- Email: [email protected]
Naturopathy, Nightingale, and nature cure: a convergence of interests
Naturopathy, Nightingale, and nature cure: a convergence of interests Pauline McCabe Naturopathy is making a strong resurgence in many Western countries, and its philosophical and theoretical basis has much in common with nursing theories of health. This article will give an overview of naturopathy, its origins in Hippocratic medicine and nature cure, and its re-emergence during the V|ctorian era in the context of a renewal of interest in health. The question is posed, `To what extent did the nature cure movement of last century influence the thinking of Florence Nightingale?' An examination of her writings supports the hypothesis that nature cure was a signif|cant influence on Nightingale's understanding of health and healing. Contemporary nursing theory is also congruent with naturopathic principles in signif|cant ways, and a convergence between the two disciplines is emerging. # 2000 Harcourt Publishers Ltd
INTRODUCTION The Australian nursing profession is increasingly using complementary therapies, particularly aromatherapy and massage, as nursing interventions. Two national bodies have supported this interest by releasing policies on complementary therapies (Royal College of Nursing, Australia 1997, Australian Nursing Federation 1998), and several state registration boards have published guidelines. Australian nurses are also studying naturopathy, and there is strong anecdotal evidence that 20±30% of students attracted to this discipline are nurses (McCabe et al. 1995). Nursing's interest in working with nature to support healing is not new. An exploration of the relationship between the ideas and practices of nursing and naturopathy supports the nursing profession's role in the provision of complementary care.
NATUROPATHY Pauline McCabe School of Nursing, La Trobe University, Bundoora, 3083, V|ctoria Australia Tel: 61 (3) 9479 5917; Fax: 61 (3) 9479 5988; E-mail: [email protected]
Naturopathy is the natural medicine system of the Western world. Its origins go back to ancient Greece, but most of its connections with the old humoral theory of medicine were severed long ago. The practical side of its teaching remained, and is increasingly supported by research into nutrition, herbal medicine, and other relevant
sciences. Theoretically, naturopathic medicine rests on vitalistic and holistic principles of health (Murray & Pizzorno 1990, Turner 1990). Naturopathy is a `distinct system of medicine that stresses health maintenance, disease prevention, patient education, and patient responsibility' (Pizzorno 1996). Its starting point is a philosophy of life and health, and consequently it avoids the strict focus on disease which has characterized modern medicine. The central principle, based on experience, is the existence in nature of a tendency to restore order. This may be seen at any level of nature, for example in the renewal of land after devastating ¯oods and ®re. Called vis medicatrix naturae, the healing power of nature, this tendency was ®rst commented upon by the Hippocratic physicians of ancient Greece, c.400 BCE. Hippocrates taught that it could, however, be overcome by strong diseases, and that only interventions which would support natural restorative mechanisms had any chance of success (Chadwick & Mann 1950). The various medical schools of ancient Greece were synthesized into one system by Galen in the second century AD. Galenical theory dominated Western medicine for around 1500 years, until the advent of the `new chemical medicine' which relied on the eects of toxic minerals such as mercury, sulphur and antimony to purge the body of disease. The devastating and often
Complementary Therapies in Nursing & Midwifery (2000) 6, 4 ^ 8 # 2000 Harcourt Publishers Ltd
Naturopathy, Nightingale, and nature cure: a convergence of interests
mortal eects of the bleeding, blistering, purging, vomiting and salivation therapies used by orthodox doctors, which came to be known as `heroic medicine', eventually prompted a backlash via development of gentler therapies such as homoeopathy, osteopathy and herbs, and a return to simple Hippocratic principles of healing (Griggs 1981). These principles, still taught to naturopathic students today, are (Pizzorno 1996): . First, do no harm . Use therapies that are in harmony with the restorative powers of nature . Find the cause . Treat the whole person in the context of their environment . Reinstate vitality and optimal balance . Practice preventative medicine . Educate the patient. Therapies which are in harmony with restorative mechanisms are those that work with the basic elements required for life and health, such as sunlight, pure air and water, sleep and relaxation, appropriate foods, herbs, exercise, ecient elimination, purpose, and creativity. Four million years of evolution has ®tted humans for a hunter-gatherer lifestyle which is symbiotic with the natural elements provided by the earth, and socially favours family and community life (Eaton et al. 1988a). Caucasians have had a few thousand years to try to adapt to settlement but the accelerated pace of modern society has overwhelmed our adaptive response, resulting in an epidemic of chronic diseases which originate in factors like stress, poor diet, sedentary occupations, pollution, and lack of personal meaning (Eaton et al. 1988b).
