"Alternative Nursing Interventions for Facilitating Holistic"
!"#$%&' NP Alternative Nursing Interventions for Facilitating Holistic Nursing based on Eastern Philosophy Hui-ling Lai • Mei-lin Hsieh ABSTRACT Technological advances and economic, social, and cultural conditions have created a climate of change in the health care arena. The re-emergence of the holistic health care paradigms has begun to induce a revolution in the health care system. New roles and approaches are developing in relation to the holistic health movement. Since holistic thinking is diverse, an introduction among eastern philosophies, holistic nursing, alternative nursing interventions based on the view of holism is presented. The meanings of holism, and their significance to nursing are scrutinized. (Tzu Chi Nursing Journal, 2003; 2:1, 13-19.) Key words: alternative nursing intervention, holistic nursing, eastern philosophy, holism. Introduction lic interest in alternative therapies and holistic health (Eiesnberg, Kessler, Foster, Norlock, Calkins, & Delbanco, The Transition of the Health Care Environment 1993; Micozzi, 1995; Office of Alternative Medicine, Health care is undergoing change related to three 1992). In recent years, there has been increasing public factors: economics, society, and technology. From the per- interest in complementary, alternative, and holistic health spective of economics, containment cost causes a switch practices. In the United States, up to the 1940's, the medi- toward prevention as a cost-effective method in reducing cal arsenal consisted primarily of natural therapies (Colbath, cost. As hospitals move to systems with tighter cost 1997). Study (Eiesnberg et al., 1993) revealed that about controls, nurses will be taught more wellness prevention one-third of all American adults participated in some mo- and health promotion to decrease hospital admissions and dalities of complementary and alternative therapy. The health care costs (Dossey, 1997). The second factor of the influences of the social force include not only the public, change is social forces. There has been a surge in the pub- but also the health care providers. Nurses are at the fore- Received: November 18, 2002 Revised: December 24, 2002 Accepted: January 7, 2003 Address correspondence to: Hui-ling Lai, Community Health Center, Buddhist Tzu Chi General Hospital,707, Sec.3, Chung- Yang Road, Hualien, Taiwan, 970 Tel: (03)8561825 ext. 2109 ! VO P !"#$ O N NQ front of the dramatic and dynamic changes that are occur- points to provide a more comprehensive definition as ring in health care delivery. Nowadays, nurses are also follows: using alternative forms of therapy with more frequency "Holistic nursing embraces all nursing practice which (Dossey, 1997). has healing the whole person as its goal. Holistic nursing Modern medicine is based on the belief that health and recognizes that there are two views regarding holism: that illness can be isolated and physically reduced to body parts holism involves studying and understanding the interrela- or fragments that are diseased or compromised. Alterna- tionships of the bio-psycho-social-spiritual dimensions of tive therapy may be understood as a search for the human the person, recognizing that the whole is greater than the or holistic components of healing that have been lost in sum of its parts; and that holism involves understanding the highly technological modern approach to medicine. the individual as the integrated whole interacting with and Technological progress is moving from the mass produc- being acted upon by both internal and external environ- tion characteristic of the industrial age toward a more indi- ments." vidualized focus (Negroponte, 1995). Throughout the his- In the modern health care society, nurses are urged to tory of health care, there has been an evolution of new be alert to cost-shifting that affects caring and its quality. roles, techniques, and modalities. Change is needed to re- One of the effective ways is monitoring costs using an in- form the biotechnology-driven health care system into a expensive intervention, such as alternative nursing. Nurses relationship-centered care system. are challenged to operate from a holistic perspective rather than from the limitations of a traditional Western medical Alternative Nursing Intervention and Holistic Nursing model. A nurse's most powerful holistic tool is his/her own The goal of alternative therapy is to help people un- self (Andrus & Lunt, 1997). Holistic nursing attempts to derstand how to sustain their wellness, including their mentally, emotionally, and spiritually help the patient to environment. Alternative therapy is defined as the "broad set up a mutual connectedness (Schubert & Lionberger, sense of healing that aspires to wholeness or harmony 1995). A holistic nurse will be sensitive to the patient's within the self, the family, and the global community to whole