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Environmental Theory,Florence Nightingale

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 BAHIRDAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCE

DEPARTMENT OF PEDITRICS AND CHILD HEALTH NURSING

THEORTICAL FOUNDATION OF NURSING THEORY PRESENTATION

SUMBITTED TO: GEBRE YITAYIH (BSc, MSc, ASSISTANT PROF, PHD

FELLOW)

BAHIRDAR, ETHIOPIA
JANUARY 2020

2/11/2020 1
Environmental Nursing Theory
of Florence Nightingale
Presenter :Ayichew Alemu( BSCN)

2/11/2020 2
 Learning objectives

At the end of this discussion the learners will able to:

 Define what is Theory and Nursing theory
Explain Environmental Nursing Theory
of Florence Nightingale
 Explain Major Concepts and Definitions
Explain Importance of the theory
List Principle of the theory
State Major Assumptions
Describe Metaparadigm in Nursing
discuss Application of the theory
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Presentation outline
 Back ground of Florence Nightingale
 Introduction
 Major Concepts and Definitions
 Importance of the theory
 Principle of the theory
 Major Assumptions
 Metaparadigm in Nursing
 Application of the theory
 Case scenario
 Acknowledgment
 References

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 GROUP MEMBERS
NAME ID
AYICHEW ALEMU--------------BDU1207021
GASHAW KEREBIH ------------BDU1207025
HABTAMU DINKU --------------BDU1207026
MAHILET TAMIRAT -----------BDU1207027
MOLLA AZMERAW ----------- BDU1207029
SILENAT MULUKEN -----------BDU1207030
ZENEBE JEBERO -----------BDU1207033

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 introduction
Theory :

 set of concepts, definitions, and propositions that projects a

systematic view of phenomena by designating specific inter

relationships among concepts for purposes of describing,

explaining, predicting, and/or controlling phenomena (Chinn

& Jacobs, 1987).

 creative and rigorous structuring of ideas that projects a

tentative, purposeful, and systematic view of phenomena

(Chinn & Kramer, 2004).

2/11/2020 6
 Cont..

Nursing theory :

 a conceptualization of some aspect of reality (invented or

discovered) that pertains to nursing.

 The conceptualization is articulated for the purpose of

describing, explaining, predicting, or prescribing nursing
care (Meleis, 1997).

2/11/2020 7
 Cont..

Nursing theory:
 an inductively and/or deductively derived collage of
coherent, creative, and focused nursing phenomena that
frame, give meaning to, and help explain specific and
selective aspects of nursing research and practice(Silva,
1997).

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Florence Nightingale, from May
12,1820-August13,1910

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The goal of nursing is
“to put the patient in the
best Condition for nature
to act upon him”.
(Nightingale)

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 Background Of The Florence Nightingale
Florence Nightingale, was born on May 12,1820,
in Florence, Italy
 the founder of modern nursing
 the first nursing theorist.
 Privately educated by father
 Inclined to care for sick

2/11/2020 11
 Cont..

In 1837, when she was 17

She visited sick people at
their homes
She had other ideas and
travelled to look hospitals

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 Cont..

 Florence announced her decision to enter

nursing in 1844.
 She attended nursing programs in Kaiser Werth,
Germany in 1850 and 1851.

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 Cont..
 She worked as the Nursing super intendent at
the Institution for care of sick gentlewomen in
distressed circumstances.
 Begin the Nightingale school of nursing at
St. Thomas hospital, King’s College in London

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 Books
 Notes on Nursing: What it is, what it is not (1860)

 Notes on hospitals (1863)

 Sick-Nursing and Health-Nursing (1893)

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 Crimean War
In 1854 the Crimean War broke out – England
was at war with Russia

People in England heard that soldiers in hospitals

were poorly treated.

Florence was invited to take a group of female

nurses to work in hospitals in the Crimea.

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 Cont..

Her work proved successful in decreasing

the mortality rate in the war.

 “ Lady with the lamp“

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 Cont..
She believed that "Healthy surroundings were
necessary for proper nursing care.“
On 1854, she and a staff of 38 women volunteer
nurses, trained by Nightingale were sent.
She insisted that soldiers be:
- bathed
- their wounds dressed
- unspoiled food be fed to the sick
- A pure water supply was established.
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 Generally
Known for

-Pioneering modern nursing

Profession

-Nurse and Statistician

Specialism

Hospital hygiene and sanitation

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 Cont..
 She changed hospitals all over the world.

