ENVIRONMENTAL MODEL

• Born in Florence, Italy

• 12 May 1820
• Named Florence,
after the city she was
born in
• Born to very wealthy,
educated parents
• Traveled extensively,
owned multiple
estates
• Returned to England in
1821
• Well Educated
• Father believed women
should have a strong
education
• Florence and her sister
learned Italian, Latin,
Greek, history and
mathematics. Florence
especially excelled in
mathematics.
• In 1837, when she was 17,
she felt a “calling” to help
people
• She visited sick people at
their homes
• Her parents wanted her to
get married
• She had other ideas and
travelled in Europe looking at
hospitals
 Hospitals in 1830’s
Often people who went into hospital died
• They were Dirty

• Badly run

• Nurses didn’t know what to do

Florence Nightingale
• Parents did not want
her to become a nurse
• She studied medicine
books herself for years
• She was 30 when her
parents let her go to
Germany and Paris to
study nursing
 Introduction to Nursing

• Spent three months at Kaiserwerth training as a sick

nurse
• Upon returning home, she inspected hospitals in
London, Edinburgh and Dublin
• In 1853, she accepted her first administrative post
where she became the Superintendent of the
Establishment for Gentlewomen.
 Crimean War 1854

• Reports of the sufferings of the sick and wounded in

English camps inspired Florence to enlist her services

• She was offered “plenary authority over all nurses and

the fullest assistance and cooperation from medical
staff.”
 Upon Arrival
~ Florence’s volunteers were inexperienced and the
behavior of the orderlies was offensive to women
~ Poor sanitation, cholera, typhus, frost-bite and lack of
supplies, etc. led to over 2,000 sick and wounded in the
hospital in 1855 with death rate rising to 42%. Doctors
and nurses died as well due to conditions.
“There were no vessels for water or utensils of any kind; no
soap, no towels, or clothes, no hospital clothes; the men lying
in their uniforms, stiff and gore and covered with filth to a
degree and a kind no one should write about; their person
covered with vermin…” (Florence Nightingale and volunteers)
 Making a Difference

• Florence collected data, kept impeccable records and systematically

used statistics to demonstrate the effects of poor sanitation and
surgical practices on death rates.

• Diagram of the Causes of Mortality in the Army in the East (1858)

• With simple education, she was able to bring down the death rate
from 42% to 2% in six months.
 FLORENCE NIGHTINGALE

• Founder of educated and scientific nursing 

• Widely known as "The Lady with the Lamp",

wrote the first nursing notes that became the basis
of nursing practice and research.
 FLORENCE
NIGHTINGALE

The notes, entitled Notes on Nursing: What it is, What is

not (1860), listed some of her theories that have served as
foundations of nursing practice -including the succeeding 
conceptual frameworks and theories 
Nightingale is considered the first nursing theorist.

