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Plato, Nightingale, and Nursing: Can You Hear Me Now? Jacqueline Michele Arnone, MSN, RN, and Virginia Fitzsimons, EdD, RNC, FAAN Jacqueline Michele Arnone, MSN, RN, is Adjunct Professor of Nursing, and Virginia Fitzsimons, EdD, RNC, FAAN, is Professor, PhD Program Coordinator, School of Nursing, Kean University, Union, New Jersey.
Search terms: Nightingale, nursing, Plato Author contact: [email protected], with a copy to the Editor: [email protected]
PURPOSE: A historical perspective on how the writings of Plato influenced Florence Nightingale in the formation of nursing as a respected profession for women. Comparing Nightingale’s life and legacy to Platonic philosophy demonstrates how philosophy continues to speak to the profession of nursing practice as guardians of society in the 21st century. METHODS: A review of the literature using EBSCO, SAGEpub, MEDLINE, and CINAHL databases and hand searches of literature were initiated for the years 1990–2014 using the terms “Plato,” “Nightingale,” and “nursing” restricted to English. FINDINGS: Florence Nightingale, known as the mother of modern-day nursing, embodied her life and work after the philosophic tenets of Plato. Plato’s Allegory of the Cave influenced Nightingale’s attitudes with regard to the value of education, knowledge of the good, and the importance of imparting learned knowledge to others. Plato’s work spoke of educating both men and women to seek the truth, affording both sexes to become competent as future leaders in the role of guardians to society. Nightingale’s emphasis of education for women as a conduit for their usefulness to society mirrored Plato’s philosophy. CONCLUSION: Over 100 years after her death, the impact Florence Nightingale still has on professional nursing practice remains. Scholarship in nursing education today is infused with a liberal arts background in philosophy, ethics, and the sciences. Nightingale’s holistic concepts of person, health, and environment in the practice of nursing coalesced with her statistical analyses in validating nursing actions foreshadowed the development of universal nursing knowledge and language base and meta-paradigm concepts in nursing. Further classification and categorization of Nightingale’s concepts of assessing, implementing, and evaluating delivery of care became the linguistic precursors for the identification of nursing process, nursing actions, and nursing diagnoses. NURSING IMPLICATIONS: Plato’s and Nightingale’s holistic, scientific, and humanistic approach to living, and to care practice in all its dimensions, grounds the discipline of nursing in a liberal arts and critical thinking matrix, elevating nursing to higher ethical, safe, and professional levels of standards.
You ask me why I do not write something . . . I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results. (Nightingale, 1844, Letter to a friend, quoted in The Life of Florence Nightingale [1913] by Edward Tyas Cook, p. 94) Florence Nightingale, known as the founder of modernday nursing and the “lady with the lamp” (McDonald, 2010), truly embodied and modeled her life and work after the great philosopher Plato. She is well known for nursing the sick and wounded during the time of the Crimean War 156
(1854–1856) and for “popularizing nurse training which led to the establishment of a new profession for women” (Attewell, 1998, p. 153). Importantly, yet less talked about, was Nightingale’s expertise as a prolific researcher, statistician, military and lay hospital reformer, advocate, and social policy reformer. McDonald (2010) notes, She had a vision of a comprehensive health care system, and even the core principles of what would become the welfare state, with a system of agencies for the care of the aged, long-term infirm, disabled and children of © 2014 NANDA International, Inc. International Journal of Nursing Knowledge Volume 26, No. 4, October 2015
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destitute parents, and some measures for income security. (p. 722) Additionally, Nightingale’s concepts of person, health, and environment in the practice of nursing, coalesced with her use of statistical analyses in validating nursing actions, would foreshadow the future development of universal nursing knowledge and language base. Yet it was the works of the philosopher Plato that influenced Nightingale in her attitudes regarding the value of education, knowledge of the good, and the importance of imparting learned knowledge to others. Plato, student of Socrates, made significant contributions during his lifetime in establishing the Academy and in “immortalizing Socrates in writing” (Christian, 2006, p. 52). Plato’s written work spoke of the importance of educating both men and women to seek the truth. This truth would lend both sexes to become competent as future leaders in society, “where the truths could be put to work” (Christian, 2006, p. 53). Also known for his views on women’s rights and their usefulness to society, Plato felt that it “was a waste of woman-power to seclude women in their homes, when they could be performing useful tasks . . . just as men were, for the benefit of the community” (Craik, 1990, p. 223). Nightingale’s emphasis of the importance of education for women and their usefulness to society mirrored Plato’s philosophic tenet. It was Nightingale’s “words put to action” that impacted the development of nursing as a respected profession, the establishment of the concept of holism in nursing care and whose work that would become the foundation for change in health care in society, and foreshadowed the development of the discipline of professional nursing practice. Her education in philosophy and the classics would serve as the proponents for her direction and purpose in life and become the underpinnings of Nightingale’s nursing. The unconventionality of an upper-class Victorian woman to be so bold in her commitment to apply her education and social status to reform society through caring for the disenfranchised was nothing short of revolutionary. A comparative analysis of Nightingale’s life to Platonic philosophy will demonstrate how philosophy continues to speak to nursing today in the twenty-first century as guardians of society. Platonic Philosophy and Nightingale Plato Plato, a student of Socrates, made significant contributions during his lifetime in establishing the Academy and in “immortalizing Socrates in writing” (Christian, 2006, p. 52). His students included men and women from all over Greece who devoted their lives to a “demanding program of study that included literature, history, music, mathematics, geometry and philosophy” (Christian, 2006, p. 52). Plato had a very clear foresight of his intentions. He believed
“that truth must be universal” (Christian, 2006, p. 53). For Plato, mathematics and geometry were conduits in discovering universal truths, for their premise and application were based on reason versus perception (Christian, 2006). Educating both men and women to seek the truth would lend them to become competent as future leaders “where the truths could be put to work” (Christian, 2006, p. 53). Also known for his views on women’s rights and their usefulness to society, Plato felt that it “was a waste of womanpower to seclude women in their homes, when they could be performing useful tasks . . . just as men were, for the benefit of the community” (Craik, 1990, p. 223). Plato’s Allegory of the Cave elucidates the evolution of the psyche in the perception of reality from a basic level of comprehension to a higher level of intellect that constitutes a more replete and progressive discernment of reality. Contrasting between the perspicacity of experiencing the world through senses or pure reason, Plato used forms and shadows their forms as a platform in creating this distinction (Plato, trans. 1979). Plato’s forms are changeless entities, identified by reason, and provide objects of reality. Conversely, sensate encounters (shadows on the walls) are in constant flux in the practical world, and therefore when experienced only initiate the formation of opinions (Plato, trans. 