 Nursing became a respected profession

because of her.

 museum in London which celebrates her

life and work

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 MORTAL IS INVITABLE

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 Introduction Of
Nightingale’s Theory
 The foundation of nightingale's theory is the
environmental Nursing theory which says
all external conditions and forces can influence
the life and development of an organism
 According her, external influences and
conditions can prevent, suppress or contribute
to disease or death.
 Her goal was to help the patient retain his/ her
own vitality by meeting his/ her basic needs
through control of the environment .

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 Cont..
Nightingale found that open sewers and lack of
- cleanliness
- pure water
- fresh air
- wholesome food
She think that more often the cause of
soldier’s death than their wounds
she implemented changes to address these
problems.
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 Major Concepts and definition Florence
Nightingales Theory
Nursing:“ defines nursing as it is to put
the patient in the best condition for nature
to act upon him”
Human Beings: Human beings are not
defined by Nightingale specifically. They
are defined in relation to their
environment and the impact of the
environment upon them.
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 Cont..
Environment: The physical environment is
stressed by Nightingale in her writing.
In her theory, Nightingale’s writings reflect a
community health model in which all that
surrounds human beings is considered in
relation to their state of health.

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 Health

She believed that nursing should provide care to

the healthy as well as the ill and discussed health
promotion as an activity in which nurses should
engage.

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 Sub concepts of the Environmental Theory

Health of Houses:
Badly constructed houses do for the healthy what
badly constructed hospitals do for the sick. Once
ensure that the air is stagnant and sickness is
certain to follow.”
Ventilation and Warming:
”Nightingale believed that the person who
repeatedly breathed his or her own air would
become sick or remain sick.
 She was very concerned about “noxious air” and
foul odors that came from excrement.
2/11/2020 27
 Cont..
 The importance of room temperature was
also stressed by Nightingale.
 The patient should not be too warm or too
cold.
 The temperature could be controlled by an
appropriate balance between burning fires and
ventilation from windows.

2/11/2020 28
 Cont..
Light: Nightingale believed that second to fresh
air, the sick needed light.
She noted that direct sunlight was what
patients wanted.
Noise: She stated that patients should never be
“walked intentionally” or accidentally during
the first part of sleep. She asserted that
whispered or long conversations about patients
are thoughtless and cruel.
She viewed unnecessary noise, including noise
from female dress, as cruel and irritating to the
patient.
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 Cont..
Bed and Bedding: Nightingale noted that an adult
in health exhales about three pints of moisture
through the lungs and skin in a 24-hour period.
This organic matter enters the sheets and stays
there unless the bedding is changed and aired
frequently.
Personal Cleanliness:“Just as it is necessary to
renew the air round a sick person frequently to
carry off morbid effluvia from the lungs and skin,
by maintaining free ventilation.
 so it is necessary to keep pores of the skin free
from all obstructing excretions.”
2/11/2020 30
 Cont..
Nutrition and Taking Food: she noted that
individuals desire different foods at different
times of the day.And frequent small servings
may be more beneficial to the patient than a
large breakfast or dinner.
Chattering Hopes and Advice: she wrote that
to falsely cheer the sick by making light of their
illness and its danger is not helpful. She
encouraged the nurse to heed what is being said
by visitors, believing that sick persons should
hear the good news that would assist them in
becoming healthier.
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 Environmental Factors
she identified five (5) environmental factors:
Pure fresh air – “to keep the air he breathes
as pure as the external air without chilling
him.”
Pure water – “well water of a very impure
kind is used for domestic purposes. And
when epidemic disease shows itself, persons
using such water are almost sure to suffer.”

2/11/2020 32
 Cont..
Effective drainage – “all the while the sewer
maybe nothing but a laboratory from which
epidemic disease and ill health is being
installed into the house.”
Cleanliness – “the greater part of nursing
consists in preserving cleanliness.”
Light (especially direct sunlight) – “the
usefulness of light in treating disease is very
important.”
Deficiencies in these five factors produce
illness or lack of health, but with a nurturing
environment, the body could repair itself.
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 Importance of the Enviromental theory

 clearly describes the environment and its

essential elements; fresh air, clean water,
proper sanitation, cleanness and light.
considers illness as imbalance in these
essential elements and believes that
manipulation in environment makes client
prone for acting of nature.

2/11/2020 34
 Cont..
Nightingale was aware of germ theory and the
role of hygiene in infection control.
emphasis on the proper disposal of excreta .
Noise management
Control of room temperature

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

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1. VENTILATION AND WARMTH:
Keeping 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.

