Category Archives: Florence Nightingale

Which Florence Nightingale will we remember today? The ‘Lady with the Lamp’ or the influential writer and activist?


Judith Godden, University of Sydney

Florence Nightingale’s birth on May 12, 1820, is commemorated as International Nurses Day, honouring her founding role in modern nursing. Today would be her 200th birthday, so expect to hear even more about her.

Yet mention her name to nurses, the reaction tends to be an eye-roll. Why?

Read more:
Florence Nightingale carried the lamp but modern nurses carry the can

Nightingale influenced nursing and health care in two ways.

First there is the impact of her myth. This myth was created when she headed a group of nurses to care for the thousands of British troops dying from disease during the Crimean War (1853-56).

This painting by Henrietta Rae (1891) captures the romantic stereotype of the selfless Lady with the Lamp.
Wikimedia/Wellcome Trust

The public revered Nightingale as the Lady with the Lamp, gliding around at night at Scutari Hospital in Turkey embodying selfless care. This image has been a burden for nurses as it ignores the skills involved in effective nursing.

Second, there was the impact of the real Nightingale. After the Crimean War, she spent most of her remaining 54 years as an invalid in her bedroom.

She wrote insightful reports and papers on reforming the army and improving public health. These were highly influential.

So too was her practical guide for women nursing family members at home, Notes on Nursing (1859). Later, her focus was on improving conditions in India.

In all her work, Nightingale aimed to prevent needless deaths from disease, as had occurred during the Crimean War.

In 1869, writing to one of the nurses she sent to Australia, Nightingale described her wartime experience as:

like a horrid spectre one is afraid of conjuring up out of the dark corner of one’s mind […] ready to spring, if one were not so overwhelmed with present work.

The reality, as depicted in a photograph of Florence Nightingale by Henry Hering (around 1860).
National Portrait Gallery London/Wikimedia

Her description resonates with the despair of those caring for COVID-19 patients with inadequate facilities today.

Meanwhile, the public insisted Nightingale reform civilian nursing. They poured money into a Nightingale Fund to establish a training school for nurses under her guidance.

Nightingale complained; she had not asked for the money nor been consulted about its aim. Eventually, in 1860, the Nightingale School of Nursing began at St Thomas’ Hospital, London. Though she tried to influence it, she had little to do with its management.

Nightingale also had little choice but to respond to the innumerable requests she received for advice, especially about hospital design and nursing.

Australians wanted a piece of her too

Australian hospitals and politicians equally clamoured to collaborate with the famed Nightingale.

One result was the spread of the hospital building style she favoured. These hospitals had separate buildings (pavilions) to help prevent cross-infection.

Inside were long, traditional wards that became known as Nightingale wards. They had high windows for light and ventilation; patients and beds were arranged for
easy supervision. An example can be seen in the original buildings at Royal Prince Alfred Hospital, Sydney.

Read more:
From army barracks to shopping malls: how hospital design has been a matter of life and death

Nightingale was not immune from imperialist prejudices. An example is her collecting statistics about indigenous health in British colonies.

As the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives points out, her involvement did not help Indigenous Australians. Nor was she always successful.

While Australian hospitals and governments boasted they consulted her, the tyranny of distance was against them. In the 1860s, she commented on plans for new wards at Sydney Infirmary (now Sydney Hospital), but in the three months it took for her letter to arrive, the plans had changed.

It was certainly not her fault that, after the building was completed, it was discovered the architects had forgotten to include toilets.

Nightingale advised on a new Australian nursing school

Nightingale’s major contribution to Australian nursing occurred when she was asked to establish a school of nursing at Sydney Infirmary.

The new nurses were expected to be a secular version of the other trained nurses in the colony, the Sisters of Charity.

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Florence Nightingale: a pioneer of hand washing and hygiene for health

Nightingale agreed to send nurses to Sydney, but largely left it to the matron of the UK’s St Thomas’s Hospital to choose them. Only later would Nightingale view the matron as someone who would not know “a sheep’s head from a carrot”.

The six nurses arrived in 1868. Most were inexperienced, including their leader Lucy Osburn. Nightingale tried to advise, but again the length of time letters took to arrive meant they were of little use. Problems mounted. Three years later, Nightingale disowned the project and deemed Osburn a failure.

Strict hygiene, hard work and patients first

Nightingale had been too hasty. Osburn learnt from her mistakes and persisted in her work. She implemented Nightingale’s key ideals including strict hygiene and conscientious, patient-centred nursing.

She demonstrated that nursing needed to be taught, rather than learnt from experience. As important, her nurses had reasonable pay and good living conditions in the Nightingale wing. Better conditions attracted nurses more able to implement the new standards of antiseptic practice.

