We have only just passed another anniversary of Florence Nightingale’s birth, and we are, in fact, now only six years away from its bicentenary observance. It seems to me that her relevance is quite a valid issue. How might this relevance be organized? What does it rest on? And even, is it realistic at all in this modern, high-tech world that Florence Nightingale should be relevant to nurses? And finally, what has this got to do with tea?
There are two basic reasons—in my view—why Nightingale is so appealing as a symbol of nursing worldwide: On the one hand, her life makes a dramatic and engaging nursing story that inspires and communicates well about the essence of caring, and, on the other, her thinking underpins some of the very principles of nursing practice today.
Let’s look at this second point. In reading 20th-century archives, we see that Nightingale’s importance to nursing was often lauded in general terms, but without much systematic referencing, while practitioners of epidemiology and statistics were beginning to laud Nightingale’s contributions to their areas, with discussions carefully referenced to her writings. Then, toward the end of the 20th century, a global trend took the majority of nurse education away from the hospital and into the university—incidentally, something Nightingale had not approved of in the 19th century. It looked as if her relevance was waning in one of her key constituencies of influence.
But now, for more than two decades, entirely new and scholarly statements have increased appreciation for Florence Nightingale’s relevance to nursing. Among these, I particularly want to highlight the work of Barbara Dossey, PhD, RN, AHN-BC, FAAN, and Louise Selanders, EdD, RN, FAAN. Dossey has given us new biographical insight into Florence Nightingale as a holistic nurse, while, since 1993, Selanders has restated Nightingale’s thinking systematically in terms of an environmental adaptation model. Five years ago, the International Council of Nurses reissued Nightingale’s Notes on Nursing, with a foreword by the International Alliance of Patients’ Organizations.
If I could summarize this work, I would say that there is now a much clearer conception of the value and modern relevance of Nightingale’s nursing principles. Also, as Dossey has shown, the underlying philosophy of patient care has intricate links to Nightingale’s religious and spiritual views. The main thrust of this nursing history research work is to look at principles and to give Nightingale’s ideas a more theoretical perspective that is in tune with modern nursing theory and practice.
In other words, we are looking at the “universal truth” of Florence Nightingale’s nursing thought. It is certainly true that Nightingale’s thoughts on nursing have universal appeal, and this is clearly evident in the work of the scholars I have mentioned. Without making too extensive a claim, I define “universal” as passing the tests of time and space—from Florence Nightingale in 19th-century England to all corners of the globe today. I will give one example that I think passes the universal test. Nightingale’s statement that hospitals should do the sick no harm is in that category, and it seems just as relevant today as it was a century and a half ago, when it was written.
I am getting close to the point about tea. It is a mechanism for talking about another category of truth: contingent truth. It is more challenging to frame Florence Nightingale’s relevance based on contingent truth, because, by its nature, contingent truth is more elusive. You could talk about Nightingale’s attitudes regarding observation of the unique circumstances of every patient and the importance of intelligent processing of these signs by nurses. Alternatively, you could say, based on the reams of research she produced in the decades following the Crimean War, that her relevance is in the minute details of patient care. The case for Nightingale’s scientific nursing research, effectively summarized by her statistical diagrams, has been well-made already.
However, I am still not quite satisfied. I am looking for a specific and concrete case to demonstrate an idea. The idea I would like to test is that something that is a remedy under one specific set of circumstances (which we could call Group X of patients) might not apply under other circumstances (to Group Y of patients), in which Groups X and Y are separated by time and space.
Perhaps, one of the nicest examples I can think of is quite obscure. It comes from Nightingale’s reports on the health of the Maori people and correspondence more than 150 years ago with Sir George Grey, British governor of New Zealand. It should be noted that, at no point, did Nightingale go to New Zealand. The only information she had to draw on was official reports and answers to questions she sent to the colonial government.
The “Maori depopulation question” was a euphemism for the catastrophic effects of colonialism on indigenous health. Nightingale was asked for advice, and one of her conclusions was that the standard approach to health employed by missionaries and the colonial government was to blame. For example, the Manchester cotton clothes given by the British to the Maori people to replace traditional dress were not necessarily healthier. In fact, under many circumstances, Nightingale considered, they were damaging to the health of the Maori people. Nightingale noted that a traditional Maori feather dress was probably much warmer than Manchester cotton. This was just one small example identified by Nightingale of how traditional lifestyles were being altered to the detriment of health.
She also had much to say on the subject of diet. I was fortunate that Lady Jocelyn Keith, that distinguished researcher of the Stout Research Center at Victoria University in Wellington, showed me the accumulated research on the subject 25 years ago. We then put together an exhibition on the subject at the Florence Nightingale Museum. Despite this fact, the episode I mention above remains obscure, and few people have much idea that Florence Nightingale’s thinking on the effects of colonialism was so subtle and advanced, or that she understood that cultural differences can affect the universality of notions about health care.
We can find the same principle at work when we look at tea. But, I’ve taken longer to introduce this topic than I intended, and that discussion can wait. Right now, Englishman that I am, I’m going to break for a cup of tea and write a follow-up post a little later.
For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.
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