Last summer, a service commemorating the inclusion of Florence Nightingale in the Calendar of Lesser Feasts and Fasts was held at the Cathedral Church of Saint Peter & Saint Paul in the city and Episcopal Diocese of Washington, DC. In addition to prayers, readings, and hymns, using the candle that was burning in the center of the crossing a ceremony was held called the Passing of the Light of Knowledge.
Representatives from the American Nurses Association, Sigma Theta Tau International, the National League for Nursing, the American Association of Colleges of Nursing, the American Organization of Nurse Executives, and the National Student Nurses' Association passed the candle from one to another symbolizing the passing of knowledge from one nurse to another from generation to generation, and highlighting the diversity of care nurses provide for humanity.
The Florence Nightingale Window, located in the Cathedral's north transept, was installed in 1938 and depicts six outstanding scenes in the life of Florence Nightingale (1820-1910): St. Thomas, London, Hospitals, Childhood, the Crimea, Education, and Notes on Nursing.
As I viewed the window, I reflected on her Notes on Nursing: What it is and What it is Not (1859, 1992). I am awed every time I read her original notes written almost 150 years ago. She addressed so many of the nursing and healthcare issues that nurses are still confronting in the 21st century. Before the days of federal and state laws and regulation, she was aware of the need for nurses to be involved. Following are just a few of the issues she wrote about in 1859:
Confidentiality
[horizontal ellipsis]And remember every nurse should be one who is to be depended upon, in other words, capable of being a "confidential" nurse. She does not know how soon she may find herself placed in such a situation; she must be no gossip, no vain talker, she should never answer questions about her sick except to those who have a right to ask them[horizontal ellipsis] (Page 70).
Nursing is an art: and if it is to be an art, it requires as exclusive a devotion, as hard a preparation, as any painter's or sculptor's work; for what is the having to do with dead canvas or cold marble, compared with having to do with the living spirit-the temple of God's spirit? It is one of the Fine Arts; I had almost said, the finest of the Fine Arts. - Florence Nightingale, 1859
Dust
[horizontal ellipsis]But no particle of dust is ever or can ever be removed or really got ride of by present system of dusting. Dusting in these days means nothing but flapping the dust from one part of a room on to another with doors and windows closed. What you do it for I cannot think. You had much better leave the dust alone, if you are not going to take it away altogether[horizontal ellipsis]The only way I know to remove dust, the plague of all lovers of fresh air, is to wipe everything with a damp cloth[horizontal ellipsis] (p. 50).
Infection Control
[horizontal ellipsis]Every nurse ought to be careful to wash her hands very frequently during the day. If her face too, so much the better. One word as to cleanliness merely as cleanliness. Compare the dirtiness of the water in which you have washed when it is cold without soap, cold with soap, hot with soap. You will find the first has hardly removed any dirt at all, the second a little more, the third a great deal more[horizontal ellipsis] (p. 53).
[horizontal ellipsis]True nursing ignores infection, except to prevent it. Cleanliness and fresh air from open windows, with unremitting attention to the patient are the only defence a true nurse either asks or needs. Wise and humane management of the patient is the best safeguard against infection[horizontal ellipsis] (p. 20).
Noise (Inappropriate Conversation)
I have often been surprised at the thoughtlessness, (resulting in cruelty, quite unintentionally) of friends or of doctors who will hold a long conversation just in the room or passage adjoining to the room of the patient, who is either every moment expecting them to come in, or who has just seen them, and knows they are talking about him. If he is an amiable patient, he will try to occupy his attention elsewhere and not to listen-and this makes matters worse-for the strain upon his attention and the effort he makes are so great that it is well if he is not worse for hours after. If it is a whispered conversation in the same room, then it is absolutely cruel; for it is impossible that the patient's attention should not be involuntarily strained to hear[horizontal ellipsis] (p. 26).
[horizontal ellipsis]I need hardly say that the other common cause, namely, for a doctor or friend to leave the patient and communicate his opinion on the result of his visit to the friends just outside the patient's door or in the adjoining room, after the visit, but within hearing or knowledge of the patient is, if possible, worst of all[horizontal ellipsis] (p. 26).
Observation
[horizontal ellipsis]In dwelling upon the vital importance of sound observation, it must never be lost sight of what observation is for. It is not for the sake of piling up miscellaneous information or curious facts, but for the sake of saving life and increasing health and comfort[horizontal ellipsis] (p. 70).
Quality
[horizontal ellipsis]Keep your patient's cup dry underneath. One very minute caution-take care not to spill into your patient's saucer, in other words, take care that the outside bottom rim of his cup shall be quite dry and clean, if, every time he lifts his cup to his lips, he has to carry the saucer with it, or else to drop the liquid upon, and to soil his sheet, or his bed gown, or pillow, or if he is sitting up, his dress, you have no idea what a difference this minute want of care on your part makes to his comfort and even to his willingness for food[horizontal ellipsis] (p. 39).
Safety
[horizontal ellipsis]Always sit within the patient's view, so that when you speak to him he has not painfully to turn his head round in order to look at you. Everybody involuntarily looks at the person speaking. If you make this act a wearisome one on the part of the patient you are doing him harm. So also if by continuing to stand you make him continuously raise his eyes to see you. Be as motionless as possible, and never gesticulate in speaking to the sick[horizontal ellipsis] (p. 28).
[horizontal ellipsis]This brings us to another caution. Never speak to an invalid from behind, nor from the door, nor from any distance from him, nor when he is doing anything[horizontal ellipsis] (p. 28).
Remembering Wisdom
Throughout her Notes on Nursing, Ms. Nightingale also shares her thoughts on light, food, self-care, and many other aspect of patient care that are as current in 2002 as they were in 1859. I share my recent experience with you for three reasons:
1. to encourage all nurses to take time to visit the National Cathedral and view the Nightingale Window when you are in Washington, DC,
2. to encourage all nurses to read and reread the original and commemorative edition of Notes on Nursing: What it is, and What it is Not (1859, 1992), and
3. to remind us that we need to continue to pass the light of knowledge from one nurse to another and to celebrate our heritage and the diversity of care nurses provided.
Because May is a month that celebrates nurses and nursing, it is important that we reflect on nursing's past, present, and future and our role in continuing the profession as Ms. Nightingale envisioned. Even though we at times may become discouraged, we should find strength in her words and affirm within ourselves that as nurses we continue to be critically important and significant to the well being of society.
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