Many nurses are energized by the idea of practicing through an integrative lens, but feel overwhelmed at the idea of getting started. At this point in time, you may be thinking, "I can't be an integrative nurse. I don't have training in any of the therapies. Where do I even begin?" Well, evidence-based interventions, such as whole-person approaches to care and integrative therapies are often the first things that come to mind when considering an integrative approach. Becoming an integrative nurse begins with honing your assessment skills. Performing a comprehensive, person-centered and integrative assessment plays an essential role in choosing the most appropriate interventions. Remember, there is no set formula for conducting an integrative assessment. In this video, we will discuss the key elements of an integrative nursing assessment and apply them to different case scenarios. The nursing behaviors at the core of an integrative assessment include: building rapport and trust, gathering data and responding to patient feedback, formulating a care pathway based on patient feedback, and providing closure to each encounter. So why do these behaviors matter? Some of them seem so simple, yet how often are these small but important behaviors forgotten during a busy nursing shift? Developing rapport with the patient is an essential first step in performing a comprehensive integrative assessment. This begins with actions as simple as introducing yourself and asking the patient what their preferred name is. By taking the steps to build rapport, the nurse is letting the patient know they are here to partner with them to make decisions together that will enhance their quality of life. These behaviors build trust. When patients trust their nurse, they are more likely to give honest and complete information. The patient feels safe to ask questions, empowered to make choices, and confident that you, as the nurse, have their best interests at the forefront of your mind and in your actions. Over time, your ability to establish rapport will deepen as will the ease with which you can accomplish an integrative assessment. Here are some examples of behaviors that can help build rapport; introducing yourself, promoting ongoing communication, positioning yourself at eye level with the patient, maintaining eye contact, practicing deep listening, and asking follow-up questions, making connections between different pieces of information. Healing is a dynamic and emergent process. Integrative nurses adjust their approach to fit the evolving needs of the patient. If one intervention or strategy doesn't work, you need to be ready to reassess and move on to the next. The more information and feedback you have from the patient, the easier this is to do. Remember that an integrative assessment is ongoing and continuous. It involves gathering data from multiple sources and values both objective and subjective data. Objective data includes observation, lab values, vital signs, medications, and the physical assessment. Physical assessment should always be included with any integrative assessment. This means the nurse examines all areas of the body pertinent to the encounter. Integrative therapies such as a back massage provide a way to visually assess areas of the skin comprehensively while making the patient feel comfortable and relaxed. When a patient is more relaxed and comfortable, you have a better opportunity to gather quality subjective data. Subjective data includes patient, family, and caregiver interviews, patient history, experience, and preferences, intuition, and other ways of knowing. When interviewing a patient, explore the patient's lifestyle factors. Ask about the environment and other important factors and whole-person care. Additional questions that should be incorporated into the assessment and evaluation cycle include what body, mind, spirit changes are going on? How is the patient and their loved ones adapting to these changes? How can nursing care best support the intrinsic healing process? Integrative nursing assessment pulls together data and feedback from all of the various sources to formulate an individualized care pathway for the patient. Following Principle 5, a continuum of interventions is applied. Integrative therapies are used when appropriate to augment the healing process. Care pathway may involve interdisciplinary communication, such as a nurse talking with the pharmacist to ensure that the patient's medications are dispensed in a way that does not involve complicated dosing at home. It could also take the form of a nurse collecting data from multiple specialists and making a recommendation for a palliative care consult. Last but not least, make sure to provide closure to each encounter with the patient. Some examples include discussing next steps in care, discharge teaching, identifying signs and symptoms to be on the lookout for, telling the patient who to call if questions or issues arise, and when to call or seek emergency care. The key takeaway is that integrative nursing is first and foremost a method for practicing sound clinical nursing. Developing the ability to listen deeply, be present with the patient, and put pieces of information together from the various ways nurses gather data is key to an integrative assessment. When nurses practice integrative nursing assessments, they are using high levels of autonomy and working to the full scope of their practice to impact patient outcomes.
