1. Zuzelo, Patti Rager EdD, RN, ACNS-BC, ANP-BC, ANEF, FAAN

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Nurses are often intrigued by the possibilities of holistic care practices that potentially improve clients' health and well-being. Holistic nursing offers opportunities beyond the more traditional approaches to health typically emphasized in basic and graduate nursing education programs and promoted in acute care settings. Although nurses are taught to value the "body, mind, and spirit" and demonstrate this value through interventions that include the "art and science" of nursing, it is often the case that care settings prioritize physical well-being, technology-driven care management, and decision-making algorithms over individualized care practice that include physical, nutritional, emotional, social, spiritual, intellectual, and even financial well-being. Nurses may struggle to figure out how to contribute to promoting holistic care within the traditional health care system.


One strategy is to engage in research activities that provide some answers as to the efficacy of holistic care interventions on a certain variable or concern of interest. In the evidence-based practice hierarchical model to which nurses are routinely exposed, the gold standard of science includes multiple randomized controlled trials (RCTs) analyzed together (otherwise known as meta-analyses) or the well-designed, appropriately sampled RCT. While this design is certainly ideal in many cases, an experimental study that looks for differences, relationships, or predictions specific to the effects of a single planned holistic intervention on a dependent variable of interest is not the only type of investigation model needed to move holistic care forward. Implementation science research and quality improvement (QI) investigation are also essential to provide the evidence necessary for reliable and valid approaches to holistic care delivery and improved outcomes.


Implementation science (IS) focuses on systematically adopting and integrating evidence-based interventions into practice.1 Consider that when well-done research concludes that a holistic nursing intervention provides a beneficial clinical and statistical difference on a dependent variable of importance, there is still work to be done by those in the field to determine the suitability, practicability, and acceptability of this intervention. Another way to consider this concern is to ask, "What is the most effective way to deliver this intervention in the clinical setting?"


Research findings may demonstrate that the intervention contributes to an improved outcome, but the next steps should be to ascertain the most effective, acceptable, and feasible way to incorporate this intervention into the delivery system. Is there a "best" way to implement the intervention that will enhance patient satisfaction? How should the intervention delivery be designed to best meet the many work demands of care providers? What are the fixed and fluid costs associated with the intervention and how might the implementation process be revised to save money and resources while still achieving the maximum outcome improvement? These are a few of the questions that holistic nursing practice implementation scientists need to rigorously explore. Rather than asking whether the proposed independent variable makes a difference on the dependent variable of interest, IS asks how to best implement the evidence-based intervention.


QI projects are another critically important investigation type that asks how a process or outcome could be better if evidence-based interventions were incorporated into the practice routine. QI differs from research, particularly in its focus on a local practice problem rather than on a generalizable concern. This statement is not meant to suggest that QI projects offer benefit only to the agency that has conducted the project; we can certainly learn from others' QI efforts!


There are excellent resources available to nurses and interprofessional colleagues who are interested in exploring implementation science and/or QI. Boehm et al1 provide a table of resources for those interested in learning about or conducting implementation science. The table offers brief content descriptions of each resource and also notes whether the source is available for free and online.


The SQUIRE (Standards for QUality Improvement Reporting Excellence) Web site ( offers excellent resources to those looking for opportunities to enhance QI expertise.2 The QI reporting guidelines were developed and subsequently revised through a consensus process.2 Exploring the guidelines offers nurses and colleagues a mechanism for understanding the step-by-step process of QI investigation. The SQUIRE Web site is not a "how-to" tool for designing a QI project; this type of information is best retrieved from the Institute for Healthcare Improvement (IHI) ( but reviewing the reporting guidelines offers insight into the information that should be included when publishing QI project methodology and findings. These data provide the QI team with a good idea of the kinds of content areas that should be considered when designing the investigation.


Nurses interested in a holistic approach to health care recognize that complementary and alternative health practices include a broad range of potential interventions and techniques that need rigorous examination. The traditional research proposal process learned in undergraduate and graduate nursing programs is critical to building nursing science, but there are other approaches to evidence-based practice and research that are essential to robust and effective holistic care enterprises, including implementation science and well-designed QI investigations. Holistic nursing practice requires a comprehensive approach to science building that includes traditional research, implementation science, evidence-based practice projects, and QI studies. Nurses and health care colleagues should work to enrich their expertise across these science-building approaches and support those engaging in all types of research and improvement efforts.




1. Boehm LM, Stolldorf DP, Jeffery AD. Implementation science training and resources for nurses and nurse scientists. J Nurs Scholarsh. 2020;52(1):47-54. doi:10.1111/jnu.12510. [Context Link]


2. SQUIRE. Homepage. Published 2020. Accessed February 14, 2022. [Context Link]