Nursing Perspectives
APPLICATION OF HOLISTIC NURSING
Toni Gilbert, RN, MA, HNCSITUATION
The following was a one-hour session with a client who was interested in investigating the possible connections between her physical illness and her mental state. She wanted to learn about any possible mind-body techniques that would help her with her illness. She had read my brochure before her initial visit and was especially interested in guided imagery.
ASSESSMENT AND COUNSELING SESSION
Margaret was a Caucasian, 48 year old, married, fourth grade teacher with no children of her own. Her medical diagnosis of Hashimoto’s thyroiditis was an autoimmune disorder involving the thyroid, which was being treated with thyroid hormone replacement.
The client’s body appeared thin and ridged. She had a flat but slightly anxious affect (as if she were holding anxiety or anger in check). She was polite and poised with a wide-eyed “little orphan” look to her eyes. I sensed an underlying current of anger and emotional coldness, which was confirmed during the interview, especially when she talked about teaching children or her own childhood.
Her parents had three children of their own when they adopted twoChinese orphans aged two and five years old. The client was ten years old at the time of the adoption. Because the client was the oldest, she was put in charge of their care much of the time. “The orphans were just awful, they kicked and scratched me. I hated them. They made me an orphan in my own family.”
When the client spoke of her fourth grade class it sounded as though she was emotionally repeating a pattern learned long ago. She spoke of her class in an embittered, exasperated way and used the term “they are just awful.” She described anger and frustration when teaching children of the fourth grade but felt she could not quit her job because she had only five more years before she could retire with benefits. As a solution, she took the step of getting a part-time kindergarten position, which she feels more positive about.
As a holistic nurse my assessment included a body-mind component. How may the state of her emotions be affecting her body and producing the thyroiditis?
The symptoms of this illness were located at the throat, or fifth chakra. One of the functions of the chakras is to act as funnels for the life force. The chakras can be understood on many levels. On the gross physical level, they channel life force to particular organs and endocrine glands such as the thyroid. Looking at a diagram of the chakras you can see that they correspond with the most active parts of the body, the brain, eyes, speech center, heart, middle organs, digestion, endocrine glands, and sex organs. I understand that each chakra has a specific consciousness, a specific set of values.
The fifth chakra is located over the throat, at the third cervical vertebra. It provides life force to the thyroid and parathyroid glands. It is the chakra of communication, of sharing and the synthesizing of ideas.
I suspected that her polite controlled manner, ridged body posture, and her subtle angry emotional undercurrents, expressed that she was holding in dangerous (to her health) emotional energy. This person’s childhood was traumatized by the intrusion of the Chinese orphans. She seemed to project archetypal orphan energy with her affect and emotionally laden remarks about her childhood and classroom. I felt her angry (hurt?) energy needed some release to begin healing. I suggested that we access her inner healer for advice. She agreed.
GUIDED IMAGERY SESSION
She had some experience with guided imagery and stated that she was comfortable using it. After explaining the procedure and talking her through the steps to access an inner healer, we began with a total body progressive relaxation using the image of healing light. I guided her as she asked for an image of her inner healer to appear. The image of herself as a small child appeared.
Because of the appearance of her inner child, I knew that we were standing on the threshold of what is called inner child work. Usually, I don’t do inner child work during the first session. I like to build rapport and trust before embarking upon this sensitive kind of work. I checked my own intuition before proceeding and decided that I felt good about the client’s trust level and where we were heading. And besides, the inner child work was presenting itself to be done. I trusted my intuition.
In her imagery she was both the adult and the child. She held her child self and nursed herself at her own adult breast and looked into her child’s eyes in a nurturing way for several minutes. She stated that she felt loved and loving at the same time. This portion of the session lasted twenty minutes. Because of this work she gained the following insights to use in her own healing. 1. She was to work with the image of herself nurturing herself in whatever way occurred to her as she went through her activities of daily living. 2. The sun was shining bright yellow during the nurturing. She felt this color would benefit her in her healing. She thought that wearing yellow might make her feel nurtured. 3. She felt she needed to find ways to express nurturing and anger, and not hold either in.
After the session she said she felt like a weight had been lifted and her body felt lighter and freer (a hallmark of inner child healing). She was smiling and had a peaceful, rested-looking affect.
