Florence Nightingale’s Environmental Theory

Biography of Florence Nightingale

 Florence Nightingale (12 May 1820 – 13 August 1910) was a nurse who contributed to
developing and shaping the modern nursing practice.
 Nightingale is the first nurse theorist well-known for developing the Environmental Theory that
revolutionized nursing practices to create sanitary conditions for patients to get care.
 She is recognized as the founder of modern nursing. During the Crimean War, she tended to
wounded soldiers at night and was known as “The Lady with the Lamp.”
Early Life

 Florence Nightingale was born on May 12, 1820, in Nightingale, Italy.

 She was the younger of two children. Her British family belonged to elite social circles.
 Her father - William Shore Nightingale, a wealthy landowner who had inherited two estates—one
at Lea Hurst, Derbyshire, and the other in Hampshire, Embley Park Nightingale was 5 years old.
 Her mother - Frances Nightingale, hailed from a family of merchants and took pride in
socializing with prominent social standing people.
 Despite her mother’s interest in social climbing, Nightingale herself was reportedly awkward in
social situations. She preferred to avoid being the center of attention whenever possible. Strong-
willed, Nightingale often butted heads with her mother, whom she viewed as overly controlling.
Still, like many daughters, she was eager to please her mother. “I think I am got something more
good-natured and complying,” Nightingale wrote in her own defense concerning the mother-
daughter relationship.
Education

 Florence Nightingale was raised on the family estate at Lea Hurst, where her father provided her
with a classical education, including German, French, and Italian studies. As for being
homeschooled by her parents and tutors, Nightingale gained excellence in Mathematics.
 Nightingale was active in philanthropy from a very young age, ministering to the ill and poor
people in the village neighboring her family’s estate.
 At seventeen, she decided to dedicate her life to medical care for the sick resulting in a lifetime
commitment to speak out, educate, overhaul and sanitize the appalling health care conditions in
England.
 Nightingale enrolled as a nursing student in 1844 at the Lutheran Hospital of Pastor Fliedner in
Kaiserswerth, Germany.

Personal Life

 Only announcing her decision to enter the field in 1844, following her desire to be a nurse, was
not easy for Florence Nightingale.
 She rejected a suitor, Richard Monckton Milnes, 1st Baron Houghton, because she feared that
entertaining men would interfere with the process.
  Nightingale had several important friendships with women, including correspondence with an
Irish nun named Sister Mary Clare Moore, she had little respect for women in general and
preferred friendships with powerful men.
Environmental Theory
Florence Nightingale’s Environmental Theory defined Nursing as “the act of utilizing the patient’s
environment to assist him in his recovery.”
She identified 5 environmental factors:

 fresh air
 pure water
 efficient drainage
 cleanliness or sanitation
 light or direct sunlight.

Works

 Crimea, Florence Nightingale wrote Notes on Matters Affecting the Health, Efficiency, and
Hospital Administration of the British Army, an 830-page report analyzing her experience and
proposing reforms for other military hospitals operating under poor conditions. The book would
spark a total restructuring of the War Office’s administrative department, including establishing a
Royal Commission for the Health of the Army in 1857.
 In 1860, her best-authored works were published, “Notes on Nursing,” outlining nursing
principles. It is still in print today with translation in many foreign languages. In all, she had
published some 200 books, reports, and pamphlets.
 In the 1870s, Nightingale mentored Linda Richards, “America’s first trained nurse,” and enabled
her to return to the USA with adequate training and knowledge to establish high-quality nursing
schools. Linda Richards went on to become a great nursing pioneer in the USA and Japan.
 In the early 1880s, Nightingale wrote an article for a textbook in which she advocated strict
precautions designed, she said, to kill germs. Nightingale’s work served as an inspiration for
nurses in the American Civil War.
Appointments
In 1853, Florence Nightingale accepted the superintendent’s position at the Institute for the Care of Sick
Gentlewomen in Upper Harley Street, London. She held this position until October 1854.
In 1854, Britain was involved in the war against the Russians (Crimean War). British battlefield medical
facilities were deplorable, prompting Minister at War Sidney Herbert to appoint Nightingale to oversee
the wounded’s care. She arrived in Constantinople, Turkey, with a company of 38 nurses

