Reading Hospital is a 697-bed non-profit teaching hospital located in West Reading , Pennsylvania . The hospital was established in 1867 and is the anchor institution of Tower Health.
69-598: Reading Hospital is a level I trauma center and certified stroke center. With more than 133,500 annual visits, the emergency department is the single busiest site in Pennsylvania and the 11th busiest nationwide. The hospital operates several residency training programs for newly graduated physicians such as internal medicine, internal medicine osteopathic, transitional year, family medicine, OB/GYN, emergency medicine, anesthesiology, general surgery, neurology, podiatric surgery & psychiatry. One year pharmacy residency
138-555: A Level III trauma center. It provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. It may also provide surgery and critical-care services, as defined in the scope of services for trauma care. A trauma-trained nurse is immediately available, and physicians are available upon the patient's arrival in the Emergency Department. Transfer agreements exist with other trauma centers of higher levels, for use when conditions warrant
207-883: A Transitional Year. All programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME). The internal medicine program is also dually accredited by the American Osteopathic Association . There is also a residency programs for pharmacists. In January 2021, Tower Health announced additional residency programs in neurology and physical medicine and rehabilitation , as well as fellowship programs in nephrology, plastic surgery, sleep medicine, and pulmonary disease and critical care medicine. 40°19′49″N 75°57′02″W / 40.330315°N 75.950553°W / 40.330315; -75.950553 Level I trauma center A trauma center , or trauma centre ,
276-452: A bed. They often delegate such care to nursing assistants . Medication management and administration are common hospital nursing roles, although prescribing authority varies across jurisdictions. In many areas, RNs administer and manage medications prescribed by others. Nurses are responsible for evaluating patients throughout their care – including before and after medication administration – adjustments to medications are often made through
345-720: A collaborative effort between the prescriber and the nurse. Regardless of the prescriber, nurses are legally responsible for the drugs they administer. Legal implications may accompany an error in a prescription, and the nurse may be expected to note and report the error. In the United States, nurses have the right to refuse to administer medication that they deem to be potentially harmful. Some nurses take additional training that allows them to prescribe medications within their scope of practice. Effective patient/family education leads to better outcomes. Nurses explain procedure, recovery, and ongoing care, while helping everyone cope with
414-465: A day at the hospital: Key elements include 24‑hour in‑house coverage by general surgeons and prompt availability of care in varying specialties—such as orthopedic surgery , cardiothoracic surgery , neurosurgery , plastic surgery , anesthesiology , emergency medicine , radiology , internal medicine , otolaryngology , oral and maxillofacial surgery , and critical care , which are needed to adequately respond and care for various forms of trauma that
483-513: A deadly weapon. In the United States, Robert J. Baker and Robert J. Freeark established the first civilian Shock Trauma Unit at Cook County Hospital in Chicago, Illinois on March 16, 1966. The concept of a shock trauma center was also developed at the University of Maryland, Baltimore , in the 1950s and 1960s by thoracic surgeon and shock researcher R Adams Cowley , who founded what became
552-652: A few hundred municipal hospices to remain in operation in northern Europe. Nuns who had been serving as nurses were given pensions or told to marry and stay home. Nursing care went to the inexperienced as traditional caretakers, rooted in the Roman Catholic Church , were removed from their positions. The nursing profession in Europe was extinguished for approximately 200 years. During the Crimean War , Grand Duchess Elena Pavlovna called for women to join
621-647: A half century, over 5,000 deaconesses had surfaced in Europe. Formal use of nurses in the military began in the latter half of the nineteenth century. Nurses saw active duty in the First Boer War , the Egyptian Campaign (1882), and the Sudan Campaign (1883). In the 19th and early 20th century, nursing was considered a woman's profession, just as doctoring was a profession for men. With increasing expectations of workplace equality during
690-551: A hospital can receive trauma center status by meeting specific criteria established by the American College of Surgeons (ACS) and passing a site review by the Verification Review Committee. Official designation as a trauma center is determined by individual state law provisions. Trauma centers vary in their specific capabilities and are identified by "Level" designation, Level I (Level-1) being
