CHAPTER 3 Current Trends and Issues in Holistic Nursing Carla Mariano © Olga Lyubkina/Shutterstock people desire to be more actively involved in Nurse Healer Objectives health decision making. They have expressed their dissatisfaction with conventional (West- Theoretical ern allopathic) medicine and are calling for a ■ Describe the major issues in health care care system that encompasses health, quality of and holistic nursing today. life, and a relationship with their providers. The ■ Identify changes needed in health care to National Center for Complementary and Alter- promote health, wellness, well-being, and native Medicine’s Third Strategic Plan 2011–20151 healing. and Healthy People 2020 2 prioritize enhancing ■ Discuss recommendations of the Institute physical and mental health and wellness, pre- of Medicine (IOM) report The Future of venting disease, and empowering the public to Nursing . take responsibility for their health. The vision of Healthy People 2020 is “A society in which all people live long, healthy lives” and its goals are Clinical as follows: 2 ■ Evaluate how current trends in health care ■ will affect clinical nursing practice. Attain high-quality, longer lives free of ■ Discuss with other health professionals the preventable disease, disability, injury, and unique and common contributions of one premature death. ■ another’s practice. Achieve health equity, eliminate disparities, and improve the health of all groups. ■ Create social and physical environments Personal that promote good health for all. ■ ■ Become a member of the American Holistic Promote quality of life, healthy development, Nurses Association (AHNA) to participate and healthy behaviors across all life stages. in improving holistic health care for society. The American public increasingly calls for health care that is compassionate and respect- Health Care in the United States ful, able to provide a variety of options, eco- Western medicine is proving ineffective, wholly nomically feasible, and grounded in holistic or partially, for a significant proportion of com- ideals. A shift is occurring in health care where mon chronic diseases. Furthermore, highly 77 9781284082463_CH03_PASS02.indd 77 25/02/15 6:07 pm 78 Chapter 3 Current Trends and Issues in Holistic Nursing technological health care is too expensive to and episodic, as well as often ineffi- be universally affordable. In a 2011 poll, 55% cient and impersonal.5 of Americans indicated that the healthcare Chronic diseases—such as heart disease, can- system has major problems, 50% indicated cer, hypertension, diabetes, and depression— that the healthcare system needs fundamental are the leading causes of death and disability changes, and 36% stated that there is so much in the United States. About half of all adults wrong with the healthcare system that it needs (117 million people) have one or more chronic to be completely rebuilt.3 A 2012 poll, Sick in health conditions. One in four adults has two America,4 conducted by the Harvard School of or more chronic health conditions. Chronic dis- Public Health and Robert Wood Johnson Foun- eases account for 70% of all deaths in the United dation, indicated that more than half of Ameri- States, which is 1.7 million deaths each year. cans (57%) think there is a serious problem with These diseases also cause major limitations in the quality of the nation’s health care. However, daily living for almost 1 out of 10 Americans, or their concern about the quality of health care is about 25 million people.6 lower than their concern about the cost of care Stress accounts for 80% of all healthcare in the nation. Most Americans (87%) see the cost issues in the United States. “SuperStress” is a of care as a “very serious” (65%) or a “somewhat serious” (22%) problem for the country. Fur- result of both the changing nature thermore, nearly two-thirds believe that the cost of our daily lives and our choices in of U.S. health care has gotten worse over the lifestyle habits, as well as a series of last 5 years (65%). One-quarter of sick Ameri- unfortunate events. Extreme chronic cans report that a doctor, nurse, or other health stress . has silently become a pan- professional did not provide all of the needed demic that disturbs not only how we information about their treatment or prescrip- perceive our quality of life but also tions (25%), or they had to see multiple medical our health and mortality. The APA professionals, and no one doctor understood or [American Psychological Association] kept track of all of the different aspects of their issued a report on stress, revealing that medical issues and treatments (23%). Nearly nearly half of all Americans were expe- three-quarters of sick Americans want their doc- riencing stress at a significantly higher tor to spend time with them discussing other, level than the previous year and rated broader health issues that might affect their its