Crimean War

 The Crimean War began, and soon reports in the newspapers described the desperate lack of
proper medical facilities for wounded British soldiers at the front. Sidney Herbert, the war
minister, already knew Nightingale and asked her to oversee a team of nurses in Turkey’s
military hospitals.
  In 1854 she led an expedition of 38 women to take over the management of the barrack hospital
at Scutari, where she observed the disastrous sanitary conditions.
 She returned to England in 1856
 In 1860, she established the Nightingale Training School for nurses at St Thomas’ Hospital in
London.

Awards and Honors

 England has given Florence Nightingale numerous awards and honors.

 Nightingale became known as “The Lady with the Lamp.” During the Crimean War, she initially
made her rounds on horseback and at night used an oil lamp to light her way, then reverted to a
mule cart and finally a carriage with a hood and curtains.
 In the summer of 1856, she left once the Crimean conflict was resolved and returned to her
childhood home at Lea Hurst.
 The Queen rewarded Nightingale’s work by presenting her with an engraved brooch that came to
be known as the “Nightingale Jewel” and by granting her a prize of $250,000 from the British
government.
 In 1883, Nightingale was awarded the Royal Red Cross by Queen Victoria.
 In 1904, she was appointed a Lady of Grace of St John’s Order (LGStJ).
 In 1907, she became the first woman to be awarded the Order of Merit. In the following year, she
was given the Honorary Freedom of the City of London.

Death

 Despite being known as the heroine of the Crimean War, Florence Nightingale fell ill in August
1910. She seemed to recover and was reportedly in good spirits.
 However, she developed an array of troubling symptoms a week later, on the evening of Friday,
August 12, 1910. She died unexpectedly at 2 pm the following day, Saturday, August 13, at her
home in London.
 However, she developed an array of troubling symptoms a week later, on the evening of Friday,
August 12, 1910. She died unexpectedly at 2 pm the following day, Saturday, August 13, at her
home in London.
 In honor of the life and career of the “Angel of the Crimea,” the Florence Nightingale Museum
sits at the site of the original Nightingale Training School for Nurses, which houses more than
2,000 artifacts. And up to this day, the name “Florence Nightingale” is universally recognized
and known as the pioneer of modern nursing.

Memory
Florence Nightingale has a memorial in St. Paul’s Cathedral, where a formal memorial service was held.

 There is a Florence Nightingale Museum located at St. Thomas Hospital in London, where she
founded the nursing school.
  The US Navy launched a namesake troop transport during World War II, “USS Florence
Nightingale,” which served gallantly during the course of the war, receiving four battle stars.
 In addition to the Florence Nightingale School of Nursing and Midwifery’s continued operation
at King’s College London, The Nightingale Building in the School of Nursing and Midwifery at
the University of Southampton is also named after her.

Nightingale’s Environmental Theory

The Environmental Theory by Florence Nightingale defined Nursing as “the act of utilizing the
environment of the patient to assist him in his recovery.”
Nightingale discussed the Environmental Theory in her book Notes on Nursing: What it is, What it is
Not.

Major Concepts of Florence Nightingales Theory

The major concepts of Florence Nightingale’s Theory are:

 Nursing
“What nursing has to do… is to put the patient in the best condition for nature to act upon him”
(Nightingale, 1859/1992)
Nightingale stated that 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.” She reflected the art of nursing in her statement that “the art of nursing, as now practiced, seems
to be expressly constituted to unmake what God had made disease to be, viz., a reparative process.”

 Human Beings
Human beings are not defined by Nightingale specifically. They are defined in relation to their
environment and the impact of the environment upon them.

 Environment
Nightingale stresses the physical environment in her writing. In her theory, Nightingale’s writings reflect
a community health model in which all that surrounds human beings is considered concerning their health
state.