HEALTH AND DISEASE FROM THE NATUROPATHIC PERSPECTIVE The naturopathic approach to disease is grounded in its understanding of health.
The naturopathic approach to disease is grounded in its understanding of health. Rather than being confounded by a multiplicity of apparently dierent and unrelated diseases, naturopathic medicine seeks the cause in an analysis of the health state. Once the cause is understood, the remedy is obvious. Considering our evolutionary origins, health is dependent upon: . . . . .
Optimum nutrition A sound constitution A strong energy ®eld with good vitality Mental and emotional balance Ecient physiological function (digestion, metabolism, absorption, excretion, etc.) . Structural integrity of the body (joints and soft tissues)
. . . .
5
Minimal toxic load Adequate sleep and rest A clean environment Satisfying relationships and work (Jacka 1977, Murray & Pizzorno 1990, Turner 1990).
De®ciencies in any of these areas will undermine health, producing susceptibility to illness. In naturopathic theory disease falls into three major categories:
Eliminative Pathogens, toxins, excess metabolic wastes, and pollutants need to be removed from the system. The immune system responds through fever, in¯ammation and discharges to neutralise, convert and excrete the oending material (Turner 1990). This type of disease can be viewed as purposive, having cleansing and adaptive outcomes such as education of the immune system. Obviously from this perspective, eliminative symptoms should not be suppressed. Suppression with `anti' drugs (antipyretics, etc.) leads to a cycle of eliminative response, suppression, and weakening of vitality and immune response which eventually may result in chronic disease. Naturopathy manages this type of disease with supportive therapies, but if the patient is weak and the disease strong, medical treatment may be required until health can be improved.
Def|cient A typical diet of re®ned foods, meats, sugar, etc., often results in sub-clinical de®ciencies which can produce a wide variety of physical, mental and emotional symptoms (Werbach 1988). Nutrition is a young science which continues to discover more nutrients and new relationships between disease and diet (Carper 1988, Brighthope 1998). Replacement of vitamins, minerals, trace elements, and the variety of organic compounds found in fruit, vegetables, seeds, ®sh, legumes, herbs, etc. improves many illnesses. Low vitality is another signi®cant form of de®ciency. Restoring vitality is often the ®rst task of the naturopath, as it is dicult to improve health when energy is low. The concept of eliminative and de®cient disorders is a holistic concept which embraces the mental±emotional±spiritual sphere. For example, a harmful experience needs to be digested, its essence integrated and the negative residue eliminated, in order to move on.
Inherited These range from inevitable genetic anomalies to tendencies which may or may not manifest. Understanding one's constitution and adjusting
6 Complementary Therapies in Nursing & Midwifery
diet and lifestyle accordingly may prevent or reduce proneness to inherited tendencies.
PATTERN AND PRESCRIPTION Assessment and treatment are always individualised, depending on the cause of disease and other factors such as sex (hormonal factors), age, and the patient's own goals and expectations. Upon analysis, clinical patterns such as congested liver, poor digestion, toxaemia, low vitality, and areas of hyper- or hypo-activity emerge, which the naturopath learns to recognize (Murray & Pizzorno 1990). Treatment will address both the patterns and their causes, and the total prescription may include dietary changes, medicines (herbal, homoeopathic), nutritional supplements, and adjuvant therapies such as relaxation, counselling, or massage (Jacka 1998). Education about cause, prevention and optimizing health is central to the naturopathic consultation. Contemporary naturopathy has integrated a range of therapies in the last hundred years, but still owes much to the principles of nature cure which emerged last century at the same time as the new profession of nursing. Nature cure is a system which works in harmony with the vis medicatrix naturae through the use of simple methods such as fasting, rest, fresh air, sunlight, and whole, vegetarian foods, to combat the precursors of disease ± lowered vitality, abnormal composition of body ¯uids, and accumulation of wastes and poisons (Lindlahr 1918).
FLORENCE NIGHTINGALE, AN EARLY NATURALTHERAPIST
Many of Nightingale's ideas are completely in accord with early naturopathic theory.