759-578: A narrower scope of practice. Nursing is a female-dominated profession in many countries; according to the WHO's 2020 State of the World's Nursing, approximately 90% of the nursing workforce is female. For instance, the male-to-female ratio of nurses is approximately 1:19 in Canada and the United States. This ratio is matched in many other countries. Notable exceptions include Francophone Africa , which includes
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#1732801358849828-432: A patient may suffer, as well as provide rehabilitation services. Most Level I trauma centers are teaching hospitals/campuses. Additionally, a Level I center has a program of research, is a leader in trauma education and injury prevention, and is a referral resource for communities in nearby regions. A Level II trauma center works in collaboration with a Level I center. It provides comprehensive trauma care and supplements
897-632: A plan of care, working collaboratively with physicians , therapists , patients, patients' families, and other team members that focuses on treating illness to improve quality of life. In the United Kingdom and the United States, clinical nurse specialists and nurse practitioners diagnose health problems and prescribe medications and other therapies, depending on regulations that vary by state. Nurses may help coordinate care performed by other providers or act independently as nursing professionals. In addition to providing care and support, nurses educate
966-787: A source of free/inexpensive labor. Exploitation of nurses was not uncommon by employers, physicians, and education providers. Many nurses saw active duty in the First World War , but the profession transformed again during the Second World War . British nurses of the Army Nursing Service were part of every overseas campaign. More nurses volunteered for service in the US Army and Navy than any other occupation. The Nazis had their own Brown Nurses, numbering 40,000. Two dozen German Red Cross nurses were awarded
1035-417: A transfer. A Level V trauma center provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. They may provide surgical and critical-care services, as defined in the service's scope of trauma care services. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the emergency department. If not open 24 hours daily,
1104-432: A traumatic injury and arrange for transfer of the patient to a higher level of trauma care. The operation of a trauma center is often expensive and some areas may be underserved by trauma centers because of that expense. As there is no way to schedule the need for emergency services, patient traffic at trauma centers can vary widely. A trauma center may have a helipad for receiving patients that have been airlifted to
1173-412: A wide range of settings, including hospitals, private homes , schools , and pharmaceutical companies . Nurses work in occupational health settings (also called industrial health settings), free-standing clinics, physician offices, nurse-led clinics , long-term care facilities and camps. They work on cruise ships , military bases , and in combat settings. Nurses act as advisers and consultants to
1242-409: Is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls , motor vehicle collisions , or gunshot wounds . A trauma center may also refer to an emergency department (also known as a "casualty department" or "accident and emergency") without the presence of specialized services to care for victims of major trauma . In the United States,
1311-684: Is a principal teaching site for Drexel University College of Medicine. In 2021, Drexel opened a new 4-year medical campus in West Reading. Students at the Drexel College of Medicine at Tower Health have the opportunity to complete all 4 years of the MD program at Reading Hospital. Reading Hospital operates a number of residency training programs for newly graduated physicians . Programs include Emergency Medicine, Family Medicine , Internal Medicine , OB/GYN , Podiatric Medicine and Surgery, and
1380-428: Is a specialty unto itself. Adult trauma surgeons are not generally specialized in providing surgical trauma care to children and vice versa, and the difference in practice is significant. In contrast to adult trauma centers, pediatric trauma centers only have two ratings, either level I or level II. Nurse Nursing is a health care profession that "integrates the art and science of caring and focuses on
1449-661: Is also offered. The residency programs are accredited by the Accreditation Council for Graduate Medical Education . The internal medicine residency is also accredited by the American Osteopathic Association . In November 1867, physicians with the Reading Medical Association and 16 local business leaders developed plans for the area's first hospital. The Reading Dispensary opened in downtown Reading on Jan. 27, 1868, and moved to northwest Reading in 1886 under its new name, The Reading Hospital. Public demand for hospital care led to constant expansion, resulting in
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#17328013588491518-537: Is defined and governed by law, and entrance to the profession is regulated at the national or state level. The nursing community worldwide aims for professional nurses to ensure quality care, while maintaining their credentials, code of ethics , standards, and competencies, and continuing their education. Multiple educational paths lead to becoming a professional nurse; these vary by jurisdiction; all involve extensive study of nursing theory and practice as well as training in clinical skills. Nurses provide care based on
