Holistic Nursing

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORHolistic SALE OR DISTRIBUTION Nursing: ScopeNOT FOR SALE OR DISTRIBUTION and Standards of Practice © Jones & Bartlett Learning,Carla Mariano LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC whole person—body, mind,© emotion, Jones spirit, & Bartlettand Learning, LLC NURSE HEALER OBJECTIVES environment, not just signs and symptoms—and NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Theoretical that may replace or be used as complements to or Describe the scope of holistic nursing. in conjunction with conventional Western medical, • Describe the standards of holistic nursing. surgical, and pharmacologic treatments. • Discuss the five core values of holistic nursing. Critical thinking: An active, purposeful, organized • cognitive process involving creativity, reflection, © JonesClinical & Bartlett Learning, LLC problem© solving, Jones rational & Bartlett judgment, intuitiveLearning, LLC • Integrate the principles of holistic nursing into judgment, an attitude of inquiry, and a philosophical NOT FORpractice. SALE OR DISTRIBUTION orientationNOT toward FOR thinking SALE about OR thinking. DISTRIBUTION • Identify how you implement the standards of Cultural competence: The ability to deliver health care holistic nursing in your practice. with knowledge of and sensitivity to cultural factors • Discuss Holistic Nursing: Scope and Standards of that influence the health behavior and the curing, Practice, 3rd ed., with colleagues. healing, dying, and grieving processes of the person. © Jones & Bartlett Learning,Personal LLC © JonesDisease: & Bartlett A disorder Learning, or state of unbalance LLC that may Reflect on your worldview and how it is similar to produce signs or symptoms. NOT FOR SALE OR• DISTRIBUTIONor different from the philosophy of holism. NOT FORHealing: SALE A lifelong OR journey DISTRIBUTION into wholeness, seeking Explore how the concepts of holistic nursing apply harmony and balance in one’s own life and in • to your personal life. family, community, and global relations. Healing involves those physical, mental, social, and spiritual processes of recovery, repair, renewal, and DEFINITIONS*© Jones & Bartlett Learning, LLC transformation that increase© wholeness Jones and & oftenBartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION(though not invariably) orderNOT and coherence. FOR SALE Healing OR DISTRIBUTION Allopathic/conventional therapies: Medical, is an emergent process of the whole system bringing surgical, pharmacologic, and invasive and together aspects of one’s self and the body, mind, noninvasive diagnostic procedures; those emotion, spirit, and environment at deeper levels interventions most commonly used in allopathic of inner knowing, leading toward integration and Western medicine. balance, with each aspect having equal importance © JonesComplementary/integrative & Bartlett Learning, health LLC approaches and value.© Jones Healing can & lead Bartlett to more complexLearning, levels LLC NOT FOR(CIHA): SALE A broad OR set DISTRIBUTION of healthcare practices, of personalNOT understanding FOR SALE and meaning OR DISTRIBUTION and may be therapies, and modalities that address the synchronous but not synonymous with curing.

© Jones & Bartlett Learning,© Jones LLC & Bartlett Learning LLC, an Ascend Learning© Jones Company. & NOT Bartlett FOR SALE Learning, OR DISTRIBUTION. LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Healing process: A continual journey of change right relationship at one or more levels of the and the evolving of one’s self through life that is body-mind-spirit-environment-energy system. characterized ©by theJones awareness & Bartlett of patterns Learning, that Holistic LLC nurse: A nurse who recognizes© Jonesand integrates & Bartlett Learning, LLC support or thatNOT are challenges FOR SALE or barriers OR to DISTRIBUTIONbody-mind-emotion-spirit-environmentNOT principles FOR SALE OR DISTRIBUTION health and healing and that may be done alone or and modalities into daily life and clinical practice, in a healing community. creates a caring, healing space within herself or Healing relationships: The quality and characteristics himself that allows the nurse to be an instrument of interactions between one who facilitates of healing, shares authenticity of unconditional healing and the person in the process of healing. presence that helps to remove the barriers to the © JonesCharacteristics & Bartlett of such interactions Learning, involve LLC empathy, healing process,© facilitatesJones another & Bartlett person’s Learning, growth LLC NOTcaring, FOR love, SALE warmth, OR trust, DISTRIBUTION confidence, credibility, (body-mind-emotion-spirit-environment-energeticNOT FOR SALE OR DISTRIBUTION competence, honesty, courtesy, respect, shared connections), and assists with recovery from illness expectations, and good communication. or transition to peaceful death. Healing system: A true healthcare system in which Holistic nursing practice process: An iterative people can receive adequate, nontoxic, and and integrative process that involves six steps noninvasive assistance in maintaining wellness that can occur simultaneously: (1) assessing; © Jones & Bartlettand healingLearning, for body, LLC mind, emotion, and spirit, © Jones(2) diagnosing & Bartlett or identifying Learning, patterns, challenges, LLC NOT FOR SALE togetherOR DISTRIBUTION with the most sophisticated, aggressive NOTneeds, FOR and SALE health issues; OR DISTRIBUTION (3) identifying outcomes; curing technologies available. (4) planning care; (5) implementing the care plan; Health: An individually defined state or process in and (6) evaluating. which the individual (nurse, patient, family, group, Honor: An act or intention indicating the holding or community) experiences a sense of well-being, of self or another in high respect, esteem, and harmony, and unity© Jones such that & subjective Bartlett Learning, dignity,LLC including valuing and accepting© Jones the & Bartlett Learning, LLC experiences about health, health beliefs, and humanity of people with regard for the decisions values are honored;NOT a FORprocess SALE of becoming OR an DISTRIBUTION and wishes of another. NOT FOR SALE OR DISTRIBUTION expanding consciousness. Human caring: The moral ideal of nursing Health promotion: Activities and preventive in which the nurse brings one’s whole self measures to promote health, increase into a relationship with the whole self of the well-being, and actualize the human potential person being cared for to protect that person’s © Jonesof people, & families, Bartlett communities, Learning, society, LLC and vulnerability, preserve© Jones her &or hisBartlett humanity Learning, LLC ecology; such activities and measures include and dignity, and reinforce the meaning and NOTimmunizations, FOR SALE fitness OR and DISTRIBUTION exercise programs, experience of NOToneness FOR and unity. SALE OR DISTRIBUTION breast self-exams, appropriate nutrition, Human health experience: That totality of relaxation, stress management, social support, human experience including each person’s prayer, meditation, healing rituals, cultural subjective experience about health, health practices, and promoting environmental health beliefs, values, sexual orientation, and © Jones & Bartlettand safety.Learning, LLC © Jonespersonal & preferences Bartlett thatLearning, encompasses LLC Holistic communication: A free flow of verbal and health-wellness-disease-illness-death. NOT FOR SALE nonverbalOR DISTRIBUTION interchange between and among people NOTIllness: FOR A subjective SALE experience OR DISTRIBUTION of symptoms and and significant beings such as pets, nature, and suffering to which the individual ascribes meaning God/Life Force/Absolute Being/Transcendent and significance; not synonymous with disease; a Being that explores meaning and ideas leading to shift in the homeodynamic balance of the person mutual understanding and growth. to disharmony and imbalance. Holistic ethics: The© Jonesbasic underlying & Bartlett concept ofLearning, the Intention: LLC The conscious awareness© of Jones being in &the Bartlett Learning, LLC unity and integral wholeness of all people and of present moment to help facilitate the healing all nature, identifiedNOT and FOR pursued SALE by finding OR unity DISTRIBUTION process; a volitional act of love; consciousNOT FOR SALE OR DISTRIBUTION and wholeness within the self and within humanity. alignment of essence and purpose allowing In this framework, acts are not performed for the the highest good to flow through a healing sake of law, precedent, or social norms but rather intervention. from a desire to do good freely to witness, identify, Interdisciplinary/interprofessional: Conversation © Jonesand contribute & Bartlett to unity. Learning, LLC or collaboration© acrossJones disciplines & Bartlett where Learning, LLC NOTHolistic FOR healing: SALE A form OR of healingDISTRIBUTION based on knowledge is NOTshared FORthat informs SALE learning, OR DISTRIBUTION attention to all aspects of an individual—physical, practice, education, and research; it includes mental, emotional, sexual, cultural, social, individuals, families, community members, and spiritual, and energetic. The manifestation of various disciplines.

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Meaning: That which is signified, indicated, reformed integrative healthcare delivery system referred to, or understood. Personal/individual in a hospital, clinic, or community or in the meaning© denotesJones symbolic & Bartlett value, significance, Learning, LLC home. Each component involves© Jones a unique & set Bartlett of Learning, LLC and purpose—anNOT FOR individual’s SALE perception OR DISTRIBUTION of an responsibilities and tasks thatNOT addresses FOR theSALE three OR DISTRIBUTION experience. Philosophical meaning is meaning areas of knowledge, values, and skills (Tresolini that depends on the symbolic connections that and Pew-Fetzer Task Force, 1994). are grasped by reason. Psychological meaning is Spirituality: The feelings, thoughts, experiences, and meaning that depends on connections that are behaviors that arise from a search for meaning; experienced through intuition or insight. that which is generally considered sacred or holy; © JonesPatient-centered & Bartlett care: Learning, Care that is LLC respectful of and usually,© though Jones not universally,& Bartlett considered Learning, to LLC NOT FORresponsive SALE to OR individual DISTRIBUTION patient preferences, needs, involve NOTa sense FOR of connection SALE with OR an absolute,DISTRIBUTION and values and that ensures that patient values imminent, or transcendent spiritual force, however guide all clinical decisions. Patient-centered care named, as well as the conviction that meaning, encompasses identifying, respecting, and caring value, direction, and purpose are valid aspects of about patients’ differences, values, preferences, the individual and universe; the essence of being and expressed needs; relieving pain and and relatedness that permeates all of life and is © Jones & Bartlett Learning,suffering; coordinating LLC continuous care/listening© Jonesmanifested & Bartlett in one’s Learning, knowing, doing, LLC and being; NOT FOR SALE OR DISTRIBUTIONto, clearly informing, communicating with, and NOT FORthe SALE interconnectedness OR DISTRIBUTION with self, others, nature, educating patients; sharing decision making and and God/Life Force/Absolute/Transcendent; not management; and continuously advocating disease necessarily synonymous with religion. prevention, wellness, and promotion of healthy Transformational leadership: Leadership that lifestyles, including a focus on population health creates valuable and positive change in individuals (Institute© of Jones Medicine, & 2001). Bartlett Learning, LLC and systems, encouraging individuals© Jones to contribute& Bartlett Learning, LLC Person: An individual, patient, patient, family to their fullest potential by enhancing the motivation, member,NOT support FOR person, SALE or community OR DISTRIBUTION member morale, and performance ofNOT followers. FOR SALE OR DISTRIBUTION who has the opportunity to engage in interaction Transpersonal: A personal understanding that with a holistic nurse. is based on one’s experiences of temporarily Person-centered care: The human caring process transcending or moving beyond one’s usual in which the holistic nurse gives full attention identification with the limited biological, historical, © Jonesand & Bartlettintention to theLearning, whole self of LLC a person, not cultural,© andJones personal & selfBartlett at the deepest Learning, and LLC merely the current presenting symptoms, illness, most profound levels of experience possible; NOT FORcrisis, SALE or tasks OR to beDISTRIBUTION accomplished, and that also that whichNOT transcends FOR SALE the limits OR and boundariesDISTRIBUTION includes reinforcing the person’s meaning and of individual ego identities and possibilities to experience of oneness and unity; the condition of include acknowledgment and appreciation of trust that is created in which holistic care can be something greater. From this perspective the given and received. ordinary biological, historical, cultural, and © Jones & Bartlett Learning,Presence: The LLCessential state or core of healing;© Jonespersonal & Bartlett self is seenLearning, as an important, LLC but only a approaching an individual in a way that respects partial, manifestation or expression of this much NOT FOR SALE OR DISTRIBUTIONand honors her or his essence; relating in a NOT FORgreater SALE something OR DISTRIBUTION that is one’s deeper origin and way that reflects a quality of being with and destination. in collaboration with rather than doing to; Well-being: An inner attitude of feelings of comfort entering into a shared experience (or field of and harmony and acceptance to the wholeness consciousness) that promotes healing potential of one’s being. Integrated, congruent functioning and an ©experience Jones of & well-being. Bartlett Learning, LLC aimed toward reaching one’s© higherJones potential. & Bartlett Learning, LLC Relationship-centered care: A process model Wellness: An active process through which people of caregivingNOT that FOR is based SALE on a visionOR DISTRIBUTIONof become aware of and makeNOT choices FOR toward SALE a OR DISTRIBUTION community where three types of relationships are more successful existence. It is a conscious, identified: (1) patient–practitioner relationship, self-directed and evolving process of achieving (2) community–practitioner relationship, and full potential. Wellness is multidimensional and (3) practitioner–practitioner relationship. Each holistic, encompassing lifestyle, mental and © Jones of& these Bartlett relationships Learning, is essential LLC within a spiritual© well-being,Jones & and Bartlett the environment. Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

* Many of the definitions in this chapter were adapted from Holistic Nursing: Scope and Standards of Practice, 3rd ed. (ANA and AHNA, 2019) and from Holistic Nursing: A Handbook for Practice, 7th ed. (Dossey et al., 2016).

