Environmental Model Critique

Meaning

Florence Nightingale was the brain behind modern nursing, and she put forward the environmental theory that changed the nature of nursing practice. During her service as a nurse, she observed the correlation between patients who died in Crimean War and the underlying environmental conditions. The observations formed a basis for the creation of the Environmental Theory of nursing. The elements developed from the theory have remained unchanged since the start of the modern nursing profession.

There are several assumptions made in the Environmental Theory, and the major focus is taking care of the patient’s environment to reach the goals of health and also for curing illnesses. The assumptions include; natural laws, humanity can attain perfection, nursing is a calling, art, and science, is achieved through environmental alteration, requires a specific educational base, and it is different and separate from medicine. The main purpose of nursing according to the model is to change the patient’s environment to facilitate change in their health (Medeiros, Enders & Lira, 2015).

The common environmental factors that affect health as discussed in the model are fresh air, pure water, adequate food supply, efficient drainage system, patient and environmental cleanliness, and direct sunlight. The lack of any of the aspects makes a patient experience limited health. The role of a nurse is to enhance patient’s recovery by altering the environment to have the optimal conditions for the body to heal by itself. It can be through the use of particular diet or providing a conducive environment devoid of noise. The environmental aspects can be modified to meet the health goals of the patient and allow them to live healthily. The Environmental Theory is centered on patient care since it focuses on the care of the patient and not the nursing process, patient-nurse relationship as well as individual care. The model ought to be manipulated to fit individual patient needs (Medeiros, Enders & Lira, 2015). The environmental factors tend to affect various patients in a unique way depending on their situations and illnesses that require nurses to address the factors on a case-by-case basis.

The major concepts of the Environmental Theory are nursing, human beings, environment, and health which are further subdivided into; ventilation and warming, light and noise, cleanliness, health of the premises, bed and beddings, individual cleanliness, variety, offering hope and advice, food, and observation (Gonzalo, 2011). The concepts are related to each other and identify that nursing is different from medicine with the goal of nursing being to subject the patient to the best conditions for nature to act. As seen in the concepts, nursing entails the activities that promote health and arise in a caregiving situation (Gonzalo, 2011). The concepts can be achieved by anyone willing to offer appropriate nursing services. Nightingale valued the environment as a crucial tool in the healing process and highlighted the importance of ventilation, heating, sanitary conditions in the premises, and housing hygiene. The factors are related and have to be considered to enhance the quality of nursing services provided as well as their impact on the general nursing field. Other factors that influence patient’s care such as noise and other habits are also discussed in the model since they affect patients based on the situation. There is need to provide appropriate premises where patients can be treated. Ventilation, warming, light, noise, cleanliness and state of the premises affect the quality of nursing services offered to a patient. Personal cleanliness, giving hope and advice are beneficial to individual patients and may not have a direct relationship with light, noise, ventilation, and warming.

A healthy environment is crucial to healing and windows ought to be opened to allow light to enter and also have fresh air exchange. The patient can be kept warm with appropriate clothing and at the same time have a well-ventilated environment. The style of administration of a residence affects the healing process of the sick and nursing care is defined by the people living in the premise and those in contact with the patient. Noise tends to harm good health and the resting ability of patients. On the other hand, nutritious food, beds, and beddings, as well as personal hygiene, are essential to nursing. Also, cleaning hinders morbidity, and a clean environment reduces the cases of infections. The external conditions that affect the life of an organism can help to prevent or contribute to a disease. The interrelationships between the concepts are critical in influencing the nature of nursing care provided.                       

Origins of the Theory

In the current era, the world is faced with environmental conditions that are beyond what is considered natural and nurturing. The world suffers from global warming, nuclear threats, artificial pollution and destructive activities in which Nightingale observed to be undoing to nursing care. She looked forward to providing the best conditions in nursing such as fresh air to patients amidst the existing industrialization effects. Nightingale asserted that health environment heals, but the major issue of consideration is how the environment remains healthy amidst the negative impacts of the advancement in technology and industrialization (Zborowsky, 2014).

