o cite this article:
,oanna Papathanasiou, 3ela!hrini 41la5ou, .a#brini 6our1outa 0olisti! (ursin" 7are: *heories and Perspe!ti5es American Journal of Nursing Science. 8ol 2, (o 1, 2013, pp 1-5 doi: 10 11%&'/$ a$ns 20130201 11
!bstract: ,ntrodu!tion: 0olisti! #edi!ine and holisti! nursin" ai# at the i#pro5e#ent o- healin" o- the indi5idual as a bio-psy!ho-so!ial unity, -ro# birth until death 9i#: *o sear!h -or !urrent data on the 5alue and appli!ations o- holisti! nursin", pla!in" e#phasis on the -ield o- psy!hiatry .iterature re5iew: ,nternational data bases and internet were sear!hed (in!ludin" Pub#ed/3edline) +#phasis was pla!ed on theoreti!al ba!1"round, on alternati5e therapies and on the pra!ti!al appli!ations o- holisti! !are 7on!lusion: 0olisti! approa!h ta1es into a!!ount the biolo"i!al, so!ial and spiritual needs o- the patient 9 !onsiderable nu#ber o- alternati5e therapies !an !ontribute to the #ana"e#ent o- psy!hiatri! and other diseases Ke"#ords: 0olisti! 7are; (ursin"; Psy!hiatry; 9lternati5e *herapies
1$ Introduction
*he te!hnolo"i!al ad5an!e#ent in the -ield o- biolo"y and the o5er-spe!iali:ation o- the health personnel has led to the su!!ess-ul treat#ent o- pre5iously !onsidered in!urable !onditions 0owe5er, the -a!t that se5eral diseases ha5e been treated with su!!ess does not ne!essarily "uarantee the lon"-ter# rehabilitation o- the patient 0ealth is a !o#ple; !on!ept, whi!h re-ers #ainly to an indi5idual<s well-bein" in a "i5en en5iron#ent, rather than to the absen!e o- a disease, as that is de-ined by patholo"y and the traditional bio#edi!al health approa!h 3oreo5er, the sy#pto#s o- a disease re-le!t a deeper disturban!e o- the biopsy!hoso!ial balan!e o- an indi5idual and thusly, the de-initi5e treat#ent o- the =disease> lies #ainly on treatin" e--e!ti5ely the underlyin" !auses and not the super-i!ial ones *he 5alue o- !on5entional !are is not underesti#ated, but rather bestowed with a #ore inte"rated di#ension and is now rendered holisti! ?1,2@ 9!!ordin" to this approa!h, the physi!al and #ental #ani-estations o- a disease are now treated as a whole in the #edi!al pra!ti!e o- ea!h spe!ialty ,t re-ers to a #ore inte"rated (A holisti!) treat#ent o- ea!h #orbid pro!ess in a hu#an bein", who is no lon"er !onsidered as #erely a !arbon-based li-e -or# (body) 0olisti! !are allows a #ore thorou"h !onsideration o- a disease and an es!ape -ro# traditional #e!hanisti! approa!hes, whi!h e5en thou"h ha5e o--ered a lot in the -ield o- 3edi!ine and (ursin", now see# obsolete ,n that !onte;t, holisti! !are, as a set o- #ethods
whi!h "o beyond the status Buo o- !are, and whi!h are related to treat#ent #ethods obser5ed in traditional so!ieties, not only #ana"es to !oe;ist but also to e5ol5e alon"side !on5entional !are and #edi!ine *here is an in!reasin" nu#ber o- s!ientists who re!o"ni:e the si"ni-i!ant !ontribution o- alternati5e #edi!ine to the rehabilitation o- a patient<s health, and also patients who turn to alternati5e-holisti! #edi!ine in their ti#e o- need ?3@ *he purpose o- this study was to -ind !urrent biblio"raphi! data on the 5alue and appli!ations o- holisti! nursin" !are First, the theoreti!al -oundations o- holisti! !are are #entioned, and then, the #odern 5iew o- the biopsy!hoso!ial #odel o- the disease and the holisti! approa!h appli!ations in patient !are desi"n are analy:ed
2$ he %olistic !pproach to herap"
