FLORENCE NIGHTINGALE’S

Environmental Model
• Born in Florence, Italy on May 12, 1820

• Has broad education: a linguist, broad

knowledge in science, math, literature,
the arts; well read in philosophy,
history, politics, and economics
• Wanted to do more with her life
than become an idle wife of an
aristocrat

• Has a strong belief in God and for a

time believed she had a religious
calling
Kaiserswerth, Germany
• Studied in Kaiserswerth, Germany
where she developed skills in nursing
care and management, which she took
back to England.
• When she returned in England,
championed her cause as a reformer
for health and well-being of the
citizens.

• Requested by Sir Sidney Herbert,

secretary at war, to manage hospitals
and train nurses in the Crimean War
Scutari Hospital
• Described very poor sanitary
conditions in Scutari

• Fought bureaucracy for

bandages, food, fresh bedding,
and cleaning supplies for the
invalid soldiers, at times she
bought supplies with her own
money.
Heroine of the Crimean War

Mortality rate at the hospital at

Scutari was 42.7% six months after
Nightingale arrived, dropped to
2.2% (due to attending to the
environment of the soldiers)
After The Crimean War

• Established schools of
nursing and influenced
public policy by lobbying
her concerns

"Florence Nightingale and Sir Harry Verney,

along with nurses of the Nightingale School,
at Claydon House
After The Crimean War

• Wrote notes and essays based on her life

experiences which helped develop
modern nursing
• Notes on Nursing – most popular work;
became a manual for teaching nursing
Henry Wadsworth
Longfellow wrote
“The Lady with the Lamp”
to honor her.
Death And Legacy

• Died on Aug. 13, 1910

• Honored each year through commemorative

service at St. Margaret’s Church in GB where
she is buried

• Nightingale's lasting contribution has been

her role in founding the modern nursing
profession
Death And Legacy

• She is viewed as the mother of

modern nursing:
• Capping

• Florence Nightingale Medal - highest

int’l distinction a nurse can achieve.

• International Nurses Day celebrated on

her birthday: May 12.
• In her perspective, the focus of nursing care is on environmental

hygiene, the most basic concept and characteristic of her works.

• Nightingale lists the tasks that nurses must perform to assist sick

individuals, and many of them are relevant even nowadays.

Major Areas of Environment Nurses
could control:

Health of houses, ventilation and warmth, light,

noise, variety, bed and bedding, cleanliness of
rooms and walls, personal cleanliness,
and nutrition.
• When one or more aspects of the environment are out of
balance, the client must use increased energy to counter the
environmental stress.

• These stresses can drain the client of energy needed for healing.

• The aspects of physical environment are also influenced by the

social and psychological environment of the individual.
 Health of Houses

• Consists of pure air, pure water, efficient drainage,

cleanliness and light.

• Applicable to modern society as families can be affected

by toxic waste, contaminated water, and polluted air.
 Ventilation and Warming

• Caregivers should consider the source of the air in

patient’s room. (E.g.: Fumes from gas, mustiness,
open sewage if the source was not the freshest)
• Nightingale believed that the person who repeatedly breathed
his/her own air would become sick or remain sick. In 21st century,
it is known as building sickness.

• Importance of room temperature. The patient should not be too

warm or too cold.
• Today buildings can be constructed in such a way that
the patient or the nurse cannot control the temperature
of the individual room. In shared rooms the climate
control may not satisfy either patient, with one wanting
the room colder and another wanting it warmer.
 Light
• Nightingale believed that direct sunlight was what
patients wanted.

• Lack of appropriate environmental stimuli can lead

to intensive care psychosis or confusion related to
the lack of the accustomed cycling of day and night.
 Noise
• Avoid jarring noises. Patients should never be wakened intentionally or
accidentally during the first part of sleep.

• Nightingale believed that whispered or long conversation about patients are

thoughtless and cruel.

• Other modern noises include snapping of rubber gloves, clank of stethoscope

against metal bed rails, and radios/televisions, phones.
 Variety

• Variety in the environment was a critical aspect affecting the

patient’s recovery.

• She discussed the need for changes in color and from, including
bringing the patient brightly colored flowers or plants.
• “volumes are now written and spoken upon the
effects of the mind upon body”.

• The increasing research being done on the

interaction between body and mind has supported
this observation.
 Bed and Bedding

• Nightingale viewed bedding as an important part of

the environment.