One of her theories was the Environmental Theory, which

incorporated the restoration of the usual health status of the
nurse's clients into the delivery of health care.
 Nightingale’s Nursing Theory The first published
nursing theory (1860)
 Persons are in relation with the environment
 Stresses the healing properties of the physical
environment (fresh air, light, warmth, and
cleanliness)
 Nursing puts patients in the “best conditions” for
nature to act upon them Health is “the positive
of which the pathology is the negative”
 “Nature alone cures”
ENVIRONMENTAL MODEL
• When one or more aspects of the
environment are out of balance,
the client must use increased
energy to counter the
environmental stress.
• This stress drains the client of
energy needed for healing.
• Theory basis: the inter-relationship of a healthful
environment with nursing
– External influences and conditions can prevent,
suppress, or contribute to disease or death
• Theory goal: Nurses help patients retain their
own vitality by meeting their basic needs
through control of the environment
• Nursing’s Focus: control of the environment for
individuals, families & the community
ENVIRONMENTAL MODEL
Major component of Nursing care is manipulation
of the physical environment.
Major areas of the environment that a Nurse can
control include;
 Health of houses
 Ventilation and warming
 Light
 Noise
 Variety
 Bed and bedding
 Cleanliness of rooms and walls
 Personal cleanliness
 Nutrition and taking food
 Chattering hopes and advices
 Social considerations
Client & environment in balance
Client expending unnecessary energy
 HEALTH OF HOUSES
• Closely related to presence of pure air, pure
water, efficient drainage, cleanliness and light.
• Badly constructed houses do for health, what
badly constructed hospitals do for the sick.
 Ventilation and warming
• Patient should not be too warm or too cold.
• Temperature to be appropriately controlled.
• Concerned about noxious air or effluvia – foul
odours – bedpans, urinals & other utensils to
discard excrement.
 Light
• Second to fresh air the sick needed light
• Believed light has quite real and tangible
effects upon the human body.
 Noise
• Patients should never be wakened
intentionally or accidentally during the first
part of sleep.
• Whispered or long conversations about
patients are thoughtless and cruel.
 Variety
• Variety in the environment was a critical
aspect affecting the patient’s recovery.
• Need for changes in colour and form – bright
coloured flowers etc.
• Effect of mind on body.
• Advocated reading, needle work, writing and
activities to relive boredom.
 Bed and bedding
• Adult in health exhales about 3 pints of moisture
through lungs and skin in 24 hrs.
• This organic matter enters the sheets and stays
there unless the bedding is changed and aired
frequently.
• Bed to be placed in the lightest part of the room
and to be so that patient could see out of the
window.
• Nurse to keep bedding clean, neat and dry and to
position patient for maximum comfort.
 Cleanliness of rooms and walls
• Greatest part of nursing consists in preserving
cleanliness.
• Removal of dust – using damp cloth
 Personal cleanliness
• Unwashed skin poisoned the patient and
bathing & drying the skin provided great relief
to the patient
• Personal cleanliness extends to the nurse and
every nurse ought to wash her hands very
frequently during the day.
 Nutrition and taking food
• Importance of variety in the food
• Small servings may be more beneficial to a
patient than large breakfast or dinner
• Right food be brought at right time and be
taken away eaten or uneaten at the right time
 Chattering hopes and advices
• To falsely cheer the sick by making light of
their illness and its danger is not helpful
• Sick persons should hear good news that
would assist them in becoming healthier
 Social considerations
• She assured petty management – ways to
assure that “ what you do when you are there,
shall be done when you are not there”
• Importance of “ observing the sick”
• Importance of looking beyond the individual
to the social environment in which he or she
lived
 Types of environment
1. Physical
2. Psychological
3. Social
 Physical environment
• Physical Environment Consists of physical
elements where the patient is being treated
• Affects all other aspects of the environment
• Cleanliness of environment relates directly
to disease prevention and patient mortality
• Aspects of the physical environment
influence the social and psychological
environments of the person
 Psychological environment
• Psychological Environment Can be affected by a
negative physical environment which then causes
STRESS
• Requires various activities to keep the mind active
(i.e, manual work, appealing food, a pleasing
environment)
• Involves communication with the person, about the
person, and about other people communication
should be therapeutic, soothing, & unhurried!
 Social environment
• Social Environment Involves collecting data
about illness and disease prevention
• Includes components of the physical
environment - clean air, clean water, proper
drainage
• Consists of a person’s home or hospital room,
as well as the total community that affects the
patient’s specific environment
 5 Major Components of a Healthful
Environment
1. Proper ventilation
2. Adequate light
3. Sufficient warmth
4. Control of noise
5. Control of effluvia (noxious odors)
 Assumptions
• Nightingale (1860/1957/1969) believed that five points
were essential in achieving a healthful house: “pure air,
pure water, efficient drainage, cleanliness and light.”

A healthy environment is essential for healing. She

stated that “nature alone cures.”

Nurses must make accurate observations of their

patients and be able to report the state of the patient
to the physician in an orderly manner.

Nursing is an art, whereas medicine is a science. Nurses

are to be loyal to the medical plan, but not servile.
 Nightingale’s Theory & Nursing’s
Metaparadigm - PERSON
• Not defined by nightingale specifically
• PERSON Referred to by Nightingale as “the
patient”
• A human being acted upon by a nurse, or
affected by the environment
 Nightingale’s Theory & Nursing’s
Metaparadigm - ENVIRONMENT
• The foundational component of Nightingale’s
theory
• Physical environment is stressed – light etc
• The external conditions & forces that affect
one’s life and development
 Nightingale’s Theory & Nursing’s
Metaparadigm - HEALTH
• Did not define health specifically
• Maintained by controlling the environmental
factors so as to prevent disease
• Disease is viewed as a reparative process
instituted by nature Health & disease are the
focus of the nurse
• Nurses help patients through their healing
process
• Nature alone cures
 NURSING

• What nursing has to do ………is to put the patient

in the best condition for nature to act upon him.
• 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.
• The art of nursing is to unmake what God has
made disease to be – a reparative process.
•
The Analysis
Simplicity: The theory is simply explained as the nurse, patient and
environment interacts with each other. The roles of environmental
management to patient recovery is greatly emphasized. Her care focus on
eating patterns and food preferences of the patients, provision of comfort,
protection from emotional distress and conservation of energy.

Generality: The universality of the concepts provide general guidelines and

is still applicable and relevant today.

Empirical Precision: The theory is stated completely and presented facts.

She uses quantitative research method. She focus on observation and
experiences rather than systematic empirical research.

Derivable Consequences: Measures of independence and accuracy of care.

Nurse-patient relationship towards wellness, environmental manipulation
and psychological care.
 Criticisms

• She emphasized subservience to doctors.

• She focused more on physical factors than on
psychological needs of patient
 Importance of Environmental Theory

Practice
1. Disease control
2. Sanitation and water treatment
3. Utilized by modern architecture in the prevention of "sick building
syndrome" applying the principles of ventilation and good lighting.
4. Waste disposal
5. Control of room temperature.
6. Noise management.

Education
1. Principles of nursing training. Better practice result from better
education.
2. Skills measurement through licensing by the use of testing methods, the
case studies.

Research
1. Use of graphical representations like the polar diagrams.
2. Notes on nursing.
 Conclusion
• Florence Nightingale provided a professional
model for nursing organization.
• She was the first to use a theoretical
foundation to nursing.
• Her thoughts have influenced nursing
significantly