Holistic Nursing

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Chapter 2 Holistic Nursing: Scope © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONand Standards ofNOT Practice FOR SALE OR DISTRIBUTION

Carla Mariano

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE ORNurse DISTRIBUTION Healer NOTDEFINITIONS* FOR SALE OR DISTRIBUTION OBJECTIVES Allopathic/conventional therapies: Medi- cal, surgical, pharmacological, and invasive Theoretical and noninvasive diagnostic procedures; n Describe© Jonesthe scope &of holisticBartlett nursing. Learning, LLCthose interventions most© commonly Jones &used Bartlett Learning, LLC n Describe the standards of holistic nursing. in allopathic, Western medicine. n DiscussNOT the five FOR core values SALE of holistic OR DISTRIBUTION nursing. Complementary/alternativeNOT modalities FOR SALE OR DISTRIBUTION (CAM): A broad set of healthcare prac- Clinical tices, therapies, and modalities that n Integrate the principles of holistic nursing address the whole person—body, mind, © Jones into& Bartlett practice. Learning, LLC emotion,© spirit,Jones and & environment, Bartlett Learning, not just LLC n Identify how you implement the standards signs and symptoms—and that can replace NOT FORof SALEholistic nursingOR DISTRIBUTION in your practice. or mayNOT be used FOR as complements SALE OR toDISTRIBUTION con- n Discuss Holistic Nursing: Scope and Standards ventional Western medical, surgical, and of Practice with colleagues. pharmacological treatments. Critical thinking: An active, purposeful, Personal organized cognitive process involving cre- © Jones & Bartlett Learning,n Reflect on LLCyour worldview and how it is© Jonesativity, & Bartlett reflection, Learning, problem solving, LLC both NOT FOR SALE OR DISTRIBUTIONsimilar to or different from the philosophyNOT FORrational SALE and OR intuitive DISTRIBUTION judgment, an atti- of holism. tude of inquiry, and a philosophical orien- n Explore how the concepts of holistic nurs- tation toward thinking about thinking. ing apply to your personal life. Cultural competence: The ability to deliver health care with knowledge of and sensi- © Jones & Bartlett Learning, LLCtivity to cultural factors that© Jones influence & the Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONhealth behavior and theNOT curing, FOR healing, SALE OR DISTRIBUTION dying, and grieving processes of the person.

This chapter is derived from the Holistic Nursing: Scope and Standards of Practice (2007), C. Mariano, primary © Jonescontributor. & Bartlett Printed with Learning, permission ofLLC the American * Many of the© definitions Jones in & this Bartlett chapter were Learning, adapted LLC Holistic Nurses Association (AHNA) and American from Holistic Nursing: Scope and Standards of Practice, 2007 NOT NursesFOR AssociationSALE OR (ANA). DISTRIBUTION and from DosseyNOT & Keegan, FOR 2009, SALE with permission. OR DISTRIBUTION

