1 CORE VALUE 1. Holistic Philosophy, Theories, and Ethics Chapter 1. Nursing: Integral, Integrative, and Holistic Local to Global Barbara Montgomery Dossey Nurse Healer Personal OBJECTIVES Create an integral self-care plan. Examine ways to enhance integral under- Theoretical standing in your personal endeavors. Explore the theory of Integral Nursing and Develop short- and long-term goals related its application to Holistic nursing. to increasing your commitment to an inte- Examine the United Nations Millennium gral developmental process. Goals. Link Florence Nightingale's legacy of heal- DEFINITIONS. ing, leadership, global action, and her work Global health: Exploration of the emerging as a nurse and citizen activist to 21st-century value base and new relationships and inno- integral and Holistic nursing. vations that occur when health becomes Analyze relationship-centered care and its an essential component and expression of three components.
2 Global citizenship; an increased awareness Examine optimal healing environments that health is a basic human right and a and their four domains. global good that needs to be promoted and protected by the global community. Clinical Holistic nursing: See Chapter 2 definitions. Apply relationship-centered care principles Integral: Comprehensive way to organize and components in your practice. multiple phenomena of human experi- Compare and contrast the three eras of ence related to four perspectives of real- medicine. ity: (1) the individual interior (personal/. Examine the theory of Integral Nursing, intentional); (2) individual exterior (physi- and begin the process of integrating the ology/behavioral); (3) collective interior theory into your clinical practice. (shared/cultural); and (4) collective exte- Determine whether you have an integral rior (systems/structures).
3 Worldview and approach in your clinical Integral dialogue: Transformative and vision- practice and other education, research, hos- ary exploration of ideas and possibilities pital policies, and community endeavors. across disciplines where the individual inte- 3. 4 Chapter 1 Nursing: Integral, Integrative, and Holistic Local to Global rior (personal/intentional), individual exterior to how individuals perceive reality and (physiology/behavioral), collective interior relationships that includes the individual (shared/cultural), and collective exterior interior (personal/intentional), individual (structures/systems) are considered as equally exterior (physiology/behavioral), collective important to exchanges and outcomes. interior (shared/cultural), and collective Integral healing process: Contains both exterior (systems/structures). nurse processes and patient/family and Relationship-centered care: A process model healthcare worker processes (individual of caregiving that is based in a vision of interior and individual exterior), and col- community where the patient practitioner, lective healing processes of individuals and community practitioner, and practitioner.
4 Of systems/structures (collective interior practitioner relationships, and the unique and exterior); an understanding of the uni- set of responsibilities of each are honored tary whole person interacting in mutual and valued. process with the environment. Integral health: Process through which we Q NURSING: INTEGRAL, reshape basic assumptions and worldviews INTEGRATIVE, AND Holistic . about well-being and see death as a natu- In the future, which I shall not see, for ral process of living; may be symbolically I am old, may a better way be opened! viewed as a jewel with many facets that May the methods by which every infant, is reflected as a bright gem or a rough every human being will have the best stone depending on one's situation and chance at health the methods by personal growth that influence states of which every sick person will have the health, health beliefs, and values.
5 Best chance at recovery, be learned and Integral health care: A patient-centered and practiced. Hospitals are only an inter- relationship-centered caring process that mediate stage of civilization, never includes the patient, family, and commu- intended, at all events, to take in the nity and conventional, integrative, and inte- whole sick population.. gral healthcare practitioners and services May we hope that, when we are all and interventions; a process where the indi- dead and gone, leaders will arise who vidual interior (personal/intentional), the have been personally experienced in individual exterior (physiology/behavioral), the hard, practical work, the difficul- the collective interior (shared/cultural), and ties, and the joys of organizing nursing the collective exterior (structures/systems). reforms, and who will lead far beyond are considered in all endeavors.
6 Anything we have done! May we hope Integral nurse: A 21st-century Nightingale that every nurse will be an atom in the who is engaged as a health diplomat and hierarchy of ministers of the Highest! an integral health coach who is coaching But she [or he] must be in her [or his]. for integral health. place in the hierarchy, not alone, not Integral nursing: A comprehensive integral an atom in the indistinguishable mass worldview and process that includes holis- of thousands of nurses. High hopes, tic theories and other paradigms; holis- which shall not be deceived! 1. tic nursing is included (embraced) and transcended (goes beyond); this integral Florence Nightingale's (1893) words above em- process and integral worldview enlarges power us in our mission of service. In 2010, the our Holistic understanding of body-mind- Institute of Medicine Future of Nursing report spirit connections and our knowing, published a landmark document that presented doing, and being to more comprehensive four key messages:2.
7 And deeper levels. Nurses should practice to the full extent of Integral worldview: Process where values, their education and training. beliefs, assumptions, meaning, purpose, Nurses should achieve higher levels of edu- and judgments are identified and related cation and training through an improved Global Nursing, Nightingale Declaration, and United Nations Millennium Development Goals 5. education system that promotes seamless dence, and makes use of all appropriate ther- academic progression. apeutic approaches, healthcare professionals, Nurses should be full partners, with physi- and disciplines to achieve optimal health and cians and other healthcare professionals, in The next section provides an overview redesigning health care in the United States. of how we can globally integrate and translate Effective workforce planning and policy integral and Holistic nursing concepts.
8 Making require better data collection and information infrastructure. Q GLOBAL NURSING, NIGHTINGALE. To fulfill the challenges addressed in the IOM. DECLARATION, AND UNITED. report an integral perspective has never been NATIONS MILLENNIUM. more important. At the forefront, nurses are now DEVELOPMENT GOALS. engaged as change agents to improve the health Severe health needs exist in almost every com- of the nation, to focus on increasing the health munity and country. These are no longer isolated span of individuals rather than focusing on life problems in far-off places. Across humankind, span. Integral nursing can be described as a com- we all face common health concerns and global prehensive integral worldview and process that health imperatives. With globalization and includes Holistic theories and other paradigms; global warming, no natural or political boundar- Holistic nursing practice is included (embraced) ies stop the spread of 13 Yet, the health and transcended (goes beyond).
9 3 6 This integral and well-being of people everywhere can be seen process and the integral worldview enlarge our as common ground to secure a sustainable, pros- Holistic understanding of body-mind-spirit con- perous future for everyone. In interdisciplinary nections and our knowing, doing, and being to and interprofessional collaboration with pro- more comprehensive and deeper levels (Note: See fessional and allied health colleagues, as well the section titled theory of Integral Nursing as concerned citizens, nurses can play a major later in this chapter for full discussion.) role in mobilizing new approaches to educa- Holistic nursing is defined as all nursing prac- tion, healthcare delivery, and disease prevention. tice that has healing the whole person as its Global health requires new leadership models goal. 7 As described and developed later in this in communication, negotiations, resource, man- text (Chapter 2), Holistic nursing has attained agement, work-life balance, and mentor-mentee new levels of acceptance and is now officially models and 14.
10 Recognized by the American Nurses Associa- Global health is the exploration of the emerg- tion (ANA) as a nursing specialty with a defined ing value base and new relationships and agen- scope and standards of Our Holistic das that occur when health becomes an essential nursing challenges as described throughout this component and expression of global citizen- text include ways to learn and integrate new It is an increased awareness that health theories, models, and information, and how to is a basic human right that is decent care 15. articulate the science and art of Holistic nurs- that addresses the body, mind, and spirit and ing, complementary and alternative modalities is a global good that needs to be promoted (CAM), integrative modalities, and healing in and protected by the global community. Severe all areas and specialties of nursing. Our chal- health needs exist in almost every commu- lenges and opportunities to interface in inter- nity and nation throughout the world.