Nightingale's Environmental Theory

“If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault of not of the disease, but of the nursing. I use the word nursing for want of a better” (Nightingale, 1860, p. 8). While Nightingale stressed the impact of one’s environment to promote healing, Virginia Henderson aimed to establish on the fundamental needs as a knowledge base to guide Professional nursing practice. Henderson emphasized on fourteen components required for effective nursing care which includes: breathing normally, eating and drinking adequately, elimination of body wastes, movement and posturing, sleep and rest, select suitable clothes-dress and undress, maintaining body temperature, keeping body clean and well groomed, avoiding dangers in the environment, communication, worship according to one’s faith, work accomplishments, play or participate in various forms of recreation, and learn, discover, or satisfy the curiosity (Fernandes et al., 2015). Her division of the fourteen components acknowledged patient needs with a holistic approach that is applied through the nursing process in a clinical setting.

This paper will examine the origin of the nursing theory in reference to the Florence Nightingale Theory of Positive Manipulation Of the environment. Initially the paper will introduce the theorist and the context in which the theory was developed. Will critique the theory according to nursing theory critique. The paper will further describe the utility of the theory with respect to practice, administration, education and research will also examine the empirical precision of the theory(testability and logical adequacy). Infact the entire paper demonstrates the understanding of the theory.

Jean Watson’s 8th Caritas Process 8 is an extension of her 8th Carative Factor and states, “Creating healing environment at all levels (physical, nonphysical, subtle environment of energy and consciousness whereby wholeness, beauty, comfort, dignity, and peace are potentiated (Being/Becoming the environment)” (Watson, 2008, p. 31). The process can be further defined as the nurse providing, and together with the patient becoming the environment, thus “affecting the entire field” (Watson, 2008, p. 140). Watson believed that to create a healing environment, certain views needed a second look such as Nightingale’s view to “remove noxious stimuli from the external environment…”, “issues related to safety…” by providing comfort, “violation of

The term environment, as it relates to the metaparadigm perspective, is a multilayered view that can explain the understanding of an individual’s perspective (McEwen & Willis, 2011). More specifically, some may believe the environment related to the nursing profession encompasses any setting in which a therapeutic interaction can occur; that is, a hospital, clinic, nursing home, school, corporation, or home (Tourville & Ingalls, 2003). According to McEwen and Willis (2011), however, this perceived way of identifying the environment only limits its domain by making it fixed, uncompromising, and natural. Although the specific setting in which care disperses is vital to understand the nursing discipline, it is not the only factor influencing the phenomena. Internal and external circumstances are a part of one’s environment, and both play a vital role in identifying and altering one’s perspective and philosophy related to the nursing discipline (McEwen & Willis, 2011). Individuals, such as family members, significant others, and lifelong friends that one interacts with also influence

Those two theories are Florence Nightingale’s theory of the important of the environment and Katharine Kolcaba’s theory of comfort. Both of these theories are lacking in the emergency room because of the lack a therapeutic environment for these patients. The goal for most emergency room physician is to keep the patient safe until the patient can be moved to an inpatient pscyharitic unit (Nicks & Manthey, 2012, p. 2). By the physicians having this mentality, it does not allow the patient to start his or her healing process in the emergency room while the patient is boarding waiting for an inpatient bed to become available. With the implementation of both of the nursing theories mentioned above this writer believes that it will change the environment that the patient is in and will teach the physicians to start to treat these patients and in turn, it will provide the patients with the quality care that he or she

The concept of environment and its integral role in the delivery of nursing care was among the first identified and documented nursing theory since its early days. Florence Nightingale pioneered the profession of nursing and along with it, pioneered the concept of nursing theory. Her environmental theory was patient focused and incorporated five environmental components needed to promote health. Jarrin (2012) supported that the role of nursing is to promote the best possible environment for the patient to assist in their natural reparative process. According to Rahim (2013), as considered as the profession’s first nurse theorist, Florence Nightingale provided the essential foundation in environmental theory. She believed

Florence Nightingale’s nursing theory is probably the most well known in the nursing profession. “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’ anxiety, and to help them sleep” (Theories of Florence Nightingale, 2012). This theory emphasizes that environmental factors and adaptation is the basis of holistic nursing care. This theory is important in my opinion because it ensures that the center of focus is on the patient. When patients are hospitalized making them comfortable in a new and strange environment is important to me. Eliminating noise at the nursing station and turning down the lighting in the hallways at night are just a few ways that nurses can improve the environmental factors surrounding patients. During hospitalizations I strive to eliminate any anxiety that my patient may be experiencing. Upcoming procedures and treatments can cause tremendous stress. Simply by providing sufficient information regarding treatments or procedures can be beneficial in reducing anxiety or

Grand theories are relatively abstract concepts and help to provide nursing knowledge in a general way. However, this theory is the most complex and widest in scope of the level of theory have been subdivided into Human needs, Interactive and Unitary process theories (McEwen, & Wills, 2014). For this reason, Nightingale’s Environmental theory is part of the grand theory because it encompasses different areas of nursing care. This theory incorporate knowledge made from observing the patient and critical thinking as contrast to empirical and medical care (McEwen, & Wills, 2014). Between these three subdivisions, Nightingale’s theory is also a Human Need Theory because she based her theory on how the environment cause changes in ill patients. Nightingale used inductive reasoning through observation and experiences to obtain laws of health, disease and nursing (pdf).

