August 8, 2020

Florence Nightingale on Nursing, Part 2: Ahead of Her Time or Obsolete in Ours?

Last week, I mentioned that I have recently begun to revisit some of the sources of my nursing knowledge and experience. As I attempt to “refine my professional identity,” I hope to strengthen what I have already found to be of value and extend it into new territory. I do not take the task lightly, and in this, as in all of my nursing life, I am seeking a way to practice with greater integrity and skill.

As I mentioned last week, one of the ways I will begin to take stock is to read Florence Nightingale’s Notes on Nursing, published in 1860, near the beginning of the American Civil War. Ever since I was a child, I have known the name Florence Nightingale as the “founder of modern nursing.” However, my earliest awareness of Nightingale’s status was never connected to the notion of nursing as a female-dominated field. Only as an adult, particularly while in nursing school, have I given conscious thought to the gender-related cultural understanding and gender disparities of nursing.

Why go so far back for inspiration, you might ask? After all, the entire world of Florence Nightingale is obsolete and has been for a long time, right? To be sure, some of what Nightingale wrote is obsolete from our contemporary perspective. For example, she begins her Notes with the general principle that

[A]ll disease, at some period or other of its course, is more or less a reparative process, not necessarily accompanied with suffering: an effort of nature to remedy a process of poisoning or of decay, which has taken place weeks, months, sometimes years beforehand, unnoticed, the termination of the disease being then, while the antecedent process was going on, determined[.]

Nightingale, Notes on Nursing, Introduction, paragraph 1

In this opening statement, Nightingale seems to suggest that the disease and the reparative process we intervene to treat are two different things and that the former may have ended long before our encounter with the latter. Clearly, this notion cannot account for all possible disease scenarios. For example, necrotizing fasciitis is an ongoing problem, not a process by which the human body repairs damage done by a disease in the past.

Still, there is something laudable and–in this day and age–refreshing about Nightingale’s outlook. Her underlying assumption seems to be that the human body engages in an intrinsically energized process of self-healing. Further, she seems to believe that

[T]he symptoms or the sufferings generally considered to be inevitable and incident to [a] disease are very often not symptoms of the disease at all, but of something quite different…. If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault not of the disease, but of the nursing.

Nightingale, Notes on Nursing, Introduction, paragraphs 3 and 5

In other words, we hinder the reparative process of Nature by our “lack of knowledge or attention” (Nightingale, Notes on Nursing, Introduction). This strikes me as similar to various alternate systems of health and disease that have developed throughout history. This may be because of the timing of Notes in the 1860’s. During the nineteenth century, there were many rival schools of thought in human health, many of which held in high esteem the self-healing capabilities of the human body.

It is precisely the self-healing capabilities of the body that have become the focus of so many in our society today. Think of all the self-help information available to us today in the form of books, posters, the internet and television, and personal trainers. Complementary and alternative medical approaches are fueled by this basic understanding of intrinsically-motivated health processes in the human body. Caring for my own family’s health issues has demonstrated to me the value of keeping an open mind concerning alternatives to the scientific (read: well-researched) medical perspective.

Nightingale seems to embrace the idea that her notes provide “hints for thought” rather than “rules of thought” for nursing. It seems that, for Nightingale, just as the reparative process of “disease” returns the human body to proper function through intrinsic processes, so Nightingale’s Notes are intended to foster the intrinsic and poetic knowledge of nursing, which she considered to be “all but unknown” (Nightingale, Notes on Nursing, Introduction, paragraph 7).

If the nature and meaning of nursing are unknown, as Nightingale suggests, then there is much work to be done to explore the territory of nursing. This need is even greater in view of various crises in society in general and healthcare in particular, which I would like to discuss in future posts. However, at least at this point, I am inclined to believe there is something still deeply relevant in Florence Nightingale’s Notes on Nursing.

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