Treatment Measures for COVID-19 Actually Began More than a Century Ago

The COVID-19 virus is barely 5 months old, but some of the methods for fighting it and other contagious diseases were developed more than 150 years ago by nursing legend, Florence Nightingale.

Considered the founder of modern nursing, Nightingale would have turned 200 on May 12, which is recognized annually as International Nurses Day in her honor. She developed principles of good environmental design and optimal nursing care during the Crimean War that have stood the test of time in some form or fashion. Indeed, long before Drs. Fauci and Birx became household names in America, the European-born Nightingale extolled the virtues of good hand hygiene and sanitary clothing for hospital staff and patients.

At HKS, we have used several of Nightingale’s same principles in our designs for our permanent and temporary field hospitals to help battle the coronavirus.

For example, in her famous Notes on Nursing, she said that nurses who had worked in an infectious unit should not return to their regular sleeping quarters or homes. Today, health care staff working directly with COVID-19 patients have stayed in hotels or other spaces away from their homes to protect their families.

In another instance, for infection prevention reasons Nightingale recommended separate buildings for inpatient and outpatient care. Today, persons under investigation for COVID-19 are triaged outside of the hospital Emergency Department.

It may be difficult to imagine that a woman who lived nearly two centuries ago would still have such an effect on the nursing industry, which according to Gallup is the most trusted profession in America for the 18th year in a row. Yet Nightingale’s influence continues to grow – even in the field of architecture.

She measured and discussed at length how patient beds should be configured and spaced to minimize infection and promote maximum ventilation. She wrote extensively about the matter.

In those vaunted Notes on Nursing, she proclaimed the primary function of nursing, in all caps: “TO KEEP THE AIR HE BREATHERS AS PURE AS THE EXTERNAL AIR, WITHOUT CHILLING HIM.”

Today, health care engineers design facilities to provide ample air exchanges with clean filters to deliver clean air as well as positive and negative pressure rooms where necessary. And proper ventilation is also important when we consider alternate care sites for patients with or suspected of having the coronavirus.

But before even dealing with ventilation matters, Nightingale and other health providers of her era, faced an even greater challenge – maintaining sanitary conditions.

When Nightingale led 38 other nurses to the front lines of the Crimean War in 1854, they arrived at the so-called hospital to find deplorable conditions. Rats, blood-soaked linens, and lack of sanitation in a dark, damp environment prompted Nightingale to take swift action.

With training in both nursing and hospital administration, she organized her team to provide clean linens, improve the supply of food, developed cleaning protocols for walls and floors and the surroundings. And she advised that staff should change their clothes and wash between infectious and noninfectious patients, an established practice in today’s health field.

In addition to providing ventilation and sanitary conditions, another of Nightingale’s principles that has become a basic tenet of modern health care is natural light. She determined window size and placement on the wall to maximize healing and patient distraction through outdoor views or provide light for reading. Today, the health care design industry recognizes the need for maximizing outdoor light.

Another of Nightingale’s methods now considered obvious was the advent of 24-hour nursing. During the war, she made a habit of visiting wounded soldiers during all hours of the night. This practice has been even more evident during the current pandemic as nurses and other health professionals have often worked extended shifts. 

Christopher Shaw, health care architect in the UK who is designing one of Nightingale’s Field hospitals for the NHS, also designed respite spaces for staff.

“You need de-stressing, individual facilities that value people,” Shaw said. “These are the people who are making the difference. You really want something like business class lounges for them.”

The efforts of Nightingale, the first health statistician to provide evidence-based practice for nursing, did not go unnoticed. She is the first female member of the Royal Statistical Society. She is the first woman to be awarded the Order of Merit by the United Kingdom for her influence in social reform, culture, and the sciences. 

And supported by Queen Victoria of England, Nightingale developed the world’s first professional nursing school whose training standards reached around the world.  The school is now a part of King College London and nursing students there still take the “Nightingale pledge.”

Today, Nightingale’s once cutting-edge evidence-based principles are commonplace. Nurses work with a team of health professionals to provide environments that promote health and well-being. But with the coronavirus maximizing hospital bed capacity in many places and the sporadic use of field hospitals to manage the excess of patients, her methods of good environmental design and optimal nursing care still stand.

And so does her belief that a nurse’s responsibility doesn’t end at the patient’s bedside.  It extends to the overall administration of a hospital management, patient care delivery, and other aspects of patient care.  Nurses within and without the hospital setting influence health facility architecture, interior design and mechanical and plumbing systems.

It’s small wonder, then, that the World Health Organization has proclaimed 2020 as The Year of the Nurse and Midwife. But it wouldn’t be so without Florence Nightingale, “the lady with the lamp.”