Theory of Integral Nursing

Contributor – Barbara M. Dossey
May 23, 2020

Author – Barbara M. Dossey, PhD, RN, AHN-BC, FAAN, HWNC-BC

Year First Published – 2008
B. M. Dossey (2008). Integral and Holistic Nursing: Local to Global. In B. M. Dossey & L. Keegan; Holistic Nursing: A Handbook for Practice (5th ed. Jones & Bartlett. Healing and AQAL (all Quadrants, All Levels) adapted from K. Wilber (2000). Used by permission.

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Major Concepts
  • Healing
  • Metaparadigm in Nursing
  • Patterns of Knowing
  • Four Quadrants (individual interior, individual exterior, collective interior, collective exterior)
  • AQAL (All Quadrants, Levels, Lines, States, Types)
© NIGH 2011

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Typology

The Theory of Integral Nursing (TIN) is a grand theory in the integrative-interactive paradigm that presents the art and science of nursing.

Description

The Theory of Integral Nursing (TIN) is a comprehensive process and worldview that enlarges our holistic understanding and connections. It shifts our consciousness to deeper levels of meaning and understanding about our knowing, doing, and being. It incorporates Florence Nightingale’s legacy, philosophy, and sacred activism. It adapts the integral process and four perspectives of reality from the work of Ken Wilber’s (1949-), one of the most significant American new-paradigm philosophers.

The major components and assumptions are:

  • An integral understanding recognizes the individual as an energy field connected to the energy fields of others and the wholeness of humanity; the world is open, dynamic, interdependent, fluid, and continuously interacting with changing variables that can lead to greater complexity and order.
  • An integral worldview is a comprehensive way to organize multiple phenomena of human experience from four perspectives of reality: (a) “I” Capacity of Self (individual interior, subjective, personal); (b) “It” Capacity for Actions and Skill Development (individual exterior, objective, behavioral); (c) “We” Capacity for Collective Intelligence (collective interior, interobjective, cultural); and (d) “Its” Capacity for Alignment in Systems/ Structures (collective exterior, interobjective).
  • Healing is a process inherent in all living things; it may occur with curing of symptoms; it is not synonymous with curing; it may occur at the moment of death in dying time.
  • An integral nurse is an instrument in the healing process and facilitates healing through her or his knowing, doing, and being.
  • Integral health is experienced by a person as wholeness with development toward personal growth and expanding states of consciousness to deeper levels of personal and collective understanding of one’s physical, mental, emotional, social, spiritual, cultural, and environmental dimensions.
  • Integral nursing strengthens knowledge development and understanding of the metaparadigm in nursing (nurse, health, person(s), environment (society) and patterns of knowing (personal, empirics, aesthetics, ethics, not knowing, and sociopolitical).
  • Integral nursing incorporates integral language, worldview, dialogues, knowledge and integral/integrative life practices and skills each day.
  • Integral nursing is applicable to all areas of practice, education, research, and health policy.

In summary, the Theory of Integral Nursing expands nurses’ capacities as 21st-century Nightingales, health diplomats, and integral nurse coaches. It strengthens our 21st-century nursing endeavors and guide integral nurse self-development and expand our consciousness to recognize that all of us are engaged in global nursing. When we focus on improving our own health and that of our family and community at the local level, each small change connects “me” to “us” to “all of us”—that creates the ripple effect of healthy people living on a healthy planet—local to global.

Primay Sources

Dossey, B. M. (2020). Theory of integral nursing. In M. Smith (Ed.), Nursing Theories and Nursing Practice (5th ed.) (pp. 211-234). Philadelphia: F. A.
Davis.

Rosa, W. E., Dossey, B. M., Koithan, M., Kreitzer, M. J., Manjrekar, P., Meleis, A. I., Mukamana, D., Ray, M. A., & Watson, J. (2020). Nursing theory in the quest for the sustainable development goals. Nursing Science Quarterly, 33(2) 178–182.

Dossey, B. M., Beck, D.M, Oerther, S. & Manjrekar, P. (2017). Florence Nightingale’s legacy: The rationale for an integral worldview in achieving the sustainable development goals. In W. Rosa (Ed.), A New Era in Global Health: Nursing and the United Nations 2030 Agenda for Sustainable Development (pp. 149-178). New York, NY: Springer Publishing Company.

Dossey, B. M. Theory of integral nursing. (2016). In Dossey, B.M. & Keegan, L. (Eds.) Holistic Nursing: A Handbook for Practice (7th ed). Note. Published in (5th ed., 2009, 6th ed., 2013; 8th ed 2020).

Shea, L. & Frisch, N. C. (2016).Wilber’s integral theory and Dossey’s theory of integral nursing: An examination of two integral approaches in nursing scholarship. Journal of Holistic Nursing, 34(3): 244-52.

Hess, D. R. (2016). Curriculum for an RN-to-BSN program using the theory of integral nursing. In B. M. Dossey & L. Keegan (Eds). Holistic nursing: A Handbook for Practice (7th ed.) (pp.40-46). Burlington, MA: Jones and Bartlett Learning.

Dossey, B. M. (2008). Theory of integral nursing. Advances in Nursing Science, 31(1): E52–73.

Application Sources

Education. Darlene Hess, PhD, NP, AHN-BC, HWNC-BC, used the Theory of Integral Nursing for an entire curriculum for an RN-to-BSN program at Northern New Mexico State (NNMC), in Espanola, New Mexico. This RN-to-BSN program prepares registered nurses to assume leadership roles as holistic and integral nurses at the bedside, within organizations, in the community, and other areas of professional practice.
Source. Hess, D. R. (2016). Curriculum for an RN-to-BSN program using the theory of integral nursing. In B. M. Dossey & L. Keegan (Eds). Holistic nursing: A Handbook for Practice (7th ed.) (pp. 40-46). Burlington, MA: Jones and Bartlett Learning.

