JHNXXX10.1177/0898010114563312Journal of Holistic NursingHolistic Nursing Care / Kinchen 563312research-article2014 1 Practice Development of a Quantitative Measure jhn of Holistic Nursing Care Journal of Holistic Nursing American Holistic Nurses Association Volume XX Number X Elizabeth Kinchen, PhD, RN, AHN-BC XXXX 201X 1 –9 Florida Atlantic University © The Author(s) 2014 10.1177/0898010114563312 http://jhn.sagepub.com Holistic care has long been a defining attribute of nursing practice. From the earliest years of its formal history, nursing has favored a holistic approach in the care of patients, and such an approach has become more important over time. The expansion of nursing’s responsibility in delivering comprehensive primary care, the recognition of the importance of relationship-centered care, and the need for evidence-based legitimation of holistic nursing care and practices to insurance companies, policy-makers, health care providers, and patients highlight the need to examine the holistic properties of nursing care. The Holistic Caring Inventory is a theoretically sound, valid, and reliable tool; however, it does not comprehensively address attributes that have come to define holistic nursing care, necessitating the development of a more current instrument to measure the elements of a holistic perspective in nursing care. The develop- ment of a current and more comprehensive measure of holistic nursing care may be critical in demon- strating the importance of a holistic approach to patient care that reflects the principles of relationship-based care, shared decision-making, authentic presence, and pattern recognition. Keywords: holistic; conceptual/theoretical descriptors/identifiers; holistic care; holistic nursing; methodological innovations/instrument development; common themes Holistic care has long been a defining attribute become necessary to quantify and substantiate holis- of nursing practice. Indeed, as Lang and Krejci tic nursing care to policy-makers, legislators, nurses, (1991) attest, “the phrase ‘holistic nursing’ is redun- and consumers. The purpose of this article is to dant. Whether nursing is defined by the [ANA] identify instruments that describe and quantify Social Policy Statement, Nightingale (1860/1992), holistic nursing care from the patient’s perspective or Rogers (1990), it is holistic or it is not nursing” and to explore those attributes of holistic care that (p. 16). From the earliest years of its formal history, may be lacking in existing instruments and that may nursing has favored a holistic approach in the care contribute to the development of a current and com- of patients, and such an approach has become more prehensive measure. important over time. With the publication of the Institute of Medicine’s (IOM, 2010) recommenda- Evolution of Holistic Nursing Care tions for the future of nursing and passage of the Patient Protection and Affordable Care Act (PPACA, The defining characteristics of holistic nursing 2010), nursing continues to broaden its practice care have evolved subtly over time. Nightingale (1860/ boundaries and more clearly articulate its perspec- 1992) considered illness as a state of disequilibrium tive, as the profession takes on greater responsibility in delivering high-quality patient care. In view of patients’ expressed preference for relationship-cen- tered care, the high cost and growing fragmentation Author’s Note: Please address correspondence to Elizabeth Kinchen, PhD, RN, AHN-BC, Florida Atlantic University, 777 of health care delivery, and the struggle Glades Rd., Boca Raton, FL 33431, USA; e-mail: ekinche1@ to secure reimbursement for holistic practices, it has fau.edu. Downloaded from jhn.sagepub.com at SAGE Publications on June 18, 2015 2 Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX and healing as a natural process, strongly influenced and healing activities. A relationship that focuses on by a patient’s environment. By the turn of the 20th the patient’s experience of health and illness and century, this view had expanded to public health nurs- seeks to understand and honor the patient’s priori- ing, and although the term “holistic” was not yet used, ties in healing is an integral component of holistic nurses continued to promote health using a holistic nursing care (Dossey, 2009). Patient preference for approach—considering the effects of the physical, a relationship-centered approach to care is well- social, and community environments in patients’ lives documented (Luxford, Safran, & Delblanco, 2011; (Boschma, 1994). In the latter half of the century, McQueen, 2000; Miller & Apker, 2002; Tresolini, nursing theorists (Orlando, 1961; Peplau, 1952) had 1994; Watson & Foster, 2003); such an approach is begun to include concepts from