Florence Nightingale—Activist, Statistician, Author, and Nurse

Florence Nightingale was born into a life of privilege and ease but turned her back on it to dedicate herself to caring for others. Known as the founder of modern nursing, in reality, she was a polymath. In addition to her medical expertise, she was an accomplished statistician, a seasoned traveler, and a prolific writer. Above all, she was an activist who firmly rejected the stereotypical Victorian view of a woman’s place in favor of doing what needed to be done.

Nightingale transformed nursing from a rudimentary practice akin to domestic service into a modern profession. Her approach to care forever changed the way healthcare facilities treat patients. She is rightly considered the founder of modern nursing, and her career is characterized by the numerous personal sacrifices she made advocating for patient well-being amidst significant opposition. She remained single despite her many suitors, reasoning that married life would interfere with her calling.  She rejected the poet Richard Monckton Milnes after a nine-year courtship, much to the anguish of her mother and sister. Looking at Nightingale’s achievements in hindsight, she was a visionary, and perhaps she wouldn’t have accomplished so much with a husband and children to attend to.

Born into Privilege

Florence Nightingale was born in 1820 in Italy to upper-class English parents. Her father owned estates in Derbyshire and Hampshire, while her mother came from a family of prominent merchants. Florence was home-schooled by her father, who held advanced ideas on women’s education. She displayed a great aptitude for math and especially statistics, a skill she would use effectively in later life. She believed God had called her to help the vulnerable in society and informed her parents that she wanted to study nursing. They were resolutely opposed to this. It was not considered a suitable career choice for a young gentlewoman. The work had a bad reputation because the caregivers in those days were mainly lower-class, untrained, and regularly associated with depraved behavior. The hospitals where they worked were dirty, disorganized, and breeding grounds for infection. It’s not hard to see why a wealthy family would discourage their daughter from becoming a nurse. But Nightingale was not to be deterred; she educated herself in science and the arts before traveling to Germany for medical training.

A Life-Changing Posting

The Crimean war in 1854 brought to light the disturbing conditions in military hospitals. The subsequent public outcry prompted the English Minister of War to appoint Nightingale and a team of volunteer nurses to an army hospital in Scutari, in current-day Turkiye. Even though Nightingale and her team had been forewarned, nothing could have prepared them for the bloody shambles they witnessed first-hand. The stench from blocked drains was overwhelming. Patients were lying in their excrement on stretchers left in the hallways with rodents and cockroaches everywhere. Fundamentals like soap, water, and bandages were insufficiently supplied, even as the number of patients increased. Consequently, ten times more soldiers died from infectious illnesses like cholera, typhoid, and dysentery than combat wounds.

Nightingale sprang into action. She requested 80 additional nurses and 300 scrubbing brushes and put her team to work cleaning the hospital. She asked The Times to lobby the government, and as a result, the engineer Isambard Kingdom Brunel designed a field hospital that could be shipped to Crimea in sections. On a personal level, Florence gave soldiers the care they desperately needed. When night fell, she would continue her rounds carrying a lamp through the dark corridors as she attended to the sick. Her compassion moved the soldiers, earning her the nickname The Lady with the Lamp. Through Florence’s leadership, nurses brought the troops sanitation, nutritious food, cleanliness, and comfort. The patient mortality rate decreased by around 40% within six months.

Pioneer of Modern Nursing

Nightingale’s experiences during the Crimean war helped shape nursing today. Her revolutionary efforts to reform nursing by making it more human-centric are the basis of modern healthcare. Many of today’s healthcare practices originated with Nightingale’s work:

Infection Control

Infection control is vital in nursing and, as the name suggests, focuses on preventing or stopping the spread of illnesses in healthcare facilities. In the 19^th century, microbes and the chain of infection were not understood. This is one reason why infection rates in hospitals were high. Nightingale recognized the correlation between a clean environment and good health. This knowledge helped direct her nurses to clean the hospital serving soldiers in the Crimean War. She encouraged good hygiene by providing clean bed linens to patients, improving their diet, and practicing hand washing with soap and water. Modern hospitals employ people solely to maintain optimal sanitary conditions using appropriate disinfectants to eliminate disease-causing pathogens. As a result, medical facilities enjoy public trust as safe areas.

Patient Assessment

Most of us are familiar with the concept of patient assessment, where a doctor asks questions and performs physical exams to determine what is ailing you. This type of assessment gained prominence during the Crimean war as Nightingale attended to patients. She would take time to talk to and review the health status of soldiers before recommending care. Today, patient assessment is the initial part of the nursing process to model the clinical condition before constructing an effective care plan.

Therapeutic Communication

Compassionate care is another tenet of modern nursing that Nightingale pioneered. She listened to patients, providing the empathy and compassion they needed to avoid feeling hopeless. This element, popularly known as therapeutic communication, seeks to demonstrate empathy by prioritizing patients’ emotional, physical, and mental well-being. Nurses interact with patients sympathetically, addressing their reluctance, concerns, or worries. The goal is to assist patients in overcoming psychological or emotional distress. Therapeutic communication ultimately increases the accuracy of diagnoses and treatment adherence, leading to better outcomes.

