Ateneo de Davao University

Graduate School

Name: Dennis N. Muñoz, LPT, RM, RN Course: Nsg 697 - Theoretical Foundation
Student Number: 22017001253391 in Nursing Practice

Degree: Master’s in Nursing Professor: Dr. Patria V. Manalaysay

How would Florence Nightingale reacted if she would be alive today with the
current COVID-19 pandemic?

For the sake of poetic license, if Florence Nightingale would only be alive today, She
would instead be very busy gazing intently at her laptop, her smartphone holding
thousands of text messages coming from the most influential people of the day, starting
from monarchs of the country, prime minister, President Duterte, President Xi Jin Ping,
the Holy See up to the academician including the mathematicians, doctors, scientist,
nurse leaders and epidemiologists to question the failed plan she laid down some 150
years ago that as if, modern-day people of the 21st century as had never learned the
lesson from the past such as those that were recorded in the medical history such as
Bubonic plague, cholera, smallpox, and among other communicable diseases similar to
her time. Her computer would be filled with data-laden spreadsheets and she would be
having a lively Twitter debate about the reliability of death figures.

If she would only be alive today should be surprised, she decries the absurdity of
politicized health data, health management crisis, deficiencies of medical supplies to
protect the health frontlines against the current COVID pandemic. There are countries
around the world whose world leaders are furious to make fake data, some would also
fume for early indecision and the other nation suffers shortages of medical equipment
supplies including PCR diagnostics tools to identify a potential patient who may be
asymptomatic but highly infectious.

If she would only be around today in the Philippines, she would cry that nurses are seen
as a cost rather than having an economic benefit for society. She will feel the
devastation on how our government treated the Filipino nurses as a frontline health
worker putting their lives to risk with no significant economic gain. I think the most
obvious form of dehumanizing nurses in the work environment is that nurses are treated
as the least important individual whose responsibility is much heavier with an extremely
high level of accountability in the practice. The salary of most nurses working the private
entity for exploiting nurses would be below the national capital region per day income
capita of fewer than 500 pesos. This form of exploitation has even brought critical
attention even during the pandemic times when nurses were asked to volunteer for the
said amount in a government entity to augment the workforce. See Figure 1.0 for the
DOH volunteer campaign. For risking their lives at the front lines, doctors and nurses
who will volunteer to help the government stop the spread of the new coronavirus
disease (COVID-19) will be paid P500 per day (Yee, 2020). Sad but this is the ugly
truth, nurses are treated as machines who should obey the bureaucratic system with no
question. In an ethical perspective that sounds “exploitative and devalues the worth” for
the frontline health workers. On the part of The Filipino Nurses United (FNU) stressed
that the amount the DOH was willing to give volunteer health workers was “unjust,
inconsiderate and exploitative” given that under the law nurses are to be paid P32,000
monthly.

Figure 1: Volunteer campaign of DOH

An excerpt from the letter written by Florence Nightingale address to Sir Sidney Herbert:
“The three things which all but destroyed the army in Crimea were ignorance,
incapacity, and useless rules; and the same thing will happen again, unless future
regulations are framed more intelligently, and administered by better informed and more
capable officers,” she wrote, exasperated by inept civil servants and politicians.

For the sake of poetic license, if she would post on her Twitter, Instagram, or even on
her Facebook page today the letter she has written 150 years ago, she would have a
million followers in just a minute. And the post would be cascaded to the political
leaders around the world as an eye-opener to make a drastic response: do something,
to act on something, and to make an immediate contingency plan to help overcome this
growing pandemic. Nightingale was the hero in her time; however, she will portray today
as the Rockstar in today’s modern world.

Synopsis of Her Life History

Florence nightingale (1820-1910), is considered as the first nurse theorist (Naz Ali Sher
& Akhtar, 2018) and the founder of modern nursing (Strickler,2017). She is also a
reformer (Social activist), statistician, administrator, and researcher (Attewell, 1998).
Her theory of nursing focused on the environment and she gave a detailed portrayal of
each feature of the environment in her theory as she was the first person to clearly
describe a distinct nursing role (Strickler,2017).
In 1851, she went to the Institution for Protestant Deaconesses at Kaiserwerth in
Germany to study nursing for 2 months and continued her education in Paris for 6
months. In her return to London, she became the head of the Institute for the Care of
Sick Gentlewomen (Strickler,2017). In 1854, Sir Sidney Herbert, the British Secretary of
War, a personal and a family friend of the Nightingales, commissioned Florence to lead
a contingent of 38 nurses to improve the conditions at Barrack Hospital in Scutari,
Turkey (Strickler,2017).

