Florence Nightingale Theory
Presentation
Renee Lark, Nichole Kraai, Julie Sullivan, &
Adrianne Tozer
What is nursing theory?
 According to Chitty &
Black in the book
Professional Nursing Concepts
and Challenges, theory is “a
general explanation
scholars use to explain,
predict, control, and
understand commonly
occurring events” (424).
What is the nursing model?
 Through the utilization of
knowledge and skills in
combination with values
and beliefs set by a nursing
theory a nurse creates a
model to provide patient
care and define the four
key concepts: person,
environment, health, and
nursing.
Florence Nightingale
“A lady with a lamp shall stand,
In the great history of the land,
A noble type of good,
Heroic womanhood.”
-Henry Longfellow
Who is Florence Nightingale?
 Born May 12, 1820 to an affluent British family
 Received a classical education from her father in German, French, and
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Italian
Nightingale’s parents expected her to marry a “man of means” and join
them in climbing the social ladder
Nightingale was unhappy and depressed as a teen and sought to do
something with meaning
Nightingale chose the forbidden path after she turned down a proposal
from a “suitable” man and started a journey to pursue a nursing
education and becoming what was a lowly labor worker in her parents
eyes
Became a nurse at a Middlesex hospital caring for ill governesses and
was promoted to superintendent after only one year
(Florence Nightingale: Biography, 2013).
Florence Nightingale’s Motivation
 Nightingale believed there
to be a direct relationship
to the sanitary conditions
of the environment and the
spread of disease.
 This focus led to a more
broad focus on the effect of
every part of the patient’s
environment.
The Lady With the Lamp
 October of 1853 the Crimean War broke out.
 Per request from the Secretary of War, Nightingale assembled a
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team of 34 nurses to care for wounded soldiers
Upon arrival found the hospital to be over a cesspool
contaminating the water and hospital, rodents and insects crawling
all around, and patients dying from infections.
Nightingale collected scrub brushes and had the healthiest patients
scrub the hospital top to bottom while she spent every waking
moment caring for the wounded.
In the evening she carried her lamp with her while she moved
from patient to patient an became known as “the lady with the
lamp” and “the angel of the Crimea”.
(Florence, 2013)
Nightingale created:
 a kitchen to cook appealing food for patients
with special dietary requirements
 a laundry so that linens could be cleaned
 a classroom and a library, for patients
entertainment and intellectual stimulation
Nightingale’s Focus
The Patient’s
Environment
Results of Nightingale’s
Involvement in the Crimean War
 “wound sepsis, cholera,
dysentery and 'Crimea
fever' were rampant and
the mortality rate was an
unbelievable 42.7%”
before Nightingale
 “the 'lady with the lamp‘
had the mortality down
to 2.7% in a few months”
( Ellis, 2008)
Philosophic Influences
 “I use the word nursing for want of a better. It has been
limited to signify little more that the administration of
medicines and the application of poultices. It ought to signify
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” (Nightingale,
1946, p.6).
Philosophic Values as Seen in the
Florence Nightingale Pledge
“ I solemnly pledge myself before God and presence of this assembly; to
pass my life in purity and to practice my profession faithfully (fidelity).
I will abstain from whatever is deleterious and mischievous and will not
take or knowingly administer any harmful drug (nonmaleficence).
I will do all in my power to maintain and elevate the standard of my
profession (beneficence)
And will hold in confidence all personal matters committed to my keeping
and family affairs coming to my knowledge in the practice of my calling
(confidentiality).
With loyalty will I endeavor to aid the physician in his work (fidelity),
And devote myself to the welfare of those committed to my care (justice)”
(Chitty, 113).
The Rest of Florence Nightingale’s Life
 Nightingale saw the importance of the differentiation between the
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professional nurse and a caregiver. After the Crimean War, Nightingale
was given a prize of $250,000 for her work from the British
government. The importance of nursing education was so important to
Nightingale that she used her prize to create the St. Thomas Hospital
which housed the Nightingale Training School for Nurses (Florence,
2013).
At age 38 Nightingale became homebound and bedridden for the rest of
her life due to contracting the Crimean Fever.
She continued her work on health care reform and advocacy from her
bed publishing Notes on Hospitals and serving as an authority on public
sanitation.
She received a merit of honor from King Edward at age 88 and died at
age 90.
(Florence, 2013)
Information and Concepts
Florence Nightingale paved the way for modern
nursing practice through her Environment Theory.
