Let's make this clear from the start: the blending of nursing and holistic health care is not a popular choice in the UK. The Nursing and Midwifery Council (NMC) does not recognise holistic nursing as a specialty. At a time when the professional body is trying to reduce the number of specialties, this may not seem like much of an issue. However, is this really reflecting the needs of the population that it serves? The simple fact is that public health is changing, and this is not just because of an increasingly ageing population. Since the onset of the COVID-19 pandemic, the landscape of health has changed, and this is only going to continue. Therefore, it's time to build a bridge between these two aspects of health care, and that connection is the formation of the Holistic Nurses UK group.
What is holistic nursing?
The complex issue of terminology surrounding holistic nursing does not help its cause, as there is not one definitive definition. The interchangeable use of language around holistic, complementary, alternative and integrative care, adds fuel to the fire to those who do not take the specialism seriously within nursing. If practitioners can't even decide on a common description, then how can it be seen as an area of expertise? The NMC (2018a) Future Nurse Standards state:
‘A holistic approach to the care of people is essential and all nursing procedures should be carried out in a way which reflects cultural awareness and ensures that the needs, priorities, expertise and preferences of people are always valued and taken into account.’
Clearly, this definition does not identify complementary or alternative health care as part of holistic care. This explanation of holism doesn't appear to be fully comprehensive - it doesn't cover the broad spectrum of biopsychosocial care, let alone spiritual needs. Furthermore, frameworks such as the Fundamentals of Care (Welsh Assembly Government, 2003) and the Roper Logan Tierney model based on activities of daily living (Roper et al, 2000) are considered best practice, although neither of these models of care considers holistic or complementary health care.
For the purposes of this article, the term ‘holistic’ will be used to encompass all the integrative varieties of health care including complementary and alternative medicine (CAM) that are not part of the medical model of care.
Patient empowerment
Recent public health messages stress the importance of taking responsibility for one's own wellbeing. The UK public is being tasked with taking more control of their health. Encouraging ownership of health is not a new concept to nurses, as the NMC Code (2018b) has a long association with patient empowerment. Current health messages strive to promote positive action by service users to make healthy choices and embrace self-care. However, these do not routinely extend to holistic health care. Despite waiting lists that are longer than ever, difficult-to-access primary care, over-stretched acute services and a flurry of new chronic conditions associated with COVID-19, the advice remains the same as it was in the previous century.
The public's response to this has been to reach out to holistic therapies to fill the gap. Therefore, is it neglectful of traditional health care to ignore their own failings and not explore alternative sources of support that may be able to offer relief; even if this is only in the short term? Would it not be better to adapt the conventional provision of care and embrace the changing world? By ignoring the benefits and pitfalls of holistic care, we are doing the public an injustice and are actually putting them at risk. As with any public-facing healthcare provision, there are potentially hazardous holistic practices and professionals. But turning the other way and overlooking this reality will not make the problem go away. After all, it is our duty of care to protect the vulnerable. It is holistic nurses' duty to provide high-quality holistic care that is of the same standard as that of traditional nursing.
NMC standards
Despite the most recent review of the NMC Code in 2018 (NMC, 2018b), there is no mention of holistic, complementary or alternative health care in the professional standards. The 2018 NMC review of its standards – Future Nurse: Standards of proficiency for registered nurses (NMC, 2018a) does not acknowledge complementary or alternative health care, although there are two mentions of holistic care. Furthermore, the NMC Standards for Pre-registration Nursing Programmes (NMC, 2018c) and the Standards for Return to Practice Programmes (NMC, 2019) have one admission of holistic care in both documents. Moreover, the NMC Standards Framework for Nursing and Midwifery Education, (NMC, 2018d) as well as the Standards for Student Supervision and Assessment (NMC, 2018e) worryingly also have no discussion of holistic care.
