Nightingale, Florence

Florence Nightingale

Born	12 May 1820(1820-05-12) Florence, Grand Duchy of Tuscany
Died	13 August 1910(1910-08-13) (aged 90) Park Lane, London, United Kingdom
Profession	Nurse and Statistician
Institutions	Selimiye Barracks, Scutari
Specialism	Hospital hygiene and sanitation
Known for	Pioneering modern nursing
Signature

Florence Nightingale, OM, RRC (pronounced /ˈflɒrəns ˈnaɪtɨŋɡeɪl/, historically [ˈflɒɾəns]; 12 May 1820 – 13 August 1910) was a celebrated English nurse, writer and statistician. A Christian universalist, Nightingale believed that God had called her to be a nurse. She came to prominence for her pioneering work in nursing during the Crimean War, where she tended to wounded soldiers. She was dubbed "The Lady with the Lamp" after her habit of making rounds at night.

Nightingale laid the foundation of professional nursing with the establishment, in 1860, of her nursing school at St Thomas' Hospital in London, the first secular nursing school in the world. The Nightingale Pledge taken by new nurses was named in her honour, and the annual International Nurses Day is celebrated around the world on her birthday.

Contents 1 Biography 1.1 Early life 1.2 Crimean War 1.2.1 The Lady with the Lamp 1.3 Later career 1.4 Relationships 1.5 Death 2 Contributions 2.1 Statistics and sanitary reform 2.2 Literature and the women's movement 2.3 Theology 3 Legacy and memory 3.1 Nursing 3.2 Hospitals 3.3 Museums and monuments 3.4 Audio 3.5 Theatre 3.6 Television 3.7 Film 3.8 Banknotes 3.9 Photography 3.10 Biographies 3.11 Fiction 3.12 Florence Nightingale syndrome 3.13 Other 4 See also 5 Works 6 Sources 7 References 8 Further reading 9 External links

[edit] Biography

[edit] Early life

Florence Nightingale was born into a rich, upper-class, well-connected British family at the Villa Colombaia,^[1] near the Porta Romana at Bellosguardo in Florence, Italy, and was named after the city of her birth. Florence's older sister Frances Parthenope (pronounced /pɑrˈθiːnəpɪ/) had similarly been named after her place of birth, Parthenopolis, a Greek settlement now part of the city of Naples.

Her parents were William Edward Nightingale, born William Edward Shore (1794–1874) and Frances ("Fanny") Nightingale née Smith (1789–1880). William's mother Mary née Evans was the niece of one Peter Nightingale, under the terms of whose will William inherited his estate Lea Hurst in Derbyshire, and assumed the name and arms of Nightingale. Fanny's father (Florence's maternal grandfather) was the abolitionist William Smith. (For family trees, see ^[2])

Inspired by what she took as a call from God in February 1837 while at Embley Park, Florence announced her decision to enter nursing in 1844, despite the intense anger and distress of her mother and sister. In this, she rebelled against the expected role for a woman of her status, which was to become a wife and mother. Nightingale worked hard to educate herself in the art and science of nursing, in spite of opposition from her family and the restrictive societal code for affluent young English women.

Nightingale was courted by politician and poet Richard Monckton Milnes, 1st Baron Houghton, but she rejected him, convinced that marriage would interfere with her ability to follow her calling to nursing.

In Rome in 1847, she met Sidney Herbert, a brilliant politician who had been Secretary at War (1845–1846), a position he would hold again during the Crimean War. Herbert was on his honeymoon; he and Nightingale became lifelong close friends. Herbert and his wife were instrumental in facilitating Nightingale's nursing work in the Crimea, and she became a key adviser to him in his political career, though she was accused by some of having hastened Herbert's death from Bright's Disease in 1861 because of the pressure her programme of reform placed on him.

Nightingale also much later had strong relations with Benjamin Jowett, who may have wanted to marry her.

