Florence Nightingale Was Born 200 Years Ago and Is More Important Than Ever

By Roger Chriss, PNN Columnist

This week marks the 200th anniversary of Florence Nightingale’s birth. She was born on May 12, 1820, and is considered the founder of modern nursing and an innovator in the use of medical statistics.

Named for the city of Florence, Italy, where she was born, Nightingale grew up in a wealthy British family and demonstrated a gift for mathematics. She traveled extensively throughout Europe during her youth and announced her decision to enter the nursing field when she was 24, despite the opposition of her family and the restrictive social mores of Victorian England.

Nightingale made fundamental contributions to nursing and biostatistics during the Crimean War, during which she managed and trained nurses, and organized care for British soldiers.

In 1854, she identified poor care for the wounded at Selimiye Barracks in what is now Istanbul due to overworked and under-equipped medical staff and official indifference. Medicine was limited, hygiene neglected and soldiers suffered as a result, she found.

Nightingale collected meticulous records of patient outcomes in the military field hospital she managed. Then she summarized this information in a form of pie chart now known as the polar area diagram, clearly showing the benefits of improved patient care.

FLORENCE NIGHTINGALE

FLORENCE NIGHTINGALE

This visual representation of statistics was much more readily understood than conventional columns of numbers and helped convince civil servants and even members of Parliament that her findings were significant.

Nightingale applied the same methodology to a study of sanitation in rural India, playing a key role in improving medical care and public health services in that country. She found that bad drainage, contaminated water, overcrowding and poor ventilation were important risk factors in the spread of disease. Her work ultimately helped reduce mortality among British soldiers stationed in India from 69 to 18 per 1,000.

But Nightingale is best known for her role in the foundation of modern nursing. She led by example, with a commitment to patient care and medical administration.

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She developed the first official nurse training program, the Nightingale School for Nurses, which opened in 1860. It is now known as the Florence Nightingale Faculty of Nursing and Midwifery at King's College London.

Her work is also remembered in the Florence Nightingale Medal for outstanding service in nursing, among many other honors in her name.

Nightingale’s work in public health and record keeping dovetailed with the first epidemiological success in Britain. In the summer of 1854, English physician John Snow showed that a cholera outbreak could be traced to the contaminated Broad Street Pump, which he stopped by simply removing the handle of the pump so people couldn’t use it anymore.

Snow’s methods involved what we would now call outbreak maps and contact tracing. And his findings inspired improvements in water and waste systems in London and around the world.

NIghtingale’s 1859 book, “Notes on Nursing: What It Is, and What It Is Not,” is a seminal text about the nature and practice of nursing. In it she wrote: “The very first requirement in a hospital is that it should do the sick no harm.”

Today, amid the global coronavirus pandemic, the dedication of nurses and the importance of medical statistics cannot be understated. Nurses are falling sick and dying at alarming rates, in part because institutional leadership is failing them. One-third of Covid-19 deaths in the U.S. are occurring among nursing home residents and staff.

Nightingale’s example needs to be recognized and followed. Her bicentennial provides a timely opportunity to emulate her lifelong dedication to medical care and public health.  

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research. 

Nursing Textbook Slammed for Racist Content on Pain

By Pat Anson, Editor

Blacks believe suffering and pain are inevitable. Hispanics believe pain is a form of punishment. Muslims consider pain a test of faith. Jews are vocal and demanding about pain care.

Those are some of the startling claims being made in "Nursing: A Concept-Based Approach to Learning," a nursing textbook that has a section that looks at ethnic and cultural differences in how people respond to pain.

The book advises nursing students that a patient’s culture and religion play a “critical role” in how a patient responds to acute or chronic pain, and that “nurses must approach each client with cultural competence.”

Fair enough. But then the book makes sweeping generalizations about various ethnic groups that some consider offensive and racist.

“Clients from Asian cultures often value stoicism as a response to pain. A client who complains openly about pain is thought to have poor social skills,” the book declares.

“Native Americans may prefer to receive medications that have been blessed by a tribal shaman…. They may pick a sacred number when asked to rate pain on a numerical scale.”

The textbook has been used by nursing students for years, but the section on diversity and culture drew little attention until a page from the book started circulating on social media this week.

“This is an excellent example of how not to be even remotely culturally sensitive. These assumptions are not evidence-based, they encourage nurses to ignore what a patient is actually saying,” said Onyx Moore, who posted the page on Facebook. “If a patient tells you their pain level, believe them -- because *they* are the expert on their body."

“I'm so disgusted. In 2017 how is this being published?” asked one poster. “Why isn't the protocol basic compassion instead of that ignorant nonsense?”

"I’ve seen so many examples like this in my nursing textbooks. It’s infuriating," wrote another Facebook poster.

“This is horrifyingly wrong,” said another.

In response to the uproar on social media, the book’s publisher apologized and said it would drop the offending section from the textbook.

“While differences in cultural attitudes towards pain are an important topic in medical programs, we presented this information in an inappropriate manner. We apologize for the offense this has caused and we have removed the material in question from current versions of the book, electronic versions of the book and future editions of this text,” Scott Overland, Pearson Publishing’s communications director told Mic.com.

“In addition, we now are actively reviewing all of our nursing curriculum products to identify and remove any remaining instances of this inappropriate content that might appear in other titles.”

Now in its second edition, “Nursing: A Concept-Based Approach to Learning” is still available for sale on Amazon, where a new hardcover can be bought for $235. First published in 2014, many of the early reviews of the book are positive, with some nursing students saying it was “indispensable” and a “life safer.”

The more recent reviews -- apparently in response to the uproar on social media -- are scathing.

“This book should cease to be printed. The fact that this is taught in schools makes me quite literally sick,” one reviewer said.

“This book is racist and if you apply it's concepts you will hurt your patients and possibly get in some uncomfortable situations or even litigation,” said another.

“If this kind of racist dreck can pass unnoticed by the authors AND editors of this book, it cannot be trusted. And they cannot be trusted. Unbelievable,” wrote another reviewer.

Pearson is the world’s biggest publisher of educational textbooks. Today the company put a video on its YouTube page in which Tom Bozik, president of Pearson’s global product development, made another apology and said the book doesn't represent the company's values.