History
Florence Nightingale (1820-1910), considered the founder of educated and scientific
nursing and widely known as "The Lady with the Lamp"[1], wrote the first nursing
notes that became the basis of nursing practice and research. The notes, entitled Notes
on Nursing: What it is, What is not (1860), listed some of her theories that have
served as foundations of nursing practice in various settings, including the succeeding
conceptual frameworks and theories in the field of nursing.[2] Nightingale is
considered the first nursing theorist. One of her theories was the Environmental
Theory, which incorporated the restoration of the usual health status of the nurse's
clients into the delivery of health care—it is still practiced today.
History of nursing
Nurses have experienced difficulty with the hierarchy in medicine that has resulted in
an impression that nurses primary purpose is to follow the direction of medics.[3] This
tendency is certainly not observed in Nightingale's Notes on Nursing, where the
doctors are mentioned relatively infrequently and often in critical tones, particularly
relating to bedside manner.[4]
Environmental effects
She stated in her nursing notes that nursing "is an act of utilizing the environment of
the patient to assist him in his recovery" (Nightingale 1860/1969),[3], that it involves
the nurse's initiative to configure environmental settings appropriate for the gradual
restoration of the patient's health, and that external factors associated with the patient's
surroundings affect life or biologic and physiologic processes, and his development.[4]
Environmental factors affecting health
Adequate ventilation has also been regarded as a factor contributing to changes of the
patient's process of illness recovery
Defined in her environmental theory are the following factors present in the patient's
environment:
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Pure or fresh air
Pure water
Sufficient food supplies
Efficient drainage
Cleanliness
Light (especially direct sunlight)[5]
Any deficiency in one or more of these factors could lead to impaired functioning of
life processes or diminished health status.[6]
Provision of care by environment
The factors posed great significance during Nightingale's time, when health
institutions had poor sanitation, and health workers had little education and training
and were frequently incompetent and unreliable in attending to the needs of the
patients. Also emphasized in her environmental theory is the provision of a quiet or
noise-free and warm environment, attending to patient's dietary needs by
assessment, documentation of time of food intake, and evaluating its effects on the
patient.[7]
Nightingale's theory was show to be applicable during the Crimean War when she,
along with other nurses she had trained, took care of injured soldiers by attending to
their immediate needs, when communicable diseases and rapid spread of infections
were rampant in this early period in the development of disease-capable medicines.
The practice of environment configuration according to patient's health or disease
condition is still applied today, in such cases as patients infected with Clostridium
tetani (suffering from tetanus), who need minimal noise to calm them and a quiet
environment to prevent seizure-causing stimulus.
Nursing theory is the term given to the body of knowledge that is used to support
nursing practice. In their professional education nurses will study a range of
interconnected subjects which can be applied to the practice setting. This knowledge
may be derived from experiential learning, from formal sources such as nursing
research or from non-nursing sources. To speak of nursing theory is often difficult.
Nursing is many things to many people. Most universally agreed upon is that Nursing
is a science involving people, environment and process fueled by a vision of
transcendence in the context of healthcare. It is interesting to note that 90% of all
Nursing theories have been generated in the last 20 years. Many schools encourage
students to formulate personal philosophies or mid-range theories of Nursing as part
of their curriculum. Some might argue that this multiplicity of theory is detrimental to
the practice and undermines common vision. Others would say that the nature of the
young science is sufficiently far reaching to require such tactics in order to elicit true
consensus.
Theory
For formal theories as studied in mathematical logic, see Theory (mathematical logic). For
other uses, see Theory (disambiguation).
The word theory has many distinct meanings in different fields of knowledge,
depending on their methodologies and the context of discussion.
In science a theory is a testable model of the manner of interaction of a set of natural
phenomena, capable of predicting future occurrences or observations of the same
kind, and capable of being tested through experiment or otherwise verified through
empirical observation. For the scientist, "theory" is not in any way an antonym of
"fact". For example, it is a fact that an apple dropped on earth has been observed to
fall towards the center of the planet, and the theories commonly used to describe and
explain this behavior are Newton's theory of universal gravitation (see also
gravitation), and the general theory of relativity.
In common usage, the word theory is often used to signify a conjecture, an opinion, a
speculation, or a hypothesis. In this usage, a theory is not necessarily based on facts;
in other words, it is not required to be consistent with true descriptions of reality. True
descriptions of reality are more reflectively understood as statements that would be
true independently of what people think about them
Nursing theory and process
In general terms, the nursing process is the method used to assess and diagnose needs,
plan and implement interventions, and evaluate the outcomes of the care provided.
Like other disciplines, the profession has developed different theories derived from
sometimes diverse philosophical beliefs and paradigms or worldviews to help nurses
direct their activities to accomplish specific goals. Currently, two paradigms exist in
nursing, the totality paradigm and the simultaneity paradigm.