spectrum of needs. In alignment with holism, the accompany, help, lead, teach, and care for others who seek appropriate construct for the nursing profession is healing wholeness" (Achterberg, 1991). From this definition, the (Engebretson, 1997). Healing is the central concept of al- importance of the interaction between persons and envi- ternative nursing intervention. Through the process of ronment is implicit. The therapy provides a spiritual healing, holism of nursing can be achieved. connection, and the classic healer moves between two worlds: that of the spirit and that of daily life (Wardell & Relationship between Alternative Nursing Intervention Engebretson, 1998). However, alternative therapies are and Holistic Nursing not routinely taught in medical school (Dossey, 1997). Alternative and holistic medicine are rooted in tradi- The concept that the whole is greater than the sum of tional ancient healing practice that have been used through- its parts, and that mind and spirit have an effect on the out the world. The nurses of a healing modality may de- body is gaining acceptance among health care profess- velop a philosophy of holism through practice. They must ionals. From the concept of the whole, the holistic health continue to explore the scientific data and acquire the movement encompasses divergent philosophies, religious knowledge and skills to integrate both the art and the sci- doctrines, and psychological theories (Kolcaba, 1996). ence of holistic nursing practice. The development of in- Holistic nursing is defined as a holistic approach to the tuitive skills and a commitment to healing may be mani- body-mind-spirit process for peace in living and for peace fested as nurses begin to interpret and understand healing in dying (Dossey & Guzzetta, 1995). The American Ho- at a deeper level. As nurses expand their role in address- listic Nurses' Association (AHNA) synthesized all these ing the body-mind-spirit dimensions of individuals, they !"#$ O N ! VO P !"#$%&' NR serve as models of how healing can enter the health care Lindquist, 1998). As more nurses strengthen their knowl- arena. They also demonstrate the holism of nursing. edge base and understanding of the scientific basis for use of alternative therapies, they more frequently integrate these Alternative Nursing Intervention modalities into practice and empower the clients for whom they care. Most of the alternative nursing interventions This interest in holism resulted in the rapid growth of are inexpensive, non-invasive, self-administered, and have the American Holistic Nurses Association in 1980. The low side effects. Due to these advantages, alternative complementary and alternative therapies most frequently therapy is most suitable for the health care demands of the used by nurses who practice from a holistic perspective current state of the health care system. have been listed by the American Holistic Nurses' Asso- ciation (1997). The common use of alternative therapy in Holistic Nursing the nursing field includes music therapy, acupuncture, acupressure, imagery, and meditation (Holmes, 1984; Historical Development: from Nightingale's Reisser, Reisser, & Weldon, 1983). In 1992, the National Perspective to Naturalistic Inquiry Institutes of Health (NIH) created the Office of Alterna- Holism is a practical concept and way of health care tive Medicine (OAM) to evaluate alternative therapies. delivery, which was introduced to modern medicine in the However, the extent to which complementary therapies had late 1970s and early 1980s. Environment is one of the been used was unknown until 1993 (Colbath, 1997). There major concepts in holistic nursing. Environment is also are many alternative nursing interventions for nursing the core concept in Nightingale's model of nursing which problems; the challenge is to choose the most effective is based on experimental observations made about the re- approach to restore the patient's balance and promote self- lationship of individuals known as patients and their atten- healing. dant health status (Selanders, 1993). The Nightingale model that is descriptive in nature (Fawcett, 1995) has been Advantages of Alternative Nursing Intervention in actual practice settings for more than 100 years. The Even though alternative therapies can reduce health real benefit of the model for today's practice is the legacy care costs and improve quality of care to engage clients in of values that she conferred on modern nursing. Simple improving their well-being and quality of life, alternative environmental control can impact patients' conditions therapy must be considered as adjuncts or complements to significantly. Nightingale's model may be classified as a conventional biotechnology and pharmacology and not a grand theory (Fawcett, 1995) because of its broad terms replacement for them. Many of the nursing problems can and abstractions. However, Nightingale was