كتاب الرعاية التمريضية الشاملة PDF

Faculty of Nursing, Beni -Suef University Holistic Health Care Prepared by Dr/ Sahar Sedky Faheim Assistant Professor Doctor of Pediatric Nursing Dr/Rasha ElSayed Ibrahim Assistant professor Doctor of Maternity Nursing Dr/...

Faculty of Nursing, Beni -Suef University Holistic Health Care Prepared by Dr/ Sahar Sedky Faheim Assistant Professor Doctor of Pediatric Nursing Dr/Rasha ElSayed Ibrahim Assistant professor Doctor of Maternity Nursing Dr/ Sahar Sayed Abd EL- Ghafar Lecturer of Community Health Nursing Faculty of nursing 2025 1  Content Topic 1- Overview of Holistic Health care and concepts 2. Holistic Health assessment 3. The Holistic Health care 4. The Holistic Caring for all body disease 5-Dimensions of Holistic Health 6-Healthy life style of Holistic Health 7-Ethical and of Holistic Health care practice 8-New trends in of Holistic Health 9--The Holistic Caring Process 10- Self-Assessment 11- Healthy Relationships 12- Focusing process: Holistic Health Care Tools for Nurses 2  The Holistic Caring Process Introduction The holistic caring process is not essentially different from the nursing process many nurses learned in school. However, the nursing process has come to represent something less than the whole encounter. Many think of the nursing process in terms of limited nursing care plans that focus on physiologic priorities of care and omit the important intangibles of practice, such as presence, hope, support, caring, and mutuality. Definitions Holistic caring process: A circular process that involves five steps.These steps are assessment, patterns/challenges/needs, outcomes, therapeutic care plan, implementation, and evaluation. Focused on establishing health and well-being, the holistic caring process represents the entire range of activities taking place within the nurse- person relationship. It is, quite simply, the process of nurse and client coming together in a professional interaction. Electronic health record (EHR): A patient care record in digital format. Purposes of nursing process: Providing professional, quality nursing care Directs nursing activities for health promotion, health protection, and disease prevention and is used by nurses in every practice setting and 3 specialty. Provides the basis for critical thinking in nursing. Steps of holistic caring process Holistic nurses need to remember that the nursing process is a framework that gives us the means to reflect on the entire range of nursing activities. These activities are usually described as the following steps: 1- Holistic Assessment -Holistic assessment is an important aspect of providing high quality care focused on meeting a patient's individual needs. -A holistic assessment is a collection of data about patient's physical, psychological, spiritual and social needs. The focus is on the patient as a whole – not just his illness. Components of holistic assessment: 4 1. Patient's self-assessment. 2. Patient history. 3. Patient's ability to communicate. 4. Patient's preference for the delivery of care. 5-Cultural and religious beliefs. 6-Language 1. Assessment During the first step of the process, the nurse works to understand the client’s condition and needs. They’ll do this by collecting various data points, such as the client’s health history, and using their critical thinking skills to collect observations. The types of nursing assessment data needed to complete this step include:  Objective data: These include vital signs, weight, pulse, intake, and output  Objective observations: These include skin color, the ability of the client to make eye contact, how easily they can get out of bed, and the sounds of the lungs.  Client data points: These subjective data points include the client’s current physical feelings — such as nausea — and The nurse can collect the information from primary, secondary, and tertiary sources. 5   Primary: The client is the primary source, and the nurse gathers information directly from them.  Secondary: Family members, friends, and health professionals who have worked with the client can provide secondary sources. Other sources include medical records, test results, and lab reports that can provide more detailed information about a client’s condition.  Tertiary: Tertiary sources might include textbooks or journals that provide an outside look at data points and data collection. 2. Diagnosis During the diagnoses as a part of the nursing process, a nurse combines all the collected data points. Then, they’ll use their experience, clinical judgment, and expertise to understand how the different points relate to each other so they can provide a nursing diagnosis. This diagnosis articulates the client’s needs and condition. These diagnoses follow Maslow’s Hierarchy of Needs, helping nurses understand how to help clients improve their overall health. Nurses use their diagnosis to guide them through the rest of the nursing process. 3- Planning 6  the holistic registered nurse develops a plan that identifies strategies and alternatives to attain outcomes. During the planning stage, nurses who use the holistic caring process help the person identify ways to re pattern her or his behaviors to achieve a healthier state. The planning process reveals interventions that will achieve outcomes. The plan outlines nursing interventions, which are the specific actions that the nurse performs to help the person solve problems and accomplish outcomes. Nursing interventions direct the implementation of care. A nursing intervention has been defined as ―any treatment, based upon clinical judgment and knowledge that a nurse performs to enhance patient or client outcomes. Holistic nursing interventions reflect acceptance of the person’s values, beliefs, culture, religion, and socioeconomic background. Any revision of the care plan reflects the person’s current status or ongoing changes. This plan is documented in the person’s record. During the planning portion of the process, the nurse organizes their thoughts and ideas about the actions they’ll take to treat the client. It’s important to note that planning is an ongoing portion of the nursing process. There is an initial planning stage, conducted immediately after evaluating the client. Then, there are the ongoing planning stages of the nursing process, which the nurse conducts as they care for the client. They will need to: 7   Watch how the client’s condition changes in response to their care.  Decide where to focus their attention on a given day.  Set evolving goals based on the client’s progress The biggest thing is that the goals set by nurses should be SMART. A SMART goal is:  Specific  Measurable  Attainable  Realistic  Time-oriented 4- Implementation During the implementation stage, the nurse involved in client care puts the plan into action. Based on the diagnosis and plan outlined in the above steps of the nursing process, the nurse predetermines medical nursing interventions that will help the client achieve their goals. This process often involves informing the client about their care (and why they’re receiving it) so they can better articulate whether the interventions work. The interventions taken by nurses typically fall under a few different types of classifications: 8   Interventions designed to target client behavior: Behavioral interventions help adjust client behavior for better health outcomes, such as helping with stress management or encouraging exercise.  Interventions that help communities or families: These interventions help the client and those around them. This includes providing HIV education or helping family members better understand their loved one’s illness and how to care for them.  Interventions to help patients in a clinical setting: Nurses follow interventions to help clients receive the best possible care in the hospital. For example, they might help clients adjust positions to avoid bed sores  Interventions to promote safety: Nurses also keep clients safe and free of harm in the clinical care setting. For example, they may create a fall prevention plan or ensure that clients with allergies receive medication without allergic reactions.  Interventions to help patients physically: Interventions to improve the client’s physical health include inserting an IV or assisting the client with hygiene. ▪ Nurses who are guided by a holistic framework approach the implementation phase of care with an awareness that:- 1. People are active participants in their care; 2. Nursing care must be performed with purposeful, focused intention; 9 3. A person’s humanness is an important factor in implementation 5- Evaluation Finally, nurses will need to continually monitor and evaluate the success of interventions to ensure that they are effective. During the evaluation phase, nurses should compare the client outcomes they see with the desired outcomes they identified as goals during the planning stage. This means nurses should regularly reassess clients to determine whether they need to adjust the plan. The holistic registered nurse evaluates progress toward attainment of outcomes while recognizing and honoring the continuing holistic nature of the healing process. Evaluation is a planned review of the nurse– person interaction to identify factors that facilitate or inhibit expected outcomes. Within the holistic caring process, evaluation is a mutual process between the nurse and the person receiving care. The goal of evaluation is to determine if outcomes have been successful and, if so, to what extent. The nurse, person, family, and other members of the healthcare team all participate in the evaluation process. Documenting the Holistic Caring Process ▪ Most nurses are familiar with nursing care plans as tools to document all of the activities included in the nursing process. 11 ▪ These care plans can be formal and lengthy such as those most students prepare in school to illustrate their thinking patterns for faculty preceptors or may be very brief identifications of needs and interventions on a computer system used in a busy acute care unit. ▪ The nursing care plan is a means to document that, based on nursing assessment data, a particular nursing concern (nursing diagnosis) was established and a plan (nursing orders) was prepared to address the concern. Self-Assessment Introduction Integrative Health and Wellness Assessment (IHWA) Holistic nurses use self- assessments and other strategies to assist individuals to learn how to prefer 11 wellness to unhealthy habits. They are assuming a leadership role in the health- and wellness coaching movement. Definition Self-assessment is the process of looking at oneself in order to assess aspects that are important to one’s identity. It is one of the motives that drive self- evaluation and self enhancement. The Integrative Health and Wellness Assessment (IHWA) wheel has eight components: (1) Life Balance and Satisfaction (2) Relationships (3) Spirituality (4) Mental (5) Emotional (6) Physical (Nutrition, Exercise, Weight Management) (7) Environmental (8) Health Responsibility They all are important components of the self that are interwoven and constantly interacting. The IHWA assists people in becoming aware of their human potentials in each of these categories, identifying strengths and weaknesses and considering and creating new health goals. Each individual body is in a constant state of change. Most of these internal energetic, hormonal, 12 biochemical checks and balances occur outside of any conscious awareness of what is taking place in the body. The Integrative Health and Wellness Assessment is best used as a personal assessment by the nurse or as a coaching tool with clients. The holistic nurse skillfully creates and holds space in which the client feels trust, respect, listened to, and not being judged. 