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1.     Holistic nursing emphasizes self-care, self-responsibility, and reflection. Along with self-care and self-responsibility comes healthier habits that can help the client regain control of their health while also preventing further illnesses

2.     Holistic nurses have a sense of fulfillment because they practice to help every person as a whole rather than being task oriented and rushing from patient to patient. The holistic nurse is actively involved in individual patient care.

3.     Holistic nursing is a universal practice. These nurses can be found in hospitals, private practices, hospice, and education. Holistic health therapy is quickly growing and will continue to grow due to its unique and individualized approach utilizing traditional and cultural treatments, focusing on every person as a whole, and connecting the mind and spirit.

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Our online RN-BSN degree completion program is our newest at Ameritech, but it's founded on decades of thoughtful research and practice in the field of nursing. We built the curriculum around the recommendations in The Future of Nursing Report and the standards from the American Holistic Nurses Association (AHNA). We love holistic nursing education, because we agree that nurses have to care for the whole patient: Not just their body, but their mind, spirit, emotion, and environment too. There are many benefits of learning holistic nursing, and we've assembled eight of them.

1. Greater fulfillment

In nursing it's easy to become task- or goal-oriented. You have an assignment of patients, all with individual health needs, and a limited amount of time to tend to and care for them. It makes sense to move through the motions quickly, but this can make you forget about the person in the bed, recovering or awaiting surgery or hurting or scared. Most nurses enter the practice to help people, and holistic nursing compels you to focus on each person as an individual, which benefits their care, and it makes your work more fulfilling.

2. More effective care

Focusing on patients not as tasks but more holistically as people, obviously benefits them emotionally, especially if they're worried or fearful. It also benefits them physically, since bodily health is intimately related to emotional, spiritual, and environmental health too. Many patients, like victims of car accidents, are being treated for obvious injuries that require stitches or surgery. Others, though, may enter the hospital for back pain or heart disease, ailments that can be due to environmental factors like their diet and lifestyle. Holistic nurses are aware of this interconnectedness, and so they're better able to treat and care for patients physically, by attending to them emotionally, environmentally, and spiritually too.
Related Resource: 5 Reasons You Need Your BSN Degree
3. Emphasized self-care

All nurses focus on their patients, but the best nurses are aware of themselves and their own needs and emotions as they care for others. Holistic nursing emphasizes the importance of self-care, self-responsibility, spirituality, and reflection for nurses. Nursing is hard work. It can be emotionally draining, even devastating sometimes, especially for nurses who often experience loss. An emphasis on self-care keeps holistic nurses emotionally healthy, which makes them better at their job.
Related Resource: What You Should Know about Mental Health and Nursing
4. Sustainable practice

That emphasis on self-awareness and reflection also benefits nursing as a career in general. Every nurse is at risk of burnout and compassion fatigue. If you just give and give and give at work, you'll quickly feel drained, maybe even bitter. By emphasizing nurses and keeping them emotionally, spiritually, and mentally health, holistic nursing reduces that risk of burnout, which benefits the nursing practice as a whole.

5. Recognized specialty

Thanks in large part to the efforts of the AHNA, holistic nursing became a recognized nursing specialty by the American Nursing Association in 2006. The AHNA clearly demonstrated that holistic nursing had a defined scope and unique standards of practice, as unique and specialized as any other area of nursing. This recognition has been a huge benefit in supporting holistic nurses by giving their practice more clarity, and by laying a foundation for them and the future of holistic nursing.

6. Universal practice

Holistic nursing is a specialty, but its philosophy applies to any practice in any hospital wing in any part of the world. Holistic nurses can be found in hospitals, private practice, hospice, and education, helping patients and families of all ages to live better, holistically. Whatever area of nursing you want to pursue, a holistic nursing education will benefit you and everyone you work with or treat.

7. Long history

Florence Nightingale is often said to be the Mother of Modern Nursing. She's also believed to be the founder of holistic nursing. According to the AHNA, she "believed in care that focused on unity, wellness, and the interrelationship of human beings and their environment." Modern holistic nursing is based on Nightingale's philosophical approach, and over the years it has benefited from new theories, knowledge, and experience. Ameritech's holistic nursing education draws on that large body of knowledge to train nurses to better treat and care for their patients.

8. Future focused

Though holistic nursing has only been recognized as a specialty for nine years, it's already become an integral part of the healthcare system-and many healthcare leaders look to holistic nurses as guides to the future. More and more fields of medicine are understanding the importance of a holistic philosophy to treat patients and communities. Nurses trained in a holistic education will very likely be better prepared for the changes already occurring in healthcare-in addition to all of the other benefits that holistic nursing offers.
Related Resource: Why Some Hospitals Already Require a BSN Degree
At Ameritech College of Healthcare we're proud of our BSN curriculum, particularly how it integrates holistic philosophy. If you've been on the fence about earning your baccalaureate in nursing and want to become a better nurse, read about our online BSN degree program here, and please reach out with any questions. We'd love to hear from you.

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8 Benefits of a Holistic Nursing Education

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Our online RN-BSN degree completion program is our newest at Ameritech, but it's founded on decades of thoughtful research and practice in the field of nursing. We built the curriculum around the recommendations in The Future of Nursing Report and the standards from the American Holistic Nurses Association (AHNA).

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Advantages of holistic health perspective

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Advantages of holistic health perspective

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1. The perspective/focus recognizes that a person cannot be treated by focusing only on a single aspect of their health or a single organ. All parts of the body, mind and spirit are interconnected and are impacted by imbalance in any area within the individual.
2. The perspective is partially "defined" by integrating complimentary practices. People have an intuitive connection with many of the complimentary practices for various reasons. Denying patients the practice of these again isolates a part of the being leaving the treatment incomplete and foreign/artificial. Complimentary practices help integrate the different parts of the being - physical, mental and spiritual.
3. Holistic medicine will ultimately be our primary solution given the unsupportably large number of patients that otherwise will end up with chronic diseases needing support (ie baby boomers' increasing needs). This practice will help health promotion to strengthen each individual and reduce or delay the entry into acute care.

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Many patients feel empowered and respected by the holistic nurse. This approach allows the patient to take charge of their own health which is very important in holistic medicine. They understand their own abilities to heal and the importance of self-care. It brings change in the lifestyle of the person causing an overall complete recovery that last long term. It allows the patient to understand their need for a well-balanced lifestyle by bringing awareness to keeping a safe and healthy environment thus increasing their overall satisfaction. Next, they tend to use natural resources rather than chemicals such as herbs and medicines thus limiting the use of medications whereas many physicians may approach medications as a first line response. It is also more financially affordable to many patients because many of the healing treatments offered are through massages, acupuncture, chiropractic or natural remedies. This will allow the patient to save more money and ultimately reduce their stress.

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The landscape of medicine is changing. More and more people are realizing the many benefits of complementary and integrative health, medicine, healing, and nutrition who are seeking practitioners who can provide it. A career in the field of Holistic Medicine and Healing Nutrition can begin with understanding these 5 advantages, followed by getting a Degree or Certification Online in Holistic Medicine & Healing or Holistic Nutrition & Natural Health. nutrition certificate online.

1. It Empowers Patients

Holistic healing involves helping patients understand their own innate ability to heal. Holistic healers educate patients on healthy lifestyle changes, the importance of self-care, and the many healing options available to them. This empowers patients to take the necessary steps for optimal health and supports them in this endeavor.

Holistic healing involves helping patients understand their own innate ability to heal. Holistic healers educate patients on healthy lifestyle changes, the importance of self-care, and the many healing options available to them. This empowers patients to take the necessary steps for optimal health and supports them in this endeavor.

2. No Chemicals

Where a patient may already be receiving conventional treatments involving pharmaceutical products, holistic healing can present a welcome reprieve. This form of healing treatment uses natural methods, foods, nutrition, and medicines such as herbs to help eliminate symptoms and address the root causes of whatever issue the patient is dealing with.

In many cases, a patient may be able to reduce the number of pharmaceutical products they are taking or eliminate them completely from their treatment plan when they choose to add Holistic Medicine & Healing Nutrition Principles by applying their learned skills to their daily lifestyle.

3. Easier on Patient Finances

These Holistic Natural Health Treatments of Healing offered can often be far less expensive for a patient than other treatments they may be receiving. Acupuncture, chiropractic, and massage, as well as natural remedies and certain dietary supplements, can save the patient money and, ultimately, reduce their stress.

4. It Addresses Several Conditions

Holistic Medicine & Healing Nutrition Principles, Remedies, Methods, and Treatments have been used for many years and centuries to address a wide range of conditions. Some of the symptoms and conditions helped by these Holistic Methods, Remedies and Treatments include:

5. It Treats the Whole Person

Holistic Medicine & Healing Nutrition treatment not only "Removes The Causes" of their physical illness but also the mental, emotional, and spiritual aspects. In pursuit of Optimum Health, Power, Strength and Endurance one must live to fulfill a healthy lifestyle that a WHOLE HEALING TREATMENT PLAN offers a patient the hope and experience that is Naturally required to improve one's physical condition or symptoms, as well as achieve a greater understanding that any natural form of healing must include the WHOLE MIND, BODY AND SOUL working in total harmony. We must remember that we are not "The Sum of Our Individual Parts, But The Sum of All Parts Working Together as Whole"!

Holistic Medicine & Healing Nutrition as a Career!

With more people turning to Natural Healing and Holistic Medicine and Healing Nutrition Methods than ever before, choosing a Holistic Career would be a wise choice. If you want to begin a rewarding and fulfilling Holistic Career, you can now receive a formal education in many Holistic Fields of Interest such as entering Holistic Medicine & Healing Nutrition Schools to undergo the holistic education and training required to build a solid foundation as well as a successful Holistic Practice that will support your career-choice for life.

The University of Natural Health is one of the largest Holistic Medicine & Healing Nutrition as well as Natural Health Schools Online in the world. We offer both in-class and distance learning options to suit your schedule. Our accredited degree & certification programs in holistic health, healing and nutrition, as well as holistic medicine, allow you to diversify your education as you apply what you learn to your own life. Learn how to earn your Online Degrees & Certifications by visiting our website.

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5 Advantages of Holistic Healing | University of Natural Health

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The landscape of medicine is changing. More and more people are realizing the many benefits of complementary and integrative health, medicine, healing, and nutrition who are seeking practitioners who can provide it.

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1. You get to take care of the patient as a whole. Not just as a missing piece on a puzzle. Holistic health looks at patients as a whole with physical, spiritual, and emotional well-being.
2.Holistic nursing can help build rapport with patients and nurses. Patients may feel comfortable opening up with nurses when they feel and know that every aspect of them is being taken care of.
3. Hollistic health sets us apart from regular care. Holistic health takes care of the inside of someone in order to take care of the outside. Having a healthy mindset can really make for a quicker better recovery.

https://www.ozassignments.com/solution/holistic-nursing-health-editing-service

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One main advantage of holistic health and holistic nursing is that patient's treatment is not only centered on treating the disease but it also focuses on the mental, emotional, spiritual and social factors of their health. I feel like this is an advantage because as humans we are not a disease process and there may be other aspects in our lives that can be influencing disease such as the above factors I previously mentioned. Another advantage is the use of mind-body medicine which includes art therapy, hypnotherapy, and meditation. This form of holistic health can help reduce stress which is a significant driving force for disease. Lastly, another advantage of holistic health is it gives individuals more treatment options and they feel more in control of their treatment plan when given the option to explore holistic therapies and remedies. This may help individuals feel less limited when seeking treatment options of conventional medicine and may also assist with incorporating a spiritual aspect of care.

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1. Holistic medicine is a type of medicine that focuses on a persons total physical and emotional well being rather than merely treating the symptoms of a disease. It considers the individual has three parts that are important to maintain homeostasis: body, mind, and spirit.
2. Proactive health model: Customized care and natural therapies with fewer adverse effects than prescription-grade medications. Improving the situation where traditional medicine failed to evaluate the mediation's long-term effects of patient dealing with opiate addiction because of failed pain management and uses of alternative therapies like  massage therapy, relaxation, acupuncture.
3. Preventative actions: identifies individuals specific requirements and help you implement sustainable long-term solutions to offer you long-term outcomes using advanced testing and understanding of a person's individual genetic composition.

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Have you ever thought what the definition of health is? The dictionary tells that it's the lack of illness or injury. But, according to holistic medicine practitioner, merely being free of disease does not make you healthy.

Your health is a continuously progressive state. You might feel good today and not tomorrow.

How you treat your body impacts your overall wellness and health for many years to come. So, when it comes to health, consciously making the right decision every day is most likely your best strategy. Holistic medicine practitioner uses data driven scientific and natural safe approaches to help you restore wellness and maintain good health.

If you're trying to find ways to boost your immunity and avoid illness, preventive medicine might be a great option for you. This approach of healthy lifestyle centers around practices that concentrate on the promotion, prevention, and maintenance of health and wellness.

What is holistic medicine?

Holistic medicine focuses on the person as a whole, instead of treating one condition or body system. The holistic approach takes into account the intrinsic connection between the body, mind, and spirit. Advanced scientific approaches using specialty lab work including genetic testing, allows a holistic doctor to work with your body's unique and individual needs rather than just focusing on covering up symptoms. Through advanced testing and understanding a persons individual genetic makeup, your holistic practitioner can determine your individual needs and help you implement sustainable long term solutions to give you long term results.

Why Should I Try Holistic Medicine?
6 adults out of 10 in the United States have a chronic health disease. 4 out of 10 have two or more long-term conditions. Suicide rates are at an all time high. Why is the U.S. the sickest industrialized nation in the world when we have the most advanced medical science at our finger tips?!

There are many contributing factors that are contributing to the rise in chronic health issues including sustained long term high stress. Let's not forget the Standard American Diet which consists of foods that cause neural inflammation, leaky gut, and body wide inflammatory conditions. Take gluten, for example, which can accelerate auto immune attacks on the thryoid known as Hashimoto's or cause brain based diseases like atrophy of the cerebellum region of the brain, J Neurol Neurosug Psychiatry 2002;72:560 - 563. - AND this isn't new news! The problem isn't that we don't have the advanced testing available to us, the problem is that the current health system is not set up to allow doctors to offer the type of testing that is looking for underlying causes of disease.

Our current health model is excellent at acute care but is failing at reversing and preventing chronic illness. There are so many variables that can cause not only the brain chemistry to shift out of balance but the entire body... variables that include underlying infections, foods or chemicals and preservatives in the foods, environmental toxins like glyphosate, and even lifestyle choices. It takes a complex model approach to understand what the variables can be and how all the variables can effect the body and the brain. Shifting to this more complex thinking approach and understanding that we need to find the underlying root causes of an individuals chronic illness is going to be the long term solution for those who are struggling for answers, and holistic doctors are experts in finding root causes of chronic illness.
The following are the most common and expensive illnesses:
Choices like insufficient physical activity, bad eating habits, environmental toxins, prolonged stress, and underlying infections which many don't know they have, can increase one's risk of long-term health conditions.

The Centers for Disease Control and Prevention reports that practicing prevention can reduce your healthcare cost. Americans spend $3.3 trillion on health care each year. 90% of this total arises from a persistent mental and physical health conditions.

When you choose holistic healthcare approaches, you are placing your long-term health goals over short-term lifestyle decisions with the goal of healthy living well into your golden years. Holistic health practices are not only beneficial for you...If you are a woman wanting to have a family, for example, your lifestyle choices will directly effect the long term health of your child. Having a healthy pregnancy is essential for the long-term health of both the mother and the child.

Advantages of holistic preventive care
Functional Health Screenings:
As you age, life gets busier. This may leave you struggling to find time for routine check-ups and tests. Keep in mind; staying on top of your health and having a holistic doctor on your team are a crucial part of holistic health and prevention.

Health screenings can detect persistent conditions and infections early so that you can get proper treatment and hence slow down the progression of this illness. These types of examinations are essential as you age, especially in the middle-adult and senior years.

Have you ever considered how essential your heart is to daily life? There are lots of things you should know about the heart. Among the most critical components of healthy living is taking good care of your heart by making heart-healthy decisions in your daily lifestyle choices. Genetic testing is a great way to discover what lifestyle choices will optimize your heart, mind, and body.

Holistic Medicine Practitioners often recommend that their patients get annual laboratory tests as a part of routine preventive health care. Lab tests typically vary depending on the unique history of the patient.
Individually Tailored Diets:
Choosing to eat a healthy diet reduces your risk of developing conditions like high cholesterol and obesity. But understanding that each person has unique requirements for what foods are healthy for them is usually not addressed. Holistic doctors who utilize genetic and other testing with their clients can help them tailor a diet that will best suit their individual requirements to sustain health.

If you have any chronic health disorder, like diabetes or Gastrointestinal Reflux Disease (GERD), your diet is a critical step to reversing those conditions. If you have GERD, be sure to avoid foods that agitate symptoms. These consists of spicy foods, coffee, tea, and fatty or fried foods and may also consists of otherwise 'healthy' foods that are causing inflammation to your body. This is where your holistic doctor can really help by understanding which testing to order for you to determine what foods you might need to steer away from so that your body can heal. A healthy eating strategy can help you reverse many diseases and other complications.
Proactive Health Model:
The Holistic approach to health focuses on addressing the root causes of physiological illness and mental health imbalances by using a biological and genetic data driven approach to determine healing protocols that work with your body's unique and individual needs rather than just focusing on covering up symptoms.

If you're ready to take your health back, give your holistic medicine practitioner a try!

Among the simplest ways to begin is to make an appointment with a holistic medicine doctor. She/He can work with you to establish a plan of action to get your health back on track. Try a data driven approach that can put you on the path towards health and a more balanced lifestyle!

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How A Holistic Medicine Practitioner Can Change Your Life

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Have you ever thought what the definition of health is? The dictionary tells that it's the lack of illness or injury. But, according to holistic medicine practitioner, merely being free of disease does not make you healthy. Your health is a continuously progressive state. You might feel good today and not tomorrow.

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1. One of the advantages of holistic health is that it treats every aspect of the person including physical, intellectual, emotional, social, cultural and spiritual. When patient notice health providers are treating all aspects, the feel like they are taken care of and trust their provider more.
2. Patients are taught different ways to manage and decrease their stress levels, for example yoga, medication, prayer. Patients incorporate this into their daily lives and can potentially decrease their risks of disease.
3. In holistic health, we are practicing treating the actual patient and not just the disease

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1. More effective patient care: If we emphasize our care on the patient and not see it as a task to complete, helps our patients know they are our priorities.  This can also help patients who are fearful by helping them feel safe, which then benefits them physically and emotionally also.
2. Can help improve their habits and lifestyle of our patients: since our bodies work as a whole and together if we can educate our patients on the holistic approaches once they are benefited physically it circulates and benefits them as a whole.
3. Reduced stress and anxiety level: Having a holistic approach can help find ways to relax without use medications yoga and breathing exercises are only two examples among many

https://downtownshealthcare.com/regenerative-therapy/the-benefits-of-holistic-health-what-can-you-achieve-through-holistic-practices/

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One of the aspects that I disliked about working in the hospital setting while I was a nursing student was the feeling that all I did was administer pills and medication. I remember many instances where my patient's had 17 PO meds to be administered, plus IV antibiotics and many more medications....Not only did I feel like giving all of those medications was sometimes unnecessary, but also gave me no time to provide one of the most important aspects of nursing, emotional support through either touch, active listening or a simple hug. My point is that the process of healing is not only achieved through medication interventions. I believe the process of healing involves treating the patient as a whole, considering not only their physical health, but emotional and spiritual health as well. I am glad this topic is being highlighted in the class, as I think we live in a country ruled by Western medicine. I wish more countries incorporated holistic approaches in their healthcare systems, and included holistic healthcare education in their nursing and medical programs. It looks like Europe has already started!

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Alternative medicine is always accompanied by controversy, with those who swear by its healing potential and others who denounce it as quackery. When it comes down to it, most of us are really just wanting a safe, personalized medical experience that considers both who we are and why we're suffering. These European countries are showing us, each in their own way, how the modern medical model can coexist with alternative medicine and how we can have the best of both medical worlds.
Editor's note: Please consult a doctor before incorporating any alternative medicine into your health regime.
What is alternative medicine, and how is it used in Europe?

Complementary and alternative medicine, or CAM, is a popular term in Europe to describe a wide range of medical services that are less reliant on modern medication, such as acupuncture, reflexology, herbology, chiropractic, osteopathy, massage therapy, homeopathy, and naturopathy. People frequently report that their CAM services are individualized and not rushed, giving them a sense of personal care they can't find in other treatments. CAM continues to grow in acceptance across Europe with 100 million EU citizens using an alternative treatment. At least a third of the population in nine countries uses CAM regularly. The EU is expecting demand to continue to grow and is working to streamline regulation and research on CAM as EU citizens press to have CAM covered in their normal healthcare.

1. Norway: how alternative medicine found a home in hospitals

Healthcare in Norway is showing how CAM can infiltrate and even be embraced in the most hostile medical arena: hospitals. Physicians and administration in hospitals across all nations are typically far more skeptical of CAM than general practitioners or other health providers. Yet, even with recent controversy, the number of Norwegian hospitals offering CAM (and especially acupuncture) rose dramatically since 2000.

Two things happened: First, the Norwegian Research Council developed a CAM research group in 2000 at the University of Tromso. This became the National Research Center in Complementary and Alternative Medicine ( NAFKAM), bringing CAM more evidence-based credibility that doctors are seeking. Second, hospital administrations began to take note of the growing demand from patients and providers to move away from medication reliance and use natural-based therapies. As a result, 50 percent of the hospitals in Norway offered at least acupuncture in 2008, doubling the number from seven years earlier. Patient satisfaction and demand were now a part of administrative decisions.

Then came 2012. A popular series in Norwegian public television ran a piece criticizing the lack of documented effect in acupuncture. A heavy debate fired off in the media with detractors claiming acupuncture as a " theatrical placebo." Several Norwegian CAM providers at the time noted a decrease in acupuncture services, and hospitals in 2013 reported a drop in offered acupuncture. The debate rages on both in and out of Norway.

Yet Norway is nowhere near done with alternative treatments. Despite the drop in acupuncture in hospitals in 2013, overall hospitals were offering more total CAM services, moving from 50 percent to 65 percent in five years. Usage of CAM in psychiatric hospitals staggeringly jumped from 29 percent to 76 percent. By 2016, CAM usage was on the rise again in Norway, outpacing inflation and medical costs. And acupuncture remains the most widely used and requested CAM treatment in Norway, in and out of hospitals. Norwegian hospitals are proving that even with some bumps, traditional and CAM medicine can coexist, blending research and patient satisfaction, even in the most intensive medical settings.

2. Denmark: reducing sick leave and building trust with reflexology

Denmark's open attitude to modern CAM started over 25 years ago with reflexology and some field-shifting research. In 1992, reflexology was the most popular alternative treatment in Denmark (and remained the lead CAM for Danes until recently). With the demand came the money for research, and the research Denmark put out in the '90s is still widely touted by reflexologists across the world.

Three studies showed not only high patient satisfaction but also that reflexology for employees lowered sick leave. In three different work settings, and across longer and longer research spans, at least 75% of participants consistently reported partial to full pain relief. In total, the studies showed thousands of saved hours in sick leave and a decrease in leave loss of over $100,000 in just one sitting. The result of this research: Two-and-a-half times more Danes used reflexology in 2003 compared to 1987.

These days Denmark is seventh in CAM usage in the EU with at least one-third of its citizens using at least one alternative treatment a year. Over 60 percent would like to see insurance cover the vast array of alternative healing, and 73 percent of Danish doctors are positive about CAM research. Danes still use reflexology but are also seeking acupuncture, homeopathy, and chiropractic treatment. The increasing demand and the spreading interest appear directly related to optimism around past and future research. Denmark's research push decades ago demonstrated that CAM methods could show results and helped legitimize funding for research around the continent and globe.

3. Lithuania: modernizing herbalism and sharing it worldwide

Lithuania is a growing medical tourism destination that is holding onto its traditional healing roots. Lithuanian folk medicine, including herbalism, started with rich and complex belief systems. This type of medicine was practiced within families or by local healers and involved herbal rituals with symbolic charms to treat the physical and spiritual health of the person. As the medical field advanced, herbalism remained accessible, affordable, and trusted by Lithuanians.

Today, Lithuania commandingly leads other EU countries when it comes to alternative medicine use and exports both supply and demand with herbal medicine. Lithuanian immigrants still desire herbal medication and search their local stores to find an equivalent. Most declare that herbal medication from Lithuania is still superior and either bring their own Lithuanian medication back after visits or have others bring orders. Lithuanian naturopathy and herbal stores have found success in larger cities across the US and Europe, keeping the tradition and business thriving.

In response to the national and global demand, Lithuanian university pharmacies and private pharmacies are active manufacturers on the global medicinal herbs scene. Modern herbalism is now in the field of endobiogenics, where herbs meet pharmacies. Eight percent of registered Lithuanian pharmacies prepare herbal medications with over 100 registered medicinal plants in Lithuania. Search through the resumes of leading global endobiogenists and you will find most had a fellowship at the Lithuania University of Health Sciences in Kaunas. Modern medicine processes are keeping Lithuanian herbalism alive and well.

4. Austria: alternative medicine as part of medical training

Over and over patients say they want alternative medical treatments incorporated with their current medical services, not as a replacement. As the battles rage in the global medical field over who does what service and which services are covered, Austria is moving towards integration. More and more Austrian general practitioners (GPs) are receiving special training in CAM so that they can directly offer their patients multiple types of treatment.

The data on Austrian GPs receiving specialized CAM training is the definition of exponential growth. In 1996, nine percent of GPs were trained in at least one CAM service. In two years, that number doubled. There was another substantial jump by 2000 and then another 66 percent jump to 2007. Around 6,000 GPs now have special training in CAM. As the number of doctors seeking training grows so does the number of Austrian programs offering training, currently 29 across the country. The more programs that are offered through the Austrian Medical Association, the more the confidence of both patients and physicians increases. It's no surprise then that Austria is in the top three users of CAM in the EU (along with Germany and Switzerland).

Integrative health care is the wave of the future across western medicine, bringing multiple types of health-care providers together under one roof in one center. Austria, with CAM, is taking this one step further by providing a single provider that can offer one assessment and multiple services.

5. Germany: leaders in evolving alternative medicine practices

From being the birthplace of homeopathy to being first in CAM usage in Europe to leading regulation and coverage movements, Germany is at the forefront of alternative medicine. Now it's time to see where the next stage of change happens in CAM. Doctors and politicians in Germany are currently moving to strike the incredibly popular homeopathy from insurance coverage, and how Germany proceeds from here may set the tone for CAM coverage across the EU.

Homeopathy is the only surviving alternative medicine that was born in Europe. Dr. Samuel Hahnemann from Meissen, Germany, discovered that cinchona bark, or quinine, produced mild symptoms of malaria. He came up with the concept that "like treats like" and that what would make a healthy person ill can make an ill person well. Holistic assessment and heavily diluted natural substances make up the core of homeopathic treatment. Modern German homeopathic remedies come as globuli, or little white balls, and are available from both GPs and Heilpraktikers (state-recognized natural health practitioners). Germany is one of the top two users of all complementary medicine in Europe, but its usage of homeopathy sets it apart and remains much higher than in other countries, especially in children and among wealthier Germans.

But the evidence for homeopathy is frequently called into question. France has moved to phase out insurance payments for homeopathy by 2021, and now German medical organizations are pushing to introduce a law to ban insurance reimbursement, as well. But the possible subtraction of homeopathy from coverage is not signaling a step back from Germans using CAM. On the contrary, the German medical system is multi-tasking; also on the agenda for CAM policies is regulation for Heilpraktikers, broad insurance coverage for all evidenced-based CAMs, and integrative training for German GPs. Germany has been innovative in healthcare and healthcare coverage, and the next steps they take in CAM regulation will likely lead trends.

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5 European countries with different views on alternative medicine, and what can we learn from them

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Alternative medicine is always accompanied by controversy, with those who swear by its healing potential and others who denounce it as quackery. When it comes down to it, most of us are really just wanting a safe, personalized medical experience that considers both who we are and why we're suffering.

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Three advantages of Holistic Health

1. One of the main advantages of holistic health is that it empowers patients. It teaches patients about self-care, lifestyle changes, emotional state, stress reduction techniques and encourages them to strive for wholeness.

2. Secondly, holistic health approaches the "mind-body-spirit-emotional-environment," allowing patients to connect with their physical and mental health. Making connections between their physical symptoms and emotional stage can help them reach the root of their condition.

3. Holistic nursing is also rewarding to the provider. When nurses promote a patient's psychological and emotional well-being to facilitate physical healing, their relationship with the patient changes and grows into something more optimistic. Holistic nursing can lead to better patient outcomes and increased satisfaction in the nurse's role. A study by Valizadeh et al. (2015) found that nurses who tend to go beyond the routines are more likely to address the entirety of patients' needs.

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Holism is a philosophical approach in support of the belief that the whole is greater than the sum of its parts. According to this approach, the whole cannot be understood by examining its individual parts; instead, it is individual parts that allow us to see and hear the reality of the whole. This philosophy can be applied to the health care field in the form of holistic care. Holism goes beyond the actions performed or words spoken to a patient. It's a method to ensure care for all parts of a patient. The American Holistic Nurses' Association defines holistic nursing as "all nursing practice that has healing the whole person as its goal."

Holistic nurses are those who recognize and treat each patient differently. They nurture wholeness and healing by respecting each patient's unique physical, mental, emotional, spiritual and environmental strengths and challenges and honoring each patient's values, health beliefs and health experience.

Carson-Newman's online family nurse practitioner program prepares registered nurses to become more complete and autonomous caregivers. The university's Christian mission fits hand-in-glove with the call to compassionate care that equips nurses with a holistic approach to support more than just recovery. Carson-Newman graduates learn how to provide extra care for patients by promoting a healthy lifestyle and finding resources that positively affect patients' lives.

Holistic Nursing Care is Based on Florence Nightingale's Work

Holistic nurses take a "mind-body-spirit-emotion-environment" approach to the practice of traditional nursing. This form of whole-health nursing is grounded in caring, relationship and interconnectedness. It's based on the work of Florence Nightingale, who emphasized unity, wellness and the connection between patients and their environment. Since 2006, holistic nursing has been officially recognized by the American Nurses Association (ANA) as a nursing specialty with a defined scope and standards.

One of the best things about holistic nursing care is that it can be practiced in all settings. It's not specific to a particular patient group, disease or demographic. Holistic nurses use "doing" and "being" therapies (known as complementary and alternative therapies) to remove the barriers to the healing process and create a space that allows them to be instruments of healing. "Doing" therapies include most forms of modern medicine (medications, procedures, dietary manipulations, radiation and acupuncture). "Being" therapies use states of consciousness to affect the body (imagery, prayer, meditation and quiet contemplation, and the presence and intention of the nurse).

Whole-Health Nursing Pays Attention to the Whole Person

The fundamental care functions of the health care establishment are to protect and enhance health, prevent diseases and relieve pain. When a person's health or life is threatened by illness, that person is likely to seek treatment with both physical symptoms and spiritual issues in mind.

Health care providers are more likely to enhance the health of the individual holistically when health is defined as the harmony between mind, body and spirit. Full attention must be paid to the whole person, not just the current presenting symptoms, illness, crisis or tasks to be accomplished. Whole-health nursing entails considering and then assisting patients with the effects of illness on the body, mind, emotions, spirituality and personal relationships.

When trust is present in the provider-patient relationship, a plan of care can be co-created with the patient, and care can be given and received. Each patient's subjective experience about health, health beliefs and values are explored and incorporated into the plan.

Nurses Who Go Beyond Routines More Likely to Address Full Needs of Patients

When nurses are under time constraints and the patient load is high, it's easy to simply treat the physical being and move on to the next patient. Studies have shown that typical nursing care is routine-based and one-dimensional. Attention is paid to the usual problems, the patient's physical needs and the doctor's orders. Frequently, the patient's psychological, spiritual, emotional and social needs are ignored or not fully identified and satisfied.

Routine-based care results in wasted time and resources, slower recovery and potential risk to the patient's life. It's necessary to modify nurses' attitudes and encourage whole-health nursing in order to overcome this problem.

A study by Valizadeh et al. (2015) found that nurses who tend to go beyond the routines are more likely to address the entirety of patients' needs. These nurses work to establish closer relationships with patients and evaluate their overall conditions. Researchers observed that religious, moral and professional principles significantly influenced nurses' tendency to provide holistic care. These principles induced nurses to pay more attention to their patients, have a better understanding of their needs, and try to offer an optimal care plan, as well as contributed to a nurse's sense of commitment.

Holistic Nursing Can Foster Greater Integration of Self-Care

Holistic nursing care also enriches the life of the nurse. Holistic nurses understand that failure to care for themselves reduces their ability to care for others. Nursing can be a physically, mentally and emotionally draining profession. It's of great benefit to seek out those experiences that remind us why we became nurses in the first place. This can be achieved through the provision of holistic nursing care because it encourages nurses to integrate self-care, self-responsibility, spirituality and reflection in their own lives.

When nurses promote a patient's psychological and emotional well-being to facilitate physical healing, their relationship with the patient changes and grows into something more positive than before. This can lead to better patient outcomes and increased satisfaction in the nurse role. A study by Goodwin and Candela (2013) examined whether newly practicing nurses benefited from learning holistic comfort theory during their baccalaureate education. Researchers found holistic comfort helped ease the transition from school to practice, allowing nurses to transcend the unavoidable difficulties experienced during this period. Additionally, participants experienced improved patient safety and pride in patient care.

Holistic care will continue to be a focus as health care moves forward. The Patient Protection and Affordable Health Care Act of 2010 has placed the focus on patient-centered care. In this environment, patients are key players in determining which outcomes are valued.

Pew Health Professions Commission's landmark 1994 report on relationship-centered care serves as a guideline for addressing the bio-psycho-social-spiritual dimensions of individuals in integrating caring, healing and holism into health care. The current health care climate emphasizes effectiveness, coordination of services and preventive care. A strong foundation in lifestyle change and holistic care strategies are required to meet these objectives.

Increasingly, hospitals and other health care facilities are creating delivery models that include integrative health. Holistic nursing has flourished within these integrative care systems. Students are also seeking programs that focus on holistic nursing care and integrative health such as Carson-Newman's Online Master of Science in Nursing - Family Nurse Practitioner program. The American Association of Colleges of Nursing (AACN) identifies "holistic, patient-centered care" and an understanding of complementary and alternative modalities as essential to baccalaureate education.

Contact us to find out more about our online MSN-FNP program.

Sources:

American Holistic Nurses Association (n.d.). What is holistic nursing? Retrieved on August 13, 2018 from the American Holistic Nurses Association website at http://www.ahna.org/About-Us/What-is-Holistic-Nursing

Demirsoy, N. (2017). Holistic care philosophy for patient‐centered approaches and spirituality. In O. Sayligil (Ed.), Patient centered care (pp. 119-138). IntechOpen. Retrieved from https://www.intechopen.com/books/patient-centered-medicine/holistic-care-philosophy-for-patient-centered-approaches-and-spirituality

Dossey, B. M. (2013). Nursing: Integral, integrative, and holistic - local to global. In B. M. Dossey & L. Keegan (Eds.), Holistic Nursing: A handbook for practice (pp. 3-57). Burlington, MA: Jones and Bartlett Learning. Retrieved from http://www.dosseydossey.com/barbara/pdf/Dossey-Integral_Nursing_HN_6th_ed.pdf

Goodwin, M., and Candela, L. (2013). Outcomes of newly practicing nurses who applied principles of holistic comfort theory during the transition from school to practice: A qualitative study. Nurse Education Today, 6 (1), 614-619. Retrieved from https://linkinghub.elsevier.com/retrieve/pii/S0260-6917(12)00255-9

Klebanoff, N. A. (2013). Holistic nursing: Focusing on the whole person. American Nursing Today, 8(10). Retrieved from https://www.americannursetoday.com/holistic-nursing-focusing-on-the-whole-person/

The importance of holistic nursing care: How to completely care for your patients (n.d.). Retrieved on August 14, 2018 from the Practical Nursing website at https://www.practicalnursing.org/importance-holistic-nursing-care-how-completely-care-patients

Valizadeh, L., Zamanzadeh, V., Jasemi, M., Taleghani, F., Keoch, B., and Spade, C. M. (2015). Going beyond-the-routines view in nursing: A qualitative study. Journal of Caring Sciences, 4(1), 25-34. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363649/

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Holism is a philosophical approach in support of the belief that the whole is greater than the sum of its parts. According to this approach, the whole cannot be understood by examining its individual parts; instead, it is individual parts that allow us to see and hear the reality of the whole.

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From my understanding, holistic health is inclusive of all aspects of the person, in such a way that a biopsychosocial approach is utilized to assess the overall well-being of the person. In holistic health, the spiritual needs of the person are just as important as the mental, physical, and social aspect of the individual.

The three advantages of holistic health are as follows:

1. The first advantage of holistic care is that the unique individual person is addressed in a way that does not just address the somatic symptoms, but also the mental and social health of the individual. In this way, the individual not only feels as if their needs are being met physically, but that they themselves are actually being cared for and not just being treated for their somatic symptoms.

2. As for the second advantage, the wide spectrum in which care can be provided for the individual is a huge defining factor. Particularly, there can be multiple interventions that may be implemented, whether they be non-pharmacological and/or pharmacological, so as to address the overall person. For instance, if a patient is under extreme stress, the physical body will may be subjected to physical symptoms as well as mental symptoms as a result of the stress. Therefore, environmental stimuli reduction, rest, and some medications to address the somatic symptoms would be geared to address all the parts of the person.

3. Last but not least, the third advantage is the increased availability of resources for addressing both health problems of any aspect and to promote health for the overall person. This also allows for decreased financial strain for the individual.

https://www.dignityhealth.org/articles/what-is-holistic-health-care-anyway#:~:text=Holistic%20health%20is%20about%20caring,aspect%20affects%20you%20in%20others.

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When you hear "holistic health," do you think of alternative medicine, naturopathy, or other Eastern-inspired health trends? If so, you're at least partly right.

Holistic health does incorporate complementary therapies that have been scientifically proven to work, and like alternative medicine, it focuses on wellness and prevention, rather than just treating diseases. But holistic care is about more than integrating Eastern and Western medicine. It's a more comprehensive and personalized way of thinking about wellness.

So, what is holistic health care?

Treating the Whole You

Holistic health is about caring for the whole person - providing for your physical, mental, spiritual, and social needs. It's rooted in the understanding that all these aspects affect your overall health, and being unwell in one aspect affects you in others.

Take stress, for example. It's a psychological response, but it can also cause physical symptoms, such as headaches, trouble sleeping, weight gain, and muscle pain. Of course, it works both ways, and being physically ill can cause you to feel anxious or depressed. Meanwhile, your spirituality and your relationships can boost your mental and physical health. Studies show that having close friendships lowers your blood pressure, reduces your stress levels, and can even improve your chances of surviving cancer.

Understanding this, doctors who take a holistic approach to health don't just ask you about your symptoms. They ask about you - your overall health and your life - so they can make personalized recommendations to improve your wellness.

Doctoring Outside the Box

Holistic care providers address a wide variety of wellness concerns, and they use a wide variety of clinically proven therapies - from surgery and pharmaceuticals, to dietary changes and exercise plans, to psychological and spiritual counseling. They might also recommend evidence-based alternative therapies, such as massage, acupuncture, and yoga, for supportive care.

For example, if you're experiencing chronic pain, a holistic health care provider might prescribe medications or recommend surgery to repair an injury, but they'll also recommend that you increase your endorphins naturally by getting more exercise. They'll ask about your diet, and discuss how certain foods contribute to inflammation. They'll ask you about stress, anxiety, and depression - all of which can cause pain or be caused by it - and refer you to a therapist if you want one. Then they might also recommend massage to relax your muscles, acupuncture to help with nerve pain, or mindful meditation to help with pain management and stress relief.

Simply put, rather than treating the pain, they'll treat the person, and use all the tools at their disposal to do it.

Making Wellness Doable

Wellness is a big, important goal, and it can feel overwhelming. You know you should eat healthier foods, drink more water, hit the gym more often, sleep eight hours a night, give up your vices, and make more time for rest and relaxation. But the busyness of work and life can make it hard to prioritize self-care, and the more you think about what you "should" be doing differently, the more daunting wellness can seem.

Holistic doctors empower you with the education and motivation to make better choices. Rather than suggesting a long list of lifestyle changes, they include you in the conversation and help you determine which changes would make the greatest impact on your health. They help you set wellness goals and then provide you with resources - whether that's a personalized plan or a referral to a specialist.

So, what is holistic health care? It's about honoring the mind-body connection and treating the whole person, using a variety of clinically proven therapies. It's about developing a strong relationship with a doctor who is committed to getting you healthy and keeping you that way.

Dignity Health strives to make holistic care part of its care and an integral part of how the entire team works every day.

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When you hear "holistic health," do you think of alternative medicine, naturopathy, or other Eastern-inspired health trends? If so, you're at least partly right. Holistic health does incorporate complementary therapies that have been scientifically proven to work, and like alternative medicine, it focuses on wellness and prevention, rather than just treating diseases.

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Improving Overall General Health

The holistic treatment approach focuses on healthy eating habits and therapeutic practices.
1. Stress relieving and self-relaxing exercises like yoga are also believed to be effective in improving your overall health. Holistic health treats the whole person not just one body system.
2. Holistic Natural Health Treatments of Healing offered can often be far less expensive for a patient than other treatments they may be receiving.Holistic healing involves helping patients understand their own innate ability to heal.

3. Holistic healers educate patients on healthy lifestyle changes, the importance of self-care, and the many healing options available to them.

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The landscape of medicine is changing. More and more people are realizing the many benefits of complementary and integrative health, medicine, healing, and nutrition who are seeking practitioners who can provide it. A career in the field of Holistic Medicine and Healing Nutrition can begin with understanding these 5 advantages, followed by getting a Degree or Certification Online in Holistic Medicine & Healing or Holistic Nutrition & Natural Health. nutrition certificate online.

1. It Empowers Patients

Holistic healing involves helping patients understand their own innate ability to heal. Holistic healers educate patients on healthy lifestyle changes, the importance of self-care, and the many healing options available to them. This empowers patients to take the necessary steps for optimal health and supports them in this endeavor.

Holistic healing involves helping patients understand their own innate ability to heal. Holistic healers educate patients on healthy lifestyle changes, the importance of self-care, and the many healing options available to them. This empowers patients to take the necessary steps for optimal health and supports them in this endeavor.

2. No Chemicals

Where a patient may already be receiving conventional treatments involving pharmaceutical products, holistic healing can present a welcome reprieve. This form of healing treatment uses natural methods, foods, nutrition, and medicines such as herbs to help eliminate symptoms and address the root causes of whatever issue the patient is dealing with.

In many cases, a patient may be able to reduce the number of pharmaceutical products they are taking or eliminate them completely from their treatment plan when they choose to add Holistic Medicine & Healing Nutrition Principles by applying their learned skills to their daily lifestyle.

3. Easier on Patient Finances

These Holistic Natural Health Treatments of Healing offered can often be far less expensive for a patient than other treatments they may be receiving. Acupuncture, chiropractic, and massage, as well as natural remedies and certain dietary supplements, can save the patient money and, ultimately, reduce their stress.

4. It Addresses Several Conditions

Holistic Medicine & Healing Nutrition Principles, Remedies, Methods, and Treatments have been used for many years and centuries to address a wide range of conditions. Some of the symptoms and conditions helped by these Holistic Methods, Remedies and Treatments include:

5. It Treats the Whole Person

Holistic Medicine & Healing Nutrition treatment not only "Removes The Causes" of their physical illness but also the mental, emotional, and spiritual aspects. In pursuit of Optimum Health, Power, Strength and Endurance one must live to fulfill a healthy lifestyle that a WHOLE HEALING TREATMENT PLAN offers a patient the hope and experience that is Naturally required to improve one's physical condition or symptoms, as well as achieve a greater understanding that any natural form of healing must include the WHOLE MIND, BODY AND SOUL working in total harmony. We must remember that we are not "The Sum of Our Individual Parts, But The Sum of All Parts Working Together as Whole"!

Holistic Medicine & Healing Nutrition as a Career!

With more people turning to Natural Healing and Holistic Medicine and Healing Nutrition Methods than ever before, choosing a Holistic Career would be a wise choice. If you want to begin a rewarding and fulfilling Holistic Career, you can now receive a formal education in many Holistic Fields of Interest such as entering Holistic Medicine & Healing Nutrition Schools to undergo the holistic education and training required to build a solid foundation as well as a successful Holistic Practice that will support your career-choice for life.

The University of Natural Health is one of the largest Holistic Medicine & Healing Nutrition as well as Natural Health Schools Online in the world. We offer both in-class and distance learning options to suit your schedule. Our accredited degree & certification programs in holistic health, healing and nutrition, as well as holistic medicine, allow you to diversify your education as you apply what you learn to your own life. Learn how to earn your Online Degrees & Certifications by visiting our website.

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5 Advantages of Holistic Healing | University of Natural Health

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The landscape of medicine is changing. More and more people are realizing the many benefits of complementary and integrative health, medicine, healing, and nutrition who are seeking practitioners who can provide it.

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Holistic Nursing Advantages:  How and Why
1. Holistic nursing requires that nurses themselves become an instrument of healing through their own self-care.  Self-care cultivates personal health and awareness.  When nurses, themselves, are proactive with their own self care, they obtain personal experience with the aspects of holistic nursing and protection from the aspects of nursing that take a toll on their "whole" persona.  It is my opinion that patients will identify the aspects of a nurse they "want" when they choose to partner with a provider in their own care and strive to achieve that balance.

2.  Holistic nursing encompasses the persons mind (emotions, spirituality, culture) as well as the body.  When an individual is stressed (worried, consumed by fear) the body will follow with physical dysfunction.  In looking at all aspects of a patient's life, with the patient, realization of how the patient has power over their self-care becomes an active and effective part of their treatment.

3. Holistic nursing can be practiced anywhere. The components of holistic nursing are accessible to nurses in any setting and benefit patients individually as a whole. Patients feel valued and dignified and the opportunity for them to become proactive in their care is heightened through a trusting relationship with their nurse.

Writers, P. S. (2021, June 17). The importance of Holistic Nursing CARE: How to completely care for your patients. PracticalNursing.org. https://www.practicalnursing.org/importance-holistic-nursing-care-how-completely-care-patients.

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1. The first advantage of holistic nursing is that it acknowledges the individual as a whole, mind-body-spirit connection. By understanding the relationship of these 3, it will allow nurses to help the patient improve their overall health and maintain it in harmony.

2. The second advantage of holistic nursing is the practice of complementary/alternative medicine. Less invasive procedures are used to help the patient heal and treat as a whole such as biofeedback, humor, prayer, and a healing presence.

3. A third advantage of holistic nursing is that it requires nurses to participate in self-care. This allows the nurse to be aware and acknowledge the interrelation with self, ultimately being able to provide the best care for the patients.

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/HolisticNursingPractice.html

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Complementary and alternative medicine (CAM) includes therapies and treatments that help to regulate fundamental aspects of patient care management. The philosophy and concepts behind the holistic health framework is consistent with CAM therapies and approaches.

Three advantages of Holistic health include:

1. Whole person health focuses on improvement and health restoration in multiple interrelated areas of health rather than solely treating disease.

2. Integration of complementary approaches emphasizes on multimodal interventions that include conventional medicine and CAM therapies for whole person treatment and management.

3. Complementary approaches play a part in supporting healthy behaviors. Promotion of healthy behaviors can reduce the risks associated with disease development.

Nurses are the driving force of healthcare and are often the first ones spending the most time in direct patient care. Nurses that are proficient in CAM knowledge and safe effective uses can provide patients education on appropriate CAM approaches for numerous health conditions.

Reference:
U.S. Department of Health and Human Services. (n.d.). Complementary, alternative, or Integrative health: What's in a name? National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name.

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We've all seen the words "complementary," "alternative," and "integrative," but what do they really mean?

This fact sheet looks into these terms to help you understand them better and gives you a brief picture of the mission and role of the National Center for Complementary and Integrative Health (NCCIH) in this area of research. The terms "complementary," "alternative," and "integrative" are continually evolving, along with the field, but the descriptions of these terms below are how we at NIH currently define them.

Complementary Versus Alternative

According to a 2012 national survey, many Americans-more than 30 percent of adults and about 12 percent of children-use health care approaches that are not typically part of conventional medical care or that may have origins outside of usual Western practice. When describing these approaches, people often use "alternative" and "complementary" interchangeably, but the two terms refer to different concepts:

If a non-mainstream practice is used together with conventional medicine, it's considered "complementary."

If a non-mainstream practice is used in place of conventional medicine, it's considered "alternative."

Most people who use non-mainstream approaches also use conventional health care.

In additional to complementary and alternative, you may also hear the term "functional medicine." This term sometimes refers to a concept similar to integrative health (described below), but it may also refer to an approach that more closely resembles naturopathy (a medical system that has evolved from a combination of traditional practices and health care approaches popular in Europe during the 19th century).

Integrative Health

Integrative health care often brings conventional and complementary approaches together in a coordinated way. It emphasizes a holistic, patient-focused approach to health care and wellness-often including mental, emotional, functional, spiritual, social, and community aspects-and treating the whole person rather than, for example, one organ system. It aims for well-coordinated care between different providers and institutions.

The use of integrative approaches to health and wellness has grown within care settings across the United States. Researchers are currently exploring the potential benefits of integrative health in a variety of situations, including pain management for military personnel and veterans, relief of symptoms in cancer patients and survivors, and programs to promote healthy behaviors.

Types of Complementary Health Approaches

Complementary health approaches include natural products and mind and body practices.

This group includes a variety of products, such as herbs (also known as botanicals), vitamins and minerals, and probiotics. They are widely marketed, readily available to consumers, and often sold as dietary supplements.

According to the 2012 National Health Interview Survey (NHIS), which included a comprehensive survey on the use of complementary health approaches by Americans, 17.7 percent of American adults had used a dietary supplement other than vitamins and minerals in the past year. These products were the most popular complementary health approach in the survey. (See chart.) The most commonly used natural product was fish oil.

Researchers have done large, rigorous studies on a few natural products, but the results often showed that the products didn't work for the conditions studied. Research on others is in progress. While there are indications that some may be helpful, more needs to be learned about the effects of these products in the human body, and about their safety and potential interactions with medicines and other natural products.

Mind and body practices include a large and diverse group of procedures or techniques administered or taught by a trained practitioner or teacher. The 2012 NHIS showed that yoga, chiropractic and osteopathic manipulation, and meditation are among the most popular mind and body practices used by adults. According to the 2017 NHIS, the popularity of yoga has grown dramatically in recent years, from 9.5 percent of U.S. adults practicing yoga in 2012 to 14.3 percent in 2017. The 2017 NHIS also showed that the use of meditation increased more than threefold from 4.1 percent in 2012 to 14.2 percent in 2017.

Other mind and body practices include acupuncture, relaxation techniques (such as breathing exercises, guided imagery, and progressive muscle relaxation), tai chi, qi gong, hypnotherapy, Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, and Trager psychophysical integration.

The amount of research on mind and body approaches varies widely depending on the practice. For example, researchers have done many studies on acupuncture, yoga, spinal manipulation, and meditation, but there have been fewer studies on some other practices.

Other Complementary Health Approaches

Some complementary approaches may not neatly fit into either of these groups-for example, the practices of traditional healers, Ayurvedic medicine, traditional Chinese medicine, homeopathy, naturopathy, and functional medicine.

NCCIH's Role

NCCIH is the Federal Government's lead agency for scientific research on complementary and integrative health approaches.

NCCIH's Mission and Vision

The mission of NCCIH is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care.

NCCIH's vision is that scientific evidence informs decision making by the public, by health care professionals, and by health policymakers regarding the use and integration of complementary and integrative health approaches.

To learn more, visit the NCCIH Facts-at-a-Glance and Mission webpage.

For More Information

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

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Complementary, Alternative, or Integrative Health: What's In a Name?

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We've all seen the words "complementary," "alternative," and "integrative," but what do they really mean? This fact sheet looks into these terms to help you understand them better and gives you a brief picture of the mission and role of the National Center for Complementary and Integrative Health (NCCIH) in this area of research.

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One advantage of holistic health nursing is that it emphasizes healing on holism meaning that the whole body is greater than the sum of it's parts. Focusing on whole human healing incorporates the mind and spirituality of the individual, not simply just the science behind the disease. I doing so, all patients can be recognized to play a role in their own health care despite their situation.

A second advantage of holistic health nursing is that it may help health care providers increase their understanding of the patient's needs. Communicating with patients to discover their holistic beliefs may help measure the individual's motivation for self-care. Holistic health can increase self awareness and self confidence which may help nurses to understand the patients true needs.

Lastly, holistic health care can be considered as culturally universal. Many individuals can discover their definition of a higher power despite what religion, ethnicity, or background they may come from. Although there is a science behind holistic care, it is not the forefront of it and may be less intimidating to certain cultures which may increase the willingness to participate in their own care.
References
Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective factors in providing holistic care: a qualitative study. Indian journal of palliative care, 21(2), 214–224. https://doi.org/10.4103/0973-1075.156506

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1. Empowering patients- Holistic healing methods make patients see how resilient they can be. It allows a person to focus on the innate abilities of the body to heal itself. This can improve mental health as well by giving confidence to a person.

2. Chemical free-Most people do not want all of the chemicals and unnatural substances contained in medications and supplements. Holistic healing is natural and does not promote all of the commercial chemicals out there. I can name several instances in which I had a patient that did not feel good with regular medications. There are many people who claim that natural healing methods make the body feel better.

3. Cheaper-Various health cures can be expensive. With holistic healing, a person can improve his health by simply engaging in natural healing methods. This also alleviates stress from financial burdens from medical bills. A mind without stress is a healthy mind. The mind has a strong influence on a person's overall health.

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The landscape of medicine is changing. More and more people are realizing the many benefits of complementary and integrative health, medicine, healing, and nutrition who are seeking practitioners who can provide it. A career in the field of Holistic Medicine and Healing Nutrition can begin with understanding these 5 advantages, followed by getting a Degree or Certification Online in Holistic Medicine & Healing or Holistic Nutrition & Natural Health. nutrition certificate online.

1. It Empowers Patients

Holistic healing involves helping patients understand their own innate ability to heal. Holistic healers educate patients on healthy lifestyle changes, the importance of self-care, and the many healing options available to them. This empowers patients to take the necessary steps for optimal health and supports them in this endeavor.

Holistic healing involves helping patients understand their own innate ability to heal. Holistic healers educate patients on healthy lifestyle changes, the importance of self-care, and the many healing options available to them. This empowers patients to take the necessary steps for optimal health and supports them in this endeavor.

2. No Chemicals

Where a patient may already be receiving conventional treatments involving pharmaceutical products, holistic healing can present a welcome reprieve. This form of healing treatment uses natural methods, foods, nutrition, and medicines such as herbs to help eliminate symptoms and address the root causes of whatever issue the patient is dealing with.

In many cases, a patient may be able to reduce the number of pharmaceutical products they are taking or eliminate them completely from their treatment plan when they choose to add Holistic Medicine & Healing Nutrition Principles by applying their learned skills to their daily lifestyle.

3. Easier on Patient Finances

These Holistic Natural Health Treatments of Healing offered can often be far less expensive for a patient than other treatments they may be receiving. Acupuncture, chiropractic, and massage, as well as natural remedies and certain dietary supplements, can save the patient money and, ultimately, reduce their stress.

4. It Addresses Several Conditions

Holistic Medicine & Healing Nutrition Principles, Remedies, Methods, and Treatments have been used for many years and centuries to address a wide range of conditions. Some of the symptoms and conditions helped by these Holistic Methods, Remedies and Treatments include:

5. It Treats the Whole Person

Holistic Medicine & Healing Nutrition treatment not only "Removes The Causes" of their physical illness but also the mental, emotional, and spiritual aspects. In pursuit of Optimum Health, Power, Strength and Endurance one must live to fulfill a healthy lifestyle that a WHOLE HEALING TREATMENT PLAN offers a patient the hope and experience that is Naturally required to improve one's physical condition or symptoms, as well as achieve a greater understanding that any natural form of healing must include the WHOLE MIND, BODY AND SOUL working in total harmony. We must remember that we are not "The Sum of Our Individual Parts, But The Sum of All Parts Working Together as Whole"!

Holistic Medicine & Healing Nutrition as a Career!

With more people turning to Natural Healing and Holistic Medicine and Healing Nutrition Methods than ever before, choosing a Holistic Career would be a wise choice. If you want to begin a rewarding and fulfilling Holistic Career, you can now receive a formal education in many Holistic Fields of Interest such as entering Holistic Medicine & Healing Nutrition Schools to undergo the holistic education and training required to build a solid foundation as well as a successful Holistic Practice that will support your career-choice for life.

The University of Natural Health is one of the largest Holistic Medicine & Healing Nutrition as well as Natural Health Schools Online in the world. We offer both in-class and distance learning options to suit your schedule. Our accredited degree & certification programs in holistic health, healing and nutrition, as well as holistic medicine, allow you to diversify your education as you apply what you learn to your own life. Learn how to earn your Online Degrees & Certifications by visiting our website.

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5 Advantages of Holistic Healing | University of Natural Health

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The landscape of medicine is changing. More and more people are realizing the many benefits of complementary and integrative health, medicine, healing, and nutrition who are seeking practitioners who can provide it.

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Three benefits to holistic health include
1. improved health habits and lifestyle changes
2. decreased risk of depression
3. reduced stress and anxiety levels
These are all benefits because holistic health doesn't just take one part of the body into consideration, it considers the whole thing. When something hurts, when one organ is affected, the whole body is affected because in some way the body as a whole has to learn how to compensate for that one affected organ or body part, so why would we only treat/manage that ONE part and not the whole thing? Holistic health allows patients to improve their lifestyle choices and it can be the push to help them improve their overall health to achieve their optimal healthy level. Focusing on all the parts of the body that are affected when a person is ill, like the stress it can cause, the depression, anxiety, etc. can help better manage the illness and result in better outcomes for the patient because you are not only treating the pain, but the anxiety and stress that can potentially create other health issues in the patient.

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The holistic approach has long been accepted as a way to improve our overall health and even target some specific ailments. While most doctors will tell you that serious health problems such as heart disease or kidney disease can't be corrected through holistic practices, there are many practitioners and patients who claim their health has improved drastically as a result of using the holistic approach. Look at positive Denver regenerative medicine reviews to see how this approach can help your body heal.

Holistic health is nothing more than a concept according to which the body, mind and spirit are considered as a whole, or complete, living organism, in which the health or sickness of each individual part affects the whole. As a result, instead of using medicine to target specific areas or functions of the body, holistic medicine aims to improve the health of the entire body/mind system, and ultimately causing it to enhance the specific, sick areas as well.

