Theories are critical aspects of any professional discipline. In nursing, theories are vital elements of knowledge that support the practice and provide distinctions from other disciplines.
A nurse theory could use deductive, inductive, or reproductive reasoning where concepts, definitions, relationships, and assumptions are interrelated and defined. As such, a theory is viewed as describing, predicting, and explaining the phenomenon of nursing while providing the critical foundation of the discipline and provision of care (Lee, 2014; Adams, 2016; Lynn, 2014). It is imperative to note that there are various theories in nursing, which were authored by different authors in diverse environments.
This paper analyzes the environmental theory of nursing, which was championed by Florence Nightingale (a founder of modern nursing) and is considered as one of the most significant theories that have brought vital changes in nursing (Adams, 2016; Medeiros, Enders, & Lira, 2015).
Theory/Author Name and Background
The environmental theory is based on the perspective that the goal of nursing is to assist patients through the manipulation of the environment such that the needs of the patients are met. As such, nurses do not provide healing services but they place patients in proper environments, which act on them and facilitate healing (Medeiros et al., 2015).
The environmental theory of Florence Nightingale is one of the most applicable theories in care delivery. The theory is described as a provision of explicit paradigmatic and philosophical reinforcements with conceptual clarification of meta paradigm and pertinent unique knowledge reference in contemporary nursing (Awalkhan & Muhammad, 2016).
Florence Nightingale who is commonly referred to as “Lady with the Lamp” in the field of nursing, especially after the poem by Henry Wadsworth Longfellow in 1857, developed the basis of the theory (Adu-Gyamfi & Brenya, 2016). Florence was born in 1820 in Italy and she is believed to be the first nurse theorist (Adams, 2016; Lee, 2014). In addition, Nightingale was a scientist, writer, and a philosopher who believed in caring while incorporating wholeness and spirituality (Awalkhan & Muhammad, 2016). It is worth noting that she was born into a wealthy family that had objections to her goal of joining nursing. Nevertheless, she was committed and dedicated to serving humankind, especially due to her spirituality and belief in humanity and focus on nature. She emphasized the role of spirituality along with physiological determination and the aspect of environmental alternation in augmenting care delivery.
Florence received nurse training from different institutions in different countries. When she graduated, she got an appointment to serve as a superintendent in a hospital that focused on caring for underprivileged patients. At the hospital, she gained skills and insights on health as a basic right to every person (irrespective of their socioeconomic backgrounds) (Asha, 2016).
Later, Florence would be requested to join a military hospital, which provided care to armed soldiers during the Crimean war, in Scutari (Asha, 2016). Her service at the camp is what made her receive global recognition. With the war intensifying, more casualties were brought to the camp. The camp’s capacity to hold patients was overwhelmed and, therefore, the environment for care provision deteriorated. The conditions became dirtier and callous heightening risks to patients (Adams, 2016; Awalkhan & Muhammad, 2016).
Florence decided to change the working environment through ensuring hygiene, sanitation, proper nutrition, and comfort to the patients. Moreover, she made contact with family members of the injured and, thus, enhanced psychological healing (Awalkhan & Muhammad, 2016; Adams, 2016). She would appear at night with her lamp and provide assurance to her patient. With the improved environment of care delivery, better outcomes were realized and hence the genesis of the environmental theory (especially through using observation to make conclusions) (Arnone & Fitzsimons, 2015; Lynn, 2014).
Many pieces of literature regard Florence as the first nurse theorist (Asha, 2016; Awalkhan & Muhammad, 2016). Florence addressed critical concerns, which are the center of care provision. As such, numerous crucial references have been made on her theory. Several studies have been performed to criticize the theory. For instance, Medeiros et al. (2015) adopt the Johnson and Webber model to analyze the theory and conclude that it has crucial concepts, which serve today nursing and it is substantially relevant.
