Holistic care is a model of patient care, which can be regarded as core to the science of nursing in general. According to Zamanzadeh, Jasemi, Valizadeh, Keogh, & Taleghani (2015), “the philosophy behind holistic care is based on the idea of holism which emphasizes that for human beings the whole is greater than the sum of its parts and that mind and spirit affect the body” (p. 214). Based on this, a holistic approach to the practice of nursing implies behaviors that show the view on a patient as a whole and the acknowledgment of interdependence among various environmental and individual factors, as well as their influence on health outcomes. Although a large body of research provides evidence verifying multiple beneficial effects of holistic nursing on both patient outcomes and professional practice, in many hospitals, nurses face distinct obstacles to the implementation of this model. One such barrier is the lack of understanding of the concept of holism (Zamanzadeh et al., 2015). Therefore, in the given paper, the conceptual-theoretical-empirical (CTE) structure aimed to facilitate the practice of holistic care will be developed and evaluated.
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According to Fawcett (2013), theoretical components of the CTE structure are directly derived from the propositions of the conceptual framework, which is selected to guide the practice. Since the holistic care model is used in the present paper, the suggested middle-range theory concepts will include patient-centered care and holism, which refers to the integral parts of a person as the mind-and-body unity: physical, social, mental, and spiritual aspects of being. In their turn, the suggested theoretical concepts can be translated in such practices (sub-concepts) as transpersonal nurse-patient relationships/communication, promotion of self-care, medical interventions and complementary treatment methods, and community social/family support, which will be consequently measured through empirical indicators. The empirical component of the CTE structure “encompasses the research instruments or practice tools that are selected to measure the middle-range theory concepts” (Fawcett, 2013, p. 189). Empirical indicators for the selected theory concepts are listed in the table below.
|Middle-range theory sub-concepts||Transpersonal nurse-patient relationships||Promotion of self-care and lifestyle changes/ patient empowerment||Medical interventions and complementary treatment methods, modifications of the physical environment||Social/family support|
|Empirical indicators||Patient questionnaires comprised of both open-ended and Likert-scale questions||Objective patient data||Demographic data survey|
Evaluation of the Selected Theory
The identified theoretical elements −holism and patient-centered care − are directly related to the selected conceptual framework of holistic nursing as it is conceived by Florence Nightingale. They focus on patient-nurse and patient-environment interactions. The proposed theory suggests that the environment and health are closely linked. Therefore, it is difficult to characterize their effects individually, and, for this reason, practitioners should address the physical, social, mental, and spiritual aspects of being through caring behaviors. Additionally, as stated by Potter, Condon, Montgomery, Muhammad, and McGee (2012), “the patient’s perception of nurse caring behaviors is critical to the nurse-patient relationship” (p. 5). It is implied that to be effective, caring behaviors must be performed considering subjective patient experiences and beliefs in every patient-nurse interaction.
Evaluation of the Empirical Indicators
According to Fawcett (2013), when selecting practice and research tools, it is essential to determine their validity and appropriateness, which refers to “what middle-range theory concept the research instrument or practice tool measures” (p. 189). To facilitate the process of translation of theory into practice and the measurement of outcomes, the identified empirical indicators aim to capture the formulated sub-concepts. Since the quality of nurse-patient relationships is largely defined by personal perceptions and engagement in self-care − by individual motivations, the questionnaires should be developed to evaluate this type of quantitative and introspective data from patients to modify nurses’ behaviors according to specific patient needs.
Secondly, the effects of medical interventions and complementary therapies are mainly manifested in physiological improvements, etc. Therefore, the collection of objective data through patient examination, lab tests, and so on, can be considered appropriate in this regard. Additionally, qualitative questionnaires and interviews can be applied to measure the given sub-concepts as well to understand patient perceptions of treatment, e.g., efficacy, psychological effects, etc. Lastly, family and social support can be evaluated via a demographic data survey to understand the extent of current social support that a patient may access. It can be recommended to measure the given conceptual area at the initial stage of patient interaction to develop an appropriate plan to address support identified deficiencies if needed.
Evaluation of Research Findings
The concepts of holism and patient-centeredness can be applied to multiple clinical contexts and a plethora of health and practical issues. For instance, as Povlsen and Borup (2011) state, in the sphere of health promotion, they can be translated in holistic tailor-made care programs, involving “close nurse-patient collaboration established to identify the patient’s needs,” patient empowerment, interdisciplinary interventions, etc. (p. 799). Along with this, Kress et al. (2015) note that patient empowerment and encouragement of self-care can largely contribute to the improvement of such outcomes as pain and distress in the management of chronic pain. Moreover, Kress et al. (2015) observe that healthcare practitioners usually pay greater attention to treating the underlying symptoms of chronic pain, neglecting any psychological coping strategies, and effective communication, while the integration of a more holistic approach can significantly help improve the overall quality of patients’ lives.
The discussed research findings are consistent with the observations by Zamanzadeh et al. (2015), who states that “most nurses have been educated with a biomedical allopathic focus and do not have a good understanding of the meaning of holistic care” (p. 215). It means that the majority of healthcare practitioners neglect this conceptual model, preferring to consider patients’ physiological needs only. At the same time, the practice according to the concepts of holism and patient-centeredness helps avoid multiple risks including prolonged hospitalization, and allows reducing an unnecessary financial burden on both patients and hospitals.
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Conclusion: Utility and Soundness of the Practice Theory
It is possible to say that the identified middle-range theoretical concepts and sub-concepts help address the problem of the misunderstanding of holistic care principles among nurses as it provides clear, practical indications. The given theory is also consistent with modern approaches to health promotion and community nursing because it emphasizes the importance of patient empowerment and community and family involvement in the process of care and health improvement. Based on this, one of the major implications of the suggested theory is that people can influence their health through interactions with others and the world around them, as well as through active participation in the creation and modification of the environmental factors. It is implied that the human-environment relationship is a mutual process, and a nurse can play an essential role in it through meaningful communication, which helps motivate patients towards change, and education, which allows patients to become aware of available opportunities for change.
Fawcett, J. (2013). Thoughts about conceptual models and measurement validity. Nursing Science Quarterly, 26(2), 189-191.
Kress, H., Aldington, D., Alon, E., Coaccioli, S., Collett, B., Coluzzi, F.,… Sichère, P. (2015). A holistic approach to chronic pain management that involves all stakeholders: Change is needed. Current Medical Research and Opinion, 31(9), 1743-1754.
Potter, D. R., Condon, E. H., Montgomery, A. J., Muhammad, T. S., & McGee, Z. T. (2012). Selected African American first-time teenage mothers perceptions of nurse caring behaviors during the postpartum period. International Journal of Advanced Nursing Studies,1(1), 1-21.
Povlsen, L., & Borup, I. K. (2011). Holism in nursing and health promotion: Distinct or related perspectives? – A literature review. Scandinavian Journal of Caring Sciences, 25(4), 798-805.
Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective factors in providing holistic care: A qualitative study. Indian Journal of Palliative Care, 21(2), 214–224.