UNIT II

CHAPTER 6
NURSING PHILOSOPHIES
CHAPTER 6

FLORENCE
NIGHTINGALE

Modern
Nursing
Objectives:
1.Discuss the life of Florence Nightingale as a
person and as a nurse.
2.Define the philosophy of nursing according
to the view of Nightingale.
3.Describe relevant situations where
Nightingale’s theory can be practically
applied.
4.Identify the significant contributions of
Nightingale to the nursing profession.
 Florence Nightingale
❑ Is known as the Mother of Modern Nursing
❑ The lady with the lamp
❑ Daughter of William Nightingale of Embly
Park, Hampshire.
❑ Was born in Italy, on the 12th day of May
1820.
❑ At the age of 25, Florence told her parents
she wanted to become a nurse.
❑ Was motivated by Elizabeth Blackwell at St.
Bartholomew’s Hospitals in London
❑ In 1851, Florence’s father gave her
permission to train as a nurse. She was
already 31 years old.

❑ Nightingale went to Kaiserworth, Germany

where she studied to become a nurse at the
Institute of Protestant Deaconesses.

❑ Two years later she was appointed resident

lady superintendent of a hospital for invalid
women in Harley St., London.
THE CRIMEAN WAR
 Crimean War
❑In March 1853, the Crimean War
broke out between Russia and
Turkey
❑Nightingale volunteered her
services and was eventually
given permission to take a group
of 38 nurses to Turkey
❑She found the conditions of the
hospital as:
❑Soldiers lay in filth straw
pallets in crowded hallways.
❑Rats and insects, crawled the
floors and walls
❑ The hospitals lack basic supplies, such as cots,
mattresses, bandages, washbasins, soap, and
towels.
❑ Water was rationed, and available in totally
inadequate amounts.
❑ The wounded army were placed in rooms
without blankets or decent food.
❑ Wounded armies were wearing unwashed
uniforms that were “stiff with dirt and gore”
❑ Diseases such as typhus, cholera, and dysentery
were the primary reasons why the death rate
was high.
❑ She recognized that overcrowding, filth, and
poor ventilation were all contributed to the
illness of the soldiers.

❑ At night, she carried a lamp through the

corridors, stopping to help the suffering of
the wounded soldiers, for this, she was
nicknamed, “the lady with the lamp”

❑ John Delane
❑ The editor of the Times
❑ The Times – a newspaper that reported the
details of the way that the British Army
treated its wounded soldiers.
 Post-War contributions
❑ Florence returned to England as a national
heroine in 1856
❑ In October 1856, she had a long interview
with Queen Victoria and Prince Albert.
❑ In 1857, Nightingale gave evidence to the
1857 Sanitary Commission which eventually
resulted in the formation of the Army
Medical College.
❑ She published 2 books:
❑ Notes on Hospital (1859)
❑ Notes on Nursing (1859)
❑Nightingale raise enough funds
and used this to establish the
Nightingale School and Home for
Nurses at St. Thomas Hospital.

❑Florence’s work greatly

influenced John Stuart Mill’s
book on women’s rights.

❑She died in London on the 13th

day of August 1910.
FLORENCE NIGHTIGALE
❑FLORENCE NIGHTINGALE

❑Theory in Nursing
❑“Nursing is the art of
utilizing the patient’s
environment for his or her
recovery.”
 Focus of Nightingale’s Theory:
1.Environment
❑Is defined as the external
conditions and influences affecting
the life and development of an
organism and capable of preventing,
suppressing, or contributing to
disease, accidents, or deaths.
❑Components of environment:
⮚Warmth, light, diet, cleanliness,
and quiet
• Concepts and Definitions

1. Healthy Environment
>Is characterized by pure air,
pure water, efficient drainage,
cleanliness and light.
2.Proper ventilation
❑Nightingale believed that
nurses have the responsibility
to keep the air that the patient
breathes pure as the external
air without necessarily chilling
him.
❑She recognized the possibility
that inadequate ventilation may
be the source of disease.
3.Adequate Light
❑Direct sunlight has “quite as
real and tangible effects on the
human body… who has not
observed the purifying effect of
light, and especially of direct
sunlight.
4.Cleanliness

