Running Head: THE LADY WITH THE LAMP

A Modern-Day Analysis of The “Lady with the Lamp:” ’s Contributions to the Development of

Bailey A. Reidy [email protected]

Major in Sociology College of Liberal Arts and Sciences

Thesis Advisor: Dr. Constance L. Shehan Department: Sociology

CLAS Honors University of Florida

THE LADY WITH THE LAMP 2

Abstract

In Florence Nightingale’s book Notes on Nursing: What it is and What it is Not (1859, 2018), her opinions and proposals regarding the nursing profession are discussed from a unique historical yet pertinent perspective. The point of my paper is to bring to light the practices Florence

Nightingale speaks about in her book and discover their true relevance in today’s society. Many believe that nursing became a true profession when Nightingale deviated from social norms and expressed the importance for the profession. In the 1800’s Nursing was believed to be a career for uneducated lower-class women whereas today those who pursue this career must complete a rigorous educational program. However, even today, nursing continues to be a primarily female dominated field globally. In this analysis I will discuss the relevance of Florence Nightingale’s key influences on contemporary nursing. I will review recent research that supports her principles of nursing. I will also discuss societal influences on nursing as a profession.

THE LADY WITH THE LAMP 3

TABLE OF CONTENTS

ABSTRACT ...... 2

TABLE OF CONTENTS ...... 3

ACKNOWLEDGEMENTS ...... 4

LIST OF FIGURES ...... 5

1 INTRODUCTION ...... 6

2 LITERATURE REVIEW ...... 7

3 METHODS ...... 19

4 CONCLUSION ...... 21

5 REFERENCES ...... 23

THE LADY WITH THE LAMP 4

ACKNOWLEDGEMENTS

First off, I would like to thank all of the individuals who have assisted me in reaching my academic goals and success at the University of Florida. Thank you to my parents for supporting me physically and morally throughout this academic journey while always providing me with constant encouragement.

Furthermore, I would like to thank my supervisor and mentor, Dr. Constance Shehan, for her unwavering support. Amid these incredibly trying times, Dr. Shehan never failed to provide me with the utmost reassurance and provision throughout the entirety of this research process.

Without her relentless guidance and comprehensive wisdom, this would not have been possible.

THE LADY WITH THE LAMP 5

LIST OF FIGURES

Figure Page

1 Causes of Mortality During the Crimean War. ………………………………….10 2 The Importance of Cleanliness of Rooms, Walls, and Floors. ………………….12

THE LADY WITH THE LAMP 6

Introduction

The year was 1854 when the “Lady with the Lamp” came to fame. This name was given to Florence Nightingale for her endless efforts to reform the hospital systems during the Crimean

War. Florence Nightingale, a British woman, born to William Nightingale and Frances

Nightingale was advisor to the Queen of England. She expressed her concerns and ideas for reform of the current healthcare system that was in place at the time of the Crimean War. As a woman during times of discrimination Florence was neither supported by her family nor most individuals with whom she crossed paths. However, she was supported by Queen Victoria who trusted her in sending her to the British Army’s Barracks Hospital in Scutari. Here Nightingale was sent to assist the wounded soldiers with a group of other female nurses.

Florence Nightingale grew up in the Victorian Era which was primarily characterized as a patriarchic system. During this time in the Victorian Era men and women were not viewed as equals and both men and women were designated specific roles and duties. Men were expected to be working heads of households while possessing qualities such as strength and high levels of educational attainment. Women were deemed to be caretakers, and the extent of their abilities to be working professionals was becoming a teacher. At this time women could not own property and they could not vote while men could do both. The gender roles during this time were very strict and individuals were looked down upon by society if they deviated from the typical gender norms. However, clearly the gender norms did not discourage Florence Nightingale from pursuing her passions in life. I believe that Florence Nightingale would be considered to be a modern-day feminist if she were still alive today. I found it incredibly unique in her writing, that in the mid 1800’s, Florence recognized that nursing and caretaking were primarily womanly duties. However, Nightingale did not only speak to women, rather she spoke to a broad and

THE LADY WITH THE LAMP 7 generalized audience as she believed that these rules were so imperative that everyone must know them.

