Keeping Her Lamp Burning Brightly: Honoring Florence Nightingale's Enduring Legacy in Our Current Age of Miraculous Medical Advancement

It’s been a long time since Florence Nightingale’s day.  The changes, innovations, and advancements in medicine occur at an ever-increasing rate.  Even during my own 22-year practice as an acute care nurse in a major hospital - a brief blip in the context of the big picture - the change has been substantial.  Therapies and practices that were considered “mainstream” or “leading-edge” in my early days as a new nurse have been replaced by new innovations and therapies that make the “old ways” seem old indeed.   And the wheels of innovation and evolution roll on:  consider how far we have come in the handling and treatment of the Covid-19 pandemic.  It’s inspiring to contemplate how the early fear and ignorance surrounding this unknown intruder have been replaced by understanding, new knowledge, enhanced isolation practices, and heroic response to the demands for supplies, equipment, and manpower.  To say nothing of the development and distribution of a vaccine!

Everyone involved in healthcare during this revolutionary time in medical history, from the geniuses of epidemiology who have been, and continue to be, the authors of these solutions, all the way down the line to the valiant nursing students - attempting to complete their degree and join the battle despite staggering limitations on their education imposed by the pandemic are, in a word, superheroes.

First and foremost, what would Nurse Nightingale’s impression be of this particular drama?  I believe she would be proud.  I think she would approve of the way all of the players and props in this tale have come together to provide answers and solutions.  I believe she would be impressed by the teamwork involved in crafting and implementing all of the component parts and pieces to contend with and control not only the disease itself but also the fear and uncertainty associated with it.

Beyond the issue of the pandemic, which has occupied the minds of all of us for so many months now, I like to imagine taking her on a tour of my hospital - to witness up-close the daily practices, therapies, and healing modalities that take place there on a daily basis.  What would she think as she looked around herself in the gleaming ICU - surrounded by the beeps and buzzes of technology, the likes of which could scarcely be imagined in her day?  The wonders of “CCRT” - continuous renal replacement therapy:  ongoing, continuous dialysis that provides precision, patient-specific therapy in real-time?  (Especially considering that dialysis of any kind didn’t exist in her day).  What would be the look on her face as she visited various departments and witnessed heart catheterization procedures, early stroke interventions to minimize or even prevent the devastating impact of a cerebral embolus or stenosis, or learned of advanced chemotherapy treatment designed to lessen the devastations of cancer and extend life?  It’s not unlikely that she’d wonder if she’d been transported to another universe, wherein things that existed primarily in the creative imaginations of practitioners had been brought into reality.  

Additionally, I also suspect that she’d wonder about progress and innovation that had been made in the non-medical realm of patient care.  I picture her questioning what new and revolutionary methods were being consistently and universally practiced to address the inevitable fear, worry, and anxiety that plague a patient whenever physical health suffers.  Would we have an equally impressive tour to provide - a similarly outstanding report to present?  Nightingale’s concern for and emphasis on these patient needs is clearly evident in her inspiring words:  

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“The symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different - of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality of care in the administration of diet, or each or all of these.”

And more directly:

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“Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion.”

It is here that Florence might have much to still teach us - areas in which our understanding and practice (consistent practice, at least), might still be lacking.  Do we sometimes get so caught up in the excitement and enthusiasm for all of our new medical theories, therapies and practices that we forget the most basic thing of all:  that our patient is also a human being, with all of the complex and convoluted basic human needs that come along for the ride?  Nurse Nightingale might point out that “the old ways are still the best ways.”    

Regardless of why the patient is in the bed with the ID band on their arm - to one degree or another their world has been “turned on its ear” for the time being, with new conditions, new discomforts, perhaps loss of a portion of physical/mental/emotional functioning and independence.  Most fearful of all can be the unanswered question - the uncertain future.  They are surrounded by the unknown - an unknown which might have a potentially long-standing negative impact on their well-being.  Can anything feel as threatening?  More terrifying, in some cases?

Obvious or not, expressed or not, these individuals are scared.  And who better to address these fears and uncertainties than the caregiver who has the most frequent and intimate contact with them?  No one has more raw power to positively influence the patient’s well-being than their nurse.  Do we have a shadow of a clue to the nature of that power - to the amount of good that we can accomplish, far beyond the mere administration of medications or therapies?

Florence’s list of needs is clear and concise:  “fresh air…light…warmth…quiet…cleanliness,” as well as “punctuality of care in the administration of diet.”  Basic creature comforts - all these, which we all crave and cherish as human beings.  It’s ironic that as closely as we claim to value these things, most often we only take note of them when they are diminished or missing.  Welcome to the inpatient experience.

Equally ironic (laughable, really) is how easy it is to address these needs.  I work in acute care and once I receive word that I have a patient coming, I immediately go to the room they’ll occupy and do a little rearranging.  I turn the bed toward the television, open the window blinds, and turn up the lights.  The white-board on the wall is a powerful communication tool, and I make sure that my name, as well as the name of my assistant, is on that board.  Most importantly, I ensure that the patient’s name is there, along with the word “Welcome” in front of it.  I turn down the sheets on the bed and place the call light control within easy reach on the bedside table nearby.  How long does all of this preparation take?  Usually less than three minutes.  And yet, what impact on the patient’s first impression?  Their room is ready and welcoming.

Never underestimate the power of ridiculously simple things when providing care.  Be open, patient, and empathetic.  Want to stun a patient with surprise?  Maintain eye-contact, use their name, and patiently listen to them.  Really listen.  Want to take it to the next level?  For the three minutes while you do this, actually SIT DOWN.  Combined, all of these ridiculously simple efforts send a powerful message of kindness, interest, understanding, and a desire to serve.  As a human being with human needs, the patient is in as much need of these things as they are the very medications and treatments they’re in need of for their physical health.

The value of the softly spoken word of empathy, together with a hand gently placed on an arm or shoulder cannot be underestimated.  Simply setting up a dinner tray for a patient with limited vision, or speaking loudly for one who is hard of hearing - will fill needs that the patient will frequently not identify.  Offering reassurance to a concerned family member - telling them that they need to go home in the evening so they can get the rest that they themselves need, assuring them that their mother or father will be in good hands throughout the night - provides worried loved ones with the security to do just that.  Even providing something as simple as a warm blanket or a fresh pitcher of ice water gives you superhero status in the eyes of someone who is cold or thirsty.

Finally - addressing the cause of potentially the greatest fear of all - that of the unanswered question - is perhaps the easiest of all.  It’s likely that I won’t have all the answers the patient or their family members need.  It’s fine to say, “I don’t know” - when followed up with, “I’ll do everything I can to find out.”  Even with no specific answers provided at all - frequent contact with patients, especially when they’re waiting - provides them with the assurance that they haven’t been forgotten.

I believe that if Florence Nightingale had a curriculum of total patient care, many of these principles and ideas would be found there.  It was important to her to care for the whole patient - to address all of his or her needs, insofar as possible.  Successfully accomplishing this is easier than it looks, and takes less time and effort than we might imagine.  And, at the end of the day, can there be any compliment more pure, direct, and sincere than a patient or their family member asking, “Are you working tomorrow?”