ByNs Chanif, S.Kep. MNS

An Overview of Holistic Nursing

Health as Wholeness

What is Health?Does it go beyond physical experience?Is it the absence of disease?What does health have to do with the way

we think?How is it related to our relationships with

others and with the environment?

Holism and healthCome from the same Anglo-Saxon root as

heal, whole and holy.Health is the state or process in which the

individual experiences as a sense of well-being, harmony, and unity where subjective experiences about health, health beliefs, and value are honored (Dossey & Guzzetta, 2005)

1. Traditional model: Natural System TheoryProvide a way of comprehending the interconnectedness of natural structures in the universe.

The goal of health care is to decrease the many different disturbances and stressors caused by person’s illness.

Pattern of Natural Systems Components

SystemOrgansCellsOrganellesMoleculesAtomsSubatomic particlesQuarks

2. Holistic model: Bio-Psycho-Social-Spiritual Model• This model, all disease has a psychosomatic component, and spiritual factors always contribute to patient’s symptoms, disease or illness (Dossey, 1997)• Each component is interdependent and interrelated .• It is necessary to address all these components to achieve optimal therapeutic results

Bio-Psycho-Social-Spiritual Model

Biologic Psychologic

SociologicSpiritual

The emergent paradigm of health

Traditional paradigmNew paradigm (holistic)

Treatment of symptoms

Emphasis on efficiencyProfessional should be

emotionally neutralPain and disease are

wholly negativePrimary intervention

with drugs, surgery

• Search for patterns and cause plus treatment of symptom

• Emphasis of human values

• Professional’s caring is a component of healing

• Pain and disease may be valuable signals of internal conflicts

• Minimal intervention with appropriate technology, complemented, noninvasive

The emergent paradigm of health (cont.)

Disease or disability seen as entity

Emphasis on eliminating symptoms and disease

Patient is dependentProfessional is

authority

Mind is secondary factor in organic illness

etc

• Disease or disability seen as process

• Emphasis on achieving maximum body-mind health

• Patients is autonomous• Professional is

therapeutic partner• Mind is primary factor

in all illness• etc

What is Holistic Nursing?

Florence Nightingale, who believed in care that focused on unity, wellness, and the interrelationship of human beings and their environment, is considered to be one of the first holistic nurses.

Holistic nursing is defined as “all nursing practice that has healing the whole person as its goal” (American Holistic Nurses’ Association, 1998, Description of Holistic Nursing).

Holistic nursing is a specialty practice that draws on nursing knowledge, theories, expertise and intuition to guide nurses in becoming therapeutic partners with people in their care. This practice recognizes the totality of the human being - the interconnectedness of body, mind, emotion, spirit, social/cultural, relationship, context, and environment.  

Holistic Nursing• Semua bantuk praktek keperawatan yang tujuannya adalah membantu kesembuhan seseorang secara menyeluruh• Perawat melihat pasien sebagai manusia secara total dimana ada keterkaitan antara tubuh, pikiran, emosi, sosial/budaya, spirit, relasi, konteks dan lingkungan(American Holistic Nurses’ association)

The holistic nurse is an instrument of healing and a facilitator in the healing process.

Holistic nurses honor each individual's subjective experience about health, health beliefs, and values.

Holistic nurses may integrate complementary/alternative therapy (CAT) into clinical practice to treat people’s physiological, psychological, and spiritual needs. 

Doing so does not negate the validity of conventional medical therapies, but serves to complement, broaden, and enrich the scope of nursing practice and to help individuals access their greatest healing potential. 

Complementary and Alternative TherapyThe terms Complementary and Alternative are often used interchangeably , but they are equivalent in meaning.

Complementary implies a therapy used in conjunction with a conventional one.

Alternative therapy refers to one that is utilized instead of conventional treatment

Many Americans use complementary and alternative therapy in pursuit of health and well-being.

The 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of CAT use by Americans, showed that approximately 38 percent of adults use CAT

Defining CAT

Defining CAT is difficult, because the field is very broad and constantly changing.

NCCAT defines CAT as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.

Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathic medicine) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses.

"Complementary medicine" refers to use of CAT together with conventional medicine, such as using acupuncture in addition to usual care to help lessen pain.

Most use of CAT by Americans is complementary.

"Alternative medicine" refers to use of CAT in place of conventional medicine.

"Integrative medicine" combines treatments from conventional medicine and CAT for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine

NCCAM organizes alternative therapies in to seven categories:

1.Natural products2.Mind-body intervention3.Manipulative and Body-Based Practices4.Energy therapy5.Alternative system of medical practice6.Pharmacologic and biological treatment7.Diet and nutrition

Types of Complementary alternative therapy

Natural products

Includes use of a variety of herbal medicines (also known as botanicals), vitamins, minerals, and other "natural products”.

