Nursing Theory and Theorist: Florence Nightingale

The goal of nursing as described by Nightingale is assisting the patient in his or her retention of “vital powers” by meeting his or her needs, and thus, putting the patient in the best condition for nature to act upon (Nightingale, 1860/1969). This must not be interpreted as a “passive state,” but rather one that reflects the patient’s capacity for self-healing facilitated by nurses’ ability to create an environment conducive to health. The focus of this nursing activity was the proper use of fresh air, light, warmth, cleanliness, quiet, proper selection and administration of diet, and monitoring the patient’s expenditure of energy and observing. This activity was directed toward the environment and the patient.

Health was viewed as an additive process, the result of environmental, physical, and psychological factors, not just the absence of disease. Disease was the reparative process of the body to correct a problem, and could provide an opportunity for spiritual growth. The laws of health, as defined by Nightingale, were those to do with keeping the person, and the population, healthy. This was dependent upon proper environmental control—for example, sanitation. The environment was what the nurse manipulated. It included those physical elements external to the patient. Nightingale isolated five environmental components essential to an individual’s health: clean air, pure water, efficient drainage, cleanliness, and light.

The patient is at the center of the Nightingale model, which incorporates a holistic view of the person as someone with psychological, intellectual, and spiritual components. This is evidenced in her acknowledgment of the importance of “variety.” For example, she wrote of “the degree . . . to which the nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings” (Nightingale, 1860/1969). She remarked upon the spiritual component of disease and illness, she felt they could present an opportunity for spiritual growth. In this, all persons were viewed as equal. A nurse was defined as any woman who had “charge of the personal health of somebody” whether well, as in caring for babies and children, or sick, as an “invalid” (Nightingale, 1860/1969). It was assumed that all women, at one time or another in their lives, would nurse. Thus, all women needed to know the laws of health. Nursing proper, or “sick” nursing, was both an art and a science and required organized, formal education to care for those suffering from disease. Above all, nursing was “service to God in relief of man”; it was a “calling” and “God’s work” (Barritt, 1973). Nursing activities served as an “art form” through which spiritual development might occur (Reed & Zurakowski, 1983/1989). All nursing actions were guided by the nurses’ caring, which was guided by underlying ideas about God.

Consistent with this caring base is Nightingale’s views on nursing as an art and a science. Again, this was a reflection of the marriage, essential to Nightingale’s underlying worldview, of science and spirituality. On the surface, these might appear to be odd bedfellows; however, this marriage flows directly from Nightingale’s underlying religious and philosophic views, which were operationalized in her nursing practice. Nightingale was an empiricist, valuing the “science” of observation with the intent of use of that knowledge to better the life of humankind. The application of that knowledge required an artist’s skill, far greater than that of the painter or sculptor:

Nursing is an art; and if it is to be made an art, it requires as exclusive a devotion, as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or cold marble, compared with having to do with the living body—the Temple of God’s spirit? It is one of the Fine Arts; I had almost said, the finest of the Fine Arts.

Nightingale’s ideas about nursing health, the environment, and the person were grounded in experience; she regarded one’s sense observations as the only reliable means of obtaining and verifying knowledge. Theory must be reformulated if inconsistent with empirical evidence. This experiential knowledge was then to be transformed into empirically based generalizations, an inductive process, to arrive at, for example, the laws of health. Regardless of Nightingale’s commitment to empiricism and experiential knowledge, her early education and religious experience also shaped this emerging knowledge.

According to Nightingale’s model, nursing contributes to the ability of persons to maintain and restore health directly or indirectly through managing the environment. The person has a key role in his or her own health, and this health is a function of the interaction between person, nurse, and environment. However, neither the person nor the environment is discussed as influencing, in turn, the nurse. Nightingale’s education, spiritual development, her time in the Crimea, as well as the role of women in the nineteenth century all affected the development of Nightingale’s ideas about nursing. Although it is difficult to describe the interrelationship of the concepts in the Nightingale model. Note the prominence of “observation” on the outer circle, important to all nursing functions, as well as the interrelationship of the specifics of the interventions such as “bed and bedding” and “cleanliness of rooms and walls” that go into making up the “health of houses.”