1. DiGiulio, Sarah

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Earlier this year the American Holistic Nursing Association (AHNA) and the American Nurses Association (ANA) co-published a new, second edition of Holistic Nursing: Scope and Standards of Practice-an update to the original publication, previously revised in 1995. The new edition includes 16 standards with specific, measurable competencies that hold all holistic nurses accountable to their practice


"The Scope and Standards of Practice is the blueprint about what the practice is about," AHNA President Peggy A. Burkhardt, PhD, FNP, AHN-BC, said. "It gives nurses the framework to practice in a more specific way."

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These standards build on the standards of practice expected of all registered nurses, she said, noting that holistic nursing was recognized as its own specialty by the ANA in 2006. As a member of the AHNA Board of Directors, Burkhardt was involved in the review of the new standards before they were published.


In this interview with OT, she explained the key takeaways from the recent revisions to the Scope and Standards of Practice and where holistic nursing fits into traditional nursing practice:


What has been updated in the new version of the Scope and Standards?

"What's been updated is looking at where we are in the world right now. One example is core value four, which is holistic education and research. What has been added there is the tenet that nurses possess a wider range of cultural norms and health care beliefs and values-so they can individualize teaching to guide patients and their families. That standard was updated because things like health literacy are much more on the radar today than they would have been in 1990.


"The new version includes the evolving concepts that nurses need to be aware of, such as recognizing the patient's authority over his or her own health and experience. We're saying that all nurses need to do that, and the holistic perspective places emphasis on this.


"We looked at what has happened within the nursing profession, and looked at how the current Scope and Standards need to change to reflect that."


How do the Scope and Standards apply to traditional, as well as holistic, nurses?

"These standards are appropriate for all nurses because the essence of all nursing is holistic-they build upon the standards for basic nursing practice.


"Each of us [as nurses] is an instrument of healing. And that healing presence is important, especially in oncology. It's not just what we do for the patient; it's how we are with the patient. It's not just that the nurse is skilled at being able to administer a chemotherapy treatment; it's the caring presence he or she brings to the situation that can make all the difference in the world. That's really important to us, and is emphasized in our Scope and Standards.


"The Scope and Standards also emphasize the importance of self-care. It's not just being competent-having the right education and communication skills. It's important that we take care of ourselves if we're going to be effective healers for someone else. That's something that any nurse could and should learn from."


How would you say holistic nursing differs from-or has a role within-traditional nursing practice?

"Holistic nurses look at care of the whole person, body, mind, and spirit. We've got to recognize that each person has a mind, emotions, and spirit-and we have to attend to those as well as the physical person, because anything that affects our emotional being is going to affect our physical being.


"It's a little broader than just taking care of the body. And that to me is the essence of all nursing-from the time of Florence Nightingale-to look at the body, mind, and spirit within the context of the environment."


What are some of the ways holistic nurses care for more than "just the body"?

"Holistic nursing will look at both conventional and integrative approaches. For example, if someone has high blood pressure, the conventional allopathic approaches are generally to talk about diet, exercise, and medications.


While diet and exercise are part of dealing with the whole person, a holistic nurse might say, 'OK, maybe walking isn't for you, but maybe doing something like yoga that also incorporates relaxation and stress management could help with blood pressure.' Or, sometimes certain aromatherapies can help people to relax. It's looking at various ways and approaches to working with people.


"In oncology, it's looking at what's going to help the patient with the symptoms related to his or her pain, chemotherapy, or medications. Can you sit down and do some breathing exercises-does that help your pain? They may suggest acupuncture. Or, they may suggest ginger tea, because there's research to show that that helps with nausea."


Book Version

A book version of the updated American Holistic Nursing Association's Scope and Standards for Practice is available for purchase from the AHNA: