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 Table of Contents  
MEDICAL HISTORY
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 144-148

Florence Nightingale: The queen of nurses


Department of Paediatric Nursing, Yenepoya Nursing College, Yenepoya University, Mangalore, Karnataka, India

Date of Web Publication2-Jun-2016

Correspondence Address:
Asha P Shetty
Department of Paediatric Nursing, Yenepoya Nursing College, Yenepoya University, Deralakatte, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4848.183362

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  Abstract 

Florence Nightingale, who was called as “the lady with the lamp,” by the sick and injured at Crimean war, has laid down strong foundational principles in nursing. Her multitasked role contributed significantly toward the development of nursing profession into structured institution. As an administrator, educator, researcher Nightingale's contributions moved nursing from disrespectable profession into replacing more of autonomy and evidence-based practice.

Keywords: Advocacy, Florence Nightingale nursing research, nursing


How to cite this article:
Shetty AP. Florence Nightingale: The queen of nurses. Arch Med Health Sci 2016;4:144-8

How to cite this URL:
Shetty AP. Florence Nightingale: The queen of nurses. Arch Med Health Sci [serial online] 2016 [cited 2017 Dec 14];4:144-8. Available from: http://www.amhsjournal.org/text.asp?2016/4/1/144/183362


  Introduction Top


Nursing, a caring profession was multifaceted in the nineteenth century amidst the complexities such as societal acceptance, gender discrimination, and the educational preparation. It has paved the way into intricate nursing care as provided by the professional nurse to meet the basic nursing interventions. A woman with her dedication, conviction, and profound vision transformed the status of nursing from that of domestic service to that of the profession. She seemed to be a goddess with lamp sent from heaven to those who were on the death threshold, and they called this woman as “The Lady with the Lamp.”

This woman who was born in a wealthy family with a life of luxury is Florence Nightingale, dedicated her entire life to serve humankind. Her untiring effort to develop nursing as an essential and educative component of the health care has made the nursing profession deep-rooted on the solid foundation even today.


  God — Given Purpose Top


Florence Nightingale was the second child of wealthy couple William and Frances Nightingale born in Florence, Italy, on May 12, 1820. She was born in Florence and hence name of the city was attached to her. Her father was a wealthy landowner, provided her with classical education including studies in German, French, and Italian.

Her mother Francis Nightingale hailed from the merchant family and had a strong desire for social climbing, whereas Nightingale was awkward in social situations. She had a strong religious conviction. She was an intellectual child performing exceptionally well in mathematics and learning multiple languages.

Despite her family's wealth Florence had great concern toward ill and poor people. She seemed to be comfortable with solitary activities such as reading and journal writing. She believed that God wanted her to work with him to improve the well-being of humankind. She wrote, “The highest honor is to be God's servant and fellow worker.”[1]

Nightingale's family had a great desire to get her married into a prominent family. Perhaps Nightingale had enormous desire in helping sick people and rejected the proposals. She wrote.[2] “I think I am got something more good natured and complying” in her own defense. By the age of 16, she decided that she received a distinct call from God and was clear that nursing was her calling. Despite her parent's objections, Nightingale enrolled as a nursing student at the Lutheran Hospital of Pastor Fliedner in Kaiserswerth, Germany, in 1844, as she was determined to pursue her true calling. In 1851, she completed her training and further 1853, went for additional training in Paris, with Sisters of Mercy.


  The Crimean War Top


Florence returned to London in 1853, after her training. She was appointed as a superintendent of a hospital in Harley Street in Central London, a hospital which was meant to serve poor women. During the service, she developed effective skills and demonstrated that competent care is basic human right to all human.

Conflicts between Russia and Turkey resulted in the declaration of war in 1853. Fighting broke out in Crimea on the shore of the Black Sea. Florence Nightingale is probably famous for her service during Crimean war. The military hospitals were located in Scutari. A very close friend of Nightingale, Sidney Herbert, Secretary of the war, consented her and a group of female nurses to organize and manage camp to take care of the wounded soldiers. As the number of sick and wounded rose, the dirt and callous conditions deteriorated rapidly. She demonstrated dexterity in providing personal care to wounded soldiers and played a significant role in improving their psychological health. Her leadership was reflected in transforming the hospital into health environment. She ensured cleanliness, sanitation, nutritious food and comfort to the wounded soldiers. She attended every sick and injured including writing letters to their family to place them at ease and improve their psychological health. She was conscientiously promoting well-being of soldiers [Figure 1]. It was the soldiers in Crimean that initially named her the “lady with the lamp” because of the reassuring sight of her carrying around a lamp to check on the sick and wounded during the night, and the title remained with her.[3] Nightingale responded to the British war office's request for advice on army medical care in Canada and was also a consultant to the United States government on army health during the American Civil War.[4]
Figure 1: Florence Nightingale as team leader taking care of sick and injured in Crimean war

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Florence returned to England in 1856. People had recognized her serves which even led to decreasing mortality. Queen Victoria sent her a medal with a letter of appreciation. She was in very poor health when she returned since she toiled without rest for 2 years. Her nerves were debilitated and her heart was weak, and she would faint every now and then. Doctors advised her to take complete long rest to restore her vigor. However, her reply was “work is rest for me.”