59 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Environment: The context of habitat within taining wellness and healing for body, which all living systems participate and mind, emotion, and spirit, together with interact,© Jones including & the Bartlett physical bodyLearning, and its LLC the most sophisticated,© aggressive Jones curing& Bartlett Learning, LLC physicalNOT habitat FOR along SALE with the OR cultural, DISTRIBUTION psy- technologies available. NOT FOR SALE OR DISTRIBUTION chological, social, and historical influences; Health: An individually defined state or pro- includes both the external physical space cess in which the individual (nurse, client, and the person’s internal physical, mental, family, group, or community) experiences emotional, social, and spiritual experience. a sense of well-being, harmony, and unity © JonesEvidence-based & Bartlett practice:Learning, The process LLC by which such © that Jones subjective & Bartlett experiences Learning, about LLC NOT FOR integrativeSALE OR healthcare DISTRIBUTION practitioners make health,NOT health FOR beliefs, SALE and values OR areDISTRIBUTION hon- clinical decisions using the best integrative ored; a process of becoming an expanding philosophy and theories, research evidence, consciousness. clinical expertise, and patient preferences Health promotion: Activities and preventive within the context of available resources. measures to promote health, increase well- © Jones & Bartlett Learning,Healing: A lifelongLLC journey into wholeness,© Jones being,& Bartlett and actualize Learning, the human LLC potential NOT FOR SALE OR DISTRIBUTIONseeking harmony and balance in one’s ownNOT FORof SALE people, ORfamilies, DISTRIBUTION communities, society, life and in family, community, and global and ecology; such activities and measures relations. Healing involves those physi- include immunizations, fitness and exer- cal, mental, social, and spiritual processes cise programs, breast self-exam, appropriate of recovery, repair, renewal, and transfor- nutrition, relaxation, stress management, mation© Jonesthat increase & Bartlett wholeness Learning, and often LLC social support, prayer, meditation,© Jones healing & Bartlett Learning, LLC (thoughNOT not FOR invariably) SALE order OR and DISTRIBUTION coher- rituals, cultural practices,NOT and FORpromoting SALE OR DISTRIBUTION ence. Healing is an emergent process of the environmental health and safety. whole system bringing together aspects of Holistic communication: A free flow of ver- one’s self and the body, mind, emotion, bal and nonverbal interchange between spirit, and environment at deeper levels of and among people and significant beings © Jones &inner Bartlett knowing, Learning, leading toward LLC integration such as© pets,Jones nature, & Bartlettand God/Life Learning, Force/ LLC NOT FOR andSALE balance, OR with DISTRIBUTION each aspect having equal Absolute/TranscendentNOT FOR SALE that OR exploresDISTRIBUTION importance and value. Healing can lead meaning and ideas leading to mutual to more complex levels of personal under- understanding and growth. standing and meaning and may be synchro- Holistic ethics: The basic underlying con- nous but not synonymous with curing. cept of the unity and integral wholeness © Jones & Bartlett Learning,Healing process: LLC A continual journey © of Jones of& allBartlett people andLearning, of all nature, LLC identified NOT FOR SALE OR DISTRIBUTIONchange and the evolving of one’s selfNOT FORand SALE pursued OR by DISTRIBUTIONfinding unity and whole- through life that is characterized by the ness within the self and within humanity. awareness of patterns that support or that In this framework, acts are not performed are challenges or barriers to health and for the sake of law, precedent, or social healing and that may be done alone or in a norms, but rather from a desire to do good healing© Jonescommunity. & Bartlett Learning, LLC freely to witness, identify,© Jonesand contribute & Bartlett Learning, LLC HealingNOT relationships: FOR SALE The quality OR DISTRIBUTIONand char- to unity. NOT FOR SALE OR DISTRIBUTION acteristics of interactions between one who Holistic healing: A form of healing based on facilitates healing and the person in the attention to all aspects of an individual— process of healing. Characteristics of such physical, mental, emotional, sexual, cul- interactions involve empathy, caring, love, tural, social, and spiritual. © Jones &warmth, Bartlett trust, Learning, confidence, credibility,LLC com- Holistic© nurse: Jones A nurse & Bartlett who recognizes Learning, and LLC NOT FOR petence,SALE honesty,OR DISTRIBUTION courtesy, respect, sharing integratesNOT FOR body-mind-emotion-spirit- SALE OR DISTRIBUTION expectations, and good communication. environment principles and modalities in Healing system: A true healthcare system in daily life and clinical practice, creates a car- which people can receive adequate, non- ing healing space within herself or himself toxic, and noninvasive assistance in main- that allows the nurse to be an instrument © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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of healing, shares authenticity of uncon- cally: Philosophical meaning is meaning ditional presence that helps to remove the that depends on the symbolic connections barriers© toJones the healing & Bartlett process, Learning,facilitates LLCthat are grasped by reason.© Jones Psychologi & Bartlett- Learning, LLC anotherNOT person’s FOR growthSALE OR (body-mind- DISTRIBUTIONcal meaning is meaning NOTthat depends FOR SALEon OR DISTRIBUTION emotion-spirit-energetic-environment con- connections that are experienced through nections), and assists with recovery from intuition or insight. illness or transition to peaceful death. Patient-centered care: Care that is respect- Holistic nursing practice process: An itera- ful of and responsive to individual patient © Jones tive& Bartlett and integrative Learning, process LLCthat involves preferences,© Jones needs, &and Bartlett values, andLearning, that LLC NOT FORsix SALE steps that OR can DISTRIBUTION occur simultaneously: ensuresNOT that patient FOR valuesSALE guide OR all DISTRIBUTION clini- (1) assessing; (2) diagnosing or identify- cal decisions. Patient-centered care encom- ing patterns, challenges, needs, and health passes identifying, respecting, and caring issues; (3) identifying outcomes; (4) plan- about patients’ differences, values, prefer- ning care; (5) implementing the plan of ences, and expressed needs; relieving pain © Jones & Bartlett Learning,care; and (6) LLC evaluating. © Jonesand & Bartlett suffering; coordinatingLearning, LLC continuous NOT FOR SALE ORHonor: DISTRIBUTION An act or intention indicating theNOT FORcare/listening SALE OR to, DISTRIBUTIONclearly informing, com- holding of self or another in high respect, municating with, and educating patients; esteem, and dignity, including valuing sharing decision making and manage- and accepting the humanity of people ment; and continuously advocating dis- with regard for the decisions and wishes ease prevention, wellness, and promotion of another.© Jones & Bartlett Learning, LLCof healthy lifestyles, including© Jones a focus & on Bartlett Learning, LLC Human caring:NOT FORThe moral SALE ideal ORof nursing DISTRIBUTION in population health.1 NOT FOR SALE OR DISTRIBUTION which the nurse brings one’s whole self into Person: An individual, client, patient, fam- a relationship with the whole self of the per- ily member, support person, or commu- son being cared for to protect that person’s nity member who has the opportunity to vulnerability, preserve her or his humanity engage in interaction with a holistic nurse. © Jones and& Bartlett dignity, and Learning, reinforce the LLC meaning and Person-centered© Jones care: & TheBartlett human Learning, caring LLC NOT FORexperience SALE ofOR oneness DISTRIBUTION and unity. processNOT in which FOR the SALE holistic ORnurse DISTRIBUTION gives Human health experience: That totality of full attention and intention to the whole human experience including each person’s self of a person, not merely the current pre- subjective experience about health, health senting symptoms, illness, crisis, or tasks beliefs, values, sexual orientation, and per- to be accomplished, and that also includes © Jones & Bartlett Learning,sonal preferences LLC that encompasses health-© Jonesreinforcing & Bartlett the person’s Learning, meaning LLC and expe- NOT FOR SALE OR DISTRIBUTIONwellness-disease-illness-death. NOT FORrience SALE of oneness OR DISTRIBUTIONand unity; the condition Illness: A subjective experience of symptoms of trust that is created in which holistic and suffering to which the individual care can be given and received. ascribes meaning and significance; not Presence: The essential state or core of heal- synonymous with disease; a shift in the ing; approaching an individual in a way that homeodynamic© Jones balance & Bartlett of the person. Learning, LLCrespects and honors her or© his Jones essence; relat& Bartlett- Learning, LLC Intention:NOT The consciousFOR SALE awareness OR ofDISTRIBUTION being ing in a way that reflects aNOT quality FOR of being SALE OR DISTRIBUTION in the present moment to help facilitate with and in collaboration with rather than the healing process; a volitional act of love. doing to; entering into a shared experience (or Interdisciplinary: Conversation or collabora- field of consciousness) that promotes healing tion across disciplines where knowledge is potential and an experience of well-being. © Jones shared& Bartlett that informs Learning, learning, LLC practice, edu- Relationship-centered© Jones & care: Bartlett A process Learning, model LLC NOT FORcation, SALE and OR research; DISTRIBUTION it includes individu- of caregivingNOT that FOR is based SALE in a vision OR ofDISTRIBUTION com- als, families, community members, and munity where three types of relationships are various disciplines. identified: (1) patient–practitioner relation- Meaning: That which is signified, indicated, ship, (2) community–practitioner relationship, referred to, or understood. More specifi- and (3) practitioner–practitioner relationship. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Each of these interrelated relationships were they practicing a unique specialty within is essential within a reformed integrative nursing, but that they needed to develop and healthcare© Jones delivery & Bartlett system in Learning, a hospital, LLCpublish standards of practice© to Jones document & andBartlett Learning, LLC clinic,NOT community, FOR SALE or in the OR home. DISTRIBUTION Each define that specialty practice.NOT Holistic FOR nursing SALE OR DISTRIBUTION component involves a unique set of respon- was officially recognized as a distinct specialty sibilities and tasks that addresses the three within the discipline of Nursing by the American areas of knowledge, values, and skills.2 Nurses Association (ANA) in November 2006. Spirituality: The feelings, thoughts, experi- The current American Holistic Nurses Associa- © Jones &ences, Bartlett and behaviors Learning, that arise LLC from a search tion (AHNA)© HolisticJones Nursing: & Bartlett Scope and Learning, Standards LLC NOT FOR forSALE meaning; OR that DISTRIBUTION which is generally con- of Practice (2007)NOT was FOR written SALE to inform OR DISTRIBUTION holistic sidered sacred or holy; usually, though not nurses, the nursing profession, students and fac- universally, considered to involve a sense ulty, other healthcare providers and disciplines, of connection with an absolute, imminent, employers, third-party payers, legislators, and the or transcendent spiritual force, however public about the unique scope of knowledge and © Jones & Bartlett Learning,named, as LLC well as the conviction that mean©- Jonesthe standards & Bartlett of practice Learning, and professional LLC perfor- NOT FOR SALE OR DISTRIBUTIONing, value, direction, and purpose are validNOT manceFOR ofSALE a holistic OR nurse. DISTRIBUTION3 The current standards aspects of the individual and universe; the are an updated and substantive revision of previ- essence of being and relatedness that per- ous standards disseminated through the AHNA.* meates all of life and is manifested in one’s See Appendix 2-1 for development of the original knowing, doing, and being; the intercon- Holistic Standards of Practice: Basic and Graduate, and nectedness© Jones with &self, Bartlett others, nature,Learning, and LLCsee Appendix 2-2 for select works© Jones of individuals & Bartlett Learning, LLC God/LifeNOT Force/Absolute/Transcendent;FOR SALE OR DISTRIBUTION and AHNA documents. NOT FOR SALE OR DISTRIBUTION not necessarily synonymous with religion. Transpersonal: A personal understanding Function of the Scope of Practice that is based on one’s experiences of tem- Statement of Holistic Nursing porarily transcending or moving beyond The scope of practice statement describes the © Jones &one’s Bartlett usual identificationLearning, LLCwith the lim- who, what,© where, Jones when, & why,Bartlett and how Learning, of the LLC NOT FOR itedSALE biological, OR DISTRIBUTION historical, cultural, and practice ofNOT holistic FOR nursing. SALE3,4 The OR answers DISTRIBUTION to personal self at the deepest and most pro- these questions provide a picture of that spe- found levels of experience possible; that cialty nursing practice, its boundaries, and its which transcends the limits and boundar- membership. ies of individual ego identities and pos- Nursing: Scope and Standards of Practice, 2nd © Jones & Bartlett Learning,sibilities toLLC include acknowledgment and© Jonesed. (2010) & Bartlett applies to Learning, all professional LLC registered NOT FOR SALE OR DISTRIBUTIONappreciation of something greater. FromNOT nursesFOR (RNs)SALE engaged OR DISTRIBUTION in practice, regardless of this perspective the ordinary, biological, specialty, practice setting, or educational prepara- historical, cultural, and personal self is tion.4 With the Guide to the Code of Ethics for Nurses: seen as an important, but only a partial, Interpretation and Application5 and Nursing’s Social manifestation or expression of this much Policy Statement: The Essence of the Profession,6 it greater© Jonessomething & that Bartlett is one’s Learning,deeper ori- LLCforms the foundation of practice© forJones all registered & Bartlett Learning, LLC gin andNOT destination. FOR SALE OR DISTRIBUTIONnurses. The scope of holisticNOT nursing FOR practice SALE OR DISTRIBUTION Wellness: Integrated, congruent function- is specific to this specialty, but it builds on the ing aimed toward reaching one’s highest scope of practice expected of all registered nurses. potential.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC n SCOPE AND STANDARDS OF * To obtain a complete copy of Holistic Nursing: Scope NOT FORHOLISTIC SALE OR NURSING DISTRIBUTION PRACTICE and StandardsNOT of Practice FOR (2007), SALE contact OR the DISTRIBUTION Ameri- can Holistic Nurses Association (AHNA), 323 N. Extraordinary changes have occurred in health San Francisco Street, Suite 201, Flagstaff, AZ 86001; care and nursing during the past decade. During 1-800-278-2462 or 1-928-526-2196; www.ahna.org or this time, holistic nurses recognized that not only [email protected]. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Function of the Standards father of Western medicine, espoused a holistic of Holistic Nursing orientation when he taught doctors to observe their patients’ life circumstances and emotional “The Standards© Jones of Professional & Bartlett Nursing Learning, Practice LLC © Jones & Bartlett Learning, LLC states. Socrates stated, “Curing the soul; that is are authoritativeNOT statements FOR SALE of the dutiesOR DISTRIBUTION that all NOT FOR SALE OR DISTRIBUTION the first thing.” In holism, symptoms are believed registered nurses, regardless of role, population, or to be an expression of the body’s wisdom as it specialty, are expected to perform competently.”4 reacts to cure its own imbalance or disease. Standards reflect the values and priori- The root of the word heal comes from the © Jonesties & ofBartlett the profession. Learning, Standards LLC pro- Greek word halos© Jones and the &Anglo-Saxon Bartlett word Learning, hea- LLC NOT FORvide SALE direction OR for DISTRIBUTION professional nursing lan, which meansNOT “to FOR be or to SALE become ORwhole.” DISTRIBUTION The practice and a framework for evalua- word holy also comes from the same source. Heal- tion of this practice. Written in measur- ing means “making whole”—or restoring balance able terms, these standards define the and harmony. It is movement toward a sense of nursing profession’s accountability to wholeness and completion. Healing, therefore, © Jones & Bartlett Learning,the public and LLC the outcomes for which © Jonesis the integration & Bartlett of the Learning, totality of the LLC person in NOT FOR SALE OR DISTRIBUTIONregistered nurses are responsible.3 NOTbody, FOR mind, SALE emotion, OR spirit, DISTRIBUTION and environment. One of the driving forces behind the holistic The standards of holistic nursing practice are nursing movement in the United States was the specific to this specialty but build on the stan- formation of the AHNA. In 1981, founder Char- dards of practice expected of all registered nurses. lotte McGuire and 75 founding members began The current© Jones Holistic Nursing:& Bartlett Scope Learning,and Stan- theLLC national organization in ©Houston, Jones Texas. & Bartlett Learning, LLC dards of Practice (2007) presents a differentiation NOT FOR SALE OR DISTRIBUTIONThe national office is now locatedNOT in FOR Flagstaff, SALE OR DISTRIBUTION between practice at the basic and advanced prac- Arizona. The AHNA’s mission is to advance the tice levels. The Scope and Standards are organized philosophy and practices of holistic nursing and according to the criteria ANA uses in recognizing unite nurses in healing with a focus on holistic a nursing specialty area and build on nursing principles of health, preventive education, and © Jonesknowledge, & Bartlett skills, and Learning, competencies LLC required for the integration© Jones of allopathic & Bartlett and complemen Learning,- LLC licensure.7,8 The Holistic Nursing: Scope and Stan- NOT FOR SALE OR DISTRIBUTION tary caring andNOT healing FOR modalities SALE ORto facilitate DISTRIBUTION dards of Practice (2007) provides a blueprint for care of the whole person and significant others. holistic practice, education, and research. The From its inception in 1981, the AHNA has been standards guide clinicians, educators, research- the leader in developing and advancing holistic ers, nurse managers, and administrators in pro- principles, practices, and guidelines. The asso- fessional activities, knowledge, and performance ciation predicted that holistic principles, caring © Jones & Bartlettthat Learning, are relevant LLC to holistic nursing basic and© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOTand FOR healing, SALE and theOR integration DISTRIBUTION of complemen- advanced practice, education, research, and tary and alternative therapies would emerge into management. Because holistic nursing empha- mainstream health care. sizes that human experiences are subjectively The AHNA, the definitive voice for holistic described and that health and illness are deter- nursing, has as its vision “a world in which nurs- mined by the view of the individual, the Holistic ing nurtures wholeness and inspires peace and Nursing: Scope© andJones Standards & Bartlettof Practice (2007)Learning, are LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONhealing.” The mission of the AHNANOT is toFOR advance SALE OR DISTRIBUTION derived from values that are central to the spe- holistic nursing through community building, cialty and are consistent with the philosophies advocacy, research, and education. It is com- and theories of holism. mitted to promoting wholeness and wellness in individuals, families, communities, nurses © JonesEvolution & Bartlett of Holistic Learning, Nursing LLC themselves, the© Jonesnursing profession, & Bartlett and Learning,the envi- LLC NOT HolismFOR SALEin health OR care DISTRIBUTION is a philosophy that ema- ronment. ThroughNOT FORits various SALE activities, OR DISTRIBUTIONAHNA nates directly from Florence Nightingale, who provides vision, direction, and leadership in the believed in care that focused on unity, wellness, advancement of holistic nursing; integrates the and the interrelationship of human beings, art and science of nursing in the profession; events, and environment. Even Hippocrates, the empowers holistic nursing through education, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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research, and standards; encourages nurses to on nursing knowledge, theories of nursing and be models of wellness; honors individual excel- wholeness, expertise and intuition to guide nurses lence in the© Jonesadvancement & Bartlett of holistic Learning, nursing; LLCin becoming therapeutic partners© Jones with people & Bartlett in Learning, LLC and influencesNOT policy FOR to SALE change ORthe healthcareDISTRIBUTION strengthening human responsesNOT to facilitateFOR SALE the OR DISTRIBUTION system to a more humanistic orientation. healing process and achieve wholeness. Holistic The goals and endeavors of AHNA have con- nursing focuses on protecting, promoting, and tinued to map conceptual frameworks and the optimizing health and wellness; assisting healing; blueprint for holistic nursing practice, educa- preventing illness and injury; alleviating suffering; © Jonestion, & and Bartlett research, Learning, which is the mostLLC complete and supporting© Jones people &to Bartlettfind peace, Learning, comfort, LLC NOT FORway to SALE conceptualize OR DISTRIBUTION and practice professional harmony, andNOT balance FOR through SALE the ORdiagnosis DISTRIBUTION and nursing. Beginning in 1993, AHNA undertook treatment of human response. an organization development process that Holistic nursing care is healing oriented and included the following areas: centered on the relationship with the person in contrast to an orientation toward diseases n Identifying the steps toward national certi- and their cures. Holistic nursing emphasizes © Jones & Bartlett Learning,fication in LLC 1993–1994. © Jones & Bartlett Learning, LLC practices of self-care, intentionality, presence, NOT FOR SALE OR DISTRIBUTIONn Revising the 1990 Standards of HolisticNOT FOR SALE OR DISTRIBUTION mindfulness, and therapeutic use of self as piv- Nursing Practice, completed in 1995. otal for facilitation of healing and patterning n Completing a role delineation study, the of wellness in others. In some sense, all nurs- Inventory of Professional Activities and ing practice can be comprehensive, that is, all Knowledge Statements of a Holistic Nurse nursing practice may have a biopsychosocial (also ©known Jones as the & IPAKHN Bartlett Survey) Learning, in 1997. LLC © Jones & Bartlett Learning, LLC perspective. What makes holistic nursing prac- n DevelopingNOT FORa national SALE holistic OR nursing DISTRIBUTION cer- NOT FOR SALE OR DISTRIBUTION tice a specialty is that there is a philosophy, tification examination, completed in 1997. a body of knowledge, and an advanced set of n Completing major revisions of the 1995 nursing skills applied to practice that recog- Standards of Holistic Nursing Practice in nize the totality of the human being and the 1999, with additional editorial changes in interconnectedness of body, mind, emotion, © Jones &January Bartlett 2000 Learning,and 2005. LLC © Jones & Bartlett Learning, LLC spirit, energy, society, culture, relationships, NOT FOR n DevelopingSALE OR a DISTRIBUTION core curriculum for basic NOT FOR SALE OR DISTRIBUTION context, and environment. Philosophically, holistic nursing based on the basic stan- holistic nursing is a worldview, a way of being dards (1997). in the world, not just a modality. This philoso- n Approving and adopting Standards of Ad- phy honors the unique humanness of all people vanced Holistic Nursing Practice for Graduate- regardless of who and what they are. Knowledge © Jones & Bartlett Learning,Prepared Nurses LLC (2002, revised 2005). © Jones & Bartlett Learning, LLC for holistic nursing practice derives not only NOT FOR SALE OR DISTRIBUTIONn Developing a core curriculum for advancedNOT FOR SALE OR DISTRIBUTION from nursing, but from theories of wholeness, holistic nursing based on the advanced energy, and unity as well as from other heal- standards (2003). The American Holis- ing systems and approaches. Holistic nurses tic Nurses Certification Corporation incorporate both conventional nursing and (AHNCC) then developed the Certification complementary/alternative/integrative modali- Exam© for Jones Advanced & BartlettHolistic Nursing Learning, Prac- LLC © Jones & Bartlett Learning, LLC ties (CAM) and interventions into practice. tice firstNOT offered FOR in 2005.SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Through unconditional presence and inten- n Revising both the basic and advanced Stan- tion, holistic nurses create environments condu- dards of Holistic Nursing Practice to meet cive to healing, using techniques that promote ANA criteria for recognition of holistic empowerment, peace, comfort, and a subjective nursing as a specialty (2006, 2007). © Jones & Bartlett Learning, LLC sense of harmony© Jones and well-being& Bartlett for theLearning, person. LLC NOT FOR SALE OR DISTRIBUTION The holisticNOT nurse FOR acts in SALE partnership OR DISTRIBUTIONwith the n SCOPE OF HOLISTIC NURSING individual or family in providing options and Holistic nursing is defined as “all nursing practice alternatives regarding health and treatment. Addi- that has healing the whole person as its goal.”9 tionally, the holistic nurse assists the person to Holistic nursing is a specialty practice that draws find meaning in the health and illness experience. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Holistic nursing focuses on simultaneously practice encourages peer review of professional integrating as an iterative process all of these practice in various clinical settings and provides realms: a philosophy© Jones of & being Bartlett and living, Learning, using LLCcare based on current professional© Jones standards, & Bartlett Learning, LLC theories of NOTnursing FOR and wholenessSALE OR with DISTRIBUTION related laws, and regulations that governNOT nursing FOR prac SALE- OR DISTRIBUTION knowledge and skills, focusing on the unity tice. The major phenomena of concern to holis- and totality of humans, incorporating healing tic nursing are listed in Table 2-1. approaches, creating healing environments, part- nering with and empowering individuals, and The Core Values of Holistic Nursing: © Jonesassisting & Bartlettin the exploration Learning, of meaning LLC in the Integrating© and Jones the Art & andBartlett Science Learning, LLC NOT careFOR of people.SALE In ORholistic DISTRIBUTION nursing, the nurse is the of NursingNOT FOR SALE OR DISTRIBUTION facilitator of healing, honoring that the person Holistic nursing emanates from five core values heals him- or herself. The holistic nurse assists summarizing the ideals and principles of the individuals in identifying themselves as the healer specialty. These core values are listed here and and accessing their own innate healing capacities. then are discussed: © Jones & Bartlett Learning,The practice of LLC holistic nursing requires nurses© Jones & Bartlett Learning, LLC 1. Philosophy, Theory, and Ethics NOT FOR SALE ORto integrate DISTRIBUTION self-care and self-responsibility intoNOT FOR SALE OR DISTRIBUTION their own lives and to serve as role models for 2. Holistic Caring Process others. Holistic nurses strive for an awareness 3. Holistic Communication, Therapeutic of the interconnectedness of individuals to the Environment, and Cultural Diversity human and global community. Thus, holistic 4. Holistic Education and Research nurses also attend© Jones to the &health Bartlett of the ecosystem. Learning, LLC5. Holistic Nurse Self-Care © Jones & Bartlett Learning, LLC Holistic nursesNOT areFOR instruments SALE ofOR healing DISTRIBUTION and NOT FOR SALE OR DISTRIBUTION facilitators in the healing process. They honor Core Value 1: Holistic Philosophy, Theory, the individual’s subjective experience of health, and Ethics health beliefs, and values. To become therapeutic Holistic nurses (HNs) recognize the human partners with individuals, families, communi- health experience as a complicated, dynamic © Jonesties, and& Bartlett populations, Learning, holistic nurses LLC draw on relationship ©of health,Jones illness, & Bartlett and wellness, Learning, and LLC NOT nursingFOR SALE knowledge, OR theories, DISTRIBUTION research, expertise, they value healingNOT as FOR the desired SALE outcome OR DISTRIBUTION of the intuition, and creativity incorporating the roles practice of nursing. Their practice is based on of clinician, educator, consultant, coach, part- scientific foundations (theory, research, evidence- ner, role model, and advocate. Holistic nursing based practice, critical thinking, reflection) and

