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Holistic nursing is defined as “all nursing practice that has healing the whole person as its goal” (American Holistic Nurses’ Association, 1998, Description of Holistic Nursing). When I read this definition, I automatically think of the word ‘nurse.’ Isn’t every nurse’s goal to practice for the promotion of healing? Once you build a rapport with your patient, you start discuss the methods this patient has tried, is using, or has thought of as potentially helpful. You’re invited to a special Nurses Week event dedicated to bringing back the art of nursing—that healing presence and patient-focused practice that Florence Nightingale first envisioned. I am going to ask a "dumb" question, but here it is anyway: is there a specific specialty for "holistic' nursing? A recent call for papers for a special issue of the Journal of Integral Theory and Practice is dedicated to Integral Medicine.
One interesting online article by David Tusek is available online: An Integral Path to Medicine.
A glimpse of the excellent book on Integral Medicine  by Elliott Dacher is available: Integral Health. An audio dialogue between Marylin Schlitz (president of the Institute of Noetic Sciences) and Ken Wilber, is enlightening: Emergence of Integral Medicine on Integral Life. Integral Nursing Integral Nursing is being pioneered by Barbara Dossey, one of the originators of Holistic Nursing.
Susanne Cook-Greuter is one of the leaders of Developmental Research and Integral Coaching.
Integral Life Practice Integral Life Practice developed from merging Wilber’s Integral Map with the work of Michael Murphy and George Leonard (1923-2010). Integral Transformative Practice was co-founded by George Leonard (one of the pioneers of the human potential movement), and Michael Murphy (founder of Esalen Institute).
More than just a pretty face: the holistic impact of botulinum toxin for patients with urinary urge incontinence. Holistic wellbeing is to have a degree of wellness in each aspect of your physical, social and emotional life. Sociocultural: encompassing the external relationships the patient has, including significant others, family, friends, community groups and religion, as well as continuity of care and activity planning.
Environmental: the surrounding environment that patient experiences, such as temperature, noise, odours, shelter, pollution, synthetic environments and access to nature. If we consider what cultural beliefs are held about botulinum toxin type A use, it may be seen that anti wrinkle injection deals with only the physical and emotional comfort of patients. The development of the use of botulinum toxin to manage urinary incontinence was a logical progression from other uses in treating muscular conditions such as blepharospasm, upper limb spasticity and cervical dystonia. Urinary continence is controlled by the detrusor motor area, the pontine micturation centre and the urethral sphincter.  Lesions at any level of the sensory or motor nervous system can cause an urge incontinence. Detrusor hyperreflexia is caused by lesions above C2, above the pontine micturation centre. Detrusor hyperreflexia with vescicosphincter dyssynergia occurs when lesions form between the pontine and sacral micturation centre.
Peripheral lesions and lesions including the sacral micturation centre result in detrusor areflexia.
Most commonly, botulinum toxin type A is injected into the urinary sphincter at the neck of the bladder via cystoscopy, under local anaesthesia (Brubaker, Richter, Visco, Mahajan, Nygaard, Braun, Barber, Menefee, Schaffer et al., 2008). Botulinum toxin type A detrusor injections have shown that a significant proportion of patients experience long-term results. Two preparations of botulinum toxin type A detrusor injections are available to patients with urinary incontinence.
Three domains in Comfort Theory care planning include relief, ease and transcending discomfort (Kolcaba, 2003). Patients who suffer from urge incontinence are likely to benefit from a management plan that includes botulinum toxin type A detrusor injections.
Evidence to support the use of botulinum toxin type A in the treatment of incontinence is growing for patients with urge type urinary incontinence.
Our Speech Pathologist, Dietitian and Skincare Nurse offer 15min free health screening consults. There are now two certifications available: Holistic Nursing and Advanced Holistic Nursing. National Center for Complementary and Alternative Medicine (NCCAM) groups complementary and alternative Medical (CAM) practices into four domains, recognizing there can be some overlap. Mind-body medicine uses a variety of techniques designed to enhance the mind’s capacity to affect bodily function and symptoms. The AHNA goes on to say that it is “a specialty practice that draws on nursing knowledge, theories, expertise and intuition to guide nurses in becoming therapeutic partners with people in their care.
As you’re taking a patient’s history and listening to their story, you automatically are coming up with further questions.
While you value and practice conventional medicine, never interfering with the plan, a conversation with the patient begins on modalities that may help enhance the treatment received.
While the provider may want to treat and cure the patient, you understand that healing happens in a variety of ways. Below we have included applications that resonate with applying Integral to the philosophy of chiropractic.
Dossey and several other leaders in the field are calling for an all quadrant all level approach to nursing. Integral Coaching Canada started by Joanne Hunt and Laura Divine is a great training program. Murphy and Leonard developed Integral Transformative Practice (ITP) as a way to exercise body, heart, mind, and spirit in a daily long-term way. It has revolutionised the world of patients who suffer from medical conditions that negatively impact on their wellbeing, comfort and quality of life.
