Appreciating Richness and Complexity
A secondary purpose is to
stimulate scholarly interest in designing
studies that test the theory’s concepts and
holistic framework in practice. A peripheral
aim of the paper is to suggest how
application of the theory’s main concepts,
especially the concept of healing, may be
used to help define the emerging role of
the nurse in the 21st century regarding the
holistic care of the client experiencing pain.
the theory of Integral nursing
The experience of pain transcends the
physical body and requires a theory-driven,
tailored, whole-person approach to ensure
all effects of the pain experience on and in
the person; body, mind, and spirit are
addressed. The theory of integral nursing is
a composite theory developed by Barbara
Dossey in 2008 and built largely on the
work of Wilber (2000), whose integral
theory outlined the four dimensions of all
that is and represent what Wilbur believed
to be the true realities of life. Wilber posited
that understanding of these four dimensions
influences a person’s interpretation of reality
and carries the potential to affect one’s
relationships with others. Many of the
concepts within Dossey’s theory stem from
an amalgamation of concepts pivotal to
theories from within and outside of nursing.
The following commentary is a paraphrased
interpretation of Dossey’s theory with the
intent of aiding clinicians, academicians,
students, and others in understanding the
overall thrust of the theory. In this way,
partners in healthcare may find ways to
apply the theory’s core concepts to guide
the design of interventions in all areas of
practice, but especially in the area of pain
management practice. The concepts that
provide the organizing structure for the
theory of integral nursing are healing,
recognition of the metaparadigm of nursing,
patterns of knowing, quadrants, and all
quadrants/all levels (AQUAL). Appreciating
the richness and complexity of the theory
is a longitudinal process that begins with
unpacking each of the theory’s main
concepts and developing ways to apply
the concepts in clinical practice.
The central concept in the theory
of integral nursing is healing and is
conceptualized as a process that includes
“knowing, doing, and being” (Dossey &
Keegan, 2009, p. 21), as part of a life-long
journey toward increasing personal
harmony, harmony that is conveyed to
clients through caring actions and integral
dialogues. Integral dialogues are
transformative and visionary explorations
of ideas and possibilities within and
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