Early Nursing Theorists
Florence Nightingale, born into Victorian English society, was an affluent young woman educated in Latin, mathematics, philosophy, religion, and modern languages. She is famous for her role n the Crimean War, on her return to England she decided to use her resources to reform nursing.
She is considered to be the first nursing theorist. One of her theories was the Environmental Theory, which incorporated the restoration of the usual health status of the nurse's clients into the delivery of healthcare—it is still practiced today. In her preface to "Notes on Nursing: what it is and what it is not" she wrote:
"Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognized as the knowledge which everyone ought to have -- distinct from medical knowledge, which only a profession can have."[i]
Nightingale stated in her nursing notes that nursing "is an act of utilizing the environment of the patient to assist him in his recovery" (Nightingale 1860/1969), that it involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health, and that external factors associated with the patient's surroundings affect life or biologic and physiologic processes, and his development.
Environmental factors affecting health
· Pure fresh air- "to keep the air he breathes as pure as the external air without chilling him/her."
· Pure water- "well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer."
· Effective drainage- "all the while the sewer maybe nothing but a laboratory from which epidemic disease and ill health is being installed into the house."
· Cleanliness- "the greater part of nursing consists in preserving cleanliness."
· Light (especially direct sunlight)- "the usefulness of light in treating disease is very important."
Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status. The factors posed great significance during Nightingale's time, when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients. Also emphasized in her environmental theory is the provision of a quiet or noise-free and warm environment, attending to patient's dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient.
Florence Nightingale recognized the necessity for collecting scientific data. Her careful documentation and logical planning during the Crimean War have been credited with reducing the death rate of wounded soldiers from 427 per 1,000 to 22 per 1,000 in a six-month period. Because of her abilities with statistics, she has been called her the "Lady with the Slide Rule”.[ii]
[i] Nightingale, Florence.1860/1969. Notes on Nursing, what it is and what it is not. Preface, p.3 Dover Publications
[ii] Sarkis, op.cit.
Virginia Avenel Henderson
Nurse Theorist, Teacher, Researcher and Author.
Virginia Avenel Henderson was born in Kansas City, Missouri, in 1897. With two of her brothers serving in the armed forces World War I she enrolled in the Army School of Nursing at Walter Reed Army Hospital and graduated in 1921.
As Reverby points out, “the model for the trained nurse stressed discipline, self-sacrifice and order.”[i]Regimentation of patient care was common in the hospitals of that time and not unexpected in a military hospital. Students were treated like cadets in the U. S. Military Academy. Courses were taken at Teacher's College, Columbia University under the direction of her mentor, Miss Annie Goodrich.[i] Henderson described her introduction to nursing as a “series of almost unrelated procedures, beginning with an unoccupied bed and progressing to aspiration of body cavities” [ii] (Henderson, 1991,p. 9). Faced with this situation, Virginia Henderson began to question both the Regimentation of patient care and the concept also very prevalent, of nursing as ancillary to medicine. She earned her BS in 1931 and a Master's degree in 1934 from Teachers College, Columbia University,
Nurses practicing in the early twentieth century tended to be task oriented and, while they provided care for patients, few considered nursing’s unique role in health care. Henderson wrote about nursing the way she lived it: focusing on what nurses do, how nurses function, and on nursing’s unique role in health care.[i]
She began her career as a nurse educator in 1924 at the Norfolk Protestant Hospital in Virginia where she was the first and only teacher in the school of nursing. After five years there she returned to New York to begin formal degree studies in nursing at Teacher's College.[i]
Henderson believed that the nurse has the responsibility to assess the needs of the individual patient, help individuals meet their health needs, and/or provide an environment in which the individual can perform activities unaided. In the her 1966 publication, The Nature of Nursing, Henderson stated: “It is my contention that the nurse is, and should be legally, an independent practitioner and able to make independent judgments as long as he, or she, is not diagnosing, prescribing treatment for disease, or making a prognosis, for these are the physician’s functions” (Henderson, 1966, p. 22). [ii]
Henderson’s Concept of Nursing:
“The unique function of the nurse is to assist the individual, sick, or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge”.[i]