I believe that if Nightingale had been given more support by her family as well as her community and the doctors she was working alongside she may have been more successful in her attempts to assist wounded soldiers during the Crimean War. However, I also believe that there were many reasons behind why there were so many fatalities during this time in the hospital. Many of which were unavoidable and could not have been fixed by Florence

Nightingale.

Literature Review

Nursing is a profession in which trained professionals provide care for sick or injured individuals. Nurses also play key roles in hospitals or health care facilities promoting proper health as well as the prevention of illness. According to the International Council of Nurses “The nurse is a person who has completed a program of basic, generalized nursing education and is authorized by the appropriate regulatory authority to practice nursing in his/her country” (ICN,

1987). Therefore, nurses endure a rigorous curriculum before being licensed to work in hospitals or health care facilities. Nursing is an integral part of the health care system and brings in the humanistic approach that is needed to deliver proper care to patients.

Florence Nightingale, in her book “Notes on Nursing,” highlights thirteen different lessons which are essential when delivering proper patient care. The key ideas in her book were organized around proper ventilation, the importance of temperature in rooms, cleanliness, nutrition for patients, and how to manage your schedule as a nurse. These are teachings which are still widely accepted and used today in nursing schools all around the world. These notes are

THE LADY WITH THE LAMP 8 imperative to consider and follow while taking care of patients as their health depends on these practices of proper nursing.

Proper ventilation. Rooms must have an open window or a system in place in which the air is kept as pure as possible. Air cannot be pure if there is no way to release the dirty air from sick patients and a sick patient can never recover in a room without pure air. Nightingale constantly mentions the word “effluvia” which refers to impurities which fill the air and can be detrimental to patient’s health. She urges caretakers to realize the importance of proper ventilation in rooms while calling attention to common misconceptions regarding ventilation.

Recent studies have shown that the air inside of any healthcare facility must be pure as it maintains a clean and healthy environment. However, if the indoor air is contaminated with certain pollutants it can be detrimental to patient’s health and well-being resulting in worsened conditions (Lampi et al., 2020). Nightingale explains that solely keeping a room’s temperature cold does not mean that there is sufficient ventilation or that the air is pure. In the scenario of infectious diseases in hospitals it is incredibly easy for the air to be contaminated which, in turn, can infect patients, healthcare workers, and hospital visitors. Therefore “an effective ventilation system is crucial to protect doctors, nurses and other health-care workers from patients with infectious disease” (Cheong & Phua, 2006). This is supported by the necessity to design a proper ventilation strategy in hospitals that does not allow harmful air pollutants to circulate and infect others.

In relation to ventilation, Florence Nightingale teaches caretakers about her five points for maintaining good health in houses in her second chapter of the book (Nightingale, 2018 p.

24). These five points include pure air, pure water, efficient drainage, cleanliness, and light. Pure air goes hand in hand with proper ventilation as the primary way to access pure air is by having

THE LADY WITH THE LAMP 9 proper ventilation. Pure water is essential as dirty water may contain toxins which will harm patients. Patients must have access to clean water as they must be bathed in clean water and must be able to drink water free from toxins or other pollutants. These both attribute to a patient’s urgency to be well hydrated as well as exercising proper hygiene. Nightingale’s basic theory with regard to sunlight is advanced in modern medicine by also accounting for her importance of clean water. Sunlight contains ultraviolet light rays so by advancing Nightingale’s theory focusing on using certain ultraviolet light it is possible to sanitize water and promote expansion of public health in an economical fashion. A recent study done on ultraviolet lights enhancing water, sanitation, and hygiene, otherwise known as WASH, states:

UV disinfection is widely used for water and wastewater treatment in many parts of

North America, Asia, and Europe. It has the benefits of forming no trihalomethanes or

haloacetic acids, regulated by-products of chlorination, and can be successfully used

against chlorine resistant pathogens such as Cryptosporidium parvum and Giardia

lamblia. (Hazell, Braun, & Templeton, 2019, p. 2).

