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Commentary: Florence Nightingale's Ongoing Inspiration

By Marcia Gruber

Buffalo, NY – Health care is experiencing unprecedented change. New technology; new drugs; cancer vaccines; threats of international pandemics; a shortage of nurses and physicians; and hospitals reorganizing all create an atmosphere where creativity, strategic thinking and evidenced-based decisions are absolutely necessary.

Thus, it would seem logical that Nursing, as the health care profession with the greatest number of members, should evolve and advance as well. But maybe just this once, nursing needs to look backward, in order to go forward.

Florence Nightingale is known as the founder of modern nursing and most often remembered as the Lady with the Lamp' who cared for wounded British Soldiers. Florence is lesser known for her hospital reform efforts and use of statistics to implement noteworthy change. Florence Nightingale was born into a wealthy family in May1820. She was educated in Greek, Latin, French, German, and Italian as well as philosophy, history, mathematics, music and grammar. Florence had a special interest in mathematics and, at age 20, despite her parent's objections, sought additional tutoring in mathematics. Soon after, and again over the protestation of her parents, Florence attended a training program for nurses in Prussia. This qualified her to become the unpaid superintendent of London's Institution for the Care of Sick Gentlewomen in 1853. When the war began in Turkey, reports of dreadful circumstances for wounded soldiers reached England.

Florence volunteered to go to the Turkish battle front and took 38 nurses, mostly nuns, with her. From 1854-56, Florence Nightingale directed nursing care in the English military hospitals in Scutari, Turkey. During this time, Florence observed that more soldiers seemed to be dying of diseases such as cholera, typhoid and dysentery rather than from their war injuries. She was appalled by the unsanitary conditions and applied her education and interest in mathematics to collect data and create a graphical representation of the conditions. Florence is credited as being the first to use a pie chart for data presentation. That data led to the correct conclusion that the unsanitary conditions in the hospitals were the major cause of mortality among the wounded soldiers.

Florence and her nurses obtained clean supplies, bathed patients, improved the quality of the water supply and worked diligently to correct the unsanitary conditions. These efforts reduced the mortality rate at the Scutari military hospital from 42% to 2% in 6 months. With this analysis and these successful evidenced-based interventions, Florence earned the respect of the military doctors.

Eventually, Florence Nightingale becomes general superintendent of the Female Nursing Establishment for the Army Hospitals (March 16, 1856). Additionally, her work with medical statistics was so impressive that she was elected as a member of the Statistical Society of England. Her statistical evidence is said to have convinced Parliament and Queen Victoria to mandate her proposed hospital reforms. In 1860 she founded the Nightingale Nursing School at St. Thomas Hospital in London using funds contributed by the public to honor her work in Scutari. Florence also helped to inspire the English system of district nursing. During the American Civil War, Nightingale was a consultant on army health to the United States government and she also responded to a British war office request for advice on army medical care in Canada.

Florence Nightingale's reliance on systematic record keeping, data analysis and thoughtful, planned reform is exactly the approach needed to address the many challenges in health care delivery today. Using data dramatically improves our ability to identify true cause and effect so that the right solutions, evidenced-based solutions, are put in place. As health care changes, data driven decisions will allow nurses to ensure patient safety as well as to document the many contributions that nurses make to patient care and hospital processes.

Like our founder Florence Nightingale, nurses continue to be motivated by patients and the desire to ensure the right care at the right time. Florence Nightingale showed us the way to turn that motivation into meaningful and measurable action. So perhaps, this time, looking back to the methods of our founder will give us the blueprint to go forward.

Listener-Commentator Marcia Gruber is vice president of Therapeutic Services and Patient Access at the Roswell Park Cancer Institute.

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