Chapter 3 - The Theory of Integral Nursing (TIN)

1. TIN
I. Theory of integral nursing is a grand theory and is not a freestanding theory, rather it is uses
concepts and philosophies from various paradigms/theories and includes Nightingale’s philosophy.
II. TIN Intentions:
i. Embrace unitary whole person and the complexity of nursing profession
ii. Explore 4 perspectives of reality: individual interior/exterior and collective interior/exterior
iii. Expand nurse’s capacities from local to global
III. TIN Assumptions:
i. Recognize individual as an energy field connected to energy fields of others (world is open
and dynamic)
ii. Integral worldview – process where values, beliefs, assumptions, meaning, purpose, and
judgments are identified and related to how individuals perceive the 4 perspectives of reality
(Individual interior/subjective/personal, individual exterior/objective/behavioral, collective
interior/cultural, and collective exterior/systems/structures)
iii. Healing is a process found in all living things
iv. Integral nursing – comprehensive process that betters our holistic understanding of body-
mind-spirit-cultural-environmental connections
2. Content components:
I. Healing – includes knowing, doing, and being and seeks harmony and balance in one’s life.
i. Involves recovery, repair, renewal, and transformation
ii. Healing leads to more complex levels of personal understanding (not same as curing)
iii. Healing can happen until death
II. Metaparadigm – includes nurse, persons, health, and environment
i. Nurse – an instrument in healing process
ii. Person – an individual (patient or family member) who engages with the nurse or a nurse
interacting with nursing colleges or healthcare members.
iii. Health – a state defined by an individual experiencing a sense of growth, harmony, and unity.
iv. Environment – includes interior and exterior aspects where interior includes the individual’s
feelings, mental, emotional, and philological state and the exterior includes objects that can
be seen and measured.
III. Pattern of knowing – there are 6 patterns of knowing
i. Personal – nurse’s dynamic process and awareness of wholeness (personal experience)
ii. Empirics – knowing of scientific competence in nursing education and practice
iii. Aesthetics – focuses on how to explore experiences of self or others in order to explore
meaning of a situation
iv. Ethics – moral knowledge of nursing
v. Not knowing – capacity to be open to moments of no preconceived answers.
vi. Socio-political – address variables of social, economic, and cultural factors to reduce health
disparities.
IV. Quadrants – 4 dimensions that describe our inner and outer awareness of how we experience the
world.
i. ULQ – subject/personal/intentional and inside of individual so it is the “I” and includes the
nurse’s memories, emotions, perceptions, and values.
 The I emphasize the awareness of body, mind, and spirit.
ii. LLQ – intersubjective/cultural/shared values and it is the “We” that includes cultural
background, stories, values, languages, and relationships.
 The We space emphasizes me, us, and all of us
iii. URQ – objective/biological/behavioral and it is the outside of the individual so it is the “It”
which includes material body, and anything we can touch or observe like behaviors, care
plans, and skill developments.
  The It space emphasizes the gross, subtle, and casual states of awareness.
iv. LRQ - interobjective/systems/structures and refers to the “Its” because it includes social
systems.
 The Its space includes group, nation, and global
V. AQAL – all quadrant, levels, lines, states, and types
i. Levels – referred to as stages of development like cognitive, psychosocial, mental, and
emotional
ii. Lines – developmental areas that are known as multiple intelligences
iii. States – temporary changing forms of awareness
iv. Types – differences in personality and expressions.