1- Life Balance and Satisfaction Assessing our life balance and satisfaction strengthens our capacities and human potentials. Healing is recognizing our feelings, attitudes, and emotions, which are not isolated but which are literally translated into body changes. Everyone has the capacity to tap into this innate healing potential. Healing is more likely to occur on many levels when we attend to our life balance and satisfaction. During times of stress and crisis, focusing only on all the things that are wrong each day can block self healing. Therefore, it is necessary for us to continually assess and reassess our wholeness, which includes attention to stress management, time management, and adequate sleep. Recognizing and celebrating the joys and good things in life add to experiencing life balance and satisfaction. Assessing our life balance and satisfaction acknowledges our capacity for both conscious and unconscious choices in our lives. 2- Relationships 13 Healthy people live in complex networks of relationships. Learning how to understand and nurture our relationships assists us in creating and sustaining meaningful relationships. A healthy person cannot live in isolation. In a given day, we interact with many people: immediate family, extended family, colleagues at work, neighbors in the community, numerous people in organizations, and now, through the ever expanding web of electronic connection, friends, colleagues, and others around the world. Relationships have different levels of meaning, from the superficial to the deeply connected. The challenges in relationships are multifaceted. First, we need to recognize what we personally are hoping for, and what we are bringing to the variety of relationships we engage in. Many, if not most, people spend at least half of their waking hours at work with colleagues. Within the context of a work environment we need to support and nourish these relationships as well. 3- Spirituality Spirit is a vital element and driving force in how we live our lives. It affects every aspect of our life balance and satisfaction and effects the degree to which we develop our human potentials. Spirituality is considered to involve a sense of connection with an absolute spiritual force. It includes the conviction that ethical values, direction, meaning, and purpose are valid aspects of the individual and universe. 14 It is the essence of a human being that permeates all of life and is manifested in one’s knowing, doing, and being. Transcendent is not necessarily synonymous with religion. Spirit involves the development of our higher self, also referred to as the transpersonal self. A transpersonal experience is described as a feeling of oneness, inner peace, harmony, wholeness, and connection with the universe. The meaning and joy that flow from developing this aspect of our human potential allow us to have a transpersonal view. Some of the ways we may come to know this transcendence are through prayer, meditation, organized religion, philosophy, science, poetry, music, inspired friends, and group work. 4- Mental Assessing our mental capacity helps us examine our belief systems. In our early life, we had role models who influenced our beliefs, thoughts, behaviors, and values. With maturity and as a result of life experiences we begin to recognize shifts that occur in regard to these same beliefs, thoughts, behaviors, and values. We may experience conflicts when we do not take the time to examine our changing perspectives, beliefs, and values. Our challenge is to use our cognitive capacities to perceive the world with greater clarity. Through both logical and non-logical mental processes, we become aware of a broad range of subjects that enhance our full appreciation of the many great pleasures in life. We can also build our capacity to notice, process, and integrate both logical thought and intuitive awareness. With interventions such as relaxation and 15 imagery, We can notice and release the self-judging and critical inner voice that is constantly engaging in self-dialogue. We become more capable of focusing our attention away from fear and negative thoughts, and become more open and receptive to life information's. In this way, mental growth can occur. Every aspect of our life is a learning experience and becomes part of a lesson in change 5- Emotional Emotions are responses to the events in our lives. We are living systems that are constantly exchanging with our environment. All life events affect our emotions and general well-being. We have the potential to lessen varying degrees of chronic anxiety, depression, worry, fear, guilt, anger, denial, failure, or repression, and experience true healing, when we are willing to confront our emotions. As we start to live in a more balanced way, we allow our humanness to develop. Increasing emotional potential allows openness, creativity, and spontaneity to be experienced. This contributes to the emergence of a positive, healthy willing for living. Emotions are aid. Frequently, a first step toward releasing a burden in a relationship is to share deep feelings with another. There is no such thing as a good or bad emotion; each is part of the human condition. Emotions exist as the light and shadow of the self; thus, we must acknowledge all of them. The only reason that we can identify the light is that we know its opposite. 16 6- Physical When a person’s basic biological needs for food, shelter, and clothing have been met, there are many ways to seek wholeness of physical potential. Assessing our physical potential includes many elements with three major areas being nutrition, exercise, and weight management. Health is more than just physical and the absence of pain and symptoms, and it is present when there is balance. As we assess biological needs, we also must take into consideration our perceptions of these areas. Many illnesses have been documented as stress related because our consciousness plays a major role in health and physical potential. Our body is a gift to nurture and respect. As we nurture ourselves, we increase our energy, sexuality, vitality, capacity for language, and connection with our other potentials. This nurturance strengthens our self-image, which in turn causes several things to happen First, our body-mind-spirit responds in a positive and integrated fashion. Second, we become a role model with a positive influence on others. Finally, we actually enhance our general feeling of well-being. The resulting effect is a greater sense of balance and an openness to more fully realized potentials. 7- Environmental The environment is the context or habitat within which all living systems participate and interact. it includes both the external physical space and a 17 person’s internal space (physical, psychological, cultural, mental, emotional, social, and spiritual experiences). Healing environment includes everything that surrounds the nurse, healthcare practitioner, and the patient. If there is a suspicion about a harmful environment or substance, even though all of the evidence is not in, remove the person from the situation or stop the use of suspected harmful substances. The emphasis is on zero contamination and pollution of our environments as acceptable. 8- Health Responsibility Health responsibility occurs when an individual takes an active role in making lifestyle choices to protect and improve his or her health. In health care, we may hear that a patient is noncompliant with medical orders. This is often a misnomer because there are many reasons why an individual may not follow medical recommendations. The following are common reasons for this “noncompliance”: - Too much information given at one time; - Lack of fully understanding the recommendations and having unanswered questions; -language barriers or cognitive limitations; fear; denial; previous lack of commitment or lack of success (e.g., weight management, smoking cessation); -Financial constraints; -Lack of support from significant others. 18 -In addition, inadequate amount of time for effective patient education in clinics, doctors’ offices, hospitals when providing discharge information. Healthy Relationships Introduction Healthy relationships are a necessary part of healthy and successful living. Relationships enrich our lives and add to our enjoyment of being alive, but we all know that no relationship is perfect. Partners respect each other’s independence, can make their own decisions without fear of retribution or 19 retaliation, and share decisions. If or when a relationship ends, there is no stalking or refusal to let the other partner go. Meaning of healthy relationship Healthy relationships involve honesty, trust, respect and open communication between partners and they take effort and compromise from both people. There is no imbalance of power. A healthy relationship is centered on:  Empathy and kindness.  Reliability and commitment.  Mutual respect for boundaries.  The ability to work together as a team.  Similar values and goals. Characteristics of Healthy Relationships  Respect for privacy and space. You don’t have to be with your partner 24.  Your partner encourages you to spend time with friends without them, and to participate in activities that you enjoy.  You feel comfortable expressing your opinions and concerns to your partner.  Your feel physically safe and your partner don't force you to do things that make you feel uncomfortable.  Your partner respects your wishes and feelings and you can compromise and negotiate when there are disagreements or conflicts. 21 The foundation of a healthy relationship includes:  Boundaries: You and your partner are able to find ways to meet each other’s’ needs in ways that you both feel comfortable with.  Communication: You and your partner can share your feelings, even when you don’t agree, in a way that makes the other person feel safe, heard, and not judged.  Trust: Building trust can take time and allows couples to be vulnerable with one another knowing that they can rely on the other person.  