A Forgotten Nursing Theory

I have been to London’s attractive Southbank several times. It is one of the most famous tourist attraction sites in London. With its continued fun activities to accommodate the whole family, the Southbank captivates during the day and bedazzles at night. Something was leading me to the Southbank yesterday. I cannot put a finger on it. Perhaps it was the tantalizing Street Food market cleverly nestled behind the Royal Festival Hall. Probably it was the allure of the sun that was secretly peaking between skyscrapers to highlight London’s immaculate skyline. Or maybe, just maybe, it was Mary Seacole’s monument at St. Thomas Hospital.

I had never visited the Mary Seacole Monument before.? I knew it existed but had not paid much attention to it save for a desktop observation here and there. However, during the induction program, I mentioned in last week’s Newsletter, one of the key facilitators spoke about Mary Seacole and her legacy in nursing. He gave us a coin that explained the Mary Seacole Monument. The coin represented the many lands Mary traveled to and from. The coin carried a story. The story of nursing at its infancy. Just like Maya Angelou once observed, I do not remember many of the words the facilitator used but I remember what he made me feel when he spoke about Mary Seacole, her monument, and the coin that I fiddled with in my fingers.

As I stood at this monument, completely lost to my surroundings save for the reverberating voice of the facilitator somewhere in my brain, I started noticing things about Mary Seacole. She looks as if she is carrying the whole world on her back yet her gait is upright, face resolute. She is not bent out of shape, yet her heart may be bent with the rejection of her services by the London office when she volunteered to help soldiers during the Crimean War, just like Florence Nightingale. That does not stop her though. Mary has one foot in front of the other probably to remind us that the only way forward is to take one step.

She has unmistakable frowns on her brow. Is it age? Deep thoughts? I wonder. Probably she is thinking deeply about how to tackle the fever that accompanied many of the patients she attended to. From Jamaica and Panama to the frontline battle where soldiers lay in her boarding hall. Perhaps she was thinking about Florence Nightingale whom they had briefly met. Or maybe she just had these frowns on her forehead. I stared some more. Longer than anyone should perhaps stare at any statue.

“Do you want to be a nurse?” a voice asked me interrupting my reverie. I turned to see an elderly couple behind me, looking at me staring at the monument, perplexed that I would stare so long and so hard at a seemingly nondescript monument. The lady is the one who spoke out.

“Oh, I am a nurse,” I offered in reply.

“You are praying, meditating?” She continued. I laughed. She waited for an answer. “No, I am just admiring one of the greatest nurses in history.” She smiled politely in reply. This is the most British reply I know: Smile politely.

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You may have heard the story of Mary Seacole and how she was lost to history and then rediscovered. One of the ways that we have remembered and appreciated our nursing founders and foundresses is by embedding their ideas in the theoretical framework with which we train nursing students. For instance, we credit the Environmental Theory to Florence Nightingale.

Long before Handwashing was discovered as a sure way to break the chain of infection, Florence Nightingale had established that a clean environment and body hygiene, all contributed to better health outcomes. My experience yesterday made me think of theories that Mary Seacole would have been credited with had she not been erased from the annals of history by the powers that existed back then. This theory is hypothetical.

Theory of Culturally Competent Holistic Nursing Care by Mary Seacole (1805-1881).

Core Principles

1.??????? Cultural Proficiency: Seacole’s theory recognizes the relevance of understanding and respecting diverse cultural backgrounds among patients. Nurses are called to recognize their own cultural biases and actively educate themselves to accommodate and not judge people's belief systems.

2.??????? Holistic Care: Seacole’s theory encourages nurses to address the entirety of patients’ well-being. It also calls for the collaboration of care among nurses, other members of the medical team, the community, and most importantly, the patient and their families.

3.??????? Equitability in care: Seacole’s theory advocates for equitable care for all. It calls for the recognition that a person's socioeconomic, racial, cultural, and demographic factors should not limit them from accessing care.

Wherever the need arises on whatever distant shore,I ask no higher or greater privilege than to minister to it-Mary Seacole

Key Components

1.??????? Cultural assessment: Using Seacole’s theory, nurses conduct a comprehensive cultural assessment of their patients noting their language, religion, family dynamics, and health beliefs. Nurses incorporate this assessment in the formulation of patient-centered nursing care plans.

2.??????? Education in Cultural Competence: Seacole’s theory emphasizes that continued cultural training education helps in breaking down personal biases and improving skills in caring for patients from diverse backgrounds.

3.??????? Adaptability: Using Seacole’s theory, nurses recognize that culture is dynamic and they maintain an open-mind. This helps them to adjust their approach to care based on the specific cultural context of the patient.

Application in Practice

First, a thorough cultural assessment helps inform the use of specific resources for a patient. For instance, it leads to the planning of an interpreter to be available. Imagine a patient who only speaks Urdu. A common practice in some hospitals is to discuss medical information with a relative who is expected to translate it to the patient. This is poor practice. If we conduct a thorough cultural assessment, then we can ask for an official interpreter to be present in advance. This not only ensures effective teaching but also recognizes the autonomy of the patient and their ability to make their own health decisions and not rely on a relative. It also maintains confidentiality. The same is true when we need to plan for a Sign Language interpreter.

Secondly, Seacole’s Theory helps address the social determinants of health. I argue that it is on this premise that Nye Bevan helped set up the National Health Service (NHS) in the United Kingdom. The NHS is a classic example of how our backgrounds, as diverse as they are should never be used to determine whether we access quality healthcare or we do not. Money and lack of it, should not be a factor when we need to access healthcare services. Probably this theory is a good yardstick for all healthcare systems in the world that keep fighting for equitable healthcare access for all and not just the haves of society.

In addition, Mary Seacole’s theory recognizes that patients have agency over their bodies and they can and are allowed to utilize alternative therapies. Let us acknowledge that modern medicine is not the panacea for all modern ailments. Yoga, Acupuncture, aromatherapy, Pilates, and other practices that modern medicine dismisses as having ‘anecdotal’ evidence have room in the care of a patient. Mary Seacole used pomegranate juice to treat diarrhea that accompanied the Panama Cholera outbreak. She used mustard plasters and cinnamon water to help in various treatment ways.

Though we have made progress in medicine and are no longer using mustard plasters as emetics, we cannot ignore the role that alternative therapy has in medicine. This is partly the reason why though we consider our food to be of good quality in the United Kingdom and other Western countries, the High Street is full of different supplements! Seacole’s Theory recognizes that every culture has a way to deal with the diseases that commonly affect mankind. From oriental medicine to the Malagasy people, from the Aboriginals in Australia to the lost tribes of the Amazon, every culture in the world has ways to complement modern medicine. Now that is cultural competence.

How else can we apply this hypothetical Nursing Theory by Mary Seacole?

Have a thoughtful week my nursing family.

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