Facilitator : Ms.

Almas Ghaffar
Presenter : Mr. Zawar Abdul Qudoos
 Objectives
 To be able to know a brief history of Ms. Florence
Nightingale.
 To be able to learn the relevance of the environmental
theory in the nursing science and practice.
 To be able to identify the purpose of the
environmental theory.
 To be able to understand how the environment affects
patient outcomes.
A Brief History in the Life
of Ms. Florence
Nightingale
May 12, 1980 - August 13, 1910
Florence Nightingale
 She was born in Florence, Italy
 Birth: May 12, 1820 (International Nurses Day)
 She believed that God called her to become a nurse
 The Mother of Modern Nursing
 The “lady with the lamp” – Crimean War
 She is a linguist, and educated in science, mathematics,
literature and arts
 The first Nurse Educator and First Nurse Statistician
Florence Nightingale
 July 6, 1851
- entered in the nursing school of Ptr. Theodor
Fleidner as the 134th nursing student and graduated after 3
months.
 Became the “lady with the lamp” because she was
carrying the lamp at night when she was looking for
wounded soldiers in the Crimean War
Florence Nightingale
 Became a heroine in Great Britain because of her
role in the Crimean War.
 She reduced the mortality rate of the wounded
soldiers from 42.7% to 2.2% because of her
intervention in the environment.
 Death: August 13, 1910
What is Nursing?
“The act of utilizing the environment of the
patient to assist him in his recovery”
- Nightingale (1869)
 NIGHTINGALE’S
ENVIRONMENTAL MODEL
 13 CANONS OF NIGHTINGALE’S
THEORY (1860)
 Health of Houses
 Ventilation and Warming
 Light
 Noise
 Variety
 Bed and Bedding
 Cleanliness of the Rooms and Walls
 Personal Cleanliness
 Taking Food – What Food?
 Observation of the Sick
 Petty Management
Five Environmental Factors –
the absence of one produced lack of health or sickness

Pure or fresh
air

light Pure water

Health

Efficient
cleanliness drainage
Metaparadigm in Nursing
1. Nursing
- must place the patient in the best condition for
nature to act upon him
- It should provide for the patient the major
components of the environment .
- should fully maximize the reparative process of
a patient by controlling the environment
 Metaparadigm in Nursing
Nursing

- Nursing should provide care to the sick as

well as the healthy

- Health promotions must be initiated by the

nurse
Metaparadigm in Nursing
2. Person
- The patient is the focus of the environmental
theory.
- She views the person as a passive recipient of
care
- The nurse should control the environment
- The nurse should perform the task to and for the
patient
 Metaparadigm in Nursing
3. Health
 Health is “not only to be well, but to be
able to use well every power we have”.
 A healthy body can recuperate and undergo
reparative process. Environmental control
uplifts maintenance of health.
 Disease is considered as dys-ease or the
absence of comfort.
Metaparadigm in Nursing
Health
- Maintenance of health can be done through the
prevention of disease by controlling the environment.
- Health must be the goal of nursing therefore the
nurse must assist
- The nurse must provide assistance for the
patient to stay in balance with the environmental factors
Metaparadigm in Nursing
4. Environment
- Physical environment is very important because
everything that surrounds the patient have an impact on
their health
- She believed that sick, poor people could benefit
from environmental improvement.
Practice
1. Disease control
2. Sanitation and water treatment
3. Utilized 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.
Weaknesses
 There is scant information on the psychosocial
environment when compared to the physical
environment.

 The application of her concepts in the twentieth

century is in question.
Strength:
 Has broad applicability to the practitioner. Her model
can be applied in most complex hospital intensive care
environment, the home, a work site, or the community
at large.

 Reading her work raises a consciousness in the nurse

about how the environment influences client
outcomes.
 Critiques on the
Environmental Theory
1. What is the historical context of the
theory?
 Her work in the mid 1800’s provided the basis for
modern nursing especially both in education and
practice.
 Her exposure to the Crimean War leads to the
development of an epidemiological approach to
improve the quality of the environment for the injured
and ill at Scutari.
 2. What are the basic concepts and
relationships presented by the theory?
 The major concepts of this theory is the canons of the
environmental model which includes ventilation,
noise, air, health of houses, variety in the
environment, light, bedding, cleanliness, chattering
hopes and nutrition.
3. What major phenomena of concern to nursing are
presented?

