Holistic Health and Spirituality

In this article we will explore the fairly new Whole Person Caring Model (WPCM) and review relevant published literature. Originally searching The Cumulative Index of Nursing and Allied Health Literature (CINAHL), out of 673 articles that came up while searching in terms wholistic health, holistic, nursing models, three articles were directly relevant to the framework of Whole Person Caring Model.  Medline, ProQuest and Google Scholar were also explored for direct framework articles, yielding no results. After contacting the author Thornton by email, she sent a few more relevant articles and directed me to her Web site, providing additional information on the WPCM she wrote.  Thornton speaks to the model’s efficacy in helping hospitals decrease costs and improve patient satisfaction and included additional articles that speaks about two of the key concepts the model provides and how they were implemented (Personal Communication, Lucia Thornton, May 1, 2011). The Whole Person Caring Model (WPCM) incorporates physical, mental, emotional and spiritual aspects of patients and nurses life to improve one’s health (Thornton, 2010).

Review and Synthesis of Literature Related to Whole Person Care Model

The Whole Person Caring Model is born from experience and derived from nursing, physics and system analysis theories. It provides a framework for organizations to create a healing and nurturing environment for consumers (patients) and healthcare personnel (nurses). WPCM is easy to understand and interdisciplinary, having a practical application, that embraces our infinite and spiritual nature (Thornton, 2005). WPCM is considered a behavioral model for creating healing and transformational relationships (Donadio, 2005). WPCM is also an award -winning model that provides a common framework so various disciplines and cultural backgrounds are effectively able to work together to provide quality and compassionate care services. Thornton (2010) states the WPCM defines who we are from a more expansive and holistic perspective.  The model transcends the current paradigm and acknowledges the energetic and spiritual nature of our existence.  This viewpoint helps us perceive the inherent unity of life by moving beyond our cultural, religious, social and economic differences. The WPCM is based on nursing theorists Jean Watson, Martha Rogers and Florence Nightengale. Thornton, Gold and Watkins (2002) define person as “an energy field that is infinite and spiritual in essence and in continual mutual process with the environment. Each person manifests unique physical, mental, emotional and social-relational patterns that are interrelated, inseparable, and continually evolving.” Environment is defined as “An energy field beyond and inclusive of the person. Because person and environment are in a state of constant mutual process, there is no distinction from an energetic perspective” (Thornton et al., 2002). Health is defined as “The subjective experience of well-being” (Thornton, 2005). Thornton (2005) defines Whole Person Caring Model as “the delivery of care and services to promote well-being. Whole-person caring is based on the concepts of sacredness of being; therapeutic partnering: self-care and self-healing; optimal whole-person nourishment; transformational health care leadership; and caring as sacred practice” (Thornton, 2005). Spiritual is defined as:

The spiritual dimension is a unifying field that integrates the physical, mental, emotional, and social/relational aspects of being. The spiritual dimension is the essence of self and also transcends the self. It is our closest, most direct experience of the universal life force. (Thornton et al., 2002)

Tjale and Bruce (2007) conducted a qualitative, interpretive, explorative and contextual research design study to gain understanding and meaning of holistic nursing. A series of searches of the EBSCO Host, CINAHL, OVID, MEDLINE, Pubmed, PsycINFO, Medline and Sociological databases were completed to conduct an analysis of the concept and meaning of holistic nursing care.  The following search criteria and search terms were used: “holistic nursing care and definition, holistic care and

holism, holistic nursing care and health, holistic nursing care and child, holistic nursing care and paediatrics, holistic nursing care and pediatrics, holistic care and complimentary medicine”(pg 45). Seventy-seven articles on holistic nursing care were analyzed and labeled according to criteria.  Rodgers' evolutionary method was utilized to conduct the concept analysis and the objectives of this study were set in two phases:

1. Phase one was conducted to analyze the concept of holistic nursing care and obtain viewpoints of holistic nursing care from paediatric nurses working in academic hospitals.

2. Phase two the identified the characteristics and dimensions and characteristics of holistic nursing care to develop a framework of holistic nursing care for paediatric nurses working in academic hospitals and to validate and refine the framework for paediatric nursing. 

Varying qualitative and quantitative studies indicate the most prominent findings were the similarity of definitions and descriptors of holistic nursing care observed from many disciplines. Attributes of holistic nursing care yielded two dimensions: whole person and mind-body-spirit dimension. The indicated descriptors of whole-person include physical, mental, emotional and spirit. Spirituality is the predominant antecedent. Holistic nursing care is described to be the recognition of an individual as a spiritual being with a mind-body-spirit dimension. Spirituality is a present force pervading all human experience and existence. Complimentary alternative medicine (CAM) was identified as a surrogate term. The connection of CAM with holistic nursing care is the focus of therapeutic interventions that are directed to the mind-body-spirit dimension and are designed to meet the needs of the whole-person (Tjale & Bruce, 2007). Clark (2008) informs us that we are now the only country in the world that does not prepare and require a nurse, to quote the International Council of Nurses’ policy, “the capacity and authority to practice competently primary, secondary, and tertiary care in all settings and fields of nursing.” Clark (2008) notes that nursing education tends to favour a hospital-based, task-oriented training curriculum leaving specialty and community based education out. Clark (2008), states that many nurses who claim to offer holistic care, really don’t have a full understanding of holistic care and makes an observation that nurses are unable to meet the mental health needs of adult patients, people with mental illness are nursed by nurses who are unable to meet their physical health needs, and children are taken care of by nurses who know little about child development. 

