Florence Nightingale’s Theory of Nursing

As Presented by Kara Derry, Patricia Howell, Ashley Lundberg, and Lori Nousen

The promotion of health as controlled by external stimuli and environmental factors

(Clements & Averill, 2006)

Florence Nightingale(1820-1910)

Known as the founder of modern nursing

Environmental Theory of Nursing

Author of Notes on Nursing: What It Is and What It Is Not

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History of Florence Nightingale

Before The Crimean War

Before The Crimean War

Born to a wealthy family and educated intensively by her father

Traveled throughout Europe including to Kaiserswerth where she first studied nursing and was introduced to poor sanitation in relation to nursing

1853 Nightingale accepted the unpaid position of superintendent at the Establishment of Gentlewomen During Illness

Began the practice of providing quiet and comfortable recovery from illness and surgery

(Baly & Matthew, 2004)

The Crimean War 1854-1856 (Baly & Matthew, 2004)

Administrative authority over nursing during the war

Improved unsanitary conditions for nursing and recuperation

Became sick with a fever which she would never fully recover

Named “The Lady of the Lamp” for rounding on patients alone at night

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History of Nightingale’s Work

Written Work and Accomplishments

Written Work and Accomplishments

Notes on matters affecting the health, efficiency, and hospital administration of the British army (1858)◦ Never published◦ 830 pages◦ Described unsanitary

conditions that lead to senseless death amongst the troops

(Baly & Matthew, 2004)

Opening of the Nightingale Training School at St Thomas Hospital ◦ 1860

Notes on Nursing: What It Is and What It Is Not◦ 1860◦ Text written to guide nurses

(Clements & Averill, 2006)

How people may live and not die in India◦ Helped bring attention to

sanitation reform in India◦ 1863

(Baly & Matthew, 2004)

Basis For Environmental Theory

Florence Nightingale credited unsanitary conditions with high mortality rates

She believed symptoms which were thought to be of disease were actually responses to negative environmental stimuli

Nursing was as much about providing fresh air, clean sheets, appropriate diet, and decreasing environmental stimuli as it was wound management and drug administration

During the Crimean war she tested her environmental theory by creating more sanitary conditions and was labeled a heroin

(Clements & Averill, 2006)

Global Concepts of Nursing

Nursing Theory

Florence Nightingale described nursing as a divine calling to serve others

Her philosophy was about healing, not just caring for the sick

Nightingale’s philosophy reflected a change in nursing that still persists today

She believed that caring for the whole person required integration and collaboration with medicine, environment, family, and society

(Payne, 2010)

Human Being (Person)

Florence Nightingale’s theory focuses on the care of the patient rather than the nursing process

The nursing model must be adapted to fit the needs of individual patients

Improvement in the health of individuals and families leads to the improved health of society

People are multidimensional, being composed of biological, psychological, social, and spiritual components◦ It is important to address each

of these components to create a holistic person

Nightingale’s Conceptualization of Holism

(Selanders, 2010)

Environment

Environment is the umbrella concept in the Nightingale theory of nursing

Environment could be altered in such a matter to allow healing to occur. ◦Poor or difficult

environments led to poor health and disease

Nightingale was concerned about both, elements that entered the body (food, water, medications) as well as external elements (ventilation, light, noise control, stimulation, and room temperature)

Nightingale saw ventilation as the most important element

(Selanders, 2010)

Health

Nightingale stated that “health is not only to be well, but to be able to use well every power we have.”

Health is viewed as a relative state, with ultimate health being the best you can be at any given point in time

Individual does not need to be disease free to be healthy; rather one must simply maximize optimal potential to be in a healthy state

Disease is portrayed as dys-ease or the absence of comfort

Nightingale stated that disease was a reparative process, indicating that symptoms alert one to the presence of illness, thus allowing appropriate interventions to be instituted

(Selanders, 2010)

Nursing

The goal of nursing is to place the patient in the best possible condition for nature to act◦ Accomplished through alteration of the environment

Nightingale states, “If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he as a bed-sore, it is generally the fault not of the disease, but of the nursing.”

