Original Nursing
Theories of Florence
Nightingale
By Shanakay Haughton
Origins of Nightingale’s Theory
for Nursing Practice:
Florence Nightingale was a prolific writer. She
lived from 1820 to 1910 in Victorian England.
Her ideas, values, and beliefs on a wide range of
topics can be identified in her documents.
They contain philosophical assumptions and
beliefs regarding all elements found in the
metaparadigm of nursing.
In 1859, she was the first to conceptualize
nursing’s work into a theoretical framework.
She was credited with founding the practice of
nursing.
Relevance to Nursing Today
Florence Nightingale developed a body of nursing
knowledge clearly expressed in the 79 pages of
Notes on Nursing: What It Is and What It Is Not
(Nightingale, 1969).
A 221 page second edition (Nightingale, 1992)
was intended for the professional nurse, and is
relevant to nurses today who are searching for
wisdom on her perspectives on illness, the person,
their environment, and holistic nursing.
Quotations:
On the purpose of nursing.”…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”
On the empowering partnership
with clients in the community.” We
must not talk to them or at them but
with them”
Relevant to Nursing
Organization:
Florence Nightingale
provided a professional
model for nursing
organization in Britain
that spread across much
of the world.
She emphasized
subservience to doctors,
allowing nursing to gain
a foothold within a
hospital.
Her plan was that
nurse training would
not threaten the status
of the doctors, but
crucially that they
should accept the
disciplinary authority
of the matron and the
new hierarchy of
nurses within the
hospital.
Relevance to Nursing Education:
The idea that nursing
required specific
education was
revolutionary in 19thcentury England.
Nightingale’s nursing
education emphasized
the need to blend a
mixture of theoretical
and clinical
experiences.
Schools of nursing
were established on her
model throughout the
world.
They emphasized the
moral qualities of
nursing and introduced
humanitarian, patientcentered values that are
still relevant today.
Individual Relevance of
Florence Nightingale:
She was empowered
through her personal
philosophy, which was
deeply spiritual and at the
same time fundamentally
practical and related to
everyday life.
She was a systematic
thinker and passionate
statistician, using bar and
pie charts, highlighting key
points.
Besides “getting
the science right”,
Florence
Nightingale made
it comprehensible
to lay people,
especially the
politicians and
senior civil
servants who made
and administered
the laws.
Relevant to Nursing Knowledge:
The body of
knowledge left
by Florence
Nightingale
includes an
environmental
adaptation
theory, which is
entirely relevant
to the modern
setting.
Regardless of
whether the
environment is
high tech, the
“nurse remains
responsible for
altering the
environment to
improve it for
the benefit of the
client”
Assumptions of Florence
Nightingale’s Theory:
Natural laws
Mankind can achieve perfection
Nursing is a calling
Nursing is an art and a science
Nursing is achieved through environmental
alteration
Nursing requires a specific educational base
Nursing is distinct and separate from medicine
Major Premises of Environmental
Adaptation Theory:
People are multidimensional, composed of
biological, psychological, social and spiritual
components.
Disease is more accurately portrayed as dys-ease or
the absence of comfort.
Symptoms alert nurses to the presence of illness,
which allows for appropriate interventions.
Breaking the natural laws will cause disease.
Improvement in the health of individuals and
families lead to the improved health of society.
The Environmental
Adaptation Concepts:
Florence Nightingale’s original
theory for nursing practice was
holistic.
Her concepts included
human/individual,
society/environment, health/disease
and nursing.
She focused more on physical
factors than on psychological needs
of patients because of the nature of
nursing practice during her time.
Six D’s of Dys-ease:
Dirt
Drink (need clean
drinking water)
Diet
Damp
Draughts (Drafts)
Drains (need proper
drainage and sewer
systems)
A Comparison of Nightingale’s
Canons and Modern-Practice:
Nightingale’s Canons:
Modern Concepts:
Ventilation and warming
Physical environment
Light, Noise
Cleanliness of rooms/walls
Health of houses
Bed and bedding
Personal cleanliness
Variety
Psychological environment
Chattering hopes and advices
Taking food. What food?