Florence Nightingale
Florence Nightingale is the founder of modern nursing She transformed nursing into 1-a respectable
profession
2-set the standards for clean,
3- safe hospitals in the world
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Began her nursing training in 1851 in Germany
Pioneered the concept of formal nursing education
Her experience in treating sick/injured soldiers in the Crimean War strongly influenced her
philosophy of nursing
Call From God
. Religious inspiration called her to focus on the health of the masses
Nightingale Training School for Nurses
. Once trained the nursing training schools on the Nightingale model Notes on
Nursing,. It laid down the principles of nursing: careful observation and sensitivity
to the patient's needs.
Public Health
Florence Nightingale's writings on hospital planning and organization had a
profound effect.
Miss Nightingale was the principal advocate of the 'pavilion' plan for hospitals
Florence Nightingale believed that infection arose spontaneously in dirty and
poorly ventilated places.
This mistaken belief nevertheless led to improvements in hygiene and healthier
living and working environments
Nightingale Initiative for Global l Health (NIGH)
The first official nurses’ training program
The mission of the school was to train nurses to work in hospitals, work with the poor, and to teach.
This intended that students cared for people in their homes, an appreciation that is still advancing in
reputation and professional opportunity for nurses today
Her vision of nursing as a genuine natural healing practice, concerned with preventative medicine,
and was a far cry from what the profession of nursing would become in the modern health care
system
There are many foundations named after Florence Nightingale. Most are nursing foundations, but there
is also Nightingale Research Foundation, dedicated to the study and treatment of chronic fatigue
syndrome, which Nightingale is believed to have had.
There is a psychological effect known as the "Florence Nightingale Effect", whereby nurses and
doctors fall in love with their patients.
Hospital Improvements
During Florence's time, the hospitals were overcrowded, poorly run, and disease infested. They were
doing more harm than good. Florence thought hospitals should help patients, not hurt them. This was a
revolutionary idea at the time.
Florence wrote Notes on Hospitals explaining how to make improvements to hospitals. She believed
hospitals needed better ventilation, more windows, improved drainage, and less cramped conditions.
With Florence's guidance, hospitals became clean and sanitary places where lives were saved, not lost.
Florence also became an expert on designing hospitals. Foreign rulers sought her advice when building
their hospitals. Soon, hospitals throughout the world were being built according to her ideas.
Today, we still see how Florence has improved hospitals. The flowers, recreation rooms, and bright
wards are an influence of Florence's work.
Nursing becomes a Respectable Profession
Florence created high standards for the nursing profession. These standards helped transform nursing
into the respectable profession we know today. Florence's writings continue to provide excellent
resources for nurses and health care providers. Her book, Notes on Nursing, spells out the principles of
nursing.
Florence's Calling
. At this time, nurses learned through experience, not through training. Florence treated sick people,
distributed medicine, and assisted during operations. She was very happy and said, "We learned to
think of our work, not ourselves.
Nightingale wrote about many of the essential beliefs of the natural hygiene movement. She referred
to these hygienic beliefs as the "laws of life" that would give mothers knowledge of "how to give
their children healthy existences." Further, she clearly placed the comfort and needs of the patient
ahead of the thoughtless pursuit of science;
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Based her ideas on individual, societal, and professional values
Her strongest influence was education, observation, and hands-on experience
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She formulated her values through years of working , with charities, hospitals,
& the military
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In 1860 Nightingale published Notes on Nursing
Considered the first “nursing theorist”
Information on her theory has been obtained through interpretation of her writings
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Her theory significantly influenced 3 other groups of theories - Adaptation Theory, Need
Theory, & Stress Theory
Nightingale’s Notes on Nursing:
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Was not written as a nursing text
Was a guide to help organize & manipulate the environment for persons requiring nursing
care
Nightingale originally wanted women to teach themselves to nurse and viewed Notes on Nursing
Nightingale’s Nursing Theory
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The first published nursing theory (1860)
Persons are in relation with the environment
Stresses the healing properties of the physical environment (fresh air, light, warmth, and
cleanliness)
Nursing puts patients in the “best conditions” for nature to act upon them
Health is “the positive of which the pathology is the negative”
“Nature alone cures”
When aspects of the environment are out of balance, the client must use energy to counter
these environmental stresses
Stresses drain the client of the energy needed for healing
Viewed disease as a reparative process
The health of the home/community are critical components in an individual’s health
Theory basis: the inter-relationship of a healthful environment with nursing
 External influences and conditions can prevent, suppress, or contribute to disease or
death
Theory goal: Nurses help patients retain their own vitality by meeting their basic needs
through control of the environment
Nursing’s Focus: control of the environment for individuals, families & the community
Three Types of Environments
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Physical
Psychological
Social
Physical Environment
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Consists of physical elements where the patient is being treated
Affects all other aspects of the environment
Cleanliness of environment relates directly to disease prevention and patient mortality
Aspects of the physical environment influence the social and psychological environments of
the person
Psychological Environment
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Can be affected by a negative physical environment which then causes STRESS
Requires various activities to keep the mind active (i.e, manual work, appealing food, a
pleasing environment)
Involves communication with the person, about the person, and about other people
 Communication should be therapeutic, soothing, & unhurried!
