Nursing then, nursing now

International Nurses Day on May 12 marked a special occasion for nurses across the globe, a day to take a moment to reflect on our work and the contribution we make to the lives of our patients, clients and their families. This year’s International Nurses Day was especially meaningful as this is the World Health Organization’s designated International Year of the Nurse and the Midwife, and the date marks the 200th anniversary of Florence Nightingale’s birthday.

This notable event also has a special relevance this year in an Ireland where the epidemiological concepts of ‘reproduction factor’ and ‘flattening the curve’ have become features of everyday conversation, and the ominously awaited daily update of new cases and ‘mortality rates’ have become a pre-dinner staple in most Irish households.

Notwithstanding our precarious circumstances, we commemorate International Nurses Day in these unprecedented times with a tribute to Florence Nightingale, the founder of modern nursing,¹ and hope that readers enjoy some reflections from her Notes on Nursing,² which have particular resonance in the context of our current emergency.

Remarkably, Florence Nightingale’s Notes on Nursing has many parallels with Covid-19 and its management today. Her book, which was published in 1859, was considered a sensation at that time, selling 15,000 copies within the first month. This was the same year that Louis Pasteur published his paper proposing that micro-organisms might be the cause of many diseases affecting humans and animals, another idea that was considered revolutionary in 1859.³

Origins

Florence Nightingale was born in Italy and was named after the city of her birth, Florence.⁴ She noted that “we must not forget what, in ordinary language, is called ‘infection’ – a thing of which people are generally so afraid that they frequently follow the very practice in regard to it which they ought to avoid”.²

Ms Nightingale described experiencing a “calling” at the age of 16 to pursue a life devoted to reducing human suffering. Despite resistance from her family, Nightingale, aged 34, led a party of 38 women at the request of the UK government to assist in caring for the casualties of the Crimean war, arriving in Scutari, Turkey on November 5, 1854.⁴

An overwhelmed system

Regular reporting to the public at home was made possible by the man considered to be the world’s first modern war correspondent, journalist William H Russell of The Times. The public was well informed that on arrival, Ms Nightingale and her colleagues found ill-prepared facilities lacking in basic essential equipment, with a distressing mortality rate wherein the number succumbing to infection was 10 times greater than the number succumbing to injuries sustained in battle.⁴

Five days after their arrival in Scutari, the precipitous arrival of a large number of casualties from two concurrent battles completely overwhelmed the hospital facilities, with Ms Nightingale describing the scene as a “kingdom of hell”.⁴

In response to Ms Nightingale’s pleas, at least in part through the media, the UK government designed and built a prefabricated hospital, which was shipped and constructed as a civilian hospital in the Dardanelles. The hospital had a death rate that was less than one-tenth of the death rate at the hospital in Scutari.⁴ In addition, Ms Nightingale’s implementation of hygiene practices, a key component of which was handwashing, reduced the death rate from 42% to 2% in the hospital. 

Procuring essential equipment

In response to serious scarcities, Ms Nightingale was noted to have become adept at securing essential equipment, at one stage writing to a friend that “I am a kind of general dealer”.³

Flattening the curve

Ms Nightingale was a pioneer in visually presenting statistical data, and developed innovative schematic designs that enhanced those which previously existed. She utilised these schematics as a medium to effectively communicate complex data regarding both the extent of disease and the effectiveness of interventions. Her pioneering work in making epidemiological data easily accessible simplified the updating of key agencies, including the UK parliament, and facilitated compelling arguments for action.⁴

Ethical care

Notably, Ms Nightingale opened a report to the UK government with a cautionary note that “it may seem a strange principle to enunciate as the very first requirement in a hospital, that it should do the sick no harm”.²

In a letter to a friend about her Notes on Nursing, Nightingale confided that “no word is written for the sake of writing, but only forced out of me by much experience in human suffering”.⁵ Perhaps this is understandable from ancillary records that report it was a rule of Nightingale’s practice that no patient was left to die alone, and by the winter of 1855 Ms Nightingale herself had attended 2,000 deaths.³

Ms Nightingale’s dedication did not go unnoticed, and her enduring iconic representation in the public consciousness as the ‘Lady with the Lamp’ originated from a report in The Times which described her “without any exaggeration” as a “ministering angel who when all others have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, may be observed alone, with a little lamp in her hand, making her solitary rounds”.⁴ The image later became immortalised in HW Longfellow’s 1857 poem Santa Filomena.

Notes from one of her colleagues later described accompanying Ms Nightingale on her rounds: “As we slowly passed along the silence was profound… a dim light burned here and there, Ms Nightingale carried her lantern which she would set down before she bent over any of her patients. I much admired her manner to the men – it was so gentle and kind.”³

Despite her epidemiological, scientific and scholarly genius, Ms Nightingale’s notes continue to inspire us to preserve the humanistic and artistic dimensions of our practice, and remind us of the emotional burden of authentic practice. Few would doubt that this wisdom remains contemporary. 

Within contemporary Irish nursing and midwifery, Nightingale’s inspiration is enshrined within our declared core values of compassion, care and commitment.⁵ Interestingly, the position paper that declared these values as the core of Irish nursing and midwifery proposed that these would become the “benchmark against which the professional practice of nurses and midwives could be assessed”. 

Few would have anticipated that in raising this challenge to Irish nurses in 2016, within five years our nurses would find themselves literally and figuratively on the frontline of an unimaginable pandemic, and would manifest these core values with a dedication that did not go unnoticed, just as Florence Nightingale’s dedication did not go unnoticed more than 150 years ago.

Despite this year’s International Nurses Day and our commemoration of Florence Nightingale’s 200th birthday falling during sadder circumstances than any of us could have imagined, we can take comfort in our commitment to preserving a long and proud legacy of humanistic care. The ‘lamp’ is truly in safe hands.