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Calling for a Caring Focus — Competition the enemy of health

"In the future which I shall not see, for I am old, may a better way be opened!
May the methods by which every infant, every human being
will have the best chance at health ... be learned and practiced." (Nightingale, 1893)


Deva Marie-Beck, co-Director, NIGH

With these words, Nightingale looked forward to the coming decades and centuries. She envisioned people who could evolve nursing's scopes and standards of practice by continually upgrading our ways, means, and arenas for promoting the health of human beings.

Nightingale collaborated with other disciplines to promote health in a variety of ways and in numerous arenas. She was a media expert shaping public opinion about the value of nursing and health issues.

She was a health policy-maker collaborating with others to improve the environment and to promote cultural understanding. She was an international networker, constantly communicating with her friends and colleagues in the service of health around the world. She was an advisor to national leaders in many countries. She was a global citizen who understood that one person can make a significant difference in the health of humanity. With all these perspectives and accomplishments, she modeled a broader scope of nursing practice, which she labeled "sick-nursing" and "health-nursing."

Today the magnitude of health problems, in our communities as well as in our world, may seem insurmountable. Antibiotic-resistant microbes are on the increase, with the potentially virulent return of small pox, dengue fever, tuberculosis, and new strains of malaria, and with the recent onset of new killer diseases such as AIDS and SARS. Beyond these disease-vector issues, health issues also encompass economic and social issues. Our health problems are compounded by the precipitous rise in healthcare costs. Human health is also assailed in the many war-torn regions of the world.

"Life or Death" 

These conditions, added to the looming impact of the significant shortage of nurses, nursing educators, and other healthcare professionals, seem overwhelming, perhaps beyond our reach to even consider, let alone trying to plan or implement what must be done to address them. Despite all of our technical advances and perhaps, in part, because of them, our health concerns are as immense as in Nightingale's time. They remain "nearly as old as the world, nearly as large as the world, as pressing as life or death".

Nightingale marked the beginnings of sick-nursing. Since her time, especially in the Western World, where sick-nursing and sophisticated sick-treatment compose a significant amount of health care in hospital settings, the practice of sick-nursing has become almost synonymous with most of the varieties of specialty nursing practice.

Nightingale saw that the treatment of sickness was a reactive approach that approached problems after they occurred. She also saw the promotion of health as a proactive approach that sought to improve and change conditions to help people recover faster and to keep people healthy in the first place. She identified this proactive approach as the more inclusive practice of health-nursing, She acknowledged that nurses and humanity were "still far from the mark" to fully implement this practice.

Similarly, Nightingale feared that the health arena would become yet another means of making money, rather than a way of caring for people. By 1893, she had observed the trend toward making a profit first over a caring service. She warned that value could be placed on sickness because of the money to be made from treating sickness conditions.

Calling for a Caring Focus

Nightingale also urged her readers to implement care by thinking and working proactively. She asked nurses, and indeed the general public, to properly understand the factors required to sustain quality health care. Even as she recognized the ongoing need for excellent "sick-nursing" care to support people who are ill, she also noted the crucial need for "health-nursing" as an approach to bringing caring to wider arenas.

Identifying competition as the "enemy of health," she called us to become advocates for an "antidote" mindset. She urged her readers to collectively care by becoming a strong voice for the value of health. She saw "health-nurses" as proactive leaders involved in creating a stronger collective consciousness about the importance of focusing on health first, rather than treating disease after it occurs.

Deva-Marie Beck, PhD, RN, International Co-Director, Nightingale Initiative for Global Health: is a visionary, nursing scholar, clinician, health educator, and world ambassador for human health and well-being. She has networked for nursing and transdisciplinary health promotion issues in the United States, Canada, Great Britain, Switzerland, Scandinavia and Turkey. During more than 30 years of clinical nursing experience, she has practiced in a wide variety of Home-Care and Critical Care clinical settings in many parts of the world.

FN statue

At the Crimean War Memorial in London, UK with Dr. Susan Hassmiller, Senior Advisor for Nursing at the Robert Wood Johnson Foundation, taken on her 2010 Nightingale Journey. This statue is one of only two of non-royal women in Central London.

Flo with Desmond Tutu

Archbishop Desmond Tutu at the 2010 Nightingale Centenary opening of the Florence Nightingale Museum in London, UK