The Environmental Theory by Florence Nightingale defined Nursing as “the act of utilizing the environment of the patient to assist him in his recovery.” It involves the nurse’s initiative to configure environmental settings appropriate for the gradual restoration of the patient’s health, and that external factors associated with the patient’s surroundings affect life or biologic and physiologic processes, and his development. Nightingale discussed the Environmental Theory in her book Notes on Nursing: What it is, What it is Not. She is considered as the first theorist in nursing and paved the way in the foundation of the nursing profession we know today.
Major Concepts of the Environmental Theory
The major concept of Florence Nightingale‘s Theory are:
“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 are not defined by Nightingale specifically. They are defined in relation to their environment and the impact of the environment upon them.
The physical environment is stressed by Nightingale in her writing. In her theory, Nightingale’s writings reflect a community health model in which all that surrounds human beings is considered in relation to their state of 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 of 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 as well as the ill and discussed health promotion as an activity in which nurses should engage.
Subconcepts of the Environmental Theory
In Florence Nightingale‘s Theory, she states:
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.”
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 that came from excrement. She also criticized “fumigations,” for she believed that the offensive source, not the smell, must be removed.
The importance of room temperature was also stressed by Nightingale. 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.
Nightingale believed that second to fresh air, the sick needed light. She noted that direct sunlight was what patients wanted.
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 female dress, as cruel and irritating to the patient.
She discussed the need for changes in color and form, 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 as activities to relieve the sick of boredom.
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 bed of the patient.
“Just as it is necessary to renew the air round 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.”
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.
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 assist them in becoming healthier.
Nightingale supported the importance of looking beyond the individual to the social environment in which he or she lived.
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.
- Pure fresh air – “to keep the air he breathes as pure as the external air without chilling him.”
- Pure water – “well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer.”
- Effective drainage – “all the while the sewer maybe nothing but a laboratory from which epidemic disease and ill health is being installed into the house.”
- Cleanliness – “the greater part of nursing consists in preserving cleanliness.”
- Light (especially direct sunlight) – “the usefulness of light in treating disease is very important.”
The factors posed great significance during Nightingale’s time when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients.
Also emphasized in her environmental theory is the provision of a quiet or noise-free and warm environment, attending to patient’s dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient.
Deficiencies in these five factors produce illness or lack of health, but with a nurturing environment, the body could repair itself.
Analysis of the Environmental Theory
In the era that we are in today, we are faced with environmental conditions beyond what was ought to be natural and nurturing. Some of the global environmental issues that we have now are global warming, nuclear radiation threats, man-made environmental calamities, and pollution. From these occurrences, Nightingale’s model seemed to be very ideal. Her concept of providing fresh air to patients is in question with today’s industrialization effects.
In addition to the analysis of the concept of ventilation, it is not always beneficial for all clients to have fresh air. Natural air has its impurities which in turn may infect open wounds and drainages such as in burns.
With the idea of providing light, the light emitted by the sun today is proven to be harmful already because of the destruction of the ozone layer of the Earth. Exposing the patient constantly to direct sunlight may then be more destructive to the patient’s betterment than being beneficial.
It is true that a healthy environment heals as what Nightingale stated but the question now is how our environment would remain health amidst the negative effects of the progress of technology and industrialization.
Since the applicability of some of the concepts to specific situations today is non-feasible, development of this theory is utterly needed to accommodate the changes of the environment that we currently have. Still, above all this, it is very much clear the Nightingale’s Environmental Theory is superb as a starting point of the progression of our profession and served as a catalyst for nursing’s improvement.
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 be able to 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.
The language Florence Nightingale used 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 environment, the home, a work site, or the community at large. Reading Nightingale’s Environmental Theory raises consciousness in the nurse about how the environment influences client outcomes.
In Nightingale’s Environmental Theory, there is scant information on the psychosocial environment when compared to the physical environment. The application of her concepts in the twentieth century is in question.
The Environmental Theory of Nursing is a patient-care theory. It focuses on the alteration of the patient’s environment in order to affect change in his or her health. Caring for the patient is of more importance rather than the nursing process, the relationship between patient and nurse, or the individual nurse.
In this way, the model must be adapted to fit the needs of individual patients. The environmental factors affect different patients unique to their situations and illnesses, and the nurse must address these factors on a case-by-case basis in order to make sure the factors are altered in a way that best cares for an individual patient and his or her needs.
The following are the references and recommended further reading for
- Cohen, I. B. (1984). Florence Nightingale. Scientific American, 250(3), 128-137. [Link]
- Nursing Theory and Conceptual Framework, Fundamentals of Nursing: Human Health and Function, Ruth F. Craven and Constance J. Hirnle, 2003, pp.56
- The Nature of Nursing, Fundamentals of Nursing: Concepts, Process and Practice, Second Edition, Barbara Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder, 2004, p.38
- Nightingale, F. (1860/1957/1969). Notes on nursing: What it is and what it is not. In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
- Nightingale, F. (1992). Notes on nursing: What it is and what it is not. (Com. ed.). (Original publication 1859). In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
With contributions by Wayne, G., Ramirez, Q., Vera, M.Last updated on