*he ter#s &%olism' and &%olistic' !o#e -ro# & ()*+,holos ' a /ree1 word #eanin" all, whole, entire, total 0olisti! #edi!ine deals with a hu#an bein" as a whole, i e it i#ple#ents a #ulti-a!eted approa!h to the health-disease issue 0u#an bein"s, re"arded as whole entities, are the -o!us o- interest and not the indi5idual diseases 0olisti! #edi!ine is not a di--erent #edi!al or treat#ent #ethod, but rather a di--erent philosophy on how to approa!h health 4y#pto#s the#sel5es are now !onsidered as the #ani-estation o- a disease *he holisti! approa!h ta1es into !onsideration an indi5idual<s psy!holo"i!al, so!iolo"i-
2
,oanna Papathanasiou et al.: 0olisti! nursin" !are: theories and perspe!ti5es
!al and #ental 5iews and needs +a!h indi5idual !onsists obody, #ind and soul as a uni-ied total and is not $ust the su# o- his body parts 7han"e in any aspe!t o- an indi5idual<s li-e brin"s !han"e to e5ery aspe!t o- his e;isten!e and di--erentiates the Buality o- his whole ?&@ *he theoreti!al -oundation o- nursin" itsel- is intrinsi!ally holisti!, sin!e -ro# early on it had been #ade !lear that patient !are !annot and should not be one-di#ensional Floren!e (i"htin"ale hersel- en!oura"ed holisti! !are, by re!o"ni:in" the i#portan!e oen5iron#ent, tou!h, li"ht, s!ents, #usi! and silent re-le!tion in the therapy pro!ess *he holisti! approa!h su##ari:es the psy!hoso#ati! approa!h o- a disease and e;pands it by puttin" the patient in a spe!i-i! ti#e and !ultural !onte;t ,t deals with his own spe!ial needs and Buality o- li-e, by respe!tin" his !on5i!tions ?5@ *he holisti! approa!h has two i#portant aspe!ts Firstly, it treats ea!h indi5idual as a separate entity, both in biolo"i!al and so!ial ter#s 4e!ondly, it is #ultidi#ensional, introdu!in" a less si#plisti! 5iew on health and disease *hese two aspe!ts a--e!t the nurse-patient intera!tion, as well as the -or#ation o- the related resear!h Buestions Cein" able to di--erentiate between an =ob$e!ti5e> and a =sub$e!ti5e> disease is i#portant -or a nurse in ter#s o- approa!hin" the patient, interpretin" health in 5arious people, situations and en5iron#ents, and deter#inin" his/her a!tions in order to pro#ote health and pre5ent diseases Coth the patient and the nurse are !onsidered as sub$e!ts *his #eans that they are both aware o- what is i#portant and relati5e to the !ase in hand, and that they both ha5e !apabilities, alternati5es, ri"hts and -reedo# o- !hoi!e *here-ore, the #ain !hara!teristi! o- their relationship is eBuality ?1,%,D@ *he holisti! approa!h is "o5erned by !ertain prin!iples, whi!h !an be su##ari:ed in the -ollowin": +a!h indi5idual is !apable o- i#pro5in" his 1nowled"e and s1ills and !han"in" his beha5ior towards hi#sel- and others People are naturally in!lined towards bein" healthy, but are also responsible -or their "ood health status, re!o5ery and ta1in" !are o- the#sel5es 9 =person> belon"s to hi#sel- *here-ore, his de!isions and de5elop#ents ri"ht-ully belon" to hi#, the =owner> *he #ain -o!us o- the re!o5ery e--orts is the indi5idual and not the disease or in$ury *he relationship between health !are pro-essionals and their patients should be one o- #utual !ollaboration People who pro5ide health !are inter5ene on behal- o- the adult patient only when he as1s -or their help or when his health needs !annot be -ully satis-ied ?&,5@
