INTRODUCTION:

The technological advancement in the field of biology and the over-specialization of the health personnel has led to the successful treatment of previously considered incurable conditions. However, the fact that several diseases have been treated with success does not necessarily guarantee the long-term rehabilitation of the patient. Health is a complex concept, which refers mainly to an individual’s well-being in a given environment, rather than to the absence of a disease, as that is defined by pathology and the traditional biomedical health approach. Moreover, the symptoms of a disease reflect a deeper disturbance of the bio-psychosocial balance of an individual and thusly, the definitive treatment of the “disease” lies mainly on treating effectively the underlying causes and not the superficial ones. The value of conventional care is not underestimated, but rather bestowed with a more integrated dimension and is now rendered holistic [1].

According to this approach, the physical and mental manifestations of a disease are now treated as a whole in the medical practice of each specialty. It refers to a more integrated (holistic) treatment of each morbid process in a human being, who is no longer considered as merely a carbon-based life form (body). Holistic care allows a more thorough consideration of a disease and an escape from traditional mechanistic approaches, which even though have offered a lot in the field of medicine and nursing, now seem obsolete. In that context, holistic care, as a set of methods which go beyond the status quo of care, and which are related to treatment methods observed in traditional societies, not only manages to coexist but also to evolve alongside conventional care and medicine. There are an increasing number of scientists who recognize the significant contribution of alternative medicine to the rehabilitation of a patient’s health, and also patients who turn to alternative-holistic medicine in their time of need. Presently, there are two major challenges that are emerging in nursing. First the integration of the concept of technology, mind and spirit into nursing practice and secondly is to create models that focus on the healing of self and others [1].

The idea of caring for the entire person, not just their physical body, is one that dates back to Florence Nightingale. Florence Nightingale devotion was to care for those who could not care for themselves. Florence Nightingale herself encouraged holistic care by recognizing the importance of environment touch, light, scents, music and silent reflection in therapy process [2].

Holistic nursing is the concept of caring of a person as a whole. The aim is to restore the patient as a whole. Holistic nursing emphasizes on the nurses taking into account the connection between mind, body, emotion, spirit, social, cultural, environment and past relationships in order to restore the patient to a whole. This however has not always been possible to achieve. The goal of holistic nursing is to possibly elevate, reduce or prevent suffering. In the mid-90s, nursing began to become a profession and became connected to developments medicine. In 1970, most nurse student and researcher sees nursing as being concerned with the whole person. Dossey theory of nursing was boldly based on holistic, integrated, and multidimensional theory.

Holistic Nursing is a special area of nursing practice which also gives nurse practicing holistic nursing a base for practicing and also differentiates the difference between holistic nurses and ordinary nurses in healthcare professions [2].

HOLISTIC APPROACH TO THERAPY:

The terms “Holism” and “Holistic” come from “Όλος-holos” a Greek word meaning all, whole, entire, total. Holistic medicine deals with a human being as a whole, i.e. it implements a multifaceted approach to the health-disease issue. Human beings, regarded as whole entities, are the focus of interest and not the individual diseases. Holistic medicine is not a different medical or treatment method, but rather a different philosophy on how to approach health. Symptoms themselves are now considered as the manifestation of a disease. The holistic approach takes into consideration an individual’s psychological, sociological and mental views and needs. Each individual consists of body, mind and soul as a unified total and is not just the sum of his body parts.

Change in any aspect of an individual’s life brings change to every aspect of his existence and differentiates the quality of his whole. The theoretical foundation of nursing itself is intrinsically holistic, since from early on it had been made clear that patient care cannot and should not be one-dimensional. Florence Nightingale herself encouraged holistic care, by recognizing the importance of environment, touch, light, scents, music and silent reflection in the therapy process. The holistic approach summarizes the psychosomatic approach of a disease and expands it by putting the patient in a specific time and cultural context. It deals with his own special needs and quality of life, by respecting his convictions [3].

