The goal of nursing as described by Nightingale is assisting the patient in his or her retention of vital powers by meeting his

or her needs, and thus, putting the patient in the best condition for nature to act upon (Nightingale, 1860/1969). This must not be interpreted as a passive state, but rather one that reflects the patients capacity for self-healing facilitated by nurses ability to create an environment conducive to health. The focus of this nursing activity was the proper use of fresh air, light, warmth, cleanliness, quiet, proper selection and administration of diet, and monitoring the patients expenditure of energy and observing. This activity was directed toward theenvironment and the patient. Health was viewed as an additive process, the result of environmental, physical, and psychological factors, not just the absence of disease. Disease was the reparative process of the body to correct a problem, and could provide an opportunity for spiritual growth. The laws of health, as defined by Nightingale, were those to do with keeping the person, and the population, healthy. This was dependent upon proper environmental controlfor example, sanitation. The environment was what the nurse manipulated. It included those physical elements external to the patient. Nightingale isolated five environmental components essential to an individuals health: clean air, pure water, efficient drainage, cleanliness, and light.

The patient is at the center of the Nightingale model, which incorporates a holistic view of the person as someone with psychological, intellectual, and spiritual components. This is evidenced in her acknowledgment of the importance of variety. For example, she wrote of the degree . . . to which the nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings (Nightingale, 1860/1969). She remarked upon the spiritual component of disease and illness, she felt they could present an opportunity for spiritual growth. In this, all persons were viewed as equal. A nurse was defined as any woman who had charge of the personal health of somebody whether well, as in caring for babies and children, or sick, as an invalid (Nightingale, 1860/1969). It was assumed that all women, at one time or another in their lives, would nurse. Thus, all women needed to know the laws of health. Nursing proper, or sick nursing, was both an art and a science and required organized, formal education to care for those suffering from disease. Above all, nursing was service to God in relief of man; it was a calling and Gods work (Barritt, 1973). Nursing activities served as an art form through which spiritual development might occur (Reed & Zurakowski, 1983/1989). All nursing actions were guided by the nurses caring, which was guided by underlying ideas about God. Consistent with this caring base is Nightingales views on nursing as an art and a science. Again, this was a reflection of the marriage, essential to Nightingales underlying worldview, of science and spirituality. On the surface, these might appear to be odd bedfellows; however, this marriage flows

directly from Nightingales underlying religious and philosophic views, which were operationalized in her nursing practice. Nightingale was an empiricist, valuing the science of observation with the intent of use of that knowledge to better the life of humankind. The application of that knowledge required an artists skill, far greater than that of the painter or sculptor: Nursing is an art; and if it is to be made an art, it requires as exclusive a devotion, as hard a preparation, as any painters or sculptors work; for what is the having to do with dead canvas or cold marble, compared with having to do with the living bodythe Temple of Gods spirit? It is one of the Fine Arts; I had almost said, the finest of the Fine Arts. Nightingales ideas about nursing health, the environment, and the person were grounded in experience; she regarded ones sense observations as the only reliable means of obtaining and verifying knowledge. Theory must be reformulated if inconsistent with empirical evidence. This experiential knowledge was then to be transformed into empirically based generalizations, an inductive process, to arrive at, for example, the laws of health. Regardless of Nightingales commitment to empiricism and experiential knowledge, her early education and religious experience also shaped this emerging knowledge. According to Nightingales model, nursing contributes to the ability of persons to maintain and restore health directly or indirectly through managing the environment. The person has a key role in his or her own health, and this health is a function of the interaction between person, nurse, and environment. However, neither the person nor the environment is discussed as influencing, in turn, the nurse. Nightingales education, spiritual development, her time in the Crimea, as well as the role of women in the nineteenth century all affected the development of Nightingales ideas about nursing. Although it is difficult to describe the interrelationship of the concepts in theNightingale model. Note the prominence of observation on the outer circle, important to all nursing functions, as well as the interrelationship of the specifics of the interventions such as bed and bedding and cleanliness of rooms and walls that go into making up the health of houses.

Nightingale's Environmental Theory

The Environmental Theory Theoretical Sources Education: Nightingale is a very good mathematician (a nurse statistician) and a philosopher. Her aunt Mai describes her as "a woman with great mind." Literature: Her political inclinations were from the ideologies of Stanley Herbert (family friend). Dicken's novel "The Adventures of Martin Chuzzlewit", a novel with a that portrays a victorian drunken, untrained and inexpert nurse causes an stigma and bad impressions about nurses. The novel greatly affects her beliefs about being a nurse and pursue the battle to change the negative stigma about nurses. Intellectuals: Political leaders like John Stuart Mill, Benjamin Jowett, Edwin Chadwick and Harriet Marinue greatly affects and influence her beliefs of changing things as she viewed as unacceptable to society.