Finfgeld-Connett (2008) conducted a meta-syntheses qualitative study from articles developed between 1993 and 2007 for the convergence of three nursing concepts: art of nursing, presence and caring. Results led to development of a theoretical framework of nursing practice to illustrate the areas of convergence among the concepts: art of nursing, presence and caring. Nursing involves an intimate relationship-centered partnership between the patient and nurse. A value system of holistic beneficence and patient empowerment are based on specific nursing actions are derived from multiple forms of personal and professional knowledge. Nursing actions are promoted by a conducive work environment and result in enhanced well-being among patients and nurses. Continued research and work is recommended to expand the proposed framework, especially due to the wide variety of nurse–patient relationships that exist. The art of nursing, presence and caring take place within an atmosphere of interpersonal sensitivity and intimacy, which is characterized by open and honest interactions.

Personal insights are disclosed in verbal and non-verbal ways, and the nurse unobtrusively grasps the patient’s needs and responds in a kind and compassionate way. Empathy is expressed through words and actions, and a supportive nurse–patient partnership is cultivated.  Additionally, the art of nursing, presence and caring take place within an atmosphere of interpersonal sensitivity and intimacy, characterized by open and honest interactions. Nurses then unobtrusively grasp the patient’s needs and respond in a kind and compassionate way, while a supportive nurse–patient partnership is cultivated (Finfgeld-Connett, 2008). 

Gold (2003) emphasizes that caring simply comes from our hearts and nurses need to speak and listen from their hearts. The Whole Person Care Model considers caring for people as sacred work. There are many differences between the biomedical model and the Whole Person Care Model. As the biomedical model has an organized structure depicted as a pyramid with the most valuable people on the top, the WPCM requires therapeutic partnering which all parties are respectful and non-hierarchical. To aid in nurse and patient satisfaction the interdisciplinary model encourages mentoring programs and does not tolerate negativity as this is a reflection of the care the patient receives. The model encourages an atmosphere of cooperation, unity, cohesiveness, continuity of care, productivity and creative synergy in the workplace to provide patients with optimal care and nurses with job satisfaction. It encourages that self-care is an absolute crucial element in employee satisfaction and subsequently organizational health and wellbeing (Gold, 2003). 

Review of Literature related to Holistic Nursing and Nurse/Patient Satisfaction 

The WPCM pilot study, funded by Union Hospital enrolled 50 patients from the Cardiac Rehabilitation Department at Union Hospital in Lynn, Massachusetts, which is part of the North Shore Medical Center and a member of the Partners HealthCare System, founded by Massachusetts General Hospital and Brigham and Women's Hospital, both teaching hospitals of Harvard Medical School. Study population included a heart transplant recipient, patients with varying levels of heart disease, patients with multiple pathologies and patients who were obese, alcoholic and addictive. The patients were initially evaluated using SE-36, a quality of life validated survey instrument widely used to measure quality of life, as well as the Clinical Data Collection Inventory (CDCI), a non-validated internal instrument. Patients were contacted by letter, those agreeing to participate completed SF-36 and CDCI questionnaires and met with a whole health educator for a series of 6 one-on-one sessions. Six months later they completed the SE-36 and CDCI again to reevaluate treatment. Pilot studies were compared to historical data. The historical data included cardiac rehab patients without receiving WPCM. These patients completed baseline and follow-up (6 months) SF-36 and CDCI questionnaires as well. 

Six certified whole health educators and six New England School of Whole Health Education (NESWHE) interns participated. The principal investigator for the pilot study is a cardiologist and Medical Director of the Department of Cardiac Rehabilitation at Union Hospital.  The investigational review board at Union Hospital approved the study. The focus and intention is to bring the nurse and physician toward in-the-moment, compassionate, relationship-centered care regardless of the amount of time spent with the patient and becomes the foundation for all future interactions.  This study is not considered a controlled study and was not powered to reach statistical significance. According to Pelzang (2010) healthcare is rapidly changing to provide Patient Center Care (PCC), which is treating our patients as unique individuals. This standard of practice demonstrates respect for the patient, as a person and taking into consideration the patient’s circumstances and point of view in the decision-making process regarding their healthcare. PCC needs a clear definition and methods of measurement, as implementation has been hampered due to lack of understanding the core elements of PCC by nurses and healthcare providers. The underlying philosophy of PCC is to understand the patient as a person rather than as a cluster of diseases.  PCC is considered to come from a systems model and a process model. The basic aspect of PCC is to respect, care and consider the patient as a whole. Pelzang (2010) found during his literature review that PCC indicates improved continuity of care and integration of nurses and health professionals collaborating on behalf of their patients, increasingly providing autonomy to patients, empowering staff members to plan and execute their work in ways that are most responsive to the patient needs, wants and preferences. Providing patients with abundant opportunities to be informed and involved in care decision-making. Furthermore, PCC is considered to deliver more holistic care; facilitates a team approach, shifts emphasis to total body care; enhances communication skills between relatives, patients and healthcare providers, as well as between family members. The outcome of PCC for the patient includes: satisfaction with care, involvement with care, improved health, feeling of well-being and creating a therapeutic culture.