Each domain is equally valuable in contributing to the quality of life and wellness of individuals and groups (Kolcaba, 2003). Physical aspects of comfort can include homeostasis, pain, blood pressure, heart rate, positioning and physical illness. However, if we look more closely at urinary incontinence management, holistic wellbeing and comfort theory, it can be seen that the effects of botulinum are far beyond noticeable, physical changes. Botulinum toxin has been an effective treatment because it targets the neuromuscular aspect of incontinence (Schurch, Denys, Kozma, Reese, Slaton & Baron, 2007).


It can have a significant impact on the physical, psychosocial, sociocultural and environmental wellbeing of the patient. Urge incontinence is described as an “involuntary loss of urine associated with an abrupt and strong desire to void (urgency).
Pontine communication is lost and the bladder and urinary sphincter contract simultaneously, obstructing the bladder outlet.
The detrusor does not contract, resulting in the patient feeling full, without the ability to empty the bladder.
Apostolidis, Dasgupta, Denys, Elneil, Fowler, Giannantoni, Karsenty, Schulte-Baukloh, Schurch et al.
In a double-blind, placebo controlled randomised control trial (Brubaker, et al., 2008) of 210 women with OAB urge incontinence, 60% saw a significant reduction of symptoms. A systematic review found that onabotulinum and abotulinum  both show high level evidence to support their use in urinary incontinence, however, onabotulinum had a broader efficacy across different types of urinary incontinence (Mangera,  Andersson, Apostolidis, Chapple, Dasgupta, Giannantoni, Gravas, Madersbacher, 2011). Botulinum toxin type A and other incontinence interventions may provide complete relief of, ease of or allow patients to transcend urge incontinence.
If we consider the impact that urinary incontinence has on top of the burden of disease for many patients, it is essential that care plans consider intervention sooner rather than later.
Patients are not only benefiting from improved symptom control, but also improved holistic wellbeing. Every nurse knows about Florence and her devotion to caring for those who could not care for themselves. If you want finding and contacting with best clinics, then for this you should use some internet sources. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States.
Some techniques that were considered CAM in the past have become mainstream (for example, patient support groups and cognitive-behavioral therapy).
You’re potentially knowledgeable about breath, power of thought, sound healing and aromatherapy.
Several pioneering health professionals are exploring what it is like to apply the Integral Approach across health care, to patients, practice members, healers, doctors, nurses, as well as the systems involved from clinics and health centers to hospitals and managed care.
Their approach to assisting people to fully express their highest evolutionary potential can certainly inform many chiropractors. Wilber’s approach went even further by including core modules as well as all five elements of the AQAL matrix. However, patients dealing with chronic conditions are not always well and are often required to manage conditions rather than treat or cure them. The synaptic vessel transports acetylcholine across the neuromuscular junction to the axon terminal (Crowther-Radulewicz, 2010). The causes of urinary incontinence are varied and each cause has a specific treatment plan. Often associated with involuntary contractions of the detrusor” (Huether & Forshee, 2010, p.
As the pontine micturation centre functions, the urinary sphincter muscle acts normally and relaxes, causing incontinence.
The bladder is unable to relax completely, resulting in an increased intravesicular pressure (bladder pressure). Patients will experience overflow incontinence and stress incontinence, when they sneeze or cough.
Patient counselling and education about product efficacy and expected results is vital when more than one option is available. The authors used the Incontinence Quality of Life scale [I-QOL] to measure quality of life outcomes of 59 patients across eight centres. Patients that continue to use conservative treatment without success, are at risk of harm to physical, psychospiritual, sociocultural and environmental suffering.
Botulinum toxin type A is enabling many patients to have an improved quality of life and better health outcomes. Recommendations on the use of botulinum toxin in the treatment of lower urinary tract disorders and pelvic floor dysfunctions: a European census report.
The effect of botulinum-a toxin in incontinent children with therapy resistant overactive detrusor.
Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA).
Quality of life of women with urinary incontinence: further development of the incontinence quality of life instrument (I-QOL).
Botulinum toxin A improves the quality of life of patients with neurogenic urinary incontinence. Reliability and validity of the incontinence quality of life questionary in patients with neurogenic urinary incontinence. Passionate about health and wellbeing, we write about issues relevant to our clinical practice. Because she emphasized the connection between patients and their environment, she is considered one of the first holistic nurses. Basically most companies and individual experts have their own websites and free blogs to be visited for proper help.
Examples of whole medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Other mind-body techniques are still considered CAM, including meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.
