Early Nursing Theorists

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Florence Nightingale

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),[3] 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.