Download Dimensions of Holistic Health Care

Professional Nursing Practice
Concepts and Perspectives
Seventh Edition
Chapter 20
Dimensions of Holistic
Health Care
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Learning Objectives
20.1 Describe the change in the view of health care from one of biological focus
on disease management to comprehensive health care.
20.2 Define holistic health and holistic nursing.
20.3 Differentiate primary, secondary, and tertiary health promotion.
20.4 Discuss integrative health in the context of nursing.
20.5 Compare biologically based, manipulative body-based, energy, and mindbody-based therapies.
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Hallmark Features
• A focus on foundational knowledge related to
professional nursing
– Includes nursing history, nursing theory, ethics, and
legal aspects, etc.
• An overview of professional nursing roles, issues,
and changes in the profession
– Discusses nurses as healthcare providers, learners
and teachers, and leaders
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Challenges and Opportunities
• The traditional view of nursing and medicine is no
longer adequate
• Traditional views of nursing should be expanded
to encompass holistic health
• Providing health care for a diverse population
must be met by expanding perspectives of health
• Opportunities for nursing to actively participate in
expanding focus of health care
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Learning Objective 20.1
Describe the change in the view of health care
from one of biological focus on disease
management to comprehensive health care.
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The Expanding View of Health Care
• Western medicine has been through three eras
– Starting in the 1860s when the focus was entirely on
the physical
– In the 1950s there was a growing recognition of the
effect of the mind or consciousness on the physical
– Recently consciousness has expanded time and space
and is believed to be infinite
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Complementary and Alternative
Medicines
• National Center for Complementary and
Alternative Medicine (NCCAM) established at
National Institutes of Health (NIH)
• Complementary and alternative medicines (CAM)
is “a group of diverse medical and health care
interventions, practices, products, or disciplines
that are not generally considered part of
conventional Medicine”
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Complementary and Alternative
Medicines
• Complementary medicine refers to
nonmainstream approach used in combination
with or in addition to conventional medicine
– More commonly found in healthcare practice
• Alternative medicine refers to using
nonmainstream medicine in place of conventional
medicine
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Complementary and Alternative
Medicines
• Two main types of CAM therapies
– Doing therapies such as medications, dietary changes,
spinal adjustments
– Being therapies such as meditation, imagery, states of
consciousness
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Complementary and Alternative
Medicines
• All healing experiences are on continuum from
paradoxical to rational healing
– Paradoxical healing approaches are less traditional
and more difficult to explain scientifically
– Rational healing experiences are more easily
understood by scientific world
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Complementary and Alternative
Medicines
• Pew Health Professions Commission Report
(1994) put forth tenet that relationships and
interactions provide foundation for healing
• Three types of relationships
– Patient-practitioner
– Community-practitioner
– Practitioner-practitioner
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Complementary and Alternative
Medicines
• Optimal healing environments integrate social,
psychological, spiritual, physical, and behavioral
aspects of care
• Key concepts include awareness and intention
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Complementary and Alternative
Medicines
• Holistic healthcare movement has expanded
choices of treatment modalities for health and
healing
– Many treatment choices borrowed from Eastern
medicine
• Integrative medicine or integrated health is the
blending of Eastern and Western medicine
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Learning Objective 20.2
Define holistic health and holistic nursing.
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Holistic Nursing
• Holistic nursing recognized by the American
Nurses Association as a nursing specialty with
own scope and standards of practice
• American Holistic Nurses Association (AHNA)
developed standards of holistic practice
– The interconnectedness of body, mind, emotion, spirit,
social/cultural effects, relationship, and context and
environment, and their impact on health and healing
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Holistic Nursing
• Recognizes mind-body-spirit connection and uses
alternative and complementary modalities
–
–
–
–
Therapeutic massage
Imagery
Meditation
Healing presence
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Holistic Nursing
• Certification done through American Holistic
Nurses Certification Corporation and involves
– Application
– Examination
– Self-reflective self-assessment
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Holistic Nursing
• Nurses may be certified on basic or advanced
levels
– Basic - holistic nurse, board-certified (HN–BC) or
holistic baccalaureate nurse, board-certified (HNB–BC)
– Advanced - advanced holistic nurse, board-certified
(AHN–BC) or advanced practice holistic nurse,
board-certified (APHN–BC)
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Holistic Nursing
• Holistic nursing embraces art and science of
nursing
• Reality comes from four perspectives
–
–
–
–
Individual interior (personal/intentional)
Individual exterior (physiology/behavioral)
Collective interior (share, cultural)
Collective exterior (systems/structure)
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Health Promotion and Healthy Lifestyles
• Healthy People 2000 has influenced transition in
healthcare system to more holistic view
– Moved away from illness/disease-based framework to
more comprehensive approach
– Expanded to include health screening and health
promotion strategies
– Expanded to become Healthy People 2020
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Health Promotion and Healthy Lifestyles
• World Health Organization (WHO) first proposed
that health is more than absence of disease in
1946
• Eight dimensions of health, wellness, and
well-being
– Physical
– Psychological
– Emotional
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Health Promotion and Healthy Lifestyles
• Eight dimensions of health, wellness, and
well-being
–
–
–
–
–
Intellectual/cognitive
Spiritual
Occupational
Social
Environmental
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Health Promotion and Healthy Lifestyles
• Many CAM disciplines, systems of traditional
medicine, and integrative medicine practice place
strong emphasis on preventive health strategies
– Better dietary practices
– Regular physical exercise
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Health Promotion and Healthy Lifestyles
• Emerging body of data suggests that users of
CAM have greater degree of health
consciousness and are more likely to engage in
health-promoting activities
– Further investigation needed to confirm findings
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Learning Objective 20.3
Differentiate primary, secondary, and tertiary
health promotion.
