INTEGRAL  NURSING  AND  THE  NIGHTINGALE  

INITIATIVE  FOR  GLOBAL  HEALTH

Florence  Nightingale’s  Integral  Legacy  for  the  21st  Century
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ABSTRACT  dŚŝƐĂƌƟĐůĞĚĞǀĞůŽƉƐƚŚĞĂƉƉůŝĐĂƟŽŶŽĨ/ŶƚĞŐƌĂůdŚĞŽƌLJƚŽƚŚĞƚŚĞŽƌLJŽĨŝŶƚĞŐƌĂůŶƵƌƐͲ
ŝŶŐĂŶĚƚŚĞEŝŐŚƟŶŐĂůĞ/ŶŝƟĂƟǀĞĨŽƌ'ůŽďĂů,ĞĂůƚŚ;E/',Ϳ͘E/',ŝƐĂĐĂƚĂůLJƟĐ͕ŝŶƚĞŐƌĂůůLJŝŶĨŽƌŵĞĚ͕
ŐƌĂƐƐƌŽŽƚƐͲƚŽͲŐůŽďĂů ŵŽǀĞŵĞŶƚ ƚŽ ŚŽŶŽƌ ĂŶĚ ĞdžƚĞŶĚ &ůŽƌĞŶĐĞ EŝŐŚƟŶŐĂůĞ͛Ɛ ;ϭϴϮϬʹϭϵϭϬͿ ůĞŐĂĐLJ͘
EŝŐŚƟŶŐĂůĞƉĂƐƐĞĚŚĞƌŐůŽďĂůǀŝƐŝŽŶƚŽŶƵƌƐĞƐĂŶĚĐŽŶĐĞƌŶĞĚĐŝƟnjĞŶƐǁŚŽŵŝŐŚƚĐĂƌƌLJŚĞƌǁŽƌŬĨŽƌͲ
ǁĂƌĚ͘hƐŝŶŐ/ŶƚĞŐƌĂůDĞĚŝĐŝŶĞĂŶĚŚĞĂůƚŚĐĂƌĞůĞŶƐĞƐǁĞĞdžƉůŽƌĞŚŽǁƐŚĞƵƌŐĞĚŚƵŵĂŶŝƚLJƚŽĞdžƚĞŶĚ
ƚŚĞŚŽƌŝnjŽŶƐŽĨƉŽƐƐŝďŝůŝƚLJ͕ĐŚĂůůĞŶŐŝŶŐƵƐƚŽƌĞŵĞŵďĞƌǁŚŽǁĞĂƌĞ͕ǁŚĂƚǁĞĚŽ͕ĂŶĚǁŚŽǁĞĐĂƌĞ
ĨŽƌ͘dŚĞƚŚĞŽƌLJŽĨŝŶƚĞŐƌĂůŶƵƌƐŝŶŐ͕ƌĞůĞǀĂŶƚŶƵƌƐĞƐ͛ƐƚŽƌŝĞƐ͕ĂŶĚŝŶŶŽǀĂƟǀĞE/',ƉƌŽũĞĐƚƐƌĞůĂƚĞĚƚŽ
ƚŚĞhŶŝƚĞĚEĂƟŽŶƐDŝůůĞŶŶŝƵŵĞǀĞůŽƉŵĞŶƚ'ŽĂůƐĂƌĞƵƐĞĚĂƐĞdžĂŵƉůĞƐ͘  

KEY  WORDS  ĂĚǀŽĐĂĐLJ͖ĐŽŵŵƵŶŝĐĂƟŽŶ͖&ůŽƌĞŶĐĞEŝŐŚƟŶŐĂůĞ͖ŶƵƌƐŝŶŐ͖ƉƵďůŝĐŚĞĂůƚŚ

In  the  future,  which  I  shall  not  see,  for  I  am  old,  may  a  better  way  be  opened!  May  
the  methods  by  which  every  infant,  every  human  being  will  have  the  best  chance  at  
KHDOWK²WKHPHWKRGVE\ZKLFKHYHU\VLFNSHUVRQZLOOKDYHWKHEHVWFKDQFHDWUHFRY-­
ery,  be  learned  and  practiced.  Hospitals  are  only  an  intermediate  stage  of  civiliza-­
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                 May  we  hope  that,  when  we  are  all  dead  and  gone,  leaders  will  arise  who  have  
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joys  of  organizing  nursing  reforms,  and  who  will  lead  far  beyond  anything  we  have  
done!  May  we  hope  that  every  nurse  will  be  an  atom  in  the  hierarchy  of  ministers  of  
the  Highest!  But  she  must  be  in  her  place  in  the  hierarchy,  not  alone,  not  an  atom  in  
the  indistinguishable  mass  of  thousands  of  nurses.  High  hopes,  which  shall  not  be  
deceived!
–  Florence  NightingaleDVFLWHGLQ'RVVH\HWDOSS

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longer  isolated  problems  in  far-­off  places.  Due  to  globalization  and  global  warming,  21st-­century  nursing  
and  medicine  are  fragmented  and  no  political  or  natural  boundaries  stop  the  spread  of  disease,  underscoring  
the  need  for  integrative  healthcare  perspectives.  The  health  and  well-­being  of  people  can  be  seen  as  common  
ground  in  order  to  secure  a  sustainable,  prosperous  future  for  everyone.  At  the  forefront  of  these  concerns  are  
nurses  who  are  engaged  as  change  agents  to  improve  the  health  of  their  nations,  to  focus  on  increasing  the  
“health  span”  of  individuals  rather  than  focusing  on  “life  span,”  and  to  share  this  information  with  colleagues  
around  the  world.  In  collaboration  with  healthcare  practitioners  and  concerned  citizens,  nurses  can  play  a  
major  role  in  mobilizing  new  approaches  to  education,  healthcare  delivery,  and  disease  prevention.

Correspondence:  ĂƌďĂƌĂD͘ŽƐƐĞLJ͕ϴϳϴWĂƐĞŽĞů^Ƶƌ͕^ĂŶƚĂ&Ğ͕EDϴϳϱϬϭ͘E-­‐mail͗ďĂƌďĂƌĂΛĚŽƐƐĞLJĚŽƐƐĞLJ͘ĐŽŵ͘

Journal  of  Integral  Theory  and  Practice,  6(4),  pp.  71–92

 D-­M.  BECK  ET  AL.  

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nities  across  the  world.  Physically,  emotionally,  mentally,  and  spiritually,  nurses  are  prepared  and  educated  
WRHIIHFWLYHO\DFFRPSOLVKUHTXLUHGDFWLYLWLHVRIWHQEXWQRWDOZD\VZRUNLQJEHVLGHUHODWHGPHGLFDODQGDOOLHG
KHDOWKSURIHVVLRQDOV,QWKHGHYHORSHGZRUOGKHDOWKFDUHLVLQFUHDVLQJO\PRUHFRPSOH[DQGGHPDQGLQJLQWKH
GHYHORSLQJZRUOGKHDOWKFDUHLVPDUJLQDOL]HGDQGVRPHWLPHVQRQH[LVWHQW(YHU\ZKHUHQXUVHV¶NQRZOHGJH
expertise,  wisdom  and  dedication  are  required  for  humanity  to  be  healthy.  But,  across  the  world,  the  increas-­
ingly  severe  global  nursing  shortage  continues  to  threaten  the  health  of  people  andWKHUDQNVRIQXUVHVLQ
DOPRVWHYHU\QDWLRQ:LWKWKHXQSUHFHGHQWHGQHWZRUNLQJDQGFRPPXQLFDWLRQRSSRUWXQLWLHVQRZDYDLODEOH
today’s  approaches—in  practice,  education,  research,  and  policy—can  indeed  address  old,  previously  intrac-­
table  health  challenges  in  new  ways.  If  today’s  nurses—and  related  midwives  and  allied  health  profession-­
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time,  effective  local-­to-­global  voices  calling  for  and  demonstrating  the  healing,  leadership,  and  global  activ-­
ism  required  to  address  contemporary  healthcare  challenges  and  even  to  help  humanity  to  achieve  a  healthier  
world.

Florence  Nightingale’s  Legacy

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DFWLYLVPVHDPOHVVO\EOHQGHGZLWKWKHGHHSHVWVSLULWXDONQRZOHGJHDQGSUDFWLFH/LNHD¿HU\FRPHW1LJKW-­
LQJDOHVWUHDNHGDFURVVWKHVNLHVRIth-­century  England  and  transformed  the  world  with  her  passage.  She  
was  a  genius  of  both  intellect  and  spirit  and  her  legacy  resonates  today  as  forcefully  as  during  her  lifetime.  
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WKHRULVWVKHDOVRUDQNVDPRQJWKHPRVWEULOOLDQWRIVDQLWDU\PHGLFDODQGKHDOWKFDUHUHIRUPHUVLQKLVWRU\6KH
LGHQWL¿HGHQYLURQPHQWDOKHDOWKGHWHUPLQDQWVFOHDQDLUZDWHUIRRGKRXVHVHWFDQGVRFLDOKHDOWKGHWHUPL-­
nants  (poverty,  education,  family  relationships,  employment).  In  addition,  she  experienced  and  recorded  her  
personal  understanding  of  the  awareness  that  something  greater  than  her,  the  Divine,  was  present  in  all  as-­
pects  of  life  (Dossey,  2010a,  2010b).  In  a  word,  Nightingale  was  an  integralist.  Her  worldview  focused  on  the  
individual  and  the  collective,  the  interior  and  the  exterior,  as  well  as  human  and  nonhuman  concerns  (Dossey,  
D7KHHQWLUHW\RIKHUOLIHZRUNDQGLQVLJKWVFOHDUO\DUWLFXODWHDQGGHPRQVWUDWHWKHVFLHQFHDQG
DUWRIDQLQWHJUDOZRUOGYLHZIRUQXUVLQJKHDOWKFDUHDQGKXPDQNLQG
 $IWHUUHWXUQLQJKRPHIURPWKH&ULPHDQ:DU±1LJKWLQJDOHFRQWLQXHGIRUQHDUO\IRXUGH-­
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HVWDWHVPDNLQJRQO\IRXUSXEOLFDSSHDUDQFHVEHIRUHKHUGHDWKLQ6KHDGYRFDWHGIRUEHWWHUFRQGLWLRQV
for  women,  children,  the  poor  and  hungry,  and  for  better  education  programs  for  marginalized  people.  She  
analyzed  data,  wrote  statistical  reports,  and  informed  politicians,  crafting  documents  that  resulted  in  legisla-­
tion.  She  drafted  the  British  position  papers  presented  to  the  Geneva  Convention  in  1864  and  met  with  Queen  
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from  around  the  world.  She    also  served  as  a  consultant  to  both  the  northern  and  southern  states  during  the  
American  Civil  War.  She  changed  political  will  by  interacting  with  government  leaders  across  the  British  
Empire  and  elsewhere  (Dossey,  2010a,  2010d).
Nightingale   also   designed   hospitals   and   sought   to   improve   environments—in   both   rural   and   urban  
areas—by   developing   collaborative   partnerships   with   others   who   agreed   with   her   proposed   reforms.   She  
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FROOHDJXHV$VDUHVXOWRIKHUOHWWHUVDQGKHUSOXVRI¿FLDOUHSRUWVDQGERRNVH[LVWWRGD\LQFROOHF-­