It may surprise some nurses to hear Florence Nightingale described as a natural therapist, but many of her ideas are completely in accord with early naturopathic theory. Perhaps this is simply because of her strong focus on health and the promotion of healing, but there may be more intriguing reasons. Nightingale lived and worked in an era when the old understandings of medicine were being questioned. Heroic medicine was falling into disrepute, and people were increasingly interested in natural methods of healing. By the end of the century there was considerable patronage of natural medicine, with many people in the Western countries pursuing healthier habits and attending homoeopaths, osteopaths, herbalists, and nature cure practitioners (Griggs 1981). This revival of interest in health and healing coincides exactly with the time in which Florence Nightingale did her greatest work, and she must have been as aware
of this phenomenon as she was of the public health movement. The renewal of healing in the modern era began in Europe. In 1848, Austrian doctor Arnold Rickli established the ®rst nature cure institution, promoting the use of sunlight, fresh air, and a vegetarian diet (Pizzorno 1996). Florence Nightingale gained her ®rst nursing experience in Kaiserswerth, Germany, in 1851. How much, if at all, did the German nature cure movement in¯uence her ideas at this formative stage? The argument that she was aware of nature cure principles, and did incorporate them into her work, can be supported by an examination of her writings. . . . all disease . . . is more or less a reparative process . . . an eort of nature to remedy a process of poisoning or decay, which has taken place beforehand . . . the symptoms of the suerings generally considered to be inevitable and incident to the disease are very often symptoms of something quite dierent ± of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet . . . The same laws of health or of nursing, for they are in reality the same, obtain among the well as among the sick. (Nightingale in Shames 1993: 183±184).
Florence Nightingale understood that nature was the great healer, and that the nurse's role was to put the patient in the best condition for nature to act (Skeet 1980). This was to be achieved by such methods as exposure to direct sunlight and fresh air, and the use of wholesome food. Diet was determined by what the patient could eat and digest rather than the dictates of chemistry. Sleep and rest were supported by reducing noise, and a healing environment was created through attention to hygiene and provision of pleasant surroundings. The whole person was nursed, with particular attention to spiritual needs, the avoidance of boredom, and reassurance (Skeet 1980, Brown 1988). One of her most interesting views, from a naturopathic perspective, was on skin. `In almost all diseases, function of the skin is, more or less, disordered; and in many . . . important diseases nature relieves herself almost entirely by the skin' (In Skeet 1980: 83). This is a classic tenet of nature cure, which understood the skin as a major eliminator of toxins (Lindlahr 1918). Contemporary nurses have focussed mainly on the environmental aspects of Nightingale's theory (Selanders 1995, Gillette 1996). But from a naturopathic perspective, it could be argued that the driving force of her work is an understanding of health and ways of promoting health and healing, which is compatible with nature cure. Nightingale puts the nurse ®rmly in the role of a healer when she recognizes the impact that good nursing care can have on the patient's recovery,
Naturopathy, Nightingale, and nature cure: a convergence of interests
but understands that nature is the primary healer. The aim of nursing is to create the optimum conditions for the innate self-healing and self-regulating force, the vis medicatrix naturae, to initiate recovery.
NURSING AND NATUROPATHY: REVEALING COMMON GROUND The relationship between nursing and naturopathy has been nascent for one century, but perhaps its return is being prepared by the integration of complementary therapies into nursing practice. The use of natural therapies requires that nurses work with theoretical frameworks which tend to be holistic and grounded in health rather than disease. Contemporary nursing theory also focuses strongly on health, and examination of some key concepts reveals signi®cant compatibility with traditional naturopathic theory:
7
patients in identifying patterns and ways to alter them (Hensley et al. 1989).
Disease Diculty in adapting to stressors (for example, poor diet, lack of rest, pollutants, relationships), and prolonged imbalance, can result in illness. Nursing is concerned with all the variables in¯uencing response to stress (Harris et al. 1989).
Healing The innate healing response will tend to return states the system to order, but healing can be supported or suppressed (McCabe 1995). Nurses can choose to support healing in a variety of ways ± for example through therapeutic use of self (conscious healing intent), use of complementary therapies, education, and health promotion.
Health Health is the outcome of multiple factors such as vitality, environment, stress, diet, beliefs and behaviours (Leininger 1988, Harris et al. 1989). Health is also in¯uenced by our perceptions, by the way we interpret life and respond to it (Hensley et al. 1989). The health state expresses all manifestations of wellness and disorder (Hensley et al. 1989). The nurse's domain is the promotion of health and healing (McCabe 1995).
Energy The human being is an energy ®eld in constant exchange and interaction with other energy ®elds (Rogers 1987). Health and the ability to resist illness depend signi®cantly on the vitality of the energy ®eld. The nurse's energy ®eld is always in interaction with the patient's energy ®eld (Dossey et al. 1988).
Balance Health ¯uctuates owing to the interplay of balance and imbalance within the system in response to internal and external in¯uences (Harris et al. 1989).
