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.
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 modalities (CAM) into clinical practice to
treat peoples 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.
The practice of holistic nursing requires nurses to integrate self-care, self-responsibility, spirituality,
and reflection in their lives. This may lead the nurse to greater awareness of the interconnectedness
with self, others, nature, and spirit. This awareness may further enhance the nurses understanding of
all individuals and their relationships to the human and global community, and permits nurses to use
this awareness to facilitate the healing process.

Definitions[edit source | editbeta]

Team nursing is based on philosophy in which groups of professional and non-professional

personnel work together to identify, plan, implement and evaluate comprehensive client-centered
care. The key concept is a group that works together toward a common goal, providing qualitative
comprehensive nursing care (Kron 1978).

Team nursing was designed to accommodate several categories of personnel in meeting the
comprehensive nursing needs of a group of clients (Donavan 1975).

Objective of team nursing[edit source | editbeta]

The objective of team nursing is to give the best possible quality of patient care by utilizing the abilities of
every member of the staff to the fullest extent and by providing close supervision both of patient care and
of the individual who give it.

Line of organization of team nursing[edit source | editbeta]

A clear line of organization structure is needed for team nursing to provide a mechanism for horizontal
and vertical communication, and an organized pattern is employed.

Functioning of team nursing[edit source | editbeta]

The two important points of functioning are:
1. The head nurse must know at all times the condition of the patients and the plan for their care
and must be assured that assignments and workmanship contribute to quality nursing
2. The team leader must have freedom to use their initiative and the opportunity to nurse, supervise,
and teach unencumbered by the responsibility for administrative detail

Functions of RN[edit source | editbeta]

In the team nursing RN functions as a team leader and coordinates the small group (no more
than four or five) of ancillary personnel to provide care to a small group of patients.

As coordinator of the team, the RN must know the condition and needs of all patients assigned to
the team and plan for the individualised care for each patient. (Marquis and Huston, 2003)

The team leader is also responsible for encouraging a cooperative environment and maintaining
clear communication among all team members.

The team leaders duties include planning care, assigning duties, directing and assisting team
members, giving direct patient care, teaching and coordinating patient activities.

The team leader assigns each member specific responsibilities dependent on the role.

The members of the team report directly to the team leader, who then reports to the charge nurse
or unit manager.

Communication is enhanced through the use of written patient assignments, the development of
nursing care plans, and the use of regularly scheduled team conferences to discuss the patient status
and formulate revisions to the plan of care.

However, for team nursing to succeed, the team leader must have strong clinical skills, good
communication skills, delegation ability, decision-making ability, and the ability to create a cooperative
working environment.

Channels of communication in team nursing[edit source | editbeta]

1. Reports
2. Work or assignment conference
3. Patient care conference
4. Written nursing care plan
The greatest single distinguishing feature of team nursing is the team conference. In general, there are
three parts to the conference;

Report by each team member on his or her patients.

Planning for new patients and changing plans as needed for others.

Planning the next days assessment.

It is essential that the conference be well planned, brief but comprehensive and interesting. The team
leader is the chair person for the conference. They offer opportunity for all personnel to evaluate patient
care and solve the problems through team discussion.
Advantages: (Marquis and Huston, 2003) 1. High quality comprehensive care can be provided despite a
relatively high proportion of ancillary staff. 2. Each member of the team is able to participate in decision
making and problem solving. 3. Each team member is able to contribute his or her own special expertise
or skills in caring for the patient. 4. Improved patient satisfaction. 5. Organisational decision making
occurring at the lower level. 6. Cost-effective system because it works with expected ratio of unlicensed to
licensed personnel. 7. Team nursing is an effective method of patient care delivery and has been used in
most inpatient and outpatient health care settings.
Other advantages: 1. Feeling of participation and belonging are facilitated with team members. 2. Work
load can be balanced and shared. 3. Division of labour allows members the opportunity to develop
leadership skills. 4. Every team member has the opportunity to learn from and teach colleagues 5. There
is a variety in the daily assignment. 6. Interest in clients wellbeing and care is shared by several people,
reliability of decisions is increased. 7. Nursing care hours are usually cost effective. 8. The client is able to
identify personnel who are responsible for his care. 9. Continuity of care is facilitated, especially if teams

are constant. 10. Barriers between professional and non-professional workers can be minimised, the
group efforts prevail. 11. Everyone has the opportunity to contribute to the care plan.
Disadvantages: 1. Establishing a team concept takes time, effort and constancy of personnel. Merely
assigning people to a group does not make them a group or team. 2. Unstable staffing pattern make
team nursing difficult. 3. All personnel must be client centred. 4. There is less individual responsibility and
independence regarding nursing functions. 5. Continuity of care may suffer if the daily team assignments
vary and the patient is confronted with many different caregivers. 6. The team leader may not have the
leadership skills required to effectively direct the team and create a team spirit. 7. Insufficient time for
care planning and communication may lead to unclear goals. Therefore responsibilities and care may
become fragmented.
Modifications: In an attempt to overcome some of its disadvantages, the team nursing design has been
modified many times since its original inception, and variations of the model are evident in other methods
of nursing care delivery such, as modular nursing.

Modular nursing[edit source | editbeta]

Modular nursing is a modification of team nursing and focuses on the patients geographic location for
staff assignments. (Magargal 1980)

The patient unit is divided into modules or districts, and the same team of caregivers is assigned
consistently to the same geographic location.

Each location, or module, has an RN assigned as the team leader, and the other team members
may include LVN/LPN or UAP. (Yoder Wise 2003)

Just as in the team nursing, the team leader in the modular nursing is accountable for all patient
care and is responsible for providing leadership for team members and creating a cooperative work
environment.

The concept of modular nursing calls for a smaller group of staff providing care for a smaller
group of patients.

The goal is to increase the involvement of the RN in planning and coordinating care.
Communication is more efficient among a smaller group of team members. (Marquis and Huston,
2003)

The success of the modular nursing depends greatly on the leadership abilities of the team
leader.

Advantages: (Yoder Wise 2003)

1. Continuity of care is improved when staff members are consistently assigned to the same module
2. The RN as team leader is able to be more involved in planning and coordinating care.

3. Geographic closeness and more efficient communication save staff time.

Disadvantages: (Yoder Wise 2003)
1. Costs may be increased to stock each module with the necessary patient care supplies
(medication cart, linens and dressings).
2. Long corridors, common in many hospitals, are not conducive to modular nursing.