1979). Plato posits that the perfect and permanent form of objects in the material world exist without flux outside of a person’s senses, and space and time. Plato calls this other place the Realm of Forms (Plato, trans. 1979). In the cave allegory, Plato uses Socrates as the main orator. Socrates speaks with Glaucon, in an effort to symbolize what Socrates denotes as the good. Socrates uses the sun as a simile to assist his explanation. He makes a comparison between the good that is the foundation for splendor and verity, and the sun, which is the cause for illumination and energy (Plato, trans. 1979). Socrates posits to Glaucon that as the sun is the reason the world endures and renders it able to be seen, good triggers all that is comprehensible to be and makes it intelligible (Plato, trans. 1979). In the allegory, highly schooled and uneducated conditions are contrasted to their existence in the illumination of the sun, where objects are viewed as they appear, versus living in a cave where reality is skewed from the shadows on the cave’s walls (Plato, trans. 1979). Prisoners are chained together in a cave and their only vision of the world is depicted through shadows of forms that are cast on the cave wall in front of them. Shadows of those forms are cast by a fire that is, unbeknownst to the prisoners, lit behind them. A narrow walkway exists between the fire and the prisoners. As people go in and out of the cave, objects are held up in front of the fire, creating shadows on the cave wall. Those chained in the cave have a very small worldview and perception of reality. Their reality and perception of the world exist only as shadows of the forms on the cave wall. Therefore, their sensate experience provides the chained prisoners only opinions about the shadows of the forms, and not a true reality of the object. 157
Plato, Nightingale, and Nursing: Can You Hear me Now? The allegory continues as one of the chained prisoners is freed and able to go out of the dark cave into the light. The freed prisoner, after seeing all of the objects as they actually appear in the light outside of the cave, comes to the realization that there was much more to the world than just the shadows of the forms on the cave wall. Now, seeing the good (the sun) and the objects in the sun as they appear, the prisoner returns to the cave to tell the other prisoners of the larger world that exists outside of the cave. However, when the freed prisoner returns to the darkness of the cave, he is met with resistance from the others who remained chained. The enlightened prisoner is mocked and even thought to be mad, but he remains with the others in hopes of educating them as it is his duty and calling to service (Plato, trans. 1979). Plato’s idea of public service is aligned with service suitable to a guardian (Plato, trans. 1979). The formation of moral character was the basic tenet of education for guardians (LeVasseur, 1998). The point of liberal education is to make those who were once cloistered in society into people of the public. Their primary job is to first care for the good of society (Plato, trans. 1979). For Plato’s ideal political community, leaders take the role of philosopher kings. This cohort’s responsibility is to the public. Through reason and knowledge of the good, philosopher kings fashion resolutions that are paramount in importance to the community as a whole (Plato, trans. 1979). Using the cave allegory, the guardians and philosopher kings need to find a means to escape the cave, be educated in the good through philosophy, and return to the cave to enlighten the others who remain chained (Plato, trans. 1979). LeVasseur (1998) writes, “In Plato’s account, the true political function, largely neglected in actual politics, is the guardian function” (p. 282). Nightingale Plato’s tenets of societal function, education, and mathematics were significant parts of his philosophy, which Nightingale modeled. She strove to find means to utilize her education through educating others and addressing important societal issues. LeVasseur asserts that “it was not enough for Nightingale to have knowledge of the good, but it was imperative to put that knowledge into action as a guardian of the people” (1998, p. 282). Critical of the lack of formal education available to women in her day, Nightingale wrote extensively in forms of letters, notes, and pamphlets on the rationale of education. This was before she had an outlet for her training and education at the age of 31 (McDonald, 2010). Nightingale’s life and writings mirrored the Platonic philosophy of service and the good in an ideal society. Inculcating her broad knowledge into her life’s work was most notable on the impact she had on “choosing to impact policy rather than exercising power” (Attewell, 1998, p. 153). Nightingale disseminated her nurse training schools around the world. She reformed military and lay hospitals, 158
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and reformed sanitation issues. Nightingale’s efforts to create a respected profession for women was largely due in part to her belief that her role as a guardian was to demonstrate the good though service to all humankind in society. LeVasseur (1998) states that “[a]lthough Nightingale agonized over finding her true purpose in life, the one for which she was best suited, there can be little doubt into which stratum of Plato’s society she would have placed herself—that of the societal guardian” (p. 283). Nightingale: Early Years Nightingale was born to an aristocratic Christian family in Victorian England. She was educated along with her older sister by her father in “modern and ancient languages, history, composition, and philosophy” (LeVasseur, 1998, p. 281). Monros-Gaspar (2008) cites that a governess was also employed in the Nightingale home to educate the girls in courses of art and music. Educated in the classics from Cambridge University in England, Nightingale’s father William crafted much of Florence’s atypical education around the great philosophers. Young Florence quickly developed a penchant for philosophy as well as a thirst for the quest of additional knowledge. Deeply immersed in classical education and mythology, Nightingale’s proclivity for translating many of the Greek classics (LeVasseur, 1998) led to the creation of her manifesto, Cassandra (1979 [1852]), in which she wrote of the “boredom and socially enforced triviality of women’s lives in Victorian England” (LeVasseur, 1998, p. 281). Her education and her “intellect provided her with the ability to win the admiration of many eminent men of the time” (Sellman, 1997, p. 6). Nightingale sought for a more useful purpose in life. Coalesced with her frustration of the conventionality of upper-class Victorian women, Nightingale strongly believed that her duty and usefulness went beyond the accepted societal conventions and mannerisms of the women of her day. Sellman (1997) writes, “There was very little prospect of any meaningful employment because she (Nightingale) was part of the privileged minority for whom work was not considered an option” (p. 7). Impact on Nursing Practice Nightingale posited that discipline as it related to education was an “ability to continue to learn, becoming yet more finely tuned to the service of humanity” (Dossey, Selanders, Beck, & Attewell, 2005, p. 165). Additionally, she wrote extensively on how people seem to place greater importance on the remedy of an illness above health promotion (Dossey et al., 2005). Nightingale distinguished that the promotion of health and healing and the mitigation of affliction from infirmity and injury were dual interlinking components in the role of the nurse. Therefore, to Nightingale, “identifying, delivering and strengthening the factors that
