1 Slide #7 History of Holistic Nursing Understanding the concept of holistic nursing requires the knowledge of the development of holistic nursing thought in the discipline. Holistic nursing has been present since the beginning. The roots of our nursing pro fession lie in the works of Florence Nightingale, and her philosophy of health and healing. Light 1997 states that this philosophy is holistic, in which she describes health in the holistic terms and viewed people as multidimensional beings inseparable from their environment. Nightingale’s beliefs did not correspond with those of the scientific medical establishment with which nursing has become associated. It wasn’t until the 1970’s that the words “holistic nursing” appeared in nursing literature. Slide #8 Nurse Leaders in the 20th Century “Nurse-theorist Myra Levine is credited with being the first person to use the words in her writings” in 1971 she wrote: “the logic of all human experience tells us that we are whole, and yet the concept of holism is labeled esoteric, elusive and even impractical”. Her developing nursing theory that was presented recognized that modern scientific thought brought a reductionist view to the holistic phenomena. Levine was not alone in calling attention to a holistic parad igm that refused to define nursing as a science of sickness and disease. In 1970, Martha Roger’s stated that “human beings are more than and different from the sum of their parts”. She believed that the world is a single whole in which every element is interconnected with others. Jean Watson is yet another nurse-theorist of the time that described the holistic paradigm shift from nurses helping doctors practice medicine to nurses practicing the distinct art and science of nursing. This change in focus has d irected nursing’s return to the philosophy and teachings of Nightingale, emphasizing that the nurse must use the hands, hearts and head in creating healing environments to care for the patient’s body, mind, and spirit. These nursing theorists took a clearly holistic view different from the prevailing scientific view held by many nurses, physicians, and scientists of the time. 2 Slide #9 Diffusion of Holistic Practice Johnson (1990) described the diffusion of Holistic nursing practice over the previous two decades as: “the integration, harmony, and balance of body, mind, and spirit; a focus on wholeness of the individual with emphasis on the process of self- healing rather than on disease; illness as an opportunity for growth and increased self-awareness; and the reciprocal relationship between nurse and patient with emphasis on self-responsibility, health promotion, and lifestyle” Slide #10 20th Century Developments The 1970s and 80s marked a dramatic turning point in the development of nursing as a discipline, as there were four simultaneous movements that later would have huge impacts on holistic nursing. These developments were: 1) presentation of holistically oriented nursing theories, 2) development of nursing language and classification systems, 3) writing by practitioners that guided holistic nursing interventions in actual practice setting, and 4) the establishment of a number of nursing organizations committed to advancing the profession. These developments were followed in the 90s by the popular discovery of holism- holistic, alternative, and complementary care. Slide #13 The Basic Principles of Holistic health Suzan Walter, President of the American Holistic Health Association defines the basic principle as follows: “Holistic health is based on the law of nature that a whole is made up of interdependent parts. The earth is made up of systems, such as air, land, water, plants and animals. If life is to be sustained, they cannot be separated, for what is happening to one is also felt by all of the othe r systems. In the same way, an individual is a whole made up of interdependent parts: which are the physical, mental, emotional and spiritual. When one part is not working at its best, it impacts all of the other parts of that person. Furthermore, this who le person, including all of the parts, is constantly interacting with everything in the surrounding environment. For example, when an individual is anxious about an exam or a job interview, his or her nervousness may result in a physical reaction- such as a headache or stomach ache.” 3 Slide #24 American Holistic Nurses Association The American Holistic Nurses Association was founded by Charlotte McGuire in 1981, partly as a response to major changes in health care delivery that were transforming the work of nurses in hospital settings. Many felt that nursing care was suffering due to changes in staffing patterns as well as a nursing shortage exacerbated by these dramatic changes in focus. Nursing care was becoming less and less patient and wellness centered and the founding of AHNA was a response and the call for a solution. The AHNA is a non-profit membership association for nurses and other holistic healthcare professionals, serving more than 4,100 members across the U.S. The AHNA focus is to serve as a bridge between conventional healthcare and complementary/alternative healing practices. In December of 2006, due to the efforts of AHNA, holistic nursing was recognized as an “official nursing specialty” by the American Nurses Association, with its own defined scope and standards of practice. The standards of holistic nursing practice provided a foundation for certification in holistic nursing as a specialty. Slide #25 Holistic Practices Down Under Nurses in Australia have had a longstanding interest in and commitment to holistic nursing. They have established two organizations: Australian College of Holistic Nurses, Inc. and the Holistic Nurses Association of New South Wales. These organizations are no longer active, but did attract, support and launch holistic nurses in their work and quest for knowledge about Holism and complementary modalities. The Australian college of holistic nurses, inc. was devoted to education and support of nurses performing holistic practices. The college sponsored annual conferences that included speakers on theory, complementary modalities, and self care practices. In collaboration with Southern Cross University, t he organization supported the Australian Journal of Holistic Nursing, a biennial, peer-reviewed publication, printed from 1994 to 2005. The mission of the journal reflected the mission of the organization: to document the trends and issues that emerged from contemporary nursing practice. 