nursing

1. Florence Nightingale theory
INTRODUCTION:
Florence Nightingaledevelopedhertheorybasedonherideasonindividual,Societal
and professional values.Herstrongestinfluence waseducation,observationandhandsonexperience.
She formulatedhervaluesthroughyearsof workingwithcharityhospitalsandthe military.She mainly
gave importance toenvironmentintheory.
CREDENTIALS OF THEORIST:
 Florence Nightingalewasbornon12th
May 1820
 Religiousinspirationcalledherforfocusonhealthof masses
 She beganhernursingtrainingin1851 inGermany
 She pioneeredthe conceptof formal nursingeducation
 Her experience intreatingsickorinjuredsoldersinthe Cremianwarstrongly
influencedherphilosophyof nursing
 Duringthe Cremianwar Nightingale volunteeredtoTurkeywere she organized
nursingdepartmentandexposedsanitaryprobleminwardatthattime woman
workinginhospital were notrespectable
 Conditioninthe armywardswas poor.The solderssufferedfromexposurelice
infectionanddisease.There were few chamberparts,latrineswere blockedand
waterwas alsocontaminated.Patientswhocouldnotfeedthemselveswere
starved.There wasno surgerytable oranesthesia.Nightingale workmade
popularwiththose men,theycalledher‘ladywithlamp’.
 She diedon13th
August1910.
THEORITICAL SOURESE FOR THEORY DEVELOPMENT:
Many factors influencedthe developmentof Nightingale’stheory.Individual,societal,and
professionalvalueswere all integral inthe developmentof herwork.She combinedherindividual
recourseswithsocietal andprofessional toproduce change.She believedthatshe shouldstrive to
change the thingshe saw as unacceptable.She expandedherphilosophyof nursingthroughassociation
withnumerousprominentphysiciansandotherprominentmembersof the society.Herstrongest
influenceonthe developmentof herpractice washereducation,experience,andobservation.She
gainedthese throughyearsof charitable andhospital workandmilitarynursing.Theyestablishedthe
logical base forhernursingtheory.
USE OF EMPIRICIAL EVIDENCE:
Nightingalewasdevotedstatistician.She usedhercarefullycollectedinformationtoprove the
epicasyof hersystemof her hospital nursingandorganizationduringCerimanwar.The report of her
data and experiences,entitlednotesonmattersaffectingthe health,efficacy,andhospital
administrationof the Britisharmyshowedthateverymankilledinbattle inthe Cremia,sevendiedfrom

2. disease.PalmeridentifiedNightingale’sresearch skillsasrecording,communicating,orderingcoding,
conceptualization,inferringanalyzingandsynthesizing.
NIGHTINGALE’STHEORY:
 The firstpublishednursingtheoryin1860.
 Personsare inrelationwiththe environment
 Stressesthe healingproperties of the physical environment(Freshair,light,
warmthand cleanliness)
 Nursingputspatientinthe bestconditionsfornature toact uponthem.
 Healthis‘The positive of whichthe pathologyisthe negative’.
 ‘Nature alone cures’
 Whenaspectsof the environmentof outof balance the clientmustuse energy
to counterthese environmental stresses.
 Stressesdrainthe clientof the energyneededforhealing.
 She viewedasthe reparative processes.
 The healthof the home or communityiscritical componentsinan individual
strength.
TheoryBasses:
The interrelationshipof ahealthfulenvironmentwithnursing.Externalinfluencesand
conditionscanprevent,suppressorcontribute todisease ordeath.
Theorygoal:
Nurseshelppatientsretaintheirownvitalitybymeetingtheirbasicneedsthroughcontrol of the
environment.
Nursing’sfocus:
Control of the environmentforindividual’sfamiliesandcommunity
Three typesof environment:
 Physical
 Physiological

3.  Social
Physical Environment:
 Consistof physical elementswere the patientisbeingtreated
 Affectsall otheraspectsof the environment
 Cleanlinessof environmentrelatesdirectlytodiseasepreventionandpatientmortality
 Aspectsof the physical environmentinfluence the social andpsychological environment
of the person
Physiological:
 be affectedbya negative physical environmentwhichthencausesstress.
 Requiresvariousactivitiestokeepthe mindactive (i.e.Manual work,appealingfood,a
pleasingenvironment,)
 Involvescommunicationwiththe personaboutthe personandaboutotherperson.
 Communicationshouldbe therapeutic,soothingandunhurried
Social environment:
 Involvescollectingdataaboutillnessanddiseaseprevention
 Include componentsof the physical environmentinthatclearair, clear water,proper
drainage
 Consistof the person’shome orhospital roomas well asthe total communitythat
affectsthe patient’sspecificenvironment.
MAJOR CONCEPTS:
Five majorcomponentsof ahealthful environment:
1. Properventilation
2. adequate light
3. sufficientwarmth
4. control of noise
5. control of effluvia(noxiousodors)
Componentsof Nightingale’senvironmental theory:
1. Healthof houses:
In notesonnursing,Nightingale discussedthe importantof the healthof housesas
beingcloselyrelatedtothe presence of pure air,pure water,efficientdrainage,
cleanlinessandlight.Tosupportthe importance of hospital basednursingattendingto
these,said‘badlyconstructedhousesdoforthe healthywhatbadlyconstructed
hospitalsdoforthe sick.She also notedthatthe cleanlinessoutsidethe house affected
inside.E.g.:Nightingalenotedthe dungheapsaffectedthe healthof housesinhertime,
so twocan modernfamiliesaffectedbytoxicwaste,contaminatedwaterandthe
pollutedair
2. VentilationAnd Warming:
Nightingalestateditisessential to”keepthe airhe breathsas pure as the external air,
withoutchillinghim”Nightingale believedthatsteadysupplyof freshairwasthe most
principle innursing.She believedthatthe personwhorepeatedlybreathshisorherown
air wouldbecome sickorremainssick.E.g.:Freshair,whichis of primaryimportance,

