Gateways Hospital and Mental Health Center
Gateways Mental Health Hospital
Barlow Respiratory Hospital
St. Vincent Medical Center
Nursing Book Club
Notes on Nursing: What it is, and What it is Not
She promoted public health in a revolutionary way
Reviewed by Christine Contillo, RN, BSN
I have often thought it would be very, very interesting to sit down for a cup of coffee with Florence Nightingale. I’ve wondered how nursing was conducted at what is considered the very beginning of our profession. What was Nightingale like? Where did she get her motivation?
The closest I’ll ever get to that conversation is by spending the afternoon reading Nightingale’s Notes on Nursing, a slim volume originally published in 1859 and continuously in print since then, in which the author puts forth exactly what she believes is necessary to promote patient care. In effect, this book was written as a “how-to” for patient care at a time without antibiotics, when nursing care could make all the difference between life and death. By promoting nursing, then, Nightingale was promoting public health in a revolutionary way. This book was how she hoped to reach caregivers everywhere.
Conditions for Recovery
I had expected this to be a book about how to recognize disease states. However, by Nightingale’s own admission, this is not a training manual. Rather, the author says that nursing should not be thought of as the “administration of medicine and application of poultices.” Instead, she puts forth her belief that in order to battle disease and promote recovery, we need to first consider conditions such as ventilation, food, noise and the state of the patient’s bedding.
Nightingale also says that clean conditions are paramount to recovery. (At the time, she had no scientific reason to believe this, and it was considered quite radical.)
This book was written in an era when any household might have people of all ages, in all stages of convalescence, and it often fell to the woman of the household to nurse everyone back to health. She recognizes that while every woman may not necessarily make a great nurse, everyone has the ability to understand and encourage a return to health. One communicable disease could affect everyone under the same roof, so any factor that could improve recovery or limit disease spread would make a significant difference in mortality.
A Tribute During Nurses Week
I’m sure I can’t be the only person surprised that it has taken 150 years for us to put some of the author’s recommendations into use. For example, Nightingale recognizes the importance of what would now be called “change of shift”: ensuring that information isn’t lost just because the caretaker isn’t available at the bedside. She advocates privacy and not talking about a patient’s condition where the patient might overhear. She also promotes standardized observations, or what we would now classify as quantifiable symptoms. Many facilities now use the numerical pain scale.
I picked up Notes on Nursing to read during Nurse’s Week as a tribute to this nursing champion, and I’m glad that I did. I’d wondered why she was called “the Lady with the Lamp” — why didn’t she just turn on the lights? Of course, there were no overhead lights then, and she needed her lamp to walk the halls and directly observe the conditions of her patients.
Nursing care may have been technologically simple back then, but it’s no surprise to learn that our goals are still the same. While we may now have more ammunition to fight disease, the basics of patient care and public health are more important than ever. We are complex people with complex needs, but the tenets of health promotion, like cleanliness, privacy, diet and clean air, have not changed.
Christine Contillo, RN, BSN is a public health nurse who suggests joining a book club as a reason to put down trashy magazines and look smart on the subway.