Florence Nightingale: Forerunner of Critical Care Practice

EDUMECENTRO 2023;15:e2486



Florence Nightingale: Forerunner of Critical Care Practice

Florence Nigtingale: precursora de la práctica de los cuidados intensivos


Mirelys Sarduy Lugo1* https://orcid.org/0000-0001-5200-4319
Anabel Sarduy Lugo2 https://orcid.org/0000-0001-7666-7846
Yuleidy Fernández Rodríguez3 https://orcid.org/0000-0002-7483-9381


1 University of Medical Sciences of Villa Clara. Provincial Pediatric University Hospital "José Luis Miranda". Villa Clara. Cuba.
2 Santa Elena Peninsula State University. Faculty of Social and Health Sciences. Ecuador.
3 University of Medical Sciences of Villa Clara. "Mariana Grajales" University Gynecology and Obstetric Provincial Hospital. Villa Clara. Cuba.


* Corresponding author. Email: mirelyssl@infomed.sld.cu




Among the personalities with the most contributions to the development of professional nursing, Florence Nightingale stands out, a British nurse who was a forerunner of contemporary professional nursing and creator of the first conceptual model of nursing. Her contributions as a statistician, researcher, and public health professional are complemented by the fact that she is the pioneer in the practice of intensive care; her teachings are notably valid in today's health systems. In 1860 she founded the Nightingale Home and Training School for Nurses. She wrote around two hundred documents with transcendental repercussions in military health, social assistance, civil hospitals, medical statistics and care for the sick. It is the objective of the authors to highlight through this Research Paper, the relevant aspects of her work that distinguish her as a forerunner of the practice of intensive care, necessary knowledge for medical science students in training and professionals in general.

MeSH: nursing; nursing history; critical care; nursing education.


Entre las figuras con más aportes en el desarrollo de la enfermería profesional, sobresale Florence Nightingale, enfermera británica precursora de la enfermería profesional contemporánea y creadora del primer modelo conceptual de enfermería. Sus contribuciones como estadística, investigadora y salubrista se complementan con el hecho de ser la pionera de la práctica de los cuidados intensivos, sus enseñanzas tienen una notable vigencia en los sistemas de salud en la actualidad. Fundó en 1860 la Escuela de Entrenamiento y Hogar Nightingale para Enfermeras. Escribió alrededor de doscientos documentos con trascendentales repercusiones en la sanidad militar, la asistencia social, hospitales civiles, las estadísticas médicas y la asistencia a los enfermos. Es objetivo de las autoras resaltar a través de esta comunicación, los aspectos relevantes de su obra que la distinguen como precursora de la práctica de los cuidados intensivos, conocimientos necesarios para los estudiantes de ciencias médicas en formación y profesionales en general.

DeCS: enfermería; historia de la enfermería; cuidados críticos; educación en enfermería.



Submitted: 09/09/2022
Accepted: 04/03/2023



Nursing today is a legacy inherited from Florence Nightingale, who was born on May 12, 1820 in Florence, Italy and generated through her foray into this field of knowledge, a radical change in the development of this specialty leading it to the definitive and necessary professionalization.(1)

Nightingale's contributions not only to nursing, but to other sciences such as biostatistics, hygiene and epidemiology, health administration and public health have been recognized worldwide; such has been its legacy that the World Health Organization (WHO) chose 2020 as the year of Nursing.(2) She was the first woman appointed to the Royal Statistical Society and was also a member of the American Statistical Association.

The COVID-19 pandemic with devastating consequences for a considerable number of countries, which put health systems to the test and where nursing professionals carried out commendable work, served to perpetuate an idea: to progress, it is necessary retake certain knowledge and practices from another time.

