Nursing Pioneer Nightingale 

Nightingale (Florence) 

    Florence Nightingale was born on May 12, 1820, in Florence, Italy,
and died on August 13, 1910, in London, England. She is widely considered to be
the founder of contemporary nursing and nursing education, as well as an early
expert on health care statistics, hospital design and construction, and
military health care. 

    Nightingale’s remarkable success at decreasing the
death rates during the Crimean War gave birth to legends of the Lady with the
Lamp. Her personal fame was critical to her ability to gain attention for her
ideas, including those about the value of female, well trained, nurses. 

    Nightingale’s birthday is remembered each year as International Nurses’ Day,
and it is the anchor date for Nurses’ Week in the U.S.

Nightingale Nursing Education

    Nightingale did NOT find the first nursing school: religious orders
had been training nursing nuns for centuries, and the Kaiserwerth Institute
opened its training school in 1836. 

    Nightingale was much impressed by both the
training techniques and quality of care evident at Kaiserwerth (Nightingale,
1851/1956), and later recommended some of the same strategies for the Training
School at St. Thomas. Nightingale’s contribution was the attention she brought
to nursing education and in developing a system for nursing education that was
secular and could be replicated in many different places. 

    By the time she died,
“Nightingale schools” could be found in 24 countries on five continents
(Donahue, 1996).

Metaparadigm of Nursing By Nightingale

    Nightingale has further contributed to nursing by identifying what
has become known as the metaparadigm of nursing: person, environment,
health, and nursing (Fawcett, 1978). She also established a firm tradition of
basing nursing practice on carefully collected and analyzed data, the
forerunner of today’s evidence based practice emphasis. 

    Nightingale’s most
widely circulated work, Notes on Nursing: What it is and What it is Not
(Nightingale, 1859/1969), was written not only for trained nurses, but for all
women who would have the charge of another’s health, and explicated how all
persons were able to learn the laws of health through observation, experience,
and reflection. 

    This is reflective of her view of nursing as part of a larger
whole, an opportunity for all women to become useful citizens and develop their
spirituality. Nursing was also meant to be a part of social progress, and
Nightingale (1892) encouraged all women to use their influence to improve life
for everyone.

Nightingale as Nursing Theorist 

    Nightingale did not set out to develop a conceptual model for
nursing, yet her writings contain the elements needed for nursing theories, a
clear conceptualization of the client, nursing goals, and nursing interventions
(Meleis, A. 1., 2004). 

    The essential concepts she considered were the patient,
the patient’s environment, and nursing. She defined nursing as putting “the
patient in the best condition for nature to act upon him” (Nightin gale,
1859/1969, p. 133) through scrupulous attention to “fresh air, light, warmth,
cleanliness, [and] quiet, and the proper selection and administration of diet”
(p. 8). 

    Health was defined as being “able to use well every power we have to
use” (Nightingale, 1885, p. 1043), Health was affected by environmental
factors, as well as by dietary choices and adequate amounts of exercise
(Nightingale, 1863a).

View about Nursing and Human Being 

    Nightingale’s most far reaching ideas may have been her
conceptualizations of persons, their environments, and the interaction between them that affected health. She identified persons as having physical,
intellectual, social, emotional, and spiritual components (Nightingale,
1859/1969). 

    This holistic understanding was a unique one, distinct from that of
other scholars of her day (Welch, M., 1986). Her holistic view of human beings
continues to be a hallmark of nursing, differentiating it from other health
care professions.

Environmental Factor Affecting Health

    Nightingale’s insistence on the role of the environment in the
health of individuals was also extremely innovative. 

    She was adamant that
deficiencies of light, fresh air, space, and sanitation were the chief culprits
in disease, and she was fearful that the emphasis on antisepsis and
disinfection would divert attention from the “dirt, drink, diet, damp,
draughts, and drains” that needed to be addressed (Nightingale, 1859/1969,
1893/1949). 

    She initially came to her beliefs about the environment’s role in
health in Scutari, where she was greeted by filthy conditions and a hospital
mortality rate of 57% (Cohen, I. B., 1984). Conscientious application of her
principles of sanitation soon reduced the mortality rate to 2% and gave her
access to the military medical chiefs. 

Comparison of Hospital Standards and Patient Recovery Rate 

    She refined her thoughts about
environmental impacts on disease by studying the mortality rates and locations
of English hospitals. She noted that hospitals in the congested city of London
had mortality rates of 90.84%, while those in small country towns were much
more successful at discharging their patients alive (Nightingale, 1863b). 

    Healthy hospitals provided sufficient fresh air, light, and space, and
subdivided the sick into separate buildings or pavilions. Using these data,
Nightingale laid out detailed plans for the construction of hospitals,
including site selection, and hospitals for special populations such as
children. 

    A careful reading of her principles of hospital construction
demonstrates that her ideas are as salient now as when they were written. 

Scholarly Approach of Nightingale

    A
liberally educated woman, Nightingale brought the skills of a classical scholar
to her study of nursing and health, and she was passionate about the use of
data and statistics (Grier & Grier, 1978). 

    She laid a strong foundation for
nursing research and evidencebased practice, and strove for the use of
knowledge in patient care, writing “What then? Shall we have less theory? God
forbid. We shall not work better for ignorance” (Nightingale, 1851/1956, p. 6). 

    It is a curiosity that over 100 years lapsed between her initial enunciation of
these ideas and their general acceptance by the nursing profession. Too many
nurses equate Nightingale with outdated notions of etiquette and deportment,
rather than with the volumes of data and statistics she produced. 

    Even fewer
are aware of her phenomenal grasp of politics and the use of personal power,
tenacity, and shrewdness to achieve her goals (Baly, 1988). 

    Professional
nursing has made tremendous strides since Nightingale set out to establish the
school at St. Thomas’. It is almost mind boggling to think where the profession
(and discipline) might be today without that 100 year gap.