HOLISTIC NURSING PRACTICE

NURSE HEALER OBJECTIVES

Theoretical :

Synthesize the concepts of natural systems theory

Compare and contrast the allopathic nd holistic models of health care
Describe the components of the bio-psycho-social-spiritual model
Describe the practice and standards of holistic nursing
Compare anf contrast the different eras of medicine
Discuss the activities of the National Center for Complementary and Alternative Medicine
(NCCAM)

Clinical :

Explore two ways to integrate a natural systems view into your clinical practice
Determine if you use a bio-psycho-social-spiritual model to guide your clinical practice
Integrate the standards of Holistic Nursing Practice established by the American Holistic
Nurses Association (AHNA) into clinical practice, education and research.
Integrate complementary and alternative therapies into clinical practice.

Personal :

Integrate complementary and alternative therapies into your daily life to enhance your wellbeing
Develop short- and long-term goals related to increasing your commitment to the holistic
developmental process.

HOLISM
Natural Systems Theory
The traditional biomedical western view of disease usually begins at the systems level and stop at the
molecule level. From the more precise perspective of the natural system approach, however, disease
can originate in a disturbance at any level from the subatomic to the suprapersonal, and it may result
when a force disturbs or disrupts the structure of the natural systems themselves.
Holism and natural systems theory have important implications for directing future research and
health care education as well as for clients and nurses views of health and disease. Those who
advocate the allopathic method combat disease with techniques that produce effects different from
those produced by the disease; those who advocate the holistic model assert that consciousness is real
and is related to all matters of health and illness. Table 1-1 provides a comparison of the allopathic
and holistic models.
Bio-Psycho-Social-Spiritual Model
Care of the patient must include consideration of the psychosocial, spiritual and cultural variables that
influence the perception of illness. The provision of patient care reflects consideration of the patient
as an individual with personal value and belief systems that impact upon his/her attitude and response
to the care that is provided by the organization.

HOLISTIC NURSING
Two major challenges in nursing have emerged in the twenty-first century. The first is to integrate the
concepts of technology, mind, and spirit into nursing practice; the second is to create and integrate
models for health care that guide the healing of self and others. Holistic nursing is the the most
complete way to conceptualize and practice propesional nursing. The AHNA description of holistic
nursing and holism appears in appendix 1-A.
Allopathic Model
Treatment of symptoms
Specialized
Emphasis on efficiency
Profesional should be emotionally neutral
Pain and disease are wholly negative
Primary intervention with drugs, surgery

Body seen as a machine in good or bad repair

Disease or disability seen as an entity

Emphasis on eliminating symptoms and disease
Patient is dependent
Professional is authority
Body and mind are separate; physchosomatic
illnesses seen as mental; may refer (patient) to
psychiatrist
Mind is secondary factor in organic illness
Placebo effect is evidence of power of suggestion
Primary reliance on quantitative information (charts,
tests, and dates)
prevention seen as largely environmental;
vitamins, rest, exercise, immunization, not smoking.

Holistic Model
Search for patterns, causes
Integrated; concerned with the whole patient
Emphasis on human values
Profesionals carring is a component of healing
Pain and disease may be valuble signals of internal
conflicts
Minimal intervention with appropriate technology,
complemented with a range with noninvasive
techniques (physcotechnologies, diet, exercise)
Body seen as a dynamic system, a complex energy
field within fields (family, workplace, environment,
culture, life history)
Disease or disability seen as a process
Emphasis on achieving maximum bodymind health
Patients autonomous
Profesional is therapeutic partner
Bodymind perspective, psychosomatic illness is the
province of all health care profesionals
Mind is primary or co-enqual factor in all illness
Placebo effect is evidance of minds role in disease
and healing
Primary reliance on qualitative information, including
patient reports and professionals intuition;
quantitative data an adjunct
prvention synonymous with wholeness; in work;
relationships, goals, body-mind-spirit

Standards of Holistic Nursing Practice

The AHNA standards of holistic nursing practice define and establish the scope of holistic practice
and describe the level of care expected from a holistic nurse. These standards were developed as a
result of a sophisticated research study on the professional knowledge, activities, and skils required to
practice holistic nursingon a day-to-day basis. The AHNA Standards of Holistic Nursing Practice,
revised in 2003, reflect the five core values of holistic nursing, each of which has an accompanying
description and standards-of-practice action statements. The standards are to be used in conjunction
with the American Nurses Association Nursing: Scope and standards of practice and the standards of
the specific specialty in which holistic nurses practice. They are to be implemented in ones personal
life, clinical and private practice, education, research, and community service. Depending on the
setting or area of practice, however, holistic nurses may or may not use all of the action statements.

