Prof.

BINU JOE
PRINCIPAL
CHRIST COLLEGE OF NURSING, RAJKOT.
FL O R E N C E N IG H T IN G A L E
EN V IR O N M E N T A L TH E O R Y

The lady with the lamp

BRIEF BACKGROUND OF THE FLORENCE
NIGHTINGALE
 Florence Nightingale was born on 12th may
1820.
 She is the founder of modern Nursing.

 Books she wrote:

 Notes on Nursing: What it is, what it is not (1860).
 Notes on Hospitals (1863)
 Sick Nursing and Health Nursing (1893).

 She died on 13th August 1910

 She is considered has the first Nursing theorist.
 She is known has lady with the lamp, providing care to
wounded and ill soldiers during the Crimean war.
 She reduced the mortality rate of wounded soldiers from
42.7% to 2.2% because of her giving importance to the
clean environment
FL O R E N C E N IG H T IN G A L E ’S
ENVIRONMENTAL THEORY
 13 CANONS OR CONCEPTS OF
NIGHTINGALE’S THEORY
CANONS ASSESSMENT
1.Ventilation and • Assess the clients body temperature, room
temperature and room for fresh air and foul
warmth orders.
• Develop a plan to keep the room with fresh air and
free of foul odor, while maintaining the clients body
temperature.

2. Light • Assess the room for adequate light. Natural

sunlight works best.
• Develop and implement adequate light in the
clients room, without placing the client in direct
sunlight.

3. Cleanliness of • Assess the room for dampness, darkness and dust or

mild dew.
rooms and walls •Keep the room free from dust, dirt, mild dew
and dampness
13 CANONS OR CONCEPTS OF NIGHTINGALE ’S THEORY

CANONS ASSESSMENT
4. Health of houses • Assess the surrounding of the house for pure air, pure
water, drainage, cleanliness and light.
• Keep the area around the house clean, don’t allow and
standing water and ensure that air, water are clean and
free from foul odor.
•Maintain proper and adequate lighting .

5. Noise • Assess the noise level in the clients room and

surrounding area.
•Keep the noise level minimum and refrain from
whispering near to the client.

6. Bed and bedding • Assess the bed and bedding for dampness,
wrinkles and soiling and check the bed for height.
• Keep the bed dry, wrinkle free and at the lowest height
to ensure the clients comfort.
13 CANONS OR CONC EPTS OF NIGHTINGALE’S THEORY

CANONS ASSESSMENT
7. Personal cleanliness •Assess the grooming of the client.
•Always keep the client clean and dry.
•Frequent assessment of the clients skin
is needed to maintain adequate skin moisture.

8. Variety •Attempt to keep the variety and

stimulating environment near the bedside of
the client.
•Keep cards, flowers , pictures and
books at the bedside.
•Encourage friends and relatives to
engage the client in some sort of stimulating
conversation
13 CANONS OR CONCEPTS OF NIGHTINGALE ’S THEORY
CANONS ASSESSMENT
9. Chattering hopes •Avoid talking without reason or giving
and advices advice that is without fact.
•Continue to talk to the client as a person
and continue to stimulate the clients mind.
•Avoid personal talk.

10. Taking food •Assess the diet of client

•Take note of the amount of food and
drink ingested by the client at every meal
or snack.
11. What food •Assess the diet plan of the client
including type of food and drink
according to his or likes and dislikes.
•Make sure to provide some food or drink
to the client which he or she likes
13 CANONS OR CONCEPTS OF NIGHTINGALE ’S THEORY
CANONS ASSESSMENT
12. Petty management Petty management ensures continuity of care.
Proper documentation and evaluation of
client care will ensure a good continuity of
care during staff change.

13. Observation of the Observe everything about the client.

sick Record all observations.
Observations should be factual and not
merely opinions.
Observe the clients surrounding
environment and make alterations in the
plan of care accordingly.
 MAJOR CONCEPTS AND DEFINITIONS
 Environment: Nightingale focused on the key
physical aspects of the environment which are
 Ventilation
 Warmth
 Light
 Diet
 Cleanliness
 Noise.

