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Florence nightingale’s environment theory

  1. Florence Nightingale’s Environment theory Shrooti Shah Lecturer National Medical College Nursing Campus, Birganj
  2. Introduction • Florence Nightingale was born on May 12, 1820, while her parents were on an extended European tour. • Much attention has been to the “Calling” that Nightingale recorded in her diary in 1837, when she wrote that “ God spoke to me and called me to his service”. • Florence Nightingale began her nursing training in 1851 in Germany.
  3. Introduction • She pioneered the concept of formal education for nurses. • She served the injured soldiers during the Crimean war which strongly influenced her philosophy of nursing. • In 1859, she published her views on nursing care in notes on nursing. • She is considered the first nursing theorist.
  4. Introduction • 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. • 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
  5. Introduction • 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.
  6. Types of Environment There are three types of environments. Physical, Psychological and Social Physical Environment: • Physical Environment consists of physical elements where the patient is being treated. • It 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
  7. Types of Environment 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.
  8. Types of Environment Social environment • It includes components of the physical environment - clean air, clean water, proper drainage. • It consists of a person’s home or hospital room, as well as the total community
  9. Health of houses • The importance of the health of houses as being closely related to the presence of pure air, pure water, efficient drainage, cleanliness and light. • Cleanliness outside the house effected the inside.
  10. Ventilation and warming • Nurses was “ to keep the air he breathes as pure as the external air, without chilling”. • Nightingale was very concerned about “noxious air” or “effluvia” or foul odours that came from excrement. • Nightingale stressed the importance of room temperature. The patient should not be too warm or too cold.
  11. Light • She viewed that direct sunlight was what patients wanted. • Although acknowledging a lack of scientific rationale for it, she noted that light has “ quite real and tangible effects upon the human body”.
  12. Noise • She stated that patient should never be waked intentionally or accidentally during the first part of sleep. • She asserted that whispered or long conversations about patients are thoughtless and cruel. • Nurses responsibility is to assess and stop different king of noise.
  13. Variety • She believed that variety in the environment was a critical aspect of affecting the patients recovery. • She discussed the need for changes in colour and form, including bringing the patient brightly coloured flowers or plants.
  14. Bed and bedding • She stated that dirty carpets and walls containing large quantities of organic matter and provided ready source of infection, just as dirty sheets and beds did.
  15. Personal cleanliness • The need for cleanliness is extended to the patient, the nurse and the environment. • Nightingale viewed the functions of the skin is important, believing that many disease “disorders” or caused breaks in the skin.
  16. Nutrition and taking food • Nightingale addressed the variety of food presented to the patients and discussed the importance of variety in the food presented.
  17. Chattering hopes and advices • False hope was depressing to patients, she felt and caused them to worry and become fatigued. • She believed that sick persons should hear good news that would assist them in becoming healthier.
  18. Social considerations • Nightingale supported the importance of looking beyond the persons to the social environments in which he or she lived. • She observed that generations of families lived and died in poverty.
  19. Four major concepts of Nightingale’s theory
  20. 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 which occur in any care giving situation. They can be done by anyone."
  21. Person • Nightingale referred person as a patient. Person is affected by environment. • Person is multidimensional, composed of biological, psychological, social and spiritual components. • He has a vital reparative power to deal with disease, recovery is within the person’s power as long as a safe environment for recuperation exists.
  22. Health/Disease • Health is “not only to be well, but maintaining well- being by using a person’s power to the fullest extent”. • Health is maintained by controlling the environmental factors to prevent disease. • Disease is considered as dys-ease or the absence of comfort. • Health and disease are the focus of nurse, who helps a person through the healing process.
  23. Environment • "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. Relevance of theory in nursing practice, education and research Nursing Practice 1. Disease control 2. Sanitation and water treatment 3. Utilized by modern architecture in the prevention of "sick building syndrome" applying the principles of ventilation and good lighting. 4. Waste disposal 5. Control of room temperature 6. Noise management.
  25. Relevance of theory in nursing practice, education and research Education 1. Principles of nursing training. Better practice result from better education. 2. Skills measurement through licensing by the use of testing methods, the case studies. Research 1. Use of graphical representations like the bar, pie diagrams. 2. Notes on nursing.
  26. Application of nightingale's theory in nursing process Assessment The following information should be adequate. • Adequacy of ventilation • Cleanliness of environment • Presence of draft • Sudden noises • Amount of sunlight and artificial light
  27. Application of nightingale's theory in nursing process • Variety of dietary offerings • Odors present in throughout ward • Methods of disposal of human waste and sputum • Opportunity to communicate with others • Insufficient warmth • company from family and other patient • Insufficient knowledge regarding disease
  28. Nursing Diagnosis • Non-stimulating environment
  29. Implementation • Provide adequate ventilation by opening doors and windows. • Keep the surrounding environment clean (linen, bed, utensils) • Keep the patient in warm and comfortable room, avoid unnecessary noise. • Increase stimulus through a greater exposure to sunlight and fresh air. • Provide nutritious diet and encourage for liquid diet frequently. • Proper disposal of sputum, human excreta and other waste to remove odors.
  30. Implementation • Proper dress-up, maintain room temperature and wear warm clothes. • Isolate the patient from the children from the other patients but keep in touch and interaction with limited visitors. • Keep in stimulating environment such as listening to radio, reading magazines and newspapers. • Provide sufficient advice, information about disease, it’s prognosis, course of treatment to the patient and family members.
  31. Evaluation • It is based on observation on the effect of a changing environment on the health of a person specially focus on the vital signs and adequate knowledge about disease condition.
