Abstract
Named as a top trend to watch in integrative medicine, holistic nursing is a growing discipline that perhaps has never been more essential in a fragmented medical system in need of a more humanistic approach. Historically, nurses have always been on the frontlines of directing patient care in the fields of complementary and alternative medicine (CAM) and providing much-needed compassion and education for their patients. Today, the field of holistic nursing is expanding and increasingly recognized as an essential part of an integrative approach to care.
Carla Mariano, EdD, RN, AHN-BC, FAAIM Professor and Interim Program Director, Holistic Nursing Program, Pacific College of Oriental Medicine, Adjunct Associate Professor, New York University, Rory Meyers College of Nursing, commented in an interview: “Today, the American public increasingly demands healthcare that is compassionate, respectful, provides options, is economically feasible, and grounded in holistic ideals. As well, people desire to be more actively involved in health decision-making and are calling for a care system that encompasses health, quality of life, and a relationship with their provider. Holistic nursing provides this type of care.” Mariano added that while a caring and healing approach is integral to nursing, this approach is often replaced by the conventional biomedical approach focusing on cure. She said, “With today's technological advances, ‘caring healing’ is increasingly important, and nurses yearn for an opportunity to practice in a caring healing manner.”
Lourdes Lorenz-Miller, MSN-IH, RN, AHN-BC, NEA-BC, President of the American Holistic Nurses Association (AHNA), affirmed, in an interview, that the public is eager to receive holistic care because it is a more complete and personal approach to their health challenges. She said, “Since 2006, when holistic nursing became an official nursing specialty recognized by the American Nurses Association (ANA), the field has been gaining strength and impact on both nursing and healthcare.” In fact, the holistic nursing specialty is expected to grow by nearly 20% by 2022, and the same growth is expected for registered nurses by 2022, according to Lorenz-Miller. In regards to considering holistic nursing as a top trend in integrative medicine today, Lorenz-Miller stated: “Prevalent topics in holistic nursing today include: the overall demand for focused and person-centered care, the use of non-pharmacological remedies for pain management and the fact that healthcare professionals need to focus on self-care to remain healthy, vibrant practitioners.”
The Evolving Role of the Holistic Nurse
Evolving as a practice through time, holistic nurses adopt the broad view of patient care and have addressed the many aspects of a person's body, mind, and spiritual life. From holistic nursing's early roots, Kinchen commented in an article that Florence Nightingale “considered illness as a state of disequilibrium and healing as a natural process, strongly influenced by a patient's environment.” 1 Lorenz-Miller said, “Florence Nightingale is considered the first holistic nurse. She was an exemplary nurse statistician and the first to document the influence of sanitation, fresh air, sunlight, nutrition, the arts, and the environment on healing.” Lorenz-Miller added, “Holistic nurses of the past and now share a mission to create healthcare systems that promote self-care for all participants: the health professionals, the patients, and the family members, and focus on facilitating whole-person healing and healing environments rather than just treating illness.”
The AHNA defines holistic nursing as “all nursing that has healing the whole person as its goal.” 2 Clarifying this definition in further detail, Lorenz-Miller commented: “This means the ability to assess, plan, intervene, evaluate and perform preventive, supportive and restorative functions of the physical, emotional, mental and spiritual domains. This can include: providing aromatherapy, guided imagery, healing touch, mindfulness, Reiki, reflexology, creative expression and nurse coaching.” However, Lorenz-Miller cautioned that it is important for clinicians to remember that holistic care and nursing is more than just a set of complementary modalities. She said, “Holism is a philosophy and an approach to living, and holistic healing focuses on helping individuals and groups find harmony in body, mind, spirit and environment.”
Mariano, who established the Advanced Practice Holistic Nursing Graduate Program at New York University's (NYU) Division of Nursing, New York City, 3 stated: “Nurses want to practice with compassion, heart, creativity, flexibility, and partner with clients, and the holistic approach allows them to do so.” She added that holism is now incorporated into the ANA Scope and Standards of Practice and the American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education in Nursing.
