Nursing as a Spiritual Practice:

The Mystical Legacy of Florence Nightingale

 

Barbara Dossey, PhD, RN, AHN-BC, FAAN

 

            Florence Nightingale: Mystic, Visionary, Healer was written to offer a radically different view of her from the starchy, aloof figure that many of my generation encountered in nursing school. She had come to be seen as almost irrelevant to modern nursing. In Nightingale I saw someone whose values and beliefs are deeply appropriate to the challenges facing nursing today. I was intensely intrigued with her, and immersed myself in this work with such zeal and passion that it seemed to take over my life.

 

            I began my historical research on the life of Florence Nightingale (1820-1910) because nursing and healthcare are both in crisis; this has resulted in many healthcare providers losing sight of the heart and soul of what it means to be in service to others. My motivation and goal with this research was to produce a unified context from which to consider and help resolve the chaos of local, national, and international health issues that include the nursing shortage and inadequate patient care. Even as many health care organizations seek to bring healing and caring into their environments, nurses struggle to convey that their profession—for which such healing and caring is as fundamental as its science and technology—is the pivotal one for healthcare.

 

            Before I began my research, I knew very little about Nightingale except that she was considered the founder of modern nursing. As I explored her life and work, I was surprised to find that most nurses don’t know she was one of the superpower personalities of nineteenth-century Britain. Nightingale was a comet blazing across the Victorian sky, changing everything in her path.  Her accomplishments rivaled those of the greatest men. Women of her time simply did not do what she did.

 

            I marvel at what Nightingale overcame to bring her life’s work forward. What great challenges she overcame! She was born into wealth and political influence; was a highly educated aristocrat, fluent in five languages, master of the mathematics and statistics of her time, and became the leading expert of her day in hospital design.  A born feminist, she scandalized her elite family by choosing a life dedicated to the alleviation of human suffering.  Her life was staged in the bucolic English countryside, the halls of Parliament, and the bloody battlefields of the Crimea. 

 

            Next to Queen Victoria, Nightingale was the most famous and influential woman of her era.  Had she been a man, she would likely have been Prime Minister. I encourage nurses and others to visit the Florence Nightingale Museum; it is recognized as one of the ten best small museums in London. My visits to the museum are like a pilgrimage; I continue to learn something new about Nightingale’s relevance and impact for contemporary nursing and healthcare with every visit.

 

            Alex Attewell, director of the Florence Nightingale Museum, his colleagues and the wonderful, dedicated volunteers, have created a treasure for us; they are in the process of expanding the museum and creating a new foundation that will further enhance our understanding of Nightingale’s legacy. Alex Attewell is also calling for the establishment of an International Centre for Study and Research in nursing where Florence Nightingale’s originality and amazing powers can be brought together in one place to show her influence in many fields. This Centre would bring together all her books, manuscripts, personal belongings, and other symbols and articles that are intimately associated with Nightingale’s life and work.

 

For information on the Florence Nightingale Museum and the Florence Nightingale Foundation, go to http://www.florence-nightingale.co.uk/

 

            Florence Nightingale remains a profound role model for us today. When we explore her written work, we find that she has created a blueprint for healing, leading, and global visioning where we as nurses can come together and shape a vision of a healthcare system driven by the needs of patients and their families.

 

            Nightingale’s legacy has endured because her life is an example of patriotism, dedication to king and country, wealth and power, leadership, warriorship, spirituality, love, compassion, integrity, wisdom and healing.  She inspired changes in medicine, public health, and nursing, which resonate to this day.  She was forceful and sometimes eccentric, and like all brilliant agents of change, had her share of critics, who also persist to this day.  But which famous figure does not have detractors?  This aspect of Nightingale only makes her human and adds spice to her story.

 

            There is and will continue to be a major resurgence of interest in Nightingale as we approach the 100th year of her death in 2010.  The magnitude of Nightingale’s story has not been recognized by nurses and others because her legacy has been trivialized and sanitized—“the lady with the lamp.” In particular, the depth of Nightingale’s inner life has been almost totally neglected. She had a rich inner life that characterizes a mystic. Like Joan of Arc, Nightingale periodically heard the voice of God. One simply cannot understand her stunning accomplishments without taking this into consideration. Her spiritual writings are as sublime as those of the great medieval female mystics such as Saint Teresa, Hildegard of Bingen, and Julian of Norwich.

 

            After combing her 14,000 letters—the largest private collection of letters in the British Library—I uncovered evidence that her intense spiritual life defined and empowered her life mission from adolescence onward.

 

            As a nurse, I felt compelled to write about her. My challenge was to decide what I could add from a historical perspective about this remarkable woman, when hundreds of people have already written about her. A major focus of my research was to bring Nightingale forward as a mystic. Yes, Nightingale was a profound mystic. In my historical research, I used the framework of a British scholar, Evelyn Underhill, one of the most recognized writers on western mysticism, to organizational framework for my research. 

