Holistic health is the idea that the whole person is made up of interdependent parts. We achieve optimal health - which is the primary goal of holistic medicine practices - by gaining

proper balance in life

Cynthia Grace

Many patients wish to discuss spirituality with healthcare providers, but barriers such as limited training, lack of time, and personal discomfort prevent nurses from addressing these concerns (Best et al., 2015). Nursing education provides minimal preparation, creating a gap in practice. The abstract nature of spirituality further complicates assessment and intervention (Cooper et al., 2020). Addressing these gaps can enhance comprehensive, patient-centred care in palliative settings. This approach promotes a deeper connection between nurses and patients, fostering a more compassionate and patient-centred healthcare experience.

Organizations such as the Hospice and Palliative Nurses Association advocate for integrating spiritual care into practice through education and evidence-based approaches (Ali et al., 2015). They emphasizes a comprehensive approach to nursing that nurtures wholeness, peace, and healing. It highlights the importance of valuing each individual's physical, mental, emotional, spiritual, and environmental strengths and challenges. These organization advocates for honoring patients' values, health beliefs, and experiences while ensuring that holistic care is integrated into every stage of nursing, including assessment, diagnosis, planning, and evaluation (ANHA, 2017). They also highlight that while holistic nursing promotes mind-body-spirit care, the spiritual component is often overlooked in fast-paced clinical settings (Southard, 2020).

Holistic care, which includes integrating religious or spiritual practices, is impportant in respecting and acknowledging patients values, beliefs, and traditions. Religion for example, as part of a holistic approach, offers patients a framework for finding meaning, purpose, and comfort during challenging times, especially at the end of life. It allows for a deeper exploration of existential concerns, provides emotional support, and helps patients reconcile with the idea of death.

Recognizing that religious practices such as prayer, scripture reading, and rituals can be powerful tools for alleviating suffering. This attention to this spiritual aspect increase the therapeutic relationship, fosters a sense of dignity, and provides patients with a source of hope or peace in their final days.

Advocates for the creation of mandatory multidisciplinary teams in palliative care settings, which would consist of healthcare professionals such as physicians, nurses, social workers, spiritual leaders, and psychologists. These teams would be responsible for developing and implementing individualized care plans that address the full spectrum of a patient’s needs, including physical, emotional, social, and spiritual aspects. By combining the expertise of various professionals, the team would ensure that the patient’s well-being is cared for holistically.

• One of the key elements of this policy is the establishment of clear communication protocols and regular case reviews. These measures would ensure that all team members are on the same page, fostering collaboration and a unified approach to patient care. Additionally, regular reviews would allow the team to assess the effectiveness of the patient's individualized care plan and make necessary adjustments according to their preference, ensuring that the patient’s evolving needs are continually met. This holistic approach would lead to more personalized care and better overall patient outcomes.

• Another important aspect is the requirement for periodic, up-to-date training for all team members. This training would focus on numerous holistic care practices, including communication skills, cultural competency, and the ability to manage the emotional and spiritual concerns of patients and their families. By providing ongoing education, healthcare providers can stay current with best practices and enhance the quality of care they offer.

• The benefits of this policy are multifaceted. It ensures that no aspect of a patient’s well-being is overlooked, improving both the quality of care and patient satisfaction. It also reduces provider burnout by fostering a supportive, collaborative work environment.

Mindfulness-Based Interventions (MBIs)
Mindfulness-based interventions (MBIs), such as mindfulness-based stress reduction (MBSR), have been shown to improve self-efficacy and reduce stress. A systematic review of studies on MBIs for informal caregivers of palliative patients found positive outcomes, including reduced caregiver burden, anxiety, and depression. These interventions, particularly mindfulness-based breathing therapy, are now increasingly incorporated into holistic care plans for their simplicity and effectiveness.

Music Therapy
Music therapy is another valuable practice in holistic palliative care. Research suggests that music therapy helps reduce stress, anxiety, and emotional exhaustion in caregivers, promoting relaxation and comfort. Although studies specifically targeting caregivers are limited, initial findings support music therapy’s role in emotional and psychological support.

Addressing Caregiver Needs
Caregivers often face significant emotional strain, stress, and burnout. While few studies specifically target interventions for caregivers, the combination of mindfulness-based breathing therapy and music therapy is a promising approach to alleviate caregiver burden. This dual strategy offers caregivers psychological relaxation and therapeutic support, addressing their emotional and physical well-being in a holistic manner (Yildirim et al., 2024).

Physical Aspects of Holistic Palliative Care
Studies highlight the growing role of alternative therapies in managing physical symptoms like pain, nausea, and fatigue. For example, acupuncture has been shown to reduce cancer-related fatigue and chemotherapy-induced neuropathy, offering non-pharmacological symptom relief. Patients' openness to conventional treatments, such as radiotherapy or oxygen therapy, often improves with trust-building strategies and empathetic communication.