72                      Journal  of  Integral  Theory  and  Practice

 INTEGRAL  NURSING

tions  at  the  British  Library  and  Wellcome  Medical  Library  in  London  and  other  repositories  around  the  world.  
+HUPRVWIDPRXVERRNVLQFOXGHNotes  on  Hospitals1LJKWLQJDOHDQGNotes  on  Nursing  (Nightingale,  
1860)1DOVRVHH'RVVH\D0F'RQDOG  About  all  of  this,  Nightingale  declared,  “Health  is  
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  In  today’s  specialized  world,  one  may  be  tempted  to  compartmentalize  life,  placing  personal,  profes-­
VLRQDOVSLULWXDOSROLWLFDODQGHWKLFDOFRQFHUQVLQGLIIHUHQWFRUQHUV7R1LJKWLQJDOHWKLVNLQGRIIUDJPHQWDWLRQ
OLNHO\ZRXOGKDYHEHHQXQWKLQNDEOH+HUOLQHVRIGHYHORSPHQW²FRJQLWLYHHPRWLRQDOVRPDWLFLQWHUSHUVRQDO
VSLULWXDO DQG PRUDO²ZHUH VHDPOHVVO\ FRPELQHG LQ KHU ZRUN 6LQFH KHU ³FDOO IURP *RG´ DW DJH  HYHQ
EHIRUHKHUIDPRXVHIIRUWVLQ&ULPHDVKHGLVWLOOHGDOORIWKLVE\VD\LQJ³0\ZRUNLVP\PXVW´$VDQLFRQRI
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pose—our  own  “must”—in  our  individual  journeys  through  life  (Dossey,  2010a,  2010b).2  
 ,QWKHV1LJKWLQJDOHZURWHOHWWHUVLQGLFDWLQJKHUEHOLHIWKDWLWZRXOGWDNHWR\HDUVEHIRUH
educated  and  experienced  nurses  would  arrive  to  change  healthcare  delivery  for  all—as  partners  with  physi-­
cians  and  others.  Today,  nurses  are  that  generation  of  21st-­century  Nightingales  who  have  arrived  to  transform  
healthcare  and  carry  forth  her  vision  to  create  a  healthier  world  together—through  integral,  interdisciplinary  
dialogues  and  partnerships.  

From  Nightingale’s  Pattern:  The  Theory  of  Integral  Nursing  

The  theory  of  integral  nursing  (Dossey,  2009,  2012)  offers  a  grand  nursing  theory  that  maps  evolutionary  
growth  processes,  stages,  and  levels  of  human  development  and  consciousness.3,4  The  theory  of  integral  nurs-­
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SURIHVVLRQWRH[SORUHWKHGLUHFWDSSOLFDWLRQRILQWHJUDOSURFHVVHVDQGZRUOGYLHZVWRLQFOXGHIRXUSHUVSHF-­
WLYHVRIUHDOLWLHV²WKHLQGLYLGXDOLQWHULRUDQGH[WHULRUDQGWKHFROOHFWLYHLQWHULRUDQGH[WHULRUDQGWRH[SDQG
nurses’   capacities   as   health   diplomats,   health   communicators,   and   integral/integrative   nurse   coaches   who  
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'RVVH\HWDO,QWHJUDWLYH1XUVH&RDFK&HUWL¿FDWH3URJUDP7KHFRQWHQWFRQWH[WDQG
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  ContentRIDQXUVLQJWKHRU\LQFOXGHVWKHVXEMHFWPDWWHUDQGEXLOGLQJEORFNVWKDWJLYHDWKHRU\LWVIRUP
It  comprises  the  stable  elements  that  are  acted  on  or  that  do  the  acting.  In  the  theory  of  integral  nursing,  the  
VXEMHFWPDWWHUDQGEXLOGLQJEORFNVDUHDVIROORZVKHDOLQJ)LJDWKHPHWDSDUDGLJPRIQXUVLQJ)LJ
ESDWWHUQVRINQRZLQJ)LJFWKHIRXUTXDGUDQWVDVDGDSWHGIURP,QWHJUDO7KHRU\  )LJGDQG
WKH$4$/PRGHO:LOEHU)LJH  All  content  components  are  represented  together  as  an  overlay  
that  creates  a  mandala  to  symbolize  wholeness  (Fig.  1f).
  Context  in  a  nursing  theory  is  the  environment  in  which  nursing  practice  occurs  and  the  nature  of  the  
world  of  nursing.  In  an  integral  nursing  environment  the  nurse  strives  to  be  an  integralist—meaning  that  he  
or  she  strives  to  be  integrally  informed,  aware,  and  challenged  to  further  develop  an  integral  worldview,  inte-­
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integral  process  and  worldview,  as  well  as  integral  life  practices  and  self-­care.
  The  term  nurse  healer  is  used  to  describe  how  a  nurse  is  an  instrument  of  the  individual  interior  healing  
process  and  a  facilitator  of  the  individual  exterior  healing  environment  of  patients  and  their  families.  While  
nurses   also   facilitate   people   (clients/patients,   family,   and   colleagues)   to   access   their   own   healing   process  
and  potentials,  they  do  not  do  the  actual  healing.  Integral  nurses  recognize  themselves  as  components  of  the  
healing  environment  as  they  interact  with  people,  families,  and  colleagues  in  being  with  rather  than  always  
doing  to  (or  doing  for7KH\HQWHULQWRDVKDUHGHQFRXQWHURU¿HOGRIFRQVFLRXVQHVVWKDWSURPRWHVKHDO-­
ing  potentials  and  an  experience  of  well-­being.  Within  integral  nursing  practice,  relationship-­centered  care  
is  YDOXHGDVDPRGHOEDVHGXSRQDYLVLRQRIFRPPXQLW\ZKHUHWKUHHW\SHVRIUHODWLRQVKLSVDUHLGHQWL¿HG  

                     Journal  of  Integral  Theory  and  Practice                        73

 D-­M.  BECK  ET  AL.  

PERSONAL EMPIRICS
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74                      Journal  of  Integral  Theory  and  Practice

 INTEGRAL  NURSING

SDWLHQWSUDFWLWLRQHUUHODWLRQVKLSFRPPXQLW\SUDFWLWLRQHUUHODWLRQVKLSDQGSUDFWLWLRQHUSUDFWLWLRQHU

relationship  (Tresoli,  1994).  Relationship-­centered  care   is  also  valued  as  it  provides  a  map  to  highlight  the  
most  direct  routes  to  achieve  the  highest  levels  of  care  and  service  to  patients  and  families.
  Process LQ QXUVLQJ WKHRU\ LV WKH PHWKRG E\ ZKLFK WKH WKHRU\ ZRUNV$Q LQWHJUDO KHDOLQJ DSSURDFK
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individual  exterior),  and  collective  healing  modes  of  individuals  and  of  systems/structures  (interior  and  ex-­
terior).  This  is  the  understanding  of  the  unitary  whole  person  interacting  in  mutuality  with  the  environment.  
There  are  four  major  integral  nursing  principles,  listed  below  and  followed  by  brief  descriptions.  
  Integral  Nursing  Principle  #1:  Nursing  Requires  Development  of  the  “I.”  This  principle  recognizes  
the  interior  individual  “I”  (subjective)  space  where  each  nurse  values  the  importance  of  exploring  one’s  own  
health  and  well-­being—starting  with  personal  discovery  and  development  to  become  more  integrally  con-­
VFLRXVRIRQH¶VNQRZLQJGRLQJDQGEHLQJLQDOODVSHFWVRISHUVRQDODQGSURIHVVLRQDOHQGHDYRUV7KLVDOVR
includes  addressing  one’s  own  shadow—a  composite  of  personal  characteristics  and  potentials—that  have  
been  denied  life  expression.  Through  integral  practices,  nurses  understand  how  the  ego  can  deny  these  char-­
DFWHULVWLFVEHFDXVHWKHVHPLJKWZHOOEHLQFRQÀLFWDQGLQFRPSDWLEOHZLWKRQH¶VFKRVHQFRQVFLRXVDWWLWXGH
  Integral  Nursing  Principle  #2:  Nursing  Is  Built  upon  “We.”  This  principle  recognizes  the  impor-­
tance  of  the  intersubjective  space  where  nurses  come  together  and  are  conscious  of  sharing  their  worldviews,  
beliefs,  priorities,  and  values  related  to  enhancing  self-­care  and  healthcare.  It  includes  being  fully  present  and  
focused  with  intention  to  understand  what  another  person  (patient,  family,  colleagues,  or  others)  is  express-­
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intention  for  the  healing  of  the  recipient—that  moves  from  gross  body  (physical),  to  subtle  body  (energy,  
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from  others  is  experienced.67KLVKHDOLQJLVXVHGWRGHVFULEHWKHVXEWOHÀRZRIHQHUJ\ZLWKLQDQGDURXQGD
SHUVRQ²FUHDWLQJD¿HOGWKDWFDQEHH[SHULHQFHGE\RWKHUV7KLVLVWKHDELOLW\WRRSHQRQH¶VKHDUWWREHSUHVHQW
for  all  levels  of  suffering,  even  such  that  suffering  may  be  transformed  for  others,  as  well  as  for  self.  This  is  
bearing  witness  and  EHLQJSUHVHQWZLWKWKLQJVDVWKH\DUH²DVWDWHDFKLHYHGWKURXJKUHÀHFWLYHDQGFRQWHPSOD-­
tive  practice.  It  involves  developing  the  qualities  of  stillness  to  be  present  for  suffering  and  the  sufferer.  
  Integral  Nursing  Principle  #3:  Nursing  is  about  Behavior  and  Skill  Development  (“It”).  This  prin-­
ciple  recognizes  the  importance  of  the  individual  exterior  “It”  (objective)  space  where  each  person  develops  
DQGLQWHJUDWHVDVHOIFDUHSODQ7KLVLQFOXGHVVNLOOVEHKDYLRUVDQGDFWLRQVWHSVWRDFKLHYHD¿WERG\DQGWR
FRQVLGHUERG\VWUHQJWKWUDLQLQJDQGVWUHWFKLQJDVZHOODVFRQVFLRXVHDWLQJRIKHDOWK\IRRGVDQGYDULRXVUHÀHF-­
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the  space  where  the  “doing  to”  and  “doing  for”  occurs.  Here,  the  integral  nurse  combines  her  or  his  nursing  
presence  with  nursing  acts  to  provide  comfort  and  safety  and  to  assist  patients  to  access  personal  strengths  
and  to  release  fear  and  anxiety.  
  Within  this  principle,  integral  nurses  join  nursing  colleagues  and  other  healthcare  team  members  to  
compile  the  data  around  physiological  and  pathophysiological  assessment,  nursing  diagnosis,  outcomes,  and  
plans  of  care—including  medications,  technical  procedures,  monitoring,  treatments,  protocols,  implementa-­
tion,  and  evaluation.  This  space  includes  patient  education  and  evaluation  where  integral  nurses  co-­create  
plans  of  care  with  patients  whenever  possible—combining  interventions  and  integral  life  practices  to  inter-­
face  with  and  enhance  the  success  of  traditional  medical  and  surgical  technology  and  treatment.  This  includes  
phases  of  conscious  dying  and  end-­of-­life  care.
  Integral  Nursing  Principle  #4:  Nursing  Embraces  Systems  and  Structures  (“Its”).  This  principle  
recognizes  the  importance  of  the  exterior  collective  “Its”  (interobjective)  space  where  integral  nurses  join  
wider  healthcare  teams  and  institutions.  In  this  organizational  context  they  come  together  to  examine  their  
ZRUNSULRULWLHVXVHRIWHFKQRORJLHVDQGDQ\DVSHFWRIWKHWHFKQRORJLFDOHQYLURQPHQW7KH\DOVRFUHDWHH[-­

                     Journal  of  Integral  Theory  and  Practice                        75

 D-­M.  BECK  ET  AL.  

terior  healing  environments  to  incorporate  nature  and  the  natural  world  whenever  possible,  including  the  use  
of  outdoor  and  indoor  healing  gardens,  green  materials  with  soothing  colors,  and  sounds  of  music  and  nature.  
,QWHJUDOQXUVHVDOVRLGHQWLI\KRZWKH\PLJKWZRUNWRJHWKHUDQGZLWKRWKHUVDVLQWHUGLVFLSOLQDU\WHDPVWR
deliver  more  effective  patient  care,  coordination  of  care,  and  advocacy  for  care  wherever  it  is  non-­existent.  