4 Inspired by a national conference in natural therapies, the Holistic Nurses Association of New South Wales was founded in 1995. The organization grew out of “disenchantment” and was founded with intent to support nurses wishing to undertake holistic practices. The fact that these two organizations are no longer active does not necessarily mean that their interests are no longer relevant or valued in Australia. Nurses in Australia have not sought to make holistic nursing a specialization as their counterparts in Canada and the United States. Many holistic nurses in Australia carry certification in various complementary modalities and continue to build nursing practice on holistic theory. Slide #26 International Comparisons The holistic nursing movements across the world represent differing perspectives and differing views about holistic nursing. Understanding the divergent views may bring nurses to a better understanding of the complexities of determining “what is holistic” and may, in turn, stimulate nurses to consider their personal and professional need to confront the difference. All of the perspectives are legitimate and each brings value in nursing practice Slide #29 Challenges to Holistic Nursing Practice If nurses are to continue to serve as front line client contact, holistic nurses must be in a position to provide care true to the “art” of nursing practice: being focused on the caring and comforting aspects of nursing (the aspects that the profession inherited from Florence Nightingale) just as the work of early holistic nurses who refused to accept nursing as a science of disease and illness. There are three important developments in current practice that should be addressed as one considers the role of holistic nursing today. These are the use of holistic principles in the evidence-based practice environments, the use of holistic principles with the computerized patient care record, and the need for nurse self care to sustain professionalism throughout a 21st century nursing career. Challenge 1: Evidence Based Practice 5 McIntyre & McDonald state “The challenge is for holistic nurses to learn and understand the research methods being used and to be in a position to articulate the use and limits of application of those methods. All too commonly, holistic nurses embrace qualitative methods and develop an incomplete knowledge of the quantitative methods used by others. It will be impossible to negotiate holism in practice if nursing leaders do not have a level of sophistication in traditional quantitative research and statistics, a basic level of knowledge about newer approaches to quantitative analysis”, especially since the “gold standard” of evidence based research is applied using the quantitative method of a randomized controlled clinical trial. Challenge 2: Computerized Patient-Care Records Health care systems across Canada are making the move or have made the move to computerized patient-care records. “A challenge for nurses, particularly holistic nurses, is the decision of how nursing will be documented electronically. Today, holistic nurses who may have preferred narrative documentation are faced with the challenge of either using the standardized languages to give voice to nursing’s work or to become silent in a system that will include only electronic entries based on coded terms. The challenge for holistic nurses may become to learn to use the standardized languages to their fullest extent and to engage as leaders in activities that promote recording of holistic practices in systems that could easily omit nursing and result in computerized medical records rather than a computerized healthcare record” Challenge 3: Sustaining Self over the course of a nursing career “The holistic nurse becomes and instrument of healing when using unconditional presence and intention to support the healing process of another. To do so, however, the nurse must attend to his or her own personal assessment and self-care. Self care practices that assist the nurse to sustain health begin with an honest assessment of one’s life demands and personal needs, one’s risk for health problems, and forming a life pattern aimed at supporting one’s own health.” “Self care practices are highly individualized. Such that practices that support one nurse may not be those that support another. However, all self care practices give the nurse a s trength and a balance or harmony that helps one to deal with the stressors, uncertainties and demands of nursing’s work life. Considering the fact that nurses are at significant risk for vocational burnout 6 and emotional exhaustion, self care practices may be the distinguishing difference between those who thrive in nursing and those who are unable to sustain the work life demands” Slide #35 Closing Thought Modern nursing work is complex & challenging. The shortage of nurses in Canada and worldwide attracts attention to what nurses do and plays into the discussions of what nurses will do in the future: If nurses are to continue to serve as the “front- line” client contact, then we must be in a position to provide care true to the art of nursing practice Refuse to accept nursing as a science of disease & illness- our practice means so much more!