Holistic Nursing A Handbook for Practice FOURTH EDITION pot

Holistic
Nursing
A Handbook for Practice
FOURTH EDITION
Barbara Montgomery Dossey, RN, PhD, HNC, FAAN
Director
Holistic Nursing Consultants
Santa Fe, New Mexico
Lynn Keegan, RN, PhD, HNC, FAAN
Director
Holistic Nursing Consultants
Port Angeles, Washington
Cathie E. Guzzetta, RN, PhD, HNC, FAAN
Nursing Research Consultant
Children’s Medical Center of Dallas
Director
Holistic Nursing Consultants
Dallas, Texas
Endorsed by the American Holistic Nurses’ Association
Copyright © 2005 by Jones and Bartlett Publishers, Inc.
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All rights reserved. No part of the material protected by this copyright may be reproduced or
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information storage and retrieval system, without written permission from the copyright
owner.
Library of Congress Cataloging-in-Publication Data
Holistic nursing : a handbook for practice / [edited by] Barbara
Montgomery Dossey, Lynn Keegan, Cathie E. Guzzetta.— 4th ed.
p. ; cm.

Rev. ed. of: Holistic nursing : a handbook for practice / Barbara
Montgomery Dossey. 3rd. ed. 2000.
Includes bibliographical references and index.
ISBN 0-7637-3183-8 (pbk.)
1. Holistic nursing—Handbooks, manuals, etc.
[DNLM: 1. Holistic Nursing. WY 86.5 H732 2004] I. Dossey, Barbara
Montgomery. II. Keegan, Lynn. III. Guzzetta, Cathie E.
RT42.H65 2004
610.73—dc22
2003021422
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Nursing is an art; and if it is to be made
an art,
it requires as exclusive a devotion, as hard
a preparation, as any painter’s or
sculptor’s work;
for what is the having to do with dead
canvas or cold marble,
compared with having to do with the living
spirit—the temple of God’s spirit?
It is one of the Fine Arts;
I had almost said,
the finest of Fine Arts.
Florence Nightingale
To Our Colleagues in Nursing:
When a nurse
Encounters another
Something happens
What occurs
Is never a neutral event
A pulse taken

Words exchanged
A touch
A healing moment
Two persons
Are never
The same
Vision of Healing xvii
Contributors xix
Foreword xxiii
Preface xxv
Acknowledgments xxix
CORE VALUE 1—HOLISTIC PHILOSOPHY, THEORIES, AND ETHICS 1
VISION OF HEALING—Exploring Life’s Meaning 3
Chapter 1 Holistic Nursing Practice 5
Barbara Montgomery Dossey and Cathie E. Guzzetta
Nurse Healer Objectives 5
Definitions 5
Holism 7
Holistic Nursing 8
Eras of Medicine 12
Relationship-Centered Care 24
Conclusion 27
Directions for Future Research 28
Nurse Healer Reflections 28
Appendix 1-A: American Holistic Nurses’ Association (AHNA)
Standards of Holistic Nursing Practice (Revised 2003) 31
Guidelines 32
AHNA Holistic Nursing Description 32
Core Value 1: Holistic Philosophy, Theories, and Ethics 32
Core Value 2: Holistic Education and Research 33

Core Value 3: Holistic Nurse Self-Care 34
Core Value 4: Holistic Communication, Therapeutic Environment,
and Cultural Diversity 35
Core Value 5: Holistic Caring Process 36
VISION OF HEALING—Transpersonal Self 39
Chapter 2 Transpersonal Human Caring and Healing 41
Janet F. Quinn
Nurse Healer Objectives 41
Definitions 41
Table of Contents
vii
Theory and Research 42
Healing: The Goal of Holistic Nursing 43
The Healer 47
A True Healing Health Care System 48
The Wounded Healer 50
Conclusion 51
Directions for Future Research 51
Nurse Healer Reflections 51
VISION OF HEALING—Reawakening the Spirit in Daily Life 55
Chapter 3 The Art of Holistic Nursing and the Human Health Experience 57
H. Lea Barbato Gaydos
Nurse Healer Objectives 57
Definitions 57
The Art of Holistic Nursing 58
Aspects of the Human Health Experience 63
Conclusion 73
Directions for Future Research 74
Nurse Healer Reflections 74
VISION OF HEALING—Active Listening 77

