Transcript Concept of Holistic Care

HOLISM
Aims /Objectives
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Aim:
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To introduce the concept of holism as is
applies to nursing practice
Objectives:
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Define holism
Overview of the concept of holism, health
and nursing
Case Study
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Janet, aged 75, was admitted to hospital for surgical investigation of a
possible malignancy. She was of previous good health and had little
experience of hospital or healthcare services. She had been on the
waiting list for some months and was relieved to be admitted,
although naturally apprehensive about the investigations and what
they might reveal. She arrived at the time instructed, with her
daughter, and was asked by a junior nurse to wait in the ward lounge
as a bed was not yet available. After two hours, a health care worker
came to offer her lunch as the bed was still not ready. Neither of these
two carers introduced themselves to Janet, nor explained the delay or
what might happen next. Several hours later, the nurse manager
finally showed Janet to her bed. Once again, no introductions or
explanations were offered. It was not until she had been in the ward
for more than seven hours that a junior doctor made personal contact
with her, introducing herself by name and role and giving a full
explanation of what was to happen during Janet’s stay.
Case Study
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What was absent from care in the case
study?
Do you think that holistic care was
provided to Janet? Give a reason for your
answer.
What is holistic care?
HOLISM
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Holism is not a new idea.
The word holism or wholism is derived from the
Anglo-Saxon root “hal,” which means “whole” or
“to heal”.
Importance recognised by the ancient Greek
physician -Hippocrates –and the ancient Chinese
and Indian
Stressed need for harmony between the
individual, social and natural world.
HOLISM
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Holism was first described by Smuts in 1926
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“defined “holism” as, “…the principle which makes for the
origin and progress of wholes in the universe”.
“the whole is greater than the sum of its parts”
People are individuals who respond as a unified whole and who
are different from and greater than the sum of their parts
(Byrne and Thompson, 1978)
Holism is a movement away from ideas proposed by
Descartes that mind and body were separate components
of the person
A need to study the whole being and how the mind and
body interact
HOLISM
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Holism can also be understood by looking at its opposite,
reductionism. Reductionism breaks things down into their
component parts to understand each part separately.
Modern healthcare practice is sometimes considered
reductionist, as it is practiced in specialties aligned with
parts of the body or function. This is not to suggest that
specialist practitioners are only interested in parts of the
body or aspects of function, and discount the ‘person’.
The traditional medical model approach, in which
symptoms and illnesses were sought in the physical body
alone and removed or cured by physical intervention, has
largely been superseded by an increasing recognition that
the mind and body are not so separate, and that a holistic
approach is more appropriate. Good health care always
takes into account all aspects of an individual’s
functioning and lifestyle.
HOLISM
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“Holism” in health care is a philosophy that emanated
directly from Florence Nightingale.
Nightingale (1820-1910) is said to be one of the first to
acknowledge the importance of holistic care and believed
in care that focused on unity, wellness, and the
interrelationship of human beings, events, and
environment.
She was know as ‘lady of the lamp’ as she brought
comforting light and a gentle smile to war-wounded
soldiers.
As a nurse she was efficient and thorough but she also
treated patient as an individual whose personal needs
mattered.
HOLISM
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For example, she considered touch, light,
empathetic listening, music, and quiet reflection
essential components of good nursing care
If she were not holistic, she would have
considered just the soldier’s wound and nothing
else.
This is because when the other nurses had gone to
bed, she would walk through the wards at with
her lamp to check on the wounded; she wrote
letters for them; and she spent her own money to
buy them fruit and vegetables to eat.
Nightingale argued that the nurse’s role was to
create the optimal conditions for healing.
HOLISM
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Early theorists such as Rogers, (1970) and Levine (1971) describe
patients in terms of the wholeness.
Rogers believed that the world is a single whole in which every
element is interconnected with others. Levine further described the
role of the nurse as viewing each patient
The American Holistic Nurses Association (1992) defined “holistic
nursing” as, “… that state of harmony between mind, body, emotions
and spirit in an ever changing environment”.
This perspective is consistent with the contemporary view of
“holism” in nursing, where the physical, social, cultural and spiritual
realms are interconnected ( Govier, 2000, Jackson, 2004 and Smart,
2005).
It could be argued that holism was always the approach of nursing but
it was the theorists that put it into words.
HOLISM
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Its key principles are that any ‘whole’ is more than the
sum of its parts. The parts must be integrated to achieve
harmony and any disturbance in one part is a disturbance
of the whole (Basford and Slevin 2003).
A person’s ‘whole’ consists of more than the body,
including how one defines him or herself through his or
her notions of health.
It follows that nursing care should attend to the entirety of
the patient, not only his or her diagnosis or stated
problem, but also the way he or she experiences illness
and expresses needs.
Holistic Care
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Holistic Care takes the entire being of the patient
into account, rather than diagnosing specific
physical symptoms.
