Nursing theory Final Term Paper: Florence Nightingale's Environmental Theory
Nursing theory Final Term Paper: Florence Nightingale's Environmental Theory
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During the last century, the field of nursing has witnessed significant success due to the recognition of nursing as an academic discipline and occupation via a shift toward theory-based practice. This shift saw the contemporary nursing viewed as a more fulfilling and vital discipline and the profession as it changed the focus of nursing from vocational occupation to an organized profession. Several nursing theories have been developed with the main objective to advance the nursing discipline and profession (Roque & Carraro, 2015). One of such theories is the Florence Nightingale's Environmental Theory. Nightingale developed the theory in the second half of the 19th century, and she emphasized mainly on the environment and interpreted it as all the external circumstances and influences that impact the life and development of the lives of organisms that can avert, restrain or lead to ailment and eventually death (Dunphy, Lynne, P.H.D., 2015). This paper introduces Florence Nightingale's Environmental Theory and how it relates to the four nursing paradigms and the advancement of nursing practice.
Theoretical Framework of Florence Nightingale's Environmental Theory
Florence Nightingale’s environmental theory is the first nursing theory developed to advance the nursing discipline and profession. When designing the theory, she focused on relationships between nursing and the patient environment. Notably, the environment theory was developed in 1859 when Florence Nightingale realized that healthcare organizations lacked proper hygiene; health professionals had little education and training and were persistently not competent enough when caring for the needs of their patients (Dean, 2020). In her nursing records, she was specific and stated that nursing is the act of utilizing the environment of the patients to help them recover. Even though it was the first nursing theory, it possesses a significant role in contemporary nursing practice. This theory is grounded on the ideology that enhancing the patients’ environment will aid in the process of healing.
The theoretical framework of Nightingale’s theory is based on the ideology that the patient’s surroundings could be altered to enhance the conditions to enable the healing to happen naturally. This theoretical framework was developed from the comprehension that poor or unfavorable environments contribute to a decrease in health and increases the illnesses. Nightingale also understood that a “nurturing” environment could bring a difference in the health and recovery of patients (Dean, 2020). Besides, the framework being refined by her years of nursing experience and practice in health care settings, it placed to care for the patients at the center of the nursing process from a concrete outlook, while recognizing that the patients are more than just a symptom, illness or injury, and developed a holistic approach to the care of patients. In this theoretical framework, Nightingale did not only emphasize the perception of care in her work and writings but also placed more emphasis on health and the proper utilization of the resources in the environment.
The Attributes of Nightingale's Environmental Theory
Nightingale acknowledged five key environmental attributes that are crucial in the promotion of health and well-being in nursing practice. The environmental attributes incorporate the presence of “pure fresh air, pure water, effective drainage, cleanliness, and light” (Dean, 2020). According to Nightingale, the ability to breath in pure fresh air is an essential factor in the promotion and maintenance of an individual’s health. Nightingale was more worried about the negative impact that breathing in polluted smelling air had on a person’s health. She believed that if an individual lacks access to fresh air and continued breathing in their own air, they would become ill. In addition to the quality of the air, Nightingale stated that the temperature needs to be appropriately balanced to avert extreme temperatures.
Access to pure water is another key attribute described in environmental theory. For instance, Beck & Dossey (2019) noted that “well water of a very impure kind is used for domestic purposes, and when the epidemic disease shows itself, persons using such water are almost sure to suffer.” In the presence of disease and unhealthy circumstances, utilizing water sources that are contaminated can potentially result in or possibly extend sickness. Therefore, it is essential to restore a person’s health. To promote health, individuals must have a source of pure water available and accessible.
Proper drainage and appropriately functioning sewerage are indispensable in the promotion of health and healing. Sewer can be seen as “nothing less but a laboratory from which epidemic disease and ill health is being installed into the house” (Beck & Dossey, 2019). With improper drainage and raw sewerage, the risk of infection and illnesses increases substantially due to the large number of bacteria festering in the sewerage. As a result, Nightingale felt that a significant portion of nursing involves the preservation of cleanliness.
The five key environmental attributes highlighted in the environmental theory do indeed offer an excellent rationale as to how conditions within the environment can contribute to one’s health or illness. Sadly, the contemporary era is much distinct as opposed to that of the 1800s. The ability to offer access to the pure air might be a challenge bearing in mind matters such as global warming, threats of nuclear radiations, human-made pollution, and the different impurities present in the air. Through the application of the theory, further measures can be taken to clean the air and promote patient healing adequately. For instance, direct sunlight exposures may be harmful to the patient taking into account the depletion of the ozone layer. Due to the compromised ozone layer, an unnecessary amount of exposures to ultraviolet (UV) rays can result in skin illness, suppresses in the immune system, and can lead to different types of skin cancers. Despite the circumstance in contemporary environments, this theory is an excellent starting point for the nursing professions and can be seen as an incentive for nursing enhancement.
