FEAT URE S

An Overview of
Holistic Nursing
by Carla Mariano

What Is Holistic Nursing?

“Holism” in health care is a philosophy that
emanated directly from Florence Nightingale,
who believed in care that focused on unity,
wellness, and the interrelationship of human
beings, events, and environment. Holistic
nursing focuses on promoting health and
wellness, assisting healing, and preventing
or alleviating suffering.
Following are only a few of the numerous individuals who
have given us a greater understanding and appreciation of
the need for holism in our practice: Jean Watson and her
theory of human caring; Margaret Newman and her theory
of health as expanding consciousness; Martha Rogers and
her science of unitary human beings; Barbara Dossey, Lynn
Keegan, Cathie Guzzetta, Noreen Frisch, Carolyn Chambers
Clark, Janet Quinn, and Dee Krieger in their extensive writ-
ings; and Charlotte McGuire, founder of the American
Holistic Nurses Association.

Healing is the integration of the totality of humankind

in body, mind, emotion, and spirit. Holism acknowledges
and values: the connectedness of the body, mind, and spirit;
the inherent goodness of human beings; the ability to find
meaning and purpose in our lives and experiences; the
practitioner’s support for each client so that the client
may find comfort, peace and harmony; and the body’s
innate power to heal itself.

With a holistic approach, the person is treated, rather

than just their symptoms. Individuals are viewed as unique,
therefore two people with the same disease may be treated
48 FEBRUARY/MARCH 2005
 FE AT U R ES

very differently. Treatment on one Holistic nursing integrates comple- home care settings, wellness and
level impacts all levels. Factors mentary modalities (CAM), such complementary care centers, women’s
considered integral to health are as relaxation, meditation, guided health centers, psychiatric mental
social support, health practices, imagery, breath work, biofeedback, health facilities, and schools. Holistic
family illness patterns, personality Reiki, journaling, etc., with traditional nurses with advanced education can
traits, social, structural and cultural nursing interventions. It draws on become advanced practice nurses,
issues. Lifestyle patterns and habits nursing knowledge, theories of whole- faculty members, and researchers.
that maintain healthy living are ness, expertise, caring and intuition,
stressed, as are nutrition, stress There are many benefits to becoming
as nurses and clients become therapeu-
management, rest, exercise, lifestyle a holistic nurse, and global interest
tic partners in a mutually evolving
choices, values and belief systems. in alternative approaches to health
process toward healing, balance, and
There is also an emphasis on individ- care has been growing steadily in
wholeness. Holistic nurses conduct
ual responsibility – the person is an recent years. There is a growing
holistic assessments, select appropriate
active partner in the healing process shift in health care from an “illness
interventions, and assist the client
and not a passive recipient of treat- oriented, biomedically dominated”
in exploring self-awareness, spirituali-
ment. Also a strong value placed on system to a “model that encompasses
ty, and personal transformation in
cultural diversity in healing practices. health, quality of life, and the
healing. They work to alleviate clients’
recognition of the primacy of
Self-awareness and understanding signs and symptoms, provide health
relationship” (Burkhardt, 2001)
can facilitate growth and health counseling and education, and guide
enhancing changes, and clients are clients in making choices between Currently, over 42 percent of
empowered when they take more conventional medicine and compli- the public are using complementary
control over their lives, including mentary/alternative therapies. therapies, and over 630 million
their personal and lifestyle choices, Americans are spending 12.2 billion
and their relationships. There is also Benefits out-of-pocket for these resources.
the belief that practitioners are edu- and Challenges Estimates indicate that the sharp
cators, consultants, facilitators and Holistic nurses practice in numerous increase in unconventional treat-
partners, and therefore collaboration settings, including private practition- ments will continue in the next
is key. We are the learners and our er offices, ambulatory, acute, and 20-30 years (Eisenberg et al., 1998;
clients are the knowers/teachers. White House Commission on
Complementary and Alternative
Medicine Policy, 2001). Integrative
Schools with Academic clinics that include both CAM and
Programs in Holistic Nursing conventional providers and HMOs
(Endorsed by the American Holistic Nurses Certification Corporation) offering some coverage for CAM
modalities are increasing across the
Baccalaureate Programs: Xavier University (Ohio), Metropolitan State country. This driving force will
University (MN.), Humboldt State University (CA), University of Texas propel mainstream health care in
(Tyler), Indiana State University (IND), West Virginia University (W.VA), this direction, and holistic nurses
and University of Texas (Galveston). are in a prime position to meet this
need and provide leadership in this
Master’s Programs: University of Colorado (Colorado Springs and
national trend.
Denver), Dominican University (CA), Tennessee State University (TN)
and New York University (NY). Holistic nurses honor others’ journey
in truly knowing, partnering, and
The American Holistic Nurses Association (AHNA) endorses certificate being present with our clients that
programs in specific areas. These include Spirituality, Health and the current health care approach
Healing; Amma Massage; Reflexology; Imagery; Aromatherapy; often does not allow. Contributing
Healing Touch; Clinical Nursing Assessment; and Whole Health to a client’s growth and empower-
Education. It also approves continuing education offerings in holistic ment is a most gratifying experience.
nursing as well as giving the AHNA home study course, Foundations of
Holistic Nursing. Other programs in distinct therapies like acupuncture, Education
Reiki, homeopathy, massage, imagery, healing arts, Oriental Medicine,
nutrition, Ayurveda, therapeutic touch, herbology, chiropractic, etc. are
and Training
The number of nursing schools
given nationally as certificate or continuing education programs by
offering programs in holism and/or
centers, specialty organizations or schools.
CAMs is increasing. Some schools

