Nightingale’s ideas about nursing have guided both theoretical thought and actual nursing practice throughout the history of modern nursing. Nightingale considered nursing similar to a religious calling to be answered only by women with an all-consuming and passionate response. She considered nursing to be both an art and a science and believed that nurses should be formally educated. Her writings did not focus on the nature of the person but did stress the importance of caring for the ill person rather than caring for the illness. In Nightingale’s view, the person was a passive recipient of care, and nursing’s primary focus was on the manipulation of the person’s environment to maintain or achieve a state of health. Despite the fact that she did not believe in the germ theory, her experiences in the Crimean War magnified her interest in the principles of sanitation and the relationship between environment and health. A person’s health was the direct result of environmental influences, specifically cleanliness, light, pure air, pure water, and efficient drainage. Through manipulating the environment, nursing “aims to discover the laws of nature that
would assist in putting the patient in the best possible condition so that nature can effect a cure” (Nightingale, 1859). Nursing’s main focus was health, and health was closely related to nursing. Nursing was concerned with the healthy, as well as the sick (Nightingale, 1859). Nightingale’s principles regarding environmenthealth- nursing were implemented in America at the turn of the 20th century. With the development of hospital- based schools of nursing, Nightingale’s principles of sanitation were used to clean up the rat-infested, dirty hospitals of the day. With the use of Nightingale’s ideas, hospitals became a place for people to recover rather than a place to die. When, for a variety of reasons, hospitals did not hire their own nursing graduates, nurses applied Nightingale’s principles in the community in the development of public health nursing. The Henry Street Settlement founded by Lillian Wald is an excellent example of Nightingale’s theory in practice. Private duty nursing and public health nursing remained the primary focus of nursing practice until World War II. At this time, there was a tremendous increase in scientific knowledge and technology affecting health care. As the practice of medicine became more scientifically based, more clients were cared for in hospital settings. Nursing practice likewise became centered in the hospital rather than the home. With this development, it became clear that nursing did not have an adequate theory base to organize new knowledge and guide nursing practice. Nursing began to further develop its knowledge base by incorporating the principles of Nightingale into modern nursing theory.