FLORENCE NIGHTINGALE

“Nursing is the art of utilizing one’s

environment for his or her own
recovery”
 Credentials & Background
• The matriarch of modern nursing
• Born on May 12, 1820
• Parents: Edward & Frances Nightingale
• Named after Florence, Italy-> birthplace
• Well- educated, affluent, aristocratic Victorian
family who maintained residences in Derbyshire
& in Hampshire
• His father educated her much more broadly and
rigorously than other young women of her time.
• Was tutored in mathematics, languages, religion,
& philosophy.-> influenced the course of her
work.
• Developed the sense that her life should become
more useful.
• (1837) wrote about her calling in her diary.
– “God spoke to me and called me to his service.”
• She was called to become a nurse, she was finally
able to complete her training in 1851 when she
was accepted for training at Kaiseworth, Germany-
> a Protestant religious community with a hospital
facility.
• She stayed there for approx. 3 months & her
teacher declared her to be trained as a nurse.
Following her return to England
• She began to examine hospital facilities,
reformatories, & charitable institutions.
• (after 2 yrs.,1853)superintendent of the Hospital
for Invalid Gentlewomen in London.
• Crimean War
– Received a request from Sidney Herbert to go to
Scutari, Turkey to provide trained nurse to care for
wounded soldiers.
 Crimean War
• She needed to address the environmental problems
that existed:
– Lack of sanitation & presence of filth.
– Soldiers were faced with exposure, frostbite, lice
infestations, and other opportunistic diseases.

Made her popular & revered person to the soldiers

She was called “The Lady of the Lamp”

Scutari- critically ill with Crimean Fever-
typhus/brucellosis
 Returned to England
• She was awarded funds in recognition of her work.

Establish a teaching institution at St. Thomas Hospital

& King’s College Hospital (London)

