Emerging Worlds: Chronic Illness and Viral Infections

Florence Nightingale's Message For Today
Barbara Dossey, RN, MS, HNC, FAAN



Barbara Dossey,  RN,  MS, HNC, FAAN

Our Dynamic Legacy

History is one of the most important aspects of any profession.  Modern
nursing has a proud heritage through the founder, Florence Nightingale
(1820-1910), a mystic, visionary, healer, environmentalist, feminist,
practitioner, scientist, politician,  and reformer.1  She left nurses a
legacy in over 14, 000 letters and over 100 books and pamphlets.
Nightingale's achievements are astounding when considered against the
backdrop of the Victorian era.  Her contributions to nursing theory,
research, statistics, public health, and health care reform even today are
foundational and inspirational.  As a bold and brave risk-taker,
Nightingale had vision, dedication, and commitment.

Resolving the poor conditions she had observed during her Crimean work,
and the military bureaucracy that fed them, became her mission for the
rest of her life.  She referred to her work as her must, to fight for
the life and the improvement of the health of the British soldier. She
pushed for the establishment of a commission to investigate military medical
care.  Nightingale used a convincing argument with statistics, whereby she
compared the mortality rates of soldiers in wartime military and
nonmilitary situations with civilian men of comparable age.  She invented
the polar-area or pie-chart diagrams where each wedge was brightly colored
to represent certain conditions.

Nightingale envisioned a new type of nurse and created the "art and
science" model for the profession of modern nursing. Her message focused on
the recognition of the interrelationship between and among the personal,
political, social, and scientific domains.  Let us look at a few of our
current nursing challenges and some of her pithy statements (in italics)
that are still timely today.  Although Nightingale's letters and books were
written a century ago, they remind us of our history and can stimulate us
to carry on her mission, as well as ours, in shaping health care reform and
enhancing our own caring and healing.

Integration of Caring and Healing:  If we are to integrate caring and
healing into the health care system and honor the needs of patients and
families, we shall need to explore the meaning that people attach to their
disease or illness.  Nightingale was profoundly aware of the spiritual
meanings people found in their lives, and the meanings they drew from
experiencing poor health.  She respected their sense of belonging
environmentally and socially.  She believed that health could be enhanced
through the search for meaning from life experiences, and that the meaning
people attached to disease or illness influenced the outcome of their
illness and recovery.   She said: ... “It is extraordinary that, whereas the
laws of the motions of the heavenly bodies, far removed as they are from us,
are perfectly well understood, the laws of the human mind, which are under
our observation all day and every day, are no better understood than they
were two thousand years ago..."2

Nightingale saw disease as a reparative process, and she believed that
the role of the nurse was to place the patient in the best position for the
reparative state to be enhanced... Shall we begin by taking it as a general
principle-that all disease ... is more or less a reparative process... an
effort of nature to remedy a process?3

As we place people in the best reparative position to make care
choices for wellness as well as end-of-life care choices for our wise
elders ( not elderly, weak people), we must be present to listen to their
needs.  She said about presence... All hurry or bustle is peculiarly painful
to the sick... Always sit down when a sick person is talking to you, show no
signs of hurry, give complete attention and full consideration if your
advice is wanted... Always sit within the patient's view, so that when you
speak to him he has not painfully to turn his head round in order to look at
you... Never speak to an invalid from behind, nor from the door, nor from
any distance.4

Nightingale wrote in her famous Notes on Nursing in 1860 of the
importance of complementary and alternative therapies such as music
therapy...  The effect of music upon the sick has been scarcely at all
noticed.  ...wind instruments, including the human voice, and stringed
instruments, capable of continuous sound, have generally a beneficent
effect....5  On pet therapy she wrote...  A small pet animal is often an
excellent companion for the sick, or long chronic cases  especially.  A pet
bird in a cage is sometimes the only pleasure of an invalid confined for
years to the same room.  If he can feed and clean the animal himself, he
ought always to be encouraged to do so... 6

Caring and Healing of Ourselves:  Nightingale's writings challenge us to
explore our inward journey toward self-transformation and to explore our
capacity for growth, change, and healing.  Not only do these efforts help
us, they generate the compassion we need in helping others heal as well.
Only if we address our own body -mind-spirit issues will healing enter
fully into the arena of health care. 7

Nightingale was deeply spiritual and was mystically inclined.  Although
Christian in orientation, she was deeply influenced by mystics of the East
as well as the West.  She emphasized the importance of a "calling"  to
nursing.  Understanding our calling allows us to know that the roots of
nursing are in the spiritual, as well as the technical domains:

For what is mysticism?  Is it not the attempts to draw near to God, not
by rites or ceremonies, but by inward disposition?  Is it not merely a hard
word for "The Kingdom of Heaven is within"?  Heaven is neither a place nor a
time.  There might be a Heaven not only here, but now... Where shall I find
God?  In myself.  That is the true Mystical Doctrine.  But then I myself
must be in a state for Him to come and dwell in me. This is the whole aim of
the Mystical Life; and all Mystical Rules in all times and countries have
been laid down for putting the soul into such a state...8

Health Care Reform: Radical changes are occurring in health care reform,
and nursing and medicine have never been more dynamic.  Always the rule in
health care, change provides us with a greater opportunity to integrate
caring and healing into our work, our research, and our lives.  Nightingale
believed nurses have the ability to improve the system.  She always
challenged the status quo by using her power to contact people in command
and challenged others to do the same.

Nightingale would be proud of nurses today as we educate consumers and
lawmakers about health, healing, and self-care, and how we issue wake-up
calls about the unsafe patient care resulting from widespread hospital
restructuring.  In so doing, we became part of nursing history.  These
events generate power and synergy; they provide further vision for the
reform of local, national, and global health care policies. Nightingale
reminds us of the power of collaboration and the importance of our inner
work as well: 

... It is impossible indeed to live in isolation: we are dependent upon
others for the supply of all our wants, and others upon us... For, to make
progress possible, we must make this inter-dependence a source of good; not
a means of standing still.