Consent: Most commonly used when you’re being sexually active, giving consent means that you are okay with what is happening, and that no one is forcing you or guilting you into doing anything that you don’t want to do. Consent can be given and taken back at any time, and giving consent once does not mean you automatically give consent in the future. Factors that contribute to the development and maintenance of healthy relationships including:  commitment;  trust;  respect;  Responsibility. Commitment All relationships require a level of commitment. Each relationship is different, but you will likely show your commitment by:  sharing financial burdens; 21   making decisions together; Trust and respect All relationships require an element of trust, it is an essential part of bonding with others. Trust means sharing your thoughts and feelings. A relationship without trust is at risk of disagreements, suspicion and ultimately, breaking apart. Respect is essential in all relationships - brother, sister, parents, friends or partner. So much of life is shared with our family, friends and eventually our partner that it’s easy to show disrespect even when you think you’re not. You might make fun of your friend or family member's attitudes or beliefs without realising that you have hurt them. More seriously, you might treat them in a way that doesn’t value them as a person. That attitude can lead to an abusive relationship. Responsibility Being responsible means being honest about what you have said or done and being willing to face the consequences. Doing so consistently will win you respect and loyalty. 22 It’s not always easy. Taking responsibility in a relationship might mean changing your behaviour to fit with your friends, your family or your partner. Unhealthy relationships The signs of an unhealthy relationship are easy to spot. People stop communicating, become less close, argue more frequently and show less love and respect for each other. There are many reasons that a relationship might break down. Often it has to do with the personalities, attitudes and behaviours of the individuals. Other causes come from outside the relationship. There are many ways to deal with or improve an unhealthy relationship - we could try listening more to others and become more aware of their needs. We could examine our own behaviour honestly and try to identify aspects of it which is causing conflict with others. However, the best way to improve an unhealthy relationship between partners is by getting advice. The effects of unhealthy relationships It can be very damaging to your mental health if other people are disrespectful, don’t encourage you, and undermine your trust. 23 You may suffer low self-esteem or depression, which may affect all aspects of life. A poor relationship may harm your connections to other people. For example, in an unhealthy romantic relationship, your partner may try to control who you can see and speak to. This may harm your ability to maintain a healthy relationship with friends and family. All unhealthy relationships are stressful. They may lead to unhealthy behaviours such as smoking, drinking and drugs. They could lead to a loss of appetite, a change in appearance, weight loss, or a sleep disorder. Top tips on building and maintaining healthy relationships Building and maintaining healthy relationships is an important part of looking after our mental health. Here are 6 top tips to support you with yours. 1. Get to know yourself Take the time to appreciate yourself and get in touch with your emotions to be able to express yourself clearly and more effectively. Not knowing how to regulate your emotions and express them healthily can negatively affect your mental wellbeing. 24 2. Put in the work Healthy relationships are not found but built. A healthy relationship needs commitment and willingness to be accommodating to each other’s needs. 3. Set and respect boundaries Setting boundaries is not only about what you don’t want or like in your relationships, but also about letting the people around you know what you appreciate. Think about and let others know where your boundaries are; respecting your time alone for example. Doing this can take the pressure off your relationship to commit to anything unrealistic. 4. Talk and Listen All relationships have disagreements and that’s ok. what matters is how you talk and listen to one another. Listen to understand, rather than listening to respond. Don’t be afraid to express your emotions or vulnerabilities with people you trust. 25 5. Let go of control A lot of life is about how we react to our experiences and encounters. Knowing that you can only really control what you do and not what anyone else does will save you time and stress. 6. Reflect and learn If you have a healthy way of expressing your feelings, you’re able to react to other people’s in a healthy way. Being angry with someone often comes from a place of feeling hurt and upset. if you can recognise that, you can communicate it, and build better relationships with others. Reflect on the relationships that work best in your life. Focusing process: Holistic Health Care 26  Tools for Nurses Introduction Listening and Focusing are invaluable skills for communicating and for reducing stress. They provide new opportunities for nurses to take better care of patients as well as themselves. While at first these new skills may seem consuming, with practice, you will find they are efficient and awkward or time effective tools for nursing. Active Listening allows you to hear your patients' concerns in an empathetic way, allaying their anxiety and building trust between you. Focusing allows you to go beneath words and rational explanations, and attain new levels of awareness within your body. Focusing process The Focusing process is not only useful for patients; it is a method that nurses can use to reduce their own stress. One can practice Focusing alone, but it is easier in the beginning to do it with a partner. Reducing Stress through Focusing Dealing With a Stressful Medical Environment Both nurses and patients find the medical environment stressful. Nurses, on the front line of medical care, have constant demands on them which sometimes cause them to engage in unhealthy life choices. As a result, they frequently need to take better care of themselves. Focusing can help nurses cope with professional and personal overload 27 Clearing a Space -The first step of Focusing, called "Clearing a Space", involves taking an inventory of the stressors one is carrying, so they can be "cleared out" of the body. -After each stressor is removed, one can notice the beneficial effect, a distinct This process is more useful than trying to work with the entire.sense of release complex of issues, all tangled up together. -One finds that there is an actual physical release in moving each stressor out of the body. This is accomplished by imagining that one is putting each concern or problem at a distance, such as in a drawer, or in a box placed at the right distance away from you, or on a boat while one imagines sitting on a beach Sometimes the sense of release is sufficient for the moment; sometimes an immediate action step is necessary While it is possible to "clear a space" by yourself, it is easier in the beginning to have a partner Listener: Allow yourself to become relaxed and wait and see what problems or issues come up for you. Let's take an inventory. Focusing as a Coping Strategy -A person who is sick must adapt to the challenges that arise during diagnosis and treatment. He or she must also find ways to deal with the unpredictability and vulnerability that illness evokes. - Focusing empowers a person to create new ways of adapting to difficult The situation. Focusing can be used as an effective coping strategy when patient is experiencing pain and/or /discomfort. Through Focusing one can get 28 distance from the pain, can hear from it, or befriend it. -sense how the body would be without pain, and work compassionately with the feelings accompanying the pain, such as anger, disappointment, or helplessness. In a single case study of pain management in a child, Focusing along with guided imagery, was shown to be a useful approach., Focusing helps a patient to get a body sense of which decision feels righ. promotes acceptance and acknowledgement of the fearful and anxious place inside. 29  Dimensions of Holistic Care Holistic health is an approach to well-being that emphasizes the interconnectedness of all aspects of a person’s life. Rather than just focusing on physical health or treating symptoms of illness, holistic health addresses the whole person—body, mind, spirit, and emotions—recognizing that these dimensions are interdependent. The goal is to achieve a balanced and harmonious state, promoting overall wellness rather than merely the absence of disease. The holistic health dimensions: is built on several key dimensions, each contributing to an individual's overall well-being: 1- Physical Health: This dimension refers to the state of the body and its functions. It includes regular exercise, proper nutrition, sleep, …etc 31 Physical health:  Weight and height  Mobility  Disability  Physical injuries and illness  Nutrition  Consciousness  Presenting with complaints  Sleep  Rest  Family medical history Healthy habits for physical wellness:  Eat a nutrient- diet.  Exercise every day., , practice yoga, or simply go for a walk. But be sure to get your body moving for at least 15 minutes a day.  Get quality sleep. This means getting an adequate amount of sleep and avoiding stimulants. Sleep is an important part of the body’s healing process.  Limit intake of caffeine. 2-Spiritual health: relates to a sense of purpose, meaning, and connection to something greater than oneself, whether through religion, philosophy, or a personal sense of purpose. It can be nurtured through practices like meditation, mindfulness, or a connection with nature. Spiritual wellbeing: 31   Religion-Impact care? Choice of gender medical professional.  Child age,  Culture,  Cultural values,  Individual belief 3- Mental health, while intertwined with our emotional health, refers to cognitive functioning. A healthy mental state is not merely the absence of illness. Stress and anxiety are part of daily life; it is our ability to handle situations and use them to our advantage that sets those with sound mental health apart from those who do not. Mental Health: This dimension focuses on cognitive functions such as thinking, learning, and decision-making. Mental well-being includes maintaining clarity of thought, mental resilience, and engaging in activities that stimulate the mind, such as problem-solving, creativity, and learning. Mental health  Cognitive ability  Emotional status  Learning disabilities  Trauma  Postnatal depression  Length of health care stay  Preparing for discharge  Impact of new diagnosis  Anxiety  Feelings 32 4- Emotional health: involves the ability to manage and express one’s emotions in a healthy way. It includes self-awareness, emotional intelligence, stress management, and fostering positive relationships. Addressing emotional health helps individuals cope with challenges and maintain balance in their lives. 5) Social health: The social dimension focuses on relationships and interactions with others. Positive social connections, strong support systems, and healthy communication skills are essential for emotional well-being and overall happiness. Social health:  Language  Interests and hobbies  Relationship/friends/family  Socioeconomic status  Education:  Communication needs  Family structure: who do they live with  Need for safeguarding: look after of children. Social health refers to our ability to maintain healthy relationships, develop intimate connections with others, and allow others to care about us. Healthy habits for social wellness:  Make at least one genuine connection with a friend or loved one each day. 33  Get involved in your local community.  