FLORENCE NIGHTINGALE

“ENVIRONMENTAL PHILOSOPHY”

“ Nursing ought to signify

the proper use of fresh air,
light, warmth, cleanliness,
quiet, and proper selection
and administration of diet- all
at least expense of vital
power to the patient”
 Getting to Know

• The matriarch of Modern Nursing

• Born in Florence Italy, on May 12,
1820.
• Provided reputable education
• Unitarian Christian
FLORENCE NIGHTINGALE

• First Nurse Educator

• “The Lady with the Lamp
• Pioneer in the graphic display of
statistics
• First Nurse researcher
• Excellent writer
• A. “The legacy of Caring”
• B. "Notes on Nursing”
She Identified the following aspects as a major areas of
the physical, social, and a psychological environment
that the nurse could control:

• 1. Health of Houses
• -The presence of pure air, pure water,
efficient drainage, cleanliness, and light.
• 2. Ventilation and Warming
• -Nightingale believed that it was essential
to “keep the air he breathes as pure as the
external air, without chilling him.
• 3. Light
• - Seek needs both fresh air and light-direct
sunlight was what the clients wanted.
• -Lack of environmental stimuli like an
isolation rooms, NICU, ICU, etc., can
lead to confusion or intensive care
Psychosis related to the lack of the usual
cycling of day and night.
• 4. Noise
• -patient should never be wake intentionally or accidentally
during the first part of sleep.
• Noise that may irritate patients:
• jewelries worn by nurses
• keys that jingle
• snapping of rubber globes
• radios
• TV’s
• Telephones etc.
• 5. Variety
• -was a critical aspect affecting the
patients recovery
• -advocated rotating 10-12 paintings
• -agreed that mind greatly affects the body
• -also advocated reading, needle working,
writing and cleaning.
• 6. Bed and bedding
• -Nightingale postulated that an adult
exhales about 3 pints of moisture through
the lungs and skin in a 24hr. Period.
• Even in this modern times, it remains
important to keep bedding clean, neat
and dry and to position the patient for
maximum comfort.
• 7. Cleanliness of rooms and walls
• -The greater part of nursing consist in
preserving cleanliness.
• 8. Personal cleanliness
• -unwashed skin poisoned the patient and
noted that bathing and drying the skin
provided great relief to the patient.
• -frequent handwashing.
• 9. Nutrition and taking food
• -addressed the importance of variety in
the food served to patient.
• 10. Chattering hopes and advices
• -She perceived that to falsely cheer the
sick by making light of their illness and
its danger is not helpful.
• 11. Observation of the sick
• The most important practical lesson that
can be given to nurses is to teach them
what to observe, how to observe-what
symptoms indicate improvement, what
is the revere, which are of importance,
which are of none, which are evidence
of neglect, and what kind of neglect.
• 12. Petty management
• - ways to assure that “What you do
when you are there , shall be done
when you are not there”
 CONCEPTS:

• 1. Environment
• -Anything that can be manipulated to place a
patient in the best possible condition for nature
to act.
• Two Components:
• A. PHYSIAL COMPONENTS:
• -refers to ventilation, warmth, light , nutrition,
medicine, stimulation, room temperature and
activity.
TWO COMPONENTS:

• B. Psychological Components
• 1.avoids chattering hopes and advices
• 2. providing variety
 CONCEPT:

• 2. Person
• -The one who is receiving care
• -a dynamic and complex being
• 3. Health
• -”Healthy is not only to be well, but to be
able to use well every power we have”
 CONCEPT:

• 4. Nursing
• -Nurses were to assist nature to repair
the patient.
• 3 TYPES OF NURSING:
• 1. Nursing proper
• 2. General nursing
• 3. Midwifery nursing
Nightingale and the Nursing Process

• Nursing Process
• -series of phases describing the practice
of nursing.
• - systematic, rational method of planning
and providing nursing care.
NURSING PROCESS

