If you’re questioning your approach to health and wellness, a change in practice may be in order
By Kelly Rose Flanagan
December 11, 2023
- Holistic nurses take a whole-person perspective, looking at the big picture in someone’s life.
- Nurse coaches work with clients, using specialized tools and theory to help them achieve desired growth.
- An accredited program offers nurses the opportunity to earn a certificate in holistic nursing and nurse coaching.
Like many nurses in Canada today, I became exhausted, fatigued and overwhelmed. I wondered if I could feasibly continue working as a nurse until retirement. We’ve been hearing a lot about compassion fatigue, moral distress, lack of autonomy, poor control over our work environment, and burnout. There has also been an onus on nurses to use self-care and coping strategies to work through undesirable situations.
I wasn’t immune to any of these things. Thirteen years of sampling various nursing specialties didn’t provide much job satisfaction or work–life balance or much motivation to keep learning and growing as a nurse. It wasn’t all bad. I have fond memories of travelling to northern Manitoba, flight nursing, meeting like-minded nurses, and connecting with patients in amazing communities. But these adventures didn’t seem to truly resonate with me as a sustainable career option alone.
As nurses, we may often re-evaluate the trajectory of our careers and wonder if this is the correct path for us, leaving us searching for a “niche.” I realized that I had not yet discovered mine. At this pivotal moment in both my life and career, I questioned everything I believed in when it came to health and wellness and how we practise nursing in the current system. Then I discovered holistic nursing and nurse coaching.
What is holistic nursing?
Holistic nursing and nurse coaching can be two separate specialties, however, they are difficult to separate as one naturally complements the other. So for this article, I will portray them as one entity.
Barbara Montgomery Dossey and Lynn Keegan (2015, p.3) defined holistic nursing as follows: “Holistic Nurses’ practice involves healing of the whole person as its goal and honors relationship-centered care and the interconnectedness of self, others, nature, and spirituality; focuses on protecting, promoting, and optimizing health and wellness.” In other words, holistic nurses facilitate healing by viewing an individual through the whole-person perspective. Holistic nurses look at the big picture in someone’s life. This includes the physical, emotional, mental (including inner dialogue), and spiritual aspects of the person and their external environment. Ways in which a holistic nurse might go about this vary, but the core values of nursing still connect the nurse to the true intentions of the profession.
A group of holistic nurses from British Columbia who founded the Canadian Holistic Nurses Association (CHNA) in 1986 and achieved special interest group status through the Canadian Nurses Association (CNA) has built a solid foundation of what Canadian holistic nursing looks like. CHNA’s vision states that “complementary and integrative health care are incorporated into all aspects of nursing and the patient care experience within the Canadian health care system,” whereas their holistic nursing theory is “grounded in nursing knowledge and skill and guided by nursing theory. Florence Nightingale’s writings are often referenced as a significant precursor for the development of holistic nursing practice. Each holistic nurse chooses which nursing theory to apply in any individual case” (CHNA, n.d.). In essence, their goals are to bridge the gap between western and complementary health and integrate an approach that encompasses the individual or the community as a whole. This builds on their strengths and facilitates a way of healing in which the individual/community can thrive moving forward.
What does a holistic nurse do?
Holistic nursing is a new specialty and is rapidly being adopted by some trail-blazing nurses in Canada today. Since nurses are experts in health care and nursing is one of the most trusted professions, we make the perfect practitioners to identify population wellness needs, advocate for health, and facilitate healing. Often, this includes the use of complementary approaches to support enhanced self-care and autonomy. Holistic nurses do their due diligence by connecting with their provincial regulatory body to ensure that they are acting within their scope of practice as a nurse. Once certified in a holistic nurse program, the holistic nurse may create their independent practice, meeting with clients one on one or in group settings to identify their wellness concerns, such as weight loss, management of stress, pain, fatigue, and general emotional, physical, and spiritual healing. Specifically, a holistic nurse collaborates with the client to guide them in identifying what may be blocking their ability to thrive in certain health-related endevours, such as battling an addiction or losing weight. Each nurse would identify those needs alongside their client(s) based on their holistic assessment, the client’s story and shared concerns, and the nurses’ specialty in holistic care.
There also have been opportunities for holistic nurses to work within hospital settings, acting as patient advocates and providing care to adults, children and families in settings such as cancer and palliative care or for clients with special needs. Typically, holistic nurses create their opportunities while looking at the gaps in care within a community, together with their strengths, specialty and scope of practice.
For more information on holistic nursing, visit CHNA’s website.
What is nurse coaching?
The holistic nurse may also use a complementary modality such as nurse coaching, whereby theories and coaching techniques within the scope of practice help a client develop, achieve, and sustain their desired goals. The holistic nurse coach assists the client in identifying their goals and uses a theory-based approach and unique tools to support the client’s progress. This support is often the missing piece when achieving sustainable goals.
