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66 UNIT II Nursing Philosophies

patient. Her treatise on rural hygiene includes an the role of household servants and those trained
incredibly specific description of environmental specifically as nurses to provide care for the sick per-
problems and their results, as well as practical son. Nightingale (1969) believed that nurses needed
solutions to these problems for households and com- to be excellent observers of patients and the environ-
munities (Halsall, 1997). ment; observation was an ongoing activity for trained
Nightingale’s assumptions and understanding nurses. In addition, she believed that nurses should
about the environmental conditions of the day were use common sense in practice, coupled with observa-
most relevant to her philosophy. She believed that tion, perseverance, and ingenuity. Finally, Nightingale
sick poor people would benefit from environmental believed that people desired good health, that they
improvements that would affect both their bodies and would cooperate with the nurse and nature to allow
their minds. She believed that nurses could be instru- the reparative process to occur, and that they would
mental in changing the social status of the poor by alter their environment to prevent disease.
improving their physical living conditions. Although Nightingale has been ridiculed for say-
Many aristocrats of the time were unaware of the ing she didn’t embrace the germ theory, she very
living conditions of the poor. Nightingale’s mother, clearly understood the concept of contagion and
however, had visited and provided care to poor fami- contamination through organic materials from the
lies in the communities surrounding their estates; patient and the environment. Many of her observa-
Nightingale accompanied her on these visits as a tions are consistent with the concepts of infection
child and continued them when she was older. Thus and the germ theory; for example, she embraced the
Nightingale’s understandings of physical surround- concept of vaccination against various diseases.
ings and their effect on health was acquired through Small (2008) argues that Nightingale did indeed
first-hand observation and experience beyond her believe in a germ theory but not in the one that sug-
own comfortable living situation. gests that disease germs cause inevitable infection.
Such a theory was antithetical to her belief that
sanitation and good hygiene could prevent infec-
Theoretical Assertions tion. Her belief that appropriate manipulation of
Nightingale believed that disease was a reparative the environment could prevent disease underlies
process; disease was nature’s effort to remedy a modern sanitation activities.
process of poisoning or decay, or it was a reaction Nightingale did not explicitly discuss the caring
against the conditions in which a person was behaviors of nurses. She wrote very little about inter-
placed. Although these concepts seem ridiculous personal relationships, except as they influence the
today, they were more scientific than the prevailing patient’s reparative processes. She did describe the
ones of the time (e.g., disease as punishment). She phenomenon of being called to nursing and the need
often capitalized the word nature in her writings, for commitment to nursing work. Her own example
thereby suggesting that it was synonymous with of nursing practice in the Crimea provides evidence
God. Her Unitarian religious beliefs would support of caring behaviors. These include her commitment
this view of God as nature. However, when she to observing patients at night, a new concept and
used the word nature without capitalization, it is practice; sitting with them during the dying process;
unclear whether or not the intended meaning is standing beside them during surgical procedures;
different and perhaps synonymous with an organic writing letters for them; and providing a reading
pathological process. Nightingale believed that room and materials during their recuperation.
the role of nursing was to prevent an interruption Finally, she wrote letters to their families following
of the reparative process and to provide optimal soldiers’ deaths. Watson defines Nightingale’s descrip-
conditions for its enhancement, thus ensuring the tions/behaviors as a “blueprint for transpersonal
patient’s recovery. meanings and models of caring” (Watson, 2010,
Nightingale was totally committed to nursing edu- p. 107). Neils (2010) describes a nursing role of caring
cation (training). She wrote Notes on Nursing (1969) as a liaison nurse based on Nightingale’s description
for women caregivers, making a distinction between of rounding. She interprets this activity as a way of