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Transcript of Holistic Nursing
"Use of touch, sound, music, and relaxation techniques as part of nursing care" (Frisch, 2013)
Holistic Nursing in Canada: CHNA
-The Canadian Holistic Nurses Association (CHNA) is founded on Rogerian principles which highlight nursing as an art that creatively uses science for human improvement and well-being, with essential values of compassion and unconditional love. (Frisch, 2013)
-CHNA provides specialty determination for holistic nursing and provides a framework to guide the practice based on unitary human universal essence field theory and unitary energy-based nursing practice
-Holistic Nursing is a specialization program in Canada, that is strictly theory-based practice and grounded in Rogers' Science of Unitary Human Beings (UHB). (Frisch, 2013)
Challenges in Practicing Holistic Nursing
Understanding the person as a whole, as opposed to artificially dividing them based on their health conditions.
Nurses are also informed to individualize care. This prioritization of care around the patient’s unique needs, allows the nurse to see the person as whole (I.e. addressing the patient by name).
A popular viewpoint is that holistic nursing involves keeping the whole person in mind and attempts to understand how one aspect of concern relates to the whole person (Berman et al., 2008).
Holistic nursing involves not reducing a person to the sum of their part as he or she functions as a complete unit (Daniel, 2004).
Holism is looking at mind, body and soul.
Chapter Overview: Challenges to Holistic Nursing Practice
CNO Competencies Related to Holistic Nursing
Personal Experiences/Relevance to Modern Nursing Practice
In one sentence, what does holistic nursing mean to you?
Origins of Holistic Nursing
Nurse theorist Myra Levine was the first to term “Holistic Nursing” in practice (1971).
Levine recognized that science and the modernization of technology was bringing a reductionist view of human health (Levine, 1969. 1971).
Due to the technological advancements in healthcare, nursing scholars were fearful of the dehumanization of nursing care.
1. Evidence-Based Practice
2. Electronic Health Records
3. Holistic Nursing Practice in an Interprofessional Environment
4. Sustaining Self Over the Course of a Nursing Career
What is Holistic Nursing?
27. “[the entry level nurse] demonstrates a body of knowledge in nursing science, social sciences, humanities and health-related research…” (CNO, 2014).
As holistic nursing falls into many disciplines outside of nursing science (i.e. theory, humanities, philosophy) it is important for nurses to seek supplemental knowledge to help inform their practice.
the nurse “must consider the philosophy of holism and the work of nursing theorists who serve as guides to holistic practice” (Frisch, 2014) to help lead the way to successful holistic nursing.
67. "[the entry level nurse] assists clients to understand how social and lifestyle factors impact health (e.g. physical activity and exercise, sleep, nutrition, stress management, personal and community hygiene practices, family planning, high risk behaviors)” (CNO, 2006)
This competency reflects the aspect of holism, the idea of viewing the patient from several angles to understand the totality of their choices and actions
Every individual is affected by environmental, psychological, cultural, and social factors and it is important to take everything into consideration in order to provide the best care possible (CHNA, 2008).
It is important to look at factors aside from physical symptoms, such as social and environmental elements, to assess an individual’s health condition
69. "[the entry level nurse] provides pain and symptom management, psychosocial and spiritual support, and support for significant others to meet clients’ palliative care or end-of-life care needs" (CNO, 2006)
A registered nurse who is providing palliative care ensures that both the patient and their significant other/s are getting the support they need, thus enacting the holistic approach of including significant others in the care.
In holistic nursing, it is important to pay attention to patients’ religious, cultural, and spiritual beliefs as it relates to end of life care needs.
Personal Experiences: Holistic Nursing Practice
are common key words used to describe the concept of holism in nursing literature.
At it's highest level, holistic nursing views the nurse as a “healer”.
Quinn (1992) noted that the word
comes from the word “hael” which means to make sound or whole in Greek.
Quinn (1992) believed that being whole stems from the relationship between the client and the nurse and that the center of healing is not outside of the client but within their centre.
Holistically Oriented Nursing Theories
The 1970s and 1980s were important decades in nursing.
There were four movements which influenced holistic nursing during this time:
1) Presentation of holistically oriented nursing theories
2) Development of nursing language and classification systems
3) Scholarly journals written by practitioners who used holistic nursing approaches in actual practice
4) A number of nursing organizations were created which had an overarching goal of advancing the profession.
• Nursing theorists, notably Watson, Erikson, Rogers, Parse, and Newman, conceived nursing theories which related Holistic Nursing to patient care:
• Watson emphasized human care; the caring healing relationship between nurse and client (Frisch, 2013)
• Rogers defined the person as an irreducible whole - what she termed as a human energy field that cannot be separated into different parts (Frisch, 2013)
• Parse, whose Human becoming theory was influenced by Rogers, stated that the person was irreducible and completely intertwined with the environment and the nursing care provided (Frisch, 2013)
• Newman inferred that health is an expanding consciousness that includes a "person’s total energy field pattern and nursing care as an avenue through which new energy patterns can be created” (Frisch, 2013)
• Erikson emphasized modeling the client’s world which in turn asks for the nurse to understand the world and model health behavior from the client’s world view (Frisch, 2013)
: "One nursing intervention linked to holistic practice is that of touch. So much can be said in a touch, to hold someone’s hand or touch their shoulder. Humans thrive on touch and I believe it is an important aspect of interaction. When I was at the hospital with my newborn baby for five days, the nurses who made a difference for me were the ones who held my hands or gave me a hug when they could sense that I needed it. They were the nurses who made a difference in my stay and inspired this journey. The others, although competent, did not leave me feeling confident or taken care of. I do not remember their faces anymore, but will always remember the faces of the nurses who made me feel like I was doing a good job and that my baby was going to be okay."
