The Public’s Perception of Florence Nightingale’s Legacy in the Digital Media: A Critical Discourse Analysis

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The public’s perception of Florence Nightingale’s legacy in the digital media: a critical discourse analysis

Gianluca, Conte, et. al.

This is an interesting, well-written article. I appreciate having access to the video and podcast transcripts. I also appreciated the diverse expertise of the research team.

One of my chief concerns with this article is that there appears to be no evidence-based support for the assertion that nurses primarily associate Nightingale with her nurturing role, while other professionals and the general public view her as nurturing but also as a scientist and educator. I do not see any references to studies about nurses’ or the general public’s views of Nightingale. There are a few references to articles in professional journals, but these articles discuss her roles, not nurse or public perceptions of these roles. Fortunately, I don’t think you need to relate the results of this interesting study to nurses’ perceptions of Nightingale. Elucidating publicly accessible views about Nightingale in this “snapshot of time” is enough.

While the videos and podcasts are a rich source of data about how some people view Nightingale, it would be important to know the backgrounds of the people making the videos and podcasts to see if they are nurses, non-nurses, or academics. In other words, are the views in the videos and podcasts coming from the general public, or are they coming from nurses, academics, or professionals? For example, Lynn MacDonald, founder of the Nightingale Society and author of many volumes of material about Nightingale, is not an average member of the general public when it comes to Nightingale. If your objective is to discover what the general public thinks of Nightingale, this is a problem. If your objective is to discover which perspectives of Nightingale are available in the public sphere, this is not a problem

The introduction should include more discussion of the literature review, particularly of the Kelly study published in The Journal of Advanced Nursing, which has similarities to yours. A brief mention of seminal Nightingale biographies, such as that by Mark Bostridge, would also be indicated.

Much more detail needs to be given about the methodology. See the methodology used in the Kelly study. For example, if thematic saturation wasn’t used to determine the number of videos and podcasts used in this study, what were the criteria for limiting them to a certain number retrieved? How many podcasts did you start with? How did you select the final twenty-five podcasts and 18 videos? Who were the authors of the videos and podcasts? Etc.

Page 3, line 130: What is meant by “subject positions”?

Page 7. Line 245: “Mere caregiving” sounds a bit pejorative.

The limitations section is well done.

The conclusion section states that the study “underscores the importance of these portrayals in shaping professional identities and influencing public attitudes.” While the study explains how the videos and podcasts portray Nightingale, I don’t think it produces new knowledge about how they influence identities and attitudes. Then again, I don’t think it is necessary for this study to do that.

Again, I enjoyed reading this interesting article.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This article explores the portrayal of Florence Nightingale in podcasts (18) and YouTube videos (25) to understand the public perception of nursing. The authors used critical discourse analysis to analyze these podcasts and YouTube videos and identify five themes: Nightingale as a) a legendary figure, b) a modern feminist, c) a dedicated statistician, d) a pioneer in public health, and e) a pivotal contributor to STEM fields. This article sheds some light on how Nightingale is utilized as an icon in discourse in podcasts and videos.

The article puts forward a heroic view of Nightingale as central to the nursing profession. The article begins with the statement that Nightingale is “widely regarded as the founder of nursing.” Though this is contested statement, the authors do not delve into the ramifications of that statement for the profession and how that might be perpetuating a particular (and harmful) image of the profession. Throughout the introduction and conclusion, the authors use heroic language to describe Nightingale. For example, often using these descriptors “celebrated,” “pioneering,” “extensive contributions,” and “Mother of Nursing,” etc. In the introduction, the authors note that her work (particular, Notes on Nursing) “provided a comprehensive framework for nursing practice and healthcare reform” and “continue to serve as foundational texts in nursing education and practice.” The authors have cited scholarship in support of this interpretation. Yet, there is a whole body of scholarship that critiques this heroization of Nightingale and points out the harm with this narrative for nursing. The authors have not engaged with this literature at all, and this work reifies the very narrative that is heavily critiqued in the literature. Nightingale’s work in Crimea was short lived, after which she was primarily in bed for the remainder of her life (Nursing scholar Sonya Grypma has pointed out how eccentric and contradicted her writing was from that point on). Furthermore, Notes on Nursing describes the nurse as subordinate and deferential, religious, and of a particular class and race. It  was also written before the advent of the biomedical revolution and the germ theory (why is she being referred to as a rigorous scientist?). Notes on Nursing is not a document that I or my school would condone teaching as a foundation for practice, and I am confused as to why the authors would say it is a foundational text for nursing practice and healthcare reform. At the least, perhaps they could explain how they have come to that view. Furthermore, the authors should consider distinguishing between Nightingale the person and Nightingale the icon. This article reifies Nightingale the icon for nursing.

