Connecting Contemporary Trauma Care to Florence Nightingale's Visionary Work.

The impact of Florence Nightingale's visionary work continues to influence the delivery of nursing care in the contemporary emergency department (ED). Her foundational work in the Crimean War resulted in data-based recommendations for using the environment to promote healing and wellness among sick and wounded British soldiers. She advocated for attention to environmental details, including ventilation, air, warmth, drainage, cleanliness, natural light, and low noise levels. These important environmental concepts play a significant role in the nursing management of trauma patients in today's ED. This article features an application of Nightingale's environmental concepts to a trauma patient case exemplar and demonstrates the enduring impact of her work for trauma patients who receive care in the ED.

Resilient Hospital Design: From Crimean War to COVID-19.

OBJECTIVES: Serious COVID-19 nosocomial infection has demonstrated a need to design our health services in a different manner. Triggered by the current crisis and the interest in rapid deployable hospital, this article discusses how hospital building layouts can be improved to streamline the patient pathways and thus to reduce the risk of hospital-related infections. Another objective of this work is to explore the possibility to develop flexible and scalable hospital building layouts through modular construction. This enables hospitals to better cope with different future demands and thereby enhance the resilience of the healthcare facilities. BACKGROUND: During the first wave of COVID-19, approximate one-seventh to one-fifth COVID-19 patients and majority of infected healthcare workers acquired the disease in NHS hospitals. Similar issues emerged during the Crimean War (1853-1856) when more soldiers died from infectious diseases rather than of battlefield casualties in Scutari Hospital. This led to an important collaborative work between Florence Nightingale, who looked into this problem statistically, and Isambard Kingdom Brunel, who designed the rapid deployment Renkioi Hospital which yielded a death rate 90% lower than that in Scutari Hospital. While contemporary medical research and practice have moved beyond Nightingale's concept of contagion, challenges of optimizing hospital building layouts to support healing and effectively combat nosocomial infections still pose elusive problems that require further investigation. METHODS: Through case study investigations, this article evaluates the risk of nosocomial infections of airborne transmissions under different building layouts, and this provides essential data for infection control in the new-build or refurbished healthcare projects. RESULTS: Improved hospital layout can be achieved through reconfiguration of rooms and concourse. Design interventions through evidence-based infection risk analysis can reduce congestion and provide extra separation and compartmentalization which will contribute the reduced nosocomial infection rate. CONCLUSIONS: A resilient hospital shall be able to cope with unexpected circumstances and be flexible to change when new challenges arise, without compromising the safety and well-being of frontline medical staff and other patients. Such an organizational resilience depends on not only flexible clinical protocols but also flexible hospital building layouts. The latter allows hospitals to get better prepared for rapidly changing patient expectations, medical advances, and extreme weather events. The reconfigurability of an existing healthcare facility can be further enhanced through modular construction, standardization of building components, and additional space considered.

Skin disease and military conflicts: Lessons from the Crimean War (1854-56).

In the Crimean War (1854-56), infamous for its high death rate from disease at 212 per thousand British troops annually - one third of which was due to cholera or dysentery - skin disease was common, accounting for 13% of all admissions and 4.2% of all deaths. Excluding typhus, skin disease caused 252 per thousand annual admissions and 8.8 per thousand annual deaths, with an overall case fatality of 3.4%. The commonest skin diseases were: localised cellulitis/abscess, ulcer, venereal disease, frostbite, scurvy, eruptive rashes and scabies. The biggest number of skin disease-related deaths were from frostbite and scurvy. Cutaneous afflictions with the highest case fatality were erysipelas (27%), gangrene (25%), smallpox (21%) and frostbite (19%). Problems from frostbite lessened during the better provisioned second winter. The experience of skin disease in the Crimea highlights the importance of public health and personal sanitation to skin health in the military context, and shows that skin-related infections and nutritional deficiencies easily develop if environmental conditions deteriorate.

This Was My Crimean War: COVID-19 Experiences of Nursing Home Leaders.

