Running Head: Florence Nightingale

Florence Nightingale: A Literature Review of the most famous Nurse in History

Austin Farmer
University of Texas at El Paso
RWS 1302

Running Head: Florence Nightingale

Abstract
Florence Nightingale is one of the most famous nurses of all time. She modernized and
changed the way things are handled in the nursing community. She came about nursing by
wanting to serve God and humankind. She published Notes in Hospitals in 1859, which
concentrated on how to properly run civilian hospitals. The questions in this literature review
will show how Nightingale influenced and improved sanitation/hygiene levels in hospitals, what
graphs she created, how she brought nursing to become a professional vocation, how the
Nightingale Effect played a role in workplace and how it affected morals and ethical standards
of today. This review will also cover how in modern day nursing many are starting to allow
patient and nurse relationships so long as it does not hurt the patient or nurse taking care of this
patient. Women are allowing this more than men and we will discuss what ethics and morals play
into the community of nursing.

Running Head: Florence Nightingale

Florence Nightingale: A Literature Review

Florence Nightingale, a nurse who improved the unsanitary conditions at a British base
hospital, sparked worldwide health care reform. She established St. Thomas Hospital and the
Nightingale Training School for Nurses. Nightingale made it her mission to improve hygiene
practices, significantly decreasing the death rate at the hospital in the process. In addition to
greatly improving the sanitary conditions of the hospital, Nightingale created a large number of
patient services that contributed to improving the quality of their hospital stay. Florence
Nightingale was a pioneer in creating models such as the Coxcomb Chart, she gathered data on
death tolls in hospitals and compiled them into statistical charts. Modern nursing is complicated,
always changing, and multi-focused. However, the goal of nursing has remained constant since
the time of Florence Nightingale. The goal is to provide a safe and caring environment that
encourages patient health and well-being. Nightingale developed modern day nursing by creating
leadership principles and practices that are used in the 21st century. One has to question how
well known Florence is and how her practices have come to help the modern day nursing
community. Four important questions need to be considered:
1. Are the nurses at The Hospitals of Providence Memorial Campus familiar with who
Florence Nightingale was and how she influenced modern day nursing by her techniques
and methods?
2. How did Florence Nightingale bring nursing from an immoral vocation into the honest
and ethical profession that is widely enjoyed today?
3. When Florence Nightingale worked directly with her patients for a long period, did
emotions and other feelings enter the workplace and corrupt certain ethical standards of
today?
4. Are those same ethical standards of today placed upon male nurses and their patients? If
so, what are the differences and how can they be perceived?

Running Head: Florence Nightingale

This literature review will provide information regarding Florence Nightingale and how she
impacted nursing, as well as investigate how well known she is and offer insight into her life and
why she decided to pursue into the field.
Are the nurses at The Hospitals of Providence Memorial Campus familiar with who
Florence Nightingale was and how she influenced modern day nursing by her techniques
and methods?
After surveying the nurses at The Hospitals of Providence Memorial Campus the data
collected showed that out of 3 out of 10 males and 9 out of 10 females knew who Florence
Nightingale was. All of the nurses who were surveyed were familiar with the coxcomb chart
(which Florence Nightingale created), but they were not aware that she was the one who created
it. Florence Nightingale was one of the first to establish the importance of cleanliness and
sanitation in hospitals. She collected accurate data and information about the relationship
between sanitation to death tolls. She developed the following chart in 1858 and that represented
the number of soldiers in a variation of a pie chart. The graph focuses more on demonstrating
patterns rather than delivering exact numbers. The graph showed that more soldiers died from
infections than from wounds. This graph resulted in sanitation policy changes that helped save
thousands of lives and changed modern nursing forever.
Nursing has never been easy and these nurses and The Hospitals of Providence Memorial
Campus know that. Theyve gone through rigorous testing and many stressful tasks to get where
they are today. Without Florence Nightingale, none of them would be in the field of nursing. The
goal of these individuals will always be to provide a safe and caring environment that encourages
patient health and well-being. Florence Nightingale has influenced modern day nursing in a
significant way, as well as proving that nursing will always be needed in modern day society.

Running Head: Florence Nightingale

Nightingales experiences in nursing demonstrated to her the value of public support for nurses
and patients. She embraced a great value system and utilized leadership skills to create change in
nursing (Audain, 2016).

Figure 1. This figure shows the diagram known as the Coxcomb Chart created by Florence
Nightingale in 1858. Retrieved from https://visual.ly/m/coxcomb-chart/

How did Florence Nightingale bring nursing from an immoral vocation into the honest and
ethical profession that is widely enjoyed today?
Florence Nightingale brought nursing from an immoral vocation into an honest and
ethical profession by putting emphasis on strict morals in the personal lives and work lives of
nurses. In modern day nursing, ethics and strict principles guide the nursing profession and have
many similar connections to Nightingale's morals. Nightingale made sure her nurses had high

Running Head: Florence Nightingale

moral character which helped nursing rise to a respected profession in her time, teaching correct
rules and following ethical principles is crucial in boosting the nursing profession in the modern
day.
Nightingale explains her advocacy in nursing and how determined she was to reform
modern day nursing. She showed her leadership role in the hospitals and statistics to back up all
her findings. It shows tables and charts she made such as The Leadership Development Model
and it identifies a progression of stages in which individuals achieve leadership over time
(Selanders; Crane, 2012).
Nightingale established St. Thomas Hospital and the Nightingale Training School for
Nurses in 1960 with the money she received from the British government for being such an
accomplished women in the field of nursing (Biography.com Editors, 2014). Nightingale had
other accomplishments other than being known as the founder of modern nursing. She made
large contributions to public health, statistical thought, military medicine and hospital design. It
also discusses her beliefs and how they influenced her work in nursing. The average nurse during
that time would sit watching over her patient and sipping her gin, and if her patient was well
enough and had the money, extra services would be provided. Nightingale wished to reform
these unsanitary and unethical practices and not allow nurses to drink while on duty (Horsley,
2010).

