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FLORENCE Arlene L Galon RN MAN NIGHTINGALE Environmental Theory Arlene L Galon RN, MAN Florence Nightingale as described by one of the wounded soldier from Crimea War After 45 mins of lecture, the students will be able to: 1. Familiarize self with Biography of Florence Nightingale 2. Id...

FLORENCE Arlene L Galon RN MAN NIGHTINGALE Environmental Theory Arlene L Galon RN, MAN Florence Nightingale as described by one of the wounded soldier from Crimea War After 45 mins of lecture, the students will be able to: 1. Familiarize self with Biography of Florence Nightingale 2. Identify the Major Concepts or Metaparadigm of Florence Nightingales Theory 3. Name the 5 Environmental Factors of the Environmental Theory 4. Expound on the Subconcepts of the Environmental Theory 5. Present an Analysis of the Environmental Theory 6. Outline the Assumptions of Florence Nightingale’s Theory 7. Present the Strengths and Weaknesses of the Environmental Theory Who is Florence Nightingale?  Florence Nightingale (12 May 1820 – 13 August 1910) ◦ Pioneer of Public Health and Founder of Modern Nursing ◦ Because of her Nursing is one of the MOST REGULATED AND RESPECTED PROFESSIONS IN THE WORLD. ◦ Born on May 12, 1820, in Nightingale, Italy into an upper class British family ◦ She was home schooled by her parents and tutors provided her with classical education, including German, French, and Italian studies. She and gained excellence in Mathematics. ◦ As a woman of her time in her class, it would have been expected that she would marry, maintain a lovely home and be a hostess. But Florence Nightingale had very different plans. ◦ Though at that time nursing was not a respected profession, Nightingale felt very called to become a nurse ◦ At age 24 Nightingale defied her parents expectaions to marry a suitable match at left England to study at Kaiser's Worth Hospital in Dusseldorf Germany. ◦ When she returmed from Germany, she took a job as a nurse at a hospital in London, and was eventually promoted after only 1 year to be the head of Nursing there. ◦ She improved sanitary conditions so much that she garnered “Lady with the Lamp” reputation as a reformer and an advocate for public health  Crimean War (1854-1856) ◦ France, England And Turkey declared war against Russia ◦ The Crimean War began, and soon reports in the newspapers described the desperate lack of proper medical facilities for wounded British soldiers at the front. ◦ Soon after British soldiers arrived in Turkey they started to die ◦ Sidney Herbert, the war minister, already knew Nightingale and asked her to oversee a team of nurses in Turkey’s military hospitals. ◦ In 1854, with 38 women, Florence set for Crimea to take over the management of the barrack hospital at Scutari, where she observed the disastrous sanitary conditions.  Appointments ◦ In 1853, Florence Nightingale accepted the superintendent’s position at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London. She held this position until October 1854. ◦ In 1854, Britain was involved in the war against the Russians (Crimean War). British battlefield medical facilities were deplorable, prompting Minister at War Sidney Herbert to appoint Nightingale to oversee the wounded’s care. ◦ She arrived in Constantinople, Turkey, with a company of 38 nurses. The introduction of female nurses in military hospitals was a major success. Sanitary conditions were improved while nurses worked as capable assistants to physicians and raised the British soldier’s morale by acting as bankers, sending the injured man’s wages home, wrote letters to their families, and read to the wounded. ◦ She tried to provide a clean environment. She provided medical equipment, clean water and fruits. With this work the mortality rate decreased from 60% to 42% and then to 2.2% ◦ She returned to England in 1856. In 1860, she established the Nightingale Training School for nurses at St Thomas’ Hospital in London. Once the nurses were trained, they were sent to hospitals all over Britain, Florence Nightingale posing with her class of nurses from St. Thomas Hospital. where they introduced the ideas they had learned and established nursing training on the Nightingale model. ◦ Over the years, the training and the school itself went through a series of changes, mergers and expansions. And as of 2021, the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care still stands with 300 staff and 4,000 students. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care King's College London Works: Based on observations in the Crimea, Nightingale wrote Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army, an 830-page report analyzing her experience and proposing reforms for other military hospitals operating under poor conditions. In 1860, her best-authored works were published, “Notes on Nursing,” outlining nursing principles. It is still in print today. In all, she had published some 200 books, reports, and pamphlets. Using the money she got from the British government, she funded St. Thomas’ Hospital’s establishment, and within it, the Nightingale Training School for Nurses. Nightingale Statue, London Road, Derby Awards and Honors Nightingale became known as “The Lady with the Lamp.” During the Crimean War, she initially made her rounds on horseback and at night used an oil lamp to light her way, then reverted to a mule cart and finally a carriage with a hood and curtains. Nightingale remained at Scutari for a year and a half. In the summer of 1856, she left once the Crimean conflict was resolved and returned to her childhood home at Lea Hurst where she was met with a hero’s welcome. The Queen rewarded Nightingale’s work by presenting her with an engraved brooch that came to be known as the “Nightingale Jewel” and by granting her a prize of $250,000 from the British government. In 1883, Nightingale was awarded the Royal Red Cross by Queen Victoria. In 1904, she was appointed a Lady of Grace of St John’s Order (LGStJ). In 1907, she became the first woman to be awarded the Order of Merit. In the Crimean War Memorial is located facing Waterloo Place at Lower Regent Street following year, she was given the Honorary Freedom of and Pall Mall, London. the City of London.  