CONCLUSION In summary, a holistic understanding of health states is the common ground between nursing and naturopathy. The potential for a rich cross-fertilization of ideas and practices between nursing and naturopathy has been grasped by the School of Nursing at LaTrobe University in Australia. The author has been employed to explore the feasibility of developing a double degree in nursing and naturopathy. Graduates would have the ability to work in both hospital and community settings, as employees or in independent practice. A thorough grounding in the promotion of health and healing would make these graduates an asset in many ®elds of health care. For example in aged care, where residents may suer numerous disorders associated with nutritional de®ciencies (Watson 1994), in oncology where nutritional medicine can increase survival time and decrease the side-eects of chemotherapy (Brighthope 1998), or in hospital-in-the-home projects where nurses play a major role in promoting the rehabilitation, healing and wellbeing of their clients.
Pattern
REFERENCES
Patterns are the means by which health states can be observed and analysed. Patterns of disease, lifestyle, eating, relationships, body function, sleep, inheritance, and many others provide insight into the health state. Nurses can guide
Australian Nursing Federation 1998 Policy statement: complementary therapies in nursing practice. ANF, Melbourne Brighthope I 1998 Nutritional medicine ± its presence and power. Journal of the Australasian College of Nutritional and Environmental Medicine 17(2): 5±25
8 Complementary Therapies in Nursing & Midwifery Brown P 1988 Florence Nightingale: the tough British campaigner who was the founder of modern nursing. Exley, Hertfordshire Carper J 1988 The food pharmacy: dramatic new evidence that food is your best medicine. Simon & Schuster, London Chadwick J, Mann W N (trans) 1950 The medical works of Hippocrates. Blackwell Scienti®c, Oxford Dossey B, Keegan L, Guzzetta C, Kolkmeier L 1988 Holistic nursing: a handbook for practice. Aspen, Rockville, MD Eaton S B, Shostak M, Konner M 1988a The stone-age health programme: diet and exercise as nature intended. Angus & Robertson, North Ryde, NSW Eaton S B, Konner M, Shostak M 1988b Stone agers in the fast lane: chronic degenerative diseases in evolutionary perspective. American Journal of Medicine 84: 739±749 Gillette V 1996 Applying nursing theory. Association of Operating Room Nurses Journal 64(2): 261±267 Griggs B 1981 Green pharmacy: a history of herbal medicine. Norman & Hobhouse, London Harris S M, Hermiz M E, Meininger M, Steinkeler S E 1989 Betty Neuman: systems model. In: MarrinerTomey A (ed.). Nursing theorists and their work, 2nd edn. Mosby, St Louis Hensley D M, Keer M J, Kilgore-Keever K A, Lang®tt J V, Peterson L 1989 Margaret A Newman: model of health. In: Mariner-Tomey A (ed.). Nursing theorists and their work, 2nd edn. Mosby, St Louis Jacka J 1977 A philosophy of healing. J Jacka, Melbourne Jacka J 1998 A-Z of natural therapies (2nd edn). Lothian, Melbourne Leininger M 1988 Leininger's theory of nursing: culture care diversity and universality: a theory of nursing. Nursing Science Quarterly 2(4): 152±160 Lindlahr H 1918 Philosophy of natural therapeutics. Lindlahr Publishing, Chicago
McCabe P 1995 Exploring the phenomenon of healing: healing as a health capacity. Australian Journal of Holistic Nursing 2(1): 13±23 McCabe P, Ramsay L, Taylor B 1995 Discussion paper no. 2: complementary therapies in relation to nursing practice in Australia. RCNA, Canberra Murray M, Pizzorno J 1990 Encyclopaedia of natural medicine. Little Brown/Optima, London Pizzorno J 1996 Naturopathic medicine. In: Micozzi MS (ed.). Fundamentals of complementary and alternative medicine. Churchill Livingstone, New York Rogers M 1987 Science of unitary human beings. In: Parse R. Nursing science: major paradigms, theories and critiques. WB Saunders, Philadelphia Royal College of Nursing, Australia 1997 Position statement: complementary therapies in Australian nursing practice. RCNA, Canberra Selanders L C 1995 Florence Nightingale: environmental adaptation theory. In: Metzger C, McQuiston A, Web A A (eds). Foundations of nursing theory: contributions of twelve key theorists. Sage, Thousand Oaks Shames K 1993 The Nightingale conspiracy: nursing comes to power in the 21st century. Power Publications, New York Skeet M 1980 Notes on nursing: the science and the art. Churchill Livingstone, Edinburgh Turner R N 1990 Naturopathic medicine: treating the whole person ± the principles and practice of naturopathy. Thorsons, Wellingborough Watson R 1994 Guest editorial: nutrition standards and the older adult. Journal of Advanced Nursing 20: 205±206 Werbach M R 1988 Nutritional in¯uences on illness: a sourcebook of clinical research. Thorsons, Wellingborough
INTRODUCTION The Australian nursing profession is increasingly using complementary therapies, particularly aromatherapy and massage, as nursing interventions. Two national bodies have supported this interest by releasing policies on complementary therapies (Royal College of Nursing, Australia 1997, Australian Nursing Federation 1998), and several state registration boards have published guidelines. Australian nurses are also studying naturopathy, and there is strong anecdotal evidence that 20±30% of students attracted to this discipline are nurses (McCabe et al. 1995). Nursing's interest in working with nature to support healing is not new. An exploration of the relationship between the ideas and practices of nursing and naturopathy supports the nursing profession's role in the provision of complementary care.
