FLORENCE NIGHTINGALE
Biography
➢ Born in May 12, 1820 in Florence, Italy
➢ Nursing Education: trained in Kaiser
Werth, Germany at a Protestant
religious community with a hospital
and after 3 months she was declared
trained as a nurse (1851).
➢ One day she visited a hospital and
that CHANGED HER LIFE
Defined Nursing as: “the act of utilizing the
environment of the patient to assist him
in his recovery”, that involves the nurse's
initiative to configure environmental
settings appropriate for the gradual
restoration of the patient's health, and
those external factors associated with the
patient's surroundings affect life or
biologic and physiologic processes, and his
development.
Hospitals in 1830’s
o Often people who went into hospital
died
o They were Dirty
o Badly run
o Nurses didn’t know what to do
Turned down several offers of marriage to
pursue her career.
o Harry Nicholson
o Richard Monckton Milnes
o Harry Verney
Crimean War
o Broke out when Florence was 34 years
old
o War Russia vs Turkey (Britain and
France)
o Reports were coming through about
terrible conditions in hospitals
o Florence left London with 38 nurses
o Scutari Barrack Hospital
➢ Mortality rate at the hospital was
42.7% of those treated
➢ Mortality rate dropped to 2.2%
o She got to work
➢ Scrubbed the floors
➢ Cleaned the wards
➢ Washed the bedclothes
➢ Made the men comfortable
o In the night she carried a lamp, so she
was called “The Lady with the Lamp”
o Soldiers kissed her shadow
Letter from Queen Victoria
Thanking “Miss Nightingale
and her ladies” for all their
hard work.
Notes on Nursing: What it is and What it is Not
was a book first published by Florence
Nightingale in 1859.
o On the purpose of nursing.” …the
proper use of fresh air, light, warmth,
cleanliness, quiet, and the proper
selection and administration of
diet- all at the least expenseof vital
power to the patient”
o On the empowering partnership with
clients in the community.” “We must
not talk tothem or at them but with
them”
Assumptions of Florence Nightingale’s
Theory:
1. Law – “thoughts of God”
➢ This is reflective of Nightingale’s
profound belief in God. She
defined a law as“the thought of
God” and discussed the
predictability of nature.
2. Natural laws
➢ Natural Laws are universal
natural laws that govern the
ways in which theworld works.
3. Mankind can achieve perfection
➢ Mankind can achieve
perfection relates to her
strongly held beliefs in self-
determination, in self-
realization, and that ultimately,
mankind does seek self-
perfection, which means
perfect health. The route to
perfection is through strict
adherence to the natural laws.
➢ The role of the nurse was to
alter the environment in such
a way as to obey the natural
laws, and thus provide the
environment in which
perfection mightbe achieved.
4. Nursing is a calling
➢ She defined a calling as doing
work in such a way as to do what
is right andbest.
➢ Nursing work is to be done with
enthusiasm and is so important
it should be thought of as a
religious vow.
5. Nursing is an art and a science Environment - concepts of ventilation,
➢ By identifying nursing as warmth, light, diet, cleanliness and noise.
having components of art and o She focused on the physical aspects
science, she provides the of the environment.
profession with the o She believed that "Healthy
expectation that nursing will surroundings were necessary for
be practiced by educated proper nursing care."
individuals using current o She stated that “Nursing is an act of
research and methods as well utilizing the environment of the
as compassion and common patient to assist him in his recovery”
logic.
6. Nursing is achieved through
environmental alteration
➢ Environmental alteration-see
canons (which are laws or rules).
Nightingale’s Canons Major
Concept
Ventilation and warning
Light, noise
Health of houses Physical
Bed and bedding Environment
Personal cleanliness
Chattering hopes and
advices
Taking food Psychological
environment
Petty Nutrition
management/observation status

Nursing care
plan & 5 Essential Components of a Healthy Environment:
management
7. Nursing requires a specific educational
base
➢ Nursing cannot be taught by books
alone. Nurses need a combination of
clinical and theoretical training.
8. Nursing is distinct and separate from
medicine
➢ Although the physician and nurse
my deal with the same population,
nursing is not to be viewed as
subservient to medicine, as the
purposes of the two are distinctly
different.
➢ Nursing’s focus is on caring through
environmental alteration, whereas
medicine’s focus is cure of the
disease.
➢ Nursing and medicine are most
effective when working in a
collaborative manner.
ENVIRONMENTAL THEORY: Major Concepts
and Definitions
1. Pure fresh air - "to keep the air he
breathes as pure as the external air
without chillinghim. “
2. Pure water - "well water of a very
impure kind is used for domestic
purposes. Andwhen epidemic disease
shows itself, persons using such
water are almost sure tosuffer. “
3. 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."
4. Cleanliness - "the greater part of nursing
consists in preserving cleanliness. “
5. Light (especially direct sunlight) -
"the usefulness of light in treating
disease is veryimportant. “
▪ Any deficiency in one or more of
these factors could lead to
impaired functioning of life
processes or diminished health
status.
▪ The factors posed great
significance during Nightingale's
time, when health institutions
had poor sanitation, and health
workers had little education and
training and were frequently
 incompetent and unreliable in
attending to the needs of the
patients.
