The foundation of Nightingale’s theory is the environment- all the external conditions and forces that influence the life and development of an organism. According to her, external influences and conditions can prevent, suppress, or contribute to disease or death. Her goal was to help the patient retain his own vitality by meeting his basic needs through control of the environment.

1. Florence Nightingale’s
Environment theory
Shrooti Shah
Lecturer
National Medical College Nursing Campus, Birganj

2. Introduction
• Florence Nightingale was born on May
12, 1820, while her parents were on an
extended European tour.
• Much attention has been to the
“Calling” that Nightingale recorded in
her diary in 1837, when she wrote that
“ God spoke to me and called me to his
service”.
• Florence Nightingale began her nursing
training in 1851 in Germany.

3. Introduction
• She pioneered the concept of formal education for nurses.
• She served the injured soldiers during the Crimean war which
strongly influenced her philosophy of nursing.
• In 1859, she published her views on nursing care in notes on
nursing.
• She is considered the first nursing theorist.

4. Introduction
• She stated in her nursing notes that nursing “is an act of
utilizing the environment of the patient to assist him in his
recovery.”
• Her contribution during Crimean war is well-known.
• She was a statistician, using bar and pie charts, highlighting
key points.
• International Nurses Day, May 12 is observed in respect to her
contribution to Nursing.
• Died- 13 August 1910

5. Introduction
• The foundation of Nightingale’s theory is the
environment- all the external conditions and forces that
influence the life and development of an organism.
• According to her, external influences and conditions can
prevent, suppress, or contribute to disease or death.
• Her goal was to help the patient retain his own vitality by
meeting his basic needs through control of the
environment.

6. Types of Environment
There are three types of environments. Physical, Psychological
and Social
Physical Environment:
• Physical Environment consists of physical elements where the
patient is being treated.
• It 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

7. Types of Environment
Psychological Environment:
• Psychological environment can be affected by a negative
physical environment which then causes STRESS.
• It requires various activities to keep the mind active.
• It involves communication with the person, about the
person, and about other people.

8. Types of Environment
Social environment
• It includes components of the physical environment -
clean air, clean water, proper drainage.
• It consists of a person’s home or hospital room, as
well as the total community

10. Health of houses
• The importance of the health of houses as being
closely related to the presence of pure air, pure water,
efficient drainage, cleanliness and light.
• Cleanliness outside the house effected the inside.

11. Ventilation and warming
• Nurses was “ to keep the air he breathes as pure as the
external air, without chilling”.
• Nightingale was very concerned about “noxious air” or
“effluvia” or foul odours that came from excrement.
• Nightingale stressed the importance of room temperature.
The patient should not be too warm or too cold.

12. Light
• She viewed that direct sunlight was what patients
wanted.
• Although acknowledging a lack of scientific rationale
for it, she noted that light has “ quite real and tangible
effects upon the human body”.

13. Noise
• She stated that patient 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.
• Nurses responsibility is to assess and stop different
king of noise.

14. Variety
• She believed that variety in the environment was a
critical aspect of affecting the patients recovery.
• She discussed the need for changes in colour and
form, including bringing the patient brightly coloured
flowers or plants.

15. Bed and bedding
• She stated that dirty carpets and walls containing
large quantities of organic matter and provided ready
source of infection, just as dirty sheets and beds did.

16. Personal cleanliness
• The need for cleanliness is extended to the patient,
the nurse and the environment.
• Nightingale viewed the functions of the skin is
important, believing that many disease “disorders” or
caused breaks in the skin.

17. Nutrition and taking food
• Nightingale addressed the variety of food presented
to the patients and discussed the importance of
variety in the food presented.

18. Chattering hopes and advices
• False hope was depressing to patients, she felt and
caused them to worry and become fatigued.
• She believed that sick persons should hear good news
that would assist them in becoming healthier.

19. Social considerations
• Nightingale supported the importance of looking beyond
the persons to the social environments in which he or she
lived.
• She observed that generations of families lived and died
in poverty.

20. Four major concepts of Nightingale’s theory

21. Nursing
• Nursing is different from medicine and the
goal of nursing is to place the patient in the
best possible condition for nature to act.
• Nursing is the "activities that promote health
which occur in any care giving situation. They
can be done by anyone."