Chapter 4 Nursing Theory in Holistic Nursing Practice 79
Noreen Cavan Frisch
Nurse Healer Objectives 79
Definitions 79
Theory and Research 79
Selected Nursing Theories 82
A Word About Definitions of Person 86
Theory into Practice 86
Conclusion 88
Directions for Future Research 89
Nurse Healer Reflections 89
VISION OF HEALING—Ethics in Our Changing World 91
Chapter 5 Holistic Ethics 93
Lynn Keegan
Nurse Healer Objectives 93
Definitions 93
The Nature of Ethical Problems 94
Morals and Principles 94
Traditional Ethical Theories 95
The Development of Holistic Ethics 96
Development of Principled Behavior 100
Analysis of Ethical Dilemmas 101
Advance Medical Directives 102
Ethics Education and Research 102
Cultural Diversity Considerations 103
viii HOLISTIC NURSING
Conclusion 104
Directions for Future Research 104
Nurse Healer Reflections 104
CORE VALUE 2—HOLISTIC EDUCATION AND RESEARCH 107

VISION OF HEALING—Web of Life 109
Chapter 6 The Psychophysiology of Bodymind Healing 111
Genevieve M. Bartol and Nancy F. Courts
Nurse Healer Objectives 111
Definitions 111
New Scientific Understanding of Living Systems 112
Emotions and the Neural Tripwire 118
Ultradian Rhythms 120
Mind Modulation 121
Conclusion 129
Directions for Future Research 130
Nurse Healer Reflections 130
VISION OF HEALING—Evolving Process of Life’s Dance 135
Chapter 7 Spirituality and Health 137
Margaret A. Burkhardt and Mary Gail Nagai-Jacobson
Nurse Healer Objectives 137
Definitions 137
Theory and Research 138
Spirituality and the Healing Process 144
Spirituality in Holistic Nursing 148
Holistic Caring Process Considerations 159
Arts and Spirituality 166
Conclusion 167
Directions for Future Research 168
Nurse Healer Reflections 168
VISION OF HEALING—Toward Wholeness 173
Chapter 8 Energetic Healing 175
Victoria E. Slater
Nurse Healer Objectives 175
Definitions 175

An Overview of Energetic Healing 177
Meridians 178
Chakras 181
The Aura 190
Other Forms of Energy: Smells, Aromas, Sounds, Colors, and Touch 193
The Healer 194
The One Being Healed 196
Two Potentially Interesting Concepts for Energetic Healing 199
Research and Research Implications 201
Table of Contents ix
Conclusion 203
Nurse Healer Reflections 205
VISION OF HEALING—Questioning the Rules of Science 209
Chapter 9 Holistic Nursing Research 211
Cathie E. Guzzetta
Nurse Healer Objectives 211
Definitions 211
Wellness Model 212
Evidence-Based Practice 212
Need to Conduct Holistic Research 214
Holistic Research Methods 215
Enhancing Holistic Research 218
Conclusion 224
Directions for Future Research 225
Nurse Healer Reflections 225
CORE VALUE 3—HOLISTIC NURSE SELF-CARE 229
VISION OF HEALING—Toward the Inward Journey 231
Chapter 10 The Nurse as an Instrument of Healing 233
Maggie McKivergin
Nurse Healer Objectives 233

Definitions 233
Theory and Research 234
The Nature of Healing Relationships 239
The Nurse as a Healing Environment 244
Healing Interventions 246
Other Considerations for Integration of Concepts 249
Conclusion 251
Directions for Future Research 251
Nurse Healer Reflections 252
CORE VALUE 4—HOLISTIC COMMUNICATION, THERAPEUTIC ENVIRONMENT,
AND CULTURAL DIVERSITY 255
VISION OF HEALING—Human Care 257
Chapter 11 Therapeutic Communication: The Art of Helping 259
Sharon Scandrett-Hibdon
Nurse Healer Objectives 259
Definitions 259
Theory and Research 259
Therapeutic Communication 260
Therapeutic Communication Helping Model 261
Conclusion 271
Directions for Future Research 271
Nurse Healer Reflections 271
xHOLISTIC NURSING
VISION OF HEALING—Building a Healthy Environment 273
Chapter 12 Environment 275
Lynn Keegan
Nurse Healer Objectives 275
Definitions 275
Theory and Research 276
Holistic Caring Process 295

Directions for Future Research 301
Nurse Healer Reflections 301
VISION OF HEALING—Sharing Our Healing Stories 305
Chapter 13 Cultural Diversity and Care 307
Joan C. Engebretson and Judith A. Headley
Nurse Healer Objectives 307
Definitions 307
Theory and Research 308
Nursing Applications for Developing Cultural Competency 325
Holistic Caring Process 327
Directions for Future Research 333
Nurse Healer Reflections 334
Resource List 334
CORE VALUE 5—HOLISTIC CARING PROCESS 337
VISION OF HEALING—Working with Others 339
Chapter 14 The Holistic Caring Process 341
Pamela J. Potter and Cathie E. Guzzetta
Nurse Healer Objectives 341
Definitions 342
Theory and Research 342
Holistic Caring Process 347
Conclusion 370
Directions for Future Research 370
Nurse Healer Reflections 372
VISION OF HEALING—Actualization of Human Potentials 377
Chapter 15 Self-Assessments: Facilitating Healing in Self and Others 379
Lynn Keegan and Barbara Montgomery Dossey
Nurse Healer Objectives 379
Definitions 379
Circle of Human Potential 379