 

            Underhill defines mysticism as an individual’s direct, unmediated experience of God. A mystic is a person who has such an experience, to a greater or less degree. The life of a mystic is not focused merely on religious practice or belief, but on what he or she regards as firsthand personal knowledge of the love of God, or the experience of the Divine Reality of God.

 

            Nightingale’s spirituality was a profound sense of connectedness with God. Her God was not a white male who spoke only English, but a Universal Truth permeating all the great religions--the God/Life Force/Absolute/Transcendent. Her spirituality was the unifying force in her life. It infused every thing she thought and did in her long life of 90 years.

 

            Evelyn Underhill’s framework of mysticism has five phases: awakening, purgation, illumination, surrender, and union.

 

The first phase, “Awakening” is where a person hears the voice of God. This is so profound and true that it becomes embedded in that person’s life story, forever changing her life. 

 

The second phase is “Purgation.” This is the period in which the person realizes that she/he is not worthy. How could she possibly be called to do this profound work of service? She tries to purge herself of worldly connections, often through fasting and extreme acts such as giving away material possessions.

 

In the third phase, “Illumination,” he/she is utterly filled with passion for and a sense of God.

 

The fourth phase, “Surrender,” typically continues for a long time. It is a very profound period in which the person explores her inner, divine connection. This period of spiritual development often includes much suffering–because, as the person strives for perfection, she/he can never feel worthy enough. In mystic literature, this phase is often referred to as the “dark night of the soul.”

 

The fifth phase is “Union,” during which the mystic realizes that he/she has reached a level of deep inner connectedness with the Divine Reality.

 

            These five stages are not a linear process. Mystics seldom follow these phases in a rigid, linear sequence. They can experience Awakening, and then Illumination, only to fall back into Purgation. Often Purgation and Illumination run parallel, while the Surrender and Union phases alternate.

 

            In her book, Practical Mysticism (1915), Underhill referred to Nightingale as representing that of a fully integrated mystic. At an early age, Nightingale had a serious religious and spiritual nature, always with the desire to nurse the sick. 

 

            Nightingale’s “Awakening” occurred at age 16, on February 7, 1837. She recorded her first Call from God then, and on three other occasions later in life when she heard the voice of God again. Her “Purgation period” lasted around 17 years before she was finally able to break free and pursue her interest in nursing.

 

            The “Illumination” period began during Nightingale’s first superintendent position at Harley Hospital in London for eighteen months, and as Underhill states, it is this illumination period that assisted Nightingale during her Crimean War mission. Her “Surrender” phase lasted from around age 36, after she returned from the Crimea, until her late sixties. She entered the “Union” phase in her seventies when she was not as driven by her social action.

 

            As a scholar and a seeker of Truth, she spoke and wrote about God, the Universal God, and the One. For example, she wrote, “What do we mean by ‘God'? All we can say is that we recognize a power superior to our own; that we recognize this power as exercised by a wise and good will.” She believed in the messages contained within Christianity and saw Jesus Christ as a great man who revealed the fundamental truths of God.  She seriously studied and contemplated the words and parables in her Bible, heavily annotating her own King James Version, which had a blank page between almost every printed page. She wrote her own ideas, meanings, and her interpretation in English, French, Latin, Greek, and Italian, which have been translated and analyzed.

 

            Nightingale honored cultural diversity and was extraordinarily tolerant and ecumenical in her attitude toward world religions. She wrote that “to know God we must study Him in the Pagan and Jewish dispensations as in the Christian.” To her, this broad approach gave unity to the whole; it was the one continuous thread throughout humanity.

She called for religious tolerance and she also asked others to be respectful of cultural diversity. This can be seen in her work for India for over forty years; her papers on the aboriginal races, and all places where the British Empire had taken over native peoples and their lands. She read world religions widely. She was familiar with translations of early writings such the Upanishads of Hinduism, Plato, Gnosticism, and of Jesus, to name just a few. She wrote her own liberation theology, Suggestions for Thought, in three volumes of 829 pages, which she had privately printed.

 

  Much of modern nursing’s heritage comes through its founder, Florence Nightingale. She was a fiery and visionary interdisciplinary healer and practitioner; her contributions to nursing and public health practice, research and statistics, social and political reform, and nursing theory are fundamental to health care. Her message still speaks to nurses today. It speaks about the complexity and the crisis within healthcare.

 

            My new book (Dossey, B.M., Selanders, L.C., Beck. D.M. & Attewell, A. Florence Nightingale Today: Healing, Leadership, Global Action  (NurseBooks.Org, 2005) examines and analyzes this legacy and demonstrates how it offers a vision for renewing nursing and health care—a profession and industry in mutual crisis—in the coming decades. This book is grounded in the necessarily integrated personal, political, scientific, social, and spiritual domains of Nightingale’s life and work.

