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Editorial: What has Florence Nightingale ever done for clinical nurses?

2012; Wiley; Volume: 21; Issue: 17-18 Linguagem: Inglês

10.1111/j.1365-2702.2010.03455.x

1365-2702

Jacinta Kelly,

Family and Patient Care in Intensive Care Units

Until recently, Florence Nightingale’s portrait featured on the British 10-pound note. This year, marking the centenary anniversary of her death at 90 years of age on the 13 August 1910, Miss Nightingale’s name has now been etched on 2-pound coins. However, lest we think the standard-bearer of modern nursing is losing currency, commemorative events held that year in the UK and elsewhere confirm that the ‘Lady with the Lamp’, as dubbed by the poet Longfellow, remains highly valued. In fact, praise has been heaped on this national treasure in the form of an imaginative £1·4 million redevelopment of the Florence Nightingale Museum. The Museum takes pride of place on the grounds of St Thomas’s hospital in London’s vibrant South Bank where Nightingale established her first Nightingale Training School for Nurses. In this audacious tribute, supported by the Wellcome Trust, Guys and St Thomas’ Charity and Garfield Weston Foundation, the Victorian nursing pioneer is celebrated as a sanitary reformer, statistician, administrator, researcher and educationalist. The Museum exhibits a vast collection of ‘Nightingalia’ organised under three pillars: her early childhood; her activities in the Crimean war; and finally her contribution to international health reform. The net effect of this careful assembly of Florence’s singular life story leaves the public in no doubt as to why her appeal as ‘The Queen of Nurses’ or ‘Soldier’s Friend’ has endured well into the 21st century. But does this enduring appeal for all things Nightingale extend to modern day clinical nursing? What did Florence Nightingale actually ever do for clinical nurses? To begin, a ‘nurse’ in the Victorian period was usually a coarse old woman, always ignorant, usually dirty, often brutal, a Mrs. Gamp, in bunched-up sordid garments, tippling at the brandy bottle or indulging in worse irregularities. The nurses in the hospitals were especially notorious for immoral conduct; sobriety was almost unknown among them; and they could hardly be trusted to carry out the simplest medical duties (Strachey 1960). Florence, on the other hand, was born into a wealthy well-connected English family and was schooled in Philosophy, Mathematics and classical languages. As a young adult, she railed against ‘Victorian idleness’ and inclined towards philanthropy she visited and helped the poor sick around her English home. Inspired by a divine calling, she started nurse training at the age of 30 in the Institute of Saint Vincent de Paul in Alexandria, Egypt and later studied at the Protestant Deaconesses at Kaiserswerth in Germany. On her return in 1853, she became Lady Superintendent of an Institution for Gentlewomen in Illness at no. 1 Upper Harley Street in the West End of London where she earned a reputation as a brilliant manager. Undoubtedly, Miss Nightingale, who dedicated untiringly her entire life to nursing, and never married, was responsible for influencing the public perception that nursing is a vocation and exclusively a female activity. However, it has to be said that she did bring an educated respectability to the occupation of clinical nursing making it an acceptable and legitimate career. Florence was not interested in caring only for the upper classes she wanted to care for the poor. At the outbreak of war, she travelled to the Crimea in 1854 with a group of 38 nurses. She strategically agreed to subordinate nurses to the negligent army corps to gain admission to the Barrack Hospital. At the vermin infested Scutari Barrack Hospital near Constantinople, she found that wounded soldiers lay for months in their army uniforms that were ‘stiff with dirt and gore’. More soldiers died in the hospital than on the battlefield where the majority died not of war wounds but of typhus, tuberculosis, dysentery, cholera and typhoid (Swanson & Wojnar 2004). Florence Nightingale believed the duty of a nurse was to put the patient in the best condition for nature to act upon him or her. She suggested there were five essential components to an optimal healing environment; pure air, pure water, efficient drainage, cleanliness and light (Nightingale 1860). What seems like a victory for commonsense by today’s clinical standards, she insisted that a fresh, clean cloth be used for each soldier, rather than the same cloth for multiple patients. She set up huge boilers to destroy lice and had large windows installed to provide ventilation and light. She shamed hospital orderlies into removing buckets of human waste and to clean up the raw sewage that polluted the wards and unplug latrine pipes (Gill & Gill 2005). Florence and her nurses scrubbed the hospital clean, washed the sheets, blankets and towels, cleaned the hospital’s kitchens and prepared better, wholesome food for the patients. She insisted each nurse under her charge be accountable to her. Some have suggested Nightingale was a control freak, religious maniac, hysterical, power crazed, deceitful, manipulative and even cruel. However, one thing we know for certain is that the mortality rate of soldiers at Scutari reduced dramatically in conjunction with these and other clinical interventions. She also earned the admiration of the common soldiers where one reported ‘What a comfort it was to see her pass even. She would speak to one and nod and smile to many more; but she could not do it all you know. We lay there by hundreds; but we could kiss her shadow as it fell and lay our heads on the pillow again content’. Arguably, her activities in the Crimea propagated a lasting image of the clinical nurse as little more than an over eager domestic manager or devoted angel but if the truth be known many of our current clinical practices –‘the systematic care of the sick or wounded’– such as isolation of patients with antibiotic resistant pathogens, avoidance of cross-contamination, routine cleansing of all patient areas, aseptic preparation of foods, ventilation of wards and disposal of human and medical wastes, and the need for therapeutic nurse–patient relationships trace their origins to successful practices enacted by Nightingale at Scutari (Gill & Gill 2005). After her services were no longer required in Scutari, Florence returned to England in 1857, but in poor health having contracted brucellosis rendering her prone to chronic fatigue and episodes of fever. She retreated to her home and from her couch and later her bed for the next 50 years she wrote over 200 books, reports and pamphlets which had an immense impact on army health, welfare in India, civilian hospitals, medical statistics and nursing. In 1860, her most famous book Notes on Nursing was published the same year the Nightingale Training School and Home for Nurses at St. Thomas’s Hospital was established. In the training of clinical nurses, she was little concerned with content and more concerned with accountability she made the Matron supreme, giving her unlimited powers of selection and dismissal (Baly 1991), a dictate which no doubt spawned leagues of ‘battleaxes’. However, her greatest strength was that she really did have a profound understanding of what it takes to be a clinical nurse where she explained that observation tells us how the patient is; reflection tells what is to be done; training tells how it is to be done. Training and experience are, of course, necessary to teach us, how to observe, what to observe; how to think, what to think (Nightingale 1882). Such timeless pearls of wisdom reassure clinical nurses that the lavish centenary anniversary tributes are worth every penny.