpose of the theory
• Since the theory is simple and clear, to explain to the patient
on the concepts of environment , thus enabling the patient to
maintain a better health.
• It helps the nurse to be able to provide intervention to ensure
the patients healing.
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15. Major Concepts of the theory
• The major concepts in environmental theory were anchored
in the welfare of the patient and the need to improve hospital
and home environments.
• It emphasizes the need for ventilation to provide pure air and
proper lighting
• Room/walls, beds/beddings should be clean with proper and
effective drainage in hospitals.
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16. Cont…
• Patients should be clean and be fed with proper food.
• There should be efforts to talk to patients and provide them
hope. (Awalkhan & Muhammad,2016)
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17. Thirteen canons of nightingale’s Theory
1.Ventilation and warmth
• keeping the patient’s body temperature, room temperature,
ventilation and foul odors.
• “ A nurse is to maintain the air with in the room as fresh as
the air with out lowering temperature.”
2. Health of house
• health housing contain five essential components those are:
pure air, pure water, efficient drainage, cleanness, and light.
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18. Cont…
3. Petty management
• continuity of the care, when the nurse is absent
• documentation of the plan of care and all evaluation will ensure
others give the same care to the client in your absences
4. Noise
• Avoidance of sudden/ starting noises
• keeping noise in general to a minimum.
• refrain from whispering outside the door
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19. Cont…
5. Variety
• provide variety in the patients room to help him/her avoid
boredom and depression.
• this is accomplished by cards, flowers, pictures, books or
puzzles(presently known as diversional therapy)
6. Food intake
• assess the diet of the client
• documentation of amount of food and liquids ingested at
every meal
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20. Cont…
7. Food
• instruction include trying to include patients food
preferences
• attempt to ensure that the client always has some food or
drink available that he/she enjoys.
8. Bed and bedding
• keeping the bed dry, wrinkle-free and at the lowest height to
ensure the clients comfort
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21. Cont…
9. Light
• Develop and implement adequate light without placing the
client in direct light.
• Assess the room for adequate light
10. Cleanliness of rooms/walls
• Assess the room for dampness, darkness and dust or mildew
keeping the environment clean
11. Person Cleanliness
• Keeping the patient clean and dry at all times
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22. Cont…
12. Chattering hopes and advices
• avoidance of talking without reason or giving advice that
is with out fact.
• continue go talk to the client as a person and to stimulate
the clients mind and avoiding personal talking's.
13. Observation of the sick
• making and documenting observations.
• Continue to observe the clients surrounding environment
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23. Conceptual framework
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24. The relationship of the major concepts
• The environmental theory is based on the cleanliness of the
patient, the hospital or home environment and the need to
consider the social environment of the patient.
• The concepts of the theory are clearly interrelated.
• The patient is the center of the care while the hospital or the
home environment is a crucial determinant of medical
outcomes.
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25. Cont…
• Therefore , hygiene and cleanliness of the patient and
environment together augment the delivery of care while
positively influencing the patient outcome.
• On the other hand considering the social backgrounds and
incorporating in nurse practice improves the mental status of
the patient and therefore enhance care delivery.
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26. Assumptions of the theory
 There are several assumptions of environmental theory
• Natural laws play critical role in health and sickness. (Awalkhan &
Muhammad,2016)
• Nursing and medicine are two separate fields and should be
treated as such.
• Nursing is viewed as a distinct science and an art, and therefore,
should have its own theories and frameworks. (Awalkhan &
Muhammad,2016)
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27. Cont…
• Disease processes does not play an important role in nursing
but nurses should focus on the patient & environment.
• The theory is based on the beliefs that the environment in
which care is provided is vital in determination of patients’
health.
• Thus caregivers should manipulate the environment to
enhance the state and recovery of patients. (Awalkhan &
Muhammad,2016)
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28. Meta-paradigm
 The Nightingale’s theory has an elaborate description of the
four concepts of nursing metaparadigm
1. Person
2. Environment
3. Health
4. Nursing
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29. Person
• Nightingale referred to the person as a patient or recipient of
nursing care.
• Nurses performed tasks to and for the patient and controlled
the patients environment to enhance recovery.
• People are multidimensional, composed of biological,
psychological, social and spiritual components.
• The biological component is addressed by the use of medicine
and nursing to address various diseases
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30. Cont…
• The psychological and social components consists of self-
concept, feelings, thought-processes and social interactions
• Lastly, Nightingale theory of the Person is based on holism.
• Holism is the concern of integrating the biological, social,
psychological and spiritual with its environment.
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31. Environment
• Environment can be external as well as internal.
• Poor or difficult environment led to poor health and disease.
• The environment plays a very large and significant role in
maintaining health and promoting recovery from illness.
• Environment could be altered to improve conditions so that the
natural laws would allow healing to occur.
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32. Health
• Regarding health, Being healthy involves the ability of a
person to use all the power at their disposal (Awalkhan &
Muhammad,2016)
• For nightingale health is “not only to be well, to be able to use
well every power we have”.
• Disease is considered as dys-ease or the absence of comfort.
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33. Nursing
• Nursing to nightingale was above all, “service to God in the
relief of man”
• It is to alter or manage the environment to implement the
natural laws of health.
• The goal of nursing is to place the patient in the best possible
condition for nature to act.