As nurse training has virtually no statutory expectations in terms of holistic care and a significant absence of CAM, the inclusion into pre-registration nursing programmes has been sporadic in the UK. Therefore, it is not surprising that student nurses have limited knowledge of the advantages and disadvantages of holistic care. The nonexistence of professional guidelines in relation to holistic care is reflected in the poor understanding of current and future nurses. Furthermore, the NMC provides no guidance for the public in terms of what to look out for with holistic care. The only robust source of information can be found on the NHS (2022) website, which attempts to describe complementary and alternative medicine and signpost to professional associations and accredited registers.
At a time when collaborative and co-produced care with service users is the holy grail and being championed in policies, procedures and even legislation, there appears to still be an element of top-down authority behind it all. This control of the holistic narrative is indicative of the desire to downplay the good that holistic health care can offer.
Research
I appreciate that the NHS has a limited pot of money to fund all services and being totally led by a bottom-up approach is not financially feasible, but perhaps we need to take a closer look at why holistic care is being discounted. It's not because holistic care doesn't work, as the increased use of the modalities is evidence to the contrary. The lack of robust, clinical research that unequivocally demonstrates the effectiveness of holistic health care adds to the argument that it is quack medicine. Western medicine likes large-scale, quantitative studies to rubber stamp its evidence-based practice. But is this always reliable and honest, especially as much research is funded by the pharmaceutical industry? Could the self-interest of these companies be setting the tone for healthcare research and delivery? If healing could occur with little medication, cheap technologies and reusable methods then where would the profit be?
The necessity of perpetuating the superiority of randomised controlled trials leads to the ridicule of some holistic healthcare studies, as their whole-person treatments do not comply with clinical methodology and in vitro experiments. However, this is like evaluating eating soup with a fork: you're never going to get to the bottom of the bowl and it's all the fault of the tool. More attention should be paid to investigating broader methods of data collection, including qualitative research, allowing the true findings of holistic health care to be established and accreditation given.
Holistic v allopathic medicine
Holistic therapists do not claim to be able to cure every illness, but then neither does allopathic medicine. Sometimes holistic care uses a trial-and-error approach and occasionally it doesn't work, but the same can be said for traditional health care. There can be side effects when using holistic practices, but these are usually minor and temporary, unlike the extreme and long-acting effects often found in conventional medicine.
Holistic health care treats the whole person and refrains from compartmentalising people into separate sections that have no connection. It doesn't send service users to multiple specialists, each treating one body system with little communication between them. Holistic health care understands that these systems intrinsically intertwine, so to treat each one individually is wasteful of the energy and expectation of the patient, not to mention time and money of the NHS. And then we have the most perplexing situation of all – the frequent decapitation of mental health from physical health. I have been a nurse for over 24 years, and I have never come across a patient whose mental health hasn't been the cause or effect of their physical health.
Yet, conventional medicine continues to sell this Western model of health care, and stepping outside of it is not tolerated. This injustice goes beyond the postcode lottery of health care, by reinforcing the incestuous cycle of allopathic medicine instigated by the pharmaceutical industry.
Nurse training does not escape this toxic control as it is split into four distinct disciplines, which goes on to dictate the area of work allowed. This may seem like a sensible solution because being a jack of all trades can dilute knowledge and skills, but as an adult trained nurse with additional public health qualifications it is deemed acceptable for me to work with children and young people. Following a consultation, the NMC has introduced new standards for specialist community public health nurses (NMC, 2022). Most work with particular age groups, although some will work across the lifespan. The line between childhood and adulthood has long been a grey area - it is already exceptionally difficult for service users and their families/carers to navigate in traditional health care. This could be seen as advantageous for holistic practitioners, as people often seek alternative support to replace these disjointed services. So, surely this is more reason to provide the public with reputable advice, signposting and professional registers?
