Date: August 9, 2013

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florence nightingale the writer

‘The Pen is The Tongue of The Mind’
Cervantes

In 1844 she said she would ‘so much rather live than write, writing is only a supplement to living.’ But the sheer amount that came from her pen is enormous.

Many of her writings represent months of unceasing labour and all reflect deep care and thought in their composition unluckily for nurses very little of what she wrote is available for study-most of the matter was published in official government reports or in pamphlets or journals.
A lot of great Victorians left an enormous pile of papers behind them so also the ‘Nightingales’. It is said of Florence Nightingale that apart from Queen Victoria, she was probably the most prolific woman writer, unfortunately much of her written work remained unpublished and scattered all over the world, often in private collections.
From the age of five Florence started writing down what she was thinking and teaching – she was exceptional, she was different her writings continue to be a valuable resource for nurses, health managers and planners. She campaigned tiretessly to improve health standards.
Her total printed writings, published or privately circulated, are 147 as listed in her biography; 15 of which had been written prior to the publication of her ‘Notes on Nursing’.

‘Notes of nursing’

This book written after approximately 14 years observation of the sick. Florence was 39 years old when the book was published in December 1859.

“A model of arrangement and brevity”

The notes on nursing a slim 136 page book, served as the corner store of the curriculum at the Nightingale school and other established nursing schools.

The book was also read widely (and even today) by the general reading public. It was and is considered as a classic introduction to nursing notes on Nursing talks about comprehensive bedside care of the sick. An interesting feature to note is that is was not written as a manual to teach nurses to nurse but it was written to assist millions of women who had charge of their families to “think how to nurse”

The first publication of the ‘Notes on Nursing’ was in England in December,1859, by the publisher Harrision. Within a month

A brief survey of some of the more important of Florence Nightingales writing’s

Her Style- Very distinctive, combining as it does an arresting lucidity with a caustic humor which indelibly fix in the readers mind the thoughts she is expressing.

Before the Crimean War

1849 – After a journey to Egypt (with her friends Bracebridges) she printed her ‘Letters from Egypt’ for private circulation.
1851- The small anonymous pamphlet appeared titled ‘The institution of Kaiserwerth the Rhine’ first work on nursing she ever had printed. It has great historical importance it shows her interest in Fliedners establishment (she called Kaiserwerth her spiritual home).
1857- ‘Notes on matter afflicting the health, efficiency and hospital administration of the British army of the late war’
A lengthy book (least known but a most remarkable work) written at the request of Lord Panmure, Secretary of state for war. When the Royal commission of 1857 was about to start its labours, and represented the outcome of are her observations in the Crimea. It was never published….but in
1858- It was printed at her own expense for private circulation among influential people.
The book was composed in 6 months Jan-Aug 1857. During this phase she was not very well. It portrayed her powers of work and profound grasp of the subject. Her careful analysis of all that was lacking assisted the work of ‘Royal commission on the Health of the Army.’ These and other books showed Florence Nightingale as an advanced statistician and a pioneer in the use of diagrams or graphs to illustrate the statistics’
1859- ‘Notes on Hospitals’-another important book (results of many years of close study of hospitals)
1860- Notes on nursing- American edition the first edition in the U.S. was published by Appleton and Company in 1860.
1860- Religious and philosophic matters ‘suggestions for Thought to the Searchers after Truth among the Artizans of England (printed privately)
1861- Abridged form of the 1860 called ‘Notes on Nursing for the labouring classes with a charming additional chapter for girls called ‘Minding baby’
1863- Onwards wrote extensively on India. Her contributions began with a ‘Report of the Royal Commission on the Sanitary State of the Army in India. She continued to write for 30 years on matters affecting Indian health and hygiene. In these she writes as a SANITARIAN rather than a nurse and shows herself far ahead of her contemporaries regarding preventive medicine.
1871- Introductory notes on lying in institutions, an important book on a subject allied to nursing
1882- Her most interesting articles contributes (in 1882) to Quains Dictionary of medicine entitled ‘Nurses, training of, and nursing the sick’ – wherein she formulates her views on nurse training in greater detail than anywhere else and shows us as always her high ideals for nurses.
Voluminous correspondence on many topics with persons all over the world. Benjamin Jowett (1817-1893) Master of Balliol College, Oxford; with whom for a long period she exchanged letters on philosophical and religious subjects.
An annual letter to the nurses of the Nightingale school. Setting forth her own unchanging ideals. These are preserved in the Nightingale school; A few are in the British Museum
Miss Pringle, at one time Matron of St. Thomas’s had some 200 letters from Florence Nightingale.
January 1829- undertook her own autobiography in French

“La Vie de Florence Rossignol”

15 publications – They include many on

• Nursing
• Hospitals
• Administrations
• Sanitations and
• Health

Other subjects include :

• Statistics
• Philosophy
• Emigration
• Protection of aboriginal races
• Famine
• Punishment and discipline
• Conditions in India
• Thrift
• Birds and
• Woman suffrage
By reading and rereading her writings one feels that every sentence she wrote is work quoting.