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Integral  Theory  Application  Guided  by  the  Theory  of  Integral  Nursing
The  Nightingale  Initiative  for  Global  Health  (NIGH)  is  a  catalytic,  grassroots-­to-­global  movement,  envi-­
VLRQHGLQDQGRI¿FLDOO\HVWDEOLVKHGLQWRKRQRUDQGH[WHQG)ORUHQFH1LJKWLQJDOH¶VOHJDF\1,*+¶V
twin  purposes  are  1)  to  increase  global  public  awareness  about  the  priority  of  health,  and  2)  to  empower  
nurses,  nursing  students,  and  concerned  citizens  with  stronger  voices  to  address  the  critical  health  issues  of  
our  time.  Since  the  beginning  of  NIGH’s  development,  these  interrelated  approaches  have  been  developed  
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As  Nightingale  scholars  and  educators,  we  saw  that  Nightingale’s  wider  individual  and  collective  ex-­
WHULRUZRUNLQYROYHGPDQ\DSSURDFKHVWKDWFRXOGFHUWDLQO\EHUHOHYDQWWRWRGD\¶VPLOOLRQQXUVHVZRUNLQJ
DFURVVWKHZRUOG1LJKWLQJDOH%HFNSS(YHQLQWKHth  century,  before  the  invention  
of   automobiles   and   airplanes,   Nightingale   achieved   a   collective   global   health-­promotion   communications  
strategy  that  included  her  direct  contribution  to  many  forms  of  print  journalism.  For  example,  her  Notes  on  
Nursing1LJKWLQJDOHDZDVZULWWHQ¿UVWIRUWKHJHQHUDOSXEOLFDQGEHFDPHDQLPPHGLDWHEHVWVHOOHU
XSRQ¿UVWSULQWLQJ1LJKWLQJDOHDOVRFRQVFLRXVO\FXOWLYDWHGKHUFRQQHFWLRQVZLWKWKHPHGLDSURIHVVLRQDOVRI
KHUWLPHPDNLQJVXUHWKH\XQGHUVWRRGFRPPXQLFDWHGDQGVKDUHGKHUPHVVDJHV7KLVZDVKHURXWUHDFKWRWKH
JHQHUDOSXEOLFDQGWRZLGHO\LQÀXHQFHSROLWLFDOZLOO6
,QZHDVNHGRXUVHOYHVZKDWZRXOG1LJKWLQJDOHKDYHDFKLHYHGZLWKDID[PDFKLQHDQGHPDLO"
7RGD\ZHDUHVWLOODVNLQJZKDWZRXOGVKHKDYHDFKLHYHGWRSURPRWHWKHKHDOWKRIKXPDQLW\DQGGHPRQVWUDWH
JOREDO QXUVHV¶ FDSDFLWLHV²ORFDO WR JOREDO²ZLWK VPDUW SKRQHV WKH ,QWHUQHW<RX7XEH )DFHERRN 7ZLWWHU
6N\SH FRQIHUHQFH FDOOV ZHELQDUV DQG RWKHU HPHUJLQJ WHFKQRORJLHV" 8VLQJ WKH ,QWHJUDO IUDPHZRUN KRZ
would  Nightingale  have  engaged  others  in  healthcare  and  political  reform  to  support  nurses  and  all  healthcare  
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We  also  understood  that  this  global  communications  capacity—which  Nightingale  demonstrated  across  
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individualistic   mindsets,   are   achieving,   even   today.  We   saw   that   this   broader   Nightingale   approach   could  
LQGHHGEHXVHIXOWRFXUUHQWSUREOHPVFHUWDLQO\WKRVHSUREOHPVUHODWHGWRQXUVLQJDQGWRKHDOWK:HDOVRNQHZ
that—to  encourage  people  to  move  beyond  their  often  limited  view  of  a  Nightingale  who  lived  more  than  a  
century  ago—we  would  need  to  create  an  innovative,  transformational  approach  that  would  encourage  people  
WRHPEUDFHWKHJOREDOFROOHFWLYHZRUOGYLHZWKDW1LJKWLQJDOHZRUNHGIURP%HFND:HDVNHG
how  might  we—with  nurse  colleagues  and  others—explore  the  transformative  nature  of  Integral  Theory  and  
the  AQAL  model?  What  would  happen  if  we  expanded  our  identities  beyond  “me”  (egocentric)  to  “us”  (eth-­
nocentric),  and  then  to  “all  of  us”  (worldcentric)  (Wilber,  2000)?  
As  Dr.  Monica  Sharma  (2007)  notes,  “Today,  the  most  urgent  and  sustainable  response  to  the  world’s  
problems  is  to  expand  solutions  for  problems—that  are  driven  solely  by  technology—[to  solutions]  generated  
from  personally-­aware  leadership”  (p.  32).  This  type  of  leadership,  which  Sharma  calls  “global  architecture  
for  personal  to  planetary  transformation”  (p.  33),  can  arise  from  applying  Nightingale’s  broader  and  deeper  
legacy.  The  hope  is  that  this  transformation  will  inspire  and  instill  worldcentric  leadership  values  and  ca-­
pacities.  It  is  also  a  revolutionary  approach  to  develop  nurses  into  agents  of  transformation  who  create  new  
solutions.  

76                      Journal  of  Integral  Theory  and  Practice

 INTEGRAL  NURSING

  'XULQJWKHHDUO\GHYHORSPHQWRI1,*+ZHXVHGWKH,QWHJUDODSSURDFKDVNLQJKRZZHPLJKW²WKURXJK
the  development  of  NIGH  as  a  global  initiative—encourage  individuals  to  become  these  “agents  of  transfor-­
mation.”  Our  answer  was  to  craft  a  basic  integral  statement  with  the  “Nightingale  Declaration  for  A  Healthy  
:RUOG´

We,   the   nurses   and   concerned   citizens   of   the   global   community,   hereby   dedicate  
ourselves  to  the  accomplishment  of  a  healthy  world  by  the  year  2020.  We  declare  
our  willingness  to  unite  in  a  program  of  action,  sharing  information  and  solutions  to  
resolve  problems  and  improve  conditions—locally,  nationally,  and  globally—in  or-­
der  to  achieve  health  for  all  humanity.  We  further  resolve  to  adopt  personal  practices  
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for  the  year  2020  achievable  and  inevitable,  beginning  today  in  our  own  lives,  in  the  
life  of  our  nations  and  in  the  world  at  large.  

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As  NIGH’s  vision  was  formulated,  we  understood  what  Wilber  (2000)  meant  when  he  noted  that  omitting  
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three  quadrants.  Without  focusing  on  strengthening  and  sustaining  individuals,  groups  of  individuals  cannot  
thrive.  Conversely,  without  focusing  on  the  worldviews  underlying  all  situations  in  any  society,  the  structures  
ZHOLYHDQGZRUNZLWKLQFDQQRWEHSURSHUO\XQGHUVWRRGDQGVXVWDLQHG.:LWKRXW¿UVWSRSXODWLQJDQXQGHU-­
standing  of  the  nature  of  these  worldviews—with  real  people  in  real  groups  with  real  needs  in  mind—struc-­
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DQGSURSRVLQJVWUXFWXUHVIURPZRUOGYLHZVWKDWFDQPDNHDGLIIHUHQFHLQWKHZRUOGSHRSOHDQGJURXSVWHQG
WRGULIWDZD\IURPSXUSRVHIXOHIIRUWVWKDWPDNHDWDQJLEOHGLIIHUHQFH
&RQVFLRXV RI WKH QHHG WR VSHFL¿FDOO\ LQWHJUDWH D /RZHU5LJKW TXDGUDQW   FRPSRQHQW LQWR RXU ZRUN  
NIGH  representatives  have  co-­convened  many  discussions  and  meetings  in  and  around  the  United  Nations  in  
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WKHVHGLVFXVVLRQVZHKDYHLGHQWL¿HGWKDWWKHLQWHJUDOQXUVLQJZRUOGYLHZLVGLUHFWO\UHODWHGWRDOOHLJKW81
Millennium  Development  Goals  (MDGs)  (United  Nations  Millennium  Goals,  2000).    
During  the  year  2000,  world  leaders  convened  a  summit  to  establish  eight  MDGs  that  must  be  achieved  
for  the  21st  century  to  progress  toward  a  sustainable  quality  of  life  for  all  of  humanity  (United  Nations  Mil-­
lennium  Development  Goals,  2000).  These  Goals  are  an  ambitious  agenda  for  improving  lives  worldwide.  
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$,'6DUHGLUHFWO\UHODWHGWRKHDOWKDQGQXUVLQJ7KHRWKHU¿YH*RDOVDGGUHVVLQJ(UDGLFDWH([WUHPH
3RYHUW\DQG+XQJHU$FKLHYH8QLYHUVDO3ULPDU\(GXFDWLRQ3URPRWH*HQGHU(TXDOLW\DQG(PSRZHU
:RPHQ(QVXUH(QYLURQPHQWDO6XVWDLQDELOLW\DQG*OREDO3DUWQHUVKLSVIRU'HYHORSPHQWDUHIDFWRUV
WKDWGHWHUPLQHWKHKHDOWKRUODFNRIKHDOWKRISHRSOH)RUHDFK*RDORQHRUPRUHWDUJHWVKDYHEHHQVHWWREH
DFKLHYHGE\XVLQJGDWDDVDEHQFKPDUN
Within  NIGH,  the  aim  is  to  initiate  new  approaches  by  empowering  both  individuals  and  groups  to  
see   through   an   integral   nursing   lens   and   to   revisit   the   Integral   approach   to   Nightingale’s   legacy,   in   21st-­
century  terms.  In  2010,  during  the  Florence  Nightingale  Centennial/International  Year  of  the  Nurse,  NIGH’s  
team   featured   stories   of   how   integral   nurses   are   advocating   and   achieving   each   of   the   eight   MDGs   (see  
www.2010IYNurse.net).  These  stories  illustrated  how  nurses  are  creating  new  structures—widening  world-­
YLHZVZLWKORFDOGLDORJXHVWKDWVKLIWEHKDYLRUVDQGFUHDWHQHZPHDQLQJPDNLQJWRZDUGKHDOWKLQFOXGLQJWKH
SURFHVVRIKHDOWKPDNLQJJOREDOO\(LJKWRIWKHVHVWRULHV²ZLWKFRUUHVSRQGLQJVFHQDULRVIURP1LJKWLQJDOH¶V
life  and  insights—are  featured  here,  as  examples  of  nurses  who  are  demonstrating  Nightingale’s  continued  

                     Journal  of  Integral  Theory  and  Practice                        77

 D-­M.  BECK  ET  AL.  

relevance  and  legacy  for  local-­to-­global  health  and  helping  to  enact  an  integral  world.  The  following  presen-­
tation  of  the  eight  MDGs  helps  set  the  context  for  how  we  use  the  Integral  model  within  NIGH  to  produce  
¿YHTXDGUDQWFKDUWV)LJV1,*+,QWHJUDO0RGHOV$WKURXJK(