AHNA 5 Core Value :

Holistic, Philosophy, Theories, and Ethics

Holistic Education and Research
Holistic Nurse Self-Care
Holistic Communication therapeutic Environment and Cultural Diversity
Holistic Caring Process

Eras Of Medicine
Three eras of medicine currently are operational in western biomedicine. Era I medicine began to take
shape in the 1860s, when medicine was striving to become increashingly scientific. The underlying
assumtion of this opproach is that health and illness are completely physical in nature. The focus is on
combining drugs, medical treatments and technology. In the 1950s, Era II therapies began to emerge.
These therapies reflected the growing awarness that the actions of persons mind or consciousnessthought, emotions, beliefs, meaning, and attitudes-exerted important effects on the behavior of the
persons physical body. In both Era I and Era II, a persons consciousness is said to be local in
nature. That is, confined to a specific location in space (the body itself) and in time (the present
moment and a single lifetime). Era III, the newest and most advanced era, originated in science.
Consciousness is said to be nonlocal in that it is not bound to individual bodies. The minds of
individual are spread throughtout space and time; they are infinite, immortal, omnipresent, and
ultimately, one. Era III therapies involve any therapy in which the effects of consciousness create
bridges between different persons, as with distant healing, intercessory prayer, shamanic healing, socalled miracles, and certain emotions.
Doing and Being Therapies
Holistic nurses use both doing and being therapies. Doing therapies include almost all forms of
modern medicine, such as medications, procedures, dietary manipulation, radiation, and acupunture.
In contrast being therapies do not employ things.but instead use state of consciuosness.these include
imagery, prayer, meditation, and quiet templation, as well as the presence and intention of the nurse.
It is abvious that Era I medicine uses doing therapies that are highly directed in their approach. It
employs things, such as medications, for a specific goal. Era II medicine is a classic bodymind
approach that does not require the use of things, with the exception of biofeedback instrumentation to
increase awarness of bodymind connections.
Rational vs. Paradoxical Healing
Paradoxical healing

Prayer

Placebo effects

Biofeedback

Psychological counseling

Drugs

Irradiation

Surgery

Rational healing
Examples of rational healing include surgery, irradition, medications, exercise, and diet. On the other
hand being therapies fall in to the paradoxical healing category, because they frequently happen
without a scientific explanation. Such an event is called a breakthrough for the very reason that it is
unpredictable-thus, the paradox.
Biofeedback also involves a paradox. For example, the best way to reduce blood pressure or muscle
tension, or to increase peripheral blood flow, is to give up trying and just learn how to be. Individuals
can enter into a state of being, or passive volition, in which they let these physiologic state change
in the desired direction. Similarly, the phenomenon of placebo is a paradox. If an individual has just a
little discomfort, a placebo does not work very well. The more pain a person has, however, the more
dramaticthe response to a placebo medication can be. In addition, a person who does not know that
the medication is a placebo responds best. This is referred to as the paradox of success through
ignorance
This study is an example of nonlocal phenomenon an Era III approach because it involves the
conscious effort of people praying for others at a distance. miracle cures also are paradoxical,
because there is no scientific mechanism to explain them. Every nurse has known, heard of, or read
about a patient who had a severe illness that had been confirmed by laboratory evidence, but had
disappeard after the patient adopted a being approach.
Complementary and Alternative Terapies
Also called unconventional or integrative therapies, complementary and alternative medical (CAM)
therapies traditionally have been defined as those interventions neither taught widely in medical
schools nor generally available in U.S. hospitals. Recently, it has been suggested that CAM therapies

be difined as a broad set of health care practices. Yet one of the most disturbing trends related to CAM
therapies is that patients are not disclosing to their allopathic physicians more than 60 percent of the
CAM therapies used, thus creating d dont ask, dont tell scenario. this in a teapot; they simply are
unaware of what their patients are doing. In addition, skeptics frequently charge that persons
interested in CAM therapies are poorly educated and, thus easily misled. NCCAM has defined five
domains, or categories, of CAM therapies, as outlined in exhibit1-1. The therapies most frequently
used by holistic nurses (based on data collected from the AHNAs 3-year IPAKHN
study,
discussed earlier) are high-lighted. The category of mind/body therapies (ranging from biofeedback,
guided imagery,hypnotherapy, meditation, music therapy, and relaxation to prayer) is predominant in
the holistic nursing domain, undoubtedly because these therapies have the potential to affect the bodymind spirit.
The ultimate goal of the CAM therapies movement is not to supplant modern medicine with
alternatives, but rather to integrate validated alternative approaches with the best of current
conventional medical practice.