Running head: THE LITTLE THINGS COUNT
The Little Things Count
Understanding the Importance of Details in Nursing
Natasha Adib
Loyola University of Chicago
THE LITTLE THINGS COUNT
The Little Things Count
Understanding the Importance of Details in Nursing
“The little things count” or so goes the saying. When one thinks about “the little things” they are
implying the details, the elementary facts, the common sense that everyone commonly forgets. In our
fast-paced world today, nurses often overlook the details involved in caring for the sick as they are
assigned multiple patients on a given day. Therefore, they are forced to stretch themselves in order to
meet the needs of all his or her patients. When this occurs, nurses often look at the noisiest of problems,
the huge problems which scream out and cry for urgent care before all else. But if the nurse can learn to
hush the larger problems, one would find that the bigger issues can be solved first by the smallest details.
In Florence Nightingale’s, Notes on Nursing, the reader explores these small details in caring for a
patient. Although Nightingale covered a plethora of tips and her own personal experiences, I wish to
focus on ventilation and warming, light, noise, and petty management.
The first rule of nursing is as Nightingale emphasizes “to keep the air [the patient] breathes as
pure as the external air, without chilling him” (Nightingale, 1860/1969). Ventilation should be one of the
first small details to focus on, because it increases respiration and allows for bacteria to dissipate more
quickly. Today, we have air purifiers in hospitals and thermostats; however, it is still important that the
patient receives this pure air. Nightingale explains that “making the sick repeatedly breathe their own hot,
humid, putrescing atmosphere is a certain way to delay recovery” (Nightingale). Essentially, the patient
will become well much faster if proper ventilation and warming practices are put into place. It can also
be noted that ventilation should not be automatically associated with cold air. One can still control the
temperature while ventilating a room. If there is anything a nurse could do for a patient, it would first be
to increase their breathing and help them maintain a steady temperature. Breathing is what entails oxygen
to the brain and a healthy temperature makes for healthy proteins in the body. Without either of these,
one cannot survive.
THE LITTLE THINGS COUNT
Tied very closely to ventilation and warming is the detail of light. Nightingale voices that,
“…second only to [the patient’s] need of fresh air is their need of light; that, after a close room, what
hurts them most is a dark room” (Nightingale 1860/1969). Light is also completely necessary in order for
the patient to regain his or her strength mentally and physically. In the present, nurses must remember
that physical health is intricately interwoven with mental health. Therefore, it is in the patient’s best
interest to have a view at the natural light. It has been said that a patient will almost always turn their
faces towards the light. It is intrinsic of us to crave this warm feeling of being kissed by the sun. When a
patient lands in the hospital, they quickly come to appreciate each moment in life, especially the simple
ones. They realize light’s importance as it fills the starving soul. This giving of light is such a simple
task for nurses to perform. Sometimes, more than any kind of word of consolidation, a patient just needs
light.
While there are certain things patients do need and appreciate, such as light, a nurse must also
consider things in which make the patient uncomfortable, specifically noise. Noise describes any sound
in which disturbs the patient from a sound mind and body. Nightingale suggested that, “ …the rattling of
keys, the creaking of stays and of shoes, will do a patient more harm than all the medicines in the world
will do him good” (Nightingale 1860/1969). These noises, so commonplace to the nurse, make the
patient restless. In addition, a patient’s friends and family should not consult with the doctor near the
patient, even if whispering. This whispering causes anxiety for a patient, a person who has much of it to
begin with. Anxiety is one of the most awful setbacks for the healing of patients. It takes control of the
mind and moves next to the body, creating nervousness, high blood pressure, and perhaps an even more
drastic event. It is hard to believe that all of this turmoil and upset is because of mindless noise. And all
of this mindless noise because of a mindless nurse. Consequently, the distance between the healthy and
the sick continues to grow. In order to cure the patient, the nurse must put his or her mind in the patient’s
body. Only then will they be able to see how small things, such as noises, have the most detrimental
effects.
THE LITTLE THINGS COUNT
Once one has learned how to incorporate these details into their nursing practice, they should then
teach those who do not yet know. Nightingale makes a point that, “all the results of good nursing might
be spoiled…in petty management, or in other words, by not knowing how to manage that what you do
when you are there, shall be done when you are not there” (Nightingale, 1860/1969). Even the most
passionate and dedicated nurse cannot stay with the patient forever. They must also take care of
themselves in order to be the best nurse they can be. Because of this, a nurse must teach another how to
fulfill the duties when he or she is not there.
Unfortunately, some who already obtain skill do not wish to spend their time with the nursing
student, because they either find them bothersome or they fear error the student could potentially make.
They forget two major perspectives: that they were once the nursing student and that it is their duty to
think not only in the present, but of the future nursing generation. Thus, present nurses often mismanage.
Nightingale tries to clear the misconception about it when she says, “[management] is…to ensure that
each does that duty to which he is appointed” (Nightingale 1860/1969). Management is not merely
assigning people to tasks or becoming impatient with people so to resort to assigning all the work to one’s
self. It is taking the time to teach the future all the secrets and details, everything the nurse knows about
passionate nursing. This present nurse must remember that the student nurse she is teaching now will get
her fill on teaching in the future. Even with all of this being said future success in nursing begins with the
present nurses.
The future nurses may acquire much valuable knowledge from the present nurses. However, it is
in each nurse’s best interest to reacquaint themselves with the very fundamentals of nursing. Through
Nightingale’s novel, there were four significant details each nurse should pay close attention to. These
details included ventilation and warmth, which a patient’s breathing and temperature are focused on.
Associated with that is light, which heals the mind and body of the sick. The next is noise, which should
be minimal in order to prevent anxiety in the patient. The last, but not least, is to keep replenishing the
generations of passionate nurses. And so, it is the littlest things that make the most meaningful difference.
THE LITTLE THINGS COUNT
References
Nightingale, F. (1969). Notes on nursing: What it is, and what it is not (pp. 12-84). New York, NY:
Dover. (Original work published in 1860).