Florence Nightingale and Evidence-Based Nursing Practice, 1870–1920

Introduction

In the 21st century, it is presumed that healthcare practice is evidence-based, rather than arbitrary, inconsistent, or grounded in spurious superstition or religious belief. However, it was only a century ago that the struggle to integrate scientific principles into nursing practice was still ongoing. Formal nursing practice evolved in Europe and the United Kingdom as an offshoot of religious service, provided by nuns. A social history research methods approach shows how the gradual secularization of European society caused a crisis in healthcare — a crisis that Florence Nightingale recognized and helped to resolve during her work in the Crimean War. The realities of modern warfare revealed the need for improved standards of care. Nightingale applied the scientific method, empiricism, and qualitative research methods to her work as a nurse, something that had never before been done with the same degree of rigor. In 1859, Nightingale published Notes on Nursing, which established evidence-based practice and set the stage for formalized nurse training and education.

How did the integration of evidence-based practice impact nursing in the educational and practice domains from 1870 to 1920? This research question is best approached using the social history research method. Social history research methods take into account not just facts and figures but also contextual variables. Historical realities, social contexts, and issues like class, gender, and power all have a bearing on the evolution of education and practice domains in nursing. It is hypothesized that the integration of evidence-based practice into nursing by Nightingale led directly to the professionalization of nursing. Professionalization entails rigorous standards for the education and training of nurse practitioners, as well as standardized care practices that respond to emerging research in science and medicine.

Social History Research Method, Rationale, and Sources

Prior to the professionalization of nursing, patients were treated and considered inseparable from their social contexts. Patients' biographical information, their psychosocial state, and other personal factors were deemed crucial to the healing process — or at least necessary for understanding any presenting physical ailments or problems ("Social History," 2012). Integrating contextual variables into the study and practice of nursing constitutes the essence of the social history research method. Social history approaches to research take into account contextual and environmental factors impacting nursing practice, including patient outcomes. Similarly, the social history research method promotes a fuller understanding of nursing history. The social history approach is, in fact, embedded in the history of nursing itself.

As the disciplines of sociology and psychology began to weave their way into healthcare in general, the role of nurses and the nursing profession expanded. During the late 19th and early 20th centuries, healthcare was used as a form of social control via the processes of labeling (Dingwall, Rafferty, & Webster, 1988). Placing the history of nursing within a social, cultural, and historical context allows for a richer understanding of the subject, which is why this is the most appropriate method for exploring the research question. It can be considered impossible to acknowledge the role of evidence-based practice in early nursing history without the social history approach. Artificially segregating the core events in nursing history from their social contexts would lead to an incomplete assessment of the research question.

Social histories are firsthand accounts from those who actually experienced events, or from those who have interpreted events as they happened. Samuel (2017), for instance, points out that social history focuses on "real life" and "ordinary people" (p. 1). Social history approaches help reveal the variables that precipitated an event, led to a theoretical viewpoint, or caused a particular person to act or behave in certain ways. Moreover, the social history method focuses on average people to eliminate elitism and minimize bias in research. Social history specifically offers insight into how ordinary women lived their lives and reacted to the burgeoning integration of science into nursing methodology during the research era. Sources of information for the current research include both primary and secondary sources, such as those authored by Florence Nightingale.