Miller et al. (2008) conducted a Qualitative study and collected data in 2006 using non-participant observation, shadowing and semi-structured interviews with nursing, medical and allied professionals in the internal medicine wards of three urban hospitals in Canada. The findings of the study indicate nurses’ collaborations with other professionals are influenced by emotional work considerations. The establishment and maintenance of a nursing esprit decorps corridor conflicts with physicians, and the failure of the interdisciplinary team to acknowledge the importance of nursing’s core caring values are important factors underpinning nurses’ interprofessional disengagement. The conclusion is that longstanding emotion work issues must be addressed before nurses will engage collaboratively. We suggest improving nursing collaboration through the refining of holistic nursing information, and reflections on practice by all interprofessional team members.

Agrimson and Taft (2009) states the term spiritual crisis has been used ambiguously in the literature, resulting in lack of clarity. A holistic approach includes spirituality in nursing care of the whole person. Articles with search terms spiritual crisis, spiritual emergency, spirituality and life crisis between 1998 and 2007 were retrieved for analysis. Using Walker and Avant’s method of concept analysis, a definition of spiritual crisis was identified. Spiritual crisis is often described as a unique form of grieving or loss, with a profound questioning of lack of meaning in life, in which person or community reaches a turning point, that leads to a significant change in the way life is viewed. Possible reasons for this include loss of important relationships and sudden acute illness. The results of the study indicate people that are experiencing terminal illness, depression, or grieving may be at special risk for a spiritual crisis. The literature suggests that an interdisciplinary approach, nurses’ self-exploration of their own spirituality, and the ability to refrain from defining spirituality by religious affiliation will help improve nursing practice and patient centered care.

Summary

Whole Person Caring Model, holistic nursing and spirituality are intertwined. Articles articulating that mind, body and spirit makes up the patient as a whole and all aspects need to be treated for holistic health care practices.

Conclusions

• Further research using the WPCM is indicated

• WPCM comes from nursing theorist Florence Nightengale, Martha Rogers and Jean Watson

• WPCM indicates each person is a unique individual with physical, mental, emotional and social-relational aspects  

• Interdisciplinary approach to nursing care is indicated having nurses first exploring their own spirituality

• The term spiritual crisis is a unique form of grieving or loss questioning of the meaning in life that leads to a significant change in the way life is viewed

• Most nurses do not have a clear understanding of holistic care 

• Incorporating a patients’ spirituality is lacking in most nursing practices

• Holistic health is considered somewhat synonymous with spirituality 

• The studies show a correlation between holistic care and service indicating a positive professional and scholarly perspective 

References

Agrimson, L.B., & Taft, L.B. (2009). Spiritual crisis: A concept analysis.  Journal of Advanced Nursing, 65(2), 454-61.

Clark, J. (2008). Protectionist nurses stand in the way of truly holistic patient care. Nursing Standard, 22(29), 26. 

Donadio, G. (2005). Improving healthcare delivery with the transformational whole person care model. Holistic Nursing Practice, 19(2), 74-77.

Finfgeld-Connett, D. (2008). Qualitative convergence of three nursing concepts: Art of nursing, presence and caring. Journal of Advanced Nursing, 63(5), 527–534.

Gold, J. (2003). Therapuetic partnering and caring as a sacred practice. Bridges ISSSEEM Magazine, 14(2), 8-17.

Miller, K., Reeves, S., Zwarenstein, M., Beales, J.D., Kenaszchuk, C., & Conn, L.G.  (2008). Nursing emotion work and interprofessional collaboration in general internal medicine wards: a qualitative study. Journal of Advanced Nursing, 64(4), 332-343.

Pelzang, R. (2010). Time to learn: understanding patient-centered care.  British Journal of Nursing, 19(14), 912-917.

Thornton, L. (2005). The model of the whole person caring, creating and sustaining a healing environment. Holistic Nursing Practice, 19(3), 106-115.

Thornton, L. (2010). Creating Healing Environments for individual, communities and organizations. Retrieved from http://www.luciathornton.com

Thornton, L., Gold, J., & Watkins, M. (2002). The art and science of whole-person caring: an interdisciplinary model for health care practice. International Journal for Human Caring, 6 (2). 38-47.

Tjale, A.A., Bruce, J. (2007). A concept analysis of holistic nursing care in paediatric nursing. Curationis, 30(4): 45-52.