Florence Nightingale Rules

Florence Nightingale (1820-1910) transformed the practice of nursing in 1860 with the publication of her seminal work, "Notes on Nursing." Miss Nightingale sets forth 13 rule categories for caring for sick and impaired patients. She calls the rules "hints." Her primary concerns were patient sanitary conditions, environmental conditions, patient care, management and patient observation techniques.

Background

• Florence Nightingale was privileged, and provided with a classical education. Nursing was not a respected profession in the mid-19th century, but despite family pressure, Nightingale received medical training at a hospital in Kaiserwerth, Germany. Her Crimean War nursing experience was the basis for "Notes on Nursing."

Ventilation and Warming

• Nightingale was a visionary. Her concerns about environmental sanitation may be found in modern hospital practices. The Nightingale Institute for Health and the Environment recognizes the inextricable link between human and environmental health. Her first three rules relate to air quality, petty management practices and healthy housing. She stresses the importance of open windows on opposite sides of a room to allow cross-ventilation. She believed the source of human disease was caused by miasmas, or foul air, according to the Florence Nightingale Museum website.

Noise

• According to "Notes on Nursing," Nightingale recognized sick people require special consideration due to their unavoidable confinement in a hospital or at home. Rule 4 warns that "unnecessary noise, or noise that creates an expectation in the mind, is what hurts the patient." She emphasized the importance of allowing patients undisturbed rest.

  Nurses should not require patients to repeat messages, and equally important is that nurses should always face the patient when speaking. Nightingale considered interruptions or sudden communications by nurses to patients harmful. Nurses should never sit, lean or unnecessarily shake a patient's bed. Nurses should express concise communications to patients and avoid explanations of the reasoning behind the decision.

  Though not all music is acceptable, she found wind instruments, stringed instruments and the human voice beneficial to patients.

Variety

• According to rule 5, form and color in the patient's surroundings is important. Nightingale espouses the virtues of mind over body healing by attending to the patient's request for varied food substances, cut flowers and a view of the outdoors.

Patient Food

• Nourishment and liquids are essential to patient recovery and survival. Rules 6 and 7 set guidelines for food intake and types of foods most beneficial for patients. Nightingale stresses the importance of nurses' exercise of professional judgment. She details the advantages of beef tea and the need to develop a precise and consistent schedule. She advises nurses to consult patients on timing and personal preference.

Bed and Bedding

• According to rule 8, patients' bedding should be washed or aired out frequently. Nightingale specifies the dimension, size and composition of an ideal patient bed. Patients should be given pillow arrangements that support the back and optimize breathing capacity.

Light and Cleanliness

• Nightingale believed in the need for patients' cleanliness, and rules 9, 10 and 11 relate to reducing germs in the patient's environment. Walls and floors require meticulous daily cleaning, she believed, and sufficient light in the patient's room is important. Adequate lighting, she stated, was important for proper cleaning and for a patient's attitude. Subsequent to the publication of her "Notes on Nursing," Joseph Lister found that disease is caused by germs. Nightingale accepted the germ theory.

False-Hope Chattering

• According to rule 12, nurses, visitors and family members should avoid chattering or trivializing the patient's condition. Nightingale says extending unsolicited advice to sick patients is generally not advisable

Observation

• The nurse's ability to observe and report the condition of a patient requires a careful analysis of the idiosyncrasies of the patient and other relevant factors. The art and science of observation is gained by a nurse's experience. Rule 13 provides a framework for observing temperament, skin color, physical weakness and other factors critical to an analysis of observable changes in patients.