MDG  #1:  Eradicate  Extreme  Poverty  and  Hunger

This  Goal  affects  the  health  and  well-­being  of  individuals  and  communities  world-­
wide.77KHVHYHULW\RIGLVHDVHDQGWKHRSSRUWXQLW\IRUPD[LPXPUHFRYHU\²NH\LVVXHV
faced  by  nurses  in  the  delivery  of  patient  care—are  determined  not  only  by  adequate  
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nutrition  and  sanitation  concerns,  all  related  to  poverty  levels  (United  Nations  Millen-­
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OLIH,QWKHVVKHUHIRUPHGWKH/LYHUSRRO:RUNKRXVH,Q¿UPDU\ZKHUHLPSRYHULVKHGDQGKXQJU\
people  were  crowded  into  unsafe,  unsanitary  conditions.  Through  a  well-­run  public  awareness  campaign  and  
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 &DWK\&URZHD&DQDGLDQQXUVHOLYLQJLQ2QWDULRLVIDPRXVIRUKHUZRUNWRDGGUHVVKRPHOHVVQHVVDQG
all  of  its  factors  on  the  streets  of  Toronto.  As  an  activist  for  public  health,  housing  and  social  justice,  Crowe  
has  also  brought  public  attention  to  the  plight  of  the  homeless  and  poverty.  With  her  colleagues,  she  has  called  
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DPHDVXUHFDOOHGWKH³6ROXWLRQ´&URZH

MDG  #2:  Achieve  Universal  Primary  Education  

This  Goal  highlights  that  too  many  of  today’s  children,  worldwide,  grow  up  illiterate  
because  they  are  denied  the  right  to  attend  primary  school.  In  nations  where  high  lit-­
eracy  rates  have  been  achieved—particularly  for  women—higher  levels  of  health  and  
ORQJHYLW\KDYHDOVREHHQQRWHG,QWKHV1LJKWLQJDOHDGYLVHGOHDGHUVVHHNLQJWR
establish  primary  schools  in  New  Zealand  and  Australia.  She  passionately  noted  the  
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Oh  teach  health,  teach  health,  health,  health,  to  the  rich,  and  poor,  to  educated  and,  if  
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\RXQJPRWKHUVWR\RXQJPRWKHUVHVSHFLDOO\«IRUWKHKHDOWKRIWKHLUFKLOGUHQFRPHV
EHIRUH*UHHNDQGJUDPPDU1LJKWLQJDOH

Margarita  Ruiz  Severinghaus,  from  Vermont,  has  been  traveling  to  her  native  Dominican  Republic  to  
PDNHDGLIIHUHQFHLQWKHOLYHVRIKHUSHRSOH6KHLVSDUWFRPPXQLW\DPEDVVDGRUSDUWQHWZRUNHUDQGUHVRXUFH
strategist,  and  part  educator  as  she  has  led  12  trips  to  her  homeland  to  facilitate  much-­needed  education  and  
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cal  Center  in  nearby  New  Hampshire—in  addition  to  other  healthcare  professionals—with  her  on  her  hu-­
manitarian  missions.  Together,  they  bring  countless  donated  medical  supplies  to  bring  comfort  and  solace  to  
the  poorest  regions  of  the  country.  With  this  effort,  she  is  also  teaching  nurses  about  global  health  issues,  in  a  
YHU\UHDOLVWLFJUDVVURRWVZD\'DUWPRXWK+LWFKFRFNQG

78                      Journal  of  Integral  Theory  and  Practice

 INTEGRAL  NURSING

MDG  #3:  Promote  Gender  Equality  and  Empower  Women

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respect  that  many  women  and  girls  endure  (United  Nations,  2000).  In  her  own  time,  
Nightingale’s  entire  effort—to  develop  a  nursing  education  curriculum—focused  on  
improving  the  earning  capacities  and  living  conditions  of  young  women  by  providing  
them  the  means  to  join  a  profession  that  had  become  well-­respected  because  of  Night-­
ingale’s  own  example.  
In  many  parts  of  the  world,  women  still  spend  much  of  their  day  fetching  water  and  carrying  wood  to  
PHHWWKHLUIDPLO\¶VEDVLFQHHGV$UHODWHGJHQGHULVVXHLVKXPDQWUDI¿FNLQJZKHQPRVWO\ZRPHQDQGFKLO
GUHQDUHOXUHGUHFUXLWHGRUWDNHQE\IRUFHLQWRDQRWKHUFRXQWU\:RUNLQJLQFRXQWULHVZKHUHOLYLQJFRQGL
WLRQVDUHVRSRRUWUDI¿FNHUVOXUHYLFWLPVZLWKIDOVHSURPLVHVRIJRRGMREVDQGEHWWHUOLYHV,QVWHDGYLFWLPV
DUHIRUFHGWRZRUNXQGHUEUXWDORIWHQXQKHDOWK\FRQGLWLRQVRQIDUPVLQVZHDWVKRSVDVPDLGVRUQDQQLHVLQ
SULYDWHKRPHVRUDVVH[ZRUNHUV*OLFNVWHLQ%DUEDUD*OLFNVWHLQD1HZ<RUN&LW\±EDVHGQXUVHDQG
journalist,  is  helping  nurses  become  more  aware  of  this  issue,  noting  that  much  more  can  and  must  be  done,  
LQFOXGLQJLQFUHDVLQJSXEOLFDZDUHQHVVRQDWRSLFRIWHQFRQVLGHUHGWRRVHQVLWLYHIRUSXEOLFGLVFXVVLRQ*OLFN
stein,  2011).  

MDG  #4:  Reduce  Child  Mortality  

There  are  many  countries  that  still  have  unacceptably  high  levels  of  child  mortality,  
particularly  in  sub-­Saharan  Africa  and  South  Asia.  In  these  regions,  1  out  of  every  10  
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caregivers   and   advocates   for   the   health   of   infants   and   young   children.   Nightingale  
(1893)   wrote   that,   “The   causes   of   the   enormous   child   mortality   are   perfectly   well  
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want  of  whitewashing,  dirty  feather-­beds  and  bedding—in  one  word,  want  of  house-­
hold  care  of  health”  (p.  291).  
Nightingale  lived  in  a  time  when  contaminated  foods  and  water  were  the  norm,  as  were  dirty  bedding  
and  clothing.  “Whitewashing”  (chloride  of  lime,  often  mixed  with  lye  that  turned  the  mixture  white)  was  used  
to  rid  houses,  buildings,  and  streets  of  the  stench  of  rotting  food,  animals,  and  human  and  animal  excrement.  
Although  the  sanitation  issues  are  different  in  most  settings  today,  the  principle  of  altering  the  environment  
to  improve  health  still  applies.  Rodelia  Busalpa,  a  California  family  nurse  practitioner,  KDVZRUNHGWRSURYLGH
free  healthcare  at  hospitals,  orphanages,  and  villages  in  and  around  Vientiane,  the  capitol  of  Laos.  Bulsalpa  
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free  healthcare  for  Hmong  residents  of  those  villages  (Serving  the  Underserved,  2010).  

MDG  #5:  Improve  Maternal  Health

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divide   in   the   world”   (UNICEF,   2009).   Moreover,   maternal   health   goes   beyond   the  
survival   of   pregnant   mothers.   For   every   mother   dying   from   causes   related   to   preg-­
nancy  or  childbirth,  an  estimated  20  survivors  also  suffer  pregnancy-­related  illness  or  
H[SHULHQFHRWKHUVHYHUHFRQVHTXHQFHVVXFKDVEODGGHUDQGRUUHFWDO¿VWXOD$QQXDOO\
there  are  an  estimated  10  million  women  who  survive  their  pregnancies  while  experiencing  such  adverse  

                     Journal  of  Integral  Theory  and  Practice                        79

 D-­M.  BECK  ET  AL.  

outcomes  (United  Nations  Urged  to  Recognize  the  Vital  Role  of  Nurses,  2010).  Clearly  nursing  practice  has  
been  and  must  continue  to  be  integrally  involved  in  this  challenge.  Nightingale  fully  recognized  this  issue—
noting  that  the  health  of  women  is  directly  related  to  the  health  of  nations  (Nightingale,  1893,  p.  288).  Arlene  
Samen,  Founder  and  CEO  of  One  Heart  Worldwide,  is  a  San  Francisco–based  nurse  practitioner  who  has  
dedicated  her  life  to  serving  women  and  their  infants  in  isolated  communities  in  developing  countries  (Arlene  
Samen,  2011).  While  in  Tibet,  she  noted  that  women  often  deliver  alone  in  rough  conditions,  without  access  
WRREVWHWULFFDUH6KHIRUPHGDWHDPRIPHGLFDOH[SHUWVWRGHYHORSDPRGHOFRXUVHDQGUHODWHGNLWRIWRROVWR
WHDFKDQGLPSOHPHQWVLPSOHOLIHVDYLQJVNLOOVIRUPRWKHUVDQGQHZERUQVLQUHPRWH7LEHWDQYLOODJHV6LQFH
the  inception  of  One  Heart,  more  than  1,000  rural  Tibetan  mothers  and  their  families  have  received  essential  
maternal-­newborn  health  outreach  services.

MDG  #6:  Combat  HIV/AIDS,  Malaria,  and  Other  Diseases

This   Goal   highlights   that,   even   in   the   year   2008,   2.7   million   people   became   newly  
infected  with  HIV  and  2  million  died  of  AIDS,  including  280,000  children.  Two-­thirds  
of  HIV  infections  are  in  sub-­Saharan  Africa,  where  an  estimated  6.7  million  people  still  
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are  young  African  children.  On  average,  a  child  in  Africa  dies  every  30  seconds  from  
a  malaria  infection  caused  by  the  bite  of  a  mosquito.  With  an  estimated  9.4  million  
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+,9WXEHUFXORVLVLVVWLOORQHRIWKHZRUOG¶VELJJHVWNLOOHUV810LOOHQQLXP'HYHORSPHQW*RDOV$OO
of  these  diseases  require  adequate  healthcare  delivery  services—much  of  these  by  nurses—that  continue  to  be  
FULWLFDOO\ODFNLQJLQWKHVHSDUWVRIWKHZRUOG:RUOG+HDOWK2UJDQL]DWLRQ7RKHOSZLWKWKH+,9$,'6
crisis,  Katherine  H.  Murray  Frommelt,  a  nursing  educator  based  in  Iowa,  recently  traveled  to  South  Africa  
ZLWKD86GHOHJDWLRQRIQXUVHV%HIRUHOHDYLQJVKHZDVLQYLWHGWRGRDOLYHUDGLRLQWHUYLHZDQGDVNHGLI
VKHFRXOGUHDOO\PDNHDGLIIHUHQFHGXULQJKHUWULS¶VOLPLWHGWLPHIUDPH+HUUHVSRQVHZDV³,I,FRXOGPDNHD
difference  to  even  one  person,  if  I  could  hold  even  one  dying  child,  I  would  believe  I  had  made  a  difference”  
(Frommelt,  2011).  Before  she  left,  Frommelt  made  a  promise  to  a  young  South  African  man  that  she  would  
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MDG  #7:  Ensure  Environmental  Sustainability

This  Goal  concentrates  on  the  living  conditions—air,  water,  fuel,  construction  mate-­
rials,   and   food   sources—essential   to   human   health   (U.N.   Millennium   Goals,   2000).  
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tions.  In  the  1870s  and  1880s,  she  collaborated  with  a  series  of  leaders  based  in  New  
Delhi  to  address  environmental  concerns  affecting  the  health  of  the  Indian  people,  in-­
cluding  issues  related  to  deforestation  resulting  in  loss  of  tillable  soil  during  monsoon  
VHDVRQV%HFN0DU\)UDQFHV'3DWHDQ2UHJRQEDVHGQXUVLQJHGXFDWRUKDVIRUPHGD³*UHHQ7HDP´
WRH[SORUHZD\VWRUHGXFHZDVWHLQDSHGLDWULFLQWHQVLYHFDUHXQLW7KURXJKZRUNLQJZLWKKHUKRVSLWDO¶VUHF\
cling  program  and  its  Environmental  Health  and  Radiation  Safety  Department,  an  action  plan  was  developed  
to  reduce  trash  thrown  into  regulated  medical-­waste  bags.  They  installed  recycling  bins  for  cans,  paper,  glass,  
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ins  found  in  the  hospital  were  appropriately  recycled,  reduced,  or  eliminated  (e.g.,  bins  were  placed  next  to  
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EDWWHULHVZHUHFKDQJHG7KLVJURXSDOVRZRUNHGZLWKRWKHUGHSDUWPHQWVWR¿QGDOWHUQDWLYHVWRHTXLSPHQW
containing  mercury  (Condon,  2011).

