Florence Nightingale's Environmental Theory

Sarah Trafford

Where Did the Theory Come From?

The environmental theory created by Florence Nightingale concentrates on the patient’s environment and the external conditions that effect disease and death. Known as the ‘Lady with the Lamp”, Nightingale’s theory continues to guide nursing practice today. Influenced by her experiences during the Crimean war, Nightingale understood the significance of unsanitary conditions and the impact of the sanitary reforms on death rates. By carefully examining how the environmental conditions impacted patient health and outcomes Nightingale’s environmental theory was formed. In this assignment, Nightingale’s environmental theory is summarized. Throughout this assignment, this writer will explore how Florence Nightingale established the environmental theory through a personal perspective after careful literature review. Through analysis of the concepts, explanations of the relationships, and validation of her theory, Nightingale was able to create a foundation of nursing knowledge that has improved the quality of patient care.

Stage 1: Theorizing

Though my parents disproved of my wish to become a nurse I was determined to following my calling and signed up for nursing school in 1850 at the age of thirty. Expected to marry to maintain my family’s social prominence becoming a nurse which was viewed as menial labor went against my prosperous parent’s expectations. Believing that my life would be more useful I entered nursing to help those in poverty and alleviate suffering and illness. I felt that I was called by God to be a nurse. By becoming a nurse I was able to serve God by providing assistance to those with illness.

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I felt that nursing was a calling. Nursing is not only an art but also a science that requires specific education. As a nurse, any lack of understanding or nursing skill can interrupt the process of healing. By using the nursing art of caring and standardized practices nurses can improve the health of patients. I believe that nursing allows nature to influence health. Appropriate nursing care can be achieved through alteration of the environment. Changes in internal and external environmental factors helps to attain a desired health status. Within the nursing role is the responsibility to manipulate the factors that affect heath and illness to enhance patient recovery and outcomes. The practice of nursing is also a rather distinct and separate profession from medicine. Within the nursing practice, one must recognize the body’s essential needs and work accordingly to ensure that there is suitable fresh air, light, warmth, cleanliness and quiet for the patient, this is where nursing differs from medicine.

Upon arrival in Scutari during the Crimean War we were faced with barracks filled to capacity and unsanitary conditions. Horrified by our surroundings, I noted defects in light, ventilation, sewerage as well as structural defects in buildings. Being overtly aware of the sanitary conditions and high death rates the nurses went to work immediately upon arrival to meticulously clean the ward and any soldiers brought in for treatment. Through eliminating unsanitary surroundings and organizing nursing services the mortality rate in Scutari was decreased. In the course of my work at Scutari I completed experimentation and examination of the environment and the care provided by nurses. In turn, guidelines of nursing care were developed. An example of such experimentation was discussed by Mackey & Bassendowski (2017), in which I compared the dirtiness of the water in which you have washed when it is cold without soap, cold with soap and hot with soap. Through this experimentation, it was found that the first cold water without soap hardly removed any dirt at all, cold water with soap a little more and hot water with soap removed much more dirt. Through these observations and having thorough records of death rates and the causes I was able to correlate how improved sanitation and environmental influences played a role in patient outcomes. Researching the causes of high death rates and making comprehensive recommendations for changes ensured that the conditions did not reoccur (McDonald, 2014).

Stage 2: Syntax

The environment includes the external conditions and influences that modify a life. The environment is capable of preventing or contributing to disease or death. Health is not only to be well, but to be able to use well every power we have to use (Butts & Rich, 2015). The concept of health extends further than just the absence of disease. Disease is a process given by nature to clean the body from impurity which has entered the body because one or more of the body’s natural needs is not fulfilled (Rahim, 2013). By making changes to environmental influences these wants can be fulfilled and the episode of disease can be eased. Nursing is an art of nature’s work on humans to make the ill healthy and the health remain the same (Rahim, 2013). The nurse is responsible for maintaining an environment that is adequate to sustain the health of the patient. A person or human being is a member of nature whose natural defenses are influenced by a healthy or unhealthy environment (Medeiros, 2015). By having environmental control around the patient and the relationships and influences of the nurse, the health and disease states of a patient can be enhanced.

Stage 3: Theory Testing

In a quantitative study completed by Taneli (2015), the environmental effects on the elderly were studied. Many factors within the environment of the elderly, including their home, the public, and community environments, can impact human responses, especially when individuals are ill, frail, or cognitively impaired. The environment can affect the elder’s daily activities and their responses to health and illness. According to Taneli (2015), understanding the factors within environments that facilitate or hamper health, behavior, affect, and care delivery can provide new insights of theoretical and practical importance. Through quantitative measure of environmental variables Nightingale’s theory is substantiated within this study.

The need for patient advocacy in originated with Florence Nightingale. Effective patient advocacy for basic human needs enhances the quality of patient outcomes. In the qualitative study by Davoodvand, Abbaszadeh, & Ahmadi (2016), review of how internal and external risks that jeopardize a patient’s health care environment and how the nurse acts as an advocate to reduce the risk to the patient. Given that disease diminishes an individuals’ ability to defend themselves, patients must have someone to protect them against these dangers while they are ill. Nightingale demonstrated patient advocacy through development of the environmental theory.