Nurse coaching is a specialty that has bloomed in the United States over the past decade and has proven to be effective within many aspects of the health-care system there. It is thanks to a few Canadian nurses who took their nurse coach training in the US and decided to use their skills and knowledge to bring this unique approach to Canada. “Our hearts wanted to ease the suffering of nurses worldwide. But a much-needed shift had to occur from a state of simply doing and surviving to one of flourishing and thriving” (Hole, DeCoste, & Derkach, 2022). This quotation is from the Canadian holistic nurse coaches who founded the Canadian Institute of Integrative Nursing Development and Education (CIINDE) in the Nightingale Initiative for Global Health.
These nurses at CIINDE developed an accredited program that offers Canadian nurses a means to learn about both holistic and nurse coaching and consulting, which is an amazing opportunity for nurses in Canada who wish to pursue this specialty. The Comprehensive Holistic Nurse, Nurse Coach & Consultant Certificate Program has been accredited and approved by CNA as well as the American Nurses Credentialing Center for 135 nursing continuing professional development hours. It has also been endorsed by CHNA and the Watson Caring Science Institute. These are pivotal and important accomplishments and accreditations for anyone wishing to pursue a career in holistic nursing and nurse coaching. More recently, Hole, DeCoste and Derkach were inducted into the Global Academy of Holistic Nursing, a true testament to their belief in the importance of holistic nursing and its approach to health care.
Both holistic nurses and nurse coaches must uphold the standards laid out by their regulatory bodies, work within their scope of practice according to that regulatory body, abide by CNA’s Code of Ethics for Registered Nurses (2017), and follow the American Holistic Nurses Association’s Holistic Nursing: Scope and Standards of Practice (2019).
In other words, holistic nurse coaches follow the same ethical and practice requirements as all other nursing specialties. Additionally, the function of the holistic nursing practice standards reflect the values and priorities of the profession; the standards provide a framework for accountability in practice and the outcomes for which nurses are responsible (Dossey & Keegan, 2015).
Moreover, both holistic nurses and nurse coaches follow the nursing process while elevating the process with a whole-person ideology and theory. During the assessment phase of the nursing process, nurses gather pertinent information according to their area of practice. For example, a nurse working on a medicine unit may gather vital signs and reports of pain or discomfort and perhaps follow up with a quick head-to-toe physical assessment. There are many other patients they need to assess and tasks that need to be completed, so a quick gathering of pertinent information is often all that is feasible at the time. Although the nursing process is being followed, time and situational constraints often limit nurses from doing a detailed assessment (in this type of setting).
Alternatively, a holistic nurse coach would view the assessment phase of the nursing process as an opportunity to discover everything that is relevant about an individual. This includes the client’s behavioural data, strengths, readiness for change, and subjective experiences in health care; it can also include family and cultural practices and environmental factors (Dossey et al., 2016). This process is detailed and establishes a trusting relationship with a client that is always ongoing and dynamic.
The two main differences in doing a holistic assessment and a typical clinical assessment are that the holistic nurse is, first, fully present to listen and engage and, second, able to ask inquisitive and empowering questions. Doing so guides clients in a deep and reflective process where they are supported to identify their strengths and challenges related to their overall sense of well-being. This approach creates an exchange that is truly client-focused instead of the nurse simply gathering information and providing solutions that might not resonate with the client or be feasible. They are getting a glimpse of what their client is experiencing through their worldview. The phases of the nursing process following the initial assessment can prove more detailed and dynamic and may take multiple sessions with a client to assist them in their wellness needs. Just like clinic or hospital nursing, the process is ongoing and is always re-evaluated.
Essentially, holistic nurses and nurse coaches are both experts in combining the tenets of health and well-being by using their expertise in nursing, and combining it with additional education in holism and coaching, to support individuals to improve overall wellness and individual growth. For the patient, that means creating a health-care system that is client-centred, empowering, holistic and safe. For nurses, that means facilitating healing by practising self-care and wellness and gaining strength by improving relationships with other health practitioners. If this sounds like a rewarding approach to health care, I encourage you to pursue this type of nursing practice.
For more information on nurse coaching, visit CIINDE’s website.
Canadian Holistic Nurses Association. (n.d.). About us. Retrieved from https://www.chna.ca/about-us/
Dossey, B. M., Keegan, L., & Barrere, C. C., Helming, M. B., Shields, D., & Avino, K. (Eds.). (2015). Holistic nursing: A handbook for practice (7th ed.). Jones & Bartlett Learning.
Dossey, B. M., Luck, S., & Schaub, B. G. (2015). Nurse coaching: Integrative approaches for health and wellbeing. International Nurse Coach Association.
Hole, S., DeCoste, J., & Derkach, K. (2022, April). The future of nursing is here: TheCIINDE© [pronounced ‘The Kind’]. Retrieved from https://www.nighvision.net/canada.html
Kelly Rose Flanagan, RN, BN, CCHNC, is a certified holistic nurse coach, having recently completed the program offered by the Canadian Institute of Integrative Nursing Development and Education.