The holistic approach has two important aspects. Firstly, it treats each individual as a separate entity, both in biological and social terms. Secondly, it is multidimensional, introducing a less simplistic view on health and disease. These two aspects affect the nurse-patient interaction, as well as the formation of the related research questions. Being able to differentiate between an “objective” and a “subjective” disease is important for a nurse in terms of approaching the patient, interpreting health in various people, situations and environments, and determining his/her actions in order to promote health and prevent diseases. Both the patient and the nurse are considered as subjects. This means that they are both aware of what is important and relative to the case in hand, and that they both have capabilities, alternatives, rights and freedom of choice. Therefore, the main characteristic of their relationship is equality.

The holistic approach is governed by certain principles, which can be summarized as follows:

· Each individual is capable of improving his knowledge and skills and changing his behavior towards himself and others.

· People are naturally inclined towards being healthy, but are also responsible for their good health status, recovery and taking care of themselves.

· A “person” belongs to himself. Therefore, his decisions and developments rightfully belong to him, the “owner”.

· The main focus of the recovery efforts is the individual and not the disease or injury.

The relationship between health care professionals and their patients should be one of mutual collaboration. People who provide health care intervene on behalf of the adult patient only when he asks for their help or when his health needs cannot be fully satisfied [4].

HOLISTIC NURSING CARE THEORIES:

Holistic nursing care provision was based on various theories, each focusing on specific aspects of the relationship between the person with his outside and inside world and his nurse, by respectively differentiating the concept of health. Their common ground, however, is dealing with the person as a whole being. From Maslow to modern holistic theories, the holistic approach embraces the total of human needs and puts them in a hierarchy by accepting a person’s individuality and the gravity he puts on each individual need.

The Intersystem Model:

The nursing theories of interactive processes are founded philosophically on integrative process models. The latter are based on the so called humanistic philosophy. Based on that, every person is a uniform being which constitutes an energy field in constant interaction with the energy field of the universe. The supporters of such nursing theories deal with a person as a holistic being, which interacts and adapts to the situations that he faces. They support systems theory and suggest that a person is in constant interaction with his environment. In that context, health is a value which ranges constantly from the highest possible well-being to disease. This view entails that people with chronic conditions may lead a healthy life and be satisfied by it, despite their condition.

Callista Roy’s Adaptation Model:

The theoretical outline of adaptation in Roy’s nursing theory includes a set of hypotheses which can be summarized in the following: A person is a bio-psychosocial being in constant interaction with an ever-changing environment. In-order for the person to face that ever-changing world, he would have to use biological, psychological and social mechanisms. Adaptation is accentuated as a key concept to a person’s positive reaction to environmental changes. A person’s adaptation level, which may lead to a positive reaction, includes a zone, indicative of the stimulus range, which disturbs the balances and calls for a new adaptation. It is also called “adaptation” theory, based on “systems” theory, in Helson’s adaptation level theory and in humanistic values.

It suggests that a system is a set of units interrelated or interlinked together, in order to form a unity or a set. It holds that all systems have input and output data, as well as control and feedback processes, by considering, at the same time, living systems as more complex than mechanical systems. According to Roy’s model, human behavior represents an adaptation to environmental and organic forces. The overall resultant of the individual reactions represents the organism’s final state. According to Roy, the purpose of Nursing is to aid the person as he adapts to the occurring changes, his biological needs and to his self-perceptions.

Integrative process theory:

Even though today, care group cooperation and interdisciplinary approach are a given, that was not always the case.

Even during the second half of the past century, the person-patient was treated as something different than the object of physicians’ and nurses’ care. Most health professionals operated with virtually no communication between them, each focusing on their own assignment, with none of them being fully aware of the patient and his needs.

Rogers’s Theory:

That conclusion led Rogers to suggest that a person is a “uniform energy system”, which is in “constant reciprocal interaction with the energy system of the universe”, and she, thusly, ultimately achieved to drastically affect the nursing field and encourage nurses to deal with a person as a whole unit, both during care design and provision.

