1. Theorist Selected: Florence Nightingale
2. Description of key points of the theory: Components of Nightingale’s philosophy, now recognized as a theory, are Environment, Person, Health, and Nursing (Bolton, 2010). Nightingales’ Canons are as follows:
Ventilation, and warming-“Keep the air he breathes as pure as the external air, without chilling him” Health of houses- “Five essential points in securing the health of houses: pure air, pure water, efficient drainage, cleanliness, and light.”
Petty management- “Not knowing how to manage that what you do when you are there, shall be done when you are not there.” Noise-“Unnecessary noise, or noise that creates an expectation in the mind, is that which hurts the patient.” Variety – change the walls or ceilings instead of the patient having to look at the same thing day in and day out. Taking food and what food-Patients should eat regularly and the proper diet (pureed, clear or full liquid).
Bed and bedding-bedding must be clean and patients should not be laying on bunched up bedding Light-light and sunlight present, patient should not be kept in the dark Cleanliness of rooms and walls-clean areas for the patient to reside in Personal cleanliness-the skin is the body’s greatest barrier to infection and it must be kept clean Chattering hopes and advices- honesty and do not provide false hopes Observation of the sick-changes in status must be noticed immediately and reported to the proper person (Nightingale, 1860)
3. Theory’s historical background: At age 17 Nightingale believed she was called by God into his service to help mankind. She had great compassion and sympathy for people of all types. She suffered in silence for years because it was improper for someone of her social status to be involved with actual physical work and her greatest desire was to help the truly poor. She fought with her family for years before they finally allowed her to go to Germany to the Institution of Deaconessess to study nursing.
She studied there for three months and returned home. Two years later she was allowed to practice nursing. After her travel to Scutari to care for wounded soldiers during the Crimean War, she developed her nursing theory. She felt there was a need to define nursing and reform hospital environments rather than provide new nursing knowledge. She is the founder of modern nursing because of her work in nursing and nursing education. She started a school of nursing at St. Thomas Hospital in England. Nightingale clarified that nursing knowledge is distinct from medical knowledge.
Complete the following grid based on the selected theorist information.
Define each term according to the selected theorist.
Explain how the selected theorist’s approach to each element of the metaparadigm applies to the following:
Nursing practice- Nightingale identified the metaparadigm of nursing: person, environment, health, and nursing. It is the role of the nurse to modify the environment in a way to obey natural laws, by that providing an environment in which perfection could be achieved. The environmental aspects of Nightingale’s theory (ventilation, warmth, quiet, diet, and cleanliness) remain to be integral components of nursing care. Utilization of Nightingale’s theory helps the nurse have a beginning focal point and allows the nurse to view the client as an individual who interacts with and lives in an environment that may or may not be beneficial to optimal health (Bolton, 2010).
Nursing education- Nursing is a work of art and science. Nightingale was the first to suggest that nurses be specially educated and trained for their position in health care. This allowing standards of care in the field of nursing, which improves overall healthcare of patients. Nightingale’s principles of Nurse training provided a custom plan for early nurse training school beginning with St. Thomas Hospital. Nightingale believed that all nurses should be well educated and practice independently. She used brief case studies in her teachings. Nightingale encouraged independence of nursing school from the hospital to safeguard students from becoming involved in the labor pool as part of their training. Good practice can only result from good education.
Nursing research- Nightingale’s interest in scientific inquiry and statistics continues to define the scientific inquiry used in nursing research (Alligood & Tomey, 2010). Nightingale’s concepts served as the groundwork for research to test modern theories. “She established a firm tradition of basing nursing practice on carefully collected and analyzed data, the forerunner of today’s evidence-based practice emphasis” (Fitzpatrick & Kazer, 2011, pp. 377-379). Her empirical approach to solving problems was visible from her work. Nightingale used a convincing argument with statistics, whereby she compared the mortality rates of soldiers in wartime military and nonmilitary situations with civilian men of comparable age. She invented the polar-area or pie-chart diagrams where each wedge was brightly colored to represent certain conditions.
Nightingale focused on the person as “the recipient of nursing care” (Selanders, 2010). She believed that nurses should focus on the patient and their needs, not the disease in which they are stricken with. She knew that people were multidimensional and wrote about their biological, psychological, social and spiritual requirements. Nightingale emphasized that people had reparative powers and that the nurses’ duty was to facilitate these forces with the means of returning people to health. (Selanders, 2010)
Nightingale defined health as “able to use well every power we have to use.” Nightingale viewed disease is a correctable process. Nightingale contemplated the maintenance of health through prevention of disease by environmental control and social responsibility. What she described led to “public health nursing and the more modern concept of health promotion” (Bolton, 2010, Chapter 5, Nightingales’s Philosophy in Nursing Practice).
The work of nursing is described as putting “the patient in the best condition for nature to act upon him” highlighting fresh air, light, warmth, cleanliness, quiet, and the proper diet. Kindness and touch should also be included. Nursing is a spiritual calling. Three types of nursing include nursing proper (nursing the sick), general nursing (health promotion) and midwifery nursing. Nursing is specifically different and separate from medicine. The work of nursing is so important that it should be thought of as a religious vow. “Nightingale did not set out to develop a conceptual model of nursing, however, her writings contain the elements needed for nursing theories, a clear conceptualization of the client, nursing goals, and nursing interventions” (Fitzpatrick & Kazer, 2011, pp. 377-379).
The environment is the main priority in Nightingales theory. She clearly pointed out that clean environment, fresh air, warmth, noise control and management of wastes and odors were all ways that the environment could be altered to improve conditions so that nature could act to cure the patient (Selanders, 2010). She realized that internal and external environment controls were both paramount to the progress of the patient’s healing. She also knew that properly prepared food and clean water are also necessary to a patient’s healing process.
Alligood, M. R., & Tomey, A. M. (2010). Nursing Theorists and Their Work (7th ed.). Maryland Heights, MO: Elsevier Health Sciences.
Bolton, K. (2010). Nursing Theory: Utilization and Application (4th ed.). Retrieved from The University of Phoenix eBook Collection Database.
Fitzpatrick, J. J., & Kazer, M. (2011). Encyclopedia of Nursing Research (2nd ed.). New York, NY: Springer Publishing Company.
Nightingale, F. (1860). Notes on Nursing: What it is, and what it is not. : J.B. Lipincott Company.
Sealanders, L. C. (2010, March). The Power of Environmental Adaptation. Journal of Holistic Nursing, 28(1), 81-88