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Profession (ANA, 2010a), it forms the foundation Scope and Standards of practice for all registered nurses. The scope of of Holistic© Jones Nursing & Bartlett Learning,holistic LLC nursing practice is specific© Jones to this &spe -Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONcialty, but it builds on the scopeNOT of practice FOR ex SALE- OR DISTRIBUTION Practice pected of all registered nurses. Extraordinary changes occurred in health care and nursing from 2010 to 2020. During this time, holistic nurses recognized that not only were they Function of the Standards © practicingJones &a uniqueBartlett specialty Learning, within nursing, LLC but of Holistic© NursingJones & Bartlett Learning, LLC NOTalso FORthat they SALE needed OR to DISTRIBUTION develop and publish “The StandardsNOT of Professional FOR SALE Nursing OR Practice DISTRIBUTION standards of practice to document and define that are authoritative statements of the duties that all specialty practice. Holistic nursing was officially registered nurses, regardless of role, population, recognized as a distinct specialty within the disci- or specialty, are expected to perform competently” pline of nursing by the American Nurses Associa- (ANA, 2015b, p 2.). “Standards reflect the values © Jones & Bartletttion (ANA) Learning, in November LLC 2006. © andJones priorities & Bartlett of the profession. Learning, Standards LLC provide NOT FOR SALE ORHolistic DISTRIBUTION Nursing: Scope and Standards of Prac- NOTdirection FOR for SALE professional OR DISTRIBUTIONnursing practice and a tice, 3rd ed. (ANA & AHNA, 2019), articulates framework for evaluation of this practice. Written the scope and standards of the specialty practice in measurable terms, these standards define the of holistic nursing and informs holistic nurses, the nursing profession’s accountability to the public nursing profession, other healthcare providers and and the outcomes for which registered nurses are disciplines, employers,© Jones third-party & Bartlett payers, Learning, legis- responsible” LLC (ANA, 2004, p. 1). © Jones & Bartlett Learning, LLC lators, and the NOTpublic FORabout theSALE unique OR scope DISTRIBUTION of The standards of holistic nursingNOT practice FOR are SALE OR DISTRIBUTION knowledge and the standards of practice and pro- specific to this specialty but build on the stan- fessional performance of a holistic nurse. Holistic dards of practice expected of all registered nurses. Nursing: Scope and Standards of Practice, 3rd ed. (ANA Competencies accompany each standard of & AHNA, 2019), is the foundational document and holistic nursing and articulate the “expected and © resourceJones for & holisticBartlett nursing Learning, education LLCat all levels measureable level© Jones of nursing & Bartlettperformance Learning, that LLC NOT(undergraduate, FOR SALE graduate, OR DISTRIBUTIONcontinuing education) integrates knowledge,NOT FORskills, SALEabilities, OR and DISTRIBUTIONjudg- and for holistic nursing practice, theory, research, ment” (ANA, 2015b, p. 44). advocacy, and certification. Holistic Nursing: Scope and Standards of Practice, 3rd ed., presents a differentiation between practice at the basic and advanced © Jones & BartlettFunction Learning, of theLLC Scope © practiceJones levels. & Bartlett The scope Learning, and standards LLC are or- NOT FOR SALEof OR Practice DISTRIBUTION Statement NOTganized FOR according SALE toOR the DISTRIBUTION ANA criteria used to of Holistic Nursing recognize a nursing specialty area and build on The scope of practice statement describes the nursing knowledge, skills, and competencies who, what, where, when, why, and how of the prac- required for licensure (ANA, 2010b; Mariano, tice of holistic nursing. These elements provide a 2006). The text reflects a consensus of the most picture of the dynamic© Jones and & complex Bartlett practice Learning, of current LLC thinking in the specialty© andJones provides & Bartlett Learning, LLC holistic nursing,NOT its evolving FOR boundaries,SALE OR and DISTRIBUTION its a blueprint for holistic nursingNOT philosophy, FOR SALE OR DISTRIBUTION members. theory, principles, education, research, and Nursing: Scope and Standards of Practice, practices. It incorporates the fundamental phil- 3rd ed. (ANA, 2015b), applies to all professional osophical beliefs, theories, and practices as well registered nurses engaged in practice, regard- as new developments and advancements in the © lessJones of specialty, & Bartlett practice Learning, setting, or educationalLLC field of holistic© nursing. Jones It & is Bartletta foundational Learning, re- LLC NOTpreparation. FOR SALE With theOR Code DISTRIBUTION of Ethics for Nurses source for holisticNOT nursing FOR andSALE a key OR resource DISTRIBUTION With Interpretative Statements (ANA, 2015a) and for certification in holistic nursing. The stan- Nursing’s Social Policy Statement: The Essence of the dards guide clinicians, educators, researchers,

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nurse leaders, and administrators in profes- Even Hippocrates, the father of Western sional activities, knowledge, and performance medicine, espoused a holistic orientation when that are ©relevant Jones to &basic Bartlett and advanced Learning, prac- LLChe taught doctors to observe© Jones their patients’ & Bartlett life Learning, LLC tice, education,NOT FOR research, SALE and ORadvocacy DISTRIBUTION in ho- circumstances and emotionalNOT states. FOR Socrates, SALE too, OR DISTRIBUTION listic nursing. The third edition is derived from promoted it, stating, “Curing the soul; that is the values that are central to the specialty and are first thing.” In holism, symptoms are believed to consistent with the philosophies and theories be an expression of the body’s wisdom as it reacts of holism. to cure its own imbalance or disease. © Jones & Bartlett Learning, LLC The ©root Jones of the &word Bartlett heal comes Learning, from the LLC NOT FOR SALE OR DISTRIBUTION Greek wordNOT halos FOR and SALE the Anglo-Saxon OR DISTRIBUTION word Evolution of Holistic Nursing haelan, which means to be or to become whole. Ancient cultures have defined holism within the The word holy also comes from the same source. healing arts in terms of the balance of forces in Healing means “making whole”—or restoring bal- nature. These elements are foundational in the ance and harmony. It is movement toward a sense © Jones & Bartlett Learning,healing arts practicedLLC today by traditional© and Jones of wholeness& Bartlett and Learning,completion. Healing, LLC therefore, NOT FOR SALE ORindigenous DISTRIBUTION peoples around the globe. AmericanNOT FORis the SALE integration OR of DISTRIBUTION the totality of the person in physician Dr. Jacob Bigelow, in 1835, encour- body, mind, emotion, spirit, and environment. aged physicians to rethink their practice of pre- One of the driving forces behind the holis- scribing medicine for all diseases. He stated that tic nursing movement in the United States was “some diseases are controlled by nature alone” the formation of the American Holistic Nurses (Bigelow,© 1859, Jones p. 36). & BartlettThis holistic Learning, philosophy, LLCAssociation (AHNA). In ©1980, Jones founder & Bartlett Char- Learning, LLC emphasizingNOT a relationshipFOR SALE with OR nature DISTRIBUTION and her lotte McGuire and 75 foundingNOT membersFOR SALE began OR DISTRIBUTION elements, was deeply embedded in the sphere the national organization in Houston, Texas. The of American domestic medicine and family self- national office is now located in Topeka, Kansas. care and ascribed to by many physicians, com- The AHNA’s mission is to advance the philosophy munity healers, and the professional midwives and practices of holistic nursing and unite nurses © Jonesand & nurses Bartlett of the Learning, period. Holism LLC and the rela- in healing© withJones a focus & Bartletton holistic Learning, principles of LLC NOT FORtionship SALE with ORthe environmentDISTRIBUTION and the elements health, preventiveNOT FOR education, SALE ORand DISTRIBUTIONthe integra- of care is a foundational philosophy of care that tion of allopathic and complementary caring and has endured throughout centuries of American healing modalities to facilitate care of the whole nursing care. person and significant others. From its inception Early 19th century American nurses work- in 1980, the AHNA has been the leader in de- © Jones & Bartlett Learning,ing in religious LLC communities sought the balance© Jones veloping & Bartlett and advancing Learning, holistic LLC principles, prac- NOT FOR SALE ORof DISTRIBUTION the humors and the elements, as did theNOT an- FORtices, SALE and guidelines. OR DISTRIBUTION The association predicted cient Greeks. In Britain, Florence Nightingale that holistic principles, caring and healing, and continued the holistic tradition. She believed the integration of complementary and integra- that “Nature alone cures . . . and what nursing tive therapies and approaches would emerge into has to do in either case, is to put the patient mainstream health care. in the best© conditionJones &for Bartlett nature to actLearning, upon him” LLC The AHNA, the definitive© Jones voice for& Bartlettholistic Learning, LLC (Nightingale,NOT 1860, FOR p. 133).SALE Nightingale OR DISTRIBUTION believed nursing, has as its vision: “EveryNOT nurse FOR is aSALE holistic OR DISTRIBUTION in care that focused on unity, wellness, and the nurse”(AHNA, 2019). The mission of the AHNA interrelationship of human beings, events, and is “to illuminate holism in nursing practice, environment (Dossey, 2016). She, like her Amer- community, advocacy, research, and education” ican predecessors, demonstrated an enduring (ANA and AHNA, 2019, p. 5). It is committed © Jonescommitment & Bartlett to Learning,a holistic philosophy LLC and ap- to promoting© Jones wholeness & Bartlett and wellness Learning, in individ -LLC NOT FORproach SALE that incorporated OR DISTRIBUTION the elements of care in uals, families,NOT FORcommunities, SALE nurses OR DISTRIBUTION themselves, service to people’s physical, mental, emotional, the nursing profession, and the environment. and spiritual needs. Through its various activities, AHNA provides

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vision, direction, and leadership in the advance- the aspects of human experience that ment of holistic nursing; integrates the art and contribute to patterns of life, health, science of nursing© Jonesinto the profession;& Bartlett empowers Learning, LLCand illness. (Cowling, 2011,© p. Jones5) & Bartlett Learning, LLC holistic nursingNOT through FOR education, SALE research, OR DISTRIBUTION and NOT FOR SALE OR DISTRIBUTION standards; promotes research and scholarship in holistic nursing; encourages nurses to be models of wellness; honors individual excellence in the Scope of Holistic Nursing advancement of holistic nursing; and influences Holistic nursing is defined as “all nursing practice © policyJones to change& Bartlett the healthcare Learning, system LLC to a more that has healing© theJones whole & person Bartlett as its Learning, goal” LLC NOThumanistic FOR orientation.SALE OR DISTRIBUTION (AHNA, 1998).NOT Holistic FOR nursing SALE is aOR specialty DISTRIBUTION The goals and endeavors of the AHNA have practice that draws on nursing knowledge, the- continued to map conceptual frameworks and ories of nursing and wholeness, expertise, and the blueprint for holistic nursing practice, edu- intuition to guide nurses in becoming therapeu- cation, and research, which is the most complete tic partners with people in strengthening human © Jones & Bartlettway to Learning, conceptualize LLC and practice professional © responsesJones &to Bartlett facilitate theLearning, healing process LLC and NOT FOR SALEnursing. OR DISTRIBUTION The relevance and validity of holistic NOTachieve FOR wholeness. SALE ORHolistic DISTRIBUTION nursing focuses on nursing as a science and practice have been protecting, promoting, and optimizing health increasingly demonstrated in recent years, as and wellness; assisting healing; preventing illness noted here: and injury; alleviating suffering; supporting people to find peace, comfort, harmony, and balance While becoming© Jones more & Bartlettpopular and Learning, through LLC the diagnosis and treatment© Jones of human & Bartlett Learning, LLC more highlyNOT regarded, FOR holism SALE and OR ho DISTRIBUTION- response; and advocacy in the careNOT of individuals, FOR SALE OR DISTRIBUTION listic nursing have contributed to en- families, groups, communities, populations, and hancing the human condition in many the planet. ways. Holism as a philosophy, concept, Holistic nursing care is healing oriented and theory, and practice has been used to centered on the relationship with the person in © Jonesexpand & Bartlettour understanding Learning, of humanLLC contrast to an ©orientation Jones &toward Bartlett diseases Learning, and LLC NOT FORwellness SALE and illness. OR DISTRIBUTION Holistic nursing their cures. HolisticNOT FORnursing SALE emphasizes OR DISTRIBUTIONprac- has become more systematized, refined, tices of self-reflection and self-care, intentional- and diversified as strategies and prac- ity, presence, mindfulness, and therapeutic use of tices have been shown to have an im- self as pivotal for facilitation of healing and pat- pact on health and well-being. Holistic terning of wellness in others. In some sense, all © Jones & Bartlettnursing Learning, . . . has LLCprogressed . . . through © nursingJones practice & Bartlett can be Learning,comprehensive—that LLC is, NOT FOR SALE ORthe DISTRIBUTIONdevelopment of standards, endorse- NOTall nursing FOR SALEpractice ORmay DISTRIBUTIONhave a biopsychosocial ment of programs, and certification of perspective. What makes holistic nursing practice beginning and advanced practition- a specialty is that there is a philosophy, a body of ers. Holistic nursing’s contributions to knowledge, and an advanced set of nursing skills human welfare have been increasingly applied to practice that recognize the totality of recognized ©. . Jones . as evidenced & Bartlett in their Learning, the LLC human being and the interconnectedness© Jones & of Bartlett Learning, LLC current standingNOT FORin health SALE care OR and DISTRIBUTION body, mind, emotion, spirit, energy,NOT society, FOR cul SALE- OR DISTRIBUTION appreciation by society. . . . Holism as ture, relationships, context, and environment. a perspective and holistic nursing as a Philosophically, holistic nursing is a worldview, a response may offer the world something way of being in the world, not just a modality. that counteracts the fragmentation and This philosophy honors the unique humanness of © Jonesisolation & Bartlett that exists Learning, so predominantly LLC all people regardless© Jones of who & andBartlett what they Learning, are. LLC NOT FORin our SALEsociety. . . .OR Holistic DISTRIBUTION nursing . . . Knowledge forNOT holistic FOR nursing SALE practice OR derives DISTRIBUTION provides a context in which nurses can not only from nursing but also from theories of consider, understand, and appreciate all wholeness, energy, and unity as well as from other

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healing systems and approaches. Holistic nurses incorporate both conventional nursing and inte- Box 2-1 Phenomena of Concern to grative modalities© Jones and & interventions Bartlett Learning, into practice. LLC Holistic Nursing © Jones & Bartlett Learning, LLC ThroughNOT unconditional FOR SALE presence, OR DISTRIBUTION mindful- NOT FOR SALE OR DISTRIBUTION ■ The caring, healing relationship ness, and intention, holistic nurses create envi- ■ The subjective experience of and meanings ronments conducive to healing, using techniques ascribed to health, illness, wellness, healing, that promote empowerment, peace, comfort, and birth, growth and development, and dying a subjective sense of harmony and well-being for ■ The cultural values, beliefs, and folk and © Jonesthe &person. Bartlett The holistic Learning, nurse acts LLC in partnership indigenous© Jones practices & Bartlett of health, wellness,Learning, LLC NOT FORwith theSALE individual OR DISTRIBUTIONor family in providing options well-being,NOT FOR illness, SALE healing, andOR death DISTRIBUTION ■ and alternatives regarding health and treatment. Spirituality in nursing care ■ Energy and consciousness In addition, the holistic nurse assists the person to ■ Reflective practice find meaning in the health and illness experience. ■ The use and evaluation of complementary Holistic nursing focuses on simultaneously and integrative health approaches (CIHA) in © Jones & Bartlett Learning,integrating as LLC an iterative process all of these© Jones & nursingBartlett practice Learning, LLC NOT FOR SALE ORrealms: DISTRIBUTION a philosophy of being and living, usingNOT FOR■ SALEComprehensive OR DISTRIBUTION health promotion, disease theories of nursing and wholeness with related prevention, and well-being ■ knowledge and skills, focusing on the unity and Self-reflection, self-care, and self- development processes totality of humans, incorporating healing ap- ■ Physical, mental, emotional, and spiritual proaches, creating healing environments, part- © Jones & Bartlett Learning, LLC comfort, discomfort, and© painJones & Bartlett Learning, LLC nering with and empowering individuals, and ■ Empowerment, decision making, and the assisting NOTin the explorationFOR SALE of meaning OR DISTRIBUTION in the care ability to make informedNOT choices FOR SALE OR DISTRIBUTION of people. In holistic nursing, the nurse is the fa- ■ Social and economic policies and their cilitator of healing, honoring that the person heals effects on the health of individuals, families, himself or herself. The holistic nurse assists indi- and communities ■ Diverse and alternative healthcare systems viduals in identifying themselves as healers and © Jones & Bartlett Learning, LLC and© their Jones relationships & Bartlett to access Learning, and quality LLC accessing their own innate healing capacities. of health care NOT FOR TheSALE practice OR DISTRIBUTIONof holistic nursing requires ■ TheNOT environment, FOR ecosystem,SALE OR and DISTRIBUTIONprevention nurses to integrate self-care and self-responsibility of disease into their own lives and to serve as role models for ■ Healing environment others. Holistic nurses strive for an awareness of the interconnectedness of individuals to the hu- © Jones & Bartlett Learning,man and global LLC community. Thus, holistic nurses© Jones major & Bartlettphenomena Learning, of concern to LLC holistic nursing NOT FOR SALE ORalso DISTRIBUTION attend to the health of the ecosystem. NOT FORare listed SALE in Box OR 2-1 DISTRIBUTION. Holistic nurses are instruments of healing and facilitators in the healing process. They honor Philosophical Principles the individual’s subjective experience of health, health beliefs, and values. To become therapeu- of Holistic Nursing tic partners© Joneswith individuals, & Bartlett families, Learning, commun- LLCHolistic nurses express, contribute© Jones to, & and Bartlett pro- Learning, LLC ities, andNOT populations, FOR SALE holistic ORnurses DISTRIBUTION draw on mote an understanding of theNOT following: FOR SALE OR DISTRIBUTION nursing knowledge, theories, research, expertise, • A philosophy of nursing that values healing intuition, and creativity, incorporating the roles as the desired outcome of clinician, educator, consultant, coach, partner, • A foundation of holistic nursing in the sci- role model, and advocate. Holistic nursing prac- ences of health, wellness, well-being, and © Jonestice & encourages Bartlett peer Learning, review of professionalLLC prac- healing© Jones & Bartlett Learning, LLC NOT FORtice inSALE various OR clinical DISTRIBUTION settings and provides care • NursingNOT as FORan art SALE OR DISTRIBUTION based on current professional standards, laws, • The human health experience as a com- and regulations that govern nursing practice. The plex, dynamic relationship of an individual’s