Set healthy boundaries with people in your life. 6- Environmental Health: This dimension involves the surroundings in which a person lives. A clean, safe, and healthy environment—whether at home, at work, or in nature—has a profound impact on physical and emotional health. Environmental health encourages sustainable practices that protect both the individual and the planet. 7-Occupational Health: Occupational well-being refers to finding fulfillment in one’s work or daily tasks. A satisfying career or sense of purpose in daily responsibilities can significantly impact a person’s mental and emotional health. It also includes maintaining a balance between work and personal life. ***Holistic health recognizes that true well-being comes from the balance and integration of all these dimensions. Rather than focusing on a single aspect, it promotes a comprehensive approach to health, addressing the physical, emotional, mental, spiritual, and social factors that together contribute to a person's overall wellness. By adopting this holistic perspective, individuals can enhance their quality of life, prevent illness, and achieve greater health and happiness. 34  Healthy life style of Holistic Health The overall well-being include prioritizing balanced nutrition, regular exercise, stress management, quality sleep, and mindfulness, you can nurture your body, mind, and spirit. Unlike merely treating symptoms, this approach delves deeper by providing solutions to the root causes of health issues. Nutrition, a crucial component of holistic health, nourishes the body and supports overall well-being. In essence, holistic health and nutrition involve nurturing the physical body, mind, and soul. A healthy lifestyle that promotes holistic health focuses on the overall well- being of the body, mind, and spirit. It encompasses physical, emotional, mental, social, and spiritual health, all of which are interconnected. 35 The Connection between Nutrition and Holistic Health: The Body The food, nutrients and energy we put in our body is vital for the physical health of our body - both short and long term. The importance of food:  Provides us with energy.  Provide us with essential nutrients  Ensures that our bodies and all its organs work as supposed.  Contribute to normal growth and development  Prevent disease  Increases productivity and performance ***The Mind Mental health status and nutritional intake is connected. Increase a healthy, nutritious diet can lead to: Increase mental wellbeing  Decrease the risk of mental illness and diseases such as Alzheimer’s, depression and dementia  Sprit :Food and meals are large part of our culture, feelings and social life *** Healthy relationship towards food: We need food to live our life; we should not focus on living our life just to eat. Holistic health recognizes that all areas of life are interconnected, and balance in each can lead to a more fulfilling, healthy existence. Here's how you can incorporate holistic principles into your daily routine: 36  Nutrition: Eating a balanced diet that includes whole foods like fruits, vegetables, whole grains, lean proteins, and healthy fats is essential. Focus on nutrient-dense foods that fuel your body and support immunity.  Hydration: Drinking plenty of water throughout the day to keep your body hydrated and support optimal function.  Exercise: Regular physical activity, such as walking, yoga, strength training, or dancing, helps maintain physical fitness, improves cardiovascular health, boosts energy levels, and reduces stress.  Sleep: Aim for 7-9 hours of quality sleep each night. Proper rest is crucial for physical recovery, mental clarity, and emotional well-being.  Balance and Rest: Work-Life Balance: Maintaining a balance between your work, personal life, and leisure is essential for long-term health. Set boundaries and prioritize downtime to avoid burnout. Nutrition for Holistic Health emphasizes a balanced approach to diet that supports overall well-being—mind, body, and spirit. This concept goes for fueling the body and focuses on nourishment that promotes long-term health, vitality, and a sense of well-being. Nutrition can be aligned with holistic health principles: 1. Whole Foods  Focus on whole, unprocessed foods such as fruits, vegetables, whole grains, nuts, seeds, legumes, and lean proteins.  These foods are rich in vitamins, minerals, antioxidants, and fiber, which help support bodily functions and reduce inflammation,  Seasonal, local, and organic foods are often prioritized, as they are fresher and free of harmful pesticides. 37 2. Balanced Macronutrients  A holistic approach to health includes proper balance among carbohydrates, proteins, and fats.  Carbohydrates: Choose complex carbs like whole grains (brown rice, quinoa, oats), vegetables, and legumes to maintain stable energy levels.  Proteins: Include both plant-based proteins (beans, lentils, tofu) and high- quality animal proteins (lean meat, fish, eggs) to support muscle repair and immune function.  Healthy Fats: Include sources of omega-3 fatty acids like fish, flaxseeds, chia seeds, walnuts, and avocados to support brain health and reduce inflammation. 38 3. Micronutrients  Vitamins and minerals: A variety of colorful fruits and vegetables ensures that you get a wide array of essential vitamins (like vitamin C, A, and K) and minerals (like magnesium, potassium, and calcium).  Consider herbs and spices like turmeric, ginger, garlic, and cayenne for their anti-inflammatory and detoxifying benefits. 4. Gut Health  The gut microbiome is essential for overall health, influencing digestion, immunity, and even mood. Foods like probiotics (yogurt, kefir, kimchi) and prebiotics (garlic, onions, bananas, whole grains) support a healthy gut flora.  Reducing processed foods and excessive sugar helps prevent dysbiosis (imbalance of gut bacteria), which is linked to numerous chronic health conditions. 5. Mindful Eating 39  Holistic nutrition emphasizes mindful eating—slowing down and paying attention to what and how we eat. This helps improve digestion and helps with portion control.  It also encourages positive relationships with food, where eating becomes an act of self-care rather than guilt. Hydration  Proper hydration is crucial for bodily functions, including digestion, circulation, and cognitive performance. Aim to drink plenty of water throughout the day and consider herbal teas for additional benefits. Emotional and Psychological Nourishment  Nutrition for holistic health includes taking care of the emotional and psychological aspects of eating. Food can provide comfort, but it's essential to focus on developing a healthy relationship with food to avoid emotional eating or food-related guilt.  Practices like gratitude before meals can help foster positive feelings toward eating, as well as reduce stress. Detoxification and Cleansing  Natural detoxification can be supported through foods that are rich in antioxidants and fiber. These help the body naturally eliminate toxins and reduce the burden on the liver and kidneys.  Examples include green leafy vegetables, lemons, apples, and cruciferous vegetables (like broccoli and cauliflower), which aid in liver function and detox. 41 Personalized Nutrition  Everyone's body responds differently to foods, so holistic health emphasizes finding what works best for you. This may involve working with a healthcare professional or nutritionist to tailor a diet based on individual needs, such as food sensitivities, allergies, and lifestyle factors. Sustainable and Ethical Choices  A holistic approach to nutrition also considers the ethical and environmental impact of food choices. Supporting sustainable farming practices, reducing food waste, and consuming more plant-based foods can promote not just personal health but also the health of the planet. 41  Exercise and Holistic health Holistic health is a comprehensive approach to well-being, encompassing the physical, mental, emotional, and spiritual aspects of a person. Exercise for holistic health should aim to improve the overall balance of these dimensions. Below are some exercises and practices that can support holistic health. Holistic exercise isn't just about physical fitness but fostering balance in all areas of your life. Combining movement with mindfulness and relaxation techniques can enhance your well-being on multiple levels. 42 1. Yoga Yoga is a powerful practice that integrates the body, mind, and spirit. It promotes flexibility, strength, and relaxation, while also enhancing mental clarity and emotional stability. There are different styles of yoga:  Hatha Yoga: Focuses on physical postures (asanas) and breathing (pranayama) to cultivate balance and relaxation.  Vinyasa Yoga: A flowing sequence of movements tied to breath, often considered more dynamic.  Restorative Yoga: Gentle, calming, and focused on deep relaxation, ideal for stress relief. Benefits:  Improves flexibility and strength  Enhances mental clarity and reduces stress  Supports emotional balance and mindfulness 2. Tai Chi or Qigong Both Tai Chi and Qigong are ancient Chinese practices that focus on slow, flowing movements, breath control, and meditation. These exercises balance the body's energy (qi) and promote a sense of calm. Benefits:  Enhances balance and coordination  Reduces stress and anxiety  Improves circulation and internal energy flow 43 Recommended Practice: Practice slow, flowing movements in a calm, focused environment. Focus on maintaining a relaxed state, coordinating your breath with your movements. 3. Walking or Hiking in Nature Spending time outdoors can positively impact mental and emotional well-being. Walking or hiking in nature helps you connect with your surroundings, breathe fresh air, and clear your mind. Benefits:  Improves cardiovascular health  Boosts mood and reduces anxiety  Promotes mindfulness and relaxation 4. Strength Training (Bodyweight Exercises or Light Weights) Strength training is important for maintaining muscle mass, bone health, and overall fitness. Focus on using functional movements like squats, lunges, push- ups, and planks. These exercises also promote mental discipline and self- confidence. Benefits:  Builds muscle and improves metabolism  Increases bone density  Enhances mental focus and resilience 44 Recommended Practice: Incorporate functional strength exercises, like squats, lunges, and push-ups, using bodyweight or free weights. Focus on building strength with intention and awareness of your body’s capabilities. 