80                      Journal  of  Integral  Theory  and  Practice

 INTEGRAL  NURSING

MDG  #8:  Develop  a  Global  Partnership  for  Development

This  Goal  encourages  large  and  small-­scale  collaborations  (U.N.  Millennium  Devel-­
RSPHQW*RDOV:HOONQRZQH[DPSOHVLQFOXGHWKH%LOODQG0HOLQGD*DWHV)RXQ
dation  and  the  Clinton  Foundation.  The  overwhelming  humanitarian  response  to  the  
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line  Opollo,  and  Kristina  Ibitayo  are  a  small  team  of  nurses  who  are  part  of  the  North  
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HDVWHUQ8JDQGD7KHUHWKH\FRQGXFWHGDWZRGD\SK\VLFDODVVHVVPHQWZRUNVKRSXVLQJVWHWKRVFRSHVDQGSHQ
OLJKWVSURYLGHGE\GRQRUV7KLVSLHFHRIHTXLSPHQW²VRRIWHQWDNHQIRUJUDQWHGLQWKHGHYHORSHGZRUOG²ZDV
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FHUWL¿FDWHVE\WKHPHGLFDOGLUHFWRURIWKHGLVWULFW*UD\HWDO6LPLODUO\/LVD%ODNHUD1HZ
=HDODQG±EDVHGQXUVHZKRKDVVHUYHGZLWK'RFWRUV:LWKRXW%RUGHUVLQ'DUIXUQRWHV

Our  world  needs  more  nurses  who  are  willing  to  stand  up  for  what  they  believe  in,  
whatever  that  is.  For  me  it  is  equality,  justice  and  health  care  for  all.  These  are  not  
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ÀLHVIURPWKHLUZRXQGV7KH\DUHJRDOVZH¿JKWIRUHYHU\GD\$VQXUVHVZHKDYHWKH
VNLOOVDQGFRPSDVVLRQWRPDNHDGLIIHUHQFHLQWKHZRUOG:KHWKHUZHGRLWLQLQQHU
FLW\KRVSLWDOVRULQVXQEDNHGPXGKXWV3HUKDSVVRPHRQHHOVHFDQVWHSIRUZDUGWR
WDNHP\SODFHZKLOH,UHVWDZKLOH%XWSOHDVHGRQ¶WDVVXPHWKDWLWZLOOEH³VRPHRQH
else.”  Could  it  be  you?  

As   a   nurse,   Nightingale   often   served   the   suffering   by   building   collaborative   relationships   with   oth-­
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this  suffering.  Although  she  faced  many  barriers,  she  stood  within  her  own  conviction  for  changes  that  were  
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today.  She  was  a  transformative  change  agent  who  set  in  motion  a  culture  of  caring—a  culture  that  continues  
even  now  into  the  21stFHQWXU\%HFNDE
  As  you  can  see,  viewing  the  eight  MDGs  through  an  integral  lens  shows  that  some  of  them  focus  more  
on  the  UR  quadrant  and  some  focus  more  on  the  LR  quadrant.  Few  of  them  deal  explicitly  with  the  interior  
quadrants  of  the  UL  and  LL.  Nevertheless,  to  accomplish  any  of  the  eight  MDGs  we  feel  all  four  quadrants  
related  to  each  MDG  should  be  engaged.  In  other  words,  to  be  successful  with  any  of  these  planetary  Goals  
we  will  have  to  include  psychological  (UL),  behavioral  (UR),  cultural  (LL),  and  systemic  (LR)  dimensions.  
7KLVLVZK\WKHWKHRU\RILQWHJUDOQXUVLQJSURYLGHVDIRXUTXDGUDQWIUDPHZRUNWRZRUNZLWK²DQ\WKLQJOHVV
ZLOOOLNHO\QRWEHDVVXFFHVVIXO

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piecemeal  way).  Further,  we  were  advised  that—because  of  budget  constraints  and  a  limited  number  of  staff  
DQGYROXQWHHUV²ZHVKRXOG³SLFNMXVWRQHWKLQJ´DQGVHWDVLGHWKHUHVWRIZKDWZHZHUHSODQQLQJDVLWZDV
“just  too  much  to  do.”

                     Journal  of  Integral  Theory  and  Practice                        81

 D-­M.  BECK  ET  AL.  

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ZRXOGQRWZRUNEHFDXVHMXVWRQHDFWLYLW\RUSURMHFWFRXOGQRWEHHIIHFWLYHO\DFKLHYHGZLWKRXWWKHRWKHUSLHFHV
in  place—just  as  a  jigsaw  puzzle  cannot  be  “solved”  with  only  one  piece.  Using  Dossey’s  (2009)  theory  of  
integral  nursing,  we  realized  how  the  Integral  model  could  help  us  present  NIGH’s  whole  picture,  as  well  as  
the  pieces  of  the  whole  and—perhaps  most  important—the  relationships  between  the  pieces  (Fig.  2).8  
We   explored   the   complex   dynamics   within   the   NIGH   project   by   considering   integral   educator   Joel  
.UHLVEHUJ¶VSHUVRQDOFRPPXQLFDWLRQ$XJXVWRUJDQL]DWLRQRI¿UVWVHFRQGDQGWKLUGOHYHOFRP-­
SOH[LW\7KH¿UVWOHYHORIFRPSOH[LW\LVWKHLQGLYLGXDOVWKHVHFRQGOHYHORIFRPSOH[LW\LVWKHFRPPXQLW\
JURXSVDQGWKHWKLUGOHYHORIFRPSOH[LW\LVWKHHQYLURQPHQWDQGJOREDOV\VWHPV7KXVZHSODFHGLQGLYLGX-­
als  in  the  Upper-­Left  (UL)  quadrant,  groups  in  the  Lower-­Left  (LL)  quadrant,  grassroots  action  in  the  Upper-­
Right  (UR)  quadrant,  and  global  systems  in  the  Lower-­Right  (LR)  quadrant.  In  Integral  Theory,  persons  are  
individual  holons  while  groups  are  social  holons.9  From  an  Integral  Theory  perspective,  the  individuals  who  
we  placed  in  the  UL  are  really  holons  of  all  four  quadrants.  The  examples  of  individual  commitments  to  
WKH³1LJKWLQJDOH'HFODUDWLRQIRUD+HDOWK\:RUOG´DQGLQGLYLGXDOQXUVHVWDNLQJFDUHRIWKHLURZQKHDOWKDUH
H[DPSOHVRIEHKDYLRUV²85DFWLRQVUDWKHUWKDQ8/H[SHULHQFHV+RZHYHUZHDFNQRZOHGJHWKDW8/H[SHUL-­
ences  also  continuously  arise  from  these  actions,  and  so  forth.  
The  NIGH  project  “pieces”  form  a  whole  that  is  much  more  than  the  sum  of  its  parts.  Over  the  past  
several  years,  NIGH  representatives  have  met  with  a  wide  range  of  individuals  and  groups,  from  global  U.N.  
RI¿FLDOVWRJUDVVURRWVQXUVHVVWUXJJOLQJWRDFKLHYHHYHQPRGHVWOHYHOVRIKHDOWKFDUHGHOLYHU\LQUHPRWHXQ-­
derserved  areas  of  the  developing  world.  Based  upon  these  meetings  and  using  this  jigsaw  puzzle  metaphor,  
NIGH’s  team  has  recently  shaped  a  related  series  of  integral  models—shown  in  this  article  as  NIGH  Integral  
0RGHOV$ WR ( )LJV ±²ZLWK WKH 8/ TXDGUDQW QDPHG ³$PRQJ LQGLYLGXDOV´ WKH // TXDGUDQW QDPHG
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  Starting   in   2011,   NIGH’s   team   is   co-­creating—with   collaborators   across   the   world—an   interactive  
integral  “global  Internet  portal”  to  further  increase  worldwide  public  awareness  about  the  critical  priorities  

82                      Journal  of  Integral  Theory  and  Practice

 INTEGRAL  NURSING

of  local-­to-­global  health  concerns.  NIGH’s  new  online  tagline—Inform,  Inspire,  Initiate,  &  Involve—has  
EHHQGHYHORSHGZLWKLQWKHIUDPHZRUNRIWKHQHZ1,*+,QWHJUDO0RGHOV%WR')LJV±ZKLFKLGHQWLI\
IRXUNH\LQWHUFRQQHFWHGDSSURDFKHV7KHVH0RGHOVLGHQWLI\IRXULQWHUUHODWHGSUREOHPV)LJSUR-­
SRVHIRXUV\QWKHVLVVROXWLRQV)LJLPSOHPHQWIRXULQWHJUDOLQLWLDWLYHV)LJDQGDUWLFXODWHIRXU
DQWLFLSDWHGRXWFRPHV)LJ'RVVH\ %HFN  

Four  Interrelated  Problems  

:HKDYHLGHQWL¿HGIRXULQWHUUHODWHGSUREOHPV)LJ7KH¿UVWSUREOHPDQG1,*+¶VVXEMHFWIRFXVRYHUWKH
next  few  years,  is  the  prevailing  yet  preventable  deaths  of  millions  of  children  and  women  each  year—(repre-­
VHQWHGDVQRWHGDERYHE\810'*VDQG,QUHYLHZPLOOLRQFKLOGUHQXQGHUWKHDJHRI¿YHGLHHYHU\
year,  most  from  preventable  causes.  As  well,  every  dayZRPHQDQGJLUOVVXIIHUDQGWKHQGLHGXULQJ
SUHJQDQF\RUGHOLYHU\²GHDWKVRIPRWKHUVSHU\HDU81,&()
These  grim  statistics  illustrate  two  of  the  most  critical,  unmet  challenges  facing  humanity.  When  these  
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cascade  into  downward  spirals  that  cause  intergenerational  ripples.  Families  suffer  needlessly  and  the  deaths  
impact  entire  communities.  In  some  of  the  most  impoverished  regions,  orphans  can  become  child  soldiers  or  
terrorists,  growing  up  deprived  of  human  caring.  Hence,  the  loss  of  mothers—as  positive,  vital  role  models—
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 7R DQVZHU WKLV TXHVWLRQ 1,*+¶V WHDP LGHQWL¿HG D VHFRQG UHODWHG SUREOHP²UHSUHVHQWHG LQ WKH 8/
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involvement  to  meet  these  critical  global  health  issues.  The  worldwide  scope  of  this  problem  seems  beyond  
what  individuals  believe  they  can  consider,  let  alone  mitigate.  
The  third  problem—represented  by  the  UR  quadrant  of  Model  B  (Fig.  3)—is  directly  related  to  the  
second  problem.  The  grim  tragedies  of  mother  and  child  deaths  are  consistently  undervalued  at  grassroots  

At
Am o ng
g ra s sr o ot s
i ndi vi dua ls
level s
Am id s t in f or m ation
L ac k of p ub l ic ove rlo ad , glo bal
c on ce rn f or h ealt h i ss u es ar e :
c ri tic al gl ob al  Un de rr ep or t e d
h ealt h is su e s  Un de r val ued
 Po orl y un d er st ood

I IT
WE ITS
Ke en ly r ele vant Two cr iti cal glob al
to glob al h e alth , h ealt h g oals c on tin ue
n ur s es s il en tly to mis s t he ir mar k :
s tru g gle wit h Ch ild an d mat er n al
s ever e s h or t age s h ealt h
to mee t loc al n eed s ( U. N . M DGs 4 & 5)

W it h in At gl o ba l
gr o up s level s

Figure  3͘E/',/ŶƚĞŐƌĂůDŽĚĞů͘&ŽƵƌŝŶƚĞƌƌĞůĂƚĞĚƉƌŽďůĞŵƐ͘

                     Journal  of  Integral  Theory  and  Practice                        83

 D-­M.  BECK  ET  AL.  