 Florence Nightingale believed that “ Healthy

surroundings is very much necessary for proper
Nursing care”.
“ Nursing is an act of utilizing
the environment of the patient
to assist him in his/her
recovery”
 5 ESSENTIAL COMPONENTS OF A
HEALTHY ENVIRONMENT
 Pure air
 Pure water.
 Efficient
drainage.
 Cleanliness.
 Light
FLORENCE NIGHTINGALE THEORY
NIGHTINGALE’S ENVIRONMENT MODEL
 METAPARADIGM
 Nursing: The main goal of
nursing is to place the patient in
the best possible condition for the
nature to act.
 Nursing is the activities that
promotes health in any care-
giving situation.
 PERSON
 Person or patient is multidimensional composed of
biological, psychological, social and spiritual
components.
 Patient is the main focus of environmental theory.
Nurse should perform task of the patient and control
the environment for the speedy recovery of the patient.
HEALTH
 Health is “ not only to be well, but to be able to use well
every power we have.
 A health body can recuperate and undergo reparative
process.
 Proper environment leads to proper maintenance of
health.
 Disease is considered as dys-ease or the absence of
comfort.
ENVIRONMENT
 Poor environment leads to poor health and
disease.
 Environment could be altered to improve
conditions so that the natural laws would allow
healing to occur
 THEORY MAIN CONCEPT APPLICATION

Florence Environment is core concept - This model is mainly

Nightingale’s Environment could be altered in focusing on
Environmental infection control
such a way as to improve which will be
theory condition so that nature could act suitable for ward
to cure the patient management.
Most important environmental
concerns are ventilation and
clean air followed by clean
water
SIGNIFICANCE OF NIGHTINGALE THEORY
Areas Significance
Nursing Practice •Disease control
•Sanitation and water management.
•Utilizes modern architecture in the
prevention of “sick building syndrome”
•Applies principles of proper ventilation and
good lighting.
•Waste disposal
•Control of room temperature
•Noise management
SIGNIFICANCE OF NIGHTINGALE THEORY
Areas Significance
Nursing education •Better practice results from good
education. “Good practice could
result only from Good education”
•Advocated that Nursing training
schools need to be developed .
•She believed that “ art of nursing” is
accomplished through proper licensing
examinations.

Nursing Research • Use of graphical representations like

the bar and pie diagrams.
•Notes on Nursing
 CRITIQUE OF NIGHTINGALE THEORY

 Simplicity: Simple and logical, tends towards 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
systemic research. She advised Nurses that their practice should
be based on their observation and experiences, rather than
systematic, empirical research.
 Derivable consequences: Deeply religious, she viewed nursing
as a means of doing the will of God (Nursing is a divine calling.
APPLICATION OF NIGHTINGALE THEORY

Ventilation

Air
Environment
Cleanliness

Infection Health of
afte Houses
(Hospital
surger
r )

Bedding
APPLICATION OF NIGHTINAGLE’S
THEORY IN NURSING PRACTICE
 Nightingaleof modern Nursing
 Mother of modern Nursing
INTRODUCTION
 Virginia Henderson was a well known nursing educator, she is
considered as nightingale of modern nursing. Born in Kansas
city, Missouri in 1897 and is a 5th child of family of 8 children
but spent her formative years in Virginia.
 She graduated from army school of nursing in 1921

 In 1926, she was awarded BS and MA degree in nursing

education from teachers college, Colombia University, New
York city
 Her interest in nursing evolved from helping sick and
wounded military personnel during World war 1
 In 1929 she determined that she needed more education and
entered teachers college at Colombia University,
where she earned her bachelor’s degree in 1932 and
master’s degree in 1934.
INTRODUCTION
 In 1955, Henderson first published her definition of
nursing in a revised version of the text book ‘The
principles and practice of nursing.’
 As a result of working on his book she felt the need to
clarify the role of nurses even further, her involvement as a
committee member in regional nursing council and her
dissatisfaction with 1955 definition of nursing by American
nurses association. She clarified her definition of nursing in
‘The Nature Of Nursing’.
HENDERSON’S DEFINITION OF NURSING

“ The unique function of the Nurse is to assist the

individual, sick or well, in the performance of those
activities contributing to health or its recovery (or to
peaceful death) that he would perform unaided if he had
the necessary strength, will or knowledge.
And to this in such a way as to help him gain
independence as rapidly as possible”
 DEFINITION OF NURSING

