Notes on Nursing

Florence Nightingale was an English nurse commonly known as the founder of modern nursing practices. Born in Italy, she became an experienced nurse and formed many of her opinions while serving in the Crimean War, enrolling in nursing school at age 24 in Germany. She penned Notes on Nursing: What It Is, and What it Is Not in 1859, just a few years after serving in the war, and the work was first published in 1860.

Nightingale intended to provide a guide on what the art of nursing entails and the fundamental things that anyone wishing to be a nurse must know. Instead, she created a pedagogical treatise that today is renowned for being ahead of its time and in many aspects—including the importance of sanitary conditions and a patient’s mental health—remains as relevant today as it was in the middle of the 19th century. It represents one of the first comprehensive takes on Western healthcare and, as such, is foundational to many moral, scientific, and operational aspects of modern medicine. Nightingale’s highly knowledgeable and accessible style and voice, combined with her frequent use of female pronouns to refer to people in medical roles, led to her reputation as an early feminist voice in Western medicine, a field traditionally (and still) biased toward men’s opinions. Written from a first-person perspective, Notes on Nursing is a guide and field notebook for those who wish to improve their knowledge of nursing.

This study guide references the 2017 Kindle Edition reprint issued by Digireads.com Publishing.

Summary

Nightingale begins her treatise with the general principle that all disease is part of the body’s natural healing process. This principle remains a constant throughout the work as she reiterates that the body is a naturally healing organism and that part of the art of nursing is not fixing the body from the outside but allowing the patient to experience the best conditions in which the body can heal itself. Nursing should cater to the whole person, not just to one physical aspect, so that all aspects of the body contribute to recovery, health, and general flourishing. Nightingale characterizes the role of nurses and doctors as positive and restorative, distancing herself from the more isolating and analytical conceptions of the ideal medical practitioner, and endorses alternative medicine, especially homeopathy, as viable treatments for disease.

In addition to administering medicines and other practical help that nurses offer doctors and other medical professionals, Nightingale holds, the nurse’s duty is to address the entire ecosystem of care, to ensure that the patient receives all things that contribute to health and wellbeing. Fresh air, pure water, clean spaces, and dry, warm beds are just a few of the fundamental ways in which humans maintain their health and are thus instrumental in caring for the sick and dying. The text details the various elements necessary for a patient’s proper health, and many are (in Nightingale’s own words) measures that common sense dictates. As she notes, however, this manner of common sense is not so common, least of all among the nurses of her day, thus proving the necessity for a text of this kind.

Nightingale emphasizes that mental health is as crucial to recovery and health as the physical provisions—a point surprising for the time and culture. She even holds that the physical provisions are meant to be strictly material supplements. Nightingale ties her recommendations for improving the patient ecosystem to the patient’s mind, arguing that the mind-body connection works in both directions and that the body can therefore repair itself from either starting point. The presence of music, the absence of extraneous noise and distraction to promote sleep, and even the necessity of avoiding unhelpful and anxiety-inducing visitors all play a part in Nightingale’s system of health and caretaking as a nurse.

In addition to her sensitivity to the mental aspect of health and the benefits of positive psychology, Nightingale gives prescient insights into the importance of sanitation. Her insistence on eliminating dust, filth, and damp from the home and the hospital is prophetic, foreshadowing later discoveries related to microbes, epidemiology, and the implementation of germ theory measures that identify numerous causes of illness.

Nightingale makes the (now highly contentious) claim that “true nursing” addresses infection only by preventing it. While modern medicine and healthcare has moved beyond Nightingale’s approach and advice in numerous ways, her manuscript nevertheless remains a timeless source of advice on nursing. She warns against religious views that inhibit proper medical care yet is quick to criticize highly sophisticated instruments and medicines, seeing them as “perversions” that can damage the patient.

In her conclusion, Nightingale exhorts nurses to be always vigilant on behalf of their patients. While she acknowledges that little is really understood about why natural and homeopathic medicines and methods work, her philosophy is that if these treatments don’t cause harm, they’re better candidates than sophisticated medicine. Notes on Nursing places Nightingale in a distinct camp in the history of medicine that extols intuition and common sense over complex medical theories.