• Purpose:
• -To identify a client’s health status and
actual or potential health problems or
needs, to establish plans to meet the
identified needs and to deliver specific
nursing interventions to meet those
needs.
THE NURSING PROCESS IN ACTION

• 1. ASSESING
• Collect data
• Organize data
• Validate data
• Document data
 NURSING PROCESS

• 2. DIAGNOSING
• Analyze data
• Identify health problems, risks and
strength
NURSING PROCESS

• 3. PLANNING
• Prioritize problems/diagnosis
• Formulate goals/desired outcomes
• Select nursing intervention
 NURSING PROCESS

• 4. IMPLEMENTING
• -Implementation of nursing interventions
• 5. EVALUATING
• Compare data with outcomes
• Relate nursing actions to client
goals/outcomes
• Continue, modify, or terminate the client's
care plan.
 Assessment

• Two essential behavior by the nurse in the

area of assessment:
• 1. Ask the client what is needed or wanted.
• examples:
• A. ask where the pain is located.
• B. ask when he or she would like to eat and
what food is desired.
PRECISE QUESTIONS AGAINST LEADING
QUESTIONS

• CORRECT:
• “How many hours of sleep did you
have? At what hours of the night?”
• WRONG:
• “Did you have a goodnight sleep?”
 Assessment

• 2. Observation
• Use precise and specific observations
• Examples:
• A. How do light, noise, smells, and
bedding affect the client?
• B. How much food and drink had the
client ingested at every meal or snack?
 NURSING DIAGNOSIS

• The clients response to the environment

and not the environmental problem.
• Reflects the importance of the
environment to health and well being of
the client.
Outcomes and Planning

• Identifying the nursing actions needed

to keep clients comfortable, dry and in
the best state for nature to act on.
• focus on modifying the environment to
enhance the clients ability to respond to
the disease process.
 IMPLEMENTATION:

• Involves taking action

• All factors of the environment should
be considered.
 Evaluation

• Evaluate the client's response to the

intervention.
• It is based in the effect of the changes
in the environment on the client's
ability to regain his/her health at the
least expense of energy.
Nightingale 13 Canons Nursing Process and Thought
Nightingales 13
1. Ventilation and warmthNursing Process and
• Body temp., room temp., room for
fresh air and foul odors.
Canons
2. Light
Thought
• Adequate lighting.
3.1. Ventilation
Cleanliness • •Dampness,
of the roomsand
Body darkness
and walls temp., androom
dust or
mildew
warmth
4. Health and Houses
temp., room for fresh
• Pure air, pure water, drainage,
air and
cleanliness andfoul
light. odors.

