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Holistic Care Approach



Abstract


Holistic medicine means consideration of the complete person, physically, psychologically, socially, and spiritually, in the management and prevention of disease. These different states can be equally important. All healthcare practitioners should aspire towards a holistic approach to patients and attempt to practice it. Recognizing the ‘whole’ person in the prevention and treatment of a disease may hold the key to some diagnoses for doctors. It may also allow valuable and important help and guidance to be given to the patient. Patients tend to be more satisfied if a doctor takes a holistic approach, feeling that their doctor has time for them and their problems. In addition to a holistic approach, a team approach to a patient is also extremely important. There are three types of teams: a multidisciplinary, interdisciplinary and transdisciplinary team. Which team will be used depends on the possibility, knowledge and the patients’ needs. In a team approach the patient is the main focus and is thus the responsibility of every member of the team. The team has a responsibility towards one another to have open communication channels and mutual respect for different professions. Each member of the team should know his or her own abilities and limitations. In many articles the outcomes of treatment with a team approach have been reported positively, with no reports of negative consequences of team intervention. Furthermore, the use of a team approach has been demonstrated in all healthcare settings across the continuum. Forming a multidisciplinary team is only one aspect of providing a multidisciplinary health care service. Developing systems and resources that ensure the team can function effectively is also essential.




Holistic approach


Knowledge that a man is more than a combination of body and soul has existed since time immemorial, but only in the last century has there been systematic discussion about this. The term “holistic” comes from the term holism, which was coined by Jan Smuts (1870-1950), a politician and Prime Minister of the South African Republic, and a military leader and philosopher. The term is used in his book “Holism and Evolution,” which was published in London in 1926. (1) Jan Smuts defined the term holism as a theory that the whole (holos in Greek – whole, complete) is more than the sum of its systemic parts. His thesis is proved in the case of Einstein’s theory of relativity and Darwin’s theory of evolution. He believed that physical reality and nature have a tendency to more complex entirety. From his study, the key sentence on this is: “Creating a whole, holistic tendency or holism, which is manifested in units composed of parts, can be seen at all stages of all that exists.” Considering that this idea of his was based more on philosophy than on science, it was ignored for decades. (2) Only after the activities on quantum mechanics from physicist Bohm did the term “holism” take on a scientific note. (3, 4)


Although the term “holism” was coined by Jan Smuts in 1926, the concept of holism probably has its roots in ancient Indian Vedic culture (“veda” in Sanskrit means knowledge), which existed thousands of years ago. In Sanskrit, the word “sarvah” (meaning the whole, intact, uninjured) was used in the description of the nature of human existence as an integral part of the universe. (2) How the culture changed, so too did the meaning of the concept. In the Roman culture there are two words in Latin – salvus and salus that are considered to originate from the Sanskrit word sarvah. The meaning of salvusis safe, uninjured, good health, while the word salus means health, safety, well-being, salvation. In the Christian era the word save (from the Latin word salvus) means rescue from danger. (5)


The contemporary philosophical definition of holistic health incorporates a lot of these definitions. The human being consists of body, mind and spirit, integrated into a whole, whose parts are inseparable. All this represents a dynamic interaction within the human in self, among others people, and the whole universe. When all the parts are balanced and harmonious, there is a maximum of well-being. Although health can be defined in several ways, such as physical, social, emotional, cognitive and spiritual health, if that someone would be truly healthy, they must experience a sense of well-being. An imbalance and disharmony within a human being, human to human, and human being to the universe, disturbs the benefit of persons or their health. (2) Considering the above, it is very easy to make relation to the famous definition of health by Dr. Andrija Štampar (1888 – 1958), which he gave in 1926, that health is a state of complete physical, mental and social well-being and not merely the absence of disease.


Just as the concept of holism is not new, neither are holistic approaches to treatment. Its roots are found in the writings older than 5000 years describing the Ayurvedic holistic approach to treatment. (2) Ayurveda (a Sanskrit word meaning “science of life”, and consists of the words ayur = life and veda = knowledge) includes not only the aspect of treatment, but also includes other aspects that are associated with the word life. At its foundation it has three main goals: 1) mental emotional improvement, 2) prevention and 3) therapy, or curative. (7) This is a model recognized by the National Institute of Health, based on the belief that health problems arise when relations between people, the environment and the universe are disturbed. (2-8)


In the 4th century B.C., Socrates warned that treating only one part of the body would not have good results. Hippocrates also spoke about holistic medicine and (9), and a holistic approach is also advocated by Percival in his book – the first textbook of medical ethics, published just in 1803. Percival noted: “The feeling and emotions of the patients require to be known and to be attended to, no less than the symptoms of their diseases.” John Macleod in his book “Clinical Examination”, first published in 1964, also commented that “we should aim to be holistic in our care.”


A similar belief was articulated in Florence Nightingale in 1969 (12), when expressed the role of nurses to “… put the patient in the best condition for nature to act upon him.” She thought that touch, kindness and other measures of comfort, provided within the context of environment treatment, are of crucial importance for nursing. These premises are held today. Even today nurses are educated to manage the environment and use touch, massage, eye contact, voice, and other measures to make patients feel more comfortable. These nursing activities, known as ”the art of nursing”, represent the basis of professional nursing.

Nowadays different disciplines, such as physics, mathematics, science, philosophy, sociology, medicine, nursing, etc., supports the view that the integrity of an entity is much more complex and greater than the sum of their individual parts.



Definition and principles of holistic approach


Holistic medicine means consideration of the complete person, physically, psychologically, socially, and spiritually, in the management and prevention of disease. These different states can be equally important. They should be managed together so that a person is treated as a whole. A holistic approach means that the doctor is informed about a patient’s whole life situation.

Principles of a holistic approach include the following:

  • All people have innate healing powers;

  • The patient is a person, not just a disease;

  • Appropriate healing treatment needs a team approach;

  • Patient and physician are partners in the healing process;

  • Treatment involves fixing the cause of the illness, not just reliving the symptoms.

Surgical nurse Carolyn Watts often tells nursing students: “Look at the whole patient, and not just the hole in the patient”. Perhaps it is only in that one short sentence imposed the whole holistic approach to the patient.

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