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Primary, Secondary, and Tertiary
Prevention
• Three levels of health promotion
– Primary
– Secondary
– Tertiary
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Primary, Secondary, and Tertiary
Prevention
• Tertiary level of prevention
– The care and treatment of a patient after an illness or
disease has occurred
– Most common setting where nurses would care for
clients in the past was in acute-care settings
– Most expensive level of care
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Primary, Secondary, and Tertiary
Prevention
• Secondary level of prevention
– Focuses on screening and early detection with goal of
intervention
– Is an important part of mainstream medicine today
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Primary, Secondary, and Tertiary
Prevention
• Primary prevention
– A major focus of health agendas
– Focuses on health promotion and education
– Costs of primary prevention are minimal and impact is
significant
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Primary, Secondary, and Tertiary
Prevention
• Modifiable risk factors
– Identified factors that are amenable to modification
– Elevated blood pressure, smoking, obesity, sedentary
lifestyle
• Nonmodifiable risk factors
– Identified factors that are not amenable to intervention
– Gender, age, genetics
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Learning Objective 20.4
Discuss integrative health in the context of
nursing.
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Transition to Integrative Health
• Landmark study conducted in 1993 on the use of
unconventional medicine
– Revealed that one in three people surveyed used at
least one form of alternative medicine
– 325 million Americans sought some form of alternative
medicine and paid out of pocket
– Highlighted 15 different types of alternative medicine
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Transition to Integrative Health
• Updated study (1997) revealed that visits to
alternative providers had risen
• Based on the outcomes of these data, clear that
alternative medicine was becoming common
choice for Americans
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Transition to Integrative Health
• In 1997 the NIH established the Office of
Alternative Medicine (OAM)
• Later designated as a center called the National
Center for Complementary and Alternative
Medicine (NCCAM)
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Transition to Integrative Health
• NCCAM’s mission is to
– Explore complementary and alternative healing
practices within the context of science
– Train complementary and alternative medicine
researchers
– Disseminate authoritative information to the public and
professionals
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Complementary Therapies
• NCCAM has organized CAM therapies into four
categories
– Mind-body
– Biologically based
Use of substances found in nature
– Manipulative body-based
Manipulation of one or more body parts
– Energy
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Complementary Therapies
• Whole Medical Systems, a category identified by
NCCAM, include
–
–
–
–
Traditional Chinese medicine
Osteopathic medicine
Ayurvedic medicine
Homeopathy
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Complementary Therapies
• Nurses need to be aware of modalities, especially
those that encompass body-based manipulations
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Learning Objective 20.5
Compare biologically based, manipulative bodybased, energy, and mind-body-based therapies.
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Biologically Based Therapies
• Include the use of substances found in nature, such
as herbs, vitamins/supplements, and organic whole
foods
• Botanical is a plant or plant part used for its medicinal
or therapeutic properties, flavor, and/or scent
• Some herbal therapies are contraindicated in the
presences of certain illnesses, diseases, and
medications
– Clients are not always aware of contraindications
• Herbal products not monitored by the FDA
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Manipulative Body-Based Therapies
• Commonly used to treat musculoskeletal
problems
• Most common treatment
– Massage
– Chiropractic care
• Most common musculoskeletal problem that
patients seek integrative health care for is back
pain
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Energy Therapies
• Use energy fields to create change in the body
• Therapeutic touch, introduced by the nurse
Dolores Krieger in 1972
• Philosophy underlying energy healing is the
“laying on of hands,” where healer helps to
harness or redirect client’s energy to create
healing from within
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Energy Therapies
• Four phases of therapeutic touch
– Center oneself physically and psychologically to
prepare for the healing session
– Prepare the field of energy for therapeutic touch
through sensitizing hands to detect subtle changes in
energy flow
– Mobilize the energy in client’s field that may be stuck or
congested by laying on hands
– Help clients “re-pattern” their energy through the use of
healer’s excess energy
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Energy Therapies
• Elicits relaxation and can eradicate or lessen pain
• This category of integrative modalities is divided
into
– Veritable (measurable)
Laser beams, visible light, magnetism, electromagnetic forces
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Energy Therapies
• This category of integrative modalities is divided
into
– Putative (no objective measure)
Often referred to as “chi” or life force in Eastern philosophy
When chi is out of balance, illness or disease occurs
• Energy modalities include acupuncture, tai chi, qi
gong, and Reiki; magnetic therapy; therapeutic
touch; energy work
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Mind-Body-Based Therapies
• Focus on the interaction of the mental, social,
emotional, and behavioral factors and state of
health
• Progressive relaxation and visualization therapies
can be taught to clients to use at home
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Mind-Body-Based Therapies
• Focus is on empowering client through selfknowledge and encouraging self-care.
• Integrative modalities include hypnosis,
meditation, mental healing, prayer, and visual
imagery; tai chi; spirituality; creative therapies
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