Self-Assessments 380
Development of Human Potentials 387
Affirmations 391
Conclusion 391
Directions for Future Research 392
Nurse Healer Reflections 392
Table of Contents xi
VISION OF HEALING—Changing Outcomes 395
Chapter 16 Cognitive Therapy 397
Eileen M. Stuart-Shor and Carol L. Wells-Federman
Nurse Healer Objectives 397
Definitions 397
Theory and Research 398
Cognitive Therapy 402
Holistic Caring Process 418
Directions for Future Research 423
Nurse Healer Reflections 423
VISION OF HEALING—Healthy Disclosure 427
Chapter 17 Self-Reflection: Consulting the Truth Within 429
Lynn Rew
Nurse Healer Objectives 429
Definitions 429
Theory and Research 429
Holistic Caring Process 435
Directions for Future Research 444
Nurse Healer Reflections 445
VISION OF HEALING—Nourishing the Bodymind 449
Chapter 18 Nutrition 451
Susan Luck
Nurse Healer Objectives 451

Definitions 451
Theory and Research 452
Eating to Promote Health 461
Healthy Choices in Nutrition 467
Holistic Caring Process 468
Directions for Future Research 472
Nurse Healer Reflections 472
VISION OF HEALING—Moving Through Strength 477
Chapter 19 Exercise and Movement 479
Beryl H. Cricket Rose and Lynn Keegan
Nurse Healer Objectives 479
Definitions 479
Theory and Research 480
Holistic Caring Process 485
Directions for Future Research 491
Nurse Healer Reflections 491
xii HOLISTIC NURSING
VISION OF HEALING—Releasing the Energy of the Playful Child 495
Chapter 20 Humor, Laughter, and Play: Maintaining Balance in a Serious World 497
Patty Wooten
Nurse Healer Objectives 497
Definitions 497
Theory and Research 497
Holistic Caring Process 510
Directions for Future Research 516
Nurse Healer Reflections 516
VISION OF HEALING—Creating Receptive Quiet 521
Chapter 21 Relaxation: The First Step to Restore, Renew, and Self-Heal 523
Jeanne Anselmo
Nurse Healer Objectives 523

Definitions 523
Theory and Research 524
Meditation 528
Modern Relaxation Methods 536
Holistic Caring Process 553
Directions for Future Research 560
Nurse Healer Reflections 560
VISION OF HEALING—Modeling a Wellness Lifestyle 565
Chapter 22 Imagery: Awakening the Inner Healer 567
Bonney Gulino Schaub and Barbara Montgomery Dossey
Nurse Healer Objectives 567
Definitions 567
Theory and Research 568
Clinical Techniques in Imagery 575
Holistic Caring Process 581
Directions for Future Research 610
Nurse Healer Reflections 610
VISION OF HEALING—Composing the Harmony 615
Chapter 23 Music Therapy: Hearing the Melody of the Soul 617
Cathie E. Guzzetta
Nurse Healer Objectives 617
Definitions 617
Theory and Research 617
Holistic Caring Process 627
Directions for Future Research 636
Nurse Healer Reflections 636
Table of Contents xiii
VISION OF HEALING—Using Our Healing Hands 641
Chapter 24 Touch: Connecting with the Healing Power 643
Lynn Keegan and Karilee Halo Shames

Nurse Healer Objectives 643
Definitions 643
Theory and Research 644
Touch Interventions and Techniques 651
Holistic Caring Process 656
Directions for Future Research 664
Nurse Healer Reflections 665
VISION OF HEALING—Accepting Ourselves and Others 667
Chapter 25 Relationships 669
Dorothea Hover-Kramer
Nurse Healer Objectives 669
Definitions 670
Theory and Research 670
Holistic Caring Process 677
Conclusion 687
Directions for Future Research 687
Nurse Healer Reflections 688
VISION OF HEALING—Releasing Attachment 691
Chapter 26 Dying in Peace 693
Melodie Olson and Barbara Montgomery Dossey
Nurse Healer Objectives 693
Definitions 693
Theory and Research 693
Holistic Caring Process 697
Directions for Future Research 716
Nurse Healer Reflections 717
VISION OF HEALING—Nourishing Wisdom 719
Chapter 27 Weight Management Counseling 721
Sue Popkess-Vawter
Nurse Healer Objectives 721