1587-533: Is described in many sources as "the first visiting nurse". These traditions were influential in the development of the ethos of modern nursing. Its religious roots remain in evidence in many countries. One example in the United Kingdom is the use of the historical title "sister" to refer to a senior nurse. During the Reformation , Protestant reformers shut down monasteries and convents, allowing
1656-406: Is further complicated by the numerous interpretations of nursing's defining essence. During the 1980s there was an increased focus on research utilization (RU). Nursing research took an interest in clinical issues and US nursing schools began teaching research methods to facilitate interpretation and integration of scientific findings in routine practice. Several RU initiatives were active during
1725-777: Is limited to confirming and reporting on any given hospital's ability to comply with the ACS standard of care known as Resources for Optimal Care of the Injured Patient. The Trauma Information Exchange Program (TIEP) is a program of the American Trauma Society in collaboration with the Johns Hopkins Center for Injury Research and Policy and is funded by the Centers for Disease Control and Prevention . TIEP maintains an inventory of trauma centers in
1794-406: Is selected based on the care setting and the population served. In providing nursing care, the nurse uses both nursing theory and best practice derived from nursing research . Many nursing theories are in use. Like other disciplines, the profession has developed multiple theories derived reflecting varying philosophical beliefs and paradigms or worldviews . In general terms, the nursing process
1863-753: Is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate outcomes. The nursing process as defined by the American Nurses Association comprises five steps: 1) evaluate, 2) implement, 3) plan, 4) diagnose, and 5) assess. Digital health platforms connect nurses and nurse assistants with job openings in healthcare facilities such as skilled nursing homes, home health agencies, and hospitals. Platforms offer an app to facilitate communication and allow nurses to find work opportunities based on their preferences. Healthcare partners and facilities benefit from access to qualified nurses. In 2017,
1932-408: Is the most diverse of all health care professions . Nurses practice in a wide range of settings, but generally follows the needs of their patients. The major specialties are: Nurses with additional degrees allow for specialization. Nursing professions can be separated into categories by care type, age, gender, certain age group, practice setting, individually or in combination. Nurses practice in
2001-510: The Iron Cross for heroism under fire. The development of undergraduate and post-graduate nursing degrees came after the war. Nursing research and a desire for association and organization led to the formation of professional organizations and academic journals . Nursing became recognized as a distinct academic discipline, initially tasked to define the theoretical basis for practice. Nurses are perceived to be in short supply around
2070-681: The National Health Service in its formation in July 1948 and closed in 1993. The NHS now has 27 major trauma centres established across England , four in Scotland , and one planned in Wales . According to the CDC , injuries are the leading cause of death for American children and young adults ages 1–19. The leading causes of trauma are motor vehicle collisions, falls, and assaults with
2139-640: The Shock Trauma Center in Baltimore , Maryland , on July 1, 1966. The R Adams Cowley Shock Trauma Center is one of the first shock trauma centers in the world. Cook County Hospital in Chicago trauma center (opened in 1966). David R. Boyd interned at Cook County Hospital from 1963 to 1964 before being drafted into the Army of the United States of America . Upon his release from the Army, Boyd became
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2208-418: The first schools of nursing to be connected to a hospital and medical school. It spread widely in Europe and North America after 1870. Nightingale included five factors that helped nurses in her time who worked amidst poor sanitation and little education. These factors included fresh air, clean water, a working drainage system, cleanliness, and good light. Nightingale believed that a clean working environment
2277-739: The 1926 relocation to the present 36-acre (15-hectare) site in West Reading. In 2017, Reading hospital introduced Tower Health. This included a purchase of Brandywine Hospital in Coatesville; Chestnut Hill Hospital, in Philadelphia; Jennersville Hospital in West Grove; Phoenixville Hospital in Phoenixville; and Pottstown Hospital in Pottstown; St. Christopher's Hospital for Children in Philadelphia; and 20 urgent care locations across