OBJECTIVE: To describe professional and personal experiences of nursing home care leaders during early waves of the COVID-19 pandemic. DESIGN: Qualitative interpretive description. SETTING AND PARTICIPANTS: Eight sites across 2 Canadian provinces. Sites varied by COVID-19 status (low or high), size (<120 or ≥120 beds), and ownership model (for-profit or not-for-profit). We recruited 21 leaders as participants: 14 managers and 7 directors of care. METHODS: Remote Zoom-assisted semi-structured interviews conducted from January to April 2021. Concurrent data generation and inductive content analysis occurred throughout. Sampling ceased once we reached sufficient analytic variation and richness to answer research questions. RESULTS: Most participants were female, ≥50 years of age, and born in Canada. We found 4 major themes. (1) Responsibility to protect: Extreme precautions were employed to protect residents, staff, and leaders' families. Leaders experienced profound distress when COVID-19 infiltrated their care homes. (2) Overwhelming workloads: Changing public health orders and redeployment to pandemic-related activities caused administrative chaos. Leaders worked double shifts to cope with pandemic demands and maintain their usual work. (3) Mental and emotional toll: All participants reported symptoms of anxiety, depression, and insomnia, leading to ongoing exhaustion. Shifting staff focus from caring to custodial enforcement of isolation caused considerable distress, guilt, and grief. (4) Moving forward: The pandemic spotlighted deficiencies in the nursing home context that lead to inadequate quality of resident care and staff burnout. Some leaders indicated their pandemic experience signaled an unanticipated end to their careers. CONCLUSIONS AND IMPLICATIONS: Nursing home leaders faced mental distress and inordinate workloads during the pandemic. This is an urgent call for systemic change to improve working conditions for leaders and quality of care and quality of life for residents. Nursing home leaders are at increased risk of burnout, which must be addressed to mitigate attrition in the sector.

[Florence Nightingale was a reference hygienist and statistician for Pedro Felipe Monlau.] / Florence Nightingale: higienista y estadística de referencia para Pedro Felipe Monlau.

Pedro Felipe Monlau was a prominent Spanish hygienist and defender of the Miasmatic Theory of Diseases. By the nineteenth-century, Spain had not enough health infrastructure. Monlau's publications became a powerful source of transmission of the dominant scientific ideas of European hygienism. Levy, Londe, Villermé, Chadwick, Farr and Smith were personalities who influenced the thinking of the Spanish hygienist. The aim of this paper is to show whether the Florence Nightingale's hygienist doctrine influenced Spain through the work of Monlau. A review of primary documentary sources was carried out and the results were analysed from the hermeneutic perspective. The Digital Newspaper Library of the National Library of Spain was used as the main resource. Monlau referred to Nightingale eleven times. Nine fragments responded to Monlau's Hygienic Aphorisms. He recommended Nightingale's ideas regarding ventilation, lighting and housekeeping, among others. In addition, Monlau suggested the need for hospital statistics following Nightingale's proposal. In this sense, the surgeon Rubio y Galí was a clear example of its applicability in the Institute of Therapeutic Surgery. Monlau also recognized the work of Nightingale in the Crimean War. The results show the need to make women scientists visible in contemporary history, revisiting the biographies written so far.

Pedro Felipe Monlau fue un destacado higienista español y defensor de la Teoría Miasmática de las enfermedades. La España del siglo XIX tenía escasa infraestructura sanitaria, por lo que sus publicaciones se convirtieron en una poderosa fuente de transmisión de las ideas científicas dominantes del higienismo europeo. Levy, Londe, Villermé, Chadwick, Farr y Smith fueron personajes que influenciaron en el pensamiento del higienista español. El objetivo del presente trabajo es evidenciar si la doctrina higienista de Florence Nightingale influyó en España a través de la obra de Monlau. Se realizó una revisión de fuentes documentales primarias y se analizaron los resultados desde la perspectiva hermenéutica. Se utilizó como recurso principal la Hemeroteca Digital de la Biblioteca Nacional de España. Monlau referenció a Nightingale en once ocasiones. Nueve fragmentos respondían a los Aforismos Higiénicos de Monlau. Recomendaba las ideas de Nightingale en relación con la ventilación, iluminación y limpieza doméstica, entre otros. Además, Monlau sugería la necesidad de elaborar estadísticas hospitalarias siguiendo la propuesta de Nightingale. En este sentido, el cirujano Rubio y Galí fue un claro ejemplo de su aplicabilidad en el Instituto de Terapéutica Operatoria. Monlau también reconoció la labor de Nightingale en la Guerra de Crimea. Los resultados muestran la necesidad de visibilizar a la mujer científica en la historia contemporánea, revisitando las biografías escritas hasta el momento.

