Pain Management: A Holistic Nursing Approach - Research Paper Example

Pain Management: A Holistic Nursing Approach Introduction Nursing management has undergone several revisions in the past decades, with evolutions skimming from theoretical approach to the current evidenced-based approach in nursing care. As part of the nursing spectrum, one broad concept that is tentatively acknowledged nowadays is holistic nursing. Holistic nursing generally centers on the idea that the human body is “made up of the mind, body, spirit, and emotion” (“Holistic Nursing Theories,” 2009). This particular field focuses not only on the segmented parts, but it is more on how these parts are utilized together in order to generate a caring aspect that relates to the wholeness of a patient. The emphasis, as added by Frisch, Dossey, Guzzetta and Quinn (2000), not only deals with several dimensions of man, but it also takes into consideration the interaction of the holistic person with the environment (p. 1). As its name implies, holistic nursing both maintains an interest in the internal and the external side of the management process. With its large nursing scope, it requires a comprehensive integration in clinical practice--in order for health professionals to be effective in their nursing function. Problem Statement In the health care setting, pain seems to be the common modality in most of the existing disease conditions. At some point in their hospital stay, patients experience various levels of pain, from sudden onset of intense pain to gradual yet long-term pain. The advancement in medical technology has given the people more options when it comes to medical management. Unfortunately, more and more interventions are relying on pharmacological management in order to lessen the degree of patients’ pain. This is quite an expensive pursuit. In some ways, this lack of moderation can result in drug dependence and neglect in taking into account the numerous side effects of pain reliever drugs (American College of Chest Physicians, 2009). Despite the promise of improved pain threshold, the negative aspects of the drugs should still be considered in patient therapy. The intentional ignorance with the side effects of these drugs points out that other medical approach must be considered as serious alternatives--for an improved client condition. The holistic nursing approach is deemed as timely in its emergence, as health care is veering away from the usual medical set-up, wherein disease treatment has been the major focus. The usual trend is now on health promotion and early detection of diseases (Lai & Hsieh, 2003). Usually, the early stage of disease conditions is the least painful, although the experience of pain depends on the disease condition. With this, several non-pharmacological methods can be of great assistance in lessening the degree of pain experienced. In relation, holistic nursing practices have been known to be more oriented in alleviating suffering on the principle of therapeutic approaches. The emerging methods in holistic nursing management may include: “guided imagery, touch therapies, music therapies, etc” (LeMaire, 2002). As observed, such practices are more on the traditional way in handling disease states. Central to these is the concept of healing. Healing, in the holistic definition, is more on the spiritual side of the approach, with little foundation on the modern physical aspect in medicine. At this point, arguments have been ensued on the sufficiency of evidence proving the relative efficacy of holistic healing in patients suffering from severe pain. Some are even sceptical on whether these complementary interventions should be used in the absence of pharmacological pain management (American College of Chest Physician, 2009). In most cases, traditional (pharmacological) interventions can either be paired with complementary (holistic) interventions for maximum effectiveness. The appeal, at this point, is on whether the holistic nursing practices can be independently applied, or will it still require other medical techniques in the management of pain. Purpose The purpose of this research is to gain objective knowledge and deeper understanding on the fundamental nature of holistic nursing approach and its full implication in the management of pain. Specifically, it seeks to expound on the following: (1) The fundamental components of holistic nursing theory; (2) Various holistic practices that are best applicable in reducing pain; (3) Relation of the healing concept in the management of pain; (4) Effectiveness of holistic nursing practice as an independent approach. Significance to Nursing The issues surrounding the application of holistic nursing practice is a timely topic in the medical field. This type of practice has been introduced a long time ago, but has just been utilized recently. Because of the latest economic crises worldwide, health care has been looking for ways in which to lessen hospital expenses, but at the same time, provide effective care to patients (Lai & Hsieh, 2003). This is one of the reasons why the therapeutic approach in holistic nursing practices is contemplated nowadays. Expenses are greatly reduced in holistic nursing practice--while the patients can learn ways on how to control pain with their own voluntary efforts. In the nursing practice, nursing personnel will get an in-depth understanding on how the holistic nursing approach is employed. More specifically, they will have a clear picture on where they stand in the nurse-client relationship. By knowing their functions in the holistic nursing approach, nursing skills can be sharpened and the delivery of