Purpose: The goal of this quality improvement project was to increase staff nurses' knowledge of and comfort level with administration of aromatherapy, reduce barriers in the administration of aromatherapy, and increase use of aromatherapy as a holistic nursing intervention on an acute care surgical unit. Prior to the project, aromatherapy use was explored on this 28-bed unit and revealed there were less than three aromatherapy administrations per month. Design: The project followed guidelines for quality improvement outlined by the Plan-Do-Study-Act (PDSA) model and was further informed by the holistic theoretical framework of aromatherapy. Methods: The project implemented a new aromatherapy station and provided access to quick reference materials. Quantitative data surrounding aromatherapy administration were gathered through chart review. Qualitative data were gathered through observation of staff and interviews with key stakeholders. Findings: Data surrounding aromatherapy administration revealed an increase in use on this surgical unit with the project implementation. Conclusions: Benefits from this project informed an increased comfort level with aromatherapy and ease of administration by nurses. Patients may then experience subsequent benefits related to being offered aromatherapy as part of a holistic approach to their treatment plan.
Jean Watson's Theory of Human Caring offers a relevant and contemporary framework for holistic nursing care. By redefining traditional paradigms, Watson's model positions transpersonal care as both a theoretical and practical pathway for holistic nursing practice. Empathy, as a foundational human experience present in all care encounters, is central to the holistic development of transpersonal care. This essay explores, from classical and contemporary philosophical perspectives, the concept of empathy within Watson's framework, relating its core concepts to nurse-patient encounters in holistic care. Empathy is examined as an existential mode of being-with-the-other, articulated with concepts such as intercorporeality, comprehensive understanding of the other's experience, and becoming-other. Two of Watson's Caritas® Processes are analyzed as spaces for holistic openness and empathic presence. The discussion highlights the importance of developing practices that transcend the technical-biological model, emphasizing the appreciation of alterity and the cultivation of dignified, sensitive, ethical, and transformative bonds in holistic care. Empathy is also discussed in relation to mindfulness, understood as an intentional practice that integrates body, mind, spirit, and heart, fostering compassionate listening. The article offers new philosophical perspectives and highlights the relevance of empathy in advancing holistic nursing care.
Introduction: Emergency surgery for bowel obstruction can significantly impact patients' coping mechanisms, leading to various physical and psychological complications. The intentional presence of a nurse, as a holistic approach, can aid patients in enhancing their coping strategies and psychological well-being postsurgery. Aim: This study aimed to assess the effect of a nurse's intentional presence, as a holistic intervention, on stress, anxiety, depression, and coping strategies in patients undergoing bowel obstruction surgery. Method: This randomized controlled trial was conducted at Qaem Hospital in Mashhad, Iran, from March 2021 to October 2022. A total of 62 patients were randomly assigned to two groups. The intervention group received nursing care based on the theory of intentional presence over five individual sessions lasting 45-90 min each in the hospital, followed by telephone support for up to 1-month postdischarge. The control group received educational pamphlets. Data were collected using the Filipino Coping Strategies Scale (FCSS) and DASS-21 before, 1 week after, and 1 month after the intervention. Data were analyzed using SPSS 27 with quantile regression models adjusting for baseline covariates. Results: The results showed homogeneity between the two groups regarding age (P = 0.14) and other demographic and disease information (P > 0.05). The Mann-Whitney test revealed significant reductions in anxiety, stress, and depression in the intervention group compared to the control group at 1 month (P < 0.001). Additionally, there was a significant improvement in coping strategies (indicating better adaptation) in the intervention group compared to the control group at 1 month (P = 0.04). Quantile regression confirmed these findings with significant adjusted effects (anxiety: RC = -3.14, 95% CI [-4.89, -1.39]; stress: RC = -1.00, 95% CI [-1.96, -0.04]; depression: RC = -1.00, 95% CI [-1.98, -0.02]; coping: RC = 4.11, 95% CI [1.87, 6.35]). Conclusion: The findings indicate that the intentional presence of a holistic nurse can enhance patient adaptation to disease symptoms after surgery and reduce stress, anxiety, and depression. Further studies with mixed-methods designs are needed to comprehensively assess patient adaptation and the qualitative aspects of the nurse-patient relationship.