It is extremely important for hospitals to have access to clean water sources and which makes the research of ultraviolet disinfection imperative as this could assist areas of underserved populations and beyond.

Nightingale urges caretakers to recognize the importance of efficient drainage as she realized throughout her research that improper release of sewage causes many diseases and prevents complete cleanliness of homes and hospitals. Therefore, homes must not just have one pipe which drains sewage to the street but “all drains must begin and end outside the walls”

(Nightingale, 2018 p. 26). This meant that carrying sewage throughout or underneath homes or hospitals lead to improper drainage of sewage. During her time in Scutari at the British Army’s

THE LADY WITH THE LAMP 10

Barracks Hospital, Nightingale noticed that one of the main reasons her patients were not recovering was due to the hospital being located above sewage disposal. Nightingale noticed that the floors were rotten and wreaked of sewage. She later conducted research regarding her hospital and other hospitals at the time to come to a conclusion as to why twice as many as her patients were dying in comparison to patients at other hospitals (Joyce, 2008). Once collecting the data, she realized that the death rates could be attributed to the conditions of the hospital rather than the care she was providing for her patients. Figure 1 summarizes Nightingale’s analysis of the mortality rates in the British Army during the Crimean War.

Figure 1. Causes of Mortality During the Crimean War. This diagram represents the research done by Florence Nightingale comparing the mortality rates in hospitals during the time of the Crimean War (Joyce, 2008).

The reason the mortality rate of injured soldiers at the British Army’s Barracks Hospital in Scutari was so high was attributed to the health of the hospital. Today, the infections many of

THE LADY WITH THE LAMP 11 these wounded soldiers may have contracted, while in the Barracks Hospital, are known as nosocomial infections. Nosocomial infections are infections which are contracted while in hospitals which may come from the air and, in turn, can cause various other infections (Kunwar,

Tamrakar, Poudel, Sharma, & Parajuli, 2019). Nightingale’s assumptions regarding the health of hospitals are further confirmed as a similar study was conducted in a teaching hospital in Sri

Lanka in 2019. This study concluded that Intensive Care Units and Operating Rooms had higher levels of airborne microbes which exponentially increases the risk of nosocomial infections

(Sivagnanasundaram, Amarasekara, Madegedara, Ekanayake, & Magana-Arachchi, 2019). This is why Nightingale wrote her five points of the health of houses. The wounded soldiers were said to be crowded together in the hospital laying on cots which were above rotting floors. This resulted in high rates of infection and dysentery which led to the death of many wounded soldiers. Therefore, this poorly ventilated and dirty hospital did not meet any of Nightingale’s five points for the health of houses as the air was not pure, wounded soldiers did not have access to clean water, and due to the sewage issues underneath the hospital, there was not efficient drainage. The holistic review of the hospital was that it was not clean and there was inefficient lighting. Florence received her name the “Lady with the Lamp” as she would visit her patients during the night while carrying a lamp.

Cleanliness. Nurses and caretakers must practice cleanliness of rooms and walls which is another one of Nightingale’s notes. She expressed that rooms must be kept clean at all times and this derives from what the walls are made out of and what they are covered in. Nightingale states that the best walls for sick rooms are white non-absorbent cement or glass walls (Nightingale,

2018 p. 90). In her teachings she explains that caretakers are responsible for cleaning the walls and floors of rooms which contribute to the quality of air that fills the rooms. It is vital that all

THE LADY WITH THE LAMP 12 rooms exhibit proper cleanliness because if a room does not meet the standards of cleanliness it will also not have proper ventilation. Therefore, Nightingale teaches us in her book that all of these rules and regulations rely on one another. If a room is not clean it will not be properly ventilated. If a room is not properly ventilated a patient will not be able to recover. Figure 2 illustrates the problematic conditions of rooms that contribute to patient mortality.

Figure 2. The Importance of Cleanliness of Rooms, Walls, and Floors. This figure represents what surrounds patients if they are not in a clean environment (Peters et al., 2018).