nursing care will be more successful. Lastly, the result of the research paper can add to the independent function of the nursing professionals. With the nursing approach in care, the type of management that holistic approach offers can be liberating for the nursing personnel, especially on situations wherein instant pain relief is necessary at certain points in time. Theoretical Framework The concept of holistic nursing approach takes into detail how several aspects (mind, body, spirit, and environment) interact in unity to form the whole person. In the discussion on holistic nursing, the in-depth analysis of its relation to integral process must be taken into consideration. The Theory of Integral Nursing is a more accurate reflection on the Theory of Holistic Nursing--since the latter is a broader concept that encompasses more than one theoretical context. The former concept denotes the “science and art of nursing ... where holistic nursing practice is embraced” in the overall process (Dossey & Keegan, 2009, p. 17). The Integral Theory, then, is the application of holistic practices in the nursing field. In this theory, the full perception of man’s complex nature is explained more profoundly, placing emphasis on how nursing personnel can manage the interacting nature of the man’s “whole” being and apply healing in return. In the adapted paradigm from Ken Wilber, its similarity on the holistic concept makes it more suitable as the theoretical model (please see Figure 1. in Appendix A). In the assessment of the model, one can observe four divisions in the presentation, where each is denoted with the words “I,” “We”, “It”, and “Its”--all correspond to the “perspective of how (people) experience the world” (Dossey, 2007, p. 2). The symbol of “I” embodies the internal thoughts and feelings of a person, including “emotions, memories, perception and states of mind,” while “We” indicates how an individual relates to the values and cultural orientation witnessed (Dossey, 2007, p. 2). On the other hand, the words “It” and “Its” portray a more external facet; the difference between the two is that the former is on the physiological aspect of the human anatomy while the latter is on how man responds to the demands of the structured environment (Dossey & Keegan, 2009, p. 26). All the four dimensions may have different backgrounds, but they contain equal substance in the practice of holistic care. Application of Theory In the modified framework presented in Figure 2 (please see Appendix B), the fundamental dimensions of the holistic concept (mind, body, spiritual, and environment) are strategically applied. At the center of the converging object is the central action in the nursing practices, healing. As previously discussed, healing makes the holistic concept unique. It employs little on the sophisticated side of the medical advancement, and instead incorporates management on the psychological and spiritual level. As observed on the illustration (please see Figure 2 in Appendix B), all the circular objects touch one another at certain points. This denotes the interrelated four features--symbolizing them as the segments that make up a unitary being. During pain management, Howard and Saunders (2001) mentioned the four phases of pain: “physical, emotional, social, and spiritual components.” This description holds a substantial import, since it actually fits the illustration on how to best intervene on the varying levels of pain. The image (please see Figure 2 in Appendix B) pointedly shows the correlation between holistic practice and the divisions of pain that must be dealt with. The critical question, at this point, is whether the holistic approach can sufficiently maintain its position as an effective tool in reducing pain, or other methods must be reinforced in extreme cases. Literature Review The quest to prove the worth of holistic nursing approach in the world of rigid medical area has proven to be quite narrow. Holistic management is not bent on treating infirmities, per se, but on healing the unitary being (“Holistic Nursing Practice,” 2010). The focus is not limited only on the physical side of the condition. Due to this notion, it has caused a mumbling stir in several medical factions. In her work, Dossey (1997) admitted that there exists a philosophical dilemma when associating the body with the mind--as medical science has been accustomed to dealing solely on the “body” aspect (p. 6). Green (1999) argued that holistic practice is not medically valid since it lacks several evidence-based tests that prove its objective existence. It is, in fact, difficult for old-school medical practitioners to accept the reality that the state of mind and spiritual side can have a significant contribution in the medical field. The holistic model, as a widely generated theory, is defined more as a “concept, a process to bring about and focus the healing forces and energies within the individual for the integration of the body, mind, and spirit” (Lowenberg, 1989, p. 15). Upon close scrutiny, the basic study of the mind and body has already been conducted in the past year. However, the relative impact of the spirit in the holistic process is still on the darker light. Kinney, Rodgers, Nash, and Bray (2003) agreed that the spiritual dimension of the holistic practice has attracted less research studies compared to the other holistic aspects. Nevertheless, in the application of holistic practices through healing, Smith (2001) rallied that healing is now basically rooted on the spirituality of a person, “directly related to inner knowing and a source of strength reflected in one’s being.” The statement affirms