Backgroundand Aim: The primary goal of care for transgender and gender diverse (TGD) individuals is to address their somatic, psychological, and social needs holistically while promoting well-being in a manner that affirms and respects their gender identity. Health care provisions should be grounded with respect to the patient and characterized by mutual trust, respect for autonomy, maintenance of confidentiality, and delivery of the highest standard of care. The aim of this study was to examine the perceptions of individuals with gender dysphoria and TGD individuals among professionally active nursing staff, as well as undergraduate nursing and midwifery students.MethodsThis study was conducted via the diagnostic survey method. The research instrument was a questionnaire comprising a sociodemographic section and items assessing knowledge of and perceptions of transgender identity and gender diversity.ResultsThe level of knowledge regarding transgender identity and gender diversity was most frequently assessed by respondents as satisfactory (31%). More than half of the participants (65.1%) reported knowing a transgender or gender-diverse individual, and 37% declared having provided care to such a patient. According to the majority of respondents (82.9%), TGD individuals constitute a group at risk of discrimination and stigmatization, and 56.2% indicated that the Polish health care system does not adequately recognize or respond to their health-related needs. Most respondents (75.8%) reported perceiving TGD patients in the same way as all other patients did, with perceptions being primarily dependent on individual personality traits (82.6%). At the same time, respondents indicated that TGD individuals constitute a group with particular needs related to mental health care (89%) and gender-related health care (60.9%).ConclusionsPerceptions of transgender and gender-diverse individuals among the surveyed nursing personnel were heterogeneous and dependent on sociodemographic variables and levels of knowledge. According to the respondents, TGD individuals experience discrimination and are subjected to prejudice and inappropriate treatment both by medical personnel and within the broader social context.
Introduction: This study examined the relationship between person-centered perioperative nursing care and spiritual support perception of nurses working in surgical units. Design: In this descriptive and correlational study, 426 surgical nurses working in Türkiye between March and November 2024 constituted the sample. Data were collected using Google Forms through a personal information form, the Person-Centered Perioperative Nursing Scale, and the Perception of Spiritual Support Scales. Participants were reached using a virtual snowball sampling method. Results: The mean of the person-centered perioperative nursing scale was 80.07 ± 9.22, and spiritual support scale was 51.13 ± 6.78. There was a statistically significant difference between the institution of employment, participation in a conference on surgical nursing, and any training on person-centered perioperative care and the person-centered perioperative nursing scale (p < 0.05). Person-centered perioperative nursing had a statistically significant and positive effect on the perception of spiritual support (β = 0.265, p < 0.05), and 13% of the variance in the model was explained. Conclusion: The study found that person-centered perioperative care effectively promoted the perception of spiritual support. Therefore, nurses working in surgical settings are recommended to receive training on person-centered perioperative care to improve their perception of spiritual support, thereby enabling them to provide holistic care.
Background: Patients undergoing open-heart surgery require holistic-focused patient education to ensure they prepare for and recover in a manner that addresses all dimensions of well-being. However, patient education for this population of patients is predominantly biopsychosocially oriented, overlooking existential needs. Objective: To conduct a critical synthesis of the literature, exploring existential experiences of patients undergoing open-heart surgery, to inform holistic-focused patient education. Method: The literature was searched for research articles, with a focus on qualitative studies that included the existential experiences of open-heart surgery patients. Selected papers were appraised using the Critical Appraisal Skills Programme checklist. Data synthesis was conducted using interpretive hermeneutics and expressed in themes. Results: The analysis of seven eligible studies yielded three themes: (a) being between a rock and a hard place: losing freedom, dependence on healthcare providers, (b) being connected with others: alleviating existential uncertainty, the nexus of support, and (c) being faithful: preparing and recovering authentically, trust, belief, and prayer. Conclusion: A focus only on biopsychosocially oriented patient education for open-heart surgery patients can be overcome through advocating for patients' existential needs, whereby healthcare providers emphasize empowerment, incorporate psychological services, and address spiritual and religious needs. Implications for holistic-focused patient education and holistic healthcare research are discussed.