Britain's forgotten military medical school at Fort Pitt, Kent (1860-1863).

This article considers the history of Fort Pitt (1780-1922), its military hospital (founded 1814) and, in particular, its Army Medical School (1860-63). The museum and library were the work of the hospital's first directors: Dr David MacLoughlin and Sir James McGrigor, the latter the renowned reformer of military medical education. Central to the foundation of the medical school was Florence Nightingale who visited the site in 1856. The school opened in 1860 with five sets of students attending before it was transferred in 1863 to the Royal Victoria hospital, Netley, Hampshire. Fort Pitt was a "practical" medical school with students attending for 4-9 months of clinical experience. This included "instruction in tropical medicine" delivered by members of the Indian Medical Service. The foundation of a military medical school fulfilled an ambition dating back to at least 1796. Nightingale's role (exerted through Sidney Herbert) was omitted from contemporary newspaper reports. Fort Pitt continued as a military hospital until 1922 when it was converted to a school. The medical school constitutes a landmark in British military medicine, a response to the failure of British medical care in the Crimean war (1853-1856) and a forgotten legacy of Florence Nightingale.

El ángel del soldado herido en Crimea. Florence Nightingale en su Bicentenario 1820-2020 / O anjo do soldado ferido na Crimeia. Florence Nightingale em seu bicentenário 1820-2020 / The angel of the wounded soldier in the Crimea. Florence Nightingale on her Bicentennial 1820-2020

La mayoría de los héroes que conocemos son seres extraordinarios con poderes mágicos y una capa ondeando en sus hombros. Pero también existen héroes de carne y hueso, tan humanos como tú y como yo, que algunas veces se equivocan y otras aciertan a lo grande. Florence Nightingale fue una de ellas. Sus poderes fueron un gran interés por ayudar a las personas enfermas, una voluntad de hierro para mejorar su cuidado y unas ganas increíbles de aprender. Gracias a ellos se convirtió en la primera enfermera de la historia y demostró al mundo que una buena atención a los enfermos contribuye a una mejor y más rápida curación.(AU)

Most of the heroes we meet areextraordinary beings with magical powersand a cape fluttering from their shoulders.But there are also flesh and blood heroes, ashuman as you and me, who are sometimeswrong and sometimes right big. FlorenceNightingale was one of them. His powerswere a great interest in helping sick people,an iron will to improve their care, and anincredible desire to learn. Thanks to them,she became the first nurse in history andshowed the world that good care for the sickcontributes to better and faster healing.(AU)

A maioria dos heróis queencontramos são seres extraordinários compoderes mágicos e uma capa esvoaçante emseus ombros. Mas também existem heróis decarne e osso, tão humanos quanto você e eu,que às vezes estão errados e às vezes estãocertos. Florence Nightingale era uma delas.Seus poderes eram um grande interesse emajudar os enfermos, uma vontade de ferropara melhorar seus cuidados e um desejoincrível de aprender. Graças a eles, ela setornou a primeira enfermeira da história emostrou ao mundo que cuidar bem dosenfermos contribui para uma cura melhor emais rápida.(AU)

Nightingale y la Guerra de Crimea a través de la prensa española / Nightingale e a Guerra da Criméia através da imprensa espanhola / Nightingale and the Crimean War through the spanish press