Today’s nurses have reason to be ambivalent about Nightingale’s impact, but her ideals have helped ensure they are among the most trusted occupational group.The Conversation

Judith Godden, Honorary Associate, Department of History, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The healing power of data: Florence Nightingale’s true legacy

Wikimedia Commons, CC BY-SA

Alice Richardson, Australian National University; Jessica Kasza, Monash University, and Karen Lamb, University of Melbourne

When you’re in a medical emergency, you don’t typically think of calling a statistician. However, the COVID-19 outbreak has shown just how necessary a clear understanding of data and modelling is to help prevent the spread of disease.

One person understood this a long time ago. Were she alive today, Florence Nightingale would understand the importance of data in dealing with a public health emergency.

Nightingale is renowned for her career in nursing, but less well known for her pioneering work in medical statistics. But it was actually her statistical skills that led to Nightingale saving many more lives.

Read more:
Florence Nightingale: a pioneer of hand washing and hygiene for health

An early spark

Nightingale was one of the first female statisticians. She developed an early passion for statistics. As a child she collected shells and supplemented her collection with tables and lists. Nightingale was home-schooled by her father but insisted on learning maths from a mathematician before she trained as a nurse.

A photo of Nightingale taken circa 1860.
Wikimedia Commons

Upon arriving at the British military hospital in Turkey in 1856, Nightingale was horrified at the hospital’s conditions and a lack of clear hospital records.

Even the number of deaths was not recorded accurately. She soon discovered three different death registers existed, each giving a completely different account of the deaths among the soldiers. Using her statistical skills, Nightingale set to work to introduce new guidelines on how to record sickness and mortality across military hospitals.

This helped her better understand both the numbers and causes of deaths. Now, worldwide, there are similar standards for recording diseases, such as the International Classification of Diseases.

Outbreak monitoring

The ability to compare datasets from different places is critical to understanding outbreaks. One of the challenges in monitoring the COVID-19 pandemic has been the lack of standardised datasets experts can compare on the number of people infected. This is due to differences in testing rules in different countries.

More than 150 years after Nightingale pointed out the need to standardise datasets before comparing them, we are certain she would have something to say about this.

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With her improved data, Nightingale put her statistical skills to use. She discovered deaths due to disease were more than seven times the number of deaths due to combat, because of unsanitary hospital conditions.

However, knowing numbers alone have limited persuasive powers, Nightingale used her skills in statistical communication to convince the British parliament of the need to act. She avoided the dry tables used by most statisticians of the time, and instead devised a novel graph to illustrate the impact of hospital and nursing practice reform on army mortality rates.

Florence Nightingale’s graph showing deaths due to disease, wounds and other causes in the Crimean War.

Today, graphs remain one of the most effective ways to understand the effects of health care interventions, including those used to illustrate the effectiveness of physical distancing to curb COVID-19’s spread.

Flattening the curve is another way of saying slowing the spread. The epidemic is lengthened, but we reduce the number of severe cases, causing less burden on public health systems. The Conversation/CC BY ND

Florence Nightingale down under

Nightingale may not have travelled much after her wartime experience in Turkey, but she was engaged in improving public health in many countries, including Australia.

She wrote papers on the benefits of pavilion-style hospital building designs, which were later incorporated into Australian hospitals. This style consists of small wings, or pavilions, leading off a central corridor – this is convenient for nursing staff and encourages good ventilation.

In 1868, Lucy Osburn headed the first team of nurses sent to Australia to establish Nightingale-style nursing. One of the team’s first tasks was to nurse Prince Alfred, Queen Victoria’s second son, who had been shot in an attempted assassination.

Nightingale never visited Australia herself, but this did not stop her using her usual tactics of requesting data from her wide network of contacts and drawing conclusions from what she found. She was a prolific correspondent – we have more than 12,000 of her letters, and those are only the ones which haven’t been burned, lost or otherwise destroyed.

Nightingale would surely have embraced 21st-century communication. We can imagine her sitting at her laptop tweeting under the moniker @ladywiththelamp.

A trailblazer for women

In 1858, Nightingale’s achievements in statistics were recognised by the Royal Statistical Society in the UK, when she became the first woman Fellow of the Society.

After Nightingale’s fellowship, it would be more than 100 years before a woman was elected President of the Royal Statistical Society, with Stella Cunliffe’s election in 1975. It was only in 1995 that the Statistical Society of Australia had a woman as president, with the election of Helen MacGillivray.

As in many STEM (Science, Technology, Engineering and Mathematics) disciplines, female statisticians are still fighting for equal recognition. To date, only two women have received the Statistical Society of Australia’s highest honour, the Pitman Medal.