Background: Stroke is a leading cause of mortality and serious long-term disability. Palliative care may enhance overall quality of life among older adults experiencing a stroke, but a limited understanding of these patients' holistic needs exists. Objective: To conduct a scoping review of the literature exploring the palliative care needs of older adults with stroke, with the aim of tailoring holistic nursing interventions to improve quality of life. Methods: The review followed Arksey and O'Malley's five-stage framework: formulating the review question; identifying relevant studies; screening and selecting studies; charting the data; and collating, summarizing, and reporting the results. Three online databases (PubMed, Embase, and CINAHL) were searched for studies published between 2014 and 2024 using key terms such as "palliative care needs," "older adults," and "stroke". Screening and selection were managed via Endnote and Covidence review management software, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Results: Eighteen studies emphasize the need for holistic palliative care nursing in older adults with stroke. Five overarching themes emerged: physical functioning, psychosocial and emotional support, informed decision-making, symptom management, and comfort-based care. Conclusion: Integrating holistic palliative care nursing into patient-centered stroke services is vital for improving the quality of life in older adults. Findings from this scoping review will inform future nursing research priorities, as well as clinical nursing initiatives, addressing the holistic palliative care needs of older adults experiencing stroke in collaboration with patients, families, and interdisciplinary healthcare professionals.
Purpose: This paper grounds the DREAM model, a practice-based framework developed from research on caring presence, aimed at enhancing holistic nursing care through being fully present and engaged with the patient, within Watson's Transpersonal Theory of Human Caring and the Unitary Caring Science worldview. The DREAM model was subsequently operationalized as a framework for providing care to adolescents with mental health conditions using the Nursing Interventions Classification (NIC). Design/Methods: The key concepts in the DREAM: Dedication; Respect through relationship; Environment; Art of nursing; and Motivation were linked to and conceptualized within concepts in Watson's Transpersonal Theory of Human Caring to demonstrate how the DREAM model can be philosophically grounded and practically operationalized within a caring science perspective. The model was then operationalized by linking the key concepts to five priority NIC interventions. Findings: The findings underscore how evidence-based nursing actions can enhance caring presence and relational engagement in healthcare, particularly in adolescent mental health care, creating a synthesis of caring theory with NIC. Conclusion: Through the grounding of the DREAM model in Watson's theory and its operationalization using the NIC, the authors invite a new discourse on advancing adolescent mental health care.
Purpose: The purpose of this study was to explore Advanced Practice Nurses' (APN) perceptions of spirituality globally, in both clinical practice and in everyday life, and to evaluate the usefulness of Spiritually Competent Practice as a relevant framework for holistic APN care. Design/Methods: A cross-sectional survey design was used. Respondents were recruited via convenience (snowballing) sampling. Spirituality in Everyday Life (SEDL) and Spirituality in Practice (SIP) were measured, as well as the importance of spiritual care competencies and Spiritually Competent Practice. Data was analyzed using Multiple Regression Analysis and Univariate Screening Analysis. Findings: A total of n = 641 APNs from 55 countries participated in the study. Participant responses yielded mean SEDL, SIP, and CONCEPT scores above the mid-point of the associated range for each measure, representing an overall positive perception of SEDL and SIP, and a similar positive perception of personal experience of Spiritually Competent Practice. This study offers further insight into perceptions and use of spirituality to ensure holistic care by APNs' globally and how APNs' view spirituality both within and outside of their work. Conclusion: Spirituality is pivotal in advanced practice and holistic nursing, fostering comprehensive and whole-person care and providing patients and practitioners with a sense of hope, meaning, and purpose. The results from this study highlight the need to ensure spirituality is fully understood by APNs' and how APN education and continuing professional development should consider how best to integrate spirituality into holistic practice.