Some of the benefits of holistic health include:

Improved habits and lifestyle changes;

A fortified body that can withstand the onset of disease more easily;

An improvement of the natural healing abilities of the body;

The prevention of various diseases and disorders;

Reduced stress and anxiety levels;

The lessening of depression symptoms;

A thirst for happy and healthy living.

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The Benefits of Holistic Health - What Can You Achieve Through Holistic Practices?

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The holistic approach has long been accepted as a way to improve our overall health and even target some specific ailments. While most doctors will tell you that serious health problems such as heart disease or kidney disease can't be corrected through holistic practices, there are many practitioners and patients who claim their health has improved drastically as a result of using the holistic approach.

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The first advantage of holistic nursing is taht we are treating the patient as a whole and not just the disease.  We take all aspects of the patient using the biological, social, psychological and spiritual aspects of the patient.  Personalized care increase the patient's wellness and treats the patient as a whole.

The second advantage of holistic care is that it treats the patient from brith to death, which explores the idea of prevention.  The advantage of prevention leads to better health outcomes.  Preventions examples include diet, exercise, stress relief, education, and medical check ups.  This gives the patient a better sense of being in control of their care.

The third advantage of holistic care is the respect of the patient's human dignity.  The whole point of the holistic care is to bring respect, relative opness, equality, mutuality, and the patient's participation in the health care.  As part of the health care team, we need to respect the patient's role in the treatment process and encourage self care.  This is another part of holistic care that leads to therapeutic consultation, hope, dignity, self-discipline, social growth and a sense of autonomy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441185/

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Indian J Palliat Care. 2015 May-Aug; 21(2): 214-224.

Abstract

Background:

Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring.

Materials and Methods:

A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software.

Results:

Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits.

Conclusion:

Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

Keywords: Holistic care, Nursing, Qualitative research

INTRODUCTION

Holistic care is a comprehensive model of caring which is believed to be the heart of the science of nursing.[ 1] The philosophy behind holistic care is based on the idea of holism which emphasizes that for human beings the whole is greater than the sum of its parts and that mind and spirit affect the body.[ 2] Holistic care is described as a behavior that recognizes a person as a whole and acknowledges the interdependence among one's biological, social, psychological, and spiritual aspects. Holistic care includes a wide range of approaches, including medication, education, communication, self-help, and complementary treatment.[ 3] In holistic nursing, all aspects of patients and their effects on the treatment process are considered and the patients' thoughts, emotions, cultures, opinions, and attitudes are factored in as contributing to recovery, happiness, and satisfaction.[ 4] Holistic care respects human dignity[ 5]: The relationship between the providers of health care and the patients is based on respect, relative openness, equality, and mutuality[ 2, 5] and patients participate in decision making in this kind of caring.[ 6]

Providers of holistic care consider a patient as a whole within his/her environment and realize that a patient is made up of a body, mind, and spirit. Respecting the patient's role in the treatment process, having him/her take part in the process and encouraging self-care is another aspect of holistic care which leads to therapeutic consultation, hope, dignity, self-discipline, social growth, a sense of autonomy, vigor, and vitality.[ 7]

Holistic care increases the depth of care providers' understanding of patients and their needs. Educating patients about self-care and helping them to perform their daily activities independently is part of holistic care. Palliative care is part of holistic care which improves the quality of a patient's life and their emotional and physical well-being. Holistic care increases self-awareness[ 8] and self-confidence in patients[ 9] and causes nurses to better understand the effects of an illness on a person's entire life and his/her true needs. It also improves harmony between mind, body, emotions, and spirit in an ever-changing environment;[ 10] The American Association of Holistic Nurses supports this belief and points out that holistic nursing includes all the nursing practices that heal the whole of a person.[ 5]

In many hospitals, nurses do not have the freedom to perform their tasks independently and their actions are often observed by doctors. Using holistic care as the framework will result in major changes in the treatment process,[ 11] a better public view of the nursing profession, and nurses' autonomy.[ 10] The holistic care paradigm has been presented to the health-care systems in many cultures[ 4] and it can be used in every area of nursing.[ 12] Holistic care is not a new method; Florence Nightingale developed this type of nursing as a better model of caring;[ 4] many other nursing theorists, e.g. Ragers, Newman, and Parse have also emphasized holistic care.[ 13]

Unfortunately, there is compelling evidence that most nurses have been educated with a biomedical allopathic focus and do not have a good understanding of the meaning of holistic care. Furthermore, it has been suggested that nurses are not familiar with holistic care, neglect this model of caring,[ 4, 6] do not use this method,[ 2] and consider patients' corporeal needs only. In this regard, patients' other needs and sometimes more serious problems are not addressed.[ 6] The mental, spiritual, and social needs of patients are neglected[ 14] and patients are considered as biological machines.[ 15]

Using the ordinary medical model alone for treatment exposes patients to serious threats, prolongs hospitalization, and raises treatment costs.[ 6] In many countries, such as the UK,[ 6] Australia,[ 16] and Iran,[ 12] holistic aspects of patients' needs are often overlooked.[ 6, 16] Similar studies conducted in the USA have revealed that 67% of American patients in hospitals do not receive holistic care,[ 17] and a study conducted in England showed that only 5% of hospitalized patients were subject to holistic care.[ 6]

This presents as a major crisis for the nursing profession.[ 18] Considering the beneficial effects of holistic care, the identification of contributory factors is of importance for providing this method of caring. A review of literature in this field shows that most studies have been limited to specific areas, such as operating rooms or older patients who were terminally sick.[ 4, 19] Other studies attempt to explain the concept of holistic nursing and nurses' perception of it,[ 1, 2] or the reasons for failure to employ this method.[ 4, 6] According to the results obtained from several studies, holistic care is adversely affected by such factors as inadequate time, improper professional relations, incomplete reports from nurses, inadequate clinical control, unavailability of resources,[ 20] poor professional and administrational perceptions, limited knowledge, and motivational and organizational factors.[ 4] In view of the great influence of holistic care on treatment and more effective nursing, the health-care systems in many countries in recent decades have tried to promote holistic care by applying changes to the educational and administrational systems,[ 4] but studies show that their efforts have been fruitless.[ 21, 22]

Evidently, there are other factors affecting holistic nursing that must be identified. An investigation into this matter using a qualitative approach that includes multiple methods of data gathering and emphasizes reality experience[ 23] can help us to obtain meaningful and comprehensive data; it will also clarify the existing background and the real situation surrounding the formation of holistic care. Thus, this is a qualitative study and is based on the experience of nurses, who form the core of holistic care provision.

MATERIALS AND METHODS

Ethical considerations

This study was approved by the ethics committee of Tabriz University of Medical Sciences. All the participants were informed of the aim of the study and a written consent was obtained from each of them. Participation in the study was entirely voluntary and the participants could withdraw at any stage of the study.

Method

A qualitative content analysis was conducted to develop an in-depth understanding of nurses' experiences of major factors that affect holistic care formation. This method was used for describing the systematic and objective means of the phenomenon.[ 24] This study is based on conventional qualitative content analysis in which coding and categorizing are derived directly from the raw data. The advantage of this approach to content analysis is obtaining direct data from participants without imposing pre-supposed categories or theoretical perspectives. Another important attribute of this approach is its emphasis on the subject, context, and differences and similarities among codes and categories.[ 25] Purposive sampling was used to select 14 participants with abundant information. Three of the nurses selected were male and the others were female. The participants were selected from various wards [intensive care unit (ICU), emergency, general wards] in university hospitals in the Iranian cities of Tabriz, Uremia, Ardebil, and Tehran. Further characteristics of the participants are presented in Table 1 . The study lasted 6 months, from May until October 2013. In the first stage, participants were informed of the aim of the study by the researchers; if they agreed to participate in the research, they gave written consent. To respect the privacy of the interviewees, numerical codes are used instead of their names.

Table 1

The data were collected using unstructured interviews. Each interview lasted between 60 and 90 minutes and was performed in a private room in the hospital. Each interview commenced with an opening question such as "what do you do for a patient during your shift?"; this was followed by questions that addressed their experiences of caring for patients and situations and factors which affect the quality of caring and attending to patients' various needs. Based on the initial data analysis, additional questions were asked of the respondents. A second interview was conducted with four participants to help clarify the initial interpretations of the information and emerging results. To ensure accuracy of the data, the interviews were continued until data saturation: Data collection was ended when no new information could be collected and the data became repetitive.

The interviews were tape-recorded, transcribed, and coded line-by-line by MAXQDA 2010 software which was used in the initial stages of coding.[ 22] The various codes were compared and categorized and themes were constructed based on similar and appropriate categories. In this way, themes and categories were generated inductively from the data.

Rigor

To increase the dependability of the study, data were collected and analyzed by one of the researchers; the other researchers checked and verified the data, codes, and analyses. The transcripts were read several times and the categories and themes were discussed by the researchers until consensus was reached. The credibility of the results of the study was confirmed through prolonged engagement with participants in the wards. In addition, individual checking was used to examine the accuracy of the findings, and the results of the primary analysis were shared with the participants to validate the compatibility of the codes with their experiences. Transferability of the findings was made possible by the variety of the characteristics of the participants.

RESULTS

Following an analysis of the data, three themes were identified as effective factors in holistic care provision: The structure of the educational system, professional environment, and motivational factors. The themes, sub-themes, and codes are shown in Table 2 .

Table 2

The structure of the educational system

The structure of the educational system was one of the issues which most of the participants talked about. Proper education plays an important role in nurses' preparation for providing holistic care. This theme consists of three sub-themes: The content of educational programs, the teaching methods, and the educators' competence.

The content of educational programs

If the content of educational programs is comprehensive and includes the philosophy of holistic care, it will enable nursing students to address the various needs of patients and provide holistic care. One of the nurses emphasized the role of education in providing holistic care and said:

The content of the courses deeply affected my attitude toward patients and their needs; the courses on "nursing procedures" and "psychological disorders" made me stop looking at a patient only in terms of physicality and understand that an individual is more than a body with certain needs; it made me consider a patient's entire dimensions; I realized that health is the equivalent of harmony and balance among a patient's whole dimensions, not simply physical well-being. (Participant 8)

The above quotation points to the important role of designed courses in training nurses in holistic care. Another participant, similarly, referred to the importance of "nursing procedures" in creating an inclusive perception and promoting holistic care:

The course on nursing procedures broadened my horizons about patients and made me see aspects that I had been unaware of; I understood that well-being is the result of meeting a patient's various needs, from physical needs through emotional and spiritual needs to social, cultural and economic needs. (Participant 2)

The same participant, however, observed that the course of "nursing procedures" did not have enough credits and that they were not adequately trained in providing holistic care:

The course was too short and the training was not enough. But I was interested and regarded it as a specialized part of nursing; I practiced a lot and gradually learned how to exercise it. I wish the trainers had instructed us properly; then I would have realized the importance of it sooner.

Unfortunately, the data show that the content of the educational program is poor and lacks material on the various needs of patients. Regarding this issue, one of the nurses explained:

More than 90% of our lessons were about the physical problems of patients, and their other needs were usually neglected. (Participant 5)

Another participant expressed:

During the course, most of our education was about the physical problems of patients and dealing with them. So, by the end of the course, our knowledge of the physical needs of patients had increased, but we didn't know anything about the whole needs of patients and their role in the treatment. (Participant 6)

Another nurse explained:

Clinical training was too short and we didn't have enough time to establish a relationship with the patients to recognize their various problems. (Participant 13)

Teaching methods

Teaching methods are part of the educational structure and play an important role in holistic care formation. But, according to the results, the teaching methods are not designed to demonstrate holistic care. In this regard, one of the participants said:

The teaching methods were often educator-centered; a limited number of tasks were dictated and we were expected to do them only; we were not free to consider the other needs of patients and satisfy them. (Participant 3)

Practice-based teaching can increase nursing students' understanding of holistic care, but the data showed that the nursing educators did not consider this matter and focused on theory-based teaching. One of the nurses stated:

We did not receive any practical training in considering patients' various needs. In our education, we were not told that a patient is a whole with many different aspects and whose treatment requires that we consider all those aspects; although some of the educators advised us to consider the secondary needs of patients, there was no practical training in this field. (Participant 9)

The educators' competence

The educators' characteristics and competence have been introduced as a component of the educational structure in this study; educators can provide the trainees with a practical model from which to learn the principles of holistic care in practice. A participant said regarding this issue:

One of our educators was sensitive to the various needs of patients, treated them with respect and attended to their various needs. Her manners influenced my behavior. Now, I try to use her lessons in practice and provide my patients with comfort by addressing their various needs. (Participant 6)

Similarly, a participant referring to her trainer's holistic perception and emphasis on holistic care remarked:

One of our trainers always stressed that we view a patient as a whole that has different needs; she was trying to have us realize that well-being is the result of creating a harmony among the various parts of the whole and not just the physical dimensions. My trainer's attitude greatly affected my manner of nursing: I try to attend to my patients' entire needs, not just the physical ones, and consider their emotional, spiritual, cultural and social needs. I believe that meeting all these needs at the same time rather than separately is much more effective.

But the results show that most of the participants had no practical model for learning holistic care during their education. One of the nurses said:

Most of our educators had limited knowledge of the various aspects of patients' needs and their effects on health recovery and paid little attention to these matters. They paid more attention to routine tasks, and we didn't have an actual example of someone who considered all the needs of patients and provided holistic care. (Participant 6)

An educator's good relationship with students is an effective factor in attracting attention to the educator's training, as well as motivation for learning. In this regard, one of the nurses stated:

Our educators didn't usually have a suitable relationship with us and reproached us for unimportant matters, so we didn't have any motivation for learning. (Participant 14)

Professional environment

Professional environment is another factor which most participants emphasized as being important to considering the patients' different needs and providing holistic care. This theme consists of three sub-themes: Workload, management, and the gap between clinical performance and academic learning.

Workload

Workload, one of the components of professional environment, was referred to by most of the participants as a restriction in holistic care provision. Concerning this issue, one of the participants said:

Sometimes, the ward is too crowded and busy; although I understand that patients have different needs, and I want to meet them, but I don't get the opportunity to do it (Participant 2).

Another participant explained:

If the numbers of patients were smaller in the ward, we would have more opportunities to provide better care and we could attend to all of our patients' needs (Participant 12).

One of the participants referred to the sheer number of her working shifts and said:

Because of the huge number of shifts, we are always tired and don't have the required energy for providing suitable care. (Participant 9)

Management

Management-with its different domains, such as evaluation, orientation programs for staff and management approaches-plays an important role in the formation of holistic care. Most of the participants emphasized its impact on the quality of nursing. To quote one of the nurses:

There is no difference between a nurse who considers and attends to the patients' different needs and another who only does the routine tasks. Ironically, the latter is more popular with the managers. Routine tasks are considered as evaluation criteria. (Participant 8)

Another nurse mentioned:

Our head nurse and the supervisors emphasize the routine tasks and unimportant stuff and there is no incentive for considering the patients' secondary needs. (Participant 5)

Orientation programs and managers' competence can decrease nurses' stress and obsession with routine duties and encourage them to consider the patients' other needs and provide holistic care. But data show that the professional environment in Iranian hospitals lacks orientation programs for novice nurses and that most of the managers lack competence for their positions. One of the nurses stated:

We didn't have any orientation programs when we began to work in the hospital and our head nurse was very strict and belittled us for unimportant matters. It was very difficult for me. I was under pressure and lost my motivation to continue my profession, provide proper care and pay attention to the patients and their needs. (Participant 7)

Limited conformity of the clinical environment with professional norms

Conformity of the clinical environment with professional and ethical norms results in nurses' treating patients as human beings with human needs, all of which should be taken into account; upon observing the beneficial effects of holistic care on the treatment process, nurses will acquire a holistic perception: They will realize the importance of attending to patients' needs from various aspects and experience the effectiveness of meeting those needs as a whole compared to satisfying them separately. However, the participants declared that upon entering the clinical environment, they were faced with the limited conformity of their environment with professional norms. Disregard for the principles of proper nursing forms a sub-category of this phenomenon.

The participants stated that upon embarking on their careers, they were faced with a prevalent disregard for the principles of proper nursing, at both the professional and ethical level. Obviously, such disregard for professional and ethical principles leads to professional shortcomings and negligence of nursing ideals, which in turn results in nurses' failure to provide proper care and attend to patients' needs in their entirety. Attention to professional principles is the prerequisite of holistic care; but in most cases they are ignored. To quote a participant:

When I started, I saw that many of the points that were stressed during our education were simply ignored here. For example, we were always told to sterilize a catheter before placing it, but nobody in the ward followed the principle; or antibiotics weren't administered at the right times. It made me feel guilty to witness all the carelessness; they didn't care about the patients and couldn't wait for their shifts to end! Many novice nurses would adopt the same wrong practices and ignore the professional principles; the standards and techniques were pushed aside and the patients forgotten. (Participant 6)

As the above response indicates, disregard for professional principles at work results in novice nurses' loss of interest in professional values and prevents them from attending to patients' various human needs and encourages them to stick to their routine duties.

Disregard for ethical matters in nursing is another component of negligence of proper nursing principles. Many nurses are guilty of such disregard and ignore their patients and their various needs. In this regard, one of the participants stated that:

I used to work in ICU and I often witnessed the nurses' lack of care about professional ethics. They were indifferent to those of the patients' needs which were not physical; if the orderly was away and a patient had a basic need, they wouldn't care; if a patient was in pain, they were not quick enough to administer a painkiller. In many cases they weren't honest: They would write down things they hadn't done; they would turn a blind eye to the patients' needs. If a patient, for example, wished to see his or her family, they wouldn't allow it. They would close the doors and drink tea and chat away! It was not easy to act morally under those circumstances: You could be ostracized. It was like swimming against the current. Unfortunately, many of my friends would imitate them, too, and were totally indifferent to the patients and their needs, as if they were machines. (Participant 8)

Motivational factors

Motivational factors play an important role in encouraging nurses to provide holistic care as well as facilitating such provision. Motivational factors include personality traits, personal experiences of hospitalization, and input sources.

Personality traits

Personality traits, identified as one of the sub-categories of motivational factors, are among the major factors generating internal motives: They encourage and facilitate holistic care, influence nurses' performance and relations with patients, and help develop rapport between nurses and patients. According to the participants, sociability and sensitivity to people's needs-which go under the subcategory of personality traits-are influential in encouraging attention to patients' various needs, thus nurses' developing holistic perception.

Sociable and genial nurses are more likely to establish a close rapport with patients, which results in a better identification and holistic perception of patients' needs. One of the participants pointed out that:

I'm a very good mixer, highly sociable; I make sure to greet my patients warmly; I even shake hands with the old patients, because I believe that lifts their spirits and makes them trust me and cooperate. For example, if they won't let others perform venipuncture on them, they will definitely let me. They also confide in me, which lets me know about and satisfy many of their needs. This quickens the treatment process, because attending to a patient's physical needs alone won't lead to recovery. My sociability has helped me realize the importance of knowing about and satisfying the patients' needs and how it affects the recovery process; now I believe that human is a complicated creature with many different needs all of which should be taken care of before complete recovery is achieved. (Participant 7)

Being sensitive and compassionate contributes to providing holistic care on the part of nurses. The more emotional a nurse is, the more sympathy he/she will feel for patients, which in turn will result in feeling more responsible for patients: The nurse will not simply perform the routine tasks but try to identify and satisfy his/her patients' whole needs. One of the nurses stated:

Well, I'm quite emotional and love to help others if I can. I help my family too and enjoy being a comfort. That's why I feel good when my patients are satisfied. Satisfying my patients' needs gives me a feeling of pleasure; the feeling is so strong that I believe my best moments are when I'm with my patients and helping them. (Participant 9)

Personal experiences of hospitalization

Nurses' personal experiences of hospitalization is another factor which enhances nurses' sympathy for and understanding of patients and their needs; it also contributes to regarding a patient's whole needs as important and refusing to attend to the physical needs alone. Naturally, being subject to similar experiences leads to a better understanding of patients' needs. Most of the participants referred to their personal experiences of hospitalization as unpleasant ones in which their needs or their families' needs-physical or otherwise- were not satisfied.

According to the input from many of the participants' experiences, when a participant or a family member was hospitalized, he/she was frustrated at the neglect of their basic and secondary needs. The participants stated that the unpleasant experience influenced their perception of patients and their various needs. One of the participants stated that:

I had to undergo cholecystectomy last year. Now I realize how painful an operation can be. Though I was in great pain, the nurses often neglected me and didn't give me painkillers. I understand now what a patient goes through. I promised myself I would never be indifferent to my patients' pain. If every nurse had a taste of his/her patient's trouble, that'd make a difference! You would understand your patients better and treat them as humans with a variety of needs all of which should be satisfied; you wouldn't focus on one aspect only, and you'd recognize the importance of attending to all one's needs simultaneously rather than one at a time. (Participant 1)

Another participant pointed out that after the experience of the hospitalization of a family member; she began to view holistic care in a different light:

One of the reasons why I attend to my patients' needs more carefully now is my Dad's time in hospital. He had to undergo a heart surgery and we were worried to death. I was waiting nervously outside the operation room, but the ICU nursing staff did not treat me well. Though I was one of their colleagues, they weren't very nice to me, and didn't allow me to see my father, nor did they give me any hope. I was totally anxious; now I understand patients and their families better. I put myself in their shoes and that makes me feel closer to them. This can help one understand patients and their multiple dimensions a lot better. (Participant 13)

Input sources

Input sources-which include religious beliefs, the participants' upbringing, and commitment-constitute another major factor in holistic care provision. Regarding religiousness, one of the participants stated:

My religious beliefs help me to consider a patient's various needs despite the problems at work. I believe God has given me the power to give care to my patients; this idea gives me more energy for a better caring for the patients. (Participant 7)

The same participant mentioned that religiousness can lead to recognition of the greater effectiveness of meeting a patient's whole needs simultaneously rather than separately:

By satisfying their needs and witnessing the effect of that on their recovery, I now see every patient as a whole with a number of needs all of which should be taken care of as a whole, and not individually, to quicken treatment.

Another nurse stated:

My beliefs make me attend to the different needs of the patients. Neglecting a patient's needs makes me feel guilty, and I try to keep my conscience clear by satisfying my patients' needs. (Participant 4)

The manner in which one has been reared has an important impact on the formation of these beliefs. In this regard, one of the participants said:

My father usually advised me to view the patients as my own family and provide the best possible caring for them and attend to all their needs. (Participant 8)

Commitment, which can increase during work, is usually effective before entering the nursing profession; it is considered as a component of input sources that plays a key role in the formation of holistic care. One of the nurses remarked:

I try to perform my duties in the best way. I think our duty is not limited to some routine tasks. Addressing all of the needs of my patients is my duty as a nurse and I try to resolve their entire problems. When I resolve them, I feel good and my interest in my profession increases. In addition to giving me a sense of fulfillment, satisfying the patients' various needs is so effective that I've grown more attentive to my patients' multiple dimensions and try to have an overall view of them. (Participant 3)

DISCUSSION

The results of the study show that factors that affect holistic care provision the most are the educational structure, professional environment, and motivational factors.

Educational structure

Educational structure-which includes the content of educational programs, teaching methods, and educators' competence-has an important impact on the adoption of holistic care by nurses. Ahmadi et al., reach similar results in their study and introduce educational structure as an effective factor in the quality of care and extent of attending to patients' different problems.[ 26] The results of this study show that none of the components of the educational structure in Iran are appropriate enough to prepare nurses for holistic care. The content of educational programs is not based on the philosophy of holistic care. King and Gates' study points to the same results and shows that teaching holistic nursing to undergraduate nursing students is ignored in the curriculum of nursing and the content of educational programs emphasizes the medical model of.[ 27] Similarly, the results of Strindberg's study in Sweden show that most nursing lessons are based only on biological science. Revising nursing lessons seems to be required for the inculcation of holistic care in nursing students. Strandberg has also suggested this matter in his study.[ 1] Robinson, likewise, emphasizes the role of the lessons' content in the adoption of holistic care by nursing students and suggests using art and behavioral lessons in nursing courses.[ 18]

Teaching methods and educators' competence, the other components of the educational structure, play an important role in learning and the transference of theoretical knowledge of holistic care into clinical practice. However, according to the findings of this study, most nurses believe that their main concern in their courses has been with becoming competent in doing routine tasks and that they had little opportunity to consider the other needs of patients. If educators provide practical models of holistic care, students' confidence will increase and they will be able to provide holistic care. Meleis (1975) and Davies (1993) referred to this issue and emphasized its importance. King and Gates, also, stress the role of practical models, teaching methods, and explaining the philosophy of holistic care in the formation of holistic care (King and Gates, 2006). Similarly, Henderson's study suggests that defective teaching methods and educators' incompetence are barriers to holistic care provision.[ 16]

Professional environment

Professional environment, which consists of workload, management, and the limited conformity of the clinical environment with professional norms, can affect the formation of holistic care and act as a barrier or facilitator to it. When unsuitable, these components are identified as barriers to holistic care provision in this study. Workload is one of the aspects of practice in nursing environments which affects the quality of caring. In his study, Ahmadi refers to the effects of workload and states that most Iranian nurses suffer from heavy workload and do not have the opportunity to consider patients' various needs and provide holistic care.[ 26] Similarly, Olive introduces workload as a barrier to the formation of holistic care.[ 6] Management, another component of professional environment, includes various domains such as evaluation methods, orientation programs for staff and management approaches. The results of this study show that nursing management is inefficient and that the nurses in this study were dissatisfied with the style of management, and do not have any orientation programs. The above-mentioned issues play an important role in the formation of holistic care and, when suitable, can enhance the provision of this mode of caring by creating motivation in nurses and increasing their knowledge. Strindberg's study in Sweden confirms this fact and emphasizes the role of management in promoting holistic care.[ 1] Duffy and McEvoy, likewise, call attention to the importance of professional environment and its various effects on nurses' performance; they consider a suitable environment as a prerequisite of holistic care.[ 10]

Clinical environments' lack of conformity with professional norms is another factor which makes nurses loose interest in professional and ethical values, and acts as a disincentive to providing holistic care.[ 28] The results show that most nurses have encountered this problem and experienced it on the first days of working. Various studies-e.g. Silva,[ 29] Abedi[ 30] and Valdez[ 31]-recognize the limited conformity of the clinical environment with professional norms as a big challenge which most novice nurses encounter. Many of the participants in the study referred to clinical environments' poor conformity with professional and ethical norms as a deterrent to providing holistic care; they also stated that many of the novice nurses would follow their colleagues' example and neglect patients and their needs. Henderson, likewise, points out in his study that clinical environments' poor conformity with norms greatly contributes to novice nurses' disregard for holistic care and encourages them to stick to the routine duties and ignore the patients' various needs.[ 16]

Motivational factors

The findings of this study prove that motivational factors-input data, personality traits, and personal experiences-are influential in identifying patients' various needs and generating holistic perceptions of the patient, which in turn encourage nurses to attend to patients' diverse needs and provide holistic care. Personality traits play a major role in expanding relationship with patients, identifying their various needs and developing holistic perception on the part of nurses. Also, religiousness and morality can induce one to satisfy patients' needs and provide holistic care, and in many cases overcome the defects in the educational and clinical systems. Obviously, one's behavior is decided by his/her personality traits; thus, a nurse's performance, behavior toward patients, and attempts at expanding relationship with them are decided by his/her personality traits. As the most important internal factor influencing motivation, personality traits are influential in achieving success at college and at work by creating intimacy, commitment and conscientiousness.[ 13] Studies show that nurses who are temperamentally sociable and emotional tend to be cheerful at work and more capable at identifying patients' needs and nursing. The same studies reveal that these nurses, compared to their colleagues, are not only more dependable, intelligent, flexible, and conscientious, but also more highly motivated.[ 32] McEvoy and Duffy point to the importance of compatibility between personality and profession as well as the impact of beliefs and principles on a nurse's performance, and regard them as vital to the provision of holistic care.[ 10]

Nurses' personal experiences of hospitalization, either on their own part or their families', can also lead to a better understanding of patients' needs, or encourage holistic perception. In other words, such experiences can lead to viewing a patient as a whole whose needs should be met in their entirety rather than separately, hence the need for holistic care. Not many studies have addressed the effects of nurses' personal experiences of hospitalization on their perception of patients' needs and the need for holistic care; however, it has been revealed that such experiences can enhance nurses' attention to their patients' various needs and induce them to provide holistic care. Gates and King[ 27] and Strandberg,[ 1] for instance, point to the influence of nurses' knowledge and experiences on their understanding of patients' various needs and the importance of holistic care. McEvoy and Duffy believe that sympathy for and a better understanding of patients can lead to the provision of holistic care.[ 10]

CONCLUSION

The results of the study show that the educational system, working environment, and motivational factors are major factors in providing holistic care. However, the findings reveal that these factors are not appropriate enough in Iran to lead to holistic care, and Iranian nurses tend to stick to their routine duties and satisfy patient's clinical needs only. Earlier studies conducted in other countries-e.g. Strindberg (2007), King (2006), Henderson (2002), Olive (2003)-have attested to the importance of the above-mentioned factors in the provision of holistic care, hence the need for closer attention to the compatibility of the educational system with the idea of holistic care, revision of the contents and methods of education, and modification of the conditions at work in order to encourage holistic care. Personality traits, personal experiences of hospitalization, and beliefs and principles-which go under the heading of motivational factors-also contribute to and facilitate holistic care. McEvoy and Duffy (2008) suggest that these factors are vital to holistic care. As a result, to develop holistic care it is necessary to attach more importance to motivational factors, compatibility between nurses' personalities and their profession, improvement of nurses' communicative skills, promoting religiousness, and encouragement of commitment in practicing nurses and nursing students alike.

