By: Megan Cottrell, Karen Theus, Emily Cornell and
Elizabeth Klynstra
Image from
http://todayinsci.com/N/Nightingale_Florence/NightingaleFlorencePictureLarge.htm
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“Nightingale’s unique perspective on nursing
practice focused on the relationship of patients
to their surroundings” (Chitty and Black, 2011)
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Religious inspiration called Florence Nightingale
to the nursing profession
She is most remembered for her contributions to
nursing during the Crimean War
In 1854, Nightingale received a letter from the
Secretary of State at war for the British government
requesting her to organize and lead a group of
nurses to tend to the soldiers of the Crimean War
who were being poorly treated
In six months, Nightingale and her team of nurses
greatly improved the mortality rate of the British
soldiers
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Nightingale healed through providing a clean
environment, personal hygiene, clean linens
and dressings, adequate food and housing, and
recreation
She turned her observations into statistics and
diagrams, using her evidence-based practice to
change medicine and nursing
She developed the philosophy that changing
patients’ conditions can promote positive
changes in their health
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Nightingale described nursing as a divine calling to serve others
Her philosophies on the general nature of nursing include:
 Nursing is defined as a unique profession that is both art and
science
 The basic nursing activity is the alteration of the internal and
external nursing environment
 Nursing is autonomous within the defined scope of practice
 Nursing is collaborative with all other healthcare professions
 The goal of nursing is to foster health within the patient
 Individuals are complex, holistic beings
 The power of nursing comes from decision-making activities
based on empirical observation of the patient
 The practice of nursing should not be limited by gender,
spiritual beliefs, or values
 The nurse should be allowed to develop to the maximum of his
or her potential
 (Selanders, 2012)
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Nursing has specialized educational requirements
with theoretical and clinical components
Nurses should be educated by nurses who specialize
in education
Nurses should have a grounding in basic sciences
Nursing education should be controlled by the
school, not the hospital
Students are to be regularly evaluated and apprised
of this evaluation during the course of the education
 (Selanders, 2012)
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Nightingale’s philosophy on utilizing the
environment to assist in patient recovery was
influenced by her education, experiences, and
observations during her nursing career
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Nightingale's philosophy focused nursing on what is known
as the metaparadigm of nursing. She looked at the
individual in their surroundings and observed how the
environment impacted their health. Considered the founder
of modern nursing, Florence Nightingale lead a team of
nurses appointed to help at an unsanitary British military
hospital. The wards were overcrowded, unsanitary, they
had poor lighting, the water was contaminated, the food
inedible not to mention the general filth, from bloody rags
on the floor to dead animals in the courtyard. Florence
Nightingale led a team of nurses to improve the health of
the individuals and relieve suffering in a healing
environment that consisted of a cleanliness, fresh water,
sunlight and a caring attitude of the nurses who worked
there.
(Winklestein,2009)
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Human: The patient is the focus of care
Environment: Making sure patients have clean
air, water,linens, proper ventilation, and
sunlight.
Health: Positive changes in health.
Nursing: Florence Nightingale set the
foundation for nursing that is still relevant
today.
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Nightingale’s model describes the four global
concepts;
providing rest and an environment to allow
for proper healing for
allowing for rest
hand washing, maintaining a sterile field
providing patients with proper supply's for
care.
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Through her discipline and determination,
Nightingale earned respect for women as nurses.
philosophy shaped nursing into the profession it is
today.
Created the first documentation of nursing
because of the notes she took.
She started a training school for nurses and this
educational model influenced nursing education in
both the US and England.
provided a basis for nursing theories and an
impact on the future of nursing
Evaluation of Theory
• Origin of Theory
Florence nightingale felt that God
had influenced her, and nursing
was her calling.
The poor reputation for nurses and
the lack of occupations for women.
The unsanitary conditions and
spread of disease in patients
Education and
distinction between
nurses in physicians
Chitty, K. K., &
Black, B. P.
(2011). Professional
nursing concepts &
challenges (6th ed.).
Maryland Heights,
MO: Saunders
Elsevier
Sanitation in
hospitals
The relationship of
patients in their
surroundings.
Metaparadigm of
nursing
Recording of
information and
statistical data
Florence’s model consisted of the four global
concepts.
Person- Florence
viewed patients as
multidimensional and
needed to be treated
holistically
Health- Florence did
not view health as only
the absence of disease.
Environment- This is
the foundation of
Florence's nursing
philosophy; nurses
need to adjust the
environment to the
patient to promote
health and good
outcomes.
