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CHAPTER 6 Florence Nightingale 67

expressing caring and spiritual support while also by careful record keeping. From her own training, her
achieving other nursing observations. Straughair brief experience as a superintendent in London, and
(2012) reports that a loss of compassion in nursing her experiences in the Crimea, she made observations
(as a component of caring) was identified by patients and established principles for nurse training and
in the National Health Service in England and pleads patient care (Nightingale, 1969).
for nursing attention to this aspect of Nightingale’s
Christian ideal of professional nursing. Acceptance by the Nursing Community
Similarly, both Burkhart and Hogan (2008) and
Wu and Lin (2011) have conducted research to Practice
identify the spiritual care in nursing practice as first Nightingale’s nursing principles remain the foundation
described by Nightingale. The settings of these stud- of nursing practice today. The environmental aspects
ies (U.S. and Taiwan) reflect the universality of of her theory (i.e., ventilation, warmth, quiet, diet, and
Nightingale’s work. Straughair (2012) makes the cleanliness) remain integral components of nursing
case that there needs to be a rediscovery of compas- care. As nurses practice in the twenty-first century,
sion that appears to be diminishing in modern the relevance of her concepts continues; in fact, they
nursing. Finally, Wagner and White (2010) explore have increased relevance as a global society faces
and analyze “caring relationships” in Nightingale’s new issues of disease control. Although modern sanita-
own writings. This historical study contributes to tion and water treatment have controlled traditional
our understanding of how Nightingale described sources of disease fairly successfully in the United
the modern concept of caring. States, contaminated water due to environmental
Nightingale believed that nurses should be moral changes or to the introduction of uncommon contami-
agents. She addressed their professional relationship nants remains a health issue in many communities.
with their patients; she instructed them on the prin- Global travel has altered dramatically the actual and
ciple of confidentiality and advocated for care of the potential spread of disease. Modern sanitation, ade-
poor to improve their health and social situations. In quate water treatment, and recognition and control
addition, she commented on patient decision making, of other methods of disease transmission remain
a component of a relevant modern ethical concept. challenges for nurses worldwide.
Nightingale (1969) called for concise and clear deci- New environmental concerns have been created by
sion making by the nurse and physician regarding the modern architecture (e.g., sick-building syndrome);
patient, noting that indecision (irresolution) or nurses need to ask whether modern, environmentally
changing the mind is more harmful to the patient controlled buildings meet Nightingale’s principle
than the patient having to make a decision. Hoyt of good ventilation. On the other hand, controlled
(2010) analyzed how Nightingale defined nursing environments increasingly protect the public from
as an ethical profession and the ethical practices second-hand cigarette smoke, toxic gases, auto emis-
embedded in nursing. sions, and other environmental hazards. Disposal
of these wastes, including toxic waste, and the use
of chemicals in this modern society challenge profes-
Logical Form sional nurses and other health care professionals
Nightingale used inductive reasoning to extract laws of to reassess the concept of a healthy environment
health, disease, and nursing from her observations and (Butterfield, 1999; Gropper, 1990; Michigan Nurses
experiences. Her childhood education, particularly in Association (MNA), 1999; Sessler, 1999). Shaner-
philosophy and mathematics, may have contributed McRae, McRae, and Jas (2007) described environ-
to her logical thinking and inductive reasoning abili- mental conditions of our hospitals that affect not only
ties. For example, her observations of the conditions the individual patient environment but also the larger
in the Scutari hospital led her to conclude that the environment incorporating multiple environmental
contaminated, dirty, dark environment led to disease. concepts identified by Nightingale. While they focus
Not only did she prevent disease from flourishing in on Western hospitals, it is evident that this is a global
such an environment, but also validated the outcome challenge for nurses.