Definitions 721
Theory and Research 722
Holistic Caring Process 738
Directions for Future Research 752
Nurse Healer Reflections 752
VISION OF HEALING—Acknowledging Fear 757
Chapter 28 Smoking Cessation: Freedom from Risk 759
Christine Anne Wynd and Barbara Montgomery Dossey
Nurse Healer Objectives 759
Definitions 759
xiv HOLISTIC NURSING
Theory and Research 759
Holistic Caring Process 766
Directions for Future Research 776
Nurse Healer Reflections 777
VISION OF HEALING—Changing One’s World View 781
Chapter 29 Addiction and Recovery Counseling 783
Bonney Gulino Schaub and Barbara Montgomery Dossey
Nurse Healer Objectives 783
Definitions 783
Theory and Research 784
Vulnerability Model of Recovery from Addiction 788
Holistic Caring Process 799
Directions for Future Research 807
Nurse Healer Reflections 808
VISION OF HEALING—Recovering and Maintaining the Self 811
Chapter 30 Incest and Child Sexual Abuse Counseling 813
E. Jane Martin
Nurse Healer Objectives 813
Definitions 813

Theory and Research 814
Holistic Caring Process 817
Directions for Future Research 825
Nurse Healer Reflections 825
VISION OF HEALING—Healing Through the Senses 827
Chapter 31 Aromatherapy 829
Jane Buckle
Nurse Healer Objectives 829
Definitions 829
History 830
Theory and Research 830
Conclusion 840
Holistic Caring Process 841
Directions for Future Research 848
Nurse Healer Reflections 848
VISION OF HEALING—Nursing Voices of St. Charles Medical Center 853
Chapter 32 Relationship-Centered Care and Healing Initiative in a Community
Hospital 857
Nancy Moore
Nurse Healer Objectives 857
Definitions 857
Theory and Research 857
About St. Charles 858
Table of Contents xv
Life Skills 864
Life-Death Transition 866
Arts in the Hospital 871
Healing Our Community 874
Principle-Based Care Model 876
Conclusion 877

Directions for Future Research 880
Nurse Healer Reflections 880
VISION OF HEALING—Transformation of the Acute Health
Care Environment 883
Chapter 33 Exploring Integrative Medicine and the Healing Environment:
The Story of a Large Urban Acute Care Hospital 885
Lori L. Knutson
Nurse Healer Objectives 885
Definitions 885
Introduction 885
Total Healing Environment Model: Large Urban Acute Care Hospital 886
Conclusion 896
Directions for Future Research 896
Nurse Healer Reflections 896
Index 899
xvi HOLISTIC NURSING
Exploring Life’s Meaning 3
The Transpersonal Self 39
Reawakening the Spirit in Daily Life 55
Active Listening 77
Ethics in Our Changing World 91
The Web of Life 109
The Evolving Process of Life’s Dance 135
Toward Wholeness 173
Questioning the Rules of Science 209
Toward the Inward Journey 231
Human Care 257
Building a Healthy Environment 273
Sharing Our Healing Stories 305
Working with Others 339

Actualization of Human Potentials 377
Changing Outcomes 395
Healthy Disclosure 427
Nourishing the Bodymind 449
Moving Through Strength 477
Releasing the Energy of the Playful Child 495
Creating Receptive Quiet 521
Modeling a Wellness Lifestyle 565
Composing the Harmony 615
Using Our Healing Hands 641
Accepting Ourselves and Others 667
Releasing Attachment 691
Nourishing Wisdom 719
Acknowledging Fear 757
Changing One’s World View 781
Recovering and Maintaining the Self 811
Healing Through the Senses 827
Nursing Voices of St. Charles Medical Center 853
Transformation of the Acute Health Care Environment 883
xvii
Visions of Healing
Jeanne Anselmo, RN, BSN, HNC
Holistic Nurse Consultant
Private Practice
Bayside, New York
Coordinator
Contemplative Urban Law Program
Community Legal Resource Network
City University School of Law
Queens College

Flushing, New York
Genevieve M. Bartol, RN, EdD, HNC
Professor Emeritus
University of North Carolina at
Greensboro
School of Nursing
Greensboro, North Carolina
Jane Buckle, PhD, RN
Complementary and Alternative Medicine
Fellow
Center for Clinical Epidemiology and
Biostatistics
University of Pennsylvania
Philadelphia, Pennsylvania
Director, RJ Buckle Associates LLC
Hunter, New York
Margaret A. Burkhardt, RN, PhD, RNCS,
HNC
Director
Healing Matters
Beckley, West Virginia
Family Nurse Practitioner
Gulf Family Practice
Sophia, West Virginia
Nancy F. Courts, RN, PhD, NCC
Chair and Associate Professor
Adult Health Department
School of Nursing
University of North Carolina at
Greensboro

