Florence Nightingale and the early origins of evidence-based nursing
- Lynn McDonald, PhD
- Department of Sociology and Anthropology University of Guelph Guelph, Ontario, Canada
Florence Nightingale is now a much ignored historical figure. The publication of the Collected Works of Florence Nightingale by Wilfred Laurier University Press, beginning in 2001, will outline her enormous contribution not only to the foundation of the nursing profession but also to the establishment of a public healthcare system. The Collected Works will include her published works and many unpublished letters and notes. Not the least of the areas where quite a new Nightingale will appear is in evidence-based nursing, a term that was not in use in her day, but a concept central to her own theory of nursing and health care.
A passionate statistician
Let's begin by looking at Nightingale as a systemic thinker and a “passionate statistician.” Her work in nursing and social reform was informed by a religious faith or philosophy that favoured a systemic approach: God made the world and runs it by laws, which we can discover by research in both the biophysical and social spheres. For Nightingale, this entailed the best possible research, access to the best available government statistics and expertise, and the collection of new material where the existing stock was inadequate. Nightingale's leadership style was very much knowledge based.
She herself was a pioneer developer of survey instruments, always vetted by other experts and pretested on appropriate cases. She was also a pioneer in the graphical presentation of data. At a time when research reports were only beginning to include tables, Nightingale was using bar and pie charts, which were colour coded to highlight key points (eg, high mortality rates under certain conditions). Nightingale was keen not only to get the science right but also to make it comprehensible to lay people, especially the politicians and senior civil servants who made and administered the laws.
Several examples clearly reflect an evidence-based framework, …