Upon arrival in Scutari, she and her team were dismayed by the devastating health
condition in these camps. Injured soldiers were left on the floor and the few doctors
desperately were trying to manage patients with basic facilities, in a dirty environment
(Karimi & Masoudi Alavi, 2015), many are dying in squalor due to rampant infection
(Strickler,2017). In the Crimea, it constituted more of an atrocity, not only lacking care
but also food, clothing, and basic services like laundering. The soldiers’ wounds were
unattended, adhering to their clothing, and often gangrenous, resulting in many
amputations and surgeries that were rudimentary and sometimes performed without
anesthesia (Paterniti, ND). The facility was rat-infested and the floors were covered an
inch thick horse excrements, there was leaking sewer under the building which caused
major problems with sanitation, the water supply was contaminated, and the food
inedible, contagious diseases like cholera and typhoid which resulted in hundreds of
deaths, many more than resulted from war injuries.

The challenge to Ms. Nightingale was to put her nurses to work sanitizing the wards and
bathing and clothing patients. She addressed the more basic problems of providing
decent food and water, ventilating the wards, and curbing rampant corruption that was
decimating medical supplies. She had to overcome an inept and hostile military
bureaucracy, which she did in part by paying for remediation from private sources,
including her funds. She also kept careful statistics. Within 6 months, the hospital case-
fatality had dropped from 32% to 2% (Winkelstein, 2009).

Nightingale Role as a Nurse Researcher, Leader, Educator, and Patient advocate are
summarized as follows:

F. Nightingale’s basic tenet was healing and secondary to it are the tenets of leadership
and global action which are necessary to support healing at its deepest level. I research
some possible the corresponding rationale of what nursing would intend to do in her
time magnifying what it addresses in the modern-day perspective.

1. For her, nurses were to make astute observations of the sick and their
environment, record observations, and develop knowledge about factors that
promoted healing.
Modern-day rationale: She was skilled in mathematics and far ahead of her time
in understanding the importance of health data. She was a pioneer in the field of
epidemiology. She believed that good data was essential to decision-making and
 understanding. She used those finding to demand hospitals improve the
protection of staff.

2. She was the first to delineate what she considered nursing’s goal and practice
domain, and she postulated that “to nurse” meant having charge of the personal
health of someone.
Modern-day rationale: The professional practice nursing practice is both an Art
and Science. It is an art more than a great deal of science. It bridges information
from nurses to patients in a skillful way. Nursing is an applied science to give the
utmost care to the patient's needs. It is more than just knowledge; it is doing.
Nursing is Science because nursing interventions should be practical decisions
based on evidence-based research and rigorous scientific inquiry. An evidence-
based practice (EBP) is “a method that allows the practitioner to assess
research, clinical guidelines, and other information resources based on high-
quality findings and apply the results to practice.” EBP helps guide nursing care
and is associated with better patient outcomes (Vega & Hayes2019).

3. She taught the importance of rationale for actions and stressed the significance
of “trained powers of observation and reflection”
Modern-day rationale: She is a social reformer. She considered the social
determinants of health long before the term was coined. She used data to
understand how physical and social conditions impact health and consistently
called for better care for the poor.

4. She emphasized the utility of empirical knowledge, and she believed that
knowledge developed and used by nurses should be distinct from medical
knowledge. She emphasized the teaching of symptoms and what they indicate
Modern-day rationale: Health Assessment important first step in developing a
plan to deliver the best patient care. Health assessments are a key part of a
nurse's role and responsibility. Once the comprehensive health assessment has
been performed, the next step is to put all of the information together, analyzing
the objective and subjective data, and developing a care plan (Texas A&M
International University, ND).

5. She believed the role of the nurse was seen as placing the client “in the best
condition for nature to act upon him”
Modern-day rationale: Our responsibility as nurses is to provide the best patient
care possible. Patients and families expect nurses who care for them to be both
knowledgeable and compassionate. When nurses can combine their technical
skills and clinical knowledge with compassion and sensitivity, patients receive
optimum care (Strickler,2017).

