Florence Nightingale and Early Origins of Evidence-Based Nursing

Cheryl Grohn, MPH, BSN, RN-BCRegional Director, Clinical Informatics North West Region

What is Evidence-based practice?“Conscientious, explicit and judicious use of

current best evidence in making decisions about the care of the individual patient.” 1

Integration of clinical expertise, patient values and best research evidence into decision making process for patient care.

In increasing numbers, nurses as members of interdisciplinary teams are implementing evidence-based practice changes. 2

1 Dr. David Sackett, 1996.

2 Baumann, SL, 2010

Evidence Based Medicine, University of Illinois at Chicago University Library, http://researchguides.uic.edu/content.php?pid=232200&sid=1921074

“The most important practical lesson that can be given to nurses is to teach them what to observe – how to observe – what symptoms indicate improvement – what the reverse – which are of importance – which are of none.”

(Nightingale, 1860)

Florence Nightingale in HistoryNightingale believed

that caring for the sick was a component of Christianity

She was a passionate statistician, developing many of her own survey instruments and in graphical presentation of data

One of Nightingale’s graphs

Nightingale’s work after Crimea

Believing many deaths occurred due to poor nutrition, lack of supplies and overworking of soldiers, she began gathering evidence to present to the Royal Commission on the Health of the Army

She emphasized sanitary living conditions as of great importance. Consequently, she reduced peacetime deaths in the army and turned her attention to sanitary designs of hospitals and introducing sanitation in working-class homes

Nightingale’s TheoryShe believed that studying trends in sanitation

and healthcare provided many answers to questions of disease and mortality

She continued to campaign to improve health standards, publishing 200 books, reports, and pamphlets

Her beliefs led to improvements in hygiene and healthier living and working conditions in hospitals and homes

Her vision was of professional nursing for the sick and the poor versus untrained lay labor

Nursing is a continuous learning process because new and better practices are always being developed

Evidence-based PracticeSystematic data collectionMortality in battle conditionsUniform collection of hospital statisticsExplored differential mortality among

aboriginal peoplesStudied impact of trained versus

untrained nurses on mortality in workhouses

Conducted a landmark study of maternal mortality from puerperal fever

Using Evidence to Guide Policy DecisionsNightingale campaigned to have

statistical knowledge guide public policy decisions.

Unfortunately her proposal was never acted on; it would have undoubtedly led to the earlier and better use of evidence in public policy, health care and other matters

Nightingale’s Important Practical LessonTeach nurses what is important to

monitorHow to monitor itWhat trends show improvementWhat trends show negative

changeWhich indications are importantWhich indications don’t matter

Evidence Based Practice combinesResearch Data CollectionNurse experiencePatient wishes and needs

Benefits of Evidence-based practiceImproves patient outcomesSupports nursing modelReduces healthcare costs by

providing the right treatment the first time

Improves care giver satisfaction