Holistic Nursing

You’ve heard about holistic nursing for a while but you’re still not quite sure what it means.

You’ve got an integrative care department in your healthcare organization and all you know is that patients can get acupuncture treatments, guided imagery, and maybe even some energy treatment that has a name you can barely pronounce.

You’re curious about it but maybe a little intimidated about how to go about learning what holistic nursing entails.

I have been teaching holistic nursing and integrative care for 30 years, and it’s time to dispel the myths.

 

Scientific Artistry of Holistic Nursing

Holistic nursing has emerged in professional healthcare practices over the past 30 years with the founding of the American Holistic Nurses Association (AHNA) in 1981.

Derived from a Greek-Indo-European root “holos” or “hale,” meaning “whole, healthful, healing, holy,” the word holism implies a relationship based upon caring for the whole person, body-mind-spirit. It is critical to go one step further and recognize the person’s environment, both internal and external, have a significant impact on his health and well-being.

 

Nurses are experts at the science of nursing practice, but sometimes the artistry receives less attention. According to a recent Gallup poll, nurses were rated the highest in honesty and ethical standards for the 11th year in a row.¹

It is, however, the artistry of nursing practice that creates an environment conducive to healing and on which nursing care is rated in the Hospital Consumer Assessment of Health Plans Survey (HCAHPS). A caring presence can enhance the capacity to be courteous and respectful; listen and explain; hear a patient’s story and understand his needs; and respond to a call bell in both a timely and caring manner.

This is the artistry of our practice. This is what our patients are yearning for: a compassionate and caring nurse who connects with them when they are frightened, vulnerable and uncertain.

You may now be asking yourself: is that all holistic nursing is? Well, not quite.

Philosophy & Theory

Newton and Descartes, scientists in the 1700s, were forerunners of mechanistic thinking, which reduces everything into measurable parts. The Cartesian framework continues to be the foundation of conventional Western medicine as exemplified by separating a person’s body from his mind and spirit.² This may be demonstrated in nursing lingo such as “the liver in room 301.” Although we know there is a whole person in that room, the language perpetuates the mechanistic paradigm of viewing people only as their body part rather than as a whole person with a rich life story.

The early 20th century ushered in new thinking in modern physics. Albert Einstein’s theory of relativity provided a unified foundation of physics, influencing an evolving scientific worldview that was holistic and interrelated.³ Einstein viewed the universe as an interconnected web of wholeness. Recognizing this thinking as the foundation of holistic care, we understand that we cannot separate a person’s body from his mind or spirit – nor can we separate the person from the environment, including the interaction with nurses.

The roots of holistic nursing emerged from the vision of Florence Nightingale. In her book, Notes on Nursing first published in 1860, Nightingale described the work of nursing as putting patients in the best condition for nature to act upon them, emphasizing touch and kindness along with the healing properties of fresh air, sunlight, warmth, quiet and cleanliness.⁴ Nightingale viewed people as multidimensional beings inseparable from their environment.

Nightingale and three contemporary nursing theorists – Martha Rogers, Margaret Newman and Jean Watson – have contributed to the evolution of holistic nursing. Rogers’, Newman’s and Watson’s theoretical frameworks all have similar principles: you cannot separate people into parts, and cannot separate them from the influences of their environment.^5-7

Holistic nursing also embraces a unitary perspective within the healing relationship between the nurse, patient and environment.

Caring for Self

Caring for ourselves is a unique requirement for holistic nurses. Core Value 5 of the Holistic Nursing Scope and Practice is: Holistic Nurse Self-Reflection and Self-Care (see Figure ). The importance of this Core Value is well-articulated in an article by Burkhardt and Nagai-Jacobson who state “it is difficult to be a healing presence with others if our own vessel is empty.”⁸

Nurses are experts at caring for others but are often novices at caring for themselves, creating growing concerns of burnout, compassion fatigue, moral distress, lateral violence and safety. While a stressful work environment is a big contributor, we must recognize and take responsibility for our own needs, both on and off the job.

As nurses improve their self-care, they can anticipate enhanced nursing satisfaction and a reduction of safety concerns. Taking breaks will provide time for renewal to be able to greet the intensity and stressors in the workplace.

Modality Myth Dispelled

One of the oldest myths about holistic nursing is that it is simply an integration of various complementary and alternative modalities such as aromatherapy, therapeutic touch, reflexology, music therapy, guided imagery and a wide array of energy-based therapies. While these modalities provide valuable healing connections, it is not the modality that defines the essence of a holistic practice. It is the quality of relationship through the nurse’s way of being that denotes holistic nursing.

Janet Quinn, PhD, RN, describes “the nurse as a healing environment,” not just the nurse being in a healing environment.⁹ Most of our healthcare venues are not particularly healing with bright lights, noisy halls and interrupted patient sleep. This means that the nurses’ relationships with others, including their co-workers, contribute to the healing potential of the patient.

Authentic holistic nursing practice requires understanding and applying the philosophy and principles of mind-body-spirit care in all aspects of practice. Once that foundation is in place, it is important to review the research and select evidence-based integrative modalities that fall within the individual state scope of nursing practice. Before clinical implementation, it is equally important to check with the organization’s policy on integrative practices.

A Recognized Nursing Specialty

The AHNA is the professional nursing organization that supports the practice of holistic nursing. In 2006, holistic nursing was officially recognized by the American Nurses Association as a nursing specialty with a defined scope and standards of practice.

The American Holistic Nurses Credentialing Corp. (AHNCC) is responsible for the administration of the National Board Certification in Holistic Nursing examination. There are four tiers of holistic nursing certification available: Diploma and Associate Degree in Nursing (HN-BC), Baccalaureate in Nursing (HNB-BC), Master’s Degree in Nursing (AHN-BC) and APRN (APHN-BC).

Holistic Nursing is a scientific art with a body of knowledge grounded in a philosophical and theoretical framework that informs the development of heart-centered relationships between the nurses and their patients, colleagues, family and friends. It is the nurse’s way of being – their therapeutic presence, non-judgmental compassionate care and personal self-care practices – that exemplifies a holistic nurse.¹⁰

The vision for the future of holistic nursing is vibrant and progressive. With the intention of creating caring cultures and healing environments, holistic nurses are enhancing the quality of care to improve both nursing satisfaction and the patient care experience.

Veda Andrus is vice president, Education and Program Development, The BirchTree Center for Healthcare Transformation, Florence, Mass.