Original Nursing Theories of Florence Nightingale By Mary B. Knutson, RN, BSN, FCP MSN Student Viterbo University

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. Selanders, L. (1998) The power of environmental adaptation. Journal of Holistic Nursing, 16,(2) 247-263 Robinson, D., Kish, C.(2001). Core concepts in advanced practice nursing. St. Louis: Mosby. Gilette, V. (1996). Applying nursing theory to perioperative nursing practice. AORN Journal, 64(2), 261-270

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. Nightingale, F. (19690. Notes on nursing: What it is and what it is not. New York: Dover. (original work published 1860) Nightingale, F. (1992b). Notes on nursing: What it is and what it is not. London: Harrison & Son. (Original work published 1860)

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 19th-century 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, patient-centered values that are still relevant today. Selanders, L. (1998) The power of environmental adaptation. Journal of Holistic Nursing, 16,(2) 247-263

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. McDonald, L. (2001). Florence Nightingale and the early origins of evidence-based nursing, EBN Notebook 4(3), 68-9

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” Attewell, A. (1998) Florence Nightingale’s relevance to nurses. Journal of Holistic Nursing, 16 (2), 281-291

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 Natural Laws are universal natural laws that govern the ways in which the world works. This is reflective of Nightingale’s profound belief in God. She defined a law as “the thought of God” and discussed the predictability of nature. Mankind can achieve perfection relates to her strongly held beliefs in self-determination, in self-realization, and that ultimately, mankind does seek self-perfection, which means perfect health. The route to perfection is through strict adherence to the natural laws. The role of the nurse was to alter the environment in such a way as to obey the natural laws, and thus provide the environment in which perfection might be achieved. She defined a calling as doing work in such a way as to do what is right and best. Nursing work is to be done with enthusiasm, and is so important it should be thought of as a religious vow. By identifying nursing as having components of art and science, she provides the profession with the expectation that nursing will be practiced by educated individuals using current research and methods as well as compassion and common logic. Environmental alteration-see canons (which are laws or rules) on upcoming slide Nursing cannot be taught by books alone. Nurses need a combination of clinical and theoretical training. Although the physician and nurse my deal with the same population, nursing is not to be viewed as subservient to medicine, as the purposes of the two are distinctly different. Nursing’s focus is on caring through environmental alteration, whereas medicine’s focus is cure of the disease. Nursing and medicine are most effective when working in a collaborative manner.

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 cannon is pictured as a reminder that the Crimean War was where she attained national and international prominence because of the changes she was able to effect in the health and welfare of the British soldiers. She was also known as “The Lady with the Lamp”.

A Comparison of Nightingale’s Canons and Modern-Practice: 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 In this slide, a canon means a rule or law. These canons were found in Notes on Nursing (1860/1946)

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”. Watson J. (1998), Florence Nightingale and the enduring legacy of Transpersonal Human Caring. Journal of Holistic Nursing, 16(2), 292-294

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. 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

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