2. Outline
Introduction
Barbara Dossey
Shea and Frisch
Diagram theory
Overview of Integral Nursing
Historical Background
Key Concepts
Dossey Four Quadrants Model
Theories of SCDNT
Related Concepts
Relevance of the Theory in Nursing
Application to Nursing Practice
Case Study
Outcome
Future Trends
Conclusion
3. Introduction
This theory represents a holistic approach to
nursing care that focuses on the physical, mental,
emotional, and spiritual aspects of patients.
we will explore the key elements of this theory
and its relationship with Self-Care
Deficit Nursing Theory (SCDNT).
4. BarbaraDossey's
- Barbara Montgomery Dossey is internationally recognized as a pioneer in holistic nursing and integrative nurse
coaching.
- She is the Co-Director of the International Nurse Coach Association (INCA) and the Director of Holistic Nursing
Consultants.
- Dossey has authored or co-authored 25 books, including "Nurse Coaching: Integrative Approaches for Health and
Wellbeing" (2015) and "Holistic Nursing: A Handbook for Practice" (6th ed., 2013).
- She is known for her theory of integral nursing (2008, 2013), which presents the science and art of nursing.
- Dossey's collaborative global nursing project, the Nightingale Initiative for Global Health (NIGH), recognizes the
contributions of nurses worldwide in promoting global health, including the United Nations Millennium Development
Goals and the Post-2015 Sustainable Development Goals.
- She has received numerous awards and is a Fellow of the American Academy of Nursing.
Introducing the Theorist
5. Overview of the Theory
• - 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.
• The theory of integral nursing guides the practice, education, research, and policy in nursing.
• - It incorporates physical, mental, emotional, social, spiritual, cultural, and environmental
dimensions.
• - The theory recognizes the legacy of Florence Nightingale and incorporates various
philosophical foundations.
• - It is a comprehensive worldview and process that includes integrative and holistic theories.
• - Integral nursing expands our understanding of body-mind-spirit connections and deepens our
knowledge.
• - The theory includes an integral process, worldview, and dialogues that compose praxis.
• - An integral process organizes multiple phenomena from individual and collective perspectives.
• - An integral worldview examines values, beliefs, assumptions, and meaning.
• - Integral dialogues are transformative and visionary explorations of ideas and experiences.
7. Assumptions
1. 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
2. An integral worldview organizes human experience from four perspectives: individual interior,
individual exterior, collective interior, and collective exterior.
3.Healing is a process inherent in all living things; it may occur with curing of symptoms, but it is not
synonymous with curing.
4. 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, environmental dimensions
8. Assumptions
• 5. Integral nursing is founded on an integral worldview and integrates integral
language and knowledge.
• 6. Integral nursing includes knowledge development and embraces different ways
of knowing, including recognizing the patterns of not knowing.
• 7. An integral nurse is an instrument in the healing process and facilitates healing
through her or his knowing, doing, and Being
• 8. Integral nursing is applicable in practice, education, research, and health-care
policy.
9. Major Concepts
1: Healing. The first content component in a theory of
integral nursing is healing
•Healing
•Metaparadigm in Nursing
•Patterns of Knowing
•Four Quadrants (individual interior, individual exterior,
collective interior, collective exterior)
10. Major Concepts
1: Healing. The first content component in a theory of integral nursing is healing .
1. Healing is an inherent aspect of life that cannot be taken away.
2. Healing can occur at different levels of human experience and may not happen
simultaneously or in all realms.
3. Healing involves recognizing and embracing the interconnectedness of individuals and
the world.
4. Healing is not synonymous with curing and can occur even without complete symptom
resolution.
5. Intention and intentionality play a crucial role in the healing process.
6. An integral perspective that considers four perspectives of reality enhances our
understanding and experience of healing.
11. Major Concepts
2: Metaparadigm of Nursing. The second
content component in the theory of
integral nursing is the recognition of the
metaparadigm in a nurse theory: nurse,
person/s, health, and environment
(society)
Healing is depicted at the center of a
Venn diagram, showing its interrelation
and influence on different domains.
12. Major Concepts
2: Metaparadigm of Nursing.
Integral nursing provides a comprehensive way
to organize multiple phenomena of human
experience .