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understanding of health, wellness, illness, and symptoms are respected for their potential and disease messages. • Environmental© Jones influences & Bartlett and cultural Learning, per- • LLCHealing is multidimensional,© canJones occur & at Bartlett Learning, LLC spectives thatNOT inform FOR an SALE individual’s OR healthDISTRIBUTION any level of the human energeticNOT system, FOR and SALE OR DISTRIBUTION experience is creative, unfolding, and unpredictable. • Healing is an experience defined by the individual and therefore is variable. Person People, as active partners in the healthcare © Jones & Bartlett Learning, LLC • © Jones & Bartlett Learning, LLC • There are unity, totality, and energetic inter- and healing process, are empowered when NOT connectednessFOR SALE ofOR everyone DISTRIBUTION and everything they take someNOT control FOR SALEof their ORown DISTRIBUTIONlives, (body, mind, emotion, spirit, sexuality, age, health, and well-being, including personal environment, social/cultural, belief systems, choices and relationships. relationships, context). • Treatment is a process that considers the root of the problem, issue, or illness, not merely © Jones & Bartlett• Human Learning, beings areLLC unique, diverse, and in- © Jones & Bartlett Learning, LLC herently good. treating the obvious signs and symptoms. NOT FOR SALE• ORPeople DISTRIBUTION are able to find meaning and purpose NOT FOR SALE OR DISTRIBUTION in their own life, experiences, and illness. • All people have an innate power and capac- Practice ity for growth, development, and self-healing. • Practice is a science (clinical reasoning, crit- Health/illness© isJones subjectively & Bartlett described andLearning, de- LLCical thinking, reflection, evidence/research/© Jones & Bartlett Learning, LLC termined by the view of the individual. There- theory) as foundational to practice and an fore, the personNOT is honoredFOR SALE in all phases OR DISTRIBUTIONof his art (intuition, creativity, appreciation,NOT FOR pres SALE- OR DISTRIBUTION or her growth, development, and healing pro- ence, self/personal knowing) as integral to cess, regardless of expectations or outcomes. practice. • People/persons/individuals are the recipients • The values and ethic of holism, caring, moral © Jonesof holistic & Bartlett nursing Learning,services. They LLC may be insight, dignity,© Jones integrity, & competence, Bartlett responLearning,- LLC healthcare consumers, patients, families, sig- sibility, accountability, and legality underlie NOT FORnificant SALE others, ORpopulations, DISTRIBUTION or communities, holistic nursingNOT practice. FOR SALE OR DISTRIBUTION local to global. They may be well and moving • Intention for the well-being and highest good toward personal betterment and enhanced for the care of the recipient is the cornerstone well-being or ill within the healthcare deliv- of all holistic practice. ery system. • Any and all interventions have an effect on © Jones & Bartlett Learning, LLC © Jonesthe whole. & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT• FORThere SALEare various OR philosophies DISTRIBUTION and para- Healing/Health digms of health, wellness, well-being, heal- • Health and illness are natural and a part of ing, and illness and approaches/models for life, learning, and movement toward growth, the delivery of health care (both in the United development, and potential change. States and in other cultures) that should be • Health is seen© Jones as balance, & Bartlett integration, Learning, har- LLCunderstood and utilized. © Jones & Bartlett Learning, LLC mony, rightNOT relationship, FOR SALEand the bettermentOR DISTRIBUTION • Older adults represent the predominantNOT FOR pop SALE- OR DISTRIBUTION of well-being, not just the absence of disease. ulation served by nurses. Healing can take place without cure. The fo- • The health and well-being of society influ- cus is on health promotion, disease preven- ence public policy, the healthcare delivery tion, health restoration, and lifestyle patterns system, and professional nursing. © Jonesand habits,& Bartlett as well asLearning, symptom relief. LLC © Jones & Bartlett Learning, LLC NOT• FORIllness SALEand disease OR are DISTRIBUTION seen as a teacher, an EnvironmentNOT FOR SALE OR DISTRIBUTION opportunity for self-awareness and growth, • The environment includes the surroundings and part of the life process. Health challenges and conditions in which persons/groups live

9781284196597_CH02.indd 32 29/09/20 10:38 AM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Scope of Holistic Nursing 33 and function; humans constantly interact • Acting as an advocate for the rights of, eq- with their environment. uitable distribution of, and access to health • The ©World Jones Health & BartlettOrganization Learning, defines en- LLC care for all persons,© especially Jones vulnerable& Bartlett Learning, LLC vironment,NOT FORas it relates SALE to health,OR DISTRIBUTION as “all the populations NOT FOR SALE OR DISTRIBUTION physical, chemical, and biological factors ex- • Participating in and providing leadership in ternal to a person and all the related behav- the positive transformation of systems iors” (USDHHS, 2017). • Participating in research of the human experi- • Environment is physical, social, psycho- ence and improvement of the nursing process © Jones &logical, Bartlett cultural, Learning, and spiritual LLC characteris- • Conducting© Jones independent & Bartlett and Learning,collaborative LLC NOT FOR tics;SALE external OR andDISTRIBUTION internal features; animate researchNOT and FOR quality SALE demonstration OR DISTRIBUTION projects and inanimate objects; climate; seen and un- to contribute to the rapidly changing knowl- seen vibrations, frequencies, and energy pat- edge base for education and practices terns not yet understood (Luck & Keegan, • Honoring the ecosystem and our relationship 2016). with and need to preserve it, as we are all © Jones & Bartlett Learning,• Environmental LLC health integrates numerous© Jones &connected Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONinteracting factors such as safety, security,NOT and FOR SALE OR DISTRIBUTION violence; it is not simply a result of physical Self-Reflection, Self-Development, qualities (such as air quality and temperature). and Self-Care • Holistic nurses advocate for environmental • Self-reflection—defined as turning inward conditions and policies that foster health, well- to examine one’s thoughts, values, beliefs, ness,© well-being, Jones &and Bartlett healing for Learning, all people. LLC experiences, behaviors,© and Jones inner wisdom—& Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONenhances self-awarenessNOT and FOR understanding SALE OR DISTRIBUTION Nursing Roles and facilitates reflective practice. • Utilizing warmth, compassion, caring, au- • The nurse’s self-reflection, self-assessment, thenticity, respect, trust, and relationship as self-care, healing, and personal develop- instruments of healing in and of themselves ment are necessary for service to others, as © Jones &and Bartlett as part of Learning, the healing environment LLC are ©growth Jones and &change Bartlett in the Learning, nurse’s own LLC NOT FOR• UtilizingSALE ORconventional DISTRIBUTION nursing interventions well-beingNOT FORand understanding SALE OR of DISTRIBUTION the nurse’s as well as CIHA that enhance body-mind own personal journey. -emotion-spirit-environment connectedness • The nurse values herself and her calling to to foster the healing, health, wholeness, and holistic nursing as a life purpose through mo- well-being of people bilizing the necessary resources to develop © Jones & Bartlett Learning,• Collaborating LLC and partnering with all ©con Jones- &and Bartlett care for herself.Learning, LLC NOT FOR SALE OR DISTRIBUTIONstituencies in the health process, includingNOT FOR SALE OR DISTRIBUTION the person receiving care, family, significant others, community, peers, and other disci- Core Values of Holistic plines using principles and skills of coopera- Nursing: Integrating tion, alliance, consensus, and respecting and the Art and Science honoring© Jones the contributions & Bartlett of all Learning, LLC © Jones & Bartlett Learning, LLC ParticipatingNOT FOR in the SALE change OR process DISTRIBUTION to de- of Nursing NOT FOR SALE OR DISTRIBUTION • Holistic nursing emanates from five core values velop more caring cultures in which to prac- summarizing the ideals and principles of the spe- tice, learn, and live • Assisting everyone to nurture and heal cialty. These core values are listed here and then themselves are discussed: © Jones• &Participating Bartlett Learning,in activities that LLC contribute to the 1. Holistic© Jones philosophy, & Bartlett theories, andLearning, ethics LLC NOT FOR improvementSALE OR ofDISTRIBUTION local and global commun- 2. HolisticNOT nurse FOR self-reflection, SALE OR self-development, DISTRIBUTION ities, as well as the betterment of public health, and self-care the environment, and the planet 3. Holistic caring process

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4. Holistic communication, therapeutic relation- nurses. Prominent among those (with their theories ship, healing environment, and cultural care in parentheses) are the following: 5. Holistic education© Jones and research& Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION• Barbara Dossey (Theory of IntegralNOT Nursing)FOR SALE OR DISTRIBUTION • Anne Boykin (Theory of Nursing as Caring) Marlaine Smith (Theory of Unitary Caring) Core Value 1: Holistic Philosophy, • • Marilyn Anne Ray (Theory of Bureaucratic Theory, and Ethics Caring) A nurse’s philosophy is his or her personal approach Rozzano Locsin (Technological Competency © toJones nursing. & It Bartlettis shaped by Learning, the nurse’s reflection LLC on • © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION as Caring andNOT the FOR Practice SALE of Knowing OR DISTRIBUTION Per- his or her practice, beliefs, experiences, educa- sons in Nursing) tion, relationships, and the environment. Holistic • Mary Jane Smith and Patricia Liehr (Story nursing celebrates a way of being that values con- Theory) nection with others and the environment. Holistic Joanne Duffy (Quality Caring Model) nurses recognize the human health experience as • © Jones & Bartletta complicated, Learning, dynamic LLC relationship of health, ill- © InJones addition & Bartlettto nursing Learning, theory, holistic LLC nurses NOT FOR SALEness, OR and DISTRIBUTION wellness, and they value healing as the NOTutilize FOR philosophies SALE OR and DISTRIBUTION theories from other desired outcome of the practice of nursing. Their disciplines to guide and inform healing prac- practice is based on scientific foundations (theory, tice. Examples include but are not limited to the research, evidence-based practice, critical thinking, following: reflection) and© art Jones (relationship, & Bartlett communication, Learning, • LLCTheories of consciousness © Jones & Bartlett Learning, LLC creativity, presence, caring). Systems theory NOT FOR SALE OR DISTRIBUTION• NOT FOR SALE OR DISTRIBUTION Holistic nursing is grounded in nursing • Biofield theory knowledge and skill and guided by nursing • Quantum physics theory. Florence Nightingale’s writings are often • Complexity science referenced as a significant precursor of the de- • Chaos theory © velopmentJones & of Bartlett holistic nursing. Learning, Although LLC each ho- • Coherence© Jones & Bartlett Learning, LLC listic nurse chooses which nursing theory to apply Complementarity NOT FOR SALE OR DISTRIBUTION • NOT FOR SALE OR DISTRIBUTION in any individual case, the following theories, • Spirituality listed with their developers, are most often used • Self-in-relation to support holistic practice: • Holographic theory • Theory of Human Caring and Caring Science • Psychoneuroimmunology © Jones & Bartlett(Jean Learning, Watson) LLC © •Jones Morphic & Bartlett resonance Learning, LLC Science of Unitary Human Beings (Martha • Integral theory NOT FOR SALE• OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Rogers • Rig Veda • Health as Expanding Consciousness (Marga- • Four Directions ret Newman) • Eastern contemplative orientations such as • Theory of Cultural Care Diversity and Uni- the following: versality (Madeleine© Jones Leininger) & Bartlett Learning, LLC• Zen Buddhism © Jones & Bartlett Learning, LLC • Taoism • Human BecomingNOT FORSchool SALE of Thought OR (Rose DISTRIBUTION- NOT FOR SALE OR DISTRIBUTION marie Rizzo Parse) • Alternative medical systems such as the • Humanistic Nursing Theory (Josephine Pat- following: erson and Loretta Zderad) • Traditional Chinese medicine • Modeling and Role Modeling (Helen Erick- • Ayurveda © Jonesson, Evelyn& Bartlett Tomlin, Learning, and Mary Ann LLC Swain) • Native© American Jones and& Bartlett indigenous Learning, LLC healing NOTThere FOR has been SALE significant OR DISTRIBUTION development in the evo- NOT FOR SALE OR DISTRIBUTION lution of holism, healing, and caring conceptualiza- Holistic nurses further recognize and honor tion and theory, largely due to the work of holistic the ethic that each person is the authority on his

