Florence
Nightingale, by name Lady
with the Lamp, (born May 12, 1820, Florence [Italy]—died August
13, 1910, London, England), British nurse, statistician, and social reformer
who was the foundational philosopher of modern nursing. Nightingale was put in
charge of nursing British and allied soldiers in Turkey during the Crimean War.
She spent many hours in the wards, and her night rounds giving
personal care to the wounded & established her image as the “Lady with the
Lamp.” Her efforts to formalize nursing education led her to establish the
first scientifically based nursing school—the Nightingale School of Nursing, at
St. Thomas’ Hospital in London (opened 1860). She also was instrumental in
setting up training for midwives and nurses in workhouse infirmaries. She was
the first woman awarded the Order of Merit (1907). International Nurses Day,
observed annually on May 12, commemorates her birth and celebrates the
important role of nurses in health care.
Family ties and spiritual awakening
Florence Nightingale was the second of two daughters born, during an extended European honeymoon, to William Edward and Frances Nightingale. (William Edward’s original surname was Shore; he changed his name to Nightingale after inheriting his great-uncle’s estate in 1815.) Florence was named after the city of her birth. After returning to England in 1821, the Nightingales had a comfortable lifestyle, dividing their time between two homes, Lea Hurst in Derbyshire, located in central England, and Embley Park in warmer Hampshire, located in south-central England. Embley Park, a large and comfortable estate, became the primary family residence, with the Nightingales taking trips to Lea Hurst in the summer and to London during the social season.
Florence was a precocious child intellectually. Her father took
particular interest in her education, guiding her through history, philosophy,
and literature. She excelled in mathematics and languages and was able to read
and write French, German, Italian, Greek, and Latin at an early age. Never
satisfied with the traditional female skills of home management, she preferred
to read the great philosophers and to engage in serious political and social
discourse with her father.
As part of a liberal Unitarian family, Florence found great comfort
in her religious beliefs. At the age of 16, she experienced one of several
“calls from God.” She viewed her particular calling as reducing human
suffering. Nursing seemed the suitable route to serve both God and humankind.
However, despite having cared for sick relatives and tenants on the family
estates, her attempts to seek nurse’s training were thwarted by her family as
an inappropriate activity for a woman of her stature.
How
very little can be done under the spirit of fear. Florence Nightingale
Nursing in peace and war
Despite family reservations, Nightingale was eventually able to enroll at the Institution of Protestant Deaconesses at Kaiserswerth in Germany for two weeks of training in July 1850 and again for three months in July 1851. There she learned basic nursing skills, the importance of patient observation, and the value of good hospital organization. In 1853 Nightingale sought to break free from her family environment. Through social connections, she became the superintendent of the Institution for Sick Gentlewomen (governesses) in Distressed Circumstances, in London, where she successfully displayed her skills as an administrator by improving nursing care, working conditions, and efficiency of the hospital. After one year she began to realize that her services would be more valuable in an institution that would allow her to train nurses. She considered becoming the superintendent of nurses at King’s College Hospital in London. However, politics, not nursing expertise, was to shape her next move.
In October 1853 the Turkish Ottoman Empire declared war on
Russia, following a series of disputes over holy places in Jerusalem and
Russian demands to exercise protection over the Orthodox subjects of the
Ottoman sultan. The British and the French, allies of Turkey, sought to curb
Russian expansion. The majority of the Crimean War was fought on the Crimean
Peninsula in Russia. However, the British troop base and hospitals for the care
of the sick and wounded soldiers were primarily established in Scutari
(Üsküdar), across the Bosporus from Constantinople (Istanbul). The status of
the care of the wounded was reported to the London Times by the first
modern war correspondent, British journalist William Howard Russell. The
newspaper reports stated that soldiers were treated by an incompetent and
ineffective medical establishment and that the most basic supplies were not
available for care. The British public raised an outcry over the treatment of
the soldiers and demanded that the situation be drastically improved.
Sidney Herbert, secretary of state at war for the British
government, wrote to Nightingale requesting that she lead a group of nurses to
Scutari. At the same time, Nightingale wrote to her friend Liz Herbert,
Sidney’s wife, asking that she be allowed to lead a private expedition. Their
letters crossed in the mail, but in the end their mutual requests were granted.
