Download Foundations of nursing: Holistic care Introduction As a nurse, you

Foundations of nursing: Holistic care
Foundation of nursing / first year / lecture 1
‫م فادية حسين علي‬. ‫م‬
Holistic Care
Introduction
As a nurse,
you will be a professional caregiver. Your intimate contact with
clients allows you the opportunity not only to provide physical and emotional support but also
to teach ways to take an active role in maintaining health.
You may have contact with hundreds of clients, each needing specialized treatment and
care. The care you provide will vary from routine to critical to emergency.
You will be part of a multidisciplinary team of caregivers that includes registered
nurses, physicians, nursing assistants, physical therapists, respiratory therapists, laboratory
technicians, dietitians, and social workers. All caregivers work together to promote and
maintain client health.
1. Interrelated Concepts of Health
Health
is "the condition of being sound in body, mind, or spirit" (Merriam-
Webster Online Dictionary, 2008).
The WHO defines health
as follows: "Health is a state of complete
physical, mental, and social well-being and not merely the absence of disease or infirmity"
(WHO, 1974).
Health refers to the total well-being of the whole person. (Telstar Innovations, Inc.,
2000).
Holistic is a term derived from the Greek word holes, meaning "whole." Holistic
health views the physical, intellectual, sociocultural, psychological, and spiritual aspects of
a person's life as an integrated whole. These five aspects cannot be separated or isolated;
anything that affects one aspect of a person's life also affects the other aspects.
0
Foundations of nursing: Holistic care
Healing means to be or become whole. It is a state of harmony or balance in the
body, mind, and spirit connection. (Quinn, 2005)
Homeostasis is the balance or stability that the body strives to achieve among
these aspects of a person's life by continuous adaptation.
The goal of holistic nursing is the "enhancement of healing the whole
person from birth to death" (American Holistic Nurses Association [AHNA], 2004).
Nurses must understand the integration of these aspects of a person's life in order to help
clients through healing processes. Healing is often different from curing.
The AHNA supports the belief that health involves the harmonious balance of body,
mind, emotions, and spirit within an ever-changing environment.
The NIH defines holistic care as care that "considers the whole person, including
physical, mental, emotional, and spiritual aspects.
Success in using holistic modalities in client care requires an awareness of a
fundamental principle of holism: The nurse facilitates the client in attaining the best state
for healing to occur. Among the holistic modalities most frequently used in nursing are the
following:
a) Biofeedback
b) Exercise and movement
1
Foundations of nursing: Holistic care
c) Goal setting
d) Humor and laughter
e) Imagery
f) Journaling
g) Massage
h) Play therapy
i) Prayer
j) Therapeutic touch
The holistic nurse is "an instrument of healing and a facilitator in the healing
process (AHNA, 2004). By does the following:
1.
Demonstrates awareness that self-healing is a continual process
2.
Is familiar with self-development
3.
Recognizes personal strengths and weaknesses
4.
Models self-care
5.
Demonstrates awareness that personal presence is as important as technical skills
6.
Respects and loves clients
7.
Presumes that clients know the best life choices
8.
Guides clients in discovering creative options
9.
Listens actively
10. Shares insights without imposing personal values and beliefs
11. Accepts client input without judgment
12. Views time spent with clients as an opportunity to serve and share (adapted from
Dossey, 1998)
Nursing the whole person, or holistic health care, is a comprehensive approach to health
care. It considers physical, intellectual, sociocultural, psychological, and spiritual aspects; the
response to illness; and the effect of illness on a person's ability to meet self-care needs.
Nurses work with people throughout life to promote wellness and prevent illness. The
highest level of wellness should be the goal of each nurse and every client.
Wellness is a responsibility, a choice, a lifestyle design that helps maintain the
highest potential for personal health (Hill & Howlett, 2005).
2
Foundations of nursing: Holistic care
The health continuum is a way to visualize the range of an individual's
health, from highest health potential to death.
A person at the highest level of wellness is one who demonstrates good physical selfcare, emotional well-being, creative expression, and positive relationships with others.
Wellness incorporates physical, intellectual, sociocultural, psychological, and spiritual
wellness. To provide holistic care, all aspects of the individual's wellness must be addressed.
Abraham Maslow developed a theory of behavioral motivation based on needs. This
theory is often referred to as
Mallow's Hierarchy of Needs. There are five
levels in this hierarchy. The basic physiological needs must be met to maintain life. The rest
of the needs are related to quality of life. They are safety and security, love and belonging,
self-esteem, and self-actualization. The needs of the lower levels must be met before a person is
motivated to meet the needs of the next higher level.
3
Foundations of nursing: Holistic care
►Physiological Needs
The needs for oxygen, water, food, elimination, rest (sleep) /activity (exercise), and sex.
