A framework for holistic nursing care in paediatric nursing

Tjale, Adele Agatha
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ABSTRACT Emphasis on humanistic values and personal experience in nursing has led to the popularisation of holistic nursing approach to nursing care. Although holistic nursing care as a construct is widely discussed in nursing literature. Contextual clinical application has been difficult, in the absence of guiding conceptual framework and guidelines that directs nursing practice. In this study, the purpose was to examine the meaning of holistic nursing care and develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing in academic hospitals. To achieve this aim, qualitative methodological perspectives were employed based on careful selection of the population, sampling, collection and analysis of data and trustworthiness. To enable the accomplishment of the purpose, the study objectives were formulated into two phases. Phase one objective enabled the identification of the characteristics of the concept holistic nursing care through concept analysis and by obtaining the emic viewpoints of the paediatric nurses working in academic hospitals. A philosophical inquiry was employed using Rodgers’ evolutionary method of concept analysis. To elucidate the concept holistic nursing care a qualitative, interpretive, explorative and contextual research design was employed. Holistic nursing care was interpreted as whole care fostering person-centred and family-centred care. The results confirm the current discourse in nursing literature with respect to “person-centred”, “family-centred care” as opposed to “patient-centred care”. The emphasis is on recognition of the need to transform current linguistic ontology from “patient care” towards the provision of “whole-person” care. Participants’ interpreted v holistic nursing care as whole care directed towards a unique and complex human being. The dynamic, which is the driving force for the achievement of whole care, is established through enabling goal-directed nurse-family relationships. One of the key finding is the prominence of spirituality and the inclusion of spirituality in different aspects of child nursing. The dependency of individual nurses to spiritual sources for personal strength and support was recognised and acknowledged. Knowledge of disease, person and “know how” are necessary for the acomplishment of ethically, safe person-centred whole care. Attributes of holistic nursing care yielded two dimensions; whole person and mind-body-spirit dimension. The decriptors of whole person include physical, mental, emotional, spirit and spitual being. Spirituality is the predominant antecedent. Holistic nursing care is initiated by the recognition of the individual, in need of health care, as a spiritual being with mind-body-spirit dimension. Spirituaity is an ever-present force pervading all human experience. Complimentary alternative medicine (CAM) was identified as a surrogate term. The connection of CAM with holistic nursing care is the focus of therapetic interventions that are directed to the mind-body-spirit domain. The emphasis is on health rather than curing. Preventative therapeutic interventions are desingned to meet the needs of the whole-person. Caution is advocated in the use of CAM therapies in child nursing, as CAM efficacy has not been sufficiently investigated in child health care. The conceptual framework is presented as unique contribution to nursing. The framework may be introduced at undergraduate teaching of child and family nursing care and in specialists’ paediatric nurse education. Recognition of the human being as a whole person with mind-body-spirit dimension is not restricted to a child or family care. Therefore, the vi framework is presented as a fundamental structure that can be used generally to all intervention activities in relation to human–human interactions. Its use may be broadened to any therapeutic environments. The framework may be tested in adult nursing in variety of settings in health care. There is a potential to expand and transfer certain elements of the framework to other discipline beyond nursing: in doctor-patient relationships, manager-employee relationships, and person-to-person interactions. Perhaps the South African Nursing Council, as the regulating body responsible for developing the educational framework of nursing education in this country may adopt this framework in line with their philosophy of nursing to articulate with their intended goal of providing holistic nursing care for the people of this nation. Adoption of the framework may require a shift from the current “patient-centred care” towards “person-centred care”.
holistic nursing care , paediatric nursing