The nurse is an instrument in the healing
process, bringing her or his whole self into
relationship to the whole self of another or a
group of significant others and thus reinforcing
the meaning and experience of oneness and
unity.
13. Major Concepts
2: Metaparadigm of Nursing.
A person(s) is defined as an individual
(patient/client, family members, significant
others) who is engaged with a nurse who is
respectful of this person’s subjective
experiences about health, health beliefs,
values, sexual orientation, and personal
preferences.
14. Major Concepts
2: Metaparadigm of Nursing.
Integral health is the process through
which we reshape basic assumptions
and worldviews about well-being and
see death as a natural process of the
cycle of life.
15. Major Concepts
2: Metaparadigm of Nursing.
An integral environment(s) has both interior and exterior
aspects
The interior environment includes the individual’s mental,
emotional, and spiritual dimensions, including feelings and
meanings as well as the brain and its components that
constitute the internal aspect of the exterior self. It
includes patterns that may not be understood or may
manifest related to various situations or relationships.
The exterior environment includes objects that can be seen
and measured that are related to the physical and social in
some form
16. Major Concepts
3: Patterns of Knowing.
The third content component in a
theory of integral nursing is the
recognition of the patterns
of knowing in nursing
These six patterns of knowing are
personal, empirics, aesthetics, ethics,
not knowing, and sociopolitical.
17. Major Concepts
4: Quadrants.
The fourth content component in the
theory of integral nursing examines four
perspectives for all known aspects of
reality; expressed another way, it is how
we look at and/or describe anything
18. Major Concepts
5: AQAL (All Quadrants, All Levels). The
fifth content component in the theory of
integral nursing is the exploration of
Wilber’s “all quadrants, all levels, all
lines, all states, all types” or A-Q-A-L
(pronounced ah-qwul), as seen in Figure
20. Barbara Dossey's
Her Integral Nursing Theory has had a profound impact on nursing practice,
encouraging healthcare professionals to view patients as whole beings and
to provide compassionate care that encompasses all aspects of human
experience.
21. Shea and Frisch think about Barbara Dossey
theory of integrated nursing
Shea and Frisch examined Dossey's Theory of Integral Nursing in relation
to its major theoretical source, Wilber's integral theory. They compared
Dossey's theory of integral nursing with Wilber's integral theory and
contrasted Dossey's integral approach with another integral approach
used by other scholars of integral theory.
22. Shea and Frisch think about Barbara Dossey
theory of integrated nursing
Shea and Frisch believe that the Integral Nursing approach described by
Dossey is a framework that inspires a vision for the holistically inclined
nurse to integrate complementary, alternative, and integrative modalities
that potentiate and promote healing.
25. Overview of Integral Nursing
Integral Nursing is a nursing theory developed by Barbara Dossey that
emphasizes the integration of all dimensions of human experience into
nursing practice. It recognizes the importance of addressing not only
physical health but also mental, emotional, and spiritual well-being.
26. Historical Background
Barbara Dossey, a nurse, educator, and author, laid the
foundation for this theory by drawing from various nursing
philosophies and holistic health concepts.
27. Key Concepts
Integral Nursing is built upon several key concepts, including:
- Holism: Viewing patients as whole beings, not just their ailments.
-Integral Awareness: Recognizing the interconnectedness of all aspects of
human experience.
-Integral Caring: Providing compassionate care that addresses physical,
mental, emotional, and spiritual needs.
28. Dossey's Four Quadrants Model
Dossey's Four Quadrants Model divides patient care into four quadrants:
- Physical: Focusing on the patient's physical health and needs.
- Mental: Addressing cognitive and psychological aspects.
- Emotional: Attending to emotional well-being.
- Spiritual: Recognizing the patient's spiritual beliefs and values.
29. Theories of SCDNT
Self-Care Deficit Nursing Theory (SCDNT) is a nursing theory developed by
Dorothea Orem. It comprises four theories:
- Self-Care: Patients can perform self-care activities.
- Self-Care Deficit: When patients cannot meet their self-care needs.
- Dependence: Patients rely on nurses for care.
- Interdependence: Collaboration between patients and nurses.
30. Related Concepts
Integral Nursing and SCDNT share related concepts, such as self-care,
interdependence, and holistic care. These concepts emphasize the
importance of patient involvement in their care and the holistic approach to
nursing.
