This presentation is about Florence Nightingale's Environmental Theory of nursing, The environmental model of nursing care and application of Nightingale's theory in Nursing practice.

1. NIGHTINGALE’S
THEORY
Ms. Raksha Yadav
M.Sc. Nursing 1st year
AIIMS Rishikesh

2. SEMINAR OUTLINE…
 Background of the theorist
 Nightingale’s Theory: Evolution & Introduction
 Nightingale’s Thirteen Canons
 Major concepts of nursing according to Nightingale
 Nightingale’s environmental model
 Analysis of Nightingale’s Environmental model of Nursing
 Nightingale’s Environmental model as a framework for nursing
practice
 The nursing process and Nightingale’s Environmental model
 Research Input

3. BACKGROUND OF THE THEORIST
 The goal of nursing is “to put the
patient in the best condition for nature
to act upon him”.
- Nightingale
 Born- 12 May 1820 in Florence, Italy
 Privately educated by father
 Inclined to care for sick

4.  She attended nursing programs in KaiserWerth,
Germany in 1850 and 1851.
 She worked as the Nursing superintendent at the
Institution for care of sick gentlewomen in distressed
circumstances, where she instituted many changes to
improve patient care.
 Called to Turkey, during Crimean war.
 Her work proved successful in decreasing the mortality
rate in the war.
 Lady with the lamp

5.  Begin the Nightingale school of nursing at St. Thomas
hospital, King’s College in London
 Founder of modern nursing and the first nursing theorist.
 Books:
 Notes on Nursing: What it is, what it is not (1860)
 Notes on hospitals (1863)
 Sick-Nursing and Health-Nursing (1893)
 Died:13th August 1910 in London.

6. EVOLUTION/INTRODUCTION OF
NIGHTINGALE’S THEORY
 Early in her work at the army hospital Scutari,
Nightingale noted that the majority of the
soldier’s deaths was caused by transport to the
hospital and conditions in the hospital itself.

7.  Nightingale found that open sewers and lack of
cleanliness, pure water, fresh air and
wholesome food were more often the cause of
soldier’s death than their wounds; she
implemented changes to address these
problems.

8.  Nightingale instituted a system of care that
reportedly cut causalities from 48% to 2%
within 2 years.
 She adapted a statistical reporting method
known as polar area diagram or Cock’s comb
model, to analyse the data she rigorously
collected.

9. NIGHTINGALE’S THIRTEEN CANONS
1. Ventilation and
warmth
2. Health of houses
3. Petty management
4. Noise
5. Variety
6. Food intake
7. Food
8. Bed and bedding
9. Light
10. Cleanliness of
rooms/walls
11. Personal cleanliness
12. Chattering hopes
and advices
13. Observation of the
sick

10. 1. VENTILATION AND WARMTH:
 Keeping patient, patient’s room warm
 Keeping patient’s room well ventilated and free
of odors.
 Keep the air within as pure as the air external
air/without noxious smells.

11. 2. HEALTH OF HOUSES:
 This canon includes five essentials of- Pure
air, Pure water, Efficient drainage, Cleanliness,
Light
 Examples include:
 removing garbage or standing water
 ensuring clean air and water and free from
odour and that there is plenty of light.

12. 3. PETTY MANAGEMENT:
 Continuity of the care, when the
nurse is absent
 Documentation of the plan of care
and all evaluation will ensure others
give the same care to the client in
your absence.

13. 4. NOISE:
 Avoidance of sudden/startling
noises.
 Keeping noise in general to a
minimum.
 Refrain from whispering outside
the door.

14. 5. VARIETY:
 Provide variety in the patient’s room to help
him/her avoid boredom and depression.
 This is accomplished by cards, flowers,
pictures, books or puzzles (presently known
as diversional therapy)
 Encourage significant others to engage with
the client.

15. 6. FOOD INTAKE:
 Assess the diet of the client.
 Documentation of amount of foods and liquids
ingested at every meal.