• Within few yrs. She began receiving request to

establish new schools at hospitals worldwide.
• Established as the founder of modern nursing
• Nightingale also recognized the societal changes
of her time and their impact on the health status of
individuals.
• Similar dialogues with many political leaders,
intellectuals, and social reformers of the day.
• Her religious affiliation and beliefs were
especially strong sources for her nursing theory.
 During her life
• Devoted her energies to societal issues and causes
in an attempt to create social change.
• She continued to concentrate on army sanitation
reform, the functions of army hospitals, sanitation
in India, and sanitations & healthcare of the poor
England.
• Her writings:
– Notes on matters Affecting the Health Efficiency, and
Hospital Administration of British Army.
– Notes on Hospitals, and Report on Measures Adopted
for Sanitary Improvements in India (1869-1870).
 Shortly after her return in England
• Confined herself to her residence, citing her
continued ill health.
• She wrote 15,000-20,000 letters to friends,
acquaintances, allies, and opposition from this
environment
 Shortly after her return in England
• Confined herself to her residence, citing her
continued ill health.
• She wrote 15,000-20,000 letters to friends,
acquaintances, allies, and opposition from this
environment
Theoretical Sources for Theory
Development
• Many factors influenced the development of
Nightingale’s theory for nursing .
• Individual, societal, and professional values were
all integral to the development of her work.
• Her education from her father was an unusual
one for a Victorian girl.
• The Nightingale family’s aristocratic social status
provided her with access to persons of power and
influence.
 Use of Empirical Evidence
• Her report describing health & sanitary conditions
in the Crimea & in England identify her as an
outstanding scientist & empirical researcher.
• Her expertise as a statistician is also evident in the
reports that she generated throughout her lifetime
on the varied subjects of healthcare, nursing &
social reform.
• She invented the polar- area diagram to
dramatically represent the extent of needless death
in British military hospitals in Crimea.
 Use of Empirical Evidence
• Her research skills are identified as recording,
communicating, ordering, coding,
conceptualizing, inferring, analyzing, &
synthesizing.
 Focus of the Theory
• Emphasized greatly the role of the environment in
the care of the patient.
• Environment – external conditions & influences
affecting the life & development of an organism &
capable of preventing, suppressing, or contributing
to disease, accidents or disease, accidents, or
deaths (Murray & Zentner,1975).
 Focus of the Theory
• Defined& described the concepts of:
– Ventilation
– Warmth
– Light
– Diet
– Cleanliness
– Noise
 Major Assumptions
• Theory & Nursing
– Comparable to that of motherly instincts.
– She believed that every woman will be a nurse because
nursing is having the responsibility for someone else’s
health –a characteristic shared by women, esp.
mothers.
 Major Assumptions
• Theory & Person
– Passive pt totally control of the nurse
– Viewed the patient as a person who needed nursing care
regardless of the patient’s social worth.
 Major Assumptions
• Theory & Environment
– Environment was viewed as “those elements external
to & which affect the health of the sick and healthy
person” & included “everything from the patient’s food
and flowers to the patient’s verbal & nonverbal
interactions” (Fitzpatrick and Whall, 1983).
– Centered to the concept of a therapeutic environment
that will enhance the comfort & recovery of the pt.
 Major Assumptions
• Theory & Health
– Viewed health as being well.
– Emphasized the promotion and maintenance of health
and the prevention of diseases through prudent control
of the environment and social responsibility.
– This lay the foundations for health nursing, or that field
of nursing, or that field of nursing that is aimed at
health promotion and disease prevention.
 Theoretical Assertions
• She believed that disease was reparative process;
– Disease was nature’s effort to remedy a process of
poisoning or decay, or a reaction against the conditions
in which a person was placed.
• She did not explicitly discuss the caring behaviors
of nurses
– She wrote very little about interpersonal relationships
except as they influenced the pt’s reparative process
• She believed that nurses should be moral agents
– Professional relationship with their pts.
 Acceptance by the Nursing
Community
• Nursing Education
– (By establishing the St. Thomas Hospital & King’s
College Hospital in London)
– She was able to provide framework for the
establishment of nursing training schools through a
universal template that contains principles of nursing
training.
– These principles included instruction in scientific
principles and practical experience for the mastery of
skills.
 Acceptance by the Nursing
Community
• Nursing Education
– She also advocated the separation of nursing training
from the hospital to a more appropriate learning
environment in the school or university setting.
– She believed that good nursing can only come from
good education.
– Although she did not believe in licensure exams, she
used other methods of evaluation like case studies to
monitor the progress of nursing students.
 Acceptance by the Nursing
Community
• Research
– She is considered the mother of nursing research
because of her interest in the scientific methods of
inquiry and statistics.
– However, her theory lack complexity and testability
which limits her theory in that it cannot generate the
nursing research that is employed to test modern
theories.
– Her theory still serves as bases for current research.
 Critique
• Simplicity
– The nurse- patient relationship may be the least well
defined in her writings.
– Yet there are suggestions of cooperation &
collaboration between the nurse and patient in her
discussions of a patient’s eating patterns & preferences,
the comfort a loved pet to the patient, the protection of
the patient from emotional distress & the conservation
of energy while allowing the pt to participate in self-
care.
 Critique
• Generality
– Her theory has been used to provide general guidelines
for the last 150 yrs.
– The relation of concepts are applicable in all nursing
settings today.
– To address her audience of women who may provide
care to another, the theory she proposed remain
relevant.
 Critique
• Empirical Precision
– Concepts & relationships within Nightingale’s theory
are frequently stated implicitly & are presented as
truths rather than tentative, testable, statements.
– In contrast to her quantitative research on mortality
performed in the Crimean, she advised nurses that their
practice should be based on their observations &
experiences rather than systematic, empirical research.
 Critique
• Derivable Consequences
– To an extraordinary degree, her writings direct the
nurse to action on behalf of the patient & the nurse.
– Her principles that attempt to shape nursing practice are
the most.
– Similarly, she advised that “if you cannot get the habit
of observation one way or other, you had better give up
the being a nurse, for it is not your calling, however
kind & anxious you may be.”
 Critique
• Derivable Consequences
– She viewed nursing as a means of doing the will of her
God.
– Her rejection of the germ theory & her inability to
recognize a unified body of nursing knowledge that is
testable have subjected her to some ridicule, other parts
of her theory & her activities are relevant to nursing’s
professional identity & practice.