And maybe the outcome isn’t to continue life, as you understand there is healing in the death process as well. In Kolcaba’s Comfort Care Theory, holistic wellbeing is the state of achieving comfort or transcending states of discomfort (Kolcaba, 2003). Urinary incontinence is not a desirable state and has social impacts such as embarrassment due to wetness, odour and frequent need to manage the condition. Causes of detrusor hyperreflexia include stroke, traumatic brain injury, tumours, multiple sclerosis, Alzheimer’s disease and hydrocephalus (Huether & Forshee, 2010). Patients develop overactive bladder syndrome, suffering from frequency, urgency and an increased risk of urinary tract infections. This is known as an underactive bladder syndrome and occurs in patients with multiple sclerosis, peripheral polyneuropathies, spinal injuries between T12 and the sacrum, herpes zoster and cauda equina syndrome (Huether & Forshee, 2010).


Furthermore, in a study of children with urge incontinence (Hoebeke, De Caestecker, Vande Walle, Dehoorne, Raes, Verleyen, Van Laecke, 2006), 70% of participants had results lasting greater than one year. Measured outcomes included Intervention patients showed significant increases in I-QOL scores compared to placebo groups.
Below is an example of a comfort care plan that might be made for Penny, a 52 year old woman who suffered a traumatic brain injury 15 years ago. Further study into improved dosage requirements will increase the success of detrusor injection site interventions. Urinary incontinence in both sexes: prevalence rates and impact on quality of life and sexual life.
You can also ask many frequent question regarding the services and facilities which you really want in real life from these experienced professionals. Examples of systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda. You can feel the presence of a greater power in this world and trust in the knowing that we are all connected; we are all OK. Making the patient comfortable and enhancing the quality of their lives are important goals for you. Healthcare professionals and nurses in particular, have the opportunity to assist patients to achieve comfort in each of the four domains of holistic wellbeing.
Heavy chain and light chain neurotoxin molecules enter the synaptic cleft and synaptic vessels, replacing acetylcholine. Botulinum toxin has been successfully used for urge incontinence and results indicate increased quality of life factors for these patient groups (Schurch, et al., 2007a). Botulinum toxin type A injections are shown to improve the quality of life scores of patients. She now has urge incontinence, which stops her from going to the beach because feels like she cannot wear bathing suits, or go on long walks with her friends as there is no toilet. You know that a physical symptom is actually an end result of something that goes potentially much deeper than what can be seen with the naked eye.
Patients must be monitored closely following detrusor injections, to observe for product efficacy and unwanted side effects. However; the qualitative aspects of this treatment are limited and this author believes that further mixed method studies would improve research. This causes her discomfort, anxiety and often she finds herself in a low mood due to her increased isolation.
Due to the high patient load and often intense time constraints placed on nurses, it can be easy to simply treat the physical being and move on to the next patient, resident, or client. Destrusor hyperreflexia with vesicosphincter dyssynergia is an upper motor neuron disorder.
It is important to care for the whole person and to see them as just that; a whole person, not just a patient or diagnosis. The aim is to provide relief or ease in all of the domains of holistic wellbeing for Penny. It involves thinking about and assisting patients with the effects of illness on the body, mind, emotions, spirituality, religion, and personal relationships. Holistic care also involves taking into consideration social and cultural differences and preferences. Shouldn't our care of each patient be individualized?Holism is more than certain actions performed or words spoken to a patient. Holistic nurses are often described by patients as those nurses that a€?truly care.a€? While there is nothing inherently wrong with being task-oriented or goal-oriented in your nursing care, if a nurse is overly task-oriented or appears severely rushed, it can leave patients feeling like they are just a number or a diagnosis or worse, a burden.
Between things like patient needs, fellow nurses, doctors, charting, dealing with family members, and more, nurses have a lot to worry about.
As nurses we must find a way to balance all of the duties and responsibilities that come with the title.
Once we do this our duties and responsibilities become our privileges and success.As nurses we can not only use holistic nursing care to enrich the lives of our patients, but to enrich our own lives as well. One way to increase these experiences and provide better overall care to our patients is through holistic nursing care. The key is not necessarily about how long you spent interacting with a patient, but how you used the time you had with them. Nurses should strive to always make the most of the short time they have with each patient.
As nurses we need to promote a patients psychological and emotional wellbeing in order to facilitate physical healing. When we do this our relationship with the patient changes and grows into something more positive than before. At the end of the day holistic care is not even about how many holistic actions you performed. What matters is having the intention to care for each patient as a whole and being present for that patient while you can. Holistic nursing can be practiced in any healthcare setting.For those highly interested in the concept of holistic nursing, there are special certifications and titles that can be obtained after a through education on the subject. Whether you are a seasoned holistic nurse or a newbie that wants to get involved, just focus on the patient-nurse relationship and encourage healing in whichever ways you are ablea€¦ and remember: What would Florence do?AboutLatest Posts Daniel Bair, LPNDaniel Bair, LPN is a 2012 graduate of practical nursing school. Being relatively new to nursing he offers a different point of view and a fresh take on nursing and related topics. He loves to dispel myths and misinformation about healthcare and nurses through medical writing. Experience caring for geriatric populations in acute and long-term care settings has provided invaluable experiences and has increased his appreciation and fondness for the elderly population. In addition to geriatrics, patient advocacy and holistic nursing care are areas of special interest.



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