Printed in the Winter 2024 issue of Quest magazine.
Citation: Macrae, Janet "Florence Nightingale and Dora Kunz Perspectives on Nursing and Therapeutic Touch" Quest 112:1, pg 34-38
By Janet Macrae
Florence Nightingale’s textbook Notes on Nursing, published by the great pioneer of modern nursing in 1860, contains her basic recommendations for the care of the ill. This work is still essential for nursing because the fundamental needs of the ill, such as proper ventilation, cleanliness, adequate rest and nutrition, and confidence in the caregivers, remain unchanged. Moreover, her emphasis on cooperating with the restorative powers of nature is consistent with holistic methods in modern nursing practice.
Therapeutic Touch is a modern holistic method of facilitating healing which has been researched, practiced, and taught in nursing since its inception in the 1970s. And yet it is rarely associated with Nightingale’s work. The main reason, perhaps, is that Nightingale focused on the physical body and Therapeutic Touch is based on the concept of the human being as a complex system of energies.
Although an energy perspective might seem to be inconsistent with Nightingale’s focus on physical care, her view of health and illness was essentially dynamic. Throughout Notes on Nursing, she emphasized that (a) it is the “vital power” within the patient, derived from nature, that activates the healing; (b) this power is enhanced or reduced by environmental conditions; and (c) the nurse must knowledgeably regulate these conditions so that healing can proceed without obstruction.
There are many parallels between Florence Nightingale’s principles of nursing and those of Therapeutic Touch as explained by Dora van Gelder Kunz, its codeveloper. Two of their basic assumptions are the concept of a Higher Power and the concept of universal law.
One of the most important statements in Notes on Nursing, which reveals the way Nightingale integrated spirituality and healing, is found in a footnote: “God lays down certain physical laws. Upon His carrying out such laws depends our responsibility” (Nightingale, 25). She viewed God not only as the ultimate source of creative power but also as a divine mind or intelligence who regulates the universe through law as opposed to caprice. All processes in creation have an underlying intelligent design. Nursing’s challenge and responsibility, therefore, is to discover the principles of the healing process and to work with them effectively. Nature alone, the expression of God, cures, she wrote, “and what nursing has to do . . . is to put the patient in the best condition for nature to act upon him” (Nightingale, 133).
Dora Kunz had a unique perspective because she was clairvoyant since childhood. She was able to see various dimensions of subtle energies interpenetrating and extending beyond the physical body: vital (prana or chi), emotional, mental, intuitional (creative), and unitive (healing or inspirational). For a detailed discussion of these fields, see the series of articles by Kunz and Peper listed in the references. After observing many well-known spiritual healers, such as Kathryn Kuhlman and Ambrose Worrall, Kunz, together with nursing professor Dolores Krieger, developed a method of facilitating healing that could be practiced and researched in secular settings, such as nursing schools, hospitals, and clinics.
From Kunz’s perspective, the healing power comes from the unitive or inspirational field, which is characterized by order and compassion. The energy from this higher level, when knowledgeably channeled to the patient, quickens and strengthens the individual’s own healing resources. In Kunz’s view, there is an inner drive towards wholeness or “coordinated functioning,” which is derived from the orderly processes of nature. This drive exists not only within the physical body but within the entire multidimensional energy system. This dynamic underlying order is responsible for healing or restoring wholeness; the role of the nurse or therapist is that of a facilitator when help becomes necessary (Kunz and Krieger, 48‒62).
Therapeutic Touch Processes
The practice of Therapeutic Touch involves several processes: centering oneself, assessing the patient’s energy system, clearing congestion, and sending healing energy with the ideas of order, balance, and wholeness. These are most easily described as sequential phases, but in actual practice they tend to occur simultaneously. Each of these processes has parallels with Nightingale’s recommendations for nursing practice.
Centering
Centering, as Kunz explained, is focusing oneself in the present moment. It is making the intent to align with a higher level of consciousness that is a center of peace and quiet. She described this as the “inner self,” the core of one’s being, “the enduring constant, the continuing background of all one’s consciousness” (Kunz and Krieger, 17).
