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FEATURE STORY 07/01/2008
Author: Anne Bozievich  
Bringing the Lady with the Lamp’s Legacy to 21st Century Nursing
"Health is not only to be well, but to use well every power we have." These words, written by Florence Nightingale in 1893, stand as an inspiration for nurses and healthcare providers around the globe. At the time of her death in 1910, Nightingale had developed nursing programs in more than 20 countries and today, nurses from many countries are joining together to celebrate her legacy and use it to inspire change in the near future.

At the forefront of this movement are Barbara Dossey, PhD, RN, AHN-BC, FAAN; Deva-Marie Beck, PhD, RN; and Cynda Hylton Rushton, PhD, RN, FAAN. Bringing together their cumulative experiences in different specialized areas of nursing, they serve as International Co-Directors of the Nightingale Initiative for Global Health (NIGH). The NIGH mission and purpose is to engage the wisdom and deep values of millions of nurses and concerned citizens and act as a catalyst for the transformation of individuals, communities, and society for the achievement of a healthy world. The NIGH is a grassroots, nurse-inspired movement that promotes and models new methods for working together in the global community. They honor the legacy of Florence Nightingale and other nurses, midwives and healthcare workers, past and present, which have shown by their example how personal actions sourced from wisdom can transform entire systems. NIGH's inclusive and collaborative initiatives give nurses a voice and create opportunities for them to discover possibilities for their unique contribution toward health and well being for all. NIGH is collaborating with others to support "the growing commitment of nurses and concerned citizens of all nations—to place the health of all people as a first priority." NIGH works to achieve improved health for all people, both locally and globally, and with millions of nurses from around the world working together towards this common goal, "This is truly a nurse-inspired, grassroots initiative," explains Dossey.

Realizing that nurses and other healthcare workers alone cannot combat the problems of inadequate healthcare worldwide, NIGH seeks to inform citizens everywhere and engage their assistance. "Our goal is to help nurses recognize their powerful voice and the huge role they play in our society in improving health," says Dossey. "We want them to realize their collective contributions to the health and wellbeing of the global community." Believing that the profession of nursing can be a vehicle for change, NIGH endeavors to promote nurses as global citizens, working daily towards improved global health through expanded care systems and sacred advocacy on behalf of the world's population.

The group was born in the late 1990s when Dossey, who was writing and researching Nightingale's impact on modern-day nursing, teamed up with Beck to create a group dedicated to sharing Nightingale's mission and life story with a global audience. "I was a Nightingale scholar who saw that we needed to do more than remember her deep and broad legacy in books and articles," explains Beck. "We needed to create a global project that would give many people the opportunity to take action on the global health issues of today, as she did in her time."

Rushton joined the team in 2005 after learning of Dossey and Beck's idea to bring Nightingale's global health vision into the 21st century. "The idea of connecting millions of nurses from the grassroots level worldwide to improve health in their communities resonated for me," Rushton says.

Born into British aristocracy in 1820, Nightingale shocked her family when she announced her intent to break from her comfortable life to become a nurse. In the mid-1800s, nurses had poor reputations and were often viewed as little more than cooks for soldiers. However, Nightingale did much to change this opinion through her work caring for wounded soldiers during the Crimean War. Today, Nightingale is best remembered for her role in founding the field of modern nursing, for her compassion, and for her commitment to patient care. "She formalized the field and was the philosophical founder of modern secular nursing," explains Dossey. "Because of her work, people began to realize how important nurses are to healthcare."

During her 50-year career in nursing, Nightingale challenged her fellow nurses, as well as government leaders on every continent, to raise their standards for the wellbeing of all people. Showing her commitment to improving healthcare worldwide, Nightingale wrote, "In the future . . . may a better way be opened! May the methods by which every infant, every human being will have the best chance at health—the methods by which every sick person will have the best chance at recovery—be learned and practiced."