►Safety and Security Needs
The needs for shelter, stability, security, physical safety, and freedom from undue
anxiety.
►Love and Belonging Needs
The needs for having friends and participating with others in groups and organizations
are two ways to meet these needs. Meeting these needs is extremely important for mental
health.
►Self-Esteem Needs
The needs of the self-esteem level are met by achieving success in work and other
activities. Recognition from others increases self-esteem and feelings of pride in one's
accomplishments.
►Self-Actualization Needs
A person who has met these needs is confident, self-fulfilled, and creative; looks for
challenges; and sees beauty and order in the world.
2. Providing Quality Care
►The first step in providing quality client care is to be aware of yourself.
o What kind of personality do you have?
o Is your self-concept positive, or do you have self-doubts and lack self-confidence?
o What are your beliefs and attitudes?
o Knowing the answers to such questions will help you in your role as caregiver.
►The next step is taking care of your own needs.
When you attend to the needs in your own life, you are then free to concentrate on caring
for others. Your example of self-care inspires clients to have confidence that you will provide
quality care. Thus, self-care is a factor in your effectiveness as a caregiver.
Self-awareness is consciously knowing how the self thinks, feels, believes, and
behaves at any specific time. Being self-aware is a constant process that is focused on the
present. A person's thoughts, feelings, and beliefs are interrelated and greatly influence
behavior. Being self-aware influences a person in several ways.
Self-awareness is extremely important for nurses. Nurses must understand themselves
so that their personal feelings, attitudes, and needs do not interfere with providing quality
client care. The nurse who is self-aware is more likely to make decisions in response to the
4
Foundations of nursing: Holistic care
client's needs rather than the nurse's own needs.
For example, experienced nurses—are often anxious about caring for a specific
client. By taking some time to practice self-awareness, the nurse might discover that the
anxiety stems from never having performed the procedure in question. The nurse can
then deal directly with the situation by reviewing the procedure and requesting
assistance from an instructor or supervisor.
All decisions about client care must be made in response to the
client's needs, not the nurse's needs.
Self-concept is how a person thinks or feels about himself. These thoughts and
feelings come from the experiences the person has with others and reflect how the person
thinks others view him.
Because of its influence on client care, it is important for the nurse to be aware of how
her own self-concept has developed. Self-concept develops through feedback from others.
The nurse is responsible for providing feedback that will not negatively affect the client's selfconcept.
For example, an individual who is constantly ignored or who receives messages such
as "Don't bother me," "Can't you do anything right?" or "You don't have any sense" may
very well begin to view himself in these terms, with the likely result being a negative selfconcept. On the other hand, a person who is shown caring and who hears messages such as
"Let me help you in a minute," "Let's try it this way," or "Have you thought about ... ?"
will move toward a positive self-concept.
3. Self-Care as a Prerequisite to client care
The most effective means to teach wellness is by positive example. By first practicing
good health habits as a nursing student, you will become, by example, an important factor in
your clients' overall well-being and good health. Remind yourself and your clients that health
is a personal choice and that each person has control over his or her own wellness.
While emphasizing health promotion and client education, the nurse must also
encourage and respect the client's responsibility for wellness. This respect allows the client to
become an active partner in, rather than a passive recipient of, health care. It is not enough to
tell a client what can be done to improve health; the nurse must also be prepared to explain
why. If a client understands the reason behind an action, the likelihood of compliance
5
Foundations of nursing: Holistic care
increases.
Physical wellness refers to a healthy body that functions at an optimal level.
To achieve physical wellness, a person must practice:
►Grooming
The nurse communicates a message of health and well-being by being clean and neatly
dressed. A daily bath or shower and the use of a deodorant form the basis of good grooming.
Hair should be clean, combed, and neatly styled. Perfume should not be worn because some
clients may have allergies, and it may be offensive to other clients. Frequent brushing, regular
dental checkups, and avoiding refined sugars helps control dental caries.
►Body Mechanics
Using the body in the safest and most efficient way to move or lift objects. The use of
proper body mechanics is very important because many of the skills and tasks you will
perform as a nurse involve lifting or moving clients or objects. Bending, lifting, or stooping
can cause injury if done incorrectly.
►Posture
Good posture is the basis for proper body mechanics. Good posture means the ability
to carry oneself well and in correct body alignment. Posture can also send messages about a
person. A person who stands with feet spread apart and with hands on hips, for example,
maybe perceived as aggressive or authoritative, whereas one who holds the arms tightly
folded over the chest may be viewed as closed minded.