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VROGLHUGLHVIURPDODQGPLQHLQ$IJKDQLVWDQWKHZRUOGPHGLDPDNHVVXUHHYHU\RQHNQRZV%XWWKHIDFWWKDW
one  mother  suffers  and  dies  every  minute  of  every  day,  365  days  every  year—from  preventable  complications  
of  pregnancy—is  rarely  reported!  When  the  topic  arises—as  it  did  during  the  G-­8  and  G-­20  summits  in  2010  
in  Toronto—information  about  the  causes  surrounding  these  deaths  is  often  underreported  and  poorly  under-­
stood.  In  the  case  of  the  2010  summits,  the  Canadian  media,  for  instance,  focused  only  on  the  political  “hot  
buttons”  of  family  planning—discussing  the  pros  and  cons  of  abortion  versus  the  use  of  condoms—without  
ever  mentioning  what  and  who  is  needed  at  the  deathbeds  of  these  mothers  (Delacourt,  2010).  Thus,  NIGH  
continues  to  explore  how  integrally  informed  attitudes  can  strengthen  its  endeavors.  
7KLVGHPRQVWUDWHVWKHIRXUWKSUREOHP²LGHQWL¿HGLQWKH//TXDGUDQWRI0RGHO%)LJ$WWKHVDPH
time  that  mothers  and  children  are  so  marginalized  that  their  deaths  go  unnoticed,  nurses,  midwives,  and  
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factors  in  these  deaths  (Oulton,  2006).
Thus,   these   tragedies   are   particularly   relevant   to   NIGH’s   overarching   mandate   to   empower   nurses  
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will  be  necessary  to  train  and  sustain  the  millions  of  additional  nurses,  midwives,  and  community  health  
ZRUNHUVQHHGHG²SDUWLFXODUO\LQWKHZRUOG¶VPRVWPDUJLQDOL]HGUXUDODUHDV,IZHDVDJOREDOFRPPXQLW\FDQ
effectively  advocate  for  and  address  these  challenges,  mothers  could  still  be  alive  to  care  for  their  families,  
providing  the  world’s  most  vulnerable  children  with  what  they  need  to  become  healthy,  positive  contributors  
WRVRFLHW\%XWZLWKRXW¿UVWDFKLHYLQJWKHPRELOL]DWLRQRISXEOLFRSLQLRQRIFRQFHUQWKHVHSUREOHPVZLOO
never  adequately  be  solved.  At  NIGH,  we  believe  that  our  integral  approach  to  increase  public  concern  for  
VROYLQJWKHVHSUREOHPVZLOODVVLVWZLWKWKLVJOREDOHIIRUW%HFN 'RVVH\

Four  New  Synthesis  Solutions

Recalling   Monica   Sharma’s   observations   about   the   personal   transformations   required   to   solve   planetary  
SUREOHPVZHKDYHEHHQLQVSLUHGE\$OEHUW(LQVWHLQQG³1RSUREOHPFDQEHVROYHGIURPWKHVDPHOHYHO
of   consciousness   that   created   it.”   Further   pondering   these   ideas,   NIGH’s   team   has   developed   a   series   of  
strategies  based  on  our  initial  experiences  and  on  our  global  consultations  with  many  people  involved  in  the  
interrelated  problems  outlined  above.  Hence,  we  are  now  planning  to  co-­develop  and  implement  four  solu-­
tions  synthesized  to  create  new  levels  of  societal  understanding,  to  initiate  new  grassroots  structures,  and  to  
further  establish  ways  in  which  many  more  people  can  effectively  respond  to  these  and  other  global  health  
challenges.  
  First,  as  illustrated  in  the  UR  quadrant  of  Model  C  (Fig.  4),  health  can  be  seen  as  common  ground  be-­
tween  all  7  billion  people  who  live  on  Earth.  Each  of  us  wants  health  for  ourselves  and  for  our  families.  As  
such,  health  then  can  become  a  bridge  across  boundaries—of  belief,  race,  class,  and  culture—that  still  divide  
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individual  and  social  behavior  (Jonas,  2011).  If  we  all  want  health,  we  can  see  health  with  a  common  purpose  
DVDSDWKWRVWUHQJWKHQLQJSHDFHIXOLQWHUDFWLRQVEHWZHHQSHRSOHV,I,NQRZWKDWP\KHDOWKGHSHQGVRQ\RXU
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imperative  helping  us  to  determine  what  our  collective  present  and  future  priorities  must  be.  
Second,  as  depicted  in  the  UL  quadrant  of  Model  C  (Fig.  4),  while  collaborating  with  people  across  
the  world,  NIGH  plans  to  further  use  the  Internet  and  online  tools  to  establish  new  ways  to  demonstrate  in-­
dividual  grassroots-­to-­global  participation  and  to  increase  public  concern  for  health.  Today,  many  examples  
H[LVWWRVKRZWKDWZHFDQQRORQJHUUHO\XSRQWUDGLWLRQDOPHGLDWRLQFUHDVHLQIRUPHGFRQFHUQIRUNH\LVVXHV

84                      Journal  of  Integral  Theory  and  Practice

 INTEGRAL  NURSING

At
Am on g
gra ss ro ot s
i ndi vi dua ls
l eve ls
Identify
Esta b li s h
Health as:
par t icipat or y
 Our common ground
g r a ss ro ots -t o- glo bal
 Our moral imperative
dem ons tr ati ons o f
 A bridge across
peo ples ’ powe r
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to in cr e ase
 A path to world peace
inf o rme d c once rn
I IT
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Amp l if y Collaborate
v oice s of nu r se s with key global officials
& cit izen s to increase concern
— acro ss the for achieving U.N. MDGs,
g loba l a r e na— particularly #s 4 & 5
f or human ity ’s (Child & Maternal
dee pes t needs Health)

W it hin At gl ob al
g ro ups l eve ls

Figure  4.  E/',/ŶƚĞŐƌĂůDŽĚĞů͘&ŽƵƌƐLJŶƚŚĞƐŝƐƐŽůƵƟŽŶƐ͘

6RFLDO PHGLD WRROV OLNH )DFHERRN DQG7ZLWWHU QRZ VXFFHVVIXOO\ FDWDO\]H JOREDO DQG UHJLRQDO PRYHPHQWV
7KHVHWRROVFDQDOVREHWDSSHGWRDGYRFDWHIRUNH\JOREDOKHDOWKLVVXHV:KDWZHDUHQRZVHHLQJLVWKDWE\
using  these  tools,  the  UL  of  individuals  will  be  better  informed,  and  increasingly  concerned  with  events  be-­
yond  their  nation’s  borders.
7KLUGDVQRWHGLQWKH//TXDGUDQWRI0RGHO&)LJZHDUHVHHNLQJWRDPSOLI\WKHYRLFHVRIQXUVHV
PLGZLYHVDQGFRPPXQLW\KHDOWKZRUNHUV²DQGLQGHHGgroups  of  citizens  concerned  with  the  health  of  hu-­
PDQLW\)RULQVWDQFHRQHRIWKHPDMRUUHDVRQVZHGRQRWNQRZPXFKDERXWPDWHUQDOGHDWKLQWKHZRUOG¶VUXUDO
areas  is  that  traditional  media  sources  have  not  been  posted  there  to  tell  this  story.  But  nurses  and  midwives  
are  most  often  “on  location”  in  these  places.  When  encouraged  to  do  so,  they  can  develop  new  groups  of  ef-­
IHFWLYHRQOLQHYRLFHVVKDULQJZKDWWKHZRUOGQHHGVWRNQRZ7KH\FDQDOVREHWKHNQRZOHGJHDEOHH\HVHDUV
and  voices  to  broadcast  the  solutions  that  can  be  found  and  replicated  elsewhere.  By  cross-­pollinating  these  
strengths,  innovative  media  sources  could  provide  for  an  ongoing  “broadcast”  of  solutions.
We  have  also  noted  that,  traditionally,  nurses  are  very  good  at  communicating  with  each  other.  How-­
HYHUPRVWDUHQRW\HWVNLOOHGHQRXJKWRFRPPXQLFDWHWKHLUFRQFHUQVZLWKWKHUHVWRIWKHZRUOG7KLVFUHDWHV
DQLQVXODUHIIHFWNHHSLQJQXUVLQJ¶VYRLFHVLOHQWWRPRVWHDUV%XUHVK *RUGRQ7KLQNLQJRXWVLGHWKH
box  of  traditional  nursing  realms,  NIGH’s  team  is  developing  and  encouraging  many  ways  in  which  groups  
RIQXUVHVFDQVKDUHZKDWWKH\NQRZDQGZKDWWKH\FDUHDERXWDFURVVWKHJOREDODUHQDWKXVPRYLQJIURPHWK-­
nocentric  to  worldcentric  communication.
Fourth,  as  illustrated  in  the  LR  quadrant  of  Model  C  (Fig.  4),  NIGH’s  team  is  planning  to  collaborate  
ZLWKNH\JOREDORI¿FLDOV²SDUWLFXODUO\ZLWKLQ81DJHQFLHVLQFOXGLQJWKH:RUOG+HDOWK2UJDQL]DWLRQ²WR
communicate  global  health  concerns  at  grassroots  levels.  Based  upon  NIGH’s  own  global  experience  at  two  
U.N.  Economic  and  Social  Councils  (in  2009  and  2010)  and  at  related  international  Civil  Society  Develop-­
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ZHNQRZWKDWJOREDORI¿FLDOVDUHORRNLQJIRURSSRUWXQLWLHVWRZRUNZLWKFRPPXQLFDWRUVDWWKHJUDVVURRWVOHYHO
%HFN 'RVVH\

                     Journal  of  Integral  Theory  and  Practice                        85

 D-­M.  BECK  ET  AL.  

(DFKRIWKHVHIRXUVROXWLRQVLVGHSHQGHQWXSRQRQHDQRWKHUWRZRUNZHOO$VZHLPSOHPHQWWKHVHVROX-­
tions,  NIGH  is  developing  a  new  synthesis  between  them—establishing  what  Einstein  called  the  “new  level  
of  consciousness”  upon  which  to  solve  problems.  

