Personal Reflective Thoughts about Florence Nightingale

Abstract

2020 has been proclaimed the Year or the Nurse. Recently I have been working on several projects (including the previous article) related to the evolution of the pediatric nurse. In the process, I have had the opportunity to review the lives and experiences of health care pioneers, Florence Nightingale being one. She was nurtured by her parents, especially her father, to do great things. She was provided learning opportunities that usually were limited to males. She was expected to and did excel in science, math, philosophy. Reflecting on her life, I have concluded that in many ways she was ahead of her time and exhibited attributes of feminism. She was passionate about being a nurse and refused to follow the wishes of her parents to marry and join the ranks of her social status. Instead, she followed her calling, entered nursing school, and became a passionate driven nurse, dedicated to her patients. She also was a visionary and knew from her work in the Crimean War that the world could be a better place if the environment were healthier. Being a career-long pediatric nurse, I had never given much attention to Florence Nightingale, assuming she was solely relevant to adults. However, on closer examination, I realized that her contributions to sanitation and hygiene have life-long impact, as did her meticulous recordkeeping and work in statistical infographics to convey meaning to numbers. What I did not know and am coming to appreciate in a new way are the depth and breadth of her contributions to nursing and public health. Documenting the cause of solider deaths highlighted the gravity of infections related to the squalid conditions of the field ‘hospitals.’ Believing that sanitation and cleanliness would decrease morbidity and mortality, she advocated for sanitation that encompassed air, water, sewerage disposal and environmental cleanliness. She used data to demonstrate that sanitation had the potential to reverse the ominous numbers. Her unrelenting championing for pure air, clean water, cleanliness and light eventually translated into the current measurable social determinants of health. Nightingale lived in the late 19th century, a time of turmoil, politically, socially and economically. In homes other than the wealthy, children were of little concern and went unnoticed until they could be ‘useful.’ The high death toll among children related to infectious disease and accidents was accepted as ‘life.’ Nightingale was one of the early providers to connect the effect of living in squalid conditions to increase in illness and infections. Thus, her emphasis on sanitation, fresh air, and nutrition. She introduced the concept that infant mortality provided sensitive data for measuring the health of a society. Interestingly the infant mortality rate continues to be used as an important marker of society's overall health. What I found particularly intriguing was her expressed fondness for children. She delighted in spending time with them and telling them stories. She advocated for a child-centered hospital environment including outdoor play space and child-size furniture. Christmas was always a special time and she would send toys, presents, and decorations to St. Thomas Hospital. She also demanded more nurses to care for children than adults as children needed to play and/or be entertained. Nightingale recognized that health promotion and disease prevention were essential for child well-being, not to mention adequate housing, cleanliness, nutrition and parental knowledge of early childcare. She wrote her Notes on Nursing, to provide guidance to help family members care for children. Promotion of cleanliness, safe drinking water, good nutrition, adequate living conditions and sanitation were the cornerstone of Nightingale's legacy to nursing practice and the health promotion of children and their families. Although I did know that she founded the first School of Nursing in London (1860), I did not appreciate that it was the first scientifically based school. Nightingale envisioned nursing education to occur in an academic setting where students were expected to critique information, ask critical questions and interpret findings. She formalized secular nursing education and made it a viable, respectable option for women. Nightingale was also a realist and knew her vision would take time to implement and poor and vulnerable patients needed assistance immediately. To this end she described a second tier of nursing training, one that was skill based and limited to assigned tasks, more like an apprentice. Although limiting, this approach meets an immediate need. Thanks to Dr. Curry's admonition to reflect on Florence Nightingale's contributions to nursing, I now appreciate her data-driven contributions in a new way. Nightingale's precepts that became the cornerstone of her legacy to nursing practice and the health promotion of children and their families are cleanliness, safe drinking water, good nutrition, adequate living conditions and sanitation. Her precepts related to nursing were devotion, hard work, advancing technical skills, and interpreting assessment findings.