Nursing Theories


Nursing Theories and Florence Nightingale


Modern nursing is one of the most complex field and one that is highly dynamic and further embraces the element of multi focused approaches. As such, nurses have to constantly stay ahead of the changing curve to ensure that they are equipped with the most recent and relevant skills for best practices. This was not the case before Florence Nightingale, as she revolutionized the nursing practices (University of Texas, 2016).The main goals in the modern nursing as attributed to times of Florence in the field include the development of a caring environment that is safe and further promotes the patients’ health and well-being. This also calls for the effective use of the interpersonal tools, with reference to aspects such as advocacy which builds on enhancing the care giving environment. During the early development of the modern nursing, Florence majored on advocacy. One of the main ways that Florence brought to the nursing theory is around the clock care. She also used statistical evidence and patient records to enhance the practice. She is also recorded as having practiced patient centered care, an element that is crucial to the nursing theory and modern nursing practices(Hickman, 2016). This paper evaluates how Florence Nightingale revolutionized the modern nursing practices by enhancing the nursing theory.

Florence Nightingale

Florence was the philosophical founder of the modern secular nursing practices. She was largely recognized a nurse theorist, administrator, communicator, educator statistician, environmental activist and an integralist (Frello&Carraro, 2013). Before Florence changed the practice, most of the nurses considered their profession as any other job and not much emphasis was paid to the care practices. Ideally the nursing practice was regarded as one of the low status jobs in the job market and as such, the few that joined the profession were largely unmotivated.

‘Until the mid-nineteenth century, nursing was not an activity, which was thought to demand either skill or training. Nor did it command respect. As Florence Nightingale was to put it, nursing was left to ‘those who were too old, too weak, too drunken, too dirty, too stupid or too bad to do anything else’. The intimate body services to be done for the patient were considered to be unseemly or immodest for young unmarried or well-bred females, especially if not a family member. Cleaning and feeding of another person were regarded as domestic tasks performed by servants.’ (, 2016)

Due to the low rank of the profession at the time, quite a majority of the people that joined the field were untrained. Much of the practice was thus left to experience. As nurses practiced through trial and error, they improved on their skills. Relative to the poor quality of care delivery, diseases, health conditions and even treatable ailments ran havoc in the society. Anyone that got sick or injured at the time was at a very high risk of death; not just from whatever they immune system was fighting, but from malpractices in the profession. Treatable conditions became epidemics killing in the thousands, while medical errors were a common practice.

During her career as a nurse, treating most of the men in the army during the Crimean war brought subtle changes to the profession. She introduced the element of education and responsibilities to nursing practices. As such nurses now had to be trained on the various evolving skills in the field and further required that the nurses are held responsible for their actions when treating patients. This streamlined the practice and improved the patients’ outcome. Some of the three main ways that she improved the nursing practice to what is reflected in the modern nursing practices is through introducing patient centered care. This meant that the patients were treated in close reference to what their needs dictated (Selanders& Crane, 2012). Nurses no longer forced their patients into treatment plans that their patients did not approve. Further, she brought about evidence based care. This was elemental to the education of the nurses and collecting information on the various aspects of the practices. The records would then be compiled to help with future cases (Hickman, 2016). She constantly kept neat records of her patients, which is a now a widely practiced approach in patient care. She also had an element of being proactive, such that she would constantly check on her patients even at night. It is for this reason that she became known as the “Lady with the Lamp”(University of Texas, 2016). The element of being proactive is one that is practiced in the nursing field in association with first care. Much of her philosophies that are part of the nursing practice were inscribed in the Notes of Nursing, a text book that was first released in the 1960. This brought some new light into the practice, documenting ways in which the nursing field could be streamlined, banking on education. The shift in the nursing practices that Florence brought to nursing and the nursing theories is laid out in the general improvement that has been experienced in the field over the years.

Florence challenged the prevailing theories at the time by changing the practices to suit the shifting paradigms. Care was now oriented on the patients’ needs. This meant that the nurses have to consult their patients on the best way they can achieve what it is that they want. In the past, nurses carried the final decision without consulting the patients about their goals. At the same time there has been a massive change on the element of evidence based care approaches. Since the introduction of education in the nursing practices, the approaches to health care management have improved and continue to grow with the advent of new and improved nursing practices (Frello&Carraro, 2013).Evidence based practices is a foundation practice in the nursing field and one that since improved the patient outcomes significantly. Medical records have also enhanced the way that patients are treated, as previous medical conditions and treatment plans along other relevant information are used to formulate the best treatment plans and achieve the best outcomes.

Recent development in terms of practice, skills, research and policies are a close indication of the impact that Florence had in this field. These are facets that have continually been shaped by the background of her work (Frello&Carraro, 2013). One of the theories that is built on the foundation by Florence is the humanistic nursing theory. Kleiman and McCamant have carried out a number of independent studies on the same (Wu & Volker, 2011). The theory largely embodies, nursing that embraces everyday world and experiences. The nurses use the approach of human to human rather than human to patient interaction. This helps in relating with the patient, and better understanding the needs of the patient to boost the outcomes and expectations (Wu & Volker, 2011). This further builds on the proactive approach introduced by Florence and further enhances the nursing theory. One other theorist that has been quite influential is Anne Case. This is a theory that further enhances the elemental approach by Florence on patient centered care (Smallman, 2016). Developed in 1988, the theory has been refined, to specifically help child nurses to work with the children and their families for more focused care. While the theory is still young, it is expected to contribute to the nursing theory significantly (Smallman, 2016).


Conclusively, the nursing practices have benefited from the changes that were introduced by Florence Nightingale. With aspects such as patient centered care, patients are now assured of goals oriented care that reflect their needs and match their expected outcomes (University of Texas, 2016). Nurses are also able to make better decisions with evidence based care and further with the help of the medical records. This has led to the revolution of the theory of nursing.


Frello, A. &Carraro, T. (2013). Florence nightingale’s contributions: an integrative review of the literature. Esc Anna Nery, 17(3), 573-579. Hickman, J. (2016). An Introduction to Nursing Theory (1st ed.).

Selanders, L. & Crane, P. (2012).The Voice of Florence Nightingale on Advocacy.OJIN: The Online Journal Of Issues In Nursing, 17(1).

University of Texas,.(2016). “The lady with the lamp” and her contributions to modern nursing « UT Health Science Center Retrieved 4 August 2016, from,. (2016). University of Glasgow – Schools – School of Medicine, Dentistry and Nursing – About us – A Significant Medical History – 20th Century – Nursing. Retrieved 5 August 2016, from

Wu, H. & Volker, D. (2011). Humanistic Nursing Theory: application to hospice and palliative care. Journal Of Advanced Nursing, 68(2), 471-479.

SMALLMAN, A. (2016). ASSESSMENT OF NEED AND MODELS OF CARE (1st ed.). Retrieved from


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