6. She insisted that a trained nurse’s control and staff nursing schools and manage
nursing practice in homes and hospitals
Modern-day rationale: Today nurses advance to leadership roles and sharpen
their skills in critical thinking, effective communication, ethical and legal handling
 of issues, conflict resolution, quality improvement, and change initiation
(Strickler,2017).

How her classic work influences the current COVID 19 situations?

Florence Nightingale’s work created the foundation for professional nursing by

establishing guidelines and standards for nursing education and practice. She believed
in holistic patient care; the basis of her nursing philosophy was that nurses could let
nature help patients recover their health by providing a sanitary and healthy
environment.

Her work 150 years ago remained popular even up to today's present-day situation,
where worlds are tried by a growing pandemic that plaques almost 150 countries
worldwide. The emphasis on sanitation, good hygiene, fresh air exercise, good food and
so on, no matter how to advance the health care technology today, those fundamental
foundational principles of Florence are still very much alive as the basis of modern
nursing practice

Florence Nightingale was a pioneer of modern nursing and among the first to recognize
that a caregiver could be at the origin of patient harm by spreading infection. She is
considered the mother of infection prevention and control (Gill & Gill, 2019).

Because of her momentous achievement in the mid-19th century, her principles of

handwashing had been a widespread campaign in today’s members of the World Health
Organization in developing international policies.

According to the World Health Organization (WHO) in April 2020, the Member States
are instructed to improve hand hygiene practices widely to help prevent the
transmission of the COVID-19 virus by:
1. Providing universal access to public hand hygiene stations and making their use
obligatory on entering and leaving any public or private commercial building and
any public transport facility.
2. Improving access to hand hygiene facilities and practices in health care facilities.

WHO campaign promotes Clean Your Hands campaign that aims to maintain a global
profile on the importance of hand hygiene in health care and to ‘bring people together’ in
support of hand hygiene improvement globally
Let me Summarize the Environmental Grand theory of Florence Nightingale with the
implication in today’s global pandemic.

1. Ventilation. Those with mild to moderate symptoms of the disease will be managing
symptoms at home, staying indoors away from others. Even with these restrictions
promoting the flow of some fresh air in the home is possible, opening windows even a
few minutes every few hours. We can advocate for those in the community who are not
able to have a safe place to be outside or depend on others to get some fresh air.
2. The health of houses. We know that the novel coronavirus that is causing COVID-19 is
highly infectious. Because it spreads mainly through respiratory droplets keeping
surfaces clean and washing hands after touching anything that could be touched by
others, like doorbells, elevator buttons, mailboxes, etc. is important. Having water to
wash hands, clothes, and surfaces is essential, but we know that those who are
homeless and those whose water has been turned off need our advocacy to turn the
water on and to have hand sanitizer available for those without homes.
3. Petty management is about the holistic coordination or management of care through
environmental scanning, information, and planning. I found one passage particularly
relevant to our experience with COVID-19. “Apprehension, uncertainty, waiting,
expectation, fear of surprise, do a patient more harm than any exertion.
4. Noise – Turning on music that is comforting, relaxing, joyful, or inspirational, or tuning
into sounds from nature from apps, or being outdoors are ways to promote serenity.
5. Variety – She advice on creating variety in the environment is especially relevant. She
suggested bringing beauty, color, and interesting objects into a confined space. One way
is intentionally creating a daily schedule that includes new and interesting activities.
6. Food – Nightingale focuses on providing food that is nutritious and supportive of healing.
The science of nutrition has come a long way since Nightingale. During this pandemic,
we want to eat food that supports our immune systems, lots of fruits and vegetables if
possible. Take a multivitamin with minerals or supplements with Vitamin C, D (especially
if you are not exposed to much sunlight), A, E, selenium, magnesium, and zinc.
7. Bed and bedding – The message here from Nightingale is to keep bedding fresh and
aired out, changing the sheets frequently and airing out the bed with a window open if
possible before making it.
8. Light – We know that sunlight is indeed important for health, that ultraviolet light has
antiviral properties, and that viral infections tend to decrease when days are longer.
When there is sunlight take an opportunity to get some exposure to it.
9. Cleanliness – Washing ourselves and our clothes more frequently especially if there are
chances of exposure to the virus is important.
10. Chattering hopes and advice – Many are suffering during this time. Nurses can be with
others by listening and being present with them during this suffering without simplistic
platitudes.
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