Greensboro, North Carolina
Barbara Montgomery Dossey, RN, PhD,
HNC, FAAN
Director
Holistic Nursing Consultants
Santa Fe, New Mexico
Joan C. Engebretson, RN, DrPH, HNC
Associate Professor
University of Texas Health Science Center
Houston
School of Nursing
Houston, Texas
Noreen Cavan Frisch, RN, PhD, HNC,
FAAN
Professor and Director
School of Nursing
Cleveland State University
Cleveland, Ohio
H. Lea Barbato Gaydos, RN, PhD, CS, HNC
Assistant Professor
University of Colorado at Colorado
Springs
Beth-El College of Nursing and Health
Science
Colorado Springs, Colorado
xix
Contributors
Cathie E. Guzzetta, RN, PhD, HNC, FAAN
Nursing Research Consultant
Children’s Medical Center of Dallas

Director
Holistic Nursing Consultants
Dallas, Texas
Judith A. Headley, RN, PhD, AOCN, CCRP
Associate Professor, Division of Oncology
Director, Clinical Research Management
School of Nursing
University of Texas Health Science
Center-Houston
Houston, Texas
Dorothea Hover-Kramer, RN, EdD, CNS
Director
Behavioral Health Consultants
Cave Junction, Oregon
Lynn Keegan, RN, PhD, HNC, FAAN
Director
Holistic Nursing Consultants
Port Angeles, Washington
Lori L. Knutson, RN, BSN, HNC
Director
Integrative Medicine
The Institute for Health and Healing
Abbott Northwestern Hospital
Minneapolis, Minnesota
Susan Luck, RN, MA, HNC, CCN
Director of Nutrition Education
Biodoron Immunology Center
Hollywood, Florida
Nutrition Educator/Consultant
Special Immunology Services

Mercy Hospital
Miami, Florida
E. Jane Martin, RN, PhD, HNC, FAAN
Dean and Professor
West Virginia University
School of Nursing
Morgantown, West Virginia
Maggie McKivergin, RN, MS, CNS, HNC
Holistic Nurse Consultant
Galena, Ohio
Nancy Moore, RN, PhD
Senior Vice President
Clinical and Healing Services
St. Charles Medical Center
Bend, Oregon
Mary Gail Nagai-Jacobson, RN, MSN
Community Health Consultant
Director
Healing Matters
San Marcos, Texas
Melodie Olson, RN, PhD
Associate Professor
College of Nursing
Medical University of South Carolina
Charleston, South Carolina
Sue Popkess-Vawter, RN, PhD
Professor
University of Kansas Medical Center
School of Nursing
Kansas City, Kansas

Pamela J. Potter, APRN, DNSc (C)
Energy Oriented Psychotherapy
Wisdom Tree LLC: Resources for Healing
New Haven, Connecticut
Janet F. Quinn, RN, PhD, FAAN
Associate Professor–Adjoint
School of Nursing
University of Colorado Health Sciences
Center
Denver, Colorado
Lynn Rew, RN,C, EdD, AHN-C, FAAN
Denton & Louise Cooley and Family
Centennial Professor in Nursing
University of Texas at Austin
Austin, Texas
xx HOLISTIC NURSING
Beryl H. Cricket Rose, MSN, RN
CQI/RM/Credentialing Coordinator
Community Care Services, City of Austin
Austin, Texas
Sharon Scandrett-Hibdon, RN, PhD, CS,
FNP, CHTI, CHN
Certified Psychiatric Nurse
North Texas State University Student
Health Center
Denton, Texas
Family Nurse Practitioner
Pilot Point, Texas
Bonney Gulino Schaub, RN, MS, CS
Co-Director New York Psychosynthesis

Institute
New York, New York
Co-Director
The Dante School for Meditative Arts
Huntington, New York
Co-Director
Holistic Nursing Associates
New York, New York
Karilee Halo Shames, RN, PhD, HNC
Director of Education
Eco Nugenics/Better Health Seminars
Santa Rosa, California
Victoria E. Slater, RN, PhD, HNC
Holistic Nurse in Private Practice
Clarksville, Tennessee
Eileen M. Stuart-Shor, RN, PhD, ANP,
FAHA
Research Fellow, Cardiology
Harvard Medical School, Beth Israel
Deaconess Medical Center
Cardiology Nurse Practitioner, Roxbury
Health Center
Assistant Professor, College of Nursing,
Northeastern University
Consultant, WellCare Associates for
Integrative Medicine
Boston, Massachusetts
Jean Watson, RN, PhD, HNC, FAAN
Distinguished Professor of Nursing
Murchinson-Scoville Chair in Caring