NATUROPATHY Pauline McCabe School of Nursing, La Trobe University, Bundoora, 3083, V|ctoria Australia Tel: 61 (3) 9479 5917; Fax: 61 (3) 9479 5988; E-mail: [email protected]
Naturopathy is the natural medicine system of the Western world. Its origins go back to ancient Greece, but most of its connections with the old humoral theory of medicine were severed long ago. The practical side of its teaching remained, and is increasingly supported by research into nutrition, herbal medicine, and other relevant
sciences. Theoretically, naturopathic medicine rests on vitalistic and holistic principles of health (Murray & Pizzorno 1990, Turner 1990). Naturopathy is a `distinct system of medicine that stresses health maintenance, disease prevention, patient education, and patient responsibility' (Pizzorno 1996). Its starting point is a philosophy of life and health, and consequently it avoids the strict focus on disease which has characterized modern medicine. The central principle, based on experience, is the existence in nature of a tendency to restore order. This may be seen at any level of nature, for example in the renewal of land after devastating ¯oods and ®re. Called vis medicatrix naturae, the healing power of nature, this tendency was ®rst commented upon by the Hippocratic physicians of ancient Greece, c.400 BCE. Hippocrates taught that it could, however, be overcome by strong diseases, and that only interventions which would support natural restorative mechanisms had any chance of success (Chadwick & Mann 1950). The various medical schools of ancient Greece were synthesized into one system by Galen in the second century AD. Galenical theory dominated Western medicine for around 1500 years, until the advent of the `new chemical medicine' which relied on the eects of toxic minerals such as mercury, sulphur and antimony to purge the body of disease. The devastating and often
Complementary Therapies in Nursing & Midwifery (2000) 6, 4 ^ 8 # 2000 Harcourt Publishers Ltd
Naturopathy, Nightingale, and nature cure: a convergence of interests
mortal eects of the bleeding, blistering, purging, vomiting and salivation therapies used by orthodox doctors, which came to be known as `heroic medicine', eventually prompted a backlash via development of gentler therapies such as homoeopathy, osteopathy and herbs, and a return to simple Hippocratic principles of healing (Griggs 1981). These principles, still taught to naturopathic students today, are (Pizzorno 1996): . First, do no harm . Use therapies that are in harmony with the restorative powers of nature . Find the cause . Treat the whole person in the context of their environment . Reinstate vitality and optimal balance . Practice preventative medicine . Educate the patient. Therapies which are in harmony with restorative mechanisms are those that work with the basic elements required for life and health, such as sunlight, pure air and water, sleep and relaxation, appropriate foods, herbs, exercise, ecient elimination, purpose, and creativity. Four million years of evolution has ®tted humans for a hunter-gatherer lifestyle which is symbiotic with the natural elements provided by the earth, and socially favours family and community life (Eaton et al. 1988a). Caucasians have had a few thousand years to try to adapt to settlement but the accelerated pace of modern society has overwhelmed our adaptive response, resulting in an epidemic of chronic diseases which originate in factors like stress, poor diet, sedentary occupations, pollution, and lack of personal meaning (Eaton et al. 1988b).
HEALTH AND DISEASE FROM THE NATUROPATHIC PERSPECTIVE The naturopathic approach to disease is grounded in its understanding of health.
The naturopathic approach to disease is grounded in its understanding of health. Rather than being confounded by a multiplicity of apparently dierent and unrelated diseases, naturopathic medicine seeks the cause in an analysis of the health state. Once the cause is understood, the remedy is obvious. Considering our evolutionary origins, health is dependent upon: . . . . .