5. Breathing Exercises (Pranayama) Breathing exercises, like those practiced in yoga, can help calm the nervous system, reduce stress, and enhance mental clarity. Simple techniques like deep belly breathing or alternate nostril breathing can be very effective. Benefits:  Reduces stress and anxiety  Improves lung capacity and oxygen flow  Enhances mental focus and emotional well-being 6. Mindful Stretching Incorporating mindful stretching into your routine encourages body awareness and helps release physical and mental tension. Focus on slow, controlled movements while paying attention to how your body feels in each stretch. Benefits:  Increases flexibility and range of motion  Promotes relaxation and stress relief  Enhances mindfulness and body connection 7. Meditative Movement Dance or Free Movement 45 Dancing is an expressive and fun way to improve cardiovascular health and engage emotionally. Whether it's structured or free-flowing dance, moving to music allows you to release emotions and enhance joy. Benefits:  Enhances cardiovascular health  Improves mood and boosts endorphins  Supports emotional expression and release Recommended Practice: Engage in free-form dance or structured movement like Qigong. Let the music or flow of energy guide your movements, focusing on how your body feels. 8. Pilates Pilates focuses on strengthening the core muscles, improving posture, and promoting flexibility. It involves controlled movements and breath work that foster body-mind awareness. Benefits:  Improves core strength and posture  Enhances flexibility and body alignment  Fosters mental focus and mind-body connection 9. Meditation and Mindfulness Practice While not strictly an exercise, meditation complements physical activity by calming the mind, reducing stress, and fostering emotional resilience. Practices 46 like mindfulness, loving-kindness meditation, or guided visualization can support mental and emotional health. Benefits:  Reduces stress and enhances emotional regulation  Improves focus and mental clarity  Fosters a sense of inner peace and contentment Recommended Practice: Start with basic Pilates moves like The Hundred, Leg Circles, and Planks, paying close attention to proper form and alignment. 10. Swimming  Physical benefits: Full-body workout, improving cardiovascular health, muscle strength, and flexibility.  Mental benefits: Reduces stress, promotes relaxation, and clears the mind.  Emotional benefits: Soothing and grounding, promotes emotional balance.  Spiritual benefits: A deeply meditative experience, connecting the body with the water element. Recommended Practice: Swim at a moderate pace, focusing on your breath and the rhythm of the water. Try to maintain a relaxed, flowing stroke that complements your body’s natural movements. 10. Massage and Bodywork (e.g., Reiki, Shiatsu) 47   Physical benefits: Relieves muscle tension, improves circulation, and promotes relaxation.  Mental benefits: Clears mental blockages, reduces stress, and promotes calm.  Emotional benefits: Releases stored emotions and facilitates emotional healing.  Spiritual benefits: Aligns energy, promotes grounding, and enhances a sense of peace. Recommended Practice: Schedule regular sessions with a professional massage therapist or practice self-massage techniques, focusing on areas of tension. 48  Ethical and Holistic Health Care Practice Ethical and holistic health care practice is a philosophy of health care that integrates both moral principles and a comprehensive, whole-person approach to healing. It prioritizes not just the physical symptoms of a patient but also the emotional, mental, spiritual, and social aspects of their well-being. In doing so, it aims to provide care that respects individual dignity, promotes health, and supports long-term wellness. This kind of practice is grounded in ethical standards while emphasizing the interconnectedness of all aspects of health. 1. Ethical Principles in Holistic Health Care Ethics in health care refers to a set of moral principles or values that guide health care providers in making decisions that are in the best interest of patients. In a holistic health care context, these ethical principles may include: * Ethical principles: 1- Respect: you must respect pt.’s autonomy, dignity& liberty. 2- Beneficence: Is to do only good / non maleficent. "To do no harm" 3-Altruism: Is to protect the community by supporting actions, to meet the health and social need of the public. 4- Paternalism: Is to protect the weak person. 5- Veracity: Is the obligation to tell the truth. 6- Fidelity: Is the obligation to loyal to the pt. community and profession. 7- Justice: Is to be fair, and equitable to all patients Regardless of any service you want to give. 49  8- Egoism: Is the right to maximize personal benefits. 9- Nurses autonomy: the nurse must be autonomous which means: "Never looking up on another person" and has the right to self – determination. 10- Utilitarianism: Is the greatest good for the greatest members. 2. Holistic Approach to Health Care A holistic approach to health care considers the entire person—body, mind, and spirit—and acknowledges that these components are interconnected. Rather than focusing solely on treating the physical symptoms of an illness, holistic health care seeks to address the root causes of a health issue by considering the following:  Physical Health: This involves the traditional aspects of medicine, such as diagnosing and treating illness, managing chronic conditions, and encouraging preventive care through proper diet, exercise, and lifestyle modifications.  Emotional and Mental Health: Recognizing that mental and emotional well-being is crucial for physical health. A holistic health practitioner may use therapy, mindfulness practices, stress management techniques, and counseling to address issues like anxiety, depression, or trauma.  Spiritual Health: Spirituality is often seen as a component of holistic health, especially in practices that support the individual’s sense of purpose, meaning, and inner peace. This does not necessarily mean religious practices, but it can involve meditation, mindfulness, and finding meaning in life. 51   Social and Environmental Health: Acknowledging that an individual's social environment, community, relationships, and access to resources can impact health. Holistic practices often encourage the cultivation of supportive relationships and social connections. 3. Common Modalities in Holistic Health Care Several alternative or complementary therapies are commonly used in holistic health care. These therapies are used alongside conventional treatments to promote healing and wellness:  Acupuncture: A traditional Chinese medicine technique that involves inserting thin needles into specific points on the body to promote healing and balance.  Chiropractic Care: Focuses on diagnosing and treating musculoskeletal problems, particularly those related to the spine, through manual manipulation.  Massage Therapy: Used to reduce stress, improve circulation, and relieve muscle tension.  Herbal Medicine: The use of plants and plant-based substances to treat a wide range of health issues, from pain to digestive problems.  Nutrition and Diet Counseling: Focuses on providing advice on proper nutrition to promote healing, prevent disease, and improve overall health.  Mindfulness and Meditation: Techniques that promote mental clarity, emotional well-being, and stress reduction.  Yoga and Physical Therapy: Combines movement, breathing exercises, and mindfulness to improve flexibility, strength, and overall health. 51 4. Holistic Health Care and Preventive Care One of the key elements of a holistic health care practice is the emphasis on preventive care. Rather than waiting for illness to occur and then treating it, holistic health care practitioners focus on educating patients to maintain good health through:  Dietary changes to reduce the risk of chronic conditions like diabetes, heart disease, and obesity.  Exercise programs to promote cardiovascular health and strengthen the body.  Mental health care practices to reduce stress, promote emotional balance, and prevent burnout.  Regular screenings and check-ups to catch potential health issues before they become serious problems. 5. Challenges and Considerations in Holistic Health Care While holistic care can be beneficial, there are challenges and considerations that must be addressed:  Integration with Conventional Medicine: Many holistic treatments are used in conjunction with conventional medical treatments. The challenge is finding a balance between the two systems, especially when they may offer differing approaches to care.  Evidence and Research: Many holistic practices lack the same level of scientific evidence as conventional medicine. However, this is changing as more research is being conducted to validate holistic treatments. 52  Regulation and Licensing: Holistic health care practitioners often come from a variety of backgrounds, and the regulations surrounding their practice can vary widely depending on the jurisdiction.  Patient Education: A holistic approach often requires patients to take more responsibility for their own health and lifestyle choices. This can sometimes be a barrier for those who are unfamiliar with or resistant to non-traditional health practices. 53  New trends in holistic care Holistic nursing is an approach that treats the patient as a whole person, addressing physical, emotional, mental, and spiritual needs. This approach continues to evolve with a growing focus on integrating complementary therapies and personalized care to enhance well-being. Here are some key current trends in holistic nursing: 1. Integrating Complementary and Alternative Therapies  Mind-Body Practices: Holistic nurses are increasingly using practices such as meditation, yoga, mindfulness, and guided imagery to help patients manage stress, anxiety, and chronic conditions.  Herbal Medicine & Supplements: Nurses are incorporating evidence- based complementary therapies like herbal remedies, essential oils, and nutritional supplements to support healing.  Energy Healing: Techniques like Reiki and therapeutic touch are gaining traction as methods to promote healing by addressing imbalances in the body's energy system. 2. Focus on Preventative Care  Holistic nursing emphasizes proactive measures, focusing on prevention rather than just treating illness. Nurses are working with patients to implement lifestyle changes that promote health and prevent disease, including nutrition, exercise, stress management, and sleep hygiene.  Chronic Disease Management: Nurses are helping patients manage long-term conditions like diabetes, heart disease, and autoimmune 54  disorders through holistic strategies, blending conventional treatments with natural therapies for overall well-being. 3. Patient-Centered and Individualized Care  There is a growing emphasis on personalized care that takes into account the patient’s unique needs, preferences, values, and beliefs. Holistic nurses often collaborate with patients to develop individualized care plans that incorporate both medical treatments and complementary therapies.  Cultural Competency: Nurses are increasingly aware of the cultural differences that affect patient care. They incorporate culturally appropriate practices and show sensitivity to diverse beliefs regarding health and healing. 4. Integration of Technology and Digital Health  Telemedicine: The use of tele-health platforms has increased, allowing nurses to provide holistic care remotely. This can include virtual wellness coaching, stress management support, and follow-up care.  