The world is celebrating International Nurses Day on May 12 of each year to mark the contribution of nurses to our society. This date has been chosen since it is the anniversary of the birth of Florence Nightingale, who is considered the founder of modern nursing. The 2020 celebration is extra special as the World Health Organization has proclaimed 2020 The Year of Nurses and Midwife, and because it is the 200th birthday anniversary of Nightingale.
Florence Nightingale is primarily remembered for her accomplishments during the Crimean War, for her radical innovations and reform in health care and nursing, especially in military hospitals.
However little is known of her being a pioneer in the idea that social phenomena can be measured, subjected to mathematical analysis, and presented in a form of beautiful graphics.
Florence started collecting data when she was 9 years old. She loved exploring the countryside and kept a written record of the flowers, different fruits and vegetables she observed. She was organizing her data in some standard forms.
Throughout her life, Nightingale collected a huge number of pamphlets and reports. A skillful analysis of those data affected her campaigns for hospital and sanitary reform. After her nursing apprenticeship with the Fliedners at Kaiserswerth, Florence Nightingale continued further training at the Maison de la Providence in Paris where she proceeded to collect hospital records, statistical forms, and general information related to hospital sanitation.
In 1854 Great Britain, France, and the Ottoman Empire declared war on Russia. The first British troops disembarked on the Crimean peninsula in September, 1854. Nightingale gathered a party of 38 women and arrived at the Barrack Hospital in Scutari on November 3, 1854, but had to wait until March 1855 before they would be allowed on the wards.
The conditions at the hospital were awful: it was completely overwhelmed, basic supplies were almost missing, the hospital was full of filth, decay, disease, death, and men in a pitiful state, covered in fleas and lice. The medical records were in poor condition. Even the number of deaths was not accurately recorded.
Florence Nightingale began counting the dead. She also collected a lot of other data. The poor sanitary practices were the main cause of high mortality in the Scutari hospital, and the men were 10 times more likely to die from infectious diseases they caught in the hospital rather than from war wounds. Nightingale was determined to curb such avoidable deaths. She spent hours every day obtaining more sterile supplies, scrubbing the walls of the infirmaries, and ensuring the sanitation of the facility. However, she saved far more lives with her work in statistics, than through her efforts as a nurse. She had been recording mortality data in precise details for two years and gathered her data in a devastating report.
The report was filled with tables and diagrams. Florence Nightingale made data beautiful. The graphics that she used have marked her place in the history of statistics.
The bar chart is showing the differences between British soldiers and the general population. Nightingale compared the mortality in civil life with the mortality in army barracks. She found that in particular between the ages of 25 and 35, the mortality among soldiers was nearly double that in civil life.
Florence Nightingale’s most famous design was the “coxcomb.” It looks similar to a pie chart but it is more intricate. In a pie chart, the size of the ‘slices’ represents a proportion of data, while in a coxcomb the length, which the slice extends radially from the center-point, represents the first layer of data.
As the war lasted exactly two years, and the Sanitary Commission and the death rate reduction came exactly in the middle, Nightingale wanted to compare the two years to show the situation ‘before and after’. As the column chart only contrasts each month with preceding and succeeding months, she supposed to find a solution – the coxcomb charts.
The circle on the right has 12 sectors representing the first 12 months of the war. The circle on the left is the second 12 months. For each month colored areas represent the death:
Blue – from preventable diseases.
Red – from wounds.
Black – from accidents and other causes.
The diagram illustrates the predominant proportion of deaths from infectious diseases compared to war wounds and other causes. It also shows how the Sanitary Commission, sent in the middle of the war, dramatically reduced mortality.
The figures used to produce the diagram are shown in the following table.
After Nightingale’s administration – focused on statistical evidence related to hygiene and cleanliness – the death rate at the hospital at Scutari fell from over 50% in Nightingale’s first weeks to 2%. She recognized the crucial importance of the Sanitary Commission’s work in bringing the death rate down and she resolved to implement better sanitation wherever she had influence.
Florence Nightingale presented her report to the British government. Such data was impossible to ignore. A Royal Commission that was established, based its findings on the statistical data and analysis provided by Nightingale. The result of its work led the government to institute big reforms in the military medical and purveyance systems.
When returned from Crimea Nightingale directed much attention to hospital statistics as an adjunct to the administration of institutions for the care of the sick. She found a complete lack of scientific coordination and unification. For instance, each and every hospital followed its own nomenclature and classification of diseases. The available data had never been tabulated upon forms. Such data had little value for advancing medical knowledge. With the assistance of Dr. Farr, and of other physicians, Florence Nightingale drew up a standard list of diseases and a set of model hospital statistical forms.
Based on her experiences in Scutari Nightingale advocated sanitary reform for the British Army in India. That reform reduced the death rate from 69 to 18 per 1,000 within just a decade.
Sanitary reforms in the UK as a whole, advocated by Florence Nightingale and supported by her statistical reports and data visualizations are largely credited with improving average life expectancy by 20 years between 1871 and 1935.
Florence Nightingale was honored in her lifetime by receiving numerous awards for her work and experience in the scientific and health fields. Among them are the Royal Red Cross awarded by Queen Victoria in 1883 and the Order of Merit of the United Kingdom (she became the first woman to receive this award).
In 1859, Nightingale was elected to the Royal Statistical Society – became its first female member.
Florence Nightingale was a scientist, a statistician, a data-gatherer, an analyst, a writer, a trainer, a manager, an organizer, and a campaigner. She utilized her skills to analyze the causes of sickness and death, first in hospitals and then in broader society.
She was an excellent communicator both visually, through the power of data visualization, and verbally, through the epigrammatic prose style. Nightingale, one of the most prominent statisticians in history, promoted the use of data visualization to ensure the points she was making could be understood. She was an expert at presenting data in a graphic form to dramatize her message and move her audience to action. She understood the power of statistics to change minds and encourage politicians to implement reform. Her graphics sparked dramatic changes in hygiene in hospitals around the world, which saved innumerable lives.
Florence Nightingale’s groundbreaking work in data visualization continues to be influential to this day.