Nightingale led an officially sanctioned party of 38 women, departing October
21, 1854, and arriving in Scutari at the Barrack Hospital on November 5. Not
welcomed by the medical officers, Nightingale found conditions filthy, supplies
inadequate, staff uncooperative, and overcrowding severe. Few nurses had access
to the cholera wards, and Nightingale, who wanted to gain the confidence of
army surgeons by waiting for official military orders for assistance, kept her
party from the wards. Five days after Nightingale’s arrival in Scutari, injured
soldiers from the Battle of Balaklava and the Battle of Inkerman arrived and
overwhelmed the facility. Nightingale said it was the “Kingdom of Hell.”
In order to care for the soldiers properly, it was necessary
that adequate supplies be obtained. Nightingale bought equipment with funds
provided by the London Times and
enlisted soldiers’ wives to assist with the laundry. The wards were cleaned and
basic care was provided by the nurses. Most important, Nightingale established
standards of care, requiring such basic necessities as bathing, clean clothing
and dressings, and adequate food. Attention was given to psychological needs
through assistance in writing letters to relatives and through providing
educational and recreational activities. Nightingale herself wandered the wards
at night, providing support to the patients; this earned her the title of “Lady
with the Lamp.” She gained the respect of the soldiers and medical
establishment alike. Her accomplishments in providing care and reportedly
reducing the mortality rate to about 2 percent brought her fame in England
through the press and the soldiers’ letters.
Live
life when you have it. Life is a splendid gift – there is nothing small about
it. Florence Nightingale
In May 1855 Nightingale began the first of several excursions to
Crimea; however, shortly after arriving, she fell ill with “Crimean fever”—most
likely brucellosis, which she probably contracted from drinking contaminated
milk. Nightingale experienced a slow recovery, as no active treatment was
available. The lingering effects of the disease were to last for 25 years,
frequently confining her to bed because of severe chronic pain.
On March 30, 1856, the Treaty of Paris ended the Crimean War.
Nightingale remained in Scutari until the hospitals were ready to close,
returning to her home in Derbyshire on August 7, 1856, as a reluctant heroine.
Homecoming and legacy
Although primarily remembered for her accomplishments during the Crimean War, Nightingale’s greatest achievements centered on attempts to create social reform in health care and nursing. On her return to England, Nightingale was suffering the effects of both brucellosis and exhaustion. In September 1856 she met with Queen Victoria and Prince Albert to discuss the need for reform of the British military establishment. Nightingale kept meticulous records regarding the running of the Barrack Hospital, causes of illness and death, the efficiency of the nursing and medical staffs, and difficulties in purveyance. A Royal Commission was established, which based its findings on the statistical data and analysis provided by Nightingale. The result was marked reform in the military medical and purveyance systems.
In 1855, as a token of gratitude and respect for Nightingale,
the Nightingale Fund was established. Through private donations, £45,000 was
raised by 1859 and put at Nightingale’s disposal. She used a substantial part
of these monies to institute the Nightingale School of Nursing at St. Thomas’
Hospital in London, which opened in 1860. The school formalized secular nursing
education, making nursing a viable and respectable option for women who desired
employment outside of the home. The model was taken worldwide by matrons (women
supervisors of public health institutions). Nightingale’s statistical
models—such as the Coxcomb chart, which she developed to assess mortality—and
her basic concepts regarding nursing remain applicable today. For these reasons
she is considered the foundational philosopher of modern nursing.
Nightingale improved the health of households through her most
famous publication, Notes
on Nursing: What It Is and What It Is Not, which provided direction
on how to manage the sick. This volume has been in continuous publication
worldwide since 1859. Additional reforms were financed through the Nightingale
Fund, and a school for the education of midwives was established at King’s
College Hospital in 1862. Believing that the most important location for the
care of the sick was in the home, she established training for district
nursing, which was aimed at improving the health of the poor and vulnerable. A
second Royal Commission examined the health of India, resulting in major
environmental reform, again based on Nightingale’s statistical data.
Florence Nightingale was honoured in her lifetime by receiving
the title of Lady of Grace of the Order of St. John of Jerusalem and by
becoming the first woman to receive the Order of Merit. On her death in 1910,
at Nightingale’s prior request, her family declined the offer of a state
funeral and burial in Westminster Abbey. Instead, she was honoured with a
memorial service at St. Paul’s Cathedral, London. Her burial is in the family
plot in St. Margaret’s Church, East Wellow, Hampshire.
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