Health Apps and Wearable: Nurses are encouraging the use of apps and wearable devices that track physical activity, sleep patterns, and mental health, providing valuable data to tailor care plans. 5. Holistic Pain Management  With the opioid crisis and the growing recognition of the dangers of pharmaceutical pain management, holistic nursing has increasingly incorporated alternative approaches like acupuncture, massage therapy, aromatherapy, and biofeedback to manage chronic pain. 55   Nurses are exploring integrative pain management models to reduce reliance on medications and offer more holistic alternatives. 6. Collaborative Care and Interdisciplinary Teams  Holistic nurses are working in multidisciplinary teams, collaborating with doctors, therapists, nutritionists, and other healthcare professionals to create comprehensive care plans for patients.  The importance of teamwork and communication is emphasized to provide well-rounded care that addresses all aspects of a patient's health. 7. Mental Health and Emotional Well-Being  With the growing recognition of mental health issues, holistic nurses are using therapies like counseling, mindfulness, and emotional freedom techniques (EFT) to support mental and emotional well-being.  Trauma-Informed Care: Many holistic nurses are trained to provide care that acknowledges the impacts of trauma, using therapeutic techniques that create safe, supportive environments for healing. 8. Sustainability and Eco-Conscious Care  As part of a holistic worldview, many nurses are embracing sustainability and eco-friendly practices in their care. This may include advocating for environmentally conscious healthcare practices and promoting patient education on the connection between the environment and health.  Holistic nurses may also emphasize sustainable lifestyles, such as organic diets, reducing exposure to toxins, and supporting the mind-body connection to the natural world. 56 9. Education and Professional Development  As holistic nursing continues to grow, more nurses are pursuing specialized certifications in holistic nursing, integrative therapies, and wellness coaching. Organizations such as the American Holistic Nurses Association (AHNA) are offering training programs to advance knowledge and expertise.  Many holistic nurses are focusing on expanding public awareness about the benefits of holistic care through workshops, seminars, and community outreach. 10. Self-Care for Nurses  Nurses are recognizing the importance of self-care to prevent burnout and compassion fatigue, which are significant challenges in the healthcare profession. Holistic nursing models are now incorporating self-care practices such as mindfulness, meditation, and stress-reduction techniques for healthcare professionals.  Some hospitals and healthcare settings have started offering wellness programs for staff to support their physical and emotional well-being. Conclusion The trends in holistic nursing are shaping the future of healthcare, emphasizing a comprehensive, individualized approach to care that integrates conventional medical practices with complementary therapies. These trends reflect a broader cultural shift towards treating patients as whole people rather than just focusing on illness or symptoms, with an increased focus on prevention, patient empowerment, and sustainable care practices. 57 58  Concepts and principles of Holistic Health Care Objectives: At the end of this lecture each student will be able to  Define some terms  List importance of Holistic Care in Nursing  List benefits of Holistic Care in Nursing  Identify Principles of holistic health care  Recognize roles and responsibilities of a holistic nurse Outlines:  Introduction  Definitions  Importance of Holistic Care in Nursing  Benefits of Holistic Care in Nursing  Principles of holistic health care  Roles and Responsibilities of a Holistic Nurse 59 INTRODUCTION Presently, there are two major challenges that are emerging in nursing. The first is to integrate the concepts of technology, mind, and spirit into nursing practice; The second is to create and integrate models for health care that guide the healing of self and others. So Holistic nursing is the most complete way to conceptualize and practice professional nursing. The idea of caring for the entire person, not just their physical body, is one that dates back to Florence Nightingale. Florence Nightingale devotion was to care for those who could not care for themselves. She encouraged holistic care by recognizing the importance of environment touch, light, scents, music and silent reflection in therapy process In Greek, Holos means wholeness. From the Greek root, holism is thus to do with the whole unit rather than as a sum of its individual parts. It follows naturally, then, that holistic care is about caring for the whole human being. Socrates (470–399 BCE) warned against treating only one part of the body ―for the part can never be well unless the whole is well.‖ The wholeness of a human being is the sum of his or her body, mind and spirit. The expression of both mind and spirit 61  Definitions: Health & Holistic Health Health is a person’s physical well-being. Holistic is from the Greek word holos, meaning whole. Holistic health views the physical, intellectual, socio-cultural, psychological, and spiritual aspects of a person’s life as an integrated whole. Homeostasis: The balance or stability of the body, mind and spirit. Health: is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Disease: any harmful deviation from the normal structural or functional state of an organism, generally associated with certain signs and symptoms and differing in nature from physical injury. A diseased organism commonly exhibits signs or symptoms indicative of its abnormal state. Health Promotion: activities and preventive measures such as immunizations, fitness/exercise programs, breast self exam, appropriate nutrition, relaxation, stress management, social support, prayer ‫ عباده‬, meditation ‫ تأمل‬, healing rituals‫ طقوس‬, cultural practices, and promoting environmental health and safety. Nursing: American Nurses Association (ANA) defined ― Nursing as the protection, promotion and optimization of health and abilities, 61 prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations‖. The nurse: is a person who has completed a program of basic, generalized nursing education and is authorized by the appropriate regulatory authority to practice nursing in his/her country. Basic nursing education is a formally recognized programme of study providing a broad and sound foundation in the behavioral, life, and nursing sciences for the general practice of nursing, for  a leadership role,  for post-basic education for specialty  advanced nursing practice. The nurse is prepared and authorized : (1) To engage in the general scope of nursing practice, including the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages and in all health care and other community settings (2) To carry out health care teaching (3) To participate fully as a member of the health care team (4) To supervise and train nursing and health care auxiliaries ‫مساعدات التمريض‬ ‫مثال‬ (5) To be involved in research Holistic nursing: is the concept of caring of a person as a whole. The aim is to restore the patient as a whole. Holistic nursing emphasizes on the nurses taking into account the connection between mind, body, emotion, spirit, social, cultural, environment and past relationships in order to restore the patient to a whole. 62 Holistic nursing is a model that combine the idea of presence, healing and holism. Holistic Nursing: also is defined as ―all nursing practice that has healing the whole person as its goal‖ (American Holistic Nurses’ Association, 1998) and Florence Nightingale, is considered to be the founder of Holistic Nursing, who taught nurses to focus on the principles of holism: unity, wellness and the interrelationship of human beings and their environment. Holistic care: is an approach to health care that addresses the patient’s physical, emotional, social and spiritual needs. This type of care is comprehensive; rather than aiming to treat illness, holistic care aims to enhance the overall well-being and quality of life of an individual. 63 Holism: is a concept that is found in holistic nursing which means treating a human being as a whole. For nurses to deliver holistic care, it is important to differentiate and understand healing and curing. Curing focuses on manly eradicating what is causing the illness this includes the use of medicine in order to find a physical cure to a disease. Healing which is mainly the concept of holistic nursing focuses on finding balance in the body, mind, and spirit in a human being. The best outcome for a patient is when the two healing and curing are combined. Holistic Caring Process: a circular process that involves six steps which may occur simultaneously. These parts are assessment, patterns/challenges/needs, outcomes, therapeutic care plan, implementation, and evaluation. Holistic Communication: a free flow of verbal and nonverbal interchange between and among people and significant beings such as pets, nature, and God/Life Force/Absolute/Transcendent that explores meaning and ideas leading to mutual understanding and growth. Holistic Nurse: -a nurse who recognizes and integrates body-mind-spirit principles and modalities in daily life and clinical practice; -one who creates a healing space within herself/himself that allows the nurse to be an instrument of healing for the purpose of helping another feel safe and more in harmony; -one who shares authenticity of unconditional presence that helps to 64  remove the barriers to the healing process. Importance of Holistic Care in Nursing: Holistic care in nursing is important because it’s capable of improving the quality of care for all. Providers and researchers have learned from historical applications of health care and developed a comprehensive model for enhancing the quality of life and health of populations. According to recent studies, ―using the ordinary medical model alone for treatment exposes patients to serious threats, prolongs hospitalization, and raises treatment costs.