Nightingale's environmental theory is based on medical practice approach, specifically, on nursing. This theory is explained in a book titled, Notes on Nursing: What It Is, and What It Is Not (Nightingale, 1969). In summary, the theory states that nursing puts the patients in the best environmental conditions for the nature to act upon and heal them. This theory, describes nursing as a collection of activities that promote health and can be delivered by anyone. Some of the environmental factors that have an effect on patients health according to this theory include cleanliness, efficient drainage, direct sunlight or light, appropriate nutrition, fresh air, pure water, and sufficient food. The theory also requires responsible nurses to make continuous assessment of patients dietary needs, documenting all food intake times and evaluate their effect on recovery and general health of the patients. This theory is widely used in modern practice of nursing (A companion to nursing theories and models, 2012).

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Nightingale's environmental theory was put forward by Florence Nightingale's through her book Notes on Nursing: What It Is, and What It Is Notimage1.png. She is the most recognized person in the field of nursing, and she believed that God had called her to practice in that field. Florence Nightingale pioneered this theory in field of nursing during the Crimean war where she tended the wounded soldiers. Due to her night shifts, she came to be known as the lady with the lamp (Nightingale, 1969). During her practice, she realized that many injured soldiers were dying from causes other than their injuries. These causes were illnesses such as cholera, typhoid, dysentery and poor nutrition. In response to this, Nightingale engaged the sanitary commission to change the environment. This led to the decrease of the number of deaths from 42% to 2% (Nightingale,1969). She also worked to improve the sanitary conditions in civilian hospitals after the war. During 1860, in London, Nightingale established the first nursing school at St. Thomas Hospital. The notes on nursing, which she had written in 1859, became the first curriculum for her nursing school (Nightingale, 1969). In honor of her work, the International Nurses Day is celebrated on her birthday every year.

Paradigmatic origin of the Nightingale's environmental theory is based on her philosophical assumptions, evidence and philosophical hypotheses found in the metaparadigm of practicing as a nurse. The collection of all these facts is formed into a conceptual model. This model has essential use in nursing practice and offers an excellent framework for research and conceptualization.

Nightingale's environmental theory adapts to both the external and internal dimensions. The internal dimension of this theory involves food, medication and water. The theory recommends inclusion of food preferences as well as documentation of food quantity and liquids ingested by the patients. These internal dimensions ensure that the patients get enough energy and adequate medication necessary for healing procedures (A companion to nursing theories and models, 2012). If these dimensions are not considered, then the healing process may not be successful.

The rationale surrounding of this theory is that the main goal of nursing is to provide the patient with the best available environmental conditions to promote healing. Poor environment promotes poor health as well as diseases. In additional to this, people are composed of physiological and biological components and are multidimensional. From this note, environment must be maintained to promote these characteristics for the healing to take place (Parker, 1993).

The goal of the Nightingale's environmental theory is to provide the reader with the overall skills of nursing. She believes that little is understood about what constitutes nursing. Nightingale writes, It has been said and written scores of time, that every woman makes a good nurse. I believe, on the contrary, that the very elements of nursing are all but unknown. (Nightingale, 1969, p. 6). This is after she had experienced scores of people die out of separate illness apart from what they had been sick of before. This convinced her that these new illness are caused directly by the environment surrounding the patients. After practicing what could improve the recovery rate and reduce the death rate of the patients, she thought it was important to pass the information to other people and improve their skills of caring for the sick.

Nightingale's environmental theory posses the following attributes. To start with, the theory is characterized by ten major cannons of practice (Nightingale, 1969). These are:

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Ventilation and warming. With this canon, the theory advises keeping air and breathes as pure as the external air. This will blow away the stagnant air and destroy the breeding areas for illnesses like diphtheria, small pox, and scarlet fever among others. Patients should be kept warm, and checks should be done regularly on to the body to prevent chilling.

Noise. This canon advises keeping any unnecessary noise out of the patients reach. It creates discomforts even if it is a whisper. It gives explanation on how the instructions should be read to the patient to minimize the discomfort effect.

Light. The room where the patients stay should be well lit. The canon discourages darkness in the patients room and describes the best way to place windows and ventilations during the construction.

Health of houses. This principle advises on five essentials. These are pure water, pure air, cleanliness, light and drainage. This ensures that the patient is not contracted by new infections from the dirty environment. It also ensures that the water and air that goes to the patient are free from any infections.

Petty management. This canon advocates for continuity of nursing services even when the nurse is not around. The patient should not be left alone when the nurse is out of duty, and if so, should be informed. The person left to take care of the patient should be in a position to execute the duties of a nurse efficiently. If not, then the person must be in a condition to follow the guidelines necessary to fulfill the requirements of these canons.

Variety. This principle advocates for an attempt of a variety in patients room. Nightingale states that patients are always tired of looking at the same wall or ceiling. Similarly, they are tired of taking the same type of meals repeatedly. She notes that it is normal even for healthy persons. She gives an example of soldiers who were fed up of taking canned bottled beef. With regard to this, she advocated for a variety of everything to reduce boredom in the house. The nurse should be wisely creative to divert the thoughts of the patient.

Bed and bedding. This canon requires the nurse to keep the patients bed as comfortable as possible. The bed should be kept dry and wrinkle free. The canon recommends that it should not be too wide or too narrow. In fact, the bed should not be more than 3.5 feet wide (Parker, 1993). On the same note, the canon states that the bed should not be too high or too low. It should not be against the wall as the patient should be able to go down from any side of the bed. The sheets and blackest should be aired frequently to remove dampness. These among other factors characterize this canon.

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Taking food. Food forms the main ingredient of recovery. Virtually, no one can survive without food. The cannon notes that some patients are starved to death due to the lack of food type that they can take. Different patients require different diets for them to recover. The canon recommends that the nurse keeps a record of the amount and type of food that the patient has taken. This will go a long way in evaluating the recovery process.

Chattering hopes and advices. Since the nurse will obviously spend most of the time with the patient, the cannon cautions the nurse against talking to patients without valid reasons or giving advices which are not based on any facts.

Cleanliness of rooms/walls. This canon embraces the whole room physical environment in general. It focuses on cleanliness of walls, furniture, carpets and any other physical object in that room. It gives hints on dos and donts of keeping the environment tidy.

Nightingale's environmental theory is based on Inductive Reasoning. This is where a researcher moves from simple facts to generalization. It can be easily seen that Nightingale used this reasoning to determine the factors that aided the recovery of her patients. After that, she used deductive reasoning to test these factors, and when more patients were able to recover quickly, she solidified her theory.

This theory can be well classified as grand domain. This is because it is based on many principles which work together to define the theory objectives. The theory also applies to a wide range of patients as opposed to a specific group.

Nightingale's theory is operational. The facts put forward many years ago are still being employed in todays nursing practice. You will still find that patients wards are clean, well ventilated, and the floor is clean. It is one of the few theories that will remain relevant even across the test of times (Parker, 1993).

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