In this 2020 Year of the Nurse and the Midwife, Joan Marston, professional nurse and vice Chair of PatchSA considers the valuable legacy of Florence Nightingale in a world dealing with COVID-19.

When the World Health Assembly declared 2020 the Year of the Nurse and the Midwife in celebration of the 200th birthday of Florence Nightingale on 12 May, little did anyone imagine that the world would be celebrating nurses and midwives for their essential role in the fight to care for those affected by Covid-19 infection across the world.

The recently launched State of the World’s Nursing identified that at present 59% of the world’s health force are nurses – in South Africa it is 52%. The report also identified that the world needs 6 million new nursing posts – mostly in low and middle-income countries; with South Africa needing 50-60 000 nurses by the end of this decade.

The COVID-19 pandemic has once again highlighted the essential role of nurses and midwives who continue to care for their patients despite the potential of becoming infected themselves. They do it with so many of the qualities shown by Florence Nightingale, the Founder of modern nursing, such as their dedication to patients; their practical care with compassion and following the principles she demonstrated on infection-control.

Florence Nightingale’s Coxcomb chart showing causes of mortality in the army

Hygiene reform in hospitals

It is fitting that the large new hospitals being set up across the UK for people with COVID-19 infection are named Nightingale Hospitals. What many people do not know is that apart from her leadership in nursing, setting up the first formal training of nurses at St Thomas’ Hospital in London (and the Museum there set up in her name is well worth a visit), she also reformed hygiene and cleanliness in hospitals, and as a brilliant statistician could show, using her development of the first “cockscomb/ pie charts” that more soldiers were dying of preventable infections than of  battle wounds.

As we prepare to celebrate her life, we are reminded that so many of the nursing principles she demonstrated and wrote of in her “Notes on Nursing: what it is and what it is not” are applicable today.

A true visionary

Florence Nightingale was born in, and named for, Florence in Italy – for a long while the worst-affected country in the world by COVID-19.  She truly was a visionary – dedicated, intelligent, far-sighted and immensely practical. When she arrived in the Crimea and the British army hospital at Scutari with her team of 34 nurses in November 1854, she found a situation of unimaginable suffering. The army hospital was built over a cesspool that infected the water they were using, with rats and other rodents running freely; with soldiers unwashed and lying in soiled linen in filthy circumstances, and dying in huge numbers. Beginning by scrubbing down the hospital, setting up a laundry, keeping the patients washed and clean and arranging for them to be served nutritious food, she and her nurses reduced the deaths by two-thirds.

Recognising the need for emotional support Florence also arranged for time to be spent writing letters home for the patients and, walking through the wards at night to bring comfort and check on her patients, famously became known as “The Lady with the Lamp”.

Back in England after the war, she continued her  work as a social reformer for the government, improving both public and military hospitals.  For this we all, not only nurses, owe her a great debt of gratitude.

Florence Nightingale was an exceptional woman- highly intelligent, well-educated, fluent in a number of  languages, a brilliant mathematician and statistician, a student of philosophy, and a passionate advocate for reform in hospitals and health services.  She changed the way the world saw nursing and was able to apply all this in an immensely practical way.

How do we as nurses continue the legacy of Florence Nightingale in 2020, especially during this time of COVID-19?

Nurses and midwives who are either front-line carers, or nurses who are continuing to care for patients with many other conditions, in hospitals, hospices, care homes and in the community show so many of her qualities: courage to carry on despite their own and their loved-one’s fears for them, dedication, intelligence in the way they apply their knowledge, caring for their patient’s body, mind and spirit; and working collaboratively with other members of the health and support teams – whilst always advocating for their patients.

Let us continue to celebrate 2020 as the Year of the Nurse and Midwife and celebrate Florence Nightingale and all nurses and midwives on 12 May!

About the author

Joan Marston is an ICPCN Global Ambassador for Children’s Palliative Care and Director of Education and Development for Sunflower Children’s Hospice in South Africa. She also co-Chairs PalCHASE (Palliative Care in Humanitarian Aid Situations). Joan’s background is in Nursing and Social Science and she has 23 years’ experience in palliative care for children – caring for children when the Executive Director of Bloemfontein Hospice and then going on to found the Sunflower Children’s Hospice in 1998 in Bloemfontein, South Africa, as well a regional network for life-limited children, the St. Nicholas Bana Pele Network, in 2009. As the national paediatric development manager for the Hospice Palliative Care Association of South Africa, from 2007 – 2010 Joan and her team developed a strategy for a national network of services, promoting the considerable growth of the number of children’s palliative care services for children in South Africa .