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Figure 2. This figure shows Florence Nightingale (middle) in 1886 with her graduating class of
nurses from St Thomas' outside Claydon House, Buckinghamshire. Retrieved from
https://sites.google.com/site/florencenightingaleimpacts/home/timeline

When Florence Nightingale worked directly with her patients for a long period, did
emotions and other feelings enter the workplace and corrupt certain ethical standards of
today?
The Florence Nightingale Effect (also referred to as Nightingale Syndrome) is a modern
day reference to the real nurse, Florence Nightingale, who created better sanitation and treated
her patients with care and compassion. Some people may believe that the term implies that a
nurse falls in love with her patient, or that the patient falls in love with the nurse, but it is meant
to indicate a compassionate, not a romantic one.
Nurses are taught to be compassionate and maintain a positive attitude when treating
patients. Following these rules about being kind has shown to lead to better responses by patients
as well as faster healing times. Although its encouraged to be compassionate, nurses must be

Running Head: Florence Nightingale

careful to maintain boundaries. Relationships with patients can develop where they become too
close and can sometimes lead to emotional and even ethical dilemmas. As a general rule in
nursing, nurses are required to maintain sufficient distance from their patients to avoid the
chance of a romantic bond forming. Sometimes patients may cling to their nurses and adopt more
of a loving attitudes toward their nurse. This may occur if the patient is extremely dependent on
the care that the nurse is providing or if the nurse is providing the only perceived positive
interaction throughout the day. So what happens if a nurse and patient mutually develop strong
feelings for each other? In this case, it is the nurse who should establish boundaries and prevent
the relationships from moving forward. To act otherwise may put the nurses job in jeopardy
(AMRI Staff, 2014). A romantic relationship between patient and nurse is usually not okay.
Forming a romantic relationship while the patient is under the nurses care, man or women,
creates an ethical issue.

Figure 3. This Figure is a picture of Florence Nightingale, also known as the Lady with the
Lamp, providing care to wounded and ill soldiers during the Crimean War. Retrieved from
https://www.papermasters.com/florence-nightingale-syndrome.html

Running Head: Florence Nightingale

Are those same ethical standards of today placed upon male nurses and their patients? If
so, what are the differences and how can they be perceived?
The same ethical standards are placed upon men and their patients. One of the main
differences is that males tend to have less of a relationship with patients. Women seem to fall in
love with their patients more often according to a survey is 2013 where they asked 100 male
nurses and 100 female nurses where 13% of men and 29% of women admitted to having some
type of romantic feelings or relationship with a patient. Women tend to be more compassionate
than men, which may be why they develop feelings for patients more often.
Many people question if these relationships are acceptable once the patient is no longer in
the care of their nurse. This area becomes hazy because much of it depends on the diagnosis of
the patient and whether the patient is able to provide informed consent.
Nurses have proven that they are honest and ethical, they have earned the trust of the
American people due to their ethical standards and honesty. Nurses are held to extremely high
standards and morals by nursing schools, their respective boards of nursing and the nurses peers
in their personal and professional lives.
A news story went viral online in 2014 as it was published through a number of different
media channels. It is the heart-warming love story about an ALS patient who fell in love with,
and married, his nurse. Below is a message the patient sent his female nurse right before they
started living together:

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Figure 4. This figure is a message sent by a patient (Adam) to his nurse and soon to be wife
(Hollie). Retrieved from http://www.huffingtonpost.com/2014/09/10/als-weddingstory_n_5787742.html

Conclusion
Nursing has never been easy; its always changing and is always improving. The goal has
remained consistent since the time of Florence Nightingale. The goal will always be to provide a
safe and caring environment that encourages patient health and well-being. Florence Nightingale
has influenced modern day nursing in a significant way, nursing will always be needed in
modern day society. Nightingales experiences in nursing demonstrated to her the value of public
support for nurses and patients. She embraced a great value system and utilized leadership skills
to create change in nursing. Nightingale demonstrated that public support is what gives power to
the caring nurse.

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11

References
Audain, Cynthia. (2016, February 25). Florence Nightingale. Retrieved from
https://www.agnesscott.edu/lriddle/women/nitegale.htm
Biography.com Editors. (2014, July 7). Florence Nightingale Biography. Retrieved from
http://www.biography.com/people/florence-nightingale-9423539
Brown, Alan. (2013, February 9). Florence Nightingale [Video File]. Retrieved from
https://www.youtube.com/watch?v=hBVX5s43_Ks
Horsley, Keith. (2010, October). Florence Nightingale. JMVH: Journal of military and Veterans
Health Vol. 18, No. 4
Pettinger, Tejvan. (2010, November 25) Biography of Florence Nightingale. Retrieved from
http://www.biographyonline.net/humanitarian/florence-nightingale.html
The Florence Nightingale Museum website. (2016) Retrieved from
http://www.florence-nightingale.co.uk/
Selanders, L., Crane, P., (2012, January 31). The Voice of Florence Nightingale on Advocacy.
OJIN: The Online Journal of Issues in Nursing Vol. 17, No. 1, Manuscript 1.
Selanders, Louise. (2016, May). Florence Nightingale. In Encyclopedia Britannica. Retrieved
from https://www.britannica.com/biography/Florence-Nightingale
UAB Library (2011, May). The Life and Letters of Florence Nightingale. Reynolds-Finley
Historical Library. Retrieved from https://www.uab.edu/reynolds/nightingale/life