2. Background
Florence Nightingale was born in Florence,
Italy on May 12, 1820.
On 1851- Florence Nightangle went to
Kaiserwerth for training as nurse under the
direction of Pasture Fliedner and his wife
Erika at Kaiserwerth Germany
3. Background cont’d
1854- Florence Nightingale and 38
volunteer nurses were sent to Scutari to
assist with caring of the injured at the
Crimean war.
4. With her lamp, Nightingale traverses
the night during the Crimean war
The hospital barracks use infected
with fleas, rats sewage flow under the
ward.
She was a statistician, using bar and
pie charts, highlighting key points. She
states mortality rate was decreased
from 42.7% to 2.2% by using
environment theory.
5. Background cont’d….
•In 1860 Nightingale published Notes in
Nursing. She explained her environmental
theory in her book Notes on Nursing.
•Often considered as the first nurse
theorist and first nurse researcher.
•Nightingale’s theory remains an integral
part of nursing and healthcare today.
6. She stated in her nursing notes that
nursing “is an act of utilizing the
environment of the patient to assist him in
his recovery.”
Her contribution during Crimean war is
well-known.
International Nurses Day, May 12 is
observed in respect to her contribution to
Nursing.
Died- 13 August 1910, at the age of 90
years
7. The foundation of Nightingale’s theory is the
environment- all the external conditions and
forces that influence the life and
development of an organism.
According to her, external influences and
conditions can prevent, suppress, or
contribute to disease or death.
Her goal was to help the patient retain his
own vitality by meeting his basic needs
through control of the environment.
10. Physical environment: Physical
Environment consists of physical
elements where the patient is being
treated.
It affects all other aspects of the
environment.
It includes health of houses, ventilation
and warming, light, noise, bed and
bedding, cleanliness of rooms and walls,
personal cleanliness, nutrition and taking
of food.
Aspects of the physical environment
11. Psychological environment:
Psychological environment can be
affected by a negative physical
environment which then causes
STRESS.
It requires various activities to keep the
mind active.
It involves communication with the
person, about the person, and about
other people.
communication
Advice
12. Social environment
It consists of a person’s home or
hospital room, as well as the total
community
Mortality data especially generations
of families lived and died in poverty
and prevention of disease by
organizing hospitals and house clean
with appropriate supplies.
13. The environment is viewed as all the
external condition and influence
affecting life and development of an
organism and capable of preventing,
suppressing or contributing to disease
or death.
Although she tend to emphasize the
physical environment more than
psychological or social environment,
this need to be viewed in the context
of her time and her activities as a
nurse leader on a war-torn
environment.
14. The focus of nursing in this model is to
alter the patient's environment in order
to affect change in his or her health.
The environmental factors that affect
health, as identified in the theory, are:
fresh air, pure water, sufficient food
supplies, and efficient drainage,
cleanliness of the patient and
environment, and light (particularly
direct sunlight).
15. If any of these areas is lacking, the patient
may experience diminished health. A
nurse's role in a patient's recovery is to alter
the environment in order o gradually create
the optimal conditions for the patient's body
to heal it self
In some cases, this would mean minimal
noise and in other cases could mean a
specific diet.
All of these areas can be manipulated to
help the patient meet his or her health goals
and get healthy.
16. Florence nightingale:
Environmental Nursing Theory
Five components for healthy
environment
Proper ventilation
Adequate light
Sufficient warmth
Control of effluvia
Control of noise
17. Nightingales environmental
concept
Major area of
concentration
Example
Ventilation Fresh air which is of primary importance can be achieved
through
open windows. Corrupt, musty air breeds disease. An outlet
is needed for impure air.
Dirty carpets and furniture are a source of impurity in the air
Warmth Guarding the vital heat is essential for the patient's recovery.
Chilling is to be avoided.
Hot bottles, bricks and drinks should be used to restore lost
heat.
Effluvia (smells) Sewer air is to be avoided, and care is needed to get rid of
noxious
body odour caused by disease.
Chamber utensils should be odour free and out of site.
Fumigation and disinfectants should not be used but
the offensive substance removed.
18. Nightingales environmental
concept
Major area of
concentration
Example
Noise Intermittent sudden noise causes greater
excitement than continuous noise especially
during the patient's first sleep. The more the
patient sleeps peacefully the greater is his
ability to sleep.
Whispering or discussing a patient's
condition just outside his room is cruel.
Light Second only the need to fresh air is a value
of light. Bed should be placed in such a
position as to allow the patient to see out the
window the sky and the sunlight.
19. Nursing Paradigms
Nursing
Nursing ought to signify the proper
use of fresh air, light, warmth,
clenliness , quiet and proper selection
and administration of diet for gaining
vital power to the patient.
Nursing is different from medicine and
the goal of nursing is to place the
patient in the best possible condition
for nature to act.
20. Cont’d….
The goal is to facilitate the patient
reparative process
Nursing is the "activities that promote
health which occur in any care giving
situation. They can be done by anyone."
21. Person
Nightingale referred human as the
patient. Human being is affected by
the environment.
Human or individual has vital
reparative power to deal with the
disease
22. Health/ disease
Nightingale did not define health specifically
She believed nature alone cures disease
It is maintained by controlling the
environmental factors so as to prevent
disease.
Disease is viewed as a reparative process
instituted by the nature.
23. Environment
Physical environment is stressed by
Nightingale, especially in ventilation,
warmth, noise, light and cleanliness.
"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."
24. Application of the theory
Nightingales theory apply in all
situation in which nursing care is
provided.
Nightingales’ nursing principle remain
applicable today.