Nursing’s Four Meta-Paradigm Concepts and How Nightingale’s Environmental Theory Relates to Each
The theoretical work in nursing often focuses on the articulation of the relationships among four main concepts which include “person, environment, health, and nursing.” Since these concepts can be superimposed on almost any kind of work in the field of nursing, theoretical work in nursing emphasizes on articulation of the relationships among concepts.
Person
The term person represents both a single person and a collection of people, each present with their own unique circumstances as they become the recipients of care. Nurses or health care organizations themselves may be recipients, as health and working environments are addressed. A person’s worldviews are made up of how they see and interpret reality. This worldview impacts how a person behaves and makes meaning out of events. Despite personal perspectives and realities, a nurse engages with the person, families, groups, or communities by understanding their worldview interpretations; then plans individualized care.
According to Nightingale, the concept of caring in nursing practice recognizes that every patient is valuable and must be treated with respect irrespective of their ages, races, genders, sexual orientation, socioeconomic status, and religious beliefs. Every patient requires respect even when their points of differs from nurses’ perspectives as professionals. All patients have the right to receive quality and accessible health care services with equity and justice. The implication is that every patient is guaranteed the right to honesty and staying safe when receiving health care services.
Nurse
This concept recognizes that nurses have a responsibility to help an individual, sick or well, to perform those activities that contribute to health or its recovery including peaceful death; that he or she would perform unaided if he or she had the needed strength, will or acknowledge and help the patient to do it in such a manner as to help him or her gain independence as quickly as possible.
There is a moral foundation at the base of every nurse-patient relationship. The nurse, as a moral agent, can formulate moral, ethical decisions by gaining knowledge from/about the patient through direct physical contact. According to Nightingale, the concept of a nurse implies that the nurse needs to build a strong relationship with high-quality services (Arnone & Fitzsimons, 2015). As such, a nurse or service provider must respect the cultural views and practices of all patients, and they must refrain from harming the patient when offering health care services. The nurse must attend to every patient and ensure they communicate to patient's families and caregivers about the patient's well-being. A nurse should promote patient-centered care for quality services.
Health
On the wellness to illness continuum, a person’s health is continuously changing. Optimal wellness exists when a person’s physiological, psychological, sociocultural, developmental, and spiritual components are in harmony. The nurse’s responsibility is to ensure all needs are met and stressors are minimized, resulting in energy restoration and a state of stability. In situations when stressors cannot be removed, the nurse has the tools to assist the person with lifestyle changes and coping strategies. Along the continuum lies the opportunity to prevent the encounter or to decrease the reaction to any stressors. If required or requested, the nurse provides direct care, resources, and education (Arnone & Fitzsimons, 2015). The environmental theory considers the whole physical, mental, social, spiritual, and social well-being of the patients. A patient needs to achieve complete fitness in all aspects, either mentally, spiritually, socially, or physically. In case one element of the patient is not met, it would imply that they have not achieved the required complete fitness.
Environment
The environment is vital for nurses to connect and intervene in caring for the patient genuinely. The nurse must know the whole person within the context of their current environment or situation. Upon interaction with the person, not only is the physical setting considered but all internal and external influences. This setting can be manipulated by the nurses, loved ones, or the institution to enhance comfort” (Arnone & Fitzsimons, 2015). With compassion, nurses can make positive changes to the patient. Relaxation and healing occurs with the realization that the nurse, too, is a part of the person’s environment. Promoting the best environment begins when the nurse brings their best to the situation.
According to Nightingale, the environmental component of the nursing meta-paradigm puts more emphasis on the surroundings that affect the patients. The environment entails internal and external influences of the behaviors as well as the well-being of the patients. She emphasizes the physical elements of the environment more than the social aspects. Therefore, she held that the role of the nurses incorporates the provision of an environment that is conducive to health, such as the one with “fresh air, water, light, clean, warm, and quietness.” In her theory, Nightingale is seen as one of the first nurses to talk about how the environmental elements such as “sound, air, circulation, light, pure water and cleanliness” influence the health outcomes of patients. The environment affects not only the patients and their ability to heal but can affect nurses as well.
Significance of Nightingale’s Environmental Theory to the Advancement of Nursing Practice, Nursing Research, and Nursing Education
Florence Nightingale’s environmental theory may be used to develop healthcare policies and the environment set suitable for patients as well as nurses. Initially, policymakers need to consider all of the items involved in the environment that affect both nurses and patients. Some of these include waste, medication errors, hand washing, understaffing, patient advocacy, and electronic devices (Roque & Carraro, 2015). Nurses’ work environment can affect their ability to perform along with patient care and patient outcomes. Nurses and patients both desire to be in an environment that promotes health. Many environmental hazards are affecting both the nurses and the patients (Amber, 2017). Beginning with hand washing, if a nurse does not properly wash their hands, they not only place themselves at risk but also place their patients at risk for infection and disease.