person as a whole bein" Fro# 3aslow to #odern holisti! theories, the holisti! approa!h e#bra!es the total o- hu#an needs and puts the# in a hierar!hy by a!!eptin" a person<s indi5iduality and the "ra5ity he puts on ea!h indi5idual need 3.1. The Intersystem Model *he nursin" theories o- intera!ti5e pro!esses are -ounded philosophi!ally on inte"rati5e pro!ess #odels *he latter are based on the so !alled hu#anisti! philosophy Cased on that, e5ery person is a uni-or# bein" whi!h !onstitutes an ener"y -ield in !onstant intera!tion with the ener"y -ield o- the uni5erse *he supporters o- su!h nursin" theories deal with a person as a holisti! bein", whi!h intera!ts and adapts to the situations that he -a!es *hey support syste#s theory and su""est that a person is in !onstant intera!tion with his en5iron#ent ,n that !onte;t, health is a 5alue whi!h ran"es !onstantly -ro# the hi"hest possible well-bein" to disease *his 5iew entails that people with !hroni! !onditions #ay lead a healthy li-e and be satis-ied by it, despite their !ondition ?%,D@ 3.2. Callista Roy’s Adaptation Model *he theoreti!al outline o- adaptation in Eoy<s nursin" theory in!ludes a set o- hypotheses whi!h !an be su##ari:ed in the -ollowin": 9 person is a biopsy!hoso!ial bein" in !onstant intera!tion with an e5er-!han"in" en5iron#ent ,n order -or the person to -a!e that e5er-!han"in" world, he would ha5e to use biolo"i!al, psy!holo"i!al and so!ial #e!hanis#s 9daptation is a!!entuated as a 1ey !on!ept to a person<s positi5e rea!tion to en5iron#ental !han"es 9 person<s adaptation le5el, whi!h #ay lead to a positi5e rea!tion, in!ludes a :one, indi!ati5e o- the sti#ulus ran"e, whi!h disturbs the balan!es and !alls -or a new adaptation ,t is also !alled =adaptation> theory, based on =syste#s> theory, in 0elson<s adaptation le5el theory and in hu#anisti! 5alues ,t su""ests that a syste# is a set o- units interrelated or interlin1ed to"ether, in order to -or# a unity or a set ,t holds that all syste#s ha5e input and output data, as well as !ontrol and -eedba!1 pro!esses, by !onsiderin", at the sa#e ti#e, li5in" syste#s as #ore !o#ple; than #e!hani!al syste#s 9!!ordin" to Eoy<s #odel, hu#an beha5ior represents an adaptation to en5iron#ental and or"ani! -or!es *he o5erall resultant o- the indi5idual rea!tions represents the or"anis#<s -inal state 9!!ordin" to Eoy, the purpose o- (ursin" is to aid the person as he adapts to the o!!urrin" !han"es, his biolo"i!al needs and to his sel--per!eption ?'@ 3.3. Theories Based on Integrative Process +5en thou"h today, !are "roup !ooperation and interdis!iplinary approa!h are a "i5en, that was not always the !ase +5en durin" the se!ond hal- o- the past !entury, the person-patient was treated as so#ethin" di--erent than the ob$e!t o- physi!ians< and nurses< !are 3ost health pro-essionals operated with 5irtually no !o##uni!ation between the#, ea!h -o!usin" on their own assi"n#ent, with none o-
3$ %olistic -ursin. /are heories
0olisti! nursin" !are pro5ision was based on 5arious theories, ea!h -o!usin" on spe!i-i! aspe!ts o- the relationship between the person with his outside and inside world and his nurse, by respe!ti5ely di--erentiatin" the !on!ept ohealth *heir !o##on "round, howe5er, is dealin" with the
the# bein" -ully aware o- the patient and his needs 3. . Rogers’s Theory *hat !on!lusion led Eo"ers ?G@ to su""est that a person is a =uni-or# ener"y syste#>, whi!h is in =!onstant re!ipro!al intera!tion with the ener"y syste# o- the uni5erse>, and she, thusly, ulti#ately a!hie5ed to drasti!ally a--e!t the nursin" -ield and en!oura"e nurses to deal with a person as a whole unit, both durin" !are desi"n and pro5ision 9!!ordin" to Eo"ers, nursin" pra!ti!e ai#s towards pro#otin" a har#oni! intera!tion between the person and his en5iron#ent, and rein-or!in" the !ohesion and wholeness o- a person<s ener"y -ield ,ts "oal is to appropriately "uide the or"ani:ation and syn!hroni:ation o- a person<s -ields and en5iron#ent in order to a!hie5e the hi"hest possible health potential 3.!. "e#man’s $ealth Care %ystem Model (ew#an proposed a