Optimum nutrition A sound constitution A strong energy ®eld with good vitality Mental and emotional balance Ecient physiological function (digestion, metabolism, absorption, excretion, etc.) . Structural integrity of the body (joints and soft tissues)
. . . .
5
Minimal toxic load Adequate sleep and rest A clean environment Satisfying relationships and work (Jacka 1977, Murray & Pizzorno 1990, Turner 1990).
De®ciencies in any of these areas will undermine health, producing susceptibility to illness. In naturopathic theory disease falls into three major categories:
Eliminative Pathogens, toxins, excess metabolic wastes, and pollutants need to be removed from the system. The immune system responds through fever, in¯ammation and discharges to neutralise, convert and excrete the oending material (Turner 1990). This type of disease can be viewed as purposive, having cleansing and adaptive outcomes such as education of the immune system. Obviously from this perspective, eliminative symptoms should not be suppressed. Suppression with `anti' drugs (antipyretics, etc.) leads to a cycle of eliminative response, suppression, and weakening of vitality and immune response which eventually may result in chronic disease. Naturopathy manages this type of disease with supportive therapies, but if the patient is weak and the disease strong, medical treatment may be required until health can be improved.
Def|cient A typical diet of re®ned foods, meats, sugar, etc., often results in sub-clinical de®ciencies which can produce a wide variety of physical, mental and emotional symptoms (Werbach 1988). Nutrition is a young science which continues to discover more nutrients and new relationships between disease and diet (Carper 1988, Brighthope 1998). Replacement of vitamins, minerals, trace elements, and the variety of organic compounds found in fruit, vegetables, seeds, ®sh, legumes, herbs, etc. improves many illnesses. Low vitality is another signi®cant form of de®ciency. Restoring vitality is often the ®rst task of the naturopath, as it is dicult to improve health when energy is low. The concept of eliminative and de®cient disorders is a holistic concept which embraces the mental±emotional±spiritual sphere. For example, a harmful experience needs to be digested, its essence integrated and the negative residue eliminated, in order to move on.
Inherited These range from inevitable genetic anomalies to tendencies which may or may not manifest. Understanding one's constitution and adjusting
6 Complementary Therapies in Nursing & Midwifery
diet and lifestyle accordingly may prevent or reduce proneness to inherited tendencies.
PATTERN AND PRESCRIPTION Assessment and treatment are always individualised, depending on the cause of disease and other factors such as sex (hormonal factors), age, and the patient's own goals and expectations. Upon analysis, clinical patterns such as congested liver, poor digestion, toxaemia, low vitality, and areas of hyper- or hypo-activity emerge, which the naturopath learns to recognize (Murray & Pizzorno 1990). Treatment will address both the patterns and their causes, and the total prescription may include dietary changes, medicines (herbal, homoeopathic), nutritional supplements, and adjuvant therapies such as relaxation, counselling, or massage (Jacka 1998). Education about cause, prevention and optimizing health is central to the naturopathic consultation. Contemporary naturopathy has integrated a range of therapies in the last hundred years, but still owes much to the principles of nature cure which emerged last century at the same time as the new profession of nursing. Nature cure is a system which works in harmony with the vis medicatrix naturae through the use of simple methods such as fasting, rest, fresh air, sunlight, and whole, vegetarian foods, to combat the precursors of disease ± lowered vitality, abnormal composition of body ¯uids, and accumulation of wastes and poisons (Lindlahr 1918).
FLORENCE NIGHTINGALE, AN EARLY NATURALTHERAPIST
Many of Nightingale's ideas are completely in accord with early naturopathic theory.
It may surprise some nurses to hear Florence Nightingale described as a natural therapist, but many of her ideas are completely in accord with early naturopathic theory. Perhaps this is simply because of her strong focus on health and the promotion of healing, but there may be more intriguing reasons. Nightingale lived and worked in an era when the old understandings of medicine were being questioned. Heroic medicine was falling into disrepute, and people were increasingly interested in natural methods of healing. By the end of the century there was considerable patronage of natural medicine, with many people in the Western countries pursuing healthier habits and attending homoeopaths, osteopaths, herbalists, and nature cure practitioners (Griggs 1981). This revival of interest in health and healing coincides exactly with the time in which Florence Nightingale did her greatest work, and she must have been as aware
of this phenomenon as she was of the public health movement. The renewal of healing in the modern era began in Europe. In 1848, Austrian doctor Arnold Rickli established the ®rst nature cure institution, promoting the use of sunlight, fresh air, and a vegetarian diet (Pizzorno 1996). Florence Nightingale gained her ®rst nursing experience in Kaiserswerth, Germany, in 1851. How much, if at all, did the German nature cure movement in¯uence her ideas at this formative stage? The argument that she was aware of nature cure principles, and did incorporate them into her work, can be supported by an examination of her writings. . . . all disease . . . is more or less a reparative process . . . an eort of nature to remedy a process of poisoning or decay, which has taken place beforehand . . . the symptoms of the suerings generally considered to be inevitable and incident to the disease are very often symptoms of something quite dierent ± of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet . . . The same laws of health or of nursing, for they are in reality the same, obtain among the well as among the sick. (Nightingale in Shames 1993: 183±184).
