Theory of Integral Nursing

The following concepts are explicated in the Theory of Integral Nursing which provides the theoretical framework for the RN to BSN program content and learning experiences. While selected concepts are the focus of certain courses, each of the following is emphasized throughout the program.

Theory of Integral Nursing

The Theory of Integral Nursing, developed by Dr. Barbara Dossey (2010, 2013) is a comprehensive and contemporary way of organizing phenomena of concern to nurses. It is designed to complement principles of holistic nursing, human caring and healing. The Theory of Integral Nursing presents a comprehensive model related to the complexity of wholeness and how to simultaneously address the health and wellbeing of nurses, the healthcare team, patients, families and communities, and the healthcare system. It includes a global perspective and the role that nurses have in collectively shaping a healthy world.

The Theory of Integral Nursing incorporates concepts from the philosophies and fields of chaos, spiral dynamics, spirituality, complexity, systems, holistic nursing theories, and others. It is based on an integral philosophy and worldview. Integral is defined as a comprehensive way to organize multiple phenomenon of human experience and reality in four areas: the individual interior (personal/ intentional), individual exterior (physiology/behavioral), collective interior (shared/cultural), and collective exterior (systems/structures).

From these four areas emerge four integral principles of nursing. The individual interior is the “I” of nursing, and the collective interior is the “We” of nursing. The individual exterior is the “It” of nursing, and the collective exterior is the “Its” of nursing. Each area is an essential component of health and well-being.

The following diagram briefly depicts how the integral model is applied to the RN to BSN program at Northern New Mexico College.


INDIVIDUAL INTERIOR
(personal/ intentional)
I

Selected topics: Critical thinking, lifelong learning, self-care, spirituality, emotional intelligence, patterns of knowing, intention, self-confidence, presence, centering, active listening, relaxation, guided imagery, visualization, reflective practice

INDIVIDUAL EXTERIOR
(physiology/behavioral)
IT

Selected topics: Cellular biology, pathophysiology
of addictions, quantitative research
process,
physical examination, mental status exam,
learner characteristics,
neurologic system,
pulmonary system

COLLECTIVE INTERIOR
(shared/cultural)
WE

Selected topics: Relationship-centered care, nurse as environment, qualitative research process, cultural diversity, community partnerships, integral health coaching, motivational interviewing, appreciative inquiry

COLLECTIVE EXTERIOR
(systems/structures)
ITS

Selected topics: Health care reform, legislative process,
quality care management,
health care financing,
health care delivery systems, health disparities,
global warming, sustainability, epidemiology


Healing: Healing is the lifelong journey into wholeness. Healing is a process of bringing together aspects of oneself (body-mind-emotions-spirit-environment), family, community, and global relations at deeper levels of harmony and inner knowing leading towards integration and balance. Each aspect has equal importance and value. Healing can lead to more complex levels of personal understanding and meaning. Healing may occur with curing of symptoms, but it is not synonymous with curing (AHNA/ANA, 2007, 2013).

Health: Health is an individually defined state or process in which the individual (nurse, client, family, group, or community) experiences a sense of well-being, harmony, and unity such that subjective experiences about health, health beliefs, and values are honored.  Health is a process of becoming an expanding consciousness (ANA/AHNA, 2007, 2013).

Health promotion: Health promotion includes activities and preventive measures to promote health, increase well-being, and actualize human potential of individuals, families, communities, society, and ecology such as immunizations, fitness programs, breast self-exam, appropriate nutrition, relaxation, stress management, social support, prayer, meditation, healing rituals, cultural practices, and promoting environmental health and safety (AHNA/ANA, 2007, 2013) .

Holistic nursing: Holistic nursing embraces all nursing which has enhancement of healing the whole person from birth to death and all age groups from infant to elder - as its goal. Holistic nursing recognizes that there are two views regarding holism: that holism involves identifying the interrelationships of the bio-psycho-social-spiritual dimensions of the person, recognizing that the whole is greater than the sum of its parts; and that holism involves understanding the individual as unitary whole in mutual process with the environment. Holistic nursing responds to both views, believing that the goals of nursing can be achieved within either framework (AHNA/ANA, 2007, 2013).

Integral: Integral refers to a comprehensive way to organize multiple phenomenon of human experience and reality in four areas: the individual interior (personal/ intentional), individual exterior (physiology/behavioral), collective interior (shared/cultural), and collective exterior (systems/structures) (Dossey, 2009, 2010, 2013).

Integral dialogue: Integral dialogue is a transformative and visionary exploration of ideas and possibilities across disciplines where the individual interior (personal/ intentional), individual exterior (physiology/behavioral), collective interior (shared/cultural), and collective exterior (systems/structures) are considered as equally important to exchanges and outcomes (Dossey, 2009, 2010, 2013).

