being held at the
London School of Hygiene and Tropical Medicine
University of London
Elements of Care:
The History of Nursing in Environmental Context
Various cultures’ healing traditions, such as the American Indian medicine wheel, Indian Ayurveda, and traditional Chinese medicine typically include four or five of the environmental elements of ether, fire, air, water, and earth. There is also abundant evidence that these environmental elements were foundational to the history of the science and art of nursing when the discipline is explored within its broader socio-cultural context as a healing tradition. Examples of attention to the five elements of care are found particularly in the writings of 19th century nurses pertaining to the topic of “sickroom management.” Texts on sickroom management, such as American nurse Sister Matilda Coskery’s Advices Concerning the Sick (1850) and British nurse Florence Nightingale’s Notes on Nursing (1859) commonly addressed how a professional nurse was to create a healing environment through specific tasks that required the regulation of elements. For example, early nurses were to be expert in the control of the flow of air into and around the room of a sick patient. The writings and works of these two 19th century nurses as well as others contributed greatly to what has come to be known in professional nursing as an “environmental theory” in which “nature” was the healer and the nurse, an assistant to nature.
This paper addresses the history of the relationship between 19th century nurses and the environment. The theory and practice of the specific ways in which nurses of the period regulated the five environmental elements in the sickroom are addressed. In conclusion, the paper will examine how the history of the nurse-environment relationship of the 19th century might be used to inform the 21st century reform movement to create “optimal healing environments” in health care.