The Concept of Holism in Nursing Essay
The Concept of Holism in Nursing Essay
Holistic assessments in nursing provide a unique quality of care to the individual patient. Holism in the provision of care includes assessments obtaining data about the physiological, psychological, sociological, spiritual, developmental, cultural and environmental aspects. It is imperative that the nurse conducting these assessments adopts methods in the nursing process that reflects the standards outlined in Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse to ensure the health and wellbeing of the patient is maximized and maintained throughout the time health care is received. Nursing processes are directed at restoring overall harmony for the patient therefore an understanding of the…show more content…
Assessment in the nursing process will establish the patients’ ongoing needs and provide a quality of care best suited to the individual, to achieve a desirable health outcome. Cultural aspects of holistic assessment is relevant in the provision of nursing care as it provides the care team with an overview of cultural needs of the patient as well as providing information in which the patients’ health problems have arisen. Culture is defined as values, beliefs, artifacts, behaviors, attitudes and customs influencing and regulating interactions between members of a social group (Stein-Parbury 2010: 91; Johnstone 2006: 67). It is the nurses responsibility to adhere to the ANMC, competency 2.3, ‘accepts individuals/groups to whom care is provided regardless of race, culture, religion, age, gender, sexual preference, physical or mental state’ (ANMC 2006, p. 4).The Concept of Holism in Nursing Essay
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Simulation as a technology and holistic nursing care as a philosophy are two components within nursing programs that have merged during the process of knowledge and skill acquisition in the care of the patients as whole beings. Simulation provides opportunities to apply knowledge and skill through the use of simulators, standardized patients, and virtual settings. Concerns with simulation have been raised regarding the integration of the nursing process and recognizing the totality of the human being. Though simulation is useful as a technology, the nursing profession places importance on patient care, drawing on knowledge, theories, and expertise to administer patient care. There is a need to promptly and comprehensively define the concept of holistic nursing simulation to provide consistency and a basis for quality application within nursing curricula. This concept analysis uses Walker and Avant’s approach to define holistic nursing simulation by defining antecedents, consequences, and empirical referents. The concept of holism and the practice of holistic nursing incorporated into simulation require an analysis of the concept of holistic nursing simulation by developing a language and model to provide direction for educators in design and development of holistic nursing simulation.The Concept of Holism in Nursing Essay
Keywords holistic nursing, holistic care, simulation, nursing simulation, nursing education, teaching methods, nurses (basic)
Rapid changes are occurring in health care and in clinical nursing education making it necessary to use innovative methods to prepare nurses for practice (Benner, Sutphen, Leonard, & Day, 2010; Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). It is estimated that in the United States alone, more than 500,000 new nurses will be needed to meet the demands of the population by 2020 (U.S. Department of Labor, Bureau of Labor Statistics, 2012). One approach to address this growing health care need is to educate nurses to meet and maintain competencies in increasingly complex situations. A holistic nursing approach to simulation-based learning (SBL) may facilitate improvement in the quality and safety of patient-centered care.The Concept of Holism in Nursing Essay
Simulation started as a novel supplement to traditional clinical experiences integrated into curricula in the 1960s (Aebersold & Tschannen, 2013). It has recently been cited by the National Council of State Boards of Nursing (NCSBN) as an effective replacement for up to half of the recommended clinical hours in prelicensure nursing education if quality simulation is used (Hayden et al., 2014). With the impactful conclusions of the NCSBN’s landmark simulation study, there is reason to believe many nursing programs will increase their use of simulation. With this anticipated change in practical learning, there needs to be clear definitions and understanding of simulation. While nursing simulation has been extensively defined in the literature (Bland, Topping, & Wood, 2011), holistic nursing simulation has not. There is a pressing need to promptly and comprehensively define the concept of holistic nursing simulation so that there is consistency and quality in application to nursing curricula if simulation is going to replace any portion of clinical hours. The aim of this concept analysis is to define holistic nursing simulation by developing a language and a visual model (Figure 1) to provide direction for nurse educators in design and development of holistic nursing simulation using Walker and Avant’s (2011) eight-step process:The Concept of Holism in Nursing Essay
Select a concept.
Determine the aims of the analysis.
Identify all uses of the concept.
Determine defining attributes.
Identify antecedents and consequences.
Construct a model case to illustrate what the concept is.
Construct borderline, related, illegitimate, and contrary cases to illustrate what the concept is not.