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support health . . . and emphasized positive healthdetermining factors . . . creating health-promoting environments at the bedside, within the home, in the community, across regions and nations and for the world” (Dossey et al., 2005, p. 179) were paramount to nursing. Her views led nurses’ actions to promote health, not cure disease. Nightingale’s work during the Crimean War is her best known endeavor. Nightingale became celebrated for her “sick nursing” during the Crimean War, yet she maintained a keen focus on health nursing and health promotion (Nelson & Rafferty, 2010, p. 131). Plato’s influence and high esteem for mathematics in finding universal truths can be correlated to Nightingale’s work. Her keen observational skills and detailed record keeping during her time in Crimea led to her work in providing the first known application of statistics through graphs and pie charts (Nelson & Rafferty, 2010). The results of her statistical analysis demonstrated how fresh air, light, warmth, cleanliness, quiet, and diet greatly affected the mortality rates of soldiers during the Crimean War (Nelson & Rafferty, 2010). Patient safety (as it is called today) arose from Nightingale witnessing many deleterious incidents during her time in Crimea (Clements & Averil, 2006). Nightingale studied what interventions worked and what did not in order to decrease injury or death to patients (Woodward, 2011). After the war ended, her profound experiences in Crimea became the impetus for championing patient safety through political lobbying for army reform. Like Plato’s freed prisoner returning to the cave to enlighten others and facing hostility from those who remained chained, Nightingale refused to give up disseminating knowledge even in the face of adversity. Nightingale continued utilizing the application of statistics to support her interventions in nursing after the war to enact additional reforms. Some examples of the results of her work included discerning mortality rates between hospitals and lying-in hospitals, participating in the design of architectural blueprints for building new hospitals and the hospital’s physical layout, as well as addressing sanitation issues both in London and abroad and the impact poor sanitation had on health (Nelson & Rafferty, 2010). Nightingale’s work in using statistics as a means to find the universal truth as to why something occurred, what could be done to change the problem, and evaluating patient outcomes mirrors current issues of patient safety and patient-centered outcomes research today. Her political activism and advocacy for the military hospitals would serve as the foundation for her future reformation work (Nelson & Rafferty, 2010). Yet Nelson and Rafferty (2010) state, In order to understand the difficult decisions she (Nightingale) had to make, we must place Nightingale beyond the narrower context of nursing reform into a broader framework: the Victorian constraints on ladies which made exercising authority in a male organization so problematic, the complex interrelationships of Victorian
religious sectarianism and politics, and the political nature of the mission. (p. 52) Several factors, stemming from the basic tenets of Victorian society, increased the difficulty Nightingale had on exacting her mission (Nelson & Rafferty, 2010). Those factors were working with a disparate cohort of females, customarily segregated during this time period. These women did not, at many times, accept Nightingale’s authority. They did not possess the same level of education or knowledge to be able to perform the nursing tasks required to render care to the infirm soldiers. Second, Nightingale needed to breach the Victorian custom of ladies effecting influence in the public arena. The most problematic and politically sensitive factor was Nightingale’s ability to steer through the sectarian polemic (Nelson & Rafferty, 2010). Even though Nightingale faced these imperceptible obstacles, her determination and understanding of the need for military reform during the war in Crimea effused her ability to inculcate her knowledge to exact her objectives. They were the provision of excellent nursing care to the sick and wounded, hospital, environmental and policy reform, advocacy, and research. Impact on Nursing Knowledge Gordon (1998) writes, The world is complex. Human beings tend to manage the complexity by breaking up experiences into manageable components that have meaning. These components are stored as mental representations, or concepts, that permit thinking when the object is not present. Naming of concepts permits recognition and communication with others; grammatical rules for combining concepts permits thoughts to be shared through language, and concepts within a classification system permit organization of ideas (Introduction section, para. 1). The association amidst the concepts is the foundation for the structure of knowledge in a discipline. In nursing, identifying the significance of clinical science has “constructed concepts, theories and classification systems to further scientific development and patient care” (Gordon, 1998, Introduction section, para. 3). Nightingale was the first nurse theorist who “viewed nursing as having organized concepts and social relevance distinct from medicine” (Shaw, 1993, p. 1651). Attewell (2010, p. 102) writes, “Florence Nightingale developed a body of nursing knowledge clearly expressed in the 79 pages of Notes on Nursing: What it is and what it is not (Nightingale, 1969).” The booklet, an assemblage of her clinical observations while working with patients in London hospitals and the Crimean War, imparted instructional erudition and canons of nursing practice (Clements & Averil, 2006). Additionally, Nightingale’s letters, notes, and pamphlets would provide the language, knowledge, and 159
Plato, Nightingale, and Nursing: Can You Hear me Now? subsequent standards of care that future nurses would utilize to inform their practice in London and abroad in the United States (Dossey et al., 2005). Nightingale’s methodical process for nursing included assessing, or reassessing, implementing, and then evaluating the care delivered (Clements & Averil, 2006). These concepts constructed by Nightingale, once further categorized and classified, became the linguistic precursors for identifying nursing process, nursing actions, and nursing diagnoses. Nightingale (1969) said, I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient. (p. 5) The attributes Nightingale ascribed to nursing in the above quote delineate the “standards and thoroughness in the fundamentals of care that Nightingale insisted on and cherished above all else” (Nelson & Rafferty, 2010, p. 138). Her attributes of person, health, and environment foreshadowed what nursing today refers to as the metaparadigm concepts in the discipline (Dossey et al., 2005, p. 45) and holism in nursing practice. Nightingale’s attributes would also become the building block for future theoretical and conceptual frameworks in nursing. Gordon (1998) stated, “Historically modern nursing based on the Nightingale model used disease entities from medical classifications to organize their thinking, speaking and writing. These were the only concepts available in health care delivery up to the middle of the 20th Century” (Historical Perspective on Nursing Classifications Systems section, para. 1). Therefore, “basic structures for knowledge development in nursing had to await the introduction of theories and philosophies of nursing in the 1950’s” (Historical Perspective on Nursing Classifications Systems section, para. 2). Clements and Averil (2006) posit, “Nightingale contributed to the values that nursing has placed on theory development and implementation into practice . . . Many of her fundamental concepts are still foundations for nursing practice today” (p. 273). Nursing in the Twenty-First Century Selanders and Crane (2012) write, Modern nursing is complex, ever changing, and multi focused. Since the time of Florence Nightingale, however, the goal of nursing has remained unchanged, namely to provide a safe and caring environment that promotes patient health and well-being. (para. 1)
