NCM 100

Theoretical Foundations of Nursing

I. Nightingale’s Theory

I use the word nursing for want of a better. It has been limited to signify little more
than the administration of medicine and application of poultices. It ought to signify
the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection
and administration of diet—all at the least expense of vital power to the patient.
(Nightingale, 1969, p. 8)

BACKGROUND

-Nightingale was born in 1820 in Florence, Italy.

-From a wealthy family
-was expected to behave like
every other Victorian lady, filling her time before marriage with music, reading,
embroidery, and learning how to be the perfect hostess (Brown, 1988).
- Felt she had a calling to serve, had a strong desire to serve the poor.
-She was compassionate to people from all walks of life.
-Went to Kaiserworth, Germany, to learn nursing from the Institution of Deaconesses
-She developed what we have come to refer to as her nursing theory after her
travel to Scutari to care for wounded soldiers during the Crimean War.
-Her work is mostly philosophies and directives rather than defining nursing and adding nursing
knowledge.
-She is known as the founder of modern nursing
-Notable work Notes on Nursing: What It Is and What It Is Not (Nightingale, 1969).

Overview of Nightingale’s Environmental Philosophy

FOCUS: environment
She believed that the environment of the patient should be altered to allow nature to act on the
patient (McKenna, 1997; Nightingale, 1969).
The components of Nightingale’s philosophy:

Environment: Environment can be defined as anything that can be manipulated to place a

patient in the best possible condition for nature to act (Selanders, 1998).

This theory has both physical and psychological components.

PHYSICAL: ventilation, warmth, light, nutrition, medicine, stimulation, room temperature, and
activity
PSYCHOLOGICAL: chattering hopes and advice and providing variety.

Person: Although most of Nightingale’s writings refer to the person as the one who is receiving
care, she did believe that the person is a dynamic and complex being.

“Nightingale envisioned the person as comprising physical, intellectual, emotional, social, and
spiritual components”.

Health: Nightingale wrote, “Health is not only to be well, but to be able to use well every power
we have” (p. 357).
She believed in prevention and health promotion in addition to nursing patients from illness to
health.

Nursing: Nightingale believed nursing to be a spiritual calling. Nurses were to assist nature that
was healing the patient (Chinn & Kramer, 2011; Nightingale, 1969; Reed & Zurakowski, 1996;
Selanders, 1998).

There are different types of nursing as nursing proper (nursing the sick), general nursing
(health promotion), and midwifery nursing.

Nightingale saw nursing as the “science of environmental management” (Whall, 1996, p. 23).
Nurses were to use common sense, observation, and ingenuity to allow
nature to effectively repair the patient (Pfettscher, 2010).
Additional Notes:

-Nightingale also stressed the importance of “critical thinking” among nurses although she did
not mention the term in her work.
-She expected nurses to use their powers of observation in caring for patients.
-She wanted her nurses “to be clear thinkers and independent in their judgments” (Reed &
Zurakowski, 1996, p. 47).
-She advocated for nurses to have educational backgrounds and knowledge that were different
from those of physicians (Nightingale, 1969; Reed & Zurakowski, 1996; Selanders, 1998).
-She believed in and rallied for nursing education to be a combination of clinical experience and
classroom learning.

Application of Critical Thinking

CASE: An 80 year old cancer patient has been staying in the palliative ward for almost a month
due to cancer complications. He developed community acquired pneumonia and wound
infection. The patient is unable to fulfill activities of daily living and is reliant on his caregiver. He
has been feeling down recently and has verbalized that it seems his primary caregiver doesn’t
want to take care of him anymore. Create a simple plan of care using Nightingale’s Theory.