WWFD: What Would Florence Do in the COVID-19 Pandemic?

Florence Nightingale circa 1860. Retrieved from https://en.wikipedia.org/wiki/Florence_Nightingale

On May 12th we celebrate Florence Nightingale’s 200th birthday in the midst of a global pandemic. Nightingale, the acknowledged founder of modern nursing, was no stranger to the unfettered spread of communicable diseases. During her service in the Crimean War ten times more soldiers died from dysentery, cholera, typhoid fever, and typhus than the wounds of war. Nightingale understood how the human-environment relationship influenced health and healing. According to Nightingale, nursing was about putting the person in the best condition for Nature to act (Nightingale, 1859/1969). In other words, the focus of nursing is on nurturing and supporting the process of healing. Nightingale was a social reformer, justice activist, humanitarian, liberally-educated scholar, and bioinformatician, driven to service and care for others from a deep spirituality (Dunphy, 2020).

In her book, Notes on Nursing: What it is and what it is not (1860/1969), Nightingale offers guidance about creating an environment that can prevent disease or support healing. While she is focused on care of “sick” persons in the home, her concepts are applicable beyond this. Here are ten practical tips from Florence Nightingale as we live with COVID-19 pandemic:

  1. Ventilation. Nightingale said that “keeping the air he (sic) breathes as pure as the external air without chilling him (sic)” is the very first canon of nursing. (p. 12). While we are sheltered-in-place it is important to get fresh air. Make an effort to spend some time outdoors by sitting outside, going on a walk or run while maintaining a social distance, or just opening windows. 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. Health of houses (pure air, water, efficient drainage, cleanliness). Nightingale believed that cleanliness was the first defense in preventing disease. When she came to field hospitals in the Crimea her first action was to start cleaning the space. 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. I diffuse antimicrobial essential oils like eucalyptus, tea tree and cajeput in my bedroom and family room to cleanse the air.
  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. Remember he is face-to-face with his enemy all the time, internally wrestling with him, having long imaginary conversations with him…Rid him of his adversary quickly” (Nightingale, 1859/1969, p. 38). This is a stressful time in our lives and many are living with fear and anxiety. Receiving clear and consistent messages is important in a crisis. Providing honest information to those we encounter about the transmission of the virus, incubation period, ways to protect self from infection, and what to do when experiencing symptoms may relieve anxiety and help them to plan and gather resources. I find myself providing information to family and friends who call with questions. Nurses are trusted and approachable sources of knowledge for the public. There is so much information on the internet, and we can help to refer people to the most reliable sources. Listening and providing support to others can be helpful as well as caring for self through those activities that work for you such a meditation, exercise, watching a funny movie, journaling, etc.
  4. Noise – In this section, Nightingale calls attention to the sound environment and its potential effect on promoting rest and well-being. With most of us sheltered at home we can cultivate greater awareness of how sounds affect us. For example, it may be tempting to have the television or internet news on; however, the constant information about the pandemic may cause us to become more tense and anxious. Turning on music that is comforting, relaxing, joyful or inspirational, or tuning into sounds from nature from apps, or actually being outdoors are ways to promote serenity.
  5. Variety – We may be at home for another 1-2 months, so Nightingale’s advice on creating variety in the environment is especially relevant. She said, “…the nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings during a long confinement to one or two rooms” (p. 58). She suggested bringing beauty, color and interesting objects into a confined space. How can we bring variety into our lives when our space is limited? One way is intentionally creating a daily schedule that includes new and interesting activities. It might be creating art, journaling, working on a home project, learning a new skill like a language, touring museums using online apps, reading books, or binging on a Netflix series. Some are caring for and home schooling children, working from home, or continuing their essential work in the community. Variety is already built-in to their lives.
  6. Food – Nightingale focuses on providing food that is nutritious and supportive for 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 multi-vitamin with minerals or supplements with Vitamin C, D (especially if you are not exposed to much sunlight), A, E, selenium, magnesium and zinc. Shopping and getting groceries or prepared food delivered can be challenging and anxiety-producing. Some may have a tendency to overeat for comfort, boredom, or just having constant access. With the loss of jobs, food insecurity is a concern. We need to support food banks more than ever in this crisis.
  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. While she is referring to caring for people bedridden, this is still a useful message to consider.
  8. Light – Nightingale asserts that the need for sunlight is second only to the need for fresh air. (p. 84). She stated that sunlight not only lifts the spirit, but “has real and tangible effects upon the human body…a purifying effect” (p. 85). She suggested either letting the sunlight into the room or better yet, getting out into the sunlight. 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 – Here we go again! In this section, Nightingale is focused on actually scrubbing walls, floors, dusting and cleaning carpets or anything else harboring dirt. I guess this is another activity to keep us busy. In her section on personal cleanliness she emphasizes how vitality is restored by washing the skin and clothes. “Poisoning by the skin is no less certain than poisoning by the mouth—only it is slower in its operation” (p. 93). People feel better after a bath or shower, and she even suggests skin brushing (she calls it “rubbing” the skin). Washing ourselves and our clothes more frequently especially if there are chances of exposure to the virus is important.
  10. Chattering hopes and advices – In this section Nightingale warns against offering unsubstantiated hopeful predictions and giving advice without any foundation to it. She says to “leave off the practice of attempting to ‘cheer’…by making light of danger”…(p. 96). I believe she is telling us that during times of human suffering authentic presence through being with, listening, and following the persons’ lead is essential. Many are suffering during this time. Nurses can be with others by listening and being present with them during this suffering without simplistic platitudes.
Sources

Nightingale, F. (1860/1969). Notes on Nursing: What It Is and What It Is Not. New York: Dover Publications.

Dunphy, L.M.H. (2020). Florence Nightingale’s conceptualizations of nursing. In Nursing Theories and Nursing Practice (5th edition). M. Smith (Ed.). Philadelphia: F.A. Davis, (pp. 35-54).