Today’s nurses face a host of complicated issues in their day-to-day practice. During the centennial of Florence Nightingale’s death, Nurse.com asked noted Nightingale scholars to predict what the founder of modern-day nursing would make of it all.
What insights does Florence Nightingale bring to today’s ethical dilemmas?
Florence Nightingale is indeed a role model for us when we are faced with ethical dilemmas. She saw ethical knowing as valuing and clarifying situations to create formal behaviors, expressions and dimensions of both morality and ethics intersecting with duties; today these would be considered legally prescribed duties. Ethical knowing included daily decisions of right and wrong; what should be done in practice, in personal conduct and behaviors; priorities; responsibilities; and advocacy for the patient, nurse, hospital, clinic, environment and society.
Nightingale identified ethical conflicts in which hospital systems did not allow nurses to do what they believed was right, particularly in identifying unsafe practices or acting as patient advocates. She taught that the moral ideal of the nurse was realized when the whole self of the nurse was brought into relationship with the whole of the person receiving care. It was the nurse who must protect the vulnerable patient and who must preserve the humanity and dignity of the individual.
In her lifetime, Nightingale often was frustrated with the abuse of nurses and nurse superintendents by physicians and hospital administrators; she tried to resolve these unethical situations. For example, hospitals used nurses essentially as free labor, demanding unreasonable hours and responsibilities beyond patient care. Her work brought with it a national and international perspective concerning the ethical issues that nurses faced. These issues continue in the nursing profession.
Nightingales letters to her nurses provide guidelines on ways in which to shape personal ethics. She challenged nurses to explore personal principles of conduct in the classroom, in the hospital and in their free time. She stressed ethical decision making in both professional and personal realms: What was right and wrong must be recognized as inward values, and each nurse was responsible for her own moral conduct because there was no prescription for it. Each nurse should show ethical knowing as an expression of actions that could be demonstrated, examined and evaluated. Through reflection and knowing the meaning and purpose in the work, nurses could gain insight into the highest level of ethical choices and possibilities.
Nightingale encouraged her nurses to hold to an ethic of caring and healing that sought to preserve wholeness, and this applied to end-of-life care and all aspects of dying. She encouraged nurses to be role models and maintain dignity of self. She also taught them how to behave with colleagues and with the patient who was receiving care, as well as to consider the familys needs.
Nightingale saw self-care as part of the ethics of care. She asked her nurses to be aware of strategies that could maintain their health. She was aware of cultural diversity and recognized each person as a whole body-mind-spirit being. She emphasized that any person should be able to receive care regardless of class, religion or the ability to pay for services. She insisted on creating a plan of care consistent with cultural background, health beliefs and values.
Nightingale would be pleased today with the ways in which nurses engage in end-of-life care in hospice and create healing environments in hospitals, as well as their strategies for bringing closure to personal affairs, such as medical directives, living wills and durable powers of attorney. She would ask us to bring more healing rituals into dying and to be reminded that patients should not be left to die alone unless that is their choice.