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HOLISM Aims /Objectives Aim: To introduce the concept of holism as is applies to nursing practice Objectives: Define holism Overview of the concept of holism, health and nursing Case Study 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 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 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 Holism was first described by Smuts in 1926 “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 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 “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 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 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 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 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 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 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 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 ‘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 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 1. 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 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 What do you think are the different dimensions of the person? physical psychological social Patient/ client emotional intellectual spiritual Physical Dimension 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 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 Receptive functions; ability to acquire, process, classify and integrate information. Memory and learning Cognitive or thinking Expressive function. Spiritual Dimension ‘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 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 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 Ignoring some dimensions leave the individual in an unbalanced state. Dimensions of the Person 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? Moving from task orientated care Primary nursing Valuing the person Partnership in care Nurse-client relationship Patient charter Case Scenario 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 “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 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 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 For Patient: Harmony Healing Empowering Increased personal development For Nurse: Self-satisfaction Increased job satisfaction Increased personal development Professional development McEvoy and Duffy (2008) Potential Negative Consequences of Holistic Care For Patient: Intrusive Can focus too much on psychological For Nurse: Emotionally draining Time consuming McEvoy and Duffy (2008) Self Awareness 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 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 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 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