© Jones & Bartlett Learning,TABLE 2-1 LLCPhenomena of Concern to© Holistic Jones Nursing & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION n The caring–healing relationship n The subjective experience of and meanings ascribed to health, illness, wellness, healing, birth, growth and development, and dying n The cultural© Jones values and & Bartlettbeliefs and folkLearning, practices of LLC health, illness, and healing © Jones & Bartlett Learning, LLC n SpiritualityNOT in nursingFOR careSALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION n The evaluation of complementary/alternative modalities used in nursing practice n Comprehensive health promotion and disease prevention n Self-care processes © Jonesn Physical,& Bartlett mental, Learning, emotional, and LLC spiritual comfort, discomfort, and© Jones pain & Bartlett Learning, LLC NOT FORn Empowerment, SALE OR decision DISTRIBUTION making, and the ability to make informedNOT choices FOR SALE OR DISTRIBUTION n Social and economic policies and their effects on the health of individuals, families, and communities n Diverse and alternative healthcare systems and their relationships with access and quality of health care n The environment and the prevention of disease © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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art (relationship, communication, creativity, choices across a continuum and the possible presence, caring). Holistic nursing is grounded effects and implications of each. For instance, if in nursing© knowledge Jones & and Bartlett skill and Learning, guided by LLCa person diagnosed with cancer© Jones is experiencing & Bartlett Learning, LLC nursing theory.NOT FlorenceFOR SALE Nightingale’s OR DISTRIBUTION writings nausea caused by chemotherapy,NOT the FOR individual SALE OR DISTRIBUTION are often referenced as a significant precursor of and nurse may discuss the choices and effects the development of holistic nursing. Although of pharmacologic agents, imagery, homeopathic each holistic nurse chooses which nursing the- remedies, and so on, or a combination of these. ory to apply in any individual case, the nursing The holistic nurse acts as partner and copre- © Jonestheories & Bartlett of Jean Watson Learning, (the Theory LLC of Human scriber versus© soleJones prescriber. & Bartlett The relationship Learning, is LLC NOT FORCaring), SALE Martha OR Rogers DISTRIBUTION (the Science of Unitary a copilotingNOT of the FORindividual’s SALE health OR experience DISTRIBUTION Human Beings), Margaret Newman (Health as where the nurse respects the person’s decision Expanding Consciousness), Madeleine Lein about his or her own health. It is a process of inger (Theory of Cultural Care), Rosemarie Rizzo engagement versus compliance. Parse (Theory of Human Becoming), Josephine Client narratives, whether they arise from © Jones & Bartlett PatersonLearning, and Loretta LLC Zderad (Humanistic Nurs©- Jonesindividuals, & Bartlett families, Learning, or communities, LLC provide NOT FOR SALE ORing DISTRIBUTION Theory), and Helen Erickson (Modeling andNOT theFOR context SALE of the OR experiences DISTRIBUTION and are used as an Role-Modeling) are most frequently used to sup- important focus in understanding the person’s port holistic nursing practice. situation. Holistic nurses hold the belief that In addition to nursing theory, holistic nurses people, through their inherent capacities, heal use other theories and perspectives of whole- themselves. Therefore, the holistic nurse is not ness and healing© Jones to guide & Bartlett their practice. Learning, These LLCthe healer but the guide and© facilitator Jones &of theBartlett Learning, LLC scientific NOTtheories FOR and SALEphilosophies OR DISTRIBUTIONpresent a individual’s own healing. NOT FOR SALE OR DISTRIBUTION worldview of connectedness. Examples include In the belief that all things are connected, the following: the holistic perspective espouses that an individual’s actions have a ripple effect throughout n Theories of Consciousness humanity. Holism places the greatest worth on n Energy Field Theory individuals’ developing higher levels of human © Jones n &C. Bartlett Pribram’s HolographicLearning, Universe LLC © Jones & Bartlett Learning, LLC awareness. This, in turn, elevates the whole of NOT FOR n D.SALE Bohm’s OR Implicate/Explicate DISTRIBUTION Order NOT FOR SALE OR DISTRIBUTION humanity. Holistic nurses believe in the sacred- n C. Pert’s Psychoneuroimmunology ness of one’s self and of all nature. One’s inner n K. Wilber’s Integral Vision and Unified self and the collective greater self have steward- Field Theory of Consciousness ship not only over one’s body, mind, and spirit n Spirituality but also the planet. Holistic nurses focus on the © Jones & Bartlett Learning,n Alternative LLC medical systems such as Tradi©- Jones & Bartlett Learning, LLC meaning and quality of life deriving from their NOT FOR SALE OR DISTRIBUTIONtional Oriental Medicine, Ayurveda, NativeNOT FOR SALE OR DISTRIBUTION own character and from their relationship to the American, and indigenous healing universe rather than that imposed from without. n Eastern contemplative orientations such as Holistic nurses hold to a professional ethic Zen Buddhism and Taoism of caring and healing that seeks to preserve the Holistic nurses© Jones further & recognize Bartlett and Learning, honor the LLCwholeness and dignity of the© selfJones and others. & Bartlett Learning, LLC ethic that NOTthe person FOR is SALEthe authority OR DISTRIBUTIONon his or They support human dignity NOTby advocating FOR SALEand OR DISTRIBUTION her own health experience. The holistic nurse is adhering to the Patient Bill of Rights,10 the ANA an “option giver” and helps the person develop Guide to the Code of Ethics for Nurses: Interpretation an understanding of alternatives and implica- and Application,5 and the AHNA Position State- tions of various health and treatment options. ment on Holistic Nursing Ethics.11 © JonesThe &holistic Bartlett nurse Learning,first ascertains LLC what the indi- © Jones & Bartlett Learning, LLC Core Value 2: Caring Process NOT FORvidual SALE thinks orOR believes DISTRIBUTION is happening to him/ NOT FOR SALE OR DISTRIBUTION her, and then assists the person to identify what Holistic nurses provide care that recognizes the will help the situation. The assessment begins totality of the human being (the interconnected- from where the individual is. The holistic nurse ness of body, mind, emotion, spirit, society, cul- then discusses options, including the person’s ture, relationships, context, and environment). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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This is an integrated as well as comprehensive ing and understanding of the health and disease approach. Although physical symptoms are experience can be mutually identified with the treated, holistic© Jones nurses & also Bartlett focus on Learning, how the LLCperson. Holistic nurses first ask© Jonesan individual, & Bartlett Learning, LLC individual NOTcognitively FOR perceives SALE andOR emotion DISTRIBUTION- “What do you think is going onNOT (happening) FOR with SALE OR DISTRIBUTION ally deals with the illness; the illness’s effect on you?” and then, “What do you think would help?” the person’s family, social relationships, and eco- Another important responsibility of the holistic nomic resources; the person’s values and cultural nurse is to help the person identify risk factors and spiritual beliefs and preferences regarding such as lifestyle, habits, beliefs and values, per- © Jonestreatment; & Bartlett and the meaningLearning, of this LLC experience sonal and family© Jones health history,& Bartlett and age-related Learning, LLC NOT toFOR the person’sSALE life.OR In DISTRIBUTION addition, holistic nurses conditions thatNOT influence FOR health, SALE and ORthen DISTRIBUTIONto find may also incorporate a number of modalities and use opportunities to increase well-being. The (e.g., cognitive restructuring, stress management, focus is on the individual’s goals, not the nurse’s. visualization, aromatherapy, therapeutic touch) Therapeutic plans of care respect the person’s with conventional nursing interventions. Holis- experience and the uniqueness of each healing © Jones & Bartletttic Learning, nurses focus LLCon care interventions that pro©- Jonesjourney. & The Bartlett same illness Learning, may have very LLC different NOT FOR SALE ORmote DISTRIBUTION healing, peace, comfort, and a subjectiveNOT manifestations FOR SALE in ORdifferent DISTRIBUTION individuals. A major sense of well-being for the person. aspect of holistic nursing practice, in addition The holistic caring process involves six often to competence, is intention. That is, the nurse simultaneously occurring steps: assessment, intends for the wholeness, well-being, and high- diagnosis (pattern, problem, need identifica- est good of the person in every encounter and tion), outcomes,© Jones therapeutic & Bartlett plan of care, Learning, imple- intervention.LLC This intention honors© Jones and &rein Bartlett- Learning, LLC mentation, NOTand evaluation. FOR SALE Holistic OR nurses DISTRIBUTION apply forces the innate capacity of peopleNOT to healFOR them SALE- OR DISTRIBUTION the holistic caring process in all settings with selves. Therefore, holistic nurses respect that individuals and families across the life span, outcomes may not be those expected and may population groups, and communities. evolve differently based on the person’s individ- Holistic nurses incorporate a variety of roles ual healing process and health choices. Holis- © Jonesin their & practice,Bartlett including Learning, expert LLCclinician and tic nurses endeavor© Jones to detach & Bartlett themselves Learning, from LLC NOT facilitatorFOR SALE of healing; OR consultant,DISTRIBUTION coach, and col- the outcomes.NOT The FORnurse doesSALE not ORproduce DISTRIBUTION the laborator; educator and guide; administrator, outcomes; the individual’s own healing process leader, and change agent; researcher; and advo- produces the outcomes, and the nurse facilitates cate. Holistic nurses strongly emphasize part- this process. A significant focus of the holistic nership with individuals throughout the entire nurse is on guiding individuals and significant © Jones & Bartlettdecision-making Learning, LLC process. Holistic assessments© Jonesothers to& useBartlett their inner Learning, strength and LLC resources NOT FOR SALE ORinclude DISTRIBUTION not only physical, functional, psychoNOT- through FOR theSALE course OR of healing. DISTRIBUTION social, mental, emotional, cultural, and sexual Holistic nurses consistently provide appropriate aspects, but also the spiritual, transpersonal, and and evidence-based information (including cur- energy field assessments of the whole person. rent knowledge, practice, and research) regarding Energy assessments are based on the concept the health condition and various treatments and that all beings© Jonesare composed & Bartlett of energy. Learning, Conges- therapiesLLC and their side effects. Holistic© Jones care always & Bartlett Learning, LLC tion or stagnationNOT ofFOR energy SALE in any ORrealm DISTRIBUTION creates occurs within the scope and standardsNOT ofFOR practice SALE OR DISTRIBUTION disharmony and disease. Spiritual assessments of registered nursing and in accordance with state glean not only religious beliefs and practices but and federal laws and regulations. query a person’s meaning and purpose in life and Holistic nurses integrate complementary/ how these may have changed because of the pres- alternative modalities (CAM) into clinical prac- © Jonesent health & Bartlett experience. Learning, Spiritual assessments LLC also tice to treat ©people’s Jones physiologic, & Bartlett psychological, Learning, LLC NOT includeFOR SALEquestions OR about DISTRIBUTION an individual’s sense of and spiritualNOT needs. FORDoing soSALE does not OR negate DISTRIBUTION the serenity and peace, what provides joy and fulfill- validity of conventional medical therapies but ment, and the source of strength and hope. serves to complement, broaden, and enrich the Holistic assessment data are interpreted into scope of nursing practice and to help individuals patterns, challenges, and needs from which mean- access their greatest healing potential. Holistic © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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nurses advocate for integration rather than sepa- ventions: meditation; relaxation therapy; breath ration. The National Center for Complementary work; music, art, and aroma therapies; energy- and Alternative© Jones Medicine & Bartlett has categorized Learning, CAM LLCbased touch therapies such as© therapeutic Jones &touch, Bartlett Learning, LLC approachesNOT and these FOR are SALE identified OR in Table DISTRIBUTION 2-2. healing touch, and Reiki; acupressure;NOT FOR massage; SALE OR DISTRIBUTION Therapies frequently incorporated in holis- guided imagery; hypnotherapy; animal-assisted tic nursing practice include the following inter- therapy; biofeedback; prayer; reflexology; diet;

