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Therapies

holistic nursing

What Is It?
How Does It Work?
What You Can Expect

Health Benefits

How To Choose a Practitioner

References
Evidence Based Rating Scale 

What Is It? 

The American Holistic Nursing Association defines holistic nursing as "all nursing practice that has healing the whole person as its goal." Holistic nursing embodies the philosophy of holism, which was first formulated in the 1930s and emphasizes the importance of understanding a person's whole being rather than breaking down, studying, and treating only the component parts. In fact, the "hol" in holistic is also the root of several other words that help to define this profession: whole, health, heal, hale (as in "hale and hearty"), and holy...  

In addition to utilizing the knowledge, research, and expertise of the nursing profession in general, holistic nurses also draw upon their own and their patients' intuition and creativity to resolve health problems. This could take the form of paying close attention to a patient's emotional state, asking about that person's subjective experiences and beliefs about health, and considering the individual's values when devising treatments.  

Florence Nightingale is considered to be the "founder" of holistic nursing although that term was not used in her time. She followed holistic principles when she advocated treatments that enhanced individuals' abilities to draw upon their own healing powers. She also considered touch, light, empathic listening, music, and quiet reflection as essential components of good nursing care. Many of these principles are incorporated in the training of registered nurses today. Likewise, because of their specialized knowledge in disciplines such as homeopathy, therapeutic touch, or guided imagery, many holistic nurses are ideally poised to support the integration of Complementary and Alternative Medicine (CAM) into current mainstream medical practice. 

How Does It Work? 

In addition to holism, two other concepts are incorporated into the practice of holistic nursing. One is called presence, meaning that in addition to being “there", a holistic nurse makes a conscious decision to be “with" the patient in an emotionally and psychologically open manner. This allows the nurse to guide patients in telling their personal stories with the aim of helping them discover new health behaviors and choices. It also encourages patients to describe their symptoms in a more precise and revealing way, which often helps in diagnosis. For example, a patient in pain might be guided to realize that the pain doesn't simply "hurt," but is actually "squeezing, sharp, and more intense here than there." 

The second concept is healing, which refers not only to the relief of suffering, but to a lifelong process of integrating mind, body, and spirit with which the nurse may assist. With this mindset, a holistic nurse may involve patients in dialogue about finding meaning in life or even in illness, in order to help them discover their own fullest potential. (2) 

What You Can Expect 

During the first meeting with your holistic nurse, you will meet a good listener who is calm, centered, and non-judgmental. Your nurse will ask you questions about your body, mind, spirit, and emotions. If you visit a nurse in a private practice, you may be asked to fill out a questionnaire before your appointment in order to take time to collect your thoughts. You should be clear about your expectations and openly share them with your holistic nurse. Your nurse will be well-versed in traditional western medicine as well as CAM and may suggest how to blend them for your optimal treatment as well as providing some of these services: some holistic nurses include or specialize in modalities such as bodywork, homeopathy (there is also a Homeopathic Nurses Association), guided imagery, Reiki, Therapeutic Touch, and others. (1) 

Health Benefits 

Chronic conditions such as HIV/AIDS, chronic pain, fibromyalgia, and arthritis may not respond well to medical treatments alone and require a holistic approach to treatment. Holistic nurses encourage their patients to take responsibility for their health and wellness by making daily positive lifestyle changes. (1) For example, in a hospital setting, holistic nurses assist with the management of HIV/AIDS patients by coordinating and facilitating their hospital stay and building a relationship with them and their family. They help to establish effective communication between patients and their various healthcare practitioners and sometimes provide after-hours support. (3) The following are examples of conditions where holistic nurses have been effective. 

A holistic approach has been used to treat chronic pain, low back pain, and knee pain. (4) For patients experiencing pain, a holistic nurse understands that pain is complex and different for everyone. Holistic nurses provide compassion and facilitate comfort during pain, which may also help to optimize the effects of analgesic medication. (5) In 2009, the Journal of Holistic Nursing reviewed five studies done between 1997-2004 that indicated Therapeutic Touch, a complementary healing modality, significantly reduced pain and should be considered along with other nursing interventions for pain treatment. (6) A study of women with fibromyalgia used Goal Attainment Scaling (GAS) to measure goal achievements attained through holistic health promotion interventions. The four health promotion areas were Lifestyle Adjustment, Physical Activity, Nutrition, and Stress Management. Over an 8-month period, the study found the percentage of women who attained or exceeded their goals in the four areas increased from a range of15%-26% to 58%-76%. The study concluded that a holistic nurse facilitator was critical to the positive findings because the nurse understood the need for specific measurable GAS and encouraged women to identify their individual meaningful goals. (7) In addition, several reviews have found that a holistic approach is optimal for treating the symptoms of fibromyalgia. (8-10) 

Rheumatoid arthritis (RA) is a chronic inflammatory disease that attacks the joints causing pain and mobility problems. A holistic approach has been shown to favorably affect the progression and outcome of the disease. One Canadian teaching hospital implemented a nurse case manager delivery system wherein nurses devised an interdisciplinary treatment plan for RA. As a result of the nurse-led plan, patients were taught to trust their judgment and become effective at managing their own diseases. (11)  

