another in their lives, would nurse. Thus, all
women needed to know the laws of health. Nursing
proper, or “sick” nursing, was both an art and a sci-
ence and required organized, formal education to
care for those suffering from disease. Above all,
nursing was “service to God in relief of man”; it
was a “calling” and “God’s work” (Barritt, 1973).
Nursing activities served as an “art form” through
which spiritual development might occur (Reed &
Zurakowski, 1983/1989). All nursing actions were
guided by the nurses’caring,which was guided by
underlying ideas about God.
Consistent with this caring base is Nightingale’s
views on nursing as an art and a science.Again, this
was a reflection of the marriage, essential to
Nightingale’s underlying worldview, of science and
spirituality. On the surface, these might appear to
be odd bedfellows; however, this marriage flows di-
rectly from Nightingale’s underlying religious and
philosophic views, which were operationalized in
her nursing practice. Nightingale was an empiricist,
valuing the “science” of observation with the intent
of use of that knowledge to better the life of hu-
mankind. The application of that knowledge re-
quired an artist’s skill, far greater than that of the
painter or sculptor:
Nursing is an art; and if it is to be made an art, it re-
quires as exclusive a devotion, as hard a preparation,
as any painter’s or sculptor’s work; for what is the hav-
ing to do with dead canvas or cold marble, compared
with having to do with the living body—the Temple
of God’s spirit? It is one of the Fine Arts; I had almost
said, the finest of the Fine Arts. (Florence Nightingale,
cited in Donahue, 1985, p. 469)Nursing is an art; and if it is to be made
an art, it requires as exclusive a devotion,
as hard a preparation, as any painter’s or
sculptor’s work; for what is the having to
do with dead canvas or cold marble, com-
pared with having to do with the living
body—the Temple of God’s spirit? It is one
of the Fine Arts; I had almost said, the
finest of the Fine Arts.Nightingale’s ideas about nursing health, the en-
vironment, and the person were grounded in expe-
rience; she regarded one’s sense observationsas the
52 SECTION II Evolution of Nursing Theory: Essential Influences
only reliable means of obtaining and verifying
knowledge. Theory must be reformulated if incon-
sistent with empirical evidence. This experiential
knowledge was then to be transformed into empir-
ically based generalizations, an inductive process, to
arrive at, for example, the laws of health. Regardless
of Nightingale’s commitment to empiricism and
experiential knowledge, her early education and re-
ligious experience also shaped this emerging
knowledge (Hektor, 1992).
According to Nightingale’s model, nursing con-
tributes to the ability of persons to maintain and
restore health directly or indirectly through manag-
ing the environment. The person has a key role in
his or her own health, and this health is a function
of the interaction between person, nurse, and envi-
ronment. However, neither the person nor the en-
vironment is discussed as influencing the nurse
(Figure 5–5).
Although it is difficult to describe the interrela-
tionship of the concepts in the Nightingale model,
Figure 5–6 is a schema that attempts to delineate
this. Note the prominence of “observation” on the
outer circle (important to all nursing functions)FIGURE 5–5 Perspective on Nightingale’s 13 canons.Illustration
developed by V. Fondriest, RN, BSN, and J. Osborne, RN, C BSN in
October 1994.