‖ Despite these tangible risks, many health care practitioners are still hesitant to administer holistic care. Overall, holistic care in nursing is important to:  Enhance the health of all populations  Improve preventative care  Reduce treatment costs  Encourage respect for the dignity and humanity of those receiving care. Benefits of Holistic Care in Nursing The use of holistic care in a medical setting can:  Help destigmatize ‫المورثات‬mental health care  Honor ‫ قدسيه‬the body’s natural healing intelligence 65  Respect cultural differences and traditional healing methods  Teach the value of preventative health  Decrease the use of invasive procedures  Shed light on economic, social and political barriers in health  Empower practitioners to bring their humanity to health care Principles of holistic health care: The American Holistic Medical Association has the following ten principles for working in holistic medicine: Optimal health is the primary goal of holistic medical practice. It is the conscious pursuit of the highest level of functioning and balance of the physical, environmental, mental, emotional, social and spiritual aspects of human experience, resulting in a dynamic state of being fully alive. This creates a condition of well-being regardless of the presence or absence of disease. The healing power of love. Holistic health care practitioners strive to meet the patient with grace, kindness, acceptance, and spirit without condition, as love is life’s most powerful healer. Whole person. Holistic healthcare practitioners view people as the unity of body, mind, spirit and the systems in which they live. Prevention and treatment. Holistic healthcare practitioners promote health, prevent illness and 66 help raise awareness of disease in our lives rather than merely managing symptoms. A holistic approach relieves symptoms, modifies contributing factors, and enhances the patient’s life system to optimize future well-being. Innate healing power. All people have innate ‫ الفطره‬powers of healing in their bodies, minds and spirits. Holistic healthcare practitioners evoke and help patients utilize these powers to affect the healing process. Integration of healing systems. Holistic health-care practitioners embrace a lifetime of learning about all safe and effective options in diagnosis and treatment. These options come from a variety of traditions, and are selected in order to best meet the unique needs of the patient. Relationship-centered care. The ideal practitioner- patient relationship is a partnership which encourages patient autonomy, and values the needs and insights of both parties. The quality of this relationship is an essential contributor to the healing process. Individuality. Holistic health care practitioners focus patient care on the unique ‫فريد‬ needs and nature of the person who has an illness rather than the illness that has the person. Teaching by example. Holistic healthcare practitioners continually work toward the personal incorporation of the principles of holistic health, which then 67  profoundly influence the quality of the healing relationship. Learning opportunities. All life experiences including birth, joy, suffering and the dying process are profound learning opportunities for both patients and healthcare practitioners.  ―Prevention is the best intervention‖  ―Integration of healing systems is effective‖  ―Holistic medicine is relationship-centered care‖  ―Care should be individualized‖  ―Teach by example‖  ―Healing powers are innate‖  ―All experiences are learning opportunities‖  ―Embrace the healing power of love‖ 68  ―Optimal health is the primary goal‖ Roles and Responsibilities of a Holistic Nurse: A holistic nurse has a responsibility to apply the principles of holistic care to patients within their practice. A holistic nurse may administer the same health care services as a traditional RN, but they differ in their method of delivery. Holistic nurses deliver care in the following ways:  Compassionate: Holistic nurses are attentive, present and compassionate toward patients.  Comprehensive: Holistic nurses acknowledge the mind, body and spirit by treating the entire person rather than treating one symptom.  Curious ‫ فضولي‬: Holistic nurses believe that a variety of factors affect health, from environmental influences to dietary choices. As a result, they ask their patients questions about their overall lifestyle. 69 Mental Conditions Affecting Bodily Functions  Our emotions and strong feeling affect the body inwardly and outwardly.  Unpleasant emotions such as fear, anger, worry cause headache, insomnia, indigestion and various neurotic diseases.  Deep thinking and concentration can cause physical fatigue.  Mind motivates all physical and motor activities.  Emotional conflicts are responsible to cause various illnesses such as hysteria, gastrointestinal troubles like peptic ulcer, ulcerative colitis, flatulence etc. A holistic health care ―Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.‖ This statement from the preamble to the World Health Organization’s constitution, adopted in 1946, illustrates its belief in holistic health from its very formation. Exactly what is holistic health? Holistic health is an approach to wellness that simultaneously addresses the physical, mental, emotional, social, and spiritual components of health. As a field of practice, holistic medicine draws from many disciplines, religions, and cultures to heal people, communities, and even the environment. Areas that holistic health practitioners may examine include the following: 71  Body  What are the body’s needs for nutrition, sleep, exercise, and rejuvenation?  What are the underlying causes of physical pain,  What steps can be taken to ameliorate this pain — or live with it?  What actions can be taken to prevent bodily injury, illness, and disease? Mind  What are the mind’s needs for stimulation, curiosity, wonder, and creative expression?  What information and lessons do our emotions provide?  What is an embodied account of the mind and spirit?  What are its interdependent connections with others and the environment? Spirit  What practices and rituals ‫طقوس‬connect us with something larger than ourselves?  How can we connect with the divine, with nature, with ancestors ‫اجداد‬, and with other sources of deep purpose and meaning beyond oneself? People relationship.  How is one connected to others?  What ways can ties with kin, friends, loved ones, neighbors, and strangers be strengthened, renewed, and repaired?  How can one give time and resources generously, draw healthy boundaries, and cultivate community? 71  Culture  What is one’s cultural inheritance?  What values and traditions — including art, performances, ceremonies, rites, crafts, and ways of life — would one like to bring into the present and preserve for the future?  What can one’s culture teach us about living healthily and well? Environment  What are the unique features of the space one lives in — the neighborhood, geography, flora, and fauna?  Who lives nearby, and how has this place changed over time?  What is the history of this place?  How does this place affect one’s health — is it clean, welcoming, loud, harsh, disruptive, joyful, or peaceful?  What healing and help does this environment need to be healthy? BY Physical examination and interaction with interviewing Inspection Palpation Percussion Auscultation AND Using NOPQRST format.N—Normal: 72 Describe your normal baseline. What was it like before this symptom developed? O—Onset: When did the symptom start? What day? What time? Did it start suddenly or gradually? P—Precipitating and palliative factors: What brought on the symptom? What seems to trigger it—factors such as stress, position change, or exertion? What were you doing when you first noticed the symptom? What makes the symptom worse? What measures have helped relieve the symptom? What have you tried so far? What measures did not relieve the symptom? Q—Quality and quantity: How does it feel? How would you describe it? How much are you experiencing now? Is it more or less than you experienced at any other time? R—Region and radiation: Where does the symptom occur? 73 Can you show me? In the case of pain, does it travel anywhere such as down your arm or in your back? S—Severity: On a scale of 0 to 10, with 0 being the absence of pain and 10 being the worst ever experienced, rate your symptom. How bad is the symptom at its worst? Does it force you to stop your activity and sit down, lie down, or slow down? Is the symptom getting better or worse, or staying about the same? T—Time: How long does the symptom last? How often do you get the symptom? Does it occur in association with anything, such as before, during, or after meals? Holistic health care of cardiovascular system Heart disease has long been the No. 1 cause of death among adults in the United States. Research has shown that current and former service members are at greater risk for heart disease and heart attack than the civilian population as well. History of the Present Illness 74 Complete analysis of the following signs and symptoms (using the NOPQRST format): Chest pain Nausea or vomiting Dyspnea Edema Palpitations Syncope/dizziness Cough and hemoptysis Nocturia Cyanosis Extremity pain Past Health History Relevant childhood illnesses and immunizations: rheumatic fever, murmurs, congenital anomalies, streptococcal infections Past acute and chronic medical problems, including treatments and hospitalizations: heart failure, hypertension, coronary artery disease, myocardial infarction, hyperlipidemia, valve disease, cardiac dysrhythmias, diabetes mellitus, endocarditis, thrombophlebitis, DVT, peripheral vascular disease, chest injury, pneumonia, pulmonary embolism, thyroid disease, tuberculosis Risk factors: age, heredity, gender, race, tobacco use, elevated cholesterol, hypertension, physical inactivity, obesity, diabetes mellitus Past surgeries: coronary artery bypass grafting (CABG), valvular surgery, peripheral vascular surgeries 75  Past diagnostic tests and interventions: ECG, electrocardiogram, echocardiogram, stress test, electrophysiology studies, myocardial imaging studies, thrombolytic therapy, cardiac catheterization, percutaneous transluminal cardiac angioplasty, stent placement, atherectomy, pacemaker or implantable cardioverter defi brillator implantation, valvuloplasty Medications, including prescription drugs, over-the counter drugs, vitamins, herbs, and supplements: angiotensin-converting enzyme (ACE) inhibitors, anticoagulants, antihypertensive, antiplatelets, antiarrhythmics, angiotensin II receptor blockers (ARBs), β-blockers, calcium channel blockers, antihyperlipidemics, diuretics, electrolyte replacements, nitrates, inotropes, hormone replacement therapies, oral contraceptives, use of agents for erectile dysfunction Allergies and reactions to medications, foods, contrast dye, latex or other materials Transfusions, including type and date Family History Health status or cause of death of parents and siblings: CAD, hypertension, diabetes mellitus, sudden cardiac death, stroke, peripheral vascular disease, lipid disorders 76 Personal and Social History Tobacco, alcohol, and substance use Environment Diet: restrictions, supplements, caffeine intake Sleep patterns: number of pillows used Exercise Review of Other Systems HEENT: retinal problems, visual changes, headaches, carotid artery disease Respiratory: shortness of breath, dyspnea, cough, lung disease, recurrent infections, pneumonia, tuberculosis Gastrointestinal: nausea, vomiting, weight loss, change in bowel habits Genitourinary: incontinence, erectile dysfunction Musculoskeletal: pain, weakness, varicose veins, change in sensation, peripheral edema Neurological: transient ischemic attacks, stroke, change in level of consciousness, changes in sensations Endocrine: thyroid disease, diabetes mellitus NOPQRST format N—Normal: Describe your normal baseline. What was it like before this symptom developed? 