Nightingale continued her travels (now with Charles and Selina Bracebridge) as far as Greece and Egypt. Her writings on Egypt in particular are testimony to her learning, literary skill and philosophy of life. Sailing up the Nile as far as Abu Simbel in January 1850, she wrote

"I don't think I ever saw anything which affected me much more than this." And, considering the temple: "Sublime in the highest style of intellectual beauty, intellect without effort, without suffering... not a feature is correct – but the whole effect is more expressive of spiritual grandeur than anything I could have imagined. It makes the impression upon one that thousands of voices do, uniting in one unanimous simultaneous feeling of enthusiasm or emotion, which is said to overcome the strongest man."

At Thebes she wrote of being "called to God" while a week later near Cairo she wrote in her diary (as distinct from her far longer letters that her elder sister Parthenope was to print after her return): "God called me in the morning and asked me would I do good for him alone without reputation."^[3] Later in 1850, she visited the Lutheran religious community at Kaiserswerth-am-Rhein in Germany, where she observed Pastor Theodor Fliedner and the deaconesses working for the sick and the deprived. She regarded the experience as a turning point in her life, and issued her findings anonymously in 1851; The Institution of Kaiserswerth on the Rhine, for the Practical Training of Deaconesses, etc. was her first published work;^[4]she also received four months of medical training at the institute which formed the basis for her later care.

On 22 August 1853, Nightingale took the post of superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London, a position she held until October 1854.^[5] Her father had given her an annual income of £500 (roughly £25,000/US$50,000 in present terms), which allowed her to live comfortably and to pursue her career.

[edit] Crimean War

Florence Nightingale's most famous contribution came during the Crimean War, which became her central focus when reports began to filter back to Britain about the horrific conditions for the wounded. On 21 October 1854, she and a staff of 38 women volunteer nurses, trained by Nightingale and including her aunt Mai Smith,^[6] were sent (under the authorisation of Sidney Herbert) to Ottoman Empire, about 295 nautical miles (546 km; 339 mi) across the Black Sea from Balaklava in the Crimea, where the main British camp was based.

Nightingale arrived early in November 1854 at Selimiye Barracks in Scutari (modern-day Üsküdar in Istanbul). She and her nurses found wounded soldiers being badly cared for by overworked medical staff in the face of official indifference. Medicines were in short supply, hygiene was being neglected, and mass infections were common, many of them fatal. There was no equipment to process food for the patients.

Until recently it was commonly asserted that Nightingale reduced the death rate from 42% to 2% either by making improvements in hygiene herself or by calling for the Sanitary Commission. For example the 1911 first edition of the Dictionary of National Biography made this claim, but the second edition in 2001 did not. However, death rates did not drop; on the contrary, they began to rise. The death count was the highest of all hospitals in the region. During her first winter at Scutari, 4,077 soldiers died there. Ten times more soldiers died from illnesses such as typhus, typhoid, cholera and dysentery than from battle wounds. Conditions at the temporary barracks hospital were so fatal to the patients because of overcrowding and the hospital's defective sewers and lack of ventilation. A Sanitary Commission had to be sent out by the British government to Scutari in March 1855, almost six months after Florence Nightingale had arrived, and effected flushing out the sewers and improvements to ventilation.^[7] Death rates were sharply reduced. During the war she did not recognise hygiene as the predominant cause of death, and she never claimed credit for helping to reduce the death rate.^[8]

Nightingale continued believing the death rates were due to poor nutrition and supplies and overworking of the soldiers. It was not until after she returned to Britain and began collecting evidence before the Royal Commission on the Health of the Army that she came to believe that most of the soldiers at the hospital were killed by poor living conditions. This experience influenced her later career, when she advocated sanitary living conditions as of great importance. Consequently, she reduced deaths in the army during peacetime and turned attention to the sanitary design of hospitals.

[edit] The Lady with the Lamp

During the Crimean war, Florence Nightingale gained the nickname "The Lady with the Lamp", deriving from a phrase in a report in The Times:

She is a ‘ministering angel’ without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow's face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.^[9]

The phrase was further popularised by Henry Wadsworth Longfellow's 1857 poem "Santa Filomena":^[10]

Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.