  Transformation: Nursing as a Profession Top


Nightingale's strenuous efforts during Crimean war influenced her to establish nursing as a profession. She pioneered the concept of education for nurses and influenced the nursing education to a great extent. In 1860 in London, she opened first training institute for nurses names “Nightingale Nurse's Training School” at St. Thomas's Hospital.[5] Training in nursing school was based on two principles. First that the nurses should have practical training in hospitals specially organized for that purpose. The other was that the nurses should live in a home fit to form a moral life and discipline. Due to the foundation of this school, Nightingale had achieved the transformation of nursing from its disreputable past into a responsible and respectable career for women.[6] She herself interviewed every candidate and selected the candidate based on merit.

Nightingale believed that every woman at one time or another would be a nurse in the sense that nursing was to have the responsibility for someone's health. She envisioned health as being maintained through the prevention of disease via environmental health factors. Nightingale said, “Badly constructed houses do for the healthy what badly constructed hospital do for the sick.”[7]

Nightingale had learnt from her enormous experience that even on the verge of death one could continue to work if only one had the willpower.[8] She was a brave woman and took initiative to reform health and sanitation. She envisioned health as being maintained through the prevention of disease via environmental health factors. She believed that nursing is to have responsibility to promote someone's health. Nightingale gave a tremendous amount of time and thought to the ways and means that could be carried out and so really laid the foundation of public health work in the country.[7] She inspired nurses and hospital workers and became the symbol of compassionate health care. She is considered as the first nursing theorist, although her writings differ in form, tone, terminology, and style from those of contemporary theorists.

Though there are controversies against Nightingale, the principles of sanitation, cleanliness, nutrition are the guiding principles of practice even today. She incessantly strived hard to improve the nursing care. She framed policies to improve the working conditions as well as competent and cost effective care by the hospitals. Her tireless efforts to reform nursing education and zeal to improve health care to human being provided firm footing to the philosophy of nursing. The series of letters written by Nightingale after her enormous experience she gained in Crimean war, documented the development of nursing as well as suggestions to improve the health care by providing competent and caring nursing care. At the age of 90, she breathed her last, in 1910 August 15 leaving her inspiration for the nursing profession [Figure 2].
Figure 2: The rare photograph of Florence Nightingale was taken by Lizzie Caswall Smith in 1910 Photo: SWNS

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  Looking Back to Nightingales Contribution Top


Nursing, unlike the past, has grown tremendously in a more structured way. The conventional education to the nurse in a submissive position has been replaced by autonomy in working place. Nightingale's contribution to the present nursing scenario is significant in education, practice, research as well as administration. Her significant contributions include her advocacy for egalitarian human rights and for advocacy in her leadership roles. Nursing is now recognizing how her ideas and techniques can be useful in the 21st century.[8]

Nightingale demonstrated excellent managerial skills. She wrote several books which related to nursing featuring the essentials for nursing practice which have been guiding principles even today. She emphasized the procedure to be established for a sound practice which is possible for the next person to continue to practice even when other one is not available.[9] Nightingale stressed on transparency in addition to the competent, effective practice. She was methodical and believed that a hospital can be better managed with team work and if functioned in more organized way.

As an administrator, Nightingale's effort to improve the working conditions for effective nursing care very much applicable even today. Her practice of attempts in coordination with multidisciplinary members, though military personnel at Scutari expected her to be obedient and listen to the orders has thrown light into autonomy in nursing practice today. She believed that the availability of adequate supplies for care will result in efficiency of the hospital.


  Advocacy in Nursing Top


Advocacy refers to an active process of supporting for a cause. It was evident that nursing in earlier days was confirmed to a position subservient to physician. Nightingale's effort to bring advocacy in nursing was to replace autonomy to nurses in working place and also to help the person who is the care receiver. As a novice nurse, it is expected to be obedient and continue to be submissive throughout the profession. However, Nightingale's effort was implicit to have advocacy in nursing to transform the profession for an effective outcome. Though advocacy in nursing was not much evident until past few decades, it is now considered as a major component of practice so that nurses advocate for themselves as well as for their patients.

Nightingale's advocacy was reflected in her persistent effort to promote comfort for the sick and injured during the Crimean war. She asserted to have adequate supplies when it was not provided, and in situ ations where though supplied unable to open the boxes for the required articles. It was the military officers those days with wrong notion, as a female what great things she was capable of doing. Perhaps, it was her demonstration of exceptional skills of advocacy gave birth to serendipitous developments into the profession.

Nightingale's contribution to advocacy in nursing is innumerable. She was the author for several official letters to the government highlighting scope of improvement in health care. Nightingale was also appreciated by the Queen of England for her tremendous contribution, and Nightingale utilized every opportunity for advocacy of the profession to the possible highest level either socially or politically.

Nightingale was intolerable to the discrimination in British society for men and women. She significantly demonstrated advocacy during her role as a superintendent of the hospital though it was scary for women entering nursing profession. She dispelled the notion of higher authorities regarding women were powerless. Nightingale was very cooperative with other health care team members too. The skills she demonstrated have become the foundational principles of modern nursing today.