Florence Nightingale understood that nature was the great healer, and that the nurse's role was to put the patient in the best condition for nature to act (Skeet 1980). This was to be achieved by such methods as exposure to direct sunlight and fresh air, and the use of wholesome food. Diet was determined by what the patient could eat and digest rather than the dictates of chemistry. Sleep and rest were supported by reducing noise, and a healing environment was created through attention to hygiene and provision of pleasant surroundings. The whole person was nursed, with particular attention to spiritual needs, the avoidance of boredom, and reassurance (Skeet 1980, Brown 1988). One of her most interesting views, from a naturopathic perspective, was on skin. `In almost all diseases, function of the skin is, more or less, disordered; and in many . . . important diseases nature relieves herself almost entirely by the skin' (In Skeet 1980: 83). This is a classic tenet of nature cure, which understood the skin as a major eliminator of toxins (Lindlahr 1918). Contemporary nurses have focussed mainly on the environmental aspects of Nightingale's theory (Selanders 1995, Gillette 1996). But from a naturopathic perspective, it could be argued that the driving force of her work is an understanding of health and ways of promoting health and healing, which is compatible with nature cure. Nightingale puts the nurse ®rmly in the role of a healer when she recognizes the impact that good nursing care can have on the patient's recovery,
Naturopathy, Nightingale, and nature cure: a convergence of interests
but understands that nature is the primary healer. The aim of nursing is to create the optimum conditions for the innate self-healing and self-regulating force, the vis medicatrix naturae, to initiate recovery.
NURSING AND NATUROPATHY: REVEALING COMMON GROUND The relationship between nursing and naturopathy has been nascent for one century, but perhaps its return is being prepared by the integration of complementary therapies into nursing practice. The use of natural therapies requires that nurses work with theoretical frameworks which tend to be holistic and grounded in health rather than disease. Contemporary nursing theory also focuses strongly on health, and examination of some key concepts reveals signi®cant compatibility with traditional naturopathic theory:
7
patients in identifying patterns and ways to alter them (Hensley et al. 1989).
Disease Diculty in adapting to stressors (for example, poor diet, lack of rest, pollutants, relationships), and prolonged imbalance, can result in illness. Nursing is concerned with all the variables in¯uencing response to stress (Harris et al. 1989).
Healing The innate healing response will tend to return states the system to order, but healing can be supported or suppressed (McCabe 1995). Nurses can choose to support healing in a variety of ways ± for example through therapeutic use of self (conscious healing intent), use of complementary therapies, education, and health promotion.
Health Health is the outcome of multiple factors such as vitality, environment, stress, diet, beliefs and behaviours (Leininger 1988, Harris et al. 1989). Health is also in¯uenced by our perceptions, by the way we interpret life and respond to it (Hensley et al. 1989). The health state expresses all manifestations of wellness and disorder (Hensley et al. 1989). The nurse's domain is the promotion of health and healing (McCabe 1995).
Energy The human being is an energy ®eld in constant exchange and interaction with other energy ®elds (Rogers 1987). Health and the ability to resist illness depend signi®cantly on the vitality of the energy ®eld. The nurse's energy ®eld is always in interaction with the patient's energy ®eld (Dossey et al. 1988).
Balance Health ¯uctuates owing to the interplay of balance and imbalance within the system in response to internal and external in¯uences (Harris et al. 1989).