 Health
Nightingale (1859/1992) did not define health specifically. She stated, “We know nothing of health, the
positive of which pathology is negative, except for the observation and experience. Given her definition
that the art of nursing is to “unmake what God had made disease,” then the goal of all nursing activities
should be client health.
She believed that nursing should provide care to the healthy and the ill and discussed health promotion as
an activity in which nurses should engage.
Subconcepts of the Environmental Theory

1. Health of Houses
“Badly constructed houses do for the healthy what badly constructed hospitals do for the sick. Once
ensure that the air is stagnant and sickness is certain to follow.”
2. Ventilation and Warming
“Keep the air he breathes as pure as the external air, without chilling him.”
Nightingale believed that the person who repeatedly breathed his or her own air would become sick or
remain sick. She was very concerned about “noxious air” or “effluvia” and foul odors from excrement.
She also criticized “fumigations,” for she believed that the offensive source, not the smell, must be
removed.
Nightingale also stressed the importance of room temperature. The patient should not be too warm or too
cold. The temperature could be controlled by an appropriate balance between burning fires and ventilation
from windows.
3. Light
Nightingale believed that second to fresh air, the sick needed light. She noted that direct sunlight was
what patients wanted.
4. Noise
She stated that patients should never be “waked intentionally” or accidentally during the first part of
sleep. She asserted that whispered or long conversations about patients are thoughtless and cruel. She
viewed unnecessary noise, including noise from the female dress, as cruel and irritating to the patient.
5. Variety
She discussed the need for color and form changes, including bringing the patient brightly colored
flowers or plants. She also advocated rotating 10 or 12 paintings and engravings each day, week, or
month to provide variety for the patient. Nightingale also advocated reading, needlework, writing, and
cleaning to relieve the sick of boredom.
6. Bed and Bedding
Nightingale noted that an adult in health exhales about three pints of moisture through the lungs and skin
in a 24-hour period. This organic matter enters the sheets and stays there unless the bedding is changed
and aired frequently.
She believed that the bed should be placed in the lightest part of the room and placed so the patient could
see out of a window. She also reminded the caregiver never to lean against, sit upon, or unnecessarily
shake the patient’s bed.
7. Personal Cleanliness
“Just as it is necessary to renew the air around a sick person frequently to carry off morbid effluvia from
the lungs and skin, by maintaining free ventilation, so it is necessary to keep pores of the skin free from
all obstructing excretions.”
“Every nurse ought to wash her hands very frequently during the day.”
8. Nutrition and Taking Food
Nightingale noted in her Environmental Theory that individuals desire different foods at different times of
the day and that frequent small servings may be more beneficial to the patient than a large breakfast or
dinner. She urged that no business be done with patients while they are eating because this was a
distraction.
9. Chattering Hopes and Advice
Florence Nightingale wrote in her Environmental Theory that to falsely cheer the sick by making light of
their illness and its danger is not helpful. She encouraged the nurse to heed what is being said by visitors,
believing that sick persons should hear the good news that would help them become healthier.
10. Social Considerations
Nightingale supported the importance of looking beyond the individual to the social environment in
which they lived.

Environmental Factors
In Florence Nightingale’s Environmental Theory, she identified five (5) environmental factors: fresh air,
pure water, efficient drainage, cleanliness or sanitation, and light or direct sunlight.
1. Pure fresh air – “to keep the air he breathes as pure as the external air without chilling him.”
2. Pure water – “well water of a very impure kind is used for domestic purposes. And when the
epidemic disease shows itself, persons using such water are almost sure to suffer.”
3. Effective drainage – “all the while the sewer may be nothing but a laboratory from which
epidemic disease and ill health are 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 very
important.”
Assumptions of Florence Nightingale’s Theory
The assumptions of Florence Nightingale in her Environmental Theory are as follows:

 Florence Nightingale 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 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.

Strengths
Florence Nightingale’s language to write her books was cultured and flowing, logical in format, and
elegant in style. Nightingale’s Environmental Theory has broad applicability to the practitioner. Her
model can be applied in most complex hospital intensive care environments, the home, a worksite, or the
community. Reading Nightingale’s Environmental Theory raises consciousness in the nurse about how
the environment influences client outcomes.
Weaknesses
In Nightingale’s Environmental Theory, there is scant information on the psychosocial environment
compared to the physical environment. The application of her concepts in the twentieth century is in
question.