The historical evolution of the regulations for the Florence Nightingale Medal†

1. Introduction

The Florence Nightingale Medal is the highest honor awarded to nurses who have made an outstanding contribution to the nursing profession. The Medal was established by the International Committee of the Red Cross at the 8th International Conference of the Red Cross in 1907. The Florence Nightingale Medal was 1st awarded in1920. Subsequently, it was awarded in odd years. As of 2015, there have been a total of 45 award periods covering an award period of 100 years. Its regulations have also been revised several times. This study uses historical methods to analyze the Florence Nightingale Medal awards and assess its changing track of regulations to explore nursing developments accompanying the Florence Nightingale Medal.

应用数字化资源开展案例教学的“三环六步”教学模式主要是应用本专业的数字化资源，借助网络教学平台，让学生自主探究、合作交流、教师监督。“三环六步”，“三环”是指导学、助学、促学三个大的环节；“六步”是指案例发布、自主探究、小组讨论、组间协作、巩固提高、总结评价六个步骤。

2. Objectives and methods

2.1 Introduction to the Florence Nightingale Medal awards

The Florence Nightingale Medal award is always announced on May 12 of the awarding years. The logo of the Red Cross appears on the upper left corner, and the upper right corner contains the circular number. The award includes 3 parts: the 1st part includes the title and date in a fixed format of “x award of the Florence Nightingale Medal” followed by “Geneva, May 12, xxxx(year)”. The 2nd part is the main body of the award,which typically includes 2 sections: the preface and winner information. The 3rd part includes the requirements and signature. Each country is required to perform a ceremony celebrating the solemnity of the winner’s character. The president of the International Committee of the Red Cross signs the award. From the beginning of September of the year preceding the year in which the Medal is awarded, the International Committee of the Red Cross invites the Central Committees of the National Societies by means of a circular and application forms. The names of the candidates that they consider to be qualified to be awarded a Medal must reach the International Committee of the Red Cross before March 1 of the year on which the Medal is to be awarded.

Figure 1. The number of recipients of successive Florence Nightingale Medals.

2.2 Study objects and methods

This study uses the original awards of the Florence Nightingale Medal (1920–2015) provided by the International Committee of the Red Cross as study objects and applies historical methods to assess the awards to investigate the evolution of the partial clauses of the regulations.

3. Findings

3.1 Number of recipients of the Florence Nightingale Medal

It was proposed in the 1st award of the Florence Nightingale Medal that the number of medals awarded should be ＜50 every time and awards will be granted in odd years. As shown in Figure 1, the maximum number of medals awarded is 71 and the minimum is 12 for each previous award year, while 3 medals were awarded in a non-award year. There are 2 award ceremonies in which medals were awarded to ＞50 winners. They are the 1st award ceremony of 1920 and the 11th ceremony of 1947. The only non-award year in which 3 winners were awarded is 2010.

The awards announcement for the 1st award ceremony in 1920 referred to 41 people, which did not exceed the maximum limit of 50 people. However, in the final count of recipients, the number was 53. A possible reason for this increase involved a controversy surrounding whether the International Committee of the Red Cross can grant the award to deceased individuals, and also, many countries did not recommend deceased individuals for the 1st award. However, for the 2nd award in 1923, deceased individuals were granted the award (Figure 1).

This information helps to deduce that the International Committee of the Red Cross has offered supplemental awards to 12 deceased individuals after the 1st award announcement was published.

黄淮流域是中华文明的摇篮，苏、鲁、豫、皖四省是黄淮流域白酒的核心产区，产业规模和产品品质位居我国白酒主要产区前列，具有鲜明的区域特色和发展优势。本次峰会以“传承创新，协同发展”为主题，共同探讨进一步提升板块的优势和特色，引导区域白酒产业高质量发展，具有重要的现实意义。

The 11th award of the Florence Nightingale Medal included 71 recipients in 1947 because the Medal was not awarded over 3 award periods during World War II(1941, 1943, and 1945). After the war, awarding of the Medal resumed in 1947 and was granted to 71 nurses.This number of recipients did not exceed the total number that should be granted for 3 periods.

The International Committee of the Red Cross awarded the Medal to 3 Haitian nurses1 in 2010 for the exceptional courage that they demonstrated in helping victims of the earthquake that struck on January 12,2010, and for their many years of selfless work towards sick and wounded people.

