Nightingale 1

Running head: Nightingale

Nightingale

Jacqueline Kay

Nursing Fundamentals
 Nightingale 2

Nightingale

Artificial light illuminates the plastic flowers that do little to satisfy the desire to view the

brilliant colors and textures found in nature. Instead, the plastic flowers change only by the

amount of dust that builds up day after day and year after year and the lighting changes only by

the on and off switch. Most windows are closed and all the doors are locked. Beds are lined up

3 deep upon entering a room. Nature awaits, via a window, at the far end of the room seeking to

visit all but instead being rudely turned away by room dividers meant to ensure privacy but

serving only as barriers to sight and doing nothing to provide the quiet environment needed for

the rest and recuperation of the body. Take away the open window and doors, flowers and

nature, and all that is left is the smell of incontinence, unwashed bodies and……the lives of

people who deserve so much more.

Conditions like these still exist just shy of 200 years after the birth of Florence Nightingale

born on May 12, 1820 and named after her place of birth in Florence, Italy. The daughter of

“well educated aristocratic Victorians,” Florence was afforded opportunities rarely presented to

women born of this time. Her father is credited with educating Florence in mathematics,

languages, religion and philosophy and her mother is credited with exposing Florence to the

conditions of living that afflicted the lives of the poor and as a direct result their health. As a

young girl Florence accompanied her mother who “visited and provided care to the poor families

in the communities surrounding their estate.” Florence would later continue this work when she

was old enough to make the trips alone. Her “understanding of the physical environments and

their effect on health status was acquired first hand through observation and experience beyond
 Nightingale 3

her own comfortable living situation.” (Alligood & Tomey, 2006)

In 1837, at the age of 17 Florence believed that she received a calling from God and

recorded this in her diary stating, “God spoke to me and called me to his service.” It would be

some time before Florence would recognize this calling as being specific to nursing. Upon

realization that nursing was her gift she began her training in 1851 in Kaiserwerth, Germany “a

protestant religious community with a hospital facility.” Three months after her training began,

“her teachers declared her a trained nurse.” She returned to England and began to visit hospitals,

charitable institutions and reformatories. Only two years later she became the “superintendant of

the Hospital for Invalid Women.” (Alligood & Tomey, 2006)

The Crimean War would soon lead her in another direction as she was requested by a friend

of the family, who also happened to be the Secretary of War, to “go to Scutari, Turkey to

provided trained nurses to care for wounded British soldiers. She arrived in 1854 with 34 newly

recruited women. Upon arriving the conditions under which the soldiers were being treated were

found to be appalling. There were only a “few chamberpots, contaminated water, contaminated

sheets, and blankets and overflowing cesspools.” The overall environmental conditions were

filthy and in addition to these atrocities the soldiers were suffering from, “frostbite, louse

infestation, and opportunistic diseases during their recovery from battle wounds.” (Alligood &

Tomey, 2006) “With conditions which resulted in soldiers lying on bare floors surrounded by

vermin and unhygienic operations taking place it is not surprising that, when Nightingale first

arrived in Scutari, diseases such as cholera and typhus were rife in the hospitals. This meant that

injured soldiers were 7 times more likely to die from disease in hospital, than on the battlefield.”
 Nightingale 4

(O’Conner & Robertson, 2003)

It was here and under these conditions that Florence became known as the “lady with the

lamp.” During the daytime hours Florence would work tirelessly with less than enthusiastic

support from physicians and military officers. Florence believed that the body needed its rest

and that to wake a sleeping patient was to cause unnecessary physical and emotional damage so

she carried a lamp bright enough to light only her path as she walked among the men. She was

seeking out those in need of emotional support and offering it accordingly. (Alligood & Tomey,

2006)

Florence returned to England after the war and found that word of her diligent efforts to

improve the sanitary conditions of the hospitals and to treat the wounded did not go unnoticed.

Family and friends were well aware of the fact that Florence offered to the men not only medical

care but emotional support. Her efforts had been recognized by not only the friends and family

of those who served in the military but also by the Royal family and Queen Victoria herself.

Although Florence would shy away from any public demonstrations of appreciation she would

accept the many subsequent donations that she would receive and put them towards establishing

a “teaching institution for nurses at St. Thomas Hospital and Kings College in London.” As a

result Florence would receive numerous requests to “establish new schools at hospitals

worldwide.” It was at this point in her life that Florence would secure her place in history as the

“founder of modern nursing.” (Alligood & Tomey, 2006)

Florence would continue to address the needs of army hospitals focusing on sanitation and

the environmental conditions that most affected the health and recovery of the men. This same
 Nightingale 5

care and concern was also directed at the poor believing that they sometimes endured conditions

equal to or worse than anything she ever saw in an army hospital. Before passing away in her

sleep on August 13, 1910 Florence would compile numerous writings aimed at informing future

nurses, and any mother who would listen, how to properly care for the healthy and the sick. “One

of these publications was a book entitled Notes on Nursing.” (O’Conner & Robertson, 2003)

“Although she never used the word environment in her writings it has been said that

Florence’s writing reflected her belief that the environment included, “all the external conditions

and influences affecting the life and development of an organism, and capable of preventing,

suppressing, or contributing to disease, accidents, or death.” Major considerations were given to

the “concepts of ventilation, warmth, light, dirt, cleanliness and noise.” (Alligood & Tomey,

2006) Her teachings, however, were not limited to these specific concepts and went on to include

communications, body language, and even the medicinal effect of flowers.