Many are sold over the counter as dietary supplements e.g., taking a multivitamin to meet minimum daily nutritional requirements or taking calcium to promote bone health.

Also include probiotics that available in foods (e.g., yogurts)

Mind-body intervention

Mind and body practices focus on the interactions among the brain, mind, body, and behavior, with the intent to use the mind to affect physical functioning and promote health.

For example meditation, guided imagery, hypnotherapy, deep-breathing exercise, hypnotherapy, relaxation, tai chi, etc

Manipulative and Body-Based Practices

Manipulative and body-based practices focus primarily on the structures and systems of the body, including the bones and joints, soft tissues, and circulatory and lymphatic systems.

commonly used therapies1.Spinal manipulation2.massage therapy

Energy therapyInvolve the use of energy fieldsTwo types: bio field therapies and penetrate the human body.

Practices based on putative energy fields (also called biofields) generally reflect the concept that human beings are infused with subtle forms of energy; Reiki, and healing touch/Therapeutic touch are examples of such practices

Alternative system of medical practice

They are built upon complete system of theory and practice.

These system have evolved apart from and earlier than the conventional medical approach used in the United States.

For example:1.Acupuncture,2. Indian Ayurveda3.Chinese medicine, etc

Pharmacologic and biological treatment

These include substance that are used like certain pharmaceuticals.

For example shark cartilage therapy for cancer and chelation therapy for coronary artery disease , etc

Diet and nutrition

Hippocrates said that food should be used as medicine.

This category include research on the effects of diet and dietary supplements on the treatment and prevention disease.

Standard of holistic nursing practiceThe AHNA standards of holistic

nursing practice (AHNA, 2003), reflects the five core values of holistic nursing.

Each of core values has an accompanying description and standard of practice action statements.

The standard describe a diversity of nursing activities in which holistic nurses are engaged.

They are based on the philosophy that nursing is an art and a science for which the primary purpose is to provide services that enable individuals, families, and communities to achieve their inherent wholeness.

The five core values

2 Holistic education and

research1. Holistic philosophy, theories and

ethics3 Holistic nurse self

care

4 holistic communication, therapeutic environment, and cultural

5 holistic caring process

AHNA 5 Core value

Core 1:Holistic philosophy, theories

and ethics

Menekankan bahwa asuhan yang holistik didasarkan pada suatu kerangka filosofi serta komitmen terhadap pendidikan, refleksi dan pengetahuan.

Core 2: Holistic education and

researchMenekankan bahwa asuhan yang profesioanal didasarkan pada teori, diinformasikan oleh penelitian dan didasarkan oleh prinsip etik sebagaipetunjuk praktik yang kompeten.

Core 3: Holistic nurse self care

Keyakinan bahwa perawat harus terlibat dalam perawatan diri untuk meningkatkan kesehatan dan kesadaran pribadi sehingga perawat dapatmelayani orang lain sebagi suatu alat bagi proses penyembuhan seseorang

Core 4: Holistic communication, therapeutic environment and

cultural competency

Perawat perlu bekerja sama dengan klien untuk menentukan tujuan bagi kesehatan penyembuhan

Core 5: Holistic caring process

Menekankan pada perkembangan untuk memanfaatkan pengkajian dan asuhan terapeutik yang mengacu pada pola, masalah, dan kebutuhan klien dan suatu lingkungan yang mendukung proses penyembuhan pasien

1.1 Standard of Practice Holistic philosophyRecognize the person’s capacity for self-

healing and the importance of supporting the natural development and unfolding of that capacity.

Support, share, and recognize expertise and competency in holistic nursing practice that is used in many diverse clinical and community settings.

Participate in person-centered care by being a partner, coach, and mentor who actively listens and supports others in reaching personal goals.

Standard cont..Focus on strategies to bring harmony,

unity, and healing to the nursing profession.

Communicate with traditional health care practitioners about appropriate referrals to other holistic practitioners when needed.

Interact with professional organizations in a leadership or membership capacity at local, state, national, and international levels to further expand the knowledge and practice of holistic nursing and awareness of holistic health issues.

1.2 Standard of practice holistic theoryStrive to use nursing theories to

develop holistic nursing practice and transformational leadership.

Interpret, use, and document information relevant to a person’s care according to a theoretical framework.

1.3 Standard of practice holistic ethicsIdentify the ethics of caring and its contribution to unity of self, others, nature, and God/Life Force/Absolute/ Transcendent as central to holistic nursing practice.

Integrate the standards of holistic nursing practice with applicable state laws and regulations governing nursing practice.