2346-558: The 19th century in the Crimea, Central America, and Jamaica. Her predecessors had great success as healers in the Colony of Jamaica in the 18th century, and they included Seacole's mother (Mrs. Grant), Sarah Adams, Cubah Cornwallis , and Grace Donne, the mistress and doctress to Jamaica's wealthiest planter, Simon Taylor . Other important nurses in the development of the profession include: Red Cross chapters, which began appearing after
2415-559: The ACS. These levels may range from Level I to Level IV. Some hospitals are less-formally designated Level V. The ACS does not officially designate hospitals as trauma centers. Numerous U.S. hospitals that are not verified by ACS claim trauma center designation. Most states have legislation that determines the process for designation of trauma centers within that state. The ACS describes this responsibility as "a geopolitical process by which empowered entities, government or otherwise, are authorized to designate." The ACS's self-appointed mission
2484-733: The BC area, "Each year, Fraser Health treats almost 130,000 trauma patients as part of the integrated B.C. trauma system". In the United States, trauma centers are ranked by the American College of Surgeons (ACS) or local state governments, from Level I (comprehensive service) to Level III (limited-care). The different levels refer to the types of resources available in a trauma center and the number of patients admitted yearly. These are categories that define national standards for trauma care in hospitals . Level I and Level II designations are also given adult or pediatric designations. Additionally, some states have their own trauma-center rankings separate from
2553-513: The Nursing and Midwifery Council (NMC) are male. The number of male nurses in the United States doubled between 1980 and 2000. On average, male nurses in the US receive more pay than female nurses. Nursing practice is the actual provision of nursing care. In providing care, nurses implement a nursing care plan defined using the nursing process . This is based around a specific nursing theory that
2622-743: The Order of Exaltation of the Cross ( Krestodvizhenskaya Obshchina ) for a year of service in military hospitals. The first section of twenty-eight "sisters", headed by Aleksandra Petrovna Stakhovich, the Directress of the Order, reached Crimea early in November 1854. Florence Nightingale laid the foundations of professional nursing after the Crimean War , in light of a comprehensive statistical study she made of sanitation in India, leading her to emphasize
2691-520: The UK's National Health Service began trialing such a platform. Platforms such as United States –based ConnectRN, Nomad Health, Gale Healthcare solutions or Lantum add resources, career development tools, and networking opportunities. Florence Nightingale's seminal epidemiological study examining mortality among British soldiers during the Crimean War was published in 1858. With the exception of her works, nursing practice remained an oral tradition until
2760-489: The US, collects data and develops information related to the causes, treatment and outcomes of injury, and facilitates the exchange of information among trauma care institutions, care providers, researchers, payers and policymakers. [REDACTED] A trauma center is a hospital that is designated by a state or local authority or is verified by the American College of Surgeons. A Level I trauma center provides
2829-634: The body as mentioned before including the skin, cannot be correctly described by one who is not well versed in anatomy. Hence, anyone desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examining its different parts." In the Middle Ages , members of religious orders such as nuns and monks often provided nursing-like care. Examples exist in Christian , Islamic , Buddhist , and other traditions. The biblical figure of Phoebe
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2898-467: The clinical expertise of a Level I institution. It provides 24-hour availability of all essential specialties, personnel, and equipment. Oftentimes, level II centers possess critical care services capable of caring for almost all injury types indefinitely. Minimum volume requirements may depend on local conditions. Such institutions are not required to have an ongoing program of research or a surgical residency program. A Level III trauma center does not have
2967-503: The countries of Benin, Burkina Faso, Cameroon, Chad, Congo, Côte d'Ivoire , the Democratic Republic of Congo , Djibouti , Guinea , Gabon , Mali , Mauritania , Niger , Rwanda , Senegal , and Togo , which all have more male than female nurses. In Europe, in countries such as Spain , Portugal , Czech Republic and Italy , over 20% of nurses are male. In the United Kingdom, 11% of nurses and midwives registered with
3036-719: The establishment of the International Committee of the Red Cross in 1863, offered employment and professionalization opportunities for nurses (despite Nightingale's initial objections). Catholic orders such as Little Sisters of the Poor , Sisters of Mercy , Sisters of St. Mary , St. Francis Health Services, Inc. and Sisters of Charity built hospitals and provided nursing services during this period. The modern deaconess movement began in Germany in 1836. Within
