Florence Nightingale: An Early Pioneer, Research Paper Example

Abstract

This paper explores the work of Florence Nightingale from research using primary sources and peer-reviewed articles.  The topics discussed include Nightingale’s care on both individual and population levels, as well as how those levels are intertwined.  Nightingale’s work to break the chain of infection is discussed, as well as her accomplishments statistically and her use of surveillance to better patient care.  Finally, a conclusion paragraph discusses what I learned through this assignment and how my understanding has been improved.

Florence Nightingale’s work to better patient care has been revolutionary, and she is considered to be one of the mothers of modern nursing.  Beyond her healthcare reforms, however, Nightingale’s statistical work proves to be revolutionary and her methods are still being used to record patient care, today.  However, prior to Nightingale’s pioneering through the healthcare system, she found many problems and used her gifts of perseverance and determination to not only gather data that reflected the problems with the healthcare system, but to use that data to form arguments to make the change she saw to be necessary.

Individual and Population Care in Nightingale’s Work

Individual Care

It is not uncommon knowledge that Nightingale started out her journey by taking 40 nurses to the Crimea in order to care for soldiers wounded during the war (Ulrich, 2008). In her discussion of Nightingale’s importance in the progression of individual care, Ulrich describes year following the start of Nightingale’s time in the Crimea, in which she implemented more holistic approaches to patient care, including having “hot water piped to every floor . . . a lift installed to bring the patients’ food to the floors, and . . . bells installed for the patients to call the nurses” (p. 343).  After her work in the Crimea, Nightingale went on to affect individuals indirectly, specifically in writing Notes on Nursing, which was published and circulated in 1859.  Marie Manthey (2011), the president emeritus of Creative Health Care Management, writes that the book was well-received and revolutionary at its time, and that it was even considered to be of “first-rate importance” by leaders in the medical sciences of Nightingale’s time (p. 55).  By writing a book that would be used by nurses and medical professionals at the time and ultimately influencing their medical treatment for the better, Nightingale improved the quality of care that individuals received.

Population Care

Nightingale’s pioneering in individual care carved the way for her future impact on the population level of society’s ill.  After many years working with statistics, which she came to be known for, and specific viewing of illness as it relates to surroundings, age, and other such circumstances, Nightingale took it upon herself to gather information and make publicly-available advice for disease prevention.  Lynn McDonald (1998) speaks on Nightingale’s belief that an increase in disease prevention would prove to be more beneficial than an increase in ability to heal disease in her article “Florence Nightingale: Passionate Statistician.”  Rather than taking on treatments in a case-by-case basis, McDonald states, Nightingale publically advocated for health promotion and preventative measures, oftentimes using her influence on powerful men to get her word out. Because there were no middle-men for this approach, Nightingale was able to get basic information out directly to the people, whereas her book Notes on Nursing went through medical professionals before meeting at the civilian level. Preventative measures and tips on how to stay healthy were her primary angles when giving information to the public.

Breaking the Chain of Infection in Nightingale’s Work

However, while preventative measures were the greatest defense Nightingale brought forth to combat illness, as Nightingale researched and gathered statistics on common illnesses she came to realize that there was more to disease than chance occurrence.  McDonald (2010) writes that Nightingale began to support the germ theory in 1884 or 1885, which is now widely understood to be one of the true ways in which illness spreads (“Florence Nightingale a Hundred”).  While Nightingale understood the germ theory, as was made apparent by her 1897 address to nurses, she was still a heavy advocate of cleanliness and healthiness as preventative measures to keep from falling ill. Sanitation and hygiene were very important to Nightingale and the commonly-known practice of handwashing was one of the things for which she was a heavy advocate.

Epidemiology in Nightingale’s Work

Prior to her understanding of the germ theory, however, Nightingale’s statistics and advice to prevent mortalities in midwifery hospitals lined up directly with the germ theory. McDonald (1998) mentions Nightingale’s findings regarding women’s mortality during birth in her article “Florence Nightingale: Passionate Statistician,” saying that Nightingale found that women in contact with doctors and medical students while in labor had significantly higher mortality rates than those without said contact.  As a solution, Nightingale suggested there be as little involvement with medical professionals possible in order to avoid the spreading of diseases between patients; she even went so far as to suggest that medical students be banned, entirely.  This belief that doctors and medical students were somehow influencing the mortality rate of women in lay-ins lines up directly with the germ theory, which suggests that doctors carry germs from one patient to the next, resulting in an increased rate of mortality. Prevention, cleanliness, and less doctor-patient contact were a few of the measures Nightingale used to break the chain of infection that plagued the people of her day, and some of those measures are still in use, today.

Surveillance in Nightingale’s Work

Nightingale’s findings would not have been possible, had she not been such an advocate for program surveillance and statistic gathering. Louise Selanders and Patrick Crane (2012) wrote of Nightingale’s ability to overcome her low status as a woman of the time by using her administrative skills in the Crimea to get the attention of men in medicine and the military.  Nightingale worked her way up the ranks and relentlessly wrote to men with power until she had an audience with enough power to assist her with the healthcare reform she envisioned.  In her article “Florence Nightingale as a Social Reformer,” Lynn McDonald (2006) mentions that Nightingale’s rise in social status gave her the power to send out questionnaires (which she checked with experts to be sure they were sufficient) to colonies, which would provide her with information on mortality and sickness in hospitals and schools.  Nightingale further pleaded in 1860 for hospitals to uniformly gather information and statistics in order to better institutions and lessen mortality rates across the board; she wrote a letter to congress and gave a paper at the International Statistical Congress (titled “Hospital Statistics”) as two separate pleas for more surveillance (McDonald, “Florence Nightingale and Public Health Policy”).