The 4th award of the Florence Nightingale Medal in 1927 made the following statement: “Based on the principles of justice and equity, the International Committee of the Red Cross decided that if the Red Cross never awarded the Medal and its recommended candidates met the prescribed conditions, these individuals would likely be awarded the Medal. The 15th International Conference of the Red Cross hoped to minimize the Medal number to maintain the honor of the prize.The International Committee of the Red Cross typically only assigned a quota for each country. If a candidate failed to be selected this year, he or she could be recommended again during the next awards ceremony”(the 4th award of the Florence Nightingale Medal). This statement reflected the principle of equilibrium of countries when selecting candidates.

3.2 Can the award be given posthumously?

That is, the Medal can be posthumously awarded as an additional condition. When did the changes occur?The analysis concluded that the number of winners can be deduced given that the International Committee of the Red Cross had reached an agreement and had awarded a supplemental award before the 2nd award was given.

At the 1991 delegates meeting in Budapest, the current regulations of the Florence Nightingale Medal were passed, which stipulated that “The Medal may be awarded posthumously if the prospective recipient has fallen during active service.” When did this change begin? We found some clues in the preface of the announcement for the 1st award of the Florence Nightingale Medal, indicating that “As the arbiter of the regulations, the International Committee of the Red Cross can add an additional condition if they considered that it was suitable.”

In 1920, the 1st award announcement stipulated that the Medal cannot be applied for deceased individuals for 2 reasons. First, the regulations stipulated that medals must be personally awarded by their state leaders or the Chairman of the Central Committee of the Red Cross,and the International Committee of the Red Cross considered that the founder of this Medal focused on living nurses. Second, the International Committee of the Red Cross did not require all countries to include sacrificial nurses among the recommended persons in the lists before the 1st award.

3.3 Quota allocation of the prize

Given the increasing number of countries that applied, the regulations have been revised several times, and it was ultimately determined at the 1991 meeting in Budapest that the maximum number of awards should be 50.

3.4 The gender of the recipients

The Florence Nightingale Medal is the highest medal and honor in the international nursing field. The historical evolution of the selection regulations of the Medal indicate that the International Committee of the Red Cross is a neutral reconciliatory institution, as reflected by the solemnity and holiness of the Florence Nightingale Medal. The committee ensured that the award was balanced for each country when formulating its regulations.

（2）渠道采用梯型断面型式，预制混凝土板加塑膜的双防结构，6cm厚预制C20混凝土板，3cm厚M10砂浆垫层，0.3mm聚乙烯塑膜，下垫40cm厚砂砾石垫层防止渠道受冻胀破坏。

中心数据显示，目前中心日间手术床位28张，单个手术间单日日间手术最高可达22台。目前，全院共开设七大专科、130多种儿科日间手术，80余种妇科日间手术，这些手术使患者等待时间缩短了50%以上，住院时间由原来2～3天缩短为4～6小时。

3.5 The contributions of the recipients

Given that the Florence Nightingale Medal was 1st awarded immediately after the World War I, the International Committee gave priority to nurses who made outstanding contributions during the war when selected.The 3rd award of the Florence Nightingale Medal in 1925 posted as follows: “Faced with (In the face of) the excellent candidates presented, the International Committee hoped to distribute as many awards as possible,but the seats were limited. The International Committee had to eliminate some candidates and select nurses who played a role in times of war. The International Committee considered that the last war was still quite recent and needed to consider this factor when selecting recipients. Contributions made in times of war or public disasters were given a higher priority than contributions to nursing work in hospitals and schools”.

Figure 2. The number of male recipients of the Florence Nightingale Medal.

The following was mentioned in the award of 1949,“As limited by the regulations, which provide for the awarding of a maximum of 36 medals each 2 years, the International Committee had to make a difficult choice among the excellent candidates presented. The basic principle was to measure the selfless devotion spirit of nurses and voluntary aids. If they had equal qualifications, priority was given to the candidates who had more years of work experience” (The 12th award of the Florence Nightingale Medal).

2.2.3措施组成主要包括沟头跌水、沟底植物水道、沟坡植物防护和沟岸防护林等多种措施。在实施过程中，应优先布设植物措施，不能直接布设但通过工程修整后可用植物措施的也优先选用；因地制宜选取适宜的植物种类及苗木；对于植物措施难以有效防控的沟段，辅以工程措施。

The Florence Nightingale Medal was established by the International Red Cross, so the selection criteria were inevitably influenced by its founding institution. The 1st award of the Medal was awarded during World War I and subsequently World War II broke out. During these 2 wars, the main social background of the selection criteria placed an emphasis on dedication based on wartime services and working years.