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 FEAT URE S
incorporate this content into other
courses such as nursing therapeutics,
and others offer discrete courses in
areas such as therapeutic touch,
visualization, relaxation, aromathera-
py, etc. There are also certificate
and continuing education programs
in holistic nursing and/or specific
CAM modalities. (See box.)
One can become board-certified in
holistic nursing at either the generalist
(HN-C) or advanced level (AHN-C)
through the American Holistic Nurses
Certification Corporation (ANNCC).
Certification aids the professional ele-
vation of holistic nursing, and assures
the public of the nurse’s knowledge and
competence in the practice of holistic
nursing. Certification requires passing
an exam and meeting certain prerequi-
sites such as RN licensure, academic
credentials, holistic nursing experience,
continuing education in holistic nurs-
ing, or successful completion of the
certificate program in holistic nursing.
Current and
Future Trends
One of the most pressing issues in
holistic nursing today is acceptance
of its legitimacy, both among nurses
and other disciplines. Other trends
concern education, research, clinical
practice and policy.
Education: One key priority is
the integration of complementary/
alternative modalities into nursing
50 FEBRUARY/MARCH 2005
curricula. Holistic nurses will need to
take leadership roles in working with
the accrediting bodies to assure this
content is included in educational
programs. There is a definitive
need for increased scholarship and
financial aid to support basic and
advanced training in this area, and
faculty development programs will
be necessary to support faculty in
the teaching of these therapies. The
entire area of licensure and creden-
tialing provides another challenge
for holistic nursing. It will be impor-
tant in the future for state boards of
nursing to recognize and support
integrative nursing practice and
requirements that include CAM
for nursing educational program
approval. Holistic nurses also face
the challenge of working with the state
boards to incorporate holistic content
on the NCLEXTM, thus assuring the
credibility of this practice knowledge.
Research: One of the formidable
tasks for nurses will be to identify
and describe outcomes of holistic
therapies such as healing, well-being,
and harmony, and develop instru-
ments to measure these outcomes.
Presently, most outcome measures
are based on physical or disease
symptomatology. Methodologies
need to be expanded to capture the
wholeness of the client/patient
experience as the philosophy of
these therapies rests on a paradigm
of wholeness. An issue to be
addressed by nurses is securing
funding for their CAM research.
Another area of responsibility for
holistic nurses will be the dissemina-
tion of their research findings to the
media. For example, publishing in
and serving on editorial boards of
non-nursing journals also heightens
awareness of holistic nursing into
the mainstream.
Clinical Practice: Credentialing
remains an issue for the practice
of holistic nurses. The American
Holistic Nurses Association has
published the Standards of Holistic
Nursing Practice and Standards of
Advanced Holistic Nursing Practice
for Graduate-Prepared Nurses, which
articulate the knowledge base and
clinical competencies of holistic
nurses in the delivery of health care.
These Standards need to be widely
disseminated within and outside of
the profession and the public needs
to be aware of the qualifications of
those nurses offering holistic services.
Policy: Holistic nurses will need to
work with Medicare and other
(continued on p. 52)
The American
Holistic Nurses
Association (AHNA)
The AHNA was created to unite
nurses in healing and is committed
to promoting wholeness and well-
ness in clients/patients, nurses, and
the nursing profession. Through its
various activities, the AHNA pro-
vides vision, direction, and leader-
ship in the advancement of holistic
nursing; integrates the art and sci-
ence of nursing in the profession,
empowers holistic nursing through
education, research and standards;
encourages nurses to be models of
wellness, honors individual excel-
lence in the advancement of holistic
nursing, and influences policy to
change the health care system to a
more humanistic orientation. The
AHNA has developed Standards
of Holistic Nursing Practice (2000)
and Standards of Advanced
Holistic Nursing Practice for
Graduate-Prepared Nurses (2003).
Core curricula in holistic nursing
at both the generalist and advanced
graduate level are based on
these Standards. Membership in
the AHNA is open to all individu-
als who support the mission of
the organization
 FEAT URE S
(continued from p. 50)
third-party payers, insurance groups,
boards of nursing, health care policy
makers and legislators, and other
professional nursing organizations
to assure that holistic nurses are
appropriately reimbursed for
services rendered. One other issue
in reimbursement is the fact that the
holistic focus and integrative skill
of the provider influence the effec-
tiveness of CAM. Consequently,
reimbursement must be included for
the process of integrating care, not
just for providing the specific modality.

