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Florence Nightingale's Environmental Theory

Bruce Chesson

School of Nursing, Purdue University Global

MN502: Theoretical Foundations of Advanced Nursing Practice

Dr. Hannah Binding

June 11, 2024

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Florence Nightingale's Environmental Theory

I have chosen to write my assignment about Florence Nightingale and her theory of

environmental nursing. She, of course, is the mother of modern-day nursing (Dumitrascu et al.,

2020). Who better to write about? Putting myself in her situation has been an exciting

experience. It has also given me insight into her thoughts during this extreme time. This

assignment will discuss how she came up with her theory, the concepts that make up the theory,

and the testing in evaluating the theory. Without further ado, I present this short autobiography

of Florence Nightingale:

I, Florence Nightingale, witnessed horrible atrocities in the Crimean War of 1853. This

war, undoubtedly sparked by men's hubris, began when Russia invaded the Ottoman Empire on

the Crimean Peninsula. The original conflict was fueled by the Ottoman Empire’s weakening

power and religious and geopolitical tensions with Russia. Russia sought to expand its territory

by controlling the Black Sea. However, Great Britain, France, and the Ottoman Empire would

soon ally to deter Russian forces. By 1854, France and Great Britain occupied Crimea, a Russian

peninsula on the Black Sea's north side. That is where my story begins.

Theorizing the Environmental Theory

There had been a public outcry when British citizens discovered the deplorable

conditions in which soldiers were fighting in Crimea. The Queen and the British Parliament

required a response. The secretary of the war and a close friend of mine, Sidney Herbert, reached

out to me personally to form a solution to this madness. She knew of my passion for helping

others. She knew of my expertise within the hospital setting and requested that I create a team to

tend to the soldiers and their desperate situation in Crimea. Before I knew it, I had 38 volunteers,

many nuns, prepared to sail from London to Istanbul. From there, we traveled to Scutari, the
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hospital barracks in Crimea. This trip, in and of itself, was a harrowing experience (McEwen &

Wills, 2018). What took place there would one day be far more critical than I could have

imagined. This is why it is so important that I write this autobiography; it is where the foundation

of modern-day nursing was born.

When my team arrived, we were greeted by an old, decrepit, seemingly abandoned

building left unattended for years in communist Russia. Now, though, it was packed to the gills

with wounded and dying soldiers, victims of this senseless and brutal war. Broken windows,

dust, mold and mildew, trash strewn about, poor ventilation, and little sunlight were just a few

things we saw when we got there. We immediately began cleaning the barracks. Soldiers could

not be tended to in these conditions. We organized beds, cleaned the walls and floors, and

situated the doors and windows to allow sunlight and proper ventilation. We also had to find a

way to displace some soldiers to another barracks. This one had too many people in it. This is

where the actual theorizing began for me. I started to put together the elements of what would

come to be known as the “environmental theory.”

Syntax

It was in these conditions that I began to think about the concepts that make up the care

that we were giving: concepts such as sunlight, good ventilation and air movement, clean

surroundings, and a clean place to prepare healthy food. Other significant concepts that became

readily apparent were proper regular hygiene, excellent nutrition, and quietness. If soldiers could

have all of the above concepts as fixtures in their daily lives, then we would have the best chance

of helping them to gain a meaningful recovery.

Some of the soldiers we saw had been brutally wounded by gunshots or shrapnel. Many

of them were in danger of losing limbs or had already lost a limb due to blunt trauma or
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subsequent infection from an injury. Because of this, it was imperative that their surroundings be

clean and that the supplies we had to care for them were also clean. As one might imagine, quite

a bit of wound care occurred in these barracks. The Crimean War was quite bloody, so our

efforts here in Scutari were crucial. We worked closely with the soldiers we cared for to monitor

them constantly. If one needed tending to, we were at their bedside within seconds. We had

arranged the barracks for optimal movement of nurses and patients throughout, another concept

of mine that would soon be used in hospitals and outpatient settings worldwide (Gregory et al.,

2022). This was very helpful for those soldiers who were in critical condition. This was

genuinely patient-centered care. These soldiers being cared for were the most influential people

in the whole world to us at that time. Looking back, our efforts in treating these soldiers

positively affected the war significantly.

