Introduction
This paper analyses and evaluates Florence Nightingale’s environmental theory, which emphasizes the significance of providing environmental care (Gilbert, 2020). It is regarded as a grand nursing theory or methodological approach because it umbrellas different areas of nursing methodology and care units. This philosophy contrasts empirical information and medical treatment with knowledge gained through patient monitoring and critical thinking.
Theory Description
Historical Context of the Theory
Florence Nightingale lived from 1820 to 1910 and was a prodigy of the Victorian era (Gilbert, 2020). As the daughter of a wealthy and well-known family, she embraced her position in the social hierarchy. She could travel and engage with her period’s well-known and powerful individuals.
Even though interpersonal connections were usually challenging and confrontational, she respected the integrity of her family. Her father insisted on her receiving an education, which was uncommon for a woman, but offered her a wide breadth of knowledge in mathematics, linguistics, the classics, and philosophy (Cardoso et al., 2021). Nightingale’s intense commitment to God and awareness of spirituality, which began in her youth and persisted throughout her life, are the most important aspects of her theology. She sought out chances to help people more frequently after this incident, against her family’s concerns that she shouldn’t act in such a way as a woman.
Nightingale argued that the environment might be changed to create better circumstances so that recovery would be permitted by natural principles (Riegel et al., 2021). This resulted from her empirical discovery that unfavorable or challenging settings contributed to ill health and disease. The classic instance occurred during the Crimean War, when squalor, poor nutrition, filthy water, and improper sewage disposal caused more British men to pass away in hospitals than from wounds received on the battlefield.
The environment is defined as everything that helps manipulate a subject to place them in a viable situation for nature to act. As a result, the components consist of both internal and exterior elements. There are combined elements such as water, drugs, and food that enter the patient’s body, which Nightingale was concerned about (Nightingale, 1958a).
Similarly, light, ventilation, noise management, stimulation, room temperature, and stimulation that constitutes the external environment were also under her attention (Cardoso et al., 2021). Nightingale believed that ventilation was the most crucial of these components. This is reminiscent of the atmosphere of Victorian England, where coal burning contributed to generally bad air quality, especially in metropolitan areas.
Structural Components of the Theory
As Pfettscher (2021) described in Nightingale’s theory, the environmental theory has its structural components based on cleanliness, diet, ventilation, light, noise, and warmth.
Cleanliness
A dirty environment is a promoter of illness because it contains organic matter, a reservoir of pathogens (Pfettscher, 2021). The existence of organic material renders the clinical setting unclean even in well-ventilated environments; as a result, proper processing and disposal of human waste and sewage are necessary to avoid environmental pollution (Nightingale, 1958b). Nightingale mandated that nurses take regular showers, wear clean clothes, and wash their hands often (Nightingale, 1969). This idea is especially significant for providing treatment to individual patients, and it is crucial for enhancing the health of the underprivileged who formerly lived in overcrowded, unsanitary circumstances with little access to clean water and the environment.
Diet and Noise
In her philosophy, Nightingale incorporated the ideas of solitude and nutrition. The nurse must determine whether or not there is a need for silence and take appropriate action to keep it (Nightingale, 1969). It is best to avoid physical activity-related noise from a patient’s room since it might injure them. The patient’s food was another issue that worried Nightingale (Nightingale, 1969). She gave the nurses instructions to evaluate the patient’s impact on the meal schedule and the patient’s nutritional intake. She felt that skilled nurses effectively supplied patients’ dietary demands and that individuals with chronic illnesses may accidentally starve to death.
Light
The idea of light had a significant role in Nightingale’s thesis. She specifically mentioned that patients needed direct sunshine (Pfettscher, 2021). Light “has nearly as substantial and physical effects upon the human body,” she stated. Nightingale raises the question of noticing how light, particularly direct sunshine, purifies the air in a nursing setting. (Nightingale, 1969). Nurses were told to shift and arrange patients, so they were exposed to sunshine and got sunlight’s benefits.
Ventilation and Warmth
The patient’s air circulation appeared to be Nightingale’s priority, and she instructed the caregivers to maintain the internal air in the clinical setting to be free of contamination (Nightingale, 1969). The fact that Nightingale prioritized ventilation strongly suggests that she understood the environment as a cause and contributor to sickness as well as the healing process. Additionally, in ventilation in the space or house, she described how to assess for heat loss by palpating the patient’s extremities to determine their body temperature (Nightingale, 1969). Nightingale laid guidelines to control the environment to preserve patient warmth by placing patient beds in a strategic location and lighting a decent fire.
