Florence Nightingale is considered one of the most dedicated individuals who helped improve nursing and healthcare in the world. As a nurse, she did a great job enlightening the society on how to take care of patients and prisoners of war. Through her many theories, she focused on the well-being of the patient in an era where there was not much knowledge on infections and drugs. This literature review examines her environment theory, its relationship to effective drainage systems, cleanliness, light and pure fresh air to the treatment and prevention of infections in the hospital setup. The review aims at revealing what is known about the theory while at the same time focusing on the unknown. This will then be essential in determining the gap between the known and the unknown on the current environmental theory of nursing.
Nightingale’s Legacy focuses on the environmental protection through waste management as a way of preventing infections in the hospital setups. They present the hospital as an institution that generates streams of organic and clinical waste that are difficult to manage and might sometimes harbor certain virulent microorganisms. In the article, they write about three categories of waste in the hospitals namely solid waste, biohazard waste and hazardous chemical wastes (Shaner-McRae, McRae and Jas, 2007). They then focus on upstream and downstream wastes with the aim of creating awareness for nurses on the dangers they face and how they can create policies for isolating them and providing a healthy and infection-free hospital environment. Nurses are depicted as responsible people whose responsibility is to be aware of rules and existing systems for managing biohazard wastes. Therefore, they are responsible for ensuring safe disposal of waste products in the hospital setup by ensuring that each category of waste is disposed of separately in designated waste bins. They are also responsible for the drainage systems of liquid and chemical wastes in the hospital. The authors then provide the role of nurses as follows: they are supposed to master and use JCAHO environmental guidelines. They also recommend the hospital to join the greening movement while at the same time providing effective sharing of information on environmental safety and proper waste management in the nursing sector (Shaner-McRae, McRae and Jas, 2007)
Dossey Barbara (2013) focuses on the integral, integrative and holistic nursing in relation to the Nightingale’s environmental nursing theory. She describes the elements essential for the health of hospitals basing her findings on the theory of environment. Such elements include ample space, fresh air, availability of light as well as the subdivision of the sick into separate units to provide ventilation and avoid contamination and consequential infection. While echoing the theory of environmental nursing, she focuses on cleanliness, food and healthy housing. The provision of certain aspects such as light, noise free environment, ventilation, warming and patient assessment form core parts of the article. The environmental theory is then divided into two parts; external and internal. The external environment deals with certain aspects that may include patient and nurse relationship as well as nurse and nurse relationship. Through such models, Barbara aims at relating the effectiveness of Nightingale’s views on health care in a holistic manner. It also ensures that patient health and management is done in a controlled infection free environment with a view to maximizing nursing knowledge and practices without causing harm (Dossey, 2013).
Environmental theory of nursing focuses on hospital architecture and the need to provide standard buildings that can accommodate patients and nurses. Such buildings are supposed to be built in a way that provides proper lighting and ventilation, while at the same time preventing noise (Tourville and Ingalls, 2003).
In clinical practice, noise has always been found to cause depression in patients and prevent peaceful minds. This has often been associated to delayed wound healing, increased disturbance on the patients’ emotional state as well as making them prone to physical trauma. Clinically, the environment has often been linked to the way patients respond to treatment. Dull hospital rooms with uncomfortable bedding have been associated with increased serotonin and other catecholamine levels with an eventual rise in inflammatory cytokines. The result has often been poor prognosis of disease conditions as well as increased hospital stays and the associated complications (Tourville and Ingalls, 2003).
Results and Discussions
Florence Nightingale’s environmental theory of nursing has often proved essential in clinical nursing practices all over the world. Over the years, patients have often been managed through this model that focuses on the provision of an environment for recovery and hospital management. Nurses are often required to manage waste materials in a clinical setup in a way that prevents contamination and subsequent infections. Through the provision of ventilation, light, noise free environment and patient support, there have always been good treatment outcomes (National Environmental Education & Training Foundation, 2002).
However, there are certain gaps in this theory. As much as the theory is being practiced in many healthcare environments all over the world, some remote places still lack the capability to ensure a safe environment for their patients. Rural communities in Africa and other remote places do not often use the right disposal methods of clinical wastes in the health care environment. Together with this, there are still challenges on the provision of the right hospital environment for patients in and out patients. Infections and communicable diseases still continue to soar at an alarming rate, and these challenges have often tried tom weigh down Florence Nightingale’s environmental theory of nursing (Shaner-McRae, McRae and Jas, 2007).
In lieu to the above challenges, research needs to be done on how health care can be improved using the concepts and theories found in the environmental approach to a holistic nursing. With the right policies and developmental approaches proper and essential health care delivery can still be achieved even in the remote places.
Dossey, B. M. (2013).“Nursing: intergral, intergrative, and holistic-Local to Global. Holistic
Philosophy, theories and ethics. New York, NY: Cengage Learning
National Environmental Education & Training Foundation. (2002). “Nurses
and Environmental Health: Success Through Action.” Illustrations From Across the Nation, January 2002. New York: U.S. Department of Health
and Human Services
Shaner-McRae, H., McRae, G., and Jas, V. (2007). “Environmentally Safe Health Care
Agencies: Nursing’s Responsibility, Nightingale’s Legacy.” The Online Journal of Issues in Nursing. Vol. 12, No. 2 May’ 07. Retrieved 10th October 2014, from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No2May07/EnvironmentallySafeHealthCareAgencies.html?css=print
Tourville, C., and Ingalls, K. (2003). “The Living Tree of Nursing Theories.” Nursing Forum.
Vol 38, No. 3, July-September 2003.