Chapter 4

Florence Nightingale’s Legacy of Caring and Its

Application
On completion of this chapter, students will be able to:

1. Summarize significant events in Nightingale’s life that led her to

nursing and influenced the development of her model of nursing.
2. Discuss the influence of Nightingale’s spirituality on her practice of
nursing.
3. Compare and contrast the medical milieu of the 1800s with the
medical milieu of today.
4. Discuss the impact of Nightingale’s feminist view within the context
of her work.
5. Discuss Nightingale’s conception of nursing and analyze the
elements of Nightingale’s Theory of Nursing.
Introducing the Theorist: Florence Nightingale

• Founder of modern nursing

• Born in 1820 in Florence, Italy, the city she was named for
• Legacy of humanism, liberal thinking, and love of speculative
thought was bequeathed to Nightingale by her father
• Father believed in educating women
 Introducing the Theorist (continued)

• Florence and her sister studied

• Music; grammar; composition; modern languages; Ancient Greek
and Latin; constitutional history and Roman, Italian, German, and
Turkish history; and mathematics
• Travel also played a part in Nightingale’s education
• Visited Germany
• First acquaintance with Kaiserswerth, a Protestant religious
community that contained the Institution for the Training of
Deaconesses
• Hospital school, penitentiary, and orphanage
 Nightingale Returned in 1851

• Against much family opposition

• Stayed from July through October
• Participated in “nurses training”
• In 1852, Nightingale visited Ireland, touring hospitals and
keeping notes on various institutions along the way.
• 1853 Nightingale took two trips to Paris
• Hospital training with the sisters of St. Vincent de Paul, an
order of nursing nuns.
• In August 1853, she accepted her first “official” nursing post
 Spirituality

• A few months before her seventeenth

birthday, Nightingale recorded in a personal
note that she had been called to God’s
service.
• It took 16 years, from 1837 to 1853, for
Nightingale to actualize her calling to the
role of nurse
For Nightingale: No Conflict Between Science and Spirituality

• In her view, science was necessary for the development of a mature

concept of God
• Nursing should be a search for the truth, a discovery of God’s laws of
healing and their proper application
• Provided the stageCrimean
to actualize War
her foundational beliefs
• Rooting forever in her mind certain “truths”
• Drawn closer to those suffering injustice
• In the Barracks Hospital of Scutari, Nightingale acted
justly and responded to a call for nursing from the
prolonged cries of the British soldiers (Boykin and
Dunphy, 2002, p 17).
 Nightingale
• Appointed to head a contingent of nurses to the
Crimea
• Provide help and organization to the deteriorating
battlefield situation
• It was a brave move
• Medicine and war were exclusively male domains
• To send a woman was risky
 Crimea Experiences

• Cemented her views on disease and

contagion
• Strengthened her commitment to an
environmental approach to health and
illness
 Introducing the Theory
• Nursing became a science when Nightingale
identified the laws of nursing, also referred to as the
laws of health or nature
 Goal of Nursing

• Analysis and application of universal

“laws” would promote well-being and
relieve the suffering of humanity
• Used the presentation of statistical data to
prove her case that the costs of disease,
crime, and excess mortality was greater than
the cost of sanitary improvements
 Goal of Nursing

• Assisting the patient in his or her retention

of “vital powers” by meeting his or her
needs
• Putting the patient in the best condition for
nature to act upon (Nightingale, 1860/1969)
 Assumptions
•  Nursing is separate from medicine.
•  Nurses should be trained.
•  The environment is important to the health of the patient.
•  The disease process is not important to nursing.
• Nursing should support the environment to assist the
patient in healing.
•  Research should be used through observation and
empirics to define the nursing discipline.
 Assumptions
• Nursing is both an empirical science and an art. 
• Nursing’s concern is with the person in the
environment.
•  The person is interacting with the environment.
• Sick and well are governed by the same laws of health.
• The nurse should be observant and confidential.
 Health
• Viewed as an additive process
• Result of environmental, physical, and psychological
factors, not just the absence of disease
• Disease—reparative process of the body
• To correct a problem and could provide an opportunity for
spiritual growth
Environmental Components of Health
• The laws of health, as defined by Nightingale,
were those to do with keeping the person and
the population healthy
• Clean air
• Pure water
• Efficient drainage
• Cleanliness
• Light
 Patient

• At the center of the Nightingale model

• Model incorporates a holistic view of the
person
• Someone with psychological, intellectual, and
spiritual components
 Nurse

• Defined as any woman who had “charge of

the personal health of somebody,”
• Whether well, as in caring for babies and
children, or sick, as an “invalid” (Nightingale,
1860/1969).
 Nightingale on Women

• Assumed that all women, at one time or

another in their lives, would nurse.
• All women needed to know the laws of
health.
 Nursing
• Nursing proper, or “sick” nursing, was both an art and a science
• Required organized, formal education to care for those suffering from
disease
• Nursing was “service to God in relief of man”
• Nursing activities served as an “art form” through which spiritual
development might occur
• Nightingale’s ideas about nursing health, the environment, and the person
were grounded in experience
• She regarded one’s sense observations as the only reliable means of
obtaining and verifying knowledge.
Nightingale’s Legacy for 21st Century Nursing Practice

• Caring
• Activism
 References

Boykin, A., & Dunphy, L. M. (2002). Justice-making: Nursing’s call.

Policy, Politics, & Nursing Practice, 3, 14–19.

Nightingale, F. (1860/1969). Notes on nursing: What it is and what it is

not. New York, NY: Dover.