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Opportunities for Social Justice in Nursing

Our current practices move beyond the Hospital, Clinic or Office and move into the greater community of health concerns in our homes, streets, communities, institutions and in churches.  The issues of access to health care, food, clothing, safety and freedom to be our best selves unhindered by lack of health is an essential component of ethical practice on the continuum of social justice. 

St. Mark’s has chosen to open their hearts and doors to minister to others in ways that may also call on us to think as carefully as Nightingale, about the concerns of the whole person.  It has begun with nutritious food, safety for good sleep, for loving prayers, for listening ears and for the joy of opening hearts.


The birth of what we know as professional nursing is rooted in social justice. It was during the Crimean War (October 1853-February 1856) that Florence Nightingale saw the abject conditions of care for wounded and ill soldiers. On 21 October 1854, she and the staff of 38 women volunteer nurses that she trained, saw the horrific conditions for the wounded with overcrowding, defective sewers and lack of ventilation.

The concept that all infectious and contagious diseases are caused by living microorganisms had been known and considered to varying degrees since as early as Aristotle (350 BC), who taught Alexander the Great to boil drinking water and bury human waste to prevent disease.  Man first thought disease was punishment from God, and then brought on by miasma, defined as foul vapors or bad air.

Florence Nightingale believed that foul air was a causative factor and only gradually came to believe that most of the soldiers at the hospital were killed by poor living conditions and poor hygiene.  A Sanitary Commission, sent by the British government, arrived to flush out the sewers and improve ventilation.

In their book, Florence Nightingale and the Crimean War*, Dr. Elizabeth Fee and Mary Garafolo, RN write:

Diseases such as typhus, typhoid, cholera, and dysentery were rife in the army hospitals. Many more soldiers were dying from diseases than from wounds. The soldiers were poorly cared for, medicines and other essentials were in short supply, hygiene was neglected, and infections were rampant. Nightingale found there was no clean linen; the clothes of the soldiers were swarming with bugs, lice, and fleas; the floors, walls, and ceilings were filthy; and rats were hiding under the beds.1 There were no towels, basins, or soap, and only 14 baths for approximately 2000 soldiers.

The death count was the highest of all hospitals in the region. One of Nightingale’s first purchases was of 200 Turkish towels; she later provided an enormous supply of clean shirts, plenty of soap, and such necessities as plates, knives, and forks, cups and glasses. Nightingale believed the main problems was diet, dirt, and drains—she brought food from England, cleaned up the kitchens, and set her nurses to cleaning up the hospital wards.

Florence Nightingale deeply regretted her error in understanding and judgment, and despite providing devoted care to the soldiers, carried this regret the rest of her professional life.  This experience influenced her later career, when she gathered statistics and practiced critical thinking in the early forms of public health nursing.  Statistics provided an organized way of learning and led to improvements in medical and surgical practices.

During the Civil War, the Union Army contacted Florence to help with field medicine. Her recommendations led to the forming of the United States Sanitary Commission.



* Am J Public Health. 2010 September; 100(9): 1591.  Florence Nightingale and the Crimean War, Elizabeth Fee, PhD and Mary E. Garofalo, RN, BSN

Elizabeth Fee is with the History of Medicine Division, National Library of Medicine, National Institutes of Health, Bethesda, MD. Mary E. Garofalo is with the Lab of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda


Elizabeth Fee and Mary E. Garofalo selected the image and wrote the text together.

Accepted December 4, 2009.

Copyright © American Public Health Association 2010

This article has been corrected. See Am J Public Health. 2011 May; 101(5): 776.