Some authors have referenced the environmental theory in addressing specific medical conditions and diseases. For instance, Awalkhan and Muhammad (2016) concluded that the theory is very appropriate for application to patients with surgical conditions, including colostomies. On their part, Kamau, Rotich, Cheruiyot, and Ng’eno (2015) agree that the theory is a generic tool, which is applicable in the provision of care to patients with tuberculosis in deplorable environments.
Phenomenon of Concerns
Florence addressed the critical issues regarding the environment in which nursing is practiced. She was concerned with the physical environment (status of the hospital/home), the patient (their cleanliness and state of mind), and social backgrounds (Adams, 2016). The theorist suggests that all-inclusive approaches to these issues and their manipulation would reinforce health restoration (Awalkhan & Muhammad, 2016).
The theory sets conditions through which health could be lost or restored. As such, deductive/conditional reasoning is adopted. The processes of healing and health restoration depend on altering the environment and allowing nature to transform patients’ states positively. On the other hand, dirty and callous environments would have adverse negative effects on patients. As such, observations are used in making conclusions (Arnone & Fitzsimons, 2015; Adu-Gyamfi & Brenya, 2016; Adams, 2016).
The major concepts in the environmental theory were anchored in the welfare of the patient and the need to improve hospital and/or home environments. First, the theory emphasizes the need for proper ventilation to provide pure air and proper lighting. Second, room/walls, beds/beddings should be clean with proper and effective drainage in hospitals. Third, patients should be clean and be fed with proper food. Fourth, there should be efforts to talk to patients and provide them hope (Awalkhan & Muhammad, 2016).
Each of the concepts is defined in practical and operational ways. The concepts are demarcated and elucidated in a way that makes them ready for use in the hospital/home environment where nursing is practiced. It is notable that the author of the theory is consistent, especially due to exemplarity in providing clear definitions of concepts. Moreover, there is evident congruency among the concepts and the theory. As such, Florence emphasized the role of a nurse in ensuring clean hospital/home environments while incorporating the clear definition of each of the concepts.
Definition of Major Concepts
The concepts in the theory are defined in unambiguous and explicit ways. The definitions are detailed and they elucidate both construct and abstract concepts in the theory. Moreover, she incorporates and clearly defines her concept of spirituality and wholeness in the theory (Awalkhan & Muhammad, 2016).
The relationship among Major Concepts
The environmental theory is based on the cleanliness of the patient, the hospital or home environment, and the need to consider the social environment of the patient. Clearly, the concepts are easily interrelated (Medeiros et al., 2015). The patient is the center of care while the hospital or the home environment is a crucial determinant of medical outcomes. Therefore, hygiene and cleanliness of the patient and the environment together augment the delivery of care while positively influencing the patient outcome. On the other hand, considering the social backgrounds from where the patient comes and incorporating in nurse practice improves the mental status of the patient and therefore enhance care delivery. For instance, the psychological status of the wounded soldiers at the military camp was boosted by involving family members of the patients in the care delivery processes (Pirani, 2016; Adams, 2016; Lee, 2014).
Assumptions and Beliefs
The environmental theory is based on several assumptions. First, natural laws play critical roles in health and sickness (Awalkhan & Muhammad, 2016). As such, Florence believed that diseases in human beings are caused by a violation of natural laws. Second, the theorist believes that nursing and medicine are two separate fields and should be treated as such. Third, nursing is viewed as a distinct science and an art and, therefore, should have its own theories and frameworks (Awalkhan & Muhammad, 2016). Fourth, it is believed that nursing is a calling. Thus, any person wishing to be a nurse should have an internal conviction. Fifth, Florence believes that the disease processes do not play an important role in nursing but nurses should focus on the patient and environment (Pirani, 2016; Awalkhan & Muhammad, 2016). Sixth, the theory is based on the belief that the environment in which care is provided is vital in the determination of patients’ health. Thus, caregivers should manipulate the environment to enhance the state and recovery of patients. Seven, it is believed that nurses could achieve perfection through attaining skills, being extra vigilant, embrace confidentiality, and use evidence-based practice (Awalkhan & Muhammad, 2016).
