The Timless Value of Florence Nightingale's Environmental Model

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Florence Nightingale’s Environmental Model has interpreted how environmental factors could influence the healthy living process of an organism, and how we could utilize the environmental factors for help preventing, suppressing or reliving the diseases and deaths (Nightingale, 1860). Although the Florence Nightingale’s Environmental Model was created at a long time ago, the principles or ideas it applies are timeless. In this essay, I would like to take the current health issue of the rising number of flu cases in Hong Kong as an example to illustrate how we could use Florence Nightingale’s Environmental Model to reflect on modern healthcare context and our present nursing profession.

Florence Nightingale’s Environmental Model and its implications in modern healthcare context and nursing professionals

Florence Nightingale believed altering the environment is a key for facilitating or hampering our health (Nightingale, 1860). These environmental alterations are addressed into ten major components in the Florence Nightingale’s Environmental Model. These components includes ventilation and warming, light and noise, cleanliness of the area, health of houses, bed and bedding, personal cleanliness, variety, offering hope and advice, food and observations of sick (Nightingale, 1860). For its implications, this model is not only applied to give an environmental perspectives to health promotion and disease prevention of healthcare issues in modern public health context, but also directs our nursing professionals’ actions to alter environmental factors for promoting a satisfactory environment to patient.

The healthcare issue in modern healthcare context- Rising number of flu cases

Flu outbreak in Hong Kong this year is potent, compared to previous years. There are more and more recorded cases of flu infections and thirteen of the cases are resulted in death. According to the Centre for Health Protection, it is predicted that the local seasonal influenza activity would continue to rise and exceed the baseline level. There are more needs to provide preventives measures for public particularly children, the elderly and chronic disease patients to help them preventing from getting flu infections (“3 more flu-related deaths in Hong Kong,” 2018)

In the following paragraphs, Florence Nightingale’s Environmental Model is going to be applied to investigate the environment influences behind the flu outbreak, and provide directions on our nursing professionals’ actions towards influenza prevention in a community.

Reflection on Flu outbreak in Hong Kong with Florence Nightingale’s Environmental Model

Reflecting with Florence Nightingale’s Environmental Model, the major components suits in the flu outbreak in Hong Kong are personal cleanliness, ventilation and observation of the sick. Personal cleanliness is the most important factor influencing the flu outbreak. According to my personal experience, every day I see people cough or sneeze without covering their mouths n the MTR, because they are using both hands to play with their mobile phones. This would facilitate the transmission of the flu viruses. As evident by Florence Nightingale (Nightingale, 1860), it is necessary to keep our skin clean from all noxious matter. In referencing to journal articles, it is also widely suggested having personal hygiene practices including good coughing etiquette and hand-washing and other hygiene practices could help a lot in decreasing flu viruses loaded on hands and skins, so as to reduce chances of getting infection and onward transmission via fomites (Liao, Cowling, Lam, & Fielding, 2010). However, the busy and hectic living style in Hong Kong means Hong Kong people having little time to consider their personal hygiene.

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Ventilation is another important components suiting in the situation of flu outbreak. The winter in this year has been unusually cooler than before years in Hong Kong. Hong Kong people like me prefer to stay indoors with the windows shut. It is in favor for influenza virus spreading more easily as closing windows would result in poor ventilation. According to Florence Nightingale’s notes, she emphasized “Keep the air he breathes as pure as the external air, without chilling him.”(Nightingale, 1860). She further suggested “Always air your room, then, from the outside air, if possible.”(Nightingale, 1860) Florence Nightingale believed people would become sick if they keep breathing their own air without proper ventilation (Nightingale, 1860). There is also a review paper showing proper natural ventilation would decrease the chances of airborne disease transmission and the rate of airborne infections. (Nardell, 2015)