4. can be achievedthroughopenwindows.Corrupt,stagnatedandmustyairbreeds
disease.Anoutletisneededforimpure air.‘Noxiousairre effluviaorfoul odorsisto be
avoided.Inmanypublicplacesaswell asinhospitals,raw savage couldbe foundnear
patients,inditchesunderornearthe house.Effluviaalsoinclude bedpans,urinals,and
otherutensilsusedtodiscardexcreta.
The importance of room temperature wasstressedbynightingale.The patientshould
not be too wormor too cold.
E.g.: Guardingagainstthe lossof vital heatisessential topatientrecovery.Chillingisto
be avoided.The temperature couldbe controlledbyappropriatebalance between
burningfiresandventilationfromwindows.Todaybuildingsare constructedtobe
climate-controlledinsuch amannerthat the clientor the nurse cannotcontrol the
temperature of the individual room.
3. Light:
Nightingalenote thatlighthasthe tangible effectsuponthe humanbody‘Itisnot only
lightbuttheyneeddirectsunlight’.Lighthasa purifyingeffect of the airof a room.E.g.:
Bedsshouldbe placedinsucha positionastoallow the patienttosee out of the
window,the skyandthe sunlight.Modernhospitalsmaybe constructedinsucha
mannerthat the day lightisrarelyavailable.
4. Noise:
Noise was alsoof concern to Nightingale particularlythatcouldjarthe patient.
Unnecessarynoise ornoise thatcreatesan expectationinthe mind.
She statedthat patientshouldneverbe wakedintentionallyoraccidentlyduringthe
firstpart of sleep.She assertedthatwhisperedorlongconversationaboutpatientsis
thoughtlessandcruel.She viewedthatunnecessarynoiseincludingnoise femalethatas
cruel and irritatingtothe patient.Othermore modernnoisesinclude the snappingof
rubberglues,the clank of a stethoscope againstmetal bedraise,andradiosandTVs.
Modernhealthcare facilitiescontainmuchequipmentthatissue alarms,beeps,and
othernoisesthatstattle or jar a patientsleeptowakefulness.
5. Variety:
Nightingalebelievedthatvarietyinthe environmentwasacritical aspectaffectingthe
patient’srecovery.She discussedthe needforchangesincolorandform, including
bringingthe patientbrightlycoloredflowersorplant.E.g.:Nightingale alsoadvocated
reading,needlework,writing andcleaningasactivitiestorelieve the sickof boredom.
6. Bedand Bedding:
Nightingaleviewedbeddingasanimportantpart of the environment.She notedthatan
adultinhealthexhalesaboutthree pintsof moisture throughthe lungsandthe skinina
24 hour period.Thisorganicmatterentersthe sheep’sandstaystheirunlessthe
beddingischangedandairedfrequently.She believedthatthe bedshouldbe placedin