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

2/11/2020 38
 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.
4. Noise:
Avoidance of sudden/startling noises.
Keeping noise in general to a minimum.
Refrain from whispering outside the
door.
2/11/2020 39
 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 know as
diversional therapy)
 Encourage significant others to engage with
the client.

2/11/2020 40
 6. FOOD INTAKE:
Assess the diet of the client.
 Documentation of amount of foods and liquids
ingested at every meal.
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.

2/11/2020 41
 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.

2/11/2020 42
 9. LIGHT:
 Assess the room for adequate light.
 Sunlight works best.
 Develop and implement adequate light
without placing the client in direct light.
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)
2/11/2020 43
 11. PERSONAL CLEANLINESS:
Keeping the patient clean and dry at all times
request assessment of client’s skin is needed to
maintain adequate moisture.
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.
2/11/2020 44
 13. OBSERVATION OF THE SICK:

 Making and documenting observations.

 Continue to observe the client’s surrounding
environment.

2/11/2020 45
 Cont..

2/11/2020 46
 Assumptions of the nightingale
environmental theory

Nursing is separate from medicine.

Nurses should be trained.
The environment is important to the health of the
patient.
The disease process is not important to nursing.
Nursing should support the environment to assist the
patient in healing.
Research should be utilized through observation and
empirics to define the nursing discipline
2/11/2020 47
 Cont..
Nursing is both an empirical science and an
art.
Nursing’s concern is with the person in the
environment.
The person is interacting with the
environment.
The nurse should be observant and
confidential.
People can control the outcomes of their lives
to pursue perfect health.
2/11/2020 48
 METAPARADIGMS OF NURSING ACCORDING
TO NIGHTINGALE:
There are four meta paradigms:

2/11/2020 49
 Person
a patient /Recipient of nursing care.
 each patient as an individual
 People are multidimensional, composed of
- biological
- psychological
- social
- spiritual components.

2/11/2020 50
 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.

2/11/2020 51
 Health
 being well and using every power (resource) to
the fullest extent in living life.
 Nightingale envisioned the maintenance of
health through prevention of disease via
environmental control and social responsibility.
 What she described led to public health
nursing and the more modern concept of health
promotion.

2/11/2020 52
 Nursing
Nursing to nightingale was above all, “Service
to God in the relief of man”
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.

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 Application Nightingale’s Enviromental Theory
to colostomy care ,Case Senario)
Patient: Mrs. X with post op ,infected
colostomy.
Patient was operated for intestinal obstruction
due to colonic cancer her daughter was her
supporter.
MRS X was a widow her husband was dead 6
years back.

2/11/2020 54
 Con..
Patient was extremely pale with septic wound;
colostomy bag was not covered properly rather it
was covered by plastic bag at the surgical repair
clinic in x hospital .
Entire skin of abdomen was red and lacerated on
examination
she was febrile with 38.8oc temperature ,Blood
Pressure was 90/70 and pulse was 99/min and her
weight was 44 kg. lab findings were hemoglobin
8.5 with moderately leukocytosis.
2/11/2020 55
 Con..
During history taking patient attendant told
that they live in a small house
patient room was also shared by 5 children
mother in law and two Cattles.
 Patient economically poor living ,the family
income was by selling tela
on previous medical history there was
intestinal infestation they were used to drink
water from nearby the toilet.

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Person Mrs. X is in need of nursing care
through nature reparative process.
 Our goal is to promote nature in the process
with application of nightingale theory with
nursing process model.

2/11/2020 57
 1. Assessment of Physical Environment :

 room was over crowded and shared by domestic

cattles.
used well water and use nearby field for toileting
purpose which is the worse form of sanitation and
most common Cause of contamination of water
which leads to gastro enteric pathology .

