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70 UNIT II Nursing Philosophies

recovery. Elimination of contamination and contagion Weir-Hughes (2007) all have written about measure-
and exposure to fresh air, light, warmth, and quiet ment of patient outcomes and methods of quality
were identified as elements to be controlled or improvement based on Nightingale’s notions of
manipulated in the environment. Nightingale began to observation. The relation concepts (nurse, patient,
develop relationships between some of these elements and environment) remain applicable in all nursing
in her discussions of contamination and ventilation, settings today. Therefore they meet the criterion of
light and patient position in the room, cleanliness and generality.
darkness, and noise and patient stimulation. She also
described the relationship between the sickroom and Empirical Precision
the rest of the house and the relationship between the Concepts and relationships within Nightingale’s the-
house and the surrounding neighborhood. ory frequently are stated implicitly and are presented
The nurse-patient relationship may be the least as truths rather than as tentative, testable statements.
well defined in Nightingale’s writings. Yet cooperation In contrast to her quantitative research on mortality
and collaboration between the nurse and patient is performed in the Crimea, Nightingale advised the
suggested in her discussions of a patient’s eating pat- nurses of her day that their practice should be based
terns and preferences, the comfort of a beloved pet to on their observations and experiences. Her concepts
the patient, protection of the patient from emotional are amenable to studies with the qualitative approaches
distress, and conservation of energy while the patient of today as well as quantitative methods.
is allowed to participate in self-care. Finally, it is inter-
esting to note that Nightingale discussed the concept Derivable Consequences
of observation extensively, including its use to guide To an extraordinary degree, Nightingale’s writings
the care of patients and to measure improvement or direct the nurse to take action on behalf of the patient
lack of response to nursing interventions. and the nurse. These directives encompass the areas
of practice, research, and education. Her principles to
Simplicity shape nursing practice are the most specific. She
Nightingale provides a descriptive, explanatory theory. urges nurses to provide physicians with “not your
Its environmental focus along with its epidemiological opinion, however respectfully given, but your facts”
components has predictive potential. Nightingale could (Nightingale, 1969, p. 122). Similarly, she advises that
be said to have tested her theory in an informal manner “if you cannot get the habit of observation one way or
by collecting data and verifying improvements. She other, you had better give up being a nurse, for it is
intended to provide general rules and explanations that not your calling, however kind and anxious you may
would result in good nursing care for patients. Thus her be” (Nightingale, 1969, p. 113).
objective of setting forth general rules for the practice Nightingale’s view of humanity was consistent with
and development of nursing was met through this her theory of nursing. She believed in a creative, uni-
simple theory. versal humanity with the potential and ability for
growth and change (Dossey, 2000; Hektor, 1994;
Generality Palmer, 1977). Deeply religious, she viewed nursing as
Nightingale’s theories have been used to provide a means of doing the will of her God. The zeal and
general guidelines for all nurses since she introduced self-righteousness that come from being a reformer
them more than 150 years ago. Although some might explain some of her beliefs and the practices
activities that she described are no longer relevant, that she advocated. Finally, the period and place in
the universality and timelessness of her concepts which she lived, Victorian England, must be consid-
remain pertinent. Nurses are increasingly recogniz- ered if one is to understand and interpret her views.
ing the role of observation and measurement of Nightingale’s basic principles of environmental
outcomes as an essential component of nursing manipulation and care of the patient can be applied in
practice. Burnes Bolton and Goodenough (2003), contemporary nursing settings. Although subjected
Erlen (2007), Robb, Mackie, & Elcock (2007), and to some criticisms, her theory and her principles are