Holistic nurses have advanced the use of therapies such as music, physical activity, pet visitation, and spirituality and prayer to treat critically ill patients. (12) Patients have asked nurses to pray with or for them as part of their care. Evidence of the healing power of spirituality is inconclusive but there are indications that it may potentially benefit the health and well-being of both patients and nurses. (13) 

How To Choose a Practitioner 

Although many people who work in health care embrace holistic philosophies, only licensed/registered nursing professionals who embody holistic principles can be considered true holistic nurses. Holistic nurses may work in hospitals, clinics or, with the proper licensing, have an independent practice. Look for an individual who has these qualifications: 

  • A current Advanced Practice Nursing (APN) license in the state in which they practice. APN is an umbrella term given to a registered nurse (R.N.) who has met advanced educational and clinical practice requirements beyond the two years of basic nursing education required of all R.N.s. There are four principal types of A.P.N.s: Nurse Practitioner (N.P.), Certified Nurse Midwife (C.N.M.), Clinical Nurse Specialist (C.N.S.), and Certified Registered Nurse Anesthetist (C.R.N.A.).

  • A Bachelor of Science (B.S.) degree or higher from an accredited college or training program recognized by the state licensing agency.

  • Since clinical experience is desirable, seek out a nurse with some experience in an integrative medicine setting or demonstrated ability to integrate conventional and complementary therapies. 

In 2006, the American Nurses Association (ANA) officially recognized Holistic Nursing as a nursing specialty with a defined scope and standards of practice. Specialty  status is important to the profession because it allows holistic nurses to have a foundation of defined standards that distinguishes them from other nursing practices. It also helps them better articulate who they are to the public and to other healthcare professionals.  

The American Holistic Nurses' Certification Corporation (AHNCC) offers two credentials that can be obtained in the field through testing.  One is Holistic Nurse-Board Certified (HN-BC) for nurses with a bachelor's degree and the second is Advanced Practice Holistic Nurse-Board Certified (AHN-BC) for nurses with a master's degree or higher. Nurses who have not achieved Holistic Nurse Certification (HNC) are not authorized to use these credentials. 

References 

1. The American Holistic Nursing Association. Web page. Available at http://www.ahna.org. Accessed February 2, 2010.
2. McDonough-Means SI, Kreitzer MJ, Bell IR. Fostering a healing presence and investigating its mediators. J Altern Complement Med. 2004;10 Suppl 1:S25-41.
3. Whitehead CM. The specialist nurse in HIV/AIDS medicine. Postgrad Med J. 1996 Apr;72(846):211-3.
4. Ventegodt S, Merrick J. Clinical holistic medicine: chronic pain in the locomotor system. ScientificWorldJournal. 2005 Feb 24;5:165-72.
5. Quinlan-Colwell AD. Understanding the paradox of patient pain and patient satisfaction. J Holist Nurs. 2009 Sep;27(3):177-82;quiz 183-5.
6. Monroe CM. The effects of therapeutic touch on pain. J Holist Nurs. 2009 Jun;27(2):85-92. Epub 2009 Mar 19.
7. Becker H, Stuifbergen A, Taxis C, Beal CC, Pierini DM. The use of goal attainment scaling to facilitate and assess individualized change in a wellness intervention for women with fibromyalgia syndrome. J Holist Nurs. 2009 Dec;27(4):232-40.
8. Kenner C. Fibromyalgia and chronic fatigue: the holistic perspective. Holist Nurs Pract. 1998 Apr;12(3):55-63.
9. Littlejohn G. Fibromyalgia. What is it and how do we treat it? Aust Fam Physician. 2001 Apr;30(4):327-33.
10. Lempp HK, Hatch SL, Carville SF, Choy EH. Patients' experiences of living with and receiving treatment for fibromyalgia syndrome: a qualitative study. BMC Musculoskelet Disord. 2009 Oct 7;10:124.
11. Barry J, McQuade C, Livingstone T. Using nurse case management to promote self-efficacy in individuals with rheumatoid arthritis. Rehabil Nurs. 1998 Nov-Dec;23(6):300-4.
12. Lee D, Higgins PA. Adjunctive therapies for the chronically critically ill.  AACN Adv Crit Care. 2010 Jan-Mar;21(1):92-106.
13. Narayanasamy A, Narayanasamy M. The healing power of prayer and its implications for nursing. Br J Nurs. 2008 Mar 27-Apr 9;17(6):394-8.

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

 

Condition

Rating

Explanation

 

Chronic Pain

   

A review showed Therapeutic Touch significantly reduced pain and should be considered along with other nursing interventions for pain treatment. (6)

Fibromyalgia  
One study showed a holistic nurse facilitator was critical for the significant increase in goal attainment by fibromyalgia patients. (7)
Prayer  
Evidence indicates prayer is potentially beneficial to patients and nurses. (13)


Rheumatoid Arthritis  
In one hospital, nurses devised and managed an interdisciplinary treatment plan where patients were taught to trust their judgment and manage their disease. (11)



Date Published: 04/19/2005
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