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or her own health experience. The holistic nurse for the ethics of nursing. Each of the nine provi- is an option giver and helps the person develop an sions of the code is applicable to and of distinct understanding© Jones of alternatives & Bartlett and implications Learning, of LLCimportance in guiding holistic© Jones nursing &practice Bartlett as Learning, LLC various healthNOT and FOR treatment SALE options. OR DISTRIBUTION The holistic defined in the Scope and NOTStandards. FOR These SALE provi- OR DISTRIBUTION nurse first ascertains what the individual thinks sions are noted in Box 2-2. or believes is happening to him or her and then assists the person to identify what will help the situation. The assessment begins from where the Box 2-2 ANA Code of Ethics © Jonesindividual & Bartlett is. The Learning, holistic nurse LLC then discusses © Jones & Bartlett Learning, LLC Provision 1: The nurse practices with compassion NOT FORoptions, SALE including OR DISTRIBUTIONthe person’s choices across a andNOT respect FOR for the inherentSALE dignity, OR DISTRIBUTIONworth, and continuum and the possible effects and implica- unique attributes of every person. tions of each. The holistic nurse acts as partner Provision 2: The nurse’s primary commitment is and coprescriber versus sole prescriber. The rela- to the patient, whether an individual, family, tionship is a copiloting of the individual’s health group, community, or population. © Jones & Bartlett Learning,experience where LLC the nurse respects the person’s© Jones Provision & Bartlett 3: The Learning,nurse promotes, LLC advocates for, and protects the rights, health, and safety of NOT FOR SALE ORdecision DISTRIBUTION about his or her own health. It is a NOTpro- FOR SALE OR DISTRIBUTION the patient. cess of engagement versus compliance. Provision 4: The nurse has authority, accountability, Client/patient narratives, whether they arise and responsibility for nursing practice; makes from individuals, families, or communities, provide decisions; and takes action consistent with the the context of the experiences and are used as an obligation to promote health and to provide important© focus Jones in understanding & Bartlett the Learning, person’s sit- LLC optimal care. © Jones & Bartlett Learning, LLC uation. HolisticNOT nursesFOR holdSALE the ORbelief DISTRIBUTIONthat people, Provision 5: The nurse owesNOT the same FOR duties SALE to OR DISTRIBUTION self as to others, including the responsibility through their inherent capacities, heal themselves. to promote health and safety, preserve Therefore, the holistic nurse is not the healer but the wholeness of character and integrity, guide and facilitator of the individual’s own healing. maintain competence, and continue In the belief that all things are connected, the personal and professional growth. © Jonesholistic & Bartlett perspective Learning, espouses that LLC an individual’s Provision© Jones6: The nurse, & throughBartlett individual Learning, and LLC NOT FORactions SALE have aOR ripple DISTRIBUTION effect throughout humanity. collectiveNOT effort, FOR establishes, SALE ORmaintains, DISTRIBUTION and Holism places the greatest worth on individuals’ improves the ethical environment of the work setting and conditions of employment that are developing higher levels of human awareness. conducive to safe, quality health care. This, in turn, elevates the whole of humanity. Ho- Provision 7: The nurse, in all roles and settings, listic nurses believe in the sacredness of one’s self advances the profession through research © Jones & Bartlett Learning,and of all nature. LLC One’s inner self and the collec© Jones- & andBartlett scholarly Learning, inquiry, professional LLC standards NOT FOR SALE ORtive DISTRIBUTION greater self have stewardship over not NOTonly FOR SALEdevelopment, OR andDISTRIBUTION the generation of both one’s body, mind, and spirit but also the planet. nursing and health policy. Holistic nurses focus on the meaning and quality Provision 8: The nurse collaborates with other health professionals and the public of life deriving from their own character and from to protect human rights, promote health their relationship to the universe rather than that diplomacy, and reduce health disparities. imposed ©from Jones without. & Bartlett Learning, LLCProvision 9: The profession© of nursing,Jones collectively & Bartlett Learning, LLC HolisticNOT nurses FOR hold SALE to a professionalOR DISTRIBUTION ethic through its professionalNOT organizations, FOR mustSALE OR DISTRIBUTION of caring and healing that seeks to preserve the articulate nursing values, maintain the wholeness and dignity of the self and others. They integrity of the profession, and integrate support human dignity by advocating and adher- principles of social justice into nursing and health policy. ing to the Patient Bill of Rights (The Joint Com- © Jonesmission, & Bartlett 1992) and Learning, the AHNA LLCPosition Statement © Jones & Bartlett Learning, LLC Reproduced from American Nurses Association. (2015). Code of ethics with NOT FORon Holistic SALE Nursing OR EthicsDISTRIBUTION (AHNA, 2012). interpretativeNOT statements. FOR Silver Spring,SALE MD: Author. OR Retrieved DISTRIBUTION from The Code of Ethics for Nurses With Interpretive http://www.nursingworld.org/MainMenuCategories/EthicsStandards Statements (ANA, 2015a) provides a framework /CodeofEthicsforNurses/Code-ofEthics-For-Nurses.html

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resilience; improved nurse–patient communica- Core Value 2: Holistic Nurse tion, care, and satisfaction; and improved work Self-Reflection,© Jones Self-Development, & Bartlett Learning, environments LLC and may help sustain© Jones the nursing & Bartlett Learning, LLC and Self-CareNOT FOR SALE OR DISTRIBUTIONprofession. NOT FOR SALE OR DISTRIBUTION Self-reflection, self-development, and self-care, as well as personal awareness and continual focus on being an instrument of healing, are significant re- Core Value 3: Holistic Caring quirements for holistic nurses. Holistic nurses re- Process © flectJones in and & Bartletton action to Learning, become aware LLC of values, Holistic nurses ©provide Jones care & that Bartlett recognizes Learning, the LLC NOTbeliefs, FOR feelings, SALE perceptions, OR DISTRIBUTION and judgments that totality of the humanNOT FORbeing (theSALE interconnected OR DISTRIBUTION- may affect actions, and they also reflect on their ex- ness of body, mind, emotion, spirit, society, cul- periences to obtain insight for future practice and ture, relationships, context, and environment). to become more authentic and mindful. Holistic This is an integrated as well as a comprehensive nurses value themselves and mobilize the neces- approach. Although physical symptoms are © Jones & Bartlettsary resources Learning, to develop LLC and care for themselves. © treated,Jones holistic & Bartlett nurses Learning,also focus on LLC how the NOT FOR SALEThey OR endeavor DISTRIBUTION to integrate self-awareness, self- NOTindividual FOR SALEcognitively OR perceives DISTRIBUTION and emotion- care, and self-healing into their lives by incorpor- ally deals with the illness; the illness’s effect on ating practices such as self-assessment, meditation, the person’s family, social relationships, and eco- yoga, good nutrition, energy therapies, movement, nomic resources; the person’s values and cultural creative endeavors, support, and lifelong learning. and spiritual beliefs and preferences regarding Holistic nurses ©honor Jones their &unique Bartlett patterns Learning, and treatment; LLC and the meaning of this© experienceJones & to Bartlett Learning, LLC the developmentNOT of the FOR body, theSALE psychosocial OR DISTRIBUTION and the person’s life. In addition, holisticNOT nurses FOR may SALE OR DISTRIBUTION cultural self, the intellectual self, the energetic self, also incorporate several modalities (e.g., cognitive and the spiritual self. Nurses cannot facilitate heal- restructuring, stress management, visualization, ing unless they are in the process of healing them- aromatherapy, therapeutic touch) with conven- selves. Through continuing education, practice, tional nursing interventions. Holistic nurses focus © andJones self-work, & Bartlett holistic nurses Learning, develop theLLC skills of on care interventions© Jones that promote & Bartlett healing, Learning, peace, LLC NOTauthentic FOR and SALE deep ORself-reflection DISTRIBUTION and introspec- comfort, and a NOTsubjective FOR sense SALE of well-being OR DISTRIBUTION for tion to understand themselves and their journey. It the person. is seen as a lifelong process. The holistic caring process involves six often Holistic nurses strive to achieve harmony simultaneously occurring steps: assessment, di- and balance in their own lives and assist others agnosis (pattern, problem, need identification), © Jones & Bartlettto do theLearning, same. They LLC create healing environments © outcomes,Jones & therapeutic Bartlett care Learning, plan, implementation, LLC NOT FOR SALEfor OR themselves DISTRIBUTION by attending to their own well- NOTand FORevaluation. SALE Holistic OR nurses DISTRIBUTION apply the holistic being, letting go of self-destructive behaviors and caring process in all settings with individuals and attitudes, and practicing centering and stress- families across the life span, population groups, reduction techniques. By doing this, holistic and communities. nurses guide others on their healing journey and Holistic nurses incorporate a variety of roles serve as role models© Jones to others, & beBartlett they clients/pa Learning,- into LLC their practice, including expert© Jones clinician & Bartlett Learning, LLC tients, colleagues,NOT or personal FOR SALErelations. OR DISTRIBUTIONand facilitator of healing; consultant,NOT coach, FOR and SALE OR DISTRIBUTION Holistic nurses have played instrumen- collaborator; educator and guide; administrator, tal roles in creating and implementing self-care leader, and change agent; researcher; and advo- programs to increase health and well-being cate. Holistic nurses strongly emphasize part- for clients/patients and families, communities, nership with individuals throughout the entire © healthcareJones & staff, Bartlett and nurses Learning, themselves. LLC Recent re- decision-making© process.Jones Holistic & Bartlett assessments Learning, in- LLC NOTsearch FOR on the SALE effects ORof holistic DISTRIBUTION self-care programs clude not only NOTphysical, FOR functional, SALE psychosocial, OR DISTRIBUTION for nurses and nursing students demonstrates mental, emotional, cultural, and sexual aspects that such programs foster good health behaviors; but also the spiritual, transpersonal, and energy

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field assessments of the whole person. Energy as- individuals and significant others to use their in- sessments are based on the concept that all beings ner strength, wisdom, knowing, and resources are composed© Jones of energy. & Bartlett Congestion Learning, or stagna- LLCthrough the course of healing.© Jones & Bartlett Learning, LLC tion of energyNOT inFOR any SALErealm creates OR DISTRIBUTIONdisharmony Holistic nurses consistentlyNOT FORprovide SALE appro- OR DISTRIBUTION and disease. Holistic nurses use understanding priate and evidence-based information (inclu- of energy anatomy and electromagnetic fields in ding current knowledge, practice, and research) both their assessments and the healing process. regarding the health condition and various treat- Spiritual assessments not only glean religious ments and therapies and their side effects. Holistic © Jonesbeliefs & Bartlett and practices Learning, but also LLCquery a person’s care always© Jonesoccurs within & Bartlett the scope Learning,and standards LLC NOT FORmeaning SALE and ORpurpose DISTRIBUTION in life and how that may of practiceNOT of registeredFOR SALE nursing OR and DISTRIBUTION in accor have changed due to the present health experi- dance with state and federal laws and regulations. ence. Spiritual assessments also include questions A holistic nurse supports the integration of about an individual’s sense of serenity and peace, Complementary Integrative Health Approaches what provides joy and fulfillment, and the source (CIHA) into conventional health care to enable © Jones & Bartlett Learning,of strength and LLC hope. © Jonesthe & patient Bartlett to benefit Learning, from the LLC best of all treat- NOT FOR SALE OR DISTRIBUTIONHolistic assessment data are interpretedNOT into FORments SALE available. OR In DISTRIBUTIONtheir provision of holistic care, patterns, challenges, and needs from which mean- nurses employ practices and therapies from CIHA ing and understanding of the health and disease and conventional approaches, thus creating a fo- experience can be mutually identified with the cus on integrative health (Mariano, 2019). AHNA person. Holistic nurses first ask an individual, has developed a position statement on the role of “What do© you Jones think is& going Bartlett on (happening) Learning, with LLCnurses in the practice of CIHA© Jones (AHNA, & 2016a). Bartlett Learning, LLC you?” andNOT then, FOR“What doSALE you think OR wouldDISTRIBUTION help?” Most complementary NOThealth FORapproaches SALE fall OR DISTRIBUTION Another important responsibility of the holistic into one of two subgroups—natural products or nurse is to help the person identify risk factors mind and body practices (NCCIH, 2015). Natural such as lifestyle, habits, beliefs and values, per- products include substances found in nature such sonal and family health history, and age-related as a variety of herbal medicines (also known as bo- © Jonesconditions & Bartlett that influence Learning, health LLC and then to find tanicals),© vitamins, Jones minerals, & Bartlett whole Learning,diet therapies, LLC NOT FORand useSALE opportunities OR DISTRIBUTION to increase well-being. The and otherNOT “natural FOR products.” SALE Many OR areDISTRIBUTION sold over focus is on the individual’s goals, not the nurse’s. the counter as dietary supplements. (Some uses of Therapeutic plans of care respect the person’s dietary supplements—e.g., taking a multivitamin experience and the uniqueness of each healing to meet minimum daily nutritional requirements journey. The same illness may have very different or taking calcium to promote bone health—are not © Jones & Bartlett Learning,manifestations LLC in different individuals. A major© Jones thought & Bartlett of as CIHA.) Learning, CIHA natural LLC products also NOT FOR SALE ORaspect DISTRIBUTION of holistic nursing practice, in additionNOT to FORinclude SALE probiotics—live OR DISTRIBUTION microorganisms (usually competence, is intention. That is, the nurse in- bacteria) that are similar to microorganisms nor- tends for the wholeness, well-being, and highest mally found in the human digestive tract and that good of the person in every encounter and in- may have beneficial effects. Probiotics are available tervention. This intention honors and reinforces in foods (e.g., yogurts) or as dietary supplements. the innate© capacity Jones of & people Bartlett to heal Learning, themselves. LLC Mind–body practices ©focus Jones on the & interacBartlett- Learning, LLC Therefore,NOT holistic FOR nurses SALE respect OR that DISTRIBUTION outcomes tions among the brain, mind,NOT body, FOR and behavior,SALE OR DISTRIBUTION may not be those expected and may evolve dif- with the intent to use the mind to affect physical ferently based on the person’s individual healing functioning and promote health. process and health choices. Holistic nurses endeavor to detach themselves from the outcomes. Mind and body practices include a © JonesThe & nurse Bartlett does not Learning, produce the LLCoutcomes; the in- large© and Jones diverse & group Bartlett of procedures Learning, or LLC NOT FORdividual’s SALE own OR healing DISTRIBUTION process produces the out- techniquesNOT FORadministered SALE or OR taught DISTRIBUTION by a comes, and the nurse facilitates this process. An trained practitioner or teacher. The 2012 important focus of the holistic nurse is on guiding NHIS showed that yoga, chiropractic and

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osteopathic manipulation, meditation, and in holistic nursing elicit the relaxation response massage therapy were among the most (e.g., breath work, meditation, relaxation, imag- popular mind© Jonesand body &practices Bartlett used Learning,by ery, LLC aromatherapy and essential ©oils, Jones and diet). & Bartlett Learning, LLC adults. OtherNOT mind FOR and body SALE practices OR in DISTRIBUTION- People can learn these therapiesNOT and useFOR them SALE OR DISTRIBUTION clude acupuncture, relaxation techniques, without the intervention of a healthcare provider. such as breathing exercises, guided imag- This allows people to take an active role in the ery, and progressive muscle relaxation), management of their own health care. Holistic tai chi, qi gong, Therapeutic Touch, Heal- nurses also can teach families and caregivers to © Jonesing Touch, & Bartlett hypnotherapy, Learning, and movement LLC use these techniques© Jones for loved & Bartlettones who mayLearning, be LLC NOT therapiesFOR SALE (such ORas Feldenkrais DISTRIBUTION method, ill (e.g., simpleNOT foot orFOR hand SALE massage OR for DISTRIBUTIONolder Alexander technique, Pilates, Rolfing clients/patients with dementia). In addition, indi- Structural Integration, and Trager psycho- viduals are taught how to evaluate their own re- physical integration). sponses to these modalities. The two broad areas discussed— In addition, individuals are taught how to © Jones & Bartlettnatural Learning, products LLC and mind and body © evaluateJones their & Bartlett own responses Learning, to these LLCmodalities. NOT FOR SALE ORpractices—capture DISTRIBUTION most complemen- NOTHolistic FOR nurses SALE may prescribe OR DISTRIBUTION as legally authorized. tary health approaches. However, some They instruct individuals regarding drug, herbal, approaches may not neatly fit into either and homeopathic regimens, and, just as important, of these groups—for example, the prac- they consult on the side effects and interactions be- tices of traditional healers, Ayurvedic tween medications and herbs. They consult, collab- medicine, Traditional© Jones Chinese & Bartlett medicine, Learning, orate, LLC and refer, as necessary, to both© Jonesconventional & Bartlett Learning, LLC homeopathy,NOT and naturopathy.FOR SALE (NCCIH, OR DISTRIBUTION allopathic providers and to holisticNOT practitioners. FOR SALE OR DISTRIBUTION 2015/2018) They provide information and counseling to people about alternative, complementary, integrative, Other therapies frequently incorporated into and conventional healthcare practices. Very im- holistic nursing practice include the following in- portantly, holistic nurses facilitate negotiation of © terventions:Jones & meditation;Bartlett relaxationLearning, therapy; LLC breath services as they© guide Jones individuals & Bartlett and families Learning, be- LLC NOTwork; FOR music, SALE art, and ORaroma DISTRIBUTION therapies; energy-based tween conventionalNOT Western FOR medicine SALE andOR alterna DISTRIBUTION- touch therapies such as therapeutic touch, healing tive systems. Holistic nurses, in partnership with touch, and Reiki; acupressure; massage; guided the individual and others, evaluate whether care is imagery; hypnosis; animal-assisted therapy; bio- effective and whether changes in the meaning of feedback; prayer; reflexology; diet; herbology; and the health experience occur for the individual. © Jones & Bartletthomeopathy. Learning, Other LLCinterventions frequently em- © JonesHolistic & nursesBartlett also Learning,take a lead in incorporatLLC - NOT FOR SALEployed OR inDISTRIBUTION holistic nursing practice in addition to NOTing aFOR holistic SALE caring OR perspective DISTRIBUTION and integrating conventional nursing interventions include anxiety healing strategies into practice and systemwide reduction and stress management, calming tech- programs and organizations. niques, emotional support, exercise and nutrition promotion, smoking cessation, patient contracting, resiliency promotion,© Jones forgiveness & Bartlett facilitation, Learning, hope Core LLC Value 4: Holistic © Jones & Bartlett Learning, LLC installation, presence,NOT journaling, FOR SALE counseling, OR cogniDISTRIBUTION- Communication, TherapeuticNOT FOR SALE OR DISTRIBUTION tive therapy, emotional freedom technique, self-help, Relationship, Healing spiritual support, coaching, health education, con- Environment, and Cultural Care sultation and referral, community health develop- Creation of a therapeutic relationship through ment, and environmental management (NIC 2013). holistic communication, and the context for its © JonesBecause & Bartlettnearly 80 percentLearning, of all U.S. LLC health- expression—an© optimal Jones healing & Bartlett environment— Learning, LLC NOTcare FORissues SALEare stress OR related, DISTRIBUTION holistic nurses em- is an enduringNOT tradition FOR in holisticSALE nursingOR DISTRIBUTION use power individuals by teaching them techniques of self in interacting with another” (Thornton to reduce their stress. Many interventions used & Mariano, 2016, p. 465). Incorporating the