Chapter 19 - Peaceful Transitions at the End of Life

1. Death – moment when spirit transitions out of body

2. Dying – final stage of physical life
3. Nearing death awareness – a dying persons knowledge of death and their attempt to describe this
experience to healthcare providers and family
4. Self-transcendence – a spiritual concept referring to moving one’s self into a larger sense of consciousness.
a. People with a sense of transcendence live in the present and usually see death as a part of life.
5. Theoretical frameworks to guide end of life care is based on standards of care which includes scope and
standards of practices, state laws, and national laws.
a. Watson’s theory of human caring – focuses on the relationship between the nurse and the patient
and their family and this helps share the burden.
6. Kubler – Ross – identified spiritual development by claiming that achieving acceptance and transcendence
helps move to higher level of spiritual development
7. Assisting peaceful death – includes the nurse’s presence and the natural approaches.
a. Nurse’s presence - creates the atmosphere of safety and compassion
b. Natural approach – assists and supports the atmosphere, including acute and chronic pain;
encourage dying person to focus on breath
8. Meditative approaches at the end of life are a type of natural approach, like breathing or praying.
a. Aromatherapy at the end of life – can decrease agitation and fear and increase quality of life using
familiar smells using M technique (massage)
9. Body shutting down – at the end, energy is withdrawn from periphery and moved to internal organs and
then ultimately shutting down in a logical and sequential way.
a. Terminal dehydration occurs when person refuses water, and this results in dehydration that assists
the dying process by reducing pain and anxiety
10. Signs of imminent death:
a. Minimal speech and movement
b. Weak pulse and low BP
c. Cheyne-stokes respiration (pausing between breaths for 5-60 seconds)
d. Death rattle (gurgling breath sounds)
e. Fixed and dilated pupils.

Chapter 20 - Holistic Communication, Therapeutic Relationships, Healing Environments, and Cultural

Care

1. Holistic communication – a caring, healing process that calls forth the full use of self in interacting with
another
2. Therapeutic communication – a goal directed form of communication used to achieve goals and promote
health and well-being.
3. Martin Buber – introduced the idea that therapeutic process involves mutual discovery and placed an
importance on mutual respect between patient-therapist interaction.
 I. Coined the term I-thou relationship, which is the client-therapist relationship
4. Carl Jung – examined the complexity of gender roles and described first half of life as a search for self and
the second half as a search for soul.
5. Carl Rogers – believed the therapist is an agent of healing and patient relationship centered around
unconditional regard, empathy, and genuineness.
6. Harry Stack Sullivan – introduced the idea of therapeutic relationship and described it as being a human
connection that heals.
7. Increasing self-knowledge – awareness and understanding of one’s self helps to empathize other people’s
differences and can be done by assessing ourselves as individuals.
8. Meditation – a quiet inward focus to help achieve clearer consciousness and inner stillness
I. It can be a state of mind and a method (focusing on something like breath or a word)
II. Start meditation with 5-minute sessions and ultimately getting to 30-1 hr. sessions.

Chapter 3 - Choosing, Evaluating, and Implementing Nursing Theories for Practice

1. Purpose of nursing theory – To improve nursing practice and the health and quality of those we serve.
2. Nursing practice – helps guide the process of developing nursing theory; it is essential to develop, test, and
refine nursing theories.
I. It is a continuous process where you use theories to advance the practice of nursing.
3. Choosing a nursing theory for practice
I. Nursing theory used by nurses must reflect their practice and bring focus and freshness to that
practice.
II. First consider what beliefs and values you hold dear, then consider nursing situations, then consider
how your values and beliefs reflect in the nursing situation.
4. Multiple ways of knowing – there are 4 essential patterns of knowing identified by Carper and a 5th
developed by Chinn and Kramer.
I. Empirical knowing – is how we come to know the science of nursing and includes knowing the
actual theories and research findings (data).
II. Personal knowing – is knowing self and actualizing relationships between the nurse and person
(forming authentic relationships)
III. Ethical knowing is the moral component guiding choices and tells us what is right, obligatory, and
desirable in any nursing situation.
IV. Aesthetic knowing – is the art of nursing, or the creative and imaginative use of nursing knowledge
in practice.
V. Emancipatory knowing – is the integration of knowing, doing, and being and how social, political,
and economic forces shape the opinions about knowledge and truth of the nurse in question.
i. Praxis – is reflection and action
5. Evaluation of nursing theory – determining the value or significance of the nursing theory
I. First, the theory must be studied in its whole
II. Before selecting the theory, you must consider the scope of the theory – is it a grand theory? Middle
range?
6. Process of adoption and implementation of theory-guided practice: 6 steps
I. Grain administrative support – organizational leaders need to support theory guided practice
II. Select the theory/model to be used in practice – select a nursing theory (it is based on what your
values are) by surveying all the working nurse or let organization’s leadership decide.
III. Launch the initiative – once model is selected, begin its implementation
IV. Create a plan for evaluation – this will track process and outcomes like nurse satisfaction or patient
satisfaction.
V. Consistent and constant support and education – a process to support continued learning with the
theory is placed
 VI. Revisioning of theory based on feedback – help the theory become richer by modifying it based on
data collected during practice.

