FLORENCE NIGHTINGALE

“Nursing is the art of utilizing one’s environment for his or

her own recovery”

Credentials & Background

• The matriarch of modern nursing• Born on May 12, 1820• Parents: Edward & Frances Nightingale• Named after Florence, Italy-> birthplace• Well- educated, affluent, aristocratic

Victorian family who maintained residences in Derbyshire & in Hampshire

• His father educated her much more broadly and rigorously than other young women of her time.

• Was tutored in mathematics, languages, religion, & philosophy.-> influenced the course of her work.

• Developed the sense that her life should become more useful.

• (1837) wrote about her calling in her diary.– “God spoke to me and called me to his

service.”• She was called to become a nurse, she

was finally able to complete her training in 1851 when she was accepted for training at Kaiseworth, Germany-> a Protestant religious community with a hospital facility.

• She stayed there for approx. 3 months & her teacher declared her to be trained as a nurse.

Following her return to England

• She began to examine hospital facilities, reformatories, & charitable institutions.

• (after 2 yrs.,1853)superintendent of the Hospital for Invalid Gentlewomen in London.

• Crimean War– Received a request from Sidney Herbert to

go to Scutari, Turkey to provide trained nurse to care for wounded soldiers.

Crimean War• She needed to address the

environmental problems that existed:– Lack of sanitation & presence of filth.– Soldiers were faced with exposure, frostbite,

lice infestations, and other opportunistic diseases.

Made her popular & revered person to the soldiers

She was called “The Lady of the Lamp”Scutari- critically ill with Crimean Fever-

typhus/brucellosis

Returned to England

• She was awarded funds in recognition of her work.

Establish a teaching institution at St. Thomas Hospital & King’s College

Hospital (London)

• Within few yrs. She began receiving request to establish new schools at

hospitals worldwide.• Established as the founder of modern

nursing

• Nightingale also recognized the societal changes of her time and their impact on the health status of individuals.

• Similar dialogues with many political leaders, intellectuals, and social reformers of the day.

• Her religious affiliation and beliefs were especially strong sources for her nursing theory.

During her life• Devoted her energies to societal issues

and causes in an attempt to create social change.

• She continued to concentrate on army sanitation reform, the functions of army hospitals, sanitation in India, and sanitations & healthcare of the poor England.

• Her writings:– Notes on matters Affecting the Health

Efficiency, and Hospital Administration of British Army.

– Notes on Hospitals, and Report on Measures Adopted for Sanitary Improvements in India (1869-1870).

Shortly after her return in England

• Confined herself to her residence, citing her continued ill health.

• She wrote 15,000-20,000 letters to friends, acquaintances, allies, and opposition from this environment

Shortly after her return in England

• Confined herself to her residence, citing her continued ill health.

• She wrote 15,000-20,000 letters to friends, acquaintances, allies, and opposition from this environment

Theoretical Sources for Theory Development• Many factors influenced the

development of Nightingale’s theory for nursing .

• Individual, societal, and professional values were all integral to the development of her work.

• Her education from her father was an unusual one for a Victorian girl.

• The Nightingale family’s aristocratic social status provided her with access to persons of power and influence.

Use of Empirical Evidence• Her report describing health & sanitary

conditions in the Crimea & in England identify her as an outstanding scientist & empirical researcher.

• Her expertise as a statistician is also evident in the reports that she generated throughout her lifetime on the varied subjects of healthcare, nursing & social reform.

• She invented the polar- area diagram to dramatically represent the extent of needless death in British military hospitals in Crimea.

• Her research skills are identified as recording, communicating, ordering, coding, conceptualizing, inferring, analyzing, & synthesizing.

Use of Empirical Evidence

Focus of the Theory

• Emphasized greatly the role of the environment in the care of the patient.

• Environment – external conditions & influences affecting the life & development of an organism & capable of preventing, suppressing, or contributing to disease, accidents or disease, accidents, or deaths (Murray & Zentner,1975).