22. Person
• Nightingale referred person as a patient. Person is
affected by environment.
• Person is multidimensional, composed of biological,
psychological, social and spiritual components.
• He has a vital reparative power to deal with disease,
recovery is within the person’s power as long as a
safe environment for recuperation exists.

23. Health/Disease
• Health is “not only to be well, but maintaining well-
being by using a person’s power to the fullest extent”.
• Health is maintained by controlling the environmental
factors to prevent disease.
• Disease is considered as dys-ease or the absence of
comfort.
• Health and disease are the focus of nurse, who helps a
person through the healing process.

24. Environment
• "Poor or difficult environments led to poor health and
disease".
• "Environment could be altered to improve conditions
so that the natural laws would allow healing to
occur."

25. Relevance of theory in nursing practice,
education and research
Nursing 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.

26. Relevance of theory in nursing practice,
education and research
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 bar, pie
diagrams.
2. Notes on nursing.

27. Application of nightingale's theory in nursing
process
Assessment
The following information should be adequate.
• Adequacy of ventilation
• Cleanliness of environment
• Presence of draft
• Sudden noises
• Amount of sunlight and artificial light

28. Application of nightingale's theory in
nursing process
• Variety of dietary offerings
• Odors present in throughout ward
• Methods of disposal of human waste and sputum
• Opportunity to communicate with others
• Insufficient warmth
• company from family and other patient
• Insufficient knowledge regarding disease

29. Nursing Diagnosis
• Non-stimulating environment

30. Implementation
• Provide adequate ventilation by opening doors and windows.
• Keep the surrounding environment clean (linen, bed, utensils)
• Keep the patient in warm and comfortable room, avoid
unnecessary noise.
• Increase stimulus through a greater exposure to sunlight and
fresh air.
• Provide nutritious diet and encourage for liquid diet
frequently.
• Proper disposal of sputum, human excreta and other waste to
remove odors.

31. Implementation
• Proper dress-up, maintain room temperature and wear
warm clothes.
• Isolate the patient from the children from the other
patients but keep in touch and interaction with limited
visitors.
• Keep in stimulating environment such as listening to
radio, reading magazines and newspapers.
• Provide sufficient advice, information about disease, it’s
prognosis, course of treatment to the patient and family
members.

32. Evaluation
• It is based on observation on the effect of a changing
environment on the health of a person specially focus
on the vital signs and adequate knowledge about
disease condition.

33. Application of Nightingale’s work in the
nursing process
• Assessment: Nancy Smith, a 10 yrs old was injured
in an accident related to farm machinery. She had
head injury then she was admitted to PICU. Because
of PICU envt., she had interrupted sleep and she
became increasingly confused. Her leg has become
infected.
• Analysis of data: includes data gap
• Nursing Diagnosis: Impaired sleep pattern related to
environmental light and noise and separation from
family.

34. Application of Nightingale’s work in the
nursing process
• Planning and implementation: nursing actions focus on
changing the environment to support more normal sleep
patterns, that is, being awake during the day and sleeping
at night.
• Evaluation: After two nights of uninterrupted sleep,
normal sounds, and parental encouragement, Nancy will
demonstrate increased orientation to place being able to
identify that she is in the hospital.

35. Nightingale and the
Characteristics of theory

36. Nightingale model and the characteristics of
theory
• Theories can interrelate concepts in such a way to
create different way of looking at phenomena:
– Using her envt. Model, new insights into the phenomena of
interest to nursing can be identified.
– Examining envt.al aspects such as light, noise or warmth
can provide new insights into human responses to health
and illness, which means that health and illness not only
influenced by the pathophysiology and also psychosocial
envt.

37. Theories must be logical in nature
• Her model is illogical.
• She built her conclusion from observations, she made
her case, drew her conclusions and then acted. She
used logic to correct her conclusion.

38. Theories must be relatively simple yet
generalizable
• Her writings are simple.
• The beauty of her model is its generalizability,
including its continued applicability today.

39. Theories can be bases for hypothesis that can
be tested or for theory to the explained
• Nightingale has stimulated the development of
nursing science with her work.
• She has had a profound effect on many of the other
nursing theorists.
• The research related to the impact of the envt. on
client health has been influenced by Nightingale.

