HOLISTIC NURSING A HANDBOOK FOR PRACTICE, 4TH EDITION

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Holistic
Nursing
A Handbook for Practice
FOURTH EDITION
Barbara Montgomery Dossey, RN, PhD, HNC, FAAN
Director
Holistic Nursing Consultants
Santa Fe, New Mexico
Lynn Keegan, RN, PhD, HNC, FAAN
Director
Holistic Nursing Consultants
Port Angeles, Washington
Cathie E. Guzzetta, RN, PhD, HNC, FAAN
Nursing Research Consultant
Children’s Medical Center of Dallas
Director
Holistic Nursing Consultants
Dallas, Texas
Endorsed by the American Holistic Nurses’ Association

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Library of Congress Cataloging-in-Publication Data
Holistic nursing : a handbook for practice / [edited by] Barbara
Montgomery Dossey, Lynn Keegan, Cathie E. Guzzetta.— 4th ed.
p. ; cm.
Rev. ed. of: Holistic nursing : a handbook for practice / Barbara
Montgomery Dossey. 3rd. ed. 2000.
Includes bibliographical references and index.
ISBN 0-7637-3183-8 (pbk.)
1.  Holistic nursing—Handbooks, manuals, etc.
[DNLM: 1.  Holistic Nursing.  WY 86.5 H732 2004]  I. Dossey, Barbara
Montgomery. II. Keegan, Lynn. III. Guzzetta, Cathie E.
RT42.H65 2004
610.73—dc22
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Nursing is an art; and if it is to be made
an art,
it requires as exclusive a devotion, as hard
a preparation, as any painter’s or
sculptor’s work;
for what is the having to do with dead
canvas or cold marble,
compared with having to do with the living
spirit—the temple of God’s spirit?
It is one of the Fine Arts;
I had almost said,
the finest of Fine Arts.
Florence Nightingale


Table of Contents
Vision of Healing .............................................................................................................................. xvii
Contributors ...................................................................................................................................... xix
Foreword ............................................................................................................................................ xxiii
Preface ................................................................................................................................................ xxv
Acknowledgments............................................................................................................................ xxix
CORE VALUE 1—HOLISTIC PHILOSOPHY, THEORIES, AND ETHICS................................ 1
VISION OF HEALING—Exploring Life’s Meaning .......................................... 3
Chapter 1 Holistic Nursing Practice ...................................................................................... 5
Barbara Montgomery Dossey and Cathie E. Guzzetta
Nurse Healer Objectives ...................................................................................... 5
Definitions ................................................................................................................ 5
Holism........................................................................................................................ 7
Holistic Nursing ...................................................................................................... 8
Eras of Medicine .................................................................................................... 12
Relationship-Centered Care................................................................................ 24
Conclusion .............................................................................................................. 27
Directions for Future Research............................................................................ 28
Nurse Healer Reflections ...................................................................................... 28
Appendix 1-A: American Holistic Nurses’ Association (AHNA)
Standards of Holistic Nursing Practice (Revised 2003).............................. 31
Guidelines................................................................................................................ 32
AHNA Holistic Nursing Description .................................................................. 32
Core Value 1: Holistic Philosophy, Theories, and Ethics.............................. 32
Core Value 2: Holistic Education and Research ............................................ 33
Core Value 3: Holistic Nurse Self-Care ............................................................ 34
Core Value 4: Holistic Communication, Therapeutic Environment,
and Cultural Diversity ...................................................................................... 35
Core Value 5: Holistic Caring Process .............................................................. 36
VISION OF HEALING—Transpersonal Self ...................................................... 39
Chapter 2 Transpersonal Human Caring and Healing.................................................... 41
Janet F. Quinn
Nurse Healer Objectives ...................................................................................... 41
Definitions ................................................................................................................ 41
Theory and Research ............................................................................................ 42
Healing: The Goal of Holistic Nursing .............................................................. 43
The Healer ................................................................................................................ 47
A True Healing Health Care System.................................................................. 48
The Wounded Healer ............................................................................................ 50
Conclusion .............................................................................................................. 51
Directions for Future Research............................................................................ 51
Nurse Healer Reflections ...................................................................................... 51
VISION OF HEALING—Reawakening the Spirit in Daily Life .................... 55
Chapter 3 The Art of Holistic Nursing and the Human Health Experience ................ 57
H. Lea Barbato Gaydos
Nurse Healer Objectives ...................................................................................... 57
Definitions ................................................................................................................ 57
The Art of Holistic Nursing .................................................................................. 58
Aspects of the Human Health Experience........................................................ 63
Conclusion .............................................................................................................. 73
Directions for Future Research............................................................................ 74
Nurse Healer Reflections ...................................................................................... 74
VISION OF HEALING—Active Listening .......................................................... 77
Chapter 4 Nursing Theory in Holistic Nursing Practice .................................................. 79
Noreen Cavan Frisch
Nurse Healer Objectives ...................................................................................... 79
Definitions ................................................................................................................ 79
Theory and Research ............................................................................................ 79
Selected Nursing Theories .................................................................................. 82
A Word About Definitions of Person .................................................................. 86
Theory into Practice .............................................................................................. 86
Conclusion .............................................................................................................. 88
Directions for Future Research............................................................................ 89
Nurse Healer Reflections ...................................................................................... 89
VISION OF HEALING—Ethics in Our Changing World ................................ 91
Chapter 5 Holistic Ethics .......................................................................................................... 93
