What Is the American Holistic Nurses Association’s Position on the Role of Nurses in the Practice of Complementary and Integrative Approaches to Health?

The American Nurses Association (ANA) officially recognized holistic nursing as a distinct nursing specialty with a defined scope and standards of practice in 2006. That same year, the American Holistic Nurses Association’s board of directors approved a Position Statement on the role of nurses in the practice of complementary and integrative approaches to health. The American Holistic Nurses Association (AHNA) is a professional specialty nursing association dedicated to the promotion of holism and healing. 

Since then, AHNA’s Position Statement, together with the book Holistic Nursing: Scope and Standards of Practice, has been the primary reference for nurses, states, and legal counselors when they want clarity on this topic. The purpose of this article is to increase the AHNA Position Statement’s visibility so that more nurses become aware of it and use it as a resource for nursing practice, education, and research. The full position statement is available here.

Overview

The nursing profession has a long history of caring for individuals in a holistic manner and integrating the healing arts with conventional treatments. Prior to the famous works of Florence Nightingale of England in the 1850s, American nurses were already renowned for holistic approaches to sickroom management, which is today referred to as creating an optimal healing environment. Optimal healing environments consider fresh air, wholesome food, touch, light, aromatics, empathetic listening, music, quiet reflection, and similar healing measures as essential ingredients to nursing care. Today, holistic registered nurses and holistic advanced practice nurses build upon these same principles. In addition, one of the core values of the specialty of holistic nursing is that nurses enter therapeutic partnerships with clients, families, and communities to serve as facilitators in the healing process. This partnership begins with nurses being mindfully aware and fully present in their interactions at work and in their life as a whole.

Definitions 

Holistic nursing is defined as “all nursing practice that has healing the whole person as its goal”. The AHNA’s Position on the Role of Nurses in Complementary and Integrative Health Approaches (CIHA) provides the following additional definitions of important terms:

• Alternative health approach refers to a practice used in place of conventional medicine
• Complementary health approach is a practice that is used together with conventional medicine
• Healing does not equate to curing, although they can be synchronous. 
• Healing arts are those interventions that foster an individual’s healing process; a return of the individual toward a state of wholeness in which body, mind, emotional spirit are integrated and balanced, and the person is able to reach deeper levels of personal understanding.  
• Holistic care refers to approaches and interventions that address the needs of the whole person: body, mind, emotion, and spirit.
• Integrative health care involves the coordination of conventional and complementary approaches

The holistic nursing care process is one in which nurses apply these commitments in their practice: 

• Acquire and maintain current knowledge and competency in holistic nursing practice, including any complementary and integrative therapies they are using in their nursing practice. 
• Provide care and guidance to persons through nursing interventions and therapies consistent with evidence-based research findings and other sound evidence. 
• Embrace a professional code of ethics and healing that seeks to preserve the wholeness and dignity of self and others. 
• Engage in self-care. 
• Develop continual growth and personal awareness of his or her own unique capacity to serve as an instrument of healing.
• Recognize each person as a whole: body-mind-spirit. 
• Practice mindful presence in all interactions. 
• Assess clients holistically, using traditional nursing concepts and incorporating therapeutic communication to identify a broader scope of factors that are potential contributors to increased stress. 
• Create a plan of care in collaboration with clients and their significant others that is consistent with cultural background, health beliefs, sexual orientation, values, and preferences focusing on health promotion, recovery, restoration, or peaceful dying while maintaining an optimal level of personal independence for as long as possible. 

Nursing, Complementary, and Integrative Health 

Inherent in the professional nurse’s role is the ability to assess, plan, intervene, evaluate, and perform preventive, supportive, and restorative functions of the physical, emotional, mental, and spiritual domains. Therefore, it is expected that holistic nurses integrate principles and techniques of conventional, complementary, and alternative practices, that these are within the scope of nursing practice, and that this is holistic nursing care. 

Consistent with conventional nursing practice, nurses must be competent in the integrative therapies and practices they use. In addition, nurses can support and assist clients with their use of integrative health interventions by: 

• Identifying the need for complementary and alternative interventions 
• Assisting clients in locating providers of those services
• Facilitating the use of integrative health care through education, counseling, coaching, and other forms of assistance 
• Coordinating the use of integrative health care in collaboration with various health care providers 
• Evaluating the effectiveness of clients’ integrative health care 

The AHNA Position Statement points out that practicing within a holistic nursing framework does not imply competency in any specific health approach. Nurses are always responsible for gaining additional education and experience and demonstrating clinical competency in all interventions they use in their nursing practice. In other words, a nurse who practices a specific CIHA must have the education, skills, and credentials ascribed for that therapy, and the nurse must operate within the legal scope of practice of his or her licensure and jurisdiction. 

AHNA views registered nurses as being in a unique position to implement CIHA throughout the health care system because they: 

• Represent the greatest number of health care professionals, representing more than 5 million health care professionals, and are employed in more diverse settings than any other health care professional 
• Are uniquely prepared to differentiate normality from illness, provide interventions for health promotion and illness-related care, and use a wide range of medical technology and healing arts 
• Are advocates for clients rather than for specific products or practices, therefore are in an excellent position to assure appropriate and adequate use of all types of services 
• Are the most highly trusted professionals in the USA by consumers, and have been for the last 17 years 

In summary, the American Holistic Nurses Association’s (AHNA) Position Statement supports registered nurses in performing roles that 1) support and assist clients with their use of integrative health interventions; 2) integrate principles and techniques of conventional, complementary, and alternative practices when the nurse is competent in those practices and operating within the legal scope of practice of his or her licensure and jurisdiction, and 3) take a leadership role in the implementation of CIHA as part of an integrated approach to health.

References 

American Holistic Nurses Association. (1998) Description of holistic nursing. Flagstaff, AZ: AHNA.

American Holistic Nurses Association. (2006). Position on the Role of Nurses in Complementary and Integrative Health Approaches (CIHA) www.ahna.org 

American Nurses Association and American Holistic Nurses Association. (2019). Holistic nursing: scope and standards of practice. Silver Spring, MD.: American Nurses Association, nursesbooks.org.

National Center for Complementary and Integrative Health (NCCIH): https://nccih.nih.gov/health/integrative-health