Besides, using the environmental theory, nurses can advance their practice through the prevention of infections by maintaining compliance with aseptic practices. Through Nightingale’s environmental theory, several actions have been put in place to aid in the prevention of infections (Roque & Carraro, 2015). Such actions incorporate the use of hand sanitizer or hand foams placed at strategic nurses’ stations, or in every patient’s room next to the exit. Additionally, medication errors are another hazardous patient’s encounters where Nightingale’s environmental theory has been used to enhance nursing practice (Dunphy, Lynne, P.H.D., 2015). Due to many errors and the unfortunate death of many patients, a system has been put in place to help prevent errors. The system is known as the “barcode scanning system.” Nightingale’s environmental theory model can be viewed as a systems model that places the client at the center o care, encircled by diverse elements of the environment (Amber, 2017). The other environmental vulnerability throughout the healthcare system is the understaffing of health care providers, including nurses and physicians. Understaffing has significant effects on patient safety and accelerates stress levels, raises the risk of injuries and infections, as well as elevates morbidity and mortality rates.
Summary
Overall, Florence Nightingale was one of the first nurses to document the impact of the built environment on patients as well as on nurses' practice. The concepts of Nightingale's theory are the meta-paradigm of nursing, which incorporates "person, health, nursing, and environment" (Arnone & Fitzsimons, 2015). These concepts are strongly linked to each other. This theory contains components that have not changed since its development, that is; the ideologies of her theory have remained timeless (Dunphy, Lynne, P.H.D., 2015). In her theory, Nightingale believed that "providing a suitable environment was the difference in the recovery of patients. This is the perception that underlies theoretical framework of the environmental theory.
Most importantly, Nightingale identified five environmental factors. They include “fresh air, pure water, efficient drainage, cleanliness or sanitation, and light or direct sunlight." This theory focuses on the alteration of these factors in the patient's environment to promote complete healing. The theory noted that in case any of the attributes are missing, the patient could become ill.
Notably, Nightingale's environmental theory is a patient-care theory that focuses on the care of the patient as opposed to emphasizing on the nursing process. The theory is thus, an individualized model that affects various facets of patient care. Besides, this model is based on the perception that the environmental attributes affect patients differently. Nightingale specifically noted that disease signifies a want of the body in terms of natural laws, and by making some alterations to the environment, the desires can be fully satisfied, and diseases can be alleviated. As a result, this theory posits that the nurses need to address the factors in a case by case basis. Therefore, the role of the practitioners in patients’ recovery is to change the environment in order to gradually create the optimal conditions for the patient's body to heal itself. Bedsides, Nightingale noted that nurses are best placed to conduct research as well as observation to understand how the design environment affects their patients during the nursing process (Dean, 2020). All of these areas can be regulated to assist the patients meet their healthcare goals and become healthy and fit. More importantly, the environmental theory holds that the goal of the nurse practitioner is to put the patient in the best possible state for healing through the incorporation of the "physical, emotional, spiritual, social, and psychological" attributes of the patient's existence in supporting, guiding, and helping patients attain self-independence.
References
Amber, H. S. (2017). Nightingale’s theory and its application to pediatric nursing care. I-Manager's Journal on Nursing, 7(2), 38-42. doi:http://dx.doi.org/10.26634/jnur.7.2.13696
Arnone, J. M., & Fitzsimons, V. (2015). Plato, Nightingale, and Nursing: Can You Hear Me Now? International Journal of Nursing Knowledge, 26(4), 156–162. https://doi-org.proxygsu-alb1.galileo.usg.edu/10.1111/2047-3095.12059
Beck, D.-M., & Dossey, B. M. (2019). In Nightingale’s Footsteps-Individual to Global: From Nurse Coaches to Environmental and Civil Society Activists. Creative Nursing, 25(3), 258–263. https://doi-org.proxygsu-alb1.galileo.usg.edu/10.1891/1078-4535.25.3.258
Dean, E. (2020). Florence nightingale’s life and legacy in objects: 200 years on from her birth, we look at florence Nightingale’s life and how her approaches to nursing have translated to today’s profession. Nursing Standard (2014+), 35(1), 14-17. doi:http://dx.doi.org/10.7748/ns.35.1.14.s12
Dunphy, Lynne, P.H.D. (2015). Florence nightingale, feminist. Nursing History Review, 23, 143-145. Retrieved from https://search.proquest.com/docview/1550842013?accountid=8244
Roque, A. T. F., & Carraro, T. E. (2015). [Perceptions about the hospital environment from the perspective of high-risk puerperal women based on Florence Nightingale’s theory]. Revista Gaucha de Enfermagem, 36(4), 63–69. https://doi-org.proxygsu-alb1.galileo.usg.edu/10.1590/1983-1447.2015.04.51057