Standard cont.Engage in activities that respect,

nurture, and enhance the integral relationship with the earth, and advocate for the well-being of the global community’s economy, education, and social justice.

Advocate for the rights of patients to have educated choices in their plan of care.

Standard cont.Participate in peer evaluation to ensure knowledge and competency in holistic nursing practice.

Protect the personal privacy and confidentiality of individuals, especially with health care agencies and managed care organizations.

2.1 Standard of practice holistic educationParticipate in activities of continuing education and related fields that have relevance to holistic nursing practice.

Identify areas of knowledge from nursing and various fields such as biomedical, epidemiology, behavioral medicine, cultural and social theories.

Standard of practice holistic education cont…

Continually develop and standardize holistic nursing guidelines, protocols and practice to promote competency in holistic nursing practice and assure quality of care to individuals.

Use the results of quality care activities to initiate change in holistic nursing practice.

May seek certification in holistic nursing as one means of advancing the philosophy and practice of holistic nursing.

2.2 Standard of practice Holistic Nursing and Related ResearchUse available research and evidence from different explanatory models to mutually create a plan of care with a person.

Use expert clinical judgment to select appropriate interventions.

Discuss holistic application to clinical situations where rigorous research has not been done.

Standard of practice Holistic Nursing and Related Research cont…Create an environment conducive to

systematic inquiry into healing and health issues by engaging in research or supporting and utilizing the research of others.

Disseminate research findings at meetings and through publications to further develop the foundation and practice of holistic nursing.

Provide consultation services on holistic nursing interventions to persons and communities based on research.

3.1 Standards of Practice Holistic Nurse Self-Care

Recognize that a person’s body mind-spirit has healing capacities that can be enhanced and supported through self-care practices.

Identify and integrate self-care strategies to enhance their physical, psychological, sociological, and spiritual well-being.

Recognize and address at-risk health patterns and begin the process of change.

Holistic Nurse Self-CareStandards of Practice cont…

Consciously cultivate awareness and understanding about the deeper meaning, purpose, inner strengths, and connections with self, others, nature, and God/Life Force/Absolute/Transcendent.

use clear intention to care for self and to seek a sense of balance, harmony, and joy in daily life.

participate in the evolutionary holistic process with the understanding that crisis creates opportunity in any setting.

4.1 Holistic Communication Standards of Practice

Develop an awareness of the most frequently encountered challenges to holistic communication.

Increase therapeutic and cultural competence skills to enhance their effectiveness through listening to themselves and others.

Explore with each person those strategies that can assist her/him, as desired, to understand the deeper meaning, purpose

Holistic communication standard cont…

Recognize that holistic communication and awareness of individuals is a continuously evolving multilevel Exchange

Respect the person’s health trajectory which may be incongruent with conventional wisdom.

Promote environments conducive to experiencing healing, wholeness and harmony, and care for the person in as healthy an environment as possible.

Work toward creating organizations that value sacred space and environments that enhance healing.

Integrate holistic principles, standards, policies and procedures in relation to environmental safety

4.2 Therapeutic EnvironmentStandards of Practice

Therapeutic EnvironmentStandards of Practice cont…

Recognize that the well-being of the ecosystem of the planet is a prior determining condition for the wellbeing of the human.

Promote social networks and social environments where healing can take place.

4.3 Cultural Diversity Standards of Practice

Assess and incorporate the person’s cultural practices, values, beliefs, meanings of health, illness, and risk behaviors in care and health education.

Use appropriate community resources and experts to extend their understanding of different cultures.

Cultural diversity standard cont…

Assess for discriminatory practices and change as necessary

Identify discriminatory health care practices as they impact the person and engage in effective non-discriminatory practices.

5.1 Assessment Standards of Practice

Use an assessment process including appropriate traditional and holistic methods to systematically gather information.

5.2 Patterns/need5.3 Outcomes

5.4 Standards of Practice therapeutic care plan

Partner with the person in a mutual decision process to create a health care plan for each pattern/challenge/need or opportunity to enhance health and well-being.

Use skills of cultural competence and communicate acceptance of the person’s values, belief, culture, religion, and socioeconomic background.

5.5 ImplementationStandards of Practice

Implement the mutually created plan of care within the context of assisting the person towards the higher potential of health and well-being.

Use holistic nursing skills in implementing care including cultural competency and all ways of knowing.

5.6 EvaluationStandards of Practice

Collaborate with the person and with other health care team members when appropriate in evaluating holistic outcomes.

Explore with the person her/his understanding of the cause of any significant deviation between the responses and the expected outcomes.

Mutually create with the person and other team members a revised plan if needed.

Thank you