Purpose of the Study: To assess burnout levels among community nurses in Portugal during the COVID-19 pandemic and explore the relationship between burnout dimensions, work-related stressors, and coping strategies, through a holistic nursing lens. Design of the Study: Quantitative, descriptive, cross-sectional design. Method Used: A convenience sample of 75 nurses from ACES Grande Porto V-Porto Ocidental completed an anonymous online questionnaire. The instrument included sociodemographic and professional variables, working conditions during the pandemic, and the Professional Wear Questionnaire for Nurses-Reduced Version. The data were analyzed using both descriptive and inferential statistics. Findings: Overall levels of burnout were low across emotional exhaustion, depersonalization, and reduced personal fulfillment. The most significant stressors were work overload and contact with death and pain. Nurses primarily used social support and direct confrontation as coping strategies. No statistically significant associations were found between burnout dimensions and sociodemographic, professional, or psychological variables. Findings suggest the presence of resilience and possible institutional or personal protective factors. Conclusions: This study contributes to the holistic nursing science by emphasizing the importance of supporting nurses' well-being through holistic self-care and organizational practices. The findings underscore the need for additional research on protective factors and resilience-building interventions within comprehensive frameworks.
Purpose: The purpose is to integrate existing knowledge about spiritual needs and interventions during the perinatal period, including cultural and contextual variation, to inform how spirituality may be further integrated. Study Design: Critical narrative literature review evaluated against the Scale for the Assessment of Narrative Review Articles (SANRA) criteria. Analysis: The thematic synthesis was conducted to identify analytical themes and evidence levels across diverse cultural contexts. Findings: The review was based on 34 diverse sources (ranging from randomized controlled trials [RCTs] and systematic reviews to phenomenological and ethnographic studies). Synthesis revealed a dual nature of spirituality, in which it can act as a protective factor (contributing to meaning-making and coping) or, conversely, increase stress when interpreted as divine punishment or when spiritual needs go unmet. Conclusions: Recognizing and integrating spirituality into perinatal care contributes to holistic, person-centered midwifery and nursing. Practice should prioritize the use of spiritual assessment tools, interprofessional collaboration with spiritual caregivers, and the inclusion of spiritual care competencies in formal nursing education.
BackgroundOnline harassment has emerged as a global crisis, impacting nearly 40% of adult internet users and inflicting deep-seated "soul pain." While traditional support is standard, there is a lack of structured interventions addressing the ontological insecurity caused by digital cruelty. This study explores the integration of biblical promises as "anchors" within spiritual nursing care to restore a victim's inherent sense of worth.MethodsFollowing Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and the PCC framework, a scoping review was conducted across six major databases (2015-2025). Ten high-impact primary studies (N = 10) were selected for thematic synthesis based on their explicit focus on the intersection of digital trauma and faith-based coping.ResultsThematic synthesis revealed a four-stage trajectory: (1) digital displacement, (2) the clinical necessity of spiritual assessment, (3) the application of biblical anchors, and (4) identity restoration. Findings suggest that anchoring identity in the Imago Dei provides a stable alternative to the "digital mirror" of social media.ConclusionsThe proposed "Five Directional Statements of Restoration" framework operationalizes these findings for clinical practice. Ethical implementation is emphasized, requiring informed consent and alignment with the patient's faith tradition to ensure autonomy and avoid spiritual coercion. This review concludes that specialized spiritual nursing care offers a restorative remedy for digital shame, fostering unshakeable resilience.
In a world marked by technological acceleration, sociopolitical unrest, and ecological disruption, nursing faces growing fragmentation-of systems, relationships, and meaning. This paper re-envisions holistic nursing not merely as a clinical approach but as an ontological and ethical philosophy of wholeness that sustains nursing's identity amid such complexity. Drawing upon Lonergan's interiority as a foundation for moral awareness, Ubuntu's relational ontology, and Foucault's critique of surveillance and power, the paper develops a philosophical framework that reconnects the nurse's being and action. It proposes that the nurse's moral presence arises from interior reflection and relational accountability, enabling resistance to reductionist and algorithmic forces that dehumanize care. By viewing the nurse as a contemplative witness and ethical actor within fragmented systems, this framework invites a return to nursing's core calling-to honor human dignity, cultivate presence, and nurture authentic relationship as the essence of healing. This renewed philosophy of wholeness offers guidance for nursing education, practice, and policy in an era increasingly defined by disconnection.
