Notes on Nursing "What it Is, And What It is Not"

Notes on Nursing
What it is, and What It is Not
1859

By Florence Nightingale


Shall we begin by taking it as a general principle--that all disease, at some period or other of its course, is more or less a reparative process, not necessarily accompanied with suffering: an effort of nature to remedy a process of poisoning or of decay, which has taken place weeks, months, sometimes years beforehand, unnoticed, the termination of the disease being then, while the antecedent process was going on, determined?

If we accept this as a general principle, we shall be immediately met with anecdotes and instances to prove the contrary. Just so if we were to take, as a principle--all the climates of the earth are meant to be made habitable for man, by the efforts of man--the objection would be immediately raised,--Will the top of Mount Blanc ever be made habitable? Our answer would be, it will be many thousands of years before we have reached the bottom of Mount Blanc in making the earth healthy. Wait till we have reached the bottom before we discuss the top.

In watching diseases, both in private houses and in public hospitals, the thing which strikes the experienced observer most forcibly is this, that 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 and care in the administration of diet, of each or of all of these. And this quite as much in private as in hospital nursing.

The reparative process which Nature has instituted and which we call disease, has been hindered by some want of knowledge or attention, in one or in all of these things, and pain, suffering, or interruption of the whole process sets in.

If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault not of the disease, but of the nursing.

I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet--all at the least expense of vital power to the patient.

It has been said and written scores of times, that every woman makes a good nurse. I believe, on the contrary, that the very elements of nursing are all but unknown. By this I do not mean that the nurse is always to blame. Bad sanitary, bad architectural, and bad administrative arrangements often make it impossible to nurse. But the art of nursing ought to include such arrangements as alone make what I understand by nursing, possible. The art of nursing, as now practiced, seems to be expressly constituted to unmake what God had made disease to be, viz., a reparative process.

To recur to the first objection. If we are asked, Is such or such a disease a reparative process? Can such an illness be unaccompanied with suffering? Will any care prevent such a patient from suffering this or that?--I humbly say, I do not know. But when you have done away with all that pain and suffering, which in patients are the symptoms not of their disease, but of the absence of one or all of the above-mentioned essentials to the success of Nature's reparative processes, we shall then know what are the symptoms of and the sufferings inseparable from the disease.

Another and the commonest exclamation which will be instantly made is-- Would you do nothing, then, in cholera, fever, &c.?--so deep-rooted and universal is the conviction that to give medicine is to be doing something, or rather everything; to give air, warmth, cleanliness, &c., is to do nothing. The reply is, that in these and many other similar diseases the exact value of particular remedies and modes of treatment is by no means ascertained, while there is universal experience as to the extreme importance of careful nursing in determining the issue of the disease.

The very elements of what constitutes good nursing are as little understood for the well as for the sick. The same laws of health or of nursing, for they are in reality the same, obtain among the well as among the sick. The breaking of them produces only a less violent consequence among the former than among the latter,--and this sometimes, not always. It is constantly objected,--"But how can I obtain this medical knowledge? I am not a doctor. I must leave this to doctors."

Oh, mothers of families! You who say this, do you know that one in every seven infants in this civilized land of England perishes before it is one year old? That, in London, two in every five die before they are five years old? And, in the other great cities of England, nearly one out of two?[1] "The life duration of tender babies" (as some Saturn, turned analytical chemist, says) "is the most delicate test" of sanitary conditions. Is all this premature suffering and death necessary? Or did Nature intend mothers to be always accompanied by doctors? Or is it better to learn the piano-forte than to learn the laws which subserve the preservation of offspring?

Macaulay somewhere says, that it is extraordinary that, whereas the laws of the motions of the heavenly bodies, far removed as they are from us, are perfectly well understood, the laws of the human mind, which are under our observation all day and every day, are no better understood than they were two thousand years ago.