❑She advocated taking a bath

daily and that nurses should
also bathe daily while keeping
their duty uniforms clean and
their hands washed clean.
5. Warmth
❑Nightingale outlined a
procedure for measuring the
body’s temperature through
palpation of, or feeling for the
extremities in order to assess
for heat loss. One of the nurse’s
role is to manipulate the
environment.
❑Positioning the patient,
opening the windows, and
regulating the room
temperature are ways of
maintaining this balance.
6. Quiet
❑Nightingale described
unnecessary noise can
actually be harmful to the
patient who is ill.
7. Diet
❑Nightingale maintained that
one of the nurse’s role is to
assess both the meal
schedule and its effect on
the patient, in addition to
assessing the patient’s
dietary intake.
8. Management
❑The nurse is actually in
control of the environment,
physically, and
administratively. The nurse
is responsible for controlling
the environment so that the
patient is protected from
physical and psychological
harm.
❑Nightingale believed that the
nurse continuously
controlled the environment
even if she is physically
absent from caring for the
patient because she is still
responsible for supervising
the other members of the
health team who worked on
her patient during her
absence.
 Theory Assertions
Theory and Nursing:
❑Nightingale’s view of nursing
was comparable to that of
motherly instincts. She believed
that every woman will be a
nurse because nursing is having
the responsibility for someone
else’s health – a characteristic
shared by women, especially
mothers.
❑Her “NOTES ON NURSING”
provided guidelines to women
who wanted to become nurses
and gave advice on how to
“think like a nurse.”

❑Nursing is a vocation that

needs formal learning and
application of scientific
principles in the care of
patients.
❑Nursing personnel were thus
have more skill in terms of
assessment and reporting of
the patient’s health status.

❑At the same time, the nurse is

also able to perform nursing
interventions that will allow
the patient to heal and
recover.
Theory and Person:
❑ The person is the patient himself.
❑ Patients are the recipient of our care.
❑ A passive patient is a patient who
depends wholly on the nurse for tasks
and control of his environment.
❑ The nurse is totally in control of the
patient and his environment.
❑Nightingale viewed the patient
as a person who needed nursing
care regardless of the patient’s
social worth.

Theory and Health:

❑Nightingale viewed health as
being well.
❑Health is also living up to one’s
potential to the fullest extent.
❑Disease and illness are viewed as
reparative processes that are
instituted by Mother Nature
herself when the person did not
attend to his personal health
concerns.
❑Nightingale emphasized the
promotion and maintenance of
health and prevention of diseases
through prudent control of the
environment and social
responsibility.
❑This lay the foundations for
health nursing, or the field of
nursing that is aimed at health
promotion and disease
prevention.

❑This is the early form of what we

call primary health care today.
Theory and Environment:
❑ The environment was viewed as “those
elements external to and which affect the
health of the sick and healthy person” and
included “everything from the patient’s food
and flowers to the patient’s verbal and
nonverbal interactions.

❑ Central to Nightingale’s theory is the concept

of a therapeutic environment that will
enhance the comfort and recovery of the
patient.
Application To Nursing
Nursing Practice:
❑Ventilation, warmth, quiet, diet,
and cleanliness are still
important aspects of nursing
care.

❑With the advent of technology,

and with it, globalization, comes
threats from the environment.
❑Global warming, industrial noise,
air pollution, fad diets, and vanity
continue to pose challenges to
the nurse practitioner today.

❑We, nurses, thus need to

maintain adequate ventilation,
promote adequate and
appropriate nutrition, maintain
normal homeostatic body
temperature, and observe basic
hygiene and comfort measures,
including environmental
sanitations.
Nursing Education:
❑Nightingale had established
the St. Thomas Hospital and
King’s College Hospital in
London, which was able to
provide a framework for the
establishment of nursing
training schools through a
universal template that
contains principles of nursing
training.
❑ She also advocated the separation of nursing
training from the hospital to a more
appropriate learning environment in the
school or university setting.
❑ Because she believed that nursing student’s
role is to learn the art and science of nursing
before being employed in the nursing service.
❑ She did not believe in licensure exams,
however she used other methods of
evaluation like case studies to monitor the
progress of nursing students.
Nursing Research:
❑Nightingale is considered the
mother of nursing research
because of her interest in the
scientific methods of inquiry and
statistics.
❑She was able to gather and
analyze data efficiently and
resourcefully.
❑She was the first to use polar
diagrams in presenting study
data.
❑The concepts of Nightingale’s
theory still serves as a bases
for current research. This can
add to understanding modern
nursing science and practice.
 CHAPTER 7
Jean Watson:
Watson's Philosophy
and Theory of
Transpersonal
Caring
• “Nursing is the human
science of persons and
human health – illness
experiences that are
mediated by professional,
personal, scientific,
aesthetic, and ethical human
care transactions.”
The Major Elements
of her Theory:
1.The carative factor
2.The transpersonal
caring relationship
3.The caring
occasion/caring
moment
Carative factors are guide for the
core of nursing. She used the
term carative to contrast with
conventional medicine’s curative
factors.
❑Her carative factors attempted
to “honor the human dimensions
of nursing’s work and the inner
life world and subjective
experiences of the people we
serve”
▪ 10 Elements of Carative Factors:
1.Humanistic-altruistic system of value
2.Faith-hope
3.Sensitivity to self and others
4.Helping-trusting, human care relationship
5.Expressing positive and negative feelings
6.Creative problem-solving caring process
7.Transpersonal teaching-learning
8.Supportive, protective, and/or corrective
mental, physical, societal, and spiritual
environment
9.Human needs assistance
10.Existential-phenomenological-spiritual
forces
❑Watson introduced the
concept of clinical caritas
process, which have replaced
her carative factors.