Lynn Keegan
Nurse Healer Objectives ...................................................................................... 93
Definitions ................................................................................................................ 93
The Nature of Ethical Problems .......................................................................... 94
Morals and Principles .......................................................................................... 94
Traditional Ethical Theories................................................................................ 95
The Development of Holistic Ethics .................................................................. 96
Development of Principled Behavior ................................................................ 100
Analysis of Ethical Dilemmas ............................................................................ 101
Advance Medical Directives................................................................................ 102
Ethics Education and Research .......................................................................... 102
Cultural Diversity Considerations .................................................................... 103
Conclusion .............................................................................................................. 104
Directions for Future Research............................................................................ 104
Nurse Healer Reflections ...................................................................................... 104
CORE VALUE 2—HOLISTIC EDUCATION AND RESEARCH ................................................ 107
VISION OF HEALING—Web of Life .................................................................... 109
Chapter 6 The Psychophysiology of Bodymind Healing.................................................. 111
Genevieve M. Bartol and Nancy F. Courts
Nurse Healer Objectives ...................................................................................... 111
Definitions ................................................................................................................ 111
New Scientific Understanding of Living Systems .......................................... 112
Emotions and the Neural Tripwire .................................................................... 118
Ultradian Rhythms ................................................................................................ 120
Mind Modulation .................................................................................................... 121
Conclusion .............................................................................................................. 129
Directions for Future Research............................................................................ 130
Nurse Healer Reflections ...................................................................................... 130
VISION OF HEALING—Evolving Process of Life’s Dance ............................ 135
Chapter 7 Spirituality and Health ........................................................................................ 137
Margaret A. Burkhardt and Mary Gail Nagai-Jacobson
Nurse Healer Objectives ...................................................................................... 137
Definitions ................................................................................................................ 137
Theory and Research ............................................................................................ 138
Spirituality and the Healing Process ................................................................ 144
Spirituality in Holistic Nursing .......................................................................... 148
Holistic Caring Process Considerations .......................................................... 159
Arts and Spirituality .............................................................................................. 166
Conclusion .............................................................................................................. 167
Directions for Future Research............................................................................ 168
Nurse Healer Reflections ...................................................................................... 168
VISION OF HEALING—Toward Wholeness...................................................... 173
Chapter 8 Energetic Healing .................................................................................................. 175
Victoria E. Slater
Nurse Healer Objectives ...................................................................................... 175
Definitions ................................................................................................................ 175
An Overview of Energetic Healing .................................................................... 177
Meridians.................................................................................................................. 178
Chakras .................................................................................................................... 181
The Aura.................................................................................................................... 190
Other Forms of Energy: Smells, Aromas, Sounds, Colors, and Touch ...... 193
The Healer ................................................................................................................ 194
The One Being Healed .......................................................................................... 196
Two Potentially Interesting Concepts for Energetic Healing...................... 199
Research and Research Implications................................................................ 201
Conclusion .............................................................................................................. 203
Nurse Healer Reflections ...................................................................................... 205
VISION OF HEALING—Questioning the Rules of Science .......................... 209
Chapter 9 Holistic Nursing Research.................................................................................... 211
Cathie E. Guzzetta
Nurse Healer Objectives ...................................................................................... 211
Definitions ................................................................................................................ 211
Wellness Model ...................................................................................................... 212
Evidence-Based Practice ...................................................................................... 212
Need to Conduct Holistic Research.................................................................... 214
Holistic Research Methods .................................................................................. 215
Enhancing Holistic Research .............................................................................. 218
Conclusion .............................................................................................................. 224
Directions for Future Research............................................................................ 225
Nurse Healer Reflections ...................................................................................... 225
CORE VALUE 3—HOLISTIC NURSE SELF-CARE...................................................................... 229
VISION OF HEALING—Toward the Inward Journey ...................................... 231
Chapter 10 The Nurse as an Instrument of Healing ............................................................ 233
Maggie McKivergin
Nurse Healer Objectives ...................................................................................... 233
Definitions ................................................................................................................ 233
Theory and Research ............................................................................................ 234
The Nature of Healing Relationships ................................................................ 239
The Nurse as a Healing Environment................................................................ 244
Healing Interventions............................................................................................ 246
