"As a trailblazer in holistic nursing, Barbara is a recognized leader and authority in the field. She has the ability to write and teach about holistic health and provide innovative and practical approaches that have helped set standards of excellence."

Lynn Keegan, RN, PhD, HNC, FAAN Associate Professor, School of Nursing University of Texas Health Science Center at San Antonio

 

 

Question: Can you say more about your personal journey and your interest in a holistic approach and holistic nursing. I know you have been interested in this for a long time. How did you get started with this work?

Barbara Dossey: In the late Sixties I began my own personal journey of learning self-regulation strategies. This began primarily due to a medical condition. I was in Mexico on a vacation and ate some bad food that resulted in a twenty-four hour course of a fever of 1020, diarrhea, and vomiting. Two days later I was home and feeling awful. Then my right eye became swollen shut. I was diagnosed with dendritic keratitis, an infection of the cornea caused by the Herpes simplex virus. At this time antiviral medications were still experimental, and I was place on topical ointment and it cleared up after six weeks. However, whenever I was under any type of stress over the next eight-year period I had many flare-ups, and with each flare-up I developed severe scar formation of my cornea and eventually had no vision in my right eye.

By the end of 1975 I had gone a full year without a flare-up, which was then the criteria for a corneal transplant. Six weeks after my transplant, I had two bouts of acute rejection that was managed by an injection of steroid into my cornea on each occasion. An eyelid stretcher was place around my right eye to keep it open while receiving the injection. My anxiety in seeing the needle coming toward my eye and the helplessness I felt never left my consciousness. I can still remember holding my breath, bracing, and tensing. How I wish I had known more about distraction, relaxation and rhythmic breathing exercises. This event made me aware of the need to be more present with my patients before I poked, suctioned, and performed all the procedures and treatments on them that were part of caring for a critically ill patient.

Question: Did you use any complementary and alternative therapies before your surgery?

Barbara Dossey: I tried to relax, but my skills and knowledge were limited prior to my surgery. In 1976 Larry, my husband, and I attended our first biofeedback workshop. Larry learned to manage classical migraine headaches without taking medicine, which he still does very successfully. That was such a significant discovery for him that he began a biofeedback department in his group practice of internal medicine. I also began to realize that there was no difference in stress management for migraine headaches and stress management for my corneal flare-ups. So I asked myself: What am I going to do about it?
Around this time I began to read as much as I could find in the literature on psychophysiologic stress. I also realized that I did not know how to consistently manage my stress levels. It was clear to me that my recurrent eye condition was related to stress, as were both episodes of corneal transplant rejections. So I seriously pursued biofeedback, relaxation, and imagery. I learned how to play more and take personal time to do nothing.

Question: So you don't have to worry about your cornea any more?

Barbara Dossey: According to the statistics, I run the risk of a ten to fifteen percent rejection rate for my corneal transplant for the rest of my life. My eye is currently in a healed state, and I have a perfectly clear cornea. But when I am tired, stressed, or overworked, my right eye aches, tears, hurts, and my vision becomes cloudy. But instead of worrying about my eye, I know that I must back off, take a break, let go of some of the deadlines, and take care of myself.

How? I've learned to incorporate technology, mind, and spirit. I always travel with an antiviral medication in case I should get a flare-up that I can't manage with my relaxation, imagery, and self-care. But I know my eye well. When it begins to bother me I get a subtle sensation- almost like a single hair that sweeps above and under my right eye. This is the first step in inner self-awareness - listening to the body, whether the message is physical or psychological. But I've learned to make friends with this sensation. I say to myself, " Okay, I feel you. Thank you!" This is part of my wound that will be with me the rest of my life. But what a great gift it has been, because it's helped me recognize what it is to live with a chronic condition. It also has helped me explore this wonderful journey of self-care and healing rituals, to understand more about human consciousness and self-regulation, and to incorporate it into my life and work.

Question: So how did you begin to incorporate these ideas in your work?

