Health was viewed as an additive process, the result of environmental, physical, and psychological factors, not just the absence of disease. Disease was the reparative process of the body to correct a problem, and could provide an opportunity for spiritual growth. The laws of health, as defined by Nightingale, were those to do with keeping the person, and the population, healthy. This was dependent upon proper environmental control—for example, sanitation. The environment was what the nurse manipulated. It included those physical elements external to the patient. Nightingale isolated five environmental components essential to an individual’s health: clean air, pure water, efficient drainage, cleanliness, and light.
Consistent with this caring base is Nightingale’s views on nursing as an art and a science. Again, this was a reflection of the marriage, essential to Nightingale’s underlying worldview, of science and spirituality. On the surface, these might appear to be odd bedfellows; however, this marriage flows directly from Nightingale’s underlying religious and philosophic views, which were operationalized in her nursing practice. Nightingale was an empiricist, valuing the “science” of observation with the intent of use of that knowledge to better the life of humankind. The application of that knowledge required an artist’s skill, far greater than that of the painter or sculptor:
Nursing is an art; and if it is to be made an art, it requires as exclusive a devotion, as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or cold marble, compared with having to do with the living body—the Temple of God’s spirit? It is one of the Fine Arts; I had almost said, the finest of the Fine Arts.Nightingale’s ideas about nursing health, the environment, and the person were grounded in experience; she regarded one’s sense observations as the only reliable means of obtaining and verifying knowledge. Theory must be reformulated if inconsistent with empirical evidence. This experiential knowledge was then to be transformed into empirically based generalizations, an inductive process, to arrive at, for example, the laws of health. Regardless of Nightingale’s commitment to empiricism and experiential knowledge, her early education and religious experience also shaped this emerging knowledge.
According to Nightingale’s model, nursing contributes to the ability of persons to maintain and restore health directly or indirectly through managing the environment. The person has a key role in his or her own health, and this health is a function of the interaction between person, nurse, and environment. However, neither the person nor the environment is discussed as influencing, in turn, the nurse. Nightingale’s education, spiritual development, her time in the Crimea, as well as the role of women in the nineteenth century all affected the development of Nightingale’s ideas about nursing. Although it is difficult to describe the interrelationship of the concepts in the Nightingale model. Note the prominence of “observation” on the outer circle, important to all nursing functions, as well as the interrelationship of the specifics of the interventions such as “bed and bedding” and “cleanliness of rooms and walls” that go into making up the “health of houses.”