Application of Nursing Theories Ajesh Kumar TK, Soumya Chandran
Chapter Notes

Save Clear

Section Outline
  1. Florence Nightingale: Environmental Adaptation Theory
  2. Faye Abdellah: Twenty-one Typology Nursing Problems
  3. Lydia Eloise Hall: Core, Care and Cure Circles
  4. Virginia Henderson: Fourteen Components of Basic Nursing Care
  5. Dorothy E Johnson: Behavioral System Model
  6. Imogene King: Theory of Goal Attainment
  7. Myra Levine: Conservation Model
  8. Betty Neuman: Systems Theory
  9. Dorothea Orem: Self-Care Deficit Theory
  10. Martha Rogers: The Science of Unitary Human Beings
  11. Callista Roy: Adaptation Theory
  12. Joyce Travelbee: Human to Human Relationship Model
  13. Jean Watson: Theory of Caring
  14. Ernestine Wiedenbach: Prescriptive Theory—A Situation Producing Theory12

Florence Nightingale: Environmental Adaptation Theory1

The impact of environment on our health where we live is not simply shrugged off. This is the main concept of the Nightingales’ assumption. It is the fundamental responsibility of every nurse to maintain a conducive hospital atmosphere by providing pure water, air, light and maintaining proper cleanliness and efficient drainage system.
zoom view
Florence Nightingale
  • She was born in 1820 in Florence, Italy—the city was named after her.
  • In the very young age, she was very inquisitive and on the go in the humanitarian works especially for ill and poor people nearby her family.
  • In the mid teen years she realized her interest on nursing as career perspective. Despite of nightingales’ parents’ objection towards her ambition, she was determined to pursue her wish.
  • In 1844, Nightingale enrolled as a nursing student at the Lutheran Hospital of Pastor Fliedner in Kaiserswerth, Germany.
  • After training, she went to London and worked as nurse in Middlesex hospital for sick governesses in 1850. Hospital authorities were impressed by her work and gave promotion to the post of superintendant within one year.
  • During the cholera outbreak in London she worked extensively in improving the sanitary condition owing to a significant decrease in Cholera associated mortality rate.
  • In 1854, the aftermath of the Crimean War led to dwindling of British soldiers, the poor sanitation facilities at the war site hospitals accelerated this mortality rate.
  • The Secretary of War Sidney Herbert requested Nightingale to arrange a team and move to Crimea for treating wounded soldiers.
  • She immediately followed his order and formed that the condition of the battlefield was worst than she expected.
  • She realized that poor environmental and scarcity of basic supplies as the main catalyst for hike in the mortality rate and worked on improvement in these areas.14
  • Surprisingly, her relentless efforts produced a drastic decline in mortality rate among soldiers. For this persistent work she received many accolades and named as ‘Lady with the Lamp’.
  • In 1857, she wrote the first book on nursing ‘Notes on Nursing’ after analyzing the condition of Crimean War and even today which is considered as cornerstone for the nursing curriculum.
  • Nightingale utilized the prize money for her work from British Government to build Nightingale Training School for Nurses in St Thomas Hospital at London in 1960.
  • Many young both poor and wealthy enrolled in her nursing school and became successful nurses. One of the notable among them is Lind Richard.
  • Nightingale returned to Scutari and spent rest of her life there in assisting various hospitals and nursing institutes to implement her environmental model to promote patient care.
  • The main components which are vital for a health of houses are pure air, pure water, efficient drainage, cleanliness and light.
  • Nursing is an art and a science.
  • Nursing encompasses caring the patient through maintaining a healthy environment which is conducive for healing.
  • Nurses need to undergo certain special training in order to practice nursing.
  • Nursing profession is entirely different from physicians’.
Environmental Adaptation Model
The focus of nursing is to change the patient's environment to maintain his or her health. The environment can be physical, psychological and social.
Components of a Healthful Environment
  • Health of houses: Concentrates on the five essentials of pure air, pure water, efficient drainage, cleanliness, and light, ‘without these, no house can be healthy’
  • Ventilation and Warming: It is very indispensable to create frequent flow of air in patient's room in order to keep them healthy. Nightingale believed that stagnant air in the patient room can deteriorate the patient health. It is also essential to keep the optimum room temperature.
  • Light: Light has tangible effects to the body. Hence the nurses should include direct exposure to sunlight in their interventions.
  • Cleanliness: She considered that poor living condition and personal hygiene are the main source of infection. Nursing interventions pertains to this aspects are proper treatment of body secretions and sewage, bathing, clean cloths and handwashing.15
  • Nutrition: Nightingale noted that people interest towards food is unique and varies at different times of the day. She also mentioned the need for small and frequent meals instead of heavy one time food.
  • Variety: Changes in the patient room are very essential to keep the patient active and fresh. This can be done by changing the flower pot or engravings of patient room.
  • Bed and Bedding: The bed should be positioned near the window so that patient could see out of the window. She also asserted the importance of changing the beddings frequently.
  • Chattering Hopes and Advices: False reassurance on the illness should be avoided and sick person need to hear the good news which will assist him to be healthier.
