Conceptual Model in Nursing Analysis: Florence Nightingale’s Theory

Abstract

Florence Nightingale’s model of nursing is based on accentuating the role of the environment in affecting patients’ health outcomes. The purpose of this paper is to investigate Nightingale’s theory and assess its contribution to nursing and application in a modern healthcare context.

The analysis of the model indicates its origins, assumptions, unique focus, and content. The evaluation section provides conclusions regarding the value and congruence of the theory to influence nursing knowledge, practice, education, and administration. The application section presents the examples of how it is possible to apply Nightingale’s model to nurses’ daily practice. The findings of the analysis allow for concluding about the effectiveness of Nightingale’s model to contribute to knowledge and be applied to modern practice in spite of being developed in the 1800s.

Conceptual Model Analysis: Florence Nightingale’s Theory

Florence Nightingale (1820-1910) is usually regarded as the first theorist in the field of nursing. Nightingale’s theory of nursing based on accentuating the role of the environment in the process of healing is one of the most influential theoretical models (Smith & Parker, 2015). The rationale for selecting Nightingale as a theorist to discuss with reference to her theoretical assumptions and practical contributions is that her model can be considered as widely recognized, basic, and actively applied in healthcare even today. Furthermore, her beliefs about nursing and principles of caring are valued and shared by nurses from all over the globe. Nightingale was the first one to state that nursing should be separated from medicine and that the environment is critically important for patients’ outcomes.

Nightingale’s background played a key role in forming the model based on emphasizing such environmental aspects as light, noise, cleanliness, and food and their impact on a patient’s health. The theorist worked as a nurse during the Crimean War and observed how the lack of sanitation caused high mortality rates among patients. Nightingale noticed the same problems in other hospitals, and she focused on studying the nature of diseases and healing to open a nurse school at St. Thomas Hospital in London (Smith & Parker, 2015). The purpose of this paper is to analyze Nightingale’s theory and evaluate its contribution and application to modern nursing practice.

Analysis

Origins of the Model

The historical evolution of Nightingale’s theory is associated with the development of her views based on her experience as a nurse working during the Crimean War and as a volunteering nurse working in the hospitals of Britain, Germany, and France. After observing how patients suffer and die because of the lack of care and a supportive environment in hospitals, Nightingale developed her philosophical views based on her motivation to relieve patients’ suffering. Thus, Nightingale formulated her caring philosophy in Notes on Nursing (1859): individuals need to be put in an advantageous condition to be treated (Smith & Parker, 2015).

If a patient experiences discomfort or suffers from an inappropriate environment, this aspect influences their healing. This position was the result of Nightingale’s observation during her work, and she was not influenced by other theorists, but she became the first recognized theorist in the field of nursing (Karimi & Alavi, 2015). Referring to her experience, Nightingale formed the model of caring and the environment in nursing based on the humanistic worldview and the accentuation of the action.

Unique Focus

The unique focus of Nightingale’s model is on the environment in which a patient is cared and on a nurse’s actions to improve this environment and promote an individual’s recovery. Since the focus is on creating a comfortable environment for a patient, a nurse is expected to ensure that warmth, cleanliness, light, fresh air, food, and the level of noise in a hospital room contribute to a patient’s health (Pirani, 2016). Therefore, the category of nursing knowledge that is reflected in this theoretical model is an empirical one. The reason is that the model is action-oriented and practical or empirical in its nature as a nurse’s activities can directly influence a patient’s health and the process of healing.

Content

In her theory, Nightingale declared such ideas that the environment is more important for healing and nurses’ consideration than a disease process; hygiene is critical for health; a nurse’s observation is significant to promote wellbeing. Nightingale’s model includes the following components: nursing with a focus on management and observation and the environment with a focus on ventilation, warming, and the “health of houses” (Karim, 2015). In this model, the “health of houses” includes light, noise, bedding, cleanliness, food, and hopes (Sher & Akhtar, 2018, p. 2). The components of this model are presented in their relation to each other in Figure 1.

Nightingale’s model of nursing.
Figure 1. Nightingale’s model of nursing (Smith & Parker, 2015, p. 51).

Theorist Name: Florence Nightingale

Table 1 explains how Nightingale viewed such concepts as the person, health, environment, and nursing in the context of her theoretical model.

Table 1. Model Analysis Table: Metaparadigm.

Concept as defined by this theorist Definition and terminology as used by this theorist Example
Person: A person in this model is a patient who can accumulate their own powers to recover from the disease (Karim, 2015). Nightingale did not provide a specific definition of a person in the context of nursing, and she referred to a patient as any individual requiring a nurse’s care (Pirani, 2016).
Health: Nightingale believed that a person becomes healthy as a result of natural laws, and it is possible to manipulate environmental factors to support health (Pirani, 2016). Health is not discussed as the absence of a disease but as a result of influencing environmental factors and accumulating the power a person has to become healthy (Sher & Akhtar, 2018).
Environment: The key component of Nightingale’s model. The environment “that promotes health allows the patient to retain their energy, or vital powers for use towards self-healing” (as cited in Sher & Akhtar, 2018, p. 1). The physical environment includes such elements as ventilation, cleanliness, warming, light, noise, bedding, and food. There are also social and psychological environments (Smith & Parker, 2015).
Nursing: Art and science, the modification of an environment to assist a patient. According to Nightingale, “I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices” (as cited in Sher & Akhtar, 2018, p. 1). Nurses should be well-trained to address patients’ needs when managing the environment (Sher & Akhtar, 2018).