 

            As Nightingale scholars, my co-authors and I have employed historical research and recent scholarship to assess and analyze in-depth, the Nightingale legacy and show its relevance to contemporary nursing and health care.

 

            In the process, Florence Nightingale’s life and work can also help to counter the often fragmentary, and thus superficial or trivializing accounts, of Nightingale that continue to appear. Her life stories are contained within the primary documents that are discussed in this book, along with other supporting primary and secondary sources. These stories also convey the wholeness and unity of her life and work. Activist, feminist, healer, mystic, environmentalist, politician, practitioner, reformer, scientist… all were roles of this practical health care pioneer.

 

            Nightingale’s three tenets—healing, leadership, and global vision challenges nurses to engage in healing; she calls for us to recognize nursing as a spiritual practice. Healing can occur with curing that uses the best of western medical protocols, treatments, and procedures when necessary or appropriate. As Louise Selanders reminds us, Nightingale is the philosophical founder of contemporary nursing. Her legacy is a guiding light for nurses and all of humankind in how to integrate technology with healing. This should never be “either/or,” but must be “both/and.” These ideas are also developed in my co-authored Holistic Nursing: A Handbook for Practice (4th Ed,) that serves as a guide on how to implement these concepts into nursing practice, education, and research. 

 

            Today, there continues to be a focus on curing with empirical knowledge that is characterized as the mindset of technology, rationality, objectivity, and a linear cause-and-effect, physical-material world view and set explanations related to the reality of consciousness.

 

            My coauthor Deva-Marie Beck has done a superb job of synthesizing Nightingale’s global vision and summarizing the following seven points that are explored in detail in our forthcoming book. These are:

 

1) Make health—and influencing positive health determinants—a top priority in human affairs.

2) Value and sustain nurses in their caring in health care.

3) Collaborate—across disciplines and across cultures—for promoting health in community settings.

4) Think globally; act to create local Health Literacy—for both genders, across the lifespan.

5) Make media a catalyst for nursing and for health.

6) Keep health care holistic and interdisciplinary.

7) Answer your own “calling. “

 

            When the art and science of the profession come together, nurses’ intellect, intuition, and healing presence become more dynamic; the interaction of self with another take on a different quality. Healing presence is approaching a patient or another in a way that respects and honors her essence. Healing encounters are more frequent because there is a coming together of two people in a present moment where a different level of exchange and sharing occurs.

 

                Healing is powerful because it is not predictable. A useful metaphor in listening to another person’s story or in the telling of a story when a healing moment has been created is that the boundaries between two people in a caring moment become fluid. A thread of a story can take a person in a direction that he was not conscious of before the telling of the story. A nurse can maintain healthy boundaries within this situation, particularly when the nurse integrates self-care and reflective practice on a regular basis.

 

            There is a need for interdisciplinary dialogues in healthcare. Nightingale was a great interdisciplinarian; she was always thinking in new ways such as analyzing, communicating, exchanging, surveying, involving, synthesizing, investigating, interviewing, mentoring, developing, creating, researching, and teaching. She listened to others; she created new schemes for what was possible for healthcare providers, patients and their families. 

 

            Interdisciplinary dialogues occur when all team members come together—the professionals, complementary and alternative practitioners, volunteer caregivers with the patient and his family—to an integrated relationship-centered care, to explore healing of the whole person—body, mind, and spirit.

 

            An atmosphere of trust is created so that each person is listened to and feels that her concerns are being heard. A person’s story is heard and the uncertainty of being a person with an illness is honored.

 

            Nurses can be leaders in creating opportunities for interdisciplinary dialogues and interdisciplinary approaches to care. An interdisciplinary approach means that professionals come together to share knowledge; they emphasizes connections with each other rather than specialization; there is “collaboration with” rather than “competition among.”

 

            An interdisciplinary approach calls for being committed to learning new approaches from other disciplines; to have a new commitment, courage and spirit of exploring and understanding how to use creativity and inspiration.

 

            Both the healthcare system in the US and in Britain face grave challenges. Nurses with other healthcare professionals can reconstruct, reshape, and reinvent the hospital and the clinic into sacred spaces that empowers the health care system to provide healing. 

 

            The ultimate aim of contemporary nursing is to integrate Nightingale’s three tenets of healing, leadership and global vision so that we can reconstruct and reweave new patterns and themes into our healing tapestry of nursing education, practice, and research. One of the ways we can practice differently is to create sacred spaces in hospitals, clinics and schools that will encourage our transpersonal dimension to emerge. This dimension transcends the limits and boundaries of individual egos and possibilities that include acknowledgement and appreciation of something greater. Transpersonal also refers to a healing consciousness of wholeness, unity, and oneness. This allows nurses, other health care professionals, and society at large to increase the healing power of their theories, interventions, behaviors, and relationships.

