What's in a Definition? Holistic Nursing, Integrative Health Care
Total Page：16
File Type：pdf, Size：1020Kb
JHNXXX10.1177/0898010119860685Journal of Holistic NursingHolistic/Integrative Nursing / Frisch, Rabinowitsch 860685research-article2019 260 Conceptual/Theoretical What’s in a Definition? Holistic Nursing, jhn Integrative Health Care, and Integrative Journal of Holistic Nursing American Holistic Nurses Association Nursing Volume 37 Number 3 September 2019 260 –272 © The Author(s) 2019 Report of an Integrated Literature Review Article reuse guidelines: sagepub.com/journals-permissions 10.1177/0898010119860685 journals.sagepub.com/home/jhn Noreen Cavan Frisch, PhD, RN, FAAN University of Victoria David Rabinowitsch, DNP, RN, AHN-BC, CHTP/I, CNE Felician College Background: Nurses and others have used various terms to describe our caring/healing approach to practice. Because terms used can influence our image of ourselves and the image others have of us, we sought to clarify their meanings. Questions: How are the terms holistic nursing, integrative health care, and integrative nursing defined or described? Do we identify with these definitions/descriptions? Are the various terms the same or are they distinct? Method: We conducted an integrated review of peer- reviewed literature following the process described by Whittemore and Knafl. Using standard search methods, we reviewed full texts of 94 published papers and extracted data from 58 articles. Findings: Holistic describes “whole person care” often acknowledging body–mind–spirit. Holistic nursing defines a disciplinary practice specialty. The term integrative refers to practice that includes two or more disci- plines or distinct approaches to care. Both terms, integrative and holistic, are associated with alterna- tive/complementary modalities and have similar philosophical and/or theoretical underpinnings. Conclusions: There is considerable overlap between holistic nursing and integrative nursing. The relationship of integrative nursing to integrative health care is unclear based solely on definitions. Consideration of terms used provides opportunities for reflection, collaboration, and growth. Keywords: holistic nursing; integrative nursing; integrative health care; integrative medicine; integrated literature review Worldwide, many nurses practice patient- and Terms that serve as descriptors of care are likely family-centered care grounded in the principles of embedded with philosophical undertones, conceptual caring and healing. Nurses often define or describe meanings, phenomena attributes, and theoretical the essence of these nursing encounters with words frameworks that shape not only practice but also edu- or labels that reflect their practice and express their cation and research. This being the case, holistic experiences. Likewise, scholars, interprofessional nurses have a need to clarify the language they partners, patients, and families also use terms to and others use to describe patient encounters and the describe their health care encounters and experi- ences. Some of the labels used to describe such care are holistic nursing, integrative health care, or inte- Authors’ Note: Please address correspondence to Noreen Cavan Frisch, PhD, RN, FAAN, School of Nursing, University of grative nursing. There is not one unifying, interna- Victoria, PO Box 1700 STN CSC, Victoria, British Columbia tionally accepted term describing such practice. V8W 2Y2, Canada; e-mail: [email protected]. Holistic/Integrative Nursing / Frisch, Rabinowitsch 261 nursing care given. Clarity about use of terms will sup- of publication. The two words were searched as a port efforts to understand the concepts that have phrase since “holistic nursing” is a heading in the shaped practice and that are guiding practice today. database; limits to the search were “peer reviewed/ Therefore, the purpose of this article is to summarize scholarly publications.” This search returned 4,345 and report an integrated review of peer-reviewed litera- papers. When adding “definition of” the search ture done to identify the meaning, development, and returned 148 papers. These papers were read for current use of the terms related to holistic and integra- title and abstract to determine if the term holistic tive health care and nursing. Specifically, the questions nursing was potentially defined or described in the addressed in this review of literature were the following: article. Papers that addressed spiritual care only were excluded as were papers that did not address • How is the term holistic nursing being the meaning of the term. This resulted in 22 articles defined or described? for the authors to read full-text. || What meanings of the term can be inferred from Next the term holistic nursing was searched in its use (past and present)? MEDLINE