In hospitals today, sanitary workers are primarily responsible for properly disinfecting rooms and keeping them hygienic. However, it is a nurse’s job to assure that the room reaches its cleanliness standards for each and every patient. It is also important to recognize that not all nurses are working in hospitals and some are home healthcare workers. This means that they

THE LADY WITH THE LAMP 13 work in the homes of other individuals as caretakers for sick patients. In this case it is their responsibility that the room or rooms in which the patient resides is held up to its proper cleanliness standards. Nurses must be taught the basics of cleanliness in their training as a nurse as their patients’ lives depend on it. This then relates back to Nightingale’s final point for health of houses which is lighting. Nightingale urges her audience to understand that a dark room or environment is not healthy for patients. She states, “a dark house is always an unhealthy house, always an ill-aired house, always a dirty house” (Nightingale, 2018 p. 28). Her theory of the necessity of sunlight in hospitals and healthcare facilities is proven to be true in many studies today. Sunlight, also known as Vitamin D, influences viral responses to treatments. A study observing the effect of season and sunlight on viral kinetics during hepatitis C virus therapy concluded individuals responded better to treatment when sunlight was introduced (Hernández-

Alvarez et al., 2017). This study further confirmed Nightingale’s theory on light while examining the effects of Vitamin D deficiency stating:

Vitamin D is known to play a key role in calcium and bone homeostasis, but there is

emerging evidence that it also has antifibrotic and anti-inflammatory properties. In fact,

latest studies have found an association between low vitamin D levels and risk of severe

chronic hepatitis C (CHC) and cirrhosis,3–5 suggesting that vitamin D deficiency may be

involved in the progression of chronic liver disease. (Hernández-Alvarez et al., 2017, p.

1)

Furthermore, scientific evidence supports Nightingale’s five points for health of houses as they do translate to standards upheld in modern day healthcare facilities.

Nutrition. Another one of Nightingale’s key notes was administering proper nutrition to patients with a special attention to the frequency of feeding. Nightingale explained that she

THE LADY WITH THE LAMP 14 noticed patients would receive meat broth as meals which did not result in proper nutrition of patients. Nightingale combated this belief by stating patients should receive fair amounts of dairy products, vegetables, and sugar (Nightingale, 2018 p. 70). In hospital’s today there is a nutritionist who evaluates the health of patients and determines what they should and should not eat while at the hospital. Many patients have food allergies and restrictions that will prohibit them from eating certain foods. For example, an individual who is lactose intolerant will not be given any dairy products as it will cause them gastrointestinal issues. According to the National

Institute of Diabetes and Digestive and Kidney Disease, a patient who has any classification of diabetes will have a diet composed of dairy, protein, fruits, and vegetables; however, it will not be high in sodium, added sugars, or saturated fat.

Nightingale also noted that the times in which a patient is served food is extremely important. She states, “a nurse is ordered to give a patient a tea-cup full of some article of food every three hours,” as she believes it is important to assure a patient’s condition does not deteriorate due to malnutrition or the lack of food (Nightingale, 2018 p. 64). According to The

Journal of Hospital Medicine:

Optimal nutrition in the hospital can facilitate better patient outcomes. Malnutrition in

hospitalized patients can lead to poor wound healing, impaired immune function resulting

in infectious complications, increased hospital length of stay, and overall increased

morbidity and mortality. (J. Hosp. Med, 2006, p. 1)

Therefore, a balanced meal at set hours is necessary in order for patients to gain back proper health.

