Florence Nightingale’s

Theory of Nursing
Ns. Lisa Fitriani M,Kep
Click icon to add picture Florence
Nightingale
(1820-1910)

Known as the
founder of modern
nursing

Environmental
Theory of Nursing

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

The promotion of health as controlled by

external stimuli and environmental factors
(Clements & Averill, 2006)
Before The Crimean Before The Crimean
War War
 Born to a wealthy family  1853 Nightingale
and educated accepted the unpaid
intensively by her father position of superintendent
 Traveled throughout at the Establishment of
Europe including to Gentlewomen During
Illness
Kaiserswerth where she
 Began the practice of
first studied nursing and
providing quiet and
was introduced to poor
comfortable recovery
sanitation in relation to
from illness and surgery
nursing
(Baly & Matthew, 2004)

History of Florence Nightingale

Click icon to add picture  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

The Crimean War 1854-1856

(Baly & Matthew, 2004)
Written Work and
Accomplishments
 Noteson 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)
History of Nightingale’s Work
Written Work and
Accomplishments
 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)
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
Basis For Environmental Theory
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)
  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)

Global Concepts of Nursing

 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 Nightingale’s Conceptualization of Holism

composed of biological,
psychological, social, and spiritual
components
◦ It is important to address each
of these components to create a
holistic person (Selanders, 2010)

Human Being (Person)


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 Nightingale saw
poor health and disease
Environment
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)
ventilation as the most
important element
(Selanders, 2010)
 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  Disease is portrayed as dys-
any given point in time ease or the absence of comfort

 Individual does not need to be  Nightingale stated that disease

disease free to be healthy;
rather one must simply
maximize optimal potential to
be in a healthy state
was a reparative process,
indicating that symptoms alert
one to the presence of illness,
thus allowing appropriate
interventions to be instituted

(Selanders, 2010)

Health
 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)

Nursing
 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)

Nightingale’s Nursing Model

 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
(Selanders, 2010)

Maslow and Nightingale

 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)

Evaluation of the Nursing Model

 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 Nursing
Person
 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 Concept
Florence 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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 References
Baly, 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