through EBSCO in an identical process • How is the term integrative health care with a search for “holistic nursing” and the limit being defined or described? being “journal article” for type of publication and the || What meanings of this term can be inferred words “definition of.” This search returned 170 from its use (past and present)? papers that were read for title and abstract. The • How is the term integrative nursing being result was 23 papers. Of these 23 papers, 4 were defined or described? duplicates of those already retrieved through the || Is integrative nursing a subset of the term inte- CINAHL search, leaving additional 19 papers for grative health care or is it different? What mean- ings of this term can be inferred from its use full-text review. (past and present)? Last, the term holistic nursing was searched • Are there areas of similarity or intersec- through Google Scholar and papers from the first 15 tion between or among these terms? screens that were returned were reviewed in the • In what ways are these terms different same manner as above. This search provided four from each other? additional papers that were not duplicates of those • What can we learn about our nursing already retrieved for full-text review. practice based on terms used to describe Thus, there were 45 papers on holistic nursing or define that practice? that were selected for full-text review. Information on these papers were kept on a data extraction table in an Excel file that indicated the author and coun- Method try of publication, citation, and specific data indicat- In order to retrieve literature through a systematic ing the use or definition of the term. process, the authors followed the process described by Whittemore and Knafl (2005) for a review that Search for the Terms Integrative would be broad, inclusive of theoretical and empirical Health Care or Integrative Nursing approaches. Peer-reviewed publications were searched through three search engines: the Cumulative Index We began this search with the phrase “integra- of Nursing and Allied Health Literature (CINAHL), tive nursing” and searched CINAHL through MEDLINE, and Google Scholar. Inclusion criteria EBSCO with no limits on the date of publication. for articles were that the article either defined the Limits placed on the search were “peer-reviewed/ term in question outright or described its use so that scholarly journals,” and the terms “definition of.” its meaning could be inferred. The search strategy is This search returned 57 articles and upon reading described below. titles and abstracts there were three papers that potentially met the inclusion criteria. The vast major- ity of the papers retrieved from this search were Search for the Term Holistic integrative reviews of the literature on various topics Nursing not related to integrative nursing. We then noted The term holistic nursing was searched in that “integrative medicine” is a search phrase in the CINAHL through EBSCO with no limits on the date CINAHL headings, not “integrative health care” so 262 Journal of Holistic Nursing / Vol. 37, No. 3, September 2019 we altered our search protocol to conduct an addi- Norway, Rwanda, Singapore, South Africa, Spain, tional search using “integrative medicine” as a search Sweden, Taiwan, and from European teams repre- term, limited to peer-reviewed/scholarly journals and senting the United Kingdom, Germany, and Sweden. with the terms definition of added to the search. This There were 32 articles on integrative health care/ search resulted in 29 articles and upon review of medicine or integrative nursing spanning the years titles and abstracts and omitting duplicates from the 1998 to 2018 and again primarily from the United initial search there were 13 additional articles that States but also from Australia, Canada, China, New potentially met inclusion criteria. Next a MEDLINE Zealand, Sweden, and from European teams from search was conducted in the same manner as the several counties writing on the topic. CINAHL search (continuing to use “integrative medicine” as a search term in addition to “integra- Findings tive health care” and “integrated nursing”), yielding 23 articles, 17 of which were duplicates of papers Holistic Nursing already retrieved. Therefore, six additional papers were added. Additionally, a MEDLINE search was Extracting data from 24 papers in peer-reviewed conducted using the terms “meaning of” rather than journals, we found that the literature from the “definition of” as a qualifier as we discovered that 1980s to the present documents consistent interest “meaning of” is a useful qualifier in MEDLINE, and in and development of the concept of “holistic nurs- this search resulted in seven additional papers. Last, ing.” Throughout the decades there remains a clear Google Scholar was searched in