Self-management. Lastly, Nightingale urges fellow nurses to manage themselves as well as their time properly. Nightingale refers to poor time management as “petty management”

THE LADY WITH THE LAMP 15

(Nightingale, 2018 p. 35). She believes that hospitals will fail if there is not effective time management in place. This holds true to modern day nursing as nurses run on strict schedules in hospitals. Registered nurses in hospitals typically work 12 hour shifts and once their shift is up, a new replaces them. These shifts typically run from 7 A.M. to 7 P.M. and from 7

P.M. to 7 A.M. which means typically a patient will have two registered nurses in a given 24- hour period. It is imperative that nurses set a schedule and follow it as well as being aware of the schedule of others. It is important to rely on your team as a nurse, as in many cases, providing proper care to a patient is a team effort. Nightingale stresses that nurses must not always rely on themselves but allow themselves to rely on others for assistance. Nightingale states “how can I provide for this right thing to always be done” referring to not setting false expectations. It is your responsibility as a nurse to ensure all duties are carried out. This is why in a hospital there are many different care takers assigned to patients, each of who is assigned different roles.

Alongside these aspects of management, Nightingale also stresses the importance of telling a patient where you are going and when you will be back. As a registered nurse you must always tell your patient your course of action, so they are not left in the dark and have some sense of security.

Thus, Florence Nightingale touches upon many key components of nursing and caretaking that still stand true today. Her practices as a nurse and her experience in research led her to creating these rules and guidelines which result in optimal patient care. As a nurse or caregiver, it is important to recognize that without a proper environment there is not a likely chance of success for your patient. I strongly believe that these teachings carry to be true today because, as a society, we have faced many issues with health as a whole.

THE LADY WITH THE LAMP 16

Application of Florence Nightingale’s Theory of Nursing in Contemporary Practice

Future research might include how the recent COVID-19 outbreak can be slowed down or prevented by Florence Nightingales rules and recommendations. Coronavirus more formally known as COVID-19 is a disease which emerged from Wuhan, China in December 2019. The

Journal of Medical Virology explains that “coronaviruses (CoVs) are a group of highly diverse, enveloped, positive‐sense, and single‐stranded RNA viruses. They cause several diseases involving respiratory, enteric, hepatic, and neurological systems with vary severity among humans and animals” (He, Deng & Li, 2020). On March 11, 2020 the World Health organization characterized COVID-19 as a pandemic. A pandemic is a global outbreak of disease. The last pandemic was the HIV/AIDS pandemic which arose between 2005 through 2012. The Bubonic plague is another one of the most notorious pandemics in history.

The Bubonic plague was also known as “black death” and arose from a bacterial infection transmitted by a bacterium which is said to come from fleas called bacterium Yersinia Pestis.

The Bubonic plague made its way through Asia, Europe, and Africa, resulting in the mortality rate of about 50 million people. Fortunately, the World Health Organization did not consider the

Bubonic plague to be active after 1959. However, although the pandemic is over it does not mean that the infectious disease has disappeared. Rather, the rate at which people have been infected or died from it has decreased significantly.

In the case of COVID-19 there has not yet been a vaccine developed to protect against it.

It is assumed that once a vaccine is developed there will be a significant decrease in the number of infected individuals. However, until then individuals must practice social distancing and social isolation in order to protect themselves and others against the disease. The disease is said to be spread through physical contact which derives from droplets from the mouth or nose of

THE LADY WITH THE LAMP 17 individuals. The disease may survive on surfaces for over 24 hours, which is why it is extremely important for individuals to constantly wash their hands and avoid touching their faces.

Symptoms of COVID-19 include dry cough, fever, and tightness of chest, although some patients do experience other flu-like symptoms such as nasal congestion, runny nose, body aches, sore throat, and diarrhea. Coronavirus may not only cause these symptoms but may lead to cardiovascular damage. Individuals who have cardiovascular disease have a higher risk of death if they contract the virus (Zheng, Ma, Zhang & Xie, 2020). The broad range of symptoms may confuse individuals; however, if any individual experiences the main three symptoms they are urged to seek help from health care providers immediately. Unfortunately, some patients are asymptomatic meaning they do not develop symptoms and are carriers of COVID-19. A study recently conducted in Anyang, China confirmed an asymptomatic woman from Wuhan, China infected five of her family members while visiting them in Anyang, shortly after the coronavirus outbreak in January (Bai et al., 2020). In cases like this it only solidifies how imperative it is that individuals practice social distancing. If you are a carrier and although you do not feel sick you are able to pass on coronavirus to anyone you come into contact with.

