Florence Nightingale established the foundations of modern nursing in the 1800s. Her nursing philosophy was based on understanding how a patient's environment impacts their health. She believed the nurse's role is to control environmental factors like ventilation, light, cleanliness, noise, and diet to enhance a patient's recovery. Nightingale used observation and experience to develop her theory that the nurse manages a patient's internal and external environments. Her principles of environmental control and evidence-based practice remain highly influential to nursing today.

1. Nightingale’s Nursing Philosophy
By: Anna Sierre & Kimberly Nemecek

2. Theory and Practice
• “The systematic accumulation of knowledge is essential to
progress in any profession… however theory and practice
must be constantly interactive. Theory without practice is
empty and practice without theory is blind” (Cross, 1981,
p.110).
• Nightingale’s vision of nursing:
– Care of sick is based on knowledge of persons and their surroundings –
a different from knowledge base than used by physicians in their
practice.
– Nightingale (1992) wrote, “No man, not even a doctor, ever gives any
other definition of what a nurse should be than this--’devoted and
obedient.’ This definition would do just as well for a porter. It might
even do for a horse. It would not do for a policeman” (as cited in
Finkelman & Kenner, 2013, ¶7).

3. Florence Nightingale
• The founder of modern nursing.
• She lived and worked in the Victorian era during the Industrial
Revolution. This time period did not have women of her class
(upper class) work outside the home (Finkelman & Kenner,
2013, ¶8).
• Chinn (2001) states that Nightingale had “…a strong conviction
that women have the mental abilities to achieve whatever
they wish to achieve: compose music, solve scientific
problems, create social projects of great importance” (as cited
in Finkelman & Kenner, 2013, ¶9).

4. Florence Nightingale
• First practicing nurse epidemiologist.
• Nightingale’s work recognized through the many awards
received from her own and other countries.
• Used inductive reasoning to extract laws of health, disease,
and nursing from her observations and experiences.
• Nightingale’s theory focused on the environment of the
patient. The environmental “…factors are especially
significant when one considers that sanitation conditions in
hospitals of the mid-1800s were extremely poor…” (Blais &
Hayes, 2011, p. 100).

6. Major Concepts and Definitions of
Environmental Theory
• Ventilation and warming – source of disease and recovery.
“Keep the air he breathes as pure as the external air,
without chilling him” (Nightingale, 1969, p.12).
• Light – direct sunlight is particular needs of patients.
“Light has quite as real and tangible effect upon the
human body…” (Nightingale, 1969, pp.84-85).
• Cleanliness
Daily bath, clean floors, walls, bed linens, proper handling
and disposal of bodily excretions and sewage.
• Diet
RN to meet patient’s nutritional needs.

7. One of the Nightingale’s Models

8. Major Concepts and Definitions of
Environmental Theory
• NoiseCruel and irritating
to the patient.
• Petty managementProtect patient
from disruptions of
sleep, receiving
upsetting news
from visitors who
could negatively
affect recovery.

9. Major Assumptions
Nursing
I.
Nightingale believed that every woman at one time
in her life would be a nurse.
I.
Nightingale’s Notes on Nursing book provided
women with guidelines for caring for their loved
ones at home and to give advice on how to “think
like a nurse” (Nightingale, 1969, p.4).

10. Major Assumptions
Person
I.
The person is a patient.
I.
Each patient is an individual.
I.
RN to perform tasks to and for the passive patient, and control
the patient’s environment to enhance recovery.
I.
Patient to perform self-care when possible: being involved in the
timing and substance of meals.
I.
RN in control of and responsible for patient’s environment and in
control of some personal choices and behaviors.

11. Major Assumptions
Health
I.
Being well and using every power to the fullest extent
in living life.
I.
Disease and illness is a reparative process that nature
instituted when a person did not attend to health
concerns.
I.
Maintain health through prevention of disease via
environmental control and social responsibilities.

12. Major Assumptions
Environment
I.
Nursing to assist nature in healing the patient and to
be accomplished by managing the internal and
external environments.
I.
Nurses to create and maintain a therapeutic
environment that would enhance the comfort and
recovery of the patient.
I.
Sick poor people would benefit from environmental
improvements that would affect both their bodies
and their minds.

13. Analysis of Nightingale’s Nursing
Principles Today
• Remain foundation of nursing practice.
• Ventilation, warmth, noise, diet, and cleanliness continue
to be relevant in today’s hospitals.
• Global environmental issues, i.e. nuclear threats,
pollution, global warming, contaminated water remains a
health issue.
• Global travel causes rapid spread of diseases.
• Ability to control room temperature for a individual
patient is difficult.
• Equipment used to assist patient’s reparative process
creates noise.
• The sunlight today is proven to be harmful.
• What would Nightingale say about nursing today?

14. Click on picture for link to historical video

15. References
• Alligood, Martha Raile, and Ann Marriner Tomey. Nursing
Theorists and Their Work. 7th ed. Maryland Heights:
Mosby, 2010. Print.
• Cross, K. P. (1981). Adults as learners. Washington DC:
Jossey-Bass, a subsidiary of John Wiley & Sons.
• Finkelman, A., & Kenner, C. (2013). PROFESSIONAL
NURSING CONCEPTS: Competencies for Quality
Leadership (2nd ed.). Retrieved from
http://www.r2library.com/Resource/Title/1449649025
• Koernig Blais, K., & Hayes, J. (2011). Professional Nursing
Practice: Concepts and Perspectives (6th ed.). Saddle
River, NJ: Pearson.
• Nightingale, F. (1969). Notes on nursing: What it is and
what it is not. New York: Dover.