ENVIRONMENTAL

MODEL OF NURSING
Florence Nightingale

Batool Hassan AL-Shorafa

Noor Abdulla AL-Khamees
Duaa Albutiyan

Zahra Mohammed Bo khamseen

Entesar Al-Abbad
Batool Al Anteef

Learning Objectives:
After completing this chapter, the student should be able to:
Identify the 13 canons of nursing as proposed by
Nightingale.
Explain the major concepts important to nursing as
defined by Nightingale.
Plane nursing care for a patient scenario to utilizing
Nightingales 13 canons of nursing care.

Why we chose Florence?

Florence Nightingale was a famous nurse. She
is best known for the work she did to care for
the wounded soldiers during the Crimean War,
but she also made a big contribution to changing
the way in which hospitals were run. She was
a celebrity in Victorian times and she has continued to be
spoken and written about to this day. Nightingale is known
as the mother of modern nursing and she was caring about
the environment how it's affect the person.

BACKGROUND:
Florence Nightingale was born on May 12-1820. She was active
in aristocratic society but believed that her life could be more
useful. She was obsessed with poverty, disease, and suffering of
the masses. She believed that she was called of God to be a
nurse.
At the age of 25, she had a desired to become a nurse but her
parents refused that. Nightingale announced to her family that
she planned to return Kaiserwerth to study nursing. Finally, at the
age of 31, Nightingale was permitted to travel back to Kaiserwerth
where she learned about the care of the sick and the importance
of discipline and commitment to God.

BACKGROUND:
In 1853 she removed to London. During the Crimean War,
her work proved successful in decreasing the mortality rate.
Upon her return home she eventually began that
Nightingale School of Nursing at St. Thomas its founding
marked the beginning of professional nursing. She
expressed her views about nursing in many format. She
wrote many letters, books, pamphlets, and government
reports. She published Notes on Nursing.

Nightingale model focus is primarily on the patient and the

environment with nursing intervention aimed to manipulating the
environment to enhance patient recovery.
Nightingales Thirteen Canons to Environmental Model of Nursing
1. Ventilation and Warmth: fresh and pure air and the room should be
well ventilated and warm.
2. Health of house: pure air, pure water, efficient drainage, cleanliness
and light.
3. Petty Management: continues caring even if the nurse not there.
4. Noise: avoidance of sudden noise, the noise should be as minimum.
5. Varity: Varity in the patient room to avoid boredom and depression.

6. Food Intake: Documentation of the amount of food and fluid

intake.
7. Food: trying to include patient food preference.
8. Bed and bedding: comfortable, dry and wrinkle free bed.
9. Light: adequate light.
10. Cleanliness of rooms and walls: keeping the environment free
11. Personal cleanliness: patient should kept clean and dry.
12. Chattering hope and advice: avoidance of talking without
reason or giving advice that is without fact.
13. Observation of the sick: making observation and documenting
observation.

The thirteen canons for Nightingale theory were not all board or
general. She believed that nursing is a calling from Gad. Because
patients have some spiritual dimension, nurse is expected to care
for patients spiritual need during spiritual distress. Involving the
nurse in health promotion and health teaching was an idea that
Nightingale believed in. Her environmental theory for nursing was
a changing point in the modern nursing science, which include
four metaparadigms that define nursing:
The person: she defines it simply as the recipient of nursing care.
The person has a relationship with the environment, also the
environment has impact on his or her health status.

The environment: although the Nightingales model admits

the important impact of social environment on the patient
health, it emphasized on the physical environment. There are
two types of environmental components
External (e.g. temperature, bedding, ventilation)
Internal (e.g. food, water, medication)
The health: no specific definition of the health by Nightingale,
but believed on the nature alone can cure disease. The
description of heath as not only to be well, but to use well
every power we have to use (Nightingale, 1860/1960, p.24) .

Nursing: Nursing to Nightingale was above all. Service to

God in the relief of man (Nightingale, 1858, p.2). The
ultimate goal of nursing activities was patient health, so
nursing care is provided for both healthy and ill people. The
nurse role is to manage the environment to put the patient
in the in the best possible situation to act upon him or her.
Health promotion activities is one of the nurse role. Nursing
is provide care for both healthy and ill people.