Nightingale's advocacy is very much reflected in her work in Scutari and Crimea. She herself selected the nurses to work along with her. The selection was based on interest and commitment as well as willingness to serve for long duration. She exhibited advocacy in developing standards for nursing care. For a staff member to refuse to work to Nightingale's standard resulted in dismissal, signaling the application of administrative standards of care. This is explicitly demonstrated in her May 15, 1854, report to the Governors when she wrote, “I have changed one housemaid on account of her love of dirt and inexperience, and one nurse, on account of her love of Opium and intimidation.”[10]


  Nightingale's Role in Nursing Research and Statistics Top


In historical context, Florence Nightingale is considered to be the first nurse researcher. Though nursing in earlier days was based on trial and error, Nightingale's contribution toward research was reflected in bringing down the mortality and morbidity among the sick and wounded in Crimean war. Nightingale's landmark study of maternal mortality from puerperal fever is a formidable example of evidence-based decision making in health care.[11]

She was systematic in her approach and was motivated to reform the existing practices in health based on the statistics she collected. It was her passion toward the profession, and she pioneered the task of graphically presenting the data to convince the scenario to civil servants to reform public laws. Nightingale's statistical reports were not accepted by statisticians of those days. As statistical thought was emerging, there was a strong reaction from many intellectuals opposed to the use of statistics.[12] Jocelyn Keith described the proposal as “the first model for the systematic collection of hospital data using a uniform classification of diseases and operations that was to form the basis of the ICD code used today.”[13]

Nightingale's contribution to nursing research was unique. She analyzed the circumstances in her workplace and recorded data systematically which helped her to implement the appropriate nursing intervention. On the other hand, it was more of action research that is reflected in her relentless effort in improving environmental condition resulted in promotion of health of the clients. Such evidence helped her to develop and incorporate theoretical frameworks in nursing. Astonishingly such practices resulted in a statement of standards for nursing care which is a benchmark to assess the delivery of nursing care.


  Conclusion Top


It is obvious that nursing practice is reformed in the 21st century possibly the purpose of nursing remains unaffected since the time of Florence Nightingale. The components of dedication and long years of service with compassion seem to be vanishing in current nursing work culture which is ultimately influencing the quality of nursing care. Nightingale's service was comprehensive blend of science and art for the promotion of health care to humanity. Nightingale as pioneering figure in the history of nursing made nursing as an admirable profession for women. Her significant contribution to improve the medical care has no doubt influenced the whole world.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Nightingale F. Notes on Nursing: What it is and What it is Not. London: Lippincott Williams and Wilkins; 1992.  Back to cited text no. 1
    
2.
Available from: http://www.biography.com/people/florence-nightingale-9423539. [Last accessed on 2016 Mar 02].  Back to cited text no. 2
    
3.
The life of Florence Nightingale. Available from https://www.uab.edu/reynolds/nightingale/life [Last accessed on 2016 Apr 28].  Back to cited text no. 3
    
4.
O'Connor JJ, Robertson EF. Based on a Project by Suzanne Davidson. Available from: http://www-groups.dcs.st-and.ac.uk/~history/Biographies/Nightingale.html [Last accessed on 2016 Apr 9].  Back to cited text no. 4
    
5.
Blais KK, Hayes JS, Kozier B, Erb G. Professional Nursing Practice Concepts and Perspectives, Fifth edition, India: Dorling Kindersley (India) Pvt Ltd., licences of Pearson Education in South Asia, 2006.  Back to cited text no. 5
    
6.
Benck C, Dugan J, Hicks L, Keller J, Nuzzo M, Drake S, et al. Notes on Nursing: What it is and What it is Not. New York: D. Appleton and Company; 1860.  Back to cited text no. 6
    
7.
Wilkinson A. A Brief History of Nursing in India and Pakistan. Madras: The Trained Nurses Association of India; 1958.  Back to cited text no. 7
    
8.
Selanders L, Crane P. The voice of Florence nightingale on advocacy. Online J Issues Nurs 2012;17. [Manuscript 1].  Back to cited text no. 8
    
9.
Bharathi C. Florence Nightingale, Bangalore: SBS Publishers; third edition, 2012. ISSBN: 978-81-280-1753-0.  Back to cited text no. 9
    
10.
Verney H. Florence Nightingale at Harley Street: Her Reports to the Governors of Her Nursing Home 1853-4. London: W.P. Griffith & Sons Ltd.; 1970.  Back to cited text no. 10
    
11.
McDonald L. Florence Nightingale and the early origins of evidence-based nursing. Evid Based Nurs 2001;4:68-9.  Back to cited text no. 11
    
12.
Keith H. Editorial. J Mil Vet Health. 2010;18:4-5.  Back to cited text no. 12
    
13.
Keith JM. Florence Nightingale: Statistician and consultant epidemiologist. Int Nurs Rev 1988;35:147-50.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]


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  In this article
Abstract
Introduction
God — Give...
The Crimean War
Transformation: ...
Looking Back to ...
Advocacy in Nursing
Nightingale'...
Conclusion
References
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