that the spiritual side of the holistic practice has equal footing as the other dimensions in healing. The relative importance of holistic nursing approach does not only end in dealing with disease conditions. More importantly, such practice holds great implications in dealing with pain-ridden patients. Guzzeta (1998) presupposed that through the expansion of the consciousness, several positive effects can manifest. Both the nursing staff and patients are actively involved in the healing process. In creating a therapeutic environment, patients are treated as autonomous beings, giving them the guided control in manipulating the psychological perception of pain (Clark, 2004, p. 7). The creation of a mutually healing environment can have its advantages. In this process, healing promotes reversion from “persistent pain to a mode of perception and acceptance beyond the suffering ... (into) a wider view of the world” (Smith, 2001). It gives significance to the open-minded perspective that pain is not only dealt with through medication--tapping one’s consciousness and inner control for pain interference also yield positive outcomes. The concept of spirituality in reducing pain strengthens the resolution of holistic approach as a valid management against pain. Furthermore, several experiences from nursing staff attest to the influence of healing in the clinical practice. As stated in an article by LeMaire (2002), one nursing practitioner employed the general principles of holistic practice and conveyed success in releasing the tension of a drug-resistant patient. There is a sense of security in the holistic nursing practice; with a series of healing touch and other alternative therapies, then majority of pain levels can somehow be reduced (Tupponce, 2009). The vast majority of actual experience on the efficacy of holistic nursing practice seems to present the reality that this particular practice can be well-founded in the nursing field. In the early development of holistic practices, they had been employed as the last resort--when other “valid” medical interventions had been utilized. In the modern times, however, such practice is already a forefront in pain management, making it one of the priority therapies available. A definitive example of holistic practice is the combination of relaxation therapy with other cognitive strategies. In a research by Linton (1982, as cited in Horn & Munafo, 1997), the results had been in favor of the holistic practice--where “many pain patients (can) benefit from the relaxation” (p. 116). The validity of holistic nursing practice seems to be cemented with this type of research, implying that holistic nursing practice is more than hearsay from practitioners--it is a good technique in managing pain reduction. References American College of Chest Physicians. (2009). Report suggests holistic approach to reduce pain in the ICU. Chest. Retrieved from http://www.chestnet.org/accp/article/report-suggests-holistic-approach-reduce- pain-icu. Can the Buddhist and scientific understandings of mind and reality be united? (n.d.). Nature of Mind. Retrieved from http://natureofmind.org/142/buddhist-scientific-mind-reality/. Clark, C.C. (2004). The Holistic Nursing approach to chronic disease. Ney York, NY: Springer Publishing Company. Dossey, B.M. (1997). Core curriculum for Holistic Nursing. United States of America: Aspen Publishers. Dossey, B.M. (2007). Integral and Holistic Nursing. Alternative Journal of Nursing, (15). Retrieved from http://www.altjn.com/perspectives/dossey_sp2007.pdf. Dossey, B.M., & Keegan, L. (2009). Holistic Nursing (5th ed.). United States of America: Jones and Barlett Publishers. Frisch, N.C., Dossey, B.M., Guzzetta, C.E., & Quinn, J.A. (2000). AHNA Standards of Holistic Nursing Practice. United States: Aspen Publishers. Green, P. (1999). Digging a whole. Mental Health Nursing, 19 (2), 6+. Guzzeta, C.E. (1998). Essential readings in holistic Nursing. United States of America: Aspen Publishers. Holistic nursing practice. (2010). Lippincott Williams & Wilkins. Retrieved from http://www.editorialmanager.com/hnp/accounts/ifauth.htm Holistic nursing theories and models. (2009). Nursing Theory. Retrieved from http://nursing-theory.org/theories-and-models/holistic-nursing.php Horn, S., & Munafo, M. (1997). Theory, research, and intervention. Philadelphia: Open University Press. Howard, V., & Saunders, D. C. (2001). A holistic approach to pain. Nursing Times, 97 (34), 34. Kinney, C.K., Rodgers, D.M., Nash, K.A., & Bray, C.O. (2003). Holistic healing for women with breast cancer through a mind, body, and spirit self-empowerment program. Journal of Holistic Nursing, 21. doi: 10.1177/0898010103254919 Lai, H., & Hsieh, M. (2003). Alternative nursing interventions for facilitating holistic nursing based on eastern philosophy. Retrieved from http://www.tzuchi.com.tw/file/DivIntro/nursing/content/92-1/2.pdf. LeMaire, B. (2002). Something extra. NurseWeek. Retrieved from http://www.nurseweek.com/news/features/02-05/holistic.asp Lowenberg, J.S. (1989). Caring and responsibility: the crossroads between holistic practice and traditional medicine. Philadelphia: University of Pennsylvania Press. Smith, A. A. (2001). Concept analysis of healing in chronic pain. Nursing Forum, 36 (4), 21+. Tupponce, J. (2009). Holistic medicine: Nurse brings healing touch back into nursing. Nursing in Virginia. Retrieved from http://www.nursinginva.com/fall2007/alternatives.htm Appendix A Figure 1. Wilber’s Integral Model (“Can Buddhism and Scientific Understanding,” n.d.) Appendix B Figure 2. Conceptual Framework on Holistic/Integral Nursing (Dossey & Keegan, 2009, p. 22) Read More