Profiles In Nursing

Florence Nightingale (1820–1910), Mathematician and Social Reformer

The founder of modern nursing spoke six languages, designed hospitals, and chastised the English government for their colonial rule of India

Florence Nightingale sits on a couch smiling in multiple layers of clothing

Every nurse learns the basics about Florence Nightingale: She was a wealthy woman who, despite the gender strictures of her era, turned British healthcare on its head. Rather than leading a life of leisure (or, later, of invalidism), she threw her talents into reforming the world.

We all know that part of the story, but there are other facts about Nightingale that are less well-known. For example, she was multilingual, fluent in French, Italian, Latin and Greek.

She was also a gifted mathematician. Before she became a nurse, she tutored in arithmetic, geometry and algebra. Throughout her life, she demonstrated all the marks of a serious mathematician: clear reasoning, an emphasis on basic principles and a healthy skepticism about assumptions.

Statistically Speaking

Nightingale took a particular interest in statistics, which she once described as “the measure of his [God’s] purpose.” In 1858, she became the first female fellow of the Royal Statistical Society, and in 1874, the American Statistical Association made her an honorary member.

Among her statistical accomplishments, Nightingale refined the polar-area diagram, a form of pie-chart that illustrates values proportionally to the area of a wedge in a circular diagram. She believed this type of chart, which is still used in modern spreadsheet software, “affects thro’ the eyes what we fail to convey to the public through their word-proof ears.”

She used this pie-chart to illustrate the number of preventable non-combat deaths in the British military, an effort that was so effective it eventually convinced Queen Victoria to agree to reforms.

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Nightingale also formulated a model hospital statistical form and helped to pioneer the idea that researchers could objectively measure and analyze social forces.

Her studies showed the need for uniform metrics so that comparable data would in fact be comparable; in other words, so that 5 percent at St. Thomas Hospital meant the same thing as 5 percent measured at St. Isadora.

In this way, Nightingale was able to see that the best-intentioned efforts can have unintended consequences — and that small changes can have a big impact.

The Nightingale Ward

Hospital design was another of her passionate concerns.

Nightingale saw four major problems with hospitals: crowding, sometimes to the extent of several patients having to share a bed; poor lighting; limited space; and inadequate ventilation. She saw the latter as particularly troubling because she (like many healthcare professionals of her time) believed that miasma — bad air — was a principal cause of disease.

Her pavilion plan (known as Nightingale wards) divided a larger hospital into self-contained individual units, none ever more than two to three stories high. Each unit was self-sufficient, helping to prevent the spread of disease with a central nursing station that allowed monitoring all patients at all times.

Her design located service areas at each end of the units, which ideally had windows on three sides. Patients were positioned so that their heads came up against the wall with their feet facing a wide passageway.

All this was to enhance ventilation; in her book Notes on Hospitals, Nightingale called depriving patients of proper ventilation “manslaughter under the garb of benevolence!”

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Interestingly, only late in life did Nightingale acknowledge microbe theory, and then just barely. Many of her admonitions had the practical effect of fighting germs, but even in old age, she remained convinced that miasma was the chief culprit of disease.

Nightingale wards remained in use well into the late 20th century. Strangely, despite her interest in hospital design, Nightingale was firmly opposed to hospitals as a concept, saying that  they belonged to a stage of imperfect civilization, or rather of non-civilization.

She once wrote that she looked forward to a time without hospitals. “But it is no use to worry about the year 2000!” she conceded.

The Quiet Crusader

While she authored about 200 publications and several books, Nightingale, in keeping with Victorian sensibilities, made neither public appearances nor public statements.

Even so, she was a prolific activist and, despite lacking the right to vote, became a political force, chastising her government for the periodic famines that claimed the lives of 29 million people during British colonial rule of India.

Although her own broad education enhanced her problem-solving ability, she resisted educational requirements and even registration for nurses. She thought that good candidates would be lost if qualifications were determined by formal testing. Nurses, she held, should come from all levels of society.

Nightingale believed that character and experience counted more than exams. Despite the rampant institutional sexism of the time, she also strenuously resisted efforts to make nursing subservient in any area, especially to male-dominated medicine.

Throughout her later life, Nightingale labored mostly behind the scenes — often working from bed as she struggled with illnesses that modern researchers now believe were due to brucellosis and spondylitis.  Even so, when she died in 1910 at the age of 90, blind and bedridden, she left a legacy of work not yet rivaled.

ELIZABETH HANINK, RN, BSN, PHN, is a Working Nurse staff writer with extensive hospital and community-based nursing experience.

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