Mrs. B. Gomathi, Associate Professor and Head, Dept of OBG Nursing, Shiksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha.

1. Nightingale’s Environmental Theory
Mrs. B.Gomathi, Associate Professor & Head,
Dept of OBG Nursing, SUM Nursing College
SOA(DTU), BBSR.

2. Florence Nightingale
Introduction
• Born - 12 May 1820 on the trip of Florence ,Italy
• Founder of modern nursing.
• First nursing theorist.
• Pioneer of the formal Nursing Concept.
• Organized Nursing began in the mid 1800’s with
leadership of Florence Nightingale.
• Belong Upper –Middle – Class family.
• Nightingale hospital visit began in 1844

3. • She joined Nursing training in 1851 in Germany
• In 1854, the minister of war appointed her as Nsg.
Superintendent on War – torn environment.
• Her experience in treating sick/injured soldiers in
the Crimean war strongly influenced her
philosophy of nursing.
• Patient’s needs should be prioritized according to
Maslow’s Hierarchy
• With her lamp, Nightingale traverse the night
during the Crimean War. The Lady with the Lamp
• Nightingale became a heroine in Great Britain as a
result of her work in the war.

4. • In 1860 Nightingale published Notes on Nursing.
• She explained her environmental theory in her
famous book Notes on Nursing.
• She was the first to propose 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.
• Died - 13 August 1910

5. Nightingale’s Nursing Theory
• Nightingale’s Nursing Theory- The first published
nursing theory in 1860
• Persons are in relation with the environment.
• Stresses the healing properties of the physical
environment (fresh air, light, warmth, and
cleanliness).
• Nursing puts patients in the “best conditions” for
nature to act upon them.
• Health is “the positive of which the pathology is
the negative” “Nature alone cures”

6. • When aspects of the environment are out of
balance, the client must use energy to counter
these environmental stresses.
• Stress drain the client of the energy needed for
healing .
• Viewed disease as a reparative process.
• The health of the home/community is critical
components in an individual’s health .

7. Theory basis: The inter-relationship of a healthful
environment with nursing. External influences and
conditions can prevent, suppress, or contribute to
disease or death.
Theory goal: Nurses help patients, families & the
community to retain their own vitality by meeting
their basic needs through control of the
environment .

8. Types of Environment
1. Physical Environment
2. Psychological Environment
3. Social Environment

9. 1. Physical Environment
• Physical Environment Consists of physical
elements where the patient is being treated &
affects all other aspects of the environment.
• Cleanliness of environment relates directly to
disease prevention and patient mortality.
• Aspects of the physical environment influence
the social and psychological environments of the
person.

10. Components of a Healthful
Environment
There are 5 majors component:
• Proper ventilation
• Sufficient warmth
• Control of effluvia (noxious odors)
• Control of noise
• Adequate Light

13. Nightingale’s Environmental concepts

14. 2. Psychological Environment
• It can be affected by a negative physical
environment which then causes STRESS and affect
to the patient’s emotional state.
• It requires various activities to keep the patient’s
mind active (i.e, manual work, appealing food, a
pleasing environment).
• Communication should be therapeutic, soothing, &
unhurried
• Patient should not be encouraged by false hopes
and advice about their illness

15. 3. Social Environment
• Social Environment Involves collecting data about
illness and disease prevention.
• It includes components of the physical environment
i.e clean air, clean water, proper drainage.
• It consists of a person’s home or hospital room, as
well as the total community that affects the
patient’s specific environment .
• Observation of the social environment especially as
related to specific data collection related to illness
which is essential to preventing disease.

16. Nightingale’s Environmental Theory’s
Model

17. Nightingale’s Theory & Nursing’s
Metaparadigm

18. 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 care giving
situation. They can be done by anyone.“
• Nursing provide fresh air, light, warmth,
cleanliness, quiet, and a proper diet.
• Facilitates a patient’s reparative process by
ensuring the best possible environment &
Influences the environment to affect health.

19. ENVIRONMENT
• ENVIRONMENT is the foundational component of
Nightingale’s theory.
• The external conditions & forces that affect one’s
life and development Includes everything from a
person’s food to a nurse’s verbal & nonverbal
interactions with the patient.
• Poor or difficult environments lead to poor health
and disease.
• "Environment could be altered to improve
conditions so that the natural laws would allow
healing to occur."

20. PERSON
• PERSON referred by Nightingale as “the patient”
• A human being acted upon by a nurse, or
affected by the environment.
• Has reparative powers to deal with disease
• Recovery is in the patient’s power as long as a
safe environment exists
• People are multidimensional, composed of
biological, psychological, social and spiritual
components.

21. HEALTH
• HEALTH maintained by using a person’s healing
powers to their fullest extent.
• It maintained by controlling the environmental
factors so as to prevent disease.
• Disease is viewed as a reparative process
instituted by nature.
• Health & disease are the focus of the nurse.
• Health is “not only to be well, but to be able to
use every power we have”.