Death ◦ Florence Nightingale fell ill in August 1910. ◦ She died on her sleep on August 13 1910, at her home in London. She was 90 years old. ◦ Usually, well-known people with great contributions are offered national funerals, but Nightingale had expressed the desire that her funeral is a quiet and modest affair. A rare photograph of Nightingale in 1910 by Lizzie Caswall Smith. Memory In honor of the life and career of the “Angel of the Crimea,” the Florence Nightingale Museum sits at the site of the original Nightingale Training School for Nurses, which houses more than 2,000 artifacts.  'Florence Nightingale's turkish lantern lamp used by Crimean war nurses on display at the Florence Nightingale Museum London UK The photos above were taken by Luca Borghi in August 2011, courtesy of the Florence Nightingale Museum. Audio Florence Nightingale’s voice was saved in a phonograph recording from 1890 preserved in the British Library Sound Archive. The recording is in aid of the Light Brigade Relief Fund and says: “When I am no longer even a memory, just a name, I hope my voice may perpetuate the great work of my life. God bless my dear old comrades of Balaclava and bring them safely to shore. Florence Nightingale.” A Source of Inspiration: Her work inspired many others to take action, including the founder of Red Cross, Henry Dunant (1872) Florence Nightingale: The Mother of Nursing ◦ founder of modern nursing or professional nursing ◦ established nightingale nursing school as the first nursing school in the world in 1860 and changed nursing to a respectful profession. ◦ Her books Notes on Hospitals’ and Notes on Nursing became the first definitive textbook for the field. ◦ Nightingale raised the status of nursing through education and transformed the profession of nursing forever ◦ Revolutionized hospital conditions, making them all organized and above all, sanitary Environmental Theory Florence Nightingale’s Environmental Theory 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. Environmental Theory of Nursing ❖ a patient-care theory ❖ focuses on the alteration of the patient’s environment in order to affect change in his or her health. ❖ Caring for the patient is more important 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. Metaparadigm concepts according to Nightingale Nursing “What nursing has to do… is to put the patient in the best condition for nature to act upon him” 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 Human beings are not defined by Nightingale specifically. They are defined in relation to their environment and the impact of the environment upon them. Metaparadigm concepts according to Nightingale Environment 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. Health Nightingale (1859) 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: ◦ Health of Houses ◦ Ventilation and Warming ◦ Light ◦ Noise ◦ Variety ◦ Bed and Bedding ◦ Personal Cleanliness ◦ Nutrition and Taking Food ◦ Chattering Hopes and Advice ◦ Social Considerations 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 from excrement. She also criticized “fumigations,” for she believed that the offensive source, not the smell must be removed. Nightingale also stressed the importance of room temperature. 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. Light Nightingale believed that second to fresh air, the sick needed light. She noted that direct sunlight was what patients wanted. Noise 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 the female dress, as cruel and irritating to the patient. Variety She discussed the need for color and form changes, 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 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 patient’s bed. Personal Cleanliness “Just as it is necessary to renew the air around 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 help them become healthier. Social Considerations Nightingale supported the importance of looking beyond the individual to the social environment in which they lived. Environmental Factors 1. Pure fresh air – “to keep the air he breathes as pure as the external air without chilling him.” 2. Pure water – “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.” 3. Effective drainage – “all the while the sewer may be nothing but a laboratory from which epidemic disease and ill health are being installed into the house.” 4. Cleanliness – “the greater part of nursing consists in preserving cleanliness.” 5. Light (especially direct sunlight) – “the usefulness of light in treating disease is very important.” Assumptions of Florence Nightingale’s Theory 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 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. Strengths & Weaknesses Strengths ◦ Florence Nightingale’s language 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 environments, the home, a worksite, or the community. ◦ Reading Nightingale’s Environmental Theory raises consciousness in the nurse about how the environment influences client outcomes. Weaknesses o In Nightingale’s Environmental Theory, there is scant information on the psychosocial environment compared to the physical environment. o The application of her concepts in the twentieth century is in question. Relevance to Nursing Today ◦ Environmental Sanitation remains the basis of our holistic nursing care. In the era that we are in today, we are faced with environmental conditions beyond what was ought to be natural and nurturing ◦ 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. Her concept of providing fresh air to patients is in question with today’s industrialization effects. 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. ◦ 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 End References: ◦ Florence Nightingale: Part I. Strachey, Lytton. 1918. Eminent Victorians. (n.d.). Florence Nightingale: Part I. Strachey, Lytton. 1918. Eminent Victorians. Retrieved July 31, 2014, from https://www.bartleby.com/189/201.html ◦ Florence Nightingale and Lynn McDonald (Editor) (2010). “An introduction to Vol 14”. Florence Nightingale: The Crimean War. Wilfrid Laurier University Press. ISBN 0889204691. ◦ Himetop. (n.d.). Florence Nightingale Museum –. Retrieved July 31, 2014, from https://himetop.wikidot.com/florence- nightingale-museum ◦ Cohen, I. B. (1984). Florence Nightingale. Scientific American, 250(3), 128-137. ◦ 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.