Functional Components of the Theory
Nightingale also believed that in a situation where people or patients pay little or no focus on their health, nature-imposed illness, and diseases are a way of retribution (Pfettscher, 2021). Nightingale envisioned preserving health as the result of illness prevention via social responsibility and environmental management. She explained how this gave rise to nursing and the recent idea of promoting a good lifestyle and living. She made a distinction between the idea of health nursing and the concepts of caring for people to improve health and promote a better life until demise.
Nurses are identified as an important function of the theory. To aid in the patient’s rehabilitation, nurses performed chores too for the individual and managed the surroundings (Riegel et al., 2021). In this interaction, Nightingale mostly spoke of a passive patient. However, special mentions are made to the patients taking care of themselves wherever feasible and, in particular, participating in deciding when and what to eat. Nightingale thought of each patient as a person since she instructed the nurse to inquire about the patient’s preferences. Nightingale (1871), on the other hand, stressed that the caregiver must take charge and be accountable for the external environment in a clinical or any other setting.
Nightingale’s idea of the environment lays the functional foundation for environmental nursing. To build and preserve a therapeutic atmosphere that would improve the patient’s ease and recuperation was her advice to nurses, both those giving home health care and trained nurses in health facilities. She describes environmental issues, their effects, and workable remedies for families and communities.
Primary Source Material Utilized
Nightingale’s publications from 1858a, 1858b, 1871, and 1969 serve as the key sources for this research. In these pieces, she first offers her hypothesis, then develops it and explains why it is significant for the nursing profession. Additionally, Modern Nursing by Susan A. Pfettscher (2021) has been used in combination with several other academic informative websites, peer-reviewed research studies, and relevant articles.
Theory Analysis: Walker and Avant Method
Walker and Avant’s theory analysis technique requires taking into account the theory’s usefulness, logical adequacy, testability, generalizability, and parsimoniousness, as described below, to give an objective study of Nightingale’s theory.
Logical Adequacy
Nightingale utilized inductive reasoning to derive the rules of health, sickness, and nursing. She may have developed her capacity for logical thought and inductive reasoning due to her early schooling, notably in philosophy and mathematics. For instance, she concluded that sickness was caused by the unclean, filthy, and gloomy surroundings in the Scutari hospital based on her observations of such settings (Nightingale, 1969). She stopped the disease from spreading in such a setting and provided evidence of the success via meticulous record-keeping. She studied the structure and developed guidelines for nurse education and patient care based on her qualifications and experiences in Crimea.
Usefulness
Nightingale’s nursing ideals still lay the cornerstone of modern nursing practice. Nursing care continues to be fundamentally influenced by the environmental parts of her theory. Her ideas are still relevant to nursing practice in the twenty-first century; in fact, much more so now that global society is dealing with new disease management challenges. A health concern in many areas continues to be polluted water brought on by environmental changes or the arrival of rare pollutants, even though treatment and contemporary sanitation have successfully reduced conventional causes of disease in the United States. The actual and potential transmission of illness has changed significantly due to global travel. Nurses across the globe continue to face issues with modern sanitation, sufficient water purification, and the identification and management of various disease transmission routes.
Generalizability
Nightingale’s principles have served as comprehensive values for all nurses and other health practitioners. Even if some of the activities she described are no longer pertinent, her ideas are timeless and universal. More and more nurses realize the need for observation and outcome monitoring in nursing practice. The environment, nurse, and patient-related principles are still relevant in all nursing situations today. As a result, they satisfy the generality requirement.
Parsimoniousness
The theory is condensed and easily explained. According to Susan A. Pfettscher (2021, p55), Nightingale’s Environmental theory identifies and clarifies to nurses the value of considering how the environment affects health and recovery (Pfettscher, 2021). Per Susan A. Pfettscher (2021):
The major concepts of the model are ventilation, light, warmth, noise, diet, and cleanliness (p. 55).
Testability
The principle of environmental change has served as a foundation for research projects. Nightingale created a statistical sample of a pie graph (Nightingale, 1858a) due to a lifelong fascination with gathering data and tallying results. The pie graph’s initial purpose was to show the fatality frequency from all sources during the historical Crimean War. When she had a chance to be selected as the first female member of the Royal Statistical Society in 1860, the organization finally acknowledged her excellent work, a remarkable accomplishment for a woman in the English Society. During the Crimean War, the analytical and statistical output influenced Nightingale’s suggested hospital changes (Riegel et al., 2021).