health !are syste# #odel, a!!ordin" to whi!h a person is treated as a whole syste# with indi5idual interlin1ed parts and subparts 4tress -a!tors ta1e their toll on people, who ha5e, howe5er, -le;ible resistan!e li#its and ba!1-ups, whi!h help the# de-end the#sel5es a"ainst these stress -a!tors 9!!ordin" to this #odel, nursin" is dire!ted towards re!o"ni:in" a person<s standards in intera!tion with the en5iron#ent, and a!!eptin" that intera!tion as an awareness de5elop#ent pro!ess )isease !o#es to disrupt the relationships between a person<s standards in a #ore har#oni! way ?10@ 0ealth re-ers to a person<s ability to intera!t with his en5iron#ent and to inte"rate thin1in", -eelin" and pro!essin" o- the in-or#ation !ontained in all natural syste#s 0ealth be!o#es synony#ous with de5elopin" awareness 9wareness de5elop#ent and there-ore, the route towards health, ha5e to "o throu"h new standards reali:ation, trans-or#ation and dis!o5ery inside a !o#ple; li5in" syste# =0ealth> is e;perien!ed as a dyna#i! !oe;isten!e o- the traditionally 5iewed health and the traditionally 5iewed disease ,t is a =well-bein"> in-or#ation, whi!h re-le!ts the balan!e state a person<s entire bein" has rea!hed (ursin" is des!ribed as a =hu#an e;perien!e health !are> ,t a!tually su""ests a health !are syste# #odel, whi!h !onsiders a person as a whole syste# with indi5idual interlin1ed parts and subparts ?11,12@ 3.&. Parse’s Theory '$(man Becoming) 9!!ordin" to Parse, hu#an is !onsidered as a Cein", ohis own will, who a!ti5ely parti!ipates inside the world 9 person !an only be whole when he parti!ipates in the !os#i! pro!ess 0e is whole, open and -ree to !hoose the ways o- the pro!ess ?13@ Parse had a radi!al 5iew on health, su""estin" that health status is our way o- e;isten!e inside the world *here is neither a !ontinuu# -ro# health to disease, nor a health-disease !ounterpoint, it is #ore o- the e5eryday way o- e;isten!e ?13@ *his is a new and uniBue way o- 5iewin" health, whi!h pro5ides understandin" o- the way ea!h person !reates his own destiny
(ursin" "uides the person to -ind new ways o- e;isten!e, to dis!o5er #eanin" in situations, to !hoose ways o- !oestablishin" his personal health and to li5e his e5eryday li-e ?13@ 4u##ari:in" the #ain holisti! !are theories, it should be noted that -inal treat#ent is the o5erall resultant o- #any -a!tors related to a patient<s =reality>, as that is yielded by the indi5idual !o#ponents, whi!h also in!lude the nurse *he patient, the en5iron#ent, the nurse and the health ob$e!ti5e are all inter!onne!ted, re5ol5in" around the treat#ent, whi!h is the #ain -o!us
0$ 1rid.in. the 2ap bet#een heor" and Practice
)espite the repeated e--orts to brid"e the "ap between pra!ti!al theory, pra!ti!e and resear!h, little pro"ress has been #ade in that dire!tion Cesides, the "ap does not see# to !o#e -ro# -lawed theories, whi!h !an, in either !ase, be e5ol5ed and re5iewed in order to !o5er #odern pra!ti!e data, or -ro# deliberate o5erloo1 o- their !allin" ,n!o#plete !are pro5ision throu"h health syste#s, whi!h are not theoreti!al but totally tan"ible, is #ostly deri5ed by a shortsi"hted per!eption o- nursin" !are, whi!h is at best worn out in the !onte;t o- the bio#edi!al #odel, and also the la!1 o- resour!es, whi!h li#its interdis!iplinary potential and supple#entary so!ial !are ser5i!es (urses -a!e nu#erous !hallen"es due #ainly to the !han"es in the health pro5ision syste# For e;a#ple, li#itin" hospitali:ation ti#e has li#ited the pre-operati5e inter5ention and pro"ra##in" ti#e-ra#e 4i#ilarly, insuran!e !o#pany #e!hanis#s ha5e a drasti! e--e!t