  32. Application of Nightingale’s work in the nursing process • Assessment: Nancy Smith, a 10 yrs old was injured in an accident related to farm machinery. She had head injury then she was admitted to PICU. Because of PICU envt., she had interrupted sleep and she became increasingly confused. Her leg has become infected. • Analysis of data: includes data gap • Nursing Diagnosis: Impaired sleep pattern related to environmental light and noise and separation from family.
  33. Application of Nightingale’s work in the nursing process • Planning and implementation: nursing actions focus on changing the environment to support more normal sleep patterns, that is, being awake during the day and sleeping at night. • Evaluation: After two nights of uninterrupted sleep, normal sounds, and parental encouragement, Nancy will demonstrate increased orientation to place being able to identify that she is in the hospital.
  34. Nightingale and the Characteristics of theory
  35. Nightingale model and the characteristics of theory • Theories can interrelate concepts in such a way to create different way of looking at phenomena: – Using her envt. Model, new insights into the phenomena of interest to nursing can be identified. – Examining envt.al aspects such as light, noise or warmth can provide new insights into human responses to health and illness, which means that health and illness not only influenced by the pathophysiology and also psychosocial envt.
  36. Theories must be logical in nature • Her model is illogical. • She built her conclusion from observations, she made her case, drew her conclusions and then acted. She used logic to correct her conclusion.
  37. Theories must be relatively simple yet generalizable • Her writings are simple. • The beauty of her model is its generalizability, including its continued applicability today.
  38. Theories can be bases for hypothesis that can be tested or for theory to the explained • Nightingale has stimulated the development of nursing science with her work. • She has had a profound effect on many of the other nursing theorists. • The research related to the impact of the envt. on client health has been influenced by Nightingale.
  39. Theories contribute to and assist in increasing the general body of knowledge • This theory seems to have more relevance to practitioners today than ever before. • More and more data are becoming available to indicate the critical nature of the impact of the environment on the health and well-being of the individual.
  40. Theories can be used by practitioner to guide and improve them • Her work raises a consciousness on the nurse about how the environment influences client outcomes. • For example: controlling sound in the wards, mounting ventilation and light, put off light during nights all and all help in recovery from illness.
  41. Theories must be consistent with validated theories, laws and principles but will have open unanswered questions that need to be investigated • Works well with ecological, systems, adaptation and interpersonal theories. • she did not believe in germ theory; however the practices she recommended were not inconsistent with scientific knowledge we have today. • Many of her suggestions which she based on observation of client response to their envt., have been documented on scientifically sound when tested with rigorous application of modern research methods.
  42. Critiques of the nightingale’s environment theory • Although four major concepts are not explicit in Nightingale’s theory, they do offer nursing a specific way of looking at particular phenomenon. • The relationship between each concept is logical and consistent with similar assumptions. • Nightingale’s theory, although limited, has a lot of generalizability. • These ideas are basically simple to apply and easy to measure in terms of outcomes.
  43. Critiques of the nightingale’s environment theory • Prevention of disease would be achieved through environmental controls. • The environmental aspects of her theory remain integral components of current nursing care. • Yet it is not clear that Nightingale intended to develop a theory of nursing, she did intend to define the science and art of nursing and provide general rules with explanations.
  44. Critiques of the nightingale’s environment theory • The relation concepts-nurse, patient and environment are applicable in all nursing today. • Nightingale rejected the germ theory and her inability to recognize a unified body of nursing knowledge that is testable. • She was only relying on personal observation and experience.
  45. Nightingale and the characteristics of theory 1. What is the historical context of theory? i. Florence Nightingale is the founder of modern nursing. ii. Her work in the mid 1800s provided the basis for much of modern nursing. iii. Nightingale’s environment model fits neither the totality nor the simultaneity paradigms.
  46. What are the basic concepts and relationships presented by the theory? • Nightingale presented her ideas not as a theory but as strategies to help women care for the ill in the home and in hostels. • Relationship of concepts are not clearly articulated. However she presents her ideas in a clear manner. • Using the basic concepts she presents, new insights into phenomena of interest to nursing can be identified.
  47. What major phenomena of concern to nursing are presented? • The manipulation of the environment by the nurse to put the patients in the best place. • Nightingale does not address interpersonal relations specifically but does talk about the need for the nurse to consider what she says when talking around the patient. • Cleanliness is also of major importance.
  48. To whom does this theory apply? In what situations? In what way? • Nightingale’s writing are simple. • Nightingale’s theory applies in all situations in which nursing care is provided. • Concepts related to pure air, light, noise and cleanliness can be applied across specific environments. • Reading her work raises a consciousness in the nurse about how the environment influences client outcomes. It has directed interventions toward modulating the environment.
  49. To whom does this theory apply? In what situations? In what way? • Works well with ecological, systems, adaptation and interpersonal theories. • Her focus on the environment has relevance to practitioners in today’s global health care climate.
  50. By what method or methods can this theory be tested? • While direct testing of Nightingale’s theory has not been done, she has stimulated the development of nursing science with her work. • For example: she did not believe in germ theory; however the practices she recommended were not inconsistent with scientific knowledge we have today. • Both quantitative and qualitative methods of research could be used to test relationships in the environmental model.
  51. Does this theory direct nursing actions that lead to favourable outcome? • Her work has not been tested in a manner that nursing actions are prescribed. • However, her writings have helped nurses develop interventions that result in restructuring the environment.
  52. How contagious is this theory? • Examples of how nightingale continues to influence both modern nursing and health care can be seen in a number of articles.
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