77 O—Onset: When did the symptom start? What day? What time? Did it start suddenly or gradually? P—Precipitating and palliative factors: What brought on the symptom? What seems to trigger it—factors such as stress, position change, or exertion? What were you doing when you first noticed the symptom? What makes the symptom worse? What measures have helped relieve the symptom? What have you tried so far? What measures did not relieve the symptom? Q—Quality and quantity: How does it feel? How would you describe it? How much are you experiencing now? Is it more or less than you experienced at any other time? R—Region and radiation: Where does the symptom occur? Can you show me? In the case of pain, does it travel anywhere such as down your arm or in your back? 78 S—Severity: On a scale of 0 to 10, with 0 being the absence of pain and 10 being the worst ever experienced, rate your symptom. How bad is the symptom at its worst? Does it force you to stop your activity and sit down, lie down, or slow down? Is the symptom getting better or worse, or staying about the same? T—Time: How long does the symptom last? How often do you get the symptom? Does it occur in association with anything, such as before, during, or after meals? Hear from the experts 1. Get moving. One of the simplest ways to improve your heart health is to get at least 30 minutes of moderate- to vigorous-intensity activity at least five days a week. This can ward off other risks for heart disease such as high blood pressure, high levels of ―bad‖ cholesterol, or excess weight. ―Importantly, 30 minutes of activity does not have to be done all at once,‖ said Dr. Scott. ―You can break this up into 10 minute chucks, such as taking a 10 minute walk after meals.‖ 2. Make healthy food choices. 79 Aim for a diet made up of colorful fruits, vegetables, whole grains, and lean proteins. Try tracking your food choices to notice your calories in (what you eat and drink) and calories out (energy used during physical activity and metabolic processes such as breathing and digestion). Dr. Scott recommends ―When it comes to making healthy food choices, think about what you can add to your diet rather than what you have to cut out. It could be as simple as trying one new vegetable this week or adding 1 piece of fruit to your daily routine. 3. Know your family’s medical history. Awareness of your family’s health history can help you take preventative steps and get ahead of heart disease before it becomes an issue and discuss your risks with your healthcare provider. 4. Get enough sleep. Adults who get less than 7 hours of sleep per night are more likely to have health problems, including high blood pressure, which is a leading risk factor for heart disease and heart attack. (Nearly 50% of those who have served in the military report not getting enough sleep, compared to 36% for civilians.) 5. Keep cholesterol under control. Your food choices can affect your cholesterol and triglycerides, which are waxy substances in the bloodstream that can clog arteries and increase your risk of heart disease. The American Heart Association )AHA( suggests adults ages 81 20 and older get their cholesterol levels checked every 4 to 6 years. 6. Manage diabetes. High glucose levels in your blood can damage blood vessels and the nerves that control your heart. If you have diabetes, knowing your diabetes ABCs can help you take control of your blood sugar, blood pressure, and cholesterol. 7. Monitor your mental health. Although the link between stress and heart disease isn’t clear, chronic stress might cause people to cope in unhealthy ways such as smoking, drinking too much, or overeating. Stress also might raise your blood pressure, a known risk factor for heart disease. So, make stress manage it effectively. Depression symptoms might worsen cardiovascular health too, especially if you eat unhealthy foods or live a sedentary lifestyle. Keep in mind help is available, and mental fitness could improve your heart health. 8. Quit smoking, or never start. Smoking is a major risk factor for heart disease. The good news is that your risk for heart disease greatly lowers after 1 year of quitting smoking. Think about why you smoke and why you haven’t quit , and then take steps to shake the habit once and for all. 9. Drink alcohol in moderation. The American Heart Association (AHA) suggests 1–2 drinks per day for men and 1 drink per day for women. Drinking too much alcohol raises the levels of triglycerides (a type of fat) in your blood, which can contribute to heart disease. 81  While you might have heard some alcohol (for example, red wine) can be good for you, the research is still mixed. If you don’t already drink alcohol, AHA suggests skipping it entirely to keep your heart healthy, 10. Be aware of your blood pressure. High blood pressure or hypertension can lead to heart attacks or stroke. When it comes to heart disease, there are some risk factors you can’t change. But with healthy lifestyle choices and a Total Force Fitness approach, you can lower your risk of developing heart disease and keep your heart healthy and happy Holistic health care of respiratory system History of the Present Illness Complete analysis of the following signs and symptoms (using the NOPQRST format Dyspnea, dyspnea on exertion Shortness of breath Chest pain Cough Sputum production and appearance Hemoptysis Wheezing Orthopnea Clubbing Cyanosis Past Health History 82  Relevant childhood illnesses and immunizations: whooping cough (pertussis), mumps, cystic fibrosis Past acute and chronic medical problems, including treatments and hospitalizations: streptococcal infection of the throat, upper respiratory infections, tonsillitis, bronchitis, sinus infection, emphysema, asthma, bronchiectasis, tuberculosis, cancer, pulmonary hypertension, heart failure, musculoskeletal and neurological diseases affecting the respiratory system Risk factors: age, obesity, smoking, allergens Past surgeries: tonsillectomy, thoracic surgery, coronary artery bypass grafting (CABG), cardiac valve surgery, aortic aneurysm surgery, trauma surgery, tracheostomy Past diagnostic tests and interventions: tuberculin skin test, allergy tests, pulmonary function tests, chest radiograph, computed tomography (CT) scan, magnetic resonance imaging (MRI), bronchoscopy, cardiac stress test, ventilation–perfusion scanning, pulmonary angiography, thoracentesis, sputum culture Medications, including prescription drugs, over-the-counter drugs, vitamins, herbs, and supplements: oxygen, bronchodilators, antitussives, expectorants, mucolytics, anti-infectives, antihistamines, methylxanthine agents, anti-infl ammatory agents Allergies and reactions to medications, foods, contrast dye, latex, or other materials Transfusions, including type and date Family History 83  Health status or cause of death of parents and siblings: tuberculosis, cystic fibrosis, emphysema, asthma, malignancy Personal and Social History Tobacco, alcohol, and substance use Environment: exposure to asbestos, chemicals, coal dust, allergens; type of heating and ventilation system Diet Sleep patterns: use of pillows Exercise Review of Other Systems HEENT: strep throat, sinus infections, ear infection, deviated nasal septum, tonsillitis Cardiac: heart failure, dysrhythmias, coronary artery disease (CAD), valvular disease, hypertension Gastrointestinal: weight loss, nausea, vomiting Neuromuscular: Guillain–Barré syndrome, myasthenia gravis, amyotrophic lateral sclerosis, weakness Musculoskeletal: scoliosis, kyphosis By Inspection Palpation Percussion Auscultation 84 It is important to keep your respiratory system healthy. Exercising regularly, eating well, and getting enough sleep every day are key to helping your respiratory system function properly. Essential oils can also support feelings of clear airways and easy breathing Holistic health care of urinary system History of the Present Illness Complete analysis of the following signs and symptoms (using the NOPQRST format, ): Frequency Urgency Hesitancy Burning Dysuria Hematuria Incontinence Lower back pain Change in color, odor, or amount of urine Thirst Change in weight Edema Past Health History Past acute and chronic medical problems, including treatments and hospitalizations: renal failure, renal calculi, renal cancer, 85 glomerulonephritis, Wegener’s granulomatosis, polycystic kidney disease, dialysis (type, frequency, and duration), urinary tract infections, systemic lupus erythematosus, sickle cell anemia, cancer, AIDS, hepatitis C, heart failure, diabetes, hypertension Risk factors: age, trauma, heavy use of nonsteroidal anti-infl ammatory drugs (NSAIDs), use of heroin or cocaine Past surgeries: kidney transplantation, placement of dialysis fistula Past diagnostic tests and interventions: urinalysis, cystoscopy, intravenous pyelography (IVP), renal ultrasound, renal biopsy, magnetic resonance imaging (MRI), diagnostic tests that have used contrast material Medications, including prescription drugs, overthe-counter drugs, vitamins, herbs, and supplements: diuretics, aminoglycosides, antibiotics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), NSAIDs Allergies and reactions to medications, foods, contrast, latex, or other materials: radiopaque contrast material Transfusions, including type and date Family History Health status or cause of death of parents and siblings: hereditary nephritis, polycystic kidney disease, diabetes, hypertension Personal and Social History Tobacco, alcohol, and substance use: heroin, cocaine Environment: exposure to nephrotoxic substances (eg, organic acids, pesticides, lead, mercury) Diet: restrictions, supplements, caffeine intake 86  Sleep patterns: disruptions owing to need to get up to urinate Review of Other Systems HEENT: periorbital edema Cardiovascular: hypertension, heart failure, vascular disease Respiratory: Goodpasture’s syndrome Gastrointestinal: hepatitis, cirrhosis Musculoskeletal: rhabdomyolysis, muscle weakness Neurological: numbness, tingling, burning, tremors, memory loss Endocrine: diabetes mellitus Hematological: sickle-cell anemia Immune: systemic lupus erythematosus Integument: dryness, itching To help your urinary system work the way it should, you can: Drink plenty of water: Staying hydrated will flush out your system and can help you prevent kidney stones and UTIs. Eat a balanced diet: Low-sodium, high-calcium foods may prevent kidney stones( need to eat calcium so that it can bind with oxalate in the stomach and intestines before it moves to the kidneys. Eating foods with calcium is a good way for oxalates to leave the body and not form stones. The best way to get calcium into your body is through the foods you eat). 87 Holistic health care of nervous system History of the Present Illness Complete analysis of the following signs and symptoms (using the NOPQRST format): Dizziness, syncope, or seizures Headaches Vision or auditory changes, including sensitivity to light and tinnitus Difficulty swallowing or hoarseness Slurred speech or word finding difficulty Confusion, memory loss, or difficulty concentrating Gait disturbances Motor symptoms, including weakness, paresthesia, paralysis, decreased range of motion, and tremors Past Health History Relevant childhood illnesses and immunizations: febrile seizures, birth injuries, physical abuse or trau