The practitioner must maintain this centered state throughout the treatment process because it is through the alignment with the inner self that the higher energies are accessed. Therapists are able to avoid fatigue because, by serving as a conduit, they are continually replenished. Additionally, the inner calmness of the centered state helps to reduce any anxiety or physical tension on the part of both therapist and patient that might interfere with the energy transfer.
Although Nightingale did not use the term “centering,” she wrote about the need to “possess oneself,” to maintain a calm, purposeful manner when caring for the ill, because “all hurry or bustle is peculiarly painful to the sick” (Nighingale, 48). In her spiritual work Suggestions for Thought, she wrote that focusing on our work with a spiritual intent brings an attunement with the inner divine nature, the finest part of oneself inspired by God. From this attunement comes compassion, inner calmness, steadiness of purpose, and confidence. It also brings the flowing vitality to keep nursing alive in our hearts so that it never becomes, in her words, “a very hardening routine and bustle” (Dossey et al., 214).
Assessing
The Therapeutic Touch therapist, in a centered state, quietly attunes to the patient’s energy field, searching for areas of congestion, depletion, and/or dysrhythmia.
The assessing process enables the therapist not only to transfer energy but also to knowledgeably help the patient’s efforts toward rebalancing and assimilation. Even if some of the cues are not picked up, Kunz observed, the innate healing ability of the patient can distribute the energy where it is needed; thus the treatment is still helpful (Kunz and Krieger, 201). The centered state of the therapist aids the assessing process, for it allows her to “step back” in consciousness. From this shift in perspective, she can pick up energy cues, make observances, and see connections that might ordinarily be missed.
Nightingale was much less forgiving with respect to missed cues. For her, assessing or accurately observing the patient’s condition can be a matter of life and death. The following strong statement from Notes on Nursing relates to one of Nightingale’s fundamental teachings: although nursing is motivated by compassion, it must be guided by a knowledge base that is built through “ready and correct observation” (and statistical analyses when appropriate). “For it may safely be said, not that the habit of ready and correct observation will by itself make us useful nurses, but that without it we shall be useless with all our devotion” (Nightingale, 112).
Clearing Congestion
The Therapeutic Touch therapist clears the patient’s energy field of congestion, which is usually felt as sensations of heat, thickness, and/or pressure. This process helps to reestablish a freely flowing, balanced energy field. Because energy congestion can be experienced as discomfort or pain, often the patient will start to feel better at this point. Also, once the congestion is removed, the patient is more open to a transfer of energy through the therapist.
Clearing energy congestion has its parallel in Nightingale’s practices of ventilation and cleanliness.
“The very first canon of nursing . . . the first essential to a patient . . . is this: TO KEEP THE AIR HE BREATHES AS PURE AS THE EXTERNAL AIR WITHOUT CHILLING HIM” (Nightingale, 12).
For Nightingale, the elimination of toxins or “noxious matter” through the lungs, skin, and bowels is intrinsic to the healing process. From her perspective, assisting nature means establishing a clean, flowing interaction between the patient and the environment. Anything introduced into the patient’s system, such as air, water, and food, should be as pure as possible. All soiled materials, from wet bedclothes and sheets to dusty carpets and furniture, should be removed. This will prevent, or at least help to reduce, the buildup of stagnant conditions, which impede the healing process.
Just as the Therapeutic Touch recipient feels relief when the energy congestion is removed, Nightingale writes how patients are relieved when “noxious matter” is removed from the skin:
The amount of relief and comfort experienced by sick [sic] after the skin has been carefully washed and dried, is one of the commonest observations at a sick bed. But it must not be forgotten that the comfort and relief so obtained are not all. They are, in fact, nothing more than a sign that the vital powers have been relieved by removing something that was oppressing them. (Nightingale, 93)
Transferring Energy
Therapeutic Touch therapists make the intent to open themselves to the universal healing field and allow its energy to flow through them into the patient. This focused, conscious intent establishes and maintains alignment with the higher dimension. As Kunz emphasized, the energy is sent with the idea of wholeness, which can be understood as coordinated functioning, dynamic order, or harmonic balance of body, mind, and creative spirit. The added energy strengthens the individual’s own power to heal, or reestablish his or her inner balance (Kunz and Krieger, 99).
