Florence Nightingale: What Lessons Would She Teach us Today?

Florence Nightingale was born into a two-class society characterized by the pauper and the aristocrat.
The latter believed it was his God-given right to rule and be served by all the others. The Nightingale
family, however, was different. It saw itself as having a philanthropic duty and assumed some
responsibility and provided relief for the serfs on their property or in their villages. Florence’s father, in
a day when genteel women were held to be too fragile for any exertion except presiding at a tea or
dinner table, believed the female mind should be cultivated beyond this role. So he provided his
daughters with a broad, liberal education. (Present day Male Indian Chauvinist’s please note. How
many Florrie Nairs have you deprived us of till date?)

As a consequence, Ms. Nightingale was a scholar, fluent in at least four languages, knowledgeable in
history, philosophy, art, music, literature, religions, political science and statistics. She was well
traveled and had an enquiring mind, great powers of observation, and a keen, analytical intellect. She
was about 25 years old when she realized that her long-held attraction to social service called her to
the field of nursing and the care of the sick.

Ms. Nightingale also developed her own philosophy of life and came to grips with humankind’s unique
purpose in the world. She came to believe humankind’s purpose on earth was to create a better world
and to do so without delay. She felt that man should do what had to be done and do it well, and that it
was man’s duty to alter, not conform to, the circumstances of life to bring about the kingdom of heaven
on earth.

Because of her comprehensive knowledge and social position, she was in a key place when the British
people clamored for the government to remedy the deplorable neglect of the British soldiers in the
Crimean War. As an experiment, Sidney Herbert, Secretary of War (and personal friend), appointed
her as Superintendent of Nurses.

With an almost complete breakdown of medical management and military support systems, Ms.
Nightingale provisioned the sick and wounded and instituted extensive military and medical reforms,
which included hospital dietary, sanitary, laundry, social, recreational, and educational aspects, as well
as record keeping and morbidity and mortality statistics. In addition, she organized a system of
providing nursing and dietary services and care to the sick and wounded.

Undoubtedly, an exemplary woman. If she were alive today, what lessons would she teach us? They
would be legion, her inquiring mind would surely find much in our contemporary world to dissect and
comment on. Maybe a few of these would be as follow:

1. Ms. Nightingale would have gloried in the opportunities to develop and program home
educational material into every home; develop dial-a-disease video; input symptomatology to
obtain current information; view an interactive television for an update on communicable or
other diseases, their symptomatology, causes, immunizations, preventive measures; or see
programs on mother and well-baby problems where mothers could get audio-visual advice on
colic, croup, breast-feeding, diaper-rash, etc., as well as how to perform simple nursing duties.

2. For today’s healthcare environments, she would insist on individually controlled environments
with maximum and minimum temperature regulation, as well as humidity. While she would use
artificial light with the availability of both diffused and bright direct illumination, she would still
insist on building facilities that were oriented for the creation of appropriate natural daylight
entry, and that windows must not be hermetically sealed.

3. Ms. Nightingale would require that furniture be comfortable, easy to maintain and keep clean,
light in weight and color with non-porous exteriors, and movable. She would deplore the use
of mustard yellow and hospital grays and greens. She would appreciate the selective use of
pastels and distinctive coordination in each patients room rather than the monotonous
repetition of the same color throughout a unit or floor.

4. Inasmuch as she recommended a century ago, that everything needed should be brought to
the patient’s unit, she would expect maximum automation of as much as possible:
communications, records, reports, supplies, equipment, etc. Privacy on demand would be allimportant.
She would want a cubicle curtain that functions, stays in place, is attractive as well
as useful. Maximum decentralization consistent with individualized, personalized care would
be advocated.

5. Maybe she would challenge us design professionals to create patient rooms of a sufficient
size to accommodate two caregivers simultaneously, as well as the visitor/patient chair,
dresser, bedside cabinet, over-bed tray, straight-backed chair and washing facilities and allow
a gurney, bed or wheelchair to be moved in and out of the room.

6. The use of living greenery would be greatly admired by Nightingale, and while it may not be
economically possible to provide plants in individual rooms, she would want them to be used
in public spaces, waiting rooms, lounges etc. she would believe that an attractive and
welcoming external environment would inspire confidence in today’s healthcare consumer.

7. Providing a quiet environment is a challenge in the modern hospital. Ms. Nightingale would be
concerned about controlling the idle chitchat of workers. Patients’ use of earphones would be
of value in controlling noise from televisions and radios. What about the racket of supply carts
and dietary trays? What can be done about the telephones: blinking lights, chimes, pagers,
other noises?

8. Visitors are an important part of a patient’s recovery today. She would surely be concerned
about how these important and often anxious people could be conveniently and comfortably
accommodated while loved ones are hospitalized. Shouldn’t visitors be able to get a hot cup
of soup, an edible sandwich, or a cup of tea in the middle of the night after being at work all
day and in the emergency room since 6.00 PM?

A century ago, Florence Nightingale stated that hospitals were evidence of an imperfect civilization.
We have moved from the dark ages of the 1850’s into a much more individualized approach to hospital
design. She said we would wish that we had worked out what family, political and social life should be
and not to take it for granted that the world would continue as it was. Surely, it requires no clairvoyance
to realign the wisdom of her words with the dilemmas confronting today’s world. A better world will not
be given to us. Let us begin today to create it.