ACKNOWLEDGMENT

This study is part of a larger study conducted for a doctoral dissertation that was approved by the ethical committee and was supported with a research grant (number 350) for Ph.D. thesis from Nursing Research Team affiliated to Tabriz University of Medical Sciences, Iran. The authors would like to express their sincere gratitude to this center and all the participants for cooperating in this study.

Footnotes

Source of Support: This study is part of a larger study conducted for a doctoral dissertation that was approved by the ethical committee and was supported by a research grant (number 350) for Ph.D. thesis from Nursing Research Team affiliated to Tabriz University of Medical Sciences, Iran

Conflict of Interest: None declared.

REFERENCES

1. Strandberg E, Ingvar O, Borgquist L, Wilhelmsson S. The perceived meaning of a (w) holistic view among general practitioners and district nurses in Swedish primary care: A qualitative study. BMC Fam Pract. 2007;8:8. [[ PMC free article] [ PubMed] Google Scholar]

11. Holt Waldo. Capella University: Capella University; 2011. The lived experience of being a holistic nurse educator: A heuristic inquiry. [ Google Scholar]

17. Daaleman TP, Usher BM, Williams SW, Rawlings J, Hanson LC. An exploratory study of spiritual care at the end of life. Ann Fam Med. 2008;6:406-11. [[ PMC free article] [ PubMed] Google Scholar]

22. Gravel C. Working with MAXQDA: Coding Basics Germany. 2012 [ Google Scholar]

23. Strubert H, Carpenter D. 3rd ed. Philadelphia: Lippincott Williams and Wilking; 2007. Qualitative research in nursing: Advancing the humanistic imperative. [ Google Scholar]

25. Zhang Y, Wildemuth BM. Wildemuth BM, editor. Qualitative analysis of content. Applications of social research methods to questions in information and library science. 2009:308-19. [ Google Scholar]

Articles from Indian Journal of Palliative Care are provided here courtesy of Scientific Scholar

# data[].attributes.attachment_link.title
Effective Factors in Providing Holistic Care: A Qualitative Study

# data[].attributes.attachment_link.description
Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from ...

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There are many advantages of holistic care but three most important aspects that stood out to me includes

1. Holistic care is beneficial because it incorporates all aspects of the patient from mind, body, and soul as it does not solely focus on the patient's diagnosis. This is an essential factor in treating and the recovery of the patient. It promotes a more effective treatment process due to taking the patient's psychological needs such as thoughts, emotions, and cultures, which leads to better adherence to appropriate treatment. Therefore, it decreases recurrence or relapse of the problem.

2. Holistic care increases patient satisfaction because holistic care increases the depth of care. After all, providers increase understanding of patients and their needs when using this method of care.

3. Holistic care increases self-awareness and self-confidence in patients, which causes nurses to better understand the effects of an illness on the individual's entire life and their actual needs. Additionally, it improves the harmony between the patient's mind, body, emotions, and spirit, healing a person's whole.

Reference

Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective factors in providing holistic care: a qualitative study. Indian journal of palliative care, 21(2), 214–224. https://doi.org/10.4103/0973-1075.156506

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441185/

# data[].attributes.attachment_link.readable_text
Indian J Palliat Care. 2015 May-Aug; 21(2): 214-224.

Abstract

Background:

Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring.

Materials and Methods:

A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software.

Results:

Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits.

Conclusion:

Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

Keywords: Holistic care, Nursing, Qualitative research

INTRODUCTION

Holistic care is a comprehensive model of caring which is believed to be the heart of the science of nursing.[ 1] The philosophy behind holistic care is based on the idea of holism which emphasizes that for human beings the whole is greater than the sum of its parts and that mind and spirit affect the body.[ 2] Holistic care is described as a behavior that recognizes a person as a whole and acknowledges the interdependence among one's biological, social, psychological, and spiritual aspects. Holistic care includes a wide range of approaches, including medication, education, communication, self-help, and complementary treatment.[ 3] In holistic nursing, all aspects of patients and their effects on the treatment process are considered and the patients' thoughts, emotions, cultures, opinions, and attitudes are factored in as contributing to recovery, happiness, and satisfaction.[ 4] Holistic care respects human dignity[ 5]: The relationship between the providers of health care and the patients is based on respect, relative openness, equality, and mutuality[ 2, 5] and patients participate in decision making in this kind of caring.[ 6]

Providers of holistic care consider a patient as a whole within his/her environment and realize that a patient is made up of a body, mind, and spirit. Respecting the patient's role in the treatment process, having him/her take part in the process and encouraging self-care is another aspect of holistic care which leads to therapeutic consultation, hope, dignity, self-discipline, social growth, a sense of autonomy, vigor, and vitality.[ 7]

Holistic care increases the depth of care providers' understanding of patients and their needs. Educating patients about self-care and helping them to perform their daily activities independently is part of holistic care. Palliative care is part of holistic care which improves the quality of a patient's life and their emotional and physical well-being. Holistic care increases self-awareness[ 8] and self-confidence in patients[ 9] and causes nurses to better understand the effects of an illness on a person's entire life and his/her true needs. It also improves harmony between mind, body, emotions, and spirit in an ever-changing environment;[ 10] The American Association of Holistic Nurses supports this belief and points out that holistic nursing includes all the nursing practices that heal the whole of a person.[ 5]

In many hospitals, nurses do not have the freedom to perform their tasks independently and their actions are often observed by doctors. Using holistic care as the framework will result in major changes in the treatment process,[ 11] a better public view of the nursing profession, and nurses' autonomy.[ 10] The holistic care paradigm has been presented to the health-care systems in many cultures[ 4] and it can be used in every area of nursing.[ 12] Holistic care is not a new method; Florence Nightingale developed this type of nursing as a better model of caring;[ 4] many other nursing theorists, e.g. Ragers, Newman, and Parse have also emphasized holistic care.[ 13]

Unfortunately, there is compelling evidence that most nurses have been educated with a biomedical allopathic focus and do not have a good understanding of the meaning of holistic care. Furthermore, it has been suggested that nurses are not familiar with holistic care, neglect this model of caring,[ 4, 6] do not use this method,[ 2] and consider patients' corporeal needs only. In this regard, patients' other needs and sometimes more serious problems are not addressed.[ 6] The mental, spiritual, and social needs of patients are neglected[ 14] and patients are considered as biological machines.[ 15]

Using the ordinary medical model alone for treatment exposes patients to serious threats, prolongs hospitalization, and raises treatment costs.[ 6] In many countries, such as the UK,[ 6] Australia,[ 16] and Iran,[ 12] holistic aspects of patients' needs are often overlooked.[ 6, 16] Similar studies conducted in the USA have revealed that 67% of American patients in hospitals do not receive holistic care,[ 17] and a study conducted in England showed that only 5% of hospitalized patients were subject to holistic care.[ 6]

This presents as a major crisis for the nursing profession.[ 18] Considering the beneficial effects of holistic care, the identification of contributory factors is of importance for providing this method of caring. A review of literature in this field shows that most studies have been limited to specific areas, such as operating rooms or older patients who were terminally sick.[ 4, 19] Other studies attempt to explain the concept of holistic nursing and nurses' perception of it,[ 1, 2] or the reasons for failure to employ this method.[ 4, 6] According to the results obtained from several studies, holistic care is adversely affected by such factors as inadequate time, improper professional relations, incomplete reports from nurses, inadequate clinical control, unavailability of resources,[ 20] poor professional and administrational perceptions, limited knowledge, and motivational and organizational factors.[ 4] In view of the great influence of holistic care on treatment and more effective nursing, the health-care systems in many countries in recent decades have tried to promote holistic care by applying changes to the educational and administrational systems,[ 4] but studies show that their efforts have been fruitless.[ 21, 22]

Evidently, there are other factors affecting holistic nursing that must be identified. An investigation into this matter using a qualitative approach that includes multiple methods of data gathering and emphasizes reality experience[ 23] can help us to obtain meaningful and comprehensive data; it will also clarify the existing background and the real situation surrounding the formation of holistic care. Thus, this is a qualitative study and is based on the experience of nurses, who form the core of holistic care provision.

MATERIALS AND METHODS

Ethical considerations

This study was approved by the ethics committee of Tabriz University of Medical Sciences. All the participants were informed of the aim of the study and a written consent was obtained from each of them. Participation in the study was entirely voluntary and the participants could withdraw at any stage of the study.

Method

A qualitative content analysis was conducted to develop an in-depth understanding of nurses' experiences of major factors that affect holistic care formation. This method was used for describing the systematic and objective means of the phenomenon.[ 24] This study is based on conventional qualitative content analysis in which coding and categorizing are derived directly from the raw data. The advantage of this approach to content analysis is obtaining direct data from participants without imposing pre-supposed categories or theoretical perspectives. Another important attribute of this approach is its emphasis on the subject, context, and differences and similarities among codes and categories.[ 25] Purposive sampling was used to select 14 participants with abundant information. Three of the nurses selected were male and the others were female. The participants were selected from various wards [intensive care unit (ICU), emergency, general wards] in university hospitals in the Iranian cities of Tabriz, Uremia, Ardebil, and Tehran. Further characteristics of the participants are presented in Table 1 . The study lasted 6 months, from May until October 2013. In the first stage, participants were informed of the aim of the study by the researchers; if they agreed to participate in the research, they gave written consent. To respect the privacy of the interviewees, numerical codes are used instead of their names.

Table 1

The data were collected using unstructured interviews. Each interview lasted between 60 and 90 minutes and was performed in a private room in the hospital. Each interview commenced with an opening question such as "what do you do for a patient during your shift?"; this was followed by questions that addressed their experiences of caring for patients and situations and factors which affect the quality of caring and attending to patients' various needs. Based on the initial data analysis, additional questions were asked of the respondents. A second interview was conducted with four participants to help clarify the initial interpretations of the information and emerging results. To ensure accuracy of the data, the interviews were continued until data saturation: Data collection was ended when no new information could be collected and the data became repetitive.

The interviews were tape-recorded, transcribed, and coded line-by-line by MAXQDA 2010 software which was used in the initial stages of coding.[ 22] The various codes were compared and categorized and themes were constructed based on similar and appropriate categories. In this way, themes and categories were generated inductively from the data.

Rigor

To increase the dependability of the study, data were collected and analyzed by one of the researchers; the other researchers checked and verified the data, codes, and analyses. The transcripts were read several times and the categories and themes were discussed by the researchers until consensus was reached. The credibility of the results of the study was confirmed through prolonged engagement with participants in the wards. In addition, individual checking was used to examine the accuracy of the findings, and the results of the primary analysis were shared with the participants to validate the compatibility of the codes with their experiences. Transferability of the findings was made possible by the variety of the characteristics of the participants.

RESULTS

Following an analysis of the data, three themes were identified as effective factors in holistic care provision: The structure of the educational system, professional environment, and motivational factors. The themes, sub-themes, and codes are shown in Table 2 .

Table 2

The structure of the educational system

The structure of the educational system was one of the issues which most of the participants talked about. Proper education plays an important role in nurses' preparation for providing holistic care. This theme consists of three sub-themes: The content of educational programs, the teaching methods, and the educators' competence.

The content of educational programs

If the content of educational programs is comprehensive and includes the philosophy of holistic care, it will enable nursing students to address the various needs of patients and provide holistic care. One of the nurses emphasized the role of education in providing holistic care and said:

The content of the courses deeply affected my attitude toward patients and their needs; the courses on "nursing procedures" and "psychological disorders" made me stop looking at a patient only in terms of physicality and understand that an individual is more than a body with certain needs; it made me consider a patient's entire dimensions; I realized that health is the equivalent of harmony and balance among a patient's whole dimensions, not simply physical well-being. (Participant 8)

The above quotation points to the important role of designed courses in training nurses in holistic care. Another participant, similarly, referred to the importance of "nursing procedures" in creating an inclusive perception and promoting holistic care:

The course on nursing procedures broadened my horizons about patients and made me see aspects that I had been unaware of; I understood that well-being is the result of meeting a patient's various needs, from physical needs through emotional and spiritual needs to social, cultural and economic needs. (Participant 2)

The same participant, however, observed that the course of "nursing procedures" did not have enough credits and that they were not adequately trained in providing holistic care:

The course was too short and the training was not enough. But I was interested and regarded it as a specialized part of nursing; I practiced a lot and gradually learned how to exercise it. I wish the trainers had instructed us properly; then I would have realized the importance of it sooner.

Unfortunately, the data show that the content of the educational program is poor and lacks material on the various needs of patients. Regarding this issue, one of the nurses explained:

More than 90% of our lessons were about the physical problems of patients, and their other needs were usually neglected. (Participant 5)

Another participant expressed:

During the course, most of our education was about the physical problems of patients and dealing with them. So, by the end of the course, our knowledge of the physical needs of patients had increased, but we didn't know anything about the whole needs of patients and their role in the treatment. (Participant 6)

Another nurse explained:

Clinical training was too short and we didn't have enough time to establish a relationship with the patients to recognize their various problems. (Participant 13)

Teaching methods

Teaching methods are part of the educational structure and play an important role in holistic care formation. But, according to the results, the teaching methods are not designed to demonstrate holistic care. In this regard, one of the participants said:

The teaching methods were often educator-centered; a limited number of tasks were dictated and we were expected to do them only; we were not free to consider the other needs of patients and satisfy them. (Participant 3)

Practice-based teaching can increase nursing students' understanding of holistic care, but the data showed that the nursing educators did not consider this matter and focused on theory-based teaching. One of the nurses stated:

We did not receive any practical training in considering patients' various needs. In our education, we were not told that a patient is a whole with many different aspects and whose treatment requires that we consider all those aspects; although some of the educators advised us to consider the secondary needs of patients, there was no practical training in this field. (Participant 9)

The educators' competence

The educators' characteristics and competence have been introduced as a component of the educational structure in this study; educators can provide the trainees with a practical model from which to learn the principles of holistic care in practice. A participant said regarding this issue:

One of our educators was sensitive to the various needs of patients, treated them with respect and attended to their various needs. Her manners influenced my behavior. Now, I try to use her lessons in practice and provide my patients with comfort by addressing their various needs. (Participant 6)

Similarly, a participant referring to her trainer's holistic perception and emphasis on holistic care remarked:

One of our trainers always stressed that we view a patient as a whole that has different needs; she was trying to have us realize that well-being is the result of creating a harmony among the various parts of the whole and not just the physical dimensions. My trainer's attitude greatly affected my manner of nursing: I try to attend to my patients' entire needs, not just the physical ones, and consider their emotional, spiritual, cultural and social needs. I believe that meeting all these needs at the same time rather than separately is much more effective.

But the results show that most of the participants had no practical model for learning holistic care during their education. One of the nurses said:

Most of our educators had limited knowledge of the various aspects of patients' needs and their effects on health recovery and paid little attention to these matters. They paid more attention to routine tasks, and we didn't have an actual example of someone who considered all the needs of patients and provided holistic care. (Participant 6)

An educator's good relationship with students is an effective factor in attracting attention to the educator's training, as well as motivation for learning. In this regard, one of the nurses stated:

Our educators didn't usually have a suitable relationship with us and reproached us for unimportant matters, so we didn't have any motivation for learning. (Participant 14)

Professional environment

Professional environment is another factor which most participants emphasized as being important to considering the patients' different needs and providing holistic care. This theme consists of three sub-themes: Workload, management, and the gap between clinical performance and academic learning.

Workload

Workload, one of the components of professional environment, was referred to by most of the participants as a restriction in holistic care provision. Concerning this issue, one of the participants said:

Sometimes, the ward is too crowded and busy; although I understand that patients have different needs, and I want to meet them, but I don't get the opportunity to do it (Participant 2).

Another participant explained:

If the numbers of patients were smaller in the ward, we would have more opportunities to provide better care and we could attend to all of our patients' needs (Participant 12).

One of the participants referred to the sheer number of her working shifts and said:

Because of the huge number of shifts, we are always tired and don't have the required energy for providing suitable care. (Participant 9)

Management

Management-with its different domains, such as evaluation, orientation programs for staff and management approaches-plays an important role in the formation of holistic care. Most of the participants emphasized its impact on the quality of nursing. To quote one of the nurses:

There is no difference between a nurse who considers and attends to the patients' different needs and another who only does the routine tasks. Ironically, the latter is more popular with the managers. Routine tasks are considered as evaluation criteria. (Participant 8)

Another nurse mentioned:

Our head nurse and the supervisors emphasize the routine tasks and unimportant stuff and there is no incentive for considering the patients' secondary needs. (Participant 5)

Orientation programs and managers' competence can decrease nurses' stress and obsession with routine duties and encourage them to consider the patients' other needs and provide holistic care. But data show that the professional environment in Iranian hospitals lacks orientation programs for novice nurses and that most of the managers lack competence for their positions. One of the nurses stated:

We didn't have any orientation programs when we began to work in the hospital and our head nurse was very strict and belittled us for unimportant matters. It was very difficult for me. I was under pressure and lost my motivation to continue my profession, provide proper care and pay attention to the patients and their needs. (Participant 7)

Limited conformity of the clinical environment with professional norms

Conformity of the clinical environment with professional and ethical norms results in nurses' treating patients as human beings with human needs, all of which should be taken into account; upon observing the beneficial effects of holistic care on the treatment process, nurses will acquire a holistic perception: They will realize the importance of attending to patients' needs from various aspects and experience the effectiveness of meeting those needs as a whole compared to satisfying them separately. However, the participants declared that upon entering the clinical environment, they were faced with the limited conformity of their environment with professional norms. Disregard for the principles of proper nursing forms a sub-category of this phenomenon.

The participants stated that upon embarking on their careers, they were faced with a prevalent disregard for the principles of proper nursing, at both the professional and ethical level. Obviously, such disregard for professional and ethical principles leads to professional shortcomings and negligence of nursing ideals, which in turn results in nurses' failure to provide proper care and attend to patients' needs in their entirety. Attention to professional principles is the prerequisite of holistic care; but in most cases they are ignored. To quote a participant:

When I started, I saw that many of the points that were stressed during our education were simply ignored here. For example, we were always told to sterilize a catheter before placing it, but nobody in the ward followed the principle; or antibiotics weren't administered at the right times. It made me feel guilty to witness all the carelessness; they didn't care about the patients and couldn't wait for their shifts to end! Many novice nurses would adopt the same wrong practices and ignore the professional principles; the standards and techniques were pushed aside and the patients forgotten. (Participant 6)

As the above response indicates, disregard for professional principles at work results in novice nurses' loss of interest in professional values and prevents them from attending to patients' various human needs and encourages them to stick to their routine duties.

Disregard for ethical matters in nursing is another component of negligence of proper nursing principles. Many nurses are guilty of such disregard and ignore their patients and their various needs. In this regard, one of the participants stated that:

I used to work in ICU and I often witnessed the nurses' lack of care about professional ethics. They were indifferent to those of the patients' needs which were not physical; if the orderly was away and a patient had a basic need, they wouldn't care; if a patient was in pain, they were not quick enough to administer a painkiller. In many cases they weren't honest: They would write down things they hadn't done; they would turn a blind eye to the patients' needs. If a patient, for example, wished to see his or her family, they wouldn't allow it. They would close the doors and drink tea and chat away! It was not easy to act morally under those circumstances: You could be ostracized. It was like swimming against the current. Unfortunately, many of my friends would imitate them, too, and were totally indifferent to the patients and their needs, as if they were machines. (Participant 8)

Motivational factors

Motivational factors play an important role in encouraging nurses to provide holistic care as well as facilitating such provision. Motivational factors include personality traits, personal experiences of hospitalization, and input sources.

Personality traits

Personality traits, identified as one of the sub-categories of motivational factors, are among the major factors generating internal motives: They encourage and facilitate holistic care, influence nurses' performance and relations with patients, and help develop rapport between nurses and patients. According to the participants, sociability and sensitivity to people's needs-which go under the subcategory of personality traits-are influential in encouraging attention to patients' various needs, thus nurses' developing holistic perception.

Sociable and genial nurses are more likely to establish a close rapport with patients, which results in a better identification and holistic perception of patients' needs. One of the participants pointed out that:

I'm a very good mixer, highly sociable; I make sure to greet my patients warmly; I even shake hands with the old patients, because I believe that lifts their spirits and makes them trust me and cooperate. For example, if they won't let others perform venipuncture on them, they will definitely let me. They also confide in me, which lets me know about and satisfy many of their needs. This quickens the treatment process, because attending to a patient's physical needs alone won't lead to recovery. My sociability has helped me realize the importance of knowing about and satisfying the patients' needs and how it affects the recovery process; now I believe that human is a complicated creature with many different needs all of which should be taken care of before complete recovery is achieved. (Participant 7)

Being sensitive and compassionate contributes to providing holistic care on the part of nurses. The more emotional a nurse is, the more sympathy he/she will feel for patients, which in turn will result in feeling more responsible for patients: The nurse will not simply perform the routine tasks but try to identify and satisfy his/her patients' whole needs. One of the nurses stated:

Well, I'm quite emotional and love to help others if I can. I help my family too and enjoy being a comfort. That's why I feel good when my patients are satisfied. Satisfying my patients' needs gives me a feeling of pleasure; the feeling is so strong that I believe my best moments are when I'm with my patients and helping them. (Participant 9)

Personal experiences of hospitalization

Nurses' personal experiences of hospitalization is another factor which enhances nurses' sympathy for and understanding of patients and their needs; it also contributes to regarding a patient's whole needs as important and refusing to attend to the physical needs alone. Naturally, being subject to similar experiences leads to a better understanding of patients' needs. Most of the participants referred to their personal experiences of hospitalization as unpleasant ones in which their needs or their families' needs-physical or otherwise- were not satisfied.

According to the input from many of the participants' experiences, when a participant or a family member was hospitalized, he/she was frustrated at the neglect of their basic and secondary needs. The participants stated that the unpleasant experience influenced their perception of patients and their various needs. One of the participants stated that:

I had to undergo cholecystectomy last year. Now I realize how painful an operation can be. Though I was in great pain, the nurses often neglected me and didn't give me painkillers. I understand now what a patient goes through. I promised myself I would never be indifferent to my patients' pain. If every nurse had a taste of his/her patient's trouble, that'd make a difference! You would understand your patients better and treat them as humans with a variety of needs all of which should be satisfied; you wouldn't focus on one aspect only, and you'd recognize the importance of attending to all one's needs simultaneously rather than one at a time. (Participant 1)

Another participant pointed out that after the experience of the hospitalization of a family member; she began to view holistic care in a different light:

One of the reasons why I attend to my patients' needs more carefully now is my Dad's time in hospital. He had to undergo a heart surgery and we were worried to death. I was waiting nervously outside the operation room, but the ICU nursing staff did not treat me well. Though I was one of their colleagues, they weren't very nice to me, and didn't allow me to see my father, nor did they give me any hope. I was totally anxious; now I understand patients and their families better. I put myself in their shoes and that makes me feel closer to them. This can help one understand patients and their multiple dimensions a lot better. (Participant 13)

Input sources

Input sources-which include religious beliefs, the participants' upbringing, and commitment-constitute another major factor in holistic care provision. Regarding religiousness, one of the participants stated:

My religious beliefs help me to consider a patient's various needs despite the problems at work. I believe God has given me the power to give care to my patients; this idea gives me more energy for a better caring for the patients. (Participant 7)

The same participant mentioned that religiousness can lead to recognition of the greater effectiveness of meeting a patient's whole needs simultaneously rather than separately:

By satisfying their needs and witnessing the effect of that on their recovery, I now see every patient as a whole with a number of needs all of which should be taken care of as a whole, and not individually, to quicken treatment.

Another nurse stated:

My beliefs make me attend to the different needs of the patients. Neglecting a patient's needs makes me feel guilty, and I try to keep my conscience clear by satisfying my patients' needs. (Participant 4)

The manner in which one has been reared has an important impact on the formation of these beliefs. In this regard, one of the participants said:

My father usually advised me to view the patients as my own family and provide the best possible caring for them and attend to all their needs. (Participant 8)

Commitment, which can increase during work, is usually effective before entering the nursing profession; it is considered as a component of input sources that plays a key role in the formation of holistic care. One of the nurses remarked:

I try to perform my duties in the best way. I think our duty is not limited to some routine tasks. Addressing all of the needs of my patients is my duty as a nurse and I try to resolve their entire problems. When I resolve them, I feel good and my interest in my profession increases. In addition to giving me a sense of fulfillment, satisfying the patients' various needs is so effective that I've grown more attentive to my patients' multiple dimensions and try to have an overall view of them. (Participant 3)

DISCUSSION

The results of the study show that factors that affect holistic care provision the most are the educational structure, professional environment, and motivational factors.

Educational structure

Educational structure-which includes the content of educational programs, teaching methods, and educators' competence-has an important impact on the adoption of holistic care by nurses. Ahmadi et al., reach similar results in their study and introduce educational structure as an effective factor in the quality of care and extent of attending to patients' different problems.[ 26] The results of this study show that none of the components of the educational structure in Iran are appropriate enough to prepare nurses for holistic care. The content of educational programs is not based on the philosophy of holistic care. King and Gates' study points to the same results and shows that teaching holistic nursing to undergraduate nursing students is ignored in the curriculum of nursing and the content of educational programs emphasizes the medical model of.[ 27] Similarly, the results of Strindberg's study in Sweden show that most nursing lessons are based only on biological science. Revising nursing lessons seems to be required for the inculcation of holistic care in nursing students. Strandberg has also suggested this matter in his study.[ 1] Robinson, likewise, emphasizes the role of the lessons' content in the adoption of holistic care by nursing students and suggests using art and behavioral lessons in nursing courses.[ 18]

Teaching methods and educators' competence, the other components of the educational structure, play an important role in learning and the transference of theoretical knowledge of holistic care into clinical practice. However, according to the findings of this study, most nurses believe that their main concern in their courses has been with becoming competent in doing routine tasks and that they had little opportunity to consider the other needs of patients. If educators provide practical models of holistic care, students' confidence will increase and they will be able to provide holistic care. Meleis (1975) and Davies (1993) referred to this issue and emphasized its importance. King and Gates, also, stress the role of practical models, teaching methods, and explaining the philosophy of holistic care in the formation of holistic care (King and Gates, 2006). Similarly, Henderson's study suggests that defective teaching methods and educators' incompetence are barriers to holistic care provision.[ 16]

Professional environment

Professional environment, which consists of workload, management, and the limited conformity of the clinical environment with professional norms, can affect the formation of holistic care and act as a barrier or facilitator to it. When unsuitable, these components are identified as barriers to holistic care provision in this study. Workload is one of the aspects of practice in nursing environments which affects the quality of caring. In his study, Ahmadi refers to the effects of workload and states that most Iranian nurses suffer from heavy workload and do not have the opportunity to consider patients' various needs and provide holistic care.[ 26] Similarly, Olive introduces workload as a barrier to the formation of holistic care.[ 6] Management, another component of professional environment, includes various domains such as evaluation methods, orientation programs for staff and management approaches. The results of this study show that nursing management is inefficient and that the nurses in this study were dissatisfied with the style of management, and do not have any orientation programs. The above-mentioned issues play an important role in the formation of holistic care and, when suitable, can enhance the provision of this mode of caring by creating motivation in nurses and increasing their knowledge. Strindberg's study in Sweden confirms this fact and emphasizes the role of management in promoting holistic care.[ 1] Duffy and McEvoy, likewise, call attention to the importance of professional environment and its various effects on nurses' performance; they consider a suitable environment as a prerequisite of holistic care.[ 10]

Clinical environments' lack of conformity with professional norms is another factor which makes nurses loose interest in professional and ethical values, and acts as a disincentive to providing holistic care.[ 28] The results show that most nurses have encountered this problem and experienced it on the first days of working. Various studies-e.g. Silva,[ 29] Abedi[ 30] and Valdez[ 31]-recognize the limited conformity of the clinical environment with professional norms as a big challenge which most novice nurses encounter. Many of the participants in the study referred to clinical environments' poor conformity with professional and ethical norms as a deterrent to providing holistic care; they also stated that many of the novice nurses would follow their colleagues' example and neglect patients and their needs. Henderson, likewise, points out in his study that clinical environments' poor conformity with norms greatly contributes to novice nurses' disregard for holistic care and encourages them to stick to the routine duties and ignore the patients' various needs.[ 16]

Motivational factors

The findings of this study prove that motivational factors-input data, personality traits, and personal experiences-are influential in identifying patients' various needs and generating holistic perceptions of the patient, which in turn encourage nurses to attend to patients' diverse needs and provide holistic care. Personality traits play a major role in expanding relationship with patients, identifying their various needs and developing holistic perception on the part of nurses. Also, religiousness and morality can induce one to satisfy patients' needs and provide holistic care, and in many cases overcome the defects in the educational and clinical systems. Obviously, one's behavior is decided by his/her personality traits; thus, a nurse's performance, behavior toward patients, and attempts at expanding relationship with them are decided by his/her personality traits. As the most important internal factor influencing motivation, personality traits are influential in achieving success at college and at work by creating intimacy, commitment and conscientiousness.[ 13] Studies show that nurses who are temperamentally sociable and emotional tend to be cheerful at work and more capable at identifying patients' needs and nursing. The same studies reveal that these nurses, compared to their colleagues, are not only more dependable, intelligent, flexible, and conscientious, but also more highly motivated.[ 32] McEvoy and Duffy point to the importance of compatibility between personality and profession as well as the impact of beliefs and principles on a nurse's performance, and regard them as vital to the provision of holistic care.[ 10]

Nurses' personal experiences of hospitalization, either on their own part or their families', can also lead to a better understanding of patients' needs, or encourage holistic perception. In other words, such experiences can lead to viewing a patient as a whole whose needs should be met in their entirety rather than separately, hence the need for holistic care. Not many studies have addressed the effects of nurses' personal experiences of hospitalization on their perception of patients' needs and the need for holistic care; however, it has been revealed that such experiences can enhance nurses' attention to their patients' various needs and induce them to provide holistic care. Gates and King[ 27] and Strandberg,[ 1] for instance, point to the influence of nurses' knowledge and experiences on their understanding of patients' various needs and the importance of holistic care. McEvoy and Duffy believe that sympathy for and a better understanding of patients can lead to the provision of holistic care.[ 10]

CONCLUSION

The results of the study show that the educational system, working environment, and motivational factors are major factors in providing holistic care. However, the findings reveal that these factors are not appropriate enough in Iran to lead to holistic care, and Iranian nurses tend to stick to their routine duties and satisfy patient's clinical needs only. Earlier studies conducted in other countries-e.g. Strindberg (2007), King (2006), Henderson (2002), Olive (2003)-have attested to the importance of the above-mentioned factors in the provision of holistic care, hence the need for closer attention to the compatibility of the educational system with the idea of holistic care, revision of the contents and methods of education, and modification of the conditions at work in order to encourage holistic care. Personality traits, personal experiences of hospitalization, and beliefs and principles-which go under the heading of motivational factors-also contribute to and facilitate holistic care. McEvoy and Duffy (2008) suggest that these factors are vital to holistic care. As a result, to develop holistic care it is necessary to attach more importance to motivational factors, compatibility between nurses' personalities and their profession, improvement of nurses' communicative skills, promoting religiousness, and encouragement of commitment in practicing nurses and nursing students alike.

