1. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Professional Nursing Practice Concepts and Perspectives Seventh Edition Chapter 20 Dimensions of Holistic Health Care

2. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved 20.1 Describe the change in the view of health care from one of biological focus on disease management to comprehensive health care. 20.2 Define holistic health and holistic nursing. 20.3 Differentiate primary, secondary, and tertiary health promotion. 20.4 Discuss integrative health in the context of nursing. 20.5 Compare biologically based, manipulative body-based, energy, and mind- body-based therapies. Learning Objectives

3. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Hallmark Features A focus on foundational knowledge related to professional nursing –Includes nursing history, nursing theory, ethics, and legal aspects, etc. An overview of professional nursing roles, issues, and changes in the profession –Discusses nurses as healthcare providers, learners and teachers, and leaders

4. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Challenges and Opportunities The traditional view of nursing and medicine is no longer adequate Traditional views of nursing should be expanded to encompass holistic health Providing health care for a diverse population must be met by expanding perspectives of health Opportunities for nursing to actively participate in expanding focus of health care

5. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 20.1 Describe the change in the view of health care from one of biological focus on disease management to comprehensive health care.

6. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Expanding View of Health Care Western medicine has been through three eras –Starting in the 1860s when the focus was entirely on the physical –In the 1950s there was a growing recognition of the effect of the mind or consciousness on the physical –Recently consciousness has expanded time and space and is believed to be infinite

7. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Complementary and Alternative Medicines National Center for Complementary and Alternative Medicine (NCCAM) established at National Institutes of Health (NIH) Complementary and alternative medicines (CAM) is “a group of diverse medical and health care interventions, practices, products, or disciplines that are not generally considered part of conventional Medicine”

8. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Complementary and Alternative Medicines Complementary medicine refers to nonmainstream approach used in combination with or in addition to conventional medicine –More commonly found in healthcare practice Alternative medicine refers to using nonmainstream medicine in place of conventional medicine

9. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Complementary and Alternative Medicines Two main types of CAM therapies –Doing therapies such as medications, dietary changes, spinal adjustments –Being therapies such as meditation, imagery, states of consciousness

10. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Complementary and Alternative Medicines All healing experiences are on continuum from paradoxical to rational healing –Paradoxical healing approaches are less traditional and more difficult to explain scientifically –Rational healing experiences are more easily understood by scientific world

11. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Complementary and Alternative Medicines Pew Health Professions Commission Report (1994) put forth tenet that relationships and interactions provide foundation for healing Three types of relationships –Patient-practitioner –Community-practitioner –Practitioner-practitioner

12. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Complementary and Alternative Medicines Optimal healing environments integrate social, psychological, spiritual, physical, and behavioral aspects of care Key concepts include awareness and intention

13. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Complementary and Alternative Medicines Holistic healthcare movement has expanded choices of treatment modalities for health and healing –Many treatment choices borrowed from Eastern medicine Integrative medicine or integrated health is the blending of Eastern and Western medicine

14. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 20.2 Define holistic health and holistic nursing.

15. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Holistic Nursing Holistic nursing recognized by the American Nurses Association as a nursing specialty with own scope and standards of practice American Holistic Nurses Association (AHNA) developed standards of holistic practice –The interconnectedness of body, mind, emotion, spirit, social/cultural effects, relationship, and context and environment, and their impact on health and healing

16. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Holistic Nursing Recognizes mind-body-spirit connection and uses alternative and complementary modalities –Therapeutic massage –Imagery –Meditation –Healing presence

17. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Holistic Nursing Certification done through American Holistic Nurses Certification Corporation and involves –Application –Examination –Self-reflective self-assessment

18. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Holistic Nursing Nurses may be certified on basic or advanced levels –Basic - holistic nurse, board-certified (HN–BC) or holistic baccalaureate nurse, board-certified (HNB–BC) –Advanced - advanced holistic nurse, board-certified (AHN–BC) or advanced practice holistic nurse, board-certified (APHN–BC)

19. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Holistic Nursing Holistic nursing embraces art and science of nursing Reality comes from four perspectives –Individual interior (personal/intentional) –Individual exterior (physiology/behavioral) –Collective interior (share, cultural) –Collective exterior (systems/structure)

20. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Health Promotion and Healthy Lifestyles Healthy People 2000 has influenced transition in healthcare system to more holistic view –Moved away from illness/disease-based framework to more comprehensive approach –Expanded to include health screening and health promotion strategies –Expanded to become Healthy People 2020

21. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Health Promotion and Healthy Lifestyles World Health Organization (WHO) first proposed that health is more than absence of disease in 1946 Eight dimensions of health, wellness, and well-being –Physical –Psychological –Emotional

22. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Health Promotion and Healthy Lifestyles Eight dimensions of health, wellness, and well-being –Intellectual/cognitive –Spiritual –Occupational –Social –Environmental

23. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Health Promotion and Healthy Lifestyles Many CAM disciplines, systems of traditional medicine, and integrative medicine practice place strong emphasis on preventive health strategies –Better dietary practices –Regular physical exercise

24. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Health Promotion and Healthy Lifestyles Emerging body of data suggests that users of CAM have greater degree of health consciousness and are more likely to engage in health-promoting activities –Further investigation needed to confirm findings

25. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 20.3 Differentiate primary, secondary, and tertiary health promotion.

26. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Primary, Secondary, and Tertiary Prevention Three levels of health promotion –Primary –Secondary –Tertiary

27. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Primary, Secondary, and Tertiary Prevention Tertiary level of prevention –The care and treatment of a patient after an illness or disease has occurred –Most common setting where nurses would care for clients in the past was in acute-care settings –Most expensive level of care

28. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Primary, Secondary, and Tertiary Prevention Secondary level of prevention –Focuses on screening and early detection with goal of intervention –Is an important part of mainstream medicine today

29. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Primary, Secondary, and Tertiary Prevention Primary prevention –A major focus of health agendas –Focuses on health promotion and education –Costs of primary prevention are minimal and impact is significant

30. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Primary, Secondary, and Tertiary Prevention Modifiable risk factors –Identified factors that are amenable to modification –Elevated blood pressure, smoking, obesity, sedentary lifestyle Nonmodifiable risk factors –Identified factors that are not amenable to intervention –Gender, age, genetics

31. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 20.4 Discuss integrative health in the context of nursing.

32. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Transition to Integrative Health Landmark study conducted in 1993 on the use of unconventional medicine –Revealed that one in three people surveyed used at least one form of alternative medicine –325 million Americans sought some form of alternative medicine and paid out of pocket –Highlighted 15 different types of alternative medicine

33. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Transition to Integrative Health Updated study (1997) revealed that visits to alternative providers had risen Based on the outcomes of these data, clear that alternative medicine was becoming common choice for Americans

34. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Transition to Integrative Health In 1997 the NIH established the Office of Alternative Medicine (OAM) Later designated as a center called the National Center for Complementary and Alternative Medicine (NCCAM)

35. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Transition to Integrative Health NCCAM’s mission is to –Explore complementary and alternative healing practices within the context of science –Train complementary and alternative medicine researchers –Disseminate authoritative information to the public and professionals

36. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Complementary Therapies NCCAM has organized CAM therapies into four categories –Mind-body –Biologically based  Use of substances found in nature –Manipulative body-based  Manipulation of one or more body parts –Energy

37. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Complementary Therapies Whole Medical Systems, a category identified by NCCAM, include –Traditional Chinese medicine –Osteopathic medicine –Ayurvedic medicine –Homeopathy

38. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Complementary Therapies Nurses need to be aware of modalities, especially those that encompass body-based manipulations

39. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 20.5 Compare biologically based, manipulative body- based, energy, and mind-body-based therapies.

40. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Biologically Based Therapies Include the use of substances found in nature, such as herbs, vitamins/supplements, and organic whole foods Botanical is a plant or plant part used for its medicinal or therapeutic properties, flavor, and/or scent Some herbal therapies are contraindicated in the presences of certain illnesses, diseases, and medications –Clients are not always aware of contraindications Herbal products not monitored by the FDA

41. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Manipulative Body-Based Therapies Commonly used to treat musculoskeletal problems Most common treatment –Massage –Chiropractic care Most common musculoskeletal problem that patients seek integrative health care for is back pain

42. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Energy Therapies Use energy fields to create change in the body Therapeutic touch, introduced by the nurse Dolores Krieger in 1972 Philosophy underlying energy healing is the “laying on of hands,” where healer helps to harness or redirect client’s energy to create healing from within

43. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Energy Therapies Four phases of therapeutic touch –Center oneself physically and psychologically to prepare for the healing session –Prepare the field of energy for therapeutic touch through sensitizing hands to detect subtle changes in energy flow –Mobilize the energy in client’s field that may be stuck or congested by laying on hands –Help clients “re-pattern” their energy through the use of healer’s excess energy

44. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Energy Therapies Elicits relaxation and can eradicate or lessen pain This category of integrative modalities is divided into –Veritable (measurable)  Laser beams, visible light, magnetism, electromagnetic forces

45. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Energy Therapies This category of integrative modalities is divided into –Putative (no objective measure)  Often referred to as “chi” or life force in Eastern philosophy  When chi is out of balance, illness or disease occurs Energy modalities include acupuncture, tai chi, qi gong, and Reiki; magnetic therapy; therapeutic touch; energy work

46. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Mind-Body-Based Therapies Focus on the interaction of the mental, social, emotional, and behavioral factors and state of health Progressive relaxation and visualization therapies can be taught to clients to use at home

47. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Mind-Body-Based Therapies Focus is on empowering client through self- knowledge and encouraging self-care. Integrative modalities include hypnosis, meditation, mental healing, prayer, and visual imagery; tai chi; spirituality; creative therapies