Social Environment
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Involves collecting data about illness and disease prevention
Includes components of the physical environment - clean air, clean water, proper drainage
Consists of a person’s home or hospital room, as well as the total community that affects the
patient’s specific environment
5 Major Components of a Healthful Environmental
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Proper ventilation
Adequate light
Sufficient warmth
Control of noise
Control of effluvia (noxious odors)
Components of Nightingale’s Environmental Theory:
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Health of Houses
Ventilation and Warming
Light
Noise
Variety
Bed and Bedding
Cleanliness of Rooms and Walls
Personal Cleanliness
Nutrition and Taking Food
Chattering Hopes and Advices
Observation of the Sick
Social Consideration
Nightingale’s Theory & Nursing’s Metaparadigm - PERSON
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Referred to by Nightingale as “the patient”
A human being acted upon by a nurse, or affected by the environment
Has reparative powers to deal with disease
Recovery is in the patient’s power as long as a safe environment exists
Nightingale’s Theory & Nursing’s Metaparadigm – ENVIRONMENT
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The foundational component of Nightingale’s theory
The external conditions & forces that affect one’s life and development
Includes everything from a person’s food to a nurse’s verbal & nonverbal interactions with the
patient
Nightingale’s Theory & Nursing’s Metaparadigm – HEALTH
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Maintained by using a person’s healing powers to their fullest extent
Maintained by controlling the environmental factors so as to prevent disease
Disease is viewed as a reparative process instituted by nature
Health & disease are the focus of the nurse
Nurses help patients through their healing process
Nightingale’s Theory & Nursing’s Metaparadigm – NURSING
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Provides fresh air, light, warmth, cleanliness, quiet, and a proper diet
Facilitates a patient’s reparative process by ensuring the best possible environment
Influences the environment to affect health
Supports the nursing process (even though it was not even developed yet!)
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Nursing education belongs in the hands of nurses!
Nursing is a discipline distinct from medicine focusing on the patient’s reparative
process rather than on their disease!!
Hospital Improvements
During Florence's time, the hospitals were overcrowded, poorly run, and disease infested. They were
doing more harm than good. Florence thought hospitals should help patients, not hurt them. This was a
revolutionary idea at the time.
Florence wrote Notes on Hospitals explaining how to make improvements to hospitals. She believed
hospitals needed better ventilation, more windows, improved drainage, and less cramped conditions.
With Florence's guidance, hospitals became clean and sanitary places where lives were saved, not lost.
Florence also became an expert on designing hospitals. Foreign rulers sought her advice when building
their hospitals. Soon, hospitals throughout the world were being built according to her ideas.
Today, we still see how Florence has improved hospitals. The flowers, recreation rooms, and bright
wards are an influence of Florence's work.
Nursing becomes a Respectable Profession
Florence created high standards for the nursing profession. These standards helped transform nursing
into the respectable profession we know today. Florence's writings continue to provide excellent
resources for nurses and health care providers. Her book, Notes on Nursing, spells out the principles of
nursing.
Health of Houses
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"There are five essential points in securing the health of houses:
1. Pure air;
2. Pure water;
3. Efficient drainage;
4. Cleanliness;
5. Light"
"Badly constructed houses do for the healthy what badly constructed hospitals do for
the sick."
"You cannot have the air of the house pure with dung-heaps under the windows."
"There are other ways of having filth inside a house besides having dirt in heaps. Old
papered walls of years' standing, dirty carpets, unpleased furniture, are just as ready
sources of impurity to the air as if there were a dung-heap in the basement."
"True nursing ignores infection, except to prevent it. Cleanliness and fresh air from
open windows, with unremitting attention to the patient, are the only defense a true
nurse either asks or needs."
Noise
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"Unnecessary noise, or noise that creates an expectation in the mind, is that which
hurts a patient."
Observations of the Sick
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"The fault here generally lies in the cooking. It is not his 'appetite' which requires
'tempting,' it is his digestion which requires sparing. And good sick cookery will save
the digestion half its work."
"There may be four different causes, any one of which will produce the same result,
viz., the patient slowly starving to death, from want of nutrition:
1. Defect in cooking;
2. Defect in choice of diet; Defect in choice of hours for taking diet;
3. Defect of appetite in patient.
4. Yet all these are generally comprehended in the one sweeping assertion that
the patient has 'no appetite.'" [Today, the elderly still often are allowed to starve
to death under hospice care.]
"But if you cannot get the habit of observation one way or other, you had better give
up the [idea of] being a nurse, for it is not your calling, however kind and anxious you
may be."
Using Nightingale’s model, compare and contract the practice of nursing in the late 1800’s
with nursing in present times.
Nightingale Resources
On-line Florence Connection
Florence Nightingale Museum
Her Gravesite, Website
Interesting Stories
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Collection of Her Letters
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Her Impact on Rural Hygiene
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