Written by Professor Paul Crawford

Modern healthcare systems increasingly resemble production lines with mantras of efficiency and effectiveness dominating.

The call to meet targets is loudest. Clinical environments can marginalise human interaction and drive threat cultures that inevitably deplete the expression of compassion by health practitioners, not least nurses, and by the public to those caring for them. Such environments can chase out the more generous play of human connection, support and encouragement. Sometimes one wonders if nurses are or can be nurses anymore in the way they were conceived in the life and work of the great nursing pioneer, Florence Nightingale (1820-1910), as motherly and nurturing. This emphasis on sustaining and supporting human growth, development or flourishing despite illness and disease appears increasingly eroded.

On a recent visit to St Luke’s International University, Tokyo, colleagues proudly showed me a previously unpublished letter from Florence Nightingale to Sir George Higginson (dated 13 June 1888). In it, Nightingale provides a character ‘sketch’ of a Miss S. Constable as potential matron to Gordon Boys’ Home in relation to the candidate’s “professional and moral (motherly) qualities” (Fig.1); that she is suited to mothering them “as much as possible” (Fig.2).

As we noted in our book, Florence Nightingale at Home (Palgrave, 2020), Nightingale aligned “mothering” with nursing and consistently acted as “mother”, not only in relation to children, but in the prodigious canon of her work. She emerged from and extrapolated the dominant centuries-old tradition of non-professional nursing in the home done by women, often mothers, and utilised such nurturing capital, for example in developing the Nightingale Training School at St. Thomas' Hospital, London. Her nurses were invariably exactly that, her nurses, her progeny. Bringing over the traditions of religious “mother houses” in which she was well-versed from her time at The Deaconesses’ Institute at Kaiserswerth in Germany, Nightingale can best be described as adopting a secular “mother-superior-like” role to the cohorts of nurses whom she directed. This ethos translated into the Nightingale Training School in 1872 where she effectively became “mothering-chief”! In her draft sermon ‘Lord to Whom Should We Go’, she further underlined this nurturing role, asserting that a “Virgin mother” provides more positive influence on young people than that available from actual mothers and fathers.

Figure 1: Sample from FN Letter to Sir George Higginson (13 June 1888)

Figure 2: Sample from FN Letter to Sir George Higginson (13 June 1888)

 
It is fitting that the original letter from Nightingale to General Higginson emphasising motherly nurturing is retained at St Luke’s International University, Tokyo, where, driven by the same Christian zeal, missionary physician Dr Rudolf Bolling Teusler pioneered nurse training. Like Nightingale, Dr Teusler placed great emphasis on nurturing as integral to nursing care. That is, they both viewed the contribution of nursing as a process aligned to parenting, of maternal caring for but also encouraging the growth or development of others.

Dr Rudolf Bolling Teusler © St Luke’s International University

While this Christian-inspired focus on “mothering” and “nurturing” may feel old hat for some, buying into gender stereotypes of the nursing workforce, we should not miss the core business of what was being aimed at here, that is, relationally investing in and comforting people in distress and pain, affording opportunities for others to gain quality in life, develop, grow.

From Nightingale’s extensive writings we know that quite aside from mothering at the heart of nurse training, she viewed nurturing people in a motherly way back to health, comforting them in their distress, supporting personal growth, as key to nursing care, something relentlessly eroded in contemporary nursing more beholden to applying delimited, technical, clinical skills. One wonders where the more relational, nurturing aspects to nursing have gone. They appear low priority in the face of cooler, science-led interventions. In the passion for reductive, measurable, injectable care, nurturing effort is not easily captured, charted or appreciated. Nurturing has been backgrounded and overlooked. Sager (2018) attempts to reboot this focus, reflecting on the world of gardening: “Medicine often pushes clinicians to conceptualize patients as things that need repair. To a gardener, a seed has all the elements necessary to flourish—the gardener provides support and fosters growth. In this sense, my role as a physician has become less about fixing and more about a way of being. It is cultivating in others the innate ability to flourish and heal, even when sick and wounded.”

When nurturing and flourishing are required more than ever to warm up the clinic, to humanise the clinical mission, to enable patients to grow and heal, we would do well to turn our attention back to the efforts of Nightingale and Teusler, whether or not we wish to invest in the idea of mothering. The skills of ‘tending to’ and ‘cultivating’ healing and flourishing in healthcare settings, and sharing best practices in this, are not to be chased out, consigned to history as pre-technical. There is science behind nurturing human growth and well-being. Nurturing and flourishing can be evaluated. It is time for nursing to adopt a more ‘green-fingered’ ethos to health delivery and lean into an ecological shift to nursturing (sic), helping patients to grow and flourish in their own terms of well-being despite and beyond illness and loss. As Vanderwheele et al (2019) argue, focusing more on human flourishing than reductive ‘fixing’ of people can reimagine health for patients, their families, burnt-out practitioners and wider society.

1968 graduation thanksgiving sevice

March 10 2014, last graduation as St Luke's College of Nursing

Nightingale stained glass in library

Images provided courtesy of St. Luke's International University collection 

Acknowledgements

I am grateful to St. Luke’s International University Tokyo for permission to reproduce the image of Dr Rudolf Bolling Teusler and scans of the original letter from Florence Nightingale. In particular, I wish to thank for their hospitality: Professor Shigeko Horiuchi (President), Professor Toshiko Yoshida (Dean), Professor Mami Inoue, Professor Jeff Huffman and all the nursing students. I also wish to thank the Arts and Humanities Research Council for their substantial funding of the project ‘Florence Nightingale Comes Home for 2020: An historico-literary analysis of her family life’ (AH/R00014X/1).

References

• Crawford, P., Greenwood, A., Bates, R., & Memel, J. (2020). Florence Nightingale at Home. Palgrave Macmillan. https://link.springer.com/book/10.1007/978-3-030-46534-6
• Sager, Z. S. (2018). Nurturing medicine. JAMA 320(13), 1325. doi:10.1001/jama.2018.13766.
• VanderWeele, T.J., McNeely, E., & Koh, H.K. Reimagining health—Flourishing. JAMA 321(17), 1667-1668. doi:10.1001/jama.2019.3035.