►Smoking
Smoking contributes to many health hazards and illnesses. It may also be personally
offensive to clients. The odor of smoke on clothing or the breath (halitosis) may precipitate
allergic reactions or lead to a feeling of nausea in some clients. Most health care facilities
have strict rules about smoking. Many facilities are "smoke free."The nurse should never
smoke in a client's room. Furthermore, great care should be taken to ensure that no offensive
tobacco odors remain if the nurse uses or is in close proximity to tobacco products. In each
situation, every effort should be made to enforce all safety rules for clients and visitors.
"No smoking" signs should be posted and strictly enforced when oxygen is in use.
►Drugs and Alcohol
A nurse should never give or make a drug available to anyone without the written order
of a physician or other person who can legally prescribe medications, such as a nurse practitioner. Approximately 10% of nurses have a substance abuse problem (Dunn, 2005).
►Nutrition
6
Foundations of nursing: Holistic care
Nursing students may be tempted to skip meals, omit breakfast, eat snacks, and follow fad
diets. This is never a wise practice. While you are in school, your success depends on your
functioning at your best. Skipping meals, especially breakfast, leaves a person tired, weak, and
hungry. It is impossible to think efficiently when hungry. Remember Maslow's Hierarchy of
Needs: The need for food must be satisfied before you will be motivated to meet the need to
learn or to study.
Always eat a balanced breakfast. Pastries and coffee, although satisfying in the moment,
elevate the blood sugar level only for a short while before the level plummets. This reaction
leaves a person drained, irritable, and hungrier than before. Try to avoid snacking on junk
foods, which contain empty calories, or those having very little nutritional value. Instead, plan
to eat fruit or high-protein snacks.
Plan a routine for mealtimes and stick to it. Doing so helps prevent the urge to binge
on unhealthy snacks. Also, drink plenty of water. Water is the body's most important
nutrient. A human being can survive for weeks without food but only for a few days without
water. By weight, approximately 60% of the adult body is water. In order to maintain proper
fluid balance and to facilitate the elimination of body wastes, it is necessary to drink plenty
of fluids.
►Sleep, Rest, Relaxation, and Exercise
Sleep is necessary to allow the body's organs to function at their most minimal levels.
This period of rejuvenation for the body is necessary for total wellness.
Rest, meaning conscious freedom from activity and worry, is just as important as sleep.
Rest is a time of inner quiet and physical inactivity. Only when a person is relaxed and at
inner peace can that person rest.
Relaxation means doing something for the fun of it. That which is relaxing to one person may
not be relaxing to another. Examples of relaxation activities include reading a novel, reading to
children, playing cards or other games, fishing, painting, or sewing or other handwork.
Exercise, many experts agree that the best rest follows planned exercise. During exercise,
heart rate and breathing increase, circulation improves, and muscles stretch. Exercise is also a
time to free the mind of anxiety-producing thoughts.
Intellectual wellness is the ability to function as an independent person
capable of making sound decisions. Such decisions are based on the individual's needs
but at the same time take into account the needs of others. Clear thinking, problem solving skills, good judgment, and the desire to continually learn are all qualities found
in the person who is intellectually well.
7
Foundations of nursing: Holistic care
Sociocultural wellness is the ability to appreciate the needs of others and
to care about one's environment and the inhabitants of it. As a nurse, you will care for
clients of all ages and races who speak different languages and come from various
cultural groups.
Psychological wellness
encompasses the enjoyment of creativity, the
satisfaction of the basic need to love and be loved, the understanding of emotion s, and
the ability to maintain control over emotions.
An attitude is a feeling about people, places, or things that is evident in the way one
behaves. It can be positive or negative.
Nursing requires that you see the best in people during the worst of times. In order to
survive and function well, the nurse needs to see life as a challenge and as a gift to
cherish and enjoy.
Spiritual wellness manifests as inner strength and peace.
Spirituality is a broad concept incorporating more than a client's religious
affiliation. It encompasses the beliefs that a person has that give meaning and purpose to
their existence (Fitchett, 2002).
It encompasses values, purpose, caring, love, honesty, wisdom, and imagination
(Roberts, 2005), and
It may also reflect a belief in the existence of a higher power or guiding spirit
outside of the client's self (Burkhardt & Jacobson, 2005).
Spirituality manifests as meaningful work, creative expression, familiar rituals,
and religious practices (Wright, 1998).
It involves finding meaning in everything, including life, illness, and death.
Spiritual needs include love, meaning in life, forgiveness, and hope. The human spiritual
dimension is a major healing force. It can mean the difference between life and death
and wellness and illness (Dossey, Keegan, & Guzzetta, 2004).
Nurses play a key role in helping clients find hope and meaning in life, it is
important that nurses understand spirituality. For many, religious practices are an
expression of their spirituality. An important function for the nurse is to respect the
religious beliefs of clients, provide clients with privacy to practice those beliefs, and
make spiritual guidance available through the client's minister, priest, rabbi, or other
representative, when requested.
8