1. Tierney, Geri L.

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Figure. Geri L. Tier... - Click to enlarge in new windowFigure.

There are significant generational differences among practicing nurses today. After going beyond these differences, let us look at some of the essential concepts that still have value today. I have been reading Florence Nightingale's Notes on Nursing: What It Is, and What It Is Not. Florence was a visionary, exciting, and passionate advocate. I am glad she put her passion into nursing. I would like to look at a few of her ideas.


* "Of the sufferings of the disease, disease is not always the cause." The perception of "suffering" is so subjective and personal. Patients with arthritis often rate their own state of health lower than individuals with disease processes that are more serious or life threatening but not as painful.


* "Nursing ought to assist in the reparative process." Orthopaedic patients frequently have broken bones, and it is the responsibility of the orthopaedic nurse to keep the body as healthy as possible while the break heals. Mobility, pain management, skin integrity, nutrition, all aspects of the patient, and more, are in the scope of nursing while the broken part heals.


* "Bad sanitary, bad architectural, and bad administrative arrangements often make it impossible to nurse." Process issues must be examined to promote good care.


* "The very elements of what constitutes good nursing are as little understood for the well as for the sick." There were no wellness or prevention efforts back then. Although we have begun to make strides in this area, wellness and prevention programs should be encouraged and enhanced. We must empower individuals to take responsibility for their state of health. Nurses must take the responsibility to teach, model, and encourage healthy lifestyles in the patient/clients we touch and treat.


* "Proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet." Seems like common sense, but fad treatments, protocols, and diets are often popular.


* "Pathology teaches the harm that disease has done...nothing more. We know nothing of the principles of health... nothing but observation and experience will teach us the ways to maintain or to bring back the state of health." Florence is clear that nursing practice is not the same as medicine. Observation and experience in caring for people must be in addition to knowing the pathology of disease for nursing practice to evolve.


* "Not that the habit of ready and correct observation will by itself make us useful nurses, but that without it we shall be useless with all our devotion." Florence goes on to say that using the observations and acting on them are the hallmarks of good nursing. She is advocating critical thinking and evidence-based practice.


* Put the patient in the best condition for nature to act upon him." Nursing is often about supporting natural processes to get the best outcome.


* "First rule of nursing-to keep the air within as pure as the air without." She also goes on to discuss some of the conditions that Joint Committee on Accreditation of Healthcare Organizations (JCAHO) and Occupational Safety & Health Administration (OSHA) still watch in healthcare settings today. The sanitation practices Florence demands regarding places for clean and dirty items are specific, considering the living conditions of the times. Today, it is universal precautions; in her day, it was chamber pots without lids.




Figure. A young Flor... - Click to enlarge in new windowFigure. A young Florence Nightingale and an older Florence Nightingale.

If you haven't read Florence's notes recently or at all, I recommend it! They are only 70-80 pages and are full of wisdom, wit, history, and insight. It also will make you feel part of an expansive community. Connecting with Florence Nightingale is a wonderful way to study and appreciate the art of nursing. One of the things you must remember about nursing is that it is like brushing your teeth-no matter how well you do it each morning, you will still have to do it again the next day. Orthopaedic nursing requires using the passion in your bones each day. We must continue to advance the art and science of orthopaedic care.




Nightingale, F. (1992). Notes on Nursing: What It Is, and What It Is Not: And Commentaries by Contemporary Nursing Leaders. Philadelphia: J.B. Lippincott.