Critical Review of the Evolving Essence of the Science of Nursing: Complexity Integrated Nursing Theory

The following paper provides a critical review of the e-book The Evolving Essence of the Science of Nursing: The Complexity Integration Nursing Theory. An analysis of the complexity integration nursing theory (CINT) revealed a comprehensive meta theory that included four grand theories. CINT offered a deeper philosophical understanding of the nursing discipline for all levels of nurses. CINT is a pathway to socialize new nurses into the complex profession of nursing. The e-book is useful in both academia and evidence-based practice. The authors’ rigorous research has led to a well-organized, clear and comprehensive presentation of an overarching wealth of knowledge. The critical review draws parallels between CINT and the humanistic nursing theory through the use of the concepts of holism and energy exchange. CINT’s philosophical influences, strengths, and theoretical underpinnings are analyzed. CINT’s self-observation method can be used by advanced practice nurses to gain a better insight into the needs of the patient. Critical Review of the Evolving Essence of the Science of Nursing: Complexity Integrated Nursing Theory Publication History: Received: January 27, 2017 Accepted: April 03, 2017 Published: April 05, 2017


Introduction
The e-book The Evolving Essence of the Science of Nursing: The Complexity Integration Nursing Theory [1] extended beyond the limits of ordinary and provided a meta theory that is both multidimensional and useful for nurses.The authors' work is not just another text discussing nursing theory but takes the next step by giving the reader a bounteous and enlightened disposition to the nursing discipline.The authors were successful at putting together a much-needed and welcomed book that provided a complex pathway to socialize nurses into the profession.The following book review critically analyzes the contributions of complexity integration nursing theory (CINT), how the authors approached and presented the information, and the application to advanced practice nursing.

Evaluation and Summary
The Evolving Essence of the Science of Nursing: The Complexity Integration Nursing Theory presented an in-depth meta theory that directed the reader to delve deeper into the understanding of the nursing discipline.CINT highlighted the importance of mathematics and technology in developing nursing theory.The first section recognized that new nurses must be socialized into the complex profession of nursing.CINT is composed of four grand theories: the theory of nursing knowledge/wisdom, the theory of nursing praxis, the human being nursing theory, and the social entirety nursing theory [1].The theory of nursing knowledge/wisdom used a mathematical statement that described nursing knowledge as the sum of the nursing foundation, methodology, nursing essence, and disciplined inquiry [1].In addition, the theory of nursing praxis stated in mathematical form "The depth and breadth of practice (P) is determined by the individual nurse's (IB) integration and synthesis through cognitive, affective, psychomotor, and spiritual domains of self, times nursing knowledge (NK)" [1].
The second section of the book focused on the evolution of nursing essence.The theory used deep ecology framework that showed the interdependence of phenomena since nursing is a process of nature [1].Additionally, nursing essence acknowledges all past, present, and future nursing theories.A major construct of CINT was Plato's Allegory of the Cave which was a metaphor that showed how deceptive realities can limit perceptions [1].The complexity and chaos theory viewed the human being as a complex, open system composed of the four concepts of philosophy, science, civilization embedded in culture, and interconnection between ontology and metaphysics [1].The human being was modeled by three foundational concepts (science, philosophy, and culture) at the center of the holon [1].The hyper-holon was the surrounding areas that represent the transcended individual [1].Social entirety nursing theory recognized that the social entirety is composed of society as an entity and society constructed by individuals [1].
The third part of the book explained how problem-solving through the self-observation knowledge methodology allows the nurse to reflect through deep relaxation with introspection, self-observation, and transcendence [1].The method allows the nurse to gain critical insight into daily life [1].In the last part of the book, the authors provided meta-reflections in nursing which showed how CINT supports the shifting paradigm [1].

Contributions to Academia, Scholarly Community, and Best Practices
CINT has contributed to nursing theory which has added value to the nursing discipline as a whole.The nursing discipline has been degraded by the elimination of theory as an underpinning to practice [2].Without theory, nursing is a set of tasks rather than a profession [2].CINT's goal was to provide a framework for the process of socialization of new nurses in the ever-changing healthcare industry.Socializing the nurse into the profession involves introducing the nurse to the key theoretical concepts for practice [1].CINT can be used as a theoretical foundation for academia.An excellent example of the application to academia emerged in the discussion of Greenville Technical College.CINT's theory of nursing knowledge/wisdom and nursing praxis guided the development of the program's curriculum [1].

