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Research Paper on Florence Nightingale Theory of Positive Manipulation of the Environment



This paper will examine the origin of the nursing theory in reference to the Florence Nightingale Theory of Positive Manipulation Of the environment. Initially the paper will introduce the theorist and the context in which the theory was developed. Will critique the theory according to nursing theory critique. The paper will further describe the utility of the theory with respect to practice, administration, education and research will also examine the empirical precision of the theory(testability and logical adequacy). Infact the entire paper demonstrates the understanding of the theory.

“Nursing has evolved as a scientific discipline and is emerging into professional status. From Florence Nightingale's direct bedside patient care to its present multifaceted roles, nursing has changed significantly in its scope of practice, responsibilities and functions”


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The name of Florence Nightingale cannot be forgotten as she was considered as the pioneers in the nursing profession .She has contributed a lot in the field of nursing and her works are considered as the assets ,these works will be remembered for many years. Florence Nightingale was born in the year 1820 and died in 1910.The history shows that she lived through an era of conflict and change. The main contribution of Florence is that she has defined Nursing in its correct form. She had developed the correct and concise meaning of nursing. That is she has described what nursing is and what nursing is not. She believed that nursing involves Environmental Manipulation, Nutrition, and Conservation of Patient Energy., all these aspects were initially included in nursing .And the literal meaning of nursing was in one way or the another connected all these aspects.
The principles which have been defined by Florence Nightingale depicts that nursing is basically connected with reforms.
In order to cover all those aspects which have been mentioned earlier nursing should be actively involved in change and progress, all this comes under reforms. The reforms can be: Sanitary reform, architectural and administrative reform, scientific methodology and educational reforms, and public health reform and political action.

According to Nightingale all these concepts were considered as the basics of nursing. The main behind this was that all these aspects are concerned with the wellness and health of the individual. This quotation can best described the services which the nurses provide “Nursing is both "the lady with the lamp" comforting the wounded soldier and the lady that fights the political forces and the administrative systems that land the soldier in the squalid conditions that cause and perpetuate his wounds and illness”.

Nurses are those professionals which have the idea to prevent the health of an individual. Nurses are trained in such a manner that they serve the human beings by providing comfort to those who are mentally or physically weak. Florence designed and trained nurses to fulfill these criteria. The efforts made by Florence were related to make the nursing profession a respectable profession for women’s.

The biography of Florence depicts that she had an instinct and a natural desire to work for the humanity, she wanted to serve the humanity .This task provided her immense satisfaction. Nightingale was basically involved in those tasks which will promote a good health care system. She felt the need to derive the attention of the people towards preventive medicine and promotion of healthy care system .She thought without these aspects a good health care system would not be developed. She also insisted that good nutrition and proper housing facilities are also essential for maintenance of proper health.

Florence Nightingales life was full of efforts and hard work. She was a lady with a lot of qualities, she also showed her will power when she suffered a mental and a physical collapse in the year 1937.During those critical times she showed great amount of power and firm believe. During those times she continued working for the social reforms. Florence nightingale is such a name which will be remembered as long as this world is existing. Her works made her a controversial figure.
The incidence which is mostly remembered in reference to the services of Florence Nightingale is the leadership of Florence Nightingale after the war, after her death her biographers called her “lady with the lamp”. The readings on Florence Nightingale will depict that she was a great social activist. She was continuously involved in the services to help and nurture mankind. She possessed a heart of an angel. Nightingales activities were related to her belief that one should try to help humanity in order to be near to the God. She really loved her God and all her writings were related to this topic. As stated by Nightingale "It is not, God will not punish, we shall therefore not surely die. It is, God loves us, and therefore why will we die? One says that God is careless, the other that He is loving." In an unpublished sermon she insisted on God's "real personal interest in our welfare," not just His "mercy generally." It was hard to believe this, she acknowledged, "But if this belief once takes possession of our hearts, then are we redeemed indeed."


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Her idea was that God has made us and he also loves us .The greatness of God cannot be measured. She was mainly involved in the social activities because she thought that this act of kindness made by her might take her near to the God. All her sayings were in one way or another connected to the greatness of god. She was a person with great feeling spirituality in her. This spirituality took her to the heights of success and eventually she became a known figure due to her services which she performed for the entire humanity.

The history of nursing depicts that it was Florence Nightingale who first described the definition of nursing and further she also developed the standards which will be adopted by the nurses. She insisted that nurses should be provided with those teachings which will help them to dig out the cause and observe the symptoms of a disease and than evaluate these diseases by the help of their services. Nightingale also developed many theories for the betterment of nursing. These theories are studied even now by the women who want to be nurses. The contribution Of Florence Nightingale in the field of Nursing is innumerable. The title which is given to her that is “The Pioneer and The lady with the lamp” posess some backgrounds.

