Something Extra
Nurses who engage in holistic practices believe that the road to recovery for patients extends beyond tasks and medication

By Bree LeMaire, MS, RN
May 23, 2002

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.