Barbara Dossey: As I integrated these new behaviors into my life, my clinical practice also began to change, because it became obvious to me that the self-regulation strategies that I was using in my own life could also be taught to patients in the critical care unit as well as in my teaching role to nursing students and staff as well as in my research. This was a turning point for me not just personally but professionally as well. I began to teach relaxation, imagery, breathing exercises, and use music with critical care patients before doing procedures, during their recovery, and in outpatient cardiac rehabilitation programs. It was thrilling to participate with patients and their families as they learned to reframe their stories of fear into modalities and rituals for healing, to learn how to alter their own internal physiology, and to decrease their fear and anxiety.
For example, patients in significant pain learned how to distract themselves with relaxation and imagery exercises. A post-surgical patient I took care of, who had minimal blood flow to his severely injured left leg, used relaxation and imagery skills to increase the circulation to his injured leg and avoided amputation. By changing their attitudes, emotions, and thoughts, these patients could marshal their inner healing resources to facilitate rather than impede their healing. These bedside experiences with patients were repeated many times with patients and their families, and they allowed me to deeply understand the importance of rituals and the rich tapestry of the interconnectedness of body-mind-spirit.

Question: Wasn't this difficult with all the technology in critical care?

Barbara Dossey: It was challenging and really started me thinking about how critical care equipment could be used in the biofeedback process. As a result of learning biofeedback myself, I had a rich experience with biofeedback monitoring devices. I realized that most of the physiological monitoring equipment in the critical care unit - heart-rate monitors, temperature monitors, and Doppler devices to hear blood flow - was much like that used in an outpatient biofeedback department. In the outpatient biofeedback department, patients with high levels of anxiety and fear often had cardiac dysrhythmias. They were learning with biofeedback to abort these problems, and how to manage hypertension, migraine and tension headaches, peripheral vascular disease, and many more conditions by increasing blood flow to their hands and feet, and many were able to decrease or discontinuing their medications. If people could learn this in a biofeedback department, why not in a critical care unit?

Question: What is holistic nursing?

Barbara Dossey: Holistic nursing embraces all nursing which has enhancement of healing the whole person from birth to death as its goal. It is a philosophy and perspective which addresses the body, mind, and spirit of not just the patient but the nurse as well. This philosophy or way of being serves the holistic nurse in her or his personal life, as well as in clinical and private practice, education, research, and community service. I want to emphasize that holistic nursing is not a specialty in nursing, as I so often hear, but it is the essence of nursing, reflecting the diverse nursing activities in which holistic nurses are engaged. Standards of practice in this field are quite well developed.

Question: How did you get interested in holistic nursing?

Barbara Dossey: When I was practicing as a critical care nurse I was intensely aware that the emphasis was on the latest technology. A patient may have open-heart surgery or thrombolytic therapy to limit or stop an evolving heart attack and save his or her life. These technological interventions take only minutes to hours, but it may require years to bring about a fundamental shift in one's consciousness and reshape the thoughts, emotions, and behaviors that contributed to the heart disease in the first place. I'm referring to how patients choose to live their lives, to create healthy lifestyle patterns that includes one's spirituality, meaning and purpose, loving relationships, emotions, and health promotion activities such as exercise, stress-management, and nutrition. As I learned these skills, it was a natural to integrate them into my professional life.

Question: I understand that you are a founding member of the American Holistic Nurses' Association (AHNA). Can you tell me about the AHNA

Barbara Dossey: The American Holistic Nurses Association* is an association of nurses who develop standards, manuals, position papers on holistic philosophy, education, ethics, theories, healing environments and therapies, cultural diversity, therapeutic communication, and the caring process. The American Holistic Nurses' Association Standards of Holistic Nursing Practice are used in conjunction with the American Nurses Association Standards of Practice and the specific specialty standards where holistic nurses practice. Holistic nursing also is derived from a number of explanatory models of which biomedicine is only one.
*American Holistic Nurses' Association. P.O.B. 2130, Flagstaff, Arizona 86004. Phone (800) 278-AHNA or (520) 526-2196. Fax (520) 526-2752. AHNA-flag@flaglink.com and www.ahna.org

Question: Are there certain modalities that holistic nurses use?

Barbara Dossey: Yes. The American Holistic Nurses' Association conducted a survey and documented twenty-four frequently used complementary or alternative therapies that are used in holistic nursing practice, which are also referred to as caring-healing modalities. People often refer to holistic nurses as " those nurses who do those different kinds of therapies." However, it is important to remember that holistic nursing in not just about complementary or alternative therapies. It is about an integrative approach when needed.

Question: What trends are you seeing in holistic nursing as it relates to chronic disease like AIDS?

Barbara Dossey: The finest contemporary nurses use an integrative approach using the latest technology, procedures, and medications in addition to addressing the person's mind and spirit. So holistic nurses recognize that they should be skilled in the latest technology while they simultaneously integrate relaxation, imagery, music, therapeutic touch, and other kinds of complementary and alternative modalities.