The standards which were developed by Florence are still being used and implemented. Florence wanted to develop such nurses which will have the following qualities "The most important practical lesson that can be given to nurses is to teach them what to observe-how to observe- what symptoms indicate improvement-what the reverse-which are of importance-which are of none-which are the evidence of neglect-and of what kind of neglect.... But if you can not get the habit of observation one way or other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be." [F.N]
She regarded health care as Gods work. Therefore she also tried to develop those standards which will prove beneficial for the entire humanity.

Gradually as the profession of nursing became popular then simultaneously theories were also designed by the health care authorities, these theories were related to the nursing standards and gave new distinguished concepts of nursing. There are many theories which can be identified in this context but, in this paper the theory of Florence Nightingale will be the central point of discussion.

The nursing theories are numerous and can be studied thoroughly these theories were designed and implemented by many nursing schools. The periods of these theories differentiates from one another.

This theory is a major contribution made by Florence Nightingale. It has relative importance in the field of nursing. As it has been observed earlier in this paper that Florence thought that Environment really counts and is very important for good health. Therefore, she included it in the aspects of nursing. With this reference she developed her theory of environmental manipulation in the year 1850.This theory was a great addition in the nursing theories. This theory laid emphasis on the environment and the affects of the environment. She wanted to develop such measures which will help to keep the environment as clean as possible.

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These paper further moves on to mention the aspects of the theory which are criticized by the Nursing theory critique.
“I would like to add that the positive manipulation of the environment I used was massage, warm bath, (Nightingale’s theory of hygiene), and aromatherapy. I scented the patient's room and linens with lavender linen spray and air freshener.”
This theory is in reference to Environmental Manipulation of Blood pressure In the Preeclamptic Patient as the quotation states that the positive manipulation of the environment which was used for this a patient included massage, warm bath and aromatherapy.

The nursing theorists have critically observed the weaknesses of this theory as such:
- The foundation of Nightingales theory is those external elements which affects the sick person. The critics say that it is not only the external factors by which the health of a patient is affected but the other factors are also involved to affect the health of sick person. Those factors might be enormously contributed towards the health of such a patient. As it was stated in the nightingale’s theory of hygiene that aromatherapy was used and the patient was given warm bath. All these factors are external factors which might make the health of such a patient better or might deteriorate his health.

- The specific elements which are included in the theory are air, light, protection from upsetting news and diet of such a patient. Although all these factors which are discussed in this theory are of vital importance but, sometimes the situation becomes in favorable for the patient and the patient might suffer from the disease. If he/she would listen to unfavorable news, then the situation will become worse. A part from such weaknesses this theory is a complete theory which have discussed the aspects of environment and the affect of the environment on such patients which suffer from blood pressure.

“Florence Nightingale can boast at least two firsts among her achievements - not only was she the first to found training schools for nurses, she was also the first woman elected fellow of the Statistical Society because of her contribution to army statistics.” Florence Nightingales theory is of relative importance in the field of nursing and has also proved beneficial for many patients. This theory is basically concerned with the health of the patient. This theory has made the points to support the topic that environment do have an affect on sick patients therefore, care should be taken as much as possible to keep the environment clean and hygienic.

Florence theory relates to her idea that she wanted the environment to be free of diseases and germs; she wanted to develop those standards which would help to keep the environment as clean as possible. She wanted that the lives of all the human beings should be happy and successful. The can only happen if a person is healthy. Her works and her theories mostly related to the health aspect of the individuals. She wanted to evolve an environment which will be free of diseases.

This theory of environmental manipulation is being implemented by the nurses across the world and is considered as a standard in nursing. Her theory is such that it will help a patient to regain his powers and maximize his energies up to the fullest. She wrote her works on the aspect that how the nurses can help to improve the morale of patient lying in a bed. According to her the nurses should treat the patients as such that a hope can be developed in their minds.


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Discussing about this theory it can be said that this theory is still being taught in the nursing schools and also being implemented by the nurses. Her believe was that this theory would help to control those external factors which will affect the patient. She mentioned those vital factors and tried to convince the reader that these factors do have a great affect on the sick patient. The utility of this theory can be measured by the fact that after the implementation of this theory a considerable difference was seen in the rate of patients as the patients were treated according to the rules and standards of this theory.
Researches show that implication of this theory is still going on and the patients are being benefited by the treatment which they get. The utility of this theory can be judged by the fact that many years have passed but still this theory is taught in the nursing schools. The contribution of Florence Nightingale are innumerable and all are advantageous in one way ore the other. As she devised all her methodologies and theories with the belief that illness is a reparative process by nature, it is a period of test.

Florence theory of environmental manipulation is amongst those nursing theories which have been evolved by the other theorists on environment. But this theory stands out amongst all those theories .The biography of Florence depicts that she made her writings mostly on environmental control as she thought that prevention of many diseases can be done via environmental control. She called such methodologies as health nursing and during her entire life she wrote many things on this topic.

Testability and Logical Adequacy of the Theory of Florence Nightingale
The theory of Florence Nightingale is a great contributor in the field of nursing and this theory has opened many options for the other theorists to writer their works on this issue. This theory was able to derive the attention of the health care providers on the issue of environmental control.