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Over 100 years later after her death, the impact Florence Nightingale still has on professional nursing practice remains. Scholarship in nursing education today is infused with a liberal arts background in philosophy, ethics, and the sciences. This has become the cornerstone of nursing education. Current evidence-based research and dissemination of research findings have underpinnings from Nightingale’s early work in Crimea. Gunther (2009) stated, Nursing knowledge development is an integrated process emerging from examination of actual practice. Theories arising from practice define both the mission and the language of the discipline, allowing scholars to identify questions to be explored for refinement of scientific theory. These situation specific theories then re-energize and reform practice. (p. 146) For Nightingale, the issues of her day were the impetus for her work in the establishment of nursing practice and social, political, and environmental reform. Nightingale’s contributions were in the legitimization of nursing for women, nursing education, hospital administration, statistics and research, patient safety, and social and environmental activism. It is evident that the great philosophers spoke to her, and she wove those philosophic underpinnings into what nursing practice is today. What is past is prologue. Today, over 150 years after the establishment of nursing, “Nightingale’s legacy not only remains, but has never been so important” (Lee, Clark, & Thompson, 2013, p. 245). Professional nurses continue to be involved in social, environmental, and global issues as they relate to health care. Nightingale’s influences in professional nursing practice are evident in many areas of the discipline. They include education, research, nursing care standards, nursing process, nursing diagnoses, and nursing theory. Additionally, she impacted social, environmental, and health reform (both locally and globally), as well as public health policy, disease prevention, and health promotion, and practicing within an interdisciplinary team, which are all evident today. Issues of patient safety, health promotion, disease prevention, and patient-centered outcomes research measures mark the center of current professional nursing practice. Dossey (2010) writes, “Nightingale’s work was social action that demonstrated and clearly articulated the science and art of an integrated worldview of nursing, health care, and humankind” (p. 15). To Nightingale, health was a priority for all, and she employed a “grassroots-toglobal nursing practice” (Dossey, 2010, p. 15). Recognizing the share that power politics played in environmental and public health reform, Nightingale oftentimes had adversarial encounters with partisan powerhouses. Those particular encounters would prove to serve as allocutions in subsistence as well as how to “compete with men” (Gourlay, 2004, p. 15). Not much has changed 150 years later. With the advent of the current healthcare reform in the United States in practice, the profession of nursing stands
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at the precipice of shifting the face of health care. Equity of care across all demographic strata is the cornerstone of global health care today. The aforementioned issues Nightingale faced are no different than the global challenges nursing faces today. Effecting reform through policy either at the institutional, state, national, or global levels is at the forefront of issues of health care and nursing. These issues continue to be contentiously debated in the political arena. Gunther (2009) concludes, We must give our attention to both marginalized and privileged populations. We can best do this by changing our view of human health within a practice of language and concepts shared with other disciplines. Through focused programmes of research with the goals of prevention, empowerment and health, nursing can contribute to the knowledge that drives policy changes to achieve social justice and equity. (p. 146) What Gunther (2009) writes is the essence of Nightingale’s legacy. The equitable delivery of care across all demographic strata and working in concert with other disciplines to effect programs and policies to promote health promotion and disease prevention in varying populations around the world are all Nightingale’s tenets. Nurses must think globally but act locally. Plato spoke to Nightingale. Nightingale spoke to nursing. The voices of Plato and Nightingale can still be heard within the practice of professional nursing today. Conclusion Florence Nightingale, also known as the “lady with the lamp” and the mother of modern-day nursing, was more than the sum of her parts. Schooled by her father in the classics, mathematics, and mythology, it was the philosopher Plato that spoke to her. Plato’s philosophy helped shape her view of the role of education and knowledge of the good. Nightingale showed disdain and uselessness for the conventionality of the lives of upper-class Victorian women. Therefore, she set out to find a deeper purpose and more meaningful usefulness to society. Nursing became that focus. Nursing became her “must” (Dossey, 2005, p. 57) in establishing nursing as a respected profession for women. McDonald (2013) said, Nightingale’s contribution to nursing began with the founding of her school, which sent out teams of trained matrons and nurses throughout Britain and the world. This work raised nursing from its unsavory past as a poor-paying job, with benefits from bribes and the patient’s gin, to a new profession, with ethical standards and (increasingly rigorous) skill requirements. (p. 542) Nightingale’s work in the Crimean War laid the backdrop for the advancement of nursing practice. Her work was the
stepping stone for effecting patient safety measures through the reform of military hospitals and social reform efforts in England and abroad. Continued education, advocacy, research, and social reform as a part of nursing practice continue to be evident today. Provision of equitable delivery of nursing care across all demographic and cultural strata, the collaboration with transdisciplinary teams in the provision of health care, advocating for clients and health policy reform, and designing and implementing research projects to advance the standards of care all harken back to Nightingale. Dossey (2005) asserts that Nightingale was a sage, futurist, healer, activist, environmentalist, feminist, practitioner, scientist, politician, and global citizen. Her individual triumphs reflected on today are surprising when observed alongside the milieu of her time. Nightingale’s contributions to nursing theory, nursing knowledge, education, research, statistics, public health, and healthcare reform are nothing short of unique and stimulating. A courageous adventurer of health, Nightingale retained rare prescience, attention, perseverance, and duty to her calling. Her precepts of healing, leadership, and worldwide engagement bestow contemporary nurses with foresight for a salubrious world (Dossey, 2000; Dossey et al., 2005). As Plato wrote, one can either choose to seek freedom from the cave and return to it with the knowledge of the good to enlighten others, or they can remain chained inside the cave with a skewed perception of reality. In order for nursing to be able to address the current global issues facing the profession today, attention needs to focus on the profession of nursing practice’s goal of the provision of care for the good of all persons and society. The words of Plato still speak to professional nursing practice as nursing continues to seek the knowledge of the good and enlighten others. This fact is evident through continued scholarship, propagation, and dissemination of research effecting evidence-based practice in the extant literature and policy implementation at all levels. Let us continue to use Plato and Nightingale’s philosophical tenets as templates in advancing the standards of care in professional nursing practice. As a globally unified voice and in a universal language, let us follow Nightingale’s vision and put our own words into actions that bring results. The future of professional nursing practice stands at the crossroads of change in health care. Nursing has the unique opportunity to be that beacon which lights the way as guardians of society in the twenty-first century. This is our “must.”
