By Debra Wood, RN, contributor
With complementary and alternative medicine gaining acceptance, patients
increasingly find relief from physical ailments after consulting with holistic
nurses who guide them in blending conventional and complementary modalities.
"Holistic nursing takes place wherever healing occurs," said Carla Mariano,
RN, Ed.D., AHN-C, FAAIM, president-elect of the American Holistic Nurses
Association. "We can do it in acute care facilities, outpatient clinics, within
the home, in mental health and women's health--anyplace if you have this kind of
direction and philosophy."
Holistic nursing involves much more than complementary and alternative
medicine (CAM). Holistic nurses recognize and respect the relationships between
physical, emotional and spiritual well-being and work with the patient on all of
those dimensions to facilitate healing. While the patient typically presents
with a physical problem, the holistic nurse digs deeper to determine the
emotional or spiritual roots of the difficulty.
"We see symptoms as teachers, not as something negative," said Mariano, who
is also the coordinator of the Advanced Practice Holistic Nursing Program at New
York University.
The five-year-old program prepares nurse practitioners to integrate
conventional practice skills with holistic techniques, such as assessing energy
fields, thought patterns and spirituality. Then based on the assessment, the
nurse practitioner may recommend massage, meditation, guided imagery or
therapeutic touch.
Gloria F. Donnelly, RN, Ph.D., FAAN, dean of the Drexel University College of
Nursing and Health Professions in Philadelphia, Pennsylvania, thinks holism is
becoming more mainstream. More than a third of Americans use some form of CAM,
according to a recent government survey.
Even so, many people and health professionals fail to recognize holism's
benefits. While some research exists, more validation of the holistic approach
is needed.
"We are living in an era of evidence-based practice," said Donnelly, who is
also editor of the journal Holistic Nursing Practice. "If we are going to do
therapeutic touch or any of these things, we should have evidence that they work
and an understanding of how they work."
The National Center for Complementary and Alternative Medicine (NCCAM),
formed five years ago, supports research in this area. NCCAM-funded studies have
shown Tai Chi can enhance older adults' physical performance and immune response
and that, in vitro, herbal extracts can strongly inhibit the growth of human
head and neck cancer cells. Many more studies are under way. Meanwhile, holistic
nurses continue integrating CAM modalities into traditional treatment settings.
At MD Anderson Cancer Center Orlando in Florida, many nurses embrace a
mind-body-spirit approach to cancer care. They may teach a patient mindful
meditation or guided imagery to help them through chemotherapy treatments. They
may bring in spiritual resources. More than 40 practitioners have received
training in energy-medicine interventions.
Kim Morrison, ARNP, AOCN, a nurse practitioner at MD Anderson Orlando,
educates receptive patients in complementary techniques and cautions patients
about supplements or treatments that could interfere with their medical plan of
care.
"I like taking the best of both worlds, everything in moderation and
educating the patient how to be safe," Morrison said.
Susan Dempsey-Walls, RN, MN, AOCN, oncology clinical nurse specialist at MD
Anderson Orlando, has found complementary interventions frequently help with
symptom management, while decreasing the need for supportive medications and
their associated side effects.
"We use the best of pharmacology and the best of nondrug therapies and what
you hope you get is the best optimal individualized plan for that person,"
Dempsey-Walls said. "It makes the person feel more in control."
Teaching family members some of the techniques empowers them as well. They
feel they can contribute to the care. Even when medical treatments no longer
work, patients still have CAM interventions.
"People feel cared for instead of just being treated, and that's what nursing
is all about," Dempsey-Walls said.
Mary Amendolari, RN, CNAT, a certified nurse amma massage therapist and Reiki
master, practices at Caring Hands Family Practice in Westbury, New York. Its
physician refers patients for stress and pain management or
nutritional-supplement therapy for patients seeking an alternative to
prescription drugs.
"I look at everything and optimize what they can do to feel better,"
Amendolari said. "I love it when they come back and say, 'I feel better.'"
Amendolari became interested in holistic nursing after 15 years in critical
care. Watching patients return to the unit over and over for the same or similar
problems prompted her to explore alternative treatments. She became a full-time
holistic practitioner five years ago.
Nurses at The Harry R. Horvitz Center for Palliative Medicine at The
Cleveland Clinic in Ohio, have arranged for a music therapist to visit the
facility three times weekly.
"We find it helps all of our patients, particularly those with a high level
of anxiety and pain," said Catherine Lawrence, RN, C, CHPH. "It's relaxing and
helps them feel better."
Mary Drayton, NP, with the Veterans Affairs New York Harbor Healthcare
System, uses therapeutic touch and Reiki with terminally ill inpatients at the
VA hospital. She has found Reiki calms patients waiting for opioid pain
medications to begin taking effect.
"Western medicine works but sometimes the combination has a more powerful
effect," Drayton said. "I can go home and review the day and know I made a
difference."
Drayton first became interested in holistic practice 10 years ago, after
being diagnosed with fibromyalgia and found acupuncture eased her chronic pain.
She encourages nurses to attend workshops and learn more about CAM, including
nutritional supplements, since so many patients use these products.
Holistic nurses typically incorporate the same techniques they practice with
patients into their own lives. They may meditate to reduce stress or practice
deep-breathing exercises. Mariano thinks holism could serve as a key to
resolving the nursing shortage.
"When you use stress-management and lifestyles and health promoting
techniques, it increases the resilience of the nurse who uses them, rather than
popping pills or becoming burned out," Mariano said. "I see this approach as one
of the few things that can keep nurses in nursing, working in a way that heals
them."
As the next president of the association, Mariano aims to expand
undergraduate and graduate education in holism. Early introduction of integrated
practice will prevent new nurses from becoming entrenched in a disease-oriented,
medical model. She also hopes to raise legislators' and policymakers' awareness
about the benefits of holistic techniques.
By adopting a healthier lifestyle and holistic practices, patients may
require fewer medical visits, which could save health-care costs over the long
term. Holistic nurses help patients cope with chronic conditions and overcome
obstacles. They empower patients to heal themselves using a blend of
conventional and complementary techniques, resulting in lifelong changes and
improved health.
"We see people take what often times is disruptive and almost pathological
and turn it around and look at themselves as capable of doing their own
healing," Mariano said. "That is the real value of holism and holistic nursing."
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