12 May, International Nurses' Day: Who was Florence Nightingale?
On 12 May 1820 Florence Nightingale, the founder of modern nursing science, was born. The International Council of Nurses (ICN) commemorates this date by celebrating International Nurses Day all over the world
12 May has thus become an opportunity for the nursing profession to ‘talk a little bit about itself’ with hospital in-patients, with users of territorial services, with the elderly, with other healthcare professionals, with young people who have to choose a job, with all those – in short – who in the course of their lives have met or will meet ‘a nurse’.
FLORENCE NIGHTINGALE was born in Florence on 12 May 1820 to wealthy English parents who had travelled to Italy for an extended stay
Very young, she showed great interest in the improvement of the English health system.
At the time, hospitals were frightening environments, to be avoided at all costs: in the same ward, sometimes in the same bed, patients suffering from the most diverse diseases thronged.
The concept of hygiene was almost unknown: doctors did not wash their hands before performing surgery and entered the operating theatre in the same clothes they wore on the street.
In-hospital mortality was very high.
Nightingale realised that in order to improve the results of British healthcare it was necessary to start working on some fundamental concepts, such as the hygiene of environments and lifestyles, the organisation of social welfare services and the helping relationship with the sick.
It was around these concepts that he was able to build the foundations for the birth and development of Nursing.
The force of evidence in his theories.
Nightingale’s ideas aroused enormous interest in English government circles, thanks to her ability to support them through the tools of scientific evidence, which at the time were beginning to take on great relevance, not least because of the spread of positivist thought in Europe.
During the Crimean War, in which the British, French and Turks fought against the Russians, the British government appointed her as superintendent of the nursing corps of the British United Hospitals in Turkey.
The hospital in Shkodra had thousands of beds crowded into six kilometres of long, dirty corridors: it was infested with rats, there was no water and the clogged toilets overflowed in the wards.
Nightingale arrived there with 38 nurses, of whom only 12 would survive
She proved that the high mortality rate from illness among the soldiers (42%) was related to inadequate care and, despite the obstacles put in her way by the medical officers, who did not accept this theory, she was able to rely on funds from private donations and, with great determination, managed to equip Barrack Hospital in Shkodra with efficient sanitation and suitable infrastructure.
The mortality rate dropped to 2%.
By surveying these observations and applying mathematical models, he was able to prove the validity of his theories, which would soon lead to a significant reduction in mortality and morbidity rates even among the civilian population.
The so-called ‘wedge’ graph, created by Nightingale to explain how during the Crimean War her welfare interventions had significantly reduced mortality from disease among British soldiers, is a masterpiece of representative statistics and, at the same time, can be considered one of the first examples of www.fnopi.it welfare applications based on scientific evidence (among the various reproductions see also in Pam Brown, Florence Nightingale, Editrice Elle Di Ci, Turin, 1991).
The ‘wedge’ graph takes on a relevant value if one considers that statistical science was in its infancy at that time: there are very few examples of representative statistics applied to social phenomena that can be traced back to that period, if one excludes Minard’s famous graph of 1869, in which the freezing mortality of Napoleon’s army in Russia was represented.
Minard’s graph, considered to be one of the best representations made up to that time, was the object of attention by Nightingale, who, after a thorough test of the available data, came to the conclusion that the Napoleonic army, like most other armies, had not been decimated by battles but by disease.
Nightingale’s graphs, which in any case predate Minard’s, are not only descriptive but also prescriptive as they contain within them solutions to the observed problem.
William Farr himself, head of the General Registry Office and a friend of Nightingale, realised that by adopting the same strategies, the same results could also be obtained among the civilian population.
At the International Congress of Statistics held in London in 1860, Nightingale made a decisive contribution to the methods of systematic collection of epidemiological data.
A significant example of how essential it was for her to make decisions supported by scientific foundations is her epidemiological studies of obstetrics wards.
The results of these studies, showing a higher mortality rate for women giving birth in hospitals than for women giving birth at home, led to the closure of these wards.
Studies on the infant mortality of Aboriginal populations in the British colonies also kept the researcher busy for a long time, as she resented the idea that these children should die twice as often as those of the same age living in England.
Her work in medical statistics had been so impressive that in 1858 she was elected a member of the renowned Statistical Society of England.
The first attempts to provide skilled nursing care were made in 1865 in Liverpool’s hospices, thanks to funding from a Christian philanthropist, William Rathbone, under Nightingale’s own guidance and the superintendence of St Thomas’ Hospital.
An attempt was made to scientifically prove that skilled nursing could save lives: mortality rates were compared between wards where nurses had been introduced and wards without skilled nursing.
The study did not reveal any significant differences between the mortality rates in the two groups, but was severely criticised by Nightingale, who claimed that the allocation of cases had not been random at all, but that the wards where nurses worked had admitted the most serious patients.
12 May, Nightingale’s leadership derives fundamentally from her knowledge
It was mainly through the use of statistics that she achieved great things: the way hospitals were built, obstetrics wards were organised, barracks were run had changed thanks to her and her love of reasoning, her ability to question assumptions and to pay great attention to the process of reaching conclusions.
After returning from the Crimea and being welcomed back home as a national heroine, Nightingale spent the next 40 years of her life advising governments halfway around the world, including India and the United States, on how hospitals should be built and how care services, especially nursing services, should be organised.
Convinced that Nursing was a means, the best means, of saving lives, despite the fact that most of the medical world at the time considered it useless, Nightingale attached great importance to nursing education: within a few years hospitals on all continents would be asking Nightingale nurses to open new schools.
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