Question: Can you give me an example of this holistic, integrative approach?

Barbara Dossey: My example is very personal. My family and I have a profound treasure, a single healing event that will be with us the rest of our lives. This occurred right before my father's death because of a critical care nurse's holistic approach. Three months before his death, my dear Daddy was healthy, having celebrated his 81st birthday. He was so happy because he had a great day on the golf course, having "shot his age, an 81," which is a very good score! And one month later he was diagnosed with non-Hodgkin's lymphoma.
Daddy was started on oral chemotherapy and was doing fine, but then had to be place on intravenous chemotherapy. Shortly thereafter, he developed a bladder infection and within fourteen hours was hospitalized in the critical care unit with septic shock. He improved for a few hours, but the drugs could not save him. The critical care nurse who was caring for my father was tall - 6' 4" - and he had Daddy's bed in the top position to do his work. But when my sweet Mother, who is 5-feet, came in to visit, he stopped what he was doing and adjusted the bed to the lowest position so she could get closer to Daddy. He promptly pulled off his oxygen mask and said, "You can't believe what they're doing to me in here." Mother said, "I know, but I hope that they're doing all this so I can take you home." Daddy looked at Mother and said, "You think I'm going home?" Mother said, "I hope so, but if not, I'll see you in heaven." At that point, she bent over and kissed him. Then he said, "I'm so tired. I'm going to take a nap."

As it turned out, those were Daddy's last words to Mother, because as she left the room he went into cardiac arrest and could not be resuscitated. That same critical care nurse removed all the equipment from my father's body, cleaned up the room, and then went back to see my family. He asked my mother, "Would you like to see your husband?" Mother said "I don't think I can go in there." So this nurse said, "I just want you to know that he looks very peaceful. He died with a smile on his face." And what did Mother and the family do? They went right back into the critical care room and stayed there with Daddy for 45 minutes. And that is holistic nursing at its finest - technically competent while being there to recognize the many layers of the underlying patterns within the life of a patient and the family.

Question: What would you suggest a patient look for in a treatment team for a chronic disease?

Barbara Dossey: Interview friends to see if they know a team that listens well and is skilled in an integrative approach to dealing with the challenges of a chronic condition. Look for a team with a holistic approach where the doctor, nurse, and other members really
like their work and have a relationship-centered approach. Interview the team to see if there is a fit. If not keep on interviewing.

Question: Today, I often hear that the doctor or nurse don't have time to talk to patients. So how do you feel about the doctor or to a nurse that says "I don't have time to talk to the patient?"

Barbara Dossey: With compassion and presence I might say, "Can you imagine that the person in that bed who has a lot of anxiety and fear is your mother, father, brother, sister, child, or friend? What simple question might you ask to convey that you really care? Can you be available just to hold their hand? Can you show them that you do have time to listen?"

When people say, "I don't have time to do this," they have usually fallen into bad habits. Or they may be hiding behind the technology and routines to justify their own sense of frustration and inadequacy. The greatest challenge in health care right now for nurses, physicians, and other members of the health care team is to look a patient in the eye and genuinely ask, "How are you today?" This creates that rare opportunity for our fields of consciousness to come together in a healing moment. It is amazing how much can be said quickly, with only a few words and looks that convey authentic caring.

Question: What are your thoughts on self-care?

Barbara Dossey: Self care includes those activities that allow a person to develop different levels of personal awareness so that they truly are an instrument of healing. We can easily give to everybody else and feel drained at the end of the day. Our body has a built-in pattern called the ultradian rhythm, so that every 90 to 120 minutes it registers certain physiologic needs. For example, a nurse begins a shift at 7: 00. a.m. At about 8: 30-9: 00 a.m., her or his body gives a signal to take a short break, to sit down, to eat something nutritious, or to empty a full bladder.

But what happens? The nurse doesn't take a break and before long it is 11: 00 a.m., with another ultradian pattern emerging. The nurse's body now registers hunger, thirst, and a fuller bladder, but work often is continued. Before long its 1:30 p.m. and no break yet. And then the nurse wonders why she or he is chronically tired. Those nurses who engage in basic self-care activities such as good nutrition, exercise, and stress-management are more productive and have more joy in their life.
However, I think that the deeper level of self-care involves caring for one's mental, emotional, and spiritual well-being - spending quality time with self, family, and friends, and engaging in activities and work that have purpose and meaning. It also involves setting aside time each day for prayer, meditation, and quiet in order to be present with our self for our own reflection and healing.