Nursing work must be quiet work-An individual work-Anything else is contrary
to the whole real-ness of the work. Where am I, the individual, in my
utmost soul? What am I, the inner woman [man], called 'I'?-That is the
question-... Let each one of us take the abundant & excellent food for the
mind which is offered us, in our training, our classes, our lectures, our
examinations & reading-not as 'Parasites', no-none of you will ever do
that-but as bright & vigorous fellow workers: working out the better way
every day to the end of life.9

Where Are We Headed?
Today, nurses are challenged to rediscover our essence and to emerge
as true healers.  Nightingale's example is a source of strength from the
past.  Through it we can find the vision and strength to assert ourselves in
a very difficult moment in history.  Nightingale's message moves us towards
the integration of  the moral,  political, spiritual,  and metaphysical
aspects of nursing, and invigorates our profession with a sense of calling.
But Nightingale would not want us to dwell on the past; she would be
concerned about future developments. When we feel overwhelmed with the " 3
D's" -- downsizing, devolution, and decentralizing, or the "3 R's" --
restructuring, reengineering, and redesigning, we can think of what
Nightingale did without very  many supportive colleagues,  professional
nursing organizations, and the information superhighway.   If she achieved
what she did with her handwritten letters, publications, and networking men
in power, can you imagine Nightingale with a laptop computer, portable
phone, fax, messenger recorder,  E-mail, Internet,  CD-ROM,  and the
information superhighway!

A part of Nightingale's wisdom resides within each of us.  She would be
at home in our world.  I imagine hearing her voice as she tells each of
us to identify our must and to fight for a health care system driven by
the needs of patients.  She would encourage each of us to collectively join
together to actualize our visions. She would ask us if we are documenting
through research our work and services.  Nightingale, the master networker,
would want us always to know who is in charge, who our representatives and
senators are.  She would ask us to educate and inform them through research
findings, so that  they can develop legislation for health care reform that
makes sense.  

As our understanding of our unique heritage increases, we deepen our
personal commitment to our work in the world.  Our role in today's events
will be part of tomorrow's future. We must challenge ourselves to learn to
communicate to a wider audience.  This means learning to write clearly and
powerfully not only for our colleagues, but for consumers and other health
care professionals, about how we integrate caring and healing.

Each of us, of course, must look forward, not backwards. Exciting work
lies ahead.  How are we going to write our chapter of nursing history as
the beginning of the 21st century?  What is our role at the local,
national, or international level?  What germinating seeds are we going to
leave for others?  What is our next innovative and creative education
endeavor? What is our leadership role in the health care system? Can we hear
Nightingale's voice?

1. Dossey, B.  Florence Nightingale:  Mystic, Visionary, Healer.
Springhouse, PA:  Springhouse Corporation, 2000.
2. Nightingale, F.  Notes on Nursing:  What It Is and What It Is Not.
London:  Harrison and  Sons, 1859, p. 7
3. Ibid., p.6.
4. Ibid., p.28.
5. Ibid., p. 33.
6. Ibid., p. 58. 
7. Dossey, B., Keegan, L., and Guzzetta, C.  Holistic Nursing: A Handbook
for Practice , 3rd edition. Gaithersburg, MD: Aspen Publishers, Inc., 2000.
8. Nightingale, F. Notes from Devotional Authors of the Middle Ages,
Collected, Chosen, and Freely Translated by Florence Nightingale.  ( circa,
1872, unpublished manuscript. British Library Manuscript 45841: f1; cited in
Dossey, B. Florence Nightingale:  Mystic, Visionary, Healer.  Springhouse,
PA: Springhouse Corporation, 2000, p.343.
9. Address from Florence Nightingale to the Probationer Nurses in the
Nightingale Fund School at St. Thomas's Hospital.  May 16, 1888; cited in
Dossey, B.  Florence Nightingale:  Mystic, Visionary, Healer.  Springhouse,
PA:  Springhouse Corporation, 2000, p. 384.

To order  Barbara M. Dossey's book Florence Nightingale:  Mystic, Visionary,
Healer  (©2000, ISBN 0-87434-984-2), contact Springhouse Corporation,
Springhouse, PA. at
1-800- 666-5597.

About the Author
Barbara M. Dossey, RN, MS, HNC, FAAN, is internationally recognized as a
pioneer in the holistic nursing movement.  She is Director of Holistic
Nursing Consultants in Santa Fe, New Mexico.  She has authored or
co-authored 19 books including Florence Nightingale:  Mystic, Visionary,
Healer  (©2000), AHNA  Holistic Nursing: A Handbook for Practice (©2000),
AHNA Standards of Holistic Nursing Practice (©2000), Profiles of Nurse
Healers (©1998), AHNA Core Curriculum for Holistic Nursing (editor, ©1997),
AACN Handbook of Critical Care Nursing (©1997) and Rituals of Healing

Barbara is a Fellow of the American Academy of Nursing. She is certified in
holistic nursing.  She has received many awards and is a five-time recipient
of the prestigious American Journal of Nursing Book of the Year Award.  She
was awarded  the 1985 Holistic Nurse of the Year by the American Holistic
Nurses' Association, the 1998 Healer of the Year by the Nurse Healers,
Professional Associates International, Inc., the 1999 Pioneering Spirit
Award by the American Association of Critical Care Nurses, and the 1999
Scientific and Medical Network Book of the Year from the Scientific and
Medical Network, United Kingdom.

For more information on Barbara Dossey visit her website: