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Nightingale’s Environmental Theory


It is evident to a modern person that treatment of patients should be accompanied by a versatile and careful medical intervention, which involves not only surgical operation or prescription of drugs, but also post-clinical examination. Not least, the environment surrounding the patient plays a role in overall recovery. Examples of such conditions are usually homes, apartments, hotel rooms — in other words, the living circumstances in which the patient stays. The patient’s location may not have a positive impact on recovery, and therefore, according to Florence Nightingale, the main focus should be on the environment. This essay will discuss Nightingale’s environmental theory in the context of Mrs. Adams, 68, suffering from diabetes, hypertension, and recently undergoing breast surgery.

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A Brief Description of Nightingale’s Theory

Historically, until the 20th century, nurses at the hospital were notable for their passivity: the primary concern of women was sanitary supervision of wards, strict compliance with the instructions of the attending physician, and constant prayer for the patient’s health. Over time, this haphazard and technical approach changed into a meaningful one, in which the nurse was able to put forward her theory, apply new techniques and take care of the patient on her own (Dossey et al., 2019). The change in orientation was related to the life and work of Sister of Charity Florence Nightingale (AliSher et al., 2019). The woman created her theory of care, prioritizing research into the environment in which sick and healthy patients live. This concept was a breakthrough idea of the time, and as a legacy, Nightingale created an educational system that teaches young nurses the skills and abilities of a registered nurse.

Case of Mrs. Adams

Mrs. Adams is an older woman who had a right-sided mastectomy five days ago. In addition to breast cancer, the woman suffers from hypertension and diabetes mellitus. In other words, the case of Mrs. Adams is not uncommon for clinical practice, but it does not mean that the patient does not require individual and thorough care. Obviously, the woman who has lost her breast and survived a medical intervention is experiencing severe postoperative stress. It is essential to approach the subsequent therapy and health maintenance carefully and effectively.

The importance of the role of the nurse in patient management should not be overlooked. In this regard, the nurses at the clinic need to pay attention to Mrs. Adams first and start protecting her interests. Protection of the patient’s interests is realized through the study of psychological and physiological conditions, anamnesis, and the patient’s personal opinion. Nightingale’s theory involves an assessment of the patient’s environment, with an estimate of the potential destructiveness of the conditions (AliSher et al., 2019). Thus, according to the description, Mrs. Adams was transferred to the apartment with obvious problems: little air and light, lack of food and hygiene, a broken air conditioner, and four pets requiring attention. At the same time, the woman’s apartment is in a criminal area, and her husband died a year ago. It is not difficult to conclude that the situation described does not have any beneficial effects on the patient, so the manager should appoint a nurse to provide intensive care to Mrs. Adams.

It is important to note that Florence Nightingale focused on five factors of the environment in her theory of care. For example, when assessing living conditions, it is essential to pay attention to sufficient light and fresh air, adequate drainage, surrounding cleanliness, and clean water. Furthermore, the lack of at least one of the factors described causes complications (Ali Pirani, 2016). Projecting Nightingale factors in the case of Mrs. Adams, it is not difficult to estimate that all five health factors are absent or not fulfilled in a woman’s home. For example, a broken air conditioner prevents the room’s ventilation, and the abundance of pets creates dust and debris that the patient breathes. Moreover, Mrs. Adams has not changed her clothes in five days, which indicates a lack of hygiene with the potential to express itself as swelling, bruising, and rot in the postoperative wound area. Finally, the woman is barely eating, as there is no food in her apartment and probably clean water, and she also receives insufficient light. In other words, the nurse should pay attention to the fact that the patient’s living conditions are the exact opposite of those prescribed by environmental theory.


Further work with the patient is carried out according to the primary assessment of environmental conditions and anamnesis. It seems evident that without proper care, there is a risk of new infection of the wound, the development of psychological and nutritional imbalance. The appointed nurse should start with hygienic procedures to significantly reduce the risk of infection in the wound area. As directed by the nurse, Mrs. Adams will need to take a gentle shower and change into clean clothes. In addition, the apartment should be provided with additional lighting and air conditioning. The apartment should be cleaned, and security measures strengthened. In terms of diet, the nurse should train the patient on the importance of eating healthy food in the postoperative period. Finally, Mrs. Adams needs to be kept in touch, as she is currently under stress: it is essential to give her emotional support. It is worth clarifying that the nurse’s role is not limited to maintenance and cleaning — on the contrary, the nurse is the organizer and guide for the patient’s recovery process. In other words, the nurse’s main job is to continuously assess and analyze Mrs. Adams’ condition and transfer information to the clinic for the overall clinical picture.

Applying Theory to Nursing Practice

First of all, it is essential to point out that the key advantage of this theory is that Nightingale focuses on the patient. This means that the patient becomes the priority for the medical staff, and the primary mission is to make his or her recovery successful. Thus, with Nightingale’s theory, patients will get quality support and care they expect, and even more. Nightingale’s theory finds application not only in postoperative care but also in inpatient care, outpatient treatment, and even chronic illness prevention. For example, nurses who monitor patients can promptly monitor and correct violations of the five described factors’ functionality. For example, if an inpatient complains of poor ventilation, the nurse should take measures to provide oxygen to the patient.

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In the question of the target audience, which is best served by environmental rules, it should be initially stated that there is probably no age dependency. Quality care for Nightingale should be provided for both older patients and younger children. Provided and informed patients are aware of the importance of prescribed measures and strive to comply with them (Ferris, 2019). At the same time, theory can show poor performance for patients with low mobility, incompetence, and irresponsibility who have apparent difficulties in managing their treatment.


Theoretical research into patient care processes is always of crucial importance for clinical practice. Nightingale Environmental Theory has become a breakthrough idea, developing the concept of care based on the creation of constructive external conditions. This theory was applied to Mrs. Adams’ case, and it was found out which factors did not contribute to a positive course of recovery. It is essential to clarify that Nightingale’s theory is applied not only to unique clinical cases but also to general practice.


Ali Pirani, S. S. (2016). Application of Nightingale’s theory in nursing practice. Annals of Nursing and Practice, 3(3), 1-3. no doi.

AliSher, A. N., Atta, S., Yasin, I., & Sohail, M. A. (2019). Clinical application of nightingale’s theory. International Journal of Nursing Care, 7(1), 13-16. Web.

Dossey, B. M., Rosa, W. E., & Beck, D. M. (2019). Nursing and the sustainable development goals: From Nightingale to now. AJN The American Journal of Nursing, 119(5), 44-49. Web.

Ferris, D. (2019). Weaknesses of Nightingale theory. eHow UK. Web.

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