Furthermore, Nightingale’s environmental theory is tested in a qualitative study completed by Roque & Carraro (2015), in which high risk post-partum woman’s recovery is influenced by psychological aspects, which can be affected by the elements of the external environment, such as lighting, heating, noise or smell. Throughout the study consideration is taken into how creating an organizational culture within the hospital environment can accommodate the physical and emotional needs of these patients through controlling environmental elements of care.

Stage 4: Evaluation

The environmental theory impacts many areas of current nursing practice including personal hygiene, housekeeping procedures, administration of balanced diets to improve wound healing, observation of the sick and noise to name a few. All of these approaches to care influence patient outcomes. The theoretical principles established by Florence Nightingale remain relevant in nursing practice today.

In a study completed by Weaver (2012), it is discussed that a good standard of hygiene in the home prevents the growth and spread of bacteria, and therefore helps to prevent the development and spread of infections. This study is in line with Nightingale’s canon for personal hygiene that includes keeping patient’s patient clean and dry to prevent infection.

Contamination of environmental surfaces takes part in the transmission of pathogens. Increased attention toward disinfection and environmental cleaning is an important aspect of preventing healthcare acquired infection (Han, Sullivan, Leas, Pegues, Kaczmarek & Umscheid, 2015). This is aligned with Nightingale’s canon for cleanliness of patient rooms that concentrates on keeping the patient’s environment clean. Current evidence based research indicates that proper hygienic practices and environmental cleanliness can reduce the risk for infection and are fundamental aspects of nursing care.

Nightingale’s environmental theory also focused on observation of the sick. This canon included observations and assessments of the patient and appropriate documentation of the observations. Still applicable to nursing practice today, Inan &Dinç, (2013) discuss how poor documentation undermines patient care and threatens the safety of patients. Through appropriate documentation nurses can promotes improved quality of nursing care; enhance communication; ensure continuity of nursing services and also meet current day legal and professional standards of nursing care.

Nightingale’s environmental theory also focuses on sufficient nutritional intake through documentation of the total amount of food and liquids consumed. Malnutrition is a reversible risk factor for pressure ulcers in adults, therefore it is essential that all healthcare professionals are able to correctly identify those at risk early on and provide appropriate management (Taylor, 2016). Through adequate observation and assessment nursing professionals can establish nutritional intake therefore reducing the patients risk of pressure ulcers through implementing interventions that will correct any nutritional deficiencies.

To Nightingale, healing is concerned with bringing the body, mind, and spirit together to maintain balance within the body. Having a healing environment is a crucial element of nursing care. Within the environment are unintended consequences in the form of harmful stimuli such as unnecessary noise, bright lights, and numerous interruptions due to the inevitability of providing twenty-four-hour care. According to a study completed by Halm (2016), unwanted noise has adverse physiological and psychological effects and can adversely effect patient outcomes.

Conclusion

The influence of the Florence Nightingale’s environmental theory serves as a foundation for modern nursing practice. Widely known for instilling her nursing practice with proven evidence to enhance patient outcomes Florence Nightingale is a pioneer of evidence based practice. The development of and continued application of the environmental theory continues to be vital to providing optimal patient outcomes through altering the patient’s environment. The attributes of Nightingale’s theory continue to have merit in current day practice, even 150 years after it was originally written.

References

Butts, J. B., & Rich, K. L. (2015). Philosophies and Theories for Advanced Nursing Practice (2nd ed.). Burlington, MA: Jones & Bartlett Learning.

Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses’ viewpoint: a qualitative study. Journal Of Medical Ethics & History Of Medicine, 9(5), 1-8.

Halm, M. (2016). Making time for quiet. American Journal Of Critical Care, 25(6), 552-555.

Han, J. H., Sullivan, N., Leas, B. F., Pegues, D. A., Kaczmarek, J. L., & Umscheid, C. A. (2015). Cleaning hospital room surfaces to prevent health care-associated infections: A technical brief. Annals Of Internal Medicine, 163(8), 598-607.

Inan, N. K., & Dinç, L. (2013). Evaluation of nursing documentation on patient hygienic care. International Journal Of Nursing Practice, 19(1), 81-87.

Mackey, A., & Bassendowski, S. (2017). Original article: The history of evidence-based practice in nursing education and practice. Journal Of Professional Nursing, 3351-55.

McDonald, L. (2014). Florence Nightingale and Irish nursing. Journal Of Clinical Nursing, 23(17-18), 2424-2433.

Medeiros, A. B. (2015). The Florence Nightingale’s environmental theory: A critical analysis. Escola Anna Nery, 19(3), 518-524. doi.org/10.5935/1414-8145.20150069

Rahim, S. (2013). Clinical application of Nightingale’s environmental theory. Journal On Nursing, 3(1), 43

Roque, A. F., & Carraro, T. E. (2015). Perceptions about the hospital environment from the perspective of high-risk puerperal women based on Florence Nightingale’s theory]. Revista Gaúcha De Enfermagem / EENFUFRGS, 36(4), 63-69.

Taylor, C. (2016). Nutrition and pressure ulcers: putting evidence into practice. Journal Of Community Nursing, 30(4), 38-44.

Taneli, Y. (2015). Advancing theory and practice through collaborative research in environmental gerontology. Research in Gerontological Nursing, 8(2), 58-60.

Weaver, D. (2012). Promoting personal cleanliness. Nursing & Residential Care, 14(3), 116-120.