According to Rogers, nursing practice aims towards promoting a harmonic interaction between the person and his environment, and reinforcing the cohesion and wholeness of a person’s energy field. Its goal is to appropriately guide the organization and synchronization of a person’s fields and environment in order to achieve the highest possible health potential.

Newman’s Health Care System Model:

Newman proposed a health care system model, according to which a person is treated as a whole system with individual interlinked parts and subparts. Stress factors take their toll on people, who have, however, flexible resistance limits and back-ups, which help them defend themselves against these stress factors. According to this model, nursing is directed towards recognizing a person’s standards in interaction with the environment, and accepting that interaction as an awareness development process. Disease comes to disrupt the relationships between a person’s standards in a more harmonic way. Health refers to a person’s ability to interact with his environment and to integrate thinking, feeling and processing of the information contained in all natural systems. Health becomes synonymous with developing awareness. Awareness development and therefore, the route towards health, have to go through new standards realization, transformation and discovery inside a complex living system. “Health” is experienced as a dynamic coexistence of the traditionally viewed health and the traditionally viewed disease. It is “well-being” information, which reflects the balance state a person’s entire being has reached.

Nursing is described as a “human experience health care”. It actually suggests a health care system model, which considers a person as a whole system with individual interlinked parts and subparts.

Parse’s Theory (Human Becoming):

According to Parse, human is considered as a Being, of his own will, who actively participates inside the world. A person can only be whole when he participates in the cosmic process. He is whole, open and free to choose the ways of the process. Parse had a radical view on health, suggesting that health status is our way of existence inside the world.

There is neither a continuum from health to disease, nor a health-disease counterpoint; it is more of the everyday way of existence. This is a new and unique way of viewing health, which provides understanding of the way each person creates his own destiny.

Nursing guides the person to find new ways of existence, to discover meaning in situations, to choose ways of co-establishing his personal health and to live his everyday life.

Summarizing the main holistic care theories, it should be noted that final treatment is the overall resultant of many factors related to a patient’s “reality”, as that is yielded by the individual components, which also include the nurse.

The patient, the environment, the nurse and the health objective are all interconnected, revolving around the treatment, which is the main focus [5].

BRIDGING THE GAP BETWEEN THEORY AND PRACTICE:

Despite the repeated efforts to bridge the gap between practical theory, practice and research, little progress has been made in that direction. Besides, the gap does not seem to come from flawed theories, which can, in either case, be evolved and reviewed in order to cover modern practice data, or from deliberate overlook of their calling. Incomplete care provision through health systems, which are not theoretical but totally tangible, is mostly derived by a shortsighted perception of nursing care, which is at best worn out in the context of the biomedical model, and also the lack of resources, which limits interdisciplinary potential and supplementary social care services.

Nurses face numerous challenges due mainly to the changes in the health provision system. For example, limiting hospitalization time has limited the pre-operative intervention and programming timeframe. Similarly, insurance company mechanisms have a drastic effect on home care provision, thusly determining to a large extent when and how the nurse takes care of the patients, and the type of services that he/she provides. These changes, despite the fact that they have dealt partially with the health provision cost inflation, have had a negative effect on nursing care provision.

However, we must also take into consideration that other issues also need to be resolved, such as education, researchers-clinical nurses’ interaction, as well as modern nursing practice issues. An important issue is also the lack of theoretical principles from the basic training program. The majority of nurses graduate from secondary education, either public or private, institutions, which focus only on purely practical skills, and give little priority to theoretical foundation and research, thus rendering the nurses’ post-graduation actions limited in consistency, repeatability and precision, and the nurse more of an empiricist and less of a scientist. Holistic care, in particular, requires thorough and careful handling and utilization of all the mental resources of both the patient and his caregiver, who must have some previous training and certain skills.

Clinical nurses’ further education is equally important to help them deal with certain issues, as is the promotion of the theoretical concepts and principles of holistic care. All clinical nurses should be encouraged to increase their knowledge by familiarizing themselves with new theoretical principles and nursing research, through continuing education or basic education programs [6].