Testing Environmental Theory

The proof was in the pudding when this theory was tested. When we arrived in Crimea,

thousands of soldiers died from blunt trauma or infections caused by injuries. (What would come

to be known as) gangrene, bacteremia, sepsis, and septic shock were all common forms of death.

Many of the soldiers that we care for would have died had we not been there. Due to our efforts,

most of the patients cared for in Scutari were saved. The physicians we worked alongside had

been working with dirty instruments and supplies until we arrived. This undoubtedly caused

many soldiers to die that they otherwise would not have. This was before what was known as the

“germ theory” at the time. Although I did not subscribe to this theory, keeping clean instruments

and supplies was crucial to warding off infection (McEwen & Wills, 2018). Once we began

scrubbing instruments before and after use, infections decreased. Infection rates also reduced as
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we started using clean gauze and dressings. Surgical site infections became few and far between.

This concept will eventually be heavily focused on in modern medicine (Rana, 2020).

Soldiers also appreciated the clean air and sunlight. If you’ve ever been cooped up in a

single room with no ventilation and only fluorescent lighting, you know what that is like. It

becomes depressing and wears on your mental state. Everyone needs clean air and sunlight, and

soldiers are no different. They have an increased need for sunlight and fresh air because of their

weakened condition. Having good ventilation and sunlight brought hope and motivation to the

soldiers. It helped inspire them that they could recover and get back home to their families. This

was one of the most rewarding parts of caring for these patients. It was indeed an honor.

Evaluation

When my team could finally pack up and return to our families, I had time to think about

what we had just been through. It was a traumatic situation, to be sure. We needed time to

recover and reflect on ourselves. Once that was done, I could evaluate further what had happened

there. We did our best with what we had and developed some usable concepts that would be

applied worldwide. Of course, our work there would be known later as where nursing began. Our

work, and I say “our” because it was indeed a team effort in Scutari, would also eventually give

way to what came to be known as the clinical nurse specialist, a type of advanced practice nurse

who is a clinical expert and an educator (Matthews et al., 2020).

Environmental theory was the first nursing theory and the birth of nursing. This will

come to be used worldwide. Each reference in this assignment is based on this theory and has

been used in research and as a foundation of middle-range and practice-specific theories. Also,

this theory will continue to be used in patient care settings worldwide as time continues. Her

theory was used directly by researchers during the COVID-19 pandemic to structure
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environments for the highest quality patient care (Gregory et al., 2022). How will this theory

continue to shape our healthcare landscape in the future? It will be interesting to see.
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References

Dumitrașcu, D. I., David, L., Dumitrașcu, D. L., & Rogozea, L. (2020). Florence nightingale

bicentennial: 1820-2020. her contributions to health care improvement. Medicine and

pharmacy reports, 93(4), 428–430. Retrieved June 10, 2024, from

https://doi.org/10.15386/mpr-1799

Gregory, D. D., Stichler, J. F., & Zborowsky, T. (2022). Adapting and creating healing

environments: Lessons nurses have learned from the covid-19 pandemic. Nurse leader,

20(2), 201–207. Retrieved June 10, 2024, from https://doi.org/10.1016/j.mnl.2021.10.013

Matthews, J., Whitehead, P., Ward, C., Kyner, M., & Crowder, T. (2020). Florence nightingale:

Visionary for the role of clinical nurse specialist. OJIN: The Online Journal of Issues in

Nursing, 25(2). Retrieved June 10, 2024, from

https://doi.org/10.3912/ojin.vol25no02man01

McEwen, M., & Wills, E. M. (2018). Theoretical basis for nursing (5th ed.). LWW.

Rana, A. (2020). Health in environment: Reduce surgical site infections by applying Florence

nightingale's environmental theory. Journal of the Pakistan Medical Association, 1–8.

Retrieved June 10, 2024, from https://doi.org/10.47391/jpma.896