METAPARADIGM OF NURSING THEORY
The second content component in the theory of integral Nursing is the recognition of the meta-paradigm in a nursing theory (nurse, person(s)), health and environment (society). These concepts are important to the theory of integral Nursing because they are encompassed with the quadrant of human experience.
- An integral nurse: Is defined as a 21st century Nightingale. Using terms coined by walker nurses endeavors of social action and sacred activism reflect “nurses as health diplomats” and “integral health coaches” that are “coaching for integral health”. The nurse is an instrument in the healing process where she or he bring one’s whole self into relationship to the whole self of another or a group of significant others that reinforces the meaning and experience of oneness and unity.
- A person: IS defined as an individual (patient or client, family members, significant others), who engages with a nurse in a manner that is respectful of a person’s subjective experiences about health, health beliefs, values, sexual orientation and personal preferences. It also includes an individual nurse who interacts with a nursing colleagues, other health care team members or a group of community members or other groups.
- Integral health: Is the process through which we reshape basic assumptions and world views about well-being and see death as a mutual process of living. As seen by Gaydos, integral health may be symbolically seen as a jewel with many facts that is reflected as a “bright gem” or a “rough stone” depending on one’s situation and personal growth that influence states of health, health beliefs and values. Disease and illness at the physical level may manifest for many reasons and variables. It is important not to equate physical health, mental health and spiritual health as they are not the same thing. They are facts of the whole Jewel of integral health.
- An integral environments: Has both interior and exterior aspects. The interior environment includes the individual’s feelings, meaning, mental, emotional and spiritual dimensions. It also includes a person’s brain stem, cortex and so on, which are an internal (inside) aspect of the exterior self.
This may be related to living and non-living people and things such as a deceased relatives, animal, lost precious objects through flashes of memories stimulated by a current situation. The exterior environment includes objects that can be seen and measured that are related to the physical and social in some form in any of the gross subtle and caused levels that are expanded later in component.
The third content component in the theory of integral Nursing is the recognition of the pattern of knowing in nursing. The 6 patterns of knowing are person, empirics, aesthetics, ethics, not knowing and sociopolitical. As a way to organize nursing knowledge, carper in her now classic 1978 article identified the 4 fundamental pattern of knowing (personal, empirics, ethics, aesthetics) followed by the introduction of the pattern of not knowing in 1993 by Munhall, and the pattern of sociopolitical knowing by White in 1995. These patterns of knowing assist nurses in bringing themselves into the full expression of being present in the moment, to integrate aesthetics with science and to develop the flow of ethical experience with thinking and acting.
Personal Knowing: Is the nurse’s dynamic process of being whole, which focuses on the synthesis of perceptions and being with self. If may be developed through art, meditation, dance, music, stories and other expressions of the authentic and genuine self in daily life and nursing practice.
Empirical Knowing: Is the science of nursing that focuses on formal expression replication and validation of scientific competence in nursing education and practice. It is expressed in models and theories and can be integrated into evidence-based practice. Empirical indicators are accessed through the known senses that are subject to direct observation, measurement and verification.
Aesthetic Knowing: Is the art of nursing that focuses on how to explore experiences and meaning in life with self or another that includes authentic presence, the nurses as a facilitator of healing environment. It is the combination of knowledge, experience, instinct, and intuition that connects the nurse with a patient or client to explore the meaning of life, health, illness and death. It is the integration and expression of all the other pattern of knowing in nursing praxis.
Ethical knowing: Is the moral knowledge in nursing which focuses on behaviors expressions and dimensions of both morality and ethics. It emphasizes respect for the person, the family, and the community that encourage connectedness, responsiveness and relationship that enhance attentiveness, communication and moral action.
Not Knowing: Is the capacity to use healing presence to be open spontaneously to the moment with no preconceived answers or goals to be obtained. It engages authenticity mindfulness, openness, receptivity, surprise, mystery and discovery with self and other in the objective space and the inter-subjective space that allows for new solution possibilities and insights to emerge.