La labor de Nightingale y su equipo en la Guerra de Crimea fue trascendental. Susintervenciones fueron reconocidas en Inglaterra y otros países. Por aquel momento, en España, elcuidado estaba mayoritariamente en manos de la Iglesia. El presente trabajo pretende identificarel posicionamiento ideológico difundido en prensa española sobre el papel de Nightingale en laGuerra de Crimea. Se llevó a cabo una revisión bibliográfica en la Hemeroteca Digital de laBiblioteca Nacional de España, obteniendo 27 publicaciones en prensa española que referíannoticias de Nightingale y la Guerra de Crimea. El contenido fue analizado siguiendo lahermenéutica de Gadamer. Atendiendo a la ideología política y religiosa de cada periódico, laspublicaciones muestran discrepancias en relación con la percepción de la labor de Nightingale.Algunos periódicos la definen como imitadora de instituciones religiosas; otros destacan a unamujer con formación académica y gran capacidad de liderazgo en temas de gestión sanitaria. Estasdivergencias resultan del análisis de Nightingale en un contexto cultural, político y socialdiferente a la Inglaterra protestante. Para futuras investigaciones se propone analizar si lainformación en la prensa española en relación con la iniciativa de formación enfermera deNightingale también generó discrepancias en este contexto.(AU)

The work of Nightingale and his team in the Crimean War was significant. Theirinterventions were recognized in England and other countries. At that time, in Spain, care wasmostly in the hands of the Church. This paper aims to identify the ideological positiondisseminated in the Spanish press on the role of Nightingale in the Crimean War. A bibliographicreview was carried out in the Digital Newspaper Library of the National Library of Spain,obtaining 27 publications in Spanish press that referred to news of Nightingale and the CrimeanWar. The content was analysed following Gadamer’s hermeneutics. Based on the political andreligious ideology of each newspaper, the publications show discrepancies regarding theperception of Nightingale’s work. Some newspapers define her as a imitator of religiousinstitutions; others highlight a woman with an academic background and great leadership in healthmanagement. These divergences result from Nightingale’s analysis in a cultural, political, andsocial context that was different from Protestant England. For future research it is proposed toanalyse whether the information in the Spanish press in relation to the Nightingale nursingtraining initiative also generated discrepancies in this context.(AU)

O trabalho de Nightingale e sua equipe na Guerra da Crimeia foi significativo. Suasintervenções foram reconhecidas na Inglaterra e em outros países. Naquela época, na Espanha, ocuidado estava principalmente nas mãos da Igreja. Este artigo tem como objetivo identificar aposição ideológica disseminada na imprensa espanhola sobre o papel do Nightingale na Guerrada Crimeia. Uma revisão bibliográfica foi realizada na Biblioteca de Jornais Digitais da BibliotecaNacional da Espanha, obtendo 27 publicações na imprensa espanhola que se referiam a notíciasde Nightingale e da Guerra da Crimeia. O conteúdo foi analisado seguindo a hermenêutica deGadamer. Com base na ideologia política e religiosa de cada jornal, as publicações mostramdiscrepâncias em relação à percepção do trabalho de Nightingale. Alguns jornais a definem comouma imitadora de instituições religiosas; outros destacam uma mulher com formação acadêmicae grande liderança na gestão da saúde. Essas divergências resultam da análise de Nightingale emum contexto cultural, político e social que era diferente da Inglaterra protestante. Para futuraspesquisas propõe-se analisar se as informações da imprensa espanhola em relação à iniciativa deformação em enfermagem Nightingale também geraram discrepâncias neste contexto.(AU)

[Reminiscing the pioneers of modern nursing during Covid-19 epidemic: 200th anniversary of Florence Nightingale's birth].

Before Florence Nightingale, nurses lacked special skills and training. The nursing mainly relied on nurse's religious passion and feelings to carry out nursing activities, and some vulgar and ignorant women took care of the job. Nightingale, who well-educated, born in an aristocratic family, devoted herself to nursing career despite the opposition of her family. She travelled around the world to investigate the hospital and nursing status. Nightingale practiced her concept of nursing work in the Crimean war. After the investigation of the wounded soldiers, she pointed out that the high mortality rate of British soldiers was related to poor nursing. She put forward suggestions to strengthen military nursing education; then she established modern nursing education institutions and created a new nursing education model, which was the beginning of modern nursing career.