❑The word “caritas” originates

from the Greek vocabulary,
meaning to cherish and to give
special loving attention
The following are the translation of the
carative factors into clinical caritas
processes:
1.Practice of loving kindness and equanimity
(self-control/composure) within context of
caring consciousness.
2.Being authentically present, and enabling
and sustaining the deep belief system and
subjective life world of self and the one-
being-cared-for.
3.Cultivation of one’s own
spiritual practices and
transpersonal self, going
beyond ego self, opening to
others with sensitivity and
compassion.
4.Developing and sustaining a
helping-trusting, authentic
caring relationship.
5.Being present to, and supportive of, the
expression of positive and negative
feelings as a connection with deeper
spirit of self and the one-being-cared-for.

6.Creative use of self and all ways of

knowing as part of the caring process to
engage in artistry of caring-healing
practices.
7.Engaging in genuine teaching-learning
experience that attends to unity of being
and meaning, attempting to stay within
other’s frames of reference.

8. Creating a healing environment at all

levels (physical as well as non-physical),
subtle environment of energy and
consciousness, whereby wholeness,
beauty, comfort, dignity, and peace are
potentiated.
9. Assisting with basic needs,
with an intentional caring
consciousness, administering
“human care essentials”,
which potentiate alignment of
mind-body-spirit, wholeness,
and unity of being in all
aspects of care, tending to
both the embodied spirit and
evolving spiritual emergence.
10.Opening and attending to
spiritual-mysterious and
existential dimensions of
one’s own life-death; soul
care for self and the one-
being-cared-for.
Transpersonal caring relationship
characterizes a special kind of human
care relationship that depends on:
1.The nurse’s moral commitment in
protecting and enhancing human dignity
as well as the deeper/higher self.
2. The nurse’s caring consciousness
communicated to preserve and honor
the embodied spirit, therefore, not
reducing the person to the moral status
of an object.
3. The nurse’s caring consciousness and
connection having the potential to heal
since experience, perception, and
intentional connection are taking place
The term “transpersonal” means to go
beyond one’s own ego and the here and
now, as it allows one to reach deeper
spiritual connections in promoting the
patient’s comfort and healing.
❑ Finally, the goal of a transpersonal
relationship corresponds to protecting,
enhancing, and preserving the person’s
dignity, humanity, wholeness, and inner
harmony.
A caring occasion is the
moment (focal point in space
and time) when the nurse and
another person come together
in such a way that an
occasion for human caring is
created.
❑Assistance with the
gratification of human needs
describes the role of the
nurse in promoting wellness
and health through the
achievement of basic human
needs according to Maslow’s
hierarchy of needs.
Maslow’s Hierarchy of Needs
Theory Assertions
❑ The theory acknowledges the unity of the
person’s mind-body-spirit.
❑ The mind is the point of access to the body
and the spirit.
❑ The spirit relates to a person’s soul, the
inner self, the essence of the person, the
spiritual self.
It is the spirit that allows the person to
transcend the “here and now” coexisting
with past, present, and future, all at once
through, creative imagination and
visualization.
❑Watson ascertains that
the care of the soul
remains the most
powerful aspect of the
art of caring in nursing.
 Application of the Theory
❑One major implication of the
theory is in the realm of
bedside nursing where nurses
of today have particularly
begun to neglect.
❑The essence of nursing is in
the caring aspect and caring
is taking the wholeness, the
totality, of the patient in
consideration.
❑ It is every nurse’s duty and moral
obligation to care for his or her patient
not by merely looking into and caring for
his or her physical disease.
❑ More importantly, nurse of today should
try to care for a patient for who he is.
❑ After all, all of us were created equal
and in His likeness.
THANK YOU FOR LISTENING !
☺