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FLORENCE NIGHTINGALE AND IMPACT OF HEALTHCARE ENVIRONMENTS

RESEARCH

The Legacy of Florence Nightingale’s
Environmental Theory:
Nursing Research Focusing on the
Impact of Healthcare Environments
Terri Zborowsky, PhD, EDAC

ABSTRACT
OBJECTIVE: The purpose of this paper is to explore nursing research that is focused on the impact of healthcare environments and that has resonance with the aspects of Florence Nightingale’s environmental theory. BACKGROUND: Nurses have a unique ability to apply their observational skills to understand the role of the designed environment to enable healing in their patients. This affords nurses the opportunity to engage in research studies that have immediate impact on the act of nursing.
METHODS: Descriptive statistics were performed on 67 healthcare design-related research articles from 25 nursing journals to discover the topical areas of interest of nursing research today. Data were also analyzed to reveal the research designs, research methods, and research settings. These data are part of an ongoing study.

AUTHOR AFFILIATIONS: Terri Zborowsky is a Research Associate at The
Center for Health Design; a Principal at Zborowsky Healthcare Design Consulting; and Research Chair at the Nursing Institute for Healthcare Design.
CORRESPONDING AUTHOR: Terri Zborowsky, Terri.zborowsky@gmail.com;
(651) 724-0081.

© 2014 VENDOME GROUP LLC

RESULTS: Descriptive statistics reveal that topics and settings most frequently cited are in keeping with the current healthcare foci of patient care quality and safety in acute and intensive care environments.
Research designs and methods most frequently cited are in keeping with the early progression of a knowledge area.
CONCLUSIONS: A few assertions can be made as a result of this study.
First, education is important to continue the knowledge development in this area. Second, multiple method research studies should continue to be considered as important to healthcare research. Finally, bedside nurses are in the best position possible to begin to help us all, through research, understand how the design environment impacts patients during the act of nursing.
KEYWORDS: Evidence-based design, literature review, nursing

ACKNOWLEDGMENTS: Part of the funding for the article review process was provided by The Center for Health Design.
PREFERRED CITATION: Zborowsky, T. (2014). The legacy of Florence Nightingale’s environmental theory: Nursing research focusing on the impact of healthcare environments. Health Environments Research & Design Journal,
7(4), 19–34.

HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 19

RESEARCH

SUMMER 2014 • VOL. 7 NO. 4, pp. 19–34

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lorence Nightingale was one of the first nurses to document the impact of the built environment on patients. In addition to writing about sanitation, infection rates, and ventilation, Nightingale understood that environmental aspects such as color, noise, and light, along with the nurse’s presence, significantly contributed to health outcomes. Dossey (2005) has summarized
Nightingale’s comments on the defects of hospital construction that compromised health, including:
• Arrangement of the bed along the dead wall and more than two rows of beds between the opposite windows.
• Defective means of natural ventilation and warming; windows only on one side, or a closed corridor connecting the wards.
• Defective height of wards and excessive width of wards between the opposite windows.
• Defective ward furniture.
• Defective hospital kitchens and laundries.
• Defective condition of water closets.
• Defects of sewerage.
• Use of absorbent materials for walls and ceilings, and poor washing of hospital floors.
• Selection of bad sites and bad local climates for hospitals and erecting of hospitals in towns.
• Defective accommodation for nursing and discipline.
It is clear that Nightingale was well aware of the impact the built environment had on patients—she knew this from direct observation. In fact, all of her…