Question : This takes discipline.

Barbara Dossey: Discipline, yes. But basically it's a matter of priorities, and how we want to live our lives. When we care for our self, listen to our own stories, and weave those pieces of our life together, we become more connected, focused, centered, and balanced. So when a nurse is coming from that space, the connection she or he has with others is more authentic and genuine. This is the art of nursing, - being able to listen to others and recognize the threads and patterns that make up our patients' lives as well as our own lives. This may sound ordinary, but it's really profound.

Question: What do you see as the greatest contribution nurses and other professional caregivers can contribute to patients in the new century?

Barbara Dossey: I believe that health care professionals can make their greatest contribution by learning to really listen well to the stories of patients and their families. This is where the healing happens. All of our lives are made of rich stories that have the potential to block or facilitate healing. The joy in my work and the joy of being with others is listening and reflecting on stories. I always ask myself, How can I fully hear the stories of others and my own as well? How can I attend to the metaphors and shielded meanings that emerge, in a way that helps me get closer to the story's core meaning?
Just last week, Mother told me a story about a precious couple who have been married 60 years, and who lived at her wonderful retirement village. Bea was 82 and had just died from a heart attack, and her husband, Leon, 83, was heart-broken. Following the funeral Leon told Donya, the activity director, "I just don't think I can live without her." Donya walked from behind her desk to hugged him and to express that there were many people to help him. But he died, right then, in her arms.

How often have we heard that -- "I can't live without him"? What does it mean to be unable to go on living without someone? These deep, bonded relationships are very real and can be a matter of life or death. So when we have the privilege of hearing someone's story, how can we be present in a way that allows us to appreciate the life-and-death potential of what we are hearing?

Holistic nurses help people integrate the threads of the stories they constantly tell themselves, so they can explore the purpose and meaning of their life, identify their strengths, and help them more fully explore their connectedness with self, others, nature, and God/Life Force/Absolute/Transcendent. And it's in the telling of these stories that the healing happens.

Question: You have used the word healing a lot. How might you define it?

Barbara Dossey: For me, healing is a process, our lifelong journey. It's the weaving together of the threads of our life. When daily stress, illness, or a crisis occurs, there is an interruption, literally, in the fabric of our lives, and we have to weave those broken threads back together in a way that makes sense to us. When those patterns of fear, anxiety, and frustration come forth, we have to ask ourselves, What doe this mean to me?
Healing requires engaging in self-care activities that have meaning for us. Healing involves opening what we have closed down, remembering what is or was once sacred to us, and honoring our connections with our self, others, and the Transcendent. For me, healing involves incorporating my personal rituals into my life each day.

Question: Would you address the importance of rituals? I know you've done a lot of work with that.

Barbara Dossey: There are 3 simple and yet very profound steps in a ritual of healing. The first one is to separate--to disengage from daily activities and enter into a different state of consciousness so that you recognize a part of yourself that is in need of healing.

The second step is the transition period. This can take a few moments or much longer, 10 or 20 minutes, to get into a quiet space within yourself-a completely different level than our busy, ordinary mind. This involves connecting with your inner self and an inner truth about your healing. In connecting in this way, we can remember how we have gotten through crisis before, and we can envision what heals us.

The third step is the return. After spending quality time with our self or with another, we can return to the day's activities and feel an inner peace that is special. This allows us to have more joy and meaning in our daily activities.
To me, generating self-healing rituals is the most effective way to manage our very busy lives. No one else can heal us, and each of us has to find our own way to create healing rituals to bring about that balance and connectedness. Healing rituals are different for each of us, and there are no formulas or rigid rules for generating them.

Question: Can you share some of your healing rituals?

Barbara Dossey: I have many. Nature is one of the profound ways that helps me heal and to remember my spirit - a walk in the garden, sitting on a stone bench, or listening to the water flowing down the water rocks that we have all around our home. It is time to just be present, do nothing, look at the colors, sounds, textures, and feel the wind; connecting with my family and friends; prayer and meditation; reading sacred poems, books, or selected passages; Chinese brush stroke painting; and awareness of sacred healing objects in my office and home. Water is also a healing ritual for me with long, hot baths where I take a cup of tea, burn incense, and listen to music. It is truly a very special time alone.

