Until recent times in the history of medicine, nurses were often looked down upon and seen as those who merely cleaned up after troublesome patients. However, In the year of 1845, the Ottoman Empire and the Turks were fighting against each other in the Crimean along with France and England, making death and injury inevitable. It was then that a new face emerged to change the way patients were cared for in hospitals. Florence Nightingale, was asked to serve as a nurse in Constantinople, arriving in 1845. Her work was mostly in the Barrack Hospital in Scutari and her arrival brought her resentment from doctors due to their ideology that they were far superior. Nightingale’s presence in the Barrack Hospital led her to observe consistent flaws in the hospital, and she spent spent her time detailing her ideas that she believed could improve the life for patients in the Barrack Hospital and hopefully lead to changes in other medical areas as well. Her nursing career was not restricted to her days in Scutari, as she continued to document her advice to others working to improve the lives inside hospitals. Florence Nightingale influenced the way patients are cared for in modern times, through the improvement of hospital conditions, introducing statistical forms to keep track of progress, and making nursing a valued component of health care.
Nightingale revealed that the conditions inside hospitals being intolerable and unsanitary were detrimental to patients’ health, which signaled the need for reforms. Despite the fact that patients could stay warm if given the right bedding and clothes, it was common for windows in rooms where patients were to be permanently shut, so that no cold air from outside would enter. Nightingale recalls that this was the case with a medical officer that she once knew and explains “To attempt to keep a ward warm at the expense of making the sick repeatedly breathe their own hot, humid, putrescine atmosphere is certain to delay recovery or to destroy life” (Nightingale 6). Even if a patient were suffering from just an injury, the contaminated room is enough for the patient to get an illness which would extend their time in the hospital. The fact that doctors were inhibiting their patients from leaving the hospital even though they must have known that the air in the rooms was filthy, signals that hospitals did not have the right equipment that would allow them to keep patients warm. Given the sufficient and correct equipment such as more blankets, beds, and clothes, doctors and nurses would have been able to let their patients spend time in rooms with open windows. Nightingale also witnessed that there was little variety amongst the foods served to patients. She noted how doctors and nurses did not emphasize the value proper nutrition had on making sure that patients successfully recovered (Nightingale). A change in the types of foods served, is especially crucial for patients who were unable to take in any of the food that was provided, because before, they would have died from starvation. By hiring cooks who were experienced in preparing foods for the sick, the death rate would decrease. Nightingale also made sure to expose how much of the water patients drank was contaminated. She specifically cited the Barrack Hospital which was “built on top of a sewer”, resulting in patients contracting cholera (Bostridge). Patients inside the Barrack Hospital were at a disadvantage because if they refrained from drinking any water, they would die from dehydration, or they would become too sick to function from the fatal cholera. Nightingale was clearly able to see that clean air and water, as well as the right dietetics could allow the hospital to flourish because “Her reforms and the acquisition of better medical equipment caused the mortality rate to fall from 60 per-cent at her arrival to 43 percent in February 1855 and then to 2.2 percent by May” (Florence Nightingale). It only took three months for the death rate to decrease by almost 41 percent showcasing that majority of the death could have been avoided if hospitals had better treatment for patients. It helps prove that hospitals were providing better quality of care for their patients once they had implemented sanitary and equipment reforms into their system.
Nightingale believed that nurses played a crucial role in making patients feel comfort, , leading her to establish nursing as a well respected career. In general, nurses spend more time with their patients which allows them to discover certain qualities in each patient. Nightingale states this as, “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” (Nightingale 8). Her words signify that nurses should learn and deliver information about how a patient’s symptoms connect with how they are feeling. Nightingale emphasizes how nurses primarily are the ones to thoroughly understand the needs of each individual, and as a result their role is valuable, as patient treatment can be catered to each individual. Nightingale declares that she has seen nurses who were nervous to tell the doctor that their patients would seem better or worse than what they were when the doctor was in the room (Nightingale 124). This expands on the idea, that nurses helped save a patient from getting the wrong treatment which might leave them suffering more. Without the nurse, the doctors would know only very basic information regarding patients, where the nurses dive into emotional as well as psychological aspects of an individual. As Nightingale continued to encourage the nursing profession, she founded the the first nursing school, the Nightingale School for Nurses in 1860. Here she was able to spread her wisdom, and teach future nurses about practices such as patient care and midwifery (The Impact of Florence Nightingale). Through her creation of a school, Nightingale spreads the idea that nursing can only be done correctly when learned, adding more importance to the profession. Furthermore, because she teaches that nursing can be done in more places than just a hospital, she praises the role nurses play in creating a calm environment for suffering patients. Nightingale took on the role of educating the world on the importance of nursing and showed nurses that they truly impact the wellness of patients.
Nightingale used systems of records keeping in the Barrack Hospital, demonstrating that statistical evidence was vital in identifying areas of improvement in how hospitals functioned. Historian Eileen Magnello said that when Nightingale and her nurses first arrived to the Barrack Hospital, they were surprised to see that there was “no systematic recording or reporting; hundreds of soldiers were buried without a record being made of their deaths..bureaucratic inertia prevented nurses and administrators from spotting obvious flaws in the system” (Rooney). The lack of documented information regarding deaths of patient soldiers, lessened the accuracy of how successful, doctors were in treating their patients. Without being able to correctly identify how many soldiers actually died and what caused their death, doctors would not have been able to figure out exactly what the leading cause of deaths were. While she was trying to explain the correlation between unsanitary hospital conditions and death rates, Nightingale created a mortality diagram where “..Each wedge represented a month, and the area of the wedge showed the number of soldiers who had died that month. The blue area showed deaths from preventable diseases picked up in the terrible conditions at the Crimea. Red sections showed deaths from battlefield wounds. Black areas were deaths from other causes”(Rooney). The graphical representations were organized enough that anyone could have easily understood them and they were significant because representations were able to show how the majority of deaths could have been prevented if hospitals were far more sanitary, thus prompting a need for more sanitation. Her data made it clear that there was an error that had to be addressed in order for the Barrack Hospital to improve its death rate. Additionally, Nightingale “developed a Model Hospital Statistical Form for hospitals to collect and generate consistent data and statistics”(Riddle). Her innovation led hospitals to have a more organized approach in which they could easily see what was happening throughout the entire hospital. The form could be used as a tool to see what was beneficial to patients as well as be used by future hospitals as a reference on how they should take and record their data. Nowadays, we see Nightingale’s footprint of data collecting throughout hospitals everywhere as doctors continuously fill and file paperwork. Her emphasis stands as symbol today of learning from what previously didn’t work amongst patients, so that future patients can have a far better experience.
Nightingale’s time spent as a nurse in the Crimean War, created a lasting impact on the development of modern patient care. She was able to use her talent in statistics to establish official forms of data. Furthermore, she discovered and made the correlation between sanitation and death rates public. Finally, she gave respect to the nurses who work tirelessly to make sure that patients were cared for in comfort. Without her, hospitals would still be mistreating patients and death rates would continuously be rising with no reason as to why.