[edit] Later career

While she was in the Crimea, on 29 November 1855, a public meeting to give recognition to Florence Nightingale for her work in the war led to the establishment of the Nightingale Fund for the training of nurses. There was an outpouring of generous donations. Sidney Herbert served as honorary secretary of the fund, and the Duke of Cambridge was chairman. Nightingale was considered a pioneer in the concept of medical tourism as well, on the basis of her letters from 1856 in which she wrote of spas in Ottoman Empire, detailing the health conditions, physical descriptions, dietary information, and other vitally important details of patients whom she directed there (where treatment was significantly less expensive than in Switzerland). It may be assumed^{[citation needed]} she was directing patients of meagre means to affordable treatment.

By 1859 Nightingale had £45,000 at her disposal from the Nightingale Fund to set up the Nightingale Training School at St. Thomas' Hospital on 9 July 1860. (It is now called the Florence Nightingale School of Nursing and Midwifery and is part of King's College London.) The first trained Nightingale nurses began work on 16 May 1865 at the Liverpool Workhouse Infirmary. She also campaigned and raised funds for the Royal Buckinghamshire Hospital in Aylesbury, near her family home.

Nightingale wrote Notes on Nursing, which was published in 1859, a slim 136-page book that served as the cornerstone of the curriculum at the Nightingale School and other nursing schools established, though it was written specifically for the education of those nursing at home. Nightingale wrote "Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognised as the knowledge which every one ought to have-distinct from medical knowledge, which only a profession can have".^[11]

Notes on Nursing also sold well to the general reading public and is considered a classic introduction to nursing. Nightingale spent the rest of her life promoting the establishment and development of the nursing profession and organizing it into its modern form. In the introduction to the 1974 edition, Joan Quixley of the Nightingale School of Nursing wrote: "The book was the first of its kind ever to be written. It appeared at a time when the simple rules of health were only beginning to be known, when its topics were of vital importance not only for the well-being and recovery of patients, when hospitals were riddled with infection, when nurses were still mainly regarded as ignorant, uneducated persons. The book has, inevitably, its place in the history of nursing, for it was written by the founder of modern nursing".^[12]

Nightingale was an advocate for the improvement of care and conditions in the military and civilian hospitals in Britain. Among her popular books are Notes on Hospitals, which deals with the correlation of sanitary techniques to medical facilities; Notes on Nursing, which was the most valued nursing textbook of the day; Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army.

As Mark Bostridge has recently demonstrated, one of Nightingale's signal achievements was the introduction of trained nurses into the workhouse system in England and Ireland from the 1860s onwards. This meant that sick paupers were no longer being cared for by other, able-bodied paupers, but by properly trained nursing staff. This innovation may be said to herald the establishment of the National Health Service in Britain, forty years after Nightingale's death.

It is commonly stated that Nightingale "went to her grave denying the germ theory of infection". Mark Bostridge in his recent biography^[13] disagrees with this, saying that she was opposed to a precursor of germ theory known as "contagionism" which held that diseases could only be transmitted by touch. Before the experiments of the mid-1860s by Pasteur and Lister, hardly anyone took germ theory seriously and even afterwards many medical practitioners were unconvinced. Bostridge points out that in the early 1880s Nightingale wrote an article for a textbook in which she advocated strict precautions designed, she said, to kill germs. Nightingale's work served as an inspiration for nurses in the American Civil War. The Union government approached her for advice in organizing field medicine. Although her ideas met official resistance, they inspired the volunteer body of the United States Sanitary Commission.

In the 1870s, Nightingale mentored Linda Richards, "America's first trained nurse", and enabled her to return to the USA with adequate training and knowledge to establish high-quality nursing schools. Linda Richards went on to become a great nursing pioneer in the USA and Japan.