Two types of nursing◦ General nursing: activities that promote health. These are carried out in all

care-giving situations, regardless of whether the individual is educated in healthcare

◦ Proper nursing: individuals who are educated in the are and science of nursing. The nurse is able to implement problem solving in a logical manner (known today as the nursing process)

(Selanders, 2010)

Nightingale’s Nursing Model

Nightingale’s nursing model is a four-step process ◦ Observation◦ identification of the needed

environment alteration◦ implementation of the

alteration◦ identification of the current

health state

This process is repeated as frequently as necessary to achieve the overall goal of the improved health state

The model includes health promotion, illness prevention, health restoration, and rehabilitation as appropriate states in which the model can be implemented

(Selanders, 2010)

Maslow and Nightingale (Selanders, 2010)

Nightingale’s basic tenets of nursing practice have served the profession well for one and a half centuries

Most nurses today practice nursing while following Nightingale’s principles

Nightingale included in her theory, what we know today as the nursing process

Nightingale’s model is philosophically consistent with Maslow’s Hierarchy of Needs that we use today

Her theory of environmental alteration has served as framework for many research studies

Evaluation of the Nursing Model

Clarification of Origins

Founder of Modern Nursing The First Nursing Theorist

She explain her Environment Theory in her famous book~Notes on Nursing~

What It is and What It is not (1859) She was the first to propose nursing required specific education

and training

Selanders LC.(2010)

Nightingale’s Philosophy

Nightingale had a unique perspective on nursing practice it focused on the relationship of her patients and their surroundings

• Her philosophy’s are the foundation of Nursing practice as we know it today

• It also provided the foundational work for theory development

• Her focus on the profession became known as the metaparadigm of nursing: Person, Health, Environment and Nursing

Chitty & Black

(2011)

Nightingale’s Philosophy Content

• Ventilation and sunlight• Clean air and water• Light, Noise• Cleanliness of rooms/walls• Health of houses• Bed and bedding• Personal cleanliness• Balance diet • Observing the patient and

accurate recording information

• Monitoring noise level• Providing adequate rest• Protecting from possible

harm

Chitty & Black(2011)

Nursing Metaparadigm of NursingPerson Patient People are multidimensional, composed of biological, psychological, social and spiritual

components

Health As opposed to illness Health is “not only to be well, but to be able to use well every power we have”

Environment How the environment affects health and recovery from illness “Poor or difficult environments led to poor health and disease” “Environment could be altered to improved conditions so that the natural laws would

allow healing to occur”

Nursing As opposed to medicine Nursing is different from medicine and the goal of nursing is to place the patient in the best possible condition

for nature to act. Nursing is the “ activities that promote health which occurs in any caregiving situation” Chitty & Black(2011) Selanders LC(2010)

View and ConceptFlorence Nightingale’s Environmental Nursing Philosophy

• holistic nursing care

• Nurses who have been guided by her philosophy are sensitive to the effect to the environment and it’s impact on the patients health and recovery of illness

• Her philosophy provide the foundation for other theorist to develop their philosophy’s and theories

• She was the first nurse theorist. She continues to pave the way for those who followed and those will continue to come to this profession

Chitty & Black(2011)

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ReferencesBaly, M. E, & Matthew, H. C. G. (2004). Nightingale, Florence. Oxford Dictionary of National Biography.(Online Ed. 2011). doi:10.1093/ref:odnb/35241

Chitty, K. K., & Black, B. P. (2011). Professional Nursing Concepts and Challenges (6th ed). Maryland Heights: Saunders

Clements, P. T., & Averill, J. B. (2006). Finding the patterns of knowing in the works of Florence Nightingale. Nursing Outlook, 268-274. doi:10.1016/j.outlook.2006.06.003

Lim Fidelindo, L.M. (2011). Why Florence Nightingale still matters. retrieved www.nursing 2011critcalcare.com

Payne, K. (2010). Science, healing, and courage: the legacy of Florence Nightingale. Alabama Nurse, 37(3), p. 10.

Selanders, L. C. (2010). The power of environmental adaptation: Florence Nightingale’s original theory for nursing practice. Journal of Holistic Nursing, 28(1), 81-87. doi:10.1177/0898010109360257