truly con- be addressed with complementary and alternative thera- cerned with the body, mind, and spirit of the sick (Shealy, pies as a first line option or can be used in conjunction 1985). Until very recent times, holistic views were re- with traditional medicine. One of the frequent uses of the vealed in nursing research, practice, and education. The alternative therapies by nurses is music therapy. Music, as AHNA Core Curriculum for Holistic Nursing is a useful an aesthetic and symbolic medium, has been known for resource on how to create a holistic nursing curriculum centuries for its therapeutic properties in healing the body and clinical practice that integrates complementary and and the mind. alternative therapies (Dossey, 1997). Nursing's emphasis Music is currently one of the most useful tools in the on a whole-person orientation derives from its tradition as management of emotional and psychological disturbances. humanistic practice (Kolbaca, 1996). The philosophy of The other frequent conditions in which music has been used humanism is parallel with the naturalism. Lincoln and Guba are to orient behaviors, to decrease anxiety, to manage pain, (1985) further proposed some assumptions for the natural- to reduce stress, and to stimulate patients (Synder & istic inquiry which helps us to understand the related is- ! VO P !"#$ O N NS sues concerning the concept of whole-person. These sa- is the most frequent model available in mainstream health lient assumptions include that (1) the whole is not just the care (Selanders, 1993). In this model, all diseases have a sum of the parts, (2) the knower cannot separate from the psychosomatic component, and biologic, psychologic, and known or the observer cannot separate from the observed, social factors are always involved in a patient's symptom, (3) what is true at one time and place may not be true at disease, or illness. All four parameters are interdependent another, (4) linear causality may not be the only way, and and interrelated. Nursing is an art and a science (Peplau, (5) methodology may not guarantee that the results are free 1988). This statement not only represents where the nurs- from bias. ing knowledge derived from, but also involves other com- Nurses are uniquely positioned to enhance the quality ponents that are not consistent with a traditional view of of nursing care by improving their understanding of it and science (Rodgers, 1996). Roger's perspective of nursing beginning to incorporate more complementary healing is that "the uniqueness of nursing is in the focus of the therapies into their nursing care. The importance of the science of nursing which is unitary irreducible human be- transformation from the traditional medicine to alternative ings and their respective environments. This is where the nursing intervention is to strengthen nursing independence uniqueness in terms of nursing would come, in reference in the health care arena. to the whole." The arts are now viewed as an integral com- Holistic nursing principles must be more broadly es- ponent of holistic care for patients and families. Holism is poused by individual nurses and nurse educators so that based on the philosophy that nursing is an art and a sci- the healing philosophy can ripple outward from the nurse ence that has as its primary purpose, the provision of ser- to the patient and back to the nursing profession in general. vices that strengthen individuals and enable them to achieve Advancing technology and the current restructuring of the the wholeness inherent within them. From this standpoint, health care system have left many nurses feeling frustrated. the holistic nursing model can be synthesized from the two In fact, nursing is grounded in caring principles that em- concepts (an art and a science) to make up a whole. The body holism. The nursing profession and the patient are model is shown as Appendix A. interdependent and indivisible; therefore, nurses must adopt new goals and relationships with other health care organi- Eastern Philosophy zations and professionals in delivering relationship-cen- The goal of health care based on the eastern philoso- tered care (Tresolini, 1994). Buerhaus (1996) suggested phy is to decrease the many different disturbances and stres- that nurses must strengthen their position in the competi- sors caused by a person's illness. Eastern philosophy grew tive marketplace to make themselves increasingly valu- out of ancient Chinese culture, the culture that produced able to their employers and to society at large. The chal- the philosophy of Taoism. The fundamentals of Eastern lenge for nursing is to direct the evolution of a unifying wisdom are derived from Taoism. The Tao is the Ultimate view that can be used to maintain the integrity of whole- that creates and unites all things (Stux & Pomeranz, 1987). person holism. The Tao brings out the polarity between Yin and Yang . The concept