2. Light • Adequate lighting.

3. Cleanliness of the • Dampness, darkness
rooms and walls and dust or mildew
4. Health and Houses • Pure air, pure water,
drainage, cleanliness
and light.
5. Noise • noise level
Nightingale 13 Canons Nursing Process and
Thought
6. Bed and bedding • Dampness, wrinkles and
soiling and check the bed for
height.
7. Personal Cleanliness • Keep the client clean and dry
at all times.
8. Variety • Provide flowers pictures,
books, or puzzles
9. Chattering Hopes and • Avoid talking without
advices reasons or giving advice that
is without fact
10.Taking food • Take note of the amount of
food and drink ingested by
the client
Nightingale 13 Canons Nursing Process and
Thought
11. What Food • Assess the client’s diet
including the food and
drink the client likes or
dislikes
12. Petty management • Documentation of the
plan of care and all
evaluation.
13. Observation of the sick • Record all observations.
Observations should be
factual and not merely
opinions.
Note that the client, the nurse, and the major environment
concepts are in balance; that is; the nurse can manipulate the
environment to compensate for the client’s response to it. The
goal of the nurse is to assist the patient in staying in balance. If
the environment of a client is out of balance, the client expends
unnecessary energy.
 • Application of Florence Nightingale’s Environmental
Philosophy
• Case History of angel Gonzaga
• Miss Angel Gonzaga is a 25 year old female
who had been admitted to the medical unit with
the chief complaint of frequent, watery stools
since last night. This is accompanied by
abdominal cramps, nausea and vomiting. Her
vital signs are as follows: T=38.6 C,
P=98bpm, R=23/min, BP= 100/70mmHg. She
complains of weakness, thirst and dryness of
mouth, Her skin is warm, flushed, and dry. Her
urine is dark yellow in color.
• Miss Gonzaga claims, she had eaten oysters
for dinner. She lives in a crowded community
close to a landfill and shares toilet with 4
other families. Their source of drinking water
is from pump well in the community. She
does not practice good handwashing after
using the toilet. Stool examination revealed
salmonellosis.
• Miss Gonzaga is extremely tearful. She
expresses great concern over her absence
from her job in a garment factory and over
her health and expenses for hospitalization.
• Nursing Care of Miss angel Gonzaga with Nightingale’s
Theory
• Care for Ms. Gonzaga involves “ nursing the sick” and
review of the environment and the clients lifestyle.
• A. Nursing the Sick
• Assessment
• 1. F & E losses r/t frequent , watery stools, N & V as
manifested by changes in V/S; weakness ; dryness of mouth,
warm, flushed, dry skin’ dark-colored urine.
• Pain r/t abdominal cramps.
• Inadequate food intake related to nausea and vomiting
• Fever (T=38.6 C) r/t infection (Salmonellosis) and
dehydration.
• Plan
• 1. F & E losses
• Provide f & e replacement
• Administer medications to relieve frequent,
watery stool and nausea and vomiting as
prescribed.
• Provide good oral care for dryness of mouth.
• Promote rest to relieve weakness.
• Monitor intake and output. To assess fluid
balance status.
• Provide good perianal care.
• 2. Pain r/t abdominal cramps
• Provide low fiber diet (to reduce peristalsis)
• Promote rest ( To reduce peristalsis and to
promote comfort)
• Avoid gas forming foods. (flatulence worsens
abdominal pain)
• Administer anticholinergic as prescribed. ( To
relieve abdominal cramps)
• 3. Inadequate food intake r/t n & v
• Provide small frequent feedings.(This is better
tolerated by patient’s with nausea)
• Provide ice chips to relieve nausea.
• Administer antiemetic as prescribed. (To relieve n &
v)
• 4. Fever r/t infection and dehydration
• Provide adequate room ventilation
• Keep the room airy and free of odor (To promote
rest)
• Increase fluid intake (To reduce fever relieve
dehydration, and promote excretion of
microorganisms.
• Fever r/t infection and dehydration
• Administer antibiotic and antipyretic as
prescribed
• Render tepid sponge bath (TSB) (To
reduce fever by evaporation and
conduction)
• Keep the skin clean and dry. (To promote
comfort)
• Change gowns and bedding as needed to
prevent dampness from perspiration
• B. Physical Environment
• Home comty./neighborhood and workplace
assessment
• 1. Pure water
• 2. Cleanliness
• Home comty./neighborhood and workplace plan
• 1. H20
• Have water check for contamination in
coordination with Local department of health
personnel
• Educate the client on H20 purification and storage
• Keep garbage away from H20 supply.
• 2. Cleanliness
• Educate the client on proper food handling

• C. Psychological environment
• Ms. Gonzaga has several psychological
concerns. She is worried over her absence
from her job, her health, and expenses for
hospitalization.
• 1. Variety
• Flowers, magazines, books, music.
• Encourage visits of relatives and friends.
• 2. Chattering hopes and advices.
• Refrain from giving the patient your
opinion
• Provide factual information about health.
• Allow her to verbalize her feelings and
concerns.
Everything you are and everything you have,
Started as a thought in your mind.
Everything starts with you telling the mind
what you desire.
“ Think success and it will happen…
“Think failure and it will happen…

THANK YOU & GOOD

DAY