That being said, many of Florence Nightingale’s teachings have been particularly relevant during pandemics – especially COVID-19 (which first appeared in Wuhan, China). The

World Health Organization has advised individuals to practice cleanliness and isolation, which are two of the very important teachings Florence Nightingale advised caretakers of in her book

(WHO, 2020). It is imperative that individuals constantly wash their hands for at least 15 seconds with water and soap. They are also advised to completely disinfect their homes as well as any products that are bought into their homes. Nightingale urged her readers to understand that there is nothing more important than a clean and well-ventilated room. Her statistics prove

THE LADY WITH THE LAMP 18 that during the Crimean War many injured soldiers died because of the poor conditions of the hospital. Therefore, it is essential that we practice the teachings of Nightingale in order to avoid contracting or spreading the virus.

Currently, Nightingale’s basic theory of sunlight, is extremely significant as researchers are attempting to use ultraviolet light to combat COVID-19. Columbia University released a statement on their website:

The technology, developed by Columbia University’s Center for Radiological Research,

uses lamps that emit continuous, low doses of a particular wavelength of ultraviolet light,

known as far-UVC, which can kill viruses and bacteria without harming human skin,

eyes and other tissues, as is the problem with conventional UV light. (Cantor, 2020, p. 1)

Ultraviolet light has been proven to have a wide range of uses however, an ultraviolet light that can kill coronavirus without doing any harm to humans, could be a lifesaving advancement. This research among many others further asserts Nightingale’s importance of light as it extends far beyond natural sunlight and investigates the prominence of ultraviolet light rays.

In the case that individuals test positive for COVID-19 their health first must be assessed by a physician. If they are not in a state in which they need to be placed on a ventilator or ill enough to be in a hospital, they will be sent home. These individuals who are well enough to stay home must self-isolate for at least 15 days in order to avoid spreading coronavirus to family members or other individuals. Patients who are self-isolating must be aware of the importance of

Nightingale’s teachings of her five points for health of houses.

THE LADY WITH THE LAMP 19

Methods

I chose to use autoethnography as my qualitative research method in order to examine the nursing practices of the 19th century in comparison to those used today. I conducted an analysis of the book Notes on Nursing: What it is and What it is Not written by Florence Nightingale. I also watched the film Florence Nightingale directed by Norman Stone which highlighted

Nightingale’s influence on the nursing field we are familiar with today. I chose to examine these works in order to explore my interest in the and how it has changed over time.

As a student who is about to enter an Accelerated Bachelor of Science in Nursing program, otherwise known as an ABSN, I am extremely interested in Florence Nightingale’s impacts on the nursing field. My curiosity regarding how the nursing field has changed from the 1800’s truly drove me to examine Nightingale’s work during the Crimean War.

I chose to go into the nursing field due to my passion for health care along with my understanding that patients receive the most critical care from nurses. This care aspect is the necessity of compassion that patients desperately need. Through my experiences shadowing in hospitals I noticed that patients rely on the humanistic nature of healthcare workers. When patients are treated with kindness and compassion this enhances their experience in the darkest of times. Nightingale visited her patients at the British Army’s Barracks Hospital each night where she received the name the “Lady with the Lamp.” During her nightly visits she would assist the injured soldiers in writing letters back to their families. This is just one simple example of how

Nightingale exhibited compassion during her time in Scutari.

Nightingale believed that by respecting patients and assuring that they were in proper living conditions their chances of survival would be much more likely. This indeed is proven to be true today as assuring that each patient is treated with utmost care and respect is necessary.

THE LADY WITH THE LAMP 20

Patients typically interact most often with their nurses. My goal as a nurse is to treat each patient with compassion, just as Nightingale did.

I believe that since, care taking has historically been regarded as a woman’s job, this has had an influence on why nursing is primarily a female dominated field today. Although, there have been shifts in the inequality between men and women since the 19th century, there still are discrepancies in gender equality, especially in the professional work force. I hope to advocate for women’s rights and equality as a nurse. I also look forward to working alongside male nurses as

I believe that human compassion has no gender-based difference. Therefore, I believe men and women equally can be incredible caretakers. I hope to see many males accompany me in the field as I know that individuals who are passionate about assisting others will be incredible nurses and caretakers regardless of their gender.

