Caring-Healing Inquiry for Holistic Nursing Practice: Model for Research and Evidence-Based Practice

Karen Dorn, RN, PhD, APRN-BC

Disclosures

Topics in Advanced Practice Nursing eJournal. 2004;4(4) 

In This Article

Caring-Healing Inquiry for Holistic Nursing Practice

The research model, caring-healing inquiry for holistic nursing practice, integrates the values of the health system, principles that guide nursing governance, and caring theory and research in nursing. The guiding values for the model are compassion, hospitality, and stewardship; guiding principles include excellence, collaboration, and leadership. Caring-healing practices and a caring-healing environment contribute to the goal of human wholeness and quality care. The focus of inquiry may be on the person, family, or community; on the nurse, health team, or health system; or the relationships between them. Within this model, multiple modalities of caring-healing practice and multiple methods of inquiry are encouraged, thus honoring the art and science of nursing. The components of the model are illustrated in Figure 2.

Figure 2.

Caring-healing inquiry for holistic nursing practice: model for nursing research and evidence-based practice.

Application of Caring Model

The caring-healing model builds on existing caring research in nursing and provides a framework to guide current and future research efforts, as described below. The Avera Health System has a central commitment to "caring for life" guided by the values of compassion, stewardship, and hospitality.[19] These values, congruent with the humanistic values of caring philosophy, provide a basis for research on the human capacity for caring and the values that underlie caring. Recently, the 3 nurse governance councils conducted an exercise to help nurses clarify values and define what is important to them. Narrative analysis of responses revealed that qualities most valued by nurses include being caring and compassionate and having professional integrity (eg, being honest and trustworthy). In addition, nurses overwhelmingly express, as their central concern, a commitment to providing the best care possible to patients and families.

Organizational factors may increase or decrease the likelihood that caring may occur.[18] Leadership, collaboration, and excellence are principles that guide nursing practice at Avera McKennan and establish, in part, the organizational conditions for nursing practice. These principles are derived from the mission statement of the nurse governance council, "empowering the practice of professional nursing excellence by supporting clinical practice through leadership, decision-making and collaboration in order to provide holistic patient and family centered care."[20]

Nurse-related conditions, such as personal or professional resources, constraints, and demands, can also enhance or inhibit caring.[18] One EBP priority of the research program is to evaluate the impact of several professional development programs (summer externship, graduate internships, and professional achievement) on staff satisfaction, nurse recruitment and retention, and quality indicators.

Creating a caring-healing environment is an area of emphasis for nursing practice. Consistent with holistic nursing practice, a healing environment may include attending to environmental factors, such as light, sound, air quality, and space.[21] Policies and hospital routines can be evaluated in terms of how they contribute to a caring-healing environment or, alternatively, create barriers that inhibit caring. For example, in an EBP project in the intensive care unit (ICU), visitation practices were changed on the basis of a survey of staff and family members. One practice change was simply providing a chair for family members at the bedside, thus enhancing the caring-healing environment for families. Due to the small size of the ICU rooms, chairs had previously been considered a potential hazard should resuscitation equipment be needed. Plans for updating the ICU environment include providing more space in rooms to better meet the needs of patients, families, and care providers.

A major focus of the caring model is to make explicit caring theory as the basis of practice, regardless of whether the practice is an established nursing practice or an emerging therapeutic modality. From a holistic perspective, caring-healing practices include basic and advanced use of sensory, kinesthetic, and mental-cognitive modalities -- many of which are already foundational to nursing practice.[9] The quality of therapeutic presence is also a caring-healing practice and a fundamental aspect of nursing as a relational practice. For example, promoting positive nutrition and lifestyle change or use of touch, imagery, music, humor, or meditation are considered part of holistic nursing practice.[22] Advanced practice nurses play an important role in promoting caring-healing practices.

In the caring-healing inquiry model, quality care and human wholeness are the outcomes of caring. Qualitative and quantitative outcome data are encouraged in this model. For example, outcome data for the graduate nurse internship program include an evaluation of retention data and economic indicators, the use of research-based instruments to evaluate the impact on professional role development, and organizational commitment as well as narrative analysis of qualitative evaluations by interns and mentors of the internship experience.

Exemplar

To illustrate how the caring-healing inquiry model is effective in framing EBP improvements, an example from a pain-performance-improvement initiative is described. The pain-performance-improvement initiative is guided by the value of compassion. The project incorporates the principles of excellence through practice improvement and collaboration through interdisciplinary team effort. The performance-improvement activities include staff development regarding pain management and revision of policies and procedures relating to pain management. Both of these activities contribute to a caring-healing environment. More frequent and intentional assessment of the pain experience for patients reflects caring-healing practices that have been instituted. Outcomes of the project show improved patient satisfaction with pain control demonstrating improved quality care.

As the research program develops, research and EBP projects are increasingly framed from the caring model perspective. A task force of nurses representing advanced practice nurses, directors, managers, and staff nurses meets regularly to study caring theory and its potential to frame practice and improve professional practice. The use of caring instruments to measure outcomes of caring is being explored.

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