Science
University of Colorado Health Sciences
Center
School of Nursing
Denver, Colorado
Carol L. Wells-Federman, RN, MEd, APRN,
BC
Senior Instructor
Graduate Program, School for Health
Studies, Simmons College
Visiting Scholar, William F. Connell
School of Nursing, Boston College
Consultant, WellCare Associates for
Integrative Health
Nurse Practitioner
Massachusetts General Hospital
Boston, Massachusetts
Patty Wooten, RN, BSN, PHN
Nurse Humorist
Jest For the Health of It!
Santa Cruz, California
Christine A. Wynd, RN, PhD, CNAA
Professor and Director of the PhD in Nurs-
ing Program
The University of Akron
College of Nursing
Akron, Ohio
Contributors xxi
The fourth edition of Holistic Nursing: A
Handbook for Practice attests to the suc-

cess and use of previous versions, moving
from theory, knowledge, and values to
skills and applications that integrate per-
sonal and professional competencies of
Being into Caring—Healing Practices.
This edition builds upon and extends the
preceding editions by continuing to
update the knowledge base with the most
current, cutting-edge science. The authors
use a strong scientific-theoretical-philo-
sophical foundation to underpin both cur-
rent and futuristic practices, that inform
and guide nursing and system directions
for implementing, integrating, extending,
and sustaining both basic and advanced
holistic nursing modalities across setting,
time, and space.
The content for this edition continues to
explicate as well as incorporate compre-
hensive-integrative approaches to body-
mind-spirit nursing and Era III nursing/
medicine. These perspectives intersect and
embrace biomedical developments in the
field of “complementary-integrative bio-
medical” advances. This work is congruent
with an ethical and moral foundation for
transpersonal dimensions of caring and
healing practices at all levels, in that it
honors the wholeness of our Being and
Becoming more human, humane, and spiri-

tual in our evolution as both a profession
and as an evolving humanity.
This work continues to guide this field of
holistic nursing by offering an advanced
orientation along with advanced knowl-
edge and practices. It brings forth the
beauty, art, and artistry of the human
dimensions of holistic nursing, continually
informed and deepened by the American
Holistic Nurses’ Association, as well as the
North American Nursing Diagnosis Associ-
ation. This intellectual and standardized
foundational text expands the context and
significance of the ethical, epistemologi-
cal, and praxis dimensions. It calls forth
not only the intellectual importance, but
the values-guided aspects of higher-
deeper levels of commitment, compassion,
love, and caring that underpin this kind of
advanced practice: a holistic practice that
is oriented toward the betterment of
human health, healing, and humankind.
The evolution of the fourth edition
reflects the continuing evolution of the
nursing profession. It is a seminal work
that contributes to the emergence of mature
holistic standards and practices within a
contemporary postmodern Era III scientific
phase; yet this new edition continues to
ground these practices in a blueprint of

timeless goals, along with the finest her-
itage and wisdom of Nightingale.
These new/old developments of holistic
nursing guide students, faculty, and practic-
ing nurses with breakthroughs related to
expanding consciousness research, notions
of internationality, energetic healing, and
new views of the body, as well as spiritual-
ity through compassionate human service.
These notions transcend, yet embrace,
basic research in bodymind medicine, psy-
chophysiology, human potential, and so on,
xxiii
Foreword
integrating values with comprehensive
knowledge, clinical skills, and professional
standards that inform advanced practice.
As holistic nursing experts, the authors
are committed to the deepest actualization
of nursing, as an ancient and pioneering,
yet futuristic, profession. They practice
what they teach by translating and inte-
grating this latest thinking into pragmatic
and concrete nursing actions, processes,
and artistic acts of caring and healing.
They help us all to comprehend the critical
nature of these practices in relation to
nursing and how these practices inform
any “caring moment.” A consequence of
this important, expanded work is that the

self of the nurse is invited—and even
reminded—of their calling into nursing,
into self-care and self-healing, as essen-
tials for authentic living of this knowledge
in their personal/professional life. As such,
then, by transforming self, the holistic
nurse is helping to transform systems.
In summary, this fourth edition provides
a framework for all of nursing’s caring—
healing practices; it offers a guide for per-
sonal self-care within the holistic para-
digm. The result: a major work of
excellence that grounds nursing in the
current demands from within and without
for reform, while generating new tradi-
tions and standards of personal and pro-
fessional excellence and authenticity. At
another level, this work transcends nurs-
ing and has relevance for transdiscipli-
nary education and practices, leading to
greater authenticity and advancement of
patient care between and among all
health professionals.
Jean Watson, RN, PhD, HNC, FAAN
Distinguished Professor of Nursing
Murchinson-Scoville Chair in
Caring Science
University of Colorado Health
Sciences Center
School of Nursing