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34. Cont…
• Nursing is the activities that promote health ( as outlined in
canons) which occur in any caregiving situation.
• Florence argues that nursing practice is not a healing process
on its own. As such nurses are not healers, they should
manipulate the conditions that allow nature to preserve/restore
health.
• In addition nurses should constantly get proper education and
acquire appropriate skills.
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35. Purpose of theory evaluation and analysis
• Theory evaluation identifies a theory’s degree of usefulness to
guide practice, research, education, and administration.
• It gives insight into relationships among concepts and their
linkages to each other and allows the reviewer to determine
the strengths and weaknesses of a theory.
• It also assists in identifying the need for additional theory
development or refinement.
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36. Evaluation and Critique
 The framework used to evaluate the environmental theory of
Nightingale is Fawcett analysis and evaluation of nursing
theories(meleis,2012)
 this method requires the examination of the theory through it’s ;
• scope,
• context,
• content,
• significance,
• internal consistency,
• parsimony,
• testability,
• empirical adequacy and
• pragmatic adequacy as the criteria for evaluation of this theory
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37. Cont…
 Scope
• The theory is broad in scope which is applicable to abundance
of nursing processes.
• It can also be applied to patients in the clinic and community
setting.
 Content
• It is clear and easy to follow
• It includes the list of patient needs(fresh air, pure water,
wholesome food, cleanliness, light….)
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38. Cont…
Context
• The context of this theory is clear and
understandable.
• The theory describes the r/ship of Environment to
patient, nurse to the environment , nurse to patient .
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39. Cont…
 Significance
• Florence Nightingale offered a very clear care and disease
prevention.
• Her thought on considering the total environment, client ,
social situation and other related factor when delivering care
to patient achieve the desired goal of higher-quality care
practice.
• the clear and the accurate explanation of the environment
effect on the infectious disease occurrence process and the
importance of the cleanliness and proper sanitation in disease
prevention.
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40. Cont…
 Consistency
• Florence Nightingale’s definitions of her theory concepts
were clear and consistent with her main philosophy of care.
• Her work focused on the internal and external environment
and both physical and psychological influence on human body,
this was part of her philosophy and at the same time part of
her care concept .
• The role of environment manipulation is congruent with all
the theory concept(Awalkhan and muhhammed ,2016)
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41. Cont…
 Parsimony
• Nightingale works used simple language and concise sentences
to deliver the message explaining her thought and idea.
 Testability
• Nightingale’s theory can be the source of testable hypotheses
because she treated concrete as well as abstract concepts.
• Her concepts are well presented in her writings there fore it is
implemented in different patient care setting(Awalkhan and
muhammad,2016
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42. Cont…
• Current researchers have written about her statistical work ,
showing that it stands up to modern thinking as it did in the
19th century
 Empirical Adequacy
• Main concepts of her theory noise, spirituality and
environment are testable hypothesis, moreover her empirical
work and statistical analysis of 19th century guide the thinking
of 21st century scientist.
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43. Cont…
 Pragmatic Adequacy
• Nightingale theory works as basis and alive in the
foundation of nursing education and practice, her philosophy
of environment is still playing central role in the care
provided in the hospital.
• Nurses across the world utilized nightingale theory in nursing
education and care of the patient at different clinical settings.
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44. Strength and Limitation
 Strength
• Nightingale was concerned with teaching nurses how and
what to observe in patient.
• The nightingale training school for nurses was of great
influence to the education of the nurses of the modern
world.
• The values and principles the nightingale’s theory
encompasses are so wholesome that it is continued to be
used to day in the education of modern nursing today.
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45. Cont…
 Limitation
• In Nightingale’s Environmental Theory, there is scant
information on the psychosocial Environment compared to
the physical Environment.
• She also doesn’t directly discuss the effect of the
environment on patients psychological health.
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46. Conclusion
• Florence Nightingale is a unique figure in the history of the
world.
• She provided the first definitions from which nurses could
develop theory and the conceptual models and frameworks
that inform professional nursing today.
• And she known as the "mother of the modern nursing
profession" due to her work in which she helped improve
hospital conditions as well as improve education for nurses.
• Her theory is practical and useful to nursing because it offers
positive reception of medical facts and their relation to the
efforts of nurses.
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47. Acknowledgment
• We would like to praise GOD, without his help all this would
have been impossible.
• We would like to express our deepest appreciation to Addis
Ababa University, College of health science for the opportunity
we get to participate in this program.
• Next we would like to express our deepest gratitude to our
instructor Mr Debela G., BSc, MSc (Assistant Professor and Mr
Niguse T.(BSc, MSc, Assistant professor) for giving your time.
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48. Reference
• Afsha Awalkhan, Dildar Muhammad. Application of
Nightingale Nursing Theory to the Care of Patient
with Colostomy. European Journal of Clinical and
Biomedical Sciences. 2016; 2(6): 97-101.
• McEwen M. & Wills, E.M. (2011). Theoretical basis for
nursing. 4th edition. Philadelphia: Lippincott Williams
& Wilkins.
• Nightingale, F(1860/1957/1969) Notes on nursing:
what is ans what is not. Newyork NY: Dover
publications
• Meleis, A. I. (2012). Theoretical nursing:
Development and progress (5th ed.). Philadelphia:
Lippincott Williams & Wilkins
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