|Nightingale Bicentenary Newsletter|
|The Nightingale Society||12 May 2020|
By Lynn McDonald, co-founder
May 12 2020 is, finally, the bicentenary of Nightingale’s birth. We all join in celebrating it and her great contributions to nursing, health care and social reform.
We hope that organizations will re-schedule for 2021. Reflection and recognition of her work is still needed. Nightingale was not only the major founder of nursing, but the first advocate of the great principle of the National Health Service, health promotion with treatment, and access to quality care for all, regardless of ability to pay. She was a pioneer of evidence-based health care, an approach crucial to learning the lessons of the current pandemic.
Ironically, one of the largest events to be cancelled (re-scheduled?) is a nursing convention at the Ex-Cel Centre, London, now the venue for the first (temporary) NHS Nightingale Hospital for COVID-19 patients. There are now seven such hospitals in England and two in Norther Ireland.
However, the anti-Nightingale propaganda continues, even on the subject of the coronavirus pandemic. NHS England and the secretary of state for health, Matt Hancock, have announced the establishment of a set of NHS “centres” for ongoing care for COVID-19 patients, named after the commendable businesswoman Mary Seacole, but treated as an equal nurse to Nightingale. The Nursing Times announcement even had both of them putting their lives “on the line to nurse wounded soldiers,” when her three forays onto the battlefield all took place post-battle, after she sold wine and sandwiches to battle spectators (yes, there were spectators, happily ensconced on a hillside—battles were only a matter of hours).
Let us re-commit to celebrating Nightingale’s work, drawing on it for future studies and policy development. Let us re-commit to defending her reputation when it is wrongfully challenged. Let us “speak truth to power,” to the Department of Health, the NHS and its agencies and related ministers.
Exceptionally, this newsletter is going as well to a) people on the Nightingale Society list, whose object is to defend Nightingale’s reputation, and b) to those on the Collected Works list, for people interested in her work without sharing in joint letters going out.
There is a letter to co-sign at the end of this newsletter.
Bicentenary Events Online
British Library: Florence Nightingale at 200
Date/Time: May 12, 2020, 4:00pm British Summer Time
Register here to follow the live event on Zoom: https://us02web.zoom.us/webinar/register/WN_332yjf93SUiIxWhgyx0GHQ (free)
Florence Nightingale was born on 12 May 1820 and went on to achieve a staggering amount in a long life of nursing and campaigning. In this live event our distinguished panel considers her life, career and legacy amid the current context of the Covid-19 pandemic. With biographer Mark Bostridge; editor of the Collected Works of Florence Nightingale, Lynn McDonald; President of the Royal College of Nursing, Anne Marie Rafferty; and one of our leading statisticians, David Spiegelhalter.
An Evening With Florence Nightingale: A Reluctant Celebrity
Date/time: May 12, 2020 noon Pacific time; 2pm Central time; 3pm Eastern time (8pm British Summer Time; 7pm UTC)
Candy Campbell writes:
Let’s celebrate, as Miss Nightingale entertains you with her wit and wisdom. BYOG (bring your own glass) and join my friend and nurse colleague, Sharon Weinstein, of the Global Educational Development Institute (GEDInfp.com), as we toast Miss Nightingale’s 200 years of nursing excellence and recognize the work of GEDI in over 60 developing countries.
We’ll celebrate with a birthday cake and gifts!
Order your free ticket on Eventbrite: https://www.eventbrite.com/e/flos-200th-birthday-virtual-party-tickets-104090328976. No worries if you don’t have time to tune in that day. Just register and you will also receive a link to the recording afterwards.
Represented by: Performance Management International
Candy Campbell, DNP, RN, CNL, CEP, FNAP
Blending Art and Science for Positive System Change
On Nightingale and Coronavirus
Nightingale and the coronavirus pandemic: disease prevention, parallels and principles
Written by Lynn McDonald on 30 April 2020
Florence Nightingale (1820–1910) was an early and persistent advocate of the best means to prevent the spread of infectious diseases – frequent handwashing – calling for it in her 1860 Notes on Nursing and adding details on the use of disinfectants in later writing. She was a pioneer of evidence-based health care, from the lessons learned from the high mortality rates of the Crimean War (1854–56). NHS England, in giving the name “Nightingale Hospital” to seven temporary hospitals for Covid-19 patients, is recognizing Nightingale’s relevance to combatting infectious diseases.