• Caregivers should never lean against, sit upon, or

unnecessarily shake the bed of the patient.
• Modern technology may also interfere with providing a comfortable
bed. (E.g.: Multiple intravenous pumps, ventilators, and monitors
attached to the patient)

• It remains important for the nurse to keep bedding clean, neat, and
dry and to position the patient for maximum comfort.
 Cleanliness Of Rooms And Walls

• “The greater part of nursing consists in preserving

cleanliness” Even the best ventilation cannot
freshen the room that is not first of all clean.

• Concept that clean room is a healthy room

continues to be true.
 Personal Cleanliness
• Bathing and drying provided great relief to the patient

• Personal Cleanliness extended to nurse and “that every nurse ought to

wash her hands very frequently during the day”
 Nutrition and Taking Food

• Nightingale addressed the food presented to the patient and

discussed the importance of variety in the food presented

• 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
• No business must be done with patients while they are
eating because this was distraction.

• She urged that the right food be brought at the right

time and “be taken away, eaten or uneaten, at the right
time”
 Chattering Hopes and Advices
• Nightingale did not speak to the social and psychological
environment of the patient to the same degree as the
physical environment.

• Falsely cheer the sick by making light of their illness and its
danger is not helpful.
• She considered it stressful for a patient to hear opinions
after only brief observations had been made.

• False hope was depressing to patients, she felt, and caused

them to worry and become fatigued.
 Social Considerations

• Nightingale emphasized the importance of

observing the sick.

• It is important look beyond the individual and

to the social environment in which he or she
lived.
• Nightingale was an epidemiologist who looked not only at the
numbers of people who died but also what was unique about their
lives. She observed that generations of families lived and died in
poverty using her statistical data, she wrote letter and position papers
and sent them to her acquaintances in the government in an effort to
improve undesirable living conditions. She was a role model for
political activism by nurses
Nursing
• “What nursing has to do is to put the patient in the best
condition for nature to act upon him”
• 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”
Based on her definition of nursing,
we can deduce the definitions of
human beings, environment,

and health
Human Beings

• Human beings are not defined by Nightingale

specifically.

• They are defined in relationships to their

environment and the impact of the environment
upon them.
Environment

• The physical environment is stressed by Nightingale

in her writing. 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 did not define health specifically.

• She believed, however, that pathology teaches the harm

disease has done and nothing more.

• She believed that “nature alone cures”; the art of

• 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
Nightingale and the Nursing Process
Assessment

• An assessment guide can be structured from Nightingale’s

environmental model.

• We can examine the impact of the environment on clients

and integrate the expanding body of scientific knowledge
concerning the effects of a balanced or unbalanced
environment.
Nursing Diagnoses
• Based on the analysis of the conclusions gained from the
information in the assessment

• It is important that the diagnosis be the clients’ response to

their environment and the environmental problem.
Planning
•Includes identifying the nursing actions
needed to keep clients comfortable, dry,
and in the best state for nature to work
on.
Planning
•Planning is focused on modifying the
environment to enhance the client’s ability
to respond to the disease process.
Implementation
•Takes place in the environment that
affects the client and involves taking
action to modify the environment.
Evaluation
•Based on the effect of the changes in the
environment on the clients’ ability to
regain their health at the least expense of
energy.
Application
The Nursing Process
Assessment

• Maria Cruz, 10 year old Filipina from rural area

• Injured in an accident related to farm machinery

• head injury, conscious but not oriented to place and time, multiple
abrasions, multiple bruises, and a deep leg wound containing the dirt
and debris from the farm equipment that injured her.
Assessment
Analysis of Data
• Data gaps include information about family structure;
who lives in the household; who was present when the
injury occurred; Nancy’s school performance; Nancy’s
nutritional status. Of primary concern are Nancy’s lack of
sleep and the infected wound
Diagnosis
• Sleep disruption related to environmental light and noise
and separation from family
Planning and Implementation
• At night, sleep is supported by dimming the lights,
reducing noise (including turning down the volume of
alarms), and keeping to a minimum activities and
procedure that would awaken Maria.

• . She is also encouraged to listen to her favorite music or

watch her favorite television show to expose her to
normal sounds. Her parents are encouraged to visit more
often and to talk with her about the future…
Evaluation
• Criteria for evaluation: After two nights of uninterrupted
sleep, normal sounds, and parental encouragement,
Nancy will demonstrate increased orientation to place by
being able to identify that she is in the hospital.
Progression of wound infection has decreased.
Summary
• “What nursing has to do is to put the patient in the
best condition for nature to act upon him”
Summary
• Health of houses, ventilation and warmth, light,
noise, variety, bed, and bedding, cleanliness of
rooms and walls, personal cleanliness, and nutrition.