Chapter 11 - Betty Neuman’s Systems Model

1. Betty Neuman’s Systems Model – NSM was originally developed as a teaching aid, but it is now used
globally as a nursing model to guide curriculum development.
I. Client/client system – is an open system that interacts with the internal and external environments
(individual, family, community, and social issue)
II. Interacting variables – 5 components which work harmoniously in the interactions with the internal
and external environmental stressors.
a. Physiological variable – bodily structure and internal function (EX: how do you usually feel
physically?)
b. Psychological variable – mental processes and interactive environmental effects (EX: how
do you usually feel emotionally)
c. Sociocultural variable – combined effects of social cultural conditions and influences (EX:
Tell me about your lifestyle and culture)
d. Developmental variable – age-related development process and activities (EX: What are
your current goals)
e. Spiritual variable – spiritual belief and influences (EX: What are your spiritual beliefs or
what gives you hope?)
2. Lines of defense
I. Normal line of defense – the clients normal wellness level. (EX: how do you usually feel?)
II. Flexible line of defense – the outer boundary of the system which is a buffer that protections the
normal life of defense from stressors. (EX: how are you feeling today?)
3. Lines of resistance – internal factors that protect basic structure and support return of the client system to
wellness.
4. Environments:
I. Internal environment – forces that are internal to the client system
II. External environment - forces that are external to the client system
III. Created environment – client’s unconscious mobilization of all variables.

Chapter 14 - Martha E. Rogers’ Science of Unitary Human Beings

1. Rogers’ new worldview in nursing – contains a pandimensional view of people and their world and
pointed out that in a universe of open systems, energy fields are continuously open and integral with one
another.
2. Unique focus of nursing – the irreducible human being and its environment, both defined as energy fields.
3. 4 Fundamental postulates:
I. Energy fields – unit of the living and non-living which is dynamic and continuously moving
(includes human and environment fields)
II. Openness – it is an open universe where there are no boundaries so human, and environment are not
separated.
III. Pattern
IV. Pandimensionality
4. Principles of homeodynamics – refers to the ever-changing nature of life and the world; 3 principles:
I. Resonancy – is the continuous change from lower to higher frequency wave patterns in human and
environmental fields.
II. Helicy – is the continuous, unpredictable diversity of human and environmental field patterns.
III. Integrality – is continuous mutual human field and environmental field process where both are
unitary and inseparable.
5. Nurse’s ability to grasp meaning – nursing education is identified by transmission of nursing’s theoretical
knowledge, and nursing practice is the creative use of nursing knowledge.
I. Research is done in relation to the theories to illuminate the nature of the human-environmental field
change.
6. Theory of Accelerating Evolution
I. The only norm is accelerating change because human and environmental field rhythms are
accelerating.
II. The theory views aging as a creative process in which filed patterns show increasing diversity in
such manifestations as sleeping, waking, and dreaming.
III. The more diverse field patterns evolve more rapidly than the less ones
IV. Aging is process of growing diversity of field patterning rather than a process of decline.
7. Nursing process and nursing diagnoses
I. Nursing diagnosis – energetic unitary experiences; EX: imbalanced energy field NANDA diagnosis.
8. Research methods specific to the Science of Unitary Human Beings
I. Method’s purpose is to investigate the dynamic enfolding-unfolding of the human and environmental
field energy patterns.