CHAPTER 5 Florence Nightingale’s Legacy of Caring and Its Applications 51Pamela Reed and Tamara Zurakowski (1983/
1989, p. 33) call the Nightingale model “visionary.”
They state: “At the core of all theory development
activities in nursing today is the tradition of
Florence Nightingale.” They also suggest four major
factors that influenced her model of nursing: reli-
gion, science, war, and feminism, all of which are
discussed in this chapter.
The assumptions in the following section were
identified by Victoria Fondriest and Joan Osborne
(1994).
NIGHTINGALE’S ASSUMPTIONS
- Nursing is separate from medicine.
- Nurses should be trained.
- The environment is important to the health of
the patient. - The disease process is not important to nurs-
ing. - Nursing should support the environment to as-
sist the patient in healing. - Research should be utilized through observa-
tion and empirics to define the nursing disci-
pline. - Nursing is both an empirical science and an
art. - Nursing’s concern is with the person in the en-
vironment. - The person is interacting with the environ-
ment. - Sick and well are governed by the same laws of
health. - The nurse should be observant and confiden-
tial.
The goal ofnursingas described by Nightingale
is assisting the patient in his or her retention of
“vital powers” by meeting his or her needs, and
The goal of nursing as described by
Nightingale is assisting the patient in his
or her retention of “vital powers” by meet-
ing his or her needs, and thus, putting the
patient in the best condition for nature to
act upon (Nightingale, 1860/1969).thus, putting the patient in the best condition for
nature to act upon (Nightingale, 1860/1969). This
must not be interpreted as a “passive state,” but
rather one that reflects the patient’s capacity for
self-healing facilitated by nurses’ ability to create an
environment conducive to health. The focus of this
nursing activity was the proper use of fresh air,
light, warmth, cleanliness, quiet, proper selection
and administration of diet, monitoring the pa-
tient’s expenditure of energy, and observing. This
activity was directed toward the environment and
the patient (see Nightingale’s Assumptions).
Healthwas viewed as an additive process, the re-
sult of environmental, physical, and psychological
factors, not just the absence of disease. Disease
was the reparative process of the body to correct a
problem and could provide an opportunity for
spiritual growth. The laws of health, as defined by
Nightingale, were those to do with keeping the per-
son, and the population, healthy. This was depend-
ent upon proper environmental control—for
example, sanitation. The environment was what the
nurse manipulated. It included those physical ele-
ments external to the patient. Nightingale isolated
five environmental components essential to an in-
dividual’s health: clean air, pure water, efficient
drainage, cleanliness, and light.Nightingale isolated five environmental
components essential to an individual’s
health: clean air, pure water, efficient
drainage, cleanliness, and light.The patientis at the center of the Nightingale
model, which incorporates a holistic view of the
person as someone with psychological, intellectual,
and spiritual components. This is evidenced in her
acknowledgment of the importance of “variety.”
For example, she wrote of “the degree...to which
the nerves of the sick suffer from seeing the same
walls, the same ceiling, the same surroundings”
(Nightingale, 1860/1969). Likewise, her chapter on
“chattering hopes and advice” illustrates an astute
grasp of human nature and of interpersonal rela-
tionships. She remarked upon the spiritual compo-
nent of disease and illness, and she felt they could
present an opportunity for spiritual growth. In this,
all persons were viewed as equal.
A nursewas defined as any woman who had
“charge of the personal health of somebody,”
whether well, as in caring for babies and children,
or sick, as an “invalid” (Nightingale, 1860/1969).
It was assumed that all women, at one time or