Emotional and Spiritual Aspects
Holistic palliative care requires a multifaceted, individualized approach that addresses not only physical symptoms but also emotional and spiritual well-being. The involvement of an interdisciplinary team, includin pharmacists, integrative medicine specialists, spiritual care providers, and social workers ensures that care is tailored to the patient's needs and values. Communication techniques like motivational interviewing help build trust, allowing patients to feel heard and valued.

Interdisciplinary Teamwork and Communication
A patient-centered strategy is essential for understanding the motivations and beliefs behind patients’ preferences for alternative therapies. Regular monitoring, follow-ups, and clear documentation are necessary to assess and adjust care plans effectively. Educating palliative care teams on cultural competence, ethical considerations, and alternative therapies equips them to engage in informed discussions and support shared decision-making (Cerqueira et al., 2025)

To create a relaxed, café-style wellness space where palliative care patients and their families can connect, unwind, and find holistic support through meaningful activities that nurture physical, emotional, social, and spiritual well-being. This ongoing, nurse-led initiative combines health education, expressive therapies, and community connection in an informal, comforting environment.

📅 Schedule: Weekly or bi-weekly drop-in sessions (flexible participation)
📍 Location: Hospice centers, hospitals, or community spaces
👩‍⚕️ Facilitators: Nurses, therapists, palliative personnel, religious leaders, and wellness professionals
🎟️ Participants: Palliative care patients, families, caregivers, and healthcare providers

☕ The Atmosphere: A warm, welcoming space with soft lighting, music, and comfortable seating where people can gather, participate in wellness activities, or simply enjoy a beverage or snack and conversation.

🌿Spiritual care providers—chaplains, faith leaders, or spiritual counselors—are here to listen, guide, and offer comforting words for those who seek support.

There are also resources like sacred texts, poetry, mindfulness exercises, and affirmations available to help find peace or meaning when words feel hard to find.

🌿Gratitude & Prayer Wall: Messages of Love, Hope, and Remembrance. A dedicated space where families can leave messages of gratitude, hope, or just a few words of love. Whether it's a simple note or a heartfelt letter, this wall is a place to express whatever feels right.

✅ Art & Craft Therapy Station

• Patients and families paint, draw, create collages, or mold clay to express their feelings.

• Journaling & letter-writing stations encourage storytelling and self-reflection.

• Legacy projects like handprint art or memory create keepsakes for loved ones.

✅ Music Therapy: Live Acoustic Performances & Personalized Playlists

• Live music sessions with soothing melodies to create a calming atmosphere.

• Patients can request favorite songs that bring back meaningful memories.

• Personalized playlists can be curated for comfort, relaxation, and emotional connection.

✅ Story-Sharing Sessions: Capturing Memories & Wisdom

• Guided storytelling circles where patients share life lessons, favorite moments, and personal experiences.

• Family members and caregivers can record video or audio messages as keepsakes.

• Patients can write letters or voice messages for their loved ones, providing words of wisdom and love.

✅ Gentle Movement Sessions

• Guided chair yoga, stretching, and breathwork designed for patients with limited mobility.

• Helps reduce pain, improve circulation, and promote relaxation.

• Led by a nurse or physiotherapist specializing in palliative care.

✅ Massage Therapy & Therapeutic Touch

• Trained professionals provide gentle hand, foot, and scalp massages to relieve tension.

• Aromatherapy sessions offer non-invasive comfort techniques for relaxation and emotional balance.

• Family caregivers are taught simple massage techniques to provide comfort to their loved ones.

✅ Tea & Nutrition Corner: Nourishing the Body & Soul

• Dietitian-led talks on foods that help with fatigue, nausea, and pain management.

• A selection of calming teas and nutrient-rich snacks tailored for patients with dietary restrictions.

• Encourages mindful eating as a form of self-care.

1. How can healthcare providers move beyond cultural competency to actively integrate culturally safe and decolonized approaches in holistic palliative care, particularly for Indigenous and other marginalized communities?

2. In what ways does the medicalization of palliative care create barriers to addressing the emotional, social, and spiritual dimensions of patient well-being, and how can interdisciplinary collaboration help bridge these gaps

3. Given that many healthcare providers report discomfort or lack of training in discussing spirituality with patients, what structural and educational changes are needed to ensure that nurses feel confident in providing holistic, patient-centered spiritual care?

4. How can the nursing profession advocate for policies that recognize and prioritize holistic wellness in palliative care while balancing the constraints of time, institutional policies, and resource limitations in modern healthcare settings?