Other Considerations for Integration of Concepts ........................................ 249
Conclusion .............................................................................................................. 251
Directions for Future Research............................................................................ 251
Nurse Healer Reflections ...................................................................................... 252
CORE VALUE 4—HOLISTIC COMMUNICATION, THERAPEUTIC ENVIRONMENT,
AND CULTURAL DIVERSITY............................................................................ 255
VISION OF HEALING—Human Care.................................................................. 257
Chapter 11 Therapeutic Communication: The Art of Helping .......................................... 259
Sharon Scandrett-Hibdon
Nurse Healer Objectives ...................................................................................... 259
Definitions ................................................................................................................ 259
Theory and Research ............................................................................................ 259
Therapeutic Communication .............................................................................. 260
Therapeutic Communication Helping Model.................................................. 261
Conclusion .............................................................................................................. 271
Directions for Future Research............................................................................ 271
Nurse Healer Reflections ...................................................................................... 271
VISION OF HEALING—Building a Healthy Environment ............................ 273
Chapter 12 Environment ............................................................................................................ 275
Lynn Keegan
Nurse Healer Objectives ...................................................................................... 275
Definitions ................................................................................................................ 275
Theory and Research ............................................................................................ 276
Holistic Caring Process ........................................................................................ 295
Directions for Future Research............................................................................ 301
Nurse Healer Reflections ...................................................................................... 301
VISION OF HEALING—Sharing Our Healing Stories.................................... 305
Chapter 13 Cultural Diversity and Care ................................................................................ 307
Joan C. Engebretson and Judith A. Headley
Nurse Healer Objectives ...................................................................................... 307
Definitions ................................................................................................................ 307
Theory and Research ............................................................................................ 308
Nursing Applications for Developing Cultural Competency...................... 325
Holistic Caring Process ........................................................................................ 327
Directions for Future Research............................................................................ 333
Nurse Healer Reflections ...................................................................................... 334
Resource List............................................................................................................ 334
CORE VALUE 5—HOLISTIC CARING PROCESS...................................................................... 337
VISION OF HEALING—Working with Others .................................................. 339
Chapter 14 The Holistic Caring Process ................................................................................ 341
Pamela J. Potter and Cathie E. Guzzetta
Nurse Healer Objectives ...................................................................................... 341
Definitions ................................................................................................................ 342
Theory and Research ............................................................................................ 342
Holistic Caring Process ........................................................................................ 347
Conclusion .............................................................................................................. 370
Directions for Future Research............................................................................ 370
Nurse Healer Reflections ...................................................................................... 372
VISION OF HEALING—Actualization of Human Potentials ........................ 377
Chapter 15 Self-Assessments: Facilitating Healing in Self and Others ........................ 379
Lynn Keegan and Barbara Montgomery Dossey
Nurse Healer Objectives ...................................................................................... 379
Definitions ................................................................................................................ 379
Circle of Human Potential .................................................................................... 379
Self-Assessments.................................................................................................... 380
Development of Human Potentials .................................................................... 387
Affirmations ............................................................................................................ 391
Conclusion .............................................................................................................. 391
Directions for Future Research............................................................................ 392
Nurse Healer Reflections ...................................................................................... 392
VISION OF HEALING—Changing Outcomes .................................................. 395
Chapter 16 Cognitive Therapy.................................................................................................. 397
Eileen M. Stuart-Shor and Carol L. Wells-Federman
Nurse Healer Objectives ...................................................................................... 397
Definitions ................................................................................................................ 397
Theory and Research ............................................................................................ 398
Cognitive Therapy.................................................................................................. 402
Holistic Caring Process ........................................................................................ 418
Directions for Future Research............................................................................ 423
Nurse Healer Reflections ...................................................................................... 423
VISION OF HEALING—Healthy Disclosure...................................................... 427
Chapter 17 Self-Reflection: Consulting the Truth Within .................................................. 429
Lynn Rew
Nurse Healer Objectives ...................................................................................... 429
Definitions ................................................................................................................ 429
Theory and Research ............................................................................................ 429
Holistic Caring Process ........................................................................................ 435
Directions for Future Research............................................................................ 444
Nurse Healer Reflections ...................................................................................... 445
VISION OF HEALING—Nourishing the Bodymind ........................................ 449
Chapter 18 Nutrition .................................................................................................................... 451
