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A few years ago, after witnessing a task-oriented ER
nurse at work, Marie Shanahan, RN, HNC, became convinced
of the value of holistic nursing. Holistic nurses use
specific behaviors and language that establish an immediate
healing connection. When Shanahan took her young son
to the ER, his nurse focused on collecting the data,
but never addressed the terror in her young patient's
eyes.
Shanahan, a certified holistic nurse, is president
of the BirchTree Center for Healthcare Transformation
in Florence, Mass. The center provides nurses and health
care organizations with training programs in holistic
health care that range from introductory to in-depth
certification programs.
All programs are based on the philosophy and theory
of holism, which is an emphasis on the importance of
the whole and the interdependence of the parts.
Shanahan received her holistic training and certification
from the Seeds and Bridges Center for Holistic Nursing
Education, also in Florence, and is board certified
by the American Holistic Nurses' Certification Corp.
She established the first Holistic Nursing Center in
a New Jersey hospital after her training.
Later, she served on the faculty at Seeds and Bridges
and went on to create new programs as its program director.
When the principals at Seeds and Bridges wanted to pursue
other endeavors, she bought some of the existing programs,
developed new ones and renamed the company the BirchTree
Center for Healthcare Transformation.
"I believe nurses, patients and their families
derive much more satisfaction from their experience
if there is a sense of personal connection within the
context of the therapeutic relationship," Shanahan
said.
Holistic nurses take responsibility for initiating
that connection from the moment of first contact. They
look at relationships to partner with their patients
and to use all available modalities. There are many
complementary modalities (guided imagery, touch therapies,
music therapies and aromatherapies for example) suitable
for integration into practice.
Holistic nurses see their approach as a way to connect.
The holistic tools that nurses use daily can lead to
making a connection with a patient. These become the
magical moments of being a nurse.
Emphasis on healing
Holistic nursing changed Judy Kay's life. Kay, RN,
HNC, decided to become certified after she was laid
off after working 15 years at the same hospital. She
realized the problem was not in nursing, but in the
care delivery system. Today, as a home hospice nurse,
she feels she's back to the heart of nursing. She can
"continue nursing in the medical community and
be a healthy agent for change in a place so resistant
to change."
Kay said she didn't go into nursing to learn only tasks,
such as how to flush a patient's line or start IVs,
but to be with people and assist them in their healing.
When she asks patients to tell her a story about their
life, she can discover what's going on, and it shifts
the energy emphasis where it needs to be-on healing.
On one visit, Kay said, a patient was having a difficult
time. The patient, who had metastatic cancer, needed
something more, but neither of them knew what it was.
The patient, it turned out, was resistant to many pain
meds. Using one of the many alternate modalities, Kay
taught the patient an imagery technique. He then was
able to relax and no longer felt the grogginess of overmedication.
Veronica Polverari, RN, HNC, manager of cardiac rehabilitation
services at Santa Monica-UCLA Medical Center, said that
people at her hospital who know of her holistic approach
often ask her to consult on difficult cases.
Recently, she was asked to talk with a woman in her
50s who was receiving chemotherapy, but who had developed
pulmonary emboli. The staff was doing everything they
could for her, but the patient still wasn't comfortable.
Polverari talked with the woman for a while and then
used some soothing music and Reiki, a hands-on, healing
approach that works with the body's natural energies.
She described the Reiki process as getting a "mental
hit of where to put her hands," and the patient
was finally able to relax.
Polverari spoke of another patient who had breast cancer.
The patient had opted not to undergo chemo, but the
cancer had metastasized beyond the chest wall. In this
case, the nurses only could keep the patient comfortable.
Polverari said that many times the nurse brings about
harmony and peace, especially with terminal patients,
when it seems nothing else can be done. When she communicates
with patients, she looks for an attitude shift in both
the nurse and the patient.
Polverari asks herself when she enters a patient's
room, "Where's my head?" which translates
to, "What is my mental attitude?" When she
uses her holistic approach, the tasks go more smoothly.
There's room for the patient's natural healing process
to take place.
James Brown, RN, staff nurse IV in the ortho-spine
surgical unit at Seton Hospital in Daly City, Calif.,
said that because he has always seen what he does as
holistic nursing, he finds patient outcomes are much
better. Brown said he sees many patients with repeat
surgeries who have developed a resistance to pain meds.
They also may have traveled far and are separated from
supportive people that live nearby.
Brown said that one of his most memorable times was
on a weekend, the supposedly quiet time with fewer staff
and patients. A woman wanted to be discharged on a Sunday,
but she lived in Redding, Calif., and had every imaginable
complication known: pain management issues, equipment
to be ordered and an estranged son who would offer little
help for home care. Brown said he found himself doing
all those tasks, which would have been quickly accomplished
on a weekday. He stayed through to her discharge, called
four drugstores for meds, spent time with her and told
her everything would work out OK. Although putting out
a number of fires so quickly was a bit taxing, it was
a rewarding experience for both of them.