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LeVasseur, J. (1998). Plato, Nightingale and contemporary nursing. Journal of Nursing Scholarship, 30(3), 281–285. McDonald, L. (2010). Florence Nightingale a hundred years on: Who she was and what she was not. Women’s History Review, 19(5), 721–740. doi:10.1080/09612025.2010.509934 McDonald, L. (2013). What would Florence Nightingale say? British Journal of Nursing, 22, 542. Monros-Gaspar, L. (2008). The voice of Cassandra: Florence Nightingale’s Cassandra (1852) and the Victorian women. New Voices in Classical Reception Studies, 3, 61–76. Retrieved August 31, 2014, from http:// www2.open.ac.uk/classicalstudues/GreekPlays/newvoices/issue%203/ MonrosGaspar.doc Nelson, S., & Rafferty, A. M. (2010). Notes on Nightingale: The influence and legacy of a nursing icon. Ithaca, NY: IRL Press-Cornell University. Nightingale, F. (1969). Notes on nursing: What it is and what it is not. Dover: New York. Plato. (1979). The Republic. R. Larson (Trans.). Arlington Heights, IL: Harlan Davidson. Selanders, L. C., & Crane, P. C. (2012). The voice of Florence Nightingale on advocacy. Online Journal of Issues in Nursing, 17(1). doi:10.3912/ OJIN.Vol17No01Man01 Shaw, M. C. (1993). The discipline of nursing: Historical roots, current perspectives, future directions. Journal of Advanced Nursing, 18, 1651–1656. doi:10.1046/j.1365-2648.1993.18101651.x Woodward, S. (2011). Review: Patient safety: A core value of nursing—So why is achieving so difficult? Journal of Research in Nursing, 16(3), 224–225. doi:10.1177/1744987110393544.
Plato, Nightingale, and Nursing: Can You Hear Me Now? Jacqueline Michele Arnone, MSN, RN, and Virginia Fitzsimons, EdD, RNC, FAAN Jacqueline Michele Arnone, MSN, RN, is Adjunct Professor of Nursing, and Virginia Fitzsimons, EdD, RNC, FAAN, is Professor, PhD Program Coordinator, School of Nursing, Kean University, Union, New Jersey.
Search terms: Nightingale, nursing, Plato Author contact: [email protected], with a copy to the Editor: [email protected]
PURPOSE: A historical perspective on how the writings of Plato influenced Florence Nightingale in the formation of nursing as a respected profession for women. Comparing Nightingale’s life and legacy to Platonic philosophy demonstrates how philosophy continues to speak to the profession of nursing practice as guardians of society in the 21st century. METHODS: A review of the literature using EBSCO, SAGEpub, MEDLINE, and CINAHL databases and hand searches of literature were initiated for the years 1990–2014 using the terms “Plato,” “Nightingale,” and “nursing” restricted to English. FINDINGS: Florence Nightingale, known as the mother of modern-day nursing, embodied her life and work after the philosophic tenets of Plato. Plato’s Allegory of the Cave influenced Nightingale’s attitudes with regard to the value of education, knowledge of the good, and the importance of imparting learned knowledge to others. Plato’s work spoke of educating both men and women to seek the truth, affording both sexes to become competent as future leaders in the role of guardians to society. Nightingale’s emphasis of education for women as a conduit for their usefulness to society mirrored Plato’s philosophy. CONCLUSION: Over 100 years after her death, the impact Florence Nightingale still has on professional nursing practice remains. Scholarship in nursing education today is infused with a liberal arts background in philosophy, ethics, and the sciences. Nightingale’s holistic concepts of person, health, and environment in the practice of nursing coalesced with her statistical analyses in validating nursing actions foreshadowed the development of universal nursing knowledge and language base and meta-paradigm concepts in nursing. Further classification and categorization of Nightingale’s concepts of assessing, implementing, and evaluating delivery of care became the linguistic precursors for the identification of nursing process, nursing actions, and nursing diagnoses. NURSING IMPLICATIONS: Plato’s and Nightingale’s holistic, scientific, and humanistic approach to living, and to care practice in all its dimensions, grounds the discipline of nursing in a liberal arts and critical thinking matrix, elevating nursing to higher ethical, safe, and professional levels of standards.
You ask me why I do not write something . . . I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results. (Nightingale, 1844, Letter to a friend, quoted in The Life of Florence Nightingale [1913] by Edward Tyas Cook, p. 94) Florence Nightingale, known as the founder of modernday nursing and the “lady with the lamp” (McDonald, 2010), truly embodied and modeled her life and work after the great philosopher Plato. She is well known for nursing the sick and wounded during the time of the Crimean War 156
(1854–1856) and for “popularizing nurse training which led to the establishment of a new profession for women” (Attewell, 1998, p. 153). Importantly, yet less talked about, was Nightingale’s expertise as a prolific researcher, statistician, military and lay hospital reformer, advocate, and social policy reformer. McDonald (2010) notes, She had a vision of a comprehensive health care system, and even the core principles of what would become the welfare state, with a system of agencies for the care of the aged, long-term infirm, disabled and children of © 2014 NANDA International, Inc. International Journal of Nursing Knowledge Volume 26, No. 4, October 2015
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destitute parents, and some measures for income security. (p. 722) Additionally, Nightingale’s concepts of person, health, and environment in the practice of nursing, coalesced with her use of statistical analyses in validating nursing actions, would foreshadow the future development of universal nursing knowledge and language base. Yet it was the works of the philosopher Plato that influenced Nightingale in her attitudes regarding the value of education, knowledge of the good, and the importance of imparting learned knowledge to others. Plato, student of Socrates, made significant contributions during his lifetime in establishing the Academy and in “immortalizing Socrates in writing” (Christian, 2006, p. 52). Plato’s written work spoke of the importance of educating both men and women to seek the truth. This truth would lend both sexes to become competent as future leaders in society, “where the truths could be put to work” (Christian, 2006, p. 53). Also known for his views on women’s rights and their usefulness to society, Plato felt that it “was a waste of woman-power to seclude women in their homes, when they could be performing useful tasks . . . just as men were, for the benefit of the community” (Craik, 1990, p. 223). Nightingale’s emphasis of the importance of education for women and their usefulness to society mirrored Plato’s philosophic tenet. It was Nightingale’s “words put to action” that impacted the development of nursing as a respected profession, the establishment of the concept of holism in nursing care and whose work that would become the foundation for change in health care in society, and foreshadowed the development of the discipline of professional nursing practice. Her education in philosophy and the classics would serve as the proponents for her direction and purpose in life and become the underpinnings of Nightingale’s nursing. The unconventionality of an upper-class Victorian woman to be so bold in her commitment to apply her education and social status to reform society through caring for the disenfranchised was nothing short of revolutionary. A comparative analysis of Nightingale’s life to Platonic philosophy will demonstrate how philosophy continues to speak to nursing today in the twenty-first century as guardians of society. Platonic Philosophy and Nightingale Plato Plato, a student of Socrates, made significant contributions during his lifetime in establishing the Academy and in “immortalizing Socrates in writing” (Christian, 2006, p. 52). His students included men and women from all over Greece who devoted their lives to a “demanding program of study that included literature, history, music, mathematics, geometry and philosophy” (Christian, 2006, p. 52). Plato had a very clear foresight of his intentions. He believed