Note the parallels between the challenges she faced and the current pandemic:
- Nightingale’s Crimean War Barrack Hospital had 4,000 beds and was then, in 1854, the largest in the world. The newly created NHS Nightingale Hospitals in Birmingham and London’s Docklands may not be the largest in the world, but both have the capacity to house up to 4,000 patients.
- Like the infectious diseases of Nightingale’s day (fevers and bowel diseases), coronavirus has no vaccine or effective treatment. Health care workers help the patient through the crisis, now with respirators, but given the advances in medical sciences since Nightingale’s day, the prospects of a vaccine and/or effective treatment for Covid-19 are great.
One other parallel from then to now: London’s NHS Nightingale Hospital was officially opened by Prince Charles, “attending” remotely from his residence at Birk Hall, on the Balmoral estate in Scotland. Nightingale herself stayed at Birk Hall in 1856, when it was the home of Queen Victoria’s physician, Sir James Paget, a Nightingale ally. The Queen, Prince Albert and Nightingale together, at Balmoral, pressed Lord Panmure, the Secretary of State for War, for a study to be done of what went wrong in the Crimean War hospitals, where high death rates were common. This became Nightingale’s 853-page Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army, published in 1858.
In preparing this analysis, Nightingale and her team of experts learned the lessons of the Crimean War and went on to press, successfully, for higher standards in ventilation, cleanliness and clean water (through improved sewers and drains) in hospitals, barracks, towns and rural areas. The new standards worked: death rates declined.
Evidence of this success can be seen in the declines in the number of hospital beds the British Army needed. The vast army hospital that was built after the war, at Netley on the south coast of England, was over-built, its number of beds based on the usual pre-Crimea percentage. That hospital was not filled to capacity until the Boer War of 1899–1902, more than 30 years after it opened. Nightingale joked to her MP brother-in-law, Sir Harry Verney: “Really, it is not our fault if the number of sick has fallen so much that they can’t fill their hospitals.”
Nightingale was not only an expert herself in analysing statistical data, she could call on leading experts in public health (Dr John Sutherland), medical statistics (Dr William Farr), civil engineering (Robert Rawlinson) and military engineering (Douglas Galton). She typically sent her results to one or more of them, asking for a critique before publishing – this in the time before peer review. She could ask the right questions and bring in the most appropriate data to answer them, including cross-sectional comparisons (making the most relevant comparisons) and longitudinal data (to see what changes after causal factors are altered).
After the Crimean War, and learning its lessons, Nightingale began to call for systematic improvements in data collection, both for the military and general population. Then, as now, epidemics have to be identified and tracked without delay. Good weekly data on disease and death has to be produced, to become daily data as an epidemic appears.
Will the lessons of this coronavirus pandemic be learned? It happens that different countries/states have adopted different measures of prevention, from thorough lockdown to mere voluntary social distancing. The amount of testing done has also varied enormously, from substantial numbers to only the very worst cases. Thus, like it or not, the elements of an experiment are in place. We will soon see who achieves the best results, in terms of the lowest number of deaths per population.
This coronavirus pandemic is likely to carry on for some time, and/or return in later waves. We need medical experts to find an effective vaccine and methods of treatment. As well, especially while waiting for such developments, we need Nightingale-type research to assess the success (or not) of the various measures used to limit that spread.
How would Florence Nightingale have tackled Covid-19?
by Carola Hoyos
The Guardian, May 5, 2020
Two hundred years on, the lady with the lamp would be a fearsome thorn in the government’s side on PPE, if not prime minister herself
Florence Nightingale was born 200 years ago this month. Warped by Victorian romanticism and our antiquated view of women, she has been taught for generations as “the lady with the lamp” who during the Crimean war in 1854 heeded God’s call to travel to Scutari, part of today’s Istanbul. With her small troupe of dedicated nurses, she scrubbed hospital floors, swept away rats, and saw to it that soldiers’ wounds were tended to properly.