Approach, Rigor, Theoretical Foundation, and Readability
The nearly nine-page reference list and robust in-text support from scholarly works spoke to the rigor of the authors' research.The authors approached the topic by first identifying the existing need for the socialization of nurses.CINT has merged nursing theory with mathematics and science which supports nursing as a true discipline of science.The mathematical equation gave a simple representation of a complex, abstract concept.The theoretical foundation was influenced by the philosophies of Albert Einstein, Socrates, and Florence Nightingale.The e-book provided a meta theory that offers complex, overarching ideas written in a fluid, readable style.The authors provided extensive examples to describe the presented ideas better.Brightly colored, visually-interesting models depicted the content in a thought-provoking manner.

Comparison to Humanistic Nursing Theory
Similarities are drawn between the concepts of CINT with Paterson and Zderad's Humanistic Nursing Theory.CINT detailed how energy flows from the nurse in the form of nursing care to the patient and transformed and returned to the nurse.The human being has a continuous flow of energy through the connected components that make up the individual.Similarly, the humanistic theory views the human being as an open energy field with unique life experiences [3][4][5].The human being as an energy field is more than the sum of the individual parts [3].The two meta theories exhibited parallels on the perspective of the human being containing energy and holistic view of the human being.

Influences and Evidence-Based Practice
The philosophies of Albert Einstein, Socrates, and Florence Nightingale were common threads throughout the book.Einstein influenced CINT by defining the components of science and art.CINT also used Einstein's principle of energy exchange by applying the concept to energy exchange between the human being and the environment [1].Socratic ignorance was applied to the nurse's need first to study the self.Socrates' influence appeared through the use of the metaphor of the Platonic cave.Florence Nightingale's appreciation of health and beauty influenced CINT with the view that nursing is an art [1].
CINT provided the theoretical basis for evidence-based practice.Evidence-based practice integrates best current research with a theory to develop the best practices [6].Nursing theory is the best evidence for evidence-based nursing care [6].In the social entirety nursing theory, holistic care encompassed all components that make up the human being.The human being is a complex living system with interconnected links of philosophy, culture, science, and the being [1].The theory guided evidence-based practices in holistic nursing and informed research efforts that incorporate the whole person as the central focus.

Merits, Usefulness, Strengths, Weaknesses, and Theoretical Base
The book was coauthored by nurses with different graduate level educational preparation which established the credibility.An international perspective enlightened the book since the authors have different countries of origin.The international perspective was evident through the Greek influence.Strength of CINT was how elements of the theory brought to life clinical applications and scenarios that engaged the reader.A weakness of CINT was that it is not testable since it is a metatheory.However, the grand nursing theories are testable.Also, there is one minor spelling error noted in the instructions on self-observation methodology, but it does not interfere with understanding the message.The authors were instructing the reader to find a quiet environment and erroneously used the word quite.

Theoretical Underpinnings
Holism was a common theoretical underpinning throughout the text.Holism's focus is on the whole rather than each component [7].CINT viewed the human being within the holon or the entirety in the human being theory.Greek philosophy appeared to be a theoretical underpinning in CINT.Greek philosophy was incorporated through the use of metaphysics which derived from Aristotle's collection of books [8].As a metatheory, CINT viewed the nursing discipline through a metaphysical looking glass.Metaphysics is a branch of philosophy that deals with the nature of being and the world that encompasses it [8].CINT used metaphysics to try to decipher the nature of nursing, the human being, and the environment.Another Greek philosophical underpinning was the use of the Plato's Allegory of the Cave.The metaphor was used to portray how false realities can alter one's perception of the world.

Application to Advanced Practice Nursing
The self-observation method is a unique, useful technique for advanced practice nurses (APN) to delve deeper into the perceptions of their patients.The technique is a useful way for the APN to connect with patients on a higher level to better understand the patient's true needs.The self-observation method has taken the nursing skill of intuition to a greater level.APNs will appreciate CINT alignment with the unique attributes that the APN contributes as a clinician.The book is a must-read for nursing scholars as they evaluate important nursing issues to identify areas of future nursing research.As a metatheory, CINT touched on multiple abstract concepts that informed lower level theory development and areas of research that led to evidencebased practice.

& Clinical Practices Natalina Stanga 1 and Lois Oquin 2*
© 2017 Stanga et al.This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.