Needlepoint is a healing ritual for me. I look around at all the needlepoint in our home that Larry and I have done. As you can tell, needlepoint is special for us, in fact, we both almost always have several projects underway. For some people this might appear as work, but for us it is very relaxing, creative, and one of the many things we enjoy doing together. I get absolutely lost in my needlepoint and become very quiet inside. I often come up with solutions, solve ways to get through personal blocks, or come up with many creative ideas.

When Larry and I finish a piece of needlepoint, we take a hair from each other's head and weave it into the needlepoint piece as a way of bringing closure to the work and as a way to put more of our self into the piece. That's an example of a self-generated ritual, which I think are very important.

If we cultivate rituals of healing each day, then when we get pulled off center at work, at meetings, or at any other time, we have a way to get back to that place of healing. Rituals help us to show up, to pay attention, and to tell the truth whether it makes sense to anybody else or not. It also helps us to keep our ego out of the way, to not be so attached to outcomes and personal expectations. Healing rituals help us go to a deeper level of being. When we do so, we are clearer about what is important and what is not, and we learn to connect with our deepest core.

Question: I have heard that Florence Nightingale had been accused of Victorian melodrama and took to her couch, and has been called one of the most famous Victorian invalids. Was she really an invalid, and do you think she had a real illness?

Barbara Dossey: Yes. She had a real organic illness. Her contributions are all the more fascinating in view of the fact that she was an invalid following a severe, chronic illness, as a result of Crimean Fever that she contracted, probably from eating contaminated goat milk products or meat. This is another area of my research on Nightingale that clarifies many false statements about her invalidism. Today, Crimean Fever is recognized as Malta or Mediterranean Fever, and is classified as chronic brucellosis. The original paper by D.A.B. Young in 1995 on the connection of Nightingale's Crimean Fever, chronic illness, and chronic brucellosis stated that she had no symptoms after 1870. I have extended his original research and found in her letters that she had specific symptoms of chronic brucellosis until the end of 1887. Her symptoms after this period were primarily due to limited physical stamina and old age.

Her most significant symptoms were years of severe spinal pain, spondylitis, that is said to be one of the most painful maladies that can affect humans. The causative organism, Brucella melitensis was not isolated from the spleens of several British Army personnel until 1887 by Dr. David Bruce, and was not fully recognized until 1918 when Dr. Alice Evans, a distinguished bacteriologist, contracted the disease herself in her own laboratory while working with cultures of Brucella melitensis. Evans suffered with symptoms for six years before it was isolated in her blood, and another 17 years with chronic symptoms. The antibiotic treatment protocol for brucellosis was only established in 1986 by the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) Expert Committee on Brucellosis.

As a result of her severe illness following her return to England, Nightingale began to meet with only one person at a time for over thirty-four years as a way to manage her chronic symptoms and limited physical reserve. She made only four public appearance from 1857 to 1910. She took her work with her and traveled to her family's countryside estates as well as her sister's country estate, often visiting for long periods, but she still enforced limited visiting. These behaviors have also added to the intrigue around her, but she was an extreme introvert and nothing interfered with her work.

Question: Your new illustrated book Florence Nightingale: Mystic, Visionary, Healer, (Springhouse, 2000) is terrific. So you are calling Nightingale a mystic? Can you define mysticism and mystic for me?

Barbara Dossey: Yes, Florence Nightingale was a profound mystic. I focused on Evelyn Underhill's five phases of spiritual development in the life of a mystic as I did my research. I followed her five phases because she is one of the foremost scholars on western mysticism, and hers is a recognized framework from which to study mysticism. Using Underhill's definitions, mysticism is 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 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 received her first call from God at age sixteen, and she recorded three additional calls throughout her life

Question: Tell us about those five stages.

Barbara Dossey: The first is "Awakening" in which one hears the voice of God. This is so profound and true that it becomes so embedded in that person life story, forever changing their life dramatically. The second stage is "Purgation." This is the period in which the person realizes that they are not good enough. How could they possibly be called to do this profound work of service ? So they try to purge themselves of worldly connections, often through fasting and extreme acts such as giving away their material possessions. The third phase, "Illumination," is when the person is utterly filled with passion for and a sense of God. The fourth phase, "Surrender," typically goes on for a long time. It is a very profound period in which the person explores their inner, divine connection. This period of spiritual development often includes much suffering - because, as the person strives for perfection, she or he can never be good enough. And finally, the fifth phase is "Union," during which the mystic realizes that he or she has reached a level of deep inner connectedness with the Divine Reality.