STANDARD AND SCOPE OF PRACTICE FOR HOLISTIC NURSING PRACTICE:

The standard of practice that describes the standards of practice and professional performance of holistic nursing is summarized as follows. The five core values of holistic nursing are shown [7]:

· Holistic philosophy, theories, and ethics

· Holistic caring process

· Holistic communication, therapeutic environment, and cultural diversity

· Holistic education and research

HOLISTIC CARE:

Holistic nursing focuses on protecting, promoting, and optimizing health and wellness and preventing illness and injury at the same time reducing suffering and supporting people to find peace, comfort and balance through their illness. Holistic nursing also recognizes holism. Holism involves studying and understanding the interrelationship of the bio-psycho-social-spiritual dimensions of the person recognizes that the whole is greater than the sum of its parts; and that holism involves understanding the individual as an integrated whole interacting with and being acted upon by both internal and external environment. It is believed that the whole person is made up of interdependent parts and if one part is not working properly, all the other parts will be affected. Therefore there is an in balance of physical, emotional, or spiritual in sick people which in turn negatively affect their overall health. The aim of holistic nursing is to focus on all forms of healing from conventional medication to alternative therapies to treat a patient. Role of holistic nurses “is to learn to incorporate mind-oriented therapies in all areas of nursing in order to treat the physiologic as well as the psychologic and spiritual sequel to illness” [8].

HOLISTIC NURSE:

A holistic nurse is described as one who really cares. They are nurses who really take their time with the patient; they recognize and treat each individual differently, they are able to see beyond the diagnosis and not treat the patient as a burden. A holistic nurse needs to recognize the psychological and emotional well-being of a patient to facilitate physical healing. Respecting the patients role in the treatment process having the patient take part in the process and encouraging self-care is an aspect of holistic care which leads to therapeutic consultation, hope, dignity, self-discipline, social growth a sense of autonomy, vigor and vitality. The goal of a holistic nurse is to identify what the patient’s idea of health and healing is and facilitate a treatment plan to enhance the entire well-being of the individual. A holistic nurse acts as a partner to the patients guiding them in their journey of healing. The holistic practice is built on the philosophy that all elements in life are connected; self, nature, spirit and others. All aspects influence the other and can impact the overall health of a patient.

Holism is a concept that is found in holistic nursing which means treating a human being as a whole. For nurses to deliver holistic care, it is important to differentiate and understand healing and curing. Curing focuses on manly eradicating what is causing the illness this includes the use of medicine in order to find a physical cure to a disease. Healing which is mainly the concept of holistic nursing focuses on finding balance in the body, mind, and spirit in a human being. The best outcome for a patient is when the two healing and curing are combined [8].

CORE VALUES OF HOLISTIC CARE:

Holistic nursing is governed by five core values that summarize the ideals and principles of holistic nursing. The core values describe a diversity of nursing activities in which holistic nurses are involved. They are based on the philosophy is an art and science for which the primary purpose is to provide services that enable individuals, families and communities to achieve wholeness. The core values of holistic nursing are [9]:

· Philosophy theory and ethics

· Holistic caring process

· Holistic communication

· Therapeutic environment and cultural diversity

· Holistic education and research

· Holistic nurse self-care

HOLISTIC CARING PROCESS:

A holistic nurse provides care recognizing the patient as a whole. The holistic caring process involves assessment, diagnosis, and outcome, therapeutic plan of care, implementation and evaluation.

HOLISTIC COMMUNICATION:

Holistic communication is the art of sharing and as well as factual communication. It involves the patient experiencing the presence of the nurse as caring, sincere, non-judgmental, and compassionate and appreciating the patient's point of view. This begins with non-verbal communication for example keeping eye contact and an inviting facial expression and willingness to listen to a patient's point of view. “Active listening” is the basic form of holistic communication. It is the act of listening to what the patient says and reflecting it back to the patient. The goal is to listen to the whole person and provide the person with empathic understanding. This helps the patient feel heard and understood [9].

