The Crimean War: Putting Theory Into Practice

When the Crimean War broke out, she began work at once in a British hospital. Her emphasis was placed on maintaining proper hygiene and the importance of the nurse's role in managing the environment. Nightingale tied her religious beliefs to theory about the causes of disease, distinguishing her from other disease theorists of the time. She believed that god create miasmatic disease so that man should learn its causes through observation. Man was then supposed to prevent its reoccurrence through management of their environment (Atwell, 1998).

She believed that nurses had a special responsibility in this process and thus, a chance for spiritual advancement through this practice (Atwell, 1998). She felt that one could learn the nature of God through learning his laws of health (Atwell, 1998). Nightingale did not learn what she knew about disease through her formal training at Kaiserwerth, but through her own careful observation and reflection (Atwell, 1998). Her nurses training programs reflected what she had learned through observation and reflection.

One of the key difficulties that Nightingale had in her positions as nurse was that she needed to make her ideals known. However, society was not ready to accept women in leadership roles. Doctors and nurses were set up in a hierarchy that could not be broken. Nightingale had to be careful to acknowledge that hierarchy. Otherwise it could lead to the rejection of her ideas. In order to get her ideas across, she had to work within the established social system.

When Nightingale began working in the hospital during the Crimean War, she felt that she could improve the conditions at the hospital with her knowledge. The Secretary of the State for War also saw the logic in her methods. He appointed Nightingale to superintend a group of nurses. This was the first time a woman had held an official position in the Army (Atwell, 1998).

These experiences during the Crimean War allowed Nightingale to put her theories into practice for the first time. She recognized the problems with the system immediately, but had to step lightly in order to preserve her ability to continue working in this setting. She immediately placed her nurses under the orders of the doctors and immediately established a hospital laundry (Atwell, 1998). Within a month she had provided new bedding, significantly improved conditions there, and improved hospital diets (Atwell, 1998).

Nightingale not only saw to the medical and physical needs of the patients, she saw to their emotional needs as well. She wrote letter for them, devised a method for remitting money to their families, and provided reading rooms and games for those that were convalescing (Atwell, 1998). She walked the floors at night with a lamp, keeping watch. She became respected among the men for her treatment of them (Atwell, 1998).

She also provided for setting up a pathology lab and insisted that junior surgeons continue to attend lectures during their service time (Atwell, 1998). She also insisted that soldiers refrain from the problems associated with the drink and promiscuity (Atwell, 1998). Upon returning from the war, Nightingale began a public campaign to reform civilian hospitals as well. She was not satisfied with the mismanagement of hospitals that caused 16,000 deaths from disease, while only 4,000 had died in battle. She caused quite an uproar and demanded an investigation by the government, seeing those deaths as senseless (Atwell, 1998).

In 1859, Florence Nightingale established the Nightingale School for the training of nurses (Atwell, 1998). This training school emphasized hands-on training over textbook knowledge. This school transformed the field and perception of the nurse from a lower level member of society to that of a respected professional. Soon her theories and philosophy spread all over the world and formed the basis for modern nursing practice.

The Theories of Florence Nightingale

One can easily see how Nightingale's life and experiences led to the development of her theories. Her existence outside of the social circles of the upper class gave her a unique perspective. She saw the problems and used her social influence and education to further her ideas. Although it is important to understand how Nightingale's thought patterns developed in connection to her theories, her autobiography is not the focus of this research project. The focus of the research is on the theories themselves and how the impact that they have on modern nursing practice.

Metaparadigms of the Theory

Metaparadigms in the field of nursing are those concepts that identify the principles of central interest to the profession. These four concepts...

Health is the main nursing concern for the population in question. Florence Nightingale was one of the first to promote the concept of public health. Not only was she concerned about the health of individuals. She was concerned about improving the health of the community as a whole.
The second metaparadigm of the nursing profession is the person. Florence Nightingale established reading rooms and game rooms in order to help with the person's mental health. She believed in treating the whole person, not just the part affected by disease or injury. She worked to make patients comfortable, as well as treating their injuries. She would often write letter home for them and sit and talk with them in order to comfort them. She treated the whole person, which is a key metaparadigm of the nursing profession.

The third metaparadigm of the nursing profession is the environment. Florence Nightingale made tremendous strides in improving the environment within hospital wards. She increased the light, air flow, and provided better meals. However, she also demonstrated concern for the environment of the community by her participation in the development of public works to help promote health and sanitation in the city.

The fourth metaparadigm is the principle of nursing itself. Florence Nightingale promoted the concept of health through not only her daily practice within the professional scope, but also she worked to make the nursing profession a respected field of study. She insisted that her nursing students remain upright citizens of the community both in and out of the work setting. Only those with dedication and a true desire were allowed to remain in the school and continue their profession. This key concept still drives those that choose the nursing profession today.

Although these metaparadigms are the ultimate abstraction of the concepts of nursing practice, Florence Nightingale was able to put them into practice on a macro level. The work of Florence Nightingale exemplifies how these concepts can become guiding concepts that result in real changes for personal and public health. They demonstrate how the nurse can affect real changes on the health status of the community in which they live.

Nightingale's theory was unified through the idea that a nurse's training could not be separated from their spiritual and moral development. Her theory of learning emphasized practical skills. It can be summarized in the following quote.

"Observation tell how the patient is; reflection tells what is to be done; training tells how it is to be done. Training and experience are, of course, necessary to teach us, too, how to observe, how to think, what to think. (Nightingale, 1882, in Atwell, 1998).

This statement guided Nightingale nursing training and formed the core of her nursing theories. Nightingale emphasize teaching the nurse to learn how to learn. She did not believe that training stopped after the nurse finished her schooling. She saw nursing as a never-ending process of acquiring knowledge and putting it into practice.

Not surprisingly, this metaparadigm led to her protest against the registration of nurses after they received their training (Atwell, 1998). She felt that after they attained their registered status that they would discontinue the nursing practice. Nightingale's major theory was based on the idea of continual improvement, one that still drives the nursing profession today. Nurses of today depend on Nightingale's model of continual learning and improvement as the basis for professional development.

Education and continual improvement were the major paradigms of Nightingale's theories. All of the other concepts and methods had to meet these two tests and standards. Nightingale emphasized education both inside and outside of the hospital setting. She sponsored educational workhouses for the poor (Atwell, 1998). Nightingale believed in treating everyone as equals, not matter what their station in life happened to be. Humanitarianism was the first, and most important overriding tenet of Nightingale's theory throughout her life.

Nightingale philosophy is laced with elements of her profound devotion to God and her "calling" into the life and works. She had a very real interaction with God and elements of her beliefs can be found throughout her writings. She had a Protestant work ethic and was inclusive of all people, not only the wealthy and upper society (Shaner, 2006).

Seven Assumptions

Seven key assumptions served as the basis for model development and theory. These are known as the 7 Nightingale Philosophical Assumptions and are still the key tenets that form the foundation of…