of Yin and Yang reflects the ancient Chinese Theory of Whole worldview. It deeply affects Chinese daily life. The two primal forces are represented by the Sun and the Moon. Science and Art Holistic Nursing Model All pairs of opposites in nature are subject to this dynamic Holistic theories are the fastest growing trend in nurs- polarity between Yin and Yang. These two forces always ing (Barnum, 1994). Holistic nursing brings the latest body- combine to make up the whole: Tai-Ji. Yin can not exist mind-spirit medical and nursing directions related to re- without Yang, and Yang can not exist without Yin. Yin cent medicine together with the latest developments in the always contains some Yang, and Yang always has a Yin art and science of nursing. The bio-psycho-social model component (Hin, 1991; Mole, 1992). The interaction of !"#$ O N ! VO P !"#$%&' NT the opposing forces Yin and Yang gives rise to the flow of profession has remained relatively silent regarding inte- vital energy, or Qi. According to the eastern philosophy, grating nursing unique holism. At present, the health care most illnesses and disturbances are rooted in the unbal- system still operates from a scientific paradigm that sepa- anced flow of Qi. rates an individual into a biologic, psychologic, sociologic, The ancient Chinese viewed a person as a whole iden- and spiritual being. Holistic nursing care is the corner- tity which cannot be separated. In this model, human be- stone of health care in the future. Nursing has a rich theo- ings are viewed as having three dimensions: body, mind, retical base for holistic practice, which is precisely what and spirit. Each dimension includes two parts: Yin and the other caregivers appear to be requesting. A proactive Yang. These dimensions and the two parts are constantly approach could position nurses to meet the needs of the changing to maintain dynamic health. The eastern phi- health care industry, improve consumer satisfaction, and losophy emphasizes the interactions between patients and pave the way for the profession of nursing to meet an iden- their environment. The human energy field finds itself in tified social need (Wardell & Engebretson, 1998). Most an ongoing, mutual and integral process with the environ- of alternative nursing interventions would seem to fit com- mental energy field. Eastern philosophy elucidates in this fortably within the realm of natural therapies. As the ill- way that the human energy field is integral to a continuous, ness-healing paradigms shift and converge, and the con- mutual process of becoming and enfolding with the cept of holism rises more and more to the fore, the role of universe. the nurse shifts from caregiver to healer. The use and ac- ceptance of alternative therapies are increasing with the Consistency between the Eastern Philosophy and the general public. When nurses demonstrate holistic nursing, Holistic Nursing Model one thing they should keep in mind is that alternative nurs- The eastern philosophy is not only consistent with the ing interventions are adjuncts and not substitutes for tradi- philosophy of the holistic nursing model, but also consis- tional care. tent with Roger's science of unitary person model. Even though Roger did not explicitly state the nursing science References and art in her model, nursing professionals can envision her model as a science-and-art holism. Ellis (1968) sug- ^ÅÜíÉêÄÉêÖI=gK=ENVVNFK=tçã~å=~ë=ÜÉ~äÉêK=_çëíçåW gested that nursing must examine and treat the variables pÜ~ãÜ~ä~K that affect a patient's health in combination or in isolation ^ãÉêáÅ~å=eçäáëíáÅ=kìêëÉëD=^ëëçÅá~íáçåK=pí~åÇ~êÇë with each other. This combination of variables is often çÑ=eçäáëíáÅ=kìêëáåÖ=mê~ÅíáÅÉK=ENVVQK=oÉîáëÉÇ=NVVTFK represented as greater than the sum of each part, a system o~äÉáÖÜI=k`W=^ãÉêáÅ~å=eçäáëíáÅ=kìêëÉëD=^ëëçÅá~íáçåK ^åÇêìëI=sKI=C=iìåíI=gK=vK=ENVVTFK=_êáåÖáåÖ=ÜçJ model approach (Ellis, 1968; Rogers, 1970). There is a äáëíáÅ=åìêëáåÖ=áåíç=íÜÉ=åÉï=ãáääÉååáìãK=^äíÉêå~íáîÉ high level of congruence among the eastern philosophy, ~åÇ=`çãéäÉãÉåí~êó=qÜÉê~éáÉëK=PEOQFI=OUNK the science-and-art holistic nursing model, and Roger's _~êåìãI=_K=gK=pK=ENVVQFK=kìêëáåÖ=íÜÉçêóW=^å~äóëáëI model. ~ééäáÅ~íáçåI=Éî~äì~íáçåK=mÜáä~ÇÉäéÜá~K=m^W=iáééáåÅçííK _ìÉêÜ~ìëI=mK=ENVVSFK=nì~äáíó=~åÇ=ÅçëíW=qÜÉ=î~äìÉ Conclusion çÑ=ÅçåëìãÉê=~åÇ=åìêëÉ=é~êíåÉêëÜáéëK=kìêëáåÖ=mçäáÅó cçêìãI=OEOFI=NOK `çäÄ~íÜI=gK=aKI=ENVVTFK=eçäáëíáÅ=eÉ~äíÜ=léíáçåë The health care arena is largely informed and domi- Ñçê=ïçãÉåK=`êáíáÅ~ä=`~êÉ=kìêëáåÖ=`äáåáÅë=çÑ=kçêíÜ nated by the biomedical and technological modern values ^ãÉêáÅ~åK=VEQFI=RUVJRVVK of efficiency, objectivity, and standardized care. Much of açëëÉóI=_K=jKI=dìòòÉíí~I=`K=bK=ENVVRFK=eçáäëíáÅ nursing education has focused on producing nurses to fill åìêëáåÖ=éê~ÅíáÅÉK=få=_K=jKI=açëëÉóI=iKI=hÉÉÖ~åI=`K job roles in the health care system. 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