To enter , I filled out many applications which challenged my desires within the nursing field. Many institutions wanted to know what drives me to become a nurse along with what I intend on doing while I am a nurse. My typical response is as follows:

My ambitions of pursuing higher levels of education are driven by my desire to improve

patient care and the quality of patient health. Specifically, the various Doctor of Nursing

Practice programs that the University of Miami offers are a part of my long-term goals.

During my studies at the University of Florida, I was continuously inspired to become

involved with many global health care issues including the lack of healthcare for

underserved populations. I hope to become a nurse to advocate for issues like this and

truly make a difference in the health care field (Reidy, 2019, p. 2)

THE LADY WITH THE LAMP 21

I am truly motivated by the opportunities that lie ahead and all of the individuals in need of proper healthcare. Nightingale’s teachings and long-lasting effects on the nursing field made me curious about her practices along with her research. Simply by picking up her book I felt that I was learning to become a better nurse before even entering nursing school.

Conclusion

Irrefutably, through the examination of Florence Nightingale’s work in the nursing field and the health care system today, it is seen that Nightingale’s practices are still used today.

Recent research has proven that hospitals and caretaking facilities must meet certain rules and regulations in order to maintain proper standards. Human health is extremely important especially in today’s society which is why Nightingale’s theories are constantly being researched and found to be useful for various reasons.

It is seen that Nightingales’ practices are applicable in all aspects of life. Nightingale constantly referred to healthcare facilities as the “home” because in the 1800’s most caretakers worked out of the home. Therefore, not much research was done in the 19th century regarding these theories Nightingale had. Ultimately this led her to completing her own research based on her experiences during the Crimean War. However, in today’s rather progressive society nursing is a universally accredited and widely accepted profession. Nightingale’s five points for health of houses can be translated to modern day hospitals and have been supported by scientific research.

Along with hospitals, these practices are used in nursing homes and various healthcare facilities that constantly contain patients or sick individuals.

Conclusively, the thirteen theories Nightingale discusses in her book, originally published in 1859, truly highlight many important aspects nurses will be expected to maintain and challenge to research as the healthcare field is rapidly changing. Her most prominent theories are

THE LADY WITH THE LAMP 22 those on ventilation, health of houses, petty management, light, and cleanliness. All of these contribute to a properly functioning hospital along with attributing to keeping patients as healthy as possible.

Nightingale also strived to teach nurses to respect patients while also respecting their own limitations. Her theories constantly displayed her urgency for nurses to display compassion when treating patients. This is an extremely important rule to live by as a healthcare worker as all humans need to be treated with respect and equally cared for. Although Nightingale did not write a section on compassion she constantly mentioned in each of her theories as she believed that was not even something a nurse needed to. She believed it was “natural.”

Due to COVID-19, and all of the risks it poses, individuals must preserve their health as it may be essential for survival. Respecting your own limitations as a healthcare worker during a pandemic is crucial. Healthcare workers must be reminded that they are a team and no one person alone is expected to carry that team. It is during the most difficult times that individuals learn to rely on one another and work as a cohesive team. Nightingale recognized the importance of management and working together in the healthcare field in the 1800’s. We must remember

Nightingale’s practices when it comes to caring for the sick as many individuals may find themselves caring for a sick relative at one point in their lives. Her practices transcend professional work for educated nurses as Nightingale’s suggestions serve to educate all individuals who will experience some sort of caretaking in their lifetime.