American Holistic Nurses Association (AHNA). (2017). What is holistic nursing? http://www.ahna.org/About-Us/What-We-Do

Best, M., Butow, P., & Olver, I. (2015). Do patients want doctors to talk about spirituality? A systematic literature review. Patient Education and Counseling, 98(11), 1320–1328. https://doi.org/10.1016/j.pec.2015.04.017

Baldacchino, D. (2015). Spiritual Care Education of Health Care Professionals. Religions (Basel, Switzerland ), 6(2), 594–613. https://doi.org/10.3390/rel6020594

Cerqueira, P., Pereira, S., Costa, R., & Garrido Gomes, A. (2025). Navigating Alternative Medicine Preferences in Palliative Care: Challenges and Collaborative Solutions. Cureus, 17(1), e77864. https://doi.org/10.7759/cureus.77864

Cooper, K. L., Chang, E., Luck, L., & Dixon, K. (2020). How Nurses Understand Spirituality and Spiritual Care: A Critical Synthesis. Journal of Holistic Nursing, 38(1), 114–121. https://doi.org/10.1177/0898010119882153

Dahlborg Lyckhage, E., Brink, E., & Lindahl, B. (2018). A Theoretical Framework for Emancipatory Nursing With a Focus on Environment and Personsʼ Own and Shared Lifeworld. Advances in Nursing Science, 41(4), 340–350. https://doi.org/10.1097/ANS.0000000000000227

Ferrell, B. (2019) National Consensus Project Clinical Practice Guidelines for Quality Palliative Care: Implications for Oncology Nursing. Asia-Pacific Journal of Oncology Nursing, 6(2), 151–153. https://doi.org/10.4103/apjon.apjon-75-18

Jethva, D. D., Patel, B. C., Sundar, S., Patel, J. B., Vora, H. H., & Sanghavi, P. R. (2025). Harmonising Hope: Impact of Music Therapy on Cancer Pain and Palliative Care. Indian Journal of Palliative Care, 31(1), 21–26. https://doi.org/10.25259/IJPC_235_2024

Lukovsky, J. , McGrath, E. , Sun, C. , Frankl, D. & Beauchesne, M. (2021). A Survey of Hospice and Palliative Care Nurses' and Holistic Nurses' Perceptions of Spirituality and Spiritual Care. Journal of Hospice & Palliative Nursing, 23 (1), 28-37. doi: 10.1097/NJH.0000000000000711.

Southard, M. E. (2020). Spirituality: The Missing Link for Holistic Health Care. Journal of Holistic Nursing, 38(1), 4–7. https://doi.org/10.1177/0898010119880361

Yildirim, D., Çiriș Yildiz, C., & Harman Özdoğan, M. (2024). The Effects of Mindfulness-Based Breathing on Strain, Burden, and Burnout in Family Caregivers of Palliative Care Patients: Randomized Controlled Study. Holistic Nursing Practice. https://doi.org/10.1097/HNP.0000000000000685

References

Karaca, T., & Ercan Sahin, N. (2025). The Effect of Palliative Spiritual Care Education on Nursing Students’ Perception of Spiritual Care and Attitudes towards Death in Turkey: A Quasi-Experimental Study. Journal of Religion and Health, 64(2), 920–929. https://doi.org/10.1007/s10943-024-02196-0

Colker, R. (2023). Overmedicalization? Harvard Journal of Law & Gender, 43. https://ssrn.com/abstract=4622766

The response to the discussion question as well as the resource you have used to support your answer is very insightful especially to us nursing students. I agree that to make holistic care and spiritual conversations more common, seminars or workshops that normalize talking about emotions, beliefs, and spirituality can help. These discussions should be a regular part of training, not just something extra. Nurses can play a huge role by using their voices to bring up sensitive topics with patients, like what brings them peace or what they believe about death. Palliative care is often in a fast-paced environment, and while we should absolutely push for more holistic training, we have to recognize that small changes over time are often more practical and sustainable than big shifts all at once.

Thank you so much for your kind feedback :)

You have touched on a significant tool, that is, the medicine wheel. In palliative care, especially when working with Indigenous patients, using the Medicine Wheel can be really powerful. It’s about recognizing the balance between physical, emotional, mental, and spiritual well-being, which is central to holistic care like you mentioned. This approach helps us support the whole person, not just treat their physical symptoms, but also address their emotional and spiritual needs.

Spiritual care in palliative care is more than just religion, I believe it’s also about helping people find meaning, purpose, and connection. For many Indigenous people, this can mean connecting with ancestors, traditions, or the land, and sometimes includes ceremonies or the guidance of elders. Supporting these spiritual practices can bring peace and comfort at the end of life.

By incorporating the Medicine Wheel or other Indigenous views into care, healthcare providers can respect and honor the patient’s cultural beliefs. It’s about asking the right questions, listening carefully, and offering support in a way that feels true to the patient's individuality, this may include their values and identity.