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Why Florence Nightingale still matters

Lim, Fidelindo MA, RN

doi: 10.1097/01.NURSE.0000389025.10889.c3
Feature

Many of her insights and innovations are still current today. Celebrate this nursing pioneer on the 100th anniversary of her death.

Fidelindo Lim is a clinical instructor at the New York University College of Nursing, New York, NY.

THIS YEAR WE CELEBRATE the International Year of the Nurse to commemorate the 100-year anniversary of Florence Nightingale's death. On -August 15, 1910, her obituary in The New York Times concluded with this observation: "Perhaps the -greatest good that has resulted from her noble life has been the setting in -motion of a force which has led thousands of women to devote themselves to -systematic care of the sick and wounded."1

Yet today, very few nurses have read Florence Nightingale's work or derive inspiration from it. When I invoke Florence Nightingale's words in clinical teaching, I often get a blank stare from students and experienced nurses alike. Many don't realize that Nurses Day is celebrated on May 12th because that is Florence Nightingale's birthday.

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Exactly 150 years ago this year, Florence Nightingale published her cutting-edge book, Notes on Nursing: What It Is and What It Is Not. In less than 100 pages, she gave the world a handbook for taking care of the sick and a blueprint for running a healthcare system. True, much of what she wrote is outdated (though not for her time). But when you consider the following direct quotations from the original edition of her book and compare them to modern standards, you can see the undeniable relevance of her work to today's healthcare problems.

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ON INFECTION CONTROL

Notes on Nursing, 18602

"True nursing ignores infection, -except to prevent it." (p. 20)

"Every nurse ought to be careful to wash her hands very frequently during the day. If her face too, so much the better." (p. 53)

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2010 National Patient Safety Goals (NPSG)3

"Comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines." (NPSG 07.01.01)

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World Health Organization Hand Hygiene Guidelines, 20054

"Hand hygiene, a very simple action, remains the primary measure to -reduce health-care associated infection and the spread of antimicrobial resistance, enhancing safety of care across all settings."

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ON PATIENT -CONFIDENTIALITY

Notes on Nursing , 1860

"And remember every nurse should be one who is to be depended upon, in other words, capable of being a ‘confidential’ nurse...she must be no gossip, vain talker; she should never answer questions about her sick -except to those who have a right to ask them." (p. 70)

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The Health Insurance Portability and Accountability Act of 1996 (HIPAA)5

"The goal of the privacy rule is to assure that individuals' health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care."

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ON PREVENTING NURSING SHORTAGES

Notes on Nursing , 1860

"To increase the efficiency of this class [nurses], and to make as many of them as possible the disciples of the true doctrine of health, would be a great national work." (p. 79)

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Nurse Reinvestment Act, 2002

President George W. Bush signed into law the Nurse Reinvestment Act (H.R. 3487), designed to encourage people to enter and remain in nursing careers, thus helping to alleviate the nation's growing nursing shortage.6

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ON PATIENT SAFETY

Notes on Nursing, 1860

"If you look into reports of trials or accidents, and especially of suicides...it is almost incredible how often the whole thing turns upon something which has happened because ‘he,’ or still oftener ‘she,’ was not there." (p. 22)

Notes on Hospitals, 1859 7

"It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm."

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"Is There a Nurse in the House?" The New York Times, June 18, 20108

"Cost-cutting at hospitals often means fewer nurses, so the number of patients each nurse must care for increases, leading to countless unnecessary deaths. Unless Congress mandates a federal standard for nurse-patient ratios, those deaths will continue."

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2010 National Patient Safety Goals

  • "The labeling of all medications, medication containers, and other solutions is a risk-reduction activity consistent with safe medication management." (NPSG 03.04.01)
  • "Identification of individuals at risk for suicide while under the care of or following discharge from a health care organization is an important step in protecting these at-risk individuals." (NPSG 15.01.01)
  • "Reduce the likelihood of patient harm associated with the use of anticoagulant therapy." (NPSG 03.05.01)
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ON DOCUMENTATION

Notes on Nursing , 1860

"Oh, leave these jargons and go your way straight to God's work, in simplicity and singleness of heart." (p. 76)

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2010 National Patient Safety Goals

"Create a standardized list of abbreviations, acronyms, etc., not to be used." (NPSG 02.02.01)

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ON FALSE ENDEARMENT

Notes on Nursing , 1860

"I would appeal most seriously to all friends, visitors, and attendants of the sick to leave of this practice of attempting to 'cheer' the sick by making light of their danger and by exaggerating their probabilities of recovery." (p. 54)

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National Institute on Aging, A -Clinician's Handbook, 20049

"Avoid using familiar terms, like ‘dear’ and ‘hon,’; which tend to sound patronizing. Talk to your staff about the importance of being respectful to all your patients, especially those who are older and perhaps used to more formal terms of address."

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ON EVIDENCE-BASED -PRACTICE

Notes on Nursing , 1860

"The most important practical lesson that can be given to nurses is to teach them what to observe—how to observe—what symptoms indicate improvement—what the reverse—which are of importance—which are of none—which are the evidence of neglect—and of what kind of -neglect." (p. 59)

"Statistics is the most important -science in the world."10

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The Institute of Medicine, 200111

"Evidence-based practice is the -integration of best research with -clinical expertise and patient values."

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Heed lessons from our history

Florence Nightingale has been dead for 100 years, but she could have written the 2010 National Patient Safety Goals. I encourage you to grab a copy of her book and try to envision the future of nursing and healthcare so deeply rooted in the past. It's time to bring her back to the nursing syllabus to reinforce evidence-based practice at the bedside.

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REFERENCES

1. Miss Nightingale dies, aged ninety. The New York Times. 1910; August 15.
2. Nightingale F. Notes on Nursing: What It Is and What It Is Not. London: Harrison and Sons; 1860.
3. The Joint Commission. 2010 National Patient Safety Goals (NPSGs) effective July 1, 2010 .
4. World Health Organization. WHO launches global patient safety challenge; issues guidelines on hand hygiene in health care; 2005 .
5. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules .
6. American Nurses Association. Nurse Reinvestment Act background .
7. Dossey BM. Florence Nightingale: Mystic, Visionary, Healer. Springhouse, PA: Springhouse Corporation; 1999:237.
8. Brown T. Is there a nurse in the house? The New York Times. 2010; June 18.
9. National Institutes of Aging. Talking With Your Older Patient: A Clinician's Handbook. Gaithersburg, MD: National Institutes of Health, Department of Health and Human Services; 2008:7.
10. Porter R. Greatest Benefit to Mankind (A Medical History of Humanity). London: Harper Collins; 1997:378.
11. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001:147.
© 2010 Lippincott Williams & Wilkins, Inc.