PurposeThis concept analysis aims to clarify the concept of faith-concordant nursing care and examine its relevance to holistic nursing practice, particularly within culturally and religiously diverse healthcare contexts.Design/MethodsA concept analysis was conducted using Walker and Avant's approach to refine and define the concept within nursing. The process included identifying the concept, reviewing its uses in literature, determining defining attributes, constructing model and related cases, and examining antecedents, consequences, and empirical referents. Literature on spiritual care, cultural competence, and holistic nursing was synthesized to inform the analysis.FindingsFaith-concordant nursing care is defined by four key attributes: shared belief alignment, cultural-religiosity competence, relational trust (theological safety), and holistic integration. Antecedents include spiritual vulnerability, self-identification of faith preferences, institutional and provider openness, and culturally and linguistically safe communication. Consequences include enhanced psychological well-being, spiritual peace, improved patient satisfaction, and strengthened therapeutic relationships.ConclusionsFaith-concordant nursing care advances holistic nursing by offering a unitary and practice-oriented framework that moves beyond general spiritual care toward intentional alignment with patients' self-identified faith beliefs and practices. The concept contributes to nursing science and has implications for nursing practice, education, future research, and healthcare systems seeking to address patients' spiritual needs more effectively.
Purpose: This study explored how family members of terminally ill patients in an intensive care unit (ICU) experience anticipatory grief as a holistic, multidimensional phenomenon. Design: A qualitative phenomenological approach guided by Jean Watson's Theory of Human Caring was used to capture participants' lived experiences. Methods: In-depth semi-structured interviews were conducted with seven family members of terminally ill patients in the ICU of a public hospital in West Java, Indonesia. Participants were recruited using purposive sampling. Data were analyzed using Colaizzi's method and reported according to the COREQ checklist. Findings: Five interrelated themes emerged: (a) emotional storm in the face of uncertainty; (b) faith as a spiritual anchor; (c) searching for meaning through reflection; (d) the need for connection and compassion; and (e) preparing the heart through ritual, hope, and letting go. Families experienced grief as a spiritually rooted, emotionally intense, and relationally significant journey, shaped by cultural practices and their interactions with nurses. Conclusions: Anticipatory grief in the ICU is a holistic crisis that calls for intentional, compassionate, and spiritually sensitive nursing presence. Findings support the integration of holistic caring principles and culturally congruent support into ICU practice.
PurposeProviding spiritual care is an essential part of holistic nursing practice since it promotes patients' mental, emotional, and spiritual health. Spirituality and religiosity affect nurses' ability to provide spiritual care. A thorough evaluation of these elements is necessary to guarantee high-quality care. The purpose of this study was to determine the relationship between Filipino nurses' spirituality, religiosity, and spiritual care competency.DesignThe study used a descriptive-correlational design. Validated measures evaluating spirituality, religiosity, and spiritual care competency were used to gather data from registered nurses. Descriptive statistics were used to summarize the participants' profiles and competence levels, while Pearson's r was used to assess the relationships among spirituality, religiosity, and spiritual care competency.FindingsThe results showed that nurses have a high level of spirituality and religiosity, while their spiritual care competency is moderate. A significant positive relationship was found between nurses' spirituality, religiosity, and spiritual care competence.ConclusionRecognizing the role of spirituality and religiosity in nursing practice may support the development of spiritual care competency and holistic nursing care.
