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In 2001, I attended a service at the Washington National Cathedral in Washington, DC, commemorating the inclusion of Florence Nightingale in the Calendar of Lesser Feasts and Fasts. This experience was published in Home Healthcare Nurse (Harris, 2002).

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2010 is the International Year of the Nurse (Sigma Theta Tau International, 2010), in recognition of the United Nations' Millennium Development Goals (MDGs) ( The 2010IYNurse was founded by Sigma Theta Tau International, the Nightingale Initiative for Global Health (2007), and the Florence Nightingale Museum in London. The year 2010 is also the centennial year of the death of Ms. Nightingale (1910-2010).


I had the opportunity to return to the Cathedral on Sunday, April 25, 2010 to attend the Commemorative Global Service Celebrating Nursing and the Florence Nightingale Centennial. The processional included the service participants, eight who carried banners that displayed the eight MDGs. The service included hymns, prayers, scripture readings, a reflection, and the Passing of the Light of Knowledge. This ceremony symbolized the passing of knowledge from one generation to another. Five nursing leaders from national and international nursing organizations lit candles and passed the flame to representatives from the United States and Canadian Student Nurses Associations.


During this recent visit I again viewed the Florence Nightingale Window, located in the Cathedral's north transept, that was installed in 1938 and depicts six outstanding scenes in the life of Florence Nightingale (1820-1910): St. Thomas in London, Hospitals, Childhood, the Crimea, Education, and Notes on Nursing.


While there I reflected on her Notes on Nursing: What it is and what it is not (1859, 1992). I am awed every time I read her original notes written 150 years ago. She addresses so many of the nursing and healthcare issues that nurses are still confronting in the 21st century. Before the days of federal and state laws, regulations, and evidence-based practice, she was aware of the need for nurses to be involved and leaders in nursing. The following are just a few of the issues she wrote about in 1859.



And remember every nurse should be one who is to be depended upon, in other words, capable of being a "confidential" nurse. She does not know how soon she may find herself placed in such a situation; she must be no gossip, no vain talker, she should never answer questions about her sick except to those who have the right to ask them (p. 70).



But no particle of dust is ever or can ever be removed, or really got rid of by present system of dusting. Dust in these days means nothing but flapping the dust from one part of a room on to another with doors and windows closed. What you do it for I cannot think. You had much better leave the dust alone, if you are not going to take it away altogether. The only way I know to remove dust, the plague of all lovers of fresh air, is to wipe everything with a damp cloth (p. 50).


Infection Control

Every nurse ought to be careful to wash her hands very frequently during the day. If her face too, so much the better. One word as to cleanliness merely as cleanliness. Compare the dirtiness of the water in which you have washed when it is cold without soap, cold with soap, hot with soap. You will find the first has hardly removed any dirt at all, the second a little more, the third a great deal more (p. 53).


True nursing ignores infection, except to prevent it. Cleanliness and fresh air from open windows, with unremitting attention to the patient are the only defence a true nurse either asks or needs. Wise and humane management of the patient is the best safeguard against infection (p. 20).


Noise (Inappropriate Conversation)

I have often been surprised at the thoughtlessness (resulting in cruelty, quite unintentionally) of friend or of doctors who will hold a long conversation just in the room or passage adjoining to the room of the patient, who is either every moment expecting them to come in, or who has just seen them, and knows they are talking about him. If he is an amicable patient, he will try to occupy his attention elsewhere and not to listen-and this makes matters worse-for the strain upon this attention and the effort he makes are so great that it is well if he is not worse for hours after. If it is a whispered conversation in the same room, then it is absolutely cruel, for it is impossible that the patient's attention should not be involuntarily strained to hear (p. 26).


I need hardly say that the other common cause, namely, for a doctor or friend to leave the patient and communicate his opinion on the result of his visit to the friends just outside the patient's door or in the adjoining room, after the visit, but within hearing or knowledge of the patient is, if possible, worst of all (p. 26).



In dwelling upon the vital importance of sound observation, it must never be lost sight of what observation is for. It is not for the sake of piling up miscellaneous information or curious facts, but for the sake of saving life and increasing health and comfort (p. 70).



Keep your patient's cup dry underneath. One very minute caution-take care not to spill into your patient's saucer, in other words, take care that the outside bottom rim of his cup shall be quite dry and clean, if, every time he lifts his cup to his lips, he has to carry the saucer with it, or else to drop the liquid upon, and to soil his sheet, or his bed gown, or pillow, or if he is sitting up, his dress, you have no idea what a difference this minute want of care on your part makes to his comfort and even to his willingness for food (p. 39).



Always sit within the patient's view, so that when you speak to him he has not painfully to turn his head round in order to look at you. Everybody involuntarily looks at the person speaking. If you make this act a wearisome one on the part of the patient you are doing him harm. So also if by continuing to stand you make him continuously raise his eyes to see you. Be as motionless as possible and never gesticulate in speaking to the sick (p. 28).


This brings us to another caution. Never speak to an invalid from behind, nor from the door, nor from any distance from him, nor when he is doing anything (p. 28).



A small pet animal is often an excellent companion for the sick for long chronic cases. A pet bird in a cage is sometimes the only pleasure of an invalid confined for years to the same room. If he can feed and clean the animal himself, he ought always to be encouraged to do so (p. 58).


Remembering Wisdom

Throughout her Notes on Nursing, Ms. Nightingale also shares her thoughts on light, food, self-care, and many other aspects of patient care that are as current in 2010 as they were in 1859. I share my recent experience with you for three reasons:


1. To encourage all nurses to take time to read and reread the original and commemorative edition of Notes on Nursing: What It Is, and What It Is Not (1859, 1992).


2. To encourage all nurses to take the time to visit the National Cathedral and view the Nightingale Window when in Washington, DC.


3. To remind us that we need to continue to pass the light of knowledge from one nurse to another and celebrate our heritage and the diversity of care nurses provide.



It is important that we reflect on nursing's past, present, and future and our individual role in continuing the profession as Ms. Nightingale envisioned. Even though we at times may become discouraged and challenged, we should find strength in her words and affirm within ourselves that as nurses we continue to be critically important and significant to the well-being of society.




Harris, M. (2002). Remembering Florence Nightingale. Home Healthcare Nurse, 20(5), 291-293. [Context Link]


Nightingale, F. (1859). Notes on nursing: What it is, and what it is not. Philadelphia, PA: J.B. Lippincott.


Nightingale, F (1992). Notes on nursing. What it is and what it is not (commemorative edition). Philadelphia, PA: J.B. Lippincott.


Nightingale Initiative for Global Health Inc. (2007). The Nightingale declaration for our healthy world. Retrieved from [Context Link]


Sigma Theta Tau International, Inc. (2010). 2010 international year of the nurse: a celebration in recognition of the United Nations Millennium Development Goals (MDGs) seeks to recognize the contributions of nurses globally and to engage nurses in the promotion of world health. Retrieved from [Context Link]