There are many barriers to the use of

CAM therapies, providing yet anoth-
er challenge for holistic nurses in the
future. Although the number is grow-
ing, over half of all Americans did
not use CAM therapies in 2001.
Often, there is lack of awareness
of the therapies and their benefits,
uncertainty about their effectiveness,
inability to pay for them, and limited Holistic nurses have a unique oppor- individual providers. They also
availability of qualified providers. tunity to educate the public more must actively participate in the
Access is even more difficult for fully about complementary/alterna- political arena as leaders in this
minorities, rural populations the tive modalities and practitioners movement, to ensure an increased
uninsured and underinsured, and and to guide clients so that they can focus on wellness, health promotion,
vulnerable populations, such as the make informed choices among the access and affordability for all. ¥
chronically and terminally ill. array of health care alternatives and

resources references Saddle River, NJ: Prentice Hall.

Sparber, A. (2001). State boards of nursing

American Holistic Nurses Association American Holistic Nurses Association. (2000). and scope of practice of registered nurses
(AHNA) AHNA standards of holistic nursing performing complementary therapies.
P.O. Box 2130 practice. Flagstaff, AZ: Author Online Journal of Issues in Nursing,
Flagstaff, AZ 86003-2130 6(3), Manuscript 10. Retrieved from
Phone: (800) 278 2462 American Holistic Nurses Association. (2003). w w w. nu rsi ng wo r ld . o rg /
info@ah na . org AHNA standards of advanced holistic o j i n / to p i c 1 5 / t p c / 1 5 _ 6 . ht m.
w w w.a hn a. org nursing practice for graduate prepared
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American Holistic Nurses Certification handbook of alternative & comple-
Burkhardt, M. (2001). Foreward in M.A. Bright mentary therapies. Springhouse, PA:
Corporation (AHNCC) (Ed), Holistic health and healing (pp. v-vi).
811 Linden Loop Author.
Philadelphia: F.A. Davis.
Cedar Park, Texas White House Commission on Complemen-
78613 Eisenberg, D.M. et. al. (1998). Trends in
(877) 284-0998 alternative medicine use in the United States,
A H N CC@fla s h. net 1990-1997. Journal of the American Carla Mariano, EdD,
w w w.a hn a. org/e du/c erti f i c ati o n Medical Association, 280, 1569-1575. RN, AHN-C, FAAIM, is
president-Elect,
National Center for Complementary Dossey, B., Keegan, L., Guzzetta, C. (2005). American Holistic
Holistic nursing a handbook for practice, Nurses Association,
and Alternative Medicine (NCCAM)
(4th edition). Boston: Jones and Bartlett Pub- Flagstaff, AZ, and
National Institutes of Health
lishers. coordinator, Advanced
P.O. Box 8218
Practice Holistic Nurse
Silver Spring, MD 20907-8218 Fontaine, K.L. (2000). Healing practice: Practitioner Program, Division of Nursing,
Phone: (888) 644-6226 Alternative therapies for nursing. Upper New York University, New York, NY. She
http: //ncca m. n ih. gov
was 2003 Holistic Nurse of the Year.

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