Evaluation

Explication of Origins

Philosophical claims associated with Nightingale’s model can be regarded as explicit because the theorist strictly declared her visions and position as a nurse. Thus, according to Nightingale, the role of a nurse is to focus on a patient’s needs changing their environments and “put the patient in the best condition for nature to act upon him” (as cited in Smith & Parker, 2015, p. 50). However, when developing her theory, Nightingale referred only to her own experience and observation. That is why, despite being explicit, her philosophical views are not based on other scholars’ ideas as she was a pioneer in theorizing the aspects of nursing.

Comprehensiveness of Content

In Nightingale’s model, three out of four metaparadigm concepts are described in detail, and the concept of a person has no explicit definition. However, the role of a patient is explained in relation to other concepts in Nightingale’s writings. Furthermore, the model demonstrates a strong link between the four concepts as it is explained by the theorist that allows for speaking about the depth of the theory (Pirani, 2016).

Additional propositions are related to theoretical assumptions (for example, the role of natural laws and nursing as art and science, separated from medicine), statements of nursing goals, outcomes of a nurse’s actions for patients, and nursing as a calling (Sher & Akhtar, 2018). It is possible to state that the model is broad in its scope to guide nursing research, practice, education, and administration. The reason is that Nightingale’s theory became the ground for later nursing models, and its principles are still taught for nurses and applied in care settings as basic ones.

Logical Congruence

Nightingale’s model can be discussed as logically congruent because only one world view was considered by the theorist in order to provide a frame for her ideas. According to Nightingale, nursing can be achieved only through changing environmental factors to improve a patient’s state (Karim, 2015). This idea informs the theorist’s overall model and accentuates the correlation and linkage between its components. In this context, only one congruent frame is observed in this theory of nursing.

Generation of Theory

Nightingale is recognized as the first theorist in nursing, that is why, her model provided the background for the development of a range of currently used grand and middle-range theories. The most explicit examples of Nightingale’s impact on the development of theories can be observed with reference to the theory by Algase about the need-driven-dementia-compromised behavior (Smith & Parker, 2015). In other theories, the model influenced the vision of the aspect of the environment as one of the key concepts of nursing theory.

Legitimacy

The practical character of Nightingale’s model, when health outcomes depend on the management of the environment, makes the theory rather feasible and compatible with patients’ expectations. Thus, all the pieces of advice and principles formulated by the theorist decades ago are easily implemented in a modern healthcare setting, leading to positive health outcomes (Karim, 2015). It is possible to state that the legitimacy and effectiveness of care based on this model is supported by years of application and evidence.

Contributions

The contribution of Nightingale’s model to nursing is in accentuating an important relationship between the environment, a nurse’s actions, and a patient’s outcomes. Furthermore, the theorist described the role and responsibility of a nurse in the context of her model (Pirani, 2016). As a result, modern nurses are educated according to these basic principles to guarantee patients are placed in supportive physical and psychological environments to contribute to their recovery.

Application

Application to Real-World Nursing

In modern nursing education, much attention is paid to studying Nightingale’s model as a holistic theory explaining the principles of thoughtful nursing practice. This theoretical model is also easily applied to nurses’ work because, in their daily activities, nurses supervise environmental conditions in rooms and patients’ nutrition (Pirani, 2016). Furthermore, in the context of administration, much attention is paid to realizing regular sanitation procedures grounded in Nightingale’s ideas.

Applicability of the Model to Specific Situations

Nightingale’s theory can be applied in situations when it is necessary to prevent wound infection, for example. In the context of the model, a nurse needs to guarantee supporting personal hygiene for a patient and environmental cleanliness to prevent infection. Furthermore, it is necessary to ensure proper ventilation and temperature in a room. Much attention should also be paid to bedding because this aspect can also provoke complications (Karim, 2015). If these points are addressed, it is possible to expect positive health outcomes for a patient with severe wounds. Thus, Nightingale’s theory is expected to be applied in nurses’ practice on a daily basis in the context of following hospital hygiene norms.

Theorist’s Views in Congruence with a Nurse’s Views

Nightingale’s views provide the ground for forming my personal views of nursing. The reason is that Nightingale’s ideas about nursing as a calling and the role of the environment in promoting the process of healing are reflected in my practice as a nurse. I am sure that a nurse is responsible for providing a patient with effective environmental conditions to promote their recovery. Despite the fact that these actions are rather simple and basic, they are important for caring, and problems arise when the views promoted by Nightingale are ignored.

Conclusion

The paper has provided the analysis of Nightingale’s model of nursing with a focus on its purpose, content, propositions, assumptions, and visions in the context of the four concepts of nursing. The evaluation of the model indicates that it is rather efficient and logical to be actively applied in nursing education, for developing nursing knowledge, and in practice. Thus, the conclusions regarding the application of the model to nurses’ everyday activities are positive because the overall character of the model is practical and empirical.

References

Karim, H. N. (2015). Clinical application of Nightingale theory. International Journal of Innovative Research & Development, 4(11), 225-227.

Karimi, H., & Alavi, N. M. (2015). Florence Nightingale: The mother of nursing. Nursing and Midwifery Studies, 4(2), e29475. Web.

Pirani, S. A. (2016). Application of Nightingale’s theory in nursing practice. Annals of Nursing and Practice, 3(1), 1-3.

Sher, A. N. A., & Akhtar, A. (2018). Clinical application of Nightingale’s theory. Journal of Clinical Research and Bioethics, 9(4), 1-3. Web.

Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). F.A. Davis.