psychology and soci- characterized by a conscious and intentional shift ology relating to the dynamics of interpersonal rela- toward caring and healing relationships and modali- tionships in care theories, and models emerged that ties, communication patterns, and authentic rela- were individualized, comprehensive, and patient- and tionships (Moore & Hanson, 2009). These qualities relationship-centered. Social consciousness, plane- mirror a holistic focus in care delivery, and patient tary stewardship, dissatisfaction with the effects of preference for care that honors these qualities is an industrialization and technology, and interest in new important impetus for exploring its advantages. age and Eastern philosophies and spiritual beliefs contributed to the conceptualization of a holistic focus in health and healing. Such a focus embraced Comprehensive Care the unity of mankind and the interconnectedness of Comprehensive care is aimed at coordinating mind, body, and spirit. The counterculture of the and improving how care is delivered, with the goal of 1960s was especially influential in bringing what are improving health outcomes and quality of life. now termed alternative and complementary modali- Advances in medical science have enabled peo- ties such as meditation, yoga, acupuncture, herbal ple to live longer; this increase in longevity has remedies, and relaxation techniques into the public brought with it an increase in the number of indi- discourse. The concepts of patient- and relationship- viduals living with chronic illnesses (Volland, centered care, the interconnectedness of the mind Schraeder, Shelton, & Hess, 2013). Chronic illness and body, and the healing potential of alternative presents significant challenges in care management, therapies began to define a holistic framework for as the needs of patients with chronic conditions are nursing (Boschma, 1994). often complex, and may be addressed by numerous The American Holistic Nursing Association health care providers. Patient care is therefore often (AHNA) was formally established in 1981 as a venue fragmented, incomplete, and inefficient, leading to for the exploration, discussion, and dissemination of unnecessary hospitalizations, increased use of emer- holistic ideas and the American Nurses Association gency facilities, polypharmacy, and conflicting plans (ANA), recognizing holistic nursing’s unique approach of care (Volland et al., 2013). to health and healing, granted specialty status to the Holistic nursing care is comprehensive in that it AHNA in 2006. The AHNA (2012) describes a holistic takes into account the patient’s physical, emotional, nurse as one who takes a holistic (mind-body-spirit- social, spiritual, and psychological well-being and emotion) approach to the practice of traditional nurs- includes the consideration and use of complemen- ing, an approach that is based on a body of knowledge, tary and alternative modalities (CAMs), if desired or sophisticated skill sets, standards of practice, and a indicated. And although the use of CAM is not nec- philosophy of living and being that is grounded in car- essarily a defining attribute of holistic nursing care, ing, relationship, and interconnectedness. such therapies may be proposed and utilized by patients as avenues to healing and as adjuncts to The Importance of Holistic more conventional medical treatment. Nursing Care CAMs Patient Preference Public interest in CAMs has increased in recent The nurse’s relationship with patients consti- years. The American Hospital Association, in part- tutes the foundation for therapeutic interactions nership with the Samueli Institute (2011), reports Downloaded from jhn.sagepub.com at SAGE Publications on June 18, 2015 Holistic Nursing Care / Kinchen 3 that holistic therapies used in conjunction with or as nurses to be allowed to practice to the fullest extent alternatives to conventional medical therapies (phar- of their education, to achieve higher levels of educa- maceuticals, surgery, etc.) are becoming more popu- tion, to be recognized as full partners with physi- lar across the United States. Their most recent cians and other health care professionals in reforming survey indicates that approximately 38% of all health care delivery, and to expand research and Americans use therapies such as meditation, mas- improve data collection, in order to identify best sage, yoga, and natural products (including herbal practices and ensure better quality health care. preparations) for a variety of chronic conditions, In addition, the question of legitimation of holis- including musculoskeletal pain, migraines, arthritis, tic nursing care and practices for purposes of reim- anxiety and depression, and high cholesterol. In bursement and policy creation