Purpose of Study: Nurses' caring behaviors are essential for improving patient outcomes. This study aimed to investigate the associations between spiritual well-being, job satisfaction, and specific dimensions of caring behaviors among Iranian nurses. Design of Study: A descriptive cross-sectional design was used. Methods Used: A total of 200 nurses were recruited through convenience sampling from four government hospitals in northern Iran during 2023. Data were collected using a demographic form, the Caring Behaviors Inventory, the Spiritual Well-being Scale, and the Job Satisfaction Survey. Statistical analyses were conducted using two-level logistic regression models with the Restricted Maximum Likelihood (REML) method in STATA Version 17. Findings: Spiritual well-being was significantly associated with overall caring behaviors and subdimensions such as respectful communication and ensuring human presence (p < 0.001). Internal job satisfaction was significantly related to ensuring human presence (p < 0.05), while external satisfaction and existential well-being showed no significant associations (p > 0.05). Unit-level clustering accounted for less than 3% of variance in caring behaviors. Conclusion: Spiritual well-being and internal job satisfaction play key roles in promoting nurses' caring behaviors. Interventions to enhance spiritual well-being hand strengthen internal aspects of job satisfaction may contribute to better patient care outcomes.
Aim: This study aims to examine the use and attitudes of complementary and alternative medicine (CAM) in patients undergoing cardiac surgery from a holistic nursing perspective. Methods: This descriptive study was conducted with 156 patients undergoing cardiac surgery in a research hospital. Data were collected using a questionnaire and the "Attitudes Toward Holistic Complementary and Alternative Medicine Scale." Analysis involved descriptive statistics and bivariate correlation. Results: Findings indicate that 16.7% of participants considered conventional medical treatment inadequate. Reasons for CAM use included strengthening the immune system (10.3%) and seeking physical/psychological relaxation (15.4%). Crucially, 71.8% of CAM users failed to disclose this information to healthcare personnel. The mean attitude score was 31.38 ± 4.40, revealing significant positive correlations between CAM use, education level, and the perception of benefit. Conclusion: Consistent inquiry into patients' use of supportive methods is essential for effective postoperative management. This planning must prioritize the integrity of the patient's body, mind, and spirit, ensuring that care is fully aligned with a holistic nursing approach.
The aim is to determine nurses' professional values and individualized care experiences and the affecting factors. This cross-sectional study was conducted with 470 nurses in a city hospital between September and November 2021. Information Form, Nurses Professional Values Scale (NPVS), and The Individualized Care Scale-Nurse Version (ICS-Nurse) were used for data collection. The average score on the NPVS was 118.16 ± 21.9. The total ICS-Nurse score of the participants was 3.96 ± 0.7. A positive, weak and statistically significant relationship was found between the NPVS and ICS-Nurse in terms of clinical status, personal life, and decision-making subdimension scores (p < .05). The professional values of nurses were found to be at a moderate level which directly affect their approaches to individualized care. Having high levels of professional values can help nurses provide better individualized care to their patients.
Purpose: Discussing death with terminally ill patients is a challenging yet essential part of palliative care nursing. This study explored nurses' perceptions and experiences, emphasizing holistic care that addresses patients' physical, emotional, social, cultural, and spiritual needs. Design: A descriptive, exploratory qualitative design was used with content analysis. Methods: Data were collected through in-depth interviews with 16 participants and analyzed using traditional content analysis. MAXQDA software was used for coding and organizing the qualitative data. Results: Four main themes emerged: "Professional Readiness and Communication Competence," "Experiences in Talking About Death," "Factors Shaping Death-Related Communication," and "Internalization of Death and Its Influence on Care." Nurses stated that talking about death was influenced by patient requests, disease progression, family expectations, and the nurse's communication skills. Training and expertise were seen as essential. Some nurses felt this task was more appropriate for physicians or psychosocial teams. Conversations included both positive experiences (e.g., offering hope) and challenges (e.g., emotional strain, patient resistance). Nurses described death as both a fearful and natural experience. Conclusions: Supporting nurses through communication-focused in-service training, with an emphasis on holistic care principles, is recommended to enhance the quality of end-of-life care and better address the multidimensional needs of patients facing death.