Denver, Colorado
xxiv HOLISTIC NURSING
The American Holistic Nurses’ Associa-
tion (AHNA) has joined with the authors and
contributors of Holistic Nursing: A Handbook
for Practice, Fourth Edition, to develop fur-
ther the knowledge base for holistic nursing
and delineate the essence of contemporary
nursing. The purposes of this book are three-
fold: (1) to expand an understanding of heal-
ing and the nurse as an instrument of
healing; (2) to explore the unity and related-
ness of nurses, clients, and others; and (3) to
develop caring-healing interventions to
strengthen the whole person.
Since the third edition of this book in 2000,
much has changed in the world. We are fac-
ing, as never before, unprecedented short-
ages of nurses, educators, and leaders.
Because of the physical and emotional dev-
astation of September 11, 2001, the fear of
biological weapons such as anthrax and
smallpox, the global outbreak of SARS, and
the need to be prepared for biological/
chemical terrorism, we all are being con-
fronted with new challenges in nursing
practice. In this time of great national and
international uncertainty, self-care and self-
healing are essential. But how do we
respond to these challenges as responsible,

caring professionals and leaders in this
movement of holistic nursing and integra-
tive health care?
This book guides nurses in the art and
science of holistic nursing and healing. It
offers ways of thinking, practicing, and
responding, both personally and profes-
sionally. It addresses our own self-healing
so that we can offer new ways of healing
to others, and practice the art of healing in
innovative ways in a time of great vulnera-
bility. It presents expanded strategies for
enhancing our psychophysiology using self-
assessments, relaxation, imagery, nutrition,
exercise, and aromatherapy. It also assists
nurses in their challenging roles of bringing
healing to the forefront of health care and
helping to shape health care reform.
Because of public demand for alterna-
tive medicine, the National Institutes of
Health (NIH) created in 1992 the Office of
Alternative Medicine (OAM). In 1999, the
OAM was elevated to freestanding center
status, now renamed the National Center
for Complementary and Alternative Medi-
cine (NCCAM), in which it is able to fund
its own research grants without partnering
with other institutes. The NCCAM is evalu-
ating strategies that capitalize dramati-
cally on bodymind and transpersonal

therapies. The consistent and cumulative
research findings are revealing that these
therapies not only work and are extremely
safe, but are also cost-effective. At the
present time, they should be considered
complements to orthodox medical treat-
ments and not a replacement for them. We
advocate a “both/and” instead of an
“either/or” approach in interfacing these
healing modalities with contemporary
medical and surgical therapies.
We challenge nurses to explore the fol-
lowing three questions:
1. What do you know about the mean-
ing of healing?
2. What can you do each day to facili-
tate healing in yourself?
xxv
Preface
xxvi HOLISTIC NURSING
3. How can you be an instrument of
healing and a nurse healer?
Healing is a lifelong journey into under-
standing the wholeness of human exis-
tence. Along this journey, our lives mesh
with those of clients, families, and col-
leagues, where moments of new meaning
and insight emerge in the midst of crisis.
Healing occurs when we help clients, fam-
ilies, others, and ourselves embrace what

is feared most. It occurs when we seek har-
mony and balance. Healing is learning
how to open what has been closed, so that
we can expand our inner potentials. It is
the fullest expression of oneself that is
demonstrated by the light and shadow
and the male and female principles that
reside within each of us. It is accessing
what we have forgotten about connec-
tions, unity, and interdependence. With a
new awareness of these interrelation-
ships, healing becomes possible, and the
experience of the nurse as an instrument
of healing and as a nurse healer becomes
actualized. A nurse healer is one who
facilitates another person’s growth toward
wholeness (body-mind-spirit) or who
assists another with recovery from illness
or with transition to peaceful death. Heal-
ing is not just curing symptoms. Rather, it
is the exquisite blending of technology
with caring, love, compassion, and cre-
ativity.
This holistic approach is developed by
incorporating ideas of perennial philoso-
phy, natural systems theory, and the holis-
tic caring process. The information
presented within Holistic Nursing: A Hand-
book for Practice may be of additional
interest to the nurse because it incorpo-