31. Relevance of the Theoryin Nursing
The integration of Dossey's Integral Nursing and SCDNT enhances nursing
practice by promoting holistic, patient-centered care. It recognizes the
importance of addressing physical, mental, emotional, and spiritual aspects,
ultimately improving patient outcomes.
32. Application to Nursing Practice
In nursing practice, these theories guide healthcare professionals to provide
comprehensive care. For instance, nurses can use the Four Quadrants
Model to assess and address patients' physical, mental, emotional, and
spiritual needs.
33. Case Study
Patient A, a 65-year-old individual, was admitted to the hospital with a
diagnosis of congestive heart failure (CHF).
- The patient had a history of CHF, hypertension, and diabetes mellitus.
-Patient A had been experiencing increased shortness of breath, edema,
and difficulty managing daily activities.
34. 1. Application of Integral Nursing and SCDNT
1. Assessment(Dossey's Four Quadrants Model):
- Physical Quadrant: The nursing team assessed the patient's physical health, including
vital signs, lab results, and the severity of CHF symptoms.
- Mental Quadrant: A thorough cognitive assessmentwas conductedto evaluate the
patient's understanding of their condition and the prescribed medications.
35. 1. Application of Integral Nursing and SCDNT
1. Assessment(Dossey's Four Quadrants Model):
- Emotional Quadrant: The nursing staff identified and addressed the patient's anxiety
and concerns related to their health condition and hospitalization.
- Spiritual Quadrant: The patient's spiritual beliefs were explored, and a chaplain was
consulted to provide emotional and spiritual support.
36. 2. Care Planning (SCDNT)
-Self-Care Assessment: The nursing team worked with Patient A to assess
their ability to perform self-care activities, such as monitoring blood sugar
levels, managing medications, and recognizing signs of worsening CHF.
-Self-Care Deficit Identification: It was determined that the patient had
difficulty managing their daily self-care due to worsening CHF symptoms.
37. 2. Care Planning (SCDNT)
- Dependence and Interdependence: The nursing team collaborated with
the patient to create a care plan that incorporated both self-care activities
that the patient could manage and interventions that required nursing
assistance. This approach encouraged interdependence between the
patient and the healthcare team.
38. 3. Implementation
- The care plan included
management education, dietary
• and a personalized exercise program.
- Nursing staff ensured that the patient had access to educational materials
and resources to support their self-care efforts.
- The patient's family was involved in the care plan, helping to reinforce self-
care activities and providing emotional support.
medication
counseling,
39. 4. Evaluation
-Over time, the patient's condition improved as they became more
engaged in self-care activities.
-Regular assessments were conducted to monitor progress, and
adjustments were made to the care plan as needed.
-The patient reported decreased anxiety and an improved overall sense of
well-being.
40. Outcome
-Patient A's CHF symptoms were better managed, resulting in fewer hospital
readmissions.
-The patient reported an improved quality of life and felt more empowered
to manage their chronic conditions.
-The holistic approach of Integral Nursing and the patient-centered care
approach of SCDNT contributed to better patient outcomes.
41. Future Trends
As nursing continues to evolve, we anticipate greater emphasis on holistic
care, patient involvement, and integration of nursing theories like Integral
Nursing and SCDNT.
42. Conclusion
In conclusion, Barbara Dossey's Theory
of Integral Nursing and Dorothea Orem's
Self-Care Deficit Nursing Theory are
complementary frameworks that
promote holistic, patient-centered care.
By integrating these theories, nurses can
better address the diverse needs of their
patients.
43. References
Dossey, B. M. (2022). Theory of integral nursing. In Helming, M. B, Shields, D. A, Avino, K. M., & Rosa, W. E. (Eds.),
Dossey and Keegan’sHolistic Nursing: A handbookfor practice.
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.
Shea, L. & Frisch, N. C. (2016). Wilber’s integral theory and Dossey’s theory of integral nursing: An examinationof two
integral approaches in nursing scholarship. Journal of Holistic Nursing, 34(3): 244-52.
Purdue, J. S. (2018). Integrative rehabilitation model: A conceptual framework for rehabilitation nursing.
Rehabilitation Nursing, 43(1), 47-54.
Rosa, W.E., Dossey, B. M., & Keegan, L. (2019). Holistic nursing: A handbook for practice (8th ed.). Jones & Bartlett
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