Testability and reliability of this theory can be checked after the observation of the implication and application of this theory. Researches show that after the evolution of this theory many patients were cured according to the standards set out in this theory and eventually these strategies proved advantageous for the nurses.

"I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet -all at the least expense of vital power to the patient." [F.N]

The name of Florence Nightingale will always be remembered especially with reference to the field of nursing. As she was a lady who had the feeling of helping the humanity, she worked as a social activist because she gained satisfaction by doing all these activities. She was a firm believer and had firm belief in God. As her statement depicts that she wanted to develop nursing as a profession which will be suitable for the women. She has not limited the field of nursing just for the administration of medicines but nursing according to her was a very respectable profession for women and this profession should include those aspects which will be beneficial for the health of the humanity.


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Amongst these factors she included all environmental aspect such as air, water, light and hygiene. According to her a man should utilize all his energies until he dies. He should take use of all his capabilities .Florence efforts widened the scope of nursing profession and included all those factors which were essential for a good health care system. In this aspect Florence developed many theories which is and will be advantageous for the nurses across the world.

The theory of environmental manipulation given by Florence is a theory of distinctive nature; it has included all those aspects of environment which can affect the health of a patient. According to her these environmental aspects should be controlled and the environment should be kept as hygienic as possible to control the health of the patient. Disturbing environment will deteriorate the health of the patient further. The theory is of immense importance and is evolved as a standard in the nursing field. Therefore, it is being taught in the nursing schools. After the evolution of this theory many other theorists also contributed their writings and they also mentioned certain aspects of environmental control.

Florence Nightingales achievements cannot be forgotten as her achievements are uncountable...Florence also had great difficulty in adopting the profession of nursing as can be depicted by the information “Although she was conscious of her calling at an early age, she found it difficult to break from her social circle and pursue a nursing career” This information depicts that she had a lot of problem before she decided to become a nurse. But eventually she broke all the circles and adopted nursing as her profession. After getting into the nursing profession she developed standards for this profession and also broadened the scope of nursing she gave a new definition of nursing with innumerable aspects in it.

It was all due to the efforts of Florence that nursing has become respectable profession in the present era and will be respected always. A Florence nightingale theory of environmental, manipulation defines those concepts which are involved in the environment and which badly affects the environment as well as the health of the patient. Therefore the theory suggests that the environment should be kept clean and hygienic for the safety of the patient. The room should be scented to give the patient a pleasant feeling. Moreover all those aspects which will have a bad affect on the health of the patient should be eradicated.

These activities should be done basically to provide the patient a healthy environment where in he can be treated properly and can get better as soon s possible. All these information which have been provided in this paper are related to the works of Florence nightingale, her theories and her background. All her writings and works show that she was a lady of ambition and did all those things by which she got satisfaction. Discussing the theory of environmental manipulation it can be said such theory has directed the attention of the theorists towards very important issue that is health care and how can health be prevented by control environmental aspects.

“Florence Nightingale has now been dead for 90 years, the same length of time she was on this earth. During that time, people who have written biographies of her are largely responsible for the way we see her and the values that we ascribe to her. Biographies of Florence Nightingale will always reflect the prejudices of the author and may describe apparently different women even though they stick to the truth. These prejudices are particularly evident in the work of her 20th century biographers.”

The life of Florence Nightingale is better understood when the biography of her life will be read throuoghly. Researches show that although Florence is not amongst us but her contributions and achievements will be remembered forever. Numerous writers have tried to write a biography and have achieved popularity by the publication of their books. As the readers are attracted by the personality of Florence Nightingale.

In the end it can be said that the theory of environmental manipulation which ahs been given by Florence is of vital importance and will be practiced and implemented by the nurses. According to this theory the nurses try to keep the environment of the patient clean and hygienic .The environment is kept free of germs so that the health of the patient cannot be affected. This theory is mainly in reference to the environmental manipulation of the blood pressure patients. In fact it can be said that the ideas which re presented by Florence are hundred percent advantageous fore the health of the patients .But the nursing theory critics has also evolved certain flaws in this theory. Despite of the flaws this theory is considered very important in the field of nursing and is taught in the nursing schools.

Huxley, E. (1975). Florence Nightingale, illustrated portrayal of the founder of modern nursing. New York: Putman.
Nightingale, F. (1946). Notes on nursing: What it is and what it is not. Norwalk, CT: Appleton-Century-Crofts.
Nightingale, F. (1954). Selected writings. New York: MacMillan.
Nightingale, F. (1970). Florence Nightingale at Harley Street: Her reports to the governor. London: Dent.
Nightingale, F. (1974). Letters of Florence Nightingale in the history of nursing archives. Boston University, Mugar Memorial Library.
Nightingale, F. (1979). Cassandra: An essay. Old Westbury, NY: Femenist Press.
Nightingale, F. (1987). "I have done my duty"; Florence Nightingale in the Crimean War. Manchester: Manchester University Press.


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