Learning Objectives
By the end of this section, you will be able to:
- Define holistic health-care theories and therapies, including social determinants of holistic health care
- Describe mindfulness as a type of holistic health care
- Identify nursing application of holistic theories
Holistic health care is a wellness modality used to treat and prevent physical and mental health problems. Holistic health care can greatly enhance the success of treatment and outcomes and can be combined with pharmacological interventions. Clients in treatment for mental health care may spend a lot of time in a hospital setting trying new therapies or medication regimens. A holistic approach to transitioning back into a community setting can prevent hospital readmissions (State of New South Wales [NSW] Government, 2020). Incorporation of community-based programs after hospital discharge, such as social services, community treatment facilities, and group housing are often used as reintegration techniques. The ultimate goal of holistic health care is increased treatment effectiveness.
Definitions
The multifaceted approach that reflects the client’s physical and emotional well-being and considers the whole person and how they interact with their environment is called holistic health. It is a focus on one’s quality of life versus a physical ailment, illness, or disease. The nurse understands there are numerous factors that affect a client’s actual health goals and potential outcomes. These factors include physical, emotional, cultural, family, spiritual, psychological, and environmental influences. Accurate assessment helps the nurse interpret the complex interactions between all the different factors. To assess the impact of each influence, the nurse should perform a functional assessment. Functional assessments include the client’s developmental patterns as well as behavior and response to stressors. Analyzing collected data from the functional assessment and applying interventions creates a solid foundation for providing holistic health care.
Link to Learning
The Functional Analysis Screening Tool (FAST) is designed to identify a number of factors that may influence the occurrence of problem behaviors.
Social Determinants and Associated Interventions: Healthy People 2030
The conditions of the environments where people live, work, play, worship, and go to school, which represent the nonmedical factors that influence health outcomes, are social determinants of health (SDOH). Ideally, all components of the environment would support health and a good quality of life for the inhabitants. Environmental conditions may contribute to health and well-being or may be detrimental or harmful. Even moderate support can be beneficial in a less-than-optimal environment. For example, someone with no home or income of their own may be part of a faith-based community that comforts and assists them.
As described by Healthy People 2030, the five areas that comprise SDOH are economic, education, health care, neighborhood, and community (Figure 2.6). Therefore, unemployment or debt, education that is disrupted or unavailable, low access to health care, a neighborhood with violence or crime, or a larger community without resources can have damaging effects on health of the people.
Drafted by the Office of Disease Prevention and Health Promotion, Healthy People 2030 sets data-driven national objectives to improve health and well-being associated with social determinants. Through research, common themes of social determinants emerged among various populations that appeared to be preventing people from achieving health-care goals, as defined by the person. The Healthy People Committee developed interventions for health-care workers to help individuals overcome the effects of these conditions. The goal or mission envisions a society in which all people can achieve their full potential for health and well-being across the life span.
Link to Learning
Healthy People 2030 is a set of objectives based on public health priorities that are intended to improve the health and well-being of Americans.
The Patient-Centered Medical Home Model
The patient-centered medical home (PCMH) model, developed by the Veterans Health Administration, is an example of a proactive, primary care-based, interdisciplinary team model using person-centered, holistic care, and active communication and coordination among providers. This model is considered effective for clients with complex health-care needs. Figure 2.7 illustrates the medical home model. As homeless veterans stabilize clinically and socially, as evidenced by their moving into permanent housing and demonstrating appropriate self-care and health-seeking behaviors, they are transitioned to traditional care settings to continue their care. Research indicates that the medical home model reduced emergency department visits and hospitalizations of the homeless population by integrating supports that addressed social determinants of health into a clinical care model (Centers for Disease Control and Prevention [CDC], 2021).
Mindfulness
An individual’s state of awareness, achieved through personal focus, being in the present, and/or meditation is called mindfulness. Attention to being fully cognizant of a situation without extreme reaction can provide calming and centering. The practice of mindfulness dates back to ancient times and was originally grounded in Buddhist and Hindu traditions (Figure 2.8).
Research has shown that mindfulness can have positive health outcomes related to managing stress, anxiety, and many types of depression (Crosswell et al., 2017). Mindfulness has been described as, “non-elaborative, nonjudgmental, present-centered awareness in which each thought, feeling, or sensation that arises is acknowledged and accepted as it is” (Delegran & Haley, 2016, para 3). Mindfulness is a holistic technique, involving all the person’s senses and contributing to overall well-being.
Mindfulness practice utilizes techniques for one to be present and in the moment. One exercise might be the following:
Compare your default state to mindfulness when studying for an exam in a difficult course or preparing for a clinical experience. What do you do? Do you tell yourself, “I am not good at this” or “I am going to look stupid”? Does this distract you from paying attention to studying or preparing? How might it be different if you had an open attitude with no concern or judgment about your performance? What if you directly experienced the process as it unfolded, including the challenges, anxieties, insights, and accomplishments, while acknowledging each thought or feeling and accepting it without needing to figure it out or explore it further?
If practiced regularly, mindfulness helps a person start to see the habitual patterns that lead to automatic negative reactions that create stress. By observing these thoughts and emotions instead of reacting to them, a person can develop a broader perspective and can choose a more effective response.