Define empirical referents.
figure
Figure 1. Visual Depiction of Holistic Nursing Simulation
Literature Review Method
The nursing literature pertaining to holistic nursing simulation is scarce. The concepts of holistic nursing and simulation are frequently paired together but they appear to rarely be operationalized and no studies were identified that analyzed or defined holistic nursing simulation.The Concept of Holism in Nursing Essay
A comprehensive analysis of the databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Source: Nursing, Medline, The Educational Resources Information Center (ERIC), and Google Scholar was conducted with the ultimate goal of defining holistic nursing simulation. Electronic databases were search for peer reviewed, English language articles from 2005 to 2015 using keywords and keyword combinations including holistic care, holistic nursing, and simulation, nursing simulation, nursing education, and teaching methods. Reference lists of some of the articles provided the opportunity to identify other relevant articles that met the inclusion and exclusion criteria. The decision to use articles within the past 10 years was primarily due to a rapidly growing body of work on simulation. Studies were sought that focused on “holistic nursing simulation” which when search as a term resulted in zero citations. Additionally, online and university dictionaries and textbooks through the academic university library provided keyword and keyword combination definitions.The Concept of Holism in Nursing Essay
The initial search using the keywords and combinations retrieved 822 articles from the databases. These citations included articles, books, and training manuals about simulation in aviation, computer science, marine ecosystems, and nursing. When the search was narrowed to “holistic nursing” AND “simulation” or gave a reasonable account of holism in relation to simulation, 109 articles were acquired. The search was further narrowed by combining terms “holistic nursing” AND “nursing simulation” AND “teaching methods or educational strategies” resulting in 102 articles, which then required further delineation. Abstracts of these articles were reviewed for this concept analysis. Fifty-eight abstracts from these articles were not specific to holistic nursing simulation and were excluded. For this concept analysis, 38 articles, 10 books, or book chapters are included along with one sentinel publication (Kolb, 1984).
Description of Uses of Concept
Holistic nursing has been used to define patient-centered care in which the nursing focus is on the patient as a unified whole being (Cordeau, 2010). Simulation has been used in a number of disciplines including aviation, health care, and in the military to train and educate personnel (Barry Issenberg, Mcgaghie, Petrusa, Lee Gordon, & Scalese, 2005; Jeffries, 2005; Reddy, 2006).The Concept of Holism in Nursing Essay
Simulation in nursing is a strategy to mirror a real situation with guided interactive experiences (Li, 2007). This concept analysis identifies the attributes, antecedents, and consequences and develops a definition of the concept of holistic nursing in SBL.
Significance of the Concept
Simulation as a technology and holistic nursing care as a philosophy are two components within nursing programs that have collided during the process of knowledge and skill acquisition to achieve the care envisioned by the American Holistic Nurses Association (Dossey & Guzzetta, 1995,) of the patient as a whole person. Simulation provides various opportunities for students to apply knowledge and skill through the use of simple reproductions of specific body sections to the high-fidelity simulators, standardized patients (SPs), and virtual clinics and offices (Moule, Wilford, Sales, & Lockyer, 2008). High-fidelity simulators, virtual clinics and offices, and SPs will be expanded on later in the article. The purpose of simulation is to provide the participant with the ability to engage in learning, problem-solving, critical-thinking, and decision-making in a safe and controlled environment (Jeffries, 2005; Rodgers, Adamson, & Jeffries, 2015; Wilford & Doyle, 2006).The Concept of Holism in Nursing Essay
The National League for Nursing/Jeffries Simulation theory, previously the Jeffries Simulation framework provides guidance for simulation structure, delivery, and outcome strategy. The five components of the National League for Nursing/Jeffries Simulation Theory combine to improve participant and organizational outcomes (Adamson, 2015, Jeffries, 2005, 2007; Jeffries & Rogers, 2012). Simulation provides opportunities within these safe environments that mimic real-life unexpected events. Concerns with simulation have been raised regarding the integration of the nursing process, specifically recognizing the totality of the human being, the interconnectedness of the environment with mind, body, spirit, emotions, social, and cultural relationships (Dossey & Guzzetta, 1995). Furthermore, the widespread move to integrate technology without the pedagogy of the nursing philosophy (Day-Black & Watties-Daniels, 2006; Parker & Myrick, 2009) is of concern.The Concept of Holism in Nursing Essay
Though simulation is very seductive as a technology, the nursing profession places a great deal of importance on care of the patient, drawing on knowledge, theories, and expertise to administer patient care. The concept of holism, and the practice of holistic nursing incorporated into the technology of simulation require that an analysis of the concept of holistic nursing simulation be framed for delivery within the curriculum. An analysis of the literature to determine the understanding and usefulness of this concept is imperative.