 The Environmental theory has a basis in the idea that; the provision of a suitable environment creates a difference in the recovery of patients. Nightingale defined nursing as an act of utilizing the environment of the patient in assisting him to recover. The nurse is obliged to configure environmental aspects for the restoration of the patient’s health, and the external factors related to patient’s surrounding that affect life, physiologic processes, and development.  According to the theorist, nursing has to subject the patient to the best conditions for nature to act upon him. Nightingale stated that nursing should signify the appropriate use of fresh air, light, cleanliness, quiet environment, and proper diet which are vital to the patient. According to the theorist, the art of nursing is practiced by then seemed to unmake what God already made disease to be. As such, there was a need to change the narrative of nursing to adopt a practice that accords patients with the best condition for nature (Kamau, Rotich, Cheruiyot, Ng’eno, 2015).

 In several of Nightingale’s writings, she believed that the provision of a suitable environment is the difference in the recovery of patients which forms the basis of the Environmentalist theory. She addressed the provision of factors that can maintain an environment which is favorable for facilitating healing and healthy living processes. The theory has the assurance that the recovery process is not prevented as provided for by nature. The concern about the environment has been in existence for age’s right from the foundation of professional nursing and is considered as part of the relationships and interactions with the environment. The goal of nursing is to provide assistance to patients in the maintenance of their capacity and satisfying their needs (Zborowsky, 2014). Nursing is a non-healing practice since patients are placed in the best conditions for nature to take its course. The focus of nursing care rests upon environmental hygiene which is a basic concept in theory. Nurses should perform certain tasks that assist the sick persons to live a dignified life.            

Florence Nightingale was motivated by several aspects of nursing that led her to write Environmental theory. The care processes in the rehabilitation of the wounded soldiers in war and the others from surgeries was a significant factor that motivated her to develop innovative thoughts in the care context. The experience during Crimean War enabled her to consider what was effective and what could hinder the process of effective nursing care (Medeiros, Enders & Lira, 2015). The theorist believed to be important in caring for the sick person, and the message of the Environmental Theory show value for the environment as a crucial tool in the healing process of individuals. The importance of ventilation, heating, sanitary conditions in housing, and personal hygiene were critical aspects that motivated her to develop the theory.    

Usefulness

The theory is significant to nursing in practice and is easy to understand. The meaning of environmental theory is well articulated in which disease is closely related to the environment where the patient is placed, most often unhealthy. Nightingale championed for essential factors that would ensure that all the sanitation facilities of the dwelling places of patients including clean air, water, efficient drainage, and cleanliness are provided.

Nightingale’s theory is important in the care of the sick persons and includes the details of the environment that patients should be treated and also about the management of hospitals. The environment aspect in the model is the most crucial since unsanitary environments contribute to ill health, and the environment can be manipulated to improve the conditions of the patient in the healing process.

The theory is relevant to nursing practice, education, and nursing research in the aspects of disease control, sanitation, and water treatment. The theory is applied to disease control by the provision of good sanitation services and subjecting patients to a clean environment for effective disease control. Personal hygiene as well as living in good premises with good ventilation ensures that individuals are free from common illnesses. Proper sanitation and water treatment systems are critical to enhancing the quality of patient care and are basic aspects in the Environmental model of nursing. The theory applies to the present day life architecture for the prevention of the “sick building syndrome” in the aspects of ventilation and good lighting. Buildings are constructed using the basics in the theory since ventilation allows fresh air to flow in and out of a building thereby providing appropriate conditions for the patient (Awalkhan, 2016).

 The significance of the theory justifies its worthiness in offering unambiguous paradigmatic and understanding alongside the conceptual clarification and knowledge. The theorist described the concept of environment and its relevance in disease and health continuum. She considered illness as an imbalance in the elements of the environment and thus manipulation helps the patient cope in nature (Selanders, 2010). The theory helps in infection control and emphasizes on proper disposal of wastes. The theory is practical in nursing and applicable in several nursing contexts thereby forming a good basis for nursing care that focuses on providing appropriate conditions for patient care. The theory significantly contributes to the understanding and prediction of outcomes in nursing care since each environmental aspect influences uniquely care delivery. The physical environment reflects a community health model where everything that surrounds human beings is viewed in its relation to the state of health. 

Case scenario

            An example of a case study where the theory can be applied involves a scenario where a patient was taken to a surgical unit through causality. The patient had post op colostomy and underwent an operation for intestinal obstruction due to unclear etiology by her mother in law and children. On examination, the findings showed that she was febrile with 103f temperature, blood pressure of 100/70 and pulse was 96/min. The patient history taken revealed that the patient lived in a small house and the shared the room with five children, mother in law, and two castles. The patient lived in poor economic conditions and lived for 1 dollar per day (Awalkhan, 2016).