 Nightingale’s main focus is the environment and its

manipulation to help the patient attain maximum
health.
4. To whom does this theory apply? In what
situations? In what way?
 The environmental theory is very general that it can
be applied in all kinds of environments such as
homes, community, and work sites and even in the
most complex type of hospital intensive care
environment. The concepts of pure air, light, noise and
cleanliness are very much applicable across specific
environment
 5. Does this theory affect critical thinking in
the nursing practice?

 Manipulation of the environment could lead to the

betterment or further downgrade of the health of
person therefore critical thinking needs to be utilized.
 7. Does this theory direct therapeutic
nursing interventions?

 The environmental theory has directed the nursing

interventions towards the modification of the
environment.
 With the emphasis that noise, light, and ventilation
can be and should be controlled and variety should
be provided in order to maximize the patient’s
response to intervention.
Summary
 The Environmental Theory of Nursing is a patient-
care theory. It focuses in the alteration of the patient’s
environment in order to affect change in his or her
health. Caring for the patient is of more importance
rather than the nursing process, the relationship
between patient and nurse, or the individual nurse.
Reference:
Books
 George, Julia B.(2001). Nursing Theories: The Base for Professional
Nursing Practice. Upper Saddle River NJ:Prentice Hall

 McEwen Melanie and Wills, Evelyn M.(2007) Theoretical Basis for Nursing
(2 ed.) Philadelphia:Lippincot Williams & Wilkins

 Octaviano, Eufemia F. and Balita, Carl E.(2008). Theoretical Foundations

of Nursing: The Philippine Perspective. Philippines : Ultimate Learning
Series

Journals
 (2012,02) Metaparadigm in
Nursing.StudyMode.com.www.studymode.com/essays/Metaparadigm-in-
Nursing-911796.html
Thank you!!!
The Helping Art of Clinical Nursing
by
Ernestine Wiedenbach
Ernestine Wiedenbach
 was born in August 18, 1900, in Hamburg, Germany.
 Conceptual Model: “The Helping Art of Clinical Nursing".
 Education:
 B.A. from Wellesley College in 1922
 R.N. from Johns Hopkins School of Nursing in 1925
 M.A. from Teachers College, Columbia University in 1934
 Certificate in nurse-midwifery from the Maternity Center
Association School for Nurse-Midwives in New York in
1946.
Ernestine Wiedenbach
 Career:
 Wiedenbach joined the Yale faculty in 1952 as an instructor in maternity
nursing.
 Assistant professor of obstetric nursing in 1954 and an associate professor in
1956.
 She wrote Family-Centered Maternity Nursing in 1958.
 She was influenced by Ida Orlando in her works on the framework.
 She died on March 8, 1998.
Theoretical Sources
 Ida Orlando Pelletier - understanding of the use of self
and the effect the nurse’s thoughts and feelings has on
the outcome of her actions.

 Patricia James and William Dickoff, - identified

elements of a prescriptive theory in Wiedenbach’s
work, which she developed more fully in Meeting
the Realities in Clinical Teaching.
PRESCRIPTIVE THEORY
 Wiedenbach's prescriptive theory is based on three
factors:
 The central purpose which the practitioner recognizes
as essential to the particular discipline.
 The prescription for the fulfillment of central purpose.
 The realities in the immediate situation that influence
the central purpose.
The patient

 any person who has entered the healthcare system

and is receiving help of some kind, such as care,
teaching, or advice.

 need not be ill since someone receiving health-

related education would qualify as a patient.
A need-for-help
 "any measure or action required and desired by the
patient that has the potential to restore or extend the
ability to cope with the demand implicit in his
situation.”

 It is crucial to nursing profession that a need-for-help

be based on the individual perception of his own
situation.
Nurse
 The nurse is a functioning human being.

 The nurse not only acts, but thinks and feels as well.
Wiedenbach proposes 4 main elements to clinical nursing.

a philosophy
a purpose
a practice and
the art.
The Philosophy
 Wiedenbach believed that there were 3 essential
components associated with a nursing philosophy:
 Reverence for life
 Respect for the dignity, worth, autonomy and
individuality of each human being and
 Resolution to act on personally and
professionally held beliefs.
The Purpose
 Nurses purpose is that which the nurse wants to
accomplish through what she does.