40. Theories contribute to and assist in increasing the
general body of knowledge
• This theory seems to have more relevance to
practitioners today than ever before.
• More and more data are becoming available to
indicate the critical nature of the impact of the
environment on the health and well-being of the
individual.

41. Theories can be used by practitioner to guide
and improve them
• Her work raises a consciousness on the nurse about
how the environment influences client outcomes.
• For example: controlling sound in the wards,
mounting ventilation and light, put off light during
nights all and all help in recovery from illness.

42. Theories must be consistent with validated theories, laws and
principles but will have open unanswered questions that need
to be investigated
• Works well with ecological, systems, adaptation and
interpersonal theories.
• she did not believe in germ theory; however the practices she
recommended were not inconsistent with scientific knowledge
we have today.
• Many of her suggestions which she based on observation of
client response to their envt., have been documented on
scientifically sound when tested with rigorous application of
modern research methods.

43. Critiques of the nightingale’s environment
theory
• Although four major concepts are not explicit in
Nightingale’s theory, they do offer nursing a specific way
of looking at particular phenomenon.
• The relationship between each concept is logical and
consistent with similar assumptions.
• Nightingale’s theory, although limited, has a lot of
generalizability.
• These ideas are basically simple to apply and easy to
measure in terms of outcomes.

44. Critiques of the nightingale’s environment
theory
• Prevention of disease would be achieved through
environmental controls.
• The environmental aspects of her theory remain
integral components of current nursing care.
• Yet it is not clear that Nightingale intended to
develop a theory of nursing, she did intend to define
the science and art of nursing and provide general
rules with explanations.

45. Critiques of the nightingale’s environment
theory
• The relation concepts-nurse, patient and environment
are applicable in all nursing today.
• Nightingale rejected the germ theory and her inability
to recognize a unified body of nursing knowledge that
is testable.
• She was only relying on personal observation and
experience.

46. Nightingale and the characteristics of
theory
1. What is the historical context of theory?
i. Florence Nightingale is the founder of modern nursing.
ii. Her work in the mid 1800s provided the basis for much of
modern nursing.
iii. Nightingale’s environment model fits neither the totality
nor the simultaneity paradigms.

47. What are the basic concepts and relationships
presented by the theory?
• Nightingale presented her ideas not as a theory but as
strategies to help women care for the ill in the home and
in hostels.
• Relationship of concepts are not clearly articulated.
However she presents her ideas in a clear manner.
• Using the basic concepts she presents, new insights into
phenomena of interest to nursing can be identified.

48. What major phenomena of concern to nursing
are presented?
• The manipulation of the environment by the nurse to
put the patients in the best place.
• Nightingale does not address interpersonal relations
specifically but does talk about the need for the nurse
to consider what she says when talking around the
patient.
• Cleanliness is also of major importance.

49. To whom does this theory apply? In what
situations? In what way?
• Nightingale’s writing are simple.
• Nightingale’s theory applies in all situations in which nursing
care is provided.
• Concepts related to pure air, light, noise and cleanliness can be
applied across specific environments.
• Reading her work raises a consciousness in the nurse about
how the environment influences client outcomes. It has
directed interventions toward modulating the environment.

50. To whom does this theory apply? In what
situations? In what way?
• Works well with ecological, systems, adaptation and
interpersonal theories.
• Her focus on the environment has relevance to practitioners in
today’s global health care climate.

51. By what method or methods can this theory
be tested?
• While direct testing of Nightingale’s theory has not been
done, she has stimulated the development of nursing
science with her work.
• For example: she did not believe in germ theory; however
the practices she recommended were not inconsistent with
scientific knowledge we have today.
• Both quantitative and qualitative methods of research
could be used to test relationships in the environmental
model.

52. Does this theory direct nursing actions that
lead to favourable outcome?
• Her work has not been tested in a manner that nursing
actions are prescribed.
• However, her writings have helped nurses develop
interventions that result in restructuring the environment.

53. How contagious is this theory?
• Examples of how nightingale continues to influence
both modern nursing and health care can be seen in a
number of articles.