Principles of Integrative Nursing
1. Human beings are whole systems inseparable from their environments.
Integrative nurses view each person as a whole system—body, mind, and spirit—whose health and wellbeing is influenced by their environment. We know from the field of complexity science that everything is connected through networks of relationships. The 2014 Integrative Nursing textbook gives the example of the cardiovascular system—it cannot be understood fully by simply examining the heart muscle, and then the valves, and so on; the condition of the system can only be known by assessing its function as a whole. In the same way, integrative nurses acknowledge the complexity of the whole-person system and take into consideration the ways in which relationships, experiences, the community, and beliefs affect the health and wellbeing of the individual. Applying this principle, integrative nurses recognize that people are dynamic, individualistic and complex and cannot be reduced to diagnoses, symptoms and deviations from norms.
2. Human beings have the innate capacity for health and wellbeing.
People have the capacity for self-healing which is defined as the innate restorative capacities of the body. There is evidence that healing occurs on physical, social, emotional and spiritual levels. As noted by Florence Nightingale, the role of the nurse is to put the patient in the best possible condition so that nature can act and healing occur.
3. Nature has healing and restorative properties that contribute to health and wellbeing.
There is a strong relationship between access to nature and outcomes of health and wellbeing. We know from research based on biophilia that being in nature or having access to nature produces positive outcomes. Biophilic design in health care facilities has demonstrated a connection between physical space and outcomes in staff as well as patients.
4. Integrative nursing is person-centered and relationship-based.
Integrative nurses are co-creators of wellbeing and work in partnership with patients and their families and communities. Relationship-based care calls upon the nurse to be fully present, listening deeply and providing options that best support the person’s healing. Co-creative relationships are also formed between nurses, or between nurses and other members of the care team.
5. Integrative nursing practice is informed by evidence and uses the full range of therapeutic modalities to support/augment the healing process, moving from least intensive/invasive to more, depending on need and context.
In order to best support innate healing, integrative nurses make use of the full range of interventions possible. A plan of care may include traditional modalities or integrative therapies, such as massage, breathwork, or acupuncture, as well as medications or surgical therapies backed by western science. Recognizing that there are multiple ways of knowing, integrative nurses consider and weigh different forms of evidence, from empirical science to personal experience. When developing a plan of care, integrative nurses begin with the least intensive/ invasive intervention to minimize side effects and disruption to the person’s body, mind, and spirit. Interventions move to more intensive/invasive treatments as needed.
6. Integrative nursing focuses on the health and wellbeing of caregivers as well as those they serve.
In order to deliver effective care, nurses need to cultivate their own health and wellbeing. Self-reflection, consideration of purpose, and seeking out activities that are nourishing to the body, mind, and spirit are ways that integrative nurses can care for themselves.
Why We Need Integrative Nursing in Contemporary Healthcare
Healthcare is shifting from a disease-centered model to one of preventative care and wellbeing, one that sees the individual in context of his or her relationships, environment, and sense of self. The Centers for Disease Control and World Health Organization recognize the multiple determinants of health, including social, psychological, economic, environmental, and physical factors. New models, such as that of the Center for Spirituality & Healing at the University of Minnesota, describe wellbeing as a state of balance that goes beyond health and includes a sense of purpose, relationships with others, security, environment, and community. Integrative nurses address the whole-person system.
What’s more, alarming statistics about healthcare provider burnout—including exhaustion, depression, and fatigue—point to a growing need for an emphasis on self-care and recognizing the need for nurses and healthcare providers to attend to their own wellbeing.
Bowler, D. E., Buyung‐Ali, L. M., Knight, T. M., & Pullin, A. S. (2010). A systematic review of evidence for the added benefits to health of exposure to natural environments. BMC Public Health, 10, 456.
Centers for Disease Control. http://www.cdc.gov/socialdeterminants/
Halbesleben, J.R., Rathert, C. (2008). Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Management Review; 33(1):29‐39.
Kreitzer, M.J., Koithan, M. (Eds). (2014). Integrative Nursing. New York: Oxford Press.
Shanafelt, T.D., Boone, S., Tan, L., et al. (2012). Burnout and satisfaction with work‐life balance among US physicians relative to the general US population. Archives of Internal Medicine;172(18):1377‐1385.
Stamatakis, E. (2011). Screen‐based entertainment time, all‐cause mortality, and cardiovascular events: Population‐based study with ongoing mortality and hospital events follow‐up. Journal of the American College of Cardiology, 57(3), 292‐299.
Taking Charge of Your Health. The wellbeing model. http://www.takingcharge.csh.umn.edu/wellbeing-model
Wilson, E.O. (1984). Biophilia. Cambridge: Harvard University Press. World Health Organization. http://www.who.int/hia/evidence/doh/en/
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