Nursing- Florence
described “ what
nursing is and what
nursing is not” and
gave nursing a whole
other dimension.
Before Florence,
nursing was viewed as
work of the servants or
working class.
Selanders LC. The
power of
environmental
adaptation: Florence
Nightingale's original
theory for nursing
practice. .J Holist Nurs.
2010 Mar; 28(1):81-8.
Nursing Theories emerging from Florence’s model
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Cleanliness- Hospitals prioritize “wash in, wash
out” method. Making sure to wash hands when
going in or out of a patients room to prevent the
spread of infection among patients.
Nightingale promoted the view that nurses
primary responsibility was to protect patients by
careful management of their surroundings (Chitty
& Black, 2011).
Rest- quiet environment is promoted to allow for
quicker healing times. Clustering work together
throughout night to allow for less interruptions
and more sleep.
Positive Environment Promotion
Maintaining a positive environment
promotes optimal healing. Maintain a positive
attitude with patients.
Nightingale recognized the effect of the
environment on the patient's health or
recovery(Chitty & Black, 2011).
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Florence Nightingale was a pioneer to modern
nursing and her practices is currently still being
used.
first to use theoretical foundation in nursing.
Provided a professional nursing model for
nursing organizations.
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Florence Nightingale was a pioneer in nursing
in the 19th century. Her focus on environment
and its impact on health is still relevant in
today’s nursing practice. She taught us how to
promote health and to focus on the
improvement of healthy environments in all
practice settings (Beck, 2010). The following
case study seeks to assist us in focusing on
healthy environments and how to change the
environment for the good of the patient.
Answers include a nursing diagnosis and
interventions.
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Mr. Jones has recently evaluated by a home care nurse
after being requested by the patients wife. Mr. Jones
has recently had an increased number of falls. Three
weeks ago Mr. jones got a hip fracture with an ORIF
following a fall.
Mr. Jones has a hx of Parkinson's disease, BPH, HTN,
falls and recent ORIF.
Medication Mr Jones takes is Carbidopa/levodopa
10/100mg QID, Diovan (valsartan) 160mg QD, Multi
vit QD, Flomax 0.4mg QD and Norco 5/325 1 or 2 q6h
PRN (has been taking 2 as prescribed)
Lives with wife, has two children who live in town and
assist when necessary.
Former machinist, woodworking as a hobby.
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Pt is being evaluated for home care services r/t recent
fall and disease progression. Wife is struggling to care
for him r/t unsteady gait, need for support while
ambulating.
Nurse inspects home for potential danger zones. She
notices rugs on the hardwood floor, a sunken living
room where the pt and his wife are sitting. Dimly lit
hallway, heavy drapes pulled in the bedroom (wife
states to keep the summer heat out) stairs at exits, no
hand rails. Bathtub not handicap accessible.
Wife states she leaves pt alone sometimes to run
errands
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1. Based on Nightingale’s theory what can be
changed to Mr Jones’ care to promote a safety?
2. What teaching needs to be completed to the
patient and wife to promote a safer living
environment? List three
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Chitty, K. K., Black, B. P. (2011). Professional Nursing: Concepts and Challenges. Maryland Heights,
MO. Saunders Elsevier.
Florence Nightingale. (2013). In Encyclopedia Britannica. Retrieved from
http://www.britannica.com/EBchecked/topic/415020/Florence-Nightingale/280687/Nursing-inpeace-and-war
Nightingale, F. Notes on nursing: What it is and what it is not. 1860.
Payne, K. (2010). Science, healing, and courage: the legacy of Florence Nightingale. Alabama
Nurse, 37(3), 10 Retrieved from http://0web.ebscohost.com.libcat.ferris.edu/ehost/pdfviewer/pdfviewer?vid=3&sid=bc11d590-8d29-4a3c9360-e74455d2417b%40sessionmgr104&hid=103
Selanders LC. The power of environmental adaptation: Florence Nightingale's original theory for
nursing practice. .J Holist Nurs. 2010 Mar; 28(1):81-8.
Selanders, L. (2012). The voice of florence nightingale on advocacy. The online journal of issues in
nursing,17(1), Retrieved from
http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofC
ontents/Vol-17-2012/No1-Jan-2012/Florence-Nightingale-on-Advocacy.html
Winklestein, W. (2009). Florence Nightingale: Founder of modern nursing and hospital epidemiology.
Epidemiology , 20 (2), 311. doi: 10.1097/EDE.0b013e3181935ad6 & (Chitty & Black, 2011).