Similar to other healthcare professions, those in the nursing profession suffer from a high rate of burnout. Fortunately, holistic nursing has at its core an emphasis on the importance of self-care. Mariano said, “Self-care practices help increase resilience in nurses and prevent burnout, and many nurses are searching for a more meaningful and rewarding practice and a way to be in the world. Holistic nursing principles and practices affect the nurse both personally and professionally.” She added, “In today's stressful environment, self-care and self-reflection are essential ingredients to holistic nursing.”
An article by Lange et al. explored the legacy of several holistic nurses and their core experiences, roles, and values as a holistic nurse. 4 The authors commented that courage, dedication, relationship-centered care, openness to alternative and natural approaches when caring for people, and attention to the whole person in practice were common themes. One of the nurses featured in the article, Eileen Cunningham, was described as one who “recognized that health occurred within the totality of the community and environment and not as a series of fragmented parts and departments in the hospital.” 4 The authors added, “Eileen views holistic nursing as always remembering that the person who has certain symptoms still exists within an environment, a family, and has a spiritual life. This view has transformed health care from fragmentation to a more comprehensive perspective.” 4
The Future and Challenges
In terms of the future, Mariano said that holistic nurses will play a vital role in increasing nurses' and other disciplines' understanding of holistic principles, practices, healing environments, and integrative therapies. She said, “Holistic nurses will be a growing voice in health policy decision-making related to healthcare reform, especially quality, access, value, patient-centered care, and ecological wellbeing.” Regarding providing financial support for staff recruitment, research involvement, and so on, Mariano stated: “Holistic nurses, with their education and experience, are the logical leaders in integrative care and must advance that position.” She added: “Holistic nurses need to work with payers, insurance groups, nursing boards, policy-makers, legislators, and other professional nursing organizations to ensure the holistic nurses are appropriately reimbursed for services rendered.”
Other challenges within the field include educational issues. Lange et al. commented on the importance of providing holistic philosophy, principles, and practices early on in nursing education and stated: “Curricula need to focus on wholeness: the human being, the family, the community versus the fragmented and pathology focused medical model.” 4 Other experts agree, and one of the important ways that continued education in holistic nursing is being disseminated is through the AHNA.
Lorenz-Miller commented: “The AHNA has a strong contingent of doctorally-prepared holistic nurses who are devoted to conducting and disseminating research that explores and validates holistic approaches. Based on this research, the AHNA provides more than 200 Continuing Education (CE) programs each year to assist nurses in increasing their holistic nursing knowledge and skills. Educational programs include 1-hour webinars, home study research articles, regional and annual conferences, and the Integrative Healing Arts Program in Holistic Nursing (IHAP)—a unique 84-hour CE program in a retreat setting that prepares nurses to meet the CE requirements to apply for a number of holistic certification exams and be empowered to take pivotal roles in a new paradigm of healthcare.”
Mariano hopes that eventually, all nurses will be holistic nurses, and that holism will be introduced in all educational nursing programs. She said, “My hope is that all nurses will learn self-care, integrative approaches, care of the whole person and about energy and psychoneuroimmunology. By incorporating holistic principles and practices, nurses will find more meaning and purpose in their work and life.”
For clinicians contemplating adding holistic nursing to their practice, Mariano said, “By all means do so. It adds value to your nursing practice with client-centered care, additional nursing approaches and integrative modalities, knowledge of caring healing environments to help you deal with the often toxic environments in health care, and an understanding of stress—how it underlies 40% of all illnesses in the US, how it affects the body, mind and spirit, and how to effectively deal with stress.”
Conclusion
The field of holistic nursing aims to expand and enhance the provision and scope of healthcare within both conventional and integrative medicine settings, as well as ensure comprehensive and holistic patient education, a whole-person and a patient-centered approach, and instruction in self-care. Lorenz-Miller stated: “The concepts of holism—healing the person as a whole and not just curing an illness—are what people are looking for in healthcare. Not only is the public looking for more holistic healthcare, but nurses can benefit from self-care as a focus and prevent burnout.” Lorenz-Miller concluded: “With an impressive body of research and growing support from the public, from hospital administrators, and from policymakers, holistic nursing has become a significant contributor to positive outcomes for patients, healthcare professionals, and health-oriented organizations, and it is positioned to grow in the coming years. The hope for nursing as a whole is that it encompasses holism, not just holistic nurses, but every registered nurse practicing holism in their day-to-day practice.” ■