Florence Nightingale

1. Florence Nightingale Environmental Theory of Nursing Presented by Michelle Metzger Bridgett Weldon Carrie Smith

2. Purpose • When sanitation techniques are not practiced, and when a healthy diet and adequate rest periods are not allotted, illness occurs and can spread to others. • Are there simple measures that a nurse can make to promote health and healing in ill persons and how much of an effect will they have on healing?

3. Introduction • Florence Nightingale’s Philosophy was to focus on health and healing rather than illness and to incorporate a patient’s environment into their plan of care (Chitty & Black, 2011).

4. Origins of the Model • Nightingale’s focus on the environmental setting as being a vital part of patient care began when caring for those injured and sick during the Crimean War in 1854. • At this time, Nightingale included clean laundry and linens, quality food, adequate rest, and decreased noise to her nursing care to help with the healing of her patients. • In a six month time frame, Nightingale and 38 other nurses decreased the mortality rate of these patients from 42.7% to 2.2%. (Payne, 2010)

5. Origins continued • While caring for the injured of the Crimean War, Nightingale closely recorded observations of her patients, even at night (This is why she is known at “Lady of the Lamp”). • Having a mathematical background, she turned her observations into statistics and her findings soon had effects on military and civilian hospitals in England and the United States, and began influencing the education for the nursing and medical professions as well. (Payne, 2010)

6. Origins continued • Nightingale not only focused on the health and healing aspect of care but also discovered the need to provide holistic care, including not only a patient’s body but also their family, environment, mind, and spirit. Payne, 2010

7. Theory Basics • Nightingale believed in health of the patients, and tried to integrate holistic care in combination with a clean environment for the patients. • With that she was able to promote health with her patients by having clean air to breathe, clean sheets for their bedding and available exposure to sunlight. • She would try to reduce noise in areas of treatment for the patients. • Nightingale pushed this care of patients by promotion of nursing with the idea of health and recovery. (Chitty & Black, 2011). • As nurses, we exercise this idea every day in patient care.

8. Human Being • People are multidimensional, composed of biological, psychological, social and spiritual components. (Current Nursing, 2012)

9. Environment • "Poor or difficult environments led to poor health and disease". • "Environment could be altered to improve conditions so that the natural laws would allow healing to occur.“ (Current Nursing, 2012)

10. Health • Health is “not only to be well, but to be able to use well every power we have”. • Disease is considered as disease or the absence of comfort.  (Current Nursing, 2012)

11. Nursing • Nursing is different from medicine and the goal of nursing is to place the patient  in the best possible condition for nature to act. • Nursing is the "activities that promote health (as outlined in canons) which occur in any caregiving situation.  They can be done by anyone.“ (Current Nursing, 2012)

12. Theory for Today’s Nurses • Florence Nightingale’s Environmental Model creates a basis to which nurses today can follow with the practice of patient care. Such ideas are stated here:  • “Nightingale delved into the most basic needs of human beings and all aspects of environment (e.g., clean air, water, food, housing). She also used what today are recognized as Integrative modalities/therapies such as light, music, relaxation, aromatherapy, touch, music therapy, pet therapy, health nutrition, and exercise”(Dossey, 2010).

13. What Influenced This Model? • This Environmental model or holistic model of nursing was tested in the Crimean War between 1854 to 1856. Nightingale reported back to Britain from the war that many were wounded and conditions for treatment were even worse. She had taken more than 38 volunteers to help with care for the Crimean War. Nightingale found that mass infection was present probably due to inadequate medical supplies and sanitary environment or good hygiene (Chitty & Black, 2011). • She was also able to gather a statistical analysis of the data collected consisting of wounded soldiers and fatalities. (Dossey, 2010). This data gave way to support reform in the medical system of the British Army.

14. Where Can This Theory be Used? • The Environment model can be intended to use in any hospital setting. • Nightingale didn’t designate this model to any specific area; her main intention was creating a suitable environment for patients and thereby trying to increase their health. • This is something that we practice whether it is in a Critical Care, Hospice or even in the OB. • What are some things that you do in patient care to promote a sustainable environment to help your patients reach optimal health?

15. Where has This Model Been Used? • The American Holistic Nurses Association (AHNA) believes in using Florence Nightingales theory by stating, “The words ‘Holistic Nursing’ means nursing in the whole person in the ways of Nightingale….fresh air, fresh food and water, spiritual sustenance, and mental and emotional support leading to clarity for the one being cared for”(AHNA, 2012). • Organizations such as this are trying to promote this holistic care in nursing and influence others to join in their stride.

16. Case Study • A patient is admitted to a post-surgical care unit following surgical repair of a hip fracture. The patient was homeless at the time of the incident and was found lying on the street by a passerby. EMS was called and the patient was taken to the hospital for treatment. The patient has a history of alcohol and drug abuse, mental illness, as well as the recent history of homelessness resulting from the substance abuse. • What are some of the issues that Nightingale’s environmental model would focus on in this situation? • What are some interventions that would be indicated by the use of the model?

17. References • American Holistic Nursing Association (AHNA) (2012). Retrieved from www.ahna.org • Chitty, K. K., & Black, B. P. (2011). Professional nursing: Concepts and challenges (6th ed.) Maryland Heights, MO: Saunders • Dossey, B.(2010).Holistic Nursing: From Florence Nightingale’s historical legacy to 21st-centuary global Nursing. Alternative therapies in Health and Medicine.16(5). 14-6.doi: 755053957 • http://nursingplanet.com/Nightingale/ • Nursing theories: Theory of Florence Nightingale.(2012) Retrieved from www.currentnursing.com/nursing_theory/Florence_Nightingale_theory.html • Payne, K. (2010). Science, health, and courage: The legacy of Florence Nightingale. Tennessee Nurse, 73(2). Retrieved from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/pdfviewer/pdfviewer?sid=e2a2e901-1936-40d9-b96d-56711f8a1507%40sessionmgr110&vid=4&hid=117 • Selanders, L., Crane, P., (January 31, 2012) "The Voice of Florence Nightingale on Advocacy" OJIN: The Online Journal of Issues in Nursing Vol. 17, No. 1, Manuscript 1. DOI:10.3912/OJIN.Vol17No01Man01