16. 7. FOOD:
 Instructions include trying to include
patient’s food preferences.
 Attempt to ensure that the client always has
some food or drink available that he/she
enjoys.

17. 8. BED AND BEDDING:
 Comfort measures related
to keeping the bed dry,
wrinkle-free and at the
lowest height to ensure the
client’s comfort.

18. 9. LIGHT:
 Assess the room for
adequate light.
 Sunlight works best.
 Develop and implement
adequate light without
placing the client in direct
light.

19. 10. CLEANLINESS OF ROOMS/WALLS:
 Assess the room for
dampness, darkness and
dust or mildew.
 Keeping the environment
clean (free from dust, dirt,
mildew and dampness)

20. 11. PERSONAL CLEANLINESS:
 Keeping the patient clean and dry at all
times
 Frequent assessment of client’s skin is
needed to maintain adequate moisture.

21. 12. CHATTERING HOPES AND ADVICES:
 Avoidance of talking without reason or giving
advice that is without fact.
 Continue to talk to the client as a person. And
to stimulate the client’s mind
 Avoid personal talks.

22. 13. OBSERVATION OF THE SICK:
 Making and documenting observations.
 Continue to observe the client’s surrounding
environment.

24. METAPARADIGMS OF NURSING
ACCORDING TO NIGHTINGALE:
There are four metaparadigms:
 Person
 Environment
 Heath
 Nursing

25. Person
 Recipient of nursing care.
 People are multidimensional, composed of biological,
psychological, social and spiritual components.
Environment
 Environment can be external as well as internal.
 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.

26. Health
 For nightingale, health is “not only to be well,
but to be able to use well every power we
have”.
 Disease is considered as dys-ease or the
absence of comfort. [Six D’s of Dys-ease are:
Dirt, Drink (need clean drinking water), Diet,
Damp, Draughts and Drains (need proper
drainage and sewer systems)]

27. Nursing
 Nursing to nightingale was above all, “Service to God
in the relief of man”
 To alter or manage the environment to implement the
natural laws of health.
 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 caregiving
situation.

28. NIGHTINGALE’S ENVIRONMENTAL
MODEL

30. ANALYSIS OF NIGHTINGALE’S
ENVIRONMENTAL MODEL OF NURSING
1. Assumptions:
Philosophical assumptions:
 Nursing is a calling.
 Nursing is both art and science.
 People can control the outcomes of their lives to
pursue perfect health.
 Nursing requires a specific educational base.
 Nursing is distinct and separate from medicine.

31. Additional assumptions:
 Maintaining a clean room, bedding and
clothing aids in patient recovery.
 Noise can be harmful to patients.
 Managing the environment improves the
health of the patient.

32. 2. Propositions:
 The person is desirous of health, so that the
nurse, nature and the person will co-operate;
so that all reparative process occur.
 The nurse’s role is to prevent the reparative
process from being interrupted and to provide
conditions to optimize the reparative process.

33. BRIEF CRITIQUE
 The model is a simple one, characterized by only
three major relationships:
1) Environment to patient
2) Nurse to environment
3) Nurse to patient
 Nightingale’s model was developed inductively
 Major concepts are clearly defined, and the
relationships among the concepts flow logically

34.  She focused more on physical factors than on
psychological needs of patient.
 Although, some of the Nightingale’s rationales have
been modified or disproved by advances in
medicine and science, many of the concepts in her
theory have not only endured but have been used to
provide guidelines for nurses for more than 150
years.
 In particular, her model remains relevant to illness
prevention and health promotion.

35. NIGHTINGALE’S ENVIRONMENTAL MODEL AS A
FRAMEWORK FOR NURSING PRACTICE
 Nightingale expected nurses to use their skills of
observation in caring the patients.
 Nursing observations and documentation should
focus on the assessment of the patient in relation
the 13 canons identified by Nightingale when
nursing care is provided that is framed by
Nightingale’s environment model.

36. THE NURSING PROCESS AND NIGHTINGALE’S
ENVIRONMENTAL MODEL

40. THANK YOU!!