‘Holistic care treats the whole person and refrains from compartmentalising people into separate sections that have no connections. It does not send service users to multiple specialists, each treating one body system with little communication between them’
The same theory can be applied when considering other pockets of the population who access holistic health care. It appears that at times of greatest vulnerability for patients, such as when undergoing cancer care, holistic practices are not only tolerated by NHS professionals but are accepted for their therapeutic benefits. Other countries have longstanding associations with ‘energy-based’ medicine that is built into their healthcare systems. Two examples of this can be seen in traditional Chinese medicine and Ayurvedic medicine; parts of which, like acupuncture, have interestingly been adopted into Western health care.
Meditation and mindfulness are also being increasingly recognised in the UK to support mental wellbeing. At the heart of both these practices is the slowing down of brain activity, so it reaches relaxing alpha and theta waves. This is the essence of holistic health care as the modalities calm the thinking brain, so the body can achieve its natural state of stillness. ‘Pressing pause’ in this way allows space to occur whereby the body can bring its own healing mechanisms to the forefront.
There is also interesting research on the role of the heart and how heart signals have a significant effect on brain function – influencing emotional processing as well as higher cognitive faculties such as attention, perception, memory, and problem-solving. The HeartMath Institute has conducted research into the psychophysiology of stress, emotions, and the interactions between the heart and brain (HeartMath, 2023). This is all part of an holistic approach to health.
Time for change
Simply put, it's time for change within UK healthcare provision to ensure it remains respectful and responsive to the needs of the population who pay for the service. However, historically Western medicine is not great at adapting to change. Fear of the unknown and limited quantitative research doesn't make the transition any easier. Also, we have to be realistic about what holistic health care has to offer. No tuning fork is ever going to replace a scalpel and nor should it. But as a public health nurse I can clearly see the value of prevention and early intervention, which are the core principles of holistic health care. I have frequently witnessed very successful symptom management and reversal of conditions that match and often exceed traditional health care.
This brings us to the sticky subject of the placebo effect. Two words that are a source of irritation and discomfort to Western researchers, because the pesky subjects receiving the placebo inconveniently improve their condition anyway. How can that possibly happen if the subjects didn't receive the treatment or were in the control group? Rather than take these results seriously, the researcher pats them on the head with a benevolent smile while quietly pushing them to one side. Nothing to see here! However, the regularity and reliability of the placebo effect surely proves that holistic health care achieves the gold standard every time. This outcome is real, it's measurable but it can only be happening on the body's ‘energetic’ level. In fact, studies have shown that the expectation and intent of subjects and researchers do influence the findings. It's just that we haven't invested the resources or research into developing technology that can display these factors in a tangible way.
There is undeniably a way to go to ensure the safety and safeguarding of those who access holistic health care. But let's at least open the door to the full range of possibilities and realise that we may not know all there is to know about health and healing.
The impact of COVID-19 on nurses' mental and physical health is fast becoming apparent in the high levels of sickness and staffing problems. These numbers are rising, and the ongoing issue of nursing recruitment and retention will potentially suffer as more people question their career choice following the pandemic. These workforce concerns, mixed with the continued pay struggles, add fuel to the fire, which raises the question of who is caring for the nurses? Unsurprisingly, holistic therapies are a popular choice for both clinical and academic nurses, although they don't routinely recommend them to service users (Siedlecki, 2021). Wouldn't you feel more reassured if this was being delivered by a qualified holistic practitioner who had received the same initial training and continued professional development as we do in nursing?
Join us
If you feel this way or are a past, present or future holistic nurse, then please join the Holistic Nurses UK group. Together we can raise the profile of holistic nursing in the UK and start the conversation to address the above issues and advise on equitable health care. The LinkedIn group also offers a safe space for peer support, as well as the exchange of experience, education, and resources. Thank you for becoming a Holistic Nurses UK member: find us on LinkedIn or follow the link (https://www.linkedin.com/groups/12669724/). For more information please contact Sally Star on LinkedIn: www.linkedin.com/in/sallystaratbioelectriclife or phone 07971 949090.