When addressing the quality of air that a patient breathes Florence was adamant that nurses

should “keep the air he breathes as pure as the external air without chilling him.” (Nightingale,

1860) This simply put means that the air inside should be as fresh as the air outside. Florence

goes on to note that opening a window is only beneficial if the source of the air being brought in

is fresh and from a well ventilated area. For example, using the air from a closed in court that

receives little sunshine would not serve the intended purpose. Florence also believed that

sunlight had the power to purify air and that any area or room that did not receive sunlight was

sure to be filled with dirty air. A thorough understanding of this concept would mean recognizing

that a dark room that stays dark and suffers daily from a lack of sunshine is always a dirty room.
 Nightingale 6

In our day no room, other than a dark room, should probably be considered to be more

contaminated than the bathroom. Yet, walk into a facility today that is funded primarily from

government sources and what you will find is grossly similar to the chamber pots that were once

stored under the beds of wounded soldiers. Consider that the occupants of this facility can have

wounds relative in severity to that of a man who has just returned from the battlefield and one

should find it appalling that the gloves that are used by nurses to change such gaping wounds are

stored in an open containers and hanging on the walls of the bathrooms. As a lay person one

knows that the flushing of a toilet in room, with no window for ventilation nonetheless means

that the contaminants from the pot are being sprayed into this confined space in which the gloves

are being stored. In her day Florence understood how poverty affected the poor and today would

probably recognize that not much has changed.

Proper ventilation was also believed, by Florence, to be much more important in the

nighttime hours than in the daytime hours. Florence cites the example of entering the bedroom

of even a person of high class and if one was to do so before any window is cracked and before

the air has been circulated there would be a foul smell hanging in the air. Florence believed this

foul air to be much more harmful to the sleeping body than to the awake body.” (Nightingale,

1860)

In reference to nurses needing sleep as well as the patients Florence believed that “nursing

care was never ceasing, night or day” and as such defined a good nurse as being one who makes

herself available even though she is not there. (Nightingale, 2008) This is a concept similar to

the nursing care plans and charting methods used in nursing today. It was Florence’s hope that
 Nightingale 7

each nurse would leave her shift with adequate instructions for the replacement nurse in regards

to maintaining the same level of patient care that she would provide if she were there. Upon each

nurse returning to her shift it was Florence’s hope that adequate documentation would provide

the information she needed to such a degree that it would be as if she never left.

Florence also pointed out that the confidence that a nurse portrays is vital to the health of

her patient. A patient, according to Florence, that is subjected to a nurse that is unsure of herself

is better off having no nurse at all because of the stress the patient will feel as a result of feeling

that an incompetent nurse is in charge of his welfare. (Nightingale, 1860)

Another vital teaching that Florence brings to light is that of communicating with a patient

that is fully aware he is dying. Much like the therapeutic communication techniques used to

today, Florence points out the importance of listening to a patient without reassuring them that

everything will be o.k. Florence tells the story of a dying man who feels isolated in the “midst of

friends.” “He feels what a convenience it would be, if there were any single person to whom he

could speak simply and openly, without pulling the string upon himself of this shower-bath of

silly hopes and encouragement; to whom he could express his wishes and directions without that

person saying, “I hope it will please God yet to give you twenty years,” or “You have a long life

of activity before you.” In the end when the patient dies the family and friends will take the news

of the inevitable death with shock and disbelief but Florence said it may have been unexpected

by others but by no means unexpected by the one dying. The person surely knew that he was

dying but “found it useless to insist upon his own knowledge to his friends.” (Nightingale, 1860)

So many things can be learned from Florence and although she herself was still unsure of
 Nightingale 8

what it was that made a good nurse her teachings may have provided just such a measure. In

closing it’s important to note that Florence saw deep inside the soul to view things that even

close family members and friends may have had trouble seeing. In regards to the institutions

today that provide such inadequate care the patients also have this to endure. In the words of

Florence Nightingale, “To any but an old nurse, or an old patient, the degree would be quite

inconceivable to which the nerves of the sick suffer from seeing the same walls, the same ceiling,

the same surroundings during a long confinement to one or two rooms.”

References

"Florence Nightingale." The Columbia Encyclopedia, Sixth Edition. 2008. Retrieved November
09, 2009 from Encyclopedia.com: http://www.encyclopedia.com/doc/1E1-Nighting.html
Notes on nursing what it is and what it is not by Florence Nightingale. (1860). A celebration of
women writers. Retrieved November 3, 2009, from http://
http://digital.library.upenn.edu/women/nightingale/nursing/nursing.html

O'Conner, J. J., & Robertson, E. F. (2003, October). Florence Nightingale. In Nigthingale.

 Nightingale 9

Retrieved November 2, 2009, from

http://www.gap-system.org/~history/Biographies/Nightingale.html

Tomey, A. M., & Alligood, M. R. (2006). Florence Nightingale Modern Nursing. In Nursing
theorists and their work (pp. 71-83). St. Louis: Mosby Elsevier.