How  To  Achieve  This?  

%XLOGLQJXSRQWKLVQHZV\QWKHVLVRIVROXWLRQV²ZRUNLQJDPRQJLQGLYLGXDOVDQGZLWKLQJURXSVDWJUDVVURRWV
and   global   levels—NIGH’s   team   is   establishing   four   sets   of   initiatives   as   outlined   in   the   NIGH   Integral  
0RGHO')LJ$OORIWKHVHLQLWLDWLYHVKDYHEHHQZHOOHVWDEOLVKHGWKURXJKSUHYLRXV1,*+SLORWSURMHFWV
$V LGHQWL¿HG DERYH 1,*+¶V LQLWLDO ZRUN HVWDEOLVKHG WKH ³1LJKWLQJDOH 'HFODUDWLRQ IRU$ +HDOWK\:RUOG´
ZKHUHLQGLYLGXDOQXUVHVDQGFRQFHUQHGFLWL]HQVKDYHSDUWLFLSDWHGIURPDFURVVWKHZRUOG,QNHHSLQJZLWKWKH
8/TXDGUDQWRI0RGHO')LJWKLVLVDJRRGVWDUW$QGZHFDQGRPXFKPRUHZLWKWKLVRXWUHDFK2YHUWKH
coming  years,  NIGH’s  team  will  encourage  many  thousands  more  to  sign  the  declaration,  hopefully  creating  
a  ripple  effect  of  participation  and  concern.  This  foundational  NIGH  project  continues  to  establish  ways  to  
inspire  individuals,  worldwide,  to  ponder  what  else  they  can  do  and  share.  
 $ORQJWKHZD\1,*+¶VWHDPKDVDOVRGHYHORSHGDQLQLWLDOVHULHVRIJURXSZRUNVKRSVWREXLOGVNLOOVHWV
DURXQGPHGLDDQGUHODWHGFRPPXQLFDWLRQFDSDFLWLHVDVQRWHGLQWKH//TXDGUDQWRI0RGHO')LJ7KHVH
sessions  have  become  quite  popular.  With  NIGH’s  global  Internet  portal  now  being  created,  we  are  establish-­
ing  the  online  venue  needed  to  further  involve  many  groups  of  nurses  and  other  healthcare  practitioners  to  
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At
A m on g
INFORM g ra s sr oots
i n di vi d u al s
l evel s
S ha re Feature
T he “ Ni ghti nga le compelling stories
De cl ar at io n f or about child and
a Hea l thy Wor l d” maternal health
—w or ld wi d e (U.N. MDGs 4 & 5)

I IT
INSPIRE INVOLVE
WE ITS
Devel op & Net wo rk Connect
gr as sro ot s- to- gl o ba l People and groups with the
sk i ll s - ca pa ci ty United Nations and World
f o rum s a nd s oc i al Health Organization
m ul ti m ed ia
e x pe r ti s e

Wi th i n At gl o b a l
INITIATE
gr ou ps l evel s

Figure  5͘E/',/ŶƚĞŐƌĂůDŽĚĞů͘&ŽƵƌŝŶƚĞƌƌĞůĂƚĞĚŝŶŝƟĂƟǀĞƐ͘

86                      Journal  of  Integral  Theory  and  Practice

 INTEGRAL  NURSING

global  health  leaders  to  better  reach  a  worldwide  grassroots  audience.  It  can  also  encourage,  support,  and  
sustain  grassroots  voices  to  therefore  initiate  projects  that  commit  to  what  they  deeply  care  about.

Four  Outcomes  To  Build  Strength-­Upon-­Strength

1,*+¶VSLORWSURMHFWVKDYHDOUHDG\PDGHVWURQJVLJQL¿FDQWFRQWULEXWLRQVWRQXUVLQJDQGKHDOWKDFURVVWKH
world,  as  demonstrated  by  the  collaborative  success  of  the  2010  International  Year  of  the  Nurse.  Based  on  
WKHVHDFKLHYHPHQWVZHNQRZZHFDQEXLOGQHZVWUHQJWKXSRQVWUHQJWKLQFRPLQJ\HDUV,QNHHSLQJZLWK
IRXULQWHJUDODSSURDFKHVWR1,*+¶VZRUNDVLOOXVWUDWHGLQ1,*+,QWHJUDO0RGHO()LJZHDQWLFLSDWHD
synthesis  of  successes  as  outcomes  to  these  plans.  First,  in  response  to  broadening  the  global  outreach  of  the  
“Nightingale  Declaration  for  A  Healthy  World,”  we  expect  that  a  growing  number  of  individual  nurses  and  
concerned  citizens  will  continue  to  share  their  commitment  to  achieving  a  “Healthy  World  by  2020”—the  
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6HFRQGDVLQWKH85TXDGUDQWRI0RGHO()LJZHNQRZWKLVRXWUHDFKFDQGULYHRQOLQHWUDI¿FDQG
build   continuing   interest   in   learning   more   about   health   problems,   particularly   of   vulnerable   children   and  
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FUHDVHJUDVVURRWVSXEOLFFRQFHUQWRPDNHDNH\GLIIHUHQFHHVSHFLDOO\LQUHJLRQVZKHUHPRWKHUVDQGFKLOGUHQ
die  unnecessarily.
We  also  anticipate,  as  in  the  LL  quadrant  of  Model  E  (Fig.  6),  well-­received  teams  of  collaborators  
IRFXVHGRQGHPRQVWUDWLQJWKHLUQHZVNLOOVDQGFDSDFLWLHVXVLQJPXOWLPHGLDWRROV³1HZV´FUDIWHGE\JURXSV
from  the  world  of  nursing  can  go  a  long  way  toward  achieving  a  better  understanding  of  global  health.  Done  
VNLOOIXOO\WKHVHPXOWLPHGLDHQGHDYRUVZLOOUHLQIRUFHZK\QXUVHVDUHUHJDUGHGDVVRPHRIWKHPRVWWUXVWHG
health  professionals  in  the  world.  
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FLDOLQWHUDFWLRQVEHWZHHQJUDVVURRWVZRUNHUVDQGWKHJOREDOKHDOWKOHDGHUVZLWKLQWKHIDPLO\RI8QLWHG1DWLRQV
organizations  and  agencies,  including  the  World  Health  Organization.

At
Am on g
gra ssro ot s
in div id u als
leve ls
Nu r se s an d Child and
c onc e r n e d c i t ize n s maternal health
sh ar e t he i r issues featured
c om mi t me nt and effectively addressed
t o a “H e al t hy in all regions of need
Wor ld b y 2 0 20 ”
I IT
WE ITS
Tea ms of nur se s a nd Substantially increased,
c onc e r n e d c i t ize n s mutually beneficial
d e mons t r at e n ew s ki ll s interactions between
a nd c ap ac i t i es usi ng citizen communicators
mu lt i m ed i a t ool s and health
t o p ro mot e he a lt h organization leaders

Wi t hin At glob a l
g rou ps leve ls

Figure  6͘E/',/ŶƚĞŐƌĂůDŽĚĞů͘&ŽƵƌŽƵƚĐŽŵĞƐͶƐƚƌĞŶŐƚŚͲƵƉŽŶͲƐƚƌĞŶŐƚŚ͘

                     Journal  of  Integral  Theory  and  Practice                        87

 D-­M.  BECK  ET  AL.  

Conclusion
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RIWKHZRUOGWKLVNQRZOHGJHFRQWLQXHVWRKHOSDOORIXV²QXUVHVDQGFRQFHUQHGFLWL]HQVDOLNH²WRLGHQWLI\
RXURZQ³PXVWV´7KLVNHHSVXVIRFXVHGDQGHPSRZHUHG1LJKWLQJDOHVDZth-­century  problems  and  cre-­
ated  20th-­century  solutions.  Conversely,  we  have  seen  20th-­century  problems  and  can  continue  to  create  21st-­
FHQWXU\VROXWLRQVE\DGGUHVVLQJERWKJOREDOLVVXHVVXFKDVWKH81JRDOVDQGWKHORFDOFRQFHUQVZH¿QGLQ
our  own  communities  and  healthcare  settings.  By  increasing  global  public  awareness  about  the  priority  of  
health—and  empowering  nurses,  nursing  students,  and  concerned  citizens  to  address  the  critical  health  is-­
VXHVRIRXUWLPH²WKHVHLQWHUUHODWHGDSSURDFKHVZLOOFRQWLQXHWRPDNH1LJKWLQJDOH¶VGHHSDQGEURDGOHJDF\
UHOHYDQW%HFN 'RVVH\
To  further  address  grassroots-­to-­global  health,  please  consider  signing  the  “Nightingale  Declaration  for  
D+HDOWK\:RUOG´KWWSZZZQLJKWLQJDOHGHFODUDWLRQQHWWKHGHFODUDWLRQDQGZDWFKLQJIRUQHZLQLWLDWLYHVWR
be  developed  by  the  growing  team  of  NIGH  collaborators.  As  we  remember  Nightingale’s  integral  legacy,  we  
DVN\RXWRFRQVLGHUWKHIROORZLQJVHYHQUHFRPPHQGDWLRQV

‡ 0DNHKHDOWKDQGLQÀXHQFLQJSRVLWLYHKHDOWKGHWHUPLQDQWVDWRSSULRULW\LQ
human  affairs  (LR)
‡ Value  and  sustain  nurses  in  their  caring  in  healthcare  (UR)
‡ Collaborate  across  disciplines  and  across  cultures  to  promote  health  in  
community  settings  (LL)
‡ 7KLQNJOREDODFWWRFUHDWHORFDOKHDOWKOLWHUDF\IRUERWKVH[HVDFURVVWKH
lifespan  (LR)
‡ 0DNHPHGLDDFDWDO\VWIRUQXUVLQJDQGIRUKHDOWK85/5
‡ Keep  health  holistic  and  trans-­disciplinary  (UR,  LR)
‡ $QVZHU\RXURZQFDOOLQJ\RXU³PXVW´8/%HFNES

Acknowledgments  
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,QLWLDWLYHIRU *OREDO +HDOWK 1,*+:H DOVR DSSUHFLDWH WKDW WKH IROORZLQJ KDYH EHHQ VLJQL¿FDQW SDUWQHUV
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5HODWLRQVKLSZLWKWKH8QLWHG1DWLRQV&R1*26LJPD7KHWD7DX,QWHUQDWLRQDO677,WKH+RQRU6RFLHW\
RI1XUVLQJWKH:RUOG+HDOWK2UJDQL]DWLRQ:+2+HDOWK3URIHVVLRQV1HWZRUNDQG2I¿FHRI1XUVLQJ 
0LGZLIHU\DQGWKH*OREDO1HWZRUNRI:+2&ROODERUDWLQJ&HQWHUVIRU1XUVLQJ 0LGZLIHU\