EVALUATION
Presence/Conscious Process: During the session I felt I was present and in touch with my intellectual knowledge and my intuition (a knowing which, for me, also includes a voice) at the same time. I was able to be conscious, flexible, and creative during the process. This was especially evident when the guided imagery session presented the inner child work and I went ahead with it.
Sacredness of Interaction: I recognized the client as being a part of the all-knowing Universe by acknowledging the work that was presenting itself (as her inner child) during the imagery session.
Client Empowerment: The client was empowered by the imagery and came up with her own insights on how to further her healing.
Distinctive Body of Knowledge: I am certified in Interactive Guided Imagery. I also have a working knowledge of the chakra system, and I have more education and experience in psychology and psychiatry than the traditional nurse.
NURSE THEORIST
Margaret Newman, Ph.D., R.N., F.A.A.N.
I resonate with the “Health as Expanding Consciousness” theories of Dr. Newman. Especially relevant for this paper are her theories of “Patterns of Energy Exchange,” in which she regards disease as the manifestation of blocked energy, which is beyond our awareness and is part of a personality pattern. My client recognized that she needed to change an old pattern of holding emotion in and release pent up emotional energy by expressing herself. Another important concept for me is “Disease as Integrating Factor.” Dr. Newman believes that many of us have lived our lives in such a way that we have not become fully aware of ourselves or our own patterns. Such a pattern may then manifest itself in a more “unconscious” manner, presenting symptoms that may be interpreted as maladaptive ("disease") but which may represent movement to a higher level of consciousness. For example, physical disease may be associated with the internalization of stress and may represent that person’s inability to be fully aware of stress.
The "disease" of my client seems to be working to help her get in touch with her feelings and thus to a more integrated and conscious personality.
UNIVERSALITY OF HOLISTIC NURSING
I feel like I am a part of a Whole. I trust that the Whole will work with me as I work with the integrity of clear intent to do the best I can do. I tune into and notice my feelings, thinking, and knowing as I work. I can feel a harmony inside and notice synchronicities without as I center myself and just Am.
The session described was clearly in a “flow.” I hesitated only to check with my intellect and intuition before continuing. The outcome was beneficial to the client as evidenced by her feedback and her presence.
SECOND SITUATION
A one-hour session with a client of two years who had recently learned that she was to undergo another surgery to remove cancer tumors. She had undergone a miraculous and desperate surgery in January of ’98. As her private holistic nurse, I employed the following techniques: facilitated guided imagery pre-op; prayed with her as she was prepped for surgery; encouraged her to take the pre-op medicine; played music for her with head set during surgery; talked to her unconscious mind during surgery per her surgeon’s request; performed energy work on her post-op. Here we were again. She wanted me to be with her during the upcoming ordeal and to prep her for it.
ASSESSMENT AND COUNSELING SESSION
Trudy, a Caucasian, 48 year old, building contractor, married woman with no children (by choice). Her medical diagnosis was gastro-intestinal stromal sarcomas. This condition had been treated with allopathic surgery (which removed a 10 pound tumor), chemotherapy, experimental vitamin D, freezing the tumors, and daily injections of an antiangiogenesis treatment. She put herself on a strict low sugar diet and studied anti-cancer dietary regimens. From me she received energy work, guided imagery sessions, and she learned meditation, expressive arts, and dream analysis. Together we have held prayer sessions, which have included a Baptism. I have also offered, and continue to offer, regular friendly support any time she needs it.
Trudy appeared wide-eyed, with occasional tears as she recounted that tests had found more tumors. The doctor suggested surgery, and soon. This tumor was located further down her abdomen and was probably seeded by the larger tumors in her liver and stomach. The client was an intelligent, intuitive, strong-willed, determined, warrior type. She had a strong will to live and liked to be informed realistically about everything regarding her cancer. She assertively told the doctors what she wanted. Her doctors felt that it was a miracle that she was still alive. In fact there are times when it looks like she may beat the odds and be rid of the cancer.
Trudy felt a gratitude for her cancer because it has put her in touch with her spirituality, which she felt she would never have achieved had she not had this crisis. She knew that she may, at some point, have to give up the fight and die, but she was not ready for that. At my encouragement she has sought out other alternative treatments like a chakra meditation class and tai chi chuan.
As a holistic nurse my assessments included a mind-body and in this case a spiritual assessment. What would set up the terrain of Trudy’s body to accept and grow these new tumors? What do we need to do know emotionally, physically and spiritually? My intuition told me to ask Trudy these questions.
