holistic care complementary care nursing practice

Introduction: Synopsis and Theme
In “A Patient’s Story,” Kenneth Schwartz provides a personal biopsychosocial narrative about his experiences undergoing treatment for cancer. Himself a physician, Schwartz finds himself adopting a new role as patient, seeing for the first time in his career the medical system from the patient’s point of view. The healthcare system that he had for so long contributed to as a doctor seemed suddenly limited, painfully bereft of the human factors that Schwartz claims would have enhanced his healing process.
Factors Schwartz never considered relevant or meaningful within the realm of healthcare service delivery—from eye contact and touch to the use of prayer—suddenly became central to his ability to build psychological and spiritual resilience during the toughest times of his life. Some nurses were “cool and brusque,” which promoted the already intense feelings of agitation, apprehension, anger, and fear burgeoning within Schwartz and his family members (p. 2). Other nurses offered him the opposite: brief moments of genuine kindness expressed through simple gestures and acts of kindness. Some of Schwartz’s needs were also fulfilled by small changes to the healthcare environment.
Schwartz had access to the best doctors and the best treatments available, thanks not only to his own professional stature but also to his family and colleague connections in oncology. Yet no amount of money or resources could substitute for the holistic treatment that Schwartz truly needed. The primary theme of “A Patient’s Story” is the importance of patient-centered care. Schwarz’s story also shows how healing is not just about elimination of disease. Healing is about cultivating the mental, emotional, and spiritual mindset conducive to wellbeing, transcending physical health status. It is about promoting a culture of healing among nurses and other healthcare workers, so that all patients feel safe, supported, and empowered. For some patients, healing will include the proximity to loved ones; to others it will entail specific religious practices. Regardless of the patient’s background or spiritual orientation, holistic patient-centered care can address the critical gaps in quality of service.
Statement on Complementary and Holistic Care
Schwartz’s narrative illustrates some of the key issues in complementary, holistic, and patient-centered care. Based on the Schwartz biopsychosocial narrative, nurses can learn how to improve communication with patients, how to create a patient-centered environment and corresponding care model, and how to empower other healthcare workers also to maintain an environment of caring. Holistic care can, but does not necessarily have to, include access to the patient’s preferred spiritual resources including people, books, music, or items that help them to pray or meditate. Within the holistic, patient-centered model, nurses listen actively to patient needs and shift the focus from the disease to holistic healing. Schwartz’s story is one of many that have stimulated discussions on how to improve service delivery in the contemporary healthcare institution.
Research
Research on holistic, complementary, and patient-centered care substantiates what Schwartz points out in his narrative. For example, Gallison & Kester (2018) claim that holistic nursing practice has become an “increasingly important aspect of today’s healthcare delivery system,” (p. 181). Holistic nursing practice is further defined as “creating supportive, caring environments for both staff and patients,” thereby implying the strong role that nurse leadership plays in fostering a patient-centered model (Gallison & Kester, 2018, p. 181). Nurse education also needs to uphold the tenets of holistic care, embedding the principles of complementary and patient-centered care practices into core curriculum. A survey of hundreds of nursing books used in certified nurse training and education showed that while many textbooks included some mention of spirituality and religion, the subject was marginalized and treated as ancillary to the general practice of the profession (Timmins, Murphy, Neill, et al., 2015). Likewise, Booth & Kaylor (2018) found that nurses are “unprepared to meet the spiritual needs of patients,” and are “often uncomfortable” addressing matters related to patient spirituality or complementary care needs (p. 177). If nurse leaders truly intend to address the shortfalls of their profession vis-a-vis the Schwartz narrative, they need to centralize holistic care and show how holistic care is actually the crux of all patient-centered care.
