Florence Nightingale, Part 2

This is part two of my three part post of a paper I wrote in 1994 while in nursing school. You can read part one here. Nightingale’s advice on sanitary practices, especially frequent hand washing, seems very relevant.

Amy Mittelman ©2020,                                                                                   Professional Nursing I, Fall 1994


In Nightingale’s view the environment was also nature centered and physically based; it was the nurse’s responsibility to manipulate it to provide sanitary conditions. Her emphasis was one of prevention. “True nursing ignores infection, except to prevent it.  Cleanliness and fresh air from open windows, with unremitting attentions to the patient, are the only defense a true nurse either asks or needs”[1] Giger, Davidhizar and Miller have found Nightingale’s focus on the environment to be similar to Sister Callista Roy’s adaptation nursing theory.[2]

In 1860 the germ theory of disease was not a part of scientific discourse.  As it became prevalent, Nightingale refused to believe it.[3] Because Nightingale believed that disease was a reparative process, external forces such as dirt, odors, and poor diet had to cause it. She would not accept that a person could get sick in sanitary conditions.  Nightingale did not believe that medicine was a “curative process . . . nature alone cures.”[4] Health was a state of nature; illness was a response to a disruption in that state.

Although Nightingale rejected the germ theory of disease which is a cornerstone of modern medicine and nursing, many of her opinions on sanitary practices are still appropriate. She emphasized frequent hand washing, the value of fresh air, the evils of dirty carpets, the importance of modulating the stimulus a patient receives, and the importance of maintaining a patient’s spirits. These all remain critical aspects of caring for a patient and effecting recovery.

Nightingale believed that the same guidelines of sanitation applied to the healthy as well as the sick. The person was a subject of nature and had the responsibility to observe nature’s law in such a manner (sanitary) as to avoid infection and illness.  Again, the emphasis was prevention.[5]

To Nightingale, the nurse’s role in the reparative process was “to put the patient in the best condition for nature to act upon him” She felt that nursing should “signify the proper use of fresh air, light, warmth, cleanliness, quiet and the proper administration of diet – all at the least expense of vital power to the patient.”[6]

Nightingale advocated a patient centered nursing. She stressed the importance of “sound observation” for “the sake of saving life and increasing health and comfort.” Although Nightingale emphasized the high level of attention that the nurse must undertake, she also pointed out the importance of delegating responsibility as a way of knowing that “what you do when you are there, shall be done when you are not there.”[7]


[1] Nightingale, Florence. 1860. Notes on nursing. New York: D. Appleton and Company, p. 34.

[2] Giger, Joyce N., Ruth Davidhizar, and Scott Wilson Miller. 1990. Nightingale and Roy: A comparison of nursing models. Today’s OR Nurse (April): 25-30.

[3] Vicinus, Martha, and Bea Nergaard. 1990. Ever yours, Florence Nightingale. Cambridge, Massachusetts: Harvard University Press.

[4] Nightingale, Notes, p.133.

[5] Ibid.

[6] Nightingale, Notes, p. 133, 8.

[7] Nightingale, Notes, p. 125, 35