 

            Nightingale’s core values are being integrated beautifully by nurses today. She imparted guidelines and core values for today’s modern nursing practice. These core values are philosophy, education, ethics, nursing theory, research, self-care, therapeutic relationships with clients, cultural diversity, healing environments, and the holistic caring process. And at the core of all her social actions was this profound connectedness with God. She would also tell us that she could have done a better job at self-care, for she was notorious for working months and years without a break. 

 

            A major insight occurred as I focused on Nightingale’s life as a mystic. I realized that there are mystics who walk with us every single day. I wondered who they are, and what does their presence mean?  As I questioned, I felt a deepening sense of my connection to all life. I asked myself old questions I thought I’d laid to rest. I sensed more deeply my need to be of more service to my friends, my community, the earth itself. Nightingale influenced me to pay closer attention to how I can put myself in that reparative state in which healing can take place.

 

            My hope is that people who read my illustrated biography, Florence Nightingale: Mystic, Visionary, Healer, and my co-authored book, Florence Nightingale Today: Healing, Leadership, Global Action will reflect on their own healing journey and identify their “must,” which is what Nightingale called her work. I hope they will explore what it means to be called to a work of service, whatever the work is, for the greater good of their family and community.

 

            Nightingale’s story is an ongoing one, in which I will continue to connect with other nurses and people who are also involved in healing work. Discovering the work of other Nightingale scholars and forming new friendships with them has been one of the greatest joys of this work.

 

References

Dossey, B.M. (2000). Florence Nightingale: Mystic, Visionary, Healer. Philadelphia: Lippincott, Williams & Wilkins.

 

Dossey, B.M., Selanders, L.C., Beck, D.M., & Attewell, A. (2005) Florence Nightingale Today: Healing, Leadership, Global Action. Washington, D.C.: Nursesbooks.org.

 

Dossey, B.M., Keegan, L. & Guzzetta, C. (2005). Holistic Nursing: A Handbook for Practice (4th ed.). Sudbury, MA: Jones & Bartlett.

 

 

·        I would also like to recognize the important work of Dr. Lynn McDonald, Nightingale scholar and Professor of Sociology at the University of Guelph, Ontario, Canada. She is the Editor of The Collected Works of Florence Nightingale (Wilfried Laurier University Press, 2001, 2002, 2003; see web site: www.wlupress.wlu.ca). The first six of sixteen volumes that includes Nightingale letters and major documents are now published. (See web site: www.sociology.uoguelph.ca/fnightingale)

 

Barbara Dossey, PhD, RN, 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 23  books including Florence Nightingale Today: Healing, Leadership, Global Action (NurseBooks.Org, 2005), Holistic Nursing: A Handbook for Practice (4th ed.), Jones & Bartlett, 2005), Florence Nightingale: Mystic, Visionary, Healer (Lippincott, Williams & Wilkins, 2000), AHNA Standards of Holistic Nursing Practice (Jones & Bartlett, 2000), and AHNA Core Curriculum for Holistic Nursing (editor, Jones & Bartlett, 1997).

 

Barbara is a Fellow of the American Academy of Nursing. She is certified in holistic nursing. She is a seven-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; the 1999 Scientific and Medical Network Book of the Year by the Scientific and Medical Network, United Kingdom. In 2001 she was recognized as TWU 100 Great Nursing Alumni, Texas Woman’s University, Denton, Texas. In 2003 she received the Distinguished Alumna Award from Baylor University, Waco, Texas. With her husband, Larry, she received the 2003 Archon Award from Sigma Theta Tau, International, the international honor society of nursing, honoring the contributions that they have made to promoting global health. In 2004, Barbara and Larry also received the first awarded Pioneers of Integrative Medicine Award from the Aspen Center for Integrative Medicine, Aspen, Colorado.

 

A major focus of her work currently is holistic nursing, compassionate care for the dying, and virtual education.  She is also exploring the impact of Florence Nightingale’s life and work on modern nursing and humankind.  For the 72nd General Episcopal Church Convention in Philadelphia July 1997, Barbara wrote three of five documents to accompany the Resolution Proposal to request the reconsideration of Nightingale’s commemoration and for her name to be placed on the church calendar list of Lesser Feast and Fasts in the Book of Common Prayer.  The official vote to accept Nightingale to the church calendar occurred in July 2000. The inaugural Florence Nightingale Commemorative Service was held on August 12, 2001, at the Washington National Cathedral, Washington, D.C.

 

For more information see Barbara Dossey’s web site: www.dosseydossey.com