5. the lightestpartof the roomso that the patientseesoutof the window.She remained
that the car givertoleave against,situponor unnecessarilyshake the bedof apatient.
E.g.: Inmodernhospitalsmattressare usuallycoveredwithplasticthatcan be washed
to remove drainage,excretaorothermatter.These mattressesoftencause the patient
to perspire leadingtodampbedclothing.Sheetsalsodonotfittightlyonthese
mattresses,leadingtowrinklesthatcanresultinpressure pointsonthe skinof the
patientlyinginbed.Multipleintravenouspumps,ventilators,andmonitorsattachedto
a patientmayimpede comfort.Itremainsimportantforthe nurse tokeepbedding
clean,neatand dryto positionthe patientformaximumcomfort.
7. Personal cleanliness:
Nightingaleviewedthe functionof the skinasimportant,believingthatmanydiseases
’disordered’are causedbrakesinthe skin.She thoughtthatunwashedskinpoisonedthe
patientandnotedthat bathinganddryingthe patientskinprovidedgreatrelief tothe
patient.E.g.:Bedriddedpatient.She saidthat‘justasit isnecessary torenew the air
rounda sickpatientfrequently,tocarry off morbideffluviafromthe lungsandthe skin,
by maintainingfreeventilation,soitisnecessarytokeepporesof the skinfree fromall
obstructingexcretions.She alsobelievedthatpersonal cleanlinessextendedtothe
nurse and that ‘everynurse oughttowashherhands veryfrequentlyduringthe day’.
8. Nutritionandtakingfood:
Nightingaleaddressedthe varietyof foodpresentedtothe patientanddiscussedthe
importance of varietyinthe foodpresented.She notedthatindividualsdesire different
foodsat differenttimesof the dayandthat frequentsmall servingmaybe more
beneficial tothe patientthana large breakfastora dinner.
9. Chatteringandadvises:
Nightingaledidnotspeaktothe social and psychological environmentof the patientto
the same degree thatshe addressedthe psychical environment.Howevershe includeda
chapteron ‘ chatteringhopesandadvises’false hopeswasdepressingtopatient,she
felt,Andcausedthemtoworry andbecome fatigued.Nightingaleencouragedthe nurse
to heedwhatisbeingsaidbyvisitors,believingthatsickpersonshouldheargoodnews
that wouldassisttheminbecominghealthier.
10. Social considerations:
Nightingalesupportedthe importance of lookingbeyondthe individual tothe social
environmentinwhichhe orshe lived.She believedthatthe housedandthe hospital
neededtobe well managed.I.e.organizedcleanandappropriatesupplies.E.g.:She
observedthatgenerationsof familiesviewedanddiedinpoverty.Usingherstatistical
data, she wrote lettersandpositionpapersandsentthemtoheracquaintance inthe
governmentinanefforttoimprove the undesirable livingconditions.Nightingale was
role model forpolitical activismbynursing.

6. MAJOR ASSUMPTIONS:
Person:
 Referredbynightingale as“the patient”
 A humanbeingacteduponby a nurse or affectedbythe environment.
 Has sreparative powerstodeal withdisease
 Recoveryisinpatient’spoweraslongas a safe environmentexists.
Environment:
 The foundational componentsof Nightingale’stheory
 “Those elementsexternal toandwhichaffect the healthof the sickand healthy
person”.
 Includeseverythingfromaperson’sfood andflowersto a nurse’sverbal and
non-verbal interactionwiththe patient.
Health:
 Maintainedbyusinga person’shealingpowertotheirfullestextent
 Maintainedbycontrollingthe environmentalfactorssoas to preventdisease.
 Disease isviewedasa reparative processininstitutedbynature
 Healthand disease are the focusof the nurse
 Nurseshelppatientsthroughthe healingprocess.
Nursing:
 “What nursinghas to dois to putthe patientinthe bestconditionfornature to
act upon him
 Nightingalestatedthat nursing”oughttosignifythe properuse of freshair,
light,warmth,cleanliness,quietandthe properselectionandadministrationof
diet.
THEORETICAL ASSERTION:
Nightingalebelieveddisease wasareparative process.Nursesencouragedthisprocessby
providingproperenvironmental conditionssuchasfreshair,light,pure water,andefficientdrainage,
cleanliness,andwarmth,quite andappropriate diet.Nightingalealsofeltnurseshadtouse common
sense toachieve these conditions,butithadto be coupledwithperseverance,observationand
ingenuity.Nightingale assumedthe personwasdesirousof health,sothata nurse,nature andthe
personwouldco-operate to allowthe reparativeprocesstooccur.
CRITIQUE OF THE THEORY:
1. Theoriescaninterrelate conceptsinsuchawayas to create a differentwayof lookingata
particularphenomenon.Whennursingsituationsare viewedfromNightingale perspective
usingherenvironmental model,new insightstothe phenomenaof interesttonursingcan
be identified.E.g.:Whenaclientinanisolationroombecomesdisoriented,obviousthingto
considerwouldbe medical pathologyandfluidandelectrolyte balance.FromNightingale’s
perspective the impactof the environmentwouldbe aninitial concern.
2. Logical innature:
Nightingaleenvironmentmodel islogical.She buildherconclusionsfromobservations,
she made her case,draw herconclusionsandthenacted.
3. Theoryisverysimple:

7. 4. Theoryisgenralisiable:The butyof hermodel isitsgendralisabilityincludingitscontinued
applicationtoday.Itcan be appliedinthe mostcomplex hospitalintensive care
environment,the home,awork,a worksite,are the communityat large.
5. The theorycan be the basesfor hypothesisthatcan be testedorfor theoryto be expanded.
6. Thistheorycontributestoand assistsinincreasingthe general bodyof knowledge within
the disciplinethroughthe researchimplementedtovalidate them.
7. Thistheorycan be usedbypractionierestoguide andimprove theirpractice.
8. Her theoryisconsistentwithothervalidatedtheorieslawsandprinciples.