By 1882, Nightingale nurses had a growing and influential presence in the embryonic nursing profession. Some had become matrons at several leading hospitals, including, in London, St Mary's Hospital, Westminster Hospital, St Marylebone Workhouse Infirmary and the Hospital for Incurables at Putney; and throughout Britain, e.g., Royal Victoria Hospital, Netley; Edinburgh Royal Infirmary; Cumberland Infirmary and Liverpool Royal Infirmary, as well as at Sydney Hospital in New South Wales, Australia.

In 1883, Nightingale was awarded the Royal Red Cross by Queen Victoria. In 1907, she became the first woman to be awarded the Order of Merit. In 1908, she was given the Honorary Freedom of the City of London. Her birthday is now celebrated as International CFS Awareness Day.

From 1857 onwards, Nightingale was intermittently bedridden and suffered from depression. A recent biography cites brucellosis and associated spondylitis as the cause.^[14] An alternative explanation for her depression is based on her discovery after the war that she had been mistaken about the reasons for the high death rate.^[8] There is, however, no documentary evidence to support this theory which remains, therefore, largely supposition. Most authorities today accept that Nightingale suffered from a particularly extreme form of brucellosis, the effects of which only began to lift in the early 1880s. Despite her symptoms, she remained phenomenally productive in social reform. During her bedridden years, she also did pioneering work in the field of hospital planning, and her work propagated quickly across Britain and the world.

[edit] Relationships

Although much of Nightingale's work improved the lot of women everywhere, she had little respect for women in general^[15] preferring the friendship of powerful men. She often referred to herself in the masculine, as for example "a man of action".^{[citation needed]}

She did, however, have several important and passionate friendships with women. As a young woman she adored both an aunt and a female cousin. Later in life she kept up a prolonged correspondence with an Irish nun, Sister Mary Clare Moore, with whom she had worked in Crimea.^[16] Her most beloved confidante was Mary Clarke, an Englishwoman she met in 1837 and kept in touch with throughout her life.^[17]

In spite of these deep emotional attachments to women, some scholars of Nightingale's life believe that she remained chaste for her entire life; perhaps because she felt an almost religious calling to her career, or because she lived in the time of Victorian sexual morality.^[18]

[edit] Death

On 13 August 1910, at the age of 90, she died peacefully in her sleep in her room at 10 South Street,^[19] Park Lane.^[20] The offer of burial in Westminster Abbey was declined by her relatives, and she is buried in the graveyard at St. Margaret Church in East Wellow, Hampshire.^[21][22]

[edit] Contributions

[edit] Statistics and sanitary reform

Florence Nightingale had exhibited a gift for mathematics from an early age and excelled in the subject under the tutorship of her father. Later, Nightingale became a pioneer in the visual presentation of information and statistical graphics.^[23] Among other things she used the pie chart, which had first been developed by William Playfair in 1801. While taken for granted now, it was at the time a relatively novel method of presenting data.^[24]

Indeed, Nightingale is described as "a true pioneer in the graphical representation of statistics", and is credited with developing a form of the pie chart now known as the polar area diagram,^[25] or occasionally the Nightingale rose diagram, equivalent to a modern circular histogram, in order to illustrate seasonal sources of patient mortality in the military field hospital she managed. Nightingale called a compilation of such diagrams a "coxcomb", but later that term has frequently been used for the individual diagrams. She made extensive use of coxcombs to present reports on the nature and magnitude of the conditions of medical care in the Crimean War to Members of Parliament and civil servants who would have been unlikely to read or understand traditional statistical reports.

In her later life Nightingale made a comprehensive statistical study of sanitation in Indian rural life and was the leading figure in the introduction of improved medical care and public health service in India. In 1858 and 1859 she successfully lobbied for the establishment of a Royal Commission into the Indian situation. Two years later she provided a report to the commission, which completed its own study in 1863. "After 10 years of sanitary reform, in 1873, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per 1,000".^[25]

In 1859 Nightingale was elected the first female member of the Royal Statistical Society and she later became an honorary member of the American Statistical Association.