TABLE 2-2 Categories of Complementary/Alternative Modalities (CAM) Therapies © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION In the context of this chapter, these descriptive categories encompass generally, but not exhaustively, those therapies described as alternative or complementary. Natural products. This area includes substances found in nature such as a variety of herbal medicines (also known as botanicals), vitamins, minerals, whole diet therapies, and other “natural products.” Many © Jones & Bartlett Learning,are sold over theLLC counter as dietary supplements.© (SomeJones uses & of Bartlettdietary supplements—e.g., Learning, taking LLC a mul- tivitamin to meet minimum daily nutritional requirements or taking calcium to promote bone health—are NOT FOR SALE OR DISTRIBUTIONnot thought of as CAM.) CAM “natural products”NOT also FOR include SALE probiotics—live OR DISTRIBUTION microorganisms (usually bacteria) that are similar to microorganisms normally found in the human digestive tract and that may have beneficial effects. Probiotics are available in foods (e.g., yogurts) or as dietary supplements. Mind–body medicine. Mind–body practices focus on the interactions among the brain, mind, body, and behavior, with the intent to use the mind to affect physical functioning and promote health. Many CAM© Jones practices & embody Bartlett this concept—in Learning, different LLC ways. Some techniques that© were Jones considered & Bartlett Learning, LLC CAM inNOT the past FOR have SALE become ORmainstream DISTRIBUTION (for example, patient support groups,NOT psychotherapy, FOR SALE OR DISTRIBUTION cognitive-behavioral therapy). Mind–body techniques include meditation, relaxation, imagery, hypnotherapy, yoga, biofeedback, and Tai Chi. Other therapies are autogenic training, spirituality, prayer, mental healing, and therapies that use creative outlets such as art, music, dance, or journaling. Acupuncture is considered to be a part of mind–body medicine, but it is also a component of energy © Jonesmedicine, & Bartlett manipulative Learning, and body-based LLC practices, and traditional© Chinese Jones medicine. & Bartlett Learning, LLC NOT FORManipulative SALE OR and DISTRIBUTIONbody-based practices. Manipulative and body-basedNOT FORpractices SALE focus primarilyOR DISTRIBUTION on the structures and systems of the body, including the bones and joints, soft tissues, and circulatory and lymphatic systems. Two commonly used therapies fall within this category: spinal manipulation including Chiropractic or osteopathic manipulation, and massage. Movement therapies. CAM also encompasses movement therapies—a broad range of Eastern and West- ern movement-based approaches used to promote physical, mental, emotional, and spiritual well-being. © Jones & Bartlett Learning,Examples include LLC Feldenkrais method, Alexander© technique,Jones &Pilates, Bartlett Rolfing Learning,Structural Integration, LLC and NOT FOR SALE OR DISTRIBUTIONTrager psychophysical integration. NOT FOR SALE OR DISTRIBUTION Practices of traditional healers. Traditional healers use methods based on indigenous theories, beliefs, and experiences handed down from generation to generation. Examples include Native American healer/ medicine man, African, Middle Eastern, Tibetan, Central and South American, and Curanderismo. Energy therapies. Some CAM practices involve manipulation of various energy fields to affect health. Such fields© Jonesmay be characterized & Bartlett as Learning, veritable (measurable) LLC or putative (yet to be measured).© Jones Prac & -Bartlett Learning, LLC tices basedNOT on veritableFOR SALE forms of OR energy DISTRIBUTION include those involving electromagnetic fieldsNOT (e.g., FOR magnet SALE OR DISTRIBUTION therapy, light therapy, or alternating-current or direct-current fields). Practices based on putative energy fields (also called biofields) generally reflect the concept that human beings are infused with subtle forms of energy. Some forms of energy therapy manipulate biofields by applying pressure, such as acupressure and manipulating the body by placing the hands in or through these fields. Examples © Jonesinclude & Bartlett Gong, Reiki, Learning, therapeutic LLC touch, and healing touch. © Jones & Bartlett Learning, LLC NOT FORWhole SALE medical OR systems. DISTRIBUTION Complete systems of theory and practiceNOT that haveFOR evolved SALE over OR time DISTRIBUTIONin different cultures and apart from conventional or Western medicine, may be considered CAM. Examples of ancient whole medical systems include Ayurvedic medicine and Traditional Chinese medicine. More modern systems that have developed in the past few centuries include Homeopathy and Naturopathy. Source: National Center for Complementary and Alternative Medicine, National Institutes of Health (2011); © Jones & Bartlett Learning,http://nccam.nih.gov. LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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herbology; and homeopathy. Other interventions sincere. This is more than offering therapeutic frequently employed in holistic nursing practice techniques such as responding, reflecting, sum- in addition ©to conventionalJones & Bartlettnursing interventions Learning, LLCmarizing, and so on. This is deep© listening,Jones &or asBartlett Learning, LLC include anxietyNOT reduction FOR SALE and stress OR manageDISTRIBUTION- some say “listening with the heartNOT and FOR not justSALE OR DISTRIBUTION ment, calming techniques, emotional support, the ears.” It is done with conscious intention and exercise and nutrition promotion, smoking ces- without preconceptions, busy-ness, distractions, sation, patient contracting, resiliency promo- or analysis. It takes place in the “now” within an tion, forgiveness facilitation, hope installation, atmosphere of shared humanness—human being © Jonespresence, & Bartlett journaling, Learning, counseling, cognitive LLC ther- to human being.© Jones Through & Bartlettpresence or Learning, “being LLC NOT apy,FOR self-help, SALE spiritual OR DISTRIBUTION support, and environ- within the moment,”NOT FOR holistic SALE nurses provideOR DISTRIBUTION each mental management.12 person with an interpersonal encounter that the Because many of today’s healthcare problems individual can experience as a connection with are stress related, holistic nurses empower individ- one who is giving undivided attention to his or uals by teaching them techniques to reduce their her needs and concerns. Using unconditional © Jones & Bartlettstress. Learning, Many interventions LLC used in holistic nursing© Jonespositive & regard, Bartlett holistic Learning, nurses convey LLC to the indi- NOT FOR SALE ORelicit DISTRIBUTION the relaxation response (e.g., breath work,NOT vidual FOR receiving SALE care OR the DISTRIBUTION belief in his or her worth meditation, relaxation, imagery, aromatherapy and value as a human being, not solely as a recipi- and essential oils, and diet). People can learn these ent of medical and nursing interventions. therapies and use them without the intervention The holistic nurse recognizes the importance of a healthcare provider. This allows people to of context in understanding the person’s health take an active© Jonesrole in the & managementBartlett Learning, of their experience.LLC Space and time are allowed© Jones for explo & Bartlett- Learning, LLC own healthNOT care. Holistic FOR SALEnurses also OR can DISTRIBUTION teach ration. Each person’s health encounterNOT FOR is truly SALE OR DISTRIBUTION families and caregivers to use these techniques seen as unique and may be contrary to conven- for loved ones who may be ill (e.g., simple foot or tional knowledge and treatments. Therefore, the hand massage for older clients with dementia). In holistic nurse must be comfortable with ambi- addition, individuals are taught how to evaluate guity, paradox, and uncertainty. This requires © Jonestheir own& Bartlett responses toLearning, these modalities. LLC a perspective© that Jones the nurse & Bartlett is not “the Learning, expert” LLC NOT FORHolistic SALE nurses OR prescribe DISTRIBUTION as legally authorized. regarding another’sNOT FORhealth andSALE illness OR experience DISTRIBUTION They instruct individuals regarding drug, herbal, but is actually a “learner.” and homeopathic regimens, and, just as impor- Holistic nurses have a knowledge base of the tant, they consult on the side effects and inter- use and meanings of symbolic language and use actions between medications and herbs. They interventions such as imagery, creation of sacred © Jones & Bartlettconsult, Learning, collaborate, LLC and refer, as necessary, to© Jonesspace and & Bartlettpersonal rituals, Learning, dream exploration,LLC NOT FOR SALE ORboth DISTRIBUTION conventional allopathic providers and toNOT and FOR aesthetic SALE therapies OR suchDISTRIBUTION as music, visual arts, holistic practitioners. They provide informa- and dance. They encourage and support others in tion and counseling to people about alternative, the use of prayer, meditation, and other spiritual complementary, integrative, and conventional and symbolic practices for healing purposes. healthcare practices. Very important, holistic A cornerstone of holistic nursing practice is nurses facilitate© Jones negotiation & Bartlett of services Learning, as they assistingLLC individuals to find meaning© Jones in their& Bartlett Learning, LLC guide individualsNOT andFOR families SALE between OR DISTRIBUTIONconven- experience. Regardless of the person’sNOT condition,FOR SALE OR DISTRIBUTION tional Western medicine and alternative systems. the meaning that individuals ascribe to their sit- Holistic nurses, in partnership with the individ- uation can influence their response to it. Holis- ual and others, evaluate whether care is effec- tic nurses attend to the subjective world of the tive and whether changes in the meaning of the individual. They consider meanings such as the © Joneshealth & experience Bartlett occur Learning, for the individual. LLC person’s concerns© Jones in relation & Bartlett to health andLearning, fam- LLC NOT FOR SALE OR DISTRIBUTION ily economics,NOT as well FOR as deeper SALE meanings OR DISTRIBUTIONrelated Core Value 3: Holistic Communication, Thera- to the person’s purpose in life. Regardless of the peutic Environment, and Cultural Diversity technology or treatment, holistic nurses address The holistic nurse’s communication ensures that the human spirit as a major force in healing. each individual experiences the presence of the Each person’s perception of meaning is related © Jones & Bartlettnurse Learning, as authentic, LLC caring, compassionate, and© Jonesto all factors & Bartlett in health-wellness-disease-illness. Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Holistic nurses realize that suffering, ill- Holistic nurses actively participate in building ness, and disease are natural components of an ecosystem that sustains the well-being of all the human© condition Jones &and Bartlett have the potentialLearning, to LLClife. This includes raising the ©public’s Jones conscious & Bartlett- Learning, LLC teach us aboutNOT ourselves, FOR SALE our relationships, OR DISTRIBUTION and ness about environmental issuesNOT and FOR stressors SALE OR DISTRIBUTION our universe. Every experience is valued for its that affect not only the health of people but the meaning and lesson. health of the planet. Holistic nurses have a particular obligation to create a therapeutic environment that values Core Value 4: Holistic Education © Jonesholism, & Bartlett caring, social Learning, support, and LLC integration and Research© Jones & Bartlett Learning, LLC NOT FORof conventional SALE OR and CAMDISTRIBUTION approaches to healing. Holistic nursesNOT possess FOR an SALE understanding OR DISTRIBUTION of a They seek to create environments where individ- wide range of norms and healthcare practices, uals, both clients and staff, feel connected, sup- beliefs, and values concerning individuals, fami- ported, and respected. A particular perspective lies, groups, and communities from a variety of of holistic nursing is the nurse as the “healing racial, ethnic, spiritual, and social backgrounds. © Jones & Bartlett environment”Learning, andLLC “an instrument of healing.”© JonesThis rich& Bartlett knowledge Learning, base reflects LLC their formal NOT FOR SALE ORHolistic DISTRIBUTION nurses shape the physical environmentNOT academicFOR SALE and continuing OR DISTRIBUTION education preparation. (e.g., light, fresh air, pleasant sounds or quiet, Their knowledge also includes a wide diversity of neatness and order, healing smells, earth ele- practices and modalities outside of conventional ments). And they provide a relationship-focused Western medicine. Because of this, holistic nurses environment by creating sacred space through have a significant impact on peoples’ understand- presence and© Jones intention & where Bartlett another Learning, can feel LLCing of healthcare options and© alternatives, Jones & thus Bartlett Learning, LLC safe, can unfold,NOT andFOR can SALE explore theOR dimensions DISTRIBUTION serving as both educators and NOTadvocates. FOR SALE OR DISTRIBUTION of self in healing. Additionally, holistic nurses provide much Culture, beliefs, and values are inherent com- needed information to individuals on health ponents of a holistic approach. Concepts of promotion including such topics as healthy life- health and healing are based in culture and often styles, risk-reducing behaviors, preventive self- © Jonesinfluence & Bartlett people’s actionsLearning, to promote, LLC maintain, care, stress© management, Jones & Bartlettliving with Learning, changes LLC NOT FORand restore SALE health. OR CultureDISTRIBUTION also may provide an secondary toNOT illness FOR and treatment, SALE OR and opportuDISTRIBUTION- understanding of a person’s concept of illness nities to enhance well-being. or disease and appropriate treatment. Holistic Holistic nurses value all the ways of knowing nurses possess knowledge and understanding and learning. They individualize learning and of numerous cultural traditions and healthcare appreciate that science, intuition, introspection, © Jones & Bartlett practicesLearning, from LLCvarious racial, ethnic, and social© Jonescreativity, & Bartlett aesthetics, Learning, and culture produce LLC differ- NOT FOR SALE ORbackgrounds. DISTRIBUTION However, holistic nurses honorNOT entFOR bodies SALE of knowledge OR DISTRIBUTION and perspectives. They the individual’s understanding and articulation help others to know themselves and access their of his or her own cultural values, beliefs, and inner wisdom to enhance growth, wholeness, health practices rather than relying on stereotyp- and well-being. ical cultural classifications and descriptions. The Holistic nurses often guide individuals and nurse then© uses Jones these understandings& Bartlett Learning, to provide LLCfamilies in their healthcare© decisions, Jones &espe Bartlett- Learning, LLC culturally NOTcompetent FOR care SALE that corresponds OR DISTRIBUTION with cially regarding conventionalNOT allopathic FOR SALEand OR DISTRIBUTION the beliefs, values, traditions, and health prac- complementary/alternative practices. Therefore, tices of people. Holistic nurses ask individuals, holistic nurses must be knowledgeable about “What do I need to know about you culturally in the best evidence available for both conventional caring for you?” and CAM therapies. In addition to developing © JonesHolistic & Bartlett healing Learning, is a collaborative LLC approach. evidence-based© Jones practice & using Bartlett research, Learning, practice LLC NOT FORHolistic SALE nurses OR take DISTRIBUTION an active role in trying to guidelines, NOTand expertise, FOR holisticSALE nurses OR DISTRIBUTIONstrongly remove the political and financial barriers to the consider the person’s values and healthcare prac- inclusion of holistic care in the healthcare sys- tices and beliefs in practice decisions. tem. Of particular importance to holistic nurses Holistic nurses look at alternative philoso- is the human connection with the ecology. phies of science and research methods that are © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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compatible with investigations of humanistic cannot facilitate healing unless they are in the and holistic occurrences, that explore the con- process of healing themselves. Through continu- text in which© phenomenaJones & Bartlettoccur and theLearning, mean- LLCing education, practice, and self-work,© Jones holistic & Bartlett Learning, LLC ing of patternsNOT that FOR evolve, SALE and that OR take DISTRIBUTION into nurses develop the skills of authenticNOT FOR and deep SALE OR DISTRIBUTION consideration the interactive nature of the body, self-reflection and introspection to understand mind, emotion, spirit, and environment. themselves and their journey. It is seen as a life- Holistic nurses conduct and evaluate research long process. in such diverse areas as follows: Holistic nurses strive to achieve harmony and balance in their own lives and assist others © Jones n Outcome& Bartlett measures Learning, of holistic LLC therapies © Jones & Bartlett Learning, LLC to do the same. They create healing environ- NOT FORsuch SALE as therapeutic OR DISTRIBUTION touch, prayer, and NOT FOR SALE OR DISTRIBUTION ments for themselves by attending to their own aromatherapy well-being, letting go of self-destructive behav- n Instrument development to measure car- iors and attitudes, and practicing centering ing behaviors and dimensions; spirituality; and stress-reduction techniques. By doing this, self-transcendence; cultural competence, holistic nurses serve as role models to others, © Jones & Bartlett Learning,and so forth LLC © Jones & Bartlett Learning, LLC be they clients, colleagues, or personal relations. NOT FOR SALE OR n DISTRIBUTIONClient responses to holistic interventions inNOT FOR SALE OR DISTRIBUTION health and illness n Explorations of clients’ lived experiences n STANDARDS OF HOLISTIC with various health/illness phenomena NURSING PRACTICE n Theory development in healing, caring, intentionality,© Jones cultural & Bartlett constructions, Learning, OverarchingLLC Philosophical ©Principles Jones &of Bartlett Learning, LLC empowerment,NOT FOR and so SALE forth OR DISTRIBUTIONHolistic Nursing NOT FOR SALE OR DISTRIBUTION Further, research that advances the work of Holistic nurses express, contribute to, and pro- holistic nursing theories (Watson, Rogers, New- mote an understanding of the following: a phi- man, Parse, Erickson, and Leninger) helps to losophy of nursing that values healing as the © Jonesbuild the& Bartlett knowledge Learning,base of nursing LLC and advance desired outcome;© Jones the human & Bartlett health experience Learning, LLC as a complex, dynamic relationship of health, NOT theFOR nursing SALE science OR of DISTRIBUTION holism. The AHNA has NOT FOR SALE OR DISTRIBUTION incorporated an active research agenda by assist- illness, disease, and wellness; the scientific foun- ing and mentoring members in research endeav- dations of nursing practice; and nursing as an ors, granting research awards, identifying and art. Holistic nursing is based on the following reporting on research that focuses on holistic overarching philosophical tenets that are embed- healing phenomena and modalities, and apply- ded in every standard of practice. The following © Jones & Bartlett Learning, LLC © Jonesprinciples & underlieBartlett holistic Learning, nursing: LLC NOT FOR SALE ORing researchDISTRIBUTION in practice. NOT FOR SALE OR DISTRIBUTION Core Value 5: Holistic Nurse Self-Care Person Self-care as well as personal awareness