Following in her footsteps, NIGH's mission is to bring Nightingale's inspirational work into today's modern world of healthcare and health promotion. The most dire problem nurses face today is a nursing shortage not just in the United States, but worldwide. As a result of the shortage, patient care is suffering around the globe. To combat this problem, NIGH is currently involved in collaboration with nurses, midwives, related professionals, allied healthcare providers and other concerned citizens from around the world. NIGH is building a diverse grassroots global network whose goal is to face this shortage. They are addressing this by working on improving education, empowerment and support throughout the next decade.

Currently, more than 18,000 people around the world have showed their support by signing the "Nightingale Declaration for Our Healthy World" both online (http://www.nightingaledeclaration.net) and in print. The Declaration, which has been signed by representatives from 89 member states of the United Nations, and over 1000 signatories representing their organizations of millions of constituents worldwide lays the foundation for accomplishing NIGH's current goal: Seeing the adoption of two United Nations Resolutions declaring 2010 International Year of Nursing and Midwifery and 2011-2020 United Nations Decade for a Healthy World. These resolutions are timed to celebrate the centennial of Nightingale's death in 2010 and the bicentennial of her birth in 2020.

According to Dossey, "these proposed Resolutions bring visibility, recognition and value to nurses and allied healthcare providers, and this action not only empowers them but also raises public awareness as to the crucial connection between empowered nurses and allied healthcare workers and the health of people everywhere."

"Creating healthy nurses and healthy work environments is a key element of NIGH's vision," Rushton adds. "Nurses must be supported to learn ways to care well for themselves so that they are able to care well for others. The cultures of individuals, institutions and systems must shift toward a new model of healthcare that is sourced from the wisdom of meaning, abundance and service rather than scarcity and competition. New partnerships must be forged to support the integration of personal renewal, skillful communication, healthcare diplomacy, cultural humility and full spectrum advocacy."
This is the first global Internet grassroots nursing signature campaign, especially involving the United Nations, and it is giving nurses a voice while at the same time centering on worldwide health needs. "While there are many great global healthcare challenges today, I believe that we are, with NIGH, addressing a key one," says Beck. "This is to empower the individual nurses of the world to lead and to give voice to their relevant capacities and action-oriented impact upon the actual conditions that build a healthy world. Nightingale herself called this scope the practice of ‘Health-Nursing.'"

Realizing their goal of doing much more than simply celebrating Nightingale's influential life and career in print, today, Dossey, Beck, and Rushton are leading a growing grassroots team to build a one-of-a-kind global network by joining with nurses and concerned citizens from all over the world. A core value of NIGH is honoring the wisdom and values of each person to serve the health of humanity. This is accomplished through intentional engagement of individuals, organizations, communities and societies who commit to this shared vision for global health. Through writing, travel and constant communication, they are drawing on their extensive backgrounds in nursing and are gradually breaking new ground worldwide.

A strategic priority for NIGH is to create global forums from fall 2008-2020 for education, leadership and advocacy, health capacity-building forums for nurses in formal and informal leadership roles in collaboration with others from their communities and around the world. These educational forums will focus on five principles for building a healthy world: Individual Health, Wellness and Renewal; Healthy Home and Workplace Environments; Cross-Cultural Understanding and Health Diplomacy; and Environmental and Social Determinants of Health.

Last February, Rushton was honored as the only nurse on the faculty of the International Conference, Recent Advances in Clinical Oncology, which was held in Al Ain in the United Arab Emirates. In June, she was also a speaker at the Fifth Pediatric Critical Care World Congress in Geneva, Switzerland. During this conference, she gave a presentation titled "Collaborative Practice: Nursing Leadership in the Pediatric Critical Care Team," challenging attendees to adopt healthcare models emphasizing trust, respect and collaboration. At the conference, she also challenged each listener to embrace NIGH's vision for a healthy world by demonstrating deeper collaboration between healthcare professionals, patients, families and communities.

While Rushton was busy in the United Arab Emirates and in Switzerland, Dossey and Beck were also doing their fair share of traveling for NIGH. Last June, they each traveled to the Sixth National Turkish Student Nursing Congress at the University of Istanbul, sharing information about the Nightingale Initiative with more than 1,400 students and faculty members. In August, Beck also traveled to Caracas, Venezuela to launch the Spanish version of the Nightingale Declaration for a Healthy World to more than 500 Latin American nursing leaders.