on ho#e !are pro5ision, thusly deter#inin" to a lar"e e;tent when and how the nurse ta1es !are o- the patients, and the type o- ser5i!es that he/she pro5ides *hese !han"es, despite the -a!t that they ha5e dealt partially with the health pro5ision !ost in-lation, ha5e had a ne"ati5e e--e!t on nursin" !are pro5ision ?1&@ 0owe5er, we #ust also ta1e into !onsideration that other issues also need to be resol5ed, su!h as edu!ation, resear!hers-!lini!al nurses intera!tion, as well as #odern nursin" pra!ti!e issues 9n i#portant issue is also the la!1 otheoreti!al prin!iples -ro# the basi! trainin" pro"ra# *he #a$ority o- nurses "raduate -ro# se!ondary edu!ation, either publi! or pri5ate, institutions, whi!h -o!us only on purely pra!ti!al s1ills, and "i5e little priority to theoreti!al -oundation and resear!h, thusly renderin" the nurses< post-"raduation a!tions li#ited in !onsisten!y, repeatability and pre!ision, and the nurse #ore o- an e#piri!ist and less oa s!ientist 0olisti! !are, in parti!ular, reBuires thorou"h and !are-ul handlin" and utili:ation o- all the #ental resour!es oboth the patient and his !are"i5er, who #ust ha5e so#e pre5ious trainin" and !ertain s1ills ?5,%,15,1%@ 7lini!al nurses< -urther edu!ation is eBually i#portant to help the# deal with !ertain issues, as is the pro#otion o- the theoreti!al !on!epts and prin!iples o- holisti! !are 9ll !lini!al nurses should be en!oura"ed to in!rease their
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,oanna Papathanasiou et al.: 0olisti! nursin" !are: theories and perspe!ti5es
1nowled"e by -a#iliari:in" the#sel5es with new theoreti!al prin!iples and nursin" resear!h, throu"h !ontinuin" edu!ation or basi! edu!ation pro"ra#s ?1%@
!o#es to !o#plete the !on5entional approa!hes and to pro#ote health to in!reasin"ly hi"her le5els o- #ental and physi!al well-bein" and -un!tionality
3$ /onclusions
3odern #edi!ine in an atte#pt to -ree itsel- -ro# the ri"id, non-s!ienti-i! 5iews whi!h hindered its de5elop#ent -or !enturies was led to its o5er-se"#entation in sub-spe!ialties and #e!hanisti! 5iews on hu#an bein"s 9s a result, a disease is treated as a #e!hani!al #al-un!tion o- an instru#ent, rather than as the result o- a disturban!e in the balan!e o- an or"anis# as a whole and its en5iron#ent ,t dri-ted apart -ro# obser5in" -eelin"s and the way -eelin"s #ay be related to the #ani-estation o- a "i5en !ondition ,t does not e;a#ine the e--e!t o- a person<s !on5i!tions in his li-e and the dys-un!tions these #ay !ause ,t does not ta1e into !onsideration the "reat part o- interpersonal hu#an relationships in the -or#ation o- a disease, while it also de"rades #ental reality and does not utili:e its treatin" potentials ?2,1D@ 0olisti! #edi!ine in!ludes both #odern (#edi!al, sur"i!al, et! ) and alternati5e treat#ent #ethods (atural, #ild alternati5e treat#ent is applied only when it !an "uarantee the patient<s sa-e and se!ure treat#ent, otherwise it is !o#bined with or repla!ed by #odern #edi!al approa!hes, with the physi!ian -o!usin" not only on the sy#pto#s and epipheno#ena, but also on the patient<s o5erall health !ondition 0olisti! #edi!ine !o#es to satis-y the health pro-essionals< s!ienti-i! !uriosity, by showin" the# the 5ersatile potential and bene-its o- the so !alled natural or alternati5e treat#ent, and that both their patients and their pra!ti!e !ould bene-it -ro# that ?1',1G@ 0u#an bein"s are not $ust biolo"i!al or"anis#s with #ental and e#otional #ani-estations, but a #ultidi#ensional entity with a body, #ind, soul and spirit 9ll o- these ele#ents intera!t and a--e!t one another 0ealth is