The inventive mother of all nurses

1 May 2010

2010 marks the 100th anniversary of Florence Nightingale’s death and the 150th anniversary of the publishing of her Notes on Nursing. Nursing Review pays tribute to the mother of modern nursing, to mark the International Year of the Nurse and International Nurses’ Day – Florence’s birthday. FIONA CASSIE looks at the life, works and words of the world’s most famous nurse

A skilled statistician, effective lobbyist and cutting social commentator.

Florence Nightingale was them all. The mother of “modern nursing” may have railed against crinolines and beef tea but she was also an intellectual force ahead of her time.

Nightingale is believed to be the first person ever to use graphs – in her case some “graphic” soldier mortality data – to back an argument for reform.

Her belief that nursing should support nature’s own repairing process by attending to the mind, body and spirit of the patient also sounds very contemporary.

And you could argue she was the first post-feminist, with her call to “sisters” to keep clear of the “jargons” of the time – the one urging women “to do all that men do” and the other to keep to “women’s work”.

“You do not want the effect of your good things to be, ‘How wonderful for a woman!’,” she wrote, back in 1860. Nor should you be put off good works, she advises, by those saying ‘Yes, but she ought not to have done this, because it is not suitable for a woman’.

Instead she argued good things should be done whether they were ‘suitable for a woman’ or not.

So stating Nightingale’s achievements were remarkable for a woman of her era is likely to have made her bristle. Adding that her work was even more admirable as she was a bedridden invalid for much of the last half of her life (a result of the disease and trauma she experienced during the Crimean War) is equally unlikely to impress.

Nightingale definitely did do “good things”. Born into a privileged and educated household, the only expectations of her were to “marry well”. But Nightingale, whose Cambridge graduate father had started teaching her mathematics at age 11, heard at 17 a “calling” from God. Rather than being trapped by what she came to view as the “tyranny” of the drawing room she began to believe her calling was to nurse – then a job associated with old women and drunkenness.

Her shocked parents tried to dissuade her and hoped travel would distract her, but in her travelling she managed to fit in visits to Italian nursing sisters and a German training hospital – where at the age of 31 she returned to do her first formal nurse training.

Nightingale’s parents relented and she was living independently in London and working as the superintendent of a genteel women’s hospital when the Crimean War broke out in 1854.

A politician friend called on her to lead the first group of women nurses to work in a military hospital. On arrival Nightingale was aghast at the unsanitary and poorly equipped hospital. More soldiers were dying from disease and cold than enemy action. She worked tirelessly to reform the hospital management, improve cleanliness and sanitation and put into effect her philosophy of nursing. Worshipped by the wounded soldiers, by early 1855 her fame was sealed by newspaper images and stories about the ‘Lady with the Lamp’ walking the wards into the late hours of the night.

By spring 1855 she came down with Crimean Fever (now suspected to have been brucellosis) and nearly died, but recovered enough to keep working until the war ended in 1856.

The story could have ended there, but Nightingale on returning to England wanted to ensure lessons were learned and was instrumental in setting up the Royal Commission into the health of the British Army. Using her knowledge of statistics she developed the polar-area diagram (a sophisticated variation of a pie chart) to show graphically how many soldier deaths would have been preventable by good hospital sanitation. Recognition of her innovation saw her elected in 1858 a fellow of what is now the Royal Statistical Society.

This was followed up by publishing in 1859 her Notes on a Hospital, the first of 200 reports, pamphlets and books covering sanitation to nursing and hospital design to Indian tenancy reform she wrote over the next 20 years.

In 1860 the most famous of these works was published – her international bestseller Notes on Nursing – intended not as a nursing manual but “hints” to help everyday women teach themselves how to nurse.

In chapters covering ventilation to cleanliness and observation to diet, she lays down her philosophy of “sanitary” nursing. But beyond stressing the need for cleanliness, good sanitation and intelligent observation (and her disproved theories about disease being caused by miasma or foul air) she stressed the need for nursing to give nature its best chance to heal the patient.

And this she argued included the need for sunlight, a view, pleasant distractions and variety in their day as well as protection from unnecessary noise, interruptions and well-meaning but ignorant advice from visitors.

She is often critical of what passed for nursing in her time, but again sounds surprisingly modern when she says nurses are not always to blame as “bad sanitary, bad architectural, and bad administrative arrangements often make it impossible to nurse”.

Nightingale is also very “bluestocking” in her criticism of the impractical, rustling and sometimes “indecent” crinoline skirts of the day. “A respectable elderly woman stooping forward, invested in crinoline, exposes quite as much of her own person to the patient lying in the room as any opera dancer does on the stage,” writes Nightingale, possibly with a twinkle in her eye.

In the same year Notes on Nursing was published, the Nightingale School for Nursing was opened at St Thomas’ Hospital in South London using excess funds raised in her name during the Crimean War (£44,000 or the equivalent of £2 million pounds today).

Complaints by probationers (student nurses) saw Nightingale become more involved in the school in the 1870s, including an annual open letter to students and staff, offering advice and encouragement, and an invitation to tea on graduation.

The Nightingale alumni went off to staff hospitals and set up nursing schools around the world. The modern nurse was born and colonies like our own introduced a register for this new generation of educated nurses before Nightingale’s death a hundred years ago this year. 

Florence’s Life TIMELINE

1820 – Born in Florence, Italy while wealthy British parents on extended European honeymoon.

1837 – Has a “calling” to do God’s work. Begins to investigate hospitals and nursing but family resistant.

1850 – Travels to Italy, Egypt and Greece and on way home visits Pastor Theodor Fliedner’s hospital and school for deaconesses in Kaiserwerth, Germany.

1851 – Returns to Kaiswerwerth to do three months nursing training.

1853 – Takes up position as superintendent of Harley Street’s An Establishment for Gentlewomen During Illness.

1854 – Appointed to oversee introduction of female nurses into military hospitals in Turkey during Crimean War.

1856 – Returns to England and becomes active in Royal Commission to investigate health of the British Army.

1858 – Elected first female Fellow of the Royal Statistical Society.

1859 – Publishes Notes on Hospitals – one of the 200 reports, pamphlets and books she writes over her lifetime on hygiene, hospital design, health care for the poor, nursing and midwifery.

1860 – Publishes Notes on Nursing. Established Nightingale Training School for Nurses at St Thomas’ Hospital, London.

1872 – For the next 30 years writes an almost annual open letter to nurses and students at Nightingale School offering advice and encouragement.

1883 – Awarded Royal Red Cross by Queen Victoria.

1907 – First woman to receive Order of Merit honour.

1910 – Dies at home in London.

Sources include: Florence Nightingale Museum Trust museum

website: www.florence-nightingale.co.uk

Notes on Nursing (1860) by Florence Nightingale.