zoom view
Fig. 1.1: Conceptual frame work based on environmental adaptation model
Person: Patient is the passive receiver of nursing care. Human beings are in constant interaction with the environment and any minute changes in the surrounding can affect them.
Environment: The external conditions which have direct influence on patient. When the environment is in disequilibrium the patient need to use energy in order to adjust with it.16
Health: It is not properly defined by Nightingale. She believed that health can be maintained by prevention of illness through environmental modification.
Nursing: According to Nightingale ‘What nursing has to do… is to put the patient in the best condition for nature to act upon him’. A nurse ensures proper water, air, light and maintaining proper cleanliness and efficient drainage system for environment to act on patient.
Application of Environmental Adaptation Model
Nursing Practice: The entire nursing field is highly influenced by Nightingale theory. Manipulation of environment remains the foundation of contemporary nursing.
Nursing Education: Environmental adaptation is the fundamental guide for the nursing curriculum across the globe. She asserted that nursing school should be sovereign from the hospital.
Nursing Research: Nightingale found many basis for scientific enquiry in nursing. Nonetheless, her theory is short of the complexity and testability of the modern nursing theories.
Application of Environmental Adaptation Model in Nursing Process
Case Scenario: Mrs Y age 48 years has admitted in female medical ward, diagnosis of fever. She had complaints of fever with headache, chills, diarrhea, rigor malaise and anorexia. She was in hospital for 5 days. Her laboratory report shows plenty of WBCs in urine and waiting for blood and urine culture report, chest X-ray shown normal.
Physical Environment
  • Presence of enough window and proper ventilation.
  • Presence of fowl smelly dumping site outside the window.
  • Having proper light but no direct sun light to the bed.
  • Well facility for hot water twice a day but without purification.
  • Ward toilet drainage system is good but presence of food particles and dust in the pan and around the pan.
  • Room environment is clean and ward is swiped frequently.
  • Presence of water leakage around the sink.
  • Having only one piece of biscuits with milk, one full cup of dhal and 1 glass of plain water during 6 hours period.
  • Bed is clean and tidy but presence of food particles and cover of medicines, pieces of papers and dust inside the locker.
  • Cool room temperature.17
  • Patient is covered with two blankets but still feeling cold.
  • Hospital is located centrally near to the main city so there is noise of horn, loudspeakers.
Psychological Environment
  • Mrs has never been admitted in hospital before.
  • Feeling uncomfortable and have trouble in sleep.
  • She felt that noise because of presence of nursing station near to her bed.
  • She is very active woman and feels her time is wasted since the admission.
Social Environment
  • Patient told that her home environment is clean.
  • They use to drink boiling water.
  • Her room is small but with enough ventilation and sunlight.
  • No history of illness like her in the family or neighborhood.
Nursing Diagnosis
  • Risk for infection related to unsafe drinking water, dust from locker, dirt from sink and outside of the room.
  • Risk for injury related wet floor.
  • Altered nutrition less than body requirement related to inadequate intake of food.
  • Altered comfort measures related to strange, noisy and cold environment.
  • Mrs Y will be free from infection during hospital stay as evidence by normal WBCs range.
  • Client will be free from injury as evidence by not slip on the floor.
  • Client's nutrition level will be maintained as evidence by constant weight till hospitalization.
  • Client will feel comfortable as evidence by absence of noise near to the nursing station and increase room temperature.
  • Provided purified and boiling water for drinking according to patient demand.
  • Cleaned the locker routinely and keep all medicines in small paper box or medicine bag.
  • Informed to the incharge for maintenance of sink, waste disposal.
  • Kept the surrounding clean.
  • Provided adequate diet by encouraging small frequent and nutritious feeding.
  • Maintained temperature by proper dress up and provide extra blanket.
  • Adhered to the biomedical waste management protocol18
  • Kept the patient in calm and comfortable position and avoid unnecessary stimulation, noise.
  • Provided sufficient support and advice related to disease process, diet therapy.
  • She told that she is getting boiled and purified water.
  • She said that she has no vomiting and loose motion.
  • She has gained a weight and no feeling of weakness and increased appetite.
  • Locker is cleaned and no presence of dust around the sink.
Clarity and Simplicity: The concepts in the environmental adaptation model areas very clear and followed a logical sequence.
Generality: This theory is having a wide horizon of application. Some of the concepts can be easily adapt into the every spheres of nursing practice ranges from hospital to a vast community. Nevertheless, ventilation is not always been bliss for the patients, the contaminated air can infect an open wound or a burned skin.
Empirical Precision: Nightingale theory lacks the complexity and testability of the modern nursing theories.
Florence Nightingale developed the first model of nursing care that is grounded in the belief that alteration of the environment will prevent disease. Hence it is the onus of every nurse to maintain a smoothening environment health promotion of patients and themselves.