Holistic Nursing Practice is a useful approach to nursing which can greatly benefit a patient’s care. Viewing the client as a whole can make them feel more at ease and more motivated to participate in their care.
: "Holistic Nursing practice is difficult to implement in my current practice (complex continuing care unit) for several reasons:
• Most patients are non-verbal therefore it is difficult to get a sense of the uniqueness of each one of them
• the uniqueness of each patient is difficult to gauge without the two-way interactional relationship between client and nurse
• The emphasis seems to be on recognizing each patient’s diagnoses and how those diagnoses affect the client’s disease state and physical needs."
- Modern healthcare is in a continuous search for quality through standardization that is based on research.
- The Evidence-based practice (EBP) movement neither defines what evidence is nor does it readily examine the limits of evidence.
- EBP is usually determined through randomized controlled clinical trials that leave no room for clients who do not meet standard of homogeneity required of experimental subjects.
- It is difficult, or nearly impossible to define and obtain evidence of efficacy for some of the healing modalities used by holistic nurses.
- EHR are seen as efficient and time saving means.
- The language used in EHR, classification systems and taxonomies are often too specific for a holistic nurse to fully portray the range of information, action, and outcomes involved in providing holistic care.
- Holistic nurses who may be more comfortable using narrative documentation are faced with the challenge of either using the standardized language or to become silent in a system that will include only electronic entries based on coded terms.
Electronic health records
Holistic practice in an interprofessional environment
-The nurse’s contribution to the interprofessional team resides not only in holistic values and attitudes but also in the ability to implement care processes that incorporate them.
- Nurses are often in the best position to interpret for the team members what is important to the patient, as they attend to the needs, feelings, and subjective experiences of the client.
- Essentially, the nurses contribution to the interprofessional team depends on whether the nurse's ability to practice holism, as it depends on the nurses' ability to engage in relational practice, understand the patient, and bring unique contribution to the team's thinking.
Sustaining self over the course of a nursing career
- Nurses are at significant risk for vocational "burnout" and emotional exhaustion, self-care practices may be the difference between those who prosper in nursing and those who are unable to sustain the work-life demands.
- Nurses must attend to their own personal awareness and self-care through honest self-assessment of one's life demands and must cultivate awareness and understanding of the deeper meaning and purpose of life.
• Many of the nurses concerned about patient dehumanization took a holistic view versus the prevailing scientific views held by other healthcare providers.
• Erikson (2007) describes it in this manner:
(1) One group of nurses were advocating for the progression of the profession through the advancement of nursing care for specific organs i.e. medical-surgical; nephrology, cardiac - this group of nurses believed that an individual was divided into different parts i.e. physiological , biological; cognitive parts; but also believed that nursing care could be provided to one of these parts in isolation to the other parts; she termed these nurses as “wholisitic”
(2) The second group of nurses represented the holistic approach to nursing care- these nurses understood that the whole is greater than the sum of the parts. Erikson (2007) termed these nurses as being Holistic. They followed in the foot-steps of Florence N. and made caring and emphatic care the main focus of nursing care.
Origins of Holistic Nursing
How would you approach this situation from a holistic nursing prospective?
Family members can be used as an extension of the patient. For example, family members of one patient have informed staff that the patient likes a certain type of music. A nurse was able to institute a holistic approach by recognizing that this simple request (having the radio on) adds to the healing and comfort of the patient as a whole.
When interacting with clients or providing nursing interventions be truly present.
Remember that your clients have physical needs, but also spiritual and intellectual needs. Don't forgo nourishing the latter two.
Form a partnership rather than a hierarchy with your clients and their families.
Tend to the client's healing environment as it is integral to their well-being.
Love yourself! Self care will allow you to be an amazing nurse for years to come.
What is Holistic Nursing?
Holistically Oriented Nursing Theories
Berman, A., Snyder, S.J., Kozier, B. (2008). Fundamentals of nursing: Concepts, process and practices (8th ed.). Upper Saddle River, NJ: Prentice Hall.
Briggs, C.L, Lovan, S.R. (2014). Nursing Students’ Feedback to a Spiritual Health Reflection.
Journal of Holistic Nursing: American Holisitc Nurses Association. 23
CNO. (2014). Competencies for entry-level Registered Nurse practice. Retrieved from, http://www.cno.org/Global/docs/reg/41037_EntryToPracitic_final.pdf
Erickson, H. (2007). Philosophy of theory of holism.
Nursing Clinics of North America, 42
Frisch, N. (2013). The Challenges of Holistic Nursing Practice. In McIntyre, M. & McDonald, C. (Eds.),
Realities of Canadian nursing: Professional, practice and power issues (4th ed.)
(pp. 338-352). Philadelphia: Walters Kluwer Lippincott, Williams & Wilkins.
Jackson, C. (2012). The Role of Healing Modalities (Complementary/Alternative Medicine) in Holistic Nursing Practice.
Holistic Nursing Practice, 26
(1), p 3–5.
Levine, M. (1971). Holistic Nursing.
Nursing Clinics of North America, 6
Quinn, J. (1992). On healing, wholeness and the haelan effect.
Nursing Outlook, 10
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7. “[the entry level nurse] actively engage[s] in interprofessional collaborative practice essential for improvement in client health outcomes” (CNO, 2014).
A core belief of the CHNA is it that nurses should practice in collaboration with other health care professionals, to achieve favourable health outcomes for the client (CHNA, 2008).
Interprofessional collaboration allows nurses to lead to the best outcomes for their clients by influencing decisions outside of nursing scope of practice. As nurses are the health care professionals who are most closely involved with the client, they are in a unique position to inform other team members of the clients' unique needs, desires and hopes.