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processes and constructs of therapeutic commu- interventions such as imagery, creation of sacred nication, it acknowledges the infinite, spiritual, space and personal rituals, dream exploration, and energetic© Jones nature & of Bartlett being, the Learning, centrality of LLCnarrative, story, journaling,© andJones aesthetic & Bartlett thera- Learning, LLC heart centeredness,NOT FOR and SALE the incorporation OR DISTRIBUTION of in- pies such as music, color, NOTvisual arts,FOR and SALE dance. OR DISTRIBUTION tention, self-knowledge, transcendent presence, They encourage and support others in the use of and intuition in our interactions. prayer, meditation, and other spiritual and sym- The holistic nurse’s communication ensures bolic practices for healing purposes. that each individual experiences the presence of A cornerstone of holistic nursing practice is © Jonesthe &nurse Bartlett as authentic, Learning, caring, LLC compassionate, assisting ©individuals Jones to& findBartlett meaning Learning, in their ex- LLC NOT FORand sincere.SALE This OR is DISTRIBUTIONdeep listening, or as some say, perience.NOT Regardless FOR of SALEthe person’s OR condition, DISTRIBUTION the “Listening with the heart and not just the ears.” meaning that individuals ascribe to their situation It is done with conscious intention and without can influence their response to it. Holistic nurses preconceptions, busyness, distractions, or analy- attend to the subjective world of the individual. sis. It takes place in the now within an atmos- They consider meanings such as the person’s con- © Jones & Bartlett Learning,phere of shared LLC humanness—human being© toJones cerns & inBartlett relation toLearning, health and familyLLC economics, NOT FOR SALE ORhuman DISTRIBUTION being. Through presence or being withNOT in FORas well SALE as deeper OR meanings DISTRIBUTION related to the person’s the moment, holistic nurses provide each person purpose in life. Regardless of the technology or with an interpersonal encounter that the individ- treatment, holistic nurses address the human ual can experience as a connection with one who spirit as a major force in healing. Each person’s is giving undivided attention to his or her needs perception of meaning is related to all factors in and concerns.© Jones Holistic & nursesBartlett actively Learning, engage in LLChealth-wellness-disease-illness.© Jones & Bartlett Learning, LLC the therapeuticNOT FORuse of self.SALE Communication OR DISTRIBUTION tech- Holistic nurses realizeNOT that suffering, FOR SALE illness, OR DISTRIBUTION niques used by holistic nurses to build therapeutic and disease are natural components of the human relationships include but are not limited to un- condition and have the potential to teach us about conditional regard, respect, deep and active listen- ourselves, our relationships, and our universe. Ev- ing, active observing, demonstrating empathy and ery experience is valued for its meaning and lesson. © Jonesconcern, & Bartlett instilling Learning, hope, mindfulness, LLC relaxation, Holistic© Jones nurses have& Bartlett a particular Learning, obligation LLC NOT FORstress SALE management, OR DISTRIBUTION goal management, crisis inter- to createNOT a therapeutic FOR SALE healing ORenvironment DISTRIBUTION that vention, negotiation, and problem solving. values holism, caring, social support, and in- Using these techniques, holistic nurses convey tegration of conventional and complementary/ to the individual receiving care the belief in his or integrativeapproaches to healing. They seek to her worth and value as a human being, not solely create caring cultures and environments where © Jones & Bartlett Learning,as a recipient ofLLC medical and nursing interventions.© Jonesindividuals, & Bartlett both Learning, clients/patients LLC and staff, feel NOT FOR SALE OR DISTRIBUTIONThe holistic nurse recognizes the importanceNOT FORconnected, SALE supported, OR DISTRIBUTION and respected. A partic- of context in understanding the person’s health ular perspective of holistic nursing is the nurse experience, including family history and com- as the healing environment and an instrument of munity relationships, culture, health, social roles, healing. Holistic nurses shape the physical envi- interdependence, and self-concept. Space and ronment (e.g., light, fresh air, pleasant sounds or time are ©allowed Jones for &exploration. Bartlett EachLearning, person’s LLCquiet, neatness and order,© healing Jones smells, & Bartlett earth Learning, LLC health encounterNOT FOR is truly SALE seen as OR unique DISTRIBUTION and may elements), and they provideNOT a relationship-focused FOR SALE OR DISTRIBUTION be contrary to conventional knowledge and treat- environment by creating sacred space through ments. Therefore, the holistic nurse must be com- presence and intention where another can feel fortable with ambiguity, paradox, and uncertainty. safe, unfold, and explore the dimensions of self in This requires a perspective that the nurse is not healing. The focus on healing environments is ex- © Jonesthe & expert Bartlett regarding Learning, another’s healthLLC and illness tended to© the Jones creation & of Bartlett caring cultures Learning, and com -LLC NOT FORexperience SALE but OR is actually DISTRIBUTION a learner. munitiesNOT where FORfamilies, SALE populations, OR DISTRIBUTION and nations Holistic nurses have a knowledge base of the can feel connected, supported, and respected. use and meanings of symbolic language and use Holistic nurses have an integral role in revisioning

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and transforming organizational cultures into au- practices and modalities outside of conventional thentic healing healthcare systems and in trying to Western medicine. Because of this, holistic nurses remove the political© Jones and financial & Bartlett barriers Learning, to the have LLC a significant effect on people’s© Jonesunderstanding & Bartlett Learning, LLC inclusion of holisticNOT care FOR in the SALE healthcare OR system. DISTRIBUTIONof healthcare options and alternatives,NOT thus FOR serv SALE- OR DISTRIBUTION Culture, beliefs, and values are inherent com- ing as both educators and advocates. ponents of a holistic approach. Concepts of health In addition, holistic nurses provide much- and healing are based in culture and often influ- needed information to individuals on health ence people’s actions to promote, maintain, and promotion, including such topics as healthy © restoreJones health. & Bartlett Culture also Learning, may provide LLC an under- lifestyles, risk-reducing© Jones behaviors, & Bartlett preventive Learning, LLC NOTstanding FOR of aSALE person’s OR concept DISTRIBUTION of illness or disease self-care, stress NOTmanagement, FOR SALEliving with OR changes DISTRIBUTION and appropriate treatment. Holistic nurses pos- secondary to illness and treatment, and oppor- sess knowledge and understanding of numerous tunities to enhance well-being. cultural traditions and healthcare practices from Holistic nurses value all the ways of know- various racial, ethnic, and social backgrounds. ing and learning. They assess health literacy and © Jones & BartlettHowever, Learning, holistic nurses LLC honor the individual’s © individualizeJones & Bartlett learning, appreciatingLearning, that LLC science, NOT FOR SALEunderstanding OR DISTRIBUTION and articulation of his or her own NOTintuition, FOR introspection, SALE OR creativity, DISTRIBUTION aesthetics, and cultural values, beliefs, and health practices rather culture produce different bodies of knowledge than relying on stereotypical cultural classifications and perspectives. They help others to know them- and descriptions. The nurse then uses these under- selves and access their inner wisdom to enhance standings to provide culturally competent care that growth, wholeness, and well-being. corresponds with© Jonesthe beliefs, & Bartlettvalues, traditions, Learning, LLCHolistic nurses may offer guidance© Jones and sup& -Bartlett Learning, LLC and health practicesNOT of FORpeople. SALE Holistic ORnurses DISTRIBUTION ask port to individuals and families NOTin their FOR health SALE- OR DISTRIBUTION individuals, “What do I need to know about you care choices and decisions, especially regarding culturally in caring for you?” This understanding is conventional biomedical and integrative health then used in the creation of a healing environment approaches. Therefore, they must be knowledge- and in promoting communication and cultural care able about the best evidence available for both © thatJones is responsive & Bartlett to the Learning,beliefs, values, LLC traditions, conventional approaches© Jones and & BartlettCIHA. In addition Learning, LLC NOTand healthFOR practicesSALE ofOR all persons.DISTRIBUTION to developing evidence-basedNOT FOR SALE practice OR using DISTRIBUTION re- Holistic healing is a collaborative approach. search, practice guidelines, and expertise, holis- Of particular importance to holistic nurses is the tic nurses strongly consider the person’s values human connection with ecology. Holistic nurses and healthcare actions, customs, behaviors, and actively participate in building an ecosystem that beliefs. © Jones & Bartlettsustains Learning, the well-being LLC of all life. This includes © JonesThe American& Bartlett Holistic Learning, Nurses AssociationLLC NOT FOR SALEraising OR theDISTRIBUTION public’s consciousness about environ- NOTembraces FOR and SALE supports OR all DISTRIBUTION research that has ho- mental issues and stressors that affect not only the lism as a foundation (AHNA, 2016b). Holistic health of people but also the health of the planet. nursing research is based on a philosophy of holism, or belief in the union of body-mind- emotion-spirit-energy-environment. The focus of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Core Value 5: Holistic Education holistic nursing research is understanding holistic and ResearchNOT FOR SALE OR DISTRIBUTIONphenomena, determining the effectivenessNOT FOR of ho SALE- OR DISTRIBUTION Holistic nurses possess an understanding of a listic interventions, and developing an evidence wide range of norms and healthcare practices, base for holistic nursing practice. beliefs, and values concerning individuals, fam- Holistic nurses conduct and evaluate research in diverse areas such as: © ilies,Jones groups, & Bartlett and communities Learning, from aLLC variety of © Jones & Bartlett Learning, LLC NOTracial, FOR ethnic, SALE spiritual, OR and DISTRIBUTION social backgrounds. • outcome measuresNOT FOR of various SALE CIHA OR (e.g., DISTRIBUTION ther- This rich knowledge base reflects their formal apeutic touch, prayer, aromatherapy, imagery); academic and continuing education preparation. • instrument development to measure holistic Their knowledge also includes a wide diversity of phenomena; caring behaviors and dimensions;

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spirituality; self-transcendence; cultural com- registered nurse (APRN). Because each standard petence; intuition; presence; mindfulness; and has numerous competencies, only one or two com- more;© Jones & Bartlett Learning, LLCpetency examples per standard© Jones are included & Bartlett in the Learning, LLC • client/patientNOT FOR responses SALE to ORholistic DISTRIBUTION interven- following sections. NOT FOR SALE OR DISTRIBUTION tions in health, illness, and wellness; • explorations of client/patients’ lived experiences with various health, illness, and life Overarching Philosophical phenomena; © Jones & Bartlett Learning, LLC Principles© Jones of & Holistic Bartlett Learning,Nursing LLC • health decision making; Holistic nurses express, contribute to, and pro- NOT FOR• healthSALE and OR wellness DISTRIBUTION promotion and illness mote an NOTunderstanding FOR SALE of the following: OR DISTRIBUTION a philos- prevention; ophy of nursing that values growth, development, • theory development in healing, wholeness, and healing as desired outcomes; the human caring, intentionality, well-being, compas- health experience as a complex, dynamic rela- sion, social and cultural constructions, em- © Jones & Bartlett Learning, LLC © Jonestionship & Bartlett of health, Learning, wellness, illness, LLC disease, and powerment, and more; well-being; the scientific foundations of nursing NOT FOR SALE OR• DISTRIBUTION healing relationships and healing NOT FORpractice; SALE and ORnursing DISTRIBUTION as an art. As discussed ear- environment; lier in this chapter, the philosophical principles • teaching and evaluation of holism; of holistic nursing are embedded in every stan- • identification of attributes and skills that in- dard of practice and standard of professional fluence health (e.g., presence). © Jones & Bartlett Learning, LLCperformance. © Jones & Bartlett Learning, LLC It isNOT critical FOR that SALEholistic nursingOR DISTRIBUTION continue NOT FOR SALE OR DISTRIBUTION to advance the scientific knowledge base of evidence for holistic practice. Healthcare profes- Standards of Practice sionals need such quality information to provide for Holistic Nursing comprehensive evidence and outcome-based Standard 1. Assessment care that promotes a focus on healing and rec- © Jones & Bartlett Learning, LLC The holistic© Jonesregistered & nurse Bartlett collects Learning,comprehensive LLC ognizes the importance of compassion and car- NOT FOR SALE OR DISTRIBUTION data pertinentNOT to FOR the healthcare SALE consumer’s OR DISTRIBUTION health or ing. The varied settings in which holistic nurses the situation. practice offer many opportunities to conduct meaningful research to improve healthcare con- The holistic registered nurse: sumer outcomes. The AHNA has incorporated Competencies. © Jones & Bartlett Learning,an active research LLC agenda by assisting and men© Jones- • &Collects Bartlett comprehensive Learning, data, LLC including but toring members in research endeavors, granting not limited to demographics, social determi- NOT FOR SALE ORresearch DISTRIBUTION awards, identifying and reportingNOT on FOR nantsSALE of health,OR DISTRIBUTION health disparities, and phys- research that focuses on holistic healing phe- ical, functional, psychosocial, emotional, nomena and modalities, and applying research cognitive, sexual, cultural, age-related, en- in practice. vironmental, spiritual or transpersonal, © Jones & Bartlett Learning, LLC economic and energy ©field Jones assessments & Bartlett in a Learning, LLC systematic, ongoing process with compas- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Standards of Holistic sion, unconditional acceptance, and respect for the inherent dignity, worth, and unique Nursing Practice attributes of every person. There are 17 standards in Holistic Nursing: • Assesses the healthcare consumer’s health © JonesScope & Bartlettand Standards Learning, of Practice LLC—6 for practice and© cultural Jones practices, & Bartlett values, Learning,beliefs, prefer -LLC and 11 for professional performance (ANA & ences, meanings of health, wellness, illness, NOT FORAHNA, SALE 2019). OR Each DISTRIBUTION standard addresses com- disease,NOT well-being, FOR SALE lifestyle OR patterns, DISTRIBUTION fam- petencies for both the registered nurse and the ily issues, and perceived risk behaviors and graduate-level–prepared and advanced practice context.

