In 1859, Florence Nightingale published "Notes on Nursing: What It Is, and What It Is Not."
This slim volume became the foundation of modern nursing education. Her principles remain
remarkably relevant today.
1. Fresh Air
"The very first canon of nursing... is this: TO KEEP THE AIR HE BREATHES AS PURE AS
THE EXTERNAL AIR, WITHOUT CHILLING HIM." Nightingale was a fierce advocate for
ventilation—she believed stale air was a primary cause of disease.
2. Pure Water
Access to clean water was essential. At Scutari, she found soldiers drinking from
wells contaminated by sewage. Her first reforms focused on water supply and drainage.
3. Efficient Drainage
Proper sanitation saves lives. Before germ theory was accepted, Nightingale understood
empirically that proximity to sewage correlated with mortality.
4. Cleanliness
Of patients, of nurses, of bedding, of rooms. "The amount of relief and comfort
experienced by the sick after the skin has been carefully washed and dried, is one
of the commonest observations made at a sick bed."
5. Direct Sunlight
"Direct sunlight, not only daylight, is necessary for speedy recovery." Her hospital
designs incorporated large windows and outdoor spaces.
6. Proper Nutrition
"Every careful observer of the sick will agree in this, that thousands of patients
are annually starved in the midst of plenty." She organized kitchens to ensure
patients received adequate food.
7. Observation of the Patient
"The most important practical lesson that can be given to nurses is to teach them
what to observe—how to observe—what symptoms indicate improvement—what the
reverse—which are of importance—which are of none."
8. Variety
"The effect of beautiful objects, of variety of objects, and especially of brilliancy
of colour is hardly at all appreciated." She understood the psychological dimensions
of recovery.
9. Quiet
"Unnecessary noise, or noise that creates an expectation in the mind, is that which
hurts a patient." She wrote extensively about the harm of disturbing rest.
10. Management of the Environment
The nurse's job was not merely to administer medicine but to manage the entire
environment of care—air, light, warmth, cleanliness, diet, quiet.
"Nature alone cures... what nursing has to do... is to put the patient in the best
condition for nature to act upon him."
— Florence Nightingale, Notes on Nursing