“一带一路”战略是我国对于沿线国家的和平倡导，更是支持沿线国家共同发展的重要规划。而在此过程中，文化输出是极为重要的方式，也是消解双方芥蒂的有效途径。以传统文化为载体，加强我国与沿线国家的文化互动，是传递合作信息乃至包容态度的必要方式。中华五千年文明中文化载体不胜枚举，武术便是其中极为重要的一项。而武术与其他文化呈现方式最大的区别在于表现力更为突出，交际功能犹在。自古以来我国便有以武会友的民族传统，而武术中也蕴含了我国传统文化的内涵，是增强国际交流时可以借助的有效载体，是在跨文化交际中极为重要的文化枢纽，对于“一带一路”战略的文化包容具有重要的支持作用。

The award announcement of 2003, for the 1st time,referred to initiative in its objective. “The objective of this Medal is to honor male and female nurses and voluntary aides who have distinguished themselves by exceptional courage and devotion to the victims of a conflict or disaster, by exemplary service or by a creative and pioneering spirit in the areas of public health or nursing education” (The 39th award of the Florence Nightingale Medal).

Thus, the selection regulations of the Florence Nightingale Medal started to pay attention to initiative but lacked quantitative standards.

树木在视觉环境上是繁杂的，因此你最好灵活选择一支变焦镜头，比如70-200mm来简化画面，压缩树木的透视，创造一个紧密的视野。沿用传统的构图三等分原则，即地平线在下1/3处，让枝叶填满画幅的上半部分。整体画面充分体现森林的繁茂，带给观众最直观的冲击。

4. Conclusions

4.1 The regulations of the Florence Nightingale Medal reflected the neutrality of the International Committee of the Red Cross

Before the time of Florence Nightingale, nurses were mostly low-status women or nuns. Ms. Nightingale’s services led to the development of modern nursing. However, the profession predominantly involved females, and few men were nurses. The profession was associated with the low status of nursing at that time as well as patriarchy.2 At the 1991 delegates meeting in Budapest, the International Committee of the Red Cross 1st passed the regulation that male nurses could be considered as candidates. In 1993,the award announcement mentioned that “the object of this Medal is to honor male and female nurses and voluntary aides who have distinguished themselves,whether in time of peace or in war, by their exceptional devotion to the wounded, the sick, the disabled or persons whose health is at risk.” Since then, male nurses have been given attention and have been promoted in the nursing profession. Figure 2 shows that the 1st male recipient was granted the Medal in 1993, and an increasing trend followed.

4.2 “Humanitarianism, love, and dedication”encompass the spirit of the International Red Cross and serve as the basis for the selection criteria of the Florence Nightingale Medal based on dedication

The above award showed that the selection criteria of the Medal placed an emphasis on the dedication of the winners, and this emphasis was continued until the end of the 20th century.

4.3 The selection criteria of the Florence Nightingale Medal changed from an emphasis on dedication to equal attention to dedication and innovation

For the 2003 award, the selection criteria of the Medal already began to be representative of the initiative of the recipients. As the war ended and world peace was established, the International Red Cross stayed current with the times and was committed to reform and innovation. The International Red Cross allowed male nurses to be awarded with the Medal and complied with the trend of the times. The emphasis on dedication was changed to equal attention for both dedication and innovation, confirming the conclusion of the study on China’s recipients.3,4 The future development of nursing and embodiment of the nursing occupational spirit require not only dedication but also innovation.The continuous revisions of the regulations with the times ensure their guidance of the direction of nursing.

Conflicts of interest

All contributing authors declare no conflicts of interest.

Acknowledgments

The authors thank the International Red Cross for providing the original materials of the award announcements. The contents of the award referred to in this paper were based on a translation of the original award announcements. Because many languages were used in the original materials, please provide corrections on inaccurate translation.

References

1. ICRC. Florence Nightingale Medal. http://www.icrc.org/chi/resources/documents/misc/5qmkdb.htm.2003.

2. Andrist LC, Nicholas PK, Wolf KA. A History of Nursing Ideas. Canada: Jones and Bartlett Publishers;2006:35-42.

3. Duan ZG. Dedication and creation: the education value orientation of the Nightingale Prize laureates.Chin J Med Educ. 2009;29:1-4. (in Chinese).

4. Duan ZG, Wang Q, Chen H. Innovation: Florence Nightingale’s spirit is important as dedication. Chin Nurs Res. 2007;1:1-2. (in Chinese).