Yet, she did much more than this. She transformed society for generations through her social activism and intellect. Were she alive today, Nightingale would not be walking, torch in hand, among the patients of the Covid-19 hospitals named after her. She would instead be gazing intently at her laptop, her smartphone holding thousands of texts with the most influential people of the day, from the Queen and the prime minister to mathematicians and epidemiologists. Her computer would be filled with data-laden spreadsheets and she would be having a lively Twitter debate about the reliability of death figures.
Of course, the question of what Nightingale would be doing requires a degree of poetic licence. But there are clues within her enormous archive of letters, books and reports that allow the exercise to rise above a flight of fancy.
For example, in an 1864 letter to Charles Hathaway, a special sanitary commissioner for Calcutta, she decries the absurdity of politicised health data. “I could not help laughing at your critics who ‘exclude’ specific diseases such as ‘cholera’, accidents ‘proving fatal’ etc. It is very convenient indeed to leave out all deaths that ought not to have happened, as not having happened. And it is certainly a new way of preventing preventable mortality to omit it altogether from any statement of mortality, then they would ‘exclude deaths above 60.’ Their principle, if logically carried out, is simply to throw out all ages and all diseases and then there would be no mortality whatever.”
Nightingale would be furious about Donald Trump’s fake data. But she would also fume at Boris Johnson’s early indecision and the UK’s shortages of medical equipment.
“The three things which all but destroyed the army in Crimea were ignorance, incapacity, and useless rules; and the same thing will happen again, unless future regulations are framed more intelligently, and administered by better informed and more capable officers,” she wrote, exasperated by inept civil servants and politicians.
Nightingale came back from Scutari a celebrity. Today, she would have millions of Twitter followers and use her popularity to press and cajole the government to make informed decisions about when to come out of lockdown and how to decrease the enormous death toll in care homes. And also to fundraise for supplies, as she did in her day.
Nightingale was born on 12 May, 1820 to a wealthy family. This gave her access to a first-class home education and an erudite network of influential acquaintances ranging from the mathematician Charles Babbage to Sidney Herbert, the secretary of state for war. She had a strong sense of justice and was an immensely studious child who excelled at every subject. But her greatest love was mathematics, particularly statistics. The statistician Karl Pearson wrote that for Nightingale, the study of statistics was a religious duty. “To understand God’s thoughts, she held we must study statistics, for these are the measure of His purpose.”
She made her biggest impact by unleashing her quantitative skills on the data she had collected about Scutari. She used her findings and her dogged determination to drive the restructuring of the army medical services and sanitation in the UK, later taking her expertise abroad to as far afield as India and North America. The same data-led approach led her to develop modern nursing – she founded her nursing school at St Thomas’, the same London hospital Johnson was rushed to last month with the coronavirus. She also developed palliative care and midwifery, and to rethink the design of hospital buildings and the civilian health system.
Mathematicians and data scientists revere Nightingale as one of history’s most important statisticians. She used data comparisons to find the causes of problems and to make forecasts.
But Nightingale knew that data was only as persuasive as the graphs that illustrated them, so she became a pioneer in data visualisation. She made famous the polar area graph, which showed that soldiers in Scutari died of preventable diseases rather than their battle wounds, and that their mortality rate plummeted when a sanitation commission cleaned up the hospital’s infected water supply. She would use the information to save countless more civilians and soldiers from dying because of poor living standards and sanitation at home. In 1858, the woman who was not allowed to attend university because of her gender was elected the first female member of the Royal Statistical Society.
Lynn McDonald, the author of numerous books based on Nightingale’s writing, believes Nightingale’s statistically driven ideas of social reform created the early bedrock on which the NHS was founded after the second world war.
Were Nightingale alive today, I could imagine her as prime minister, guiding the UK through a pandemic experience closer to that of New Zealand and Germany. But now I am taking a lot of poetic licence.
At the very least, she would not be known as the lady with the lamp. Instead, generations would know her as “the social reformer with the spreadsheet”.
Carola Hoyos is writing a screenplay about Florence Nightingale. She is a former journalist for the Financial Times and the founder of the charity mathsteams.org.
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