Evelyn R. Barritt, professor of nursing, suggested
that nursing became a science when Nightingale
identified her laws of nursing, also referred to as the
laws of health, or nature (Barritt, 1973). The re-
mainder of all nursing theory may be viewed as
mere branches and “acorns,” all fruit of the roots of
Nightingale’s ideas. Early writings of Nightingale,
compiled in Notes on Nursing: What It Is and What
It Is Not(1860/1969), provided the earliest system-
atic perspective for defining nursing. According to
Nightingale, analysis and application of universal
“laws” would promote well-being and relieve the
suffering of humanity. This was the goal of nursing.
As noted by the caring theorist Madeline
Leininger, Nightingale never defined human care
or caring in Nightingale’s Notes on Nursing(1859/
1992, p. 31), and she goes on to wonder if
Nightingale considered “components of care such
as comfort, support, nurturance, and many other
care constructs and characteristics and how they
would influence the reparative process.” Although
Nightingale’s conceptualizations of nursing, hy-
giene, the laws of health, and the environment
never explicitly identify the construct of caring, an
underlying ethos of care and commitment to oth-
ers echoes in her words and, most importantly,
resides in her actions and the drama of her life.
Nightingale did not theorize in the way we are
accustomed to today. Patricia Winstead-Fry (1993),
in a review of the 1992 commemorative edition of
Nightingale’s Notes on Nursing(1859/1992, p. 161),
states: “Given that theory is the interrelationship of
concepts which form a system of propositions that
can be tested and used for predicting practice,
Nightingale was not a theorist. None of her major
biographers present her as a theorist. She was a
consummate politician and health care reformer.”
Her words and ideas, contextualized in the earlier
portion of this chapter, ring differently than those
of the other nursing theorists you will study in this
book. However, her underlying ideas continue to be
relevant and, some would argue, prescient.
Karen Dennis and Patricia Prescott (1985) note
that including Nightingale among the nurse theo-
rists has been a recent development. They make the
case that nurses today continue to incorporate in
their practice the insight, foresight, and, most
important, the clinical acumen of Nightingale’s
century-old vision of nursing. As part of a larger
study, they collected a large base of descriptions
from both nurses and physicians describing “good”
nursing practice. Over 300 individual interviews
were subjected to content analysis; categories were
named inductively and validated by four members
of the project staff, separately.
Noting no marked differences in the descrip-
tions obtained from either the nurses or physicians,
the authors report that despite their independent
derivation, the categories that emerged during the
study bore a striking resemblance to nursing prac-
tice as described by Nightingale: prevention of ill-
ness and promotion of health, observation of the
sick, and attention to physical environment. Also
referred to by Nightingale as the “health of houses,”
this physical environment included ventilation of
both the patient’s rooms and the larger environ-
ment of the “house”: light, cleanliness, and the tak-
ing of food; attention to the interpersonal milieu,
which included variety; and not indulging in su-
perficialities with the sick or giving them false en-
couragement.
The authors note that “the words change but the
concepts do not” (Dennis & Prescott, 1985, p. 80).
In keeping with the tradition established by
Nightingale, they note that nurses continue to fos-
ter an interpersonal milieu that focuses on the per-
son, while manipulating and mediating the
environment to “put the patient in the best condi-
tion for nature to act upon him” (Nightingale,
1860/1969, p. 133).
Afaf I. Meleis (1997), nurse scholar, does not
compare Nightingale to contemporary nurse theo-
rists; nonetheless, she refers to her frequently.
Meleis states that it was Nightingale’s concep-
tualization of environment as the focus of nursing
activity and her deemphasis of pathology, empha-
sizing instead the “laws of health” (as yet un-
known), that were the earliest differentiation of
nursing and medicine. Meleis (1997, pp. 114–116)
describes Nightingale’s concept of nursing as in-
cluding “the proper use of fresh air, light, warmth,
cleanliness, quiet, and the proper selection and ad-
ministration of diet, all with the least expense of
vital power to the patient.” These ideas clearly had
evolved from Nightingale’s observations and expe-
riences. The art of observation was identified as an
important nursing function in the Nightingale
model. And this observation was what should form
the basis for nursing ideas. Meleis speculates on
how differently the theoretical base of nursing
might have evolved if we had continued to consider
extant nursing practice as a source of ideas.50 SECTION II Evolution of Nursing Theory: Essential Influences