N O T E S  
1
 Within  six  months,  the  Notes  on  Nursing,  Revised  Edition  (Nightingale,  1860b)  was  expanded  to  229  pages  and  is  
UHFRJQL]HGWRGD\DVWKH¿UVWQXUVLQJWH[WERRN
2  
)RUDIXOOGLVFXVVLRQRI1LJKWLQJDOH¶VP\VWLFVSLULWXDOGHYHORSPHQWDSSOLHGWR(YHO\Q8QGHUKLOO¶V¿YHSKDVHVRIP\V-­
WLFDOVSLULWXDOGHYHORSPHQWDZDNHQLQJSXUJDWLRQLOOXPLQDWLRQVXUUHQGHUDQGXQLW\VHH'RVVH\DE
3  
$IXOOGLVFXVVLRQRIWKHWKHRU\RILQWHJUDOQXUVLQJLVEH\RQGWKHVFRSHRIWKLVVHFWLRQ'HWDLOVFDQEHIRXQGLQDERRN
FKDSWHU3RZHU3RLQWSUHVHQWDWLRQDQGKDQGRXWDWKWWSZZZGRVVH\GRVVH\FRPEDUEDUDWLQKWPO.
4  
The  theory  of  integral  nursing  may  be  used  with  other  nursing  theories  and  non-­nursing  caring  concepts,  theories,  and  
UHVHDUFK,WGRHVQRWH[FOXGHRULQYDOLGDWHRWKHUQXUVHWKHRULVWVZKRKDYHLQIRUPHGWKHLQWHJUDOQXUVLQJIUDPHZRUN

$OWKRXJKWKHSDWWHUQVRINQRZLQJDUHVXSHULPSRVHGRQWKHVSHFL¿FTXDGUDQWVWKH\FDQDOVR¿WLQWRRWKHUTXDGUDQWV

88                      Journal  of  Integral  Theory  and  Practice

 INTEGRAL  NURSING

6  
7KHVHVXEWOHHQHUJ\ERGLHVDUHDVVRFLDWHGZLWKWKH85TXDGUDQWDQGWKHHQHUJ\¿HOGVWKDWWKH\FUHDWHE\LQWHUDFWLQJ
with  the  LL  and  LR  quadrants.  For  an  explanation,  see  Wilber  (2003).
7  
7KH8QLWHG1DWLRQV0LOOHQQLXP'HYHORSPHQW*RDOLFRQVZHUHUHWULHYHG-XO\IURPZZZXQGSRUJ
mdg/basics.shtml.
8
 We  also  understood  that  we  could  use  Integral  Theory  and  integral  modeling  as  an  application.
9
 Wilber  (2000)  describes  the  holon  as  anything  that  is  both  a  whole  and  a  part  of  another  whole,  creating  structures  of  
increasing  complexity.

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1<,1&$3UHVV VSRQGHQFH UHJDUGLQJ %HFN '0  ³8Q-­
'RVVH\%%HFN'0 5XVKWRQ&1LJKWLQ-­ derstanding  the  width  and  depth  of  U.N.  MDG  #  
gale’s  vision  for  collaboration.  In  S.  Weinstein  &   ´3DQHOSUHVHQWDWLRQDWWKH&LYLO6RFLHW\'HYHO-­
$07 %URRNV (GV   Nursing   without   borders:   opment   Forum   on   Women’s   Rights   in   consulta-­
Values,  wisdom,  success  markers  (pp.  11-­29).  In-­ tion  with  the  2010  United  Nations  Economic    and  
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Dossey,   B.,   Selanders,   L.C.,   %HFN '0  $WWHZHOO McDonald,  L.  (2001-­2011).  The  collected  works  of  Flor-­
$Florence  Nightingale  today:  Healing,   ence  Nightingale9ROV:DWHUORR2QWDULR
leadership,   global   action 6LOYHU 6SULQJ 0' Wilfred  Laurier  University  Press.  

90                      Journal  of  Integral  Theory  and  Practice

 INTEGRAL  NURSING

1LJKWLQJDOH ,QLWLDWLYH IRU *OREDO +HDOWK %XLOGLQJ D roads   of   change.   Shift,   12(September-­October),  
Worldwide  Movement.  (2011).  Retrieved  Decem-­ 17-­21.
EHUIURPKWWSZZZQLJKWLQJDOHGHFODUD-­ 6KDUPD 0 :RUOG ZLVGRP LQ DFWLRQ 3HUVRQDO
tion.net/. to  planetary  transformation.  Kosmos,  Fall/Winter,  
Nightingale  Declaration  for  our  Healthy  World.  (2007).   
5HWULHYHG 'HFHPEHU   IURP KWWSZZZ Tresoli,  C.  (1994).  Pew-­Fetzer  Task  Force  on  Advancing  
nightingaledeclaration.net/the-­declaration. Psychosocial   Health   Education:   Health   profes-­
NIGH   launches   global   music   video   on   nursing.   Re-­ sions   education   and   relationship-­centered   care.  
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nightingaledeclaration.net/nigh-­who-­video-­nurs-­
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Maternal   and   newborn   health. 5HWULHYHG -XO\ 
video-­on-­nursing.
2011,  from  KWWSZZZXQLFHIRUJVRZF.
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United  Nations.  (2000).  The  United  Nations  millennium  
rison.
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rison.
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Nightingale,  F.  (1860b).  Notes  on  nursing  (new  edition,  
development   goals   report   2011.   Retrieved   July  
revised  and  enlarged)/RQGRQ+DUULVRQ
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goals/11_MDG  Report_EN.pdf
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UN   Urged   to   Recognize   the   Vital   Role   of   Nurses   in  
Attewell   (Eds.),   Florence   Nightingale   today:  
Global   Health.   (2010).   Retrieved   December   2,  
Healing,   leadership,   global   action SS 
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Nurses  Association. net.
Nightingale  F.  (1870).  Private  note.  British  Library  Ad-­ 86$,'  86$,' UHVSRQGV WR +DLWL HDUWKTXDNH.  
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overview  of  issues  and  actions.  Policy,  Politics  &   Wilber,  K.  (2000).  Integral  psychology:  Consciousness,  
Nursing  Practice,  7(3),  34S-­39S. spirit,  psychology,  therapy%RVWRQ0$6KDPE-­
Samen,   A.   (2011).   One   Heart   Worldwide.   Retrieved   hala.
-XO\   IURP KWWSZZZ\RXWXEHFRP :LOEHU.([FHUSW*7RZDUGDFRPSUHKHQVLYH
ZDWFK"Y *X<<TB7)NR IHDWXUH \RXWXEH theory   of   subtle   energies.   Retrieved   November  
Serving  the  Underserved  in  Laos.QG*RDO5HGXFH 28,   2011,   from   KWWSZLOEHUVKDPEKDODFRP
child   mortality.   Retrieved   December   2,   2011,   KWPOERRNVNRVPRVH[FHUSW*SDUWFIP
IURPKWWSZZZQLJKWLQJDOHGHFODUDWLRQQHWVHUY-­ World  Health  Organization.  (2006).  World  health  report  
ing-­the-­underserved-­in-­laos.   :RUNLQJWRJHWKHUIRUKHDOWK.  Retrieved  July  
Sharma,  M.  (2004).  Conscious  leadership  at  the  cross-­ 14,  2011,  from  KWWSZZZZKRLQWZKUHQ

DEVA-­MARIE  BECK,  Ph.D.,  R.N.,  earned  her  nursing    degree  in  1976  and  went  on  to  complete  two  bachelor’s  degrees  
in  1991  in  health  sciences  and  in  theater  arts,  while  launching  a  27-­  year  career  in  clinical  nursing  focused  on  critical  
FDUH,QVKHZURWHDFRPSUHKHQVLYH0DVWHU¶V(TXLYDOHQF\7KHVLVEDVHGRQ\HDUVRIYROXQWHHUZRUNDQGWUDYHO
in  international  development.  She  earned  her  Ph.D.  in  2002  in  Interdisciplinary  Nursing  Studies  with  a  specialty  in  Inter-­
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VHTXHQWSXEOLFDWLRQVKDYHFRQWULEXWHGQHZVFKRODUVKLSRQ)ORUHQFH1LJKWLQJDOH¶VH[WHQVLYHFRPPXQLW\DQGJOREDOZRUN
for  health,  recommending  how  Nightingale’s  legacy  can  further  inform  and  strengthen  21st-­century  nursing  practice  and  
proactive  global  citizenship.  As  an  International  Director  of  the  Nightingale  Initiative  for  Global  Health,  her  focus  has  

                     Journal  of  Integral  Theory  and  Practice                        91

 D-­M.  BECK  ET  AL.  

been  to  travel,  meet,  discuss,  present,  and  produce  online  multimedia  with  global  nursing  leaders  in  Asia,  Africa,  Europe,  
the  Middle  East  and  North  and  South  America.  She  continues  to  be  actively  involved  in  advocacy  for  global  healthcare  
LVVXHVLQFOXGLQJPDWHUQDODQGFKLOGKHDOWKDQGWKHZRUOGZLGHQXUVLQJVKRUWDJH6HHZZZ1LJKWLQJDOH'HFODUDWLRQQHW

BARBARA  M.  DOSSEY,  Ph.D.,  R.N.,  A.H.N.-­B.C.,  F.A.A.N,  graduated  with  a  Bachelor  of  Science  in  Nursing  from  
%D\ORU8QLYHUVLW\LQ:DFR7H[DVLQ6KHWKHQZHQWRQWRHDUQKHU06IURP7H[DV:RPDQ¶V8QLYHUVLW\LQ'HQ-­
WRQ7H[DVLQDQGKHU3K'IURP8QLRQ,QVWLWXWH 8QLYHUVLW\LQ&LQFLQQDWL2KLRLQ,QVKHDOVR
earned  her  A.H.N.-­B.C.  from  the  American  Holistic  Nurses  Association.  Dr.  Dossey  has  authored  or  co-­authored  23  
ERRNV+HU1LJKWLQJDOHELRJUDSK\LVFlorence  Nightingale:  Mystic,  Visionary,  Healer  Commemorative  Edition  (F.A.  
'DYLV'U'RVVH\ZLWK'U'HYD0DULH%HFNLVFRDXWKRURIFlorence  Nightingale  Today:  Healing,  Leadership,  
Global  Action1XUVH%RRNVRUJ'U'RVVH\¶VFRDXWKRUHGHolistic  Nursing:  A  Handbook  for  Practice  (Jones  &  
Bartlett  Publishers,  2009)  contains  Nightingale’s  philosophical  foundation  for  contemporary  nurses.  Today,  Dr.  Dossey  
is  International  Co-­Director  of  the  Nightingale  Initiative  for  Global  Health  in  Washington,  D.C.,  and  Ottawa,  Ontario,  
DQG&R'LUHFWRU,QWHUQDWLRQDO1XUVH&RDFK$VVRFLDWLRQ+XQWLQJWRQ1HZ<RUN6HHZZZGRVVH\GRVVH\FRPZZZ
integrativenursecoach.com,  and  www.nightingaledeclaration.net.

&<1'$+586+7213K'51)$$1UHFHLYHGKHUXQGHUJUDGXDWHGHJUHHDWWKH8QLYHUVLW\RI.HQWXFN\LQ
1978  and  completed  her  M.S.N.  at  the  Medical  University  of  South  Carolina  in  1982.  She  went  on  to  earn  her  doctor-­
ate  in  nursing  with  a  concentration  in  bioethics  from  Catholic  University  of  America  in  1994.  Today,  Dr.  Rushton  is  a  
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well  as  a  clinical  nurse  specialist  in  ethics  and  the  Program  Director  of  the  Harriet  Lane  Compassionate  Care  Program  
DWWKH-RKQV+RSNLQV&KLOGUHQ¶V&HQWHULQ%DOWLPRUH0DU\ODQG6KHZDVD)HOORZ±LQWKH5REHUW:RRG
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,  and  is  involved  in  a  variety  of  interdisciplinary  
LQLWLDWLYHVZRUOGZLGH6HHKWWSZZZELRHWKLFVLQVWLWXWHRUJPVKRPH",' 

92                      Journal  of  Integral  Theory  and  Practice