and con- n There is unity, totality, and connectedness tinual focus on being an instrument of healing of everyone and everything (body, mind, are significant© Jonesrequirements & Bartlett for holistic Learning, nurses. LLCemotion, spirit, sexuality,© Jones age, environ & Bartlett- Learning, LLC Holistic nursesNOT value FOR themselves SALE andOR mobilizeDISTRIBUTION ment, society, culture, beliefNOT systems, FOR rela SALE- OR DISTRIBUTION the necessary resources to care for themselves. tionships, and context). They endeavor to integrate self-awareness, self- n Human beings are unique and inherently care, and self-healing into their lives by incor- good. porating practices such as self-assessment, n People are able to find meaning and purpose © Jonesmeditation, & Bartlett yoga, good Learning, nutrition, LLCenergy thera- in their ©own Jones lives, experiences, & Bartlett and illnesses. Learning, LLC NOT pies,FOR movement, SALE ORart, support,DISTRIBUTION and lifelong learn- n All peopleNOT have FOR an innate SALE power OR and DISTRIBUTION capac- ing. Holistic nurses honor their unique patterns ity for self-healing. Health and illness are and the development of the body, the psycho- subjectively described and determined by social and cultural self, the intellectual self, the view of the individual. Therefore, the the energetic self, and the spiritual self. Nurses person is honored in all phases of his or her © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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healing process regardless of expectations n Older adults represent the predominant or outcomes. population served by nurses. n Various© Jones people are & the Bartlett recipients Learning, of holistic LLC n Public policy and the healthcare© Jones delivery & Bartlett Learning, LLC nursingNOT services: FOR clients, SALE patients, OR DISTRIBUTION families, system influence the healthNOT and FOR well-being SALE OR DISTRIBUTION significant others, populations, or com- of society and professional nursing. munities. They may be ill and within the healthcare delivery system or well, moving Nursing Roles toward personal betterment to enhance n The nurse is part of the healing environ- © Jones &well-being. Bartlett Learning, LLC ment ©using Jones warmth, & Bartlettcompassion, Learning, caring, LLC NOT FOR SALE OR DISTRIBUTION authenticity,NOT FOR respect, SALE trust, ORand relationDISTRIBUTION- Healing and Health ship as instruments of healing in and of n Health and illness are natural and a part themselves. of life, learning, and movement toward n The holistic nurse uses conventional nurs- change and development. ing interventions as well as holistic, com- © Jones & Bartlett Learning,n Health is LLCseen as balance, integration, har©- Jones plementary,& Bartlett alternative, Learning, and LLC integrative NOT FOR SALE OR DISTRIBUTIONmony, right relationship, and the betterNOT- FORmodalities SALE ORthat DISTRIBUTIONenhance the body-mind- ment of well-being, not just the absence emotion-spirit connectedness to foster the of disease. Healing can take place with- healing, health, wholeness, and well-being out cure. The focus is on health promo- of people. tion, disease prevention, health restoration, n The holistic nurse collaborates and part- and lifestyle© Jones patterns & Bartlett and habits Learning, as well as LLC ners with all constituencies© Jones in the health& Bartlett Learning, LLC symptomNOT relief. FOR SALE OR DISTRIBUTIONprocess including the personNOT receiving FOR SALEcare OR DISTRIBUTION n Illness is considered a teacher and an and his or her family, significant others, opportunity for self-awareness and growth community, colleagues, and individuals as part of the life process. Symptoms are from other disciplines; this is all accom- respected as messages. plished using principles and skills of coop- © Jones n &As Bartlett active partners Learning, in the healing LLC process, eration,© alliance,Jones and & Bartlettrespect and Learning, honoring LLC NOT FOR peopleSALE are OR empowered DISTRIBUTION when they take the contributionsNOT FOR of SALEall. OR DISTRIBUTION some control of their own lives, health, and n The holistic nurse participates in the well-being including personal choices and change process to develop more caring cul- relationships. tures in which to practice and learn. n Treatment is a process that considers the n The holistic nurse assists nurses to nurture © Jones & Bartlett Learning,root of the LLC problem and does not merely© Jones and& Bartlett heal themselves. Learning, LLC n NOT FOR SALE OR DISTRIBUTIONtreat the obvious signs and symptoms. NOT FOR The SALE holistic OR nurse DISTRIBUTION participates in activities that contribute to the improvement Practice of communities, the environment, and the n Practice is a science using critical think- betterment of public health. ing, reflection, evidence, research, theory; n The holistic nurse acts as an advocate for practice© Jones is also an & art Bartlett requiring Learning, intuition, LLC the rights of and equitable© distributionJones & andBartlett Learning, LLC creativity,NOT presence, FOR SALEand self-knowledge. OR DISTRIBUTIONaccess to health care forNOT all persons, FOR espeSALE- OR DISTRIBUTION n The values and ethic of holism, caring, cially vulnerable populations. moral insight, dignity, integrity, compe- n The holistic nurse honors the ecosystem tence, responsibility, accountability, and and our relationship with and need to pre- legality underline holistic nursing practice. serve it. © Jones n &There Bartlett are various Learning, philosophies LLC and para- © Jones & Bartlett Learning, LLC Self-Care NOT FOR digmsSALE of ORhealth, DISTRIBUTION illness, and healing and NOT FOR SALE OR DISTRIBUTION approaches and models for the delivery of n Holistic nurses’ self-reflection and self- health care both in the United States and in assessment, self-care, healing, and personal other countries that need to be understood development are necessary for service to and utilized. others and for growth/change in their own © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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well-being and for understanding of their The holistic advanced practice registered nurse: personal journey. 1. Initiates and interprets diagnostic proce- n Holistic nurses value themselves and their © Jones & Bartlett Learning, LLCdures relevant to the person’s© Jonescurrent status. & Bartlett Learning, LLC calling to holistic nursing as a life purpose. NOT FOR SALE OR DISTRIBUTION 2. Explores the meanings NOT of the FOR symbolic SALE OR DISTRIBUTION Holistic nursing practice is guided by the holistic language expressing itself in areas such as caring process, whether used with individuals, dreams, images, symbols, sensations, or families, population groups, or communities. prayers that are a part of the individual’s This process involves assessment, diagnosis, out- health experience. © Jonescome &identification, Bartlett Learning,planning, implementation, LLC © Jones & Bartlett Learning, LLC NOT andFOR evaluation. SALE ORIt encompasses DISTRIBUTION all significant Standard 2. DIAGNOSISNOT FOR OR SALE HEALTH OR ISSUES: DISTRIBUTION actions taken in providing culturally competent, The holistic nurse analyzes the assessment data ethical, respectful, compassionate, and relevant to determine the diagnosis or issues expressed as holistic nursing care to all persons. actual or potential patterns/problems/needs that © Jones & BartlettThe Learning, Standards LLC of Holistic © Jonesare related & Bartlettto health, wellness, Learning, disease, LLCor illness. NOT FOR SALE ORNursing DISTRIBUTION Practice* NOTThe FOR holistic SALE registered OR nurse: DISTRIBUTION There are 15 standards in the Holistic Nursing: 1. Derives the diagnosis or health issues Scope and Standards of Practice (2007), 6 for prac- based on holistic assessment data. tice and 9 for professional performance.3 Each 2. Assists the person to explore the meaning standard addresses measurement criteria (com- of the health/disease experience. petencies) for© bothJones the registered& Bartlett nurse Learning, and the LLC © Jones & Bartlett Learning, LLC advanced practiceNOT FOR registered SALE nurse. OR Included DISTRIBUTION The holistic advanced practice registeredNOT FOR nurse: SALE OR DISTRIBUTION here are only one or two examples of measure- 1. Utilizes complex data and information ment criteria because each standard has numer- obtained during interview, examination, ous measurement criteria. and diagnostic procedures in making the diagnosis. © JonesStandard & Bartlett 1. ASSESSMENT: Learning, The LLCholistic nurse © Jones & Bartlett Learning, LLC NOT collectsFOR SALEcomprehensive OR DISTRIBUTION data pertinent to the Standard 3.NOT OUTCOMES FOR SALE IDENTIFICATION: OR DISTRIBUTION person’s health or situation. The holistic registered nurse identifies outcomes The holistic registered nurse: for a plan individualized to the person or the 1. Collects comprehensive data including but situation. The holistic nurse values the evolution © Jones & Bartlett Learning,not limited LLC to physical, functional, psy©- Jonesand the & process Bartlett of healing Learning, as it unfolds. LLC This chosocial, emotional, mental, sexual, cul- implies that specific unfolding outcomes may NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tural, age-related, environmental, spiritual, not be evident immediately because of the non- transpersonal, and energy field assessments linear nature of the healing process so that both in a systematic and ongoing process while expected, anticipated, and evolving outcomes honoring the uniqueness of the person. are considered. 2. Identifies© Jones areas such & asBartlett the person’s Learning, health LLC © Jones & Bartlett Learning, LLC and cultural practices, values, beliefs, pref- The holistic registered nurse: NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION erences, meanings of health, illness, life- 1. Defines outcomes in terms of the person: style patterns, family issues, and risk the individual’s values, beliefs, and prefer- behaviors and context. ences; age; spiritual practices; ethical con- siderations; environment; or situation. © Jones* The &complete Bartlett and comprehensive Learning, statement LLC of stan- Consideration© Jones is given & Bartlett to associated Learning, risks, LLC dards of holistic nursing practice are contained in Holis- NOT FOR SALE OR DISTRIBUTION benefitsNOT and costs,FOR and SALE current OR scientific DISTRIBUTION tic Nursing: Scope and Standards of Practice (2007), which evidence. can be obtained from the American Holistic Nurses Association (AHNA), 323 N. San Francisco Street, Suite 2. Partners with the person to identify realis- 201, Flagstaff, AZ 86001; 1-800-278-2462 or 1-928-526- tic goals based on the person’s present and 2196; www.ahna.org or [email protected]. potential capabilities and quality of life. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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The holistic advanced practice registered nurse: The holistic advanced practice registered nurse: 1. Identifies outcomes that incorporate patient 1. Facilitates utilization of systems and com- satisfaction,© Jones the person’s & Bartlett understanding Learning, and LLC munity resources to implement© Jones the plan. & Bartlett Learning, LLC meaningsNOT in FOR their uniqueSALE patterns OR DISTRIBUTION and pro- 2. Incorporates new knowledgeNOT and FOR strategies SALE OR DISTRIBUTION cesses, quality of life, cost and clinical effec- to initiate change in nursing care practices tiveness, and continuity and consistency if desired outcomes are not achieved. among providers. Standard 5A. COORDINATION OF CARE: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Standard 4. PLANNING: The holistic reg- The holistic registered nurse coordinates care NOT FORistered SALE nurse developsOR DISTRIBUTION a plan that identifies delivery. NOT FOR SALE OR DISTRIBUTION strategies and alternatives to attain outcomes. The holistic registered nurse: The holistic registered nurse: 1. Coordinates implementation of the plan. 1. Develops in partnership with the person © Jones & Bartlett Learning, LLC © JonesThe holistic & Bartlett advanced Learning, practice registered LLC nurse: an individualized plan considering the per- NOT FOR SALE OR DISTRIBUTIONson’s characteristics or situation including,NOT FOR1. Provides SALE leadership OR DISTRIBUTION in the coordination of but not limited to, values, beliefs, spiritual multidisciplinary health care for integrated and health practices, preferences, choices, delivery of services. age and cultural appropriateness, and environmental© Jones sensitivity. & Bartlett Learning, LLCStandard 5B. HEALTH TEACHING© Jones & AND Bartlett Learning, LLC 2. Develops the plan in conjunction with the HEALTH PROMOTION: The holistic regis- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION person, family, and others, as appropriate. tered nurse employs strategies to promote holistic 3. Establishes practice settings and safe space health, wellness, and a safe environment. and time for both the nurse and person, family, and significant others to explore The holistic registered nurse: © Jones &suggested Bartlett potential Learning, and alternative LLC options. 1. Provides© Jones health teaching& Bartlett to individuals, Learning, LLC families, and significant others or caregivers NOT FORThe holistic SALE advanced OR DISTRIBUTION practice registered nurse: that enhancesNOT FOR the mind–body SALE ORand emotion–DISTRIBUTION 1. Identifies assessments, diagnostic strate- spirit connection. gies, and therapeutic interventions within 2. Uses health promotion and health teach- the plan, including therapeutic effects and ing methods appropriate to the situa- © Jones & Bartlett Learning,side effects LLC that reflect current evidence,© Jones tion& Bartlett and the individual’sLearning, values, LLC beliefs, data, research, literature, expert clinical health practices, age, learning needs, NOT FOR SALE OR DISTRIBUTIONknowledge, and the person’s experiences.NOT FORreadiness SALE andOR abilityDISTRIBUTION to learn, language 2. Uses linguistic and symbolic language includ- preference, spirituality, culture, and socio- ing but not limited to word associations, economic status. dreams, storytelling, and journals to explore 3. Assists others to access their own inner possibilities© Jones and options & Bartlett with individuals. Learning, LLC wisdom that may provide© Jones opportunities & Bartlett Learning, LLC to enhance and support growth, develop- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Standard 5. IMPLEMENTATION: The holis- ment, and wholeness. tic registered nurse implements in partnership The holistic advanced practice registered nurse: with the person the identified plan. 1. Synthesizes empirical evidence on risk The holistic registered nurse: © Jones & Bartlett Learning, LLC behaviors,© Jones decision & Bartlett making aboutLearning, life LLC NOT FOR 1. PartnersSALE ORwith DISTRIBUTIONthe person, family, signifi- choices,NOT learning FOR SALE theories, OR behavioral DISTRIBUTION cant others, and caregivers to implement change theories, motivational theories, epi- the plan in a safe and timely manner while demiology, and other related theories and honoring the person’s choices and unique frameworks when designing holistic health healing journey. information and education. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Standard 5C. CONSULTATION: The holistic 2. Evaluates in partnership with the person advanced practice registered nurse provides con- the effectiveness of the planned strategies sultation to ©influence Jones the & identified Bartlett plan, Learning, enhance LLCin relation to the person’s© responsesJones & and Bartlett Learning, LLC the abilities NOTof others, FOR and SALEeffect change. OR DISTRIBUTIONthe attainment of the expectedNOT and FOR unfold SALE- OR DISTRIBUTION ing outcomes. The holistic advanced practice registered nurse: The holistic advanced practice registered nurse: 1. Facilitates the effectiveness of a consultation by involving all stakeholders includ- 1. Uses the results of the evaluation analy- © Jones ing& Bartlettthe individual Learning, in decision LLC making and ses to © make Jones or recommend & Bartlett process Learning, or LLC NOT FORnegotiating SALE OR role responsibilities.DISTRIBUTION structuralNOT changes, FOR includingSALE OR policy DISTRIBUTION and procedure or protocol documentation, as Standard 5D. PRESCRIPTIVE AUTHORITY appropriate to improve holistic care. AND TREATMENT: The holistic advanced practice registered nurse uses prescriptive author- Standard 7. QUALITY OF PRACTICE: The © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ity, procedures, referrals, treatments, and thera- holistic registered nurse systematically enhances NOT FOR SALE ORpies DISTRIBUTIONin accordance with state and federal lawsNOT the FOR quality SALE and effectiveness OR DISTRIBUTION of holistic nursing and regulations. practice. The holistic advanced practice registered nurse: The holistic registered nurse: 1. Prescribes© Jones treatments, & Bartlett therapies, Learning, and pro- LLC1. Participates in quality improvement© Jones activi & Bartlett- Learning, LLC cedures based on evidence, research, cur- ties for holistic nursing practice. rent knowledge,NOT FOR and SALE practice OR considering DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the person’s holistic healthcare needs The holistic advanced practice registered nurse: and choices. 1. Evaluates the practice environment and 2. Uses advanced knowledge of phar- quality of holistic nursing care rendered in macology, psychoneuroimmunology, © Jones & Bartlett Learning, LLC relation© to Jones existing &evidence Bartlett and feedbackLearning, LLC nutritional supplements, herbal and from individuals and significant others, NOT FORhomeopathic SALE OR remedies, DISTRIBUTION and a variety of NOT FOR SALE OR DISTRIBUTION identifying opportunities for the genera- complementary and alternative therapies tion and use of research. in prescribing. 3. Evaluates therapeutic and potential adverse effects of pharmacologic and non- Standard 8. EDUCATION: The holistic reg- © Jones & Bartlett Learning,pharmacologic LLC treatments including but© Jonesistered &nurse Bartlett attains Learning, knowledge andLLC compe- NOT FOR SALE OR DISTRIBUTIONnot limited to drug, herbal, and homeoNOT- tency FOR that SALE reflects OR current DISTRIBUTION nursing practice. pathic regimens as well as their side effects The holistic registered nurse: and interactions. 1. Seeks experiences and formal and independent learning activities to maintain and Standard © 6. Jones EVALUATION: & Bartlett The Learning, holistic LLC © Jones & Bartlett Learning, LLC registered nurse evaluates progress toward develop clinical and professional skills and attainment NOTof outcomes FOR whileSALE recognizing OR DISTRIBUTION and knowledge and personal growthNOT toFOR provide SALE OR DISTRIBUTION honoring the continuing holistic nature of the holistic care. healing process. The holistic advanced practice registered nurse: The holistic registered nurse: © Jones & Bartlett Learning, LLC 1. Uses current© Jones healthcare & Bartlett research Learning, find- LLC NOT FOR1. Conducts SALE ORa holistic, DISTRIBUTION systematic, ongoing, ings andNOT other FOR evidence SALE to expand OR DISTRIBUTIONclinical and criterion-based evaluation of the out- knowledge, enhance role performance, and comes in relation to the structures and increase knowledge of professional issues processes prescribed by the plan and the and changes in national standards for prac- indicated timeline. tice and trends in holistic care. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Standard 9. PROFESSIONAL PRACTICE The holistic registered nurse: EVALUATION: The holistic registered nurse 1. Communicates with the person, family, evaluates ©one’s Jones own &nursing Bartlett practice Learning, in rela- LLC significant others, caregivers,© Jones and interdis & Bartlett- Learning, LLC tion to professionalNOT FOR practice SALE standardsOR DISTRIBUTION and ciplinary healthcare providersNOT FOR regarding SALE OR DISTRIBUTION guidelines, relevant statutes, rules, and regula- the person’s care and the holistic nurse’s tions. The holistic registered nurse’s practice role in the provision of that care. reflects the application of knowledge of current The holistic advanced practice registered nurse: © Jonespractice & Bartlett standards, Learning, guidelines, statutes,LLC rules, © Jones & Bartlett Learning, LLC and regulations. 1. Facilitates the negotiation of holistic, com- NOT FOR SALE OR DISTRIBUTION plementary,NOT integrative,FOR SALE and ORconventional DISTRIBUTION The holistic registered nurse: healthcare services for continuity of care 1. Reflects on one’s practice and how one’s and program planning. own personal, cultural, and spiritual beliefs; experiences; biases; education; and Standard 12. ETHICS: The holistic registered © Jones & Bartlett Learning,values can LLC affect care given to individuals,© Jones & Bartlett Learning, LLC nurse integrates ethical provisions in all areas NOT FOR SALE OR DISTRIBUTIONfamilies, and communities. NOT FOR SALE OR DISTRIBUTION 2. Engages in self-evaluation of practice on a of practice. regular basis, identifying areas of strength, The holistic registered nurse: as well as areas in which professional development and personal growth would 1. Uses the Guide to the Code of Ethics for 5 be beneficial.© Jones & Bartlett Learning, LLC Nurses: Interpretation and© ApplicationJones & andBartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONAHNA Position StatementNOT on Holistic FOR Nursing SALE OR DISTRIBUTION The holistic advanced practice registered nurse: Ethics to guide practice and articulate the 1. Engages in a formal process, seeking feed- moral foundation of holistic nursing. back regarding one’s own practice from 2. Advocates for the rights of vulnerable, individuals receiving care, peers, profes- repressed, or underserved populations. © Jones &sional Bartlett colleagues, Learning, and others. LLC The holistic© advanced Jones practice & Bartlett registered Learning, nurse: LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Standard 10. COLLEGIALITY: The holistic 1. Actively contributes to creating an ecosys- registered nurse interacts with and contributes tem that supports well-being for all life. to the professional development of peers and colleagues. Standard 13. RESEARCH: The holistic reg- © Jones & Bartlett TheLearning, holistic registered LLC nurse: © Jonesistered & nurse Bartlett integrates Learning, research into LLC practice. NOT FOR SALE OR 1.DISTRIBUTION Shares knowledge and skills with peers andNOT TheFOR holistic SALE registered OR DISTRIBUTION nurse: colleagues as evidenced by such activities as patient care conferences or presentations at 1. Utilizes the best available evidence, includ- formal or informal meetings. ing theories and research findings, to guide 2. Promotes work environments conducive practice decisions. to support,© Jones understanding, & Bartlett respect, Learning, health, LLC 2. Actively and ethically© participatesJones & Bartlett in Learning, LLC healing,NOT caring, FOR wholeness, SALE and OR harmony. DISTRIBUTIONresearch activities relatedNOT to holistic FOR health SALE OR DISTRIBUTION at various levels appropriate to the holistic The holistic advanced practice registered nurse: nurse’s level of education and position. 1. Models expert holistic nursing practice The holistic advanced practice registered nurse: to interdisciplinary team members and © Jones &healthcare Bartlett consumers. Learning, LLC 1. Contributes© Jones to nursing & Bartlett knowledge Learning, by con- LLC NOT FOR SALE OR DISTRIBUTION ductingNOT or synthesizing FOR SALE research OR DISTRIBUTIONthat dis- Standard 11. COLLABORATION: The holis- covers, examines, and evaluates knowledge, tic registered nurse collaborates with the per- theories, philosophies, context, criteria, son, family, and others in the conduct of holistic and creative approaches to improve holistic nursing practice. healthcare practice. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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2. Formally disseminates research findings ideas in a historical, philosophical, and through activities such as presentations, scientific context while projecting future publications,© Jones consultations, & Bartlett and Learning, journal LLCtrends in thinking. © Jones & Bartlett Learning, LLC clubs NOTfor a variety FOR ofSALE audiences OR including DISTRIBUTION NOT FOR SALE OR DISTRIBUTION nursing, other disciplines, and the pub- n EDUCATIONAL PREPARATION lic to improve holistic care and further develop the foundation and practice of AND CERTIFICATION FOR holistic nursing. HOLISTIC NURSING PRACTICE © Jones & Bartlett Learning, LLC Holistic nurses© Jones are registered & Bartlett nurses whoLearning, are LLC NOT StandardFOR SALE 14. RESOURCEOR DISTRIBUTION UTILIZATION: educationallyNOT prepared FOR for SALE practice OR from DISTRIBUTION an The holistic registered nurse considers fac- approved school of nursing and are licensed tors related to safety, effectiveness, cost, and to practice in their individual state, common- impact on practice in the planning and delivery wealth, or territory. The holistic registered nurse’s experience, education, knowledge, and of nursing services. © Jones & Bartlett Learning, LLC © Jonesabilities & establish Bartlett the Learning, level of competence. LLC The NOT FOR SALE ORThe DISTRIBUTIONholistic registered nurse: NOTHolistic FOR Nursing: SALE Scope OR andDISTRIBUTION Standards of Practice (2007) identifies the scope of practice of holistic 1. Assists the person, family, and significant nursing and the specific standards and associ- others or caregivers as appropriate in identi- ated measurement criteria of holistic nurses at fying and securing appropriate and available both the basic and advanced levels.3 Regardless services to address health-related needs. of the level of practice, all holistic nurses inte- 2. Identifies© Jones discriminatory & Bartlett healthcare Learning, prac- LLC © Jones & Bartlett Learning, LLC grate the previously identified five core values. tices asNOT they affectFOR the SALE person OR and DISTRIBUTIONengages NOT FOR SALE OR DISTRIBUTION A registered nurse may prepare for the spe- in effective nondiscriminatory practices. cialty of holistic nursing in a variety of ways. The holistic advanced practice registered nurse: Educational offerings range from associate degree, baccalaureate and graduate courses and 1. Utilizes organizational and community © Jones & Bartlett Learning, LLC programs, to© continuing Jones & education Bartlett programs Learning, LLC resources to formulate multidisciplinary or with extensive contact hours. NOT FORinterdisciplinary SALE OR DISTRIBUTIONplans of care. NOT FOR SALE OR DISTRIBUTION Basic Practice Level Standard 15. LEADERSHIP: The holistic The education of all nursing students prepar- registered nurse provides leadership in the pro- ing for registered nurse (RN) licensure includes © Jones & Bartlettfessional Learning, practice LLC setting and the profession. © Jonesbasic content & Bartlett on physiological, Learning, psychological, LLC NOT FOR SALE ORThe DISTRIBUTIONholistic registered nurse: NOTemotional, FOR SALE and some OR spiritualDISTRIBUTION processes with populations across the life span and conven- 1. Displays the ability to define a clear vision, tional nursing care practices within each of these associated goals, and a plan to implement domains. Additionally, basic nursing education and measure progress toward holistic incorporates experiences in a variety of clinical health© care. Jones & Bartlett Learning, andLLC practice settings from acute© care Jones to commu & Bartlett- Learning, LLC 2. PromotesNOT advancement FOR SALE of the OR profession DISTRIBUTION nity. However, the educational focusNOT is FOR most freSALE- OR DISTRIBUTION through participation in professional orga- quently on specialties often emanating from the nizations and by focusing on strategies biomedical disease model and cure orientation. that bring unity and healing to the nursing In holistic nursing, the individual across the life profession. span is viewed in context as an integrated totality © Jones & Bartlett Learning, LLC of body, mind,© Jonesemotion, & environment, Bartlett Learning, society, LLC The holistic advanced practice registered nurse: NOT FOR SALE OR DISTRIBUTION energy, and spirit,NOT withFOR the SALE emphasis OR on DISTRIBUTIONwhole- 1. Works to influence decision-making bodies ness, well-being, health promotion, and healing to improve holistic, integrated care. using both conventional and complementary/ 2. Articulates the ideas underpinning holis- alternative practices. Because of the lack of inten- tic nursing philosophy, places these tional focus on integration, unity, and healing, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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the educational exposure of most nursing stu- Arts, Coaching and Whole Health Education. It dents is not adequate preparation for assuming also approves continuing education offerings in the specialty© roleJones of a holistic & Bartlett nurse. Learning, LLCholistic nursing as well as giving© theJones AHNA & home Bartlett Learning, LLC A numberNOT of FORschools SALE of nursing OR areDISTRIBUTION begin- study course, Foundation ofNOT Holistic FOR Nursing. SALE OR DISTRIBUTION ning to incorporate holistic nursing content at Other programs in distinct therapies such as acu- the undergraduate level, whether it be as dis- puncture, Reiki, Homeopathy, massage, imag- crete courses such as therapeutic touch, relax- ery, healing arts, holistic health, Chinese Oriental ation, aromatherapy, and so on, or integrated in Medicine, nutrition, Ayurveda, therapeutic touch, © Jonescourses & Bartlettsuch as nursing Learning, therapeutics. LLC healing touch,© Jones herbology, & BartlettChiropractic, Learning, and so LLC NOT FOR SALE OR DISTRIBUTION on, are givenNOT nationally FOR as SALEdegrees, certificates,OR DISTRIBUTION or Advanced Practice Level continuing education programs by centers, spe- As with the basic level, there are a variety of ways cialty organizations, or schools. through both academic and professional development that registered nurses can acquire the Certification © Jones & Bartlett additionalLearning, specialized LLC knowledge and skills that© JonesCompetency & Bartlett mechanisms Learning, for evaluating LLC holis- NOT FOR SALE ORprepare DISTRIBUTION them for practice as an advanced pracNOT- ticFOR nursing SALE practice OR as DISTRIBUTION a specialty exist through tice holistic nurse. These nurses are expected to a national certification/recertification process hold a master’s or doctoral degree and demon- overseen by the American Holistic Nurses Certifi- strate a greater depth and scope of knowledge, cation Corporation (AHNCC). The AHNCC certi- a greater integration of information, increased fies at the basic level (HN-BC), which requires a complexity© ofJones skills & and Bartlett interventions, Learning, and LLCdiploma or associate degree in© nursing; Jones HNB-BC, & Bartlett Learning, LLC notable roleNOT autonomy. FOR SALE They provide OR DISTRIBUTION leader- which requires a baccalaureateNOT degree FOR in nursing; SALE OR DISTRIBUTION ship in practice, teaching, research, consultation, and the advanced practice level (AHN-BC), which advocacy, and policy formation in advancing requires a graduate degree in nursing. Further, holistic nursing to improve the holistic health the AHNCC provides endorsement for schools of people. Several schools of nursing that offer of nursing meeting the specifications put forth © Jonesgraduate & Bartlett programs Learning, in holistic nursingLLC have a in the Holistic© Nursing:Jones Scope & Bartlett and Standards Learning, of Prac- LLC NOT FORstable SALEor growing OR number DISTRIBUTION of applicants. Current tice (2007).3NOT Additionally, FOR SALE holistic OR nurses DISTRIBUTION often advanced practice nurses are increasingly gaining are certified in specific CAM modalities such as specialized knowledge preparing them as holistic imagery, Reiki, aromatherapy, healing touch, bio- nurses through postmaster’s programs, continu- feedback, and Reflexology. ing education offerings in holistic nursing care, and certificate programs throughout the coun- © Jones & Bartlett Learning, LLC © Jonesn & Bartlett Learning, LLC try that focus on specific modalities and on the SETTINGS FOR HOLISTIC NOT FOR SALE ORessence DISTRIBUTION of holism. NOT FORNURSING SALE PRACTICEOR DISTRIBUTION Holistic nurses practice in numerous settings, Continuing Education for Basic and including but not limited to private practitio- Advanced Practice Levels ner offices; ambulatory, acute, long-term, and The AHNA© isJones a provider & Bartlettand approver Learning, of con- LLChome care settings; complementary© Jones care centers; & Bartlett Learning, LLC tinuing educationNOT FOR and SALE is recognized OR DISTRIBUTION by the women’s health centers; hospiceNOT and FOR palliative SALE OR DISTRIBUTION American Nurses Credentialing Center (ANCC). care; psychiatric mental health facilities; schools; Continuing educational programs, workshops, rehabilitation centers; community nursing orga- and lectures in holistic nursing and CAM have nizations; student and employee health centers; been popular nationwide, with AHNA or other managed care organizations; independent self- © Jonesbodies & grantingBartlett continuing Learning, education LLC units. employed practice;© Jones correctional & Bartlett facilities; Learning, pro- LLC NOT FORThe SALE AHNA ORendorses DISTRIBUTION certificate programs in fessional nursingNOT FORand healthcare SALE organizations;OR DISTRIBUTION specific areas. These include Integrative Heal- administration; staff development; and universi- ing, Reflexology, Imagery, Aromatherapy, Heal- ties and colleges. There are increasing numbers ing Touch, Spirituality, Craniosacral Therapy, of holistic nurses who hold leadership roles as Holistic Stress Management, Integrative Healing clinicians, educators, authors, and researchers © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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in university-based schools of nursing, practice relationship. Jean Watson reminds us that environments, nursing, and other professional society and the public are searching for some- organizations.© Jones Holistic & nursing Bartlett practice Learning, also LLCthing deeper in terms of realizing© Jones self-care, & self- Bartlett Learning, LLC occurs whenNOT there FOR is a request SALE for OR consultation DISTRIBUTION knowledge, and self-healing potentials.NOT FOR Nurses SALE OR DISTRIBUTION or when holistic nurses advocate for care that need to acknowledge the human aspects of prac- promotes health and prevents disease, illness, or tice—attending to people and their experience disability for individuals, communities, or the rather than just focusing on the medical orien- environment. A holistic nurse may choose not to tation and disease. She concludes that “nurses © Joneswork in& a Bartlett critical care Learning, setting but provide LLC consul- have a covenant© Jones with the & public Bartlett to sustain Learning, car- LLC NOT tationFOR regarding SALE ORself-care DISTRIBUTION or stress management ing. It is ourNOT collective FOR responsibility SALE OR to DISTRIBUTIONtrans- to nurses practicing in that area. Or holistic form caring practices into the framework that nurses may practice in preoperative and recovery identifies and gives distinction to nursing as a rooms instituting a “Prepare for Surgery” pro- profession.”14 The Holistic Nursing: Scope and Stan- gram for individuals who are going to have sur- dards of Practice (2007) is a means through which © Jones & Bartlettgery Learning, that teaches LLC them meditation and positive© Jonesholistic & nurses Bartlett are educating Learning, the profession LLC and NOT FOR SALE ORaffirmation DISTRIBUTION techniques for both before and afterNOT others FOR about SALE the values,OR DISTRIBUTION principles, and practice surgery while incorporating a homeopathic regi- requirements of the specialty.3 men for trauma and cell healing. Employment or voluntary participation of holistic nurses also Directions for can influence civic activities and the regulatory FUTURE RESEARCH and legislative© Jonesarenas at &the Bartlett local, state, Learning, national, LLC © Jones & Bartlett Learning, LLC or internationalNOT levels. FOR SALE OR DISTRIBUTION 1. Explore research modalitiesNOT FOR and ap-SALE OR DISTRIBUTION Because holistic nursing focuses on well- proaches that are congruent with the holis- ness, wholeness, and development of the whole tic paradigm. person, holistic nurses also practice in health 2. Examine how the standards of holistic enhancement settings such as spas, gyms, and nursing practice are being implemented in © Joneswellness & centers.Bartlett With Learning, all populations LLC and in any nursing© settings. Jones & Bartlett Learning, LLC NOT setting,FOR SALE nurses canOR empower DISTRIBUTION patients/clients/ NOT FOR SALE OR DISTRIBUTION families by teaching them self-care practices for Nurse Healer a healthier lifestyle. Because holistic nursing is REFLECTIONS a worldview, a way of being in the world, and After reading this chapter, the holistic nurse will not just a modality, holistic nurses can practice be able to answer or to begin a process of answer- in any setting and with individuals throughout © Jones & Bartlett Learning, LLC © Jonesing the &following Bartlett questions: Learning, LLC NOT FOR SALE ORthe DISTRIBUTIONlife span. As the public increasingly requestsNOT FOR SALE OR DISTRIBUTION holistic and CAM services, there will be a greater n What attributes do I have that reflect the need for holistic nurses in a wider array of set- core values of holistic nursing? tings. Holistic nursing takes place wherever heal- n What contributions can I make as a holistic ing occurs.13 nurse to the wholeness and betterment of © Jones & Bartlett Learning, LLChumankind? © Jones & Bartlett Learning, LLC n CONCLUSIONNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOTES The specialty practice of holistic nursing is generally not well understood. Therefore, each holis- 1. Institute of Medicine, Crossing the Quality Chasm: tic nurse must educate other nurses, healthcare A New Health System for the 21st Century (Washing- © Jonesproviders & Bartlett and disciplines, Learning, and the LLC public about ton, DC: ©National Jones Academies & Bartlett Press, 2001). Learning, LLC the role, value, and benefits of holistic nurs- 2. C. Tresoli and Pew-Fetzer, Task Force on Advanc- NOT FOR SALE OR DISTRIBUTION ing PsychosocialNOT FOR Health SALE Education, OR Health DISTRIBUTION Pro- ing, whether it be in direct practice, education, fessions Education and Relationship-Centered Care management, or research. Holistic nurses articu- (San Francisco: Commission at the Center for late the ideas underpinning the holistic para- the Health Professions, University of California, digm and the philosophy of the caring–healing 1994). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