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The graduate-level–prepared holistic regis- the evolution and the process of healing as it unfolds. tered nurse: Unfolding outcomes may not be immediately evident, © Jones & Bartlett Learning,due LLC to the nonlinear nature of the healing© Jones process, & so Bartlett Learning, LLC • Explores theNOT meanings FOR of SALE the symbolic OR DISTRIBUTION lan- NOT FOR SALE OR DISTRIBUTION guage expressed in dreams, images, symbols, both expected or anticipated and evolving or emerging narratives, sensations, rituals, and prayers as outcomes are considered.) part of the healthcare consumer’s experience. The holistic registered nurse: • Uses advanced assessments, knowledge, • Defines expected outcomes in terms of the © Jonesand skills & Bartlett to maintain, Learning, enhance, orLLC improve healthcare consumer’s© Jones values & Bartlett and beliefs, Learning, pref- LLC NOT healthFOR conditionsSALE OR and DISTRIBUTION facilitate growth and erences, culture,NOT age,FOR spiritual SALE practices, OR DISTRIBUTION eth- development. ical considerations, environment, or situation. Partners with the healthcare consumer to iden- The advanced practice holistic registered nurse: • tify realistic goals based on the person’s present • Initiates diagnostic tests and procedures rel- and potential capabilities and quality of life. © Jones & Bartlettevant Learning, to the healthcare LLC consumer’s current © Jones & Bartlett Learning, LLC status. The graduate-level–prepared holistic regis- NOT FOR SALE OR DISTRIBUTION NOTtered FOR nurse, SALE including OR the DISTRIBUTION APRN: Standard 2. Diagnosis • Identifies expected outcomes incorporating The holistic registered nurse analyzes assessment data healthcare consumer satisfaction, the per- to determine the actual or potential diagnosis or issues son’s understanding and meanings in his or expressed as challenges,© Jones problems, & Bartlett or needs. Learning, LLCher unique patterns and processes,© Jones quality & of Bartlett Learning, LLC The holistic registered nurse: life, cost, practice effectiveness, and continu- NOT FOR SALE OR DISTRIBUTIONity and consistency among providers.NOT FOR SALE OR DISTRIBUTION • Formulates the diagnosis, health challenges, or issues from comprehensive holistic assessment data. Standard 4. Planning • Validates the diagnosis, health challenges, or The holistic registered nurse develops a plan outlining © Jonesissues & with Bartlett the healthcare Learning, consumer, LLC family primary strategies© Jonesand suggested & Bartlett alternatives Learning, to at- LLC NOT FORor significant SALE other, OR DISTRIBUTIONgroup, community, pop- tain expected outcomes.NOT FOR SALE OR DISTRIBUTION ulation, and other healthcare providers when The holistic registered nurse: possible and appropriate. • In partnership with the healthcare consumer, The graduate-level–prepared holistic regis- family, and others, develops an individual- tered nurse: ized plan considering the characteristics or © Jones & Bartlett Learning, LLC © Jonessituation, & Bartlett including Learning, values, beliefs, LLC knowl- Utilizes complex data and information ob- NOT FOR SALE• OR DISTRIBUTION NOT FORedge and SALE understanding, OR DISTRIBUTION spiritual and health tained during interview, examination, and di- practices, preferences, choices, developmen- agnostic procedures in identifying diagnoses. tal level, coping style, culture and environ- The advanced practice holistic registered ment, and available technology. nurse: • Establishes practice settings, safe space, and © Jones & Bartlett Learning, LLCtime for both the nurse and ©healthcare Jones con & -Bartlett Learning, LLC • FormulatesNOT a differential FOR SALEdiagnosis OR based DISTRIBUTION on NOT FOR SALE OR DISTRIBUTION the holistic assessment, history, examination, sumer, family, and significant others to ex- and diagnostic test results. plore suggested, potential, and alternative options. Standard 3. Outcomes The graduate-level–prepared holistic regis- © IdentificationJones & Bartlett Learning, LLC tered nurse: © Jones & Bartlett Learning, LLC NOTThe FORholistic SALEregistered OR nurse DISTRIBUTION identifies expected out- • IdentifiesNOT assessment FOR strategies,SALE OR diagnostic DISTRIBUTION comes for a plan individualized to the healthcare strategies, therapeutic interventions, ther- consumer or the situation. (The holistic nurse values apeutic effects, and side effects that reflect

9781284196597_CH02.indd 42 29/09/20 10:38 AM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Standards of Holistic Nursing Practice 43 current evidence, including data, research, • Assists the healthcare consumer to identify literature, expert practice-based knowledge, options for conventional and/or alternative and ©the Jones healthcare & consumer’sBartlett experiences.Learning, LLC care. © Jones & Bartlett Learning, LLC UsesNOT linguistic FOR and SALE symbolic OR language, DISTRIBUTION in- NOT FOR SALE OR DISTRIBUTION • The graduate-level–prepared holistic regis- cluding but not limited to word associations, tered nurse: dreams, storytelling, and journals, to explore with individuals the possibilities and options. • Provides leadership in the coordination of interprofessional holistic health care for in- © Jones &The Bartlett advanced Learning, practice holistic LLC registered tegrated© Jones delivery & ofBartlett healthcare Learning, consumer LLC NOT FORnurse: SALE OR DISTRIBUTION servicesNOT to FORachieve SALE safe, effective, OR DISTRIBUTION efficient, • Integrates assessment strategies, diagnostic timely, patient-centered, and equitable care. strategies, and therapeutic interventions re- • Synthesizes holistic data and information to flecting current evidence-based knowledge prescribe and provide necessary system and and practice. community support measures, including © Jones & Bartlett Learning, LLC © Jones &modifications Bartlett Learning, of environments. LLC NOT FOR SALE ORStandard DISTRIBUTION 5. Implementation NOT FOR TheSALE advanced OR DISTRIBUTION practice holistic registered The holistic registered nurse implements the identified nurse: plan. (Sometimes the plan is not directed to clinical care • Serves as the healthcare consumer’s primary but administrative, educational, or other foci.) care provider and coordinator of holistic The ©holistic Jones registered & Bartlett nurse: Learning, LLC healthcare services in ©accordance Jones &with Bartlett state Learning, LLC • PartnersNOT with FOR the healthcareSALE OR consumer, DISTRIBUTION fam- and federal laws and regulations.NOT FOR SALE OR DISTRIBUTION ily, significant others, and caregivers as appropriate to implement the holistic plan in Standard 5B. Health Teaching and a safe, realistic, effective, efficient, timely, Health Promotion person-centered, and equitable manner. The holistic registered nurse employs strategies to © Jones• &Uses Bartlett self as an Learning, instrument ofLLC healing. promote ©holistic Jones health & Bartlettand wellness Learning, and a safe LLC NOT FOR TheSALE graduate-level–prepared OR DISTRIBUTION holistic regis- environment.NOT FOR SALE OR DISTRIBUTION tered nurse: The holistic registered nurse: • Uses advanced knowledge of pharmacology, • Provides opportunities for the healthcare psychoneuroimmunology, nutritional sup- consumer to identify needed holistic health- plements, homeopathic remedies, herbal care promotion, disease prevention, and © Jones & Bartlett Learning, LLC © Jones &self-management Bartlett Learning, topics. LLC NOT FOR SALE OR DISTRIBUTIONremedies, and a variety of CIHA. NOT FOR SALE OR DISTRIBUTION • Uses systems, organizations, and community • Uses health promotion and health teaching resources to lead effective change and imple- methods in collaboration with the healthcare ment the plan. consumer’s values, beliefs, health practices, developmental level, learning needs, readi- The advanced practice holistic registered nurse: ness and ability to learn, language preference, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Uses prescriptive authority, procedures, refer- spirituality, culture, and socioeconomic status. rals, NOTtreatments, FOR and SALE therapies OR in DISTRIBUTION accordance • Assists others to accessNOT their FORown inner SALE wis- OR DISTRIBUTION with state and federal laws and regulations. dom that may provide opportunities to enhance and support growth, development, Standard 5A. Coordination of Care and wholeness. © JonesThe & holistic Bartlett registered Learning, nurse coordinates LLC care delivery. The© graduate-level–prepared Jones & Bartlett Learning,holistic regis -LLC NOT FOR TheSALE holistic OR registered DISTRIBUTION nurse: tered nurse,NOT including FOR SALEthe APRN: OR DISTRIBUTION • Organizes the components of the holistic care • Synthesizes empirical evidence on risk plan. behaviors, gender roles, learning theories,

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behavioral change theories, motiva- nursing practice and articulate the moral tional theories, translational theories for foundation of nursing. evidence-based© Jones practice, & epidemiology,Bartlett Learning, • LLCAdvocates for equitable consumer© Jones healthcare, & Bartlett Learning, LLC and other relatedNOT FORtheories SALE and frameworks OR DISTRIBUTION particularly regarding the rightsNOT of vulnerable FOR SALE OR DISTRIBUTION when designing holistic health education or underserved populations, by such activities information and programs. as: • Acting on behalf of individuals, families, groups, and communities as requested Standard 6. Evaluation © Jones & Bartlett Learning, LLC or required© Jones by law. & Bartlett Learning, LLC The holistic registered nurse evaluates progress to- NOT FOR SALE OR DISTRIBUTION • SeekingNOT to eliminate FOR SALE barriers OR to DISTRIBUTIONcare, ward attainment of goals and health outcomes. such as affordability and accessibility. The holistic registered nurse: • Commits to self-reflection, self-assessment, • Conducts a holistic, systematic, ongoing, and self-development, and self-care strategies to criterion-based evaluation of the goals and enhance physical, psychological, intellectual, © Jones & Bartlettoutcomes Learning, in relation LLC to the structure, pro- © Jonessociological, & Bartlett and spiritual Learning, well-being. LLC NOT FOR SALE ORcesses, DISTRIBUTION and timeline prescribed in the plan. NOT FOR SALE OR DISTRIBUTION The graduate-level–prepared holistic regis- Determines, in partnership with the health- • tered nurse, including the APRN: care consumer and other stakeholders, the patient-centeredness, effectiveness, efficiency, • Provides information on the risks, benefits, safety, timeliness, and equitability of the strate- and outcomes of healthcare regimens to al- gies in relation© Jonesto the responses & Bartlett to the plan Learning, and LLClow informed decision making© byJones the health & -Bartlett Learning, LLC attainment ofNOT expected FOR and SALEunfolding OR outcomes. DISTRIBUTION care consumer, including informedNOT FOR consent SALE OR DISTRIBUTION Other defined criteria (e.g., Quality and Safety and informed refusal. Education for Nurses) may be used as well. • Actively contributes to creating an ecosystem that supports well-being for all life. The graduate-level–prepared holistic regis- © teredJones nurse, & includingBartlett the Learning, APRN: LLC © Jones & Bartlett Learning, LLC NOT• FORSynthesizes SALE evaluation OR DISTRIBUTION data from the health- NOT FOR SALE OR DISTRIBUTION care consumer, community, population, and/ Standard 8. Culturally Congruent or institution to determine the effectiveness Practice of the plan. The holistic registered nurse practices in a manner • Evaluates, in partnership with the healthcare that is congruent with cultural diversity and inclusion © Jones & Bartlettconsumer, Learning, the accuracyLLC of the biomedical © principles.Jones & Bartlett Learning, LLC NOT FOR SALE ORand DISTRIBUTION nursing diagnoses and the effectiveness NOT FORThe holistic SALE registered OR DISTRIBUTION nurse: of the interventions in relationship to the • Demonstrates cultural awareness and sensi- client’s/patient’s attainment of expected and tivity by seeking knowledge of health beliefs evolving outcomes and changes of meaning and practices that are representative of the in the client’s/patient’s healing experience. cultural values, beliefs, practices, and tra- © Jones & Bartlett Learning, LLCditions of individuals, families,© Jonesgroups, and& Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONcommunities for whom they NOTcare. FOR SALE OR DISTRIBUTION Standards of Professional • Understands that a lack of cultural awareness Performance and a failure to provide care that is culturally congruent with the worldview of a person Standard 7. Ethics can greatly increase the stresses experienced The holistic registered nurse practices ethically. © Jones & Bartlett Learning, LLC by healthcare© Jonesconsumers & and Bartlett caregivers Learning, alike. LLC The holistic registered nurse: NOT FOR SALE OR DISTRIBUTION • Uses skillsNOT and tools FOR that SALE are appropriately OR DISTRIBUTION • Integrates the Code of Ethics for Nurses With vetted for the culture, literacy, and language Interpretive Statements (ANA, 2015b) to guide of the population served.

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The graduate-level–prepared holistic regis- The holistic registered nurse: tered nurse: © Jones & Bartlett Learning, LLC• Identifies the expertise© Jonesand contribution & Bartlett of Learning, LLC • AdvancesNOT organizationalFOR SALE policies, OR DISTRIBUTION programs, diverse disciplines, approachesNOT FOR to SALE health OR DISTRIBUTION services, and practices that reflect respect, eq- care, and key stakeholders. uity, and the values of diversity and inclusion. • Clearly articulates the holistic nurse’s role • Leads interprofessional teams to identify and and responsibilities within the team. act on the cultural and language needs of the • Engages in teamwork and team-building © Jones &consumer. Bartlett Learning, LLC processes.© Jones & Bartlett Learning, LLC NOT FOR TheSALE advanced OR practice DISTRIBUTION holistic registered nurse: The NOTgraduate-level–prepared FOR SALE OR holistic DISTRIBUTION regis- • Promotes shared decision-making solutions tered nurse, including the APRN: in planning, prescribing, and evaluating • Facilitates the negotiation of holistic, com- processes when the healthcare consumer’s plementary, alternative, integrative, and con- © Jones & Bartlett Learning,cultural preferencesLLC and norms may create© Jones &ventional Bartlett healthcare Learning, services LLC for continuity of incompatibility with evidence-based practice care and program planning. NOT FOR SALE OR DISTRIBUTIONand the values, beliefs, and norms of theNOT bio- FOR SALE OR DISTRIBUTION medical culture. Standard 11. Leadership The holistic registered nurse leads within the profes- Standard 9. Communication sional practice setting and the profession. The holistic© registeredJones nurse& Bartlett communicates Learning, effectively LLC The holistic registered© nurse: Jones & Bartlett Learning, LLC in a varietyNOT of formats FOR in SALE all areas ORof practice. DISTRIBUTION• Mentors colleagues forNOT the advancementFOR SALE of OR DISTRIBUTION The holistic registered nurse: holistic nursing practice, the profession, and • Assesses one’s own communication skills and quality holistic health care. effectiveness in encounters with individuals, • Engages at local, state, national, and inter- families, significant others, and colleagues. national levels to expand the knowledge and © Jones• &Uses Bartlett communication Learning, styles LLCand methods that practice© Jones of holistic & nursingBartlett and Learning, awareness of LLC NOT FOR demonstrateSALE OR intention, DISTRIBUTION centering, presence, holisticNOT health FOR issues. SALE OR DISTRIBUTION caring, respect, deep listening, authenticity, The graduate-level–prepared holistic regis- and trust. tered nurse, including the APRN: Contributes the holistic nursing perspective • Influences decision-making bodies to im- in interactions with others and discussions • prove holistic integrative care, the profes- © Jones & Bartlett Learning,with the interprofessionalLLC team. © Jones & Bartlett Learning, LLC sional practice environment, and holistic NOT FOR SALE OR DISTRIBUTIONThe graduate-level–prepared holistic regisNOT- FOR healthcareSALE OR consumer DISTRIBUTION outcomes. tered nurse, including the APRN: • Articulates the ideas underpinning holistic • Provides leadership for establishing, improv- nursing philosophy, placing these ideas in a ing, and sustaining collaborative relationships historical, philosophical, and scientific context to achieve© Jones safe, &quality Bartlett care forLearning, healthcare LLC while projecting future© trends Jones in thinking. & Bartlett Learning, LLC consumers.NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Functions as a role model and leader in creating Standard 12. Education healthy work environments that facilitate and The holistic registered nurse attains knowledge and support effective communication and healing. competence that reflect current nursing practice and promotes futuristic thinking. © JonesStandard & Bartlett 10. Learning, Collaboration LLC The© holistic Jones registered & Bartlett nurse: Learning, LLC NOT FORThe SALEholistic registered OR DISTRIBUTION nurse collaborates with the • ParticipatesNOT FORin ongoing SALE educational OR DISTRIBUTION activities re- healthcare consumer, family, and other key stakehold- lated to nursing, holism, and interprofessional ers in the conduct of holistic nursing practice. knowledge bases and professional topics.