[edit] Literature and the women's movement

“

Nightingale's achievements are all the more impressive when they are considered against the background of social restraints on women in Victorian England. Her father, William Edward Nightingale, was an extremely wealthy landowner, and the family moved in the highest circles of English society. In those days, women of Nightingale's class did not attend universities and did not pursue professional careers; their purpose in life was to marry and bear children. Nightingale was fortunate. Her father believed women should be educated, and he personally taught her Italian, Latin, Greek, philosophy, history and - most unusual of all for women of the time - writing and mathematics.[26]

”

But while better known for her contributions in the nursing and mathematical fields, Nightingale is also an important link in the study of English feminism. During 1850 and 1852, she was struggling with her self-definition and the expectations of an upper-class marriage from her family. As she sorted out her thoughts, she wrote Suggestions for Thought to Searchers after Religious Truth. This was an 829 page, three-volume work, which Nightingale had printed privately in 1860, but which until recently was never published in its entirety.^[27] An effort to correct this was made with a 2008 publication by Wilfrid Laurier University, as volume 11^[28] of a 16 volume project, the Collected Works of Florence Nightingale.^[29] The best known of these essays, called Cassandra, was previously published by Ray Strachey in 1928. Strachey included it in The Cause, a history of the women's movement. Apparently, the writing served its original purpose of sorting out thoughts; Nightingale left soon after to train at the Institute for deaconesses at Kaiserswerth.

Cassandra protests the over-feminization of women into near helplessness, such as Nightingale saw in her mother's and older sister's lethargic lifestyle, despite their education. She rejected their life of thoughtless comfort for the world of social service. The work also reflects her fear of her ideas being ineffective, as were Cassandra's. Cassandra was a princess of Troy who served as a priestess in the temple of Apollo during the Trojan War. The god gave her the gift of prophecy but when she refused his advances he cursed her so that her prophetic warnings would go unheeded. Elaine Showalter called Nightingale's writing "a major text of English feminism, a link between Wollstonecraft and Woolf."^[30]

[edit] Theology

Suggestions for Thought is also Nightingale's work of theology, her own theodicy, which develops her heterodox ideas.

Nightingale was a Christian universalist.^[31] She explained that on 7 February 1837 – not long before her 17th birthday: "God spoke to me", she wrote, "and called me to His service."^{[citation needed]}

[edit] Legacy and memory

[edit] Nursing

The first official nurses’ training program, the Nightingale School for Nurses, opened in 1860. The mission of the school was to train nurses to work in hospitals, work with the poor, and to teach. This intended that students cared for people in their homes, an appreciation that is still advancing in reputation and professional opportunity for nurses today.^[32]

Florence Nightingale's lasting contribution has been her role in founding the modern nursing profession. She set an example of compassion, commitment to patient care, and diligent and thoughtful hospital administration.

The work of her School of Nursing continues today as the Florence Nightingale School of Nursing and Midwifery at King's College London. The Nightingale Building in the School of Nursing and Midwifery at the University of Southampton is also named after her. International Nurses Day is celebrated on her birthday each year.

The Florence Nightingale Declaration Campaign,^[33] established by nursing leaders throughout the world through the Nightingale Initiative for Global Health (NIGH), aims to build a global grassroots movement to achieve two United Nations Resolutions for adoption by the UN General Assembly of 2008 which will declare: The International Year of the Nurse–2010 (the centennial of Nightingale's death); The UN Decade for a Healthy World–2011 to 2020 (the bicentennial of Nightingale's birth). NIGH also works to rekindle awareness about the important issues highlighted by Florence Nightingale, such as preventive medicine and holistic health. So far, the Florence Nightingale Declaration has been signed by over 18,500 signatories from 86 countries.

During the Vietnam War, Nightingale inspired many U.S. Army nurses, sparking a renewal of interest in her life and work. Her admirers include Country Joe of Country Joe and the Fish, who has assembled an extensive website in her honour.^[34]

The Agostino Gemelli Medical School^[35] in Rome, the first university-based hospital in Italy and one of its most respected medical centres, honoured Nightingale's contribution to the nursing profession by giving the name "Bedside Florence" to a wireless computer system it developed to assist nursing.^[36]

There are many foundations named after Florence Nightingale. Most are nursing foundations, but there is also Nightingale Research Foundation in Canada, dedicated to the study and treatment of chronic fatigue syndrome, which Nightingale is believed to have had.