Nightingale’s Work in Measuring Health Outcomes

Nightingale’s surveillance efforts finally paid off, because institutions began regularly recording statistics she called for.  Nightingale was primarily known for her ability to use statistics and comprehend them in a very professional and intelligent way; while translating those statistics in order to make strategies to fix problems, Nightingale created several rules for the reports written.  McDonald (2006) writes specifically of Nightingale’s reports in her essay “Florence Nightingale and Public Health Policy,” where she reports the four main points that Nightingale always followed:

Reports are not self-executive; implementation must be worked out while the report is being written. | Specific actions by specific agents, institutions, government departments, etc., must be identified and assigned; | The report must circulate through opinion leaders to the public; hence reviews in academic journals, the leading “progressive” periodicals and such high-status newspapers as the Times must be sought; the political system has to be worked: Cabinet ministers, senior public servants, back-bench MPs, committees; briefings have to be arranged for and questions drafted; these actors themselves have to motivated, one of the purposes of the reviews, etc., immediately above.

Nightingale’s findings almost always supported her belief that nurses needed more formal training.  Louis Monteiro (1985) writes that if illness struck, it was vital for the nurses to have had the training required, as well as the means, to take care of those ill (p. 181).  Many of the mortalities could have been prevented if nurses had been better trained.

Beyond having used statistics to reform and better patient care, the statistics that Nightingale used, in and of themselves, were revolutionary.  Rather than simply looking at illness and mortality, Nightingale looked at outside sources and circumstances that might have been overlooked by others doing similar statistics.  In her article “Florence Nightingale: Passionate Statistician,” McDonald (1998) mentions Nightingale’s use of graphical mortality data; she provided easy-to-visualize bar charts and pie charts, which revolutionized the way government statistics were presented.  Nightingale compared different groups—more specifically the army versus civilian mortality rates—and utilized those statistics in order to reform barracks construction; McDonald writes that Nightingale’s efforts increased “diet and the provision of medical and nursing services” for the soldiers in the barracks (p. 270).  Nightingale used her statistics in a fight against the Contagious Diseases Act, specifically, which Phillip Howell (2000) discusses further; the Act intended to “isolate, segregate, and domesticate prostitution activity” in order to prevent the spread of venereal diseases (p. 376).  Nightingale used statistics to show that venereal disease was not reduced where inspections of prostitutes were taking place, which partly contributed in the Act’s repeal in 1886 (McDonald, “Florence Nightingale: Passionate Statistician,” p. 270).  By applying things such as geography, patient age, and other health or circumstantial information, Nightingale took a new approach to statistics that allowed her to challenge the medical practices of her day while simultaneously finding the sources of some illnesses and increased mortality rates.

Summary and Learning

This assignment gave me a new appreciation for Florence Nightingale and her ability to use statistics without having taken any official classes that might be found on university campuses, today.  In fact, her impact on modern day statistics and medical procedure surprised me; I was aware that she had a big impact—her name is recognizable to anyone—but I did not know the extent to which she revolutionized nursing.  Her meticulous and time-consuming work gathering sources and professional opinions to back up her data was beyond impressive and it certainly made her stand out from the people of her day.  After reading the amount of letters she wrote and sent out to many professionals in the field while also attempting to earn herself status with men with power (in order to better her outreach), I am amazed that one woman could accomplish so much in such a short amount of time.  In addition, I learned from the McDonald readings that Nightingale was cautious so as not to try and change too much in too little a time; with that information in mind, I am curious as to how much she would have accomplished if she had not been careful to take things one step at a time.  I did not realize how much Nightingale wrote—either in book or handout form—and now that I have a better understanding of how much she contributed to nursing in her day, I can better comprehend how she is still so relevant, even more than a hundred years later.  Especially for a woman, Florence Nightingale was far more astounding and groundbreaking that I’d originally thought her to be.

References

Howell, P. (2000). A private Contagious Diseases Act: prostitution and public space in Victorian Cambridge. Journal of Historical Geography, 26(3), 376-402.

Manthey, M. (2011). “Notes on nursing”: the caring remains. Creative Nursing, 17(1), 55-56.

McDonald, L. (1998). Florence Nightingale: passionate statistician. Journal of Holistic Nursing, 16(2), 267-277.

McDonald, L. (2003). Florence Nightingale’s radical approach to public health care. The Collected Works of Florence Nightingale. Retrieved from http://www.uoguelph.ca/~cwfn/nursing/radical.htm

McDonald, L. (2006). Florence Nightingale and public health policy: theory, activism, and public administration. The Collected Works of Florence Nightingale. Retrieved from http://www.uoguelph.ca/~cwfn/nursing/theory.htm

McDonald, L. (2006). Florence Nightingale as a social reformer. History Today, 56(1). Retrieved from http://www.historytoday.com/

McDonald, L. (2010). Florence Nightingale a hundred years on: who she was and what she was not. Women’s History Review, 19(5), 721-740.

Monteiro, L. A. (1985). Florence Nightingale on public health nursing. American Journal of Public Health, 75(2), 181-186.

Selanders, L. C., & Crane, P. C. (2012). The voice of Florence Nightingale on advocacy. Online Journal of Issues in Nursing, 17(1), 1. doi:10.3912/OJIN.Vol17No01Man01

Ulrich, B. (2008). Florence Nightingale: a proud heritage of carrying the torch for nursing and patient care. Nephrology Nursing Journal, 35(4), 343.