More importantly, however, contemporary realists differ from Nightingale in four main areas, those of theistic assumption, methods of research, determinism, and naturalism. While contemporary realists certainly agree with Nightingale's position that simply realizing fact is not enough, and that actions based on findings is important (Porter, 2001), Nightingale inserted a certain assumption of God into her realistic viewpoints that modern realism avoids. Whereas Nightingale supported the concept that man's actions were dictated by God, modern realists recognize specific non-theistic causes for behaviors.

Secondly, Nightingale relied solely on quantitative method of research, since such methods were most available in her period. Such methods, involving the scientific, external, specific identification of patterns of events, are useful, but modern realists understand the need for individualistic understanding of information. Whereas Nightingale's focus was on identifying the patterns of relationships, modern realists focus more on understanding those relationships (Porter, 2001).

Third, modern realists differ slightly from Nightingale in their views on determinism. As discussed, Nightingale believed firmly in determinism, and believed no true free will of behavior existed (Porter, 2001). Modern realists, however, focus not only on the tendencies for patterns, rather than inevitable patterns of relationships (Porter, 2001). In this way, modern realists allow for flexibility in causation, whereas nightingale's hard deterministic stance did not.

Finally, modern realists recognize a unity between causation of social structure and natural structure. Whereas Nightingale held a naturalistic belief that social and natural events occur due to the same causation factors, modern realists see the two independently, in that social structures are the result of human action, while natural events occur due to natural law (Porter, 2001). Since human action is interpretable, such a belief breaks the naturalistic viewpoint.

Understanding these differences in realism views is vital to nursing practice. While Nightingale's harsh realism was acceptable in her time period, due to a reliance on theology and quantitative methods, such concepts are outdated, and should be rejected in modern nursing. While theological perspectives are important, understanding the basis of causation outside such a doctrine is vital to understanding modern causation of events, and thus, modern nursing concepts. The interpretable actions of individuals, outside of deterministic viewpoints, is vital to understanding human beings in the modern age, and is thus necessary to understanding the structures, norms, diseases, and atmospheres of modern man. Further, the break between social and natural law is necessary, in that natural law is not subjective. In order to fully comprehend causes and effects of specific nursing concepts, such an understanding of different levels of causation is necessary.

Porter (2001) concludes his article by noting the influence Nightingale's philosophy has had on modern nursing. While some critics have downplayed this influence, Porter is accurate in his analysis. He stresses the admitted limitations of her philosophy, such as her reliance on theological and religious aspects and quantitative research methods, due to the time period in which she lived, but also stresses the importance of her focus on the beginnings of a realistic approach to nursing and medicine. He points to Nightingale's insistence on deeper causes of illness and health, her focus on statistics as a means of measurement, and her linkage of fact and value. In this, Porter refers to the concept of understanding not only the disease and the etiology of disease, but also the experiences of those with disease and the social belief systems of the...

In other words, according to Porter, Nightingale's philosophy not only stresses the importance of health, but also of the social and personal ramifications of health on each individual (Porter, 2001).
Clearly, Porter's analysis is accurate. In looking at the role of nursing in the care of teenage pregnant woman, one can clearly recognize Nightingale's philosophical influences. First, Nightingale would stress the importance of how such a condition is presented and achieved. In modern nursing, the understanding of the overall process of pregnancy and the possible complications of such a condition on a younger female is vital to the care of such a patient. This is the positivist scientism role in the process.

However, in addition to understanding the basic condition, nurses also must understand how the young teens experience their pregnancy. Understanding how each individual feels about her condition is also vital to the care of the patient. In understanding the various ways in which individuals respond to their own pregnancy, nurses can learn to better assist others in similar situations, thus introducing the deterministic approach.

Furthermore, nurses must understand the social ramifications and causes for specific viewpoints about teenage pregnancy. In order to fully treat and understand a patient, the nurse must understand societal structures and how those structures promote false beliefs, in addition to understanding the values of such beliefs. In the case of the pregnant teen, one can clearly see that, in Western societies, such a condition is believed by society to be one of shame, since such a condition suggests promiscuity and a lack of safe sexual practices. These demeaning beliefs have an effect on the behaviors of the patient, in that such a social stigma can, in itself, create several manifestations of complications and irregularities during the pregnancy. It is only by understanding the scientific, deterministic, naturalistic, and social aspects of health that complete care can be achieved, and this paradigm is, at least in part, founded on the principles laid out by Nightingale.

Nightingale's firm belief in statistical analysis as a method of determining causation, her insistence on underlying causes of illness and health, and a firm belief in scientific knowledge as a basis for health and wellness, are clearly guidelines in modern medicine. Further, her instance that sociology plays an important role in health care has been vastly influential in modern nursing. Many in health care have moved beyond simply attempting to medicate the ill, and have begun to focus on underlying causes of health related issues, and on how to treat the entire individual. As one scholar noted, "Observation, not merely chemistry, must decide the care for the sick...Nightingale showed us the need for sympathetic treatment of each patient as a human being, with not only a body, but a mind, and a heart." (Allison Bashford, 2000, pg. 137).