Sociopolitical Knowing: Address the important contextual variables of social economic, geographic, cultural, political, historical and other key factors in theoretical, evidence-based practice and research. This pattern includes informed critique and social justice for the voices of the underserved in all areas of society along with protocols to reduce health disparities. (Ken Wilber 1999).
4. Quadrant:-The Fourth content component in the theory of integral Nursing examines 4 perspectives, for all known aspects of reality or expressed another way. It is how we look at and/or describe anything. These 4 quadrants show the 4 primary dimensions or perspective of how we experience the World, these are represented graphically as follows:-
Upper Left (UL), Upper Right (UR) and lower Left (LL) and lower Right (LR) quadrants. Each quadrant which is intricately linked and bound to each other carries its own truths and language.
Upper Left (UL):- In this “I” space (subjective, the inside of the individual) can be found the world of the individuals interior experiences. These are thoughts, emotions, memories, perceptions immediate sensations and states of mind (imagination, fears, feelings, beliefs, values, esteem, cognitive capacity, emotional maturity, moral developed and spiritual maturity), integral nursing requires the development of the “I” (which is the first person pronoun ie the person who is speaking.
Upper Right (UR):- In the “it” space (objective the outside of the individual) can be found the world of the individual’s exterior (an internal aspect of the exterior self). This includes the material body (physiology (Cells, molecules, neurotransmitters, limbic system), biochemistry, chemistry, physics), integral patient care plans, skill development (health, fitness, exercise, nutrition etc), behaviors, leadership’s skills and integral life practices in time or space.
Lower Left (LL): In the “We” space (inter-subjective, the inside of the collective) can be found the interior collective of how we can come together to share our cultural background stories, values, meanings, vision, language, relationships, and to form partnerships to achieve a healing mission. This can decrease our fragmentation and enhance collaborative practice and deep dialogue around things that really matter. The integral nursing is built upon “we”.
Lower Right (LR): In this “its” space (inter objective, the outside of the collective) can be found the world of the collective exterior things. This includes social systems or structures networks organizational structure and systems (including financial and billing system in health care),information technology regulatory structures (environmental and governmental policies etc), and any aspect of technological environment and in nature and natural world.
When we fail to consider these subjective, inter subjective, objective, and inter objective aspects of reality already described in each quadrant, this is what leads our endeavors and initiatives to be fragmented and narrow and where we often fail to reach identified outcomes and goals. (Ken Wilber 2000).
5. 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. These levels, lines, states, and types are important elements of any comprehensive map of reality. The integral model simply assists us in further articulating and connecting all areas, awareness and depth in these 4 quadrants.
Levels: Levels of development that become permanent with growth and maturity (e.g cognitive, relational, psychosocial, physical, mental, emotional, spiritual) that represents a level of increased organization of level of complexity. These levels are also referred to as waves or stages of development. Each individual possesses the masculine and feminine voice or energy.
Lines: Developmental areas that are known as multiple intelligences (e.g cognitive line, interpersonal line, emotional or affective line, moral line, needs line (Maslow’s hierarchy of needs), aesthetic line, self-identity line, spiritual line and values line.
States:- Temporary changing forms of awareness meditative state (due to meditation yoga, contemplative, prayer etc) altered states (due to mood swings, physiology and pathophysiology shifts with disease or illnesses, seizures, cardiac arrest, low or high oxygen saturation, drug-induced). Peak experiences (triggered by intense listening to music, walks in nature, love making, mystical experiences such as hearing voice of God or the voice of a deceased person. Etc).
Type: Differences in personality and masculine and famine expressions and development (e.g cultural creative types, personality type, enneagram).
Context in a nursing theory is the environment in which nursing acts occur and the nature of the world of nursing. In an integral nursing environment, the nurse strives to be integrally informed and is challenged to further develop an integral worldview, integral life practice and integral capacities, behaviors and skills.
Process in a nursing theory is the method by which the theory works. An integral healing process contains both nurse processes and patient or family and healthcare workers processes (individual interior and individual exterior) and collective healing processes of individuals and of systems or structures (interior and exterior). This is the understanding of the unitary whole person interacting in mutual process with the environment.