2/11/2020 58
 Cont…
Currently Mrs. x is lying on bed in surgical unit
with a colostomy bag not appropriately attached
rather over tied by a plastic shopping bag.
The leakages of feces contents badly infected the
stoma and lacerate the abdominal skin.
2. Nursing Diagnosis : Infection related to the
contamination of the wound with feces
Impaired Skin Integrity related to skin contamination
with feces
3. Planning: she will be free from any signs and
symptoms of infection and the skin integrity will be
maintained .
2/11/2020 59
 4.Interventions:
It is planed that:-
Mrs. x and her attendant will be fully educate
regarding importance and methods of cleaning
drinking water.
Proper disposal for house excreta and source of
social aid will be searched for financial support
to Mrs. x in this connection.
Mrs. X Was provided a side room in the unit.
Her stoma was cleaned with antiseptics and
colostomy bag was appropriately applied.
2/11/2020 60
 Cont…
The surrounding skin was washed with saline
and soothing anti-infective ointment was
applied.
A pad (gauze) putted to absorb the flow of feces
Demonstration regarding stoma care and
change of bag provided to patient.
Room windows were kept open for ventilation.
Prescribed medication were given.

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 Assessment of Psychological Environment

Mrs. X was very much anxious regarding her

health and kids as she is a widow and have
financial Burdon as well as she is feeling little bit
and limited approaches to local resources currently.
She has problem to adapt to new life style with
stoma and have difficulty in falling asleep due to
fear of opening bag during sleep time.

2/11/2020 62
 Cont..
Nursing Diagnoses: Anxiety related to fear of
isolation from society
 Disturbed Sleep Pattern related to the fear of
the state of the stoma
Planning; she will be free from any fear related
to the wound and social isolation and to
maintain the sleep pattern in her circadian
rhythm.

2/11/2020 63
 Cont..
Nursing Intervention : Mrs. X was reassured that she will
soon adopt to society. Her special deserving case in
financial terms was forwarded to hospital administration
for free treatment and a social worker of the hospital
contacted to help her in easing financial burden.
Environmental factors were evaluated to avoid
disturbance in her sleep.
Her visitors were informed regarding importance of rest
and sleep in her recovery they were counseled to
minimize rush in sleeping hours and avoid unnecessary
interruption in the room environment of Mrs. x.
 Mrs. X was explained that her stoma bag will not open
during sleep as it is closed mechanically.

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 Assessment of Nutritional Status

Mrs. x was underweight she lost weight

significantly in the last three weeks.
Due to fear of colostomy problem she was
afraid of eating as according to her attendant
she avoids eating as after eating she develops
empting problem.
Nursing diagnosis: Imbalanced Nutrition Less
Than Body Requirements related to ignorance
against the needs of food as evidenced by wt
loos.
2/11/2020 65
 Cont..
Interventions:
 Adequate nutrition was provided: containing
foods rich in nutritious values and less in
gastro enteric troubles.
Client was motivated for eating and reassured
not spare food due to fear of causing trouble.

2/11/2020 66
 Cont..

her attendant was demonstrated and trained regarding

colostomy dressing, cleanness of stoma with antiseptic
moisturizing medication, patient diet need and variety
along with observation of skin color near stoma was
explained in detail and searching for any financial
support for colostomy belt.
Beside systematic care given through nursing process
under the influence of nightingale theoretical stance her
remaining canon are related to observation of patient
condition and petty management which focus on
continuity of care. In case of Mrs.

2/11/2020 67
 Outcomes of Care Plan
Successful attainment of care out comes achieved by
application of nightingale theory to nursing process of
Mrs. X.
As patient verbalize sign of improvement are evident
on skin around stoma, client demonstrate behavior
regarding health promotion and prevention of skin
breakdown complications.
Weight is maintaining and demonstrates progression
in weight gaining.
Patient Report increased feeling rested and senses of
wellbeing she also verbalizes better sleep and rest
comparatively and less disturbance.
2/11/2020 68
 Conclusion

 The condition required effective nursing care and Florence

nightingale theory is very appropriate for application to the
care of such patients, beside the fact that theory is more
than a century old it is still alive, easy to applicate in the
fundamental undertaking of nursing interventions.

2/11/2020 69
Acknowledgment
We would like to express our heart felt thanks to
our instructor Gebre Yitayih (Bsc, Msc,
Assistant Prof, Phd Fellow) who provides us
this assignment so that we thoroughly search
and read about it and gain knowledge which
helps us for future teaching –learning process.

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 REFERENCES
1. Boykin, A., & Schoenhofer, S. (2001). Nursing as caring:
A model for transforming practice. New York: Jones and
Bartlett, National League for Nursing Press.
2. National League for Nursing Press.Carper, B. (1978).
Fundamental patterns of knowing in nursing.Advances
in Nursing Science, 1(1), 13–24.
3. Daniels, L. (1998). Vulnerability as a key to authenticity.
Image:Journal of Nursing Scholarship, 30(2), 191–192.

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 THANK
YOU

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