 It is all of the activities directed towards the overall good

of the patient.
The Practice
 Overt action, constitutes the practice of clinical nursing
 It is goal-directed, deliberately carried out and patient-
centered.
 Practice based on;
 Knowledge
 Judgment
 Skills.
 Components of Practice Directly
Related to Patient’s Care

• Identification
• Ministration
• Validation
 Component of Practice Indirectly
Related to Patient’s Care

Coordination of Resources
- Reporting
- Consulting
- Conferring
The Art
 Application of knowledge and skill to bring about
desired results.
THE ART
 Four Main Goals:
 understanding patients needs and concerns
 developing goals and actions intended to
enhance patients ability and
 directing the activities related to the medical
plan to improve the patients condition.
 The nurses also focuses on prevention of
complications related to reoccurrence or
development of new concerns.
THE ART
 Nursing art involves three initial
operations:

 Stimulus
 Preconception
 Interpretation
LOGICAL FORM
 Induction

 Situation-producing prescriptive theory

Practice
 More acceptable today than on 1950’s and 1960’s
 Serve to guide assessment, interventions, and
evaluation of nursing care.
EDUCATION
Wiedenbach proposed that nursing education serves the
practice in four major ways:
1. It is responsible for the preparation of future
practitioners of nursing.
2. It arranges for nursing students to gain experience in
clinical areas of hospitals or the homes of their
patients
3. Its representatives may function in the clinical area
and may work closely with the staff
4. It offers educational opportunities to the nurse for
special or advanced study
RESEARCH
 Before the development of Wiedenbach’s model,
nursing research focused more on the medical model
than on a nursing model.

 In her model, focus of nursing research is to be related

to the patient’s
response to the health
care experience.
Strength
• directing the activities related to the nursing plan to

improve the patients condition.

• The concepts are applicable within many practice

settings of nursing.

• provide a pathway to enhance the body knowledge

I different clinical areas.
Weakness
 The theory itself does not provide the specific
direction for action in any given situation.

 The nurse must have enough knowledge to be able to

identify the central purpose.

 Wiedenbach’s work have potential limitation that the

prescription is determined by the nurse.
CRITIQUE
 Clarity – concepts and definitions are clear,
consistent.

 Simplicity – too many relational statements

CRITIQUE
 Generality – broad; concept of need-for-help not
applicable to some patients

 Derivable Consequence – fulfills the purpose for

which it was developed – to describe professional
practice
Summary
 This nursing theory focuses on individualizing care for each
patient. This is done by assessing the individual needs of each
patient, so the nurse knows when to step in and help the
patient. This assessment involves observation and
understanding the patient's behavior. Under this theory, the
nurse learns how to identify causes of discomfort and knowing
when the client is able to resolve problems on their own, and
when they need assistance.
Comparison of Theorist
Florence Nightingale
 Matriarch of modern nursing.
 First Nurse Educator and first Nurse
Statistician.
 Became the “lady with the lamp”
 She was a statistician, using bar and
pie charts, highlighting key points.
 She was the first to propose nursing
required specific education and
training
 Published the Environmental theory.
 First women and nurse to be awarded
the Order of Merit in 1907.
Ernestine Wiedenbach
 Pioneer in the writing of nursing
theory.
 She was influenced by Florence
Nightingale and Ida Orlando in her
works on the framework.
 Developed theoretical framework for
future .
 joined the Yale faculty in 1952 as an
instructor in maternity nursing.
 Awarded with Hattie Hemschemeyer
award from the American College of
Nursing Midwifery.
 She published the Clinical Nursing-
the helping art.
Comparison between environment theory and
Helping art-clinical nursing
Primary focus
 Focus on environment.
 Central purpose is, environment
should be well managed.
 Enhance critical thinking.
 Applied in all kind of situation.
 Logical in nature.
 Generalizable , and utilized by
the practitioner.
 Grand theory and logical in
nature.
Primary focus
 Focus on ministration.
 Central purpose is, patient
should be complain free.
 Enhance critical thinking
 Applied in immediate
situation.
 Logical in nature
 Simple yet Generalizable also
utilized by practitioner.
 Grand theory and logical in
nature.
References
 www.currentnursing.com

 Tomey, A.M., (1994). Nursing Theorists and

Their Work. 3rd ed. Missouri: Mosby
 Wiedenbach, E. (1963). The helping art of
nursing. American Journal of Nursing, 63, 54-
57.
 Weidenbach, E. (1964). Clinical nursing: A
helping art. New York: Springer.
THANK YOU!