Assignment: Quadrants of Reality

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Assignment: Quadrants of Reality

Assignment: Quadrants of Reality

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The “WE” space—the collective sense of engagement within the individual’s reality

Relationships to others’ cultures and worldviews

Shared visions

Shared leadership

Integral dialogues


How am I relating to others involved in pain management efforts?

What is the meaning of my pain management relationships with my clients? My peers? My supervisors? Other healthcare professionals?

Am I fully engaged in using integral dialogues to enhance my pain management relationships with others?

Collective Exterior


The “ITS” space—the broader sense of being part of an external reality whose systems and structures govern practice

Relations to social systems and the environment

Organ structures and systems

Financial systems

Policy development

Regulatory structures and systems

Information technology

How do pain management policies and procedures influence my connection with my clients?

What is my group role in meeting or changing pain management regulatory guidelines?

How do I use systems and structures to improve pain management practice?

Do I allow technology to help me deliver better pain relief care or does it interfere?

Adapted from Dossey, B., & Keegan, L. (2009). Holistic nursing: A handbook for practice (5th ed.). Sudbury, MA: Jones & Bartlett.

30 International Journal for Human Caring

of quadrants are terms used in everyday

language to convey the direction of our

communication and the direction of one’s

experiences in the world. Each quadrant

helps provide a framework for interpreting

the theory and is guided by four main

principles: (a) Nursing requires the

development of the “I,” (b) the discipline of

nursing is built upon the “We,” (c) “It” is

about behavior and skill development, and

(d) systems and structures are embedded in

and frame the understanding of “Its.” Each

principle continues to remind us that being

an integral nurse is first, more than being a

holistic nurse, and, secondly, an evolving

process that becomes clearer and more

meaningful over time through ongoing

practice and reflection.

All Quadrants, All Levels (AQUAL)

The final concept in the theory of

integral nursing is all quadrants, all levels

(AQUAL). Wilber (2000) recognized that

the quadrants of reality are connected to

levels, lines, states, and types that help

the individual create a comprehensive map

of reality. Levels refer to aspects of the

self that change over time and become

permanent as one moves through stages

of growth and development. Lines refer

to the complex aspects of self that enrich

and enhance one’s development, such

things as multiple intelligences, cognitive

awareness, etc. States refer to temporary


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