Faculty Members Explore Alignment of Integrative Nursing Principles and the Navajo Wellness Philosophy of Hózhó

Jul 9, 2015

In the journal Global Advances in Health and Medicine, University of Arizona College of Nursing faculty members recently authored two articles in which they examined the relationships among cultural wisdom, integrative health and our current health-care system.

In “Living in Health, Harmony, and Beauty: The Diné (Navajo) Hózhó Wellness Philosophy,” Dr. Michelle Kahn-John, assistant professor and member of the Diné tribe, and Dr. Mary Koithan, the Anne Furrow Professor of Integrative Nursing, explored the complex wellness philosophy and belief system of the Navajo people, called Hózhó, and its alignment with the principles of integrative nursing and health.

As identified and defined by Dr. Kahn-John, Hózhó consists of six distinct elements believed necessary for a long, healthy life:

  • Spirituality: honoring spirit of self, others, the Creator, nature and all beings through prayer; paying homage to spirit, ritual, ceremony and spiritual/religious practice
  • Respect: respecting self, others, nature, spirit, animals, the Creator and the environment
  • Reciprocity: the exchange and receipt of support, kindness, help and appreciation
  • Discipline: achieving goals through work and study, self-care, physical activity and helping others
  • Thinking: planning, thoughtfulness, maintaining consistent and positive thoughts
  • Relationships: the interconnectedness of self and family, community, tribe, spirits, living creatures, nature and the universe

These elements are consistent with key principles of integrative nursing, a healing-oriented, whole-person approach to achieving optimal health:


  • are whole systems, inseparable from their environments (Respect, Relationships, Reciprocity)
  • have the innate capacity for health and wellbeing (Thinking, Discipline, Respect)


  • has healing and restorative properties that contribute to health and wellbeing (Spiritualty, Reciprocity, Relationships)

Integrative nursing:

  • is person-centered and relationship-based (Respect, Relationships, Reciprocity)
  • is informed by evidence (Thinking)
  • is focused on the health and wellbeing of caregivers as well as those they serve (Reciprocity, Relationships, Respect, Spirituality)

“The close alignment of integrative nursing principles and the Hózhó Wellness Philosophy elements can be powerful in informing us on how to enhance health-care delivery to be more culturally open and responsive to the needs of our varied populations,” said Dr. Kahn-John. “These two models (Integrative Nursing and the Hózhó Wellness Philosophy) provide us with insights that may be implemented to empower individuals, families and communities with whole-person approaches to achieving optimal health and wellness.”

In a second article, “Gazing With Soft Eyes: Envisioning a Responsive, Integrative Healthcare System,” Dr. Koithan uses the metaphor of “hard” and “soft” eyes, a concept from horseback riding, to envision how to create a more meaningful health-care system that is relationship-centered, culturally open and personalized.

“Hard eyes are sharply focused, seeing very clearly but with limited range and almost oblivious to surroundings,” wrote Dr. Koithan. “Someone riding with hard eyes can almost run another rider over before realizing the other rider is there.”

Instead, says Dr. Koithan, integrative nursing can provide a way to turn “soft eyes” toward our health-care system, offering new solutions and paths to shared goals.

“When riding with soft eyes, you see not only what is immediately ahead but also everything else in the environment… 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.”

Dr. Kahn-John says both articles help underline the significance of integrative nursing as a process that recognizes, supports and encourages the implementation of integrative, whole-person, culturally relevant approaches in the delivery of health care and nursing practice.

“By embracing the principles of integrative nursing, we expand our knowledge and opportunities to integrate existing systems of care and wellness, such as the Diné Hózhó philosophy, into our current health-care system to serve diverse populations in meaningful ways.”


Faculty at the University of Arizona College of Nursing envision, engage and innovate in education, research and practice to help people of all ages optimize health in the context of major life transitions, illnesses, injuries, symptoms and disabilities. Established in 1957, the college ranks among the top nursing programs in the United States. For more information about the college, please visit its website, www.nursing.arizona.edu.