The environment theory of nursing is a patient-care theory. The delivery of patient centered care is the best delivery of care a patient can receive. Applying Nightingales environmental care theory of manipulation of the patient environment can affect the patient and assist in the delivery of quality of care. The concept of a clean patient environment has an effect on the patient’s recovery and the prevention of spread of diseases (Harvard Libraries, 2012). Using Florence Nightingales environmental theory and concepts will give a

Florence Nightingale was born in Florence, Italy. Her parents named her after the city she was born in. She was born on May 12,1980, she was raised mostly in Derbyshire England. Many people when they hear Florence Nightingale think about her as a nurse and for her fight for better hospital care. Florence did a lot more in her life than achieve better hospital conditions, and become a nurse. She was a brilliant mathematician, and used statistics to apply them to achieve her reforms. Florence was a well-educated woman in a number of fields other than math;

The nursing theory consists of four major concepts including person, health, environment, and nursing. According to the Fundamentals of Nursing, these four concepts “… give nurses a comprehensive perspective that allows you to identify and treat patient’s health care needs at all levels and in all health care settings.” (Potter & Perry, 2009, p. 40) Florence Nightingale’s theory was one of the first models for nursing. The focus of this theory was that nursing consists of caring through the environment and helping the patient overcome their symptoms and changes in function related to their prevailing illness. It also focuses on the manipulation on the environment for the potential benefit of the patient. Florence “… had always seen to the heart of things- that the real nurse must be a dedicated being- that

The empirical pattern of knowing encompasses “the science of nursing,” (Creasia, 2011). This draws upon scientific ideas that have been established, and seeks to apply them to practice or refine them by discovering more. For instance, nursing theory is deeply seeded in the science of nursing. Florence Nightingale, a renowned nurse and nursing theorist, placed a large emphasis on change within the patient’s environment to promote healing (Creasia, 2011). This can be applied in any nursing practice, whether it means providing for fresh air, cleanliness of the patient, or enough food to meet energy needs (Creasia, 2011). Knowing the importance of these and many other factors defines the parameters of empirics within nursing.

The concept of environment and its integral role in the delivery of nursing care was among the first identified and documented nursing concept since its early days. Florence Nightingale pioneered the profession of nursing and along with it, pioneered the concept of Nursing Theory. Her Environmental Theory was patient focused and incorporated five environmental components needed to promote health. Jarrin (2012) supported that the role of nursing is to promote the best possible environment for the patient to assist in their natural reparative process. It dates back from the time of ancient Greek philosophers and historians, including Plato, Hippocrates, and Aristotle, whose works are studied by Nightingale in her early years. According to Rahim (2013), as considered as the profession’s first nurse theorist, Florence Nightingale provided the essential foundation in environmental theory. She believed that some laws of nature, when applied and integrated into nursing care, can assist individuals in restoring their health during their illness, and, in those who are already healthy, promote health and prevent illness.

Florence Nightingale developed the environmental model theory of nursing. Nery, (2015) states that Florence Nightingale’s environmental theory of nursing, “focus primarily on the environment, interpreted as all external conditions and influences that affect the life and development of an organism, that are able to prevent, suppress or contribute to disease and death.” The four metaparadigm concepts of this theory consist of person, environment, nursing, and health. Within this theory, the patient is being cared for by the nurse, has been influenced by the environment, and has reparative powers (“Nursing Theories, 2011). Nightingale’s theory does not have a clear definition of the person; however, it can be inferred that the person correlates “in relation to the environment and the impact of the environment on the person’s health status” (Butts & Rich, 2018). The highlight of Nightingale’s theory is the environment. Both the external and internal environment needs to be in sanitary conditions. The environment concept of this theory contains “physical, psychological, and social” factors (“Nursing Theories, 2011). The goal of the nurse is the control the patient’s environment to achieve ideal health for the patient. Nightingale’s theory did not define health; however, she stated that nature itself can heal ailments (Butts & Rich, 2018). Nightingale (1859) stated that health is ‘not only to be well, but able to use well every power we have to use it.”

Theory and practice are said to go hand in hand. Theory is shaped based on practice and insight, while it also gives shape and foundation to practice. Florence Nightingale is acknowledged as the founder of modern nursing and a theorist. She believed in the patient’s capacity for self-healing which is reinforced by the nurse’s ability to create an environment conducive to health (Smith &Parker, 2015, p. 50). Her philosophy of nursing is that one should put the patient in the best position for nature to act on him or her. This paper will identify the five essential components of her theory to draw out an appropriate plan of care for Mrs. Adams in the case study. In addition, discuss the applicability of Nightingale’s