The conservation of vital energy necessary for healing was important enough to Nightingale to be part of her definition of nursing:
I use the word nursing for want of a better. . . . It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet and the proper selection and administration of diet—all at the least expense of vital power to the patient. (Nightingale, 8)
Nightingale’s concern, expressed throughout Notes on Nursing, is that the patient’s vital powers not be undermined and diminished through want of attention to the fundamentals of care. For example, the patient’s taste should dictate what food he takes and at what time; otherwise the food will be left untouched or undigested. Unnecessary noise, or noise that creates an expectation in the mind, is hurtful and tiring to the patient. Being roused out of a first sleep is extremely detrimental. And if the patient becomes chilled through a lack of attention to hot water bottles and bricks, flannels, or warm drinks, the results can be fatal. Although modern hospitals do not use hot water bottles or bricks, Nightingale’s observations and recommendations are as accurate and important today as they were in 1860.
A Spiritual Practice
The regular practice of Therapeutic Touch, during which one’s energies are focused and harmonized, holds healing potential for the therapist as well as for the patient. From Kunz’s perspective, the inner self gradually comes closer to the personal self: its peace and confidence became more accessible, flashes of insight come through more frequently, and negative patterns tend to dissipate. Her clairvoyant observations of changes in her students’ energy fields should be encouraging not only for Therapeutic Touch therapists but for all those who regularly center themselves in their healing work.
I have now known people who have been practicing Therapeutic Touch for several years. I have noticed increasingly how they have changed individually from year to year. Their continued involvement in the Therapeutic Touch process radiates from them, changing their character and breaking some of their old habit patterns, often without their being aware of it. It is very encouraging to know that Therapeutic Touch has done that and I emphasize it because you may not be seeing it from my point of view. (Kunz and Krieger, 33)
Strengthening the communion or alignment between the individual and the inner divine nature was, for Nightingale, the ultimate purpose of human life. From the perspective of her active spirituality, this inner alignment is both cultivated and expressed through one’s chosen work. In Suggestions for Thought, she wrote:
“Work your true work, and you will find His presence within yourself—i.e. the presence of those attributes, those qualities, that spirit, which is all we know of God” (Calabria and Macrae, 143).
By “true work,” Nightingale meant work for which one is personally suited, which is freely chosen, holding one’s interest and love, and which is performed for a higher purpose. In her view it is the motivation that transforms one’s personal work into God’s work. This has its parallel with the Therapeutic Touch therapist’s focused intent to attune to the inner self and the higher healing energies. Nightingale understood what Kunz saw clairvoyantly: that our motivation or intent not only changes the quality of our therapeutic interactions, but can change the whole of our lives for the better.
Sources
Emphasis in quoted material is from the original.
Calabria, Michael, and Janet Macrae, eds. Suggestions for Thought by Florence Nightingale: Selections and Commentaries. Philadelphia: University of Pennsylvania Press, 1994.
Dossey, Barbara. Florence Nightingale: Mystic, Visionary, Healer. Springhouse, Pa.: Springhouse, 2000.
Dossey, Barbara, Louise Selander, Deva-Marie Beck, and Alex Attewell. Florence Nightingale Today: Healing, Leadership, Global Action. Silver Spring, Md.: American Nurses Association, 2005.
Kunz, Dora. The Personal Aura. Wheaton: Theosophical Publishing House, 1991.
Kunz, Dora, and Erik Peper. “Fields and Their Clinical Implications.” In Kunz, ed., Spiritual Healing. Wheaton: Theosophical Publishing House, 1995.
Kunz, Dora, and Dolores Krieger. The Spiritual Dimension of Therapeutic Touch. Rochester, Vt.: Bear and Co., 2004.
Nightingale, Florence. Notes on Nursing. New York: Dover, 1969 [1860].
Van Gelder, Kirsten, and Frank Chesley. A Most Unusual Life: Dora van Gelder Kunz. Wheaton: Theosophical Publishing House, 2005.
Janet Macrae is a coeditor of Suggestions for Thought by Florence Nightingale (University of Pennsylvania Press) and the author of Therapeutic Touch: A Practical Guide (Knopf).