Spiritual Care

Nightingale’s spiritual background—a devout Christian—influenced her treatment of patients. She believed that our bodies are God’s temple and that nurses must consider a person’s spiritual needs during care. She stuck by her patients’ side, bringing comfort even when they were dying. Currently, emphasis is given to the requirement for nurses to consider a patient’s faith and belief systems when caring for them. A growing body of evidence reveals that spirituality is vital for emotional wellness, especially for patients suffering from chronic or terminal illnesses. Spiritual distress is widespread among these individuals and their loved ones, and front-line nurses can help them cope. Spiritual awareness has been proven to enhance a patient’s health and life quality. It also plays a vital role in assisting patients in managing pain and handling the stress and suffering linked to severe sickness and the end of life.

Public Health Advocacy

As impressive as Nightingale’s other achievements were, perhaps her most significant accomplishment was bringing preventive health to the public’s attention. She emphasized the importance of simple measures that can have an impact on the health of a population.

As a statistician, Nightingale pioneered the use of statistics in understanding and demonstrating the effect cleanliness (or lack of it) had on population health. The work she did lead to the science of epidemiology. When she arrived in Scutari, she used statistics to prove that most soldiers died due to poor hygiene rather than their wounds. Her example lives on with hundreds of thousands of public health officials and nurses worldwide using data to curb and control diseases. These data are fundamental in measuring population care, mortality, and health needs and designing services that address those needs. Healthcare professionals also use data analysis to conduct and support health needs assessments, public health surveillance, health equity assessment, health protection, and performance management. The primary objective of this analysis is to enhance general wellness.

The Environmental Theory

The Nightingale transformation story wouldn’t be complete without mentioning the environmental theory she developed. According to this idea, nurses holistically manage the patient’s environment to help them recover. It prompts nurses to organize the total care environment to restore the patient’s health. In this context, Florence introduced pets, music, colors, flowers, and exercise to create a favorable environment that promotes healing.

The theory also posits that external elements linked to the patient’s surroundings impact their life, including physiological, biological, and developmental processes. The environmental factors Nightingale cites are clean water, proper sanitation, light, fresh air, and adequate drainage. All elements must be present for the best possible outcome, which still applies today.

The Nightingale Pledge

Nurses in America have taken the Nightingale Pledge since 1893 as they enter the profession or complete their training. The pledge is a declaration that commits a nurse to abide by nursing doctrines and ethics. Each nurse commits to serving humanity and raising the profession’s standards and status. The pledge also emphasizes cooperation and offers moral guidance regarding patient care.

Professionalizing Nursing

Nightingale’s determination to make nursing a respectable profession saw her open the first training school in 1860 after returning to London from Crimea. The school was the first of its kind, providing an official training program preparing nurses to work in hospitals, assist the poor, and educate others. Nightingale graduates furthered her legacy as many were appointed as matrons in major hospitals in England and overseas, setting up their training programs around the world.

The school is still open and specializes in training midwives. It also integrates nursing research, postgraduate programs, and professional development. Thousands of nursing professionals have graduated from this institution, including prominent figures like Alice Fisher, Ian Norman, and Anne Marie Rafferty.

Before Nightingale, nurses didn’t have formal training, and they mainly learned from experience. She established professional training standards by detailing education and duties in her ‘Notes on Nursing’ handbook. The book highlights the importance of observing patients closely to develop a proper diagnosis and treatment plan. It also advocates for sufficient ventilation, room cleanliness, home health, nutrition, confidentiality, and patient safety.

Nightingale’s Influence Today

Nightingale was selfless in her good deeds. She ignored the dangers she was exposing herself to as she served humanity and interacted freely with the sick. The emergence of Covid-19 as a deadly virus brought to light the selfless acts of nurses. Regardless of the heightened risk of exposure to the virus and inadequate clinical resources, they were and are still dedicated to offering front-line care. At the pandemic’s beginning, most nurses had to spend hours in the hospital and were isolated from their loved ones for long periods. Even the inadequacy of protective gear didn’t even stop these professionals from attending to infected patients. The number of Covid-19 casualties would have been higher if not for the sacrifices nurses have made. Nurses have always taken selfless measures to ease the pain of others. Nightingale serves as a good role model.

A Vision for a Better World

Nightingale transformed the world in remarkable ways. More than 200 years after her birth, she still inspires us, and nurses observe the principles she developed.

If courage had a face, then Nightingale would be it. Not only was she brave, but she was also unstoppable. Despite being opposed by the British upper classes and a patriarchy of doctors, politicians, and military leaders, she didn’t stop achieving. When she encountered challenges, she found a way around or over them. In many respects, she was a modern woman.

Nightingale knew she couldn’t transform nursing alone, so she contacted politicians, leaders, and other influential people for help. She advocated for the needs of her patients by presenting data about illness and statistics to influence stakeholders to act. She understood the power of cooperation and teamwork.

Florence Nightingale lived to be 90 years old and witnessed many of her recommendations implemented by hospitals in London and worldwide. Incredibly, her practices are still used to treat patients today. Nightingale was a pioneer in so many areas. Not only did she revolutionize nursing into a science-based profession, but she also invented epidemiology and the use of statistics to support patient care. For these and many other reasons, we celebrate her legacy and her example of how much difference individuals can make when they single-mindedly apply themselves to the problem at hand.

Edited by Michael Moss