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Nightingale's environment theory



Mrs. B. Gomathi, Associate Professor and Head, Dept of OBG Nursing, Shiksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha.

Nightingale's environment theory

  1. 1. Nightingale’s Environmental Theory Mrs. B.Gomathi, Associate Professor & Head, Dept of OBG Nursing, SUM Nursing College SOA(DTU), BBSR.
  2. 2. Florence Nightingale Introduction • Born - 12 May 1820 on the trip of Florence ,Italy • Founder of modern nursing. • First nursing theorist. • Pioneer of the formal Nursing Concept. • Organized Nursing began in the mid 1800’s with leadership of Florence Nightingale. • Belong Upper –Middle – Class family. • Nightingale hospital visit began in 1844
  3. 3. • She joined Nursing training in 1851 in Germany • In 1854, the minister of war appointed her as Nsg. Superintendent on War – torn environment. • Her experience in treating sick/injured soldiers in the Crimean war strongly influenced her philosophy of nursing. • Patient’s needs should be prioritized according to Maslow’s Hierarchy • With her lamp, Nightingale traverse the night during the Crimean War. The Lady with the Lamp • Nightingale became a heroine in Great Britain as a result of her work in the war.
  4. 4. • In 1860 Nightingale published Notes on Nursing. • She explained her environmental theory in her famous book Notes on Nursing. • She was the first to propose nursing required specific education and training. • 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. 5. Nightingale’s Nursing Theory • Nightingale’s Nursing Theory- The first published nursing theory in 1860 • Persons are in relation with the environment. • Stresses the healing properties of the physical environment (fresh air, light, warmth, and cleanliness). • Nursing puts patients in the “best conditions” for nature to act upon them. • Health is “the positive of which the pathology is the negative” “Nature alone cures”
  6. 6. • When aspects of the environment are out of balance, the client must use energy to counter these environmental stresses. • Stress drain the client of the energy needed for healing . • Viewed disease as a reparative process. • The health of the home/community is critical components in an individual’s health .
  7. 7. Theory basis: The inter-relationship of a healthful environment with nursing. External influences and conditions can prevent, suppress, or contribute to disease or death. Theory goal: Nurses help patients, families & the community to retain their own vitality by meeting their basic needs through control of the environment .
  8. 8. Types of Environment 1. Physical Environment 2. Psychological Environment 3. Social Environment
  9. 9. 1. Physical Environment • Physical Environment Consists of physical elements where the patient is being treated & 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.
  10. 10. Components of a Healthful Environment There are 5 majors component: • Proper ventilation • Sufficient warmth • Control of effluvia (noxious odors) • Control of noise • Adequate Light
  11. 11. Nightingale’s Environmental concepts
  12. 12. 2. Psychological Environment • It can be affected by a negative physical environment which then causes STRESS and affect to the patient’s emotional state. • It requires various activities to keep the patient’s mind active (i.e, manual work, appealing food, a pleasing environment). • Communication should be therapeutic, soothing, & unhurried • Patient should not be encouraged by false hopes and advice about their illness
  13. 13. 3. Social Environment • Social Environment Involves collecting data about illness and disease prevention. • It includes components of the physical environment i.e clean air, clean water, proper drainage. • It consists of a person’s home or hospital room, as well as the total community that affects the patient’s specific environment . • Observation of the social environment especially as related to specific data collection related to illness which is essential to preventing disease.
  14. 14. Nightingale’s Environmental Theory’s Model
  15. 15. Nightingale’s Theory & Nursing’s Metaparadigm
  16. 16. 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 (as outlined in canons) which occur in any care giving situation. They can be done by anyone.“ • Nursing provide fresh air, light, warmth, cleanliness, quiet, and a proper diet. • Facilitates a patient’s reparative process by ensuring the best possible environment & Influences the environment to affect health.
  17. 17. ENVIRONMENT • ENVIRONMENT is the foundational component of Nightingale’s theory. • The external conditions & forces that affect one’s life and development Includes everything from a person’s food to a nurse’s verbal & nonverbal interactions with the patient. • Poor or difficult environments lead to poor health and disease. • "Environment could be altered to improve conditions so that the natural laws would allow healing to occur."
  18. 18. PERSON • PERSON referred by Nightingale as “the patient” • A human being acted upon by a nurse, or affected by the environment. • Has reparative powers to deal with disease • Recovery is in the patient’s power as long as a safe environment exists • People are multidimensional, composed of biological, psychological, social and spiritual components.
  19. 19. HEALTH • HEALTH maintained by using a person’s healing powers to their fullest extent. • It maintained by controlling the environmental factors so as to prevent disease. • Disease is viewed as a reparative process instituted by nature. • Health & disease are the focus of the nurse. • Health is “not only to be well, but to be able to use every power we have”.