Theory Evaluation
Potential Contribution to Nursing’s Knowledge Base
Nightingale was a productive writer who produced countless transcripts, diaries, literature, novels and reports on various subjects, including health reform. This precise, succinct, and traceable historical account makes Nightingale’s work easier to comprehend (Gilbert, 2020). It allows the modern nursing profession to incorporate her ideas into current nursing models of care, including infection control and hygienic treatments like aseptic techniques (Riegel et al., 2021). The Nightingale Pledge, which states that people must “dedicate themselves to the wellbeing of those motivated to their care, applies to every aspect of nursing in the twenty-first century.
The theory continues to impact modern infection control procedures and the healthcare practice that goes along with them (Gilbert, 2020). In particular, with the COVID-19 epidemic and the persistence of hospital-based infections, simple practices like hand sanitation can offer safety measures to patients and others (Nightingale, 1860). The establishment of infection control measures, including aseptic techniques, sterilization technologies, quarantine procedures, and isolation nursing care methods, still used today, has also been impacted by Nightingale’s commitment to sanitary reforms.
Examples of Settings in Which Theory Has Greater Utility
The principles of Nightingale serve as the stanch groundwork for the ongoing development of contagion control approaches in response to COVID-19 (Gilbert, 2020). Even Nightingale’s hospital planning and design concepts are presently popular, with unpremeditated medical accommodations built to lodge people with mild symptoms resembling her pavilion-style ward preparation (Fernandes & Silva, 2020). Frontline healthcare professionals, like nurses, voluntarily expose themselves to the possibility of COVID-19 infection from colleagues and patients every day but, like Nightingale, are entirely committed to the care and wellness of others.
In the home care setting for COVID-19 patients, the basic fundamental concepts of Environmental theory are highly used. The general cleanliness of the surface area, clothes, and surroundings is important to prevent the disease from spreading (Gilbert, 2020). There is a need for proper ventilation, which also comprises social distancing and avoiding crowded places. This also requires that public and private rooms are properly ventilated by ensuring that windows and vents are always open.
Contemporary health facilities have benefited much from Nightingale’s knowledge and skills. The industry has produced cutting-edge facilities and technology, but this is just the beginning (Fernandes & Silva, 2020). COVID-19 might have a “good” effect on hospitals, but it also presents new difficulties for planners and designers.
Limitations of the Theory
Nightingale did not specifically address the compassionate actions of nurses. She wrote little about interactive relations, excluding how they affected the patient’s healing progressions. She did speak on the phenomena of caregiving callings and the necessity of dedication to nursing practice (Hussain & Karim, 2020). Nightingale’s philosophy must mention the correct measures for handling dependent or desperately needy patients. This discourages nurses from caring for these patients since it could result in a psychological drain, which might negatively impact other patients getting treatment.
Conclusions
Nightingale defined the knowledge, abilities, and attitudes needed for professional nursing. Despite the fact that modern nurses are unlikely to be aware of their origins, these descriptors nevertheless benefit the nursing profession effectively. The subsequent years, during and after her lifetime, have seen the global growth of these changes. Her precise and structured notions comprise her Environmental Theory, which has opened up an entire world of infection control invention, adaptation, and progress, generating health services that are well beyond anything she could have imagined today. In modern nursing settings, the fundamental ideas of environmental theory, manipulation, and patient care may be implemented.
References
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Fernandes, A. G., & Silva, T. D. (2020). War against the COVID-19 pandemic: reflection in light of Florence Nightingale’s nursing theory. Revista Brasileira de Enfermagem, 73. Web.
Gilbert, H. A. (2020). Florence Nightingale’s Environmental Theory and its influence on contemporary infection control. Collegian, 27(6), 626-633. Web.
Hussain, A., & Karim, K. (2020). Enhancing Patient’s Surrounding: Application of Nightingale’s Environmental Theory into Nursing Practice. i-Manager’s Journal on Nursing, 10(1), 45. Web.
Nightingale, F. (1858a). Notes on matters affecting the British army’s health, efficiency, and hospital administration were founded chiefly on the experience of the late war. Presented by request to the Secretary of State for War. London: Harrison & Sons.
Nightingale, F. (1858b). Notes on hospitals: Being two papers read before the National Association for the Promotion of Social Science, at Liverpool, in October 1858. With evidence given to the Royal Commissioner on the state of the army in 1857. London: John W. Park and Son.
Nightingale, F. (1871). Report on measures adopted for sanitary improvements in India, from June 1870 to June 1871. London: George Edward Eye and William Spottiswoode.
Nightingale, F. (1969). Notes on nursing: what it is and what it is not. New York: Dover.
Pfettscher, S. A. (2021). Florence Nightingale: modern nursing. Nursing Theorists and Their Work E-Book, 52.
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