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 patient’s 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 all- important. 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.
 
 
 
 

The story of Florence Nightingale

Florence Nightingale