  20. 20. Nightingales Theory and Application EDUCATION: Nightingale’s principles of Nursing training provided a universal template for early nurse training school beginning with St. Thomas Hospital. RESEARCH: Nightingale’s interest in scientific inquiry and statistics continues to define the scientific inquiry used in nursing research. Concepts that Nightingale identified served as the basis of research to test modern theories. PRACTICE: The environmental aspects of her theory (ventilation, warmth, quiet, diet and cleanliness) remain integral components of nursing care.
  21. 21. Application of Nightingale’s theory in the nursing process • Miss. Rekha, age 48 years, has admitted in female medical ward of hospital in Dehradun with a diagnosis of fever. • She had complaints of fever with headache, chills, rigor, 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.
  22. 22. Assessment 1. Physical Environment:  Presence of enough window & proper ventilation.  Presence of fowl smelly dumping site outside the window.  Having proper light but no direct sun light to the bed.  Well facility for hot water twice a day but without purification.  Ward toilet drainage system is good but presence of food particles and dust in the pan & around the pan.
  23. 23.  Room environment is clean and ward is swiped frequently.  Presence of water leakage around the sink.  Having only one pieces of biscuits with milk, one full cup of dal and 1 glass of plain water during 6 hours period.  Bed is clean & tidy but presence of food particles and cover of medicines, pieces of papers and dust inside the locker.  Cool room temperature.  Pt. covered with 2 blankets but still feeling cold.  Hospital is located centrally near to the main city so there is noises of horn, loudspeakers.
  24. 24. 2. Psychological Environment  Pt. has never been admitted in hospital before.  Feeling uncomfortable and unable to sleep well.  Pt. felt noise because of presence of nsg. station near to the pt. bed.  She is very active woman and feels her time is wasted since the admission.
  25. 25. 3. Social Environment  Patient told that her home environment is clean.  They use to drink boiling water.  Her room is small but with enough ventilation and sunlight.  No h/o illness like her in the family or neighborhood.
  26. 26. Nursing Diagnosis  Risk for infection R/T unsafe drinking water, dust from locker, dirt from sink and outside of the room(poor environmental sanitation).  Risk for injury R/T wet floor.  Impaired nutritional status less than body requirement R/T inadequate intake of food.  Impaired comfort R/T strange, noisy & cold environment.
  27. 27. Goal  A client will be free from infection during hospital stay as evidence by normal WBCs range.  A client will be free from injury as evidence by not slip on the floor.  A client’s nutrition level will be maintained as evidence by constant weight till hospitalization.  A client will feel comfortable as evidence by absence of noise near to the nursing station and increase room temperature.
  28. 28. Intervention  Provide purified & boiled water for drinking according to patient demand.  Clean the locker routinely and keep all medicines in small paper box or medicine bag.  Inform to the incharge for maintenance of sink, waste disposal.  Keep the surrounding clean.  Provide adequate diet by encouraging small frequent and nutritious feeding.
  29. 29.  Maintain temperature by proper dress up and provide extra blanket.  Dispose waste properly.  Keep the patient in calm and comfortable position and avoid unnecessary stimulation, noise.  Provide sufficient support and advice related to disease process, diet therapy.
  30. 30. Evaluation  She told that she is getting boiled and purified water  She said that she has no vomiting & loose motion.  She has gained a weight and no feeling of weakness and increased appetite.  Locker is cleaned and no presence of dust around the sink.  Bed seems to be cleaned, absence of dust, piece of papers, medicines.  Absence of crowd near to the nursing station so she felt comfortable and felt asleep.  She said that she is not feeling cold.  Her laboratory test result shows normal WBCs and no evidence of fever so no risk for infection
  31. 31. Overview of the Theory  Florence Nightingales theory conceived of health care not merely as the treatment of disease but the elevation of good health and quality of life in general.  The theory emphasized the environmental aspects of care, especially those that nurses could provide, such as constructing a clean, sanitary treatment & environment.  Her conception of care was patient-centered. An important tenet of the theory is that the patient should be enabled and encouraged to take an active role in his own healing.
  32. 32. Limitations  The theory’s emphasis on environmental measures - - clean air and water, drainage, light and warmth.  It may be effective to an extent but is inherently limited.  Healthy environmental conditions can only go so far in treating disease and illness.  It says little about the application of medical technology, which was rudimentary but nonetheless existent in Nightingales time.
  33. 33. Conclusion  Florence Nightingale’s Theory is one that every nurse should strive to achieve by maintaining a healthy environments not only for their patients, but also for themselves.  Florence Nightingale provided a professional model for nursing organization.  She was the first to use a theoretical foundation to nursing.  Her thoughts have influenced nursing significantly.