Environment Theory
The Environment Theory focuses on the patients environment and
how it contributes to health.
Environmental Factors:
 Fresh air
 Pure water
 Sufficient food
 Appropriate nutrition
 Efficient drainage
 Cleanliness
 Sunlight
 Quiet and warmth
(“Nightingale’s," 2011)
Environment Theory is Patient Care
Theory
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Nightingale’s Environment Theory is considered a patientcare theory because the primary focus is on the patient and
not the nursing process or the patient-nurse relationship
(“Nightingale’s," 2011).
Nursing Paradigms
 NURSING
Nightingale believed nursing is separate from medicine She
felt nursing should focus on health rather than illness
(Chitty et al, 2011).
Nightingale felt nurses should provide the patient with optimal
conditions in order for nature to act (“Nightingale’s," 2011).
Nursing Paradigm
 PERSON
An individual is multifaceted, making up physical, psychological
social, cultural and spiritual layers. The nurse must include all
aspects of the individual when providing care and makes
changes to the theory to accommodate the patient
(Nightingale’s," 2011).
Nursing Paradigm
 ENVIRONMENT
Nightingale believed that environment played a large role in the
positive or negative outcomes of patient recovery. She felt the
nurse should incorporate the proper environmental
factors into the patient's care so the body can heal itself
(Nightingale’s," 2011).
Nursing Paradigm
 HEALTH
Nightingale believed disease is the absence of discomfort. She
took a holistic view of health and stressed the importance of
health promotion and disease prevention. She realized that
one’s health was closely related to their living conditions
(McDonald, 2006).
Interpretation
Nightingale
 Activist for health promotion
 Holistic focus on the patient
 Health closely related to the environment
 Developed modern nursing practice
 Helped improve sanitation
 Took close notes of her patients
Inference and Implications
Nightingale’s theory has been relied on for years. She was a
pioneer that lead the way for other nurses to form their own
theories , philosophies and models which has helped to shape
nursing. Her work has been closely studied and researched. It
remains just as pertinent today, as it did years ago and the
implications of her untiring work is still seen throughout
healthcare today.
Consequences
 Proper hygiene of patient and nurse (clean linens, baths)
 Hand washing (Infection control)
 Environmental services (housekeeping)
 Food and nutrition (dietary)
 Patient charting
 Provide patient comfort (positioning, warmth)
 Maintaining patient safety (medication, falls, etc.)
 Holistic nursing approach (social work, Chaplin,
family/friends)
 Health promotion (education )
Evaluation of Nightingale’s Nursing
Model
Origins:
 Florence Nightingale’s ideas originated from her social and
historic environment.
 Born to wealthy family in 1820
 Nursing was considered appropriate only for working class
women at the time
 Trained for nursing in Kaiserswerth, Germany
 Wanted to demonstrate that academically trained nurses could
impact health care in a manner beyond the care offered by
household servants at the time
Influences:
 Florence Nightingale’s idea was significantly influenced by
her experiences serving in Crimean War field hospitals.
 She noted the relationship between lack of cleanliness and
infection
 As hospitals were better cleaned and organized patient health
improved and mortality rates declined.
Content:
 Florence Nightingale developed the metaparadigm
philosophy of nursing. Meaning the “person as a patient,
health as opposed to illness, environment (how the
environment affect health and the recovery from illness), and
nursing (as opposed to medicine)” (Chitty and Black, p.306)
Content:
 Beliefs about Human Beings:
 Florence Nightingale’s primary focus was to advocate for a
patient’s wellbeing and to be in a healthy environment where
one could obtain their optimal health.
 She recognize that patients are holistic in nature, with
biological, psychological, social and spiritual components.
 Saw the benefit of protecting patients from unwanted visitors
 Protected them from excess fatigue, inappropriate advice,
and anxiety producing misinformation
Content:
 Beliefs about Environment:
 She believed that one’s environment could have a profound
effect on a person’s health.
 That clean air, water, adequate ventilation, and sunlight could
have a positive impact on your health.
 Adequate amounts of sleep, nutrition, and decreasing noise
would provide peace and healing.
Content:
 Beliefs about Health:
 She believed that health and environment were intrinsically
interconnected.
 She believed health is “not only to be well, but to be able to use
well every power we have” and that disease is “dys-ease or the
absence of comfort” (Nursing Theories, A companion to nursing
theories and models)
Content:
 Beliefs about Nursing:
 Believed that nursing is a calling.
