The purpose of this paper is to investigate Florence Nightingale Environmental theory and test its usage in nursing practice. With this theory being known to target the nursing profession, it is imperative to highlight the components, models, concepts, philosophical aspects, and viewpoints of the theory to bring an understanding of its application in nursing. This theory, with the support of literature reviews will be dissected by examining structural counterparts while also seeing how beneficial it is to other academic disciplines within nursing. Also, the environmental theory will be further addressed in depth on how it is applies to my area of practice as a pediatric nurse. What readers will come to learn throughout the paper is if the theory is testable, what methods if any are applied, strengths and weaknesses of the theory, and are there any theoretic framework models in place that support my area of practice. Last but not least, the theory will be assessed by sharing an example in my practice of the pros and cons of this theory. I will express the challenges I have had with the environmental theory and what future issues can result from the usage of the theory. Overall, despite the challenges I may have faced, on a positive note, I will share in great detail why I believe this theory is important to nursing practice and the reasons it should be used more often.
Keywords: environmental theory, nursing, practice, pediatrics, Florence Nightingale
Florence Nightingale: The Environmental Theory
Florence Nightingale left a remarkable impact on the nursing profession that has changed the way healthcare professionals practice today. A nurse, who had dedicated her service during the time of an unprecedented war, sought ways to improve patient outcomes by looking into the environment and its surrounding elements. The environment composed of living and non-living existences, at the time; was viewed as external effects that contributed to disease onset and fatality. Nightingale observed how the environment altered health conditions and patients recovery status. Due to this event, death rates increased and because of the tragic outcomes, she began to research how patients and the environment can be balanced to restore optimal health. The Environmental theory, one of the most well-known theories, still applies to nursing practice decades later. As the first theorists of nursing, she organized a theory that was patient-focused, and because of her hard work; her theory continues to flourish throughout healthcare implementing interventions within the environment that aid in patient healing.
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To understand her theory and its purpose in nursing practice, it is imperative that healthcare professionals follow along as I study the concepts that inspired her to develop a theory that has been so promising to the nursing profession. Selanders (2010), expressed that the environment was an “umbrella concept” to the environmental theory and that the focus was shifted towards allowing natural laws to overpower the healing process of patients (p. 84). Nightingale believed that the environment contributed to unstable outcomes for patients because the elements they were exposed to were compromising their health. Little emphasis was placed on sanitation and equipment, so she made it her duty to fight for such a change that would not only save the lives of soldiers she cared for, but thousands of others in the world. Nevertheless, her observations were put into action and the Environmental theory was created to improve the health of people. In mentioning that, she encouraged trained nurses to implement the theory into their practices to better serve patients under their care. The components of the theory focused on the following: “ventilation and warming, bedding arrangement, light, noise, cleanliness, healthy house, personal cleaning, variety, advice, food, and observation” (Selanders, 2010, p. 84). These concepts were important because it allowed nature to act independently to enhance environment conditions. However, every patient health conditions were different, and the theory was designed in mind for nurses to act on an individual basis to make sure that the patient and their environment were in sync. Meaning, if the problem for one patient was cleanliness and the other was temperature then modifications to the environment would be made to better accommodate the patient during their time of restoration.
Nature truly works at its own pace and I believe as human beings, we have educated ourselves like Florence Nightingale, to understand the theoretical origins and keystones of the environment. Examining the philosophical foundation of the environmental theory was very simple because her direct observations were the key components in understanding the environment and how it operated. The majority of patients did not succumb because of their injuries; it was their surroundings that contributed to their fatality. This predicament enhanced her comprehension of the environment and became the groundwork for her theory development. Zborowsky (2014), conveyed that worldview was a major component to her theory because of her commitment to finding a solution instead of acting off personal beliefs that could be contrary to patient improvement. Nightingale knew that it would be impossible to go up against nature and change everything, but making minute adjustments according to patient’s need would be a start in improving survival rates. Her efforts prompt her to create a model specifically for nursing practice. This theoretical model, constructed in a systematic manner; is a four step process that observes the patient, determines the need for alterations, make environmental adjustments, and evaluate health outcomes (Zborowsky, 2014). The purpose of the nursing model is to identify elements in the environment that are hindering the healing process and modify until patient equilibrium is established. Furthermore, the establishment of this model has shown nurses enforcing Nightingale’s philosophy into their daily practice to provide safe and effective care.
When examining the essential characteristics of the theory, seven assumptions were created that focused on health promotion, illness, and disease prevention. The literature listed the succeeding: “natural laws, achieving perfection, nursing is a calling, nursing is both art and science, nursing excellence is achieved through environment modifications, an educational foundation is required, and nursing and medicine are two different entities” (Selanders, 2010, p. 83-84). Nightingales’ theory is based on the theorem that if there is a balance in the environment then the nurse can nurture the patient back to health by keeping stressors away. Stressors can cause drastic changes in patient health outcomes because they are often overwhelmed by the stimuli in their surroundings. As I stated earlier, health, disease, environment, prevention, and nursing were important concepts to Nightingale and relatable to her theory because it helped to construct propositions that would serve as guideline principles in practice. Just to name a few, noise is a potential threat to the patient and their environment, sanitation eliminates infection and promotes healing, and a stable environment decreases morbidity and mortality. The Environmental theory is clear, concise, and essential to the nursing profession because it has allowed the patient to not only be in control of their own health, but lean on the nurse as an outlet to help with recovery. This theory is adequate because it was rooted from direct observations where Nightingale later went on to incorporate scientific evidence to make her theory effective to the nursing profession.