ACKNOWLEDGMENT

This study is part of a larger study conducted for a doctoral dissertation that was approved by the ethical committee and was supported with a research grant (number 350) for Ph.D. thesis from Nursing Research Team affiliated to Tabriz University of Medical Sciences, Iran. The authors would like to express their sincere gratitude to this center and all the participants for cooperating in this study.

Footnotes

Source of Support: This study is part of a larger study conducted for a doctoral dissertation that was approved by the ethical committee and was supported by a research grant (number 350) for Ph.D. thesis from Nursing Research Team affiliated to Tabriz University of Medical Sciences, Iran

Conflict of Interest: None declared.

REFERENCES

1. Strandberg E, Ingvar O, Borgquist L, Wilhelmsson S. The perceived meaning of a (w) holistic view among general practitioners and district nurses in Swedish primary care: A qualitative study. BMC Fam Pract. 2007;8:8. [[ PMC free article] [ PubMed] Google Scholar]

11. Holt Waldo. Capella University: Capella University; 2011. The lived experience of being a holistic nurse educator: A heuristic inquiry. [ Google Scholar]

17. Daaleman TP, Usher BM, Williams SW, Rawlings J, Hanson LC. An exploratory study of spiritual care at the end of life. Ann Fam Med. 2008;6:406-11. [[ PMC free article] [ PubMed] Google Scholar]

22. Gravel C. Working with MAXQDA: Coding Basics Germany. 2012 [ Google Scholar]

23. Strubert H, Carpenter D. 3rd ed. Philadelphia: Lippincott Williams and Wilking; 2007. Qualitative research in nursing: Advancing the humanistic imperative. [ Google Scholar]

25. Zhang Y, Wildemuth BM. Wildemuth BM, editor. Qualitative analysis of content. Applications of social research methods to questions in information and library science. 2009:308-19. [ Google Scholar]

Articles from Indian Journal of Palliative Care are provided here courtesy of Scientific Scholar

# data[].attributes.attachment_link.title
Effective Factors in Providing Holistic Care: A Qualitative Study

# data[].attributes.attachment_link.description
Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from ...

# data[].attributes.body
1. Holistic nursing can lead to better healing and overall better quality of life. The mind and body are interconnected therefore making it necessary to include those factors into treatment.

2. Holistic nursing can prevent us from becoming desensitized and look at patients as human beings, rather than simply a problem to be solved.

3. Holistic nursing can create a better patient-nurse relationship where the patient feels more comfortable and that their concerns are being heard.

I think unfortunately there is a stigma associated with holistic practices in general; I know myself that I associate it with modalities that have no scientific backing. For example, using modalities such as "healing energies" from crystals.

Picture from: https://www.ozassignments.com/solution/holistic-nursing-health-editing-service

# data[].attributes.body
Three advantage of Holistic Health and Nursing:

1. Holistic nursing care focuses on the patient as a whole person and treats the person for all needs, including; spiritual, social, mental, and physical needs. This is beneficial because the patient's medical team will not just focus on illness and symptoms but take into account the patient's life and health as a whole in order to improve wellness. Many studies show the link between various aspects in life and how that influences health status, with the holistic approach this will be factored in to personalize their treatment.

2. Holistic care does not solely use pharmaceuticals but instead includes a variety of clinically successful treatment options. Some holistic care therapies may include diet, fitness schedules, massage, acupuncture, yoga, counseling and many other evidence-based alternative options. This is beneficial because at times medicinal therapy is not the only way to improve wellness if other aspects of the patient's life are contributing to their health issues. This approach helps the patient not just be treated for their complaints but instead be treated as a person using multiple therapeutic tools.

3.  In holistic health care, the medical staff will provide education and motivation in order for their patient's to make choices that will benefit their wellness. It is challenging to make many lifestyle changes but with holistic care focus is put on the major aspects in the patient's life that are impacting their health. Setting goals in the patient's life that are achievable will increase the likelihood of success of overall health impact and using holistic care resources will be included to personalize their mind-body healthcare plan.

# data[].attributes.attachment_link.readable_text
When you hear "holistic health," do you think of alternative medicine, naturopathy, or other Eastern-inspired health trends? If so, you're at least partly right.

Holistic health does incorporate complementary therapies that have been scientifically proven to work, and like alternative medicine, it focuses on wellness and prevention, rather than just treating diseases. But holistic care is about more than integrating Eastern and Western medicine. It's a more comprehensive and personalized way of thinking about wellness.

So, what is holistic health care?

Treating the Whole You

Holistic health is about caring for the whole person - providing for your physical, mental, spiritual, and social needs. It's rooted in the understanding that all these aspects affect your overall health, and being unwell in one aspect affects you in others.

Take stress, for example. It's a psychological response, but it can also cause physical symptoms, such as headaches, trouble sleeping, weight gain, and muscle pain. Of course, it works both ways, and being physically ill can cause you to feel anxious or depressed. Meanwhile, your spirituality and your relationships can boost your mental and physical health. Studies show that having close friendships lowers your blood pressure, reduces your stress levels, and can even improve your chances of surviving cancer.

Understanding this, doctors who take a holistic approach to health don't just ask you about your symptoms. They ask about you - your overall health and your life - so they can make personalized recommendations to improve your wellness.

Doctoring Outside the Box

Holistic care providers address a wide variety of wellness concerns, and they use a wide variety of clinically proven therapies - from surgery and pharmaceuticals, to dietary changes and exercise plans, to psychological and spiritual counseling. They might also recommend evidence-based alternative therapies, such as massage, acupuncture, and yoga, for supportive care.

For example, if you're experiencing chronic pain, a holistic health care provider might prescribe medications or recommend surgery to repair an injury, but they'll also recommend that you increase your endorphins naturally by getting more exercise. They'll ask about your diet, and discuss how certain foods contribute to inflammation. They'll ask you about stress, anxiety, and depression - all of which can cause pain or be caused by it - and refer you to a therapist if you want one. Then they might also recommend massage to relax your muscles, acupuncture to help with nerve pain, or mindful meditation to help with pain management and stress relief.

Simply put, rather than treating the pain, they'll treat the person, and use all the tools at their disposal to do it.

Making Wellness Doable

Wellness is a big, important goal, and it can feel overwhelming. You know you should eat healthier foods, drink more water, hit the gym more often, sleep eight hours a night, give up your vices, and make more time for rest and relaxation. But the busyness of work and life can make it hard to prioritize self-care, and the more you think about what you "should" be doing differently, the more daunting wellness can seem.

Holistic doctors empower you with the education and motivation to make better choices. Rather than suggesting a long list of lifestyle changes, they include you in the conversation and help you determine which changes would make the greatest impact on your health. They help you set wellness goals and then provide you with resources - whether that's a personalized plan or a referral to a specialist.

So, what is holistic health care? It's about honoring the mind-body connection and treating the whole person, using a variety of clinically proven therapies. It's about developing a strong relationship with a doctor who is committed to getting you healthy and keeping you that way.

Dignity Health strives to make holistic care part of its care and an integral part of how the entire team works every day.

Taylor Mallory Holland is a seasoned freelance writer specializing in healthcare and technology. Taylor has more than a decade's experience writing for media outlets and organizations, including a top medical school and several leading healthcare systems. She is passionate about helping consumers navigate the healthcare system. She also enjoys interviewing physicians, breaking down complex medical jargon, and sharing health and wellness tips that help people make informed healthcare decisions.

More articles from this writer

# data[].attributes.attachment_link.description
When you hear "holistic health," do you think of alternative medicine, naturopathy, or other Eastern-inspired health trends? If so, you're at least partly right. Holistic health does incorporate complementary therapies that have been scientifically proven to work, and like alternative medicine, it focuses on wellness and prevention, rather than just treating diseases.

# data[].attributes.body
1. Holistic health looks at all aspects of the patient: their physical, emotional and spiritual well being. For example, curing a patient's anxiety may not just be through medication, but through clinical therapy, yoga and meditation. The whole patient is cared for, not just a physical ailment.
2. Holistic health can allow the patient to feel more involved in their care. It provides more options for the patient to consider, especially for those who are weary of taking medication.
3. Having a doctor who is holistically focused allows the patient to feel fully seen and heard, knowing the doctor is not just there to prescribe medications. If and when the doctor does prescribe a medication, they know it's the best option of all the options considered and explored.

# data[].attributes.attachment_link.readable_text
When you hear "holistic health," do you think of alternative medicine, naturopathy, or other Eastern-inspired health trends? If so, you're at least partly right.

Holistic health does incorporate complementary therapies that have been scientifically proven to work, and like alternative medicine, it focuses on wellness and prevention, rather than just treating diseases. But holistic care is about more than integrating Eastern and Western medicine. It's a more comprehensive and personalized way of thinking about wellness.

So, what is holistic health care?

Treating the Whole You

Holistic health is about caring for the whole person - providing for your physical, mental, spiritual, and social needs. It's rooted in the understanding that all these aspects affect your overall health, and being unwell in one aspect affects you in others.

Take stress, for example. It's a psychological response, but it can also cause physical symptoms, such as headaches, trouble sleeping, weight gain, and muscle pain. Of course, it works both ways, and being physically ill can cause you to feel anxious or depressed. Meanwhile, your spirituality and your relationships can boost your mental and physical health. Studies show that having close friendships lowers your blood pressure, reduces your stress levels, and can even improve your chances of surviving cancer.

Understanding this, doctors who take a holistic approach to health don't just ask you about your symptoms. They ask about you - your overall health and your life - so they can make personalized recommendations to improve your wellness.

Doctoring Outside the Box

Holistic care providers address a wide variety of wellness concerns, and they use a wide variety of clinically proven therapies - from surgery and pharmaceuticals, to dietary changes and exercise plans, to psychological and spiritual counseling. They might also recommend evidence-based alternative therapies, such as massage, acupuncture, and yoga, for supportive care.

For example, if you're experiencing chronic pain, a holistic health care provider might prescribe medications or recommend surgery to repair an injury, but they'll also recommend that you increase your endorphins naturally by getting more exercise. They'll ask about your diet, and discuss how certain foods contribute to inflammation. They'll ask you about stress, anxiety, and depression - all of which can cause pain or be caused by it - and refer you to a therapist if you want one. Then they might also recommend massage to relax your muscles, acupuncture to help with nerve pain, or mindful meditation to help with pain management and stress relief.

Simply put, rather than treating the pain, they'll treat the person, and use all the tools at their disposal to do it.

Making Wellness Doable

Wellness is a big, important goal, and it can feel overwhelming. You know you should eat healthier foods, drink more water, hit the gym more often, sleep eight hours a night, give up your vices, and make more time for rest and relaxation. But the busyness of work and life can make it hard to prioritize self-care, and the more you think about what you "should" be doing differently, the more daunting wellness can seem.

Holistic doctors empower you with the education and motivation to make better choices. Rather than suggesting a long list of lifestyle changes, they include you in the conversation and help you determine which changes would make the greatest impact on your health. They help you set wellness goals and then provide you with resources - whether that's a personalized plan or a referral to a specialist.

So, what is holistic health care? It's about honoring the mind-body connection and treating the whole person, using a variety of clinically proven therapies. It's about developing a strong relationship with a doctor who is committed to getting you healthy and keeping you that way.

Dignity Health strives to make holistic care part of its care and an integral part of how the entire team works every day.

Taylor Mallory Holland is a seasoned freelance writer specializing in healthcare and technology. Taylor has more than a decade's experience writing for media outlets and organizations, including a top medical school and several leading healthcare systems. She is passionate about helping consumers navigate the healthcare system. She also enjoys interviewing physicians, breaking down complex medical jargon, and sharing health and wellness tips that help people make informed healthcare decisions.

More articles from this writer

# data[].attributes.attachment_link.description
When you hear "holistic health," do you think of alternative medicine, naturopathy, or other Eastern-inspired health trends? If so, you're at least partly right. Holistic health does incorporate complementary therapies that have been scientifically proven to work, and like alternative medicine, it focuses on wellness and prevention, rather than just treating diseases.

# data[].attributes.body
1. Holistic care helps providers consider a patient as whole and that he or she is made up of the body, the mind, and the spirit. By acknowledging that, providers can better serve the patient to ensure therapeutic consultation and treatment, promote autonomy, personal growth, and emphasize dignity.
2. Holistic care also helps providers better understand the patient and their needs. This promotes self-care, health promotion and patient education. By doing so, self-awareness and satisfaction are increased and fulfilled.
3. Holistic care ensures all aspects of a person matters, such as emotions, cultures, opinions, and attitudes. Nursing is not just about recovering, but also caring. This promotes patient's dignity and encourage his or her participation in decision making regarding healthcare.

# data[].attributes.attachment_link.readable_text
Indian J Palliat Care. 2015 May-Aug; 21(2): 214-224.

Abstract

Background:

Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring.

Materials and Methods:

A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software.

Results:

Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits.

Conclusion:

Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

Keywords: Holistic care, Nursing, Qualitative research

INTRODUCTION

Holistic care is a comprehensive model of caring which is believed to be the heart of the science of nursing.[ 1] The philosophy behind holistic care is based on the idea of holism which emphasizes that for human beings the whole is greater than the sum of its parts and that mind and spirit affect the body.[ 2] Holistic care is described as a behavior that recognizes a person as a whole and acknowledges the interdependence among one's biological, social, psychological, and spiritual aspects. Holistic care includes a wide range of approaches, including medication, education, communication, self-help, and complementary treatment.[ 3] In holistic nursing, all aspects of patients and their effects on the treatment process are considered and the patients' thoughts, emotions, cultures, opinions, and attitudes are factored in as contributing to recovery, happiness, and satisfaction.[ 4] Holistic care respects human dignity[ 5]: The relationship between the providers of health care and the patients is based on respect, relative openness, equality, and mutuality[ 2, 5] and patients participate in decision making in this kind of caring.[ 6]

Providers of holistic care consider a patient as a whole within his/her environment and realize that a patient is made up of a body, mind, and spirit. Respecting the patient's role in the treatment process, having him/her take part in the process and encouraging self-care is another aspect of holistic care which leads to therapeutic consultation, hope, dignity, self-discipline, social growth, a sense of autonomy, vigor, and vitality.[ 7]

Holistic care increases the depth of care providers' understanding of patients and their needs. Educating patients about self-care and helping them to perform their daily activities independently is part of holistic care. Palliative care is part of holistic care which improves the quality of a patient's life and their emotional and physical well-being. Holistic care increases self-awareness[ 8] and self-confidence in patients[ 9] and causes nurses to better understand the effects of an illness on a person's entire life and his/her true needs. It also improves harmony between mind, body, emotions, and spirit in an ever-changing environment;[ 10] The American Association of Holistic Nurses supports this belief and points out that holistic nursing includes all the nursing practices that heal the whole of a person.[ 5]

In many hospitals, nurses do not have the freedom to perform their tasks independently and their actions are often observed by doctors. Using holistic care as the framework will result in major changes in the treatment process,[ 11] a better public view of the nursing profession, and nurses' autonomy.[ 10] The holistic care paradigm has been presented to the health-care systems in many cultures[ 4] and it can be used in every area of nursing.[ 12] Holistic care is not a new method; Florence Nightingale developed this type of nursing as a better model of caring;[ 4] many other nursing theorists, e.g. Ragers, Newman, and Parse have also emphasized holistic care.[ 13]

Unfortunately, there is compelling evidence that most nurses have been educated with a biomedical allopathic focus and do not have a good understanding of the meaning of holistic care. Furthermore, it has been suggested that nurses are not familiar with holistic care, neglect this model of caring,[ 4, 6] do not use this method,[ 2] and consider patients' corporeal needs only. In this regard, patients' other needs and sometimes more serious problems are not addressed.[ 6] The mental, spiritual, and social needs of patients are neglected[ 14] and patients are considered as biological machines.[ 15]

Using the ordinary medical model alone for treatment exposes patients to serious threats, prolongs hospitalization, and raises treatment costs.[ 6] In many countries, such as the UK,[ 6] Australia,[ 16] and Iran,[ 12] holistic aspects of patients' needs are often overlooked.[ 6, 16] Similar studies conducted in the USA have revealed that 67% of American patients in hospitals do not receive holistic care,[ 17] and a study conducted in England showed that only 5% of hospitalized patients were subject to holistic care.[ 6]

This presents as a major crisis for the nursing profession.[ 18] Considering the beneficial effects of holistic care, the identification of contributory factors is of importance for providing this method of caring. A review of literature in this field shows that most studies have been limited to specific areas, such as operating rooms or older patients who were terminally sick.[ 4, 19] Other studies attempt to explain the concept of holistic nursing and nurses' perception of it,[ 1, 2] or the reasons for failure to employ this method.[ 4, 6] According to the results obtained from several studies, holistic care is adversely affected by such factors as inadequate time, improper professional relations, incomplete reports from nurses, inadequate clinical control, unavailability of resources,[ 20] poor professional and administrational perceptions, limited knowledge, and motivational and organizational factors.[ 4] In view of the great influence of holistic care on treatment and more effective nursing, the health-care systems in many countries in recent decades have tried to promote holistic care by applying changes to the educational and administrational systems,[ 4] but studies show that their efforts have been fruitless.[ 21, 22]

Evidently, there are other factors affecting holistic nursing that must be identified. An investigation into this matter using a qualitative approach that includes multiple methods of data gathering and emphasizes reality experience[ 23] can help us to obtain meaningful and comprehensive data; it will also clarify the existing background and the real situation surrounding the formation of holistic care. Thus, this is a qualitative study and is based on the experience of nurses, who form the core of holistic care provision.

MATERIALS AND METHODS

Ethical considerations

This study was approved by the ethics committee of Tabriz University of Medical Sciences. All the participants were informed of the aim of the study and a written consent was obtained from each of them. Participation in the study was entirely voluntary and the participants could withdraw at any stage of the study.

Method

A qualitative content analysis was conducted to develop an in-depth understanding of nurses' experiences of major factors that affect holistic care formation. This method was used for describing the systematic and objective means of the phenomenon.[ 24] This study is based on conventional qualitative content analysis in which coding and categorizing are derived directly from the raw data. The advantage of this approach to content analysis is obtaining direct data from participants without imposing pre-supposed categories or theoretical perspectives. Another important attribute of this approach is its emphasis on the subject, context, and differences and similarities among codes and categories.[ 25] Purposive sampling was used to select 14 participants with abundant information. Three of the nurses selected were male and the others were female. The participants were selected from various wards [intensive care unit (ICU), emergency, general wards] in university hospitals in the Iranian cities of Tabriz, Uremia, Ardebil, and Tehran. Further characteristics of the participants are presented in Table 1 . The study lasted 6 months, from May until October 2013. In the first stage, participants were informed of the aim of the study by the researchers; if they agreed to participate in the research, they gave written consent. To respect the privacy of the interviewees, numerical codes are used instead of their names.

Table 1

The data were collected using unstructured interviews. Each interview lasted between 60 and 90 minutes and was performed in a private room in the hospital. Each interview commenced with an opening question such as "what do you do for a patient during your shift?"; this was followed by questions that addressed their experiences of caring for patients and situations and factors which affect the quality of caring and attending to patients' various needs. Based on the initial data analysis, additional questions were asked of the respondents. A second interview was conducted with four participants to help clarify the initial interpretations of the information and emerging results. To ensure accuracy of the data, the interviews were continued until data saturation: Data collection was ended when no new information could be collected and the data became repetitive.

The interviews were tape-recorded, transcribed, and coded line-by-line by MAXQDA 2010 software which was used in the initial stages of coding.[ 22] The various codes were compared and categorized and themes were constructed based on similar and appropriate categories. In this way, themes and categories were generated inductively from the data.

Rigor

To increase the dependability of the study, data were collected and analyzed by one of the researchers; the other researchers checked and verified the data, codes, and analyses. The transcripts were read several times and the categories and themes were discussed by the researchers until consensus was reached. The credibility of the results of the study was confirmed through prolonged engagement with participants in the wards. In addition, individual checking was used to examine the accuracy of the findings, and the results of the primary analysis were shared with the participants to validate the compatibility of the codes with their experiences. Transferability of the findings was made possible by the variety of the characteristics of the participants.

RESULTS

Following an analysis of the data, three themes were identified as effective factors in holistic care provision: The structure of the educational system, professional environment, and motivational factors. The themes, sub-themes, and codes are shown in Table 2 .

Table 2

The structure of the educational system

The structure of the educational system was one of the issues which most of the participants talked about. Proper education plays an important role in nurses' preparation for providing holistic care. This theme consists of three sub-themes: The content of educational programs, the teaching methods, and the educators' competence.

The content of educational programs

If the content of educational programs is comprehensive and includes the philosophy of holistic care, it will enable nursing students to address the various needs of patients and provide holistic care. One of the nurses emphasized the role of education in providing holistic care and said:

The content of the courses deeply affected my attitude toward patients and their needs; the courses on "nursing procedures" and "psychological disorders" made me stop looking at a patient only in terms of physicality and understand that an individual is more than a body with certain needs; it made me consider a patient's entire dimensions; I realized that health is the equivalent of harmony and balance among a patient's whole dimensions, not simply physical well-being. (Participant 8)

The above quotation points to the important role of designed courses in training nurses in holistic care. Another participant, similarly, referred to the importance of "nursing procedures" in creating an inclusive perception and promoting holistic care:

The course on nursing procedures broadened my horizons about patients and made me see aspects that I had been unaware of; I understood that well-being is the result of meeting a patient's various needs, from physical needs through emotional and spiritual needs to social, cultural and economic needs. (Participant 2)

The same participant, however, observed that the course of "nursing procedures" did not have enough credits and that they were not adequately trained in providing holistic care:

The course was too short and the training was not enough. But I was interested and regarded it as a specialized part of nursing; I practiced a lot and gradually learned how to exercise it. I wish the trainers had instructed us properly; then I would have realized the importance of it sooner.

Unfortunately, the data show that the content of the educational program is poor and lacks material on the various needs of patients. Regarding this issue, one of the nurses explained:

More than 90% of our lessons were about the physical problems of patients, and their other needs were usually neglected. (Participant 5)

Another participant expressed:

During the course, most of our education was about the physical problems of patients and dealing with them. So, by the end of the course, our knowledge of the physical needs of patients had increased, but we didn't know anything about the whole needs of patients and their role in the treatment. (Participant 6)

Another nurse explained:

Clinical training was too short and we didn't have enough time to establish a relationship with the patients to recognize their various problems. (Participant 13)

Teaching methods

Teaching methods are part of the educational structure and play an important role in holistic care formation. But, according to the results, the teaching methods are not designed to demonstrate holistic care. In this regard, one of the participants said:

The teaching methods were often educator-centered; a limited number of tasks were dictated and we were expected to do them only; we were not free to consider the other needs of patients and satisfy them. (Participant 3)

Practice-based teaching can increase nursing students' understanding of holistic care, but the data showed that the nursing educators did not consider this matter and focused on theory-based teaching. One of the nurses stated:

We did not receive any practical training in considering patients' various needs. In our education, we were not told that a patient is a whole with many different aspects and whose treatment requires that we consider all those aspects; although some of the educators advised us to consider the secondary needs of patients, there was no practical training in this field. (Participant 9)

The educators' competence

The educators' characteristics and competence have been introduced as a component of the educational structure in this study; educators can provide the trainees with a practical model from which to learn the principles of holistic care in practice. A participant said regarding this issue:

One of our educators was sensitive to the various needs of patients, treated them with respect and attended to their various needs. Her manners influenced my behavior. Now, I try to use her lessons in practice and provide my patients with comfort by addressing their various needs. (Participant 6)

Similarly, a participant referring to her trainer's holistic perception and emphasis on holistic care remarked:

One of our trainers always stressed that we view a patient as a whole that has different needs; she was trying to have us realize that well-being is the result of creating a harmony among the various parts of the whole and not just the physical dimensions. My trainer's attitude greatly affected my manner of nursing: I try to attend to my patients' entire needs, not just the physical ones, and consider their emotional, spiritual, cultural and social needs. I believe that meeting all these needs at the same time rather than separately is much more effective.

But the results show that most of the participants had no practical model for learning holistic care during their education. One of the nurses said:

Most of our educators had limited knowledge of the various aspects of patients' needs and their effects on health recovery and paid little attention to these matters. They paid more attention to routine tasks, and we didn't have an actual example of someone who considered all the needs of patients and provided holistic care. (Participant 6)

An educator's good relationship with students is an effective factor in attracting attention to the educator's training, as well as motivation for learning. In this regard, one of the nurses stated:

Our educators didn't usually have a suitable relationship with us and reproached us for unimportant matters, so we didn't have any motivation for learning. (Participant 14)

Professional environment

Professional environment is another factor which most participants emphasized as being important to considering the patients' different needs and providing holistic care. This theme consists of three sub-themes: Workload, management, and the gap between clinical performance and academic learning.

Workload

Workload, one of the components of professional environment, was referred to by most of the participants as a restriction in holistic care provision. Concerning this issue, one of the participants said:

Sometimes, the ward is too crowded and busy; although I understand that patients have different needs, and I want to meet them, but I don't get the opportunity to do it (Participant 2).

Another participant explained:

If the numbers of patients were smaller in the ward, we would have more opportunities to provide better care and we could attend to all of our patients' needs (Participant 12).

One of the participants referred to the sheer number of her working shifts and said:

Because of the huge number of shifts, we are always tired and don't have the required energy for providing suitable care. (Participant 9)

Management

Management-with its different domains, such as evaluation, orientation programs for staff and management approaches-plays an important role in the formation of holistic care. Most of the participants emphasized its impact on the quality of nursing. To quote one of the nurses:

There is no difference between a nurse who considers and attends to the patients' different needs and another who only does the routine tasks. Ironically, the latter is more popular with the managers. Routine tasks are considered as evaluation criteria. (Participant 8)

Another nurse mentioned:

Our head nurse and the supervisors emphasize the routine tasks and unimportant stuff and there is no incentive for considering the patients' secondary needs. (Participant 5)

Orientation programs and managers' competence can decrease nurses' stress and obsession with routine duties and encourage them to consider the patients' other needs and provide holistic care. But data show that the professional environment in Iranian hospitals lacks orientation programs for novice nurses and that most of the managers lack competence for their positions. One of the nurses stated:

We didn't have any orientation programs when we began to work in the hospital and our head nurse was very strict and belittled us for unimportant matters. It was very difficult for me. I was under pressure and lost my motivation to continue my profession, provide proper care and pay attention to the patients and their needs. (Participant 7)

Limited conformity of the clinical environment with professional norms

Conformity of the clinical environment with professional and ethical norms results in nurses' treating patients as human beings with human needs, all of which should be taken into account; upon observing the beneficial effects of holistic care on the treatment process, nurses will acquire a holistic perception: They will realize the importance of attending to patients' needs from various aspects and experience the effectiveness of meeting those needs as a whole compared to satisfying them separately. However, the participants declared that upon entering the clinical environment, they were faced with the limited conformity of their environment with professional norms. Disregard for the principles of proper nursing forms a sub-category of this phenomenon.

The participants stated that upon embarking on their careers, they were faced with a prevalent disregard for the principles of proper nursing, at both the professional and ethical level. Obviously, such disregard for professional and ethical principles leads to professional shortcomings and negligence of nursing ideals, which in turn results in nurses' failure to provide proper care and attend to patients' needs in their entirety. Attention to professional principles is the prerequisite of holistic care; but in most cases they are ignored. To quote a participant:

When I started, I saw that many of the points that were stressed during our education were simply ignored here. For example, we were always told to sterilize a catheter before placing it, but nobody in the ward followed the principle; or antibiotics weren't administered at the right times. It made me feel guilty to witness all the carelessness; they didn't care about the patients and couldn't wait for their shifts to end! Many novice nurses would adopt the same wrong practices and ignore the professional principles; the standards and techniques were pushed aside and the patients forgotten. (Participant 6)

As the above response indicates, disregard for professional principles at work results in novice nurses' loss of interest in professional values and prevents them from attending to patients' various human needs and encourages them to stick to their routine duties.

