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CHAPTER 6 Florence Nightingale 65

Nightingale’s carefully collected information that Person
illustrated the efficacy of her hospital nursing system In most of her writings, Nightingale referred to the
and organization during the Crimean War is perhaps person as a patient. Nurses performed tasks to and for
her best-known work. Her report of her experiences the patient and controlled the patient’s environment
and collected data was submitted to the British Royal to enhance recovery. For the most part, Nightingale
Sanitary Commission in Notes on Matters Affecting described a passive patient in this relationship. How-
the Health, Efficiency, and Hospital Administration ever, specific references are made to the patient per-
of the British Army Founded Chiefly on the Experience forming self-care when possible and, in particular,
of the Late War (Nightingale, 1858a). This Commis- being involved in the timing and substance of meals.
sion had been organized in response to Nightingale’s The nurse was to ask the patient about his or her
charges of poor sanitary conditions. The data in this preferences, which reveals the belief that Nightingale
report provided a strong argument in favor of her saw each patient as an individual. However, Nightin-
proposed reforms in the Crimean hospital barracks. gale (1969) emphasized that the nurse was in control
According to Cohen (1984), she created the polar of and responsible for the patient’s environmental
area diagram to represent dramatically the extent surroundings. Nightingale had respect for persons of
of needless death in British military hospitals in the various backgrounds and was not judgmental about
Crimea. In this article, Cohen summarized the work social worth.
of Nightingale as both a researcher and a statistician
by noting that “she helped to pioneer the revolution- Health
ary notion that social phenomena could be objectively Nightingale defined health as being well and using
measured and subjected to mathematical analysis” every power (resource) to the fullest extent in living life.
(1984, p. 128). Palmer (1977) described Nightingale’s Additionally, she saw disease and illness as a reparative
research skills as including recording, communicat- process that nature instituted when a person did not
ing, ordering, coding, conceptualizing, inferring, ana- attend to health concerns. Nightingale envisioned the
lyzing, and synthesizing. The observation of social maintenance of health through prevention of disease
phenomena at both individual and systems level via environmental control and social responsibility.
was especially important to Nightingale and served What she described led to public health nursing and
as the basis of her writings. Nightingale emphasized the more modern concept of health promotion. She
the concurrent use of observation and performance distinguished the concept of health nursing as different
of tasks in the education of nurses and expected from nursing a sick patient to enhance recovery, and
them to continue to use both of these activities from living better until peaceful death. Her concept of
in their work. health nursing exists today in the role of district nurses
and health workers in England and in other countries
Major Assumptions where lay health care workers are used to maintain
health and teach people how to prevent disease and
Nursing illness. Her concept of health nursing is a model
Nightingale believed that every woman, at one time in employed by many public health agencies and depart-
her life, would be a nurse in the sense that nursing is ments in the United States.
being responsible for someone else’s health. Nightin-
gale’s book Notes on Nursing was published originally Environment
in 1859, to provide women with guidelines for caring Nightingale’s concept of environment emphasized
for their loved ones at home and to give advice on that nursing was “to assist nature in healing the
how to “think like a nurse” (Nightingale, 1969, p. 4). patient. Little, if anything, in the patient’s world is
Trained nurses, however, were to learn additional excluded from her definition of environment. Her
scientific principles to be applied in their work and admonition to nurses, both those providing care in
were to be more skilled in observing and reporting the home and trained nurses in hospitals, was to
patients’ health status while providing care as the create and maintain a therapeutic environment that
patient recovered. would enhance the comfort and recovery of the