ARTICLE READINGS THEORETICAL FOUNDATIONS IN NURSING

FIRST SEMESTER
FLORENCE NIGHTINGALE’S
ENVIRONMENTAL THEORY AND ITS
INFLUENCE ON CONTEMPORARY
INFECTION CONTROL
Florence Nightingale (1820-1910), who died over a
century ago, was a true explorer into uncharted
territory. She was a teacher, reformer, reactionary and
revolutionary, championing the cause of healthcare
reform for the good of all. Her prolific research,
analyses and writings included many works on nurses
and nursing, nursing education, infection and infection
control, sanitation, hospital planning, design and
construction, hospital administration, health promotion
and healthcare and statistical analysis, all of which
had a close association with her Environmental Theory
(Nightingale, 1855, 1858, 1859a, 1859b, 1860, 1863,
1874, 1885).
DISCUSSION 3.1
Crimean War experiences highlight the need for
improved conditions
In early 1854, Nightingale was asked by the Secretary
of State at War, Sir Sidney Herbert, a friend of
Nightingale and her family and someone who was
aware of Nightingale’s keen interest in nursing, to
oversee the introduction and administration of nurses
to military hospitals in Turkey, during the course of the
Crimean War (1853-1856).This was in response to
reports by William Russell and Thomas Chenery in
The Times newspaper (Times, 1854), which criticised
the British medical facilities there (Bostridge, 2009;
Burchill, 1992). These were reported to be poorly
managed and ill-prepared in every respect. They
lacked the necessary staff, medical supplies and
transport for the wounded, some of whom waited for
weeks, without treatment, before being taken from the
battlefield by boat across the Black Sea to the British
Army Hospital established in the Turkish Selimiye
Barracks at Scutari (now Uskudar in modern
Istanbul).Conditions were appalling. These reports
initiateda Times Fund which raised £11,000 to provide
medical supplies and equipment for the British Army
hospitals (Bostridge, 2009).
& Chermesh, 2011). The situation rapidly became
considerably worse with the arrival of 500 more
wounded, bringing the total number of patients to
almost 3000 (Bostridge, 2009). Straw beds on the
stone floors stretched for an incredible 6.4 kilometres
(4 miles) throughout the Barrack Hospital(Attewell,
2010).Added to this was the appalling stench of
human waste from open, blocked sewers, rat, lice, fly
and flea infestations and horse carcasses floating in
the water supply. Surgeries were conducted in the
open wards, without screens, proper equipment or
medicines, ‘Disease, neglect and mismanagement had
united to render the scene one of unparalleled
hideousness’ (Bostridge, 2009). Traditionally, Army
care of the wounded and dying had been undertaken
by military male orderlies and women, the latter often
following the military camps as ‘comforters’, however
many women were also known to be the wives and
sweethearts of the
sick and wounded (Hallett, 2010). Hence the abrupt
arrival of Nightingale and her nurses was seen as
highly irregular and completely unnecessary.
Nightingale, therefore, waited patiently with her nurses
for the medical officers to request their attendance on
the sick, wounded and dying. Although this was not
immediately
forthcoming, the sheer number of casualties, and
deaths, made the outcome inevitable (Bostridge,
2009). In January 1855, a further 50 nurses arrived to
support the nursing work already begun (Times,
1910).
3.2 THE GERM THEORY, DISEASE,
AND DYING

In November 1854, Nightingale, now the

‘Superintendent of the Female Nursing Establishment
of the English General Hospitals in Turkey’, arrived in
Scutari with 38 nurses (Times, 1910). Her first
impressions must have been horrific, for she
commented, ‘we are steeped to our necks in blood’
(Nixon, 2011). There were two main hospitals, the
Barrack Hospital (British Army Barracks) where
Nightingale and her nurses were based, and the
General Hospital, with an initial total of 2300 soldiers,
who were either ill from disease or infection, wounded
in battle or dying from starvation, frostbite and
gangrene (Ben-Ishay, Gertsenzon, Mashiach, Kluger,