 Henderson view her work as a philosophical

statement rather than a theory because the term
theory was not used at the time formulated her
ideas.
 In her definition, she emphasizes care of both sick
and well individuals, she was one of the first
theorist who include spiritual aspects of the nursing
care, the nurse assist the client with essential
activities to maintain health recover from illness, or
achieve a peaceful death and patients independence
is an important criterion for health.
 NEED THEORY

Henderson’s basic needs / 14

components:
She identifies 14 basic needs that form
the components of nursing care the
nurse helps the client to meet those
needs.
 HENDERSON 14 COMPONENTS AS APPLIED T O
MASLOW’S HEIRARCHY OF NEEDS

SELF ESTEEM
12. WORK IN SUCH A WAY THAT THERE IS SENSE OF
ACCOMPLISHMENT.
13. PLAY OR PARTICIPATE IN
VARIOUS FORMS OF
RECREATION.
14. LEARN DISCOVER OR
SATISFY THE CURIOSITY THAT
LEADS TO HOLISTIC DEVELOPMENT
LOVE AND BELONGINGNESS
15. Communicate with others to express emotions needs fears and
opinions
16. Worship according to ones faith.
SAFETY NEEDS
9. Avoid dangers in the environment and
avoid injuring others
PHYSIOLOGIC NEEDS
1. Breathe normally. 2. Eat and drink adequately
3. Eliminate body wastes.
HENDERSONS THEORY AND
METAPARADIGM
 PERSON
 Is an individual requiring assistance to achieve health
and independence or a peaceful death.
 Person and family are viewed as a unit.
 Mind and body are inseparable and interrelated.
 Consists of biological, psychological, sociological and
spiritual components
 Is either sick or well and strives towards a state of
independence
 Has certain basic need for survival
 Needs strength will or knowledge to perform
activities necessary for healthy living
 ENVIRONMENT
ENVIRONMENT
 Is not specifically defined by Henderson

 It involves the relationship one shares with one’s

family
 Also involves the community and its
responsibility for providing health care
 Healthy individuals may be able to control the
environment, but illness may interfere with that ability.
 Nurses need to protect the patient from
mechanical injury.
 HEALTH
HEALTH
 It refers to an individual ability to function
independently in relationship to the basic 14 needs, is
a quality of life that is basic to human functioning
and it requires strength, will or knowledge
 Health is the quality of life and basic to human
functioning.
 NURSING

NURSING
 Nurses requires basic knowledge of social science and
humanities, this pioneering belief which lead to
baccalaureate education as basic training for nurses
 She identifies three levels of nursing function

 Substitute- making up for what patient lacks

 Helper- instituting medical interventions

 Partner- fostering a therapeutic relationship with the patient

and function as member of healthcare team.
 Is a logical scientific approach to problem solving that result
in individualized care
 Nursing involves the use of written nursing care plan
 HENDERSON’S DEFINITION OF
NURSING

“ The unique function of the Nurse is to assist

the individual, sick or well, in the performance of
those activities contributing to health or its recovery (or
to peaceful death) that he would perform unaided if he
had the necessary
strength, will or knowledge. And to this in such a way as
to help him gain independence as rapidly as possible”
APPLICATIONS

Practice
 The Nurse can help the patient to become independent by
 Assessment: Assess the patients for 14 fundamental needs and
determine what are lacking.
 Planning: Plan to meet the as per the prescribed plan of Doctor.
 Implementation: Help the patient to meet the 14 basic needs of the
patient. Assess the sick or well individual to maintain health or
recover from illness.
 Evaluation: Evaluate weather the goals are met or not
APPLICATIONS

Education
 Developed 3 phases of curriculum development that the
students must go through in the process of learning
 Phase 1: Assisting the patient when he needs strength, will or

knowledge in performing daily activities unaided with the

ultimate goal of independence.
 Phase 2: Develop a habit of inquiry, undergo courses in biological,

physical, social sciences and humanities. Observe effective care

and provide effective care in various settings.
 Phase 3: Involve student in the complete study of patient and all

his needs.
APPLICATIONS

Research
 Research problem arises from each of the 14
components of basic nursing care.
 Henderson believed that no profession, occupation or
industry in this age can survive without research.
 Offers a framework for generating knowledge and new ideas.

