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Copy of NURS1511, Florence Nightingale

Presentation of Florence Nightingale's Environmental Theory. York University, 2013.

Fathima Jawfer

on 25 November 2013

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Transcript of Copy of NURS1511, Florence Nightingale

Florence Nightingale's Environmental Theory

Florence Nightingale's History
Florence Nightingale was born in Florence, Italy on May 12th 1820 to an affluent British family
By the age of 16, it was clear to Florence that nursing was her divine calling
Despite this type of profession being against her family's wishes, she enrolled as a nursing student in 1844 at the Lutheran Hospital of Pastor Fliedner in Kaiserwerth, Germany (The Biography Channel, 2013).
The Crimean War
Nightingale's central focus became the Crimean war when word came back to Britain about the horrific conditions for the wounded soldiers
She arrived in 1854 & her team found lack of medical supplies & equipment, hygiene was neglected, & infections were rampant
She made notes about poor conditions:
lack of ventilation, lack of cleanliness, overcrowding & increased mortality
Through her leadership & efforts, mortality rates were reduced from 42% to 2% in 6 months (Potter & Perry, 2013).
Danielle Smith, Melissa Mason,
Delaine Lloyd & Janny Chituh

Florence's Achievements
In 1859 she published her books "Notes on Hospitals" & "Notes on Nursing" where her environmental theory is explained
In 1860 she opened Nightingale Training School for Nurses at St. Thomas Hospital
She is known as the founder of modern nursing & the first health statistician (Potter & Perry, 2013).
Metaparadigm Concepts of Environmental Theory
Now... Let's look at the ten major concepts of Florence's Environment Theory
Florence viewed persons as multidimensional. They are not just a physical being, but also have psychological, social and spiritual components (Parker & Smith, 2010).
Nightingale views the person as the patient. The nurse should maintain control over the environment and perform patient-centered tasks for simple recovery.
She believed in a patient passive relationship, however she noted the importance of patient preferences while carrying out tasks.
Florence focuses on the physical environment as the fundamental component of her theory.
Altering the physical environment in relation to the patient is needed in order to elicit change in his or her state of health.
In "Notes on Nursing" Florence states, "Environment could be altered to improve conditions so that natural laws would allow healing to occur" (Nightingale, 1959).
Nightingale defined health not only as being well but as using every ability that the person has to their fullest extent (Nightingale, 1859).
Health is maintained by controlling the environment to allow for reparative processes and to prevent disease.
The goal of nursing activities is client health
Florence explained, "What nursing has to do ... is to put the patient in the best condition for nature to act upon him" (Nightingale, 1859).
Nursing is an act that anyone can do, it is both an art and a science (Parker & Smith, 2010).
Nursing should always focus on the use of light, fresh air, warmth, quiet, cleanliness & nutrition.
Florence focused on women as nurses and felt it was a role to be filled by this gender
Ventilation & Warmth
Health of Houses
Chattering Hopes
Social Considerations
Nightingale believes that maintaining a well ventilated environment is the first and last thing upon which a nurse's attention must be fixed
It is essential to keep the air within as pure as the air without, while ensuring the patient's warmth by use of blankets & hot bottles
To achieve fresh air in the room, it is important to open windows
Stagnant or corrupt air can breed diseases
Florence explained that there are five essential points in securing the health of houses
pure air
pure water
efficient drainage
Without these, no house can be healthy
Florence points out that without cleanliness inside and outside of the home, ventilation is useless
Variety is a means to recovery
It can cause further suffering to see the same environment, same room and same surroundings for an extended period of time
The effect that beautiful objects and a variety of objects has on the sick is underrated & unappreciated
"Variety of form and brilliancy of colour in the objects presented to patients are actual means of recovery" (Nightingale, 1859)
Some examples mentioned by her include flowers, paintings, needle work, and cleaning
Light is essential to both health and recovery, second only to fresh air
It is essential to provide not only artificial sources of light but also direct sunlight
"Put the pale withering plant and human being into the sun, and, if not too far gone, each will recover health and spirit" (Nightingale, 1859).
Unnecessary noise hurts a patient, and shows the absence of care
Intermittent or sudden and striking noise affects patients much more than continuous noise does
Florence states the importance of sleep and stresses that a patient should never be waked
She mentions that there are helpful and hurtful sounds
Some beneficial sounds include wind instruments (example: human voice) and stringed instruments which are continuous sounds
Sounds that have the opposite effect include instruments with no continuity of sounds, for example a piano
Nightingale advocates for the importance of beds and bedding
It is essential to have clean sheets and blankets, which should be changed on a regular basis
To defer nurses from placing trays or supplies onto the patient's bed, the hospital beds should not be too wide
This also ensures that the nurse can easily reach the patient from either side
The bed should also not be too high, to ensure that the patient is never above the flow of fresh air from the window
It should be placed in the lightest spot in the room and they should be able to see outside the window
Florence notes that the greater part of nursing is dedicated to the preservation of cleanliness
One should not have to tell a nurse to come to work clean nor to keep their patient clean, as this should be a given
She stresses the importance of removing dust by use of a damp cloth, avoiding the use of carpet, and of papered, plastered or oil painted walls
The best wall for a room is pure white non-absorbent cement, glass or tiles
Keeping the room and environment the patient is in clean ensures the inside air is clean
"Without cleanliness, you cannot have all the effect of ventilation, and without ventilation you can have no thorough cleanliness" (Nightingale, 1859).
Florence appealed to all friends, visitors and attendants of the sick to avoid attempting to "cheer" the sick by providing false hope or exaggerating their chances of recovery
She mentioned that providing advice should also be avoided, as the friends and family may not have the proper knowledge to do so
The sick however do enjoy hearing good news and hearing of any material good, such as books and fiction
It is important for the sick to be provided with nourishing food to help promote recovery
Florence stresses the importance of food quality and states that the nurse should have her patient's diet in mind
Individuals desire different foods at different times of the day & small servings served more frequently may be beneficial
She also noted that no business should be dealt with involving the patient, while they are eating, as this can be distracting
Nightingale supported the importance of not only looking at the individual but at their social environment in which they live
The social environment involves observing the patient in their home, hospital room, or community in order to collect data
This is related to illness and is important in preventing disease
Remember .. the client is always the center of focus within Florence's theory...
Lady of the Lamp
Florence Nightingale is considered a visionary in the field of nursing and her theory remains essential and vital to modern day nursing.
In order for any patient in the health care setting to thrive, and to avoid disease and mortality, these three environments need to be utilized. The nurse strives to create the most optimal environmental conditions possible in order to positively affect the patient's biological, physical and physiological well being.
