Holistic Care

This assignment intends to define holism prior to identifying individualised and holistic care. It will then follow by exploring relevant nursing requirements on individualised and holistic care. Continuing with focusing on how the care is delivered, which will include theories, concepts and principles that explain how individuality, client involvement, autonomy, empowerment, advocacy, evaluation and monitoring are all significant within holistic care. A brief patient history will be offered and the development of the nursing process along with how the individualised care package was accomplished in a holistic approach. In concluding, feedback will be given on how individualised and holistic care is achieved.

Holism described by McFerran (1998) is a term that is applied to a range of orthodox and un-orthodox methods. It is the approach to patient care in which the physiological, psychological, and social factors of the patient’s condition are taken into account, rather than just the diagnosed disease. Ewles and Simnett (1999) state that holism is seen as positive well being, including social, emotional, mental and societal aspects as well as physical ones and is seen to be affected by social, environmental economic and political factors. According to Bertie et al (1991) the physical functioning of the body can be affected by the mental and spiritual state. The emphasis on nursing is then to care for or treat that person in a holistic approach. Maslow (1970) maintains this by stating that the lower order physiological needs must be met before the higher levels can be accomplished. An example of this could be an individual who lacks warmth, shelter and food is unlikely to feel safe, secure or cared for. Holism can therefore be defined as involving all aspects of the patient including the mental, physical, intellectual, emotional, spiritual and social outlook the individual has.

Roper et al (1996) claims individualised nursing consists of four phases, assessing, planning, implementing and evaluating in order for holistic and individualised care to be accomplished. McFarlane and Castledine (1982), reason that individualised and holistic care is important to each individual. To plan the nursing care successfully the nurse will need to be able to assess where there are problems of continuing a sufficient quality and quantity of self-care activity for health and well being. To make this assessment, information is required on all aspects of performance. Ward, (1992), claims that each patient responds to his symptoms in a slightly different way. Many factors contribute to this for example, environment, life experiences, social and cultural background and physical make-up.

Since each of these elements is unique to each patient, it makes sense that the care they are offered by the nurse must cater for this individuality. By distinguishing the effects of the patient’s responses to their symptoms in relation to their ability to meet their personal needs, they should receive an individualised approach to their care. It could be prudent to define this as dealing with each persons problems or needs as individual and unique so as to avoid depersonalising and treating the patient as a diagnosis and not a whole person, for instance referring to a patient suffering from a broken leg as “The broken leg in bed four”.

Mallik et al (1998) maintains that the care is delivered to meet the requirements of the patient by means of a care plan that is put into place on admission. Whenever possible, the plan of care should be made with the collaboration of all concerned in the care, for example informal carers, relatives and members of the multi-professional team. According to Ward (1992), within the nursing process, the structure for individualising care exists. When individuality is conveyed to a person they become aware that their care has been formulated especially for them. They become aware of their individuality more from a feeling of being cared about than being cared for, knowing that someone has taken the time and trouble to take into account their particular problems and design care that will be of assistance to them. The care plans should also involve the client; however, with a severely confused client, this may be beyond their ability. As indicated by the United Kingdom Central Council for Nurses (1996), nurses must work in an open manner with the patients/ clients and their families, foster their independence and recognise and respect their involvement in the planning and delivery of care.

Client empowerment or as it is also known ‘autonomy’ as indicated by Mc Ferran (1998) is the right of personal freedom of action which implies independence; self-control, self-sufficiency and self-esteem, which can mean a healthy awareness of own positive attributes. Self-esteem and autonomy, as stated by Lyttle (1986) contribute to a positive self-image. A lack of self-esteem may be very noticeable in depression and mental disorders.

The U.K.C.C. (1996) also state that a registered nurse must act always in such a manner as to promote and safeguard the interests and well being of patients and clients. Promoting clients’ rights to choose and empowering them to decide for themselves is a form of advocacy. Therefore it can be said that when caring for clients, an effort must be made to encourage and protect their interests.

According to Hinchliff et al (1993), an advocate is one who pleads the cause of another. This implies that the other cannot do this for him or her self. It is consequently for the most part important to be clear why and how a person cannot speak for himself or herself. This is usually the case in severe physical or mental illness, but people who are unassertive or ignorant of facts need help and therefore require a advocate. Practising in a way, in which it is taken for granted that only you know what is best for the clients may create reliance; hold back teamwork and can interfere with the client’s right to choose. Some clients may be easily persuaded and as a consequence be more likely to agree to suggestions or choices from those in positions of authority (U.K.C.C. 1996). Roper et al (1996) continues with this stating that patient advocacy is a broad and controversial issue and has found that an interesting development is the initiation and funding by local councils of Citizen Advocacy Schemes.

Evaluation offers a starting point for assessment in progress and planning as the person’s circumstances and requirements change. The skills used are observing, questioning, examining, testing and measuring to ascertain whether or not the set goals are being or have been accomplished (Roper, Logan and Tierney 1996).

Miss White, which is a pseudonym in order to comply with confidentiality requirements, had previous mental health problems that began from an early age and was diagnosed with schizophrenia at the age of sixteen.

As indicated by Lyttle (1986), schizophrenia is a condition that is characterised by features such as, hallucinations, hearing voices in the absence of an eternal stimuli, having strange, tormenting and often paranoid ideas (persecution complex). A person suffering from schizophrenia may also have a fixed unshakable belief which is out of their cultural context and not amenable to argument. In all cases there is a great loss of self-esteem, and loneliness and isolation may be extreme. Schizophrenia is a socially disabling disorder and rehabilitation must be directed towards improving social functioning from the onset. The emphasis should be on promoting maximum independence and autonomy. Treatment may be physical, psychological or social, though usually a blend of all three approaches is used. The nurse must remember that effective and dynamic nursing care may be one of the most important factors in prognosis.