Susan Luck
Nurse Healer Objectives ...................................................................................... 451
Definitions ................................................................................................................ 451
Theory and Research ............................................................................................ 452
Eating to Promote Health...................................................................................... 461
Healthy Choices in Nutrition .............................................................................. 467
Holistic Caring Process ........................................................................................ 468
Directions for Future Research............................................................................ 472
Nurse Healer Reflections ...................................................................................... 472
VISION OF HEALING—Moving Through Strength ........................................ 477
Chapter 19 Exercise and Movement........................................................................................ 479
Beryl H. Cricket Rose and Lynn Keegan
Nurse Healer Objectives ...................................................................................... 479
Definitions ................................................................................................................ 479
Theory and Research ............................................................................................ 480
Holistic Caring Process ........................................................................................ 485
Directions for Future Research............................................................................ 491
Nurse Healer Reflections ...................................................................................... 491
VISION OF HEALING—Releasing the Energy of the Playful Child............ 495
Chapter 20 Humor, Laughter, and Play: Maintaining Balance in a Serious World .... 497
Patty Wooten
Nurse Healer Objectives ...................................................................................... 497
Definitions ................................................................................................................ 497
Theory and Research ............................................................................................ 497
Holistic Caring Process ........................................................................................ 510
Directions for Future Research............................................................................ 516
Nurse Healer Reflections ...................................................................................... 516
VISION OF HEALING—Creating Receptive Quiet ........................................ 521
Chapter 21 Relaxation: The First Step to Restore, Renew, and Self-Heal...................... 523
Jeanne Anselmo
Nurse Healer Objectives ...................................................................................... 523
Definitions ................................................................................................................ 523
Theory and Research ............................................................................................ 524
Meditation ................................................................................................................ 528
Modern Relaxation Methods................................................................................ 536
Holistic Caring Process ........................................................................................ 553
Directions for Future Research............................................................................ 560
Nurse Healer Reflections ...................................................................................... 560
VISION OF HEALING—Modeling a Wellness Lifestyle ................................ 565
Chapter 22 Imagery: Awakening the Inner Healer.............................................................. 567
Bonney Gulino Schaub and Barbara Montgomery Dossey
Nurse Healer Objectives ...................................................................................... 567
Definitions ................................................................................................................ 567
Theory and Research ............................................................................................ 568
Clinical Techniques in Imagery ........................................................................ 575
Holistic Caring Process ........................................................................................ 581
Directions for Future Research............................................................................ 610
Nurse Healer Reflections ...................................................................................... 610
VISION OF HEALING—Composing the Harmony .......................................... 615
Chapter 23 Music Therapy: Hearing the Melody of the Soul ............................................ 617
Cathie E. Guzzetta
Nurse Healer Objectives ...................................................................................... 617
Definitions ................................................................................................................ 617
Theory and Research ............................................................................................ 617
Holistic Caring Process ........................................................................................ 627
Directions for Future Research............................................................................ 636
Nurse Healer Reflections ...................................................................................... 636
VISION OF HEALING—Using Our Healing Hands ........................................ 641
Chapter 24 Touch: Connecting with the Healing Power .................................................... 643
Lynn Keegan and Karilee Halo Shames
Nurse Healer Objectives ...................................................................................... 643
Definitions ................................................................................................................ 643
Theory and Research ............................................................................................ 644
Touch Interventions and Techniques................................................................ 651
Holistic Caring Process ........................................................................................ 656
Directions for Future Research............................................................................ 664
Nurse Healer Reflections ...................................................................................... 665
VISION OF HEALING—Accepting Ourselves and Others ............................ 667
Chapter 25 Relationships .......................................................................................................... 669
Dorothea Hover-Kramer
Nurse Healer Objectives ...................................................................................... 669
Definitions ................................................................................................................ 670
Theory and Research ............................................................................................ 670
Holistic Caring Process ........................................................................................ 677
Conclusion .............................................................................................................. 687
Directions for Future Research............................................................................ 687
Nurse Healer Reflections ...................................................................................... 688
VISION OF HEALING—Releasing Attachment................................................ 691
Chapter 26 Dying in Peace ........................................................................................................ 693
Melodie Olson and Barbara Montgomery Dossey
Nurse Healer Objectives ...................................................................................... 693
Definitions ................................................................................................................ 693
