Guest Editorial
Footsteps of Fabiola
Lori Harloe
Greenslopes Repatriation Hospital, Brisbane QLD
PP: 147 - 149
Article Text
In Rome, 1600 years ago, lived a singular woman named Fabiola. History ranks her as a role model for nursing today. She is one of the first people individually identified as a nurse in the history of nursing.
Fabiola was a wealthy Roman, a descendent of Julius Maximus. She was born in the third century AD and lived life to the full. She loved love and led an adventurous life. She divorced her first husband, and outlived her second. She helped establish the first hospital in Christendom, at Porto in Italy where she nursed. When she died, in 399, all Rome mourned her passing.
The Australian Catholic University, Queensland division, honours Fabiola with an annual oration named after her. The timelessness and importance of the ethic of nursing are thereby acknowledged.
I offer the nursing profession two themes for consideration. They are interrelated and complex. Both themes are from a personal perspective. The first is the legacy of passivity, some would say the silence, of our profession. The second is the hope for constructive changes which will promote the values of nursing to the society in which we live.
History has been preoccupied with winners. In 2500 years of recorded history, half the population was not included in the fabric of the human story. The history of the lives of women has been eclipsed by one artificial construction of what is important - namely the deeds of glory, the action and reactions of one great man, or a few great military leaders, against each other.
The history of nursing has closely paralleled the history of women in society. The practice of lauding exclusively the role of the physically strong has been the material of myths and legends which promote the masculine values of triumph and survival. The achievements of women in this now outdated model of history have been largely ignored.
Until recently, the ethic of diagnosis and cure has eclipsed the caring aspects of treatment. Gender distinctions, long sanctioned by history but condemned by logic can be replaced. Nurses, regardless of gender, race or situation are united by a fundamental bond with the patient which transcends national or religious boundaries.
All cultures have people who care for others. The ethic of care and compassion is the core of professional nursing. The values of nursing care are often misjudged or misunderstood by people who have a limited understanding of nursing.
In recent decades, the contribution of nursing in health promotion has become recognised. However, in an audit of history, nursing has an important stake. Florence Nightingale was a noted public health reformer, influential in improving health and hospital care, especially for the less privileged.
Of all the professions, nursing has the proudest and longest tradition of direct compassionate 'hands on' care. As modern historians, we must continue to recognise the 'golden thread of Samarkand'.
Throughout time, in apparently hopeless situations of pandemic illness and more recently, in the early days of the hysteria surrounding the emergence of the HIV virus and AIDS, there have always been nurses. One may use as an example Mother Teresa of Calcutta, to highlight the core values of nursing which shine through to the world-showing that care is worthwhile and fundamental for human society. In medical terms, and judged by so-called cure rates, Mother Teresa's statistics would not be spectacular. Her care illustrates for contemporary nursing a role model of significance and extraordinary proportion.
The essence of nursing, that of caring for a sick or helpless victim of accident or disease, is not of course exclusively a Christian ethic. This 'golden thread' pervades all the surviving major religions of the world and many, but not all, of the secular philosophies. Those political or ideological groups which have not espoused this central tenet-that of care of the sick, such as Nietzschean philosophy of 'Will to Power'; the Nazi movement; or some of the African political regimes- have not survived. An historian is inspired by such evidence in history. One may ask why is nursing important and essential for all societies? Connections have been made with the daily routine of human life, the progress and development of an individual through the various stages of life from birth to death. As we see the sun replaced with night, we know from past experience there will be another day. Another day in which human life continues. Nurses help people live their lives by attending daily to the needs of the human mind, body and spirit.
Nurses are there in the most obvious ways. I believe that is why nursing has been enveloped in silence throughout history.
The silence of nursing also stems from the position of women in society and the devaluation of women's work. Florence Nightingale promoted nursing as a province of women. In evolutionary terms, it was right at the time, but the discipline suffered social fixation-a fossilization born in its infancy. The knowledge and social acceptability of nursing as the exclusive domain of women is now challenged, as the Florence Nightingale model is scrutinised by modern post-structural philosophy and changes within society such as equal opportunity and social justice.
The fossilization of the profession of nursing-its fixation, until recently, as a gender specific, subservient stereotype - has been due, not only to the pressure from external society, but to misdirection from within. Fortunately, only vestiges of this conservatism remain.
During the 1930s, in Queensland and elsewhere in Australia, the high regard for the Nightingale system influenced nursing leaders to reject a proposal to provide tertiary education for nurses. This decision directly impeded the intellectual development of the nurse. The self-imposed professional silence was perpetuated through lack of comparative educational standards. This set nursing apart and prevented participation in national debate. I believe that society has been adversely affected by the silence of professional care givers. To redress the absence of the nursing voice in national debate, nursing participation in research and health promotion is essential.
To attract funds, vital for clinical nurses to participate in research, the nursing profession must promote itself in the research world. The research community needs to know that care, as well as cure, is a significant and a legitimate area of research.
Sister Elizabeth Kenny - one of the most outstanding researchers this country has produced-is an example of a committed researcher. Her remarkable qualities of intellectual inquiry, tenacity and perseverance in the face of formidable medical opposition highlights the spirit of nurses in breaking new ground in the research world.
The World Health Organization states that nursing care is the critical factor between health and illness, indeed, illness and survival. In the Western world, the shifting emphasis from cure to health promotion is driven in part by economic necessity, and by the realization that social justice and health are intimately associated. Nurses now have a greater opportunity to promote health and the nursing ethic of care.
As awareness of health and the human body increases, the better informed Australian population will be well placed to recognize and be receptive to nurses who have specialized in health promotion. I think the silence surrounding nursing will not survive vigorous intellectual debate, generated by well educated and articulate nurses today and in the future. Attitudes of the past have silenced the voice of the nursing profession in contemporary debate on such important subjects as domestic violence, smoking and drug abuse, and the effects of modern life on the individual and on the society in which we live.
Often the media has glamorized conflict and bad news. This implicitly devalues nursing attributes of consideration and care. There is no reason why nurses should not be active in the media, promoting the qualities of care and compassion which could re-humanize modern society.
I believe that nurses should be publicly involved in a national campaign for the ethic of nursing. We should be promoting the excellent values of care for which Australian nurses are known throughout the world.
Fabiola, whose example we remember, is one of the greatest role models in our profession. She was an innovator, a communicator, and a social leader. Despite 1600 years- 1600 years of intervening passivity at best, and silence at worst, nursing has evolved. The ethos of Fabiola's life, that of compassion and care are elements nurses continue to value.
The greatest challenge for the future is to preserve those elements of professional care and compassion, while revitalizing the themes of innovation, especially those of research and health promotion. It is my hope that nurses will speak out for the values of nursing and the ethic of care.
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