The mystic seldom follows these phases in a rigid, linear sequence. They can experience the first phase, Awakening, and then the fifth phase, Union. But then they may fall back into Purgation. Often Purgation and Illumination run parallel, and Surrender and Union go back and forth.

Question: You found these patterns in Nightingale's life?

Barbara Dossey: Absolutely. Her life represents that of a fully developed mystic. At an early age Nightingale had a serious religious and spiritual nature, and she always had the desire to nurse the sick. At the age of 16, February 7, 1837, she recorded her first Call from God, and, as I mentioned, she also recorded three other occasions later in life when she heard the voice of God. Her Purgation period lasted for 17 years before she was finally able to break free and pursue her interest in nursing. This long period should also be viewed in the context of Victorian life. Nightingale was from a very wealthy family, and nurses at that time were of the uneducated and lower class. Her family wanted her to marry into wealth and high society. But she refused and made a conscious choice to serve God through social action.

Nightingale believed that nursing was a very high calling, and that nurses could be in service to others and to God without taking religious vows. She advocated that nurses not only receive proper instruction and education-including instruction in how to live a moral life-but also that they be open to treating people of all religions. She also advocated that nursing was a complement to medicine-that nursing and medicine were 2 distinct entities. Nurses had to have scientific training as well. Because she focused on the science and the art of nursing outside of religious vows, she is considered the founder of modern secular nursing.

When Nightingale was 34, she received an official invitation from her dear friend and Secretary at War, Mr. Sidney Herbert, as Superintendent of Nurses of the Turkish Hospitals during the Crimean War (1854-1856) that was later extended to the Crimea as well. At this time she had only received three months basic instruction at the Kaiserswerth Institute in Dusseldorf, Germany, and had one year's experience as a Superintendent in a small 27-bed hospital, Institute for Sick and Gentlewomen in Distressed Circumstances, in London. Part of her success and fame while in Scutari was because of her self education in sanitation and the new science of statistics during her twenties and early thirties. In fact, by age 30 she was recognized as one of the most knowledgeable people in Europe on hospital construction. Nightingale was blessed with monumental intelligence. She spoke five languages and knew advanced mathematics. Moreover, she was an organizational genius.

Nightingale went to Turkey in service to God, which was source of the legendary "Nightingale Power." She recognized that the majority of the major problems at the sprawling Scutari hospital, as well as other facilities in the war zone, were not due to war wounds. Rather, they were the result of poor sanitation, lack of proper diet, and the close contact of soldiers suffering from different kinds of fevers, cholera, typhus, and typhoid together. Because of her knowledge and her keen, analytic mind, she identified these problems, and wrote detailed letters that included her observations and the best solutions to correct these problems to Mr. Sidney Herbert. In early 1855 two different Sanitary Commissions were sent to the actual site of battle at the southern tip of Russia, the Crimea, and also to Scutari, which is now part of larger Istanbul. These two commissions had been given the power to implement the needed changes that she had suggested. These Sanitary Commissioners worked closely with Nightingale and within 6 months, the death rate at the large Barrack Hospital in Scutari fell from 42 percent to 2.2 percent.
She was also very comfortable in a man's world with politicians and influential people. Six weeks after her return to England from the East, she worked with the two Sanitary Commission teams that were sent to the Crimea, Mr. Sidney Herbert, and others to prepare for a meeting with Queen Victoria and Prince Albert to state the facts about the chaos and problems in the British Army Medical Department during the Crimean War. Her proposed reforms resulted in a Royal Commission where she prepared briefs, abstracts, and witnesses.

Question: As I understand it, Nightingale believed that nature heals and that it's the nurse's responsibility to put the patient in the healing hands of nature.

Barbara Dossey: You are so right. She said that the first thing that should be done is to place the person in the best state for nature to work on him or her, because nature is a reparative process. Her writings are very relevant today. Her Notes on Nursing, published in 1860 are also profound because she wrote from personal experience as a person living with a chronic illness. She also integrated what today we refer to as complementary therapies such as "pet therapy," "light therapy", "music therapy", "aroma therapy', and much more. Nightingale wrote about how a small bird in a cage is sometimes the only outlet for an invalid confined to bed. She commented that the effect of music upon the sick had been scarcely at all noticed and that wind instruments, including the human voice, and stringed instruments, capable of continuous sound, have generally a beneficent effect--while the piano-forte, with such instruments as have no continuity of sound, have just the reverse. She wrote about the effect of fresh flowers, good food, a healing environment, and the negative effect of noise and trivial conversation on a patient's healing. And we are only just beginning to integrate these areas into mainstream health care.