9781284196597_CH02.indd 45 29/09/20 10:38 AM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 46 Chapter 2 Holistic Nursing: Scope and Standards of Practice • Demonstrates a commitment to lifelong The holistic registered nurse: learning through self-reflection and inquiry Ensures that holistic nursing practice is safe, for learning© and Jones personal & growth.Bartlett Learning,• LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONeffective, efficient, equitable,NOT timely, FOR patient SALE OR DISTRIBUTION The graduate-level–prepared holistic regis- centered, and grounded in holism. tered nurse, including the APRN: • Uses creativity and innovation to enhance • Uses current healthcare research findings and holistic nursing care. other sources of evidence to expand clinical The graduate-level–prepared holistic regis- © Jonesknowledge, & Bartlett skills, abilities, Learning, and judgment; LLC to tered nurse: © Jones & Bartlett Learning, LLC NOT enhanceFOR SALE holistic ORrole performance;DISTRIBUTION and to in- NOT FOR SALE OR DISTRIBUTION • Engages in development, implementation, crease knowledge of professional issues and evaluation and/or revisions of policies, pro- changes in national standards for practice and cedures, and guidelines to improve holistic trends in holistic care. healthcare quality. © Jones & Bartlett Learning, LLC © •Jones Evaluates & Bartlett the practice Learning, environment LLC and qual- Standard 13. Evidence-Based ity of holistic care rendered in relation to NOT FOR SALEPractice OR DISTRIBUTION and Research NOT FORexisting SALE evidence OR and DISTRIBUTION feedback from individ- The holistic registered nurse integrates evidence and uals, families, and significant others. research findings into practice. The holistic registered nurse: Standard 15. Professional Practice • Utilizes the© best Jones available & Bartlett evidence, Learning,which Evaluation LLC © Jones & Bartlett Learning, LLC includes nursingNOT theoriesFOR SALE and research OR DISTRIBUTIONfind- The holistic registered nurse evaluatesNOT one’s FOR own and SALE OR DISTRIBUTION ings, to guide practice. others’ nursing practice. • Incorporates evidence from experience, intu- The holistic registered nurse: ition, research, and population responses to care Engages in self-reflection and self-evaluation when initiating changes in nursing practice. • of practice on a regular basis, identifying ar- © JonesParticipates & Bartlett in research Learning, related LLCto holistic © Jones & Bartlett Learning, LLC • eas of strength as well as areas in which pro- nursing. NOT FOR SALE OR DISTRIBUTION fessional developmentNOT FOR and SALE personal OR growth DISTRIBUTION The graduate-level–prepared holistic regis- would be beneficial. tered nurse, including the APRN: • Reflects on his or her practice and how his or Contributes to nursing knowledge by con- her own personal, cultural, and/or spiritual be- • liefs, experiences, biases, education, and values © Jones & Bartlettducting Learning, or synthesizing LLC research that discov- © Jones & Bartlett Learning, LLC ers, examines, and evaluates current practice, may affect care given to individuals, families, NOT FOR SALE ORknowledge, DISTRIBUTION theories, philosophies, context, NOT FORand communities. SALE OR DISTRIBUTION criteria, and creative approaches to improve The graduate-level–prepared holistic registered holistic healthcare outcomes. nurse: Disseminates research findings through ac- • Applies knowledge obtained from advanced tivities such as presentations, publications, • © Jones & Bartlett Learning, LLCpreparation, as well as current© Jonesresearch and& Bartlett Learning, LLC consultations, and journal clubs for a variety NOT FOR SALE OR DISTRIBUTIONevidence-based information, NOTto clinical FOR deci SALE- OR DISTRIBUTION of audiences (including nursing, other dis- sion making at the point of care to achieve ciplines, and the public) to improve holistic optimal holistic health outcomes. care and further develop the foundation and practice of holistic nursing. Standard 16. Resource Utilization © Jones & Bartlett Learning, LLC The holistic registered© Jones nurse &utilizes Bartlett appropriate Learning, re- LLC NOTStandard FOR SALE 14. Quality OR DISTRIBUTION of Practice sources to plan, NOTprovide, FOR and sustain SALE evidence-based OR DISTRIBUTION The holistic registered nurse contributes to quality nursing services that are holistic, safe, effective, and nursing practice. fiscally responsible.

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The holistic registered nurse: Settings for Holistic • Assists© Jonesthe healthcare & Bartlett consumer, Learning, family, sig- LLC © Jones & Bartlett Learning, LLC nificantNOT other, FOR and SALE caregivers OR inDISTRIBUTION identifying Nursing PracticeNOT FOR SALE OR DISTRIBUTION and securing appropriate and available ser- Holistic nurses practice in numerous fields and vices to address needs across the healthcare settings, including but not limited to: continuum. • Addresses discriminatory healthcare prac- Ambulatory outpatient settings © Jones &tices Bartlett and the Learning,impact on resource LLC allocation. Acute care© hospitalsJones & Bartlett Learning, LLC NOT FOR TheSALE graduate-level–prepared OR DISTRIBUTION holistic regis- Long-termNOT and FORextended SALE care ORfacilities, DISTRIBUTION nursing tered nurse: homes, and assisted living facilities • Designs innovative solutions to use resources Home care settings effectively and maintain quality. Complementary and integrative care centers © Jones & Bartlett Learning,• Engages organizationalLLC and community© re Jones- & Bartlett Learning, LLC sources to formulate and implement inter- Women’s health and birthing centers NOT FOR SALE OR DISTRIBUTIONprofessional plans. NOT FOR SALE OR DISTRIBUTION Hospice palliative care Psychiatric mental health facilities Standard 17. Environmental Private practitioner offices Health© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC The holistic registered nurse practices in an environ- Schools NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION mentally safe and healthy manner. Rehabilitation centers The holistic registered nurse: Religious parishes Assesses the practice environment for factors • Community health and primary care centers that support or threaten health and healing, © Jones &such Bartlett as sound, Learning, odor, vibration, LLC light, clean air, Student ©and Jones employee & health Bartlett clinics Learning, LLC NOT FOR shelter,SALE water, OR andDISTRIBUTION food to ensure that the basic ManagedNOT care organizations FOR SALE OR DISTRIBUTION health and safety needs within our own world and that of healthcare consumers are met. Independent, self-employed private practice • Promotes a safe and healthy practice environ- Telehealth and cyber care services ment that reduces environmental health risks © Jones & Bartlett Learning,for self, workers, LLC and healthcare consumers© toJones Correctional & Bartlett facilities Learning, LLC NOT FOR SALE OR DISTRIBUTIONsupport resilience and protect them from harm.NOT FORInternational SALE andOR travel DISTRIBUTION nursing The graduate-level–prepared holistic regis- Military tered nurse, including the APRN: Professional nursing and healthcare organizations Ascertains the impact of social, political, and • Informatics economic© Jones influences & Bartlett on the environment Learning, and LLC © Jones & Bartlett Learning, LLC Administration humanNOT health FOR exposures. SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Acts as a leader, collaborator, consultant, Staff development and change agent in evaluating global health issues related to environmental health and Universities and colleges safety; designing holistic plans of care that ad- There are increasing numbers of holistic © Jones &dress Bartlett all effects Learning, of environmental LLC changes on nurses who© Joneshold leadership & Bartlett roles as clinicians,Learning, edu -LLC NOT FOR theSALE health OR and DISTRIBUTIONwelfare of individuals, groups, cators, authors,NOT FORand researchers SALE inOR university-based DISTRIBUTION and communities; and assisting in reducing schools of nursing, practice environments, nurs- or eliminating environmental hazards. ing, and other professional organizations. Holistic

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nursing practice also occurs when there is a request their individual state, commonwealth, or territory. for consultation or when holistic nurses advocate The American Holistic Nurses Credentialing Cor- for care that promotes© Jones health & and Bartlett prevents disease,Learning, poration LLC (AHNCC) conducted an© examination Jones & of Bartlett Learning, LLC illness, or disabilityNOT for FOR individuals, SALE communities, OR DISTRIBUTION nursing education from the basic NOTto the advancedFOR SALE OR DISTRIBUTION or the environment. A holistic nurse may choose level. This process included reviewing state li- not to work in a critical care setting but provide censure requirements, exploring best practices in consultation regarding self-care or stress manage- education, and analyzing the AACN Essentials of ment to nurses practicing in that area. Or holistic Baccalaureate, Master’s and Doctorate of Nursing © nursesJones may & practice Bartlett in preoperative Learning, and LLC recovery Practice education© Jones in nursing. & Bartlett The comparative Learning, LLC NOTrooms, FOR instituting SALE a pre- OR and DISTRIBUTION postsurgical program analysis of theseNOT with theFOR AHNA SALE Core ORValues DISTRIBUTION and for individuals that teaches them meditation and Holistic Nursing: Scope and Standards of Practice re- positive affirmation techniques while incorporat- sulted in the development of the Foundations, ing a homeopathic regimen for trauma and cell Competencies, and Curricular Guidelines for Basic healing. Employment or voluntary participation to Doctoral Holistic Nursing Education (Erickson © Jones & Bartlettof holistic Learning, nurses also LLC can influence civic activities © etJones al., 2017). & BartlettThe holistic Learning, registered nurse’s LLC experi- NOT FOR SALEand OR the DISTRIBUTIONregulatory and legislative arenas at the lo- NOTence, FOR education, SALE knowledge, OR DISTRIBUTION and abilities establish cal, state, national, or international levels. the level of competence. Holistic Nursing: Scope and Because holistic nursing focuses on the well- Standards of Practice identifies the scope of practice ness, wholeness, and development of the whole of holistic nursing and the specific standards and person, holistic nurses also practice in health associated measurement criteria of holistic nurses enhancement settings© Jones such & as Bartlett spas, gyms, Learning, and at LLCboth the basic and advanced levels© Jones (ANA and& Bartlett Learning, LLC wellness centers.NOT With FOR all populationsSALE OR and DISTRIBUTION in AHNA, 2019). Regardless of the levelNOT of FORpractice, SALE OR DISTRIBUTION any setting, nurses can empower patients/clients/ all holistic nurses integrate the previously identi- families by teaching them self-care practices for a fied five core values. healthier lifestyle. In addition, there are numerous A registered nurse may prepare for the spe- entrepreneurial possibilities for holistic nurses to cialty of holistic nursing in a variety of ways. © developJones integrative& Bartlett care Learning, programs in LLC hospitals, Educational offerings© Jones range & from Bartlett associate’s Learning, de- LLC NOThome FOR care, SALEprimary ORcare DISTRIBUTIONpractices, occupational gree, baccalaureate,NOT andFOR graduate SALE courses OR DISTRIBUTION and and school settings, and the community. programs to continuing education programs with Because holistic nursing is a worldview, a way extensive contact hours. of being in the world, and not just a modality, holistic nurses can practice in any setting and with © Jones & Bartlettindividuals Learning, throughout LLC the life span. As the pub- © BasicJones Practice& Bartlett Learning,Level LLC NOT FOR SALElic ORincreasingly DISTRIBUTION requests holistic and CIHA ser- NOTThe FOReducation SALE of allOR nursing DISTRIBUTION students prepar- vices and a comprehensive, humanistic emphasis ing for registered nurse (RN) licensure includes on the whole person, there will be a greater need basic content on physiological, psychological, for holistic nurses in a wider array of settings, be- emotional, and some spiritual processes with cause “Holistic nursing takes place wherever heal- populations across the life span and conventional ing occurs” (Mariano,© Jones 2009, &p. Bartlett6). Learning,nursing LLC care practices within each© Jonesof these &do -Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONmains. In addition, basic nursingNOT education FOR in SALE- OR DISTRIBUTION corporates experiences in a variety of clinical and Educational Preparation practice settings from acute care to community. and Certification for However, the educational focus is most frequently on specialties often emanating from the biomed- © HolisticJones & Bartlett Nursing Learning, Practice LLC ical disease model© Jones and cure & orientation. Bartlett In Learning, holis- LLC NOTHolistic FOR nurses SALE are registered OR DISTRIBUTION nurses who are edu- tic nursing, theNOT individual FOR across SALE the ORlife span DISTRIBUTION is cationally prepared for practice from an approved viewed in context as an integrated totality of body, school of nursing and are licensed to practice in mind, emotion, environment, society, energy, and