Integral healthcare: Integral healthcare is a patient-centered and relationship-centered caring process that includes the patient, family, and community; traditional and integral healthcare practitioners; conventional, integrative, and integral healthcare services and interventions. It addresses all four areas: individual interior (personal/ intentional), individual exterior (physiology/behavioral), collective interior (shared/cultural), and collective exterior (systems/structures) (Dossey, 2009, 2010, 2013).

Integral nurse: An integral nurse is a nurse who embraces and applies the principles of integral nursing to professional practice. Dossey (2009, 2010, 2013) refers to the integral nurse as a 21st century Nightingale engaged as a “health diplomat” and a “health coach” who “coaches for integral health through social action and sacred activism”.

Integral nursing: Integral nursing is professional nursing practice that utilizes a comprehensive integral worldview and process. It embraces and transcends holistic nursing theories leading to an enlarged holistic understanding of body-mind-spirit connections. Integral nursing leads to knowing, doing, and being at more comprehensive and deeper levels (Dossey, 2009, 2010, 2013).

Integral worldview: An integral worldview is a way of viewing the world and nursing practice from an individual interior (personal/ intentional), individual exterior (physiology/behavioral), collective interior (shared/cultural), and collective exterior (systems/structures) perspective. An integral worldview allows one to holistically examine and include the values, beliefs, assumptions, and judgments that are embedded in each of the four areas. It provides an overall framework for orienting personal meaning, connection, and purpose to professional nursing practice (Dossey, 2009, 2010, 2013).

Integrative nursing: Integral, integrative, and holistic nursing practice encompasses approaches to care and healing and supports the blending of conventional nursing practice with practices originating outside of nursing, affirms the relationship between provider and patient, focuses on the whole person, is informed by research and evidence, and utilizes all appropriate therapeutic healthcare professionals and disciplines, and therapeutic approaches to achieve optimal health and healing from a comprehensive integral worldview and process (Dossey, 2019, 2010, 2013).

Intention: Intention is conscious awareness of one’s purpose and objective. Intention is a major aspect of holistic/integral nursing practice (AHNA/ANA, 2007). Intending for the wholeness, well-being, and highest good of all plays an important role in the course of health and well-being of self and clients.

Presence: Presence is the essence of nursing care. It is a way of being that utilizes the nurse as an instrument of healing (Dossey & Keegan, 2009, 2013). Being present is approaching an individual in a way that respects and honors the essence of another, while also honoring the essence of self. It is relating in a way that reflects a quality of being with and in collaboration with, rather than doing to. It is entering into a shared experience that promotes healing potential and an experience of well-being (AHNA/ANA, 2007, 2013). Presence involves believing in inherent wholeness, whatever the current situation.

Relationship-centered care: Relationship-centered care is a process model of caregiving based in a vision of community where three types of relationships are identified: 1) Patient-Practitioner Relationship, 2) Community-Practitioner Relationship, and 3) Practitioner-Practitioner Relationship. Each of these interrelated relationships is essential within an integral system of health care no matter where the health care is provided. Each component involves a unique set of responsibilities and tasks that addresses three areas - knowledge, values, and skills (Tresolini & Pew as cited in AHNA/ANA, 2007, 2013).

Self-care: Self-care involves the conscious and deliberate integration of practices that promote physical, mental, emotional, social, and spiritual well-being of self. Holistic/integral nurses value themselves and mobilize the necessary resources to care for themselves. Nurses cannot facilitate healing unless they are in the process of healing themselves by attending to their own well-being (AHNA/ANA, 2007, 2013; Dossey & Keegan, 2009, 2013).

RN-BSN PROGRAM STUDENT LEARNING OUTCOMES

Graduates of the RN to BSN program will:

  1. Use the Theory of Integral Nursing and the American Holistic Nurses Association and the American Nurses Association Holistic Nursing Scope and Standards of Practice (2013) to provide integral and holistic nursing care in a variety of settings.
  2. Demonstrate critical thinking skills from an “I”, “It”, “We”, “Its”, integral perspective.
  3. Communicate effectively from a relationship-centered care perspective involving Patient-Practitioner, Community-Practitioner, and Practitioner-Practitioner relationships.
  4. Conduct integral holistic health assessments in relation to client needs.
  5. Apply concepts of integral nursing to a personal plan for holistic self-care.
  6. Integrate and apply knowledge to support individual and collective health.
  7. Analyze the links between and among individual, community, and global health issues from an integral world view.
  8. Analyze and utilize research findings to facilitate individual and collective health.
  9. Demonstrate the role of the integral nurse as change agent in regards to current health policy issues.
  10. Utilize integral coaching strategies in relation to client-centered goals.
  11. Apply transformational leadership principles to professional nursing practice.
  12. Integrate selected complementary/alternative health practices into professional nursing practice.
  13. Demonstrate commitment to lifelong learning to facilitate personal and professional development.

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