Florence Nightingale, Part 3

This is part three of my three part post of a paper I wrote in 1994 about Florence Nightingale. You can read part one here and part two here. I had a good time revisiting this paper from almost thirty years ago.

Amy Mittelman ©2020, Professional Nursing I,                                                           Fall 1994


Lauren Smith used the Nightingale concept of management to frame her discussion of clinical nurse specialist (CNS) managed care for the chronically ill child.  In myelomeningocele clinics in Ohio, clinical nurse specialists provide case management.  Smith argues that this case management has provided early identification and intervention, continuity of care, increased parental advocacy skills, improved social and development skills for the children as well as professional growth and interdisciplinary collegiality for the nurses. She feels this work has carried out Nightingale’s directive of knowing that “what you do when you are there shall be done when you are not there.”[1]

Smith’s article was part of two in a recent issue of Clinical Nurse Specialist presented under the heading “Florence Nightingale: A CNS Role Model.”[2] The other article, “CNS Roles in Implementation of a Differentiated Case Management Model,” did not mention Nightingale.[3]

In doing research for this paper, I found many references to Nightingale, particularly in Japanese nursing literature. I disagree with the opinion expressed a few weeks ago that modern nursing views Nightingale as outdated. She remains a starting point for many nurse scholars and many nurses are eager to link their work with hers.  This may explain why that article appeared under the rubric “Florence Nightingale: A CNS Role Model” even though it did not mention Nightingale. Other examples of this are an article in Nurse Educator that is a letter by a nursing student to Nightingale and a response written by a Nightingale scholar, an article by Elise Gropper that claims Nightingale as “Nursing’s First Environmental Theorist,” and the work by Giger, Davidhizar and Miller that links Roy and Nightingale.[4]

Smith is an example of clinical use of an aspect of Nightingale’s theory. However, there are not that many explicit clinical examples because many of her themes – particularly asepsis – are an integral and unquestioned part of nursing today.  A Nightingale nurse caring for an ill hospitalized patient would not focus on the medical aspects of the patient’s condition. Nightingale did not consider that part of the nurse’s domain. As a Nightingale nurse you would assess the environment of the patient, paying particular attention to sanitary issues. You would draw your diagnoses from those functional health patterns that are environmentally oriented including Activity-Exercise, Sleep-Rest, Role-Relationship and Nutritional. Decreased Cardiac Output would not be an appropriate Nightingale diagnosis, but Impaired Physical Mobility or Impaired Skin Integrity would be. Your goals for the patient would focus on preventing illness from environmental conditions. Thus, your interventions would involve repositioning if the patient was bedridden, providing a restful, clean atmosphere and keeping the patient’s skin clean and dry to prevent skin breakdown.

Florence Nightingale had a tremendous impact on the history and development of nursing as a profession. I found it interesting and informative to read her work.  Many of her practical suggestions are still applicable today. Perhaps her claim that “observation, ingenuity and perseverance … really constitute the nurse” says it all.[5]

[1] Smith, Lauren D. 1994. Continuity of care through nursing: Case management of the chronically ill child. Clinical Nurse Specialist 8 (2), p. 68.

[2] Sparacino, Patricia S.A. 1994. Florence Nightingale: A CNS role model. Clinical Nurse Specialist 8 (2): 64.

[3] Brubakken, Karen, Wendy R. Janssen, and Diane L. Ruppel. 1994. CNS roles in implementation of a differentiated case management model. Clinical Nurse Specialist 8 (2): 69-73.

[4] Decker, Bernita, and Joanne K. Farley. 1991. What would Nightingale say? Nurse Educator 16 (May/June): 12-13; Gropper, Elise I. 1990. Florence Nightingale: Nursing’s first environmental theorist. Nursing Forum 25: 30-33; 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.

[5] Nightingale, Florence. 1860. Notes on nursing. New York: D. Appleton and Company, p. 65.