Introduction
The study of nursing theory has always been a key aspect of nursing education. The evolution of theory over time-based on the available knowledge and technologies allows us to determine its practicality and usability in nursing practice. Nightingale’s environmental theory is a vital nursing theory that discusses the impact of the physical healthcare setting on patient health and guides nursing practice in creating the best possible surroundings for optimal health outcomes.
Meaning
The primary purpose of Nightingale’s environmental theory is to provide guidance to nursing practice in the context of environmental modification and adaptation with the purpose of improving patient care and positive health outcomes. It is based on the premise that the environment encompasses “all external conditions and influences that affect the life and development of an organism, that are able to prevent, suppress or contribute to disease and death” (Medeiros, Enders, & Lira, 2015, p. 519). Nightingale supported the approach that a suitable environment can make a significant difference in the treatment outcomes and recovery of patients.
Nightingale specifically focused on nursing care as a driving force in environmental hygiene and participating in their capacity in non-healing practice. The environmental theory has two distinct concepts. One is focused on nursing practice, with health delivery maintain the objective of putting an individual in a state where there is no disease and one can recover from sickness. Nightingale believed that health went beyond the absence of disease but encouraged wellness, which required the best possible conditions to preserve and restore health (Medeiros et al., 2015). Meanwhile, the concept of environmental elements is also explored in theory. Nightingale specifically identifies 10 concepts that encompass the medical environment, including:
- Ventilation and temperature;
- Light and noise;
- Cleanliness and hygiene;
- Domestic health;
- Bed and bedding;
- Personal hygiene;
- Variety;
- Nursing advice;
- Nutrition;
- Observation (“Environmental theory,” n.d.).
The environment consists of physical, social, and psychological components which are interrelated and interact to create a setting that can be either beneficial or detrimental to patient health. Nightingale and other applications of the theory encouraged environment management to be established as a fundamental principle in the profession. The concepts, both professional care and environment, interact in a cohesive manner to affect the treatment process. They are dependent on each other since nursing care identifies and modifies changes in the environment, while the setting influences the outcome of the healing process. The theory set the necessary foundations for hygiene and other aspects in healthcare settings which managed to reduce infection and deaths while stimulating recovery, which led to the success of this theoretical framework.
Origins
Florence Nightingale is considered one of the first and classical nursing theorists. Although she never focused on creating theories, her writings in the latter part of the 19th century were later used to derive these frameworks, including the environmental theory. At this time, the medical and nursing profession was undergoing significant change and growth, with the support of increased financing and scientific research in the field. Society as a whole became more aware of the importance of healthcare in the provision of life and health. However, healthcare continued to experience high morbidity and mortality rates, creating concern about the environment in which treatment was provided (Medeiros et al., 2015). It was Nightingale’s motivation to improve health standards and recognition of the nursing role. Nightingale believed and cited that nature and environment were the primary forces involved in the healing process. Therefore, the focus of nursing care should be on the environmental alteration to cure illness since perceived symptoms are often a result of setting influences on the patient, such as temperature, ventilation, and nutrition, among others. It is likely that Nightingale used an inductive approach to theory development by observing and collecting data, identifying relevant issues, and developing a relevant framework based on the logical analysis that would produce a general solution or process (Blackstone, n.d.).
Usefulness
The theory has significant potential and usefulness in daily nursing practice. In combination with modern knowledge and technology, the metaparadigms described by Nightingale can be implemented into policy and procedure in order to ensure holistic delivery of care. Although Nightingale does engage in spiritual and philosophical in theory, there is a level of structure and empirical adequacy to warrant the application of theory can be pragmatic. With each given patient, the physical and psychological environment should be examined to determine if there are any issues or causes of a more significant health problem. Using this, nursing diagnosis and intervention can be formed through a comprehensive assessment of the health status and interaction of the patient with the environment (Awalkhan & Muhammad, 2016).
The theory is a quality-driven metaparadigm that does contribute to understanding and predicting outcomes. Nurses using their direct presence and connection with patients can use sensory observation to identify areas of the environment that may be affecting or interfering with the care process. The theory has a broad scope and can be applied in a variety of aspects of nursing practice and research. The theory has significant applications in care for patients with serious diseases and conditions, where environmental factors can be very impactful on the health of the patient. For example, patients with HIV or tuberculosis are susceptible to complications from even the simplest diseases, creating a necessity to maintain highly sanitary and complex upkeep of their environment both at home and in healthcare delivery (Kamau, Rotich, Cheruiyot, & Ng’eno, 2015). In such cases, Nightingale’s environmental theory can be utilized to analyze patient needs and disease management in order to create an appropriate setting.