I have taught Trudy that suffering offers us an opportunity for movement to higher levels of consciousness, and that suffering, disease and even death do not diminish us. She is learning to let go and embrace the experience, allowing her illness to teach her as it raises her consciousness. Trudy likes to be in control but she is learning to accept just being without control.
The new tumors were located in the region of the second chakra, which is just a few inches below the navel, and at the area of the first lumbar vertebra. I read through the chapter about the second chakra in “Anatomy of the Spirit”, by Carolyn Myss. My sense was to let Trudy decide what issues might be involved in the development of these new tumors.
Since Trudy was familiar with the chakra system, I loaned her my book so she could decide for herself what this might mean to her. I wondered if this development could symbolically be her fear of losing control of her physical body. I suggested she meditate and gain insights about the development of these new tumors. I suggested that she consider what needed to change in her life, and what techniques would be beneficial at this time? For instance, would chakra meditation on a daily basis help her with her fear of losing control (if this was an issue), and would this be a self-nurturing activity for her?
Trudy doesn’t see herself as being good at spontaneous imagery so I don’t push her to do it. She seems to be best at imagery when she’s involved in a procedure and she can visualize each step. We discussed her making a list of points that she wants to hear during pre-op guided imagery, which gives her a measure of control.
We discussed spiritual issues and her altar at home. She decided she needed more pillows for her alter space, but that it was serving her well. Together we came up with a plan for guided imagery pre-op, and what we would do in surgery and post-op. All would be similar to the last surgery (mentioned above).
My sense and belief was that I needed to empower her by encouraging her to access her own higher self, and her own contact with "Spirit" (her word for God). I believe that, through such self-empowering exercises, she will have more confidence in her own abilities to heal herself and to draw in healing energies. She has shown a great deal of ability in this area. She confidently takes care of her own spiritual needs but seeks me out in times of crisis. I feel she needs extra support at those times.
After the session, she felt she had a plan and was willing to begin. She wondered if she was getting complacent about her spirituality and this was Spirit’s way of saying “Okay Trudy, it’s time to work some more.” Then she said, “I wonder what kind of teaching this part of my journey bring?”
EVALUATION
Sacredness of Interaction: Trudy and I had a spiritual connection and rapport. We have discussed many issues of living and dying. We felt that we were together to teach each other.
Client Empowerment: Empowerment is one of the best things I could do for Trudy. She looked to me for support and encouragement. I encouraged her to find her own way on her own path. I was someone she could discuss her “path findings” with.
Reflects Client Wholeness: I acknowledged her whole mind, body, and spirit. My encouragement of her education in these areas helped her grow stronger emotionally and spiritually. For instance, She has less dependence on me now than in the beginning of our association because I have encouraged her to gain her own insights. This has facilitated her healing and spiritual growth.
Distinctive Body of Knowledge: The basis for counseling in this session was my Master’s level certification in Wellness Counseling and Mind body Consciousness. I have a passion for the spiritual aspects of Transpersonal Psychology with many years of formal and informal education in this area.
NURSE THEORIST
Margaret Newman, Ph.D., R.N., F.A.A.N.
I agree with Dr. Newman who supports a paradigm shift to a collaborative caring model based on a unitary, transformative vision of health that can encompass medical technology as an alternative within the whole, rather than the primary focus. She saw nursing as the heart and mind of medicine that makes transformation of the health experience possible. Her theories of nursing address both the science of nursing, and the art (the “caring” dynamic) of nursing. The new paradigm rules call for unconditional acceptance of the pattern of the whole (unconditional love), which manifests itself in sensitivity to self, attention to others, and creativity. The essence of the process is in being fully present in the transformation of others and ourselves as we allow the meaning of the new reality to unfold. She sees care of the soul during suffering as a part of nursing, “a moral imperative.”
This paper is an example of a nurse caring for a soul.
UNIVERSALITY OF HOLISTIC NURSING
I view nursing in a holistic way. The care of the soul is as important as care of any other part of a person (maybe more important). I concentrate on listening and look carefully at what is being presented in a person’s suffering. In addition to describing to them what “I” see about their situation, I stay with, and trust, a creative and intuitive process, which allows information to unfold for them (and me) at the correct time. This usually comes in the form of their insights coupled with synchronistic experiences. As a holistic nurse I have skills, training and techniques to help in this process.