In this sense, it is important to remember that in the historical background of care, Florence Nightingale is distinguished as a personality that was directly related to the professional field, there are indications that she was its initiator and protagonist, being recognized as the pioneer of modern nursing, as well as the first research nurse.(3,4)

These merits granted throughout the history of nursing place it as a paradigm of this profession, but it is also related to the paradigm of categorization by dividing and classifying to define and understand; According to Kerouac, a paradigm aims to provide valid answers to theoretical and practical questions and contribute to disciplinary and professional construction, which she achieves by leaving written evidence of each of her incursions regarding the conceptual, theoretical, practical and managerial training of this profession.(3)

This main characteristic that she reveals during her foray into the care of the wounded in the Crimean War also relates her to being the forerunner of intensive care, whose maximum expression is currently the continuous observation of the patient in serious condition and the implementation of intensive therapy.(5,6)

Intensive care units were designed for the care, monitoring and treatment of critically ill patients and although various indications have been reported about their first existence, the reality is that the first evidence of a theoretical and practical contribution to intensive care was made by Florence Nightingale when in 1854 during the Crimean War she considered it appropriate to separate soldiers in serious condition from those who only had minor injuries in order to care for them in a special way.(7,8)

This measure managed to drastically reduce the mortality rate, which was 40 % among hospitalized soldiers; It is stated in the literature that Florence and more than 38 volunteers trained by her dedicated themselves to caring for wounded soldiers. The organization and incorporation of intensive nursing care led by this figure of universal nursing lowered mortality to 2 %. Her innovative thinking and acting allowed to establish the guidelines and the path to modern nursing and intensive care.(7)

All this work carried out by the so-called lady of the lamp, is covered by the implementation of care with a strict sense of humanism, which is explicitly recorded in the different documents that have been published about her person and made her a personality followed and loved by the sick whom she cared for.

In the 21st century when the unequivocal signs of depersonalization in the practice of intensive care are identified in these fundamental scenarios for the survival of the human being, given by factors such as: highly competent and trained work teams, existence of the most advanced technology available In these areas, it has managed to maintain, replace, and support systems in organ failure through ventilators with neuromuscular adaptation modalities, renal replacement therapies with software adapted to different clinical situations, extracorporeal oxygenation systems (ECMO), external ventricular support systems. /interns, advances in radio intervention in neurocritical patients among others; Patient care is focused on the diagnosis and treatment of the disease, leaving behind the humanized practice of care, a fundamental attribute promoted and practiced by Florence in her work as a nurse.(9)

In addition, several aspects stated by her in the environmental theory presented in 1859 are fully valid today despite being written 163 years ago and are directly related to the practice of intensive care; these are: the prevention of morbidity by guaranteeing hygiene, the reduction of infection cases by guaranteeing a clean environment and hand washing as a fundamental measure to avoid intra-hospital infections.(10, 11)

Intensive care units constitute the hospitalization area where the five fundamental components related to patient care that Florence supported in her theoretical contributions converge in a marked way: careful attention to the environment with special emphasis on ventilation, heat, tranquility, diet, and cleanliness that represents the contribution to this area of nursing care that guarantees holistic and specialized care, to improve the health condition of patients.

But in the personal order, there are qualities of Florence Nightingale that have been recognized as those that made her succeed during the chaos that prevailed in hospitals during the Crimean war, the first definition scenario for this woman; among them we can mention compassion, dedication, patient care, diligence and care in hospital administration.(12)

In the authors' opinion, these attributes should be part of the personality of nursing human resources that provide care in modern intensive care units with the aim of fostering a comprehensive professional.

Florence Nightingale died on August 13, 1910, at the age of 90 after becoming one of the most paradigmatic women of the 19th century. Her work today reveals her to us as a forerunner and protagonist of intensive care, which is why she continues to be a reference for health systems that accredit nursing as a profession, throughout the world.