Disregard for ethical matters in nursing is another component of negligence of proper nursing principles. Many nurses are guilty of such disregard and ignore their patients and their various needs. In this regard, one of the participants stated that:

I used to work in ICU and I often witnessed the nurses' lack of care about professional ethics. They were indifferent to those of the patients' needs which were not physical; if the orderly was away and a patient had a basic need, they wouldn't care; if a patient was in pain, they were not quick enough to administer a painkiller. In many cases they weren't honest: They would write down things they hadn't done; they would turn a blind eye to the patients' needs. If a patient, for example, wished to see his or her family, they wouldn't allow it. They would close the doors and drink tea and chat away! It was not easy to act morally under those circumstances: You could be ostracized. It was like swimming against the current. Unfortunately, many of my friends would imitate them, too, and were totally indifferent to the patients and their needs, as if they were machines. (Participant 8)

Motivational factors

Motivational factors play an important role in encouraging nurses to provide holistic care as well as facilitating such provision. Motivational factors include personality traits, personal experiences of hospitalization, and input sources.

Personality traits

Personality traits, identified as one of the sub-categories of motivational factors, are among the major factors generating internal motives: They encourage and facilitate holistic care, influence nurses' performance and relations with patients, and help develop rapport between nurses and patients. According to the participants, sociability and sensitivity to people's needs-which go under the subcategory of personality traits-are influential in encouraging attention to patients' various needs, thus nurses' developing holistic perception.

Sociable and genial nurses are more likely to establish a close rapport with patients, which results in a better identification and holistic perception of patients' needs. One of the participants pointed out that:

I'm a very good mixer, highly sociable; I make sure to greet my patients warmly; I even shake hands with the old patients, because I believe that lifts their spirits and makes them trust me and cooperate. For example, if they won't let others perform venipuncture on them, they will definitely let me. They also confide in me, which lets me know about and satisfy many of their needs. This quickens the treatment process, because attending to a patient's physical needs alone won't lead to recovery. My sociability has helped me realize the importance of knowing about and satisfying the patients' needs and how it affects the recovery process; now I believe that human is a complicated creature with many different needs all of which should be taken care of before complete recovery is achieved. (Participant 7)

Being sensitive and compassionate contributes to providing holistic care on the part of nurses. The more emotional a nurse is, the more sympathy he/she will feel for patients, which in turn will result in feeling more responsible for patients: The nurse will not simply perform the routine tasks but try to identify and satisfy his/her patients' whole needs. One of the nurses stated:

Well, I'm quite emotional and love to help others if I can. I help my family too and enjoy being a comfort. That's why I feel good when my patients are satisfied. Satisfying my patients' needs gives me a feeling of pleasure; the feeling is so strong that I believe my best moments are when I'm with my patients and helping them. (Participant 9)

Personal experiences of hospitalization

Nurses' personal experiences of hospitalization is another factor which enhances nurses' sympathy for and understanding of patients and their needs; it also contributes to regarding a patient's whole needs as important and refusing to attend to the physical needs alone. Naturally, being subject to similar experiences leads to a better understanding of patients' needs. Most of the participants referred to their personal experiences of hospitalization as unpleasant ones in which their needs or their families' needs-physical or otherwise- were not satisfied.

According to the input from many of the participants' experiences, when a participant or a family member was hospitalized, he/she was frustrated at the neglect of their basic and secondary needs. The participants stated that the unpleasant experience influenced their perception of patients and their various needs. One of the participants stated that:

I had to undergo cholecystectomy last year. Now I realize how painful an operation can be. Though I was in great pain, the nurses often neglected me and didn't give me painkillers. I understand now what a patient goes through. I promised myself I would never be indifferent to my patients' pain. If every nurse had a taste of his/her patient's trouble, that'd make a difference! You would understand your patients better and treat them as humans with a variety of needs all of which should be satisfied; you wouldn't focus on one aspect only, and you'd recognize the importance of attending to all one's needs simultaneously rather than one at a time. (Participant 1)

Another participant pointed out that after the experience of the hospitalization of a family member; she began to view holistic care in a different light:

One of the reasons why I attend to my patients' needs more carefully now is my Dad's time in hospital. He had to undergo a heart surgery and we were worried to death. I was waiting nervously outside the operation room, but the ICU nursing staff did not treat me well. Though I was one of their colleagues, they weren't very nice to me, and didn't allow me to see my father, nor did they give me any hope. I was totally anxious; now I understand patients and their families better. I put myself in their shoes and that makes me feel closer to them. This can help one understand patients and their multiple dimensions a lot better. (Participant 13)

Input sources

Input sources-which include religious beliefs, the participants' upbringing, and commitment-constitute another major factor in holistic care provision. Regarding religiousness, one of the participants stated:

My religious beliefs help me to consider a patient's various needs despite the problems at work. I believe God has given me the power to give care to my patients; this idea gives me more energy for a better caring for the patients. (Participant 7)

The same participant mentioned that religiousness can lead to recognition of the greater effectiveness of meeting a patient's whole needs simultaneously rather than separately:

By satisfying their needs and witnessing the effect of that on their recovery, I now see every patient as a whole with a number of needs all of which should be taken care of as a whole, and not individually, to quicken treatment.

Another nurse stated:

My beliefs make me attend to the different needs of the patients. Neglecting a patient's needs makes me feel guilty, and I try to keep my conscience clear by satisfying my patients' needs. (Participant 4)

The manner in which one has been reared has an important impact on the formation of these beliefs. In this regard, one of the participants said:

My father usually advised me to view the patients as my own family and provide the best possible caring for them and attend to all their needs. (Participant 8)

Commitment, which can increase during work, is usually effective before entering the nursing profession; it is considered as a component of input sources that plays a key role in the formation of holistic care. One of the nurses remarked:

I try to perform my duties in the best way. I think our duty is not limited to some routine tasks. Addressing all of the needs of my patients is my duty as a nurse and I try to resolve their entire problems. When I resolve them, I feel good and my interest in my profession increases. In addition to giving me a sense of fulfillment, satisfying the patients' various needs is so effective that I've grown more attentive to my patients' multiple dimensions and try to have an overall view of them. (Participant 3)

DISCUSSION

The results of the study show that factors that affect holistic care provision the most are the educational structure, professional environment, and motivational factors.

Educational structure

Educational structure-which includes the content of educational programs, teaching methods, and educators' competence-has an important impact on the adoption of holistic care by nurses. Ahmadi et al., reach similar results in their study and introduce educational structure as an effective factor in the quality of care and extent of attending to patients' different problems.[ 26] The results of this study show that none of the components of the educational structure in Iran are appropriate enough to prepare nurses for holistic care. The content of educational programs is not based on the philosophy of holistic care. King and Gates' study points to the same results and shows that teaching holistic nursing to undergraduate nursing students is ignored in the curriculum of nursing and the content of educational programs emphasizes the medical model of.[ 27] Similarly, the results of Strindberg's study in Sweden show that most nursing lessons are based only on biological science. Revising nursing lessons seems to be required for the inculcation of holistic care in nursing students. Strandberg has also suggested this matter in his study.[ 1] Robinson, likewise, emphasizes the role of the lessons' content in the adoption of holistic care by nursing students and suggests using art and behavioral lessons in nursing courses.[ 18]

Teaching methods and educators' competence, the other components of the educational structure, play an important role in learning and the transference of theoretical knowledge of holistic care into clinical practice. However, according to the findings of this study, most nurses believe that their main concern in their courses has been with becoming competent in doing routine tasks and that they had little opportunity to consider the other needs of patients. If educators provide practical models of holistic care, students' confidence will increase and they will be able to provide holistic care. Meleis (1975) and Davies (1993) referred to this issue and emphasized its importance. King and Gates, also, stress the role of practical models, teaching methods, and explaining the philosophy of holistic care in the formation of holistic care (King and Gates, 2006). Similarly, Henderson's study suggests that defective teaching methods and educators' incompetence are barriers to holistic care provision.[ 16]

Professional environment

Professional environment, which consists of workload, management, and the limited conformity of the clinical environment with professional norms, can affect the formation of holistic care and act as a barrier or facilitator to it. When unsuitable, these components are identified as barriers to holistic care provision in this study. Workload is one of the aspects of practice in nursing environments which affects the quality of caring. In his study, Ahmadi refers to the effects of workload and states that most Iranian nurses suffer from heavy workload and do not have the opportunity to consider patients' various needs and provide holistic care.[ 26] Similarly, Olive introduces workload as a barrier to the formation of holistic care.[ 6] Management, another component of professional environment, includes various domains such as evaluation methods, orientation programs for staff and management approaches. The results of this study show that nursing management is inefficient and that the nurses in this study were dissatisfied with the style of management, and do not have any orientation programs. The above-mentioned issues play an important role in the formation of holistic care and, when suitable, can enhance the provision of this mode of caring by creating motivation in nurses and increasing their knowledge. Strindberg's study in Sweden confirms this fact and emphasizes the role of management in promoting holistic care.[ 1] Duffy and McEvoy, likewise, call attention to the importance of professional environment and its various effects on nurses' performance; they consider a suitable environment as a prerequisite of holistic care.[ 10]

Clinical environments' lack of conformity with professional norms is another factor which makes nurses loose interest in professional and ethical values, and acts as a disincentive to providing holistic care.[ 28] The results show that most nurses have encountered this problem and experienced it on the first days of working. Various studies-e.g. Silva,[ 29] Abedi[ 30] and Valdez[ 31]-recognize the limited conformity of the clinical environment with professional norms as a big challenge which most novice nurses encounter. Many of the participants in the study referred to clinical environments' poor conformity with professional and ethical norms as a deterrent to providing holistic care; they also stated that many of the novice nurses would follow their colleagues' example and neglect patients and their needs. Henderson, likewise, points out in his study that clinical environments' poor conformity with norms greatly contributes to novice nurses' disregard for holistic care and encourages them to stick to the routine duties and ignore the patients' various needs.[ 16]

Motivational factors

The findings of this study prove that motivational factors-input data, personality traits, and personal experiences-are influential in identifying patients' various needs and generating holistic perceptions of the patient, which in turn encourage nurses to attend to patients' diverse needs and provide holistic care. Personality traits play a major role in expanding relationship with patients, identifying their various needs and developing holistic perception on the part of nurses. Also, religiousness and morality can induce one to satisfy patients' needs and provide holistic care, and in many cases overcome the defects in the educational and clinical systems. Obviously, one's behavior is decided by his/her personality traits; thus, a nurse's performance, behavior toward patients, and attempts at expanding relationship with them are decided by his/her personality traits. As the most important internal factor influencing motivation, personality traits are influential in achieving success at college and at work by creating intimacy, commitment and conscientiousness.[ 13] Studies show that nurses who are temperamentally sociable and emotional tend to be cheerful at work and more capable at identifying patients' needs and nursing. The same studies reveal that these nurses, compared to their colleagues, are not only more dependable, intelligent, flexible, and conscientious, but also more highly motivated.[ 32] McEvoy and Duffy point to the importance of compatibility between personality and profession as well as the impact of beliefs and principles on a nurse's performance, and regard them as vital to the provision of holistic care.[ 10]

Nurses' personal experiences of hospitalization, either on their own part or their families', can also lead to a better understanding of patients' needs, or encourage holistic perception. In other words, such experiences can lead to viewing a patient as a whole whose needs should be met in their entirety rather than separately, hence the need for holistic care. Not many studies have addressed the effects of nurses' personal experiences of hospitalization on their perception of patients' needs and the need for holistic care; however, it has been revealed that such experiences can enhance nurses' attention to their patients' various needs and induce them to provide holistic care. Gates and King[ 27] and Strandberg,[ 1] for instance, point to the influence of nurses' knowledge and experiences on their understanding of patients' various needs and the importance of holistic care. McEvoy and Duffy believe that sympathy for and a better understanding of patients can lead to the provision of holistic care.[ 10]

CONCLUSION

The results of the study show that the educational system, working environment, and motivational factors are major factors in providing holistic care. However, the findings reveal that these factors are not appropriate enough in Iran to lead to holistic care, and Iranian nurses tend to stick to their routine duties and satisfy patient's clinical needs only. Earlier studies conducted in other countries-e.g. Strindberg (2007), King (2006), Henderson (2002), Olive (2003)-have attested to the importance of the above-mentioned factors in the provision of holistic care, hence the need for closer attention to the compatibility of the educational system with the idea of holistic care, revision of the contents and methods of education, and modification of the conditions at work in order to encourage holistic care. Personality traits, personal experiences of hospitalization, and beliefs and principles-which go under the heading of motivational factors-also contribute to and facilitate holistic care. McEvoy and Duffy (2008) suggest that these factors are vital to holistic care. As a result, to develop holistic care it is necessary to attach more importance to motivational factors, compatibility between nurses' personalities and their profession, improvement of nurses' communicative skills, promoting religiousness, and encouragement of commitment in practicing nurses and nursing students alike.

ACKNOWLEDGMENT

This study is part of a larger study conducted for a doctoral dissertation that was approved by the ethical committee and was supported with a research grant (number 350) for Ph.D. thesis from Nursing Research Team affiliated to Tabriz University of Medical Sciences, Iran. The authors would like to express their sincere gratitude to this center and all the participants for cooperating in this study.

Footnotes

Source of Support: This study is part of a larger study conducted for a doctoral dissertation that was approved by the ethical committee and was supported by a research grant (number 350) for Ph.D. thesis from Nursing Research Team affiliated to Tabriz University of Medical Sciences, Iran

Conflict of Interest: None declared.

REFERENCES

1. Strandberg E, Ingvar O, Borgquist L, Wilhelmsson S. The perceived meaning of a (w) holistic view among general practitioners and district nurses in Swedish primary care: A qualitative study. BMC Fam Pract. 2007;8:8. [[ PMC free article] [ PubMed] Google Scholar]

11. Holt Waldo. Capella University: Capella University; 2011. The lived experience of being a holistic nurse educator: A heuristic inquiry. [ Google Scholar]

17. Daaleman TP, Usher BM, Williams SW, Rawlings J, Hanson LC. An exploratory study of spiritual care at the end of life. Ann Fam Med. 2008;6:406-11. [[ PMC free article] [ PubMed] Google Scholar]

22. Gravel C. Working with MAXQDA: Coding Basics Germany. 2012 [ Google Scholar]

23. Strubert H, Carpenter D. 3rd ed. Philadelphia: Lippincott Williams and Wilking; 2007. Qualitative research in nursing: Advancing the humanistic imperative. [ Google Scholar]

25. Zhang Y, Wildemuth BM. Wildemuth BM, editor. Qualitative analysis of content. Applications of social research methods to questions in information and library science. 2009:308-19. [ Google Scholar]

Articles from Indian Journal of Palliative Care are provided here courtesy of Scientific Scholar

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Effective Factors in Providing Holistic Care: A Qualitative Study

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Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from ...

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https://www.dignityhealth.org/articles/what-is-holistic-health-care-anyway

1. Instead of simply getting asked about symptoms, healthcare providers ask about the patient's overall health (mental, emotional, physical, spiritual...) and their life to provide unique and personalized care.
2. There are no unwanted side effects to medications. Alternative therapies such as yoga, meditation, massage, and acupuncture and utilized.
3. Holistic healthcare providers empower the patient with education and motivation to make better choices and help set wellness goals.

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When you hear "holistic health," do you think of alternative medicine, naturopathy, or other Eastern-inspired health trends? If so, you're at least partly right.

Holistic health does incorporate complementary therapies that have been scientifically proven to work, and like alternative medicine, it focuses on wellness and prevention, rather than just treating diseases. But holistic care is about more than integrating Eastern and Western medicine. It's a more comprehensive and personalized way of thinking about wellness.

So, what is holistic health care?

Treating the Whole You

Holistic health is about caring for the whole person - providing for your physical, mental, spiritual, and social needs. It's rooted in the understanding that all these aspects affect your overall health, and being unwell in one aspect affects you in others.

Take stress, for example. It's a psychological response, but it can also cause physical symptoms, such as headaches, trouble sleeping, weight gain, and muscle pain. Of course, it works both ways, and being physically ill can cause you to feel anxious or depressed. Meanwhile, your spirituality and your relationships can boost your mental and physical health. Studies show that having close friendships lowers your blood pressure, reduces your stress levels, and can even improve your chances of surviving cancer.

Understanding this, doctors who take a holistic approach to health don't just ask you about your symptoms. They ask about you - your overall health and your life - so they can make personalized recommendations to improve your wellness.

Doctoring Outside the Box

Holistic care providers address a wide variety of wellness concerns, and they use a wide variety of clinically proven therapies - from surgery and pharmaceuticals, to dietary changes and exercise plans, to psychological and spiritual counseling. They might also recommend evidence-based alternative therapies, such as massage, acupuncture, and yoga, for supportive care.

For example, if you're experiencing chronic pain, a holistic health care provider might prescribe medications or recommend surgery to repair an injury, but they'll also recommend that you increase your endorphins naturally by getting more exercise. They'll ask about your diet, and discuss how certain foods contribute to inflammation. They'll ask you about stress, anxiety, and depression - all of which can cause pain or be caused by it - and refer you to a therapist if you want one. Then they might also recommend massage to relax your muscles, acupuncture to help with nerve pain, or mindful meditation to help with pain management and stress relief.

Simply put, rather than treating the pain, they'll treat the person, and use all the tools at their disposal to do it.

Making Wellness Doable

Wellness is a big, important goal, and it can feel overwhelming. You know you should eat healthier foods, drink more water, hit the gym more often, sleep eight hours a night, give up your vices, and make more time for rest and relaxation. But the busyness of work and life can make it hard to prioritize self-care, and the more you think about what you "should" be doing differently, the more daunting wellness can seem.

Holistic doctors empower you with the education and motivation to make better choices. Rather than suggesting a long list of lifestyle changes, they include you in the conversation and help you determine which changes would make the greatest impact on your health. They help you set wellness goals and then provide you with resources - whether that's a personalized plan or a referral to a specialist.

So, what is holistic health care? It's about honoring the mind-body connection and treating the whole person, using a variety of clinically proven therapies. It's about developing a strong relationship with a doctor who is committed to getting you healthy and keeping you that way.

Dignity Health strives to make holistic care part of its care and an integral part of how the entire team works every day.

Taylor Mallory Holland is a seasoned freelance writer specializing in healthcare and technology. Taylor has more than a decade's experience writing for media outlets and organizations, including a top medical school and several leading healthcare systems. She is passionate about helping consumers navigate the healthcare system. She also enjoys interviewing physicians, breaking down complex medical jargon, and sharing health and wellness tips that help people make informed healthcare decisions.

More articles from this writer

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When you hear "holistic health," do you think of alternative medicine, naturopathy, or other Eastern-inspired health trends? If so, you're at least partly right. Holistic health does incorporate complementary therapies that have been scientifically proven to work, and like alternative medicine, it focuses on wellness and prevention, rather than just treating diseases.

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Holistic nursing takes the approach of looking at the patient entirely, physical, mental, emotional, spiritual and environmental aspects altogether. It focuses on healing the whole person. One advantage is that they are open to numerous different methods of healing, including massage, acupuncture, movement therapy, and acupressure. Another advantage is that mental health is assessed and therapy and meditation are encouraged. My favorite aspect is that holistic nurses can also be wellness coaches. They focus on fitness, nutrition and holistic methods of stress management and reduction, health risks and life issues.

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A holistic approach to healthcare is based on the belief that the treatment of medical conditions needs to address not only a patient's physical symptoms but also the mental, emotional, spiritual, and social factors affecting a patient's health. A holistic nurse approaches the practice of traditional nursing and patient care with this holistic view. The American Holistic Nurses' Association (AHNA) states that the goal of holistic nursing is to heal the whole person.

In 2006, the American Nurses Association (ANA) defined holistic nursing as a distinct nursing specialty. Then, in 2007, the AHNA and ANA co-published the Holistic Nursing Scope and Standards of Practice. Most recently the AHNA and ANA worked together to develop the Holistic Nursing Scope and Standards of Practice 2nd Edition, which was published in 2013. This publication seeks to:

Define holistic nursing, including its scope.

Explain practice settings.

Define the education needed to practice.

Show the evolution of holistic nursing.

Explain the focus, philosophy and concern of holistic nursing.

Explore current issues and trends.

Define The Standards and Competencies of Holistic Nursing Practice at both the basic and advanced level.

Discuss the Core Values of Holistic Nursing:

Holistic philosophy, theories, and ethics

Holistic caring processes

Holistic communication, therapeutic environment, and cultural diversity

Holistic education and research

Holistic nurse self-car

Holistic nurses are educated in both conventional and complementary healing practices and can act as a bridge between the two. Some holistic nurses incorporate specific alternative or complementary healing modalities into their practices. A few of the modalities that nurses might choose to practice include:

Manipulative and body-based practices, such as massage, acupressure, acupuncture, and movement therapy

Mind-body medicine, such as art therapy, hypnotherapy, and meditation

Biologically based practices, such as herbal therapy and nutritional counseling

Energy medicine, such as healing touch, prayer, or reiki

Some holistic nurses maintain separate licenses or certifications to practice a modality in which they choose to specialize.

Holistic nurses work with all populations and in all areas of healthcare, including emergency rooms, intensive care units, outpatient surgery clinics, and private practices. An area where holistic nurses are becoming increasing involved is wellness coaching, according to the Winter 2011 issue of Beginnings, a publication of the AHNA. Wellness coaching integrates fitness, nutrition, and any number of holistic interventions used to manage weight, stress, health risks, and life issues.

Becoming a Holistic Nurse

Holistic nurses occupy the spectrum from entry-level RNs to advanced practice nurse practitioners (NPs). Although bachelor's degrees specifically in holistic nursing are rare, many nursing programs do promote a holistic view. Typically, a nurse with an undergraduate nursing degree who wants to work in holistic nursing goes on to complete continuing education in the field.

Nurses who want to become holistic NPs have the option to pursue master's degrees or post-master's programs specific to holistic nursing practice. Programs typically cover both traditional advanced practice nursing core competencies, such as advanced pathophysiology, health assessment, and pharmacology, along with complementary healing modalities. However all these courses are taught within the context of holistic nursing philosophy. In addition to offering knowledge on complementary healing modalities, core concepts to holistic nursing such as self-care, presence, intention/intentionality, spirit-mind-body perspectives, holistic health and healing, holistic ethics, as well as other core essentials are included in the curriculum of these programs.

Some schools offer programs that combine the holistic specialty with a patient population focus. For example adult nurse practitioner/holistic nurse practitioner programs are not uncommon. Other schools offer a holistic nurse practitioner program or an advanced holistic nursing program outside of the patient population focus. There are also post-master's certificates in holistic nursing for clinical nurse specialists.

Holistic Nursing Certification

Four holistic nurse certifications are available from the American Holistic Nurses Credentialing Corporation (AHNCC):

Holistic Nurse, Board Certified (HN-BC) is available to all RNs who completed a nursing program at an accredited school that awards at least a diploma or associate's degree.

Holistic Baccalaureate Nurse, Board Certified (HNB-BC) is available to RNs who completed a nursing bachelor's degree from a school accredited by the Association of Schools and Colleges.

Advanced Holistic Nurse, Board Certified (AHN-BC) is available to RNs who have a graduate degree in nursing from an accredited school and an existing APRN license.

Advanced Practice Holistic Nurse, Board Certified (APHN-BC) is available to RNs with a graduate degree conferred by an accredited school as well as an existing APRN license.

The following requirements apply to all four certifications:

Nurses must have a current, unrestricted RN license in the United States

Nurses must have at least one year full-time experience as a holistic nurse or have at least 2,000 hours part-time experience during the five years prior to sitting for the exam

Nurses must have completed at least 48 contact hours of continuing education in holistic nursing during the two years prior to sitting for the exam

Signed attestation (Candidate's Agreement with AHNCC) agreeing to AHNCC terms

The AHNCC also offers two certification options for those interested in nurse coaching:

Nurse Coach, Board Certified (NC-BC)

Health and Wellness Nurse Coach, Board Certified (HWNC-BC) (only available to current Board Certified Holistic Nurses)

The following requirements apply to both nurse coach certifications:

Nurses must have a current and unrestricted RN license

Nurses must have a bachelor's degree at minimum conferred through an accredited school of nursing

Nurses must have two years of full-time experience or 4000 hours of part-time experience within the five years immediately prior to sitting for the exam

Nurses must have completed at least 60 hours of continuing education during the three years immediately prior to sitting for the exam (at least 10 hours of experience in personal coaching is recommended)

Sixty hours of experience under the mentorship of a Certified Nurse Coach Supervisor (a letter from the supervising nurse coach that validates this experience is required)

Nurse Coach Self-Reflective Assessment

Signed attestation (Candidate's Agreement with AHNCC) agreeing to AHNCC terms

The Professional Testing Corporation administers the exams March through October for two weeks in more than 700 locations nationwide. Certification is valid for five years. Recertification requires continuing practice as a holistic nurse and meeting continuing education requirements.

Holistic Nursing Association

The American Holistic Nurses Association (AHNA) supports education about holistic healing and its philosophy, concepts, practice, and research for nurses, other healthcare professionals, and the public. AHNA publishes the Journal of Holistic Nursing and maintains a list of continuing nursing education programs that teach content in alignment with the mission, vision, and purpose of the organization.

Some states have holistic nursing associations, such as the Oregon Holistic Nurses Association and the Minnesota Holistic Nurses Association.

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Holistic Nursing Jobs | Holistic Nurse Practitioner Schools and Certification Programs

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Featured Programs: Sponsored School(s) Walden University Featured Program: Online Nursing Programs include an RN-BSN completion program; MSN tracks in FNP, Acute and Primary Care AGNP, Executive Leadership, Informatics and more; Post-Master's Certificates, and both a practice-focused DNP and PhD in ... Read More

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1. One advantage of holistic nursing is that it encompasses all nursing practice that has the ability to heal the whole person from the time they are born to their death.

2. Another advantage of holistic nursing is that not only is the nurse focused on patients, but it also emphasizes the importance of the nurse’s self-care and the needs of the nurse. It reminds nurse of the importance to be aware of their own emotions as they provide care for others.

3. Lastly, it is not as task oriented as most other nursing practices are. In holistic nursing, nurses focus on each of their patients as individuals which greatly impacts their care. It also allows the nurse to feel more fulfilled rather than always being in a rush to complete goals/tasks.

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Our online RN-BSN degree completion program is our newest at Ameritech, but it's founded on decades of thoughtful research and practice in the field of nursing. We built the curriculum around the recommendations in The Future of Nursing Report and the standards from the American Holistic Nurses Association (AHNA). We love holistic nursing education, because we agree that nurses have to care for the whole patient: Not just their body, but their mind, spirit, emotion, and environment too. There are many benefits of learning holistic nursing, and we've assembled eight of them.

1. Greater fulfillment

In nursing it's easy to become task- or goal-oriented. You have an assignment of patients, all with individual health needs, and a limited amount of time to tend to and care for them. It makes sense to move through the motions quickly, but this can make you forget about the person in the bed, recovering or awaiting surgery or hurting or scared. Most nurses enter the practice to help people, and holistic nursing compels you to focus on each person as an individual, which benefits their care, and it makes your work more fulfilling.

2. More effective care

Focusing on patients not as tasks but more holistically as people, obviously benefits them emotionally, especially if they're worried or fearful. It also benefits them physically, since bodily health is intimately related to emotional, spiritual, and environmental health too. Many patients, like victims of car accidents, are being treated for obvious injuries that require stitches or surgery. Others, though, may enter the hospital for back pain or heart disease, ailments that can be due to environmental factors like their diet and lifestyle. Holistic nurses are aware of this interconnectedness, and so they're better able to treat and care for patients physically, by attending to them emotionally, environmentally, and spiritually too.
Related Resource: 5 Reasons You Need Your BSN Degree
3. Emphasized self-care

All nurses focus on their patients, but the best nurses are aware of themselves and their own needs and emotions as they care for others. Holistic nursing emphasizes the importance of self-care, self-responsibility, spirituality, and reflection for nurses. Nursing is hard work. It can be emotionally draining, even devastating sometimes, especially for nurses who often experience loss. An emphasis on self-care keeps holistic nurses emotionally healthy, which makes them better at their job.
Related Resource: What You Should Know about Mental Health and Nursing
4. Sustainable practice

That emphasis on self-awareness and reflection also benefits nursing as a career in general. Every nurse is at risk of burnout and compassion fatigue. If you just give and give and give at work, you'll quickly feel drained, maybe even bitter. By emphasizing nurses and keeping them emotionally, spiritually, and mentally health, holistic nursing reduces that risk of burnout, which benefits the nursing practice as a whole.

5. Recognized specialty

Thanks in large part to the efforts of the AHNA, holistic nursing became a recognized nursing specialty by the American Nursing Association in 2006. The AHNA clearly demonstrated that holistic nursing had a defined scope and unique standards of practice, as unique and specialized as any other area of nursing. This recognition has been a huge benefit in supporting holistic nurses by giving their practice more clarity, and by laying a foundation for them and the future of holistic nursing.

6. Universal practice

Holistic nursing is a specialty, but its philosophy applies to any practice in any hospital wing in any part of the world. Holistic nurses can be found in hospitals, private practice, hospice, and education, helping patients and families of all ages to live better, holistically. Whatever area of nursing you want to pursue, a holistic nursing education will benefit you and everyone you work with or treat.

7. Long history

Florence Nightingale is often said to be the Mother of Modern Nursing. She's also believed to be the founder of holistic nursing. According to the AHNA, she "believed in care that focused on unity, wellness, and the interrelationship of human beings and their environment." Modern holistic nursing is based on Nightingale's philosophical approach, and over the years it has benefited from new theories, knowledge, and experience. Ameritech's holistic nursing education draws on that large body of knowledge to train nurses to better treat and care for their patients.