Florence Nightingale: The Making of a Hospital Reformer.

OBJECTIVES: The first of two articles is to show how Florence Nightingale became a leading, effective hospital reformer. AIM: The aim of the first paper is to relate how Nightingale was influenced by the great defects in the war hospitals of the Crimean War (1854-1856) and how she learned the lessons from those defects to set a different course. The article shows how her famous Notes on Nursing is a positive treatment of the lessons learned, turning the sanitary defects, notably in ventilation, into chapters of the book. The importance of the pavilion model of hospital design is highlighted. There is coverage of the advances made by Semmelweis at the Vienna General Hospital. METHODS: This is a purely historical study drawing on the extensive publications by Nightingale, augmented by her (massive) surviving correspondence and notes. The search for archival materials was done for the publication of the 16-volume Collected Works of Florence Nightingale, written by the author of this article. The collected works was peer reviewed, and the research process succeeded in locating material in more than 200 archives worldwide.

Florence Nightingale: creator of modern nursing and public health pioneer.

In his 2008 series of articles on notable women in healthcare, Professor Harold Ellis celebrates Florence Nightingale's contribution to nursing, research and public health. This month, we republish his article to coincide with the 2020, 'Year of the Nurse and Midwife', celebrating the famous lady with the lamp's work in the Crimean War, as well as her pioneering work in the fields of nursing and public health, that helped shape current practice and research.

Florence Nightingale como tema no ensino de história da enfermagem / Florence Nightingale como tema en la enseñanza de historia de la enfermería / Florence Nightingale as a theme in the teaching of nursing history

Florence Nightingale é uma personalidade ímpar na história das mulheres. Seu destaque está na contribuição que deu ao mundo ao construir bases profissionais para a enfermagem bem como para a bioestatística. Objetivos: elencar o conteúdo programático ministrado sobre a biografia de Florence Nightingale em Cursos de Graduação em Enfermagem e discutir sua importância para a formação da identidade profissional. Método: Estudo documental que usou como fontes o Plano de Aula sobre a personagem Florence Nightingale ministrado por professores de sete Instituições de Ensino Superior. A análise e discussão foram feitas à luz de autores que versam sobre o ensino de história e pelo referencial de identidade social e identidade profissional de Claude Dubar. Resultados: a biografia de Nightingale é tratada em todos os programas dos cursos estudados, com destaque para seus feitos na guerra da Criméia e as consequências para a profissionalização da enfermagem, também se evidencia a transdisciplinaridade a partir deste tema. Considerações finais: a biografia mostra o legado de Nightingale enquanto precursora da enfermagem moderna e permite evidenciar a relação da identidade profissional e identidade social da enfermagem.

Florence Nightingale is a unique personality in the history of women. Her highlight is the contribution she made to the world in building professional bases for nursing as well as for biostatistics. Objectives: to list the syllabus taught on Florence Nightingale's biography in Undergraduate Nursing Courses and discuss its importance for the formation of professional identity. Method: Documentary study that used as sources the Lesson Plan on the character Florence Nightingale taught by teachers from seven Higher Education Institutions. The analysis and discussion were carried out in the light of authors dealing with the teaching of history and by Claude Dubar's social identity and professional identity. Results: Nightingale's biography is treated in all the programs of the courses studied, with emphasis on his achievements in the Crimean war and the consequences for the professionalization of nursing, the transdisciplinarity based on this theme is also evident. Final considerations: the biography shows the legacy of Nightingale as a precursor of modern nursing and allows to evidence the relationship of professional identity and social identity of nursing.