Testability
Nightingale’s Environmental Theory is generally testable and has been a central theme of medical research over the decades. The testable concepts focus on healthcare environments, facilities, and patient care conditions. There is extensive nursing-focused research based on the theory, with over 60 articles found in medical databases published in the last 12 years in the most prestigious nursing journals (Zborowsky, 2014). Research has generated various types of studies included qualitative and quantitative, with case studies and literature reviews being the most common. Quantitative methods focused on variable frequency and magnitude, while qualitative methods sought to explore the meaning of concepts.
A study by Pirani (2016) seeks to determine the application of the theory in nursing practice. Using a clinical scenario, the study applies the theoretical framework into an organizational body of knowledge by describing each aspect in practice. An awareness by healthcare professionals of Nightingale’s theory and basic environmental hygiene can aid in providing holistic care. Propositions are statements that can be identified as true or false based on available facts and logic. The theory encompasses several propositions in the context of practice, including:
- A healthy environment is vital to the healing process;
- Noise is disturbing to patients who require rest;
- The environment should be well ventilated while the patient is kept comfortable to support homeostasis;
- Cleaning is necessary to prevent morbidity and infection decrease;
- External conditions affecting life and development also impact the prevention and suppression of disease (Medeiros et al., 2015).
Overall Evaluation
Nightingale’s environmental theory is comprehensive at addressing the topic of setting and environment in healthcare and patient treatment. It is general in the context of analyzing external conditions and their impact on life and disease development, with the focus of identifying the health process and nursing functions that can be used to balance the environment. However, it does offer specifics on individual elements of the environment and how they contribute to health and can be maintained. Albeit, there is little scientific explanation in theory regarding the potential medical or biological processes which are affected by the environment, with Nightingale’s explanations often taking abstract forms (Medeiros et al., 2015). Another weakness can be identified as a lack of specific structure, including implementation or definitions. The strengths of the theory include a holistic approach to nursing care and encouragement for data collection and evidence-based approaches, which have evolved to become a keystone in modern nursing practice.
In conclusion, Nightingale’s environmental theory offers a unique and comprehensive perspective on the role of environment and settings in healthcare. In advanced personal practice, this theory would be significantly beneficial in improving patient care and becoming more engaged in the treatment process. Considering all the included factors of the environment, a nurse can both make necessary changes or work with other staff to address any issues. While modern standards encourage medical settings to maintain a certain level of cleanliness, nurses who are more intimately involved in patient care can identify specific instances in the environment which need enhancement for better treatment outcomes. In turn, this can lead to improvements to various aspects of healthcare, such as HAI rates and patient satisfaction. Therefore, Nightingale’s environmental theory has a variety of applications in nursing which the author of this paper hopes to utilize in advanced practice.
References
Awalkhan, A., & Muhammad, D. (2016). Application of Nightingale nursing theory to the care of patient with colostomy. European Journal of Clinical and Biomedical Sciences, 2(6), 97-101. Web.
Blackstone, A. (n.d.). Principles of sociological inquiry: Qualitative and quantitative methods. Web.
Environmental theory. (n.d.). Web.
Kamau, S. M., Rotich, R. J., Cheruiyot, B. C., & Ng’Eno, L. C. (2015). Applying Florence Nightingale’s model of nursing and the environment on multiple drug resistant tuberculosis infected patients in the Kenyan setting. Open Access Library Journal, 2(8), 1-10. Web.
Medeiros, A. B. de A., Enders, B. C., & Lira, A. L. B. D. C. (2015). The Florence Nightingale’s environmental theory: A critical analysis. Escola Anna Nery – Revista de Enfermagem, 19(3), 518-524. Web.
Pirani, S. S. A. (2016). Application of Nightingale’s theory in nursing practice. Annals of Nursing and Practice, 3(1), 1040-1042. Web.
Zborowsky, T. (2014). The legacy of Florence Nightingale’s environmental theory: Nursing research focusing on the impact of healthcare environments. HERD: Health Environments Research & Design Journal, 7(4), 19-34. Web.