8. Future focused

Though holistic nursing has only been recognized as a specialty for nine years, it's already become an integral part of the healthcare system-and many healthcare leaders look to holistic nurses as guides to the future. More and more fields of medicine are understanding the importance of a holistic philosophy to treat patients and communities. Nurses trained in a holistic education will very likely be better prepared for the changes already occurring in healthcare-in addition to all of the other benefits that holistic nursing offers.
Related Resource: Why Some Hospitals Already Require a BSN Degree
At Ameritech College of Healthcare we're proud of our BSN curriculum, particularly how it integrates holistic philosophy. If you've been on the fence about earning your baccalaureate in nursing and want to become a better nurse, read about our online BSN degree program here, and please reach out with any questions. We'd love to hear from you.

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8 Benefits of a Holistic Nursing Education

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Our online RN-BSN degree completion program is our newest at Ameritech, but it's founded on decades of thoughtful research and practice in the field of nursing. We built the curriculum around the recommendations in The Future of Nursing Report and the standards from the American Holistic Nurses Association (AHNA).

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Holistic nursing refers to the care of the whole person, mind, body, and soul. Holistic health cares for the person beyond just the condition and thus leads to a few phenomenal benefits.

1. Rapport leads to Participation

For one, since the patient is treated as more than just their condition entails, the patient would likely feel seen as a person rather than another cog in the system. Not a stroke patient, but John, a person with a dog and whose daughter will be getting married in a week. Not a schizophrenic patient going through an acute episode, but Jane who recently lost her home and her mother. The patient feels seen for who they are, and feels included in the treatment team. When someone feels included into a group, they are more likely to participate. This is true too for patients, when they feel seen as a valuable member in the treatment team, they are more likely to participate in their care, more likely to provide feedback on what works, and more likely to be willing and helpful in the prescribed treatment plan.

2. Prevention

This leads into another very useful benefit. Rather than continuously treat acute conditions, why not try preventing it in the first place. It is known that there are less complications and less financial burden when a condition is avoided in its entirety. And so, when a patient is treated holistically, the patient will see healthcare positively and hopefully actively participate in their care. And then, as a healthcare team, we look at other things in their life, such as stressors from home life and work, or perhaps examine their thoughts and feelings, helping them work through issues. Oftentimes, as nurses, we also correct patients on misbeliefs and educate them on correct actions regarding their health. They have been engaging in risk behaviors without even knowing it. Through our actions and communication, we are able to not only treat the acute condition, but also prevent complications of the future by examining potential risks and causes in their life.

3. Mind and Body Connection

The third benefit that is found with holistic care is based on the mind and body connection. It is well known that the mind and body are connected in surprising ways. In its simplicity, when the body is stressed, the mind is stressed, and vice versa. For example, a patient may feel stressed about a recent falling out with a friend and may feel tremors in their hands, muscle cramps, or get a high blood pressure reading. And so, if a patient is not in the right head space or is not mentally prepared or willing, their treatment and healing process can be prolonged. But, by preparing the patient, by establishing rapport, and by having the patient onboard with care, healing can progress much more steadily. With a positive mindset, stress is reduced exponentially and where there's a will, there's a way.

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Holism is a philosophical approach in support of the belief that the whole is greater than the sum of its parts. According to this approach, the whole cannot be understood by examining its individual parts; instead, it is individual parts that allow us to see and hear the reality of the whole. This philosophy can be applied to the health care field in the form of holistic care. Holism goes beyond the actions performed or words spoken to a patient. It's a method to ensure care for all parts of a patient. The American Holistic Nurses' Association defines holistic nursing as "all nursing practice that has healing the whole person as its goal."

Holistic nurses are those who recognize and treat each patient differently. They nurture wholeness and healing by respecting each patient's unique physical, mental, emotional, spiritual and environmental strengths and challenges and honoring each patient's values, health beliefs and health experience.

Carson-Newman's online family nurse practitioner program prepares registered nurses to become more complete and autonomous caregivers. The university's Christian mission fits hand-in-glove with the call to compassionate care that equips nurses with a holistic approach to support more than just recovery. Carson-Newman graduates learn how to provide extra care for patients by promoting a healthy lifestyle and finding resources that positively affect patients' lives.

Holistic Nursing Care is Based on Florence Nightingale's Work

Holistic nurses take a "mind-body-spirit-emotion-environment" approach to the practice of traditional nursing. This form of whole-health nursing is grounded in caring, relationship and interconnectedness. It's based on the work of Florence Nightingale, who emphasized unity, wellness and the connection between patients and their environment. Since 2006, holistic nursing has been officially recognized by the American Nurses Association (ANA) as a nursing specialty with a defined scope and standards.

One of the best things about holistic nursing care is that it can be practiced in all settings. It's not specific to a particular patient group, disease or demographic. Holistic nurses use "doing" and "being" therapies (known as complementary and alternative therapies) to remove the barriers to the healing process and create a space that allows them to be instruments of healing. "Doing" therapies include most forms of modern medicine (medications, procedures, dietary manipulations, radiation and acupuncture). "Being" therapies use states of consciousness to affect the body (imagery, prayer, meditation and quiet contemplation, and the presence and intention of the nurse).

Whole-Health Nursing Pays Attention to the Whole Person

The fundamental care functions of the health care establishment are to protect and enhance health, prevent diseases and relieve pain. When a person's health or life is threatened by illness, that person is likely to seek treatment with both physical symptoms and spiritual issues in mind.

Health care providers are more likely to enhance the health of the individual holistically when health is defined as the harmony between mind, body and spirit. Full attention must be paid to the whole person, not just the current presenting symptoms, illness, crisis or tasks to be accomplished. Whole-health nursing entails considering and then assisting patients with the effects of illness on the body, mind, emotions, spirituality and personal relationships.

When trust is present in the provider-patient relationship, a plan of care can be co-created with the patient, and care can be given and received. Each patient's subjective experience about health, health beliefs and values are explored and incorporated into the plan.

Nurses Who Go Beyond Routines More Likely to Address Full Needs of Patients

When nurses are under time constraints and the patient load is high, it's easy to simply treat the physical being and move on to the next patient. Studies have shown that typical nursing care is routine-based and one-dimensional. Attention is paid to the usual problems, the patient's physical needs and the doctor's orders. Frequently, the patient's psychological, spiritual, emotional and social needs are ignored or not fully identified and satisfied.

Routine-based care results in wasted time and resources, slower recovery and potential risk to the patient's life. It's necessary to modify nurses' attitudes and encourage whole-health nursing in order to overcome this problem.

A study by Valizadeh et al. (2015) found that nurses who tend to go beyond the routines are more likely to address the entirety of patients' needs. These nurses work to establish closer relationships with patients and evaluate their overall conditions. Researchers observed that religious, moral and professional principles significantly influenced nurses' tendency to provide holistic care. These principles induced nurses to pay more attention to their patients, have a better understanding of their needs, and try to offer an optimal care plan, as well as contributed to a nurse's sense of commitment.

Holistic Nursing Can Foster Greater Integration of Self-Care

Holistic nursing care also enriches the life of the nurse. Holistic nurses understand that failure to care for themselves reduces their ability to care for others. Nursing can be a physically, mentally and emotionally draining profession. It's of great benefit to seek out those experiences that remind us why we became nurses in the first place. This can be achieved through the provision of holistic nursing care because it encourages nurses to integrate self-care, self-responsibility, spirituality and reflection in their own lives.

When nurses promote a patient's psychological and emotional well-being to facilitate physical healing, their relationship with the patient changes and grows into something more positive than before. This can lead to better patient outcomes and increased satisfaction in the nurse role. A study by Goodwin and Candela (2013) examined whether newly practicing nurses benefited from learning holistic comfort theory during their baccalaureate education. Researchers found holistic comfort helped ease the transition from school to practice, allowing nurses to transcend the unavoidable difficulties experienced during this period. Additionally, participants experienced improved patient safety and pride in patient care.

Holistic care will continue to be a focus as health care moves forward. The Patient Protection and Affordable Health Care Act of 2010 has placed the focus on patient-centered care. In this environment, patients are key players in determining which outcomes are valued.

Pew Health Professions Commission's landmark 1994 report on relationship-centered care serves as a guideline for addressing the bio-psycho-social-spiritual dimensions of individuals in integrating caring, healing and holism into health care. The current health care climate emphasizes effectiveness, coordination of services and preventive care. A strong foundation in lifestyle change and holistic care strategies are required to meet these objectives.

Increasingly, hospitals and other health care facilities are creating delivery models that include integrative health. Holistic nursing has flourished within these integrative care systems. Students are also seeking programs that focus on holistic nursing care and integrative health such as Carson-Newman's Online Master of Science in Nursing - Family Nurse Practitioner program. The American Association of Colleges of Nursing (AACN) identifies "holistic, patient-centered care" and an understanding of complementary and alternative modalities as essential to baccalaureate education.

Contact us to find out more about our online MSN-FNP program.

Sources:

American Holistic Nurses Association (n.d.). What is holistic nursing? Retrieved on August 13, 2018 from the American Holistic Nurses Association website at http://www.ahna.org/About-Us/What-is-Holistic-Nursing

Demirsoy, N. (2017). Holistic care philosophy for patient‐centered approaches and spirituality. In O. Sayligil (Ed.), Patient centered care (pp. 119-138). IntechOpen. Retrieved from https://www.intechopen.com/books/patient-centered-medicine/holistic-care-philosophy-for-patient-centered-approaches-and-spirituality

Dossey, B. M. (2013). Nursing: Integral, integrative, and holistic - local to global. In B. M. Dossey & L. Keegan (Eds.), Holistic Nursing: A handbook for practice (pp. 3-57). Burlington, MA: Jones and Bartlett Learning. Retrieved from http://www.dosseydossey.com/barbara/pdf/Dossey-Integral_Nursing_HN_6th_ed.pdf

Goodwin, M., and Candela, L. (2013). Outcomes of newly practicing nurses who applied principles of holistic comfort theory during the transition from school to practice: A qualitative study. Nurse Education Today, 6 (1), 614-619. Retrieved from https://linkinghub.elsevier.com/retrieve/pii/S0260-6917(12)00255-9

Klebanoff, N. A. (2013). Holistic nursing: Focusing on the whole person. American Nursing Today, 8(10). Retrieved from https://www.americannursetoday.com/holistic-nursing-focusing-on-the-whole-person/

The importance of holistic nursing care: How to completely care for your patients (n.d.). Retrieved on August 14, 2018 from the Practical Nursing website at https://www.practicalnursing.org/importance-holistic-nursing-care-how-completely-care-patients

Valizadeh, L., Zamanzadeh, V., Jasemi, M., Taleghani, F., Keoch, B., and Spade, C. M. (2015). Going beyond-the-routines view in nursing: A qualitative study. Journal of Caring Sciences, 4(1), 25-34. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363649/

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Holism is a philosophical approach in support of the belief that the whole is greater than the sum of its parts. According to this approach, the whole cannot be understood by examining its individual parts; instead, it is individual parts that allow us to see and hear the reality of the whole.

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1. One advantage of holistic nursing care is that this type of care recognizes a person as a whole. Holistic nursing ties together the patient's biological, social, psychological, and spiritual aspects. This allows for the nurse to provide better patient care.
2. A second advantage to this type of care is that holistic care respects human dignity. This allows for a better relationship between the nurse and the patient. The relationship is based on respect and openness, which allows patients to participate in decision making.
3. A third advantage to this type of nursing care is that nurses can educate patients about self-care. Holistic care increases self-awareness and self-confidence in patients. This helps  nurses to better understand the effects of an illness on a patient and understand the patient's needs. These nursing practices help to heal the patient as a whole.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441185/

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Indian J Palliat Care. 2015 May-Aug; 21(2): 214-224.

Abstract

Background:

Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring.

Materials and Methods:

A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software.

Results:

Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits.

Conclusion:

Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

Keywords: Holistic care, Nursing, Qualitative research

INTRODUCTION

Holistic care is a comprehensive model of caring which is believed to be the heart of the science of nursing.[ 1] The philosophy behind holistic care is based on the idea of holism which emphasizes that for human beings the whole is greater than the sum of its parts and that mind and spirit affect the body.[ 2] Holistic care is described as a behavior that recognizes a person as a whole and acknowledges the interdependence among one's biological, social, psychological, and spiritual aspects. Holistic care includes a wide range of approaches, including medication, education, communication, self-help, and complementary treatment.[ 3] In holistic nursing, all aspects of patients and their effects on the treatment process are considered and the patients' thoughts, emotions, cultures, opinions, and attitudes are factored in as contributing to recovery, happiness, and satisfaction.[ 4] Holistic care respects human dignity[ 5]: The relationship between the providers of health care and the patients is based on respect, relative openness, equality, and mutuality[ 2, 5] and patients participate in decision making in this kind of caring.[ 6]

Providers of holistic care consider a patient as a whole within his/her environment and realize that a patient is made up of a body, mind, and spirit. Respecting the patient's role in the treatment process, having him/her take part in the process and encouraging self-care is another aspect of holistic care which leads to therapeutic consultation, hope, dignity, self-discipline, social growth, a sense of autonomy, vigor, and vitality.[ 7]

Holistic care increases the depth of care providers' understanding of patients and their needs. Educating patients about self-care and helping them to perform their daily activities independently is part of holistic care. Palliative care is part of holistic care which improves the quality of a patient's life and their emotional and physical well-being. Holistic care increases self-awareness[ 8] and self-confidence in patients[ 9] and causes nurses to better understand the effects of an illness on a person's entire life and his/her true needs. It also improves harmony between mind, body, emotions, and spirit in an ever-changing environment;[ 10] The American Association of Holistic Nurses supports this belief and points out that holistic nursing includes all the nursing practices that heal the whole of a person.[ 5]

In many hospitals, nurses do not have the freedom to perform their tasks independently and their actions are often observed by doctors. Using holistic care as the framework will result in major changes in the treatment process,[ 11] a better public view of the nursing profession, and nurses' autonomy.[ 10] The holistic care paradigm has been presented to the health-care systems in many cultures[ 4] and it can be used in every area of nursing.[ 12] Holistic care is not a new method; Florence Nightingale developed this type of nursing as a better model of caring;[ 4] many other nursing theorists, e.g. Ragers, Newman, and Parse have also emphasized holistic care.[ 13]

Unfortunately, there is compelling evidence that most nurses have been educated with a biomedical allopathic focus and do not have a good understanding of the meaning of holistic care. Furthermore, it has been suggested that nurses are not familiar with holistic care, neglect this model of caring,[ 4, 6] do not use this method,[ 2] and consider patients' corporeal needs only. In this regard, patients' other needs and sometimes more serious problems are not addressed.[ 6] The mental, spiritual, and social needs of patients are neglected[ 14] and patients are considered as biological machines.[ 15]

Using the ordinary medical model alone for treatment exposes patients to serious threats, prolongs hospitalization, and raises treatment costs.[ 6] In many countries, such as the UK,[ 6] Australia,[ 16] and Iran,[ 12] holistic aspects of patients' needs are often overlooked.[ 6, 16] Similar studies conducted in the USA have revealed that 67% of American patients in hospitals do not receive holistic care,[ 17] and a study conducted in England showed that only 5% of hospitalized patients were subject to holistic care.[ 6]

This presents as a major crisis for the nursing profession.[ 18] Considering the beneficial effects of holistic care, the identification of contributory factors is of importance for providing this method of caring. A review of literature in this field shows that most studies have been limited to specific areas, such as operating rooms or older patients who were terminally sick.[ 4, 19] Other studies attempt to explain the concept of holistic nursing and nurses' perception of it,[ 1, 2] or the reasons for failure to employ this method.[ 4, 6] According to the results obtained from several studies, holistic care is adversely affected by such factors as inadequate time, improper professional relations, incomplete reports from nurses, inadequate clinical control, unavailability of resources,[ 20] poor professional and administrational perceptions, limited knowledge, and motivational and organizational factors.[ 4] In view of the great influence of holistic care on treatment and more effective nursing, the health-care systems in many countries in recent decades have tried to promote holistic care by applying changes to the educational and administrational systems,[ 4] but studies show that their efforts have been fruitless.[ 21, 22]

Evidently, there are other factors affecting holistic nursing that must be identified. An investigation into this matter using a qualitative approach that includes multiple methods of data gathering and emphasizes reality experience[ 23] can help us to obtain meaningful and comprehensive data; it will also clarify the existing background and the real situation surrounding the formation of holistic care. Thus, this is a qualitative study and is based on the experience of nurses, who form the core of holistic care provision.

MATERIALS AND METHODS

Ethical considerations

This study was approved by the ethics committee of Tabriz University of Medical Sciences. All the participants were informed of the aim of the study and a written consent was obtained from each of them. Participation in the study was entirely voluntary and the participants could withdraw at any stage of the study.

Method

A qualitative content analysis was conducted to develop an in-depth understanding of nurses' experiences of major factors that affect holistic care formation. This method was used for describing the systematic and objective means of the phenomenon.[ 24] This study is based on conventional qualitative content analysis in which coding and categorizing are derived directly from the raw data. The advantage of this approach to content analysis is obtaining direct data from participants without imposing pre-supposed categories or theoretical perspectives. Another important attribute of this approach is its emphasis on the subject, context, and differences and similarities among codes and categories.[ 25] Purposive sampling was used to select 14 participants with abundant information. Three of the nurses selected were male and the others were female. The participants were selected from various wards [intensive care unit (ICU), emergency, general wards] in university hospitals in the Iranian cities of Tabriz, Uremia, Ardebil, and Tehran. Further characteristics of the participants are presented in Table 1 . The study lasted 6 months, from May until October 2013. In the first stage, participants were informed of the aim of the study by the researchers; if they agreed to participate in the research, they gave written consent. To respect the privacy of the interviewees, numerical codes are used instead of their names.

Table 1

The data were collected using unstructured interviews. Each interview lasted between 60 and 90 minutes and was performed in a private room in the hospital. Each interview commenced with an opening question such as "what do you do for a patient during your shift?"; this was followed by questions that addressed their experiences of caring for patients and situations and factors which affect the quality of caring and attending to patients' various needs. Based on the initial data analysis, additional questions were asked of the respondents. A second interview was conducted with four participants to help clarify the initial interpretations of the information and emerging results. To ensure accuracy of the data, the interviews were continued until data saturation: Data collection was ended when no new information could be collected and the data became repetitive.

The interviews were tape-recorded, transcribed, and coded line-by-line by MAXQDA 2010 software which was used in the initial stages of coding.[ 22] The various codes were compared and categorized and themes were constructed based on similar and appropriate categories. In this way, themes and categories were generated inductively from the data.

Rigor

To increase the dependability of the study, data were collected and analyzed by one of the researchers; the other researchers checked and verified the data, codes, and analyses. The transcripts were read several times and the categories and themes were discussed by the researchers until consensus was reached. The credibility of the results of the study was confirmed through prolonged engagement with participants in the wards. In addition, individual checking was used to examine the accuracy of the findings, and the results of the primary analysis were shared with the participants to validate the compatibility of the codes with their experiences. Transferability of the findings was made possible by the variety of the characteristics of the participants.

RESULTS

Following an analysis of the data, three themes were identified as effective factors in holistic care provision: The structure of the educational system, professional environment, and motivational factors. The themes, sub-themes, and codes are shown in Table 2 .

Table 2

The structure of the educational system

The structure of the educational system was one of the issues which most of the participants talked about. Proper education plays an important role in nurses' preparation for providing holistic care. This theme consists of three sub-themes: The content of educational programs, the teaching methods, and the educators' competence.

The content of educational programs

If the content of educational programs is comprehensive and includes the philosophy of holistic care, it will enable nursing students to address the various needs of patients and provide holistic care. One of the nurses emphasized the role of education in providing holistic care and said:

The content of the courses deeply affected my attitude toward patients and their needs; the courses on "nursing procedures" and "psychological disorders" made me stop looking at a patient only in terms of physicality and understand that an individual is more than a body with certain needs; it made me consider a patient's entire dimensions; I realized that health is the equivalent of harmony and balance among a patient's whole dimensions, not simply physical well-being. (Participant 8)

The above quotation points to the important role of designed courses in training nurses in holistic care. Another participant, similarly, referred to the importance of "nursing procedures" in creating an inclusive perception and promoting holistic care:

The course on nursing procedures broadened my horizons about patients and made me see aspects that I had been unaware of; I understood that well-being is the result of meeting a patient's various needs, from physical needs through emotional and spiritual needs to social, cultural and economic needs. (Participant 2)

The same participant, however, observed that the course of "nursing procedures" did not have enough credits and that they were not adequately trained in providing holistic care:

The course was too short and the training was not enough. But I was interested and regarded it as a specialized part of nursing; I practiced a lot and gradually learned how to exercise it. I wish the trainers had instructed us properly; then I would have realized the importance of it sooner.

Unfortunately, the data show that the content of the educational program is poor and lacks material on the various needs of patients. Regarding this issue, one of the nurses explained:

More than 90% of our lessons were about the physical problems of patients, and their other needs were usually neglected. (Participant 5)

Another participant expressed:

During the course, most of our education was about the physical problems of patients and dealing with them. So, by the end of the course, our knowledge of the physical needs of patients had increased, but we didn't know anything about the whole needs of patients and their role in the treatment. (Participant 6)

Another nurse explained:

Clinical training was too short and we didn't have enough time to establish a relationship with the patients to recognize their various problems. (Participant 13)

Teaching methods

Teaching methods are part of the educational structure and play an important role in holistic care formation. But, according to the results, the teaching methods are not designed to demonstrate holistic care. In this regard, one of the participants said:

The teaching methods were often educator-centered; a limited number of tasks were dictated and we were expected to do them only; we were not free to consider the other needs of patients and satisfy them. (Participant 3)

Practice-based teaching can increase nursing students' understanding of holistic care, but the data showed that the nursing educators did not consider this matter and focused on theory-based teaching. One of the nurses stated:

We did not receive any practical training in considering patients' various needs. In our education, we were not told that a patient is a whole with many different aspects and whose treatment requires that we consider all those aspects; although some of the educators advised us to consider the secondary needs of patients, there was no practical training in this field. (Participant 9)

The educators' competence

The educators' characteristics and competence have been introduced as a component of the educational structure in this study; educators can provide the trainees with a practical model from which to learn the principles of holistic care in practice. A participant said regarding this issue:

One of our educators was sensitive to the various needs of patients, treated them with respect and attended to their various needs. Her manners influenced my behavior. Now, I try to use her lessons in practice and provide my patients with comfort by addressing their various needs. (Participant 6)

Similarly, a participant referring to her trainer's holistic perception and emphasis on holistic care remarked:

One of our trainers always stressed that we view a patient as a whole that has different needs; she was trying to have us realize that well-being is the result of creating a harmony among the various parts of the whole and not just the physical dimensions. My trainer's attitude greatly affected my manner of nursing: I try to attend to my patients' entire needs, not just the physical ones, and consider their emotional, spiritual, cultural and social needs. I believe that meeting all these needs at the same time rather than separately is much more effective.

But the results show that most of the participants had no practical model for learning holistic care during their education. One of the nurses said:

Most of our educators had limited knowledge of the various aspects of patients' needs and their effects on health recovery and paid little attention to these matters. They paid more attention to routine tasks, and we didn't have an actual example of someone who considered all the needs of patients and provided holistic care. (Participant 6)

An educator's good relationship with students is an effective factor in attracting attention to the educator's training, as well as motivation for learning. In this regard, one of the nurses stated:

Our educators didn't usually have a suitable relationship with us and reproached us for unimportant matters, so we didn't have any motivation for learning. (Participant 14)

Professional environment

Professional environment is another factor which most participants emphasized as being important to considering the patients' different needs and providing holistic care. This theme consists of three sub-themes: Workload, management, and the gap between clinical performance and academic learning.

Workload

Workload, one of the components of professional environment, was referred to by most of the participants as a restriction in holistic care provision. Concerning this issue, one of the participants said:

Sometimes, the ward is too crowded and busy; although I understand that patients have different needs, and I want to meet them, but I don't get the opportunity to do it (Participant 2).

Another participant explained:

If the numbers of patients were smaller in the ward, we would have more opportunities to provide better care and we could attend to all of our patients' needs (Participant 12).

One of the participants referred to the sheer number of her working shifts and said:

Because of the huge number of shifts, we are always tired and don't have the required energy for providing suitable care. (Participant 9)

Management

Management-with its different domains, such as evaluation, orientation programs for staff and management approaches-plays an important role in the formation of holistic care. Most of the participants emphasized its impact on the quality of nursing. To quote one of the nurses:

There is no difference between a nurse who considers and attends to the patients' different needs and another who only does the routine tasks. Ironically, the latter is more popular with the managers. Routine tasks are considered as evaluation criteria. (Participant 8)

Another nurse mentioned:

Our head nurse and the supervisors emphasize the routine tasks and unimportant stuff and there is no incentive for considering the patients' secondary needs. (Participant 5)

Orientation programs and managers' competence can decrease nurses' stress and obsession with routine duties and encourage them to consider the patients' other needs and provide holistic care. But data show that the professional environment in Iranian hospitals lacks orientation programs for novice nurses and that most of the managers lack competence for their positions. One of the nurses stated:

We didn't have any orientation programs when we began to work in the hospital and our head nurse was very strict and belittled us for unimportant matters. It was very difficult for me. I was under pressure and lost my motivation to continue my profession, provide proper care and pay attention to the patients and their needs. (Participant 7)

Limited conformity of the clinical environment with professional norms

Conformity of the clinical environment with professional and ethical norms results in nurses' treating patients as human beings with human needs, all of which should be taken into account; upon observing the beneficial effects of holistic care on the treatment process, nurses will acquire a holistic perception: They will realize the importance of attending to patients' needs from various aspects and experience the effectiveness of meeting those needs as a whole compared to satisfying them separately. However, the participants declared that upon entering the clinical environment, they were faced with the limited conformity of their environment with professional norms. Disregard for the principles of proper nursing forms a sub-category of this phenomenon.

The participants stated that upon embarking on their careers, they were faced with a prevalent disregard for the principles of proper nursing, at both the professional and ethical level. Obviously, such disregard for professional and ethical principles leads to professional shortcomings and negligence of nursing ideals, which in turn results in nurses' failure to provide proper care and attend to patients' needs in their entirety. Attention to professional principles is the prerequisite of holistic care; but in most cases they are ignored. To quote a participant:

When I started, I saw that many of the points that were stressed during our education were simply ignored here. For example, we were always told to sterilize a catheter before placing it, but nobody in the ward followed the principle; or antibiotics weren't administered at the right times. It made me feel guilty to witness all the carelessness; they didn't care about the patients and couldn't wait for their shifts to end! Many novice nurses would adopt the same wrong practices and ignore the professional principles; the standards and techniques were pushed aside and the patients forgotten. (Participant 6)

As the above response indicates, disregard for professional principles at work results in novice nurses' loss of interest in professional values and prevents them from attending to patients' various human needs and encourages them to stick to their routine duties.

Disregard for ethical matters in nursing is another component of negligence of proper nursing principles. Many nurses are guilty of such disregard and ignore their patients and their various needs. In this regard, one of the participants stated that:

I used to work in ICU and I often witnessed the nurses' lack of care about professional ethics. They were indifferent to those of the patients' needs which were not physical; if the orderly was away and a patient had a basic need, they wouldn't care; if a patient was in pain, they were not quick enough to administer a painkiller. In many cases they weren't honest: They would write down things they hadn't done; they would turn a blind eye to the patients' needs. If a patient, for example, wished to see his or her family, they wouldn't allow it. They would close the doors and drink tea and chat away! It was not easy to act morally under those circumstances: You could be ostracized. It was like swimming against the current. Unfortunately, many of my friends would imitate them, too, and were totally indifferent to the patients and their needs, as if they were machines. (Participant 8)

Motivational factors

Motivational factors play an important role in encouraging nurses to provide holistic care as well as facilitating such provision. Motivational factors include personality traits, personal experiences of hospitalization, and input sources.

Personality traits

Personality traits, identified as one of the sub-categories of motivational factors, are among the major factors generating internal motives: They encourage and facilitate holistic care, influence nurses' performance and relations with patients, and help develop rapport between nurses and patients. According to the participants, sociability and sensitivity to people's needs-which go under the subcategory of personality traits-are influential in encouraging attention to patients' various needs, thus nurses' developing holistic perception.

Sociable and genial nurses are more likely to establish a close rapport with patients, which results in a better identification and holistic perception of patients' needs. One of the participants pointed out that:

I'm a very good mixer, highly sociable; I make sure to greet my patients warmly; I even shake hands with the old patients, because I believe that lifts their spirits and makes them trust me and cooperate. For example, if they won't let others perform venipuncture on them, they will definitely let me. They also confide in me, which lets me know about and satisfy many of their needs. This quickens the treatment process, because attending to a patient's physical needs alone won't lead to recovery. My sociability has helped me realize the importance of knowing about and satisfying the patients' needs and how it affects the recovery process; now I believe that human is a complicated creature with many different needs all of which should be taken care of before complete recovery is achieved. (Participant 7)

Being sensitive and compassionate contributes to providing holistic care on the part of nurses. The more emotional a nurse is, the more sympathy he/she will feel for patients, which in turn will result in feeling more responsible for patients: The nurse will not simply perform the routine tasks but try to identify and satisfy his/her patients' whole needs. One of the nurses stated:

Well, I'm quite emotional and love to help others if I can. I help my family too and enjoy being a comfort. That's why I feel good when my patients are satisfied. Satisfying my patients' needs gives me a feeling of pleasure; the feeling is so strong that I believe my best moments are when I'm with my patients and helping them. (Participant 9)

Personal experiences of hospitalization

Nurses' personal experiences of hospitalization is another factor which enhances nurses' sympathy for and understanding of patients and their needs; it also contributes to regarding a patient's whole needs as important and refusing to attend to the physical needs alone. Naturally, being subject to similar experiences leads to a better understanding of patients' needs. Most of the participants referred to their personal experiences of hospitalization as unpleasant ones in which their needs or their families' needs-physical or otherwise- were not satisfied.