According to Varcarolis (1990), within categorising symptoms of schizophrenia there are positive and negative symptoms. Classifying these symptoms can be useful in deciding appropriate treatment approaches. The positive symptoms show characteristics such as hallucinations, delusions, paranoia and depersonalisation. The negative symptoms, which will affect a person holistically, are characterised by a lack of, or reduction of, some part of functioning, movement, speech, motivation, emotional expression and social life. Therefore it could be said that, due to being unable to initiate conversation or make decisions, relationships are not capable of being maintained either emotionally or socially. Lack of interest and inability to maintain a relationship will hinder that person holistically.

Care was delivered to meet the needs/problems of Miss White via an initial assessment; a care plan was then derived from this. The assessment that facilitates the care plan used is of an eclectic approach; by using various models put together it encompasses the individual’s needs in a more holistic tactic. There are five main sections to the nursing assessment used; these are risk, physical, psychological, social and political. These sections are included in Orem’s’, Henderson’s and Roper, Logan and Tierney’s models, therefore assessing each individual in all aspects of holism. The plan of care is devised with a group effort of relatives or main carers and the multi- professional team. Parents or main carers act as advocates as well as the nurses.

They all worked openly in order to promote and protect the interests of the patient. During this initial assessment it became apparent that Miss White had suffered a relapse in her mental state. The auditory hallucinations that were now being experienced were affecting her mental, emotional, social and physical well-being. The initial need required on this occasion was a solution to ease the symptoms of negative symptoms, which are hallucinations and delusions. This usually takes the form of psychosocial intervention as well as psychopharmacological involvement.

In order to implement the plans, which were to investigate a new type of medication that had not been tried previously and to start with a process known as psychosocial intervention, a meeting between the unit manager, staff, relatives and other members of the multi professional team was held. During this meeting it was discussed and decided that it would be in the patients best interest to implement the plan to begin the new treatment of the medication and the psychosocial intervention. The consultant gave authorisation for the new drug to be prescribed and the unit manager was asked to commence the psychosocial intervention. Within this framework Miss White was assessed in a holistic manner, which aimed to decrease the presenting problems and increase her social functioning, therefore maintaining individualised, holistic care.

To conclude, holism is seen as positive well being, including social, emotional, mental and societal aspects as well as physical ones and is seen to be affected by social, environmental, economic and political factors. The physical functioning of the body can be affected by the mental and spiritual state. The nurse must cater for this individuality by taking a holistic approach to nursing care. The nursing approach to patient care implies that information is needed about physiological, psychological and social functioning this means that these factors of the patient’s condition are taken into account, rather than just the diagnosed disease. The lower order physiological needs must be met before the higher levels can be accomplished. An example of this could be an individual who lacks warmth, shelter and food is unlikely to feel safe, secure or cared for. This suggests that information is needed about the persons physiological and social functioning as each person responds to his or her symptoms in a slightly different way.

When each person’s problems or needs are dealt with as individual and unique it avoids depersonalising and treating the person as an illness and not as a whole person. When the person is treated as exclusive they will become more aware of their individuality and this may contribute to a positive self- image. Self-esteem and autonomy, contribute to a positive self-image and a lack of self-esteem may be very noticeable in depression and mental disorders. Advocacy or promoting the client’s rights to choose and empowering them to decide for themselves must also be encouraged in order to support and safeguard their well being.

In order to plan the nursing care successfully and accomplish individualised nursing there are four phases, assessing, planning, implementing and evaluating which must be undertaken. The nurse will need to be able to assess where there are problems of continuing a sufficient quality and quantity of self-care activity for the patient’s health and well-being. The care is delivered to meet the requirements of the patient by means of a care plan that is put into place on admission. Within the nursing process, the structure for individualising care exists. The care plan should also involve the client; however, with a severely confused client, this may be beyond their ability.

BIBLIOGRAPHY/REFERENCES

Ewles, L., and Simnett, I. (1999). Promoting Health. A practical guide (4th Edition).London, Bailliere Tindall.

Bertie, O. et al (1991). Rediscovering Nursing. London, Chapman and Hall.

Hinchliff, S., Norman, S. and Schober, J (1993). Nursing Practice and Healthcare (2nd Edition). London, The Bath Press.

Lyttle, J. (1986). Mental Disorder Its Care and Treatment. London, Bailliere Tindall.

Mallik, M., Hall C, and Howard, D. (1998). Nursing knowledge and practice. A decision making approach. Bath, Ballier Tindall.

Maslow, A. (1970). Motivation and Personality (2nd Edition). New York, Harper and Row.

McFarlane, J. and Casltedine, G. (1982). A Guide to The Practice of Nursing using the Nursing Process. London, The C.V. Mosby Company.

McFerran, T. A. (1998). Oxford mini-dictionary for nurses. Oxford, Oxford University press.

Roper N., Logan W. and Tierney A. (1996). The Elements of Nursing A model for nursing based on a model of living (4th Edition). London, Churchill Livingstone.

UKCC. (1996). Guidelines for Professional Practice. London, UKCC.

Varcarolis, E. M, (1990). Foundations of psychiatric mental health nursing. London, W. B. Saunders Company.

Ward, M. (1992). The Nursing Process in Psychiatry (2nd Edition). London, Churchill Livingstone.