In 1860 Nightingale wrote a paper on Hospital Statistics for the fourth International Statistical Congress in London. She maintained that standardised, accurate statistics would lead to improvements in medical and surgical practice [5]. The primary objective of her proposal was to acquire a standardised record of facts from which to calculate statistical results [7]. Nightingale also urged the adoption of William Farr's classification of diseases for the tabulation of hospital morbidity in her paper, Proposals for a Uniform Plan of Hospital Statistics . Until that time only causes of death were reported but Farr recognized that it was desirable "to extend the same system of nomenclature to diseases which, though not fatal, cause disability in the population, and now figure in the tables of the diseases of armies, navies, hospitals, prisons, lunatic asylums, public institutions of every kind, and sickness societies, as well as in the census of countries like Ireland, where the diseases of all the people are enumerated" [8].
Although this classification was never universally accepted, the general arrangement proposed by Farr, including the principle of classifying diseases by anatomical site, survived as the basis of the International List of Causes of Death. In 1946 the World Health Organization (WHO) established the International List of Causes of Morbidity to combine with the International List of Causes of Death and so the International Classification of Diseases was created.
Extract from Paper "Observations on Sustainable and Ubiquitous Healthcare Informatics from Florence Nightingale"
In July 1860 Nightingale wrote a paper on Hospital Statistics that was read to delegates at the International Statistical Congress in London by Dr McWilliam. She states that at that time there was no uniform plan to which hospital statistics were kept. She proposes one such plan that had been trialled in several hospitals. The primary objective was to obtain a uniform record of facts from which to deduce statistical results for example; the total sick population – the number of beds constantly occupied during the year by disease, age and sex, the number of cases by age, sex and disease admitted for medical or surgical treatment during the year, the average duration in days and parts of a day of each disease by age and sex, the mortality from each disease by sex and age, the annual proportion of recoveries to beds occupied and to cases treated for each age, sex and disease. Nightingale’s paper was discussed at the meeting and as a result additions were suggested to her, which she acknowledged. Controversy arose regarding the practicality of collecting all the data suggested by Nightingale. Discussion occurred through one of the leading journals of the time the Medical Times and Gazette. The debate lasted several months but the Registrar General came to Nightingale’s rescue in October stating that the classification scheme that Nightingale had adapted, (the Registrar General’s own Classification) was not perfect, but the best available and that it was desirable that all statistics should be based on the same scheme [12]. Several of the London hospitals adopted Nightingale’s forms, agreed on a common patient registration system and that they should publish their statistics annually.
Extract from "Was Florence Nightingale the first Nursing Informatician?"
Here is one of my favorite Nightingale quotes:
"In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purposes of comparison. If they could be obtained, they would enable us to decide many other questions besides the one alluded to. They would show subscribers how their money was being spent, what amount of good was really being done with it, or whether the money was not doing mischief rather than good; they would tell us the exact sanitary state of every hospital and of every ward in it, where to seek for causes of insalubrity and their nature; and, if wisely used, these improved statistics would tell us more of the relative value of particular operations and modes of treatment than we have any means of ascertaining at present. They would enable us, besides, to ascertain the influence of the hospital with its numerous diseased inmates, its overcrowded and possibly ill-ventilated wards, its bad site, bad drainage, impure water, and want of cleanliness - or the reverse of all these - upon the general course of operations and diseases passing through its wards; and the truth thus ascertained would enable us to save life and suffering, and to improve the treatment and management of the sick and maimed poor."
Notes on Hospitals, p. 176
She was ahead of her time.
My belief is while she would be an epidemiologist she was not by the current definition and informaticist. If one considers the definitions as"A program that focuses on computer systems from a user-centered perspective and studies the structure, behavior and interactions of natural and artificial systems that store, process and communicate information. Includes instruction in information sciences, human computer interaction, information system analysis and design, telecommunications structure and information architecture and management." Clearly, she didn't meet that requirement, but there are modern nurses that do.
Roberta yes you are right "If one considers the definitions as"A program that focuses on computer systems" but whose definition is that? Did you read the attached articles? I wonder what definition do I would meet in her times?