Edward cook was the first of Florence Nightingales biographers to note the extent and variety of her private notes, that is to say, writings where she addressed largely herself

To nurse’s Florence Nightingale’s most interesting book, will always be ‘Notes on Nursing, what it is and what it is not (1859)’, so arresting in its clear setting forth of the fundamental principles of nursing which remain as true today as when it was first written.’
Lucy Ridgely Seymer

‘Because these notes (Notes on Nursing) record the skilful observations of a trained eye and mind on the fundamental needs of human being in sickness and in the prevention of sickness, they are to a great degree timeless in their usefulness to the student of nursing in any country in the world.’
Virginia M. Dunbar

Florence Nightingale’s Notes on Nursing

(A broad Outline)

Florence Nightingale believed that every woman is a nurse because every woman, at one time or another in her life, has charge of the personal health of someone.

The focus of nursing knowledge was how to keep the body free from disease or in such a condition that it could recover from disease

According to Nightingale, nursing ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of vital power to the patient.

That is, she maintained that the purpose of nursing was to put patients in the best condition for nature to act upon them.
Boundaries of nursing practice

Ventilation and Warming – the nurse must be concerned first with keeping the air that patients breathe as pure as the external air, without chilling them.

Health of Houses – attention to pure air, pure water, efficient drainage, cleanliness, and light will secure the health of houses.

Petty Management – all the results of good nursing may be negated by one defect: not knowing how to manage what you do when you are there and what shall be done when you are not there.

Noise – unnecessary noise, or noise that creates an expectation in the mind, is that which hurts patients. Anything that wakes patients suddenly out of their sleep will invariably put them into a state of greater excitement and do them more serious and lasting mischief than any continuous noise, however loud.

Variety – the nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings during a long confinement to one or two rooms. The majority of cheerful cases is to be found among those patients who are not confined to one room, whatever their suffering, and the majority of depressed cases will be seen among those subjected to a long monotony of objects about them.

Taking food – the nurse should be conscious of patients’ diets and remember how much food each patient has had and ought to have each day.

What food? – to watch for the opinions the patient’s stomach gives, rather than to read “analyses of foods,” is the business of all those who have to decide what the patient should eat.

Bed and Bedding – the patient should have a clean bed every 12 hours. The bed should be narrow, so that the patient does not feel “out of humanity’s reach.” The bed should not be so high that the patient cannot easily get in and out of it. The bed should be in the lightest spot in the room, preferably near a window. Pillows should be used to support the back below the breathing apparatus, to allow shoulders room to fall back, and to support the head without throwing it forward.

Light – with the sick, second only to their need of fresh air is their need of light. Light, especially direct sunlight, has a purifying effect upon the air of a room.

Cleanliness of rooms and walls – the greater part of nursing consists in preserving cleanliness. The inside air can be kept clean only by excessive care to rid rooms and their furnishings of the organic matter and dust with which they become saturated. Without cleanliness, you cannot have all the effects of ventilation; without ventilation, you can have no thorough cleanliness.

Personal cleanliness – nurses should always remember that if they allow patients to remain unwashed or to remain in clothing saturated with perspiration or other excretion, they are interfering injuriously with the natural processes of health just as much as if they were to give their patients a dose of slow poison.

Chattering hopes and advices – there is scarcely a greater worry which invalids have to endure than the incurable hopes of their friends. All friends, visitors, and attendants of the sick should avoid the practice of attempting to cheer the sick by making light of their danger and by exaggerating their probabilities of recovery.

Observation of the sick – the most important practical lesson nurses can learn is what to observe, how to observe, which symptoms indicate improvement, which indicate the reverse, which are important, which are not, and which are the evidence of neglect and what kind of neglect.

Notes on Nursing
“This is the work of genius if ever I saw one; it will, I doubt not, create an order of Nurses before it has finished it’s work.”
Harriet Martineau’s prophesy

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