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CHAPTER 6 Florence Nightingale 69

Hospital and King’s College Hospital in London. Using science and practice throughout the world. Most
the Nightingale model of nurse training, the following notable is her focus on surroundings (environment)
three experimental schools were established in the and their importance to nursing. Finally, it is interest-
United States in 1873 (Ashley, 1976): ing to note that Nightingale used brief case studies,
1. Bellevue Hospital in New York possible exemplars, to illustrate a number of the con-
2. New Haven Hospital in Connecticut cepts that she discussed in Notes on Nursing (1969).
3. Massachusetts Hospital in Boston
The influence of this training system and of many of
its principles is still evident in today’s nursing pro- Further Development
grams. Although Nightingale advocated independence Nightingale’s philosophy and theory of nursing are
of the nursing school from a hospital to ensure that stated clearly and concisely in Notes on Nursing
students would not become involved in the hospital’s (1969), Nightingale’s most widely known work. In
labor pool as part of their training, American nursing this writing, she provides guidance for care of the sick
schools were unable to achieve such independence and in so doing clarifies what nursing is and what it
for many years (Ashley, 1976). Nightingale (Decker & is not. The content of the text seems most amenable
Farley, 1991) believed that the art of nursing could not to theory analysis. Hardy (1978) proposed that Night-
be measured by licensing examinations, but she used ingale formulated a grand theory that explains the
testing methods, including case studies (notes), for totality of behavior. As knowledge of nursing theory
nursing probationers at St. Thomas’s Hospital. has developed, Nightingale’s work has come to be
Clearly, Nightingale understood that good practice recognized as a philosophy of nursing. Although
could result only from good education. This message some formulations have been tested, most often prin-
resounds throughout her writings on nursing. Night- ciples are derived from anecdotal situations to illus-
ingale historian Joanne Farley responded to a modern trate their meaning and support their claims. Her
nursing student by noting that “Training is to teach a work is often discussed as a theory, and it is clear
nurse to know her business . . . Training is to enable that Nightingale’s premises provide a foundation for
the nurse to act for the best . . . like an intelligent and the development of both nursing practice and current
responsible being” (Decker & Farley, 1991, pp. 12–13). nursing theories. Tourville and Ingalls (2003) de-
It is difficult to imagine what the care of sick human scribed Nightingale as the trunk of the living tree
beings would be like if Nightingale had not defined of nursing theories.
the educational needs of nurses and established these
first schools. Critique
Research Clarity
Nightingale’s interest in scientific inquiry and statistics Nightingale’s work is clear and easily understood. It
continues to define the scientific inquiry used in nurs- contains the following three major relationships:
ing research. She was exceptionally efficient and 1. Environment to patient
resourceful in her ability to gather and analyze data; 2. Nurse to environment
her ability to represent data graphically was first iden- 3. Nurse to patient
tified in the polar diagrams, the graphical illustration Nightingale believed that the environment was
style that she invented (Agnew, 1958; Cohen, 1984; the main factor that created illness in a patient and
McDonald, 2010b). Her empirical approach to solving regarded disease as “the reactions of kindly nature
problems of health care delivery is obvious in the data against the conditions in which we have placed our-
that she included in her numerous reports and letters. selves” (Nightingale, 1969, p. 56). Nightingale recog-
When Nightingale’s writings are defined and ana- nized the potential harmfulness of an environment,
lyzed as theory, they are seen to present a philo- and she emphasized the benefit of a good environment
sophical approach that is applicable in modern in preventing disease.
nursing. Concepts that Nightingale identified serve The nurse’s practice includes manipulation of the
as the basis for research adding to modern nursing environment in a number of ways to enhance patient