But how much more extraordinary is it that, whereas what we might call the coxcombries of education--_e.g._, the elements of astronomy--are now taught to every school-girl, neither mothers of families of any class, nor school-mistresses of any class, nor nurses of children, nor nurses of hospitals, are taught anything about those laws which God has assigned to the relations of our bodies with the world in which He has put them. In other words, the laws which make these bodies, into which He has put our minds, healthy or unhealthy organs of those minds, are all but unlearnt. Not but that these laws--the laws of life--are in a certain measure understood, but not even mothers think it worth their while to study them--to study how to give their children healthy existences. They call it medical or physiological knowledge, fit only for doctors.

Another objection.

We are constantly told,--"But the circumstances which govern our children's health are beyond our control. What can we do with winds? There is the east wind. Most people can tell before they get up in the morning whether the wind is in the east." To this one can answer with more certainty than to the former objections. Who is it who knows when the wind is in the east? Not the Highland drover, certainly, exposed to the east wind, but the young lady who is worn out with the want of exposure to fresh air, to sunlight, &c. Put the latter under as good sanitary circumstances as the former, and she too will not know when the wind is in the east.

Lauren Peterson

Hey Classmates!

I love Alice’s idea and looking forward to reading everyone’s info. My name is Lauren Petersen. I ended up in nursing in a rather round-a-about way. I did my undergrad at UW-Madison in Medical Microbiology & Immunology. I thought research was for me. By the end of undergrad, I knew research was not entirely where I wanted to be, but too late to change J So, I came back to MN for public health. I got my MPH in Environmental Health with a focus in infectious disease. Since graduation, I have been working in an Epidemiology lab on the St. Paul campus. My research has been focused on E. coli and Leptospira. Last year sometime, I realized that lab work is not at all for me. I wanted to combine my public health/micro background with a clinical background and that lead me to nursing and this program.

As for my “nursing plans,” it is wide-open. I know that I want to stay in the area of preventive health with a particular interest in ID. I would like to work with different populations on health advocacy and education. As of now, I am leaning towards Maternal/child health. Eventually, I hope to take my skills and knowledge internationally.

Life outside of school, you ask? Minimal. Just kidding. My husband, Adam, and I got married last September. We don’t have kids. We like to spend as much time as possible with friends and family. My family is here in the Cities and his is in WI. We also like to do pretty much anything outdoors—I think that is the most succinct answer.

We also both love to travel. I have been very lucky that my research has taken me to Chile and Spain (although I am embarrassed to say my Spanish is still lackluster!). So far, we have mostly international travel, but looking forward to seeing more of the US—especially the National Parks.

Pha Chan

Hi! Here is a little bit of information about me.

I am 28 years old. I am married and have a daughter who is going to turn 1 year old on the 23rd of October. My hobbies are photography and scrapbooking. Places I've traveled out of the United States are to France and Thailand. As far as nursing career interests, I don't know at the moment exactly what I want to focus on because I want to explore more options before I make a decision.

I'm always taking pictures of other people but I don't have any pictures of me. Sorry.

Lauren Trotman

I'm currently roughing it on my own up in St. Anthony. My boyfriend of 4 years is working on his Ph.D. in Evolutionary Ecology at Iowa State. We try to make the 450 mile round-trip on weekends when possible... so it’s really convenient that we have online tests almost Every weekend this semester...

I just graduated in May ‘09 from the University of St. Thomas with a degree in Community Health Education. I worked as a peer educator on campus for 2 years and I can honestly say it was a job I loved! I came to nursing through a number of different experiences (dietary aide & CNA in nursing homes, volunteering at Children’s & United Hospitals, family & personal experiences, and a love for health and wellness). I am COMPLETELY up in the air in regards to career interests. Pediatrics, OB, oncology, public health, psych/mental health... they all sound fantastic to me! I’m sometimes worried that so many people seem to have it narrowed down to 1 or 2 areas, but I know that in the coming months I will get a much better idea of what I would or would not love to do. I may or may not proceed into the DNP program.. right now I’m just concerned with surviving these 16 months :-)

In my “spare” time (hahaha, who am I kidding?!) I like to spend time with my family, friends and pets. I love to scrapbook, read, shop, try new recipes, and basically anything else that will get my mind off school for a while!