I would encourage the authors to at least engage with the scholarship that points to the enduring harmful legacy of constantly invoking Nightingale for every innovation in nursing, and the work that addresses Nightingale’s racism and how white nursing leaders used Nightingale to further perpetuate racism in nursing. The Beyond Clio peer-reviewed blog series includes many articles that the authors may want to look at including “Moving Beyond Florence: Why We Need to Decolonize Nursing History” (https://nursingclio.org/2021/02/04/moving-beyond-florence-why-we-need-to-decolonize-nursing-history/) and “The Racist Lady with the Lamp” (https://nursingclio.org/2020/11/05/the-racist-lady-with-the-lamp/). In Canada, nursing textbooks now address the problematic legacy of Nightingale. They also often include biracial nurse Mary Seacole’s work in Crimea alongside discussions of Nightingale, including the fact Seacole was rejected from joining the Nightingale contingent.

 I appreciate the fact that the authors have waded through an extensive number of podcasts and videos, but I am confused about the relationship between these videos and the public perception of nursing. How do we know the public view is informed by these videos and podcasts? There is no description of who created these videos or podcasts (i.e were student nurses making podcasts on the topic for a course assignment? Were nurses making the videos?). And if so, how is that representative of public perception). The authors do indicate that the videos and podcasts might not represent a balanced view of Nightingale. And although they argue that this is a valuable analysis, perhaps they could explain why. I think the authors premise that these videos are shaping public perception needs work – there is no understanding of who the audience is. The results of the CDA would suggest Nightingale was a pioneer of STEM, a modern feminist, a dedicated statistician, a legendary figure and a pioneer of public health. Were there any criticisms of this vision of Nightingale put forward in the videos or were there only positive interpretations? And do the authors have anything critical to say about this heroization of one woman and her seemingly unending contributions to every facet of science? Could there be other reasons why these discourses are being put forward? Perhaps the authors could include a critical reflection and discussion of these themes and the implications for the profession.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors have made appropriate revisions. 

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for asking me to review this article which explores the public perception of Nightingale through podcasts and YouTube videos through CDA.

1) The authors indicate that these 25 podcasts and 18 YouTube videos portrayed Nightingale and shaped public discourse about the profession. The authors use CDA to reveal five thematic representations of Nightingale. I appreciate the additional context around the podcasts and videos, and it is helpful to know none of them were created by nurses. I was left wondering if the videos don’t tell us more about Nightingale than they do about nursing, since the authors cite an additional study that looked at perceptions of nurses in videos which came to radically different themes as this study (the sexy nurse, etc.). The additional context is helpful to know why the authors decided to pick these videos. The authors might want to consider which public (some scholars would argue there is a multiplicity of publics).

2)  In my previous comments, I was urging the authors to distinguish between Nightingale the person and Nightingale the icon. The issue with Nightingale as an icon is that there is an assumption that Nightingale is relevant to all nurses, which is not the case. For example, countries in the Middle East celebrate a different historical trajectory relating back to Rufaida and other important Muslim women healers, not Nightingale. I would again encourage the authors to consider how they reify Nightingale as an icon for nursing in this article. I appreciate that the authors have added additional context about Nightingale's life. Statements made in the article could benefit from more clarity. For example, the authors added the first sentence in the introduction: "Florence Nightingale, often celebrated as the founder of modern nursing and the perfect example of caregiving..."  Who is saying that Nightingale is a perfect example of caregiving? As a nurse and nurse educator, I would certainly never refer to Nightingale in this way (she did very little nursing work, her idea of nursing has resulted in irreparable harm for the profession, she was racist, etc.). Who in the 21st century is looking to Nightingale as a perfect example of caregiving? Maybe the authors could qualify some of the statements. As per the scholarship I previously referred the authors to, there is a whole critique of the problematic way that Nightingale is taken up in nursing scholarship. Nightingale might represent nursing for some people, but not all people. What does it mean to evoke Nightingale as an icon for nursing then? The authors might want to consider some of these broad generalizations made in the paper.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf