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Course Objectives:

1. Identify what a holistic approach to health involves.

2. Define holistic nursing.

3. Learn about what a holistic nurse does.

4. Define complementary/alternative modalities (CAM).

5. Explore the benefits and challenges of holistic nursing.

6. List the challenges to the use of CAM therapies.

7. Understand the American Holistic Nurses Association (AHNA).

8. Understand holistic nursing education, training, policy, and research.

9. Discuss holistic nursing clinical practices and current and future trends in nursing.

10. Be able to answer frequently asked questions about the practice of holistic nursing.

 

Holistic nursing is a viable approach to nursing that can effectively be delivered in today’s health care environment if nurses have a complete understanding of what exactly holistic care is and what is involved in holistic nursing. First, let us begin with the fact that “holism” in health care is a philosophy that came directly from Florence Nightingale, who believed in care that focused on unity, wellness, and the interrelationship of human beings, events, and environment. Holism acknowledges and values:

• The connectedness of the body, mind, and spirit
• The inherent goodness of human beings
• The ability to find meaning and purpose in our lives and experiences
• The practitioner’s support for each client so s/he may find comfort, peace and harmony
• The body’s innate power to heal itself

Florence Nightingale conceived of a new breed of nurse who would practice nursing as both an “art” and a “science”. This included an idea of a collaborative effort with all health care professionals. Furthermore, she believed that nursing needed to be firmly established within the realm of science where logical affirmations are supported by statistics. She believed in nursing that was “not limited by gender, spiritual beliefs, or values.” This was one of the statements that would lead for her to be misunderstood by many. Taken out of context, her edicts might not seem to add up. Interestingly, this is something that many detractors of the modern holistic movement might say about a holistic approach to health and health care.  She also saw nurses as being self-determining but designated to one particular scope of practice, as well as advocates for their patients’ care and leaders in the medical field. This all fits in perfectly with the concept of a holistic approach to health.

With a holistic approach to health, the whole person is assessed and treated, rather than just the symptoms. Treatment on one level impacts all levels. Individuals are viewed as unique. Therefore, two people with the same disease may be treated very differently. Social support, health practices, family illness patterns, personality traits, social, structural and cultural issues are considered integral. A strong value is placed on supporting the person’s traditional cultural healing practices, if they are known or can be discerned. Lifestyle patterns and habits that maintain healthy living are emphasized, as are nutrition, stress management, rest, exercise, lifestyle choices, values and belief systems. 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.

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 focuses on promoting health and wellness, assisting healing, and preventing or alleviating suffering. They conduct holistic assessments, select appropriate interventions, and assist the client in exploring self-awareness, spirituality, and personal transformation in healing. They work to alleviate clients’ signs and symptoms, provide health counseling and education, and guide clients in making choices between conventional medicine and complementary / alternative therapies.

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 physical, mental, emotional, spiritual, financial, social/cultural, relational, contextual, and environmental aspects.

Holistic nurses honor each individual's subjective experience about health, health beliefs, and values and view themselves as instruments of healing and facilitators in the healing process. Healing can be defined as the integration of the totality of humankind in body, mind, emotion, and spirit.

Holistic nursing is not simply something that you do: it is an attitude, a philosophy, and a way of being. Holistic nurses honor the journeys of others’ by truly knowing, through partnering and being present with their clients in ways that the current health care approach often does not allow.

The following are a few of the many nurses who have given us a greater understanding and appreciation of the need for holism in nursing practice:

• Jean Watson and her theory of human caring
• Martha Rogers and her science of unitary human beings
• Margaret Newman and her theory of health as expanding consciousness
• Barbara Dossey, Lynn Keegan, Cathie Guzzetta, Noreen Frisch, Carolyn Chambers Clark, Janet Quinn, and Dolores Krieger in their extensive writings
• Charlotte McGuire, founder of the American Holistic Nurses Association (AHNA)

 What is a Holistic Nurse?

A holistic nurse is a legally licensed LPN (Licensed Practical Nurse), RN (Registered Nurse) or APRN (Advanced Practice Registered Nurse) who takes a holistic (mind-body-spirit-emotion) approach to the practice of nursing. Holistic nursing is based on a body of knowledge, evidence-based research, sophisticated skill sets, defined standards of practice, and a philosophy of living and being that is grounded in caring, relationship, and interconnectedness.

Holistic nurses may integrate ‘complementary / alternative modalities’, or CAM, into clinical practice to treat physiological, psychological, and spiritual needs through methods such as relaxation, meditation, guided imagery, breath work, biofeedback, Reiki, journaling, etc., with traditional nursing interventions. Doing so does not negate the validity of conventional medical therapies, but instead complements, broadens, and enriches the scope of nursing practice and helps individuals expand their healing potential.

The practice of holistic nursing requires nurses to integrate self-care, self-responsibility, spirituality, and reflection in their lives, leading the nurse to greater awareness of the interconnectedness with self, others, nature, and spirit. This awareness may further enhance the nurses’ understanding of their relationships to the human and global community, and permits nurses to use this awareness to facilitate the healing process.

Holistic nurses draw on nursing knowledge, theories of wholeness, expertise, caring and intuition, as nurses and clients become therapeutic partners in a mutually evolving process toward healing, balance, and wholeness.

Benefits and Challenges of Holistic Nursing

Holistic nurses practice in numerous settings, including private practitioner offices, ambulatory, acute, and home care settings, wellness and complementary care centers, women’s health centers, psychiatric mental health facilities, and schools. Holistic nurses with advanced education can become advanced practice nurses, faculty members, and researchers.

There are many benefits to becoming a holistic nurse, and global interest in alternative approaches to health care has been growing steadily in recent years. There is a growing shift in health care from an “illness oriented, biomedically dominated” system to a “model that encompasses health, quality of life, and the recognition of the primacy of relationship.” (Burkhardt, 2001)

Currently, over 62 percent of the public are using complementary therapies, and over 930 million Americans are spending 21.2 billion out-of-pocket for these resources. Estimates indicate that the sharp increase in unconventional treatments will continue (White House Commission on Complementary and Alternative Medicine Policy, 2009).

Integrative clinics that include both CAM and conventional providers and HMOs are offering some coverage for CAM modalities are increasing across the country. This driving force will propel mainstream health care in this direction, and holistic nurses are in a prime position to meet this need and provide leadership in this national trend.

Currently there are many challenges in the use of CAM therapies. The main ones are:

• Lack of awareness of the therapies and their benefits
• Uncertainty about their effectiveness
• Limited availability of qualified providers
• It can be difficult to incorporate holistic approaches into standard routines
• Efficacy of holistic approaches can be difficult to prove with scarce research resources
• It can be difficult to receive income for holistic interventions in some parts of the US
• Access to services is often difficult for minorities, rural populations and vulnerable populations such as the chronically and terminally ill

The entire area of licensure and credentialing provides another significant challenge for holistic nursing. It will be important in the future for state boards of nursing to recognize and support integrative nursing practice and requirements that include CAM for nursing educational program approval. Holistic nurses also face the challenge of working with the state boards to incorporate holistic content on the NCLEX, thus ensuring the credibility of this practice knowledge.

However, holistic nursing is essentially an enormously gratifying experience. As a holistic nurse you have the opportunity to be a significant part of the healing and/or support of a patient in a way that is all-encompassing and refreshing. To be able to assist others in making changes to all areas of their lives and watch them flourish in the process is a spiritual occurrence.

The American Holistic Nurses Association (AHNA)

Founded in 1981, the American Holistic Nurses Association (AHNA) is a non-profit membership association of nurses and other holistic healthcare professionals with headquarters in Flagstaff, Arizona. AHNA promotes wholeness and wellness in clients/patients, nurses and the nursing profession. Through its activities, AHNA:

• Provides vision, direction, and leadership in the advancement of holistic nursing
• Integrates the art and science of nursing in the profession, education, research and standards
• Encourages nurses to be models of wellness
• Honors individual excellence in the advancement of holistic nursing
• Influences policy to change the health care system to change the health care system to a more humanistic orientation

Membership in the AHNA is open to all individuals who support its mission.

Holistic Nursing Education and Training

The number of nursing schools offering programs in holism and/or CAMs is increasing. Some schools incorporate this content into other courses, such as nursing therapeutics, and others offer discrete courses such as therapeutic touch, relaxation, aromatherapy, etc. Schools with academic programs in holistic nursing that are endorsed by the American Holistic Nurses Certification Corporation (AHNCC) include:

Baccalaureate Programs

• Xavier University (Ohio)
• Metropolitan State University (MN)
• Humboldt State University (CA)
• University of Texas (Tyler)
• Indiana State University (IN)
• West Virginia University (WV)
• University of Texas (Galveston)

 

Master’s Programs

• University of Colorado (CO)
• Dominican University (CA)
• Tennessee State University (TN)
• New York University (NY)

Since you are already a nurse, you might like to receive certification in holistic nursing at either the generalist (HN-C) or advanced level (AHN-C) through the American Holistic Nurses Certification Corporation (AHNCC). Certification aids the professional elevation of holistic nursing and assures the public of the nurse’s knowledge and competence in the practice of holistic nursing.

Certification requires passing an exam and meeting certain prerequisites such as RN licensure, academic credentials, holistic nursing experience, continuing education in holistic nursing, or successful completion of a certificate program in holistic nursing. ‘Holistic nursing experience’ means practicing holistic nursing for a minimum of one year (full-time) or 2,000 hours within the last five years (part-time). You will also need to complete at least 48 contact hours of continuing education in holistic nursing within the two years before applying for your certification. AHNA approves continuing education offerings in holistic nursing and offers an AHNA home study course “Foundations of Holistic Nursing”.

Other programs in distinct therapies such as acupuncture, Reiki, homeopathy, massage, imagery, healing arts, Oriental Medicine, nutrition, Ayurveda, therapeutic touch, herbology, chiropractic, etc. are given nationally as certificate or continuing education programs by centers, specialty organizations or schools. AHNA endorses certificate programs in many of these specific skill areas including:

• Spirituality, Health and Healing
• Amma Massage
• Reflexology
• Imagery
• Aromatherapy
• Healing Touch
• Clinical Nursing Assessment
• Whole Health Education

 Holistic Nursing and Policy

In order for holistic nurses to be recognized, they must actively participate in the political process to ensure an increased focus on wellness, health promotion, access and affordability for all. They also must work with Medicare, insurance groups, boards of nursing, health care policy makers and legislators, and other professional nursing organizations to assure that holistic nurses are appropriately reimbursed for services rendered. An issue in reimbursement is the fact that the holistic focus and integrative skill of the provider greatly influence the effectiveness of CAM. Consequently, appropriate reimbursement must be included for the process of integrating care, not just for providing a specific modality.

Unfortunately, as stated above, there seem to be quite a few hurdles standing in the way of the use of CAM therapies which as a compelling challenge for holistic nursing as time goes on. Access to these therapies tends to be even more limited in rural areas, geography dominated by minorities, as well as those who do not have insurance or whose insurance does not cover these CAM therapies.

But through political participation on the local, state, and national levels, holistic nurses can affect the necessary changes to bring CAM therapies and holistic nursing into the mainstream.

Holistic Nursing and Research

Presently, most outcome measures are based on physical or disease symptomatology. One of the important tasks for holistic nurses is to identify and describe outcomes of holistic therapies such as healing, well-being, and harmony, and develop instruments to measure these outcomes. Methodologies need to be expanded to capture the wholeness of the client/patient experience as the philosophy of these therapies rests on a paradigm of wholeness. At this time, most outcome measures are only based on the symptom complex of diseases.

An issue to be addressed by nurses is securing funding for their CAM research. Another area of responsibility for holistic nurses will be the dissemination of their research findings to the media, because publishing in non-nursing journals also heightens awareness of holistic nursing into the mainstream. For instance, serving on and publishing in editorial boards of non-nursing journals also elevates the appreciation of holistic nursing within the mainstream.

Holistic Nursing and Clinical Practice

Holistic nurses have a unique opportunity to educate the public more fully about complementary/alternative modalities and practitioners and to guide clients so that they can make informed choices among the array of health care alternatives and individual providers. Self-awareness and understanding can facilitate growth and health enhancing changes, and clients are empowered when they take more control over their lives, including their personal and lifestyle choices, and their relationships. The public sees holistic nurses as educators, consultants, facilitators and partners, and therefore collaboration with clients is key. In many ways, holistic nurses are learners and their clients are teachers.

AHNA has published the Scope and Standards of Holistic Nursing Practice and the Standards of Advanced Holistic Nursing Practice for Graduate-Prepared Nurses. These foundational standards articulate the essentials of holistic nursing, its activities and accountabilities at all practice levels and settings. Contents include an overview and history of holistic nursing, core values of the profession, educational preparation necessary, standards of practice, and standards of professional performance as well as references and information about complementary and alternative modalities (CAM).

Core curricula at both the generalist and advanced degree programs are based on these Standards, which articulate the knowledge base and clinical competencies of holistic nurses in the delivery of health care. The Standards need to be widely disseminated within and outside of the profession and the public needs to be aware of the qualifications of those nurses offering holistic services.

Current and Future Trends in Holistic Nursing

One of the most pressing issues in holistic nursing today is acceptance of its legitimacy, both among nurses and other disciplines. Other trends concern education, research, clinical practice and policy.

Another priority is the integration of complementary / alternative modalities into nursing curricula. Holistic nurses will need to take leadership roles in working with the accrediting bodies to assure this content is included in educational programs. There is also a definitive need for increased scholarship and financial aid to support basic and advanced training, and faculty development programs are necessary to support faculty in the teaching of these therapies.

When holistic nurses participate actively in the area of politics, particularly as leaders in the holistic health movement that has been gaining enormous traction over the last decade. This ensures that there will be an increased focus on the promotion of health as priority, wellness, and affordable, effective healthcare as well the access to it for the entire community.

Frequently Asked Questions about Holistic Nursing

Do you have to be certified to practice as a Holistic Nurse?

No, you do not need to be certified in order to practice as a holistic nurse. Professional certification represents an individual's experience and demonstrated knowledge in a profession or specialty. The American Holistic Nurses Credentialing Corporation (AHNCC) is the only national and international credentialing corporation for holistic nursing. Please note that it is separate entity from the AHNA that has a collaborative, working relationship with the AHNA for the purposes of advancing the role of holistic nursing in all practice settings, as well as providing educational opportunities in holistic nursing, and achieving organizational synergies.

The certification examinations offered by the AHNCC substantiates the knowledge, skills, and attitudes that are considered essential for the practicing of holistic nursing. The AHNCC also serves to endorse academic nursing study programs that are based in the tents of holistic nursing as well as serving the goal of promoting holistic nursing education.

What jobs are available to Holistic Nurses?

Holistic nurses practice in a variety of settings including hospitals, universities, solo / private practices and group practices. Many holistic nurses have become personal wellness coaches or consultants to institutions that are working to integrate complementary and alternative therapies. Many holistic nurses specialize in one or more modalities, such as energetic healing or bodywork, and maintain separate certifications to legally practice these in their individual states. Examples of specialized modalities that holistic nurses practice are:

• Acupuncture: a method of encouraging the body to promote natural healing and to improve functioning by inserting needles, applying heat or electrical stimulation at very precise acupuncture points. These points exist along pathways that are known as “meridians” which act as conduits for the “Qi” and intersects with all the centers of energy throughout the body known as “chakras”.
• Stress management: methods of controlling factors that require a response or change within a person by identifying the stressors, eliminating negative stressors, and developing effective coping mechanisms to counteract the response constructively. Some of these include biofeedback, breathing techniques, progressive muscular relaxation, guided imagery, and active problem solving.
• Aromatherapy: the therapeutic use of plant-derived, aromatic essential oils to promote physical and psychological well-being. Aromatherapy is sometimes used in combination with massage or other therapeutic techniques.
• Massage therapy: the manual manipulation of soft body tissues such as the muscles, connective tissue, tendons and ligaments to enhance a person’s health and well-being. The many types of massage therapy are known as “modalities”. Massage therapy is used to relax muscles, reduce stress and anxiety, rehabilitate injuries, reduce pain, and promote overall health and wellness.
• Hypnosis: often considered an altered state of consciousness featuring “selective perception,” a process in which the subject who remains in control chooses to see only what is relevant to his task by blocking out everything else. It involves guided concentration provided by a qualified practitioner.
• Hydrotherapy: the use of water in the treatment of disease using temperature effects such as those used in hot baths, saunas, or wraps. It exploits the body’s reaction to hot and cold stimuli, the protracted application of heat to pressure exerted by the water and to the sensation it gives.
• Balneotherapy: the therapeutic use of baths containing thermal mineral waters from natural springs that has been used since ancient times.
• Chinese and Eastern healing practices: Chinese medicine is the oldest continuously practiced medical system that has been transmitted and enriched from generation to generation. It is used to treat the person as an integrated whole body, mind and spirit, as well as to remedy the root cause of illness and disease and not just the symptoms. It is extremely compatible with holistic theories as it is a holistic theory in and of itself.
• Wellness coaching: offering personalized support and motivational tools to help clients develop a behavior plan that fits the needs and lifestyle for the type of changes the clients need or want.

 

References:

American Holistic Nurses Association. (2000). (AHNA) AHNA standards of holistic nursing practice. Flagstaff, AZ: Author

American Holistic Nurses' Association. (2004). American Holistic Nurses Association standards of advanced holistic nursing practice for graduate-prepared nurses. S.l: s.n..

American Holistic Nurses Association (AHNA), P.O. Box 2130, Flagstaff, AZ 86003-2130, Phone: (800) 278-2462, info@ahna.org, www.ahna.org

American Holistic Nurses Certification Corporation (AHNCC), 811 Linden Loop Cedar Park, Texas, Phone: (877) 284-0998, AHNCC@flash.net, www.ahna.org/edu/certification

Boswell, C., Cannon, S. B., & Miller, J. (2013). Students' Perceptions of Holistic Nursing Care. Nursing education perspectives, 34(5), 329-333.

Dossey, B. M., & Keegan, L. (2013). Holistic nursing: A handbook for practice. Burlington, MA: Jones & Bartlett Learning.

Fontaine, K. L. (2015). Complementary and alternative therapies for nursing practice.

Holistic nursing: A handbook for practice. (2013). Burlington, Mass: Jones & Bartlett Learning.

Lippincott Williams & Wilkins. (2003). Nurse's handbook of alternative & complementary therapies. Philadelphia: Lippincott Williams & Wilkins.

MacFadyen, J. S. (2013). Holistic nursing: innovatively addressing health care needs?. Holistic nursing practice, 27(1), 4-5.

Maville, J. A., & Huerta, C. G. (2013). Health promotion in nursing. Clifton Park, NY: Delmar, Cengage Learning

Mosby's medical dictionary. (2012). St. Louis, Mo: Mosby.

National Center for Complementary and Alternative Medicine (NCCAM) National Institutes of Health P.O. Box 8218, Silver Spring, MD 20907-8218, Phone: (888) 644-6226, http://nccam.nih.gov

Selanders, L. C. and Crane, P.C. The Voice of Florence Nightingale on Advocacy. The Online Journal of Issues in Nursing. Accessed April 22, 2013. Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Florence-Nightingale-on-Advocacy.html

Sparber, A. (2001). State boards of nursing and scope of practice of registered nurses performing complementary therapies. Online Journal of Issues in Nursing, 6(3), Manuscript 10. Retrieved from www.nursingworld.org/ ojin/topic15/tpc/15_6.htm