Florence Nightingale and the Great British Cup of Tea

The title of this piece is somewhat misleading, because, although I will be indeed come to Florence Nightingale and tea drinking by patients, the issue I am concerned with here is somewhat more philosophical. It is a question of what Nightingale’s statements on patients and tea mean to us in terms of her relevance.

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.

Tweeting Nightingale, Part Two

In my previous post, I discussed the cultural importance of Twitter and five top Florence Nightingale-related tweets. Before proceeding to my next discussion, a historical analysis of a much-quoted Nightingale quote, a brief introduction to Twitter is in order for those who don’t know or understand the medium.

A Twitter primer

A tweet is a short burst of text—140 characters or less—which anyone with a Twitter account can send via the Internet. It’s a bit like text-messaging the world, with the abbreviated language typical of such communication. I can perch in a “tree” and tweet to the people who choose to follow my tweets. (By way of introduction, every user includes a brief profile.) I can aim a tweet to a specific person in their “tree” by starting my tweet with their name, after first entering the @ symbol, or I can tweet to numerous persons perched in the same tree by entering the # symbol and the name of the “tree” or community.

Tweeting is a bit like text-messaging the world.

It should not be surprising to know that the community #florencenightingale exists, as do #nursinghistory, #twitternurses, #nursesweek, #nurse, and so on. Sometimes, a group of nurses will fly over to a particular tree at a prearranged time and, as they do on #NurChat, all tweet to each other, promoting professional development very much in the spirit of Florence Nightingale. You can also tweet others’ tweets (retweets) and add pictures or media links to tweets. Not surprisingly, I am @alexattewell and I tweet from a kapok tree in the Mexican jungle.

The historical Florence Nightingale quote I mention above and the most popular Nightingale quote on Twitter is “I attribute my success to this—I never gave or took any excuse.” Short quotes are made for Twitter. In fact, they are the currency of Twitter in the sense that anything good gets retweeted and goes viral. Nightingale’s words are right up there; there is an endless quantity of her quotes on Twitter. Because she’s very quotable, she is also very tweetable. I got bored counting how many hundreds of her quotes there are on Twitter, so, to conduct a little survey, I used the first 100 I found and discovered that this single quote accounted for 57 percent.

In-depth tweet analysis

When Florence Nightingale put these words to paper with her steel-nibbed pen and black ink, she was addressing them to her cousin Hilary who, at the time, was helping her with secretarial work related to nurse education. Nightingale provided her cousin a humorous account of being nearly deluged with water because of bad plumbing in the hotel where she was staying, but added that it wasn’t actually so funny in view of the freezing weather. As a result of being “drowned,” as Nightingale put it, she had become ill.

In trying to get to the bottom of the problem, four of the nearest and dearest men in her life had words with the hotel works supervisor, but they were fobbed off with the excuse that it was caused by frost, so nobody was really to blame. When eventually Nightingale herself got hold of the supervisor, she said it was like “reenacting the Crimea on a small scale.” The man confessed that the problem was, indeed, the result of bad workmanship and had nothing to do with the frost! Hence, never taking an excuse. Another thing I like about the quote—“I attribute my success to this—I never gave or took any excuse”—is that Nightingale openly acknowledges her success, and in doing so, also conveys the fact that she is a success in a man’s world.

Today, researchers can view the quote and the eight-page letter it comes from in the British Library’s manuscript reading room, but it’s easier to find the quote reproduced in her biographies. Easier yet on Twitter. Florence Nightingale would be dumbfounded to know that, 142 years after writing a private letter to her cousin Hilary, a portion of it has gone viral on the Internet. I actually do wonder if the British Library staff members are aware that they are holding the source of this most famous of tweets.

In early May, around the time of Nurses Week, there was a peak of Florence Nightingale-quote tweeting and retweeting between nurses and non-nurses, and all permutations thereof. I have chosen to showcase a tweet of the quote by Shawna Allietta, a nursing student from Wheeling Jesuit University in West Virginia. She retweeted it from a #nursesweek tweet by the publisher of her nursing textbooks.

Note that the tweet, as with many things broadcast via Twitter, is not 100 percent accurate. If you want to see precisely what Florence Nightingale actually said, see page 35 of my book of Florence Nightingale quotes.

Finally, I thank Anja K. Peters, a German nursing history PhD candidate—to clarify, she is German and she is studying German nursing history—for welcoming me recently to Twitter as a fellow Florence Nightingale fanatic.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Interpreting an icon

I had the privilege of working for nearly two decades at the Florence Nightingale Museum in St. Thomas’ Hospital in London. Contrary to many public perceptions of museums, the Nightingale Museum was a lively and, at times, hectic place, with a constant whirl of services to the visiting public and, behind the scenes, development of exhibition and education projects that involved historical research and planning. There were frequent discoveries of new material connected to Nightingale that required careful investigation and assessment before being communicated to the wider public. Only rarely was there time to sit down and actually read a book, and yet, like curators everywhere, my colleagues and I were required to know exactly what the significant books had to say on the subject. 

In my current work as a translator, I have the luxury of more time to read, think, and write, and I am very pleased to have the opportunity to write this Reflections on Nursing Leadership blog about Florence Nightingale, reflecting on the significance of her legacy today and the way in which her legacy is understood in different parts of the world.

With my background in museums and culture, I am interested in the global culture of nursing and the meaning of nursing icons for the modern world. It is clear to me that Nightingale has assumed quite different meanings at different times and places. It is probably needless to say that Nightingale had quite a different meaning in Meiji Japan compared to postapartheid South Africa. The reasons for these differences fascinate me, and I have continued to collect impressions and notes—from my time with the museum, from my work as a historical-tour leader and, latterly, as a translator living in Mexico.

Nightingale used to collect notes during the course of her work, from her direct experience or from the work and research of others, whose opinions she evaluated carefully. Some of her most important writings had “Notes” in the title, namely Notes on Hospitals, Notes on Nursing and Notes on Lying-In Institutions. These works, therefore, represented her accumulated thoughts on a particular topic and, in the case of Notes on Hospitals, the book went through a considerable period of refinement, being published in various editions. With this blog I aim to do something similar, to publish my own “Notes on Nightingale” on a wide variety of topics where I perceive that her views have particular relevance.

Last year, I authored a book, Illuminating Florence: Finding Nightingale's Legacy in Your Practice, in which I link quotes by Nightingale to nursing management, leadership, and theory. In that book, published by the Honor Society of Nursing, Sigma Theta Tau International, I also highlight the relevance of Nightingale’s vision and legacy to modern-day nurses. I have always taken a practical and nondoctrinaire approach to Nightingale’s relevance today. Modern nurses across the world do continue to take inspiration from her life’s work, her writings, and philosophy, and this should be the true measure of her iconic status, rather than using the image of Florence Nightingale somewhat in the manner of a plaster saint.

From my knowledge of the archives and my understanding of Nightingale’s legacy, nurses today are only now on the verge of a much deeper appreciation of her relevance. I look forward to playing my part in increasing awareness of Nightingale and helping to inspire nurses in their excellent and valuable work of caring for patients and improving the health of the people of the world.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.