Florence Nightingale's Environment Theory in Nursing

Introduction

According to most nursing historians, Florence Nightingale is the leading figure in the development of modern nursing. As an early innovator in the field, Nightingale pioneered many of the ideologies and approaches still in circulation today. In particular, nursing professionals in her wake coined the term Environment Theory to describe the mode of care that would be her contribution to modern medicine. As the discussion below demonstrates, this theoretical model was driven by Nightingale's view that health and treatment outcomes are directly related to the context and conditions within which a patient receives care.

Description of Environment Theory

This is underscored by a basic conceptualization of Environment Theory. Tomey and Alligood (2005) provide a useful preliminary understanding of this mode of treatment, specifying that during the 19th century — the backdrop to Nightingale's work — she never actually used the term "environment" to describe her approach. Moreover, it is not sufficient to limit the meaning of environment to the modern expectation that it simply describes one's physical surroundings. To the contrary, Tomey and Alligood report that "although Nightingale never used the term environment in her writing, she did define and describe in detail the concepts of ventilation, warmth, light, diet, cleanliness, and noise — components of surroundings that have come to be known as environment in discussions of her work" (p. 75).

Tomey and Alligood further remark that, for Nightingale, the nature of this environment hinged significantly on factors beyond physical ones alone. As Nightingale viewed it, a patient's health and treatment outcomes would be directly impacted by a host of conditions that included but could not be limited to external circumstances. Accordingly, Tomey and Alligood report that "although Nightingale defined concepts precisely, she did not distinguish aspects of the patient's environment as physical, emotional, or social" (p. 75). This is an important point to consider as we move into a more detailed discussion of the concepts related to her Environment Theory, particularly as we examine the ways in which Nightingale both conceptualized and treated the patient. The inclusion of emotional and social realities as part of the treatment environment reflects an intuitive and innovative recognition of the more abstract human qualities that affect a treatment experience and its likely health outcomes.

Historical Background

In spite of the considerable opportunities afforded by her aristocratic upbringing, Nightingale's work as a nursing professional also shaped her personal development. The educator, philosopher, and field nurse exposed herself without reservation to risk and sacrifice in order to achieve goals that affected large groups of people. As Attewell (1998) conveys through the words of a close colleague of Nightingale, her willingness to give of herself so completely was central to her ultimate influence on the profession and the world. The colleague would reflect of Nightingale: "how many thousand soldiers […] are now alive owing to your forethought and diligence; how many natives of India in this generation and in generations to come have been preserved from famine and oppression and the load of debt by the energy of a sick lady who can scarcely rise from her bed" (Attewell, p. 166). For Nightingale, the call of her life's work constituted a sufficient cause to set aside many demands and opportunities in her personal life. She declined such traditional expectations as marriage and motherhood, and resisted the secondary status imposed on women of her era, in order to serve as a nurse and care provider with total devotion. Much of the emotional energy that other women of her time might have directed toward a personal support network she instead dedicated to those for whom she provided critical treatment.

During the Crimean War, Nightingale was sent to Turkey to lead a group of nurses at a military hospital where she found conditions to be deplorable. Overcrowding, poor ventilation, inadequate working spaces, and a complete lack of sanitation had produced extremely high mortality rates, prompting her dispatch. According to Cook (1913), Nightingale was noted there for her tireless efforts — efforts that, in their application to the nursing profession, served as a fitting example to others facing the overwhelming demands of that difficult context. An article published at the time of her service in Turkey described the scene: "she is a 'ministering angel' without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow's face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds" (Cook, p. 237). Again, the theme of personal sacrifice emerges as essential in identifying her as a nurse, a leader, and a figure of great importance in the history of her profession. Equally, her service stands as a point of inspiration — her stature in the field was matched only by her tenacity in performing its most rigorous duties.

Conclusion

As this discussion demonstrates, Nightingale both authored works and provided instruction that proceeded from a place at once practical and philosophical. In the latter capacity, she exhibited a clear understanding of what constitutes a positive treatment context conducive to healing. Nightingale remains a fitting template for modern nursing because of her effectiveness in balancing the need for practical skill with a theoretical grounding in environment that is, arguably, just as valuable.

References

Attewell, A. (1998). Florence Nightingale (1820–1910). Prospects, 28(1), 151–166.

Beyea, S. C. (2005). Patient advocacy: Nurses keeping patients safe. AORN Journal.

Cook, E. T. (1913). The life of Florence Nightingale (Vol. 1). MacMillan.

McDonald, L. (2001). The collected works of Florence Nightingale. Wilfrid Laurier University Press.

Tomey, A. M., & Alligood, M. R. (2005). Nursing theorists and their work (6th ed.). Elsevier Health Sciences.