3105-441: The facility must have an after-hours trauma response protocol. A facility can be designated an adult trauma center, a pediatric trauma center, or an adult and pediatric trauma center. If a hospital provides trauma care to both adult and pediatric patients, the level designation may not be the same for each group. For example, a Level I adult trauma center may also be a Level II pediatric trauma center because pediatric trauma surgery
3174-637: The first hospital to be established specifically to treat injured rather than ill patients, was the Birmingham Accident Hospital , which opened in Birmingham , England in 1941 after a series of studies found that the treatment of injured persons within England was inadequate. By 1947, the hospital had three trauma teams , each including two surgeons and an anaesthetist, and a burns team with three surgeons. The hospital became part of
3243-503: The first shock-trauma fellow at the R Adams Cowley Shock Trauma Center, and then went on to develop the National System for Emergency Medical Services , under President Ford . In 1968 the American Trauma Society was created by various co-founders, including R Adams Cowley and Rene Joyeuse as they saw the importance of increased education and training of emergency providers and for nationwide quality trauma care. According to
3312-507: The following definitions: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well, and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. The use of clinical judgment in
3381-757: The founder of the Trauma Unit at Sunnybrook Health Sciences Centre in Toronto , Ontario, Marvin Tile , "the nature of injuries at Sunnybrook has changed over the years. When the trauma centre first opened in 1976, about 98 per cent of patients suffered from blunt-force trauma caused by accidents and falls. Now, as many as 20 per cent of patients arrive with gunshot and knife wounds". Fraser Health Authority in British Columbia , located at Royal Columbian Hospital and Abbotsford Regional Hospital, services
3450-567: The founding of the Cochrane Collaboration in 1993. The emerging area of evidence-based medicine also applies to nursing. Common barriers to the study and integration of research findings into clinical decision making include: a lack of opportunity, inexperience, and the rapid pace of evidence accumulation. Nurses manage and coordinate care to support activities of daily living (ADL). This includes assisting in patient mobility, such as moving an activity intolerant patient within
3519-426: The full availability of specialists but has resources for emergency resuscitation, surgery, and intensive care of most trauma patients. A Level III center has transfer agreements with Level I or Level II trauma centers that provide back-up resources for the care of patients with exceptionally severe injuries, such as multiple trauma. A Level IV trauma center exists in some states in which the resources do not exist for
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#17328013588493588-533: The highest and Level III (Level-3) being the lowest (some states have four or five designated levels). The highest levels of trauma centers have access to specialist medical and nursing care, including emergency medicine , trauma surgery , critical care , neurosurgery , orthopedic surgery , anesthesiology , and radiology , as well as a wide variety of highly specialized and sophisticated surgical and diagnostic equipment. Lower levels of trauma centers may be able to provide only initial care and stabilization of
3657-412: The highest level of surgical care to trauma patients. Being treated at a Level I trauma center can reduce mortality by 25% compared to a non-trauma center. It has a full range of specialists and equipment available 24 hours a day and admits a minimum required annual volume of severely injured patients. A Level I trauma center is required to have a certain number of the following people on duty 24 hours
3726-529: The hospital. In some cases, persons injured in remote areas and transported to a distant trauma center by helicopter can receive faster and better medical care than if they had been transported by ground ambulance to a closer hospital that does not have a designated trauma center. Trauma centres grew into existence out of the realisation that traumatic injury is a disease process unto itself requiring specialised and experienced multidisciplinary treatment and specialised resources. The world's first trauma centre,
3795-466: The importance of sanitation. "After 10 years of sanitary reform, in 1873, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per 1,000". Nightingale believed that nursing was a social freedom and mission for women. She believed that any educated woman could help improve the care of the ill. Her Notes on Nursing (1859) was a popular call to action. The Nightingale model of nursing education led to one of
3864-435: The individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology. Nurses typically hold one or more formal credentials. Roles and responsibilities follow the level of education. For example, in the United States, Licensed Practical Nurses (LPN) have less education than Registered Nurses (RN) and accordingly,