“that truth must be universal” (Christian, 2006, p. 53). For Plato, mathematics and geometry were conduits in discovering universal truths, for their premise and application were based on reason versus perception (Christian, 2006). Educating both men and women to seek the truth would lend them to become competent as future leaders “where the truths could be put to work” (Christian, 2006, p. 53). Also known for his views on women’s rights and their usefulness to society, Plato felt that it “was a waste of womanpower to seclude women in their homes, when they could be performing useful tasks . . . just as men were, for the benefit of the community” (Craik, 1990, p. 223). Plato’s Allegory of the Cave elucidates the evolution of the psyche in the perception of reality from a basic level of comprehension to a higher level of intellect that constitutes a more replete and progressive discernment of reality. Contrasting between the perspicacity of experiencing the world through senses or pure reason, Plato used forms and shadows their forms as a platform in creating this distinction (Plato, trans. 1979). Plato’s forms are changeless entities, identified by reason, and provide objects of reality. Conversely, sensate encounters (shadows on the walls) are in constant flux in the practical world, and therefore when experienced only initiate the formation of opinions (Plato, trans. 1979). Plato posits that the perfect and permanent form of objects in the material world exist without flux outside of a person’s senses, and space and time. Plato calls this other place the Realm of Forms (Plato, trans. 1979). In the cave allegory, Plato uses Socrates as the main orator. Socrates speaks with Glaucon, in an effort to symbolize what Socrates denotes as the good. Socrates uses the sun as a simile to assist his explanation. He makes a comparison between the good that is the foundation for splendor and verity, and the sun, which is the cause for illumination and energy (Plato, trans. 1979). Socrates posits to Glaucon that as the sun is the reason the world endures and renders it able to be seen, good triggers all that is comprehensible to be and makes it intelligible (Plato, trans. 1979). In the allegory, highly schooled and uneducated conditions are contrasted to their existence in the illumination of the sun, where objects are viewed as they appear, versus living in a cave where reality is skewed from the shadows on the cave’s walls (Plato, trans. 1979). Prisoners are chained together in a cave and their only vision of the world is depicted through shadows of forms that are cast on the cave wall in front of them. Shadows of those forms are cast by a fire that is, unbeknownst to the prisoners, lit behind them. A narrow walkway exists between the fire and the prisoners. As people go in and out of the cave, objects are held up in front of the fire, creating shadows on the cave wall. Those chained in the cave have a very small worldview and perception of reality. Their reality and perception of the world exist only as shadows of the forms on the cave wall. Therefore, their sensate experience provides the chained prisoners only opinions about the shadows of the forms, and not a true reality of the object. 157
Plato, Nightingale, and Nursing: Can You Hear me Now? The allegory continues as one of the chained prisoners is freed and able to go out of the dark cave into the light. The freed prisoner, after seeing all of the objects as they actually appear in the light outside of the cave, comes to the realization that there was much more to the world than just the shadows of the forms on the cave wall. Now, seeing the good (the sun) and the objects in the sun as they appear, the prisoner returns to the cave to tell the other prisoners of the larger world that exists outside of the cave. However, when the freed prisoner returns to the darkness of the cave, he is met with resistance from the others who remained chained. The enlightened prisoner is mocked and even thought to be mad, but he remains with the others in hopes of educating them as it is his duty and calling to service (Plato, trans. 1979). Plato’s idea of public service is aligned with service suitable to a guardian (Plato, trans. 1979). The formation of moral character was the basic tenet of education for guardians (LeVasseur, 1998). The point of liberal education is to make those who were once cloistered in society into people of the public. Their primary job is to first care for the good of society (Plato, trans. 1979). For Plato’s ideal political community, leaders take the role of philosopher kings. This cohort’s responsibility is to the public. Through reason and knowledge of the good, philosopher kings fashion resolutions that are paramount in importance to the community as a whole (Plato, trans. 1979). Using the cave allegory, the guardians and philosopher kings need to find a means to escape the cave, be educated in the good through philosophy, and return to the cave to enlighten the others who remain chained (Plato, trans. 1979). LeVasseur (1998) writes, “In Plato’s account, the true political function, largely neglected in actual politics, is the guardian function” (p. 282). Nightingale Plato’s tenets of societal function, education, and mathematics were significant parts of his philosophy, which Nightingale modeled. She strove to find means to utilize her education through educating others and addressing important societal issues. LeVasseur asserts that “it was not enough for Nightingale to have knowledge of the good, but it was imperative to put that knowledge into action as a guardian of the people” (1998, p. 282). Critical of the lack of formal education available to women in her day, Nightingale wrote extensively in forms of letters, notes, and pamphlets on the rationale of education. This was before she had an outlet for her training and education at the age of 31 (McDonald, 2010). Nightingale’s life and writings mirrored the Platonic philosophy of service and the good in an ideal society. Inculcating her broad knowledge into her life’s work was most notable on the impact she had on “choosing to impact policy rather than exercising power” (Attewell, 1998, p. 153). Nightingale disseminated her nurse training schools around the world. She reformed military and lay hospitals, 158
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and reformed sanitation issues. Nightingale’s efforts to create a respected profession for women was largely due in part to her belief that her role as a guardian was to demonstrate the good though service to all humankind in society. LeVasseur (1998) states that “[a]lthough Nightingale agonized over finding her true purpose in life, the one for which she was best suited, there can be little doubt into which stratum of Plato’s society she would have placed herself—that of the societal guardian” (p. 283). Nightingale: Early Years Nightingale was born to an aristocratic Christian family in Victorian England. She was educated along with her older sister by her father in “modern and ancient languages, history, composition, and philosophy” (LeVasseur, 1998, p. 281). Monros-Gaspar (2008) cites that a governess was also employed in the Nightingale home to educate the girls in courses of art and music. Educated in the classics from Cambridge University in England, Nightingale’s father William crafted much of Florence’s atypical education around the great philosophers. Young Florence quickly developed a penchant for philosophy as well as a thirst for the quest of additional knowledge. Deeply immersed in classical education and mythology, Nightingale’s proclivity for translating many of the Greek classics (LeVasseur, 1998) led to the creation of her manifesto, Cassandra (1979 [1852]), in which she wrote of the “boredom and socially enforced triviality of women’s lives in Victorian England” (LeVasseur, 1998, p. 281). Her education and her “intellect provided her with the ability to win the admiration of many eminent men of the time” (Sellman, 1997, p. 6). Nightingale sought for a more useful purpose in life. Coalesced with her frustration of the conventionality of upper-class Victorian women, Nightingale strongly believed that her duty and usefulness went beyond the accepted societal conventions and mannerisms of the women of her day. Sellman (1997) writes, “There was very little prospect of any meaningful employment because she (Nightingale) was part of the privileged minority for whom work was not considered an option” (p. 7). Impact on Nursing Practice Nightingale posited that discipline as it related to education was an “ability to continue to learn, becoming yet more finely tuned to the service of humanity” (Dossey, Selanders, Beck, & Attewell, 2005, p. 165). Additionally, she wrote extensively on how people seem to place greater importance on the remedy of an illness above health promotion (Dossey et al., 2005). Nightingale distinguished that the promotion of health and healing and the mitigation of affliction from infirmity and injury were dual interlinking components in the role of the nurse. Therefore, to Nightingale, “identifying, delivering and strengthening the factors that