22. Nightingales Theory and Application
EDUCATION: Nightingale’s principles of Nursing training
provided a universal template for early nurse training
school beginning with St. Thomas Hospital.
RESEARCH: Nightingale’s interest in scientific inquiry and
statistics continues to define the scientific inquiry used
in nursing research. Concepts that Nightingale
identified served as the basis of research to test
modern theories.
PRACTICE: The environmental aspects of her theory
(ventilation, warmth, quiet, diet and cleanliness)
remain integral components of nursing care.

23. Application of Nightingale’s theory in
the nursing process
• Miss. Rekha, age 48 years, has admitted in female
medical ward of hospital in Dehradun with a
diagnosis of fever.
• She had complaints of fever with headache, chills,
rigor, malaise and anorexia.
• She was in hospital for 5 days.
• Her laboratory report shows plenty of WBCs in urine
RE and waiting for blood and urine culture report,
chest x-ray shown normal.

24. Assessment 1.
Physical Environment:
 Presence of enough window & proper ventilation.
 Presence of fowl smelly dumping site outside the
window.
 Having proper light but no direct sun light to the
bed.
 Well facility for hot water twice a day but without
purification.
 Ward toilet drainage system is good but presence of
food particles and dust in the pan & around the pan.

25.  Room environment is clean and ward is swiped
frequently.
 Presence of water leakage around the sink.
 Having only one pieces of biscuits with milk, one full
cup of dal and 1 glass of plain water during 6 hours
period.
 Bed is clean & tidy but presence of food particles
and cover of medicines, pieces of papers and dust
inside the locker.
 Cool room temperature.
 Pt. covered with 2 blankets but still feeling cold.
 Hospital is located centrally near to the main city so
there is noises of horn, loudspeakers.

26. 2. Psychological Environment
 Pt. has never been admitted in hospital before.
 Feeling uncomfortable and unable to sleep well.
 Pt. felt noise because of presence of nsg. station
near to the pt. bed.
 She is very active woman and feels her time is
wasted since the admission.

27. 3. Social Environment
 Patient told that her home environment is clean.
 They use to drink boiling water.
 Her room is small but with enough ventilation and
sunlight.
 No h/o illness like her in the family or
neighborhood.

28. Nursing Diagnosis
 Risk for infection R/T unsafe drinking water, dust
from locker, dirt from sink and outside of the
room(poor environmental sanitation).
 Risk for injury R/T wet floor.
 Impaired nutritional status less than body
requirement R/T inadequate intake of food.
 Impaired comfort R/T strange, noisy & cold
environment.

29. Goal
 A client will be free from infection during hospital
stay as evidence by normal WBCs range.
 A client will be free from injury as evidence by not
slip on the floor.
 A client’s nutrition level will be maintained as
evidence by constant weight till hospitalization.
 A client will feel comfortable as evidence by
absence of noise near to the nursing station and
increase room temperature.

30. Intervention
 Provide purified & boiled water for drinking
according to patient demand.
 Clean the locker routinely and keep all medicines in
small paper box or medicine bag.
 Inform to the incharge for maintenance of sink,
waste disposal.
 Keep the surrounding clean.
 Provide adequate diet by encouraging small
frequent and nutritious feeding.

31.  Maintain temperature by proper dress up and
provide extra blanket.
 Dispose waste properly.
 Keep the patient in calm and comfortable position
and avoid unnecessary stimulation, noise.
 Provide sufficient support and advice related to
disease process, diet therapy.

32. Evaluation
 She told that she is getting boiled and purified water
 She said that she has no vomiting & loose motion.
 She has gained a weight and no feeling of weakness and
increased appetite.
 Locker is cleaned and no presence of dust around the
sink.
 Bed seems to be cleaned, absence of dust, piece of
papers, medicines.
 Absence of crowd near to the nursing station so she felt
comfortable and felt asleep.
 She said that she is not feeling cold.
 Her laboratory test result shows normal WBCs and no
evidence of fever so no risk for infection

33. Overview of the Theory
 Florence Nightingales theory conceived of health
care not merely as the treatment of disease but the
elevation of good health and quality of life in
general.
 The theory emphasized the environmental aspects
of care, especially those that nurses could provide,
such as constructing a clean, sanitary treatment &
environment.
 Her conception of care was patient-centered. An
important tenet of the theory is that the patient
should be enabled and encouraged to take an active
role in his own healing.

34. Limitations
 The theory’s emphasis on environmental measures -
- clean air and water, drainage, light and warmth.
 It may be effective to an extent but is inherently
limited.
 Healthy environmental conditions can only go so far
in treating disease and illness.
 It says little about the application of medical
technology, which was rudimentary but nonetheless
existent in Nightingales time.

35. Conclusion
 Florence Nightingale’s Theory is one that every
nurse should strive to achieve by maintaining a
healthy environments not only for their patients, but
also for themselves.
 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 significantly.