level as extreme.7, p. 7 long-term health (72%), as opposed to just talk- ing about their specific medical problem (21%). Healthcare costs have been rising for several years. Expenditures in the United States for Although medical advances have saved health care surpassed $2.7 trillion in 2011, more and improved the lives of millions, than three times the $724 billion spent in 1990, much of medicine and health care and more than eight times the $255 billion have primarily focused on address- spent in 1980.8 In May 2014, healthcare expen- ing immediate events of disease and ditures were $3.02 trillion and are projected to injury, generally neglecting underly- be $4.3 trillion by 2017.9 ing socioeconomic factors, including In 2013, U.S. healthcare spending was about employment, education, and income $8,508 per resident and accounted for 17.5% of and behavioral risk factors. These fac- the nation’s gross domestic product (GDP); this tors, and others, impact health status, is among the highest of all industrialized coun- accentuate disparities, and can lead to tries. Total healthcare expenditures continue to costly, preventable diseases. Further- outpace inflation and the growth in national more, the disease-driven approach to income. The U.S. healthcare system is the most medicine and health care has resulted expensive in the world and pays about twice in a fragmented, specialized health sys- as much per capita on health care as our peers tem in which care is typically reactive in other advanced nations, but it yields worse 9781284082463_CH03_PASS02.indd 78 25/02/15 6:07 pm Health Care in the United States 79 results than the systems in Britain, Canada, Ger- beginning of 2014.14 The number of under- many, France, Japan, Australia, and New Zea- insured remains a problem at 60% or 25 mil- land. U.S. residents with below-average incomes lion.15 The reasons for both categories include are more likely than their counterparts in other workers losing their jobs in the recession, com- countries not to have received needed care panies dropping employee health insurance ben- because of cost. It is projected that healthcare efits, and families going without coverage to expenditures will climb to 22% of GDP by 2038.8 cut costs—primarily as a result of the high costs Healthcare costs for a family of four rose of health care. In addition, in 2013, around 80 again in 2014, with employees paying a much million or 43% of America’s working-age adults larger share of the growing expense. The total did not access needed medical services because cost of health care for a typical family of four is of the cost. According to the Commonwealth $23,215, an increase of 5.4% over 2010. This Fund’s Biennial Health Insurance Survey, nearly is double the cost families had to pay in 2004 3 in 10 adults said they did not visit a doctor or ($11,192). As costs continue to grow, the cost clinic when they had a medical problem, while for health care constitutes a larger and larger more than a quarter did not fill a prescription portion of the household budget. And what are or skipped recommended tests, treatment, or families paying for? The 2014 Milliman Medical follow-up visits. One in five said they did not get Index indicates that professional services rep- needed specialist care.16 resent 31% of the overall health costs; hospi- The Kaiser Family Foundation identified the tal inpatient costs account for 31%; outpatient following forces driving healthcare costs:17 costs, 19%; pharmacy, 15%; and other expenses, ■ such as medical equipment, about 4%.10 Technology and prescription drugs. Because of Recently published data from the National development costs and generation of con- Health Interview Study indicate that more than sumer demand for more intense, costly ser- 1 in 4 families in the United States experienced vices, even if they are not necessarily cost financial burden of medical care. Almost 1 in 6 effective. ■ families had problems paying medical bills in Chronic disease. Chronic disease accounts the past 12 months, and 1 in 10 families had for more than 75% of national health- medical bills that they were unable to pay at care expenditures and places tremendous all.11 demands on the system, particularly the In addition, workers paid 73% more in 2014 increased need for treatment of ongoing ill- than they did in 2007 for the health coverage nesses and long-term services. One-quarter they get through their jobs, while their wages of Medicare spending is for costs incurred have increased only 18%. Employers, in contrast, during the last year of life. ■ pay 52% more toward their employees’ health Aging of the population. Health expenses rise insurance than they did 5 years ago. Premiums with age. Baby boomers began qualifying for employer-sponsored health insurance have for Medicare in 2011 and many of their risen from $9,068 in 2003 to $16,351 in 2013, costs will shift to the public sector.