Second nature
Gail Bullard, RN, HNC, a critical care register nurse
who works in the ICU, has a private practice and teaches
holistic nursing classes. She grew up among the Sioux
in northern Minnesota, so holistic nursing, including
American Indian practices, is second nature to her.
Her most memorable experience occurred many years ago.
Bullard was on her way to lunch when she spotted a fragile
patient who had just finished his lunch. She told him
she'd be back in a half hour or so. He asked for just
one more cup of coffee [before his scheduled procedure].
She took the extra time and fixed the coffee, knowing
just how he liked it. When she returned from her lunch,
she found that he had passed away, but she knew she
had acknowledged him as a person in her small act of
kindness. "Holistic nursing is what I can do to
make a difference for each person, and sometimes what
counts most are those really easy small gestures,"
Bullard said.
At one time, with all the changes and downsizing, Bullard
felt as though her own professional life was "going
down a river with a foot in two canoes," but holistic
nursing has now brought integration and direction to
her practice, she said.
Helene Wood, RN, HNC, an outpatient surgery nurse,
said her holistic practice is more relationship-centered
nursing. She has been known as the "touchy-feely
nurse," because touch is so important. It surprised
her when she started to receive thank-you letters from
patients. They said things such as, "I felt more
in control and more understanding of what my role in
my recovery was. As I understood this more, my pain
lessened. Your manner made me feel less afraid."
Wood has noted that when taking a patient's blood pressure
as part of preop preparation, she finds a significant
drop between the initial reading and the reading when
she leaves the patient, which she believes to be a result
of her personal connection.
Marie Pintler, RN, nurse manager of an ortho-spine
surgical unit at Seton Hospital, remembers an open-and-close
surgical patient who was being cared for on the acute
surgical floor [something not done today, but this was
a while back]. The nurses wanted to give acute care.
They weren't accustomed to the dignified lawyer who
refused pastoral and family visits. Whenever the nurses
asked him what they could do, he'd answer, "Be
more comfortable," but he never elaborated. After
many queries from Pintler, he finally relented and said
he'd appreciate a backrub. To accomplish this, Pintler
tape recorded her change-of-shift report earlier and
rescheduled other tasks to provide time for a full 30-minute
backrub. This became a daily routine, but her efforts
grew into more than just a backrub, for the other nurses
began to pitch in when they saw Pintler coming in on
her day off. At first, they conferred with one another
for the one patient, but their effort mushroomed and
their caring attitude expanded into other areas. Pintler
said that patient would never know the gift he gave
the nurses.
A safe place
After 25 years of hospital nursing, Terry Reed, MS,
RN, HNC, now teaches imagery certification in Foster
City, Calif. She said one of her students was working
in the ER when a girl who had been in a horrible accident
came in. She was thrashing all over with trauma, pain,
broken bones and many complications. Reed's job was
to restrain her for X-rays.
It seemed impossible to get her to stay still. Reed
went to the head of the table, leaned down and whispered
in her ear, "Where would you like to be?"
(taking her on an imagery trip). Reed asked for details
of what the imaginary place looked like. The patient
quickly calmed down. Once the procedure was completed,
Reed said, "OK, you can come back now." The
patient said, "No, I'd rather stay here in Hawaii."
Holistic nursing stresses the importance of self-care.
Shanahan of the BirchTree Center said that nurses cannot
give from a dry well. Nothing in conventional nursing
training prepares nurses to address the day-to-day or
long-term stress of the profession.
Kay, who does hospice work, said the first thing holistic
nursing teaches is to "nurture the nurse."
That means nurses have to say, "What can I do for
myself in this moment?" then quiet down long enough
to replenish their energy banks.
Kay loves to bicycle and take long trips on weekends.
Brown, an ortho-spine unit nurse, enjoys being close
to the ocean and his family. Pintler, who also works
in the ortho-spine unit, replenishes herself through
exercise. She said, "That's the best mental health
fix ever." Wood elects to work in a well-staffed
hospital as part of her self-care, even though she has
a 45-minute commute.
In busy technological settings, tasks don't change,
but attitudes do. Nursing is a calling and a profession
unto itself, and working holistically can be self-sustaining.
Holistic nursing practices prevent nursing burnout.
These nurses said that holistic nursing is a place for
healing of the individual as well as their profession.
Holistic nursing offers nurses an opportunity to reconnect
with the heart and spirit to bring out their full potential
as healing partners.
Contact
Bree LeMaire at peraltapal@aol.com.
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