Florence Nightingale es una personalidad impar para la historia de las mujeres. Su notoriedad se por cuenta de la contribución que dio al mundo al construir bases profesionales para la enfermería, así como para la bioestadística. Objetivos: especificar el contenido programático impartido sobre la biografía de Florence Nightingale en cursos de graduación en enfermería y discutir su importancia para la formación de la identidad profesional. Método: Estudio documental usando como fuentes el plan de clase sobre el personaje Florence Nightingale impartido por profesores de siete instituciones de enseñanza superior. Los análisis y discusiones fueron hechos a la luz de autores que versan sobre la enseñanza de historia y bajo el referencial de identidad social y profesional de Claude Dubar. Resultados: la biografía de Nightingale es tratada en todos los programas de los cursos estudiados, siendo los hechos en la guerra de la Crimea y las consecuencias para la profesionalización de la enfermería los más destacados, además, se evidencia el carácter transdisciplinario a partir de este tema. Consideraciones finales: la biografía enseña el legado de Nightingale mientras precursora de la enfermería moderna y permite evidenciar la relación de la identidad profesional y social de la enfermería.

Los orígenes militares del triaje / Triage origins in the military

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Old Tricks for New Dogs? John Caddy and the Victorian Origins of TCCC.

The success of Tactical Combat Casualty Care (TCCC) in reducing potentially preventable combat deaths may rely on both specific interventions (such as tourniquets) and the systematized application of immediate care. Essential elements of a combat care system include clear specification of immediate care priorities, standardized methodology, and inclusion and training of all nonmedical personnel in early response. Although TCCC is fairly recent, the construct is similar to that first suggested during the mid-nineteenth century by John Turner Caddy (1822-1902), a British Royal Navy staff surgeon. Although naval warfare engagements at the time were relatively infrequent, casualties could be numerous and severe and often overwhelmed the small medical staff on board. Caddy recognized that nonmedical personnel properly trained in the fundamentals of combat injury management would result in lives saved and greatly improved morale. The novelty was in his attempt to make procedures simple enough to be performed by nonmedical personnel under stress. However, Caddy's guidelines were completely overlooked for nearly two centuries. The principles of best practice for managing combat trauma injuries learned in previous wars have often been lost between conflicts. Understanding the historical roots of combat first responder care may enable us to better understand and overcome barriers to recognition and retention of essential knowledge.

Treatment of Gunshot Wounds to Spine During Late 19th Century.

BACKGROUND: The demand for neurosurgical procedures increased drastically in the late 19th century owing to advances in ballistics during the American Civil War and Crimean War. METHODS AND RESULTS: Surgical care for a gunshot wound to the spine relied on skilled identification and removal of the fractured bone. Hemorrhage control and infection prevention were also imperative for improving survival rates. CONCLUSIONS: Although new techniques were implemented, the mortality rate from spinal injuries during this period was staggering. Nevertheless, those 19th century procedural methods provided the basis for present-day treatment for spinal injury patients.

Review of Treatment of Gunshot Wounds to Head in Late 19th Century.

INTRODUCTION: During the late 19th century, the seeds of modern neurosurgery were planted to bloom into what it is now known. Wars such as the American Civil War and Crimean War drove the need to find better ways of preventing mortality from gunshot wounds to the head. However, the mortality rate from all major surgical procedures to the head, neck, and face remained staggering. Herein, we describe the surgical treatments for head and neck injuries in order to improve our understanding of neurosurgical procedures performed during the late 19th century. METHODS: A literature search was conducted using PubMed and Google Books for available articles pertaining to treatment for gunshot wounds to the head during the 19th century. Search terms included "Gunshot wounds, Treatment, Civil War," "Gunshot wound, Treatment 19th century," and "Gunshot wounds, Treatment, 1800s." Literature was excluded if not in English or if no translation was provided. Most of the information was taken from the International Encyclopedia of Surgery Volume II. RESULTS: Surgical care for gunshot wounds to the cranium were based on depth and involved finding the bullet, controlling the bleeding, and preventing further brain injury. Surgical treatment for a gunshot wound to the face or neck involved controlling the bleeding, with a focus on maintaining the airway. CONCLUSIONS: Because of improved understanding of infectious processes and technologic advances in surgical equipment, the late 19th century was a major milestone in creating modern day neurosurgery. The methodology behind today's treatments is no different from that of the late 19th century.