More than 150 years ago, Florence Nightingale (1859/1992) championed holistic nursing education (HNE) by teaching nurses to care for the whole person and their environment. In professional standards and the literature, HNE is usually equated with teaching the principles, core values, and competencies of holistic nursing (American Holistic Nurses Association [AHNA] & American Nurses Association [ANA], 2013; American Holistic Nurses Credentialing Corporation [AHNCC] & AHNA, 2017; Avino, Helming, Shields, & Cordeau, 2016). Consistent with theories of holism and philosophies of holistic education, HNE focuses on the learner as a whole person and the learner’s interconnectedness with others and the environment. In HNE, faculty “value all the ways of knowing and learning” and help students “to know themselves and access their own inner wisdom to enhance growth, wholeness, and well-being, and experience personal transformation” (AHNA & ANA, 2013, p. 18). As instruments of learning and facilitators of the learning process, faculty also serve as role models by integrating self-care, self-reflection, self-responsibility, and spirituality in their own lives (AHNA & ANA, 2013).
Academic nurse educator (ANE) competencies and program outcomes describe the importance of a holistic perspective in ANE practice. For example, the National League for Nursing (NLN) core competencies (NLN, 2012) and graduate ANE program outcomes (NLN, 2017) emphasize holistic teaching practice to foster self-reflection, self-care, and the whole development of learners. Professional standards and competencies used in nursing education, such as the American Association of Colleges of Nursing [AACN] Essentials (AACN, 2018), also convey the importance of HNE, with competencies related to holistic nursing practice, patient teaching and health promotion, spirituality, caring, clinical prevention and population health, complementary health approaches, and self-care.
Despite the legacy of HNE bequeathed by Nightingale to nursing and its emphasis in professional and academic standards, current literature does not describe faculty perspectives about HNE and how faculty teach students in a holistic way to practice nursing in a holistic way. This qualitative descriptive study was conducted to address this gap.
After obtaining institutional review board approval, a convenience sample of all nursing faculty (N = 77) who teach in a private, religious-affiliated university in the Midwest were invited to complete an anonymous, online, researcher-developed survey about HNE. The survey, composed of seven open-ended and five demographic questions, was sent to faculty in May 2017; participation was voluntary. Completed surveys (43/77 = 56 percent) were analyzed for the focal survey question: How do you define HNE? Using qualitative content analysis (Polit & Beck, 2017; Sandelowski, 2000), the researchers reviewed the data independently to generate emerging categories and related themes. The researchers then compared their results and developed categories and themes together that were used to conduct the thematic analysis. Demographic data were analyzed using descriptive statistics.
Ninety percent of respondents used complementary health approaches and/or self-care practices at least weekly, 88 percent identified themselves as “holistic nurse educators,” and 87 percent believed it is “extremely” or “very” important to teach students about holistic nursing practice. Most (92 percent) were interested in learning more about HNE, and 74 percent participated in academic or continuing education programs about holistic nursing. Almost half (44 percent) planned to seek AHNCC certification in holistic nursing, and 10 percent were certified. Nearly half (48 percent) taught in undergraduate programs, 38 percent in graduate programs, and 15 percent in both.
Qualitative content analysis of respondents’ definitions of HNE yielded three categories with related themes: a) teaching holistic nursing, b) seeing with “holistic eyes,” and (c) using holistic pedagogy. The majority of definitions (n = 38, 88 percent) were related to two or more themes. Table 1 presents these categories and themes with examples.
Overall, respondents’ definitions of HNE were consistent with the literature, reflecting a holistic perspective of both the learner and the patient or client. Teaching the principles, core values, standards, and competencies of holistic nursing care were also emphasized (AACN, 2018; AHNA & ANA, 2013; AHNCC & AHNA, 2017; ANA, 2015). The majority of respondents described HNE as a way of being, seeing, and/or relating to others holistically as a nurse educator. For example, one respondent stated HNE was “a way of ‘being’ in how I teach and what I teach.” The inclusiveness of HNE was also highlighted.
Definitions included both HNE and holistic nursing practice, both students and patients, both allopathic and integrative strategies, both science and spirit. Phrases such as “body, mind, spirit” and “physical, mental, psychosocial, spiritual” were described by 18 respondents (42 percent); the word “whole” or “wholeness” was used by 14 (33 percent). Respondents also identified theorists (e.g., Newman, Parse, Rogers, Watson) and theories (e.g., holism, unitary caring science), as well as specific complementary health approaches (e.g., energy healing). In a separate question, respondents identified 114 examples of how they use HNE; these examples were consistent with the categories and themes identified in the analysis of definitions.
Several respondents expressed a sense of urgency to learn more about HNE, which resonates with Cowling’s (2013) call “to promote scholarship that reflects the role and impact of nursing education from a holistic perspective” and to “develop approaches to teaching and learning…based on core principles of holistic nursing” (p. 76). Others asserted that teaching nursing is HNE and were “reluctant to [add] some sort of special distinction for a profession which holds [holistic nursing] as a central tenet of all practice” and “the foundation of nursing education.” Still others described the challenges of HNE, such as the lack of time to teach and relate to students holistically, insufficient knowledge of complementary health approaches, and lack of collegial support. Some respondents acknowledged they were unfamiliar with HNE or not sure if their definition was “correct.” One respondent defined HNE “not favorably,” voicing concerns about integrating “alternate therapies without evidence.”
According to King and Gates (2007), HNE is “the broad base of knowledge and therapeutic presence when preparing a holistic practitioner” (p. 317). Respondents described this “broad base of knowledge” as “modeling holistic, caring relationships”; using holistic teaching practices that “allow optimum engagement and learning”; “embracing the many ways of knowing and engaging as a nurse educator with students”; and teaching the importance of self-reflection and self-care. As one respondent stated, HNE is “influencing and establishing a unique way of being in each of the nurses that leave our doors and enter the world of caring for others.”
Limitations of this study include using a researcher-developed survey and collecting data at a single institution. Findings may reflect self-selection bias, and the anonymous, online survey did not allow for clarification of individual faculty responses.
RECOMMENDATIONS AND CONCLUSIONS
The overwhelming majority of respondents expressed interest in learning more about HNE, such as how to create holistic learning environments and integrate holistic standards and competencies in curriculum (AHNA & ANA, 2013; AHNCC & AHNA, 2017). In addition to faculty development, a second recommendation emanating from this study involves connecting HNE with how faculty teach, how students learn, student learning outcomes, and patient care outcomes (NLN, 2017, p. 5). Furthermore, the National Institute of Nursing Research (n.d.) targets wellness as a key theme to implement its strategic plan. Finally, enacting educational models that embrace holistic, relationship-centered teaching; complementary health approaches; and an interprofessional team perspective is recommended to ensure nurses and all health professionals are prepared for collaborative, holistic practice (AHNA & ANA, 2013, p. 40).
Faculty responses suggest the heart and soul of HNE is teaching students to see themselves and others holistically by modeling relationships that respect and value the wholeness of every person. According to respondents’ definitions, HNE respects the dignity and diversity of students and responds to their social, mental, and spiritual needs, as well as their learning needs. With its holistic focus on students and their learning, HNE empowers faculty to teach in a holistic way and inspires students to provide patient-centered care in a holistic way that embodies the living legacy of Nightingale.
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