According to Zborowsky (2014), nurses today are taking into account the patient’s environment because many have seen firsthand the impact it has made on health outcomes. Florence Nightingale environmental theory has proven to be beneficial to nursing practice. Nurses, who are at the bedside, utilize her theory without realizing because as care is being provided; the patient and their surrounding elements are being examined to determine if adjustments need to be made. Hospital-acquired infections are one of the leading causes of prolonged stays and death in the hospital. Environmental elements are crucial to a patient’s well-being and Nightingale stressed the importance of it because injuries are not always the causative factor. Because of the environmental theory, nurses continue to practice safely and effectively while keeping in mind that hand hygiene decreases infection, reducing stimuli promotes good health, and cleanliness restores healing.
Nursing education has always been a vision of Nightingale since the development of her training school in St. Thomas. Nursing is more than just text book learning; it requires clinical application and advanced learning for professionals to work on their craft. The Journal of Holistic Nursing (1998), stated the following, “she pressed for the recognition of higher standards and emphasized the need for continuing education beyond training” (p. 287-288). In referencing the previous statement, from my understanding; the environmental theory was designed to be applied to the entire nursing discipline, not just at the bedside. Higher learning, in her perspective, allowed nurses to develop a deeper understanding of her theoretical model and work independently handling cases and constructing interventions to promote healthy outcomes and longevity. Nursing education is more prevalent today because of her efforts of inspiring nurses to expand their knowledge base and clinical practice on a higher level.
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After reviewing several academic journals and literature reviews, there is very little research that focuses on the environmental theory being used in nursing administration. Although administrators look at cost-effective measures and ensuring that the organization is practicing safely, not much inquiry has been published regarding its role in relation to the theory. Nursing administrators, from what I’ve witnessed, make sure there is an adequate amount of supplies stocked for nurses to perform their daily tasks, and also make sure the unit is adhering to policies and procedures. To a certain extent, they play a vital role when it comes to balancing the patient and their environment because they oversee the work of nurses and make sure things are up to par to enhance patient outcomes.
Nurse researchers are significant role models to the healthcare system. However, in discussing their placement regarding Nightingale’s environmental theory, there is minimal evidence acknowledging their contribution (Zborowsky, 2014). The literature implies that academics have been able to explain their studies based on the environment and its influence on nurses, but have yet to determine the appropriate proposal to determine its impact on patient outcomes (Zborowsky, 2014). What I learned from the literature, is that the focus was primarily on bedside nurses who took their own experiences to conduct research and from that, investigated ways to make changes within the environment to benefit the patient. Furthermore, the literature also mentions that journals have been dependable resources to use and give insight on how the environmental theory is still a huge impact on the nursing profession today. In all, with nursing continuously evolving, I believe that nurse researchers will soon be recognized for their work ethics in theory development.
Usage in Practice
As a pediatric nurse, I find Nightingale’s theory to be useful to my practice because on my unit we proclaim clean hands and safe care as our motto. With the season change, respiratory infections are seen in the hospital, so we strive to make sure the patient and their environment is balanced to initiate recovery. Its effectiveness has been tested throughout the hospital and has received positive feedback. A question that my pediatric team baffled with in reference to her theory was the following: does safe sleep help with healing? After encountering direct observations with patients like Nightingale, we concluded that adequate rest does promote healing. Her theoretical model coincides with my work because I constantly educate myself and make sure the work environment is clean to provide the best care. The steps I would take if I had a patient arriving to a room would be, make sure the linens are clean, the lighting and temperature are appropriate, and nutritious meals are available. The environmental theory will always be used by nurses like me, and after many trial runs; I can’t find a flaw that would make it rigorous for me to not use on a daily basis. Overall, this theory is applicable to my specialty because everything she outlined, I have used consecutively and I have witnessed a complete turnaround of my patient’s health status.
The environmental theory is designed to benefit all disciplines in the healthcare system. Nightingale’s concepts are easy to implement into one’s area of study without any difficulties. The only challenge I could see myself facing with the theory is finding ways to decrease noise. Hospital rooms are not sound proof and if I have a patient that is ill, I would work endlessly to find solutions to help them have adequate rest to help with their recovery. Honestly, I wouldn’t change anything to the theory because it is very useable, retrievable, and easy to understand. It is truly the blueprint for the nursing profession and I’m thankful that I can rely on it in my practice.
Selanders, L. C. (2010). The Power of Environmental Adaptation: Florence Nightingale’s Original Theory for Nursing Practice. Journal of Holistic Nursing, 28(1), 81 88. https://doi.org/10.1177/0898010109360257Attewell, A. (1998). Florence Nightingale’s Relevance to Nurses. Journal of Holistic Nursing,16(2), 281-291. https://doi.org/10.1177/089801019801600217
- Zborowsky, T. (2014). The Legacy of Florence Nightingale’s Environmental Theory: Nursing Research Focusing on the Impact of Healthcare Environments. Health Environments Research & Design Journal (HERD) (Vendome Group LLC), 7(4), 19–34. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=ccm&AN= 03880576&site=ehost-live
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