The Four Concepts of the Nursing Metaparadigm
The environmental theory has an elaborate description of the four concepts of the nursing metaparadigm, including concepts of health, the environment, the patient, and nursing. Regarding health, the author asserts that being healthy is beyond the state of absence of disease. Being healthy involves the ability of a person to use all the power at their disposal (Awalkhan & Muhammad, 2016). A disease, therefore, emerges as a reparative process of nature in the health process. As such, nature itself has the ability to cause disease and heal (Medeiros et al., 2015; Pirani, 2016).
Regarding the environment, it is discussed under the major concepts of the theory and the four concepts of the nursing metaparadigm owing to the fact that this is an environmental theory (Medeiros et al., 2015). Florence considered the environment as a concept where the patients/ their families, health institutions/homes, and sociological/psychological components are given considerable focus and comprehended as interrelated (Medeiros et al., 2015). As such, it is possible to obtain health by manipulating the environment and allowing nature to act upon ailing persons (Awalkhan & Muhammad, 2016).
On the issue of the patient, the author of the theory indicates that the person in ill health is the holistic center of the focus and is the receiver of nursing care. The patient, therefore, is regarded in an all-inclusive approach to include physical, emotional, intellectual, and social elements as portrayed by (Awalkhan & Muhammad, 2016). Moreover, the patient has the ability to retain health if the right environment is set. To achieve healing, therefore, adopting the holistic approach to the patient and allowing nature to act on them are highly recommended.
The fourth concept in the nursing metaparadigm, which is described by Florence in her theory, is the nursing practice. Florence argues that nursing practice is not a healing process on its own (Awalkhan & Muhammad, 2016). As such, nurses are not healers. Rather, nursing is viewed as a way of putting structures of patients in a state where there is the absence of disease and/or allow recovery. Therefore, nurses should manipulate the conditions that allow nature to preserve/restore health. Moreover, Florence incorporated spirituality in nursing (she considered hers as a calling from God) and, therefore, the natural laws in disease management is reinforced (Awalkhan & Muhammad, 2016). In addition, nurses should constantly get proper education and acquire appropriate skills.
Clarity and Consistency
The environmental theory is free of jargon and uses a simple and clear way. The concepts are further described and demonstrated with clarity from Florence’s experience (Awalkhan & Muhammad, 2016). Moreover, it is apparent that the theory has a high degree of internal consistency. The role of environment manipulation is congruent with all the theory concepts (Awalkhan & Muhammad, 2016). However, it could be argued that the consistency of the theory is affected with regard to current and future practice, especially when some factors such as nursing being associated with the female gender become outdated (Medeiros et al., 2015).
More than a century after her death, Florence still influence nursing actions through her environmental theory. The theory could be used through the adoption of holistic, humanistic, and scientific styles in care delivery. Moreover, the theory guides nurse practitioners taking the concepts of person, health, and environment in the assessment, implementation, and evaluation in care delivery (Arnone & Fitzsimons, 2015).
Specifically, the theory could be adopted in nurse practice through practical approaches, especially in adopting holistic approaches. As such, environments could be manipulated. Cleanliness, aeration, ventilation, beddings, and drainage should be emphasized in the nursing environment. Moreover, the sociological and psychological aspects of the patient should be underpinned.
Nurse theories are a vital part of the nursing profession and practice. They provide bases and reference of practice while distinguishing nursing from other fields.
One of the most significant theories in nursing is the environmental theory. It is linked to Florence Nightingale who provided guidelines on how to provide care for patients. She emphasized the need to manipulate the environment and allow nature to enhance healing to patients. As such, major concepts of her theory focus on cleaning the physical environment, stabilizing the psychological status of the patient, cleaning the patient, and incorporating social dimensions in care provision.
Although the theory is more than a hundred years old, it is vitally relevant in the current nursing practice, education, and administration. However, it is important to improve on some of the outdated aspects such as associating nursing with a certain gender.
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