Principles for a New Philosophy

 

Florence Nightingale laid the foundation for today's holistic nursing practice

 

 

 

Thursday June 23, 2011

 

Imagine nursing in a hospital where patients lay 18 inches apart on straw beds that cover the cold stone floor underneath. The sewage system is clogged, so the air is foul with the smell of human waste. Surgeries are performed in the open without the privacy of a screen. The nights are cold and dark, and most patients die in the hospital.

These were the conditions in which Florence Nightingale became convinced a patient’s environment was connected to his or her health — a revolutionary concept at the time. The year was 1854, and she was treating soldiers serving in the Crimean War. In those inhumane conditions, Nightingale practiced what later would be called holistic nursing — the concept that patients required a healthy mental, emotional, physical and spiritual environment to raise their odds of recovery.

“Nightingale was a foundational philosopher in the area of holistic nursing,” said Louise Selanders, RN, EdD, FAAN, an international Nightingale scholar and director of the master’s program in the College of Nursing at Michigan State University. “She understood that physicians would treat the disease, but nurses were the ones who could facilitate the healing environment by providing stimulating reading material, emotional connections and proper nutrition. Nightingale saw that this combination of care from physicians and nurses could improve the health of the population.”

 

Holism in desperate circumstances

 Nightingale’s environmental theory stemmed from her core belief that nursing was in essence an act of using the environment to assist the patient in his or her recovery. She believed nurses could use sunlight, fresh air, pure water, cleanliness and efficient drainage to allow nature to positively affect the patient’s body, mind and spirit.

“In Scutari, she fought hard to help the soldiers get proper nutrition,” said Susan Hassmiller, RN, PhD, FAAN, senior adviser for nursing for the Robert Wood Johnson Foundation. Hassmiller retraced Nightingale’s footsteps during a trip to London and Turkey in July 2010. “Food was very scarce, and there were a lot of problems with supplies being held up in the storerooms and not being distributed to the patients,” she said.

Nurses not only could influence the patient’s environment by meeting his or her needs for items such as food and clean water, but nurses themselves also were part of that environment.

“Nightingale saw that nurses could be a healing presence to patients,” said Barbara Dossey, RN, PhD, AHN-BC, FAAN, international co-director of the Nightingale Initiative for Global Health and co-director of the Integrative Nurse Coach Association. “She believed nurses should not go in angry and frustrated, but convey a sense of calmness and intention.”

 

‘Lamp’ legend is born

 Nightingale offered this kind of emotional and spiritual comfort when she walked down the long, dark halls with her lamp to care for sick and dying men — the practice that earned her the nickname “Lady with the Lamp.”

“Imagine a big hall that is three stories high and two football fields long, and in the dark these men would see Nightingale walking with her lamp to check on them,” said Deva-Marie Beck, RN, PhD, international co-director of the Nightingale Initiative for Global Health. “She was bringing them a sense of hope and reassurance on a spiritual level.”

To care for the soldiers psychologically, Nightingale insisted no man die alone. A nurse would be present whenever a soldier was close to death. To comfort them during their suffering, Nightingale insisted she be present during every surgery — no matter how gruesome. She also understood that connection to family was important for the sick, and she helped the soldiers in the hospital write letters home because many could not read or write.

When Nightingale saw that limb amputations were performed in the open with no regard for the patient’s sense of dignity, she created screens to afford them some privacy.

“She believed that nurses needed to speak up when things were not right,” Hassmiller said.

Nightingale not only saw the interplay between the environment and the patient, but she also believed the cultural, social and economic ills of society could affect the health of individuals, according to Beck. For example, she would consult with viceroys in India about issues, such as deforestation and outrageous interest rates in the country, that she believed were affecting the health of the population, Beck said.

“Nightingale sets an important example when we think about issues such as the greening of hospitals and clinics,” Dossey said. “Dioxin, for example, is one of the deadliest chemicals, and hospitals are a large source of dioxin air pollution. Issues like this should not be ignored.”

 

Practice what you preach

 When Nightingale returned from Scutari, she had another opportunity to put into practice the concepts of holistic nursing, but this time she was the patient. She had contracted Crimean fever, today recognized as Mediterranean fever, or chronic brucellosis, which caused her severe spinal pain for many years.

“She took a holistic approach to her own health,” Beck said. “She read from spiritual books to nurture herself, and she wrote in a journal about what she was experiencing. She also had cats on her bed to comfort her and flowers in her room.”

Another key component of Nightingale’s holistic nursing philosophy was the concept of self-care. She believed nurses needed to take care of themselves spiritually, emotionally and physically to be agents of healing for their patients.

“During her commencement essays to nursing students, she encouraged nurses to ask themselves why they are doing this work,” Beck said. “Through their own spiritual discipline, they could get back in touch with their calling as a nurse, and nurses needed to remember this to sustain themselves.”

One important way nurses today can practice self-care is by addressing areas of suffering in their own lives, Dossey said. Whether it be physical or emotional distress, Dossey said it is important to recognize that nurses who pursue healing in these areas personally will be better able to offer holistic care to their patients.

“I know a lot of hospitals only give lip service to self-care,” Dossey said. “Unfortunately, due to the pace of work in hospitals, many nurses have lost touch with how to take care of themselves, but it is important to make it a priority.”

Nurses, for example, can practice self-care by taking short breaks several times during the day and refueling themselves with nutritious meals during their shifts, Dossey said.

Although the demands of nursing in today’s healthcare system make it difficult to live out the principles of holistic care, Dossey said it is not impossible.

“Holistic nursing is a philosophy,” she said. “The pace in the hospitals is intense, but it only takes one or two minutes to ask patients how they are doing. If they are anxious, you can take their hands for a moment or help them take a deep breath. That small moment has incredible power to heal.”