 Nursing is an art and a science
 Success is achieved through environmental alteration
 Requires professional and educational training
 Role of nurse is distinctly separate from the practice of
medicine
 Recognized that a nurse’s role should extend into advocating
and protecting patients
 Nursing is based on a theoretical foundation
Content:
 Versatility of Nightingale’s philosophy:
 Nightingale’s holistic view of patients and environmental focus
continue to be utilized in every healthcare setting.
 Her ideas on the value of academic and professional training for
nurses are now basic assumptions for preparation of nurses.
 Her thoughts provided a professional model for nursing organization
Others Influenced by Nightingale
Holistic approach taken by other theorists
 Neuman’s System Model
 Roy’s Adaptation Model
 Levine’s Conservation Theory
(Knutson, n.d. )
Conclusions
Conclusion:
 Florence Nightingale is often considered the founder of
modern nursing. As the first nursing theorist, her philosophy
regarding the interconnectedness of the environment and the
wellness of patients sets a standard for how nurses are
trained. While the details and techniques of modern nursing
may differ from those of her times, her influence remains.
 Her philosophy covers each of the four global concepts, and
are generalizable to all nursing disciplines.
Florence Nightingale Advice to Nursing
Students (1873)
 “Nursing is most truly said to be a high calling, an honourable
calling. But what does the honour lie in? In working hard
during your training to learn and to do all things perfectly.
The honour does not lie in putting on Nursing like your
uniform. Honour lies in loving perfection, consistency, and in
working hard for it: in being ready to work patiently: ready
to say not "How clever I am!" but "I am not yet worthy; and
I will live to deserve to be called a Trained Nurse.“”
(Florence Nightingale: Biography, 2013)
Case Study
 1. While at work on your unit you notice that one of your
new admissions is your next door neighbor, Mrs. Smith. That
night upon returning home, your husband mentions that he
heard Mrs. Smith was in the hospital for surgery. By not
sharing any information with your husband, which of the
philosophical values outlined in Florence Nightingale’s pledge
are you honoring?
 2. What philosophical value was Florence Nightingale
referring to when she stated in her pledge that, “I will abstain
from whatever is deleterious and mischievous and will not
take or knowingly administer any harmful drug.”
Case Study
 3. After receiving report in the morning, you enter your patient’s
room and notice the following: the shades are pulled tight, last
night’s dinner tray is still on the bedside table, and the nurses out
in the hall are being extremely loud and disruptive. What would
Florence Nightingale say about this scenario?
 4. Which of the following nursing tasks can be attributed to
Florence Nightingale and her theory? (Select all that apply)
A. Documentation
B. Changing a patient’s soiled linens
C. Assisting a physician with a bedside procedure
D. Consulting social work for a patient with concerns about
their home environment.
Reference
Chitty, K. K., & Black, P. B. (2011). Professional nursing concepts and challenges (6th ed.).
Maryland Heights, MO: Saunders Elsevier.
Ellis, H. (2008). Florence Nightingale: creator of modern nursing and public health pioneer.
Journal of Perioperative Practice, 18(9), 404+. Retrieved from
http://www.afpp.org.uk/books-journals/journal_archive
Florence Nightingale. (2013). The Biography Channel website. Retrieved from
http://www.biography.com/people/florence-nightingale-9423539.
Florence Nightingale: Biography. (2013). Spartacus Educational website. Retrieved from:
http://www.spartacus.schoolnet.co.uk/REnightingale.htm
Reference
Knutson, M. B. (n.d.). Original nursing theories of Florence Nightingale [PowerPoint
Slides]. Retrieved from:
Healthvistafreehosting.net.Presentations2/Florence%20Nightingale.ppt
McDonald, L. (2006). Florence Nightingale and public health policy: theory, activism and
public administration. Retrieved from
http://www.uoguelph.ca/~cwfn/nursing/theory.html
Nightingale F: Notes on Nursing: what it is and what it is not, Philadelphia, 1946, JB
Lippincott, reprint (originally published in 1859).
Nightingale’s environment theory. (2011). Retrieved from Nursing Theory Web site:
http://nursing-theory.org/nursing-theorists/Florence-Nightingale.php
Theories of Florence Nightingale. Retrieved from Nursing Theories, a companion to
nursing theories and models Web site:
http://currentnursing.com/nursing_theory/Florence_Nightingale_the
oory.html