Defining Attributes
Defining attributes are the qualities most frequently associated with a concept (Walker & Avant, 2011). These are the characteristics of a concept that repeatedly appear in the literature. There are two primary defining attributes for holistic nursing simulation: simulation and holistic nursing. The defining characteristics within each of these two main attributes become more abstract when defining holistic nursing simulation.The Concept of Holism in Nursing Essay
The first attribute deemed necessary to clarify is holistic or holism, which is identified by this concept analysis as whole, harmony, and “mind, body and spirit” (Cumbie, 2001, p. 57). More recently, the literature also includes healing as a defining attribute of holistic or holism (Ernst, 2004; Jackson, 2004).
While most of the definitions of holism share the same attributes, nursing has applied it to the person. Nursing is certainly holistic, as the nursing profession has consistently viewed the individual as a whole being; concerned with mind, body, and spirit (Dossey & Keegan, 2009). Nursing promotes physical and psychological well-being with social–cultural awareness.The Concept of Holism in Nursing Essay
Leading experts agree that humans need to be treated as a whole being. M. E. Rogers (1970), in her discussion of the “nature of the human beings” influenced the use of the word holistic in the profession of nursing. M. E. Rogers (1970) believed that the world was an interconnection of elements making a whole. The nurse’s role was further depicted by Levine (1973) as a profession that viewed each patient as a unique human being, which has been in sharp contrast to medicine, which historically viewed patients as fixed systems. The AHNA (1992) defined holistic as “. . . the state of harmony between mind, body, emotions and spirit in an ever changing environment.” This is consistent with the modern view of “holistic nursing” where the physical, psychosocial, cultural, and spiritual paths converge into one. Also noted as part of holism is healing which is defined by the AHNA Scope and Standards of Practice as “physical, mental, social and spiritual processes of recovery, repair, renewal and transformation that increases wholeness and often (though not invariably) order and coherence” (Mariano, 2013, p. 54).The Concept of Holism in Nursing Essay
The second attribute is SBL which has specific attributes that encompass areas as diverse as the modeling of natural or human physiologic systems, technologic reproductions of equipment and environments, or entire virtual worlds of computer-generated environments in which individuals can interact (Fanning & Gaba, 2008). The origin of simulation began as an experiential and situational learning theory (Fanning & Gaba, 2007; Kolb, 1984). This theory encompassed learning by doing, thinking, and assimilating learned behaviors, and it encompasses concepts of mastery and deliberate practice (Fanning & Gaba, 2008). The approach has now become an established pedagogy for teaching and learning clinical nursing knowledge and skills providing the learner with a safe, reality-based environment (Linder & Pulsipher, 2008). In 2005, Jeffries classified simulation as an active learning strategy, contributing to greater self-motivation, and understanding of cognitive and psychomotor skills by students.The Concept of Holism in Nursing Essay
Simulation provides the learner with the ability to role-play scenarios and examine or evaluate solutions within a controlled safe environment (Bland et al., 2011; Henneman et al., 2010; Jeffries, 2005; L. Rogers, 2011; Sando et al., 2013). Simulation is a technique that portrays or immerses the student into a guided learning experience (Aebersold & Tschannen, 2013). Simulation has various forms, including low-fidelity manikins for scenarios or high-fidelity computerized manikins (HFCM) that require faculty or staff to control the advanced technological capabilities that can illicit actual verbal and physiological responses. There are actors who are prepared and trained as SPs to portray the role of a patient or family member, and virtual hospitals and clinics that use avatars as patients. To date, there are few published simulation scenarios that are holistically focused (Cordeau, 2010). The published studies in nursing simulation have primarily focused on the care of the patient with specific physiologic or psychiatric problems (Cambell & Daley, 2009; Gasper & Dillion, 2012). They are segmented in delivery of knowledge and skill, focused on an individual system or concept (Dossey & Keegan, 2009).The Concept of Holism in Nursing Essay
Antecedents and Consequences
Antecedents
Antecedents are events or incidents that must happen prior to the occurrence of the concept (Walker & Avant, 2011). Identification of the antecedents and consequences of holistic nursing simulation also allows determination of the social context in which the concept is used. The antecedents below can be seen in the visual model (Figure 1). Currently, there are few pieces of literature to support most of the antecedents in their entirety, but there is evidence to support the rationale behind aspects of the antecedents.
A Need to Provide Additional or Complementary Experiences
The need to provide a holistic learning experience during a simulated scenario as the necessary nursing clinical experience is not readily available (Hayden et al., 2014). A search of multiple databases did not provide evidence of holistic nursing simulation scenarios. However, there are research studies that identify the need for inclusion of holistic principles or have embedded a few holistic concepts (Fabro, Schaffer, & Scharton, 2014; Gibson, Dickson, Lawson, Kelly, & McMillan, 2015).The Concept of Holism in Nursing Essay
Students’ Abilities to Synthesize Holistic Nursing Care Needs Further Development
The ability of students to weave components of care such as health promotion, healing techniques, complementary and alternative therapies, cultural diversity, and spiritual care together is not yet fully developed (Cordeau, 2010).
Depth and Accuracy of Scenarios That Meet Defined Standards
The depth of the simulated scenario must meet standards in order for students to learn to deliver care in an integrated holistic environment. The International Nursing Association for Clinical Simulation and Learning has established simulation standards for participants (Sittner et al., 2015). Realistic simulations will provide the most authentic learning for students and yield results consistent with the students’ ability to empathetically care for an SP as if they would for an actual patient (Berg, Majdan, Berg, Veloski, & Hojat, 2011).The Concept of Holism in Nursing Essay
Students’ Foundational Knowledge
Students must bring foundational knowledge to apply to holistic care during simulations. Foundational knowledge and awareness of self, others, and the environment provide the nursing student with an understanding of the “caring and healing” relationship required in holistic nursing simulation (Cumbie, 2001). This foundational knowledge will vary based on the level of nursing student; but at a minimum, it includes a basic understanding of holistic care, medical terminology, and physiological processes.
Measureable Holistic Objectives With Validated Evaluation Tools
Measurable, achievable, and holistic objectives must be created and communicated with all participants (Lioce et al., 2013), and evaluation tools must be validated (Boese et al., 2013).The Concept of Holism in Nursing Essay
Adequate Training for Simulated Patients and Technology to Create Believable Scenarios
SP and HFCM facilitators should have preparation, training, and technology to competently portray holistic principles of their character. Simulation facilitators are required to be proficient in the “complexity of simulation” (Boese et al., 2013, p. S23; Li, 2007; Sittner et al., 2015).
Debriefing Facilitation Preparation
Debriefing facilitators must be adequately trained in holistic principles for a quality debriefing session. Debriefing requires exploration of actions utilized or not, gaps in knowledge and skills of the participant, as well as reflection of the simulated experience (Decker et al., 2013; Sittner et al., 2015).The Concept of Holism in Nursing Essay
Consequences
Consequences are events that occur as a result of the occurrence of the concept (Walker & Avant, 2011). The consequences of holistic nursing simulation are congruent with the consequences of quality nursing education, which is appropriate considering Hayden et al.’s (2014) landmark research supporting replacing traditional clinical hours with simulation. The crucial objective is to produce safe, holistic, competent nurses capable of critical thinking and clinical decision making. The consequences can be seen in the holistic nursing simulation model The Concept of Holism in Nursing Essay
Acquisition and Synthesis of Knowledge to Care for a Whole Being
The simulated experience allows the student to acquire and synthesize knowledge in a planned and coordinated pattern, encompassing the person as a whole being. Achieving desired patient outcomes through SBL includes “viewing the patient holistically” (Lioce et al., 2013, p. S16).
Knowledge, Skills, Attitudes, and Personal Growth
The holistic nursing simulation facilitates knowledge, skills, attitude, and personal growth of the student.
Critical Thinking and Clinical Decision Making
Holistic nursing simulation is the basis for learning how to integrate a way of thinking, practicing, and reflecting on patient care (Dossey & Keegan, 2009). Should the delivery of holistic simulation not occur, the lack of transference of these principles may be a predictor of poor patient outcomes (Fore & Sculli, 2013).The Concept of Holism in Nursing Essay
Increased Competence and Confidence
Increased competence and confidence in future clinical, didactic, and professional nursing practice that includes prioritizing and conducting holistic care (Decker et al., 2013).
Improved Patient Outcomes
Because of holistic nursing simulation experiences, future patients will likely receive holistic care in routine and emergent situations. This will ultimately work to improve patient outcomes for future patients’ minds, bodies, and spirits.