FIVE MAJOR COMPONENTS OF A HEALING
ENVIRONMENT
1. Ventilation
2. Light
3. Warmth
4. Control noise
5. Control odor
▪ Also emphasized in her
environmental theory is the
provision of a quiet or noise-free
and warm environment,
attending to patient's dietary
needs by assessment,
documentation of time of food
intake, and evaluating its effects
on the patient.
▪ Nightingale's theory was shown to NITHANGLE’S NURSING METAPARADIGM
be applicable during the Crimean Nursing
War when she, along with other
nurses she had trained, took
care of injured soldiers by
attending to their immediate
needs, when communicable
diseases and rapid spread of
infections were rampant in this
early period in the development
of disease-capable medicines.
▪ The practice of environment
configuration according to
patient's health or disease
condition is still applied today,
in such cases as patients
infected with Clostridium
tetani (suffering from tetanus),
who need minimal noise to calm
them and a quiet environment
to prevent seizure-causing
stimulus.
Concerns of Environmental Theory
Person
o Proper ventilation focuses on
the architectural aspect of the
hospital.
o Light has quite as real and
tangible effects to the body.
Her nursing intervention
includes direct exposure to
sunlight.
o Cleanliness and sanitation. She
assumes that dirty
environment was the source of
infection and rejected the
"germ theory". Her nursing Health
interventions focus on proper
handling and disposal of bodily
secretions and sewage,
frequent bathing for patients
and nurses, clean clothing and
handwashing.
o Warmth, diet and quiet
environment. She introduced
the manipulation of the
environment for patient's
adaptation such as fire,
opening the windows and
repositioning the room
seasonally, etc.
o Unnecessary noise is not healthy
for recuperating patients.
o Dietary intake.
o Petty management proposed
the avoidance of psychological
harm, no upsetting news.
Strictly war issues and concerns
should not be discussed inside
the hospital. She includes the
use of small pets of
psychological therapy.
• 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. They can
be done by anyone."
• Major component of nursing:
manipulation of physical
environment
• Nursing “ought to signify the
proper use of fresh air, light,
warmth, cleanliness, quiet, and
the proper selection and
administration of diet – all at
the least expense of vital power
to the patient.”
• People are multidimensional,
composed of biological,
psychological, social and spiritual
components.
• The patient is the focus of the
environmental theory. The nurse
should perform the task for the
patient and control the
environment for easy recovery. She
practices nurse-patient passive
relationship.
• Health is “not only to be well,
but to be able to use well every
power we have”.
• A healthy body can
 recuperate and undergo
reparative process.
• Disease is
considered as
diseases or
the absence
of comfort.
• balance
between human and his/her
environment
• being well and using every power
(resource) to the fullest extent in
living life
• disease and illness – reparative
process that nature instituted
when a person did not attend to
health concerns
• health maintenance through
prevention of disease via
environmental control and social
responsibility
Environment
• 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.
• F. N. synthesized immediate
knowledge of disease with the
existing sanitary conditions in
the environment.
Major areas of environment that can be
controlled by the nurse:
health of houses
• presence of pure air
• pure water
• efficient drainage
light
• light
• direct sunlight
• purifying effect of direct sunlight
upon room air
ventilation and warming
• breathe air that is as pure as
external air; without chilling
• source of the air in the patient’s
room
• proper room temperature
• patient’s body temperature
noise
• can harm the patient
bed and bedding
• Bed should be placed in the lightest
part of the room and placed so the
patient could see out a window.
• Care giver should never lean
against, sit upon, or unnecessarily
shake the bed of a patient.
• clean, neat, and dry
• positioning the patient for
maximum comfort
variety
• need for changing color and form
• reading, needlework, writing and
cleaning as activities to relieve
boredom
cleanliness
• personal (patient, nurse)
• physical environment
• dirty environment as source of
infection
nutrition
• dietary intake
• variety of food
• no distraction while eating
• right food brought at the right time
chattering hopes and advices
• False hope can be depressing.
• Heed what is being said; sick persons
should hear good news.
Logical Form
o She used inductive reasoning
from her experiences and
observation which is addressed
with logical thinking and
philosophy.
Importance of Environmental Theory
1. Practice
➢ Disease control
➢ Sanitation and water treatment
➢ Utilized modern architecture
in the prevention of "sick
building syndrome"applying the
principles of ventilation and
good lighting.
➢ Waste disposal
➢ Control of room temperature.
➢ Noise management.
2. Education
➢ Principles of nursing training.
Better practice result from better
education.
➢ Skills measurement through
licensing by the use of testing
methods, the casestudies.
3. Research
➢ Use of graphical representations
like the polar diagrams.
➢ Notes on nursing.
4. Critique
➢ Simplicity – simple and logical;
tends toward description and
explanation rather than
 prediction
➢ Generality – provides general
guidelines for all nurses
➢ Empirical Precision – Little or no
provision is made for empirical
examination; individual
observation rather than
systematic research
➢ Derivable Consequences – to
extraordinary degree, direct the
nurse to action on behalf of
patient and herself; These
directives encompass the
areas ofpractice, research and
education