By Carla Mariano, RN, EdD, AHN-BC, FAAIM
Holism in nursing is a philosophy that emanated directly from Florence Nightingale, the founder of modern nursing. She believed in and advocated for care that focused on unity, wellness, and the interrelationship of human beings, events and environment. Essentially, the very roots of nursing are holistic. In some sense, all nursing practice can be comprehensive—that is, all nursing practice may have a biopsychosocial perspective. What makes holistic nursing practice a specialty is that there is a philosophy, a body of knowledge and an advanced set of nursing skills applied to practice that recognize the totality of the human being—the interconnectedness of body, mind, emotion, spirit, society/culture, relationship, context and environment. Holistic nursing focuses on integrating simultaneously all of these realms in the care of people. Holistic nurses also incorporate both conventional nursing, and complementary modalities and interventions (CAM) into practice, and they guide individuals and families between conventional and alternative systems of care. Most importantly, holistic nursing is a world view, a way of being in the world, not just a modality. This philosophy honors the unique humanness of all people regardless of who and what they are. The nurse does not heal or cure but facilitates healing, honoring that the person heals him or herself (Mariano, 2006).
In our society today, there is an increased demand for health care that is compassionate and respectful, provides options, is economically feasible, and is grounded in holistic ideals. A shift is occurring in health care—people desire to be more actively involved in health decision-making. They have expressed their dissatisfaction with conventional (Western allopathic) medicine and are calling for a care system that encompasses health, quality of life, and a relationship with their providers (Barnes, Powell- Griner, McFann, & Nahin, 2004).
Additionally, numerous surveys in the last decade indicate that the American public has pursued alternative and complementary care at an ever- increasing rate (37-62 percent). Western medicine is proving ineffective, wholly or partially, for a significant proportion of common chronic diseases. And, highly technological health care is too expensive to be universally affordable (Mariano, 2009). The Institute of Medicine (2005) strongly suggests that a need for healthcare providers who have knowledge and skill in alternative/ complementary modalities is critical for Americans. The National Center for Complementary and Alternative Medicine’s Strategic Plan for 2005– 2009, the U.S. Department of Health and Human Services’ Healthy People 2010 Midcourse Review (2005), and The Institute of Medicine’s 2009 Summit on Integrative Medicine and the Health of the Public (Washington, D.C., February 25-27, 2009) have made societal priorities of enhancing physical and mental health and wellness, preventing disease, and empowering the public to take responsibility for their health, i.e. hallmarks of holistic nursing.
Considering the above, nurses in all specialties and settings must have a professional ethic that incorporates holistic principles, knowledge and skills into their practice. Following are but a few examples of how this can be done in various practices.
With all populations and in any setting, nurses can empower patients/ clients/families by teaching them self-care practices for a healthier lifestyle. These can include nutritional counseling, exercise and movement, stress-management techniques, accessing inner wisdom, finding meaning in experience, and taking time for self.
Much can be done in hospitals to incorporate holistic principles. Acute care nurses can shape the physical space to become a more healing environment through neatness and order, pleasant sounds or quiet, healing scents and noninvasive light. Surgical/OR nurses can institute “Prepare for Surgery” programs that teach patients meditation and positive affirmation techniques, pre- and post-surgery. Emergency nurses can teach clients and families simple relaxation techniques to help quell fear and anxiety. Oncology nurses can incorporate many holistic modalities for pain management and nausea due to chemotherapy and radiation such as imagery, music, aromatherapy and herbology. Pediatric nurses can use essential oils and music with children, and teach parents basic touch techniques to quiet and relax the child.
Mental health nurses and hospice nurses can encourage their clients to journal, allowing each person to express his or her innermost feelings and thoughts without fear of criticism. This often serves as a chronicle of personal growth, insights and wisdom gleaned from one’s experience. Geriatric nurses can offer older people a variety of holistic modalities. The elderly can derive many benefits from holistic/CAM therapies because most are gentler, safer and non-invasive. In addition to lifestyle counseling, employee health and school health nurses can teach adults and children conflict resolution skills and meditation techniques that they can use in school, at work and at home.
There are other areas besides direct clinical practice where nurses can incorporate holistic principles. Nurse educators and informatics nurses can insure that technology is grounded with heart and humanness. Nurse administrators can create and model “cultures of caring” that are relationship centered, supportive, respectful and compassionate, and that emphasize self-care, personal/professional balance and being treated as we ourselves wish to be treated.
If holistic nursing takes place wherever healing occurs, then surely, holistic nursing can and should be a specialty for all nurses.
Carla Mariano RN, EdD, AHN-BC, FAAIM, developed and is immediate past Coordinator of the Advanced Practice Adult Holistic Nurse Practitioner Program in the College of Nursing at New York University, the first Holistic Nurse Practitioner Program in the country. She has served as President and President- Elect of AHNA (2004-2008) and received the Holistic Nurse of the Year Award in 2003. She was integrally involved with AHNA in developing the Scope and Standards of Practice for holistic nurses and the Advanced Practice Holistic Core Curriculum. She spearheaded the initiative that gave holistic nursing official recognition as a specialty within the discipline of nursing by ANA. She has numerous publications to her credit, has presented her research nationally and internationally, and is the recipient of many awards.
Barnes, P. M., Powell-Griner, E., McFann, K., & Nahin, R.L. (2004). Complementary and alternative medicine use among adults: United States, 2002. Advance Data. No. 343. http://nccam.nih. gov/news/camstats/2002/report.pdf
Institute of Medicine. (2005). Complementary and alternative medicine in the United States. Washington, DC: The National Academies Press.
Mariano, C. (2006). Proposal for recognition of holistic nursing as a nursing specialty (Document submitted to ANA, 2006). New York, NY.
Mariano, C. (2009). Current trends and issues in holistic nursing. In B. Dossey & L. Keegan (Eds.), Holistic nursing: A handbook for practice (5th ed., pp.75-85). Boston: Jones and Bartlett.
National Center for Complementary and Alternative Medicine. (2005). Expanding horizons of health care: Strategic plan 2005-2009. Washington, DC: National Institutes of Health.
U.S. Department of Health and Human Services. (2005). Healthy people 2010: Midcourse Review. http://www.healthypeople.gov/ data/midcourse/default.htm