Florence nightingale was the founder of modern nursing. She recognized nursing as a professional endeavor distinct from medicine.
Brief History
Florence Nightingale was born on May 12, 1820, in Florence, Italy, while her affluent British parents were on an extended European tour; she was named after her birthplace.
She completed her three months nursing training in 1851 at Kaiserwerth, Germany, and then returned to England. Nightingale was employed to examine hospital facilities, reformatories, and charitable institutions.
In 1853, she became the superintendent of the Hospital for Invalid Gentlewomen in London.
During the Crimean War, she received a request from Sidney Herbert (a family friend and the Secretary of War) to travel to Turkey, with a group of 34 qualified nurses to care for wounded British soldiers.
She was called The Lady of the Lamp, because she made ward rounds during the night, providing emotional comfort to the soldiers. Her work in Improving the environmental conditions of the soldiers was well recognized.
After the war, Nightingale returned to England to great accolades, particularly from the royal family (Queen Victoria), the soldiers who had survived the Crimean War, their families, and the families of those who died at Scutari, Turkey.
She was awarded funds in recognition of this work, which she used to establish schools for nursing training at St. Thomas’s Hospital and King’s College Hospital in London. Within a few years, the Nightingale School began to receive requests to establish new schools at hospitals worldwide, and Florence Nightingale’s reputation as the founder of modern nursing was established.
During her lifetime, Nightingale’s work was recognized through the many awards she received from her own country and from many others. She was able to work into her 80s until she lost her vision; she died in her sleep on August 13, 1910, at 90 years of age.
The Environmental Theory
Nightingale’s theory focused on the environment. She defined and described the following concepts:
- Ventilation
- Warmth
- Light
- Diet
- Cleanliness
- Noise
She extended her concern about healthy surroundings involved hospital settings in Crimea and England, to the public in their private homes and to the physical living conditions of the poor and believed that healthy surroundings were necessary for proper nursing care and restoration/maintenance of health.
Her theoretical work majored on five essential components of environmental health:
1. Pure Air
- She charged her nurses to “keep the air he breathes as pure as the external air, without chilling him”
- She recognized the surroundings as a source of disease and recovery.
- In addition to discussing ventilation in the room or home, Nightingale provided a description for measuring the patient’s body temperature through palpation of extremities to check for heat loss.
- The nurse was instructed to manipulate the surroundings to maintain ventilation and patient warmth by using a good fire, opening windows, and properly positioning the patient in the room.
2. Pure Water
- She concluded that “well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer”.
3. Efficient Drainage
- She noted that a dirty environment (floors, carpets, walls, and bed linens) was a source of infection through the organic matter it contained.
- Even if the environment was well ventilated, the presence of organic material created a dirty area; therefore, appropriate handling and disposal of bodily excretions and sewage were required to prevent contamination of the environment.
4. Cleanliness
- Nightingale advocated bathing patients on a frequent, even daily, basis at a time when this practice was not the norm.
- She required that nurses also bathe daily, that their clothing be clean, and that they wash their hands frequently.
- This concept held special significance for individual patient care, and it was critically important in improving the health status of the poor who were living in crowded, environmentally inferior conditions with inadequate sewage and limited access to pure water.
5. Light
- She noted that “light has quite as real and tangible effects upon the human body . . . Who has not observed the purifying effect of light, and especially of direct sun light, upon the air of a room?”
- To achieve the beneficial effects of sun light, nurses were instructed to move and position patients to expose them to sunlight.
Major Assumptions
1. Nursing
Nightingale believed that every woman, at one time in her life, would be a nurse in the sense that nursing is being responsible for someone else’s health. She later on published a guideline to help them think like nurses.
Trained nurses, however, were to learn additional scientific principles to be applied in their work and were to be more skilled in observing and reporting patients’ health status while providing care as the patient recovered.
2. Person
In most of her writings, Nightingale referred to the person as a patient. Nurses performed tasks to and for the patient and controlled the patient’s environment to enhance recovery. For the most part, Nightingale described a passive patient in this relationship. However, specific references are made to the patient performing self-care when possible and, in particular, being involved in the timing and substance of meals.
The nurse was to ask the patient about his or her preferences, which reveals the belief that Nightingale saw each patient as an individual. However, Nightingale (1969) emphasized that the nurse was in control of and responsible for the patient’s environmental surroundings. Nightingale had respect for persons of various backgrounds and was not judgmental about social worth.
3. Health
Nightingale defined health as being well and using every power (resource) to the fullest extent in living life. Additionally, she saw disease and illness as a reparative process that nature instituted when a person did not attend to health concerns.
She envisioned the maintenance of health through prevention of disease via environmental control and social responsibility. What she described led to public health nursing and the more modern concept of health promotion. She distinguished the concept of health nursing as different from nursing a sick patient to enhance recovery, and from living better until peaceful death.
4. Environment
Nightingale’s concept of environment emphasized that nursing was “to assist nature in healing the patient. She aimed at creating and maintaining a therapeutic environment that would enhance the comfort and recovery of the patient.
She believed that sick poor people would benefit from environmental improvements that would affect both their bodies and their minds. She believed that nurses could be instrumental in changing the social status of the poor by improving their physical living conditions.
References
- Agnew, L. R. (1958). Florence Nightingale, statistician. American Journal of Nursing, 58, 644.
- Ashley, J. A. (1976). Hospitals, paternalism, and the role of the nurse. New York: Teachers College Press.
- Beck, D. M. (2010). Expanding our Nightingale horizon: Seven recommendations for 21st century nursing practice. Journal of Holistic Nursing, 28(4), 317–326.