Example Cases of Holistic Nursing Simulation
Cases are created as exemplars to illustrate what the concept is and what it is not (Walker & Avant, 2011). Walker and Avant (2011) promote development of a model case, which includes the defining attributes of holistic nursing and simulation as well as exemplars that are differing degrees of the concept: related, borderline, illegitimate, and contrary (Walker & Avant, 2011). The cases for holistic nursing simulation are vital to differentiate the proper and improper uses of the term “holistic nursing simulation.” There is a tendency in nursing to label everything as holistic and many ideas as simulation, these cases will help clarify the appropriate use of the concept of holistic nursing simulation.The Concept of Holism in Nursing Essay
Model Case
A junior-level nursing student, Jill, participates in a summative holistic nursing simulation experience. A set of measurable objectives for the simulation was given to the class a month ahead of time to allow for preparation. The objectives for the holistic nursing simulation address physical, psychosocial, spiritual, and cognitive care. However, the details of the situation were not shared with students, to simulate real-life nursing experiences.The Concept of Holism in Nursing Essay
On arrival to the simulation, the night nurse, a faculty member from the simulation center, provides Jill with a sign-off report, before Jill enters an SP’s room. The SP is on a nitroglycerin drip for acute coronary syndrome and complains of a headache, nausea, increased financial stress because of this hospitalization, and is in tears because she has just learned that her partner was in a car accident on the way to visit her. Jill implements the nursing process with the SP by first doing a thorough assessment, then sets measurable goals, implements interventions aimed at the SP’s physical and emotional distress, and evaluates all aspects of the implemented plan.The Concept of Holism in Nursing Essay
Jill prioritizes the nursing case based on Maslow’s hierarchy of needs, knowledge of the pathophysiology and psychology of the SP’s condition, and her previous experiences. Based on her educational foundation, Jill first ensures that the patient is not exhibiting any signs of decreased cardiac perfusion or other complications of acute coronary syndrome. Next, Jill assesses and manages the SP’s headache and nausea using pharmacological and nonpharmacological interventions. Once the SP reports a tolerable level of pain and absence of nausea, Jill sits at the bedside to fully assess the emotional and spiritual distress reported and demonstrated by the SP. Throughout the experience, Jill integrates patient teaching based on her knowledge of the SP’s reported available resources and learning style preferences from her initial assessment. The SP expresses appreciation for the thoughtful education related to cardiovascular health, pain control, and additional resources available for the SP and her partner following the recent accident. Additionally, Jill consults the hospital chaplain and social worker to follow up with the patient.The Concept of Holism in Nursing Essay
Following the simulation, Jill joins the other students who cared for an SP with the exact same situation for debriefing led by fully trained simulation faculty members. Jill and her classmates express feeling they were required to synthesize what they have been learning in all of their courses over the past 3 years. They also verbalized implementation of the nursing process to address the SP as a whole person, and not just as a physical ailment or psychological concern. Jill and her classmates explain that there were a number of times during the simulation that they were not sure of what the best course of action would be and that they all handled these situations differently. Jill and her classmates describe the value they feel in being able to make clinical decisions independently in a setting that would not put the patient in any harm if they made the wrong choice. Finally, the students each are required to watch the video recording of their encounter and write a reflection with a holistic focus on their performance related to each of the objectives for the assignment.
The following week in clinical, Jill reports a change in her approach to holistic care for her patients. She attributes this to her learning experiences and reflection of the holistic nursing simulation event.The Concept of Holism in Nursing Essay
Analysis of Model Case
Jill’s story is a model case because it exemplifies all of the defining attributes of holistic nursing simulation. Additionally, a number of the antecedents and consequences are evident throughout the discussion of Jill’s holistic nursing simulation experience. Jill uses her previous nursing knowledge to prioritize and implement care of the physiological, psychological, and spiritual needs of the SP. Additionally, she continued her learning in the debriefing section of the event. Her future practice can potentially improve because of her experience with this holistic nursing simulation.
In this paper it is argued that nurses should be holists whilst at the same time accepting that ‘holism’ is a contentious concept. One of the problems for a supporter of holism is that of which holism — an attempt to outline the version of holism advocated is made by identifying only two versions of holism: The Strong theory and the Pragmatic theory of holism. By introducing this device it is hoped to avoid, if only by stipulation, some of the more sophisticated nuances of holism drawn by other commentators. However despite a most judicious use of Ockham’s Razor some detailed groundwork remains. In the first part of this paper a simple example is used which aims to articulate what are arguably some of the central issues within the holism debate. These issues are then placed within a wider philosophical context. The second part of the paper will offer definitions of Strong and Pragmatic holism. Drawing on specific examples from the nursing context it will be argued that the Pragmatic theory of holism is the theory of holism most compatible with nursing theory and practice. The methods employed in this paper are philosophical. Since the questions considered are conceptual rather than empirical requiring a discursive approach, utilising thought experiments and case implication to explore the issues. The Concept of Holism in Nursing Essay