Last but not the least, observations of the sick is also an essential component to be considered in the above current healthcare issue. This canon is emphasized healthcare units should have proper observations and assessments of the patient and appropriate documentation. (Nightingale, 1860) The differences between common cold and influenza are too similar, as the signs and symptoms are overlapped. (Prior, Evans, & Prout, 2011) It may lead to a mistaken assessment. There is news about a doctor’s improper assessment on a child with high fever and suspected influenza-like illness. That doctor had assessed with his clinical experience that there was no instant need of admission to hospital for that child to have influenza test in hospital and just given cold medicines. However that child was confirmed to have influenza infection later (“A parent feels unsatisfied to public hospital,” 2018). Although this news just shows that that doctor had an inaccurate assessment, it is possible for other healthcare professionals including nurses not having correct or sufficient knowledge towards influenza, leading to wrong assessment results and no acute treatments given to patients.

Because of those environmental factors influencing the prevention of flu infections, it results in a severe outbreak. This could have been relieved if there are sufficient measures provided to alter those environmental factors.

Guiding nursing professionals’ practices towards influenza prevention by Florence Nightingale’s Environmental Model

In previous paragraphs, we have identified the three major environmental components suiting the flu outbreak with Florence Nightingale’s Environmental Model are personal cleanliness, ventilation and observation of the sick. By identifying the related components, it could give directions for our nursing actions to prevent influenza.
For personal cleanliness and ventilations these two canons, it seems that the basic problem underlying is the lack of awareness. There is a need for raising general public knowledge towards importance of maintaining good personal hygiene and proper ventilations in indoors, and teaching them the proper measures to prevent influenza infection. Nurses are playing an important role in rising public concern towards health (Kemppainen, Tossavainen, & Turunen, 2012). And, it has been discussed the health promotion by nurses are effective for increasing public adherence, improving life quality and enriching the knowledge of illness and promoting their self- health management (Kemppainen, Tossavainen, & Turunen, 2012) The nursing health promotion programs would be recommended as nursing action rising awareness for influenza prevention. Those promotion programs should focus more on promoting behavior-changing (Kemppainen, Tossavainen, & Turunen, 2012).

And, presentation talks and workshops in community these two activities might be suitable in the programs for promoting behavior-changing. In presentation talks, nurses could deliver the importance of maintaining good personal hygiene and proper ventilations in indoors against influenza. For workshops, nurses could share advices on how to maintain proper ventilation in indoors and demonstrate different proper personal hygiene measures like washing hand. Through the health promotion programs by nurse, it is expected general public would increase the knowledge and perform behavior change of maintaining proper personal hygiene and good ventilation in indoor. This would help relieving the severe situation of flu outbreak by altering influences of personal cleanliness and ventilation these two components.

For observation of sick this canon, it is important to have proper observations and assessments of the suspected patient for early treatments to those patients and preventing the spread of influenza virus in the community. To ensure the assessment of suspected patient being more accurate, I think the assessment should not just be done by medical professionals only, but also nurses. Nurse should also be able to assess the suspected patient. This would act as a primary screening to screen out patients who might have influenza infections. Further focused investigations for those screened out patients would be done by doctors to double confirm the assessment results. For acting as primary screening, nurse should increase their knowledge on how to observe and assess flu-like symptoms. Also, the nurses could also acquire the techniques of performing rapid influenza diagnostic test (RIDT). RIDT could detect the viruses faster, and are easier to use. And, the major advantage of using RIDT is that it could be performed out at or near the point of care, without laboratory testing (Bruning et al., 2017).

In my opinion, RIDT is applicable and beneficial to use in nursing primary screening for suspected patients. Based on the environmental model, the nursing primary screening would alter the observation of sick this component and it would help prevent flu outbreak becoming more severe.


Although Nightingale’s Environmental model is created a long time ago, it principles and concepts applies are timeless. In this essay, a flu outbreak has been taken as an example to illustrate how ideas in the model are still important and implicated to modern healthcare context and nursing professionals. We could reflect the health issue nowadays in an environmental perspective by considering the possible influences of those ten components in her environmental model. And, her model could also direct our nursing professionals’ actions to alter identified environmental factors in the issue to help promoting a satisfactory environment to patient.

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