To properly incorporate holistic care into nurse education and nursing practice, or to make holistic care a comprehensive component in organizational policy, it is essential to define what holistic care is. Nurses can offer operationalized definitions that help dispel myths and clarify concerns for their colleagues. For example, Booth & Kaylor (2018) define holistic care as embracing the physical, mental, and spiritual dimensions of the patient as well as those corresponding dimensions in the healthcare environment. As it stands, nursing education and practice focuses almost exclusively on the physical domain, with psychiatric nurses of course comprising some of the mental and emotional components of care. Yet nursing education lacks a comprehensive curriculum that embeds holistic principles even into the realm of psychiatric nursing, which is not holistic when it neglects to take into account patient physician or spiritual needs (Timmins, Murphy, Neill, et al., 2015). Some definitions of holistic care emphasize the “spiritual needs” of patients, but nurses fail to remember that not all patients define, perceive, or articulate their spiritual needs the same (Timmins, Murphy, Neill, et al., 2015). Patient diversity and cultural sensitivity are therefore aspects of nursing education, care, and practice that coincide with the impetus to offer holistic care. When nurses realize that spiritual needs are actually a major component of the patient’s sense of identity, well-being, and social connection, holistic care can be reframed from something that seems too religious or pseudoscientific to an approach that is evidence-based, pragmatic, and universal in its approach.
To more effectively deliver holistic care to all patients in a diverse environment, nurses are urged to gain knowledge about the principles and practices of complementary and holistic care as it varies depending on cultural orientation. Research shows that nursing students developed an “increased respect for individuals from backgrounds that differed from their own” when exposed to specific information and learning opportunities (Booth &Kaylor, 2018). Therefore, nurse leaders can actively promote nurse education and cultural awareness in their professional development programs and managerial activities. Nurse leaders and administrators can also promote a culture that values social justice as part of the overall commitment to holistic care (Gallison & Kester, 2018). Some administrators may wish to formally mention or integrate spirituality into institutional policy, while others may prefer to use broader terminology that refers to holistic care (Timmins, Murphy, Neill, et al., 2015).
Another major component of holistic care that Schwartz tacitly addresses in “A Patient’s Story” is linked to issues more typically covered in research on leadership and organizational culture. A climate of care depends on nurse leaders and administrators in the organization, as leaders set the tone for healthcare behaviors and service delivery. Human resources managers also need to consider the role they play in developing nurses and recruiting new staff. If an organization intends to make holistic care a primary value or ethical principle, or even part of the mission and vision of the institution, then all leaders in the organization need to promote a culture of holistic care. A culture of holistic care includes a collaborative and supportive work environment, and formal means to reduce nurse burnout, frustration, and fatigue (Gallison & Kester, 2018). Nurses who practice effective self-care also embody the principles of holistic nursing, serving as role models to their peers and inspirations to their patients. When nurses enjoy a safe, supportive, healthy workplace environment, they possess the tools with which to support patients on their own healing journey. Gallison & Kester (2018) mention lifestyle factors as part of the overall holistic care model, both with regards to patient complementary care options and nurse self-care. Nurse personal and professional development programs can include ongoing courses and similar opportunities to incorporate new holistic care practices. While nurses will always need to maintain their core competencies delivering evidence-based physical care to patients, holistic care needs to step off the backburner and become more central to healthcare.
Conclusion: Impact on Nursing Care and Practice
Holistic care is more than jut a buzzword. As Schwartz’s (1995) poignant patient narrative points out, holistic care is one of the hugest missing links in quality of service delivery in the American healthcare system. Nurses and other members of the healthcare team have been wonderfully trained in how to diagnose and treat the physical body. However, patients who undergo treatment in healthcare institutions need and want more than just medications, surgery, and tests. Holistic care is especially important for patients like Schwartz, who face a potentially fatal or chronic illness.
To promote the values of holistic care, nurses and administrators need to change the fundamental structure of their institutions including the educational curricula for nursing students and nurse professional development courses. Holistic care can permeate nurse core curricula and institutional policies effectively, while being aligned with evidence-based practice. The principles of holistic care form the overarching philosophical framework that guides all healthcare practice.



References
Booth, L., & Kaylor, S. (2018). Teaching Spiritual Care Within Nursing Education. Holistic Nursing Practice, 32(4), 177–181. doi:10.1097/hnp.0000000000000271
Gallison, B. & Kester, T. (2018). Connecting holistic nursing practice with relation-based care. Nurse Leader 16(3): 181-185. doi:10.1016/j.mnl.2018.03.007
Schwartz, K.B. (1995). A patient’s story. The Boston Globe Magazine. 15 July, 1995. http://www.theschwartzcenter.org/media/patient_story.pdf
Timmins, F., Murphy, M., Neill, F., et al. (2015). An exploration of the extent of inclusion of spirituality and spiritual care concepts in core nursing textbooks. Nurse Education Today 35(1): 277-282. doi:10.1016/j.nedt.2014.05.008