Florence Nightingale's nursing theory and contributions

Nursing Practice through Environmental Control April 22, 2013 Name RT Final Paper NUR 505-01

Florence Nightingale's Environmental Theory is a patient care theory designed to control environmental factors that allow nature to act in the healing processes to promote better health outcomes. The Environmental Theory argues that nature alone cures, but when aspects of the environment are out of balance, the patient must use energy (Florence Nightingale: Environmental Theory, 2013). Stresses drain energy needed for healing that makes it difficult for nature to act. Nurses can meet a patient's needs through control of environmental factors.

The basis of the theory is an inter-relationship between a healthful environment and nursing practice. The purpose of the theory is to teach nurses to use environmental factors in ways that allow nature to act to enable the healing processes to work in a natural way and to create sanitary conditions for patients to receive care. It allows the nurse to use environmental factors to provide solutions to problems and help patients have better health outcomes.

Background

The Environmental Theory was first published in 1860 by Florence Nightingale. During the Crimean War, soldiers had a high death rate from illnesses other than their injuries. Nightingale believed the deaths were due to poor nutrition, inadequate supplies, and the overworking of soldiers. After gathering evidence, Nightingale discovered the major cause of the death rate was unsanitary conditions. She developed the concepts of the Environmental Theory to improve the sanitary conditions for the soldiers to get well.

The concepts of the theory incorporated environmental factors into the nursing care plan. Nurses meet patient needs through the control of the physical environment for the individual, family, and the community the patient lives and includes social and psychological aspects. The social environment includes collecting data about disease and illness prevention, environmental components of clean air, fresh water, and proper drainage, and includes home, hospital, and community. The psychological environment requires activities, such as manual work, appealing food, a pleasing environment, and keeping the mind active. It also includes communication with the patient, about the patient, and about the people associated with the patient. Communications should be therapeutic, soothing, and unhurried.

The theory is based on assumptions of natural laws, mankind can achieve perfection, nursing is a calling, nursing is an art and a science, nursing is achieved through environmental alteration, nursing requires a specific educational base, and nursing is distinct and separate from medicine (Nightgale's Environmental Theory, 2011). Environmental factors that affect health are fresh air, pure water, sufficient food supplies, efficient drainage, the cleanliness of patient and environment, and light, particularly direct sunlight. The major concepts are ventilation and warming, light and noise, cleanliness of the area, health of houses, bed and bedding, variety, offering hope and advice, food, and observation. These concepts and factors must be adapted to fit the needs of the individual patient.

Nightingale defined disease as "a reparative process that nature instituted from a want of attention" (Florence Nightingale: Metaparadigm in Nursing, 2013). She believed the prevention of disease through environmental control greatly uplifts the maintenance of health and health promotion. Environmental improvement addresses the physical and mental aspects of patients.

The nursing goal is to place the patient in the best possible condition for nature to act. It includes activities that promote health that occur in any caregiving condition (Theory of Florence Nightingale, 2012). The person is multidimensional, composed of biological, social, and spiritual components. Health is to be well and be able to use well every power we have. Disease is considered dys-ease or the absence of comfort. Poor or difficult environments lead to poor health outcomes. Environments can be altered to improve conditions so that the natural laws would allow healing to occur.

Discussion

The characteristic of compassion drives nursing to change the health of patients and to ensure they are restored to full health as much as humanly possible. The Environmental Theory is also a driving factor in nursing because it is about the actions that nurses take to alter the environment that changes the conditions of a patient's health. Whether it is maintaining a sanitary environment, keeping the area and the patient clean, or pulling the shades back to brighten the room with sunlight, or communicating to ensure the patient their condition will get better, every patient condition requires environmental control. Most of the actions may be applied to all patient conditions, but based on assessments of the patient, some actions are specific to the patient's individual needs.

For example, cleanliness is a basic action for all patient conditions to prevent the spread of infection, but becomes specific based on the patient's individual capabilities. All patient conditions require for the area, the bed, and the patient to be clean. Patients who are mobile and have abilities to clean themselves only need for the bed and the area to be maintained. Patients who are bedridden, or have limited mobility, require additional assistance in keeping themselves clean or meeting needs. Total care patients require everything to be done for them, whether it is cleanliness, feeding, drinking, dressing, or even, being able to turn and reposition their body in bed.

Extra care should be taken in doing assessments with newly arrived patients. To ensure that all the information is gathered to determine the patient's actual needs, questions need to address all the patient's abilities, medical history, and the patient's habits, such as nutrition and exercise. One of the main purposes of the assessment is to determine what the patient will need to be able to perform after they discharge and go home. Questions need to be considered with this goal in mind. Environmental control goes beyond the hospital to the environment in home and community upon discharge and includes the social and psychological aspects of the environment. This helps in determining what the patient will need and what resources they have available on a day-to-day basis.

The Environmental Theory enables nurses to solve problems and assist patients in solving problems. For example, if a patient has needs without adequate resources, the nurse looks for resources available in the community the patient may qualify for, such as home health to assist the patient with personal care, or resources for transportation to and from appointments. It also can consist of patient teaching to enable them to promote their own health for the future. What to eat and not eat based on medical condition and medications given helps the patient be aware of how foods can interact with medications. Patient teaching also involves helping the patient to understand their condition and what they can do to overcome difficulty to cope with the condition as well as how to live a healthy life in spite of the condition.