Theory and Research ............................................................................................ 693
Holistic Caring Process ........................................................................................ 697
Directions for Future Research............................................................................ 716
Nurse Healer Reflections ...................................................................................... 717
VISION OF HEALING—Nourishing Wisdom .................................................... 719
Chapter 27 Weight Management Counseling ...................................................................... 721
Sue Popkess-Vawter
Nurse Healer Objectives ...................................................................................... 721
Definitions ................................................................................................................ 721
Theory and Research ............................................................................................ 722
Holistic Caring Process ........................................................................................ 738
Directions for Future Research............................................................................ 752
Nurse Healer Reflections ...................................................................................... 752
VISION OF HEALING—Acknowledging Fear.................................................. 757
Chapter 28 Smoking Cessation: Freedom from Risk .......................................................... 759
Christine Anne Wynd and Barbara Montgomery Dossey
Nurse Healer Objectives ...................................................................................... 759
Definitions ................................................................................................................ 759
Theory and Research ............................................................................................ 759
Holistic Caring Process ........................................................................................ 766
Directions for Future Research............................................................................ 776
Nurse Healer Reflections ...................................................................................... 777
VISION OF HEALING—Changing One’s World View.................................... 781
Chapter 29 Addiction and Recovery Counseling ................................................................ 783
Bonney Gulino Schaub and Barbara Montgomery Dossey
Nurse Healer Objectives ...................................................................................... 783
Definitions ................................................................................................................ 783
Theory and Research ............................................................................................ 784
Vulnerability Model of Recovery from Addiction .......................................... 788
Holistic Caring Process ........................................................................................ 799
Directions for Future Research............................................................................ 807
Nurse Healer Reflections ...................................................................................... 808
VISION OF HEALING—Recovering and Maintaining the Self.................... 811
Chapter 30 Incest and Child Sexual Abuse Counseling.................................................... 813
E. Jane Martin
Nurse Healer Objectives ...................................................................................... 813
Definitions ................................................................................................................ 813
Theory and Research ............................................................................................ 814
Holistic Caring Process ........................................................................................ 817
Directions for Future Research............................................................................ 825
Nurse Healer Reflections ...................................................................................... 825
VISION OF HEALING—Healing Through the Senses .................................... 827
Chapter 31 Aromatherapy.......................................................................................................... 829
Jane Buckle
Nurse Healer Objectives ...................................................................................... 829
Definitions ................................................................................................................ 829
History ...................................................................................................................... 830
Theory and Research ............................................................................................ 830
Conclusion .............................................................................................................. 840
Holistic Caring Process ........................................................................................ 841
Directions for Future Research............................................................................ 848
Nurse Healer Reflections ...................................................................................... 848
VISION OF HEALING—Nursing Voices of St. Charles Medical Center...... 853
Chapter 32 Relationship-Centered Care and Healing Initiative in a Community
Hospital ................................................................................................................ 857
Nancy Moore
Nurse Healer Objectives ...................................................................................... 857
Definitions ................................................................................................................ 857
Theory and Research ............................................................................................ 857
About St. Charles.................................................................................................... 858
Life Skills .................................................................................................................. 864
Life-Death Transition ............................................................................................ 866
Arts in the Hospital ................................................................................................ 871
Healing Our Community ...................................................................................... 874
Principle-Based Care Model................................................................................ 876
Conclusion .............................................................................................................. 877
Directions for Future Research............................................................................ 880
Nurse Healer Reflections ...................................................................................... 880
VISION OF HEALING—Transformation of the Acute Health
Care Environment .............................................................................................. 883
Chapter 33 Exploring Integrative Medicine and the Healing Environment:
The Story of a Large Urban Acute Care Hospital ...................................... 885
Lori L. Knutson
Nurse Healer Objectives ...................................................................................... 885
Definitions ................................................................................................................ 885
Introduction.............................................................................................................. 885
Total Healing Environment Model: Large Urban Acute Care Hospital .... 886
Conclusion .............................................................................................................. 896
Directions for Future Research............................................................................ 896
Nurse Healer Reflections ...................................................................................... 896
Index.................................................................................................................................................... 899