An Overview of Holistic Nursing

By
Ns Chanif, S.Kep.
MNS
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 health
Come 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 Theory
Provide 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 persons illness.
Pattern of Natural Systems
Components

System
Organs
Cells
Organelles
Molecules
Atoms
Subatomic particles
Quarks
2. Holistic model:
Bio-Psycho-Social-Spiritual
Model
This model, all disease has a
psychosomatic component, and
spiritual factors always contribute to
patients 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

Spiritual Sociologic
The emergent paradigm
of health
New paradigm
Traditional paradigm (holistic)
Treatment of Search for patterns and
symptoms cause plus treatment of
symptom
Emphasis of human
values
Emphasis on efficiency Professionals caring is a
Professional should be component of healing
emotionally neutral Pain and disease may be
Pain and disease are valuable signals of
wholly negative internal conflicts
Primary intervention Minimal intervention with
appropriate technology,
with drugs, surgery complemented,
noninvasive
The emergent paradigm of
health (cont.)

Disease or disability Disease or disability

seen as entity seen as process
Emphasis on Emphasis on achieving
eliminating symptoms maximum body-mind
and disease health
Patient is dependent Patients is autonomous
Professional is Professional is
authority therapeutic partner
Mind is secondary
Mind is primary factor
factor in organic illness in all illness
etc 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
thefirstholistic 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 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.
Com Alt Ther
Complementary and
Alternative Therapy
The 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 38percent of adults
use CAT
DefiningCAT

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
integratedmedicine
NCCAM organizes alternative therapies
in to seven categories:
1.Natural products
2.Mind-body intervention
3.Manipulative and Body-BasedPractices
4.Energy therapy
5.Alternative system of medical practice
6.Pharmacologic and biological
treatment
Types ofComplementary
7.Diet and nutrition
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-
BasedPractices
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 therapies
1.Spinal manipulation
2.massage therapy
 Energy therapy
Involve the use of energy fields
Two 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 Ayurveda
3.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 practice
Standard of holistic nursing
practice
The 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
1. Holistic research
philosophy,
theories and 3 Holistic
ethics
nurse self
AHNA 5 care
Core value

5 holistic 4 holistic
caring process communicatio
n, therapeutic
environment,
and cultural
 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
research
Menekankan bahwa asuhan
yang profesioanal didasarkan
pada teori, diinformasikan oleh
penelitian dan didasarkan oleh
prinsip etik sebagai
petunjuk 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 dapat
melayani 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
philosophy
Recognize the persons 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 theory
Strive to use nursing theories to
develop holistic nursing practice
and transformational leadership.
Interpret, use, and document
information relevant to a persons
care according to a theoretical
framework.
1.3 Standard of practice
holistic ethics
Identify 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 communitys 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
education
Participate 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 Research
Use 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 persons 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-Care
Standards 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.
Develop an awareness of the most
frequently encountered challenges to
holistic communication.
Increase therapeutic and cultural
4.1 Holistic Communication
competence skills to enhance their
Standards of Practice
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 persons health
trajectory which may be
incongruent with conventional
wisdom.
 4.2 Therapeutic Environment
Standards of Practice
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
Therapeutic Environment
Standards 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
persons 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.
 Use an assessment process
including appropriate
traditional and holistic methods
to systematically gather
5.1information.
Assessment Standards of
Practice
5.2 Patterns/need
5.3 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
persons values, belief, culture, religion,
and socioeconomic background.
 5.5 Implementation
Standards 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 Evaluation
Standards 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