The environmental aspect of her
theory remain integral component s of
in different domains of nursing
25. In practice
Nightingales’ nursing principle remain
applicable today. The environmental
aspect of her theory remain integral
component s of current nursing care
even in the 21st century.
Modern sanitation and water treatment
have fairly successfully controlled
traditional sources of disease, but
contaminated water has health issues
in communities.
26. In health care facility, increasing use
of sophisticated equipment is the
major source of noise and also the
control of room temperature
individually for the patient is difficult.
27. In education
Principle: instruction in scientific principle and
practical experience for the mastery of skills
With the influence of her training and many of its
principles still can be found in today's nursing
program.
She believed that the measurement of "the art of
nursing could not be accomplished through
licensing examination, but she used testing
methods including case studies (notes), for nursing
probationers at St. Thomas hospital.
It is clear that nightingale understood that good
practice could result only from good education
(training).
28. research
Use of graphical representations like the bar, pie
diagrams.
Notes on nursing.
Nightingale's interest in scientific inquiry and
statistics continue to define the scientific inquiry
used in nursing research.
Although Nightingale's theory cannot generate the
nursing research used to test the modern theories
but her concepts have served as the basis for
current
research, which adds to modern nursing science
and practice.
30. STRENGTH
•Nightingale’s theory has been used to provide
general guidelines for all nurses.
•The relation concepts (nurse, patient and
environment) are applicable in all nursing
settings today.
•It offers the nursing a specific way of looking
at a particular phenomenon
31. The ideas are basically simple to apply and
easy to measure in terms of outcome
The universality and timelessness of her
concepts remain pertinent even today
(hospitals, nursing homes ,schools, the
individual homes) as before.
32. We are increasingly becoming aware of
how environmental pollution affects our
health in negative way. For this reason we
should give validity to this theory.
The assumption that the environment
affects human is consistent with
Nightingale explanation of the purpose
and goal of nursing and meaning of
health.
33. LIMITATIONS
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.
34. She only focused on physical environment
but other variables of human environment
are ignored e.g. genetic makeup
,psychosocial environment.
She rejected the germ theory and only
relying on personal observation and
experience.
The concept of “Nature alone cures” may
be changed nowadays
35. Deeply religious, she viewed nursing as
a means of doing the will of God (Nursing
is a divine calling).
Four major concepts are not
explicit(clear) in Nightingales theory.
38. Application of Nightingale’s
Theory in The Nursing Process
Miss. XYZ, age 48 years, has admitted in female
medical ward of ABC hospital for a diagnosis of
fever. She had complaints of fever with headache,
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.
39. Assessment
1. Physical Environment:
o Presence of enough window & proper ventilation, but the
environment is cool. (ventilation)
o Having proper light but no direct sun light to the bed. (light)
o Well facility for hot water but without purification. (health of
houses)
o Ward toilet drainage system is good but presence of food
particles and dust in the pan & around the pan. (health of
houses)
40. Assessment Cont’d………
o Room environment is clean and ward is
swiped frequently. (cleanliness of rooms and
walls)
o Patient bed is near nursing station. (noise)
o Having only one pieces of biscuits with milk,
one full cup of dal and 1 glass of plain water
during 6 hours period. (nutrition)
o Bed is clean & tidy but presence of food
particles and cover of medicines, pieces of
papers and dust inside the locker. (bed and
bedding)
41. Contd…..
2. Psychological
Environment
o Patient has never been admitted in
hospital before
o Feeling uncomfortable and unable to
sleep well.
o She is very active woman and feels
her time is wasted since the
admission.
42. Contd…….
3. Social Environment
o Patient told that her home environment is
clean.
o No history of illness like her in the family or
neighborhood.
43. Nursing Diagnosis
o Altered body temperature (101 ˚F) related to
infection.
o Altered nutrition less than body requirement
related to inadequate intake of food.
o Sleep disturbance related to strange noisy
environment.
o Risk for infection related to unsafe drinking water,
dust from locker, dirt from sink and outside of the
room(poor environmental sanitation).
44. Goal
o Temperature will be reduced to 99 ˚F within 20
minutes.
o The client’s nutrition will be maintained during
hospitalization.
o The client will have sound sleep at night for more
than 6 hours.
o The client will be free from infection during hospital
stay.
45. Intervention
1. Reduce body temperature:
Maintain cross ventilation by opening
doors and windows.
Remove the extra clothes and blankets.
Provide cold sponge.
Provide plenty of fluids to drink.
46. Intervention cont’d..
2. Maintain nutrition:
o Encourage patient for oral care.
o Provide adequate diet by encouraging small frequent
and nutritious feeding.
3. Maintain sound sleep:
o Keep the patient in calm and comfortable position.
o Avoid unnecessary stimulation and noise.
o Keep the patient away from nursing station.
47. Intervention Cont’d……
4. Infection prevention:
o Dispose waste properly.
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 visitor for proper waste disposal.
o Keep the surrounding clean.
o Provide sufficient support and advice related to
disease process, diet therapy.
48. Evaluation
Evaluation can be done through
Vital sign of patient will be maintained
within normal limits, weight
maintained, patient feels comfort as
verbalized by sound sleep during days
of hospitalization, no sign of infection
exhibited after nursing intervention.
49. REFERENCES
Adhikary, R. D. (2010). Nursing Theories and
Models. (2nd ed). Kathmandu: Makalu
Publication House
George, J. B. (2011).Nursing Theories: The
Base for Professional Nursing Practice. (6th
ed.). India: Pearson Education
Tomey, A. M. & Alligood, M. R. (1998). Nursing
Theorists and Their Work. (4th ed.). Missouri:
Mosby
Rai, L. (2011). Nursing Concept Theories and
Principles. (2nd ed.). Udaypur: Nabin Kumar