Psychological Environment
Social Environment
Physical Environment
Physical elements & the environment where the patient is being treated
It is important to have a clean environment to prevent illness and disease
Florence subdivided some aspects of her theory into this category:
The external/physical environment can strongly affect the internal/psychological environment
This includes variety as it is important for the mental well being of the patient for them to be stimulated with different activities and surroundings
Chattering hopes and giving advice should be avoided
Therapeutic communication is essential for the psychological well being of the patient
This incorporates aspects of the physical environment and consists of the person's home/hospital room and the community
The component of Florence's theory that is included in this is social considerations
This is based on the collection of illness and disease data
Now lets enjoy a musical
adaptation by the Flo Sistas..
Putting it into Modern
Day Practice
Bob is a 55 year old male construction worker, admitted to the emergency department with a poorly healing open wound. Bob has a recent history of upper respiratory tract infections, and upon assessment, states he is a user of cigarettes and alcohol.
Nurse Nancy begins the assessment of Bob
She asks about his physical environment
job is very noisy, dirty, and he is overworked and stressed
eats take out due to time constraints
She discusses his social environment
friends that enjoy partying
smokes & drinks frequently
Nancy analyzes his psychological well-being
feels lonely, rarely sees his family since he is working so much
has troubles sleeping
She then does a physical assessment of Bob's wound, his respiratory infection & other important vitals in order to began his plan of care...
Goals & Implementation
Nurse Nancy plans for Bob's physical environment
Lee, Clark & Thompson argue for the modern use of Florence's theory and stress the importance of pure air, pure water, cleanliness and light (Lee, Clark & Thompson, 2013).
Nancy can achieve this by planning for Bob's hospital room to have as much natural light and air ventilation as possible
It is important for Bob's wound and upper respiratory tract problems to avoid encountering contaminated air
His wound should be covered with sterile dressing and his room should be kept clutter free and clean at all times
In order to alter his social environment, Nancy plans on providing patient education
She discusses the risks of alcohol and cigarette smoking to his body and health
This can interfere with receiving proper nutrition and can lead to disease and illnesses
Nancy reviews his psychological assessment and she encourages him to slow down and take time for variety in his life
In order to ensure that he gets enough adequate sleep, Nancy provides a room without any noise or disturbances
Lower, Bonsack, & Guion suggest to decrease ringers on phones, lower monitor volumes, limit intercom use, close patient doors, and limit staff discussions to conference rooms (Lower, Bonsack & Guion, 2002).
These aspects all help the patient get a proper, uninterrupted sleep which they mention is crucial in wound healing and over all well being
Due to Nurse Nancy's modern use of Florence Nightingale's theory, Bob's condition was greatly improved
Bob's wound healed successfully, and his respiratory infection was no longer negatively effecting him
Bob left the hospital with proper knowledge about nutrition and good life style choices, as well as the benefits of proper sleep
He has the tools needed to alter his physical, social and psychological environments in a way that creates optimal well being and health for his future
Modern Adaptations
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Selanders (2010) explained Nightingale's Model for nursing practice as a way to systematically plan the care of the patient. In modern terminology this is known as the nursing process.
Her nursing process is four-steps: observation, environmental alterations, implementation and identification of their current state.
Beck (2010) pointed out that in our current day there are an abundant amount of global health problems. Nightingale faced similar big health issues in her era, and was able to make a big difference in finding solutions by using the components of her environmental theory.
By applying Florence's measures to modern day global practice such as cleanliness, light, optimal room conditions & education, we can promote health & recovery.
Upon reflection, it is clear that modern hospitals and care centers are designed and set up based on Nightingale's environmental recommendations. The entire facility and the individual rooms are kept sanitary & clean. There is a window in every room, for sunlight & fresh air. In colder temperatures there is central heat as well as blankets and covers.
"Many design firms today are continuing with her pioneering spirit by producing intentional designs that provide improved function for all those associated in the delivery of patient care" (Gregory, 2009).
The space is used efficiently and effectively. Florence introduced many concepts of evidence-based and client -based design which kick started organized health care (Gregory, 2009).
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One of Florence Nightingale's focuses was to prioritize hygiene. Today, this is a main factor in the control of infectious diseases. Lack of hygiene is responsible for hospital acquired infection and it remains a leading concern to health care providers (Potter & Perry, 2013). Florence insisted that hospital wards be kept clean and today this remains a focus in hospitals and care centers (Lee, Clark & Thompson, 2013).
Florence advocated for proper light and clutter free rooms. This is evident today, as poor lighting in patients rooms or home is the biggest cause of falls in the elderly (Potter & Perry, 2013).
An advantage of Florence's environment theory is that it can be implemented globally, and across all ages and cultures. When ever the environment can be altered, Nightingale's theory can be readily applied.
Florence’s environmental theory concepts are timeless and can be applied universally in all nursing settings today. Kozier et al states that “her general concepts about ventilation, cleanliness, quiet, warmth and diet remain integral part of nursing and health care today” (Kozier, 2010).
Nightingale's theory emphasizes the importance of environment on patient health. It is important to recognize that although a healthy environment is important it can only go so far in treating illness and disease.
Florence places a large focus on changing the individuals environmental conditions, however in some situations it is extremely difficult for this to occur. Some individuals have limited resources, financial hardships, or poor social conditions which may impeed their ability to alter their environments.
As well, some individuals suffer from psychological disorders and due to the impairment in their mental health, their environment may not be adaptable.
Her theory makes little mention of the use of medical technology. We now know the importance that surgeries and medical technology now play on a patient's overall health.
Nightingale saw nursing as distinct and separate from medicine. “Nursing focus is caring through environmental adaptation, where as medicines focus is on the cure of disease” (Selanders, 2010).
Although Florence recognized the importance of a collaborative manner between nurses and physicians, and realized it was needed to achieve patient health we now know modern nursing involves more then just adapting the environment.
Nurses now play an integral role in the administration of medicine, the use of technologies, and application of external devices that are needed to help patient healing.
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http://www.theguardian.com/science/gallery/2009/apr/27/nhs-design, November 20, 2013
http://www.scienceheritage.com/products-page/books/notes-on-nursing-by-florence-nightingale-1860/, November 20, 2013
http://exhibits.lib.byu.edu/nightingale/exhibit materials.php, November 20, 2013
Original lyrics to the instrumental version of Boyfriend by Justin Bieber (2012).