In 1912 the International Committee of the Red Cross instituted the Florence Nightingale Medal, awarded every two years to nurses or nursing aides for outstanding service.

[edit] Hospitals

Four hospitals in Istanbul are named after Nightingale: F. N. Hastanesi in Şişli (the biggest private hospital in Turkey), Metropolitan F.N. Hastanesi in Gayrettepe, Avrupa F.N. Hastanesi in Mecidiyeköy, and Kızıltoprak F.N. Hastanesi in Kadiköy, all belonging to the Turkish Cardiology Foundation.^[37]

[edit] Museums and monuments

A statue of Florence Nightingale stands in Waterloo Place, Westminster, London, just off The Mall.

There are three statues of Florence Nightingale in Derby — one outside the London Road Community Hospital formerly known as the Derbyshire Royal Infirmary, one in St. Peter's Street, and one above the Nightingale-Macmillan Continuing Care Unit opposite the Derby Royal Infirmary. A public house named after her stands close to the Derby Royal Infirmary.^[38] The Nightingale-Macmillan continuing care unit is now at the Royal Derby Hospital, formerly known as The City Hospital, Derby.

A remarkable stained glass window was commissioned for inclusion in the Derbyshire Royal Infirmary chapel in the late 1950s. When the chapel was later demolished the window was removed, stored and replaced in the new replacement chapel. At the closure of the DRI the window was again removed and stored. In October 2010, £6,000 was raised by friends of the window and St Peters Church to reposition the window in St Peters Church, Derby. The remarkable work features nine panels, of the original ten, depicting scenes of hospital life, Derby townscapes and Florence Nightingale herself. Some of the work was damaged and the tenth panel was dismantled for the glass to be used in repair of the remaining panels. All the figures, who are said to be modelled on prominent Derby town figures of the early sixties, surround and praise a central pane of the triumphant Christ. A nurse who posed for the top right panel in 1959 attended the rededication service in October 2010.^[39]

The Florence Nightingale Museum at St Thomas' Hospital in London reopened in May 2010 in time for the centenary of Nightingale's death. Another museum devoted to her is at her sister's family home, Claydon House, now a property of the National Trust.

2010 marks the centenary of Nightingale's death, and to commemorate her connection with Malvern, the Malvern Museum is holding a Florence Nightingale exhibit,^[40] with a school poster competition to promote some events.^[41]

In Istanbul, the northernmost tower of the Selimiye Barracks building is now a museum,^[42] and in several of its rooms, relics and reproductions relevant to Florence Nightingale and her nurses are on exhibition.^[43]

When Nightingale moved on to the Crimea itself, in May 1855, she often travelled on horseback to make hospital inspections. She later transferred to a mule cart and was reported to have escaped serious injury when the cart was toppled in an accident. Following this episode, she used a solid Russian-built carriage, with a waterproof hood and curtains. The carriage was returned to England by Alexis Soyer after the war and subsequently given to the Nightingale training school for nurses. The carriage was damaged when the hospital was bombed by Nazi Germany during the Second World War. It was later restored and transferred to the Army Medical Services Museum in Mytchett, Surrey, near Aldershot.

A bronze plaque, attached to the plinth of the Crimean Memorial in the Haydarpaşa Cemetery, Istanbul and unveiled on Empire Day, 1954, to celebrate the 100th anniversary of her nursing service in that region, bears the inscription:^[44]

"To Florence Nightingale, whose work near this Cemetery a century ago relieved much human suffering and laid the foundations for the nursing profession."

[edit] Audio

Florence Nightingale's voice was saved for posterity in a phonograph recording from 1890 preserved in the Books By This Author

• Notes on Nursing
• Notes on Nursing