Person

Recipient of nursing role

External( temperature, bedding, ventilation) internal ( food, water,

Environment
medication)
Health

not only to be well, but to use well every power we have to use
To alter or manage the environment to implement the natural laws of

nursing
health

Assumptions of Nightingales Environmental Model of Nursing:

While Nightingale didnt explicitly state any theoretical assumptions, a number
of philosophical assumptions that can be extracted from her work include:
Nursing is a calling.
Nursing is both an art and a science.
People can control the outcomes of their lives, so they can pursue perfect
health.
Nursing require a specific educational base.
Nursing is distinct and separate from medicine.
Additional assumptions that can be extracted from Nightingales work:
Maintaining a clean room, bedding, and clothes aids in patient recovery.
Noise can be harmful to the patient.
Managing in the environment improves the health of the patient.

Propositions of Nightingales Environmental Model of Nursing:

The primary relationship that can be extracted from Nightingales writing:
The person is desirous of health, so that the nurse, nature, and the
person will cooperative so that all reparative processes to occur.
The nurses role is to prevent the reparative process from being
interrupted and provide conditions to optimize it.
Brief Critique of Nightingales Environment Model of Nursing:
Nightingales model provides a broad framework for organizing
observations about a lot of nursing phenomena. The model is
characterized by only three major relationships: Environment to patient,
Nurse to environment, and Nurse to patient. While some of its directives
may no longer be applicable, the general concepts of the relationships
between them are still relevant.

Nightingales model was developed inductively, based on

the laws of health and nursing gleaned from her
observations and experiences.
The writing of Nightingale remain important to the
profession of nursing. Her basic principles of environmental
manipulation and psychological patient care are applied in
modern situations. And also, some of Nightingales
rationales have been modified or disproved by advances in
medicine and science. Her model remains relevant to illness
prevention and health restoration.

1.Nightingales Environmental Model as a Framework for Nursing Practice

Nightingale expected nurses to use their skills of observation in caring for the sick and
to document of the observation

2.The Nursing Process and Nightingale Environmental Model

Assessment and Planning
using Nightingale 13 canons , the nursing assessment include questions ,
the nurse asks the patient questions relate to food preference and observation, the
nurse observe the presence of odors, noise and light in the patient room
Implementation
the Nightingale model involves manipulation of the environmental factors that affect the
patient health , such as noise , light ,cleanliness, bedding and ventilation of the patient
room
Evaluation
Based on the effect of the changes in the environment on the patient health by
observation and documentation

Illustrating Nursing Care Framed by Nightingales

:13 canons
The following scenario illustrates Nursing care of the patient related
to one specific nursing problem framed by Nightingales thirteen
canons.
The scenario is meant to stimulate our thinking about how specific
care might be approached using this theory as a framework for
practice.
Mrs. L. is a 78-year-old Caucasian who came to the emergency
department with a fractured hip. She was admitted to the medical
surgical unit, status post hip repair. Mrs. L complains to the nurse
that she has not been able to sleep since she was hospitalized.

Nursing care for Mrs. L. by using Nightingales

environmental model:
1) Assessment the environmental factors affecting Mrs. Ls
ability to sleep.
2) Nursing diagnosis is sleep pattern disturbance related to
environmental factors.
3) Intervention is manipulation of the environment to promote
sleep; it will include measures that decrease the patients
pain, promote her mobility, promote wound healing, prevent
infection at the surgical site.

Manipulation of the environment might include

elimination of the noise, unnecessary lights during sleep,
relaxation and comfort measures such as clean, wrinklefree linens and maintenance of a room temperature as well
as effective interventions to promote rest and sleep for
elderly post-surgical patient.
4) Evaluation will be based on the quantity and quality of
sleep experienced by Mrs. L. and observed by the nurse as
well as her subsequent restoration of health.

Videos
1) Health, Environment and Nursing
https://www.youtube.com/watch?v=Q3sugUMVAPk
2) Example of Nightingale's theory
https://www.youtube.com/watch?v=e4JQ2EoNcbY

Any Questions

THANK YOU
Wounds heal. Love lasts. We
remain.
Florence Nightingale

 References
Dr. Edith Claros, P. Kimberly Foisy, and P. Teresa Dean.

Nursing History and Theory.

CNAVideos. (2013). Health, Environment and Nursing.
YouTube. Retrieved from
https://www.youtube.com/watch?v=Q3sugUMVAPk
UpbeatNurse.(2016). Example of Nightingale's theory.

YouTube. Retrieved from https://www.youtube.com/watch?

v=e4JQ2EoNcbY