Religious Beliefs: For Nightingale, an action for the benefit fo others is called "God's Calling". As stated in her diary, "God spoke to me in silence and he called me to services" - DUM VIVIMUS, SERVIMUS. Use of Empirical Evidence She uses the polar diagram (statistical diagram) in her reports, books and letters. She is a very good researcher and a great statistician. According to Palmer, Nightingale has a very excellent research skills, she is good in recording, communicating, ordering, coding, conceptualizing, inferring, analyzing and synthesizing. Her focus is on the observation of social phenomena. She highlighted the use of observation and the performance of tasks in the nursing education. Major Concepts and Definitions Environment - concepts of ventilation, warmth, light, diet, cleanliness and noise. She focus o the physical aspect of environment. She believed that "Healthy surroundings were necessary for proper nursing care." 5 essential components of healthy environment: 1. pure air 2. pure water 3. efficient drainage 4. cleanliness 5. light Concerns of Environmental Theory 1. Proper ventilation focus on the architectural aspect of the hospital. 2. Light has quite as real and tangible effects to the body. Her nursing intervention includes direct exposure to sunlight. 3. Cleanliness and sanitation. She assumes that dirty environment was the source of infection and rejected the "germ theory". Her nursing interventions focus on proper handling and disposal of bodily secretions and sewage, frequent bathing for patients and nurses, clean clothing and handwashing. 4. Warmth, quiet and diet environment. She introduce the manipulation of the environment for patient's adaptation such as fire, opening the windows and repositioning the room seasonally, etc. 5. Unnecessary noise is not healthy for recuperating patients. 6. Dietary intake. 7. Petty management proposed the avoidance of psychological harm, no upsetting news. Strictly war issues and concerns should not be discussed inside the hospital. She includes the use of small pets of psychological therapy. Nursing Metaparadigm Nursing Nursing is very essential for everybody's well-being. Notes on nursing focus on the implementation and rendering efficient and effective nursing care. Person The patient is the focus of the environmental theory. The nurse should perform the task for the patient and control environment for easy recovery. She practice nurse-patient passive relationship.

Health Health is the being well and using every power that the person has to the fullest extent. A healthy body can recuperate and undergo reparative process. Environmental control uplifts maintenance of health. Environment People would benefit form the environment. Theoretical Assertions Prevention of interruption is very vital in the reparative process of the patient. Her focus is on nursing education that required even more training. Nursing Practice is the application of common sense, observation, perseverance and ingenuity. "If the person wants to recuperate, he needs to cooperate with the nurse." Disease came from the organic materials from the patient and environment not on the germ theory. She totally disagree and rejected the germ theory. Sanitation means the manipulation of the environment to prevent diseases. Nursing is the commitment to the nursing works. She gives a little focus on the interpersonal relationship and nurse caring behavior. She believed that the nurse should be moral agents. "Think and act like a nurse." Professional relationships, principles of confidentiality and care for the poor to improve health and social condition were the focus of her nursing care. Logical Form She used inductive reasoning from her experiences and observation with is address with logical thinking and philosophy. Importance of Environmental Theory Practice 1. Disease control 2. Sanitation and water treatment 3. Utilized by modern architecture in the prevention of "sick building syndrome" applying the principles of ventilation and good lighting. 4. Waste disposal 5. Control of room temperature. 6. Noise management. Education 1. Principles of nursing training. Better practice result from better education. 2. Skills measurement through licensing by the use of testing methods, the case studies.

Research 1. Use of graphical representations like the polar diagrams. 2. Notes on nursing. Evaluation of the Environmental Theory Hardy evaluated the environmental theory as a grand theory because it explains the totality of the behavior. It is classified as lower-level theory but it provided the greates foundation of nursing education, practice and theories. The Analysis Simplicity: The theory is simply explained as the nurse, patient and environment interacts with each other. There are dangers in the environment and benefits from the good environment. The roles of environmental management to patient recovery is greatly emphasized. Manipulating the environment to prevent diseases. Nurse-patient relationship focus on cooperation and collaboration. Her care focus on eating patterns and food preferences of the patients, provision of comfort, protection from emotional distress and conservation of energy. Generality: The universality of the concepts provide general guidelines and is still applicable and relevant today. Empirical Precision: The theory is stated completely and presented facts. She uses quantitative research method. She focus on observation and experiences rather than systematic empirical research. Derivable Consequences: Measures of independence and accuracy of care. Nurse-patient relationship towards wellness, environmental manipulation and psychological care.