Nutritional status
Petty management/observation
Nursing care planning and
management
Origin of Nightingale’s
Environmental Concepts:
Nightingale believed that the environment could be
altered to improve conditions so that the natural
laws would allow healing to occur.
This grew from empirical observation that poor or
difficult environments led to poor health and
disease.
In her Crimean experience, filth, inadequate
nutrition, dirty water, and inappropriate sewage
disposal led to a situation in which more British
soldiers died in the hospital than of battlefield
wounds.
Concepts of Nursing:
The goal of nursing is to place the patient
in the best possible condition for nature to act.
Health is “not only to be well, but to be able to
use well every power we have”
Health nursing, or general nursing are those
activities that promote health (as outlined in
canons) which occur in any caregiving
situation. They can be done by anyone.
Nursing proper is reserved for those individuals
who are educated in the art and the science of
nursing.
The Holistic Person Model:
Nightingale’s Model for Nursing
Practice:
How Watson’s Theory of Transpersonal
Human Caring was Influenced:
Jean Watson said that Nightingale’s blueprint for
transpersonal meanings and models of caring
transcend history.
It “called forth the full use of self, connecting the
divine within and without as a source of inspiration
as well as the foundation for a professional code”.
Watson also said that Nightingale “made explicit
the connections between and among all aspects of
self, other, humanity, the environment, nature, and
the cosmos as a means of learning, understanding,
and connecting health, caring, and healing”.
Many Other Theories Use
Nightingale’s Holistic Concept:
Neuman’s Systems Model
Roy’s Adaptation Model
Levine’s Conservation Theory
Modeling and Role Modeling
(MRM) Theory
The listed theories differ in environmental
influences and other aspects of nursing, but
share holistic concepts.
Research Article:
Shades of Florence Nightingale: Potential impact
of noise stress on wound healing was chosen.
This article examines the potential effects of noise
stress on wound healing.
It explains theoretical linkages between the normal
processes of wound healing, endocrine aspects of
the stress response, and the effects of stress
hormones on the biological function of leukocytes
involved in wound healing.
The effects of noise on patient sleep and cognitive
function are well-documented.
Research Findings:
Exposure to increased or novel environmental
noise has been shown to elicit neuroendocrine
changes indicative of the stress response.
They are associated with alterations in the
biological functions of cells involved in wound
healing.
Clinical research studies have shown that levels of
environmental noise in patient care units exceed
those recommended by the EPA and are
disturbing to patients.
Research Conclusions:
Recovery rate of patients would be
greatly enhanced by reduction of
noise stress.
If, as Nightingale stated, the
patients are to be put in the best
condition for nature to act on them,
it is the responsibility of nurses to
reduce noise, to relieve patients’
anxieties, and to help them sleep.
In Nursing Today:
Nurses old and young have
been influenced by
Florence Nightingale’s
Theories.
Environmental Adaptation
remains the basis of our
holistic nursing care.
I am proud to follow in the
important work of of “The
Lady with the Lamp.”
Reference List:
Attewell, A. (1998) Florence Nightingale’s relevance to nurses.
Journal of Holistic Nursing, 16 (2), 281-291
McDonald, L. (2001). Florence Nightingale and the early origins of
evidence-based nursing, EBN Notebook 4(3), 68-9
McCarthy D, Ouimen M, Daun J. (1991) Shades of Florence
Nightingale: Potential impact of noise stress on wound healing.
Holistic Nursing Practice. 5(4) 39-48
Nightingale, F. (19690. Notes on nursing: What it is and what it is
not. New York: Dover. (original work published 1860)
Selanders, L. (1998) The power of environmental adaptation. Journal
of Holistic Nursing, 16,(2) 247-263
Watson J. (1998), Florence Nightingale and the enduring legacy of
Transpersonal Human Caring. Journal of Holistic Nursing, 16(2), 292-294