ENVIRONMENTAL THEORY
FLORENCE NIGHTINGALE
FLORENCE NIGHTINGALE
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Born on Florence, Italy on May 12, 1820
Became a heroine in Great Britain as a result of her
work in the Crimean War
Known as The Lady with a Lamp and the mother of
modern nursing.
Studied nursing in Fliedner School of Nursing
(Kaiserwerth, Germany)
First nurse researcher
Approach to Nursing
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Main focus was the control of the environment of
individuals and families, both healthy and ill.
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The need for ventilation and light in sickrooms,
proper disposal of sewage and appropriate nutrition
ENVIRONMENTAL MODEL
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Environment
o The surrounding matters that influence or
modify a course of development (Webster)
o The system must interact and adjust to its
environment (Miller, 1978).
o Ventilation & warmth, light, noise, variety,
bed & bedding, cleanliness of rooms and
walls, and nutrition as major areas of the
environment the nurse could control
(Nightingale).
o When one or more aspects of the
environment are out of balance, the client
must used increased energy to counter the
environmental stress. These stresses drain
the client of energy needed for healing.
o Physical environment are also influenced by
the social and psychological environment of
the individual.
Ventilation & Warming
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Light
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Being closely related to the presence of pure air, pure
water, efficient drainage, cleanliness and light.
Stagnant air and sickness is certain to follow.
Cleanliness outside the house affected the inside.
Dung heaps affected health in her time, so too can
modern families be affected by toxic waste,
contaminated water, and polluted air.
“quite real tangible effects upon the human body.”
Sick people rarely lie with their face forward the wall
but are much more likely to face the window, the
source of the sun.
Noise
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Patients should never be waked intentionally or
accidentally during the first part of sleep
Nurse’s responsibility to assess and stop annoying
noises
Modern noises
o Snapping of gloves, clank of stethoscope,
radios & TVs. Alarms, beeps and other noises
that startle a patient from sleep to
wakefulness
Variety
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Changes in color or form
Bringing flowers or plants,
Reading, needlework, writing and cleaning as
activities to relieve the sick of boredom
Bed & Bedding
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Health of Houses
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“Keep the air that he breathes as pure as the external
air, without chilling him.”
Source of air
Person who repeatedly breathed his/her own air
would become sick or remain sick
Importance of temperature
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Bed should be place in the lightest part of the
bedroom and placed so the patient could see out of
a window.
Caregiver should never lean against, sit upon, or
unnecessarily shake the bed
It remain important for the nurse to keep bedding
clean, neat and dry and to position the patient for
maximum comfort.
Personal Cleanliness
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Just as it is necessary to renew the air around a sick
person frequently, to carry off morbid effluvia from
the lings or skin, by maintaining ventilation, so it is
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necessary to keep pores of the skin free from all
obstructing excretions
Every nurse ought to wash her hands very frequently
during the day
Nutrition & Taking Food
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Variety of food
Individuals desire different foods at different times of
the day and that frequent small servings may be
more beneficial to the patient.
No business be done with patients while eating
Chattering Hopes & Advices
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but that to falsely cheer the sick by making light of
their own illness and its danger is not helpful.
False hope was depressing to patients, and caused
them to worry and become fatigued
NURSING PROCESS
Assessment
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METAPARADIGM
Nursing
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What nursing has to do … is to put the patient in the
best condition for nature to act upon him.”
Medicine & surgery as removing obstructions to
health allow nature to return the person to health.
“ought to signify the proper use of fresh air, light,
warmth, cleanliness, quiet and the proper selection
of administration of diet – all at the least expense of
vital power to the patient.:
Human Beings
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Defined in relationship to their environment and the
impact of the environment upon them
Nightingale advocated two essential behaviors by the
nurse
o To ask the client what is needed or wanted
o The use of observation (what to observe –
how to observe – what symptoms indicate
improvement – what is the reverse – which
are of importance – which are of none –
which are evident of neglect – and what kind
of neglect)
Nursing Diagnosis
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Nightingale believed data should be used as the basis
for forming any conclusion
The diagnosis be the client’s response to their
environment and not the environment problem.
It reflect the importance of the environment to the
health and well-being of the client.
Environment
Planning
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Focused on ventilation, warmth, noise, light and
cleanliness
Health
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Nightingale believed that pathology teaches the
harm disease has done, and nothing more.
“unmake what God had made disease”
o Goal of all nursing activities should be client
health
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Includes identifying the nursing actions needed to
keep clients comfortable, dry and in the best state for
nature to work on.
Planning is focused on modifying the environment to
enhance the client’s ability to respond to the disease
process.
Implementation
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Implementation takes place in the environment that
affects the client and involves taking action to modify
the environment
All factors of the environment should be considered:
noise, air, odors, bedding, cleanliness, light, etc.
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Evaluation
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Based on the effect of the changes in the
environment on the client’s ability to regain their
health at the least expense of energy.
Observation is the primary method of data collection
used to evaluate the client’s response to intervention
APPLICATION
Assessment
Kathy Neil, a 10-year-old female from the rural area, was
injured in an accident r/t farm machinery. She had a head
injury and although she was “conscious,” she was not
oriented to place and time. She had multiple abrasions,
multiple bruises, and deep leg wound containing dirt and
debris from the farm equipment that injured her. She was
transported to the regional hospital. After triage in the ER
and surgery, she was admitted to a crowded pediatric
intensive care unit (PICU). The lights were on 24hrs,
noises from equipment permeated the unit & visits by
her parents were restricted. Today, after 2 days & nights
of uninterrupted sleep, Kathy has become increasingly
confused & her leg has become infected, requiring
increased IV antibiotics and dressing changes 2x a day.
Analysis of the data
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Data gaps include:
o Family structure; who lives in the household;
who was present when injury occurred;
Kathy’s school performance; economic
resources; nutritional status; growth &
development.
Primary concern:
o lack of sleep and the infected wound
Nursing Diagnosis
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Sleep pattern disturbance related to environmental
light and noise and separation from family
Planning & Impementation
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Nursing actions focus on:
o Changing the environment to support
normal sleep patterns
o Encouraged to listen to her favorite music /
watch favorite TV shows
o Encourage parents to visit more often
o Teaches dressing change
At night sleep is supported by dimming the
lights, reducing noise, and keeping to
minimum activities and procedures
Evaluation
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After two nights of uninterrupted sleep, normal
sounds and parental encouragement, Kathy will
demonstrate increased orientation to place by being
able to identify that she is in the hospital.