Florence Nightingale and International Nurses Day

A blog post written by Deb Rawlings, Senior Lecturer, Palliative Care and Course Coordinator, Palliative and Support Services, College of Nursing and Health Sciences, Flinders University

Florence Nightingale (12 May 1820 – 13 Aug 1910) was a philanthropist, social activist, trailblazer in public health, statistician and above all a nurse. International Nurses Day (IND) has been celebrated on Florence Nightingale’s birthday since 1974, and in 2020 we are also celebrating the International Year of the Nurse and Midwife. I invite you to salute Nightingale and acknowledge her legacy today. 

I have been reflecting on the life and work of Florence Nightingale as I complete 40 years as a Registered Nurse. My contribution to nursing commenced as a student nurse, nearly 70 years following Florence Nightingale’s death, and during this time I have seen nursing continue to grow, and to be seen as a worthy and valued profession. My clinical contributions include over 20 years of focus on Haematology -Oncology nursing and Palliative Care nursing along with many academic contributions more recently.

Nurses make up the majority of the health care workforce and as such are at the frontline in caring for the sick and dying, never more so than in caring for people during COVID-19. During this time palliative care has become increasingly visible, brought to the forefront as nurses care for those who are dying, looking to improve the way care is being given. This reflects the work that Nightingale led in the Crimean war, where she identified infection as more of a killer when compared to combat deaths in WWI all the armies together. Also she reduced death rates significantly by addressing hygiene practices which included handwashing. [1] Very relevant in 2020, with handwashing the cornerstone of our response to COVID-19.

Since Nightingale’s time, with developments seen across the millennia, there are now resources to hand that can support quality care of the dying, such as those developed in projects managed by teams at Flinders University, Adelaide, South Australia. Evidence-based palliative care information and resources (Florence would be pleased), [2] are available that resonate very loudly in this current health crisis.

End-of-Life Essentials is a website for those nurses working in acute hospitals. Nightingale spent much of her life improving the conditions in hospitals, initially by establishing a field hospital during the Crimean war (in the Ottoman Empire) with four hospitals in Istanbul subsequently named after her.

ELDAC and palliAGED are websites/projects for those working with older people. Nightingale was pivotal in improving care for impoverished people in workhouses which included older people and the dying, with district (community nurses) not yet fully established. Nightingale’s theories on the environment are still quoted today in relation to interventions in dementia. [3]

CareSearch is a website for any nurse providing care to anyone at the end of life. Information and resources are also provided that support patients and their families and communities providing this care. Nightingale was a believer in educating people about caring for the sick while promoting that medical care should be available to everyone. She advocated for dying with dignity, [4] by allowing patients to remain in her care at the end of life when hospitals were not intended for the dying.

Much as has been my experience, Florence Nightingale was a great proponent of education and research and worked tirelessly in these areas following her clinical career.

Education
Nightingale’s Notes on Nursing (1860), [5] initially intended as a guide for those caring for others, became the foundation for the curriculum of the Nightingale School for Nurses at St Thomas’s Hospital in London. Other nursing schools were subsequently developed under Nightingale’s supervision, including at the Sydney Infirmary and Dispensary (est 1827) which became the Sydney Hospital (1881). Nurse training has since transitioned from hospital (my experience) to university, including a suite of postgraduate palliative care courses at Flinders University into which I coordinate and teach.

Research
Florence Nightingale authored over 150 books, pamphlets and reports, [6] on health-related issues. She was a noted statistician, [7] publishing on work undertaken in the Crimea (1859) on sanitary history, and was an important voice in early public health and public reform initiatives. [8] Notable quotes from Nightingale include: "Preventible disease should be looked on as a social crime." (1894) and "It is cheaper to promote health than to maintain people in sickness." (1894). [9] Studying a Master in Public Health has provided me with many insights that now include the role of the community in public health palliative care initiatives such as compassionate communities, a concept that would resonate with Florence Nightingale’s ideals.

So today as we commemorate International Year of the Nurse and Midwife, I invite nurse readers of this blog to reflect on your own careers and recall and celebrate all the generations of nurses who worked before us. For those readers who work more broadly as health care professionals, join us in celebrating the inspiring and impressive profession of nursing. 

References

1. Karimi H, Masoudi Alavi N. Florence Nightingale: The Mother of Nursing. Nurs Midwifery Stud. 2015 Jun;4(2):e29475. doi: 10.17795/nmsjournal29475. Epub 2015 Jun 27.
2. McDonald L. Florence Nightingale and the early origins of evidence-based nursing. Evid Based Nurs. 2001 Jul;4(3):68-9. doi: 10.1136/ebn.4.3.68.
3. Gramegna SM, Biamonti A. Environment as non pharmacological intervention in the care of Alzheimer’s disease. Des J. 2017;20(Sup1):S2284-S2292.
4. Selanders LC, Lake K, Crane P. From charity to caring: Nightingale's experience at Harley Street. J Holist Nurs. 2010 Dec;28(4):284-90. doi: 10.1177/0898010110376324.
5. Nightingale F. Notes on Nursing: What It Is and What It Is Not. New York: Appleton and Company; 1860.
6. Alexander KL. Florence Nightingale [Internet]. National Women's History Museum. 2019. [cited 2020 May 12]. Available from: https://www.womenshistory.org/education-resources/biographies/florence-nightingale
7. McDonald L. Florence Nightingale, statistics and the Crimean War. J R Stat Soc. 2014;177(3):569-586. doi:10.1111/rssa.12026
8. Wright J. The concept of public health. Br J Sch Nurs. 2010;5(4):206.
9. Monteiro LA. Florence Nightingale on public health nursing. Am J Public Health. 1985 Feb;75(2):181-6. doi: 10.2105/ajph.75.2.181.

For more information on the Life and Times of Florence Nightingale visit: https://lifeandtimesofflorencenightingale.wordpress.com/

Deb Rawlings, Senior Lecturer, Palliative Care and Course Coordinator, Palliative and Support Services, College of Nursing and Health Sciences, Flinders University