Book Review: Integrative Nursing by Mary Jo Kreitzer and Mary Koithan

November 2014
BY Victor S. Sierpina, MD, ABFM, ABIHM Director, Medical Student Education Program, WD and Laura Nell Nicholson Family Professor of Integrative Medicine, Professor, Family Medicine University of Texas Distinguished Teaching Professor

This title is a welcome addition to the nearly a dozen books editor Andrew Weil’s Integrative Medicine Library published by Oxford University Press.

Perhaps the significance of this excellent work is best illustrated by citing some key lines. The first chapter, Concepts and Principles of Integrative Nursing opens as follows: “From its very beginnings, nursing has been an integrative healing discipline. Florence Nightingale recognized the integral nature of the person- envi ron ment system, urging nurses to assist in the reparative processes of nature by ‘putting the patient in the best condition for nature to act upon him’....Throughout time, nursing theorists have embraced the complex, holistic nature of the human being, stating that the focus of nursing is on the totality of the human response to potential or actual health problems.”

These ideas reflect the foundation of integrative nursing practice that is deeply explored in this landmark work. A subsequent chapter, Creating Optimal Healing Environments describes how hospitals can be designed and built to do the patient no harm by including essential elements of fresh air, ample space, light, and subdivision of sick into separate buildings or pavilions. This chapter offers another cogent quote from the founder of modern nursing, Nightingale. Referring to the importance of the healing environment she wrote: “People say the effect is only on the mind. It is no such thing. The effect is on the body, too. Little as we know about the way in which were are affected by form, by color, and light, we do know this, that they have an actual physical effect. Variety of form and brilliancy of color in the objects presented to patients, are actual means of recovery”. Such thinking by Nightingale was prescient in 1860 and could not foresee how research a century or more later on psychoneuroimmunology, the stress response, and neurobiology would support her common sense suggestions on the impact of environment on healing.

At the end of another chapter titled Facilitating Lifestyle Choice and Change, the chapter author offers the following practical and powerful advice: “Healthcare providers who use therapeutic presence as the basis of patient relationships will use the following: active listening, sitting down to meet people on their level, turning negative thoughts into statements of possibility, and helping the patient create achievable outcomes. Providers with therapeutic presence are those who will creatively partner with patients to achieve higher levels of wellbeing.”

These are just samples of the pearls for integrative nursing practice offered throughout this book. It is creatively divided into seven major sections. Section I, Foundations of Integrative Nursing covers the concepts of the definition of an integrative nurse, ways of healing, leadership, building programs, impacting hospitals and health systems, and optimizing the healing environment. Section II, Optimizing Wellbeing provides perspectives on helping facilitate change in individuals and systems, the use of nutrition, movement, and health coaching. Section III, Symptom Management and Integrative Nursing offers helpful chapters that exemplify integrative nursing with holistic approaches to problems faced regularly by nurses. These include stress, nausea, sleep, anxiety, depression, fatigue, pain, cognitive impairment, and care of the human spirit. Section IV, Integrative Nursing Applications explores integrative nursing in multiple settings, acute care, the community, mental healthcare, care of older adults, palliative and end of life care, and consideration of ecology and the environment and its impacts on health. Section V, Integrative Nursing: Models of Education, delves into key areas of education and integrative nursing. Several chapters written by well known nursing academics and educators including a least one former nursing dean help us to understand the topography of integrative nursing education at multiple levels from pre-licensure, graduate training, ongoing lifelong professional development, as well as a bonus chapter on how to foster health literacy. The editors’ broad experience is evidenced in Section VI, Integrative Nursing: Global Perspectives— State of the Practice. The chapters cover how nursing looks across the globe in such far-flung areas as Germany, Turkey, United Kingdom, Ireland, Iceland, and Sweden with an eye to global activism in the legacy, again, of Florence Nightingale.

The final chapter, Section VII, Conclusion, is interestingly named, Gazing with Soft Eyes. This is nothing less than a call to action to heal our beleaguered health care systems globally. To cite Dr. Koithan,“The soft, inclusive gaze of integrative nursing invites each of us to embrace the moral commitment of healthcare to be in right relationship with the earth, the people that we care for, our communities, and ourselves, creating a system that is responsive, compassionate, and caring.

That statement sums up what is a visionary and expansive work. This book builds on the legacy of Florence Nightingale and other nurses dedicated to the whole person health and healing of their patients. It belongs on the essential reading list of all practicing integrative nurses and physicians, as well as other healthcare providers, nursing faculty, executives in health care systems and hospitals, and health policy makers throughout the world.