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support health . . . and emphasized positive healthdetermining factors . . . creating health-promoting environments at the bedside, within the home, in the community, across regions and nations and for the world” (Dossey et al., 2005, p. 179) were paramount to nursing. Her views led nurses’ actions to promote health, not cure disease. Nightingale’s work during the Crimean War is her best known endeavor. Nightingale became celebrated for her “sick nursing” during the Crimean War, yet she maintained a keen focus on health nursing and health promotion (Nelson & Rafferty, 2010, p. 131). Plato’s influence and high esteem for mathematics in finding universal truths can be correlated to Nightingale’s work. Her keen observational skills and detailed record keeping during her time in Crimea led to her work in providing the first known application of statistics through graphs and pie charts (Nelson & Rafferty, 2010). The results of her statistical analysis demonstrated how fresh air, light, warmth, cleanliness, quiet, and diet greatly affected the mortality rates of soldiers during the Crimean War (Nelson & Rafferty, 2010). Patient safety (as it is called today) arose from Nightingale witnessing many deleterious incidents during her time in Crimea (Clements & Averil, 2006). Nightingale studied what interventions worked and what did not in order to decrease injury or death to patients (Woodward, 2011). After the war ended, her profound experiences in Crimea became the impetus for championing patient safety through political lobbying for army reform. Like Plato’s freed prisoner returning to the cave to enlighten others and facing hostility from those who remained chained, Nightingale refused to give up disseminating knowledge even in the face of adversity. Nightingale continued utilizing the application of statistics to support her interventions in nursing after the war to enact additional reforms. Some examples of the results of her work included discerning mortality rates between hospitals and lying-in hospitals, participating in the design of architectural blueprints for building new hospitals and the hospital’s physical layout, as well as addressing sanitation issues both in London and abroad and the impact poor sanitation had on health (Nelson & Rafferty, 2010). Nightingale’s work in using statistics as a means to find the universal truth as to why something occurred, what could be done to change the problem, and evaluating patient outcomes mirrors current issues of patient safety and patient-centered outcomes research today. Her political activism and advocacy for the military hospitals would serve as the foundation for her future reformation work (Nelson & Rafferty, 2010). Yet Nelson and Rafferty (2010) state, In order to understand the difficult decisions she (Nightingale) had to make, we must place Nightingale beyond the narrower context of nursing reform into a broader framework: the Victorian constraints on ladies which made exercising authority in a male organization so problematic, the complex interrelationships of Victorian
religious sectarianism and politics, and the political nature of the mission. (p. 52) Several factors, stemming from the basic tenets of Victorian society, increased the difficulty Nightingale had on exacting her mission (Nelson & Rafferty, 2010). Those factors were working with a disparate cohort of females, customarily segregated during this time period. These women did not, at many times, accept Nightingale’s authority. They did not possess the same level of education or knowledge to be able to perform the nursing tasks required to render care to the infirm soldiers. Second, Nightingale needed to breach the Victorian custom of ladies effecting influence in the public arena. The most problematic and politically sensitive factor was Nightingale’s ability to steer through the sectarian polemic (Nelson & Rafferty, 2010). Even though Nightingale faced these imperceptible obstacles, her determination and understanding of the need for military reform during the war in Crimea effused her ability to inculcate her knowledge to exact her objectives. They were the provision of excellent nursing care to the sick and wounded, hospital, environmental and policy reform, advocacy, and research. Impact on Nursing Knowledge Gordon (1998) writes, The world is complex. Human beings tend to manage the complexity by breaking up experiences into manageable components that have meaning. These components are stored as mental representations, or concepts, that permit thinking when the object is not present. Naming of concepts permits recognition and communication with others; grammatical rules for combining concepts permits thoughts to be shared through language, and concepts within a classification system permit organization of ideas (Introduction section, para. 1). The association amidst the concepts is the foundation for the structure of knowledge in a discipline. In nursing, identifying the significance of clinical science has “constructed concepts, theories and classification systems to further scientific development and patient care” (Gordon, 1998, Introduction section, para. 3). Nightingale was the first nurse theorist who “viewed nursing as having organized concepts and social relevance distinct from medicine” (Shaw, 1993, p. 1651). Attewell (2010, p. 102) writes, “Florence Nightingale developed a body of nursing knowledge clearly expressed in the 79 pages of Notes on Nursing: What it is and what it is not (Nightingale, 1969).” The booklet, an assemblage of her clinical observations while working with patients in London hospitals and the Crimean War, imparted instructional erudition and canons of nursing practice (Clements & Averil, 2006). Additionally, Nightingale’s letters, notes, and pamphlets would provide the language, knowledge, and 159
Plato, Nightingale, and Nursing: Can You Hear me Now? subsequent standards of care that future nurses would utilize to inform their practice in London and abroad in the United States (Dossey et al., 2005). Nightingale’s methodical process for nursing included assessing, or reassessing, implementing, and then evaluating the care delivered (Clements & Averil, 2006). These concepts constructed by Nightingale, once further categorized and classified, became the linguistic precursors for identifying nursing process, nursing actions, and nursing diagnoses. Nightingale (1969) said, I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient. (p. 5) The attributes Nightingale ascribed to nursing in the above quote delineate the “standards and thoroughness in the fundamentals of care that Nightingale insisted on and cherished above all else” (Nelson & Rafferty, 2010, p. 138). Her attributes of person, health, and environment foreshadowed what nursing today refers to as the metaparadigm concepts in the discipline (Dossey et al., 2005, p. 45) and holism in nursing practice. Nightingale’s attributes would also become the building block for future theoretical and conceptual frameworks in nursing. Gordon (1998) stated, “Historically modern nursing based on the Nightingale model used disease entities from medical classifications to organize their thinking, speaking and writing. These were the only concepts available in health care delivery up to the middle of the 20th Century” (Historical Perspective on Nursing Classifications Systems section, para. 1). Therefore, “basic structures for knowledge development in nursing had to await the introduction of theories and philosophies of nursing in the 1950’s” (Historical Perspective on Nursing Classifications Systems section, para. 2). Clements and Averil (2006) posit, “Nightingale contributed to the values that nursing has placed on theory development and implementation into practice . . . Many of her fundamental concepts are still foundations for nursing practice today” (p. 273). Nursing in the Twenty-First Century Selanders and Crane (2012) write, Modern nursing is complex, ever changing, and multi focused. Since the time of Florence Nightingale, however, the goal of nursing has remained unchanged, namely to provide a safe and caring environment that promotes patient health and well-being. (para. 1)