CONCLUSION In summary, a holistic understanding of health states is the common ground between nursing and naturopathy. The potential for a rich cross-fertilization of ideas and practices between nursing and naturopathy has been grasped by the School of Nursing at LaTrobe University in Australia. The author has been employed to explore the feasibility of developing a double degree in nursing and naturopathy. Graduates would have the ability to work in both hospital and community settings, as employees or in independent practice. A thorough grounding in the promotion of health and healing would make these graduates an asset in many ®elds of health care. For example in aged care, where residents may suer numerous disorders associated with nutritional de®ciencies (Watson 1994), in oncology where nutritional medicine can increase survival time and decrease the side-eects of chemotherapy (Brighthope 1998), or in hospital-in-the-home projects where nurses play a major role in promoting the rehabilitation, healing and wellbeing of their clients.
Pattern
REFERENCES
Patterns are the means by which health states can be observed and analysed. Patterns of disease, lifestyle, eating, relationships, body function, sleep, inheritance, and many others provide insight into the health state. Nurses can guide
Australian Nursing Federation 1998 Policy statement: complementary therapies in nursing practice. ANF, Melbourne Brighthope I 1998 Nutritional medicine ± its presence and power. Journal of the Australasian College of Nutritional and Environmental Medicine 17(2): 5±25
8 Complementary Therapies in Nursing & Midwifery Brown P 1988 Florence Nightingale: the tough British campaigner who was the founder of modern nursing. Exley, Hertfordshire Carper J 1988 The food pharmacy: dramatic new evidence that food is your best medicine. Simon & Schuster, London Chadwick J, Mann W N (trans) 1950 The medical works of Hippocrates. Blackwell Scienti®c, Oxford Dossey B, Keegan L, Guzzetta C, Kolkmeier L 1988 Holistic nursing: a handbook for practice. Aspen, Rockville, MD Eaton S B, Shostak M, Konner M 1988a The stone-age health programme: diet and exercise as nature intended. Angus & Robertson, North Ryde, NSW Eaton S B, Konner M, Shostak M 1988b Stone agers in the fast lane: chronic degenerative diseases in evolutionary perspective. American Journal of Medicine 84: 739±749 Gillette V 1996 Applying nursing theory. Association of Operating Room Nurses Journal 64(2): 261±267 Griggs B 1981 Green pharmacy: a history of herbal medicine. Norman & Hobhouse, London Harris S M, Hermiz M E, Meininger M, Steinkeler S E 1989 Betty Neuman: systems model. In: MarrinerTomey A (ed.). Nursing theorists and their work, 2nd edn. Mosby, St Louis Hensley D M, Keer M J, Kilgore-Keever K A, Lang®tt J V, Peterson L 1989 Margaret A Newman: model of health. In: Mariner-Tomey A (ed.). Nursing theorists and their work, 2nd edn. Mosby, St Louis Jacka J 1977 A philosophy of healing. J Jacka, Melbourne Jacka J 1998 A-Z of natural therapies (2nd edn). Lothian, Melbourne Leininger M 1988 Leininger's theory of nursing: culture care diversity and universality: a theory of nursing. Nursing Science Quarterly 2(4): 152±160 Lindlahr H 1918 Philosophy of natural therapeutics. Lindlahr Publishing, Chicago
McCabe P 1995 Exploring the phenomenon of healing: healing as a health capacity. Australian Journal of Holistic Nursing 2(1): 13±23 McCabe P, Ramsay L, Taylor B 1995 Discussion paper no. 2: complementary therapies in relation to nursing practice in Australia. RCNA, Canberra Murray M, Pizzorno J 1990 Encyclopaedia of natural medicine. Little Brown/Optima, London Pizzorno J 1996 Naturopathic medicine. In: Micozzi MS (ed.). Fundamentals of complementary and alternative medicine. Churchill Livingstone, New York Rogers M 1987 Science of unitary human beings. In: Parse R. Nursing science: major paradigms, theories and critiques. WB Saunders, Philadelphia Royal College of Nursing, Australia 1997 Position statement: complementary therapies in Australian nursing practice. RCNA, Canberra Selanders L C 1995 Florence Nightingale: environmental adaptation theory. In: Metzger C, McQuiston A, Web A A (eds). Foundations of nursing theory: contributions of twelve key theorists. Sage, Thousand Oaks Shames K 1993 The Nightingale conspiracy: nursing comes to power in the 21st century. Power Publications, New York Skeet M 1980 Notes on nursing: the science and the art. Churchill Livingstone, Edinburgh Turner R N 1990 Naturopathic medicine: treating the whole person ± the principles and practice of naturopathy. Thorsons, Wellingborough Watson R 1994 Guest editorial: nutrition standards and the older adult. Journal of Advanced Nursing 20: 205±206 Werbach M R 1988 Nutritional in¯uences on illness: a sourcebook of clinical research. Thorsons, Wellingborough