45632_CH02_Pass1.indd 79 1/2/12 4:31 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR80 DISTRIBUTION Chapter 2 Holistic Nursing: Scope NOTand Standards FOR SALE of Practice OR DISTRIBUTION

3. American Holistic Nurses Association & Ameri- 9. American Holistic Nurses Association, Descrip- can Nurses Association, Holistic Nursing: Scope and tion of Holistic Nursing (Flagstaff, AZ: AHNA, Standards of Practice (Silver Spring, MD: Nurse- 1998). books.org,© Jones 2007). & Bartlett Learning, LLC 10. “Patient Bill of Rights,” in Accreditation© Jones Manual & Bartlett for Learning, LLC 4. AmericanNOT Nurses FOR Association, SALE Nursing:OR DISTRIBUTION Scope and Hospitals (Oakbrook Terrace,NOT IL: Joint FOR Commis SALE- OR DISTRIBUTION Standards of Practice, 2nd ed. (Silver Spring, MD: sion on Accreditation of Healthcare Organiza- Nursebooks.org, 2010). tions, 1992). 5. American Nurses Association, Guide to the Code of 11. American Holistic Nurses Association, Ameri- Ethics for Nurses: Interpretation and Application (Sil- can Holistic Nurses Association Position Statement on © Jones &ver BartlettSpring, MD: Learning,Nursebooks.org, LLC 2010). Holistic ©Ethics Jones (Flagstaff, & AZ:Bartlett AHNA, reapprovedLearning, LLC 6. American Nurses Association, Nursing’s Social 2007). NOT FORPolicy SALE Statement: OR The DISTRIBUTION Essence of the Profession (Silver 12. B. DosseyNOT et al., FOR “Evidence SALE Blueprint OR for DISTRIBUTION Certifi- Spring, MD: Nursebooks.org, 2010). cation: Inventory of Professional Activities and 7. American Nurses Association, Recognition of a Nursing Knowledge of a Holistic Nurse,” Journal of Holistic Specialty, Approval of a Specialty Nursing Scope of Prac- Nursing 16, no. 1 (1998). tice Statement and Acknowledgement of Specialty Nursing 13. C. Mariano, “Holistic Nursing: Every Nurse’s Spe- © Jones & Bartlett Learning,Standards of Practice LLC (Washington, DC: ANA, 2005).© Jonescialty,” & Bartlett Beginnings 29,Learning, no. 4 (2009). LLC 8. C. Mariano, Proposal for Recognition of Holistic Nurs- 14. C. Mariano, “Caring for Our Future: An Inter- NOT FOR SALE OR DISTRIBUTIONing as a Nursing Specialty (New York: UnpublishedNOT FORview SALE with Jean OR Watson,” DISTRIBUTION Beginnings 25, no. 3, 12 document submitted to ANA, 2006). (2005).