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Over 100 years later after her death, the impact Florence Nightingale still has on professional nursing practice remains. Scholarship in nursing education today is infused with a liberal arts background in philosophy, ethics, and the sciences. This has become the cornerstone of nursing education. Current evidence-based research and dissemination of research findings have underpinnings from Nightingale’s early work in Crimea. Gunther (2009) stated, Nursing knowledge development is an integrated process emerging from examination of actual practice. Theories arising from practice define both the mission and the language of the discipline, allowing scholars to identify questions to be explored for refinement of scientific theory. These situation specific theories then re-energize and reform practice. (p. 146) For Nightingale, the issues of her day were the impetus for her work in the establishment of nursing practice and social, political, and environmental reform. Nightingale’s contributions were in the legitimization of nursing for women, nursing education, hospital administration, statistics and research, patient safety, and social and environmental activism. It is evident that the great philosophers spoke to her, and she wove those philosophic underpinnings into what nursing practice is today. What is past is prologue. Today, over 150 years after the establishment of nursing, “Nightingale’s legacy not only remains, but has never been so important” (Lee, Clark, & Thompson, 2013, p. 245). Professional nurses continue to be involved in social, environmental, and global issues as they relate to health care. Nightingale’s influences in professional nursing practice are evident in many areas of the discipline. They include education, research, nursing care standards, nursing process, nursing diagnoses, and nursing theory. Additionally, she impacted social, environmental, and health reform (both locally and globally), as well as public health policy, disease prevention, and health promotion, and practicing within an interdisciplinary team, which are all evident today. Issues of patient safety, health promotion, disease prevention, and patient-centered outcomes research measures mark the center of current professional nursing practice. Dossey (2010) writes, “Nightingale’s work was social action that demonstrated and clearly articulated the science and art of an integrated worldview of nursing, health care, and humankind” (p. 15). To Nightingale, health was a priority for all, and she employed a “grassroots-toglobal nursing practice” (Dossey, 2010, p. 15). Recognizing the share that power politics played in environmental and public health reform, Nightingale oftentimes had adversarial encounters with partisan powerhouses. Those particular encounters would prove to serve as allocutions in subsistence as well as how to “compete with men” (Gourlay, 2004, p. 15). Not much has changed 150 years later. With the advent of the current healthcare reform in the United States in practice, the profession of nursing stands
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at the precipice of shifting the face of health care. Equity of care across all demographic strata is the cornerstone of global health care today. The aforementioned issues Nightingale faced are no different than the global challenges nursing faces today. Effecting reform through policy either at the institutional, state, national, or global levels is at the forefront of issues of health care and nursing. These issues continue to be contentiously debated in the political arena. Gunther (2009) concludes, We must give our attention to both marginalized and privileged populations. We can best do this by changing our view of human health within a practice of language and concepts shared with other disciplines. Through focused programmes of research with the goals of prevention, empowerment and health, nursing can contribute to the knowledge that drives policy changes to achieve social justice and equity. (p. 146) What Gunther (2009) writes is the essence of Nightingale’s legacy. The equitable delivery of care across all demographic strata and working in concert with other disciplines to effect programs and policies to promote health promotion and disease prevention in varying populations around the world are all Nightingale’s tenets. Nurses must think globally but act locally. Plato spoke to Nightingale. Nightingale spoke to nursing. The voices of Plato and Nightingale can still be heard within the practice of professional nursing today. Conclusion Florence Nightingale, also known as the “lady with the lamp” and the mother of modern-day nursing, was more than the sum of her parts. Schooled by her father in the classics, mathematics, and mythology, it was the philosopher Plato that spoke to her. Plato’s philosophy helped shape her view of the role of education and knowledge of the good. Nightingale showed disdain and uselessness for the conventionality of the lives of upper-class Victorian women. Therefore, she set out to find a deeper purpose and more meaningful usefulness to society. Nursing became that focus. Nursing became her “must” (Dossey, 2005, p. 57) in establishing nursing as a respected profession for women. McDonald (2013) said, Nightingale’s contribution to nursing began with the founding of her school, which sent out teams of trained matrons and nurses throughout Britain and the world. This work raised nursing from its unsavory past as a poor-paying job, with benefits from bribes and the patient’s gin, to a new profession, with ethical standards and (increasingly rigorous) skill requirements. (p. 542) Nightingale’s work in the Crimean War laid the backdrop for the advancement of nursing practice. Her work was the
stepping stone for effecting patient safety measures through the reform of military hospitals and social reform efforts in England and abroad. Continued education, advocacy, research, and social reform as a part of nursing practice continue to be evident today. Provision of equitable delivery of nursing care across all demographic and cultural strata, the collaboration with transdisciplinary teams in the provision of health care, advocating for clients and health policy reform, and designing and implementing research projects to advance the standards of care all harken back to Nightingale. Dossey (2005) asserts that Nightingale was a sage, futurist, healer, activist, environmentalist, feminist, practitioner, scientist, politician, and global citizen. Her individual triumphs reflected on today are surprising when observed alongside the milieu of her time. Nightingale’s contributions to nursing theory, nursing knowledge, education, research, statistics, public health, and healthcare reform are nothing short of unique and stimulating. A courageous adventurer of health, Nightingale retained rare prescience, attention, perseverance, and duty to her calling. Her precepts of healing, leadership, and worldwide engagement bestow contemporary nurses with foresight for a salubrious world (Dossey, 2000; Dossey et al., 2005). As Plato wrote, one can either choose to seek freedom from the cave and return to it with the knowledge of the good to enlighten others, or they can remain chained inside the cave with a skewed perception of reality. In order for nursing to be able to address the current global issues facing the profession today, attention needs to focus on the profession of nursing practice’s goal of the provision of care for the good of all persons and society. The words of Plato still speak to professional nursing practice as nursing continues to seek the knowledge of the good and enlighten others. This fact is evident through continued scholarship, propagation, and dissemination of research effecting evidence-based practice in the extant literature and policy implementation at all levels. Let us continue to use Plato and Nightingale’s philosophical tenets as templates in advancing the standards of care in professional nursing practice. As a globally unified voice and in a universal language, let us follow Nightingale’s vision and put our own words into actions that bring results. The future of professional nursing practice stands at the crossroads of change in health care. Nursing has the unique opportunity to be that beacon which lights the way as guardians of society in the twenty-first century. This is our “must.”
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