In October, Beck traveled to China to meet with nursing leaders, media and government leaders to discuss future collaborations with the Nightingale Declaration campaign. In December, she also made the group's first trip to Africa, visiting Lusaka, Zambia, and representing NIGH at a World Health Organization consultation. During the trip, she met with African, European, South American, Western Pacific and Eastern Mediterranean WHO representatives.

As they have traveled around the world, Dossey explains that there is common ground in all countries when it comes to healthcare and working towards making it better. "Everywhere we go, we encourage participatory involvement," she says, "and we see nurses taking a stand for the people they care for. Nurses are finding their voice to stand in the unique position as health diplomats to coach for integral health and to engage in collaborative practice and integrative healthcare."

Each day, as nurses around the globe work together to promote health and take a stand for improved care for their patients, the legacy of their champion is never far from their minds. "Every day we work towards the application of Florence Nightingale's legacy for 21st-century healthcare and healing," says Dossey. "Together, with nurses around the world we are 21st-century Nightingales."

Barbara Dossey, PhD, RN, AHN-BC, FAAN, graduated with a Bachelor of Science in Nursing from Baylor University in Waco, Texas in 1965. She then went on to earn her MS from Texas Woman's University in Denton, Texas in 1975 and her PhD from Union Institute and University in Cincinnati, Ohio in 2002. In 2005, she also earned her AHN-BC from the American Holistic Nurses Association. Dr. Dossey's Nightingale biography, Florence Nightingale: Mystic, Visionary, Healer, 2d ed. Commemorative Edition, (F. A. Davis, 2010). Dr. Dossey with Dr. Beck are co-authors of Florence Nightingale Today: Healing, Leadership, Global Action (NurseBooks.org, 2005). Dr. Dossey's co-authored Holistic Nursing: A Handbook for Practice, 5th edition (Jones and Bartlett Publishers, 2008) that contains Nightingale's philosophical foundation for contemporary nurses. Today, Dr. Dossey is the director of Holistic Nursing Consultants in Santa Fe, New Mexico, and she is an International Co-Director of the Nightingale Initiative for Global Health in Washington, D.C. and Ottawa, Ontario, Canada.

Deva-Marie Beck, PhD, RN, earned her initial nursing degree and graduated in 1976 and went on to earn two bachelor's degrees in 1991 in health sciences and in theatre arts, while launching a 26-year career in clinical nursing. In 1999, she wrote a comprehensive Master's Equivalency Thesis based on ten years of volunteer work in international development. She earned her PhD in 2002 in Interdisciplinary Nursing Studies with a specialty in International Health Education from Union Institute and University, Cincinnati, Ohio. Over the last two years, Dr. Beck's focus has been to travel worldwide on behalf of NIGH. She is also an International Co-Director of the Nightingale Initiative for Global Health in Ottawa. Ontario, Canada, and is actively involved with global healthcare issues, including combating the worldwide nursing shortage.

Cynda Hylton Rushton, PhD, RN, FAAN, received her undergraduate degree at the University of Kentucky in 1978 and completed her MSN at the Medical University of South Carolina in 1982. She went on to earn her doctorate in nursing with a concentration in bioethics from Catholic University of America in 1994. Today, Rushton is an associate professor of nursing and medicine and core faculty of the Berman Institute of Bioethics at Johns Hopkins University as well as a clinical nurse specialist in ethics and the program director of the Harriet Lane Compassionate Care Program at the Johns Hopkins Children's Center in Baltimore, Maryland. She is a Fellow (2006-2009) in the Robert Wood Johnson Foundation's Executive Nurse Fellowship Program. She is also an International Co-Director of the Nightingale Initiative for Global Health in Washington, D.C. and Ottawa, Ontario, Canada and is involved in a variety of interdisciplinary initiatives worldwide.

Photo Credit: Nightingale Initiative for Global Health and International Conference Recent Advances in Clinical Oncology.

Anne Bozievich is a freelance writer from Glen Rock, Pennsylvania.
She is on the editorial staff of NEWS-Line for Nurses.

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