HOLISTIC NURSE SELF-CARE:

Holistic nursing requires the integration of self-care. It is important for holistic nurses to recognize that they cannot facilitate healing unless they are in the process of healing themselves. The World Health Organization defines self-care as "activities individuals, families, and communities undertake with the intention of enhancing health, preventing disease, limiting illness, and restoring health. These activities are derived from knowledge and skills from the pool of both professional and lay experience. They are undertaken by lay people on their own behalf, either separately or in participative collaboration with professionals." Holistic nurses value themselves and mobilize the necessary resources to care for themselves. They endeavor to integrate self-awareness, self-care and self-healing by engaging in practices such as self-assessment, meditation, yoga, good nutrition, movement, art, support and lifelong learning. They strive to achieve balance and harmony in their own life and help others do the same [10].

HOLISTIC NURSING PHILOSOPHY:

Holistic nursing is a philosophy of holism, healing and spirituality. As mentioned earlier, holistic nursing uses the bio-psycho-social-spiritual model to take into consideration the whole being of a patient. In holistic nursing disease and illness have an impact on the four bio-psycho-social-spiritual model and contribute to the patient’s symptoms, method of treatment and healing. This theory shows how the four components have the ability to be interdependent and interrelating. The theory acknowledges that the patients are more than just the disease or illness. It uses the theory that caring for a patient requires the consideration of body, mind spirit and soul. It is caring for the whole self of the patient through traditional and alternative approaches to achieving holism and optimal quality of life [10].

CONCLUSION:

This review gives valuable insight on holistic nursing practice among nursing people. Core values of holistic nursing, holistic caring process and holistic nursing philosophy is discussed in this article.

REFERENCES:

1. M. Kramer, B. Brewer, D. Halfer, P. Maguire, S. Beausoliel, K. Claman, M. Macphee, et al., “Changing Our Lens: Seeing the Chaos of Professional Practice as Complexity,” Journal of Nursing Management 21, no. 4 (2013): 690–704.

2. K. M. James, “Incorporating Complexity Science into Nursing Curricula,” Creative Nursing 16, no. 3 (2010): 137–142. J. George, ed., Nursing Theories: The Base for Professional Practice, 6th ed. (Upper Saddle River, NJ: Prentice Hall, 2011).

3. B. J. Zimmerman, “Complexity Science: A Route Through Hard Times and Uncertainty,” Health Forum Journal 42, no. 2 (1999): 44–46, 96.

4. J. W. Begun, B. Zimmerman, and K. J. Dooley, “Health Care Organizations as Complex Adaptive Systems,” in Advances in Health Care Organization Theory, eds. S. S. Mick and M. E. Wyttenback (San Francisco: Jossey Bass, 2003): 253-288.

5. K. Fiandt, J. Forman, M. E. Megel, R. A. Pakieser, and S. Burge, “Integral Nursing: An Emerging Framework for Engaging the Evolution of the Profession,” Nursing Outlook 51, no. 3 (2003): 130–137.

6. L. Shea and N. C. Frisch, “Application of Integral Theory in Holistic Nursing Practice,” 28, no. 6 (2014): 344–352.

7. J. A. Astin and K. Forys, “Psychosocial Determinants of Health and Illness: Integrating Mind, Body, and Spirit,” Advances in Mind-Body Medicine 20, no. 4 (2004): 14–21.

8. Newman MA. Toward an integrative model of professional practice. Journal of Professional Nursing 1990b; 6:167-173.

9. Raya A. Can knowledge be promoted and values ignored? Implications for nursing education. Journal of Advanced Nursing 1980; 15:504–509.

10. Koslander T, da Silva AB, Roxberg A. Existential and spiritual needs in mental health care: an ethical and holistic perspective. Journal of Holistic Nursing 2009; 27:34-42.

Received on 21.03.2018 Modified on 24.05.2018

Int. J. Nur. Edu. and Research. 2018; 6(4):447-452.

DOI: 10.5958/2454-2660.2018.00108.4