November 19, 2013

Nightingale suggests that if patients are provided with a healing environment it will help them to achieve overall well being. She places the patient as a central being in his or her own healing.
• The theory doesn’t take into consideration patients that are too incapacitated or unable to work towards their own healing.
• Her theory also doesn’t account for genetic inheritance of diseases that cannot simply be treated by changes in environment.
• It fails to consider patients that live a healthy life in the presence of chronic diseases. Patients who have diseases such as diabetes and arthritis can still function in a well state despite having this disease. This means health needs to be considered on more of a continuum then just as an absence of disease.
• “Nightingale downplayed disease and emphasized health” (Beck, 2010).
Beck states that Nightingale didn’t “wait for directives from physicians or the hospital administrator or even from her colleagues. From her own sense of calling she acted on her commitment to humanity on directives from within” (Beck, 2010).
Today as nurses we must respect the multidisciplinary team and follow the order and instructions of proper procedures and policies.
Beck also states that Nightingale, “made too much of a sacrifice, denied herself too much and nearly killed herself in the process” (Beck, 2010.)
Modern nurses understand the importance of self-preservation and although they still remain devoted to their patients they must also take care of themselves and their own health.
This helps nurses to avoid burnout and being overworked.

www.keepcalm-o-matic.co.uk, November 21.2013
Full transcript