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Illustration of Florence Nightingale and a doctor administering a patient ;

The influence and legacy of a nursing icon

We often think of Florence Nightingale as the heroine of the Crimea, but she was much more than that. Widely regarded as the founder of modern nursing, Nightingale rejected the societal expectations for middle-class women to marry well and have a family, to pursue her career as a nurse. She was a social reformer, standing on a platform of robust evidence and with a talent for visualising data.

2020 is the World Health Organisation’s Year of the Nurse and the Midwife and bicentenary of Florence Nightingale. Her spirit of compassion and gritty determination are characteristics that many nurses and midwives still identify with today. Nightingale’s transformation across multiple areas including public health, epidemiology and social science developed nursing into a multifaceted profession, requiring multidisciplinary skill coupled with a practical and compassionate approach to caring for people.

It would take a multidisciplinary team of historians and scholars drawn from many fields, spanning medicine, nursing, social science, statistics, public health, English literature, architecture, theology and military history, really to do Florence Nightingale’s legacy justice.– Anne Marie Rafferty, Professor of Nursing Policy and President of the Royal College of Nursing

The rebel with a cause

Nightingale eschewed the restrictive social code for affluence young English women of her time. Despite opposition from her family, she wanted to be a nurse which was viewed as employment that needed little study or intelligence. Nightingale never married, as she believed it would interfere with her career and although not strictly a suffragist, Nightingale believed in the expansion of women’s rights, particularly when it came to property rights and economic independence.

Typical of a young woman of her class, Nightingale spent her youth travelling extensively. Perhaps less typically, she began to spend her time abroad pursuing her strong sense of moral duty to look after the poor and started visiting hospitals. Being able to speak five languages greatly helped Nightingale during these reconnaissance missions as she could access a broad range information and literature as well as in English.

Troubled with what to do with her live, Nightingale convinced her parents to let her take what we would today call an internship at the Institute of Protestant Deaconesses at Kaiserswerth, Germany. The institute had been founded for care of the destitute and was a school for women to train as teachers and nurses. This experience during her 30’s, was the perfect communion of Christian faith and clinical practice and convinced her of the opportunities to transform nursing into a respectable profession for women.

Nightingale’s piety did not mean she was submissive to authority or the status quo. Although published after her death, in her novella Cassandra, she railed against Victorian domesticity and the idea of family, which she believed for women of her class, promoted idleness and suffocated their talents. Nightingale was part of a wider group bucking convention at the time, including the social reformist and author Harriett Martineau and the philosopher John Stuart Mill.

The world is put back by the death of everyone who has to sacrifice the development of his or her peculiar gifts to conventionality.– Florence Nightingale

The lady with the lamp

Nightingale was a superintendent of a women’s hospital in Harley Street when reports of the dreadful conditions and lack of medical supplies suffered by the soldiers in the Crimean War. She was invited to oversee the introduction of female nurses into military hospitals in Turkey by the Minister of War, who was a social acquaintance.

Once there, she and the 38 nurses who went with her, improved supplies of beds, blankets and food in the hospitals, as well as the general conditions and cleanliness. Her nickname, ‘Lady with the Lamp’, was coined by soldiers who found the sight of her checking all was well at night comforting and earnt her their undying respect.

Nightingale’s influence on nursing spans ward design, infection control and healthy diet for recovery. Nightingale Wards were developed in response to her experiences in the Crimea, and her realisation that hospital buildings themselves could affect the health and recovery of patients.

Today, hospital design remains an important issue in the health and wellbeing of both patients and health professionals. King’s researchers are part of a project which is investigating how hospital spaces can be redesigned to reduce health professional burnout and improve patient care.

The social activist

Nightingale’s success introducing female nurses to the military hospitals had made her a national celebrity and donations poured into the Nightingale Fund. The money collected meant Nightingale could continue to reform hospitals in Britain after the war and establish the world’s first professional school of nursing at St Thomas’ Hospital in 1860, which exists in the present day as the Florence Nightingale Faculty of Nursing Midwifery & Palliative Care at King’s. She also set up a School of Midwifery at King’s College Hospital.

Today, Nightingale’s belief in the need for specialist training for nurses is still evident in the vital role that higher education plays a vital role in equipping nurses and midwives with the skills to deliver high quality care.

Nightingale’s upbringing meant that she was well connected and linked to the political and intellectual aristocracy of the day. She met Queen Victoria on many occasions and they corresponded for decades. Nightingale used her influence and celebrity to campaign tirelessly to improve health standards. She published over 200 books, reports and pamphlets on hospital planning and organisation which are still widely read and respected today, including her most famous work Notes on Nursing: What It Is and What It Is Not. When ill health forced her out of the public, she continued to exert influence through writing thousands of letters.

The data visualist

If I were to nutshell it, I think she [Florence Nightingale] was interested in using data and information primarily as a means of turning information into intelligence, and that intelligence into impact through its practical application at every turn.– Professor Anne Marie Rafferty

Nightingale pioneered using a visual way of presenting data to make it easy to understand. Her obsession for codification and collection and classification of data and information began during her travels abroad and she was the first woman to be elected to the Royal Statistical Society. She was constantly innovative in the way she presented her arguments visually and is credited with developing a form of pie-chart now known as the polar area diagram.

Florence Nightingale diagram: The Causes of Mortality in the Army in the East

Example of a polar area diagram, showing ‘The Causes of Mortality in the Army in the East’.

Using data visualisation to analyse conditions in the Crimea and later for the British army and their local communities in India, Nightingale was able to illustrate the need for medical reform using statistical charts which showed that more men had died from disease than from their wounds.

Nightingale’s ability of using data to tell a story using evidence as rhetoric made her a powerful and influential voice for reform and her impact can still be seen across many aspects of nursing and public health today.

In this story

Anne Marie Rafferty

Anne Marie Rafferty

Professor of Nursing Policy

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