Nurse leaders can integrate holistic care by first checking whether their organization's culture is aware of what consumers want.
Jesus Cepero, PhD, RN, NEA-BC, witnessed a profound example of holistic patient and family care when a priest was called in to give comfort to a dying hospital patient and the patient's family.
"He created an environment in that room where everyone felt almost comfortable with the situation and it moved our thinking from trying to save a life to meeting the needs of the patient and their family," Cepero says. "It's something I'll never forget."
Cepero, who recently joined Stanford Children's Health in the San Francisco Bay Area, as senior vice president and chief nursing officer where he leads more than 1,900 nurses, is an advocate of holistic patient and family care encompassing mind, body, and soul.
"I've always felt that mind, body, and soul are three things that I've paid attention to myself and, to me, it's just part of my life and my own spiritual background," he says. "So, when I'm thinking about programs or services or the care that patients and families need, I think in those terms."
With more than 20 years of healthcare leadership experience, Cepero has held nursing and operational leadership roles across multiple specialties, including adult and pediatric emergency departments, critical care, women and infants' services, forensics, and surgical services, and served for the past eight years as a chief nursing officer for large healthcare systems.
Advanced science, new medications, and cutting-edge processes have made modern healthcare more efficient, but they are not the only aspects of healing, he says.
"We've learned great things and patients have gotten better, but in that task-oriented mindset you forget about the patient's spiritual needs or the patient's wellness needs," he says. "It's important that we have a good social service or care management approach to making sure that we're meeting all the patient's needs, as well as highly, technically experienced, proficient health providers to be able to meet the needs of the person as far as wellness and cure."
While with Meritus Health in Maryland from 2012 to 2017, Cepero deployed behavioral health screeners to implement depression screening, put in place a survivorship program at the cancer center, and redesigned the pastoral care residency program.
East meets West
Holistic healing is nothing new. Holistic healing has been identified in Chinese literature reaching back 5,000 years and Eastern treatment—therapeutic touch, acupuncture, aromatherapy, medication—has now become rooted in everyday Western healthcare to help patients deal with the stress of their illness or disease, Cepero says.
"Florence Nightingale, about 120 years ago, was talking about mindfulness and spirituality in nursing practice when delivering care to patients, so it's not new," he says.
But even with Florence Nightingale's insight, Western healthcare tended to focus primarily on the illness or injury, up until the last few decades, he says.
"In the last 50 to 75 years we've changed a lot, from trying to treat the injury or the illness, to looking at a person as a whole and trying to meet those needs," he says, "because you could cure somebody but miss the things that were important for the person or the family, which was, how are they treated for their spiritual needs? How are they treated for their mindfulness? How are they able to adapt to the new disease entity or injury that they're experiencing?"
The consumer has been the one to push holistic healthcare forward, he says.
"It's been more of a demand from the patient side, where patients want to go to be cured and healed, but they also want to be treated well," he says. "And they want all of their needs met."
Barriers to holistic care
One of the most difficult obstacles to holistic care is a language barrier, Cepero says.
"Hospitals are investing significant dollars to be able to have translators available around the clock so that you can understand each other, because one of the principles of holistic care is listening to the patient or the family to be able to meet their needs … and how do you do that if you're not able to communicate with them?" he says.
A language barrier doesn't only apply to different cultures. "A lot of time and attention has gone into communication for the English-speaking patients and families, because you want to assess how they want to be communicated with," he says. "Some people like verbal communication, some people want to see it in writing, and some people actually like video so they can have a clear understanding of their illness or injury."
A patient's socioeconomic situation may also get in the way of being treated holistically, Cepero says. For example, a patient might choose to have his or her illness or injury treated with acupuncture or massage, but insurance doesn't cover the procedure and the patient can't afford to pay for it themselves.
Integrating holistic health into a hospital
CNOs interested in introducing or expanding holistic care in their health system should start with three steps, Cepero says.
"First of all, I would assess the organization's culture and see if they are aware of the holistic approaches that our patients and our consumers are demanding," he says. "Second, I would ask them to consider looking at the resources that they're providing to their patients—their care demands—so that they can ensure that nurses do have the time to be able to manage the holistic approaches to meet those patient demands."
"Third, I like our system where we have focus groups of patients and families and assess from the patient and families' perspective, or even the community's perspective, as to how they want their healthcare services to be delivered," he says.
Integrating holistic health can be done even during the COVID-19 pandemic because nurses can make it happen, because no matter how time-strapped they are, nurses still find time to stop and meet the patients' needs, Cepero says.
"You have heard many stories where unfortunate COVID patients are dying and they can't have their families present, but the nurses stopped and made the connection on their phone or iPad to the family so that person in their time of passing was not there by themselves," he said. "I'm proud of our profession that no matter how taxed our nurses are … we still slow down in most cases to treat the patient's holistic needs and to ensure that they're getting their needs met, even during times of crisis."
“It's important that we have a good social service or care management approach to making sure that we're meeting all the patient's needs, as well as highly, technically experienced, proficient health providers to be able to meet the needs of the person as far as wellness and cure.”
Jesus Cepero, PhD, RN, NEA-BC, Stanford Children's senior vice president and chief nursing officer
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.
Demand from consumers has pushed holistic healthcare forward.
Among obstacles to holistic healthcare are language and a patient's socioeconomic situation.
CNOs interested in introducing or expanding holistic care should start by assessing the organization's awareness of the holistic approaches that consumers demand.