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spirit, with the emphasis on wholeness, well-being, through post-master’s programs, continuing ed- health promotion, and healing using both conven- ucation offerings in holistic nursing care, and tional and© Jonescomplementary/alternative & Bartlett Learning, practices. LLCcertificate programs throughout© Jones the country & Bartlett that Learning, LLC Because NOTof the lackFOR of SALEintentional OR focus DISTRIBUTION on inte- focus on specific modalitiesNOT and FOR on the SALE essence OR DISTRIBUTION gration, unity, and healing, the educational ex- of holism. posure of most nursing students is not adequate preparation for assuming the specialty role of a Continuing Education holistic nurse. © Jones &Increasingly, Bartlett Learning,schools of nursing LLC are embrac- for Basics© Jones and & BartlettAdvanced Learning, LLC NOT FORing holisticSALE nursingOR DISTRIBUTION practices and CIHA and PracticeNOT Levels FOR SALE OR DISTRIBUTION adding them to their curricula, responding to The AHNA is a provider and approver of continu- consumer use of CIHA and consumer demand for ing education and is recognized by the American health professionals who are knowledgeable about Nurses Credentialing Center (ANCC). Continuing holistic practices. The most recent version of Es- educational programs, workshops, and lectures in © Jones & Bartlett Learning,sentials of Baccalaureate LLC Education for Professional© Jones holistic & Bartlett nursing Learning,and complementary/integrative LLC NOT FOR SALE ORNursing DISTRIBUTION Practice (AACN, 2008) includes languageNOT FORmedicine SALE have OR been DISTRIBUTION popular nationwide, with on preparing the baccalaureate generalist gradu- AHNA or other bodies granting continuing edu- ate to practice from a holistic, caring framework; cation units. engage in self-care; develop an understanding of The AHNA endorses certificate programs in complementary and alternative modalities; and specific areas. These include Holistic Integrative incorporate© Jonespatient teaching& Bartlett and healthLearning, promo- LLCHealing, Reflexology, Imagery,© Jones Aromatherapy, & Bartlett Learning, LLC tion, spirituality,NOT FOR and caring,SALE healing OR DISTRIBUTION techniques Healing Touch, Spirituality,NOT Craniosacral FOR SALETherapy, OR DISTRIBUTION into practice. This acknowledges that nursing rec- Holistic Stress Management, Integrative Healing ognizes the importance of healing principles and Arts, Coaching, Whole Health Education, and RN practices in health care and the need for nurses to Patient Advocate. It also approves continuing ed- learn them in the educational process. ucation offerings in holistic nursing as well as pro- © Jones & Bartlett Learning, LLC viding the© AHNA Jones home & Bartlettstudy course, Learning, Foundation LLC NOT FOR SALE OR DISTRIBUTION of HolisticNOT Nursing. FOR Other SALE programs OR DISTRIBUTION in distinct Advanced Practice Level therapies such as acupuncture, Reiki, homeopa- As with the basic level, there are a variety of thy, massage, imagery, healing arts, holistic health, ways through both academic and professional Chinese Oriental Medicine, nutrition, Ayurveda, development that registered nurses can acquire therapeutic touch, healing touch, herbology, © Jones & Bartlett Learning,the additional LLC specialized knowledge and skills© Jones chiropractic, & Bartlett and Learning, so on are given LLC nationally as NOT FOR SALE ORthat DISTRIBUTION prepare them for advanced holistic nursingNOT FORdegrees, SALE certificates, OR DISTRIBUTION or continuing education practice. These nurses are expected to hold a programs by centers, specialty organizations, or master’s or doctoral degree and demonstrate a schools. greater depth and scope of knowledge, a deeper integration of information, increased complexity of skills© Jonesand interventions, & Bartlett and Learning, notable role LLCCertification © Jones & Bartlett Learning, LLC autonomy.NOT They FOR provide SALE leadership OR DISTRIBUTIONin practice, Competency mechanisms NOTfor evaluating FOR SALE holis- OR DISTRIBUTION teaching, research, consultation, advocacy, and tic nursing practice as a specialty exist through policy formation in advancing holistic nursing a national certification and recertification process to improve the holistic health of people. Several overseen by the AHNCC. The AHNCC offers four schools of nursing that offer graduate programs certifications: Holistic Nurse, Board Certified © Jonesin &holistic Bartlett nursing Learning, have a stable LLC or growing (HN-BC),© which Jones requires & Bartlett a minimum Learning, of a diploma LLC NOT FORnumber SALE of applicants. OR DISTRIBUTION Current advanced prac- or associateNOT degree FOR in nursingSALE fromOR anDISTRIBUTION accredited tice nurses are increasingly gaining specialized school; Holistic Baccalaureate Nurse, Board Cer- knowledge preparing them as holistic nurses tified (HBN-BC), which requires a baccalaureate

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degree in nursing from an institution regionally 2. With the increased use of CIHA by the Amer- accredited by the Association of Schools and Col- ican public, both students and faculty need leges; and Advanced© Jones Holistic & Nurse,Bartlett Board Learning, Cer- LLCknowledge of these therapies© Jonesand skill & in Bartlett Learning, LLC tified (AHN-BC),NOT and FORAdvanced SALE Practice OR HolisticDISTRIBUTION their use. NOT FOR SALE OR DISTRIBUTION Nurse (APHN-BC, APRN), which require a master’s degree in nursing from an institution regionally accredited by the Association of Schools and Research Colleges. Further, the AHNCC provides endorse- 1. Exploration of research modalities and ap- © mentJones for &schools Bartlett of nursing Learning, meeting LLCthe speci- proaches that© Jonesare congruent & Bartlett with the holisticLearning, LLC NOTfications FOR put SALE forth inORHolistic DISTRIBUTION Nursing: Scope and paradigm NOT FOR SALE OR DISTRIBUTION Standards of Practice (ANA & AHNA, 2019). In 2. Examination of how the standards of holistic addition, holistic nurses often are certified in spe- nursing practice are being implemented in cific complementary integrative modalities such healthcare settings as imagery, Reiki, aromatherapy, healing touch, © Jones & Bartlett Learning, LLC © Jones3. Secure & funding Bartlett for Learning,their holistic researchLLC to biofeedback, and reflexology. identify and describe outcomes of CIHA and NOT FOR SALE OR DISTRIBUTION NOT FORtherapies, SALE such ORas healing, DISTRIBUTION well-being, and harmony, and to develop instruments to mea- Implications sure these outcomes Self © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Policy 1. What attributesNOT do FOR I have SALEthat reflect OR the DISTRIBUTION core NOT FOR SALE OR DISTRIBUTION values of holistic nursing? 1. Working with Medicare and other third-party 2. What contributions can I make as a holistic payers, insurance groups, boards of nursing, nurse to the wholeness and betterment of healthcare policy makers, legislators, and humankind? other professional nursing organizations to © Jones & Bartlett Learning, LLC ensure that© holistic Jones nurses & Bartlett are appropriately Learning, LLC reimbursed for services rendered NOT FOR SALE OR DISTRIBUTION 2. Active participationNOT FOR in healthcare SALE ORreform DISTRIBUTION and Clinical Practice the political arena as leaders in the movement 1. Given their education and experience, holis- to ensure quality, value, an increased focus on tic nurses are the logical leaders in holistic wellness, patient-centered humanistic care, and integrative care and must advance that and access and affordability for all © Jones & Bartlettposition. Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE2. OR Monitoring DISTRIBUTION state boards of nursing for ev- NOT FOR SALE OR DISTRIBUTION idence of their recognition and support of holistic, integrative nursing practice and re- Conclusion quirements that include CIHA, holistic nurs- The specialty practice of holistic nursing is gen- ing has the challenge of working with the erally not well understood. Therefore, each holis- state boards© to Jones incorporate & Bartlett this content Learning, into tic LLCnurse must educate other nurses,© Jones healthcare & Bartlett Learning, LLC the NationalNOT Council FOR Licensure SALE Examination, OR DISTRIBUTION providers and disciplines, and theNOT public FOR about SALE OR DISTRIBUTION thus ensuring the credibility of this practice the role, value, and benefits of holistic nursing, knowledge. whether it be in direct practice, education, management, or research. Holistic nurses articulate the ideas underpinning the holistic paradigm and © EducationJones & Bartlett Learning, LLC the philosophy© of Jones the caring, & Bartlett healing relationLearning,- LLC NOT1. FORThere isSALE an urgent OR need DISTRIBUTION for integration of ho- ship. Jean WatsonNOT reminds FOR SALEus that societyOR DISTRIBUTION and listic, relationship-centered, caring healing the public are searching for something deeper in philosophies into nursing curricula. terms of realizing self-care, self-knowledge, and

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self-healing potentials. Nurses need to acknowl- and care of the whole person. “By incorporating edge the human aspects of practice—attending holistic principles and practices, nurses will find to people© andJones their &experience Bartlett rather Learning, than just LLCmore meaning and purpose© Jonesin their &work Bartlett and Learning, LLC focusing NOTon the FOR biomedical SALE orientation OR DISTRIBUTION and dis- life” (Hart, 2019, p. 2). HolisticNOT Nursing: FOR ScopeSALE and OR DISTRIBUTION ease. Watson concludes that “nurses have a cov- Standards of Practice is a means through which enant with the public to sustain caring. It is our holistic nurses are educating the profession and collective responsibility to transform caring prac- others about the values, principles, and practice tices into the framework that identifies and gives requirements of this specialty. © Jonesdistinction & Bartlett to nursing Learning, as a profession” LLC (Mariano Note:© ThisJones chapter & Bartlettis derived Learning,from Holistic LLC NOT FOR2005, SALE p. 12). ORIn a DISTRIBUTION2019 interview, Mariano ex- Nursing: NOTScope andFOR Standards SALE of OR Practice DISTRIBUTION, 3rd ed. pressed hope that eventually all nurses will be (2019), C. Mariano, Revision Workgroup mem- holistic nurses; holism will be introduced in all ber and primary contributor 1st and 2nd editions. educational levels; and that all nurses will learn Printed with permission of the American Holistic self-care, integrative approaches, energy work, Nurses Association (AHNA). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

References© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1. American Association of Colleges of Nursing (AACN). pp. 2–63. Boston, MA: Phillips Sampson & Co. Medical (2008).NOT The essentialsFOR SALEof baccalaureate OR DISTRIBUTIONeducation for Communications of the MA MedicalNOT Society.FOR SALE OR DISTRIBUTION professional nursing practice. Washington, DC: AACN. 13. Cowling, W. R. (2011). Holism as a sociopolitical 2. American Holistic Nurses Association. (1998). Description enterprise. Journal of Holistic Nursing, 29(1), 5–6. of holistic nursing. Flagstaff, AZ: AHNA. 14. Dossey, B. M., Keegan, L., Barrere, C., Helming, M. A., 3. American Holistic Nurses Association. (2012). Position Shields, D., & Avino, K. (Eds.). (2016). Holistic nursing: A © Jones &statement Bartlett on holistic Learning, nursing ethics. Flagstaff, LLC AZ: AHNA. handbook© forJones practice (7th& Bartletted.). Burlington, Learning, MA: Jones & LLC 4. American Holistic Nurses Association (2016a). Position Bartlett. NOT FORon SALE the role of OR nurses DISTRIBUTION in the practice of complementary and 15. Erickson,NOT H., Erickson,FOR SALEM., Enzman-Hines, OR DISTRIBUTION M., Sandor, integrative health approaches (CIHA). Topeka, KS: AHNA. M. K., Shields, D., & Southard, M. E. (2017). Foundations, 5. American Holistic Nurses Association. (2016b). White competencies, and curricular guidelines for basic to doctoral paper: Research in AHNA. Topeka, KS: AHNA. holistic nursing education. Cedar Park, TX: American 6. American Nurses Association. (2004). Nursing: Scope and Holistic Nurses Credentialing Corporation in concert with standards of practice. Silver Spring, MD: Nursesbooks.org. the American Holistic Nurses Association. © Jones & Bartlett Learning,7. American Nurses LLC Association. (2010a). Nursing’s ©social Jones 16. &Hart, Bartlett J. (2019, Learning,February). The LLCexpanding field of NOT FOR SALE OR DISTRIBUTIONpolicy statement: The essence of the profession. Silver Spring,NOT FORholistic SALE nursing—A OR DISTRIBUTION growing trend. Interview with Carla MD: Nursebooks.org. Mariano. Alternative and Complementary Therapies, 25(1), 8. American Nurses Association. (2010b). Recognition of a 53–55. nursing specialty, approval of a specialty nursing scope of practice 17. Institute of Medicine (2001). Crossing the quality chasm: statement, and acknowledgement of specialty nursing standards A new health system for the 21st century. Washington, of practice. Washington, DC: American Nurses Association. DC: National Academies Press. 9. American© JonesNurses Association. & Bartlett (2015a). Learning, Code of ethics LLC18. Joint Commission on Accreditation© Jones of &Healthcare Bartlett Learning, LLC for nursesNOT with interpretiveFOR SALE statements OR. Silver DISTRIBUTION Spring, MD: Organizations (JCAHO). (1992).NOT Patient FOR bill SALEof rights. OR DISTRIBUTION Nursesbooks.org. In Accreditation manual for hospitals. Oakbrook Terrace, 10. American Nurses Association. (2015b). Nursing: Scope IL: Joint Commission on Accreditation of Healthcare and standards of practice (3rd ed.). Silver Spring, MD: Organizations. Nursesbooks.org. 19. Luck, S. & Keegan, L. (2016). Environmental health. 11. American Nurses Association & American Holistic Nurses In B.M.Dossey & L. Keegan (Eds). Holistic nursing: A © Jones &Association. Bartlett (2019). Learning, Holistic nursing: LLC Scope and standards handbook© Jonesfor practice, & 7th Bartlett ed. Burlington, Learning, MA: Jones & LLC of practice (3rd ed.). Silver Spring, MD: Nursingworld.org. Bartlett Learning. NOT FOR12. Bigelow, SALE J. (1859).OR DISTRIBUTION Discourses and essays. In Nature 20. Mariano,NOT C. (2005). FOR Caring SALE for our OR future: DISTRIBUTION An interview in disease: Illustrated in various discourses and essays, with Jean Watson. Beginnings, 25(3), 12–14.

9781284196597_CH02.indd 51 29/09/20 10:38 AM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 52 Chapter 2 Holistic Nursing: Scope and Standards of Practice

21. Mariano, C. (2006). Proposal for recognition of holistic nursing 27. Nursing Interventions Classification (NIC). (n.d.).NIC labels as a nursing specialty (Unpublished document submitted to and definitions. Retrieved from http://www.nursing.uiowa the American Nurses© Jones Association). & NewBartlett York. Learning, LLC.edu/sites/default/files/documents/cncce/LabelDefinitions© Jones & Bartlett Learning, LLC 22. Mariano, C. (2009). Holistic nursing: Every nurse’s specialty. NIC5.pdf Beginnings, 29(4),NOT 4–6. FOR SALE OR DISTRIBUTION28. Thornton, L., & Mariano, C. (2016).NOT Evolving FOR from SALE OR DISTRIBUTION 23. Mariano, C. (2019). Holistic integrative therapies in palliative therapeutic to holistic communication. In B. Dossey & L. care. In M. Matzo & D. Sherman (Eds.), Palliative care nursing Keegan (Eds.), Holistic nursing: A handbook for practice (7th ed., quality care to the end of life (5th ed., pp. 257–286). New York: pp. 465–478). Burlington, MA: Jones & Bartlett Learning. Springer Publishing Co. 29. Tresolini, C. P., & Pew-Fetzer Task Force. (1994). Health © 24.Jones National & Center Bartlett for Complementary Learning, and LLC Integrative professions education© Jones and relationship-centered & Bartlett care: Learning,Report of LLC Health (2018) Complementary, Alternative, or Integrative the Pew-Fetzer Task Force on advancing psychosocial education. NOTHealth: FOR What’s SALE In a Name? OR https://www.nccih.nih.gov/health DISTRIBUTION San Francisco, NOTCA: Pew FOR Health SALEProfessions ORCommission. DISTRIBUTION /complementary-alternative-or-integrative-health-whats-in http://www.futurehealth.ucsf.edu/pdf_files/Relationship -a-name Centered.pdf 25. National Center for Complementary and Integrative 30. U.S. Department of Health and Human Services Health (NCCIH). (2015). Complementary, alternative, or (USDHHS). (2017). Environmental health. Retrieved from integrative health: What’s in a name? Retrieved from https:// https://www.healthypeople.gov/2020/topics-objectives © Jones & Bartlettnccih.nih.gov/health/integrative-health Learning, LLC © Jones/topic/environmental-health & Bartlett Learning, LLC NOT FOR SALE26. ORNightingale, DISTRIBUTION F. (1980, Originally published 1859). Notes NOT FOR SALE OR DISTRIBUTION on nursing: what it is and what it is not. Edinburgh, Scotland: Churchill Livingstone.

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