But it’s clear female statisticians are still making headway. In 2019, five major statistical associations had women presidents. Today, on her 200th birthday, Nightingale would have been proud.The Conversation

Presidents of Statistical Societies in 2019. L-R: Karen Kafadar (American Statistical Association), Louise Ryan (International Biometric Society), Deborah Ashby (Royal Statistical Society), Helen MacGillivray (International Statistical Institute), Susan Ellenberg, Jessica Utts (former President of the American Statistical Association), Susan Murphy (Institute of Mathematical Statistics).
Twitter/Author provided

Alice Richardson, Associate professor, Australian National University; Jessica Kasza, Senior lecturer, Monash University, and Karen Lamb, Biostatistician, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Florence Nightingale: a pioneer of hand washing and hygiene for health

Helping the wounded.
Shutterstock/Everett Historical

Richard Bates, University of Nottingham

Florence Nightingale, who was born 200 years ago, is rightly famed for revolutionising nursing. Her approach to caring for wounded soldiers and training nurses in the 19th century saved and improved countless lives. And her ideas on how to stay healthy still resonate today – as politicians give official guidance on how best to battle coronavirus.

For example, although Nightingale did not fully subscribe to the idea that many diseases are caused by specific micro-organisms known as germs until she was in her sixties, in the 1880s, she was well aware of the importance of hand washing. In her book Notes on Nursing (1860), she wrote that:

Every nurse ought to be careful to wash her hands very frequently during the day. If her face, too, so much the better.

During the Crimean War (1853-1856) Nightingale had implemented hand washing and other hygiene practices in British army hospitals. This was relatively new advice, first publicised by Hungarian doctor Ignaz Semmelweis in the 1840s, who had observed the dramatic difference it made to death rates on maternity wards.

Nightingale’s attention to international medical research and developments was just one factor behind her ability to make effective interventions in public health. Like many public health experts of her age, Nightingale considered the home to be a crucial site for disease-preventing interventions. This was the place where most people contracted and suffered from infectious diseases. (The same is true today: in Wuhan’s coronavirus outbreak, around 75-80% of transmissions were reportedly in family clusters).

Nightingale’s book, Notes on Nursing (1860), was more of a public health instruction book than a nursing manual. It advised ordinary people how to maintain healthy homes – particularly women, in accordance with the worldview of the times. There was straightforward advice on everything from how to avoid excessive smoke from fireplaces (don’t let the fire get too low, and don’t overwhelm it with coal) to the safest material with which to cover walls (oil paints, not wallpaper).

Nightingale strongly counselled that people open windows to maximise light and ventilation and displace “stagnant, musty and corrupt” air. And she advocated improving drainage to combat water-borne diseases like cholera and typhoid.

In her view, all domestic interiors must be kept clean. Dirty carpets and unclean furniture, she wrote with characteristic bluntness, “pollute the air just as much as if there were a dung heap in the basement”.

Notes on Nursing also called upon the “mistress” of every building to clean “every hole and corner” of her home regularly, for the sake of her family’s health. But Nightingale also recommended a more holistic approach to health. She encouraged soldiers to read, write and socialise during their convalescence so they would not sink into boredom and alcoholism.

Good data

During her youth, Nightingale’s father had introduced her to a leading practitioner of statistics, then a brand new academic field, and paid for her to have a mathematics tutor. During and after the Crimean War, Nightingale seized on statistics as a way of proving the effectiveness of different interventions.

She went on to produce her famous diagrams, which demonstrated the high proportion of soldiers’ deaths caused by disease as opposed to battle wounds, and became the first woman admitted to the London Statistical Society in 1858.

Thereafter she designed questionnaires to obtain data on such questions as the sanitary condition of army stations in India, or the mortality rates of aboriginal populations in Australia. Her guiding principle was that a health problem could only be effectively tackled once its dimensions were reliably established.

In 1857, around a year after returning from the Crimean War, Nightingale suffered a severe collapse, now believed to have been caused by a flu-like infection called brucellosis. For much of her subsequent life, she was racked with chronic pain, often unable to walk or leave her bed.

Working from home

Having been declared an invalid, she imposed a rule of seclusion on herself because of pain and tiredness rather than from fears of contagion – a form of self-isolation that extended to her closest family (though she still had servants and other visitors).

During her first years of working entirely from home, Nightingale’s productivity was extraordinary. As well as writing Notes on Nursing, she produced an influential 900-page report on the medical failings during the Crimean War, and a book on hospital design.

This was in addition to setting up the Nightingale Training School for nurses at St Thomas’ hospital in London in 1860, and a midwifery training programme at King’s College Hospital in 1861, plus advising on the design of a number of new hospitals.
Later in the 1860s, Nightingale proposed a reform of workhouse infirmaries to make them high quality taxpayer-funded hospitals; and also worked on sanitary and social reforms in India. All of this she accomplished without leaving her house (though government ministers sometimes came to her home for meetings).

Having said this, it is worth remembering that Nightingale’s was a privileged form of self-isolation. Her father’s fortune, derived from Derbyshire mining interests, meant she had no money worries.

She lived in a nice house in London with various assistants and servants to help, shop and cook for her, and had no children to look after. Her entire waking time could be devoted to reading and writing. So while this is an appropriate time to recall and celebrate the huge contribution Nightingale made to modern nursing and public health care, we shouldn’t feel too bad if we don’t quite live up to her high standards of isolated productivity.The Conversation

Richard Bates, Postdoctoral Research Fellow, Department of History, University of Nottingham

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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