the state o- balan!e between these ele#ents, whi!h reBuires the =har#oni:ation> o- a person<s li-e with the laws onature 0ealth reBuires sel--awareness, personal happiness and sel--a!tuali:ation *he #ain treat#ent ob$e!ti5e is the person<s in!reasin"ly !ons!ious and a!ti5e parti!ipation in the ra!e to "ain and preser5e his health 9ll a5ailable #ethods are in!luded in the health pro-essional<s reser5oir, but he has to !are-ully e5aluate and appropriately apply the# *he use o- these #ethods by the patients is an indisputable -a!t, a reality whi!h needs to be ta1en into serious !onsideration ,- the health pro-essionals are honest when dealin" with this reality, then, the patient will also be honest and !ooperati5e Further#ore, roo# -or #ore s!ienti-i! resear!h, whi!h would help de#onstrate the abo5e, is reBuired ?15,20@ ,n !on!lusion, the =te!hno!ra!y> and depersonali:ation o!on5entional #edi!ine, whi!h put o-- #any patients, as well as its -ailure to treat serious diseases, whi!h redu!ed its !redibility, !o#bined with the -a!t that so#e alternati5e -or#s o- treat#ent ha5e been re!o"ni:ed as su!!ess-ul by the s!ienti-i! !o##unity are all i#portant reasons as to why holisti! !are is as widespread as it is today 0olisti! !are
4e5erences
?1@ ?2@ )ossey C3 *heory o- inte"ral nursin" 9(4 9d5an!es in (ursin" 4!ien!e 200'; 31:52-D3 Fassino 4 Psy!hoso#ati! approa!h is the new #edi!ine tailored -or patient personality with a -o!us on ethi!s, e!ono#y, and Buality Pan#iner5a 3edi!al 2010; 52:2&G-%& 3olassiotis 9, Fernade:-Hrte"a P, Pud ), H:den /, 4!ott F9, Panteli 8, et al *he "rowth o- !o#ple#entary therapies: and their bene-its in the perioperati5e settin" Fournal o- perioperati5e pra!ti!e 200G; 1G:3'2-% +ri!1son 0. Philosophy and theory o- holis# (ursin" 7lini!s o- (orth 9#eri!a 200D; &2:13G-%3 3!+5oy ., )u--y 9 0olisti! pra!ti!e--a !on!ept analysis (urse +du!ation in Pra!ti!e 200'; ':&12-G Cer" /8, 4ar5i#I1i 9 9 holisti!-e;istential approa!h to health pro#otion 4!andina5ian Fournal o- 7arin" 4!ien!e 2003; 1D:3'&-G1 6ubs!h 43, 0an1erson 7, /hoorahoo E 7ontent analysis oholisti! ethi!s 7o#ple#ent *herapies in 7lini!al Pra!ti!e 2005; 11:51-D Eoy 7 *he Eoy adaptation #odel ,n Eiehl FP J Eoy 7 (+ds ), 7on!eptual 3odels -or (ursin" Pra!ti!e (orwal1: 9ppleton, 7entury 7ro-ts 1G'0 Eo"ers 3+ (ursin" s!ien!e e5ol5es ,n: 3adrid, 3 , Carrett, + 9 3 , (eds) Eo"er<s s!ienti-i! art o- nursin" pra!ti!e (ew Kor1, (ational .ea"ue -or (ursin" Press 1GG&
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?10@ (ew#an LM 0ealth as e;pandin" !onsiousness (ational .ea"ue -or (ursin" Press (ew Kor1, 1GGG ?11@ (ew#an 39 (ew#an<s theory o- health as pra;is (ursin" 4!ien!e Nuarterly 1GG0a; 3:3D-&1 ?12@ (ew#an 39 *oward an inte"rati5e #odel o- pro-essional pra!ti!e Fournal o- Pro-essional (ursin" 1GG0b; %:1%D-1D3 ?13@ Parse, E E 3an- li5in" O health: 9 theory o- nursin" (ew Kor1, Piley 1G'1 ?1&@ 4treubert 0F, 7arpenter )E Nualitati5e resear!h in nursin": 9d5an!in" the hu#anisti! i#perati5e .ippin!ott Pillia#s J Pil1ins, Philadelphia 1GGG ?15@ Pheeler 6 Psy!hotherapeuti! strate"ies -or healin" trau#a Perspe!ti5es in Psy!hiatri! 7are 200D; &3:132-&1 ?1%@ Eaya 9 7an 1nowled"e be pro#oted and 5alues i"noredQ ,#pli!ations -or nursin" edu!ation Fournal o- 9d5an!ed (ursin" 1G'0; 15:50&O50G ?1D@ 6oslander *, da 4il5a 9C, Eo;ber" 9 +;istential and spiritual needs in #ental health !are: an ethi!al and holisti! perspe!ti5e Fournal o- 0olisti! (ursin" 200G; 2D:3&-&2 ?1'@ .ed"e 4) *he duty o- nurses to #eet patients< spiritual and/or reli"ious needs Critish Fournal o- (ursin" 2005; 1&:220O225