Holistic Nursing

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 individual as a whole person must be assessed. During the nursing process, the nurse will perform the assessment, diagnose, plan, implement and evaluate the patient in an ongoing process. This essay will outline the importance of a holistic approach in nursing assessment and the importance assessment in the nursing process. ultural, spiritual and psychological aspects of the holistic assessment and the relevance of these components in the provision of care will be discussed and how AMNC standards apply to care in nursing. A holistic approach in nursing assessment establishes the patients’ physiological, psychological, sociological, spiritual, developmental, cultural and environmental aspects in their life. Obtaining data holistically is vital in assisting a patients’ ability to manage their symptoms and emotional status maximizing quality of life during the stages of illness or health changes (Margereson & Trenoweth 2009: 104).
The aim of the holistic approach in nursing assessment is to establish the type of support and care required for the individual, developing a quality of care that assists their wellbeing as a whole person (Margereson & Trenoweth 2009: 104). When assessing the patient it is important that the nurse “collects data that relates to physiological, psychological, spiritual, socio-economic and cultural variables on an ongoing basis” as outlined in ANMC competency 5. 1 (ANMC 2006, p. ). The ANMC competency is supported by, Margereson & Trenoweth (2009:104), who describes the assessment process as ongoing and is determined by the changing needs of the patient, their family and their carer’s. Margereson & Trenoweth (2009: 104) further describes that the holistic approach supports the patient to build psychological resilience and wellbeing, to maintain independence as well as developing care and support networks that is best suited to the individual.

The holistic approach in nursing assessment provides the patient assistance in decision making, achieving goals, addressing needs and desires and can build on strengths (Margereson & Trenoweth 2009: 104). Therefore, it is crucial to obtain data holistically in assessment to support and maximise the patients’ health and wellbeing. Assessment in the nursing process is an important aspect, as the information gathered enables a comprehensive response to the patients’ health status.
It is important for the nurse to adopt an approach following the guidelines outlined in the ANMC, Domain 5, “Provision and coordination of care” (ANMC 2006, p. 8) to ensure preferences are met an accuracy is maintained when carrying out assessment. The nursing process is a cyclic method that involves assessing, diagnosing, planning, implementing and evaluating (Kozier & Erb 2012: 213). Kozier & Erb (2012: p. 212-213) describes the nursing process as an overlapping lapping sequence that focuses on establishing the patients social, cultural, emotional, spiritual as well as physical needs.
Assessment will establish this data as well as a patients’ health history, concerns, health status and their ability to manage their own health care needs (Kozier & Erb: 213). Kozier & Erb (2012: 212) also maintain that data collected in the assessment phase enables the patients’ lifestyle and routines to be incorporated into the care plan. Assessment is about collecting as much information as possible enabling problem solving throughout the nursing process.
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). Kozier & Erb (2012: 360) discuss that cultural sensitivity, appropriateness, competency and safety are all factors that are required to be taken into consideration so that the patient can be provided with the best possible health care.
Kozier & Erb (2012: 360) also explain that conflicts in health care have been apparent due to cultural misunderstandings. An example of a cultural misunderstanding is the level of pain. In some cultures, it is normal to dramatically express ones level of pain whereas in other cultures people do not complain when in pain (Stein-Parbury 2010: 94). Culture is also an important aspect as it can explain nutrition, environmental and home status and level of education ( Kozier & Erb: 360) which all relate to the provision of care to be given.
The holistic assessment of a patients cultural aspects enable the best suitable approach in the provision of care, upholding the patients’ rights, addressing their needs and minimizing misunderstandings. Spiritual needs are often emphasized in times of ill health or other health related crisis therefore it is imperative that spirituality of the patient is understood in order to maximize provision of care. Kozier & Erb (2012: 1154) define spirituality as a way in which a person lives their life, bound in beliefs and values and how their own meaning or perception is viewed.
A holistic assessment will determine the spiritual needs of the patient to enable the nurse to respond appropriately to the patient whilst adhering to ANMC, competency 9. 5, ‘Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security’ (ANMC 2006, p. 12). Narayanasamy (2009:886-890), describes spirituality as a fundamental aspect in holistic assessment as it can promote the patients mind, body and spirit as well as determining there state of mind in relation to spiritual distress such as loss of hope.
Spirituality is an important part of the healing process as it can provide comfort, reduce suffering and assist in the physical and mental healing of the patient (Kozier & Erb 2012: 1154). Kozier & Erb (2012: 1155) state that the nurse who attends to their own spiritual needs is able to assist others and have a better understanding of the patients spiritual needs. Therefore, the provision of care will be heightened and the spiritual needs of the patient can be addressed in a holistic assessment.
Psychological aspects of mind-body interactions are of great importance in the holistic assessment process in order to provide provision of care. The nurse is obligated to follow ANMC, competency 5. 1 ‘Uses a relevant evidence-based assessment framework to collect data and the physical socio-cultural and mental health of the individual/group’ (ANMC 2006, p. 8). Kozier & Erb (2012:345), explain that mind-body interactions can have a good or ill effect on the body for example, stress can lead to an altered body function such as an increased urinary frequency.
Assessment of psychological status is imperative to establish the correct provision of care to be provided. Kozier & Erb (2012: 345) maintain that the minds ability to influence health status is receiving more attention and treatments such as relaxation techniques are being more commonly used to combat symptoms of stress. Illnesses have the ability to create emotional responses as well such as fear and depression, therefore the nurse must take into consideration these variables when conducting an holistic assessment to provide quality care to the patient.
Holism in the provision of care is imperative to maintain in the nursing process. Holistic assessments carried out are unique and individual for each patient. This can be obtained in the nursing process by gathering data holistically by assessing the physiological, psychological, sociological, spiritual, developmental, cultural and environmental aspects of the patient. A better understanding of the patients’ needs and requirements for care can be developed to provide health restoration in the best possible manner suited to the individual.
The Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse outlines the requirements for nurses to follow to ensure health care is delivered at the highest standard. References Australian Nursing & Midwifery Council 2006, National Competency Standards For The Registered Nurse, 4th edn, viewed 2 September 2012, . Berman, A et al. , 2012, Kozier and Erb’s fundamentals of nursing, Australian adaptation, 2nd edn, Pearson, Sydney.
Ellis, HK & Narayanasamy, A 2009, ‘An Investigation into the Role of Spirituality in Nursing’, British Journal of Nursing, Vol. 18, No. 14, pp. 886-890. Johnstone, M 2006, Bioethics: a nursing perspective, Elsevier Australia, Marrickville, NSW. Margereson, C & Trenoweth, S 2009, Developing Holistic Care for Long-term Conditions, Routledge, New York. Stein-Parbury, J 2009, Patient and Person: Interpersonal Skills in Nursing, 4th edn, Elsevier, Marrickville.

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