According to the input from many of the participants' experiences, when a participant or a family member was hospitalized, he/she was frustrated at the neglect of their basic and secondary needs. The participants stated that the unpleasant experience influenced their perception of patients and their various needs. One of the participants stated that:

I had to undergo cholecystectomy last year. Now I realize how painful an operation can be. Though I was in great pain, the nurses often neglected me and didn't give me painkillers. I understand now what a patient goes through. I promised myself I would never be indifferent to my patients' pain. If every nurse had a taste of his/her patient's trouble, that'd make a difference! You would understand your patients better and treat them as humans with a variety of needs all of which should be satisfied; you wouldn't focus on one aspect only, and you'd recognize the importance of attending to all one's needs simultaneously rather than one at a time. (Participant 1)

Another participant pointed out that after the experience of the hospitalization of a family member; she began to view holistic care in a different light:

One of the reasons why I attend to my patients' needs more carefully now is my Dad's time in hospital. He had to undergo a heart surgery and we were worried to death. I was waiting nervously outside the operation room, but the ICU nursing staff did not treat me well. Though I was one of their colleagues, they weren't very nice to me, and didn't allow me to see my father, nor did they give me any hope. I was totally anxious; now I understand patients and their families better. I put myself in their shoes and that makes me feel closer to them. This can help one understand patients and their multiple dimensions a lot better. (Participant 13)

Input sources

Input sources-which include religious beliefs, the participants' upbringing, and commitment-constitute another major factor in holistic care provision. Regarding religiousness, one of the participants stated:

My religious beliefs help me to consider a patient's various needs despite the problems at work. I believe God has given me the power to give care to my patients; this idea gives me more energy for a better caring for the patients. (Participant 7)

The same participant mentioned that religiousness can lead to recognition of the greater effectiveness of meeting a patient's whole needs simultaneously rather than separately:

By satisfying their needs and witnessing the effect of that on their recovery, I now see every patient as a whole with a number of needs all of which should be taken care of as a whole, and not individually, to quicken treatment.

Another nurse stated:

My beliefs make me attend to the different needs of the patients. Neglecting a patient's needs makes me feel guilty, and I try to keep my conscience clear by satisfying my patients' needs. (Participant 4)

The manner in which one has been reared has an important impact on the formation of these beliefs. In this regard, one of the participants said:

My father usually advised me to view the patients as my own family and provide the best possible caring for them and attend to all their needs. (Participant 8)

Commitment, which can increase during work, is usually effective before entering the nursing profession; it is considered as a component of input sources that plays a key role in the formation of holistic care. One of the nurses remarked:

I try to perform my duties in the best way. I think our duty is not limited to some routine tasks. Addressing all of the needs of my patients is my duty as a nurse and I try to resolve their entire problems. When I resolve them, I feel good and my interest in my profession increases. In addition to giving me a sense of fulfillment, satisfying the patients' various needs is so effective that I've grown more attentive to my patients' multiple dimensions and try to have an overall view of them. (Participant 3)

DISCUSSION

The results of the study show that factors that affect holistic care provision the most are the educational structure, professional environment, and motivational factors.

Educational structure

Educational structure-which includes the content of educational programs, teaching methods, and educators' competence-has an important impact on the adoption of holistic care by nurses. Ahmadi et al., reach similar results in their study and introduce educational structure as an effective factor in the quality of care and extent of attending to patients' different problems.[ 26] The results of this study show that none of the components of the educational structure in Iran are appropriate enough to prepare nurses for holistic care. The content of educational programs is not based on the philosophy of holistic care. King and Gates' study points to the same results and shows that teaching holistic nursing to undergraduate nursing students is ignored in the curriculum of nursing and the content of educational programs emphasizes the medical model of.[ 27] Similarly, the results of Strindberg's study in Sweden show that most nursing lessons are based only on biological science. Revising nursing lessons seems to be required for the inculcation of holistic care in nursing students. Strandberg has also suggested this matter in his study.[ 1] Robinson, likewise, emphasizes the role of the lessons' content in the adoption of holistic care by nursing students and suggests using art and behavioral lessons in nursing courses.[ 18]

Teaching methods and educators' competence, the other components of the educational structure, play an important role in learning and the transference of theoretical knowledge of holistic care into clinical practice. However, according to the findings of this study, most nurses believe that their main concern in their courses has been with becoming competent in doing routine tasks and that they had little opportunity to consider the other needs of patients. If educators provide practical models of holistic care, students' confidence will increase and they will be able to provide holistic care. Meleis (1975) and Davies (1993) referred to this issue and emphasized its importance. King and Gates, also, stress the role of practical models, teaching methods, and explaining the philosophy of holistic care in the formation of holistic care (King and Gates, 2006). Similarly, Henderson's study suggests that defective teaching methods and educators' incompetence are barriers to holistic care provision.[ 16]

Professional environment

Professional environment, which consists of workload, management, and the limited conformity of the clinical environment with professional norms, can affect the formation of holistic care and act as a barrier or facilitator to it. When unsuitable, these components are identified as barriers to holistic care provision in this study. Workload is one of the aspects of practice in nursing environments which affects the quality of caring. In his study, Ahmadi refers to the effects of workload and states that most Iranian nurses suffer from heavy workload and do not have the opportunity to consider patients' various needs and provide holistic care.[ 26] Similarly, Olive introduces workload as a barrier to the formation of holistic care.[ 6] Management, another component of professional environment, includes various domains such as evaluation methods, orientation programs for staff and management approaches. The results of this study show that nursing management is inefficient and that the nurses in this study were dissatisfied with the style of management, and do not have any orientation programs. The above-mentioned issues play an important role in the formation of holistic care and, when suitable, can enhance the provision of this mode of caring by creating motivation in nurses and increasing their knowledge. Strindberg's study in Sweden confirms this fact and emphasizes the role of management in promoting holistic care.[ 1] Duffy and McEvoy, likewise, call attention to the importance of professional environment and its various effects on nurses' performance; they consider a suitable environment as a prerequisite of holistic care.[ 10]

Clinical environments' lack of conformity with professional norms is another factor which makes nurses loose interest in professional and ethical values, and acts as a disincentive to providing holistic care.[ 28] The results show that most nurses have encountered this problem and experienced it on the first days of working. Various studies-e.g. Silva,[ 29] Abedi[ 30] and Valdez[ 31]-recognize the limited conformity of the clinical environment with professional norms as a big challenge which most novice nurses encounter. Many of the participants in the study referred to clinical environments' poor conformity with professional and ethical norms as a deterrent to providing holistic care; they also stated that many of the novice nurses would follow their colleagues' example and neglect patients and their needs. Henderson, likewise, points out in his study that clinical environments' poor conformity with norms greatly contributes to novice nurses' disregard for holistic care and encourages them to stick to the routine duties and ignore the patients' various needs.[ 16]

Motivational factors

The findings of this study prove that motivational factors-input data, personality traits, and personal experiences-are influential in identifying patients' various needs and generating holistic perceptions of the patient, which in turn encourage nurses to attend to patients' diverse needs and provide holistic care. Personality traits play a major role in expanding relationship with patients, identifying their various needs and developing holistic perception on the part of nurses. Also, religiousness and morality can induce one to satisfy patients' needs and provide holistic care, and in many cases overcome the defects in the educational and clinical systems. Obviously, one's behavior is decided by his/her personality traits; thus, a nurse's performance, behavior toward patients, and attempts at expanding relationship with them are decided by his/her personality traits. As the most important internal factor influencing motivation, personality traits are influential in achieving success at college and at work by creating intimacy, commitment and conscientiousness.[ 13] Studies show that nurses who are temperamentally sociable and emotional tend to be cheerful at work and more capable at identifying patients' needs and nursing. The same studies reveal that these nurses, compared to their colleagues, are not only more dependable, intelligent, flexible, and conscientious, but also more highly motivated.[ 32] McEvoy and Duffy point to the importance of compatibility between personality and profession as well as the impact of beliefs and principles on a nurse's performance, and regard them as vital to the provision of holistic care.[ 10]

Nurses' personal experiences of hospitalization, either on their own part or their families', can also lead to a better understanding of patients' needs, or encourage holistic perception. In other words, such experiences can lead to viewing a patient as a whole whose needs should be met in their entirety rather than separately, hence the need for holistic care. Not many studies have addressed the effects of nurses' personal experiences of hospitalization on their perception of patients' needs and the need for holistic care; however, it has been revealed that such experiences can enhance nurses' attention to their patients' various needs and induce them to provide holistic care. Gates and King[ 27] and Strandberg,[ 1] for instance, point to the influence of nurses' knowledge and experiences on their understanding of patients' various needs and the importance of holistic care. McEvoy and Duffy believe that sympathy for and a better understanding of patients can lead to the provision of holistic care.[ 10]

CONCLUSION

The results of the study show that the educational system, working environment, and motivational factors are major factors in providing holistic care. However, the findings reveal that these factors are not appropriate enough in Iran to lead to holistic care, and Iranian nurses tend to stick to their routine duties and satisfy patient's clinical needs only. Earlier studies conducted in other countries-e.g. Strindberg (2007), King (2006), Henderson (2002), Olive (2003)-have attested to the importance of the above-mentioned factors in the provision of holistic care, hence the need for closer attention to the compatibility of the educational system with the idea of holistic care, revision of the contents and methods of education, and modification of the conditions at work in order to encourage holistic care. Personality traits, personal experiences of hospitalization, and beliefs and principles-which go under the heading of motivational factors-also contribute to and facilitate holistic care. McEvoy and Duffy (2008) suggest that these factors are vital to holistic care. As a result, to develop holistic care it is necessary to attach more importance to motivational factors, compatibility between nurses' personalities and their profession, improvement of nurses' communicative skills, promoting religiousness, and encouragement of commitment in practicing nurses and nursing students alike.

ACKNOWLEDGMENT

This study is part of a larger study conducted for a doctoral dissertation that was approved by the ethical committee and was supported with a research grant (number 350) for Ph.D. thesis from Nursing Research Team affiliated to Tabriz University of Medical Sciences, Iran. The authors would like to express their sincere gratitude to this center and all the participants for cooperating in this study.

Footnotes

Source of Support: This study is part of a larger study conducted for a doctoral dissertation that was approved by the ethical committee and was supported by a research grant (number 350) for Ph.D. thesis from Nursing Research Team affiliated to Tabriz University of Medical Sciences, Iran

Conflict of Interest: None declared.

REFERENCES

1. Strandberg E, Ingvar O, Borgquist L, Wilhelmsson S. The perceived meaning of a (w) holistic view among general practitioners and district nurses in Swedish primary care: A qualitative study. BMC Fam Pract. 2007;8:8. [[ PMC free article] [ PubMed] Google Scholar]

11. Holt Waldo. Capella University: Capella University; 2011. The lived experience of being a holistic nurse educator: A heuristic inquiry. [ Google Scholar]

17. Daaleman TP, Usher BM, Williams SW, Rawlings J, Hanson LC. An exploratory study of spiritual care at the end of life. Ann Fam Med. 2008;6:406-11. [[ PMC free article] [ PubMed] Google Scholar]

22. Gravel C. Working with MAXQDA: Coding Basics Germany. 2012 [ Google Scholar]

23. Strubert H, Carpenter D. 3rd ed. Philadelphia: Lippincott Williams and Wilking; 2007. Qualitative research in nursing: Advancing the humanistic imperative. [ Google Scholar]

25. Zhang Y, Wildemuth BM. Wildemuth BM, editor. Qualitative analysis of content. Applications of social research methods to questions in information and library science. 2009:308-19. [ Google Scholar]

Articles from Indian Journal of Palliative Care are provided here courtesy of Scientific Scholar

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Effective Factors in Providing Holistic Care: A Qualitative Study

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Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from ...

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1. Holistic nurse and the patient work together as a team to create attainable goals for the patient while taking into account the patients health beliefs, values and over all lifestyle.
2. Uses alternative and complementary practices such as imagery, visualization, relaxation, deep-breathing techniques, stress management, and aromatherapy. The patient is able to learn life-long skills to promote wellness.
3. It emphasizes care beyond the disease and addresses the patient as a whole. Mental, emotional, spiritual wellness are incorporated into the plan of care creating a balance between medicine and the natural healing process.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219452/

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A Brief History and Overview of Holistic Nursing

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In 1997 the American Holistic Nurses Certification Corporation (AHNCC) was formed to provide credentialing programs in holistic nursing. Today the AHNCC offers several certification options for registered nurses based on level of education. Certification for nurse coaches is also available through the AHNCC. To date, 2,433 nurses have received certification in Holistic Nursing.

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1. Holistic health nursing focuses on the individual as a whole. Not only treating the individual of their disease process but as an all in one as bio-physco-social-spiritiucal dimensions.

2. Holistic health nursing also focus on each individuals subjective ideas on health, beliefs, and values.This allows the nurse to individualize their care while honoring the individuals choices.

3. Holistic health nursing focuses on the nurses role with relation to ones self-care and self-responsibility. This can allow the nurse to have greater awareness of themselves and can integrate this in their nursing practice.

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/HolisticNursingPractice.html

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Noreen Cavan Frisch, PhD, RN, FAAN
The Standards of Holistic Nursing Practice were developed by the American Holistic Nurses Association (AHNA) as a public statement regarding the practice of holistic nursing as a specialty. This article reviews the development of the practice standards, and presents the philosophies and values which underpin holistic nursing. Certification in the speciality is awarded through the American's Holistic Nurses' Certification Corporation (AHNCC) to nurses able to demonstrate knowledge and skills described in the Standards. The relationship between holistic nursing practice and complementary and alternative modalities is discussed.

Citation: Frisch, N. (May 31, 2001). "Standards for Holistic Nursing Practice: A Way to Think About Our Care That Includes Complementary and Alternative Modalities". Online Journal of Issues in Nursing. Vol. 6 No. 2, Manuscript 4. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/HolisticNursingPractice.aspx

Key words: holistic nursing, standards of practice, complementary/alternative modalities
Introduction
As nurses consider their role in the movement toward complementary modalities and integrative care, it is also useful for them to examine the standards of practice of the American Holistic Nurses Association (AHNA). The AHNA is a national nursing organization committed to bringing holism, compassion, science, and creativity to nursing practice with a stated mission "to unite nurses in healing" ( www.AHNA.org). The AHNA Standards of Holistic Nursing Practice (hereafter called the Standards) provide guidance for nursing care that meets the intent of the description of holistic nursing -- "care . . .that has enhancement of healing the whole person (from birth to death) as its goal ( AHNA, 1992/1998)." The Standards grew from an interest in describing holistic nursing, and in articulating the values, knowledge, and skills required for its practice. The Standards represent practice of a nursing speciality, but unlike speciality practice defined by a client group (pediatric nursing) or a disease category (oncology nursing), holistic nursing is practiced by nurses in virtually every area of care. The speciality is based on practice that recognizes the body-mind-spirit connection of persons, and demands its practitioners integrate self-care and self-responsibility into their own lives.

Precisely because holistic nursing recognizes the body-mind-spirit connection of persons, holistic nurses often practice complementary/alternative modalities.

Precisely because holistic nursing recognizes the body-mind-spirit connection of persons, holistic nurses often practice complementary/alternative modalities.

In a 1996 study of 708 nurses who identified themselves as holistic nurses, researchers found that a majority of the nurses defined their practice in relation to modalities practiced ( Dossey, Frisch, Forker & Lavin, 1998). The complementary/alternative modalities provide these nurses with a means to treat the body (biofeedback, therapeutic massage), relieve the mind (humor, imagery, meditation), comfort the soul (prayer), and support significant interpersonal interaction (healing presence). Holistic nurses have been interested in complementary/alternative modalities for over two decades, evidenced by the fact that of the early work published in holistic nursing (reprinted in the first compilation of historical writings on the topic) includes 41 scholarly papers addressing specific modalities and their use in practice ( Clements & Martin, 1989). As the modalities became the widely visible aspect of holistic nursing practice, it was both important and necessary to develop standards of practice so that the philosophy, values and knowledge that underpin care would be articulated.

This paper will first provide information on the development, refinement and use of the Standards to provide insights into the philosophy, values, knowledge and skills on which holistic care is based, and second, illustrate the relationship of complementary/alternative modalities to these standards.
Development and Refinement of the Standards of Practice
The AHNA Standards of Holistic Nursing Practice were published in 2000 after nearly a decade of review, study, critique and consensus-building regarding the application of holism in nursing practice ( Frisch, Dossey, Guzzetta & Quinn, 2000). The process began with reflective questions among members of the AHNA: questions like What defines the practice of holistic nursing? How is holistic nursing the same or different from all nursing practice? What is the relationship of holistic nursing to complementary modalities? Answers to these questions were not automatic, for there was no published authority from which to draw definitive (or even tentative) answers. Thus, the AHNA formed a committee to begin a process that first described holistic nursing, published position papers on social issues and on care/support of the environment, and drafted a Code of Ethics for Holistic Nursing. These position papers were developed through committees of interested nurses, critiqued by experts in the field, published in the association's newsletter ( Beginnings) for review, and finally were adopted by the organization's membership. The result was an initial set of statements to the wider nursing community about the concept of 'holistic nursing' and its meaning. The AHNA description of holistic nursing is presented below (Table 1) as an introduction to the concept.

Table 1: AHNA Description of Holistic Nursing

Holistic nursing embraces all nursing practice that has enhancement of healing the whole person from birth to death as its goal. Holistic nursing recognizes that there are two views regarding holism: that holism involves identifying the interrelationships of the bio-psycho-social-spiritual dimensions of the person, recognizing that the whole is greater than the sum of the parts; and that holism involves understanding the individual as a unitary whole in mutual process with the environment. Holistic nursing responds to both views, believing that the goals of nursing can be achieved within either framework.
The holistic nurse is an instrument of healing and a facilitator in the healing process. Holistic nurses honor the individual's subjective experience about health, health beliefs, and values. To become therapeutic partners with individuals, families, and communities, holistic nurses draw on nursing knowledge, theories, research, expertise, intuition, and creativity. Holistic nursing practice encourages peer review of professional practice in various clinical settings and integrates knowledge of current professional standards, law, and regulations governing nursing practice.

Practicing holistic nursing requires nurses to integrate self-care, self-responsibility, spirituality, and reflection in their lives. This may lead the nurse to greater awareness of the interconnectedness with self, others, nature, and God/LifeForce/Absolute/Transcendent. This awareness may further enhance the nurse's understanding of all individuals and their relationships to the human and global community, and permits nurses to use this awareness to facilitate the healing process.

© AHNA, used with permission.

The description makes clear that the views, beliefs, and practices of the nurse are as important as the nurse's view of nursing care. This statement on holistic nursing provided a basis from which to consider the actual practice. With this description of holistic nursing in hand, the AHNA undertook a four-step process to 1) develop initial Standards of Practice, 2) complete a role-delineation study of the actual practice of nurses who consider themselves to be 'holistic', 3) promote certification in the speciality, and 4) revise the Standards based on previous work ( Dossey, 2000).

While there was no definitive authority on holistic nursing practice in the early 1990s, there existed a wide literature on holistic nursing.

While there was no definitive authority on holistic nursing practice in the early 1990s, there existed a wide literature on holistic nursing.

The team working on the initial draft of the Standards reviewed all articles published in the Journal of Holistic Nursing, and the journal Holistic Nursing Practice from 1985 to 1995, as well as numerous holistic nursing articles appearing in the literature ( Dossey, 2000). It was believed that the content of this literature would cover the domain of the speciality and could form a basis for national standards. The first draft of the Standards was thus created in 1995.

An eight-member task force used these initial Standards to develop a survey instrument that would solicit information about the practice of holistic nursing in the field. This survey, titled an Inventory of Professional Activities and Knowledge of a Holistic Nurse (IPAKHN), was administered to over 700 nurses ( Dossey, Frisch, Forker, & Lavin, 1998). Data obtained indicated areas of commonality that crossed over all nursing areas of practice. These data were used to develop a nursing certification exam and to refine the Standards. The revisions of the Standards were then reviewed by a 24-member Advisory Committee, composed of AHNA members noted for leadership in practice, and by a 24-member Review Committee composed of nursing leaders/educators nationally recognized through their publications as knowledgeable of the field. A final draft of the Standards was submitted by the task force to the AHNA Leadership Council in 1999 and gained approval of the Council and the membership at that time.
Core Values of Holistic Nursing
The current Standards of Holistic Nursing are based on five Core Values of practice: 1) Holistic Philosophy and Education; 2) Holistic Ethics, Theories, and Research; 3) Holistic Nurse Self-Care; 4) Holistic Communication, Therapeutic Environment and Cultural Competence; and 5) Holistic Caring Process. These core values represent the essence of holistic nursing and are each necessary for holistic practice. Core value 1, Philosophy and Education, emphasizes that holistic nursing is based on a philosophical framework embracing holism and a commitment to education, reflection, and knowledge. Core value 2, Holistic Ethics, Nursing Theory and Research, emphasizes that professional nursing is grounded in theory, informed by research and bound by ethical principles to guide practice that is competent, thoughtful, and principled. Core value 3, Holistic Nurse Self-care, is based on the belief that nurses must engage in self-care to promote health and personal awareness so that the nurse may serve others as an instrument of healing. Core value 4, Holistic Communication, Therapeutic Environment and Cultural Competence, emphasizes the requirement for nurses to engage with clients to promote mutually-determined goals for health and healing. Lastly, Core Value 5, the Holistic Caring Process, emphasizes an evolution of the nursing process to embrace assessment and therapeutic care addressing client patterns, problems, and needs in an atmosphere of caring ( Frisch, Dossey, Guzzetta, & Quinn, 2000).
Knowledge and Skills
The knowledge and skills required for the practice of holistic nursing are summarized in the Core Curriculum for Holistic Nursing ( Dossey, 1997) and further detailed in the Handbook for Holistic Nursing ( Dossey, Keegan, & Guzzetta, 2000). The description of holistic nursing highlights the fact that holistic practice draws on knowledge, theories, expertise, intuition and creativity. These are five elements necessary for a nurse to function in a fully inclusive or comprehensive manner. Nursing knowledge is necessary for basic, legally-defensible nursing practice. Theories are needed to articulate, understand, and reflect on practice. Expertise is needed to perform tasks easily and for the ability to make accurate decisions about care. Intuition is required to understand the subjective experience of others and interpret its meaning to healing. Creativity is needed to solve problems and to identify new ways of being with clients. Each one of these elements is as important as the others and all must be present for the practice to be called 'holistic'. These elements require the nurse to function across three domains: cognitive (knowledge/theory), experiential (expertise), and affective (intuition/creativity) ( Frisch, 2000). A holistic nurse uses and values all of these elements. "A holistic nurse can move back and forth between intuitive knowing and logical reasoning; between a creative approach to care and a standard care protocol; between a hunch of what to do and a considered direction grounded in the predictions of a theory ( Frisch, 2000 p. 175)."
Certification in Holistic Nursing
The Standards of Practice and the statements of knowledge and skills required for holistic nursing have been used to establish minimum competencies for practice in the nursing specialty. These are used by the American Holistic Nurses' Certification Corporation (AHNCC) to provide certification for nurses whose practice has advanced to meet speciality standards. AHNCC uses a combination of portfolio review and standardized testing to evaluate candidates for certification. The title "Holistic Nurse - Certified" (HNC) is used by nurses obtaining the credential through AHNCC. Details of the process are available at www.ahna.org/edu/certificatin.html.
Holistic Nursing and CAM
Practicing nursing according to the Standards demands that nurses continually develop knowledge and skills in all aspects of their practice.

Holistic nursing is a way of thinking, reflecting, practicing, and being-in-the-world.

Many holistic nurses use complementary and alternative modalities to meet their client's needs for treatments promoting healing, comfort, and a sense of harmony and peace. Just as professional nursing cannot and should not be defined by tasks and a listing of activities that nurses do, holistic nursing cannot and should not be defined as use of modalities defined as 'alternative'. Holistic nursing is a way of thinking, reflecting, practicing, and being-in-the-world. Many think of holistic nursing as a way of life as the philosophy, thoughts, and self-care become incorporated into one's daily living and professional identity. As nurses increase their use of complementary and alternative practices, study of the Standards can serve as catalyst for reflection on the intents and outcomes of complementary/alternative modalities. The modalities are used to address client needs. Nurses working across cognitive, experiential and affective domains may use the Standards to articulate the philosophies and values that underpin and guide their practice.

Noreen Cavan Frisch, PhD, RN, FAAN
E-mail: nfrisch@uvic.ca

Noreen Cavan Frisch, PhD, RN, FAAN is a Professor of Nursing and Chair of the Department of Nursing at Cleveland State University. She is past-president of the American Holistic Nurses Association and has served as a member of the Advisory Council to the NIH Office of Alternative Medicine. She has published articles on topics of nursing theory, diagnosis and holism. She co-chaired a national committee to produce the AHNA Standards of Holistic Nursing Practice, which were published in 2000 in a book for which she served as first author and editor.

Acknowledgment: Members of the task force that created the Standards of Holistic Nursing Practice are: Barbara Dossey, MSN, RN, HNC, FAAN and Noreen Frisch, PhD, RN, HNC, FAAN, Taskforce Co-Chairpersons, with Cathie Guzzetta, PhD, RN, HNC, FAAN, Lynn Keegan, PhD, RN, HNC, FAAN, Susan Luck, MA, RN, HNC, Johanne Quinn, PhD, RN, HNC Lynn Rew, EdD, RN, HNC, FAAN and Louise Selanders, EdD, RN.

AHNA. (1992/revised 1998). Description of Holistic Nursing. Flagstaff, AZ: Author.

Clements, I., & Martin, E. J. (1989). Nursing and Holistic Wellness: A new beginning. Dubuque, IA: Kendall/Hunt Publishing Company.

Dossey, B. (2000). Introduction. In N. Frisch, B. Dossey, C. Guzzetta, & J. Quinn, (2000). AHNA Standards of Holistic Nursing Practice: Guidelines for caring and healing. (pp. xv - xxiii). Gaithersburg, MD: Aspen Publishers.

Dossey, B. (1997). Core Curriculum for Holistic Nursing. Gaitherburg, MD: Aspen Publishers.

Dossey, B., Frisch, N., Forker, J., & Lavin, J. (1998). Evolving a blueprint for certification. Journal of Holistic Nursing, 16(1), 33 - 56.

Dossey, B., Keegan, L., & Guzzetta, C. (2000). Holistic Nursing: A handbook for practice (3 rd ed.). Gaithersburg, MD: Aspen Publishers.

Frisch, N. (2000). Nursing theory in holistic nursing practice. In B. Dossey, L. Keegan, & C. Guzzetta (Eds.), Holistic Nursing: A Handbook for Practice (3 rd ed.), (pp. 173 - 182). Gaithersburg, MD: Aspen Publishers.

Frisch, N., Dossey, B., Guzzetta, C., & Quinn, J. (2000). AHNA Standards of Holistic Nursing Practice: Guidelines for caring and healing. Gaithersburg, MD: Aspen Publishers.

© 2001 Online Journal of Issues in Nursing
Article published May 31, 2001

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complementary therapies: are these really nursing?

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Standards for Holistic Nursing Practice: A Way to Think About Our Care That Includes Complementary and Alternative Modalities

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Noreen Cavan Frisch, PhD, RN, FAAN The Standards of Holistic Nursing Practice were developed by the American Holistic Nurses Association (AHNA) as a public statement regarding the practice of holistic nursing as a specialty. This article reviews the development of the practice standards, and presents the philosophies and values which underpin holistic nursing.

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1. One advantage to holistic nursing is that it acknowledges the mind-body-spirit connection in each individual. Understanding the interconnectedness between the three, allows nurses to help guide patients to overall wellness. If one or two of the three is failing, the patient may have delayed healing or recovery process.

2. Another advantage of holistic nursing is that it allows for the use of alternative / complementary medicine. Complementary and therapeutic medicine can be less invasive and patients may appreciate receiving this care prior to more invasive procedures. Some examples are guided imagery, therapeutic massage, prayer, etc.

3. Lastly, an advantage of holistic nursing is that it evokes autonomy. The patient is considered a sum of parts and each part is treated to ensure that the patient returns to health physically, emotionally, and spiritually. The patient gets to voice what he or she needs help with and what approach to take either being medical treatment, complementary treatment, or both.

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/HolisticNursingPractice.html

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1. One advantage to holistic health is that it addresses the patient’s physical symptoms, as well as their mental, emotional, spiritual, and social factors affecting their health. This is important since it attempts to improve an individuals overall health!
2.  A second advantage of holistic health is that it is better long-term. This will help with an existing problem but also help prevent other problems down the line by paying attention to one's diet, exercise, psychotherapy, relationship, etc.
3. A third advantage to holistic health is prevention is primary and treatment is secondary. This is an advantage because complementary and alternative medicine (CAM), education, lifestyle changes, and self-care is used before other methods. Natural methods are used and this helps people to take control of their own health.

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/HolisticNursingPractice.html

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1. The benefits of holistic medicine is that it treats the whole body and not just the disease itself. The idea is to involve the entire physical body including the person's spiritual and mental health.
2. There is an emphasis on preventing illnesses as opposed to treating them. Exercise, yoga, meditation, and eating healthy are a few of the holistic approaches to medicine and preventing diseases

3.The fewer side effects with holistic medicine is one of the benefits of holistic medicine. Holistic medicine does not rely on surgery and medication that causes all kinds of problems like nausea, weakness, and pain.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173273/