THE LADY WITH THE LAMP 23

References

Advice for public. (2020, March 31). Retrieved from

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

Bai, Y., Yao, L., Wei, T., Tian, F., Jin, D.-Y., Chen, L., & Wang, M. (2020). Presumed

Asymptomatic Carrier Transmission of COVID-19. Jama, 323(14), 1406. doi:

10.1001/jama.2020.2565

Cantor, C. (2020, April 21). Could a New Ultraviolet Technology Fight the Spread of

Coronavirus? Retrieved from https://news.columbia.edu/ultraviolet-technology-virus-

covid-19-UV-light

Cheong, K., & Phua, S. (2006). Development of ventilation design strategy for effective removal

of pollutant in the isolation room of a hospital. Building and Environment, 41(9), 1161–

1170. doi: 10.1016/j.buildenv.2005.05.007

Diabetes Diet, Eating, & Physical Activity. (2016, December 1). Retrieved from

https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-

activity

Hazell, L., Braun, L., & Templeton, M. R. (2019). Ultraviolet sensitivity of WASH (water,

sanitation, and hygiene) -related helminths: A systematic review. PLoS neglected tropical

diseases, 13(9), e0007777. https://doi.org/10.1371/journal.pntd.0007777

He, F., Deng, Y., & Li, W. (2020). Coronavirus Disease 2019 (COVID‐19): What we know?

Journal of Medical Virology. doi: 10.1002/jmv.25766

Hernández-Alvarez, N., Pascasio Acevedo, J. M., Quintero, E., Fernández Vázquez, I., García-

Eliz, M., de la Revilla Negro, J., Crespo García, J., & Hernández-Guerra, M. (2017).

THE LADY WITH THE LAMP 24

Effect of season and sunlight on viral kinetics during hepatitis C virus therapy. BMJ open

gastroenterology, 4(1), e000115. https://doi.org/10.1136/bmjgast-2016-000115

Joyce, H. (2008). Florence Nightingale: a lady with more than a lamp. Significance, 5(4), 181–

182. doi: 10.1111/j.1740-9713.2008.00327.x

Kunwar, A., Tamrakar, S., Poudel, S., Sharma, S., & Parajuli, P. (2019). Bacteriological

Assessment of the Indoor Air of Different Hospitals of Kathmandu District. International

journal of microbiology, 2019, 5320807. https://doi.org/10.1155/2019/5320807

Lampi, J., Hyvärinen, A., Erhola, M., Haahtela, T., Haukipuro, K., Haverinen-Shaughnessy, U.,

Jalkanen, K., Karvala, K., Lappalainen, S., Reijula, K., Rämö, H., Sainio, M., Salmela,

A., Salminen, M., Vasankari, T., & Pekkanen, J. (2020). Healthy people in healthy

premises: the Finnish Indoor Air and Health Programme 2018-2028. Clinical and

translational allergy, 10, 4. https://doi.org/10.1186/s13601-020-0308-1

Nightingale, F., Dunbar, V. M., & Dolan, M. B. (1859, 2018). Notes on nursing: what it is, and

what it is not. New York: Dover Publications.

Nursing Definitions. (1987). Retrieved from https://www.icn.ch/nursing-policy/nursing-

definitions

Nutrition and the hospitalized patient. J. Hosp. Med 2006;1;79-79. doi:10.1002/jhm.53

Peters, A., Otter, J., Moldovan, A., Parneix, P., Voss, A., & Pittet, D. (2018). Keeping hospitals

clean and safe without breaking the bank; summary of the Healthcare Cleaning Forum

2018. Antimicrobial Resistance & Infection Control, 7(1). doi: 10.1186/s13756-018-

0420-3

Sivagnanasundaram, P., Amarasekara, R., Madegedara, R., Ekanayake, A., & Magana-Arachchi,

D. N. (2019). Assessment of Airborne Bacterial and Fungal Communities in Selected

THE LADY WITH THE LAMP 25

Areas of Teaching Hospital, Kandy, Sri Lanka. BioMed research international, 2019,

7393926. https://doi.org/10.1155/2019/7393926

Zheng, Y.-Y., Ma, Y.-T., Zhang, J.-Y., & Xie, X. (2020). COVID-19 and the cardiovascular

system. Nature Reviews Cardiology, 17(5), 259–260. doi: 10.1038/s41569-020-0360-5