Practice. Juliann S. Purdue, DNP, RN, FNP developed the Integrative Rehabilitation Model using the Theory of integral Nursing as the conceptual framework.
Source: Purdue, J. S. (2011). Integrative rehabilitation model. (2011). In B. M. Dossey & L. Keegan (Eds). Holistic nursing: A Handbook for Practice (7th ed.) (pp. 39-40). Burlington, MA: Jones and Bartlett Learning.

Global Health—Local to Global. Nightingale Initiative for Global Health (NIGH, n.d.). http://www.nighvision.net. See NIGH’s 4 Integral Models, © 2011. The NIGH applies the Theory of Integral Nursing to present the whole picture, as well as the pieces of the whole and—perhaps most important—the relationships among these pieces in all their projects. These include A) NIGH’s 4 integral jigsaw puzzle metaphor; B) Identify 4 interrelated problems; C) Propose 4 synthesis solutions; D) Implement 4 integral initiatives; and, E) Articulate 4 anticipated outcomes.
Source: Dossey, B. M., Beck, D.M, Oerther, S. & Manjrekar, P. (2017). Florence Nightingale’s legacy: The rationale for an integral worldview in achieving the sustainable development goals. In W. Rosa (Ed.), A New Era in Global Health: Nursing and the United Nations 2030 Agenda for Sustainable Development (pp. 149-178). New York, NY: Springer Publishing Company.

See Practice Exemplar and NIGH’s Four Integral Models. Sarah Oerther, MSN, MEd, RN, used the Theory of Integral Nursing as the framework in partnering with local groups to develop a community garden project.
Source. Dossey, B. M. (2020). Theory of integral nursing. In M. Smith (Ed.), Nursing Theories and Nursing Practice (5th ed.) (pp. 211-234). Philadelphia: F. A.Davis.

Author

Barbara M. Dossey (1943 – )

Barbara Dossey

Barbara Dossey, PhD, RN, AHN-BC, FAAN, HWNC-BC, is internationally recognized as a pioneer in the holistic nursing and nurse coaching movements. She is a Florence Nightingale scholar, nurse theorist, and national and international speaker and teacher on the role of integrative nurse coaching in the emerging integrative health care paradigm. She is Co-Director, International Nurse Coach Association (INCA), Core Faculty and Co-Director, Integrative Nurse Coach Academy, North Miami, Florida; International Co-Director and Board Member, Nightingale Initiative for Global Health (NIGH), Santa Fe, New Mexico and Gatineau, Quebec, Canada; and Director, Holistic Nursing Consultants, Santa Fe, New Mexico.

Barbara is an author or co-author of 25 books. Her most recent include The Art and Science of Nurse Coaching: The Provider’s Guide to Coaching Scope and Competencies (2nd ed, 2020), Holistic Nursing: A Handbook for Practice (7th ed., 2016; 8th ed Dec. 2020), Nurse Coaching: Integrative Approaches for Health and Wellbeing (2015), and Florence Nightingale: Mystic, Visionary, Healer (Centennial Commemorative Edition, 2010).

Barbara’s Theory of Integral Nursing (TIN) (2008) is a grand nursing theory that presents the science and art of nursing. It includes an integral process, integral worldview, and integral dialogues that is Praxis—theory in action. It also includes compassionate care of the dying, and nurses’ roles as 21st Century Nightingales. Her co-authored Theory of Integrative Nurse Coaching (TINC) (2015), a middle-range theory, is a framework to guide integrative nurse coaches in nurse coaching practice, education, research, and healthcare policy.

Her collaborative global nursing project, the Nightingale Initiative for Global Health (NIGH) and the Nightingale Declaration Campaign (NDC) has been developed to strengthen individual commitment toward achieving a healthy world as a priority objective for action by ordinary citizens, by civil society organizations and by all governments, local and national. Beginning in 2016 the NIGH focus has been to advocate, worldwide, for the achievement of the 17 UN Sustainable Development Goals (SDGs) that all Member States of the United Nations (UN) unanimously approved as moving towards the 2030 Sustainable Development Agenda.

Barbara is a Fellow of the American Academy of Nursing. She is certified in Holistic Nursing (AHN-BC) and Health and Wellness Nurse Coaching (HWNC-BC). She is an 11-time recipient of the prestigious American Journal of Nursing Book of the Year Award. She has received many awards that include: 1985 Holistic Nurse of the Year by the American Holistic Nurses’ Association; 1999 Pioneering Spirit Award (with Husband Larry) by the American Association of Critical Care Nurses; 2001 TWU 100 Great Nursing Alumni, Texas Woman’s University, Denton, Texas; 2003 Distinguished Alumna Award from Baylor University, Waco, Texas; 2003 Archon Award (with husband Larry) from Sigma Theta Tau, International; 2004, Pioneer of Integrative Medicine Award (with husband Larry) from the Aspen Center for Integrative Medicine, Aspen, Colorado; 2012 Nursing Leader Award of New Mexico from the New Mexico Nurses Association; 2014 AHNA Life Time Achievement Award from the American Holistic Nurses Association; and 2016 Academy of Integrative Health and Medicine Visionary Award (with husband Larry).

See also www.iNurseCoach.comwww.online.inursecoach.com,  www.NIGHvision.net