FLORENCE NIGHTINGALE'S NOTES ON NURSING
Overview
Nightingale maintained that every woman is a nurse because every woman, at one time or another in her life, has charge of the personal health of someone. Nightingale equated knowledge of nursing with knowledge of sanitation. The focus of nursing knowledge was how to keep the body free from disease or in such a condition that it could recover from disease. According to Nightingale, nursing ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient. That is, she maintained that the purpose of nursing was to put patients in the best condition for nature to act upon them.
Implications for Nursing Practice
Nursing practice encompasses care of both well and sick people. Nursing actions focus on both patients and their environments. Thirteen “hints” provided the boundaries of nursing practice:

1. 
   Ventilation and warming—the nurse must be concerned first with keeping the air that patients breathe as pure as the external air, without chilling them.
   
2. 
   Health of houses—attention to pure air, pure water, efficient drainage, cleanliness, and light will secure the health of houses.
   
3. 
   Petty management—all the results of good nursing may be negated by one defect: not knowing how to manage what you do when you are there and what shall be done when you are not there.
   
4. 
   Noise—unnecessary noise, or noise that creates an expectation in the mind, is that which hurts patients. Anything that wakes patients suddenly out of their sleep will invariably put them into a state of greater excitement and do them more serious and lasting mischief than any continuous noise, however loud.
   
5. 
   Variety—the nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings during a long confinement to one or two rooms. The majority of cheerful cases are to be found among those patients who are not confined to one room, whatever their suffering, and the majority of depressed cases will be seen among those subjected to a long monotony of objects about them.
   
6. 
   Taking food—the nurse should be conscious of patients' diets and remember how much food each patient has had and ought to have each day.
   
7. 
   What food?—to watch for the opinions the patient's stomach gives, rather than to read “analyses of foods,” is the business of all those who have to decide what the patient should eat.
   
8. 
   Bed and bedding—the patient should have a clean bed every 12 hours. The bed should be narrow, so that the patient does not feel “out of humanity's reach.” The bed should not be so high that the patient cannot easily get in and out of it. The bed should be in the lightest spot in the room, preferably near a window. Pillows should be used to support the back below the breathing apparatus, to allow shoulders room to fall back, and to support the head without throwing it forward.
   
9. 
   Light—with the sick, second only to their need of fresh air is their need of light. Light, especially direct sunlight, has a purifying effect upon the air of a room.
   
10. 
    Cleanliness of rooms and walls—the greater part of nursing consists in preserving cleanliness. The inside air can be kept clean only by excessive care to rid rooms and their furnishings of the organic matter and dust with which they become saturated. Without cleanliness, you cannot have all the effects of ventilation; without ventilation, you can have no thorough cleanliness.
    
11. 
    Personal cleanliness—nurses should always remember that if they allow patients to remain unwashed or to remain in clothing saturated with perspiration or other excretion, they are interfering injuriously with the natural processes of health just as much as if they were to give their patients a dose of slow poison.
    
12. 
    Chattering hopes and advices—there is scarcely a greater worry which invalids have to endure than the incurable hopes of their friends. All friends, visitors, and attendants of the sick should avoid the practice of attempting to cheer the sick by making light of their danger and by exaggerating their probabilities of recovery.
    
13. 
    Observation of the sick—the most important practical lesson nurses can learn is what to observe, how to observe, which symptoms indicate improvement, which indicate the reverse, which are important, which are not, and which are the evidence of neglect and what kind of neglect.
    

Implications for Nursing Education
Nightingale's primary contribution to nursing education was her belief that nursing schools should be administratively and economically independent from hospitals, even though the training could take place in the hospital. The purpose of nursing education was to teach the theoretical and practical knowledge underlying physician's orders. Knowledge of the 13 “hints” for nursing practice was considered an essential part of the training of every nurse.

References

• Nightingale, F. (1859). Notes on nursing: What it is, and what it is not. London: Harrison and Sons. [Commemorative edition printed by J. B. Lippincott Company, Philadelphia, 1992]

VIRGINIA HENDERSON'S DEFINITION OF NURSING
Overview
The unique function of the nurse is to help individuals, sick or well, to perform those activities contributing to health or its recovery (or to peaceful death) that they would perform unaided if they had the necessary strength, will, or knowledge, and to do this in such a way as to help them gain independence as soon as possible.
Implications for Nursing Practice
The practice of nursing requires nurses to know and understand patients by putting themselves in the place of the patients. Nurses should not take at face value everything that patients say, but rather should interact with patients to ascertain their true feelings. Basic nursing care involves helping the patient perform the following activities unaided:

1. Breathe normally.
   
2. Eat and drink adequately.
   
3. Eliminate body wastes.
   
4. Move and maintain desirable postures.
   
5. Sleep and rest.
   
6. Select suitable clothes and dress and undress.
   
7. Maintain body temperature within normal range by adjusting clothing and modifying the environment.
   
8. Keep the body clean and well groomed and protect the integument.
   
9. Avoid dangers in the environment and avoid injuring others.
   
10. Communicate with others in expressing emotions, needs, fears, or opinions.
    
11. Worship according to one's faith.
    
12. Work in such a way that there is a sense of accomplishment.
    
13. Play or participate in various forms of recreation.
    
14. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.
    

Implications for Nursing Education
Henderson's definition of nursing identifies an area of health and human welfare in which the nurse is an expert and independent practitioner. This kind of nursing requires a liberal education within a college or university, with grounding in the physical, biological, and social sciences and ability to use analytic processes. The professional aspects of the curriculum should focus on the nurse's major function of supplementing patients when they need strength, will, or knowledge in performing daily activities or in carrying out prescribed therapy, with emphasis on the individualization of patient care.

References

• Henderson, V. (1966). The nature of nursing. A definition and its implications for practice, research, and education. New York: Macmillan.