I grew up in a small rural town in southeastern Minnesota. I’ve grown and learned a lot since moving to the cities just over 4 years ago, but I’ll always have a little hick in me Hahaha! I have never left the United States... pretty sad, I know. I have my passport though... so hopefully sometime in the near-ish future :-) I did study “abroad” in Hawaii in January ’08. I realize it’s still the U.S. but if you ask a lot of the Hawaiians, they’ll deny that! Living in Hawaii for a month was simply amazing (especially in January!) I Will return someday!

I immediately love anyone who can make me laugh. I can be a huge smart-ass and sometimes have those “should-have-kept-my-mouth-shut” days, but I also have a very shy side. Some are surprised to see it, some don’t know me any other way. I have crooked pinkies, 2 middle names and I Hate coffee.

Besides enjoying lunch breaks and mini-venting sessions with you guys, I hope to get to know you outside of school as well! I love to dance.. all I need is some liquid courage and at least 1 other brave soul :-) Anything else that doesn’t require any/much money is always a plus! And I know it seems so far away, but we will HAVE to have an MN night at a Twins game in the new stadium this spring!!!!

So now you probably know more than you ever wanted to about me! If not, you know where to find me! :-)

Lani (autumn) Brown

My first name is Autumn, which leads to confusion on discussion boards because i always go by my middle name, which obviously, is Lani

My boyfriend and i live in eden prairie and have been together for the better part of 9 years. we met in the virgin islands and he's the reason i live in minnesota. he's a nature photographer, so we are self-employed and trying to make that business take off. we live with his family right now, which is cozy! but, i love his parents, so it could have been worse. we don't have kids, but i'm excited for the day when we do... we're planning on getting married, but i'm not calling myself engaged till i get a ring ;)
we have dogs that are spoiled enough to be little people.

i've never had a "career" i spent my twenties exploring the world and trying to figure out what my place was in it... so i lived in the virgin islands for about three years, teaching scuba diving and waiting tables and having loads of fun! then i went back to college and got a bs in environmental biology, which i loved because i love the way ecological theory works, its very my style of thinking. i went to a small state university in nh and was in the same program and year as my younger brother... we had a blast :)

we also lived in papua new guinea for about half a year, scuba diving. that was the best ever!!! we were on a small island off the coast of new guinea and experienced a truly unique lifestyle and truly untouched underwater landscape. all kinds of crazy wildlife and reefs, etc. scuba diving was my life for a while and i really miss it living here. i'm too much of a wimp to brave the cold waters of minnesota's lakes, although i hear there is some fantastic diving in superior... maybe someday! i also lived/worked in scotland for about 6 months when i was 19 and would go back in a heartbeat. loved it. loved it. loved it.

i was a waitress throughout college (my family owns a cafe in nh) and also a firefighter and emt. small town, so it was volunteer and/or paid on call, but i got a lot of experience in some really fun and not so fun things. i LOVED being a firefighter, it was such a challenge and exciting and a little bit scary all in one. i worked as a life skills instructor for adults with developmental disabilities right after i got out of high school and it was really eye-opening for me. i learned so much from my colleagues and my clients during that period of time. i've been working with nate since i moved to mn two years ago.

i am from a super small town in northern nh (sugar hill nh, population 500). our school system incorporated 4 towns and still i had 19 kids in my graduating class (in 1997, which makes me OLD). my best friends have been the same people since we were in diapers... i really miss the mountains and my family a lot and i'm definitely planning on living there again at some point.

i'm not sure what i want to do with nursing in the future. i wanted to do the dnp and i'm still thinking about it, but not totally sure yet... i'm super excited to start clinicals instead of spending thursdays in that lab.

things to do: happy hour is great, but can i vote for a different day? tuesdays are such a long day! also, i hate going to the gym, but would love to go for walks on mondays and tuesdays during our breaks, if anyone is interested. i would also be up for jogging/running... oooh, or i would love to go snowshoeing or x-country skiing this winter if anyone is interested? and ice-skating would be pretty fantastic as well.