In this essay I intend to look at the concept of holism, why it is important, how it is supported in legislation and codes of practice and the possible benefits to the nurse – patient relationship. Due to the word limit the focus is going to be centred around the positive aspects of the approach as apposed to negative critique. In order to explore the importance of considering the patient holistically, it is imperative that we understand what the word/concept holistic means.
Weller (2004, p44) describes holism as a comprehensive approach to health care that encompasses and considers the body, mind and spirit considering all actions and interventions for the patient, while recognising the concept of uniqueness, individualism and the influence of internal and external environmental factors on health. This can be condensed to suggesting that we should consider the person as a whole in relation to their individual needs. Dryden (1995, p. 77) cites that Fitz Perls (1951), based his gestalt approach to psychotherapy on premise that we should take an holistic view in relating to a person in order to help a person grow and ascertain a sense of wholeness. Stevenson, Grieves & Stein-Parbom (2004, p16) suggests that holism is knowing more about a person rather than deciding on a clinical pathway. It could be argued that the holistic approach is a humanistic approach focussing on growth and individualism/wholeness.
Definition Of Holism
The NMC recognises the importance of wholeness and holistic care by specifying in the 2008 code of conduct that we should treat people as individuals and respect their dignity. From this statement alone it is possible to see that holistic care requires a positive regard and requires all practitioners to consider all dimensions of a person. Brown and Libberton (2007, p. 99) suggests that an whole person comprises of three dimensions; including physical spiritual and social.
We know that these theories and concepts are important as we have seen the merge of the bio-medial, reductionist, model with the psychosocial model to provide a more comprehensive approach to health care and addressing health needs. The holistic approach can support a nurse to provide better care for a patient by understanding a patient’s, lifestyle, background, social class, culture, religious/spiritual values and social support and use this information to support recovery and sustained health.
This level of engagement will allow the nurse to develop a trust relationship with the patient, allowing a therapeutic relationship to take place. Sherwood (1997, p. 40) suggests that therapeutic relationships have an impact on healing patterns that make patients feel better. Sussex and Scourfield (2004, p. 306) suggests that not only to people have needs they have ideas about their needs and these cover many areas of their lives. Therefore the therapeutic relationship will encourage the patient to be involved with their own care, recovery and can empower them to self advocate with involvement.
The white paper, valuing people 2001 suggests that as health care providers we should promote choice, independence, rights and inclusion for people with learning disabilities and the underpinning ethos is person centred and holistic care. In 1998 the Department of Health introduced the standard two: person centred care guidance directing the NHS and social care services treat older people as individuals and enable them to make choices about their own care. This would include takings into consideration the individual needs of a person and not just comparative needs or needs relating to illness.
The importance of holism is being incorporated in to many care based initiatives to create a more patient focused service. valuingpeople. gov. uk/dynamic/valuingpeople4. jsp When all the perspectives on holistic care are collated, it is possible to see that treating a patient holistically is not only important, but it is paramount from the period of admission, during assessment, care planning and discharge. It should be incorporated in all levels of nursing intervention as it is considered a macro approach by looking at the bigger picture as apposed to the micro problem or health problem.
Pearson & Vaughan (1994, p. 97) supports the view that holistic care treats the whole person and promoting holistic care as assessment and care planning which occur as an integral part of the relationship can be tailored to individual need. The need for a holistic approach is also reflected in legislations and regulations and these statues require compliance. For example the Human Rights 1998 states that people have the right not to be discriminated against, right to respect for private and family life, freedom of thought, conscience and religion.
By considering these rights it could be argued that we would be taking a holistic approach rather than treating patients as a condition; as apposed to an individual. In 2007 and the Mental Health Act was amended to remedy human right incompatibilities and the code practice changed to include recognition for diversity and sets a more holistic approach to patients care. Therefore importance of treating people holistically applies to all patients including marginalised groups. www. opsi. gov. uk/acts/acts1998/ukpga
The holistic approach embraces equality diversity and rights avoiding litigation and oppressive care practice. By looking at the person as an individual and engaging with the person we are working ethically, within legal frame works and codes of practice. We are putting the patient at the centre of all decisions made and supporting inclusion and involvement. In conclusion there are many aspects of patient care and the holistic approach is about taking a more rounded view of a person their life and their lifestyle.
It is more ethical is more likely to maintain or encourage a positive self concept/image or a balanced equilibrium. We have established that there are many elements and factors make up a person’s identity and we should consider these factors to ensure a patient maintains a sense of self and does not become diminished as a result of treatment or care provided. We need to comply with law and codes of practice to ensure that we keep patients and our selves safe. The holistic approach is one that should start at the point of contact to discharge.
It is important when identifying need within multi agency working frame works and planning patient care. It helps to maintain independence and can in some cases have an impact on recovery. The holistic approach requires nurses to be more diverse, innovate and analytical, demanding a host of new skills that are required to undertake the role. Many nurses have evolved from working with medical facts and processes to working outside the box and co-coordinating care for individuals with complex needs. The holistic approach underpins how we practice and treat our patients.