Question: It seems she was what you call a holistic nurse?

Barbara Dossey: Absolutely. And at the core of all of 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.

Question: Would you tell me about any change you experienced in yourself while writing the book?

Barbara Dossey: The major change occurred as I focused on Nightingale's life as a mystic. I had the realization that there are mystics who walk with us every single day. So who are they, and what does their presence mean? Also, I felt a deepening sense of my connection to all of life. I asked myself old questions I thought I'd laid to rest. I sensed more deeply my need to be more of 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.

Question: Can you give some examples of ways to integrate holistic concepts with traditional core courses and technology?

Barbara Dossey: The basic way is for a faculty to come together and determine the best way for the integration to take place in their particular institution or hospital setting. The whole curriculum needs to be integrated, and this takes time. But there are many teaching tools and textbooks to assist in this process, and many examples to guide us. Holistic concepts can be integrated into biology, physiology, pathophysiology, and assessments courses. For example, when a student is learning how to identify chest and heart sounds, an integrative approach would combines the technical knowledge and skills and also incorporate complementary modalities. A person with congestive heart failure, for example, has physiologic symptoms and different levels of anxiety or fear depending on the severity of the illness. A nurse can use technology, medications, and other aspects of treatment while introducing relaxation, imagery, music, or can teach breathing exercises to the patient to help them to relax and decrease their fear and anxiety.

Question: Is this what you do in your consulting work?

Barbara Dossey: Yes. Currently, teaching and writing about the integration of the five core values of holistic nursing and the most-frequently-used holistic modalities is my work. Assisting people to identify their belief systems, their inner world of images, and to find their own pathways to wellness with personal rituals continues to be a healing journey for me, and a source of immense joy.

Question: What do you think our biggest challenge is as we move forward with integrative and alternative medicine?

Barbara Dossey: The biggest challenge continues to be how to use this integrative approach when we still have a health care system driven by a disease-based model that functions as a disease-management industry. In order to meet the needs of patients and their families, we need to follow models of caring and healing. The challenge is to bring our intuition, compassion, and presence into all corners of health care, when technology tends to nudge them out - to recognize that patient care also requires "being with" rather than always "doing to."

It is thrilling to see alternative therapies becoming mainstream, but we still have a long way to go. But we are making progress in person-centered care. By that I mean the trust that is created when holistic care is given and received.

We also have to examine what works and what doesn't work in the field of holistic and alternative healing. We have to foster an open dialogue with those who are not as sensitive to this integrative approach and to the use of complementary and alternative interventions. How can we respond to the clamor of the public for these interventions, and continue to honor the best of technology?

How can we integrate healers into our health care system who do not have traditional education in nursing, medicine, and related fields. In every community there are individuals with knowledge and skills in different nontraditional therapies and the healing arts. Our traditional institutions need to create a mechanism that allows for nontraditional healers to bring their knowledge and interventions into traditional settings.

Question: What are some of the best ways that you see hospitals and clinics getting started in this process?

Barbara Dossey: When hospitals, clinics, and schools declare that they are going to offer an integrative model of care, they can't just tack on the words "caring," "healing," "holistic," or "integrated" to the institution's mission statement. Yet I see that happening all over the country right now. These are the new buzz words as hospital administrators and their marketing teams know. They are trying to graft these concepts onto the old paradigm and framework, and it doesn't work. Integrative healing comes from a completely different philosophical place. In order for integration to work, the leadership teams must be inspired, informed, and transformed themselves. This takes time. The institutions that are most successful at making these changes do so gradually, first with an interested, committed group of their staff. Then these teams are permitted to create a prototype, and eventually to expand their vision to the institution as a whole.

I know of a major hospital which several months ago opened a new wing of the hospital they called the Complementary and Alternative Medicine Clinic. They staffed it with four nurses who were new to this approach and were just learning about it. The hospital spent an enormous amount of money on marketing these services, and they are struggling to keep their doors open because the referrals are not coming in. Although their willingness to change was admirable, this is an example of how not to go in these directions. In contrast, there are many examples that do work, many of which have been featured in Alternative Therapies.