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There's Always Time for Holistic Healing

Monday December 8, 2008
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Requests for the use of complementary and alternative medicine is increasing in the inpatient setting. Holistic nurses who use CAM's evidence-based modalities, such as massage, reflexology, imagery, and energy work enhance a patient's ability to heal. The specialty is appealing to more nurses as a new career direction and has others reviewing the modalities' function in treating acute-care patients.

Special Appeal

Holistic nursing was designated as a specialty by the American Nurses Association in 2006. The American Holistic Nurses Association, which was founded in the 1980s, today boasts standards of practice, certifications, and a membership of more than 4,000 nurses. The certification process is rigorous and includes 85 continuing education units in the specialty. The specialty often attracts nurses who were approaching burnout in their career roles, as well as those who wish to expand their skills.

Studying holistic nursing often begins with nurses submitting to a body, mind, and spirit self-assessment, which includes an examination of their relationships with themselves, with others, and with a higher power or nature, as well as physical assessment. The nurses also develop self-care plans and incorporate good nutrition, exercise, and meditative practices into their daily routine.

Effective therapeutic presence, energy work, and intuition — part of a holistic nurse's tools — aren't possible when a nurse is stressed, anxious, angry, or tired. Good self-care practices allow holistic nurses to become healthy, calm, and balanced, which makes it easier for them to listen to and observe patients and assess their physical, emotional, and spiritual concerns. In doing so, nurses can form meaningful relationships with patients and help them develop healing plans.

CAM in Motion

An issue of holistic nursing and its interventions is that there is no time for it in the acute-care setting — physical care is the priority. If a patient is in rapid a-fib, CAM interventions like imagery and massage can wait until long after the appropriate meds are administered and the patient is stabilized.

However, therapeutic presence, prayer, intent, and touch can be used at any time and also can help enhance family members' perception of care. In New York State, a holistic nurse practitioner can assist with pain, anxiety, or end-of-life care by using holistic interventions such as massage, reflexology, imagery, energy work (like therapeutic touch and Reiki), and aromatherapy. This allows the nurse to develop a healing relationship with the patient and enhances family perceptions of care, which provides a deep sense of fulfillment for holistic nurses.

In one real-life instance, I visited an ICU to see if my services as a holistic nurse practitioner were needed. A nurse requested care for her patient who had surgery the day before. The patient had undergone several procedures and was stable, but exhausted. I explained the technique of reflexology, which can lead to stress and pain reduction through pressure applied to the feet or hands, and he agreed to try it.

As I began working with him, I heard someone stomp into his room. The woman asked, "Who are you?" I explained my role and she asked what I was doing to his feet. "Be quiet. This feels good," the patient said.

Three minutes after the patient drifted off to sleep, the woman stated, "I had no idea this hospital gave such great care." My use of therapeutic presence and reflexology actually improved the perception of care.

Although interventions might be provided by staff nurses who are competent in holistic nursing practices, the perception of the time it takes to work with a patient — and the money to pay for the treatment — is an issue. But a 15-minute treatment often can help a patient sleep for an hour or enhance pain relief. In New York, inpatient holistic nursing consults do not generate a bill and are not covered by insurance companies. Positions are supported by hospital administration or foundations.

At North Shore University Hospital in Manhasset, N.Y., a culture change is taking place and is under the guidance of the North Shore Long Island Jewish Health System Professional Practice Model, the Collaborative Caring Model. The Collaborative Caring Model, which is in alignment with holistic nursing values, is shared with all staff.

On each unit, staff members are identifying ways to deliver excellent patient care and learning about self-care, such as reducing stress by using imagery, reflexology, and relaxation videos. Inefficient processes that waste time or impede care are being identified and corrected. Also, Transforming Care at the Bedside principles are used to keep nurses at the bedside and further enhance care.

In the movement toward high-tech care, holistic nursing in the acute care setting is growing. Patients are seeking hospitals that will care for their bodies, minds, and spirits. Holistic nursing using CAM interventions focus on just that. The role of the holistic nurse is slowly moving to a specialty position in institutions and is open to dedicated nurses who keep self-care a priority.


Deborah McElligott, RN, ANP-BC, AHN-BC, DNP(c), is director of nurse practitioners in the Office of Complementary & Alternative Medicine for North Shore University Hospital in Manhasset, N.Y. To comment, e-mail editorNTL@gannetthg.com.