Mindfulness-Based Stress Reduction
Mental training used to alter how pain or stress is processed within the central nervous system, thereby diminishing or reducing one’s perception of pain or stress, is called mindfulness-based stress reduction (MBSR). MBSR has shown positive outcomes in a variety of health-care settings for both physical and emotional disruptions (Lamothe et al., 2016). MBSR was originally developed for clients with chronic illness who were not responding to existing medical treatments. MBSR was first researched and funded by the National Center for Complementary and Integrative Health (NCCIH) at the University of Massachusetts in 1979. The NCCIH created a Stress Reduction Clinic and treated a variety of clients with health conditions, such as cancer, chronic pain, and autoimmune disorders. Clients completed modules and workshops on techniques like meditation to lower stress levels and increase well-being.
Because MBSR showed such encouraging results in physical conditions, mental health providers started combining it with cognitive therapy and incorporating it into the treatment plans of clients suffering from depression. In recent years, MBSR has shown positive outcomes as a coping technique for caregiver burden as well (Nathan et al., 2017). Due to the pandemic and social distancing mandates, mental health-care practitioners have recently started offering MBSR modules and workshops in a virtual platform.
Link to Learning
The Mindfulness Project is a tool with numerous mindfulness activities.
Guided Imagery
Another form of mindfulness is guided imagery, which provides an alternate narration the mind can focus on during an unpleasant experience. According to the pain gate theory, the brain can only experience one pathway at a time, either pleasure or pain, but not both (Krau, 2020). Guided imagery allows for the pleasure pathway to take over, decreasing the body’s perception of pain. Guided imagery is often used during labor as a coping technique for contraction pain. The nurse helps the laboring mom picture something that brings a pleasant thought or feeling, like her newborn’s outfit or ultrasound picture. The mental image accompanied with slow, controlled breathing and relaxation of tension in the shoulders, hands, and feet can provide a nonpharmacological approach to pain management.
Guided imagery has also been proven effective as an intervention in mental health scenarios. For example, during a client’s anxiety, the nurse can offer to assist the client with an exercise. Allow the client to sit comfortably in a quiet area. Begin by describing a beach with waves coming in on the sand and going back out to sea. Using the mental image of ocean waves, the nurse can instruct the client to breathe in as the waves approach the beach and breathe out as the waves go back. Nurses also teach guided imagery to promote relaxation and sleep.
Teaching Mindfulness Requires Self-Awareness
To teach mindfulness to clients, the nurse must first examine their own self-awareness and beliefs. Different treatments and interventions work for different clients. There is no one single treatment that is effective in every situation. The nurse must not impose their own beliefs or personal opinions onto the client, nor provide less than quality care just because the client’s beliefs differ from their own.
The therapeutic relationship between a nurse and client must be founded on trust and a judgment-free space in order to be effective in producing positive outcomes. For instance, a client with obesity may want to be more accepting of their weight and may need assistance with interventions related to achieving a positive body image. The nurse may believe instead of self-acceptance, the client should be focusing on health promotion and ways to reduce their weight. The nurse has a responsibility, however, to support the client and help them achieve their goals. Using applications of mindfulness, the nurse should be aware of their surroundings and display the empathy needed by the client to achieve their goal. Nurses who practice self-awareness are better equipped to provide quality client-centered care, resulting in more positive outcomes.
Key elements for the nurse to consider when incorporating self-awareness include:
- A client’s perception is the most influential factor in determining their response to intervention, rather than how the nurse feels they should respond.
- Behavior and emotions will differ between clients in the same situation, with the same variables.
- No one intervention will work with every client.
- Becoming familiar with a variety of cognitive and holistic interventions will increase effectiveness in promoting a positive well-being.
Clinical Safety and Procedures (QSEN)
QSEN Competency: Client-Centered Care
Nurses practice client-centered care when building trust and avoiding judgment in the therapeutic relationship. Building trust means “do what you say you will do.” For example, if the nurse states a group exercise will start at 9:00, the group should start on time. If the nurse states they will return to meet with the client after lunch, the nurse should do so. Avoid judgment in nurse-client interactions, by saying, for example, “I can see your point,” “This seems important to you,” or “Is it fair to say you were angry about that?” instead of responding with comments such as, “You’re not making sense,” “That’s not relevant,” or “You shouldn’t have felt that way.”
Nursing Application of Holistic Health Care
Holism in health care is a psychosocial approach that does not set illness apart, but treats the whole person. Nightingale, by using the environment as therapy, was incorporating a holistic approach. Nurses should consider the physical and social environment when treating clients.
During interviewing and data collection, nursing awareness of the physical environment and the nurse’s attitudes are essential components. If the interaction takes place in a busy or noisy area or the nurse expresses impatience or fatigue, the client will not feel supported.
Nurses should also take into account the client’s outside environment. In the community, for example, nurses can practice advocacy by volunteering and promoting efforts to address food insecurities, housing initiatives, or transportation systems. In public health settings, nurses can make inquiries with empathy, such as, “Do you sometimes run out of necessities?” or “What would be the best way to help you with child care?” They can then make referrals or arrange consults as indicated by clients’ preferences.
Clinical Safety and Procedures (QSEN)
QSEN Competency: Quality Improvement (QI)
Nurses use quality improvement projects or task forces to track client responses and positive outcomes. For instance, surveys can be implemented after the initiation of techniques, such as mindfulness or self-awareness behaviors among staff members, then results analyzed to show correlation of positive care outcomes.