Florence Nightingale: Environmental Theory

CREDENTIALS AND BACKGROUND

·         Born on May 12, 1820 while her parents were in extended European tour.

·         Named after her birthplace Florence,Italy.

·         Parents: Edward and Frances Nightingale

·         Elder sister: Parthenope Nightingale

·         The Nightingale’s, they were well-educated, wealthy, aristocratic Victorian family.

·         During her childhood, her father educated her much more broadly and rigorously than other young women of her time.

·         Nightingale was tutored on mathematics, languages, religion, and philosophy (these later influenced the course of her work.)

·         Living in Victorian aristocratic activities and social events during her adolescences, she also developed the sense that her life should become more useful.

                THE JOURNEY STARTS

·         Year 1837, She wrote “God spoke to me and called me to his service” a diary about her calling. Although unclear for some time, she understood that she was called to become a nurse.

·         Year 1851, she got accepted at Kaiserworth, Germany (a protestant religious community with a hospital facility) after completing the 3months training.

·         Upon returning to England, she began examine hospital facilities, reformatories and charitable institutions.

·         Year 1853, Two years after the training, she became the superintendent of the hospital for invalid gentlewomen in London.

                THE CRIMEAN WAR CAME

·       Sidney Herbert (a family friend and Secretary of war) requested her to go to Scutary, Turkey to provide trained nurses to care for wounded soldiers.

·         Year 1854 November she arrived at Scutary, Turkey. In providing nursing care, she addressed the environmental problems; these were lack of sanitation and presence of filth (few chamber pots, contaminated water, contaminated sheets and blankets, and overflowing cesspools). In addition, the soldiers were faced with exposure, frostbite, lice infestation, and other opportunistic diseases during recovery.

·         She improved these deplorable (awful) conditions that made her popular and revered to the soldiers but the support of the physician and military officers was less than enthusiastic.

·         She was called “The Lady with the Lamp”, as immortalized in the poem “Santa Filomena” by Henry Wadsworth Longfellow. Because she made her rounds during the night.

·         In Scutary, she became critically ill with Crimean Fever, which might have been typhus or brucellosis.

             

                 MISSION FULFILLED, RETURNING HOME

·         Nightingale returned to England for great accolades, to Royal family (Queen Victoria) and the soldiers who had served in the Crimean War.

·         She was awarded funds in recognition of her work; she used it to establish a teaching institution for nurses at St. Thomas Hospital and King’s College Hospital in London.

·         Within few years, her school began receiving requests to establish new schools at hospitals worldwide. Florence Nightingale reputation as the founder of modern nursing was established.

·         She devoted her life to some social issues and causes in attempt to create social change. She continued to concentrate on army sanitation reform, and functions of army hospitals, sanitation in India and sanitations and healthcare of the poor in England.

·         June 1869 to June 1870, Nightingale’s Writings: 1. Notes on Matters affecting the Health, Efficiency, and Hospital Administration of the British Army, 2. Notes on Hospitals, 3. Report on Measures Adopted for Sanitary Improvements in India.

·         Shortly after returning to England, she was confined to her residence, citing her continued ill health.
·         August 13 1910 with an age of 90, Florence Nightingale died in her sleep.

Environmental Theory

a.        Define nursing as “What nursing has to do… is to put the patient in the best condition for nature to act upon him. Nursing ought to signify the proper use of fresh air, light, warmth. Cleanliness, quiet, and proper selection and administration of diet.

1.       Human Beings- humans in relations to the environment and the impact of the environment on them.

2.       Environment- physical environment focusing on ventilation, warmth, noise, light and cleanliness.

3.       Health- pathology teaches the harm disease has done: Health is positive; pathology is negative.

4.       Disease is a reparative process or nature’s way to remedy a process of poisoning or decay.

b.      Her theory focused on the control of the environment of individuals needing nursing care

Ø  Air

Ø  Health of houses

Ø  Ventilation and warming

Ø  Light

Ø  Minimal noise

Ø  Cleanliness

Ø  Appropriate nutrition

Ø  Variety

Ø  Beddings

Ø  Chattering hopes

c.       Goal of Nursing: to assist client to stay in balance; to decrease the unnecessary energy expenditure.

d.      Nursing Action: manipulate environment to compensate for client’s response to it.

MAJOR ASSUMPTIONS

Nursing:

Is having the responsibility for someone’s health. On her writing “Note’s on Nursing” provided guidelines on how to provide nursing care and how a nurse should think.

Person:

Is a patient needed to enhance the development of the recovery and this patient have the preferences. However, Nightingale gave emphasis on nurses as was in control of the patient environment.

Health:

Is being well and able to use the power to the fullest. Nightingale envisioned the environmental control to maintain health and prevention of diseases through her environmental theory.

Environment:

“Those elements external to and which affect the health of the sick and healthy person. Everything from the patient food and flowers to the patient’s verbal and nonverbal interactions with the patient.”

CRITIQUE

Simplicity

                The theory is simple. In Nightingales theory, there are three major relationships. 1. Environment to nurse, 2. Nurse to environment, and 3. Nurse to patient. Nightingale believes that the environment is a big factor in creating disease while the disease is the reaction to the person based on the environment. So Nightingale emphasized the importance of environment in preventing disease. Preventing diseases through the manipulation of environment and to enhance the recovery of a person. There is no proof that Nightingale intended to develop a theory but it is clear that nightingale intended to give meaning in science and art of nursing and to provide general rules for nursing care improvement for the patient.

Generality

                Nightingales theory remains relevant and the universality and timelessness also remains pertinent. Nightingale concept about the relationship of nurse to patient and importance of environment for the person recovery remain applicable today. These meet the criterion of generality.

Empirical Precision

                Concepts and relationships within Nightingale’s theory are frequently stated implicitly and are presented as truths rather than tentative, testable statements. She also suggests a role of qualitative and phenomenological research methodology in nursing as she were addressing the development of the art of nursing.

Derivable Consequences

                By Nightingales writings, with an unexpected, her writings directed the nurse to action on behalf of the relationship of nurse to patient. This directive encompasses the areas of practice, research and education. She viewed nursing as a divine calling as being a nurse is doing the will of God. On her environmental manipulation and psychological care of patient is applicable in contemporary nursing settings. 

References:

Nursing Theorist and Their Work by Ann Marriner Tomey and Martha Raile Alligood, 5^th Edition