            The patient required nursing care through nature reparative process, and the goal of the nurse is to promote nature by applying nightingale’s theory of nursing model. The theory suggests the assessment of the patient through certain concepts. It is evident that the patient lives in an overcrowded room which she shares by domestic castles. They use water from a well and for toileting which is a bad form of sanitation due to the likelihood of contamination. She lies on a bed in the surgical unit with a colostomy bag which is inappropriately attached resulting in leakage of feces contents that infect the stoma. The likely intervention involves educating the patient and her attendant on the importance of drinking clean water. They should also learn on proper disposal of house excreta. The patient should also be provided with a different room and her stoma cleaned with antiseptics. The room windows should be kept open for ventilation (Awalkhan, 2016).               

Testability

            Testability is crucial in the analysis of a theory as postulated by Fawcett (2006). Since nightingale’s environmental theory is a grand nursing theory; testability is achieved if research is conducted in a qualitative and inductive manner and the research methodology aligns with the contents and philosophical basis of the theory. The processes of data collection should satisfy the essence of the grand theory by highlighting the researcher personal experience of the used data collection approach. Nightingale used detailed construct and abstract concepts in her theory that makes the theory testable. She used the concept of wholeness and explained it in the theory that allows theorists and researchers to adopt the theory in practice and patient care (Awalkhan, 2016).

            The theory has generated research under various topics as evident in the study of nursing research focusing on the impact of health care environments. The study conducted in 2014 by Zborowsky Terry sought to explore nursing research on impacting healthcare environments that have a basis on the aspects of Florence Nightingale’s environmental theory. The author proposes that the use of environmental theory gives nurses an opportunity to engage in research studies with a direct effect on acts of nursing. As such, the theory is testable based on the discussed concepts and is applicable in various areas of nursing practice.     

Overall Evaluation

            The theory is fully comprehensive and specific regarding what the theorist stood for in her model of nursing care. The theory is also straightforward in highlighting the relevance of the environmental aspects in influencing nursing care which is explained in details both in the theory and practical nursing aspects. The theory is general regarding its applications in various fields but mostly focuses on the nursing field. The aspects of ventilation, bed and bedding, good diet, personal hygiene, and facility cleanliness are applicable in nursing related applications as well as other fields.

            The Environmental theory focuses on the major environmental aspects that enable patients to be subjected to the best conditions for nature to act on them. She explained that nursing should aim at providing patients with the best possible conditions for them to benefit from appropriate nursing services. It is also crucial to understand that anyone can perform the canons of the theory. The theory also has broad application areas to the practitioner. The major weaknesses of the theory are that it emphasizes on following the doctors’ suggestions without questioning and is focused more on the physical factors rather than the psychological needs of the patient.

            I would use the theory in my advanced practice by ensuring that patients are subjected to the best conditions of nursing care in my health care facility to ensure that they benefit fully. The required provisions would be availed inadequacy and patients would be allowed to enjoy the environment by having low noise levels, cleanliness in the rooms, and taking healthy food diets as necessary. The rooms occupied by patients would be in good condition, well aerated, and maintained to improve the patients’ care experiences. 

References

Awalkhan A. (2016). Application of Nightingale Nursing Theory to the Care of Patient with Colostomy: European Journal of Clinical and Biomedical Sciences. Vol. 2(6); 97-101. doi: 10.11648/j.ejcbs.20160206.17

Fawcett J. (2006) Analysis and evaluation of contemporary nursing knowledge: Aquichan; 5(1):32–43.

Gonzalo (2011) Florence Nightingale Nursing: Notes on nursing. Theoretical foundations of Nursing, 

Kamau SM, Rotich RJ, Cheruiyot BC, Ng’eno LC. (2015). Applying Florence Nightingale’s Model of Nursing and the Environment on Multiple Drug Resistant Tuberculosis Infected Patients in the Kenyan Setting. OALib; 2(8):1–10. Available from: 

Medeiros, A. B. D. A., Enders, B. C., & Lira, A. L. B. D. C. (2015). The Florence Nightingale’s environmental theory:

Selanders LC. (2010) The power of environmental adaptation: Florence Nightingale's original theory for nursing practice. .Journal of Holistic Nursing; 28(1):81-8.

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.

Carolyn Morgan is the author of this paper. A senior editor at MeldaResearch.Com in research paper writing services if you need a similar paper you can place your order from Top American Writing Services.