If there is something that every sector of our global society can agree on, it is the need for a transformed healthcare system. Broad stakeholder constituencies, including consumers, educators, providers, policy makers, executives, payers, and scientists, have all issued calls for sweeping changes that address access, quality, safety, patient/family-centeredness, prevention and community-based intervention, and affordability.1-3 Interestingly, consumers and providers alike long for relationship-centered care that is culturally safe, personalized, and meaningful in a system where the delivery of care is supported by our administrative requirements and financing. Recommendations abound, and the points of agreement seem to recede into the swirl of political and ideological controversy.
As I ponder possible ways forward for our health-care system, I am immediately struck by the potential wisdom that can be found in the metaphor of hard and soft eyes (terms that those of us who ride horses understand). Hard eyes are sharply focused, seeing very clearly but with limited range and almost oblivious to surroundings. Someone riding with hard eyes can almost run another rider over before realizing that the other rider is there. The rider with hard eyes studies the arena, takes in the boundaries and markers of the space, plots her course, and moves ahead—often straight ahead—without understanding the nuanced context within which she is operating. When riding with soft eyes, you see not only what is immediately ahead but also everything else in the environment. Riding with soft eyes improves your balance, provides connection to both horse and other riders, and helps prevent collisions. Soft eyes expand your vision and your awareness, providing all the data necessary to assess possibilities, weigh alternatives, identify priorities, and then correct your course. Riding with soft eyes doesn't necessarily mean taking your eyes off the destination; rather, it means that you may be more easily able to identify the path to the goal.4
The wisdom of integrative nursing provides a way to turn soft eyes toward our healthcare system, offering new solutions and paths to our shared goals. In the intricacies of expert integrative nursing, defined as “a way of being-knowing-doing that advances the body-mind-spirit wellbeing of those entrusted to nurses through caring/healing relationships,” we find a profession that historically has used a “soft eyes” approach to patient care.5 Let's look for just a moment at the full meaning and consequences of this approach when used to inform healthcare transformation.
Practicing nursing from a whole-person/whole-systems perspective begins with the recognition that the one we seek to help is a whole person who lives in a particular context (social, relational, temporal, cultural). It does little to recommend therapies, whether biomedical, mind-body, or manipulative, that a person cannot afford or access. Similarly, recommending interventions without considering downstream effects that could lead to a host of additional concerns is ineffective. Integrative nursing asks us to expand and soften our gaze to carefully consider the intervention within the context of the whole person/whole system, assuring that the interventions recommended are accessible, safe, and effective over both the short and long term.
When guided by the principle that people have innate healing capacity, the healthcare system becomes supportive rather than directive; providers become partners rather than prescribers; and consumers become active rather than passive. Integrative nursing invites us to focus on building individual, family, or community resources (biopsychosocialspiritual) that restore and replenish, resources that support wellbeing and wholeness. Therefore, integrative nursing invites us to soften our gaze, recognizing that prevention and active partnership creates a more cost-effective, patient-centered system that decreases the incidence/prevalence of chronic disease while improving the human and planetary condition.
Integrative nurses find meaning and purpose in co-created healing relationships based on mutuality and participatory engagement. Relationships are a central feature in treatment decision making, wherein the patient makes choices across a range of possible interventions that the nurse recommends. We stress the criticality of deep listening and presencing to wellbeing and health. Leadership roles are built upon a foundation of collaborative interprofessional relationships grounded in trust and mutual respect. 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.
Integrative nurses use a full complement of therapies to support/augment the healing process in a manner that first considers the least invasive/intensive therapy. Integrative nursing thus provides an individually nuanced and refined approach to symptom and illness management. I marvel at the potential impact of this single principle. How many iatrogenic conditions could we prevent if we could simply teach children to treat pain using heat or cold before reaching for medication? How much could we save if we tried manipulative, body-based therapies for recurrent headaches before we ordered an MRI and extensive neurological testing? What impact would we have on cost, quality of life, and productivity if we encouraged people to participate in stress-reduction activities rather than asking for the latest prescription advertised on television?
Thus, integrative nursing invites us to turn soft eyes forward and envision the benefits of a system that returns us to our roots. By creating a system that is focused on “putting the patient in the best condition for nature to act,” integrative nursing addresses accessibility, quality, safety, patient-centeredness, and affordability. With eyes that are softened and expansive, I stand in awe of the depth and breadth of the wisdom offered by integrative nurses, gazing forward and seeing so clearly the whole of the possibilities that could lift up our beleaguered healthcare system.
Disclosure Dr Koithan completed the ICMJE Form for Potential Conflicts of Interest and had no conflicts to disclose.
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