45632_CH02_Pass1.indd 80 1/2/12 4:31 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Appendix 2-1 Development of the Original © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONHolistic Nursing StandardsNOT FOR ofSALE OR DISTRIBUTION Practice: Basic and Advanced

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE ORBASIC DISTRIBUTION STANDARDS DEVELOPMENTNOTand FOR the IPAKHN SALE survey OR DISTRIBUTIONanalysis that reflected the most recent holistic nursing professional activi- The American Holistic Nurses Association ties, knowledge, and caring–healing modalities. (AHNA) first developed Standards of Holistic Nurs- Based on this review and the additional com- ing Practice in 1990; these were subsequently ments, deletions, modifications, and recommen- revised in 1995. Between 1994 and 1997, the dations by expert nurses, six areas were further AHNA conducted© Jones a 3-year & roleBartlett delineation Learning, study, LLC © Jones & Bartlett Learning, LLC refined and developed including five core values. the InventoryNOT of FOR Professional SALE Activities OR DISTRIBUTION and NOT FOR SALE OR DISTRIBUTION Knowledge of a Holistic Nurse (IPAKHN survey). Step 3: AHNA Standards of Practice In this practice analysis study the activities and Advisory Committee knowledge basic to current holistic nursing practice were determined through administration of Following the second step, the revised AHNA © Jonesa structured & Bartlett inventory Learning, to a representative LLC sample standards of© practiceJones were& Bartlett next sent Learning, to the LLC NOT ofFOR holistic SALE nurses. OR DISTRIBUTION 24-member advisoryNOT FOR committee, SALE who OR gave DISTRIBUTION addi- This 3-year endeavor was successfully com- tional comments, modifications, and recommen- pleted by a four-member AHNA task force and dations. Five subsequent revision rounds by the reviewed by the AHNA leadership council, select AHNA task force occurred until consensus was AHNA members, and other recognized holistic achieved, and then the standards were sent back © Jones & Bartlettnurse Learning, members andLLC nonmembers representing© Jonesto the advisory& Bartlett committee Learning, for additional LLC com- NOT FOR SALE ORthe DISTRIBUTIONdiversity of holistic nurse representationNOT ments, FOR modifications, SALE OR DISTRIBUTIONand recommendations, from practice, education, research, and admin- which were incorporated. istration. An extensive five-step process was used to revise the 1995 AHNA Standards of Holistic Step 4: AHNA Standards of Practice Nursing Practice and to delineate core values. Review Committee © Jones & Bartlett Learning, Next,LLC the revised AHNA standards© Jones of practice & Bartlett Learning, LLC Step 1: LiteratureNOT FOR Review, SALE Inventory OR DISTRIBUTION of were sent to the 24-member reviewNOT committee, FOR SALE OR DISTRIBUTION Professional Activities and Knowledge of who gave additional comments, deletions, mod- a Holistic Nurse (IPAKHN) Survey Data ifications, and recommendations, which were Analysis, and Expert Reviews incorporated.

© JonesStep &2: BartlettReview Process Learning, LLC Step 5: AHNA© Jones Standards & Bartlett of Practice Learning, LLC NOT FollowingFOR SALE the first OR step, DISTRIBUTION the AHNA Standards of LeadershipNOT Council FOR SALE OR DISTRIBUTION Practice Task Force incorporated the suggestions In the fifth step of the standards development and additional data from the literature review process, the final draft of the Standards of Holistic

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Nursing Practice was submitted to the AHNA lead- force to review. A decision was made that the ership council. After discussion, a final vote of standards for advanced practice would apply to approval accepted© Jones the Standards& Bartlett of Holistic Learning, Nursing LLCthose nurses with a graduate degree© Jones even though & Bartlett Learning, LLC Practice. TheseNOT were FOR then SALE presented OR at DISTRIBUTIONthe busi- there are nurses in practice NOTwith an FOR expanded SALE OR DISTRIBUTION ness meeting of the annual AHNA conference scope created not by graduate education but by in June 1999 in Scottsdale, Arizona. The AHNA certifications in particular specialties. These cer- standards received a vote of approval by the tifications were created before graduate educa- AHNA membership. Minor editorial changes tion became the entry level for advanced practice. © Joneswere & approved Bartlett by theLearning, AHNA leadership LLC council It was felt ©that Jones the basic & standardsBartlett more Learning, than LLC NOT FORin January SALE 2000, OR with DISTRIBUTION additional minor revisions adequately NOTaddress FOR the scope SALE of practice OR DISTRIBUTION for all in 2004 and 2005.* except graduate practice, and the need was to have standards to address holistic nursing prac- n ADVANCED STANDARDS tice by graduate-prepared nurses that would DEVELOPMENT guide in the development of curricula for graduate education in holistic nursing. © Jones & Bartlett InLearning, response to LLCthe growing number of gradu©- Jones & Bartlett Learning, LLC The third draft was completed during the sum- NOT FOR SALE ORate DISTRIBUTION programs with a holistic nursing focus, theNOT FOR SALE OR DISTRIBUTION mer of 2000 and then circulated in the autumn AHNA leadership council appointed a nine- to task force members. The fourth draft was member task force in January 2000 to develop prepared from the feedback of task force mem- standards for advanced practice. From that time bers and circulated to the responding and cor- until later autumn 2001, the task force worked responding committees for review and comment. to develop© standards Jones for & advancedBartlett holistic Learning, nurs- LLC © Jones & Bartlett Learning, LLC Comments on the fourth draft were received ing practice.NOT The FORfinal draft SALE was ORcompleted DISTRIBUTION and NOT FOR SALE OR DISTRIBUTION throughout the spring and summer of 2001. In accepted for submission to the council by the September, these comments were collated into a task force members in September 2001. final draft. This draft was reviewed and accepted The task force used the core values as the for submission to the leadership council. The foundation for developing the advanced practice Standards of Advanced Holistic Nursing Practice © Jonesstandards. & Bartlett Regardless Learning, of the type LLC of practice of © Jones & Bartlett Learning, LLC for Graduate-Prepared Nurses were approved and NOT FORthe holistic SALE nurse, OR these DISTRIBUTION values should serve as NOT FOR SALE OR DISTRIBUTION adopted by the AHNA leadership council in Janu- the philosophical underpinning for practice. The ary 2002, followed by a minor revision in 2005. Essentials of Master’s Education for Advanced Practice Nursing (1996), published by the American Asso- ciation of Colleges of Nursing, and ANA’s Scope n HOLISTIC NURSING: SCOPE AND © Jones & Bartlett andLearning, Standards of LLCAdvanced Practice Registered Nursing© JonesSTANDARDS & Bartlett Learning,OF PRACTICE LLC Practice (1996) served as additional guides for the NOT FOR SALE OR DISTRIBUTION NOT DuringFOR SALEthe interval OR from DISTRIBUTION 2004 until 2006 the orig- scope of practice that should be addressed by the inal Standards of Holistic Nursing Practice (advanced standards because these documents are employed and basic) were substantively revised to incorpo- in the development of graduate nursing curricula. rate language and content required by ANA to The AHNA conducted an advanced practice support the application for formal recognition of standards ©review Jones process & similarBartlett to that Learning, used to LLC © Jones & Bartlett Learning, LLC holistic nursing as a nursing specialty. The leader- create the NOTbasic practiceFOR SALE standards. OR In DISTRIBUTION addition NOT FOR SALE OR DISTRIBUTION ship council of the AHNA reviewed and approved to the task force, leaders in the field of holistic the preliminary draft statement of the standards nursing and nursing education were asked to in June 2005, and then the draft Holistic Nursing: review the draft standards to establish content Scope and Standards of Practice in March 2006. The validity. The first draft was completed and circu- Holistic Nursing: Scope and Standards of Practice was © Joneslated & to Bartlett task force Learning,members for review LLC and com- © Jones & Bartlett Learning, LLC approved by the ANA in November 2006. Holis- NOT FORment SALEin Spring OR 2000. DISTRIBUTION The comments were then NOT FOR SALE OR DISTRIBUTION tic nursing was recognized as an official specialty used to prepare the second draft for the task within Nursing by the American Nurses Associa- * Adapted from N. C. Frisch et al., AHNA Standards of tion that same month. The Holistic Nursing: Scope Holistic Nursing Practice with Guidelines for Caring and Heal- and Standards of Practice was published jointly by © Jones & Bartlett ingLearning, (Gaithersburg, LLC MD: Aspen, 2000). © JonesAHNA & and Bartlett ANA in 2007. Learning, LLC © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

45632_CH02_Pass1.indd 82 1/2/12 4:31 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Appendix 2-2 Select Works of Individuals © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONand AHNA DocumentsNOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE ORThe DISTRIBUTION foundation of Holistic Nursing: Scope and StanNOT- FORAmerican SALE Holistic OR Nurses DISTRIBUTION Association, AHNA dards of Practice (2007) is based on the works of Position Statement on a Healthful Environment a number of individuals and from AHNA docu- (Flagstaff, AZ: AHNA, n.d.). ments, including the following: B. M. Dossey, ed., Core Curriculum for Holistic American© Holistic Jones Nurses & Bartlett Association, Learning, AHNA LLCNursing (Gaithersburg, MD: Aspen,© Jones 1997). & Bartlett Learning, LLC Standards of Holistic Nursing Practice (Flagstaff, B. M. Dossey, L. Keegan, and C. E. Guzzetta, AZ: AHNA,NOT 2004). FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Holistic Nursing: A Handbook for Practice, 4th ed. American Holistic Nurses Association, AHNA (Sudbury, MA: Jones & Bartlett, 2005). Standards of Advanced Holistic Nursing Practice for Graduate-Prepared Nurses (Flagstaff, AZ: N. C. Frisch et al., AHNA Standards of Holistic © JonesAHNA, & Bartlett 2004). Learning, LLC Nursing Practice© Jones with Guidelines & Bartlett for Caring Learning, and LLC Healing (Gaithersburg, MD: Aspen, 2000). NOT FORAmerican SALE Holistic OR Nurses DISTRIBUTION Association, Description NOT FOR SALE OR DISTRIBUTION of Holistic Nursing (Flagstaff, AZ: AHNA, 1998). C. E. Guzzetta, Essential Readings in Holistic Nursing (Gaithersburg, MD: Aspen, 1998). American Holistic Nurses Association, AHNA Position Statement on the Role of Nurses in the Practice C. Mariano, Proposal for Recognition of Holistic © Jones & Bartlett Learning,of Complementary LLC and Alternative Therapies (Flag©- JonesNursing & asBartlett a Nursing SpecialtyLearning, (New York: LLC Unpub- NOT FOR SALE ORstaff, DISTRIBUTION AZ: AHNA, revised and reapproved, 2007).NOT FORlished manuscriptSALE OR submitted DISTRIBUTION to ANA, 2006). American Holistic Nurses Association, AHNA C. Mariano, “An Overview of Holistic Nurs- Position Statement on Nursing Research and Schol- ing,” Imprint 52, no. 2 (2005): 1148–1152. arship (Flagstaff, AZ: AHNA, revised and reap- C. Mariano, “Advanced Practice in Holis- proved, 2007). © Jones & Bartlett Learning, LLCtic Nursing,” in Nurse Practitioners© Jones Evolution & ofBartlett Learning, LLC AmericanNOT Holistic FOR Nurses SALE Association, OR DISTRIBUTION AHNA Advanced Practice, ed. M. Mezey,NOT D. McGivern FOR SALE & OR DISTRIBUTION Position Statement on Holistic Ethics (Flagstaff, E. Sullivan-Marx, 4th ed. (New York: Springer, AZ: AHNA, revised and reapproved, 2007). 2003).

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RESOURCE LIST National Center for Complementary and American Holistic Nurses Association (AHNA) Alternative Medicine (NCCAM) 323 N. San© Francisco Jones Street & Bartlett Learning, LLCNational Institutes of Health © Jones & Bartlett Learning, LLC Suite 201 NOT FOR SALE OR DISTRIBUTIONP.O. Box 8218 NOT FOR SALE OR DISTRIBUTION Flagstaff, AZ 96003-2130 Silver Spring, MD 20907-8218 Phone: 1-800-278-2462 Phone: 1-888-644-6226 [email protected] http://nccam.nih.gov www.ahna.org © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORAmerican SALE Holistic OR Nurses DISTRIBUTION Certification NOT FOR SALE OR DISTRIBUTION Corporation (AHNCC) 811 Linden Loop Cedar Park, TX 78613 Phone: 1-877-284-0998 © Jones & Bartlett [email protected], LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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