If one takes a holistic view of people as patients
/clients they cannot be viewed as “medical cases”
The philosophy of holistic care should put an end
to comments like “the gallbladder down the hall,”
which ignores the person and focuses on the
illness alone.
Important to consider all aspects of patients lives
in order to help them
Holism and Nursing
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Holistic nursing is based on the importance of
understanding the whole person rather than
treating parts of the person
Holistic nursing practice promotes healing by
bringing together our care of the patient in the
wholeness of mind, body and spirit, knowing that
we cannot necessarily promote a patients optimal
potential to heal physically when the patient is
psychologically or spiritually distressed.
Individuals are viewed as unique, therefore two
people with the same disease may be treated
Holism and Nursing
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If you are a holistic nurse, you will take an
active role in developing a healing
relationship with the patient.
This relationship focuses on the multiple
needs of persons who are ill and how they
can best be resolved.
Holism and Nursing
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An Bord Altranais, 2000 acknowledge the
importance of holism as outlined in the Scope of
Practice where nurses are required to expand their
practice to become more competent, developing
reflective practice skills, expertise and clinical
skills in order to meet the patients needs in a
holistic manner…..nurses must use their
discretion and work within a defined framework
to provide the patient with a truly holistic
approach to care rather than fragmenting the care
into bio/social/psycho sub-systems.
Holism and Nursing
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‘when illness occurs it is vitally important that all
aspects of the person are assessed to ensure that
the right care…is given to promote and restore
health’ (Basford and Slevin, 2003).
For example: When someone is recovering from a
total hip replacement, the person definitely wants
the hip fixed and fixed properly!
However, there may be other needs, such as
loneliness, fear about being able to live alone
again, or a misunderstanding about medications.
The person needs more than treatment for the hip.
Holism and Nursing
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Holistic nursing embraces all nursing practices that strive
to heal the whole person. The central task of a holistic
nurse is to practice healing from the deep understanding
that each person is more than the sum of individual partsthat we each live in a dynamic and busy world and are
influenced by both our internal and external
environments. (Barbara Dossey)
Holistic nurses draw upon nursing theories and practical
expertise-and the guidance of their intuition-as they
become therapeutic partners with patients.
Components of
holistic nursing
Develop a Healing
Relationship
Work with a Team
Excellent
Clinical Skills
Components of Holistic Nursing
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Develop a Healing Relationship
Unrushed time
Truly listen
Determine what has
worked in the past and
discuss options
Components of Holistic Nursing
2. Working as a Team
 Family, friends,
 MDT
 Other specialists
 There is also an emphasis on individual
responsibility – the person is an active
partner in the healing process and not a
passive recipient of treatment.
Components of Holistic Nursing
3. Excellent Clinical Skills
 Good communication
 Medication administration
 Assessment
 Bedside skills
 Management skills
Holism and health
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Holism applies as much to assessing health needs
and promoting health as it does to nursing
The concepts of health that have emerged in
nursing imply a movement towards holism.
The idea that the totality of the environment and
the place of the person in society contributes to
wholeness indicates that nursing must view the
individual and the environment as an integrated
whole (Chinn and Kramer, 1991)
Dimensions of the Person
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What do you
think are the
different
dimensions of
the person?
physical
psychological
social
Patient/ client
emotional
intellectual
spiritual
Physical Dimension
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Everything associated with ones body, both
internal and external, inputs and outputs.
Genetics, nutrition, breathing, touching,
rest, body weight, the sleep-wake cycle,
autoimmunological functioning, energy,
fitness, movement, body image, healing
capacity, stress reduction through physical
activity, the physical environment.
Emotional Dimension
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Emotional refers to affective states and
feelings.
Psychological implies a combination of
emotional and intellectual components.
Behaviour associated with emotion is what
is felt, expressed and what happens inside
the body.
Intellectual Dimension
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Receptive functions; ability to acquire,
process, classify and integrate information.
Memory and learning
Cognitive or thinking
Expressive function.
Spiritual Dimension
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‘There is little point in curing the body if we destroy the soul” (Anon
in Martsolf and Mickley, 1998).
Spirituality is at the core of the individual’s existence integrating all
dimensions.
Being spiritual does not mean saintly or affiliated with a particular
religion. Spirituality is individual incorporating individual life
principles and whole being.
Research claims that when people are ill they resort to spiritual
practices such as praying
Nurses often lack the confidence to broach spiritual issues with
patients
Spiritual Dimension
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Spiritual care can be achieved simply by being present or through
attentive listening (DiJoseph and Cavendish, 2005).
Nurses can share and express their spirituality without using
traditional religious language.
Nurses can encourage their clients to explore the following reflective
questions:
What do I feel good about?
With whom do I feel most free to "be myself"?
What is the hardest thing about my illness (or current dilemma) for
me and my family?
What helps me "from within myself and from outside"?
What worries me most?
