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application of Integral Theory to an individual case study of a surgical patient.20 Theory of Integral Nursing In 2008, Barbara Dossey first presented her work on the development of a grand theory of nursing that would incorporate Wilber’s theory, particularly the use of the quadrants in understanding the dimensions of how we perceive the world, coupled with Carper’s theory of how we come to know what we know.21 Dossey’s Theory of Integral Nursing (TIN) is meant to address very broad areas of the discipline’s concerns. The TIN has shifted the paradigm in nursing to expand our notions of whom and what we are. The reader is referred to the discussion in this text of integral and holistic nursing, from local to global, for a description of the TIN theory and its application to nursing (see Chapter 1). Dossey’s work is a creative blending 118 Chapter 5 Nursing Theory in Holistic Nursing Practice 9781284082463_CH05_PASS02.indd 118 25/02/15 6:08 pm of worldviews that include how we define, know, experience, and react to our realities and how our new understandings of our realities can influence ourselves and our work. She provides a framework for application of integral principles with practice domains of direct care, education, and research. As scholars and practitioners take up this theory, there will be more learnings as a consequence of Dossey’s expansion of our notions of nursing. Specific concepts within our nursing worldviews will be challenged; for example, Wilber’s work includes concepts of human development in stages of growth that have been rejected by unitary nursing scholars who adhere to an evolutionary model of human change. Other issues will undoubtedly arise as nursing scholarship proceeds. The TIN provides an exciting opportunity to move nursing’s work and holistic nursing in entirely new directions that we do not yet fully understand. Conclusion A theory provides a means of interpreting and organizing information. Nursing theories give nurses the tools to ensure that nursing assessments are comprehensive and systematic and that care is meaningful. While some nurses do not use a theory at all, holistic nurses will use theories to provide a base for that “reflective” and “cognitive” part of practice that is so important in holism. Because there are several theories, each nurse must decide which theory to use and when to use an alternative perspective. In selecting a theory, a nurse should ask two questions: What theory is most comfortable for me? What theory is most comfortable for my client? The perspective selected must be comfortable for both. Many clients, as well as nurses, have strong feelings and opinions about what nursing is and the type of care they wish to receive. If the theory’s perspective is not comfortable for the client, the nurse is ethically obligated to change her or his perspective and adopt a framework that is compatible with the client’s needs. Lastly, holistic nurses ought to give careful consideration to theories of practice, such as Complexity Science and Integral Theory, that take our thinking to a systems level or a higher level of abstraction than existent nursing theories. These two perspectives are being used in healthcare practice and not only provide the holistic nurse with tools for leadership and innovation but may well establish enough interest in theory in general for nurses to bring other nursing theories into practice as well. Directions for Future Research 1. Holistic nurses should consider what is and is not known about any theory being applied to practice and evaluate the next steps needed to develop the theory in their own area of practice. 2. Evaluate theories related to the identification of specific outcomes of care. Nurse Healer Reflections After reading this chapter, the holistic nurse will be able to answer or to begin a process of answering the following questions: ■ Which of the nursing theories can I use in my practice? ■ How will I determine if the theory I am using is acceptable to my clients? ■ In what ways am I able and willing to become a nursing leader, using my background to “heal” the system? ■ What is my personal plan for studying new theories and learning to apply them to my professional work? NOTES 1. J. S. Hickman, “An Introduction to Nursing Theory,” in Nursing Theories: A Base for Professional Practice, 6th ed., ed. J. George (Upper Saddle River, NJ: Prentice Hall, 2011): 1–22. 2. V. M. Malinski, “Notes on Book Review of Analysis and Evaluation of Nursing Theories: Response,” Nursing Science Quarterly 8 (1995): 59. 3. M. E. Parker, Nursing Theories and Nursing Practice, 2nd ed. (Philadelphia: F. A. Davis, 2006). 4. P. Donnahue-Porter, M. O. Forbes, and J. H. White, “Nursing Theory in Curricula Today: Challenges for Faculty at All Le Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses’ provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using
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