3933-464: The late 20th century, but the RU movement was superseded by evidence-based practice in the 1990s. Evidence-based practice (EBP) is about using research, but unlike RU it allows for the integration of research findings with clinical expertise and patient preferences. The EBP movement had originated in the field of medicine with Archie Cochrane publishing Effectiveness and Efficiency in 1972, leading up to
4002-412: The late 20th century, nursing became an officially gender-neutral profession, though in practice the percentage of male nurses remained well below that of female physicians in the 21st century. Hospital-based training became standard in the US in the early 1900s, with an emphasis on practical experience. The Nightingale-style school began to disappear. Hospitals and physicians saw women in nursing as
4071-461: The list. A 2023 American survey found that around 30% were considering leaving patient care. According to the traditional interpretation physicians are concerned with curing or treating medical conditions, while nurses focus on care. In healthcare settings this line is often blurred, complicating the task of distinguishing the professions. Although nursing practice varies both through its various specialties and countries, nursing organizations offer
4140-409: The medical situation. Many times, nurses are busy, leaving little time to educate patients. Patients' families needs similar education. Educating both patient and their families increases the chance for a better outcome. Nurses have to communicate in a way that can be understood by patients. Education techniques encompass conversations, visuals, reading materials, and demonstrations. Nursing
4209-424: The mid-20th century. The inaugural issue of Nursing Research , the first scientific journal specialized in nursing, came in in 1952. During the 1960s, interest in attaining PhDs increased among nurses in the US, but nursing remained a fledgling area of research, with few journals until the 1970s. Nursing research is increasingly presented as a valid discipline, although lacking a prevailing definition. The question
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#17328013588494278-432: The nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. The practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as accountability mechanisms. In almost all countries, nursing practice
4347-443: The protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence". Nurses practice in many specialties with varying levels of certification and responsibility. Nurses comprise the largest component of most healthcare environments. There are shortages of qualified nurses in many countries. Nurses develop
4416-515: The provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death. Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations. The unique function of
4485-524: The public and promote health and wellness. In the U.S., nurse practitioners are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications. They practice independently in a variety of settings in more than half of the United States. In the postwar period, nurse education has diversified, awarding advanced and specialized credentials , and many traditional regulations and roles are changing. Nursing historians face challenges of determining whether care provided to
4554-399: The service area. In 2019, a 16-bed pediatric emergency department was added. In 2017, Reading Hospital treated more than 133,000 people in its emergency room, delivered 3,500 babies, provided more than 750,000 outpatient services and 33,000 inpatient admissions. Reading Hospital operates a level I trauma center. The hospital is certified as an advanced comprehensive stroke center. The campus
4623-552: The sick or injured in antiquity is called nursing care. In the fifth century BC, for example, the Hippocratic Collection in places described skilled care and observation of patients by male "attendants," who may have provided care now provided by nurses. Around 600 BC in India, it is recorded in Sushruta Samhita , Book 3, Chapter V about the role of the nurse as "the different parts or members of
4692-466: The world, particularly in South East Asia and Africa. A global survey by McKinsey & Company in 2022 found that between 28% and 38% of nurse respondents in the United States, the United Kingdom, Singapore, Japan, and France said they were likely to leave their role in direct patient care in the next year. The top five factors which they said would make them stay were: Pay ranked eighth on
4761-536: Was important in caring for patients. In the 19th century, this theory was ideal for helping patients, providing a guide for nurses to alter the environment around patients for the betterment of their health. Nightingale's recommendations built upon the successes of Jamaican "doctresses" such as Mary Seacole , who like Nightingale, served in the Crimean War. Seacole practised hygiene and the use of herbs in healing wounded soldiers and those suffering from diseases in
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