What am I afraid of?
Social Dimension
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Aspects of individuals that enable them to
function in society.
Interactions and relationships with others.
Interaction with the social system - society.
Dimensions of the Person
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Ignoring some dimensions
leave the individual in an
unbalanced state.
Dimensions of the Person
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Recognising all
dimensions
encourages a
balanced view
Each facet of
individual is
important
All contribute to
the quality of life
How is Holism promoted in
nursing?
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Moving from task orientated care
Primary nursing
Valuing the person
Partnership in care
Nurse-client relationship
Patient charter
Case Scenario
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The following case scenario is a model
example for a nurse providing holistic care
to her patient.
This extract is taken from the following
Journal Article:
McEvoy L. and Duffy A. (2008) Holistic
Practice: a concept analysis. Nurse
Education Today 8, 412-419.
Case Scenario
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“Jim and I chatted away together while I assisted
with his daily wash. He told me, about his life and
following a rather informal conversation he
expressed how he would love “to go” tomorrow,
– the Feast of the Immaculate Conception”.
Initially I was struck by the change in direction of
the conversation, but I knew it was essential for
Jim that I took the time to listen to him. We talked
candidly about what prayer and life after death
meant to each of us. I sat down beside him and I
felt the need to hold his hand and listen .
Case Scenario
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Following our deep conversation, I noticed he
needed his toe-nails cut. It is our practice to call
the chiropodist but instead, I said “Jim would you
like your nails done?” “That would be lovely…
but Id like you to do it, if you have the time” he
replied, smiling and added “it will be a while
before I get them done again” After I finished, I
enquired if he would like to see Sr. Lucy. “No,
thank you dear, I’m refreshed in every sense of
the word,, much better now after talking to you”.
I left with a sense of satisfaction knowing that I
had contributed to the final moments of his life,
but overwhelmed by our frank conversation about
his impending death. Jim died that night; the
night nurses said he died peacefully.
Case Scenario
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The case demonstrates the therapeutic nursing
relationship that existed between the practitioner
and her patient, which encompassed the patients
mind, body and spirit to achieve wholeness,
harmony and healing whilst attending to the
patient’s daily activities of living in a holistic
nursing manner
The holistic care given in this model case offered
Jim mental, bodily and spiritual care which
resulted in harmony, healing and wholeness.
Potential Positive Consequences of
Holistic Care
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For Patient:
Harmony
Healing
Empowering
Increased personal
development
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For Nurse:
Self-satisfaction
Increased job satisfaction
Increased personal
development
Professional development
McEvoy and Duffy (2008)
Potential Negative Consequences of
Holistic Care
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For Patient:
Intrusive
Can focus too much
on psychological
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For Nurse:
Emotionally draining
Time consuming
McEvoy and Duffy
(2008)
Self Awareness
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The practice of holistic care requires nurses to be
self aware.
Self-awareness whereby an individual strives
toward achieving a sense of balance within
oneself and the world. This may lead the nurse to
greater awareness of the interconnectedness with
self, others, nature and spirit.
It takes personal, intellectual and professional
maturity to reach self awareness and personal
harmony.
Self Awareness
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This awareness may further enhance the nurse’s
understanding of all individuals and their relationships to
the human and global community.
In practice, nurses who display the defining attributes of
holism, are guided by past experience and intuition
(Benner, 1984).
Nurses who learn to care for the mind, body and spirit in
themselves and others can help individuals access their
greatest healing potential
The degree of harmony that exists between nurses and
their patients is central to holistic nursing.
References / Reading
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Basford, L, Slevin,O. (2003). Theory and Practice of
Nursing. 2nd Edition Cheltenham. Nelson Thornes. P. 4950
Pearson A., Vaughan B. and Fitzgerald M. (1996) Nursing
models for practice. 2nd Edition. London. Butterworth
Heinemann P. 48-50
Ewles L. and Simnett I. (1999) Promoting health: a
practical guide. 4th Edition. London. Balliere Tindall. P.
3-6
Barker, P.(2001) The Tidal Model: Developing a personcentered approach to Psychiatric and mental health
nursing. Perspectives on psychiatric care, 37 (3),79-87.
References / Reading
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Gerish, K.(2000) Individualised care: its conceptualisation
and practice within a multiethnic society. Journal of
Advanced Nursing 32(1), 91-99.
Kendall, M. L. (2001) Integrative medicine: taking the
lead in Holistic palliation. Journal of Hospital and
Palliative Nursing 1(2),56-61.
Patterson, E.F. (`1998) The Philosophy and physics of
holistic health care: spiritual healing as a workable
interpretation. Journal of Advanced Nursing 27, 287-293.
Rawlins, R.P., William, S.R. and Beck, C.K. (1993)
Mental Health- Psychiatric Nursing: A Holistic Life-Cycle
approach (3rd Ed). St. Louis: Mosby Year Book