its my presentation that i presented in class.

1. PRESENTOR:
MR. YOGENDRA PD MEHTA Florence Nightingale
MN 1ST YEAR
DATE:2069/04/14

2. WEL COME
TO
NIGHTINGALE’S ENVIRONMENTAL THEORY

3. Florence Nightingale
• Introduction
 Born - 12 May 1820 on the trip of Florence ,Italy
 Founder of modern nursing.
 The first nursing theorist.
 Pioneer of the formal Nsg. Concept.
 Organized Nsg. begin in the mid 1800’s with leadership of
Florence Nightingale.

4. Contd……….
 Belong Upper –Middle – Class family.
 Nightingale hospital visit begin in 1844.
 On the journey of Paris she met two Vincent del Paul sister.
 She joined Nsg. training in 1851 in Germany.

5. Contd……….
Religious inspiration
called her to focus on
the health of the
masses.
A call from God in February 1837 while
at Embley Park

6. Contd…………..
 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

7. Contd………
With her lamp, Nightingale
traverse the night during the
Crimean War. Nightingale
became a heroine in Great Britain
as a result of her work in the war.
The Lady with the Lamp

8. Contd………
 In 1860 Nightingale published Notes on
Nursing.
 She explained her environmental theory
in her famous book Notes on Nursing:
What it is, What it is not.
 Considered the first “nursing theorist.
 She was the first to propose nursing
required specific education and
training.

9. Contd………
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

10. Assumptions of Nightingale's Theory
 Natural laws
 Mankind can achieve perfection.
 Nursing is a calling.
 Nursing is an art and a science.
 Nursing is achieved through environmental alteration.
 Nursing requires a specific educational base.
 Nursing is distinct and separate from medicine.

11. Nightingale’s Canons & Major Concept
Nightingale’s Canons Major Concepts
Ventilation and Warming
Light, noise
Cleanliness of rooms/wall Physical Environment
Health of houses
Bed and bedding
Personal cleanliness
Chattering hopes and advices Psychological Environment
Taking food Nutritional Status
Petty management/ observation Nursing Care Plan & Management

12. 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”

13. Contd………
 When aspects of the environment are out of balance, the
client must use energy to counter these environmental
stresses.
 Stresses 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 .

14. Contd……..
 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 .

15. Nightingale’s Environmental Theory’s
Model
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.

16. Contd…………
 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

17. Contd……….
 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.

18. Physical environment
Cleanliness
Ventilation
Air
Light
Noise
Water
Bedding
Drainage
Diet
Patient condition & nature
communication Mortality data
Advice Prevention of disease
Psychological
environment Social Environment

19. Summary
The cleanliness of physical environment has direct bearing on
the prevention of disease and mortality rates within the social
environment of the community. Also all patients’ psychology
environment are strongly affected by physical surroundings.

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

21. Major Achieving
Component
Fresh air, can be achieved through open
windows. Corrupt, stagnant air breeds disease. An
Ventilation outlet is needed for impure air.
Dirty carpets and furniture are a source of
impurity in the air.
Heat is essential to the patients recovery. Chilling
is to be avoided. Hot bottles, bricks, and drinks
Warmth should be used to restore lost heat.
Sewer air is to be avoided, and care is needed to
get rid of noxious body odors caused by disease.
Effusive(smells) Fumigation and disinfectant s should not be used
but the offensive substance removed.

22. Major Achieving
Component
Intermittent sudden noise causes greater
excitement than continuous noise,
especially during sleep.
Noise The more the patient sleeps peacefully, the
greater his or her ability to sleep will be.
Beds should be placed in such a position as
to allow the patient to see out the window-
Light the sky and sunlight.

23. Nightingale’s Theory & Nursing’s
Metaparadigm
Nursing
Society/Environment
Human or Individual
Health/Disease

24. 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.

25. 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 led to poor health and disease.
 "Environment could be altered to improve conditions so that the
natural laws would allow healing to occur."

26. PERSON
 PERSON Referred to 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.

27. 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 well every
power we have”.

28. Nightingale's Theory and Nursing
Practice
 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.

29. Application of Nightingale’s theory
in the nursing process
Miss. Samjhana Dahal, age 48 years, has admitted in female medical
ward of Gandaki Medical College & Teaching Hospital, Pokhara for
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.

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

31. Contd………
o Room environment is clean and ward is swiped frequently.
o Presence of water leakage around the sink.
o Having only one pieces of biscuits with milk, one full cup of
dal and 1 glass of plain water during 6 hours period.
o Bed is clean & tidy but presence of food particles and cover of
medicines, pieces of papers and dust inside the locker.

32. Contd…….
o Cool room temperature.
o Pt. covered with 2 blankets but still feeling cold.
o Hospital is located centrally near to the main city so there is
noises of horn, loudspeakers.

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

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

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

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

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

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

39. Evaluation
o She told that she is getting boiled and purified water
o She said that she has no vomiting & loose motion.
o She has gained a weight and no feeling of weakness and
increased appetite.
o Locker is cleaned and no presence of dust around the sink.

40. Contd…….
o Bed seems to be cleaned, absence of dust, piece of papers,
medicines.
o Absence of crowd near to the nursing station so she felt
comfortable and felt asleep.
o She said that she is not feeling cold.
o Her laboratory test result shows normal WBCs and no
evidence of fever so no risk for infection.

41. Overview of the Theory
 Florence Nightingale's 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.

42. 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
Nightingale's time.

43. Characteristics
 She focused more on physical factors than on psychological needs
of patient.
 CRITIQUE SIMPLICITY: Three Major Relationships: A. Environment to
Patient- Environment was the main factor creating illness in a
patient B. Nurse to Environment Nurses need to manipulate the
environment to enhance the patient’s recovery.
 CRITIQUE C: Nurse To Patient: Suggests collaboration and
cooperation between the nurse and the patient. The protection of
the patient from emotional distress Conservation of energy while
allowing the patient to participate in self-care.
 CRITIQUE GENERALITY: Nightingale’s theory has been used to provide
general guidelines for all nurses. The universality and timelessness
of her concepts remain pertinent. The relation concepts (nurse,
patient and environment) are applicable in all nursing settings
today

44. Contd…………..
 CRITIQUE EMPIRICAL PRECISION:
Nightingale’s theory are presented as truths rather than tentative,
testable statements. She advised nurses that their practice should be
based on their observation and experiences rather than systematic,
empirical research.
 CRITIQUE DERIVABLE CONSEQUENCES:
Deeply religious, she viewed nursing as a means of doing the will of
God (Nursing is a divine calling). Her encouragement for a measure of
independence and precision guides and motivates nurses today as
the profession continues to evolve.
 She emphasized subservience to doctors.

45. 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.

46. References
 http//www.currentnursing.com, retrieved on 2069/04/2
 Rai Lalita,Nursing Concepts Theories & Principles,2nd Edition, 2011.
 Sharma Muna, Lecturer,IOM,Maharajgunj,Nursing Concepts & Principles
june 2012.
 George B. Julia, Nursing Theories,The base for Professional Nursing
Practice, 3rd Edition.
 George B. Julia, Nursing Theories,The base for Professional Nursing
Practice, 5th Edition 2002.
 http://www.slideshare.net/AlexanderJames/florence-nightingale-
7407056