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Illuminating Florence

The world renowned expert on Florence Nightingale, Alex Attewell, speaks to Linda Belardi about the vision and lasting legacy of the founder of modern nursing.

Historian and social history curator Alex Attewell has been studying the life and work of the nursing pioneer, Florence Nightingale, for more than 20 years. In 1994 he became the curator of the Florence Nightingale Museum in south London and later the museum’s first director.

Under his leadership, the museum has won a number of awards and accolades, including being named the best exhibition in London by the The Times and one of the top 10 UK small museums by The Independent.

In recognition of his contribution to nursing history, Attewell was awarded honorary membership of the Honor Society of Nursing, Sigma Theta Tau International. He has lectured around the world on Nightingale’s enduring influence and in July released a book of little-known quotes and historical facts from the reformer of modern nursing, titled Illuminating Florence: Finding Nightingale’s Legacy in Your Practice.

Q. What is Nightingale’s contemporary legacy?

A. First let me say what it is not. It is not the romantic image of the “Lady with the Lamp” of the Crimean War, which says more about Victorian sentimentalism than about the challenges facing modern nursing. Florence Nightingale’s legacy is the wisdom and philosophy of nursing to be found in her writings. Her thought is remarkably fresh and relevant for the daily practice of nurses today. It encompasses fundamental principles of patient care but it equally defines the contribution of nursing across a spectrum from sickness to health, it looks at management in terms of improving outcomes and a view of leadership which emphasises personal qualities.

Q. Can you tell us something about her that many nurses may not know?

A. She was a pioneer of the graphical representation of statistics, using her so-called “coxcombs” to represent Crimean War mortality. She was a very persuasive campaigner on health issues and she ensured that the design of her graphics made precisely the point she wanted to make. As a result of this work she was elected the first female fellow of the Statistical Society in London in 1858.

Q. What is your favourite quote from Nightingale and why?

A. I am going to go for something quirky. She characterised aseptic practice, which was new in the 1890s, as “boiling yourself… & everything within reach, including the Surgeon”. It is typical of her wit, which was always sharp, but the serious point, which her detractors have consistently got wrong, is that she clearly believed in the existence of germs. In fact with quotes such as this I am able to prove that she did not remain stuck in the pre-germ theory world of Notes on Nursing (published by Nightingale in 1859). We do have to take her thought seriously.

Q. Are there parallels between the challenges confronting today’s nurses and the experiences she faced?

A. I think the parallels are numerous but they are not often superficial, because of the intense nature of social change from Florence’s time to today. Dealing with change is itself an interesting issue which is worthwhile studying in relation to Florence’s work.

Look at Notes on Nursing, she sought to define key principles and came up with remarkably modern concepts of patient-centred care, but at the same time she developed statistical tools which provided a base of evidence with which to respond to changes in disease patterns for example. It seems that we need the same things today, the determination to stick to fundamental nursing values while at the same time developing better tools to handle the changing nursing environment.

Q. What do you consider to be her most important achievement?

A. Without doubt it is her pioneering work as the reformer of modern nursing in all its many facets from education to practice and the organisation of nursing – reaching and benefitting people in all parts of the world. Her achievements were so immense that these days many people, including academics, are breaking them down into categories such as “statistics” and “social reform” amongst others, but I see this as false. It all comes under the banner of her work as the reformer of modern nursing, because all her life’s achievements sprang directly from her nursing work in the Crimean War and it all coheres as the remarkable contribution of a visionary nurse.

Q. What made her an effective leader?

A. I think she was very tough and she needed to be at that point in history where the entire public sphere was male dominated. In her early years she spent a great deal of time reflecting on her own abilities and her potential contribution, all the time developing her own vision. This gave her remarkable strength and clarity which she called upon frequently during her greatest challenges in the Crimean War.

Q. What was her connection with Australia?

A. Quite a few Crimean veterans including Florence’s patients settled in Australia. Not so long ago I helped on a documentary on this subject. Also she was a champion of the health of the Aboriginal people who decried the effects missionaries and colonial government had on their health. She played a similar advisory role in New Zealand. A group of trained nurses from Nightingale’s school at St Thomas’ Hospital in London was sent to the Sydney Infirmary in 1866, only a decade after the Crimean War ended. The superintendent, Lucy Osburn, and her group of pioneering nurses suffered many trials and tribulations.


Q. How important is it for nursing students to be exposed to history as part of their nursing curriculum?

A. I think it is very important for the sake of understanding the bigger picture. If you know that nursing has changed in the past you are more likely to respond positively to change in the future.  I am convinced that tomorrow’s nursing leaders are those who are taking history seriously now as undergraduates. I have been privileged to know quite a few nursing leaders and I am always impressed by their depth of knowledge and critical insight into nursing history.

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