Focus of the Theory

• Defined& described the concepts of:– Ventilation– Warmth– Light– Diet– Cleanliness– Noise

Major Assumptions

• Theory & Nursing– Comparable to that of motherly instincts.– She believed that every woman will be a

nurse because nursing is having the responsibility for someone else’s health –a characteristic shared by women, esp. mothers.

• Theory & Person– Passive pt totally control of the nurse– Viewed the patient as a person who needed

nursing care regardless of the patient’s social worth.

Major Assumptions

• Theory & Environment– Environment was viewed as “those

elements external to & which affect the health of the sick and healthy person” & included “everything from the patient’s food and flowers to the patient’s verbal & nonverbal interactions” (Fitzpatrick and Whall, 1983).

– Centered to the concept of a therapeutic environment that will enhance the comfort & recovery of the pt.

Major Assumptions

• Theory & Health– Viewed health as being well.– Emphasized the promotion and

maintenance of health and the prevention of diseases through prudent control of the environment and social responsibility.

– This lay the foundations for health nursing, or that field of nursing, or that field of nursing that is aimed at health promotion and disease prevention.

Major Assumptions

Theoretical Assertions

• She believed that disease was reparative process;– Disease was nature’s effort to remedy a

process of poisoning or decay, or a reaction against the conditions in which a person was placed.

• She did not explicitly discuss the caring behaviors of nurses– She wrote very little about interpersonal

relationships except as they influenced the pt’s reparative process

• She believed that nurses should be moral agents– Professional relationship with their pts.

• Nursing Education– (By establishing the St. Thomas Hospital &

King’s College Hospital in London) – She was able to provide framework for the

establishment of nursing training schools through a universal template that contains principles of nursing training.

– These principles included instruction in scientific principles and practical experience for the mastery of skills.

Acceptance by the Nursing Community

• Nursing Education– She also advocated the separation of

nursing training from the hospital to a more appropriate learning environment in the school or university setting.

– She believed that good nursing can only come from good education.

– Although she did not believe in licensure exams, she used other methods of evaluation like case studies to monitor the progress of nursing students.

Acceptance by the Nursing Community

• Research– She is considered the mother of nursing

research because of her interest in the scientific methods of inquiry and statistics.

– However, her theory lack complexity and testability which limits her theory in that it cannot generate the nursing research that is employed to test modern theories.

– Her theory still serves as bases for current research.

Acceptance by the Nursing Community

Critique

• Simplicity– The nurse- patient relationship may be the

least well defined in her writings.– Yet there are suggestions of cooperation &

collaboration between the nurse and patient in her discussions of a patient’s eating patterns & preferences, the comfort a loved pet to the patient, the protection of the patient from emotional distress & the conservation of energy while allowing the pt to participate in self-care.

• Generality– Her theory has been used to provide

general guidelines for the last 150 yrs.– The relation of concepts are applicable in all

nursing settings today.– To address her audience of women who may

provide care to another, the theory she proposed remain relevant.

Critique

• Empirical Precision– Concepts & relationships within

Nightingale’s theory are frequently stated implicitly & are presented as truths rather than tentative, testable, statements.

– In contrast to her quantitative research on mortality performed in the Crimean, she advised nurses that their practice should be based on their observations & experiences rather than systematic, empirical research.

Critique

• Derivable Consequences– To an extraordinary degree, her writings

direct the nurse to action on behalf of the patient & the nurse.

– Her principles that attempt to shape nursing practice are the most.

– Similarly, she advised that “if you cannot get the habit of observation one way or other, you had better give up the being a nurse, for it is not your calling, however kind & anxious you may be.”

Critique

• Derivable Consequences– She viewed nursing as a means of doing the

will of her God.– Her rejection of the germ theory & her

inability to recognize a unified body of nursing knowledge that is testable have subjected her to some ridicule, other parts of her theory & her activities are relevant to nursing’s professional identity & practice.

Critique