 She stressed on developing nursing libraries which in turn

will help in research.
STRENGTHS
 The scientific definition of Nursing and 14 basic needs
given by Henderson is very clear and easy to
understand. Therefore it can be used without difficulty
as a guide for Nursing practice by most Nurses.
 Henderson work is simple and easy to generalize.

 Her work can be applied to the health of

individuals of all ages.
 Each of the 14 basic needs can be the basis for
further research
CRITIQUE
 Lack of conceptual linkage between physiological and
other human characteristics
 No concept of the holistic nature of human being
 If the assumption made is that the fourteen components
prioritised, the relationship among the components is
nuclear.
 Lacks inter – relation of factors and influence of
nursing care
 Assisting individual in dying process. She contends that
the nurse helps, but there is little explanation what the
nurse does.
 Peaceful death is curious and significant nursing
problems.
 NURSING CARE PLAN AS PER THEORIST

Nursing process Henderson’s 14 components and definitions of nursing

Nursing assessment Assess needs of human being based on 14 components of
basic
nursing care
Analysis: compare data to knowledge base of health and disease
Nursing diagnosis Identify individuals ability to meet own needs with or without
assistance taking in to consideration of strength will or knowledge.

Nursing plan Document how the nurse can assist the individual sick or well
Nursing Assist the sick or well individual in the performance of those activities
intervention in meeting human needs to maintain health, recover from illness or to
aid in peaceful death.
Implementation based on physiological principles, age, cultural
background emotional balance, physical and intellectual capacities to
carry out treatment prescribed by physician

Nursing evaluation The quality of care is drastically affected by the preparation and nativ e
ability of nursing personal rather than the amount of hours of care
CASE:
 Mr. X 45yr old male got admitted to Christ Hospital
Rajkot with complaints of head injury following a RTA. He is
unconscious and disoriented, GCS is 10/15, pupils asymmetrical,
2 episodes of bed wetting. After admission his respiratory rate got
decreased and put on to ventilator. He is married and religiously
an active person, he used to play with his children in every
Sunday. He has got a good friend circle. He was very much
concern about health of family as well as his health.
 Impaired self esteem
Client is unconscious GCS
10/15

Impaired communication and worship

Client is unconscious GCS 10/15
High risk of injury, Pressure sores

Impaired breathing, impaired nutrition, impaired elimination, can’t move and

maintain desirable positions.
 NURSING CARE PLAN
Assessment Nursing diagnosis Objective

Subjective data: He is Ineffective airway clearance Client will maintain

unconscious related to endotracheal clear open airways,
Objective data: He is on Intubation as evidenced by as evidenced by
ventilator. abnormal breath sounds normal breath
Abnormal breath sounds sounds
heard on ausculation.
He is on mechanical
ventilation.
Increased peak
airway
pressure.
 NURSING CARE PLAN
Plan of action
Observe the colour, odor,
quantity and consistency of
sputum.
Auscultate the lungs for
the presence of normal or
asdventitious breath
sound.
Monitor oxygen saturation
prior to and after
suctioning using pulse
oximetry
Implementation Evaluation
Substitute: Turn the client
every 2 hours Client will maintain
Helper: Hyper oxygenate clear open airways, as
as ordered. evidenced by normal
Administer adequate breath sounds as
fluid evidenced by
intake. auscultation.
Partner: Institute airway
suctioning as indicated on
the presence of
adventitious breath
sounds.
 CONCLUSION

 Henderson provides the essence of what she

believes is the definition of Nursing.
 She provide 14 basic components of Nursing care.
 Florence nightingale believed strongly that
physical environment has direct bearing on the
prevention of disease and mortality rate. Patients
psychology is also affected by a very clean physical
surroundings
 “IF I HEAR, I FORGET IF
I SEE, I REMEMBER
IF I PRACTICE, I
UNDERSTAND”
REFERENCES
 Wesley L Ruby, Nurisng theories and models, 2nd
edition, Spring house notes.
 Melis Ibrahim Afaf, Theoritical Nursing, 4ht edition,
Philadelphia: Lippincott company, 2007.
 Parker Marcelyn, Nursing theories and nursing
practice, F A Davis company, Philadelphia.
 Basavanthappa BT, Nursing theories, Jaypee
brothers publishers: New Delhi.
 www.google/nursingtheories.com