rates the following:
• American Holistic Nurses’ Association
Standards of Holistic Nursing Practice
(Revised and coded, 2003)
• three new chapters on Aromatherapy,
Relationship-Centered Care and
Healing Initiatives in a Community
Hospital, and Exploring Integrative
Medicine and the Healing Environ-
ment in a Large Urban Acute Care
Hospital.
• nursing diagnoses established by the
North American Nursing Diagnosis
Association related to the 13 domains
of the newly developed Taxonomy II
• guidelines for integrating holistic
interventions, divided into four areas:
before, at the beginning, during, and
at the close of the session
• both basic and advanced strategies
for integrating complementary and
alternative interventions
• client case studies in the acute care
and outpatient settings
• current research and directions for
future research
As we have explored new meanings of
healing in our work and lives, we have
interwoven the many diverse threads of
knowledge from nursing, as well as from

other disciplines, in this book. This inte-
gration has engendered a more vivid,
dynamic, and diverse understanding
about the nature of holism, healing, and
its implications for nursing. Allow yourself
to explore ideas of healing by reading a
Vision of Healing before the start of each
chapter. Each chapter then begins with
Nurse Healer Objectives to direct your
learning within the theoretical, clinical,
and personal domains. Each chapter has a
glossary of definitions for easy reference.
The term patient is used for acute care set-
tings, and the term client is used in the
outpatient settings. With both the patient
and the client, we view persons as co-par-
ticipants in all phases of care. The chal-
lenge is to integrate all concepts in this
text in clinical practice and daily life. As
clinicians, authors, educators, and
researchers, we have successfully used
Preface xxvii
these holistic concepts and interventions
from the critical care unit and home health
to the classroom.
Each chapter ends with Directions for
Future Research that are specific to each
topic. This section presents suggested
research questions that are timely and in
need of scientific exploration in nursing.

In concluding each chapter, Nurse Healer
Reflections are offered to nurture and
spark a special self-reflective experience
of body-mind-spirit and the inward jour-
ney toward self-discovery and healing.
This book is organized according to the
five core values of holistic nursing contained
within the newly revised American Holistic
Nurses’ Association Standards of Holistic
Nursing Practice. They are as follows:
Core Value 1: Holistic Philosophy, Theo-
ries, and Ethics
Core Value 2: Holistic Education and
Research
Core Value 3: Holistic Nurse Self-Care
Core Value 4: Holistic Communication,
Therapeutic Environment, and Cul-
tural Diversity
Core Value 5: Holistic Caring Process
Core Value 1 presents the philosophic
concepts that explore what occurs when
the nurse honors, acknowledges, and
deepens the understanding of inner
knowledge and wisdom. It explores rela-
tionship-centered care. It lays the founda-
tion for transpersonal human caring, the
art of holistic nursing, and provides
insight into how people create change and
sustain these new health behavior
changes related to wellness, values clari-

fication, and motivation theory. Holistic
nursing theorists and theories are devel-
oped to guide holistic nursing practice.
Holistic ethics is also addressed in both
personal and professional arenas.
Core Value 2 addresses the psychophys-
iology of bodymind healing, spirituality,
and health. Energetic healing also is
developed to expand further one’s under-
standing and practice of holism. Guide-
lines for holistic research also are
explored to provide a framework for estab-
lishing evidence-based practice.
Core Value 3 develops and explores the
concepts of therapeutic presence and the
qualities and characteristics of becoming
an instrument of healing. It also explores
the importance of self-care.
Core Value 4 explores therapeutic com-
munication and the art and skills of help-
ing. The necessary steps in creating an
external as well as an internal healing
environment are expanded to help nurses
recognize that each person’s environment
includes everything surrounding the indi-
vidual, both the external and the internal,
as well as patterns not yet understood.
Concepts related to cultural diversity are
presented so that the nurse can recognize
each person as a whole body-mind-spirit

being. Such recognition facilitates the
development of a mutually cocreated plan
of care that addresses the cultural back-
ground, health beliefs, sexual orientation,
values, and preferences of each unique
individual.
Core Value 5 expands the nursing pro-
cess to the holistic caring process and
includes a detailed discussion of the North
American Nursing Diagnosis Association
and the 13 domains of Taxonomy II. The
nursing process is a six-part circular
process: assessment, patterns/challenges/
needs, outcomes, therapeutic care plan,
implementation, and evaluation. Self-
assessments and complementary and
alternative strategies are developed to
expand concepts relevant to healing and
reaching human potential. Specific areas
covered are cognitive therapy, self-reflec-
tion, nutrition counseling, exercise and
movement, laughter, play and humor,
relaxation, imagery, music, touch, rela-