The following is taken from https://ww2.amstat.org/about/statisticiansinhistory/index.cfm?fuseaction=biosinfo&BioID=12
Which shows he involvement as a statistician rather than just an epidemiologist I believe
Florence Nightingale's interest in mathematics extended beyond the subject matter itself, as shown in letters to her sweetheart during 1846. For example, in May she wrote, "There is a most lovely character given of D'Alembert's the great mathematician's lightheartedness... It says that it is the exclusive privilege of the exact science, to enjoy everyday some new truth which comes to reward one's work." Again, in August: "The loss of power of the high priest...the inconsiderate 'following of the leader' of the people, are everyday feelings in our hearts, just as is the jealousy, which brought under a different system of police, Abel to the grave." Her letters show her sense of humor. In September after attending a political speech, she wrote:
"I have invented a new system of Logarithms (finding the capacities of arithmetic not sufficiently extensive) to count the number of times 'Imperial Majesty' occurs in the speech...." [6]
Nightingale helped to promote what was then a revolutionary idea (and a religious one for her) that social phenomena could be objectively measured and subjected to mathematical analysis. Her work with medical statistics was so impressive that she was elected (in 1858) to membership in the Statistical Society of England. One of the pioneers in the graphic method of presentation of data, she invented colorful polar-area diagrams to dramatize medical data. [7] Although other methods of persuasion had failed, her statistical approach convinced military authorities, Parliament, and Queen Victoria to carry out her proposed hospital reforms.
During the American Civil War, Nightingale was a consultant on army health to the United States government.
She also responded to a British war office request for advice on army medical care in Canada. Her mathematical activities included ascertaining "the average speed of transport by sledge" and calculating "the time required to transport the sick over the immense distances of Canada."
Graham,
It appears to me that your question is of a rhetorical nature. You both asked and answered the question. And the length of your question repels the casual reader. Perhaps you were looking to engage a cohort of nursing historians rather than researchers.
God Bless,
Christopher
Christopher,
Can historians not also be researchers? I have asked and also given some of my thoughts from earlier publications. I don't think I have actually answered the question and I think readers on researchgate are far from being casual readers.
Regards Graham
It seems as though this question is posed to provoke philosophical reflection on the nature of the current understanding of the term "informatician" and the incredible advances made by Florence Nightingale in relation to collecting and analyzing data in relation to patient outcomes. Some consider her work to be the basis of modern epidemiology. There was an excellent article in the Scientific American in the 1990's about this topic and her outstanding contributions but I do not have the citaction on hand.
I believe that Nitingale's data gathering, data management and analysis would be encompassed in the work of current informaticians, but, obviously, the many potential manipulations possible through computerized assistance are required to meet the accepted definition.
On another issue introduced by a responder, many historians are researchers. Historical research is recognized as a major branch of qualitative research and is taught in qualitative research curricula.
I think the work of Nightingale is not really for historians, but of interest of current day epidemiologists, researchers and health informaticians. Great analysis Graham. But you should pay respect to your OWN sweetheart I believe 🙂
I was at the AAN last week and the Nursing History and Policy group actually discussed this question. Some suggested that yes it was informatics while others held that there is a difference between her epidemiological approach and informatics.
William thanks for reminding me to say that Dr Helen Betts my co-author and wife undertook her doctorate looking at the work of Miss Nightingale and midwifery. We both have an interest in the historical significance of her work.
I would deny that she trained as a nurse but did learn as a Lady to manage a large household and is on record of talking to the local school girls on hygiene. That of course gave her the experience to manage servants and others, including nurses. He main interests appear to have been in managing change, re-organisation of poorly administered entities and the logistics and statistics of disease and death. She was very methodical in her research and reporting and is credited with creating the Coxcomb diagram (Polar). I have not doubt she would be a computer scientist if alive today.
Here is one of my favorite Nightingale quotes:
"In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purposes of comparison. If they could be obtained, they would enable us to decide many other questions besides the one alluded to. They would show subscribers how their money was being spent, what amount of good was really being done with it, or whether the money was not doing mischief rather than good; they would tell us the exact sanitary state of every hospital and of every ward in it, where to seek for causes of insalubrity and their nature; and, if wisely used, these improved statistics would tell us more of the relative value of particular operations and modes of treatment than we have any means of ascertaining at present. They would enable us, besides, to ascertain the influence of the hospital with its numerous diseased inmates, its overcrowded and possibly ill-ventilated wards, its bad site, bad drainage, impure water, and want of cleanliness - or the reverse of all these - upon the general course of operations and diseases passing through its wards; and the truth thus ascertained would enable us to save life and suffering, and to improve the treatment and management of the sick and maimed poor."
Notes on Hospitals, p. 176
She was ahead of her time.
That is a great one to show that she was not just interested in epidemiology but in the whole concept of health and medical records. I think she would have approved of the "The Quality and Outcomes Framework (QOF) is the annual reward and incentive programme detailing GP practice achievement results." which does to a large extent what she wishes in "the truth thus ascertained would enable us to save life and suffering, and to improve the treatment and management of the sick and maimed poor." The majority of chronic care in GP surgeries is provided by specialist Nurses some of whom are partners in the business.
http://content.digital.nhs.uk/qof
In addition NICE (The National Institute for Health and Care Excellence) provides evidence of the effectiveness of QOF and those looks at the standards using modern Patient record systems. All of the individual practices are linked to the NHS and who collect patient based data and analysis it. https://www.evidence.nhs.uk/Search?q=gp+contract
Yes she was ahead of her time.
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