1. Morales Moreno I, Herrera Justicia S. Florence Nightingale contra las epidemias. Temperamentvm [Internet].2020 [citado 07/09/2022];16:[aprox. 6 p.]. Disponible en:https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1699-60112020000100028&lng=es

2. Torres Esperón J. Paradigmas de enfermería en tiempos de COVID-19. Rev Cub Enferm [Internet]. 2020 [citado 09/09/2022];36(2):[aprox. 3 p.]. Disponible en: https://revenfermeria.sld.cu/index.php/enf/article/view/3677

3. Olivé Ferrer MC, Isla Pera MP. El modelo Watson para un cambio de paradigma en los cuidados enfermeros. Rev ROL Enferm [Internet]. 2015 [citado 09/09/2022];38(2):[aprox. 5 p.]. Disponible en: http://diposit.ub.edu/dspace/bitstream/2445/65766/1/647485.pdf

4. Naranjo Hernández Y, Álvarez Rodríguez R, Mirabal Requena JC, Alvarez Escobar B. Florence Nightingale, la primera enfermera investigadora. AMC [Internet]. 2020 [citado 09/09/2022];24(3):[aprox. 7 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1025-02552020000300014&lng=es

5. Sarduy Lugo M, Collado Cabañin LE. Observación continua de enfermería en unidades de atención al paciente grave pediátrico. Rev Cub Enferm [Internet]. 2018 [citado 09/09/2022];34(3):[aprox. 2 p.]. Disponible en: https://revenfermeria.sld.cu/index.php/enf/article/view/2507

6. Durán Rodríguez R, Cazull Imbert I, Rodríguez Romero Y, Pileta Caraballo Y, Rodríguez Leyva M. Apuntes históricos de la Enfermería Intensiva en el municipio Baracoa, Guantánamo. Gaceta Méd Estud [Internet]. 2020 [citado 09/09/2022];1(3):[aprox. 12p.]. Disponible en: https://revgacetaestudiantil.sld.cu/index.php/gme/article/view/38

7. Rodríguez Duarte KJ, Cruz Ortiz M, Pérez Rodríguez MC. Del cuidado intensivo al cuidado crítico, un cambio de nombre que refleja evolución. Rev Enferm Inst Mex Seguro Soc [Internet].2020 [citado 09/09/2022];28(2):[aprox. 9 p.]. Disponible en: http://revistaenfermeria.imss.gob.mx/editorial/index.php/revista_enfermeria/rt/captureCite/1083/1061

8. Elizalde González JJ. El manantial de la terapia intensiva. Anales Med [Internet].2018 [citado 09/09/2022];63(4):[aprox. 5 p.]. Disponible en: https://www.medigraphic.com/pdfs/abc/bc-2018/bc184k.pdf

9. Baeza Gómez I, Quispe Hoxsas LC. Proyecto "Humanizando los Cuidados Intensivos", nuevo paradigma de orientación de los Cuidados Intensivos. Rev Bio y Der [Internet]. 2020 [citado 09/09/2022];48:[aprox. 14 p.]. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1886-58872020000100008&lng=es

10. Pereira Marinelli N. Contribuciones de la teoría ambiental de Florence Nightingale a la prevención de la pandemia de COVID-19. Rev Cub Enferm [Internet]. 2020 [citado 09/09/2022];36(2):[aprox. 2 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-03192020000200002&lng=es

11. Sánchez García Z, Mora Pérez Y, González Ricardo L, Torres Esperón J, Marrero Rodríguez J, Cambill Martín J. Fundamentos teóricos de Florencia Nightingale sobre higiene de manos. Apuntes para una reflexión en tiempos de COVID-19. Medisur [Internet]. 2021 [citado 09/09/2022];19(5):[aprox. 6 p.]. Disponible en: https://medisur.sld.cu/index.php/medisur/article/view/5160

12. Dios Aguado MM, Gómez Cantarino S, Queirós PJP, Queirós MAA. A luz de Florence Nightingale no cuidado aos pacientes com COVID -19 na atenção primaria. Rev Gaúcha Enferm [Internet]. 2021 [citado 09/09/2022];42(esp):[aprox. 8 p.]. Disponible en: https://www.scielo.br/j/rgenf/a/xs9RZBMNfKQGKwG67T9dyYb/citation/?lang=en



Declaration of interests

The authors declare they have no conflict of interest.



Contribution of the authors

Document review and preparation of the final report: Mirelys Sarduy Lugo, Anabel Sarduy Lugo and Yuleidy Fernández Rodríguez

Copyright (c) 2023 EDUMECENTRO

Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional.