PurposeTo evaluate a workplace-integrated quality improvement initiative designed to address persistent staff stress and limited access to restorative experiences within the nursing work environment of a Magnet-designated academic medical center.DesignPre-post quality improvement evaluation using independent, anonymous samples.MethodsOver 11 months, brief on-site integrative modalities (e.g., chair massage, meditation, Jin Shin Jyutsu, yoga, and other restorative practices) were offered across shifts to enhance access within workflow. An author-developed electronic survey assessed stress-reduction practices, perceived self-care opportunities, knowledge of stress-reduction techniques, and perceptions of a healing nursing work environment at baseline (n = 166) and follow-up (n = 158). Descriptive statistics, chi-square, and Mann-Whitney analyses compared groups. Qualitative analysis examined open-ended responses.FindingsParticipation in wellness activities reached 43% at follow-up, with notable increases in chair massage and meditation use. Perception scores for self-care opportunities and healing culture remained stable without statistically significant change. Qualitative feedback described relaxation, restoration, and connection, while staffing and scheduling barriers limited engagement.ConclusionsEmbedding accessible, brief holistic practices within the nursing work environment is feasible and valued. Findings highlight the influence of organizational context on staff engagement and support system-level approaches to workforce well-being aligned with the Quadruple Aim.
PurposeTo describe the patterns of health-related quality of life (HRQoL) across four WHOQOL-BREF domains and to identify independent predictive factors-including cognitive health mindfulness-among community-dwelling adults with hypertension in an urbanized area of Thailand.DesignDescriptive cross-sectional study.MethodsThree hundred and thirty adults (≥35 years) with physician-confirmed hypertension were recruited by multi-stage stratified random sampling from 11 sub-district health promoting hospitals. Measures included the WHOQOL-BREF, Stress Scale (ST-5), Intellectual Well-Being Scale, and the 17-item Cognitive and Behavioral Sati Scale (CBSS). Descriptive statistics, Pearson correlation, and multiple linear regression were applied.FindingsOverall HRQoL was moderate in 55.8% of participants (M = 94.53, SD = 11.35). Cognitive health mindfulness was moderate in 64.2% (M = 50.00, SD = 12.34; α = 0.884). Multiple regression identified four independent predictors: intellectual well-being (β = 0.536), stress (β = -0.175), cognitive health mindfulness (β = 0.157), and absence of complications (β = 0.108); R2 = 0.446, F (6, 323) = 43.009, p < .001.ConclusionsCognitive health mindfulness was an independent, though modest, predictor of HRQoL among hypertensive patients, alongside intellectual well-being, stress, and absence of complications. These cross-sectional findings support incorporating mindfulness and intellectual well-being screening, alongside stress management and complication prevention, into holistic primary hypertension nursing assessment, with intervention effectiveness to be established by future longitudinal and experimental research.
PurposeTo examine the role of nursing care as a mediating bridge between biomedical cure and holistic healing within the framework of holistic nursing, and to identify barriers and strategies for integrating these paradigms in nursing practice.DesignA scoping review following Joanna Briggs Institute methodology.MethodPubMed, Scopus, and Web of Science were searched in May 2025 (updated February 2026). Twenty-seven studies met inclusion criteria. Data were analyzed using narrative synthesis with inductive thematic analysis in MAXQDA 2020.FindingTwenty-seven studies were included, yielding five interrelated themes: (i) the tension between care and cure; (ii) healing as a multidimensional and transcendent outcome; (iii) nursing care as a potential mediating mechanism between cure and healing; (iv) barriers to integration; and (v) strategies for strengthening nursing's integrative role.ConclusionFindings suggest that nursing care may function as an integrative mechanism through which biomedical cure and holistic healing can be meaningfully connected in practice. However, this potential is significantly constrained by persistent barriers. Educational reform, organizational support, culturally sensitive spiritual care, and thoughtful technology integration are essential strategies for promoting holistic nursing practice. Future research should empirically test integrative models and evaluate their impact on patient and nurse outcomes within holistic nursing frameworks.
BACKGROUND:Childbirth is a multidimensional experience involving physical, emotional, and psychological challenges. Holistic nursing interventions such as acupressure may improve maternal well-being beyond pain relief, yet comparative evidence for SP6 (Sanyinjiao) and LI4 (Hegu) acupressure is limited. PURPOSE:To evaluate the preliminary effectiveness of nurse-administered SP6 and LI4 acupressure on labour pain, maternal coping, and intrapartum maternal comfort among primiparous women. METHODS:In this three-arm pilot randomized controlled trial, 90 primiparous women were randomly assigned (1:1:1) to SP6 acupressure, LI4 acupressure, or routine intrapartum care (30/group). Acupressure was administered at 4, 6, and 8 cm cervical dilatation. Labour pain and coping were assessed repeatedly, and maternal comfort was measured once at 10 cm cervical dilatation. Data were analysed using linear mixed-effects models and one-way ANOVA. RESULTS:Significant group, time, and group × time interaction effects were observed for labour pain and coping (all p < .001). Compared with LI4 acupressure and routine care, SP6 acupressure produced greater pain reduction, improved maternal coping, and higher intrapartum maternal comfort (all p < .001). DISCUSSION:Guided by Swanson's Theory of Caring, SP6 acupressure appears to be a feasible holistic nursing intervention that supports person-centred maternity care. Larger multicentre randomized controlled trials are warranted.
PurposeTo explore how nurses in palliative care wards perceive hygiene care for patients at the end of life.DesignA theory-generating qualitative study based on the grounded theory approach.MethodsEighteen nurses working in palliative care wards were recruited through purposive and theoretical sampling. Semistructured interviews were conducted between January and May 2025. Data were analyzed using the grounded theory approach.Findings"Anchoring through touch" emerged as the core category; touch refers not merely to physical contact, but to a responsive mode of practice wherein nurses adjust care according to patients' pain, anxiety, embarrassment, comfort, and discomfort. Patients initially experienced hygiene care as "relinquishing their former everyday life," but responsive touch enabled "reorienting through bodily pleasantness" and "opening of the self through acceptance." Sensory stimuli and trusting dialogue facilitated "encountering the self across time," helping patients reinterpret their lives and achieve "recovery of a sense of connectedness." Conversely, pain and distress rendered this process fragile, increasing susceptibility to "pain-induced existential instability."ConclusionsThis study theorizes hygiene care as a holistic nursing practice supporting bodily, emotional, relational, temporal, and existential dimensions through responsive touch. "Anchoring through touch" offers an empirical foundation for understanding whole-person healing within everyday fundamental nursing care.
BackgroundSickness presenteeism, defined as attending work despite health problems that would justify sickness absence, is an important concern in holistic nursing because nurses' wellbeing is inseparable from sustainable caring practice.PurposeThis exploratory study examined associations among sickness presenteeism, burnout, perceived social support, and health-related productivity loss among nurses working in teaching hospitals in Iran.MethodsA cross-sectional exploratory study was conducted with 60 nurses working in emergency, intensive care, cardiac care, and medical wards of three teaching hospitals affiliated with Kerman University of Medical Sciences, Kerman, Iran. Data were collected using a demographic and occupational questionnaire, the Sickness Presenteeism Questionnaire, the Stanford Presenteeism Scale-6, the Maslach Burnout Inventory, and the Social Provisions Scale. Descriptive statistics, Pearson correlations, and exploratory regression analyses were used.ResultsThe mean sickness presenteeism score was 6.28 ± 1.32, suggesting frequent self-reported sickness presenteeism. Sickness presenteeism was not significantly associated with burnout, perceived social support, or health-related productivity loss. Employment status significantly predicted burnout, and age significantly predicted health-related productivity loss.ConclusionFindings should be interpreted as preliminary. Sickness presenteeism among nurses may reflect tensions among self-care, professional obligation, relational expectations, and organizational conditions. Holistic nursing approaches should address both individual self-care and healing work environments that support rest, recovery, dignity, and sustainable caring.
PurposeTo examine the mediating role of death anxiety in the relationship between religious attitudes and spiritual care needs among patients undergoing hemodialysis (HD), with implications for holistic nursing assessment and intervention.DesignA descriptive, correlational, cross-sectional design.MethodsA total of 203 patients receiving HD were recruited. Data were collected using a Descriptive Characteristics Form, the Religious Attitude Scale, the Spiritual Care Needs Scale, and the Death Anxiety Scale (DAS). Mediation was tested using Hayes' PROCESS Macro with bias-corrected bootstrap confidence intervals (5,000 resamples).FindingsReligious attitudes were significantly associated with spiritual care needs, and death anxiety partially mediated this relationship (indirect effect b = -1.754, 95% confidence interval [-2.95, -0.65]). Mean DAS scores exceeded the clinical threshold, indicating prevalent death anxiety across the sample.ConclusionsDeath anxiety functions as a mediating mechanism linking religious attitudes to spiritual care needs in HD patients. Findings support integrating structured death anxiety screening and culturally sensitive religious support into holistic nursing care, operationalizing the holistic caring process.
Purpose of StudyTo examine the recurring environmental design problems in low-resource public hospitals including insufficient ventilation and daylight, overcrowding, a raised washroom, and their cumulative burden on nursing care through Florence Nightingale's environmental theory, and to connect these patterns to the established literature on infection risk, fall prevention, and the therapeutic environment as a core value of holistic nursing.Design of StudyClinical commentary based on composite field observation, guided by Nightingale's environmental theory and the five core values of the American Holistic Nurses Association.MethodObservations were gathered over approximately 2 years of clinical teaching and supervisory ward visits across several secondary-level public hospitals in low-resource settings. No formal audit tool was used; observations were synthesized into composite, illustrative patterns and read against current evidence-based design and holistic nursing literature.FindingsFour recurring patterns were identified: insufficient ventilation and natural light; overcrowding and inadequate bed spacing; a washroom accessible only by climbing several unmarked steps above the ward floor; and a cumulative burden on nursing workflow and patient experience. Each maps directly onto Nightingale's environmental canons and connects to established evidence on infection risk, recovery, and falls.ConclusionsThe physical environment is a dimension of whole-person care, not a backdrop to it. Nightingale's environmental theory, interpreted through contemporary holistic nursing scholarship, generates specific, low-cost obligations for environmental assessment, nurse advocacy, and leadership in settings where resources are limited.
BackgroundThis study explored nursing students' lived experiences and perceptions of caregiving practices and the distribution of caregiving responsibilities in clinical settings within the context of holistic nursing.MethodsA qualitative study using an interpretive phenomenological approach was conducted. Data were collected between March and June 2026 through semi-structured interviews with 24 nursing students with clinical experience. Interviews were audio-recorded, transcribed verbatim, and analyzed using interpretive phenomenological analysis.ResultsCaregiving was often deprioritized, fragmented, and delegated to students. Clinical environments were described as task-oriented and constrained by workload and bureaucratic demands, limiting holistic and relational care. Students perceived caregiving primarily as an individual moral responsibility rather than a structured professional obligation. Limited role modeling and supervision reinforced this pattern.ConclusionA gap exists between holistic care values in education and clinical practice. The marginalization of caregiving threatens the relational and humanistic foundations of nursing. Strengthening care-focused environments, role modeling, and support for holistic care is essential to sustain core nursing values.
PurposeTo articulate the scholarly status, philosophical coherence, and disciplinary contribution of the Quadripartite Compass for Holistic Nursing.ApproachA comparative hermeneutic analysis places holistic nursing and caring science in dialogue with selected Western philosophical traditions and Islamic teleology.ArgumentThe Compass is a philosophical framework that operates at a metatheoretical level and functions in use as a reflective heuristic. Its four coordinates - ontology, axiology, epistemology, and methodology - are interdependent rather than additive: assumptions about personhood shape values; values influence what counts as knowledge; knowledge and values guide action; and practice may revise prior assumptions. Islamic teleology makes purpose, moral accountability, relational dignity, and spiritual meaning more visible, while holistic nursing constrains teleological interpretation through person-centeredness, noncoercion, and respect for individual variation. Wholeness is therefore understood as irreducible, relational, dynamic, and meaning-laden rather than as a sum of dimensions.ConclusionsThe Compass offers a disciplined vocabulary for theory development, education, reflective practice, and future inquiry. It does not replace nursing theories, evidence, professional ethics, or culturally specific assessment. Instead, it helps nurses examine whether conceptions of being, value, knowledge, and action remain coherent with whole-person care.
Background: Delirium and depression are common and serious complications among intensive care unit (ICU) patients and are associated with adverse clinical outcomes, prolonged hospitalization, and increased mortality. Although the clinical management of these conditions has been widely studied, less is known about how nurses integrate physical and psychological care to support patients experiencing these complex challenges.Aim: This study explored intensive care nurses' experiences of providing holistic care for patients with delirium and depression through the lens of Neuman's Systems Model (NSM).Study Design: A qualitative phenomenological approach was used. Semistructured, in-depth interviews were conducted with 23 intensive care nurses working in a tertiary hospital. Data were analyzed using thematic analysis.Results: Six interconnected themes illustrated how nurses balanced physical and psychological care while responding to patient, environmental, and organizational stressors. The findings highlighted the perceived impact of delirium and depression on patient recovery, the central role of non-pharmacological interventions, the emotional and professional burden of care, institutional challenges influencing practice, the effects of stressors on both care quality and nurse well-being, and recommendations for strengthening holistic care. Interpreted through NSM, nurses' experiences reflected layered preventive practices operating across primary, secondary, and tertiary levels of intervention to maintain patient stability.Conclusions: Holistic care for patients with delirium and depression extends beyond symptom management and requires attention to psychological, environmental, and organizational dimensions of care. Nurses play a pivotal role in promoting patient stability through therapeutic relationships, environmental regulation, psychosocial support, and interdisciplinary collaboration. NSM offers a valuable framework for guiding preventive, holistic nursing interventions in intensive care settings.
PurposeThe purpose of this project was to determine if there was a change in nursing students' self-perceived caring efficacy in a holistically endorsed BSN program. The curriculum embraced Unitary Human Caring Science (UHCS) and engaged students in self-care practices and caring literacy.DesignA retrospective quantitative study at a private Midwest university used undergraduate nursing student reported scores on the Coates Caring Efficacy Scale.MethodsNursing students completed the self-assessment at the beginning of the program and at the end of their final semester. Data were collected via Qualtrics and analyzed using SPSS.FindingsThere was a significantly higher mean of reported students' caring efficacy scale scores at the end of their senior semester compared to their first semester.ConclusionEducators are empowered to design curriculum grounded in holistic theory, such as UHCS, and incorporate components such as self-care, self-compassion, and self-reflection in order to enhance caring and compassion for patients.
BackgroundBurnout represents a global workforce crisis that undermines holistic nurse wellbeing, care quality and workforce retention, especially in low-resource health systems. Although sense of coherence (SOC) and adaptive coping promote resilience, holistic and salutogenic frameworks remain underutilized.ObjectivesTo examine nurses' coping strategies and intervention preferences through Antonovsky's SOC and develop the nurses' coping resource inventory (N-CRI), an empirically grounded, middle-range conceptual framework for burnout resilience.MethodsAn explanatory sequential mixed-methods study was conducted with 97 nurses at a Kenyan referral hospital. Quantitative descriptive statistics and qualitative thematic analysis mapped findings to SOC dimensions (comprehensibility, manageability, and meaningfulness).ResultsAdaptive coping predominated: spiritual practices (74.2%), peer support (67.0%), and cognitive reframing (62.9%), with maladaptive strategies rare (≤13.4%). Meaningfulness emerged strongest, yet manageability was limited by institutional gaps. Nurses prioritized structural burnout interventions, including safe staffing, fair remuneration, and work-life balance. The N-CRI organizes interdependent systemic, interpersonal, and individual holistic coping resources that mobilize generalized resistance resources and strengthen SOC to foster holistic resilience.ConclusionHolistic nurse burnout resilience reflects the interplay of organizational, relational, and individual healing resources, not individual coping alone. The N-CRI offers a concise, adaptable framework for holistic assessment, multilevel interventions, and policy supporting sustainable workforce wellbeing.
PurposeGrounded in Watson's Theory of Human Caring and holistic nursing principles, this study examined relationships among empathy, emotional intelligence, and spiritual care competence in clinical nurses and identified predictors of spiritual care competence.DesignA cross-sectional correlational design was used.MethodsData were collected from 575 hospital nurses in Taiwan using the Jefferson Scale of Empathy, the Wong and Law Emotional Intelligence Scale, and the Spiritual Care Competence Scale. Descriptive statistics, Pearson correlation coefficients, and multiple linear regression analyses were conducted.FindingsNurses demonstrated moderate-to-high spiritual care competence, which was positively correlated with empathy and emotional intelligence. Emotional intelligence (β = .383, p < .001) and empathy (β = .165, p < .001) were significant predictors, in a model that explained 21.7% of the variance (adjusted R2 = .217). Spiritual care education was positively associated with competence, whereas years of clinical experience were negatively associated with attitude toward patients' spirituality and spiritual communication.ConclusionsEmotional intelligence and empathy are key competencies associated with spiritual care competence. These findings support integrating emotional intelligence, empathy, and spiritual care training into nursing education and professional development to strengthen person-centered, holistic care.
This reflective narrative explores the lived experience of developing central cord syndrome (CCS) following a postoperative spinal epidural hematoma after anterior cervical discectomy and fusion and examines implications for holistic nursing practice and education. Grounded in Watson's Theory of Human Caring, this reflective narrative examines lived experience through a caring science lens. Findings indicate that early postoperative neurologic symptoms were initially minimized, contributing to delayed escalation and emergent surgical intervention for hematoma evacuation. The subsequent course of CCS involved persistent neuropathic pain, impaired upper and lower extremity motor function progressing to paralysis, fatigue, and significant alterations in autonomy and self-perception. Analysis suggests that vigilant clinical assessment, ethical responsiveness to patient-reported symptoms, and authentic relational presence are inseparable components of safe and holistic nursing practice. This narrative underscores the importance of integrating caring science into high-acuity clinical environments to strengthen patient safety, preserve dignity, and enhance advocacy. Reflective inquiry grounded in holistic theory contributes to nursing knowledge by reinforcing the ethical and relational foundations of whole-person care.
PurposeTo evaluate the short-term effects of a brief mindfulness-based intervention delivered during hemodialysis on trait mindfulness, cognitive reappraisal, expressive suppression, and kidney disease-related quality of life (QOL) in adults with end-stage renal disease (ESRD).DesignCluster-randomized, parallel-group, pretest-posttest trial.MethodsAdults receiving maintenance hemodialysis (N = 104 analyzed) were randomized by six dialysis day/shift clusters to a mindfulness intervention (n = 52) or wait-list control group (n = 52). The intervention consisted of a 30-min guided mindfulness protocol three times weekly for 5 weeks during dialysis. Outcomes were measured using the Mindful Attention Awareness Scale, Emotion Regulation Questionnaire, and Kidney Disease QOL.ResultsLinear mixed models showed the intervention group achieved significantly higher posttest scores than controls in trait mindfulness (mean difference [MD] = 0.64, p = .004) and cognitive reappraisal (MD = 0.53, p < .001). Regarding health-related QOL domains, significant improvements were found for the physical component summary (MD = 7.35, p < .001), kidney disease effects (MD = 25.82, p = .001), and kidney disease burden (MD = 21.66, p = .001).ConclusionPossible short-term benefits of a dialysis-chair mindfulness intervention for trait mindfulness, cognitive reappraisal, and QOL among adults receiving hemodialysis.
Purpose To map and summarize the literature on Watson's Caring Science Theory-based interventions in relation to patient satisfaction and clinical outcomes. Watson's Caring Science Theory provides a foundational framework for relational and holistic nursing care, yet evidence on patient-centered outcomes remains fragmented. Design Scoping review guided by Arksey and O'Malley's five-stage methodological framework and reported per PRISMA-ScR. Methods Two primary databases (PubMed and CINAHL) were searched, supplemented by Google Scholar, for English-language, peer-reviewed studies published between 2015 and 2025. Data were charted to summarize study characteristics, intervention components, theoretical operationalization, and outcome domains. Findings Twenty-four studies met inclusion criteria, including 17 randomized controlled trials. Studies were conducted in diverse contexts, including oncology, maternity care, chronic illness management, surgical recovery, palliative care, and caregiver support. Intervention content and duration varied, but commonly emphasized relational care, emotional presence, individualized education, and supportive environments. Interventions improved patient satisfaction, psychological outcomes, symptom management, quality of life, self-care behaviors, and caregiver well-being. Conclusions Watson's Caring Science Theory offers a meaningful framework for holistic nursing and health care. The evidence suggests positive patient-centered and psychosocial outcomes but remains heterogeneous. Future research should strengthen theory reporting, prioritize patient-centered outcomes, and use longer follow-up and multisite designs.
PurposeTo explore how undergraduate nursing students from different academic years experience and describe their spiritual development, and to explain how this process contributes to holistic professional formation.DesignA qualitative grounded theory study informed by Corbin and Strauss was conducted.MethodsTwenty-one undergraduate nursing students from different academic years participated in semi-structured interviews, and 11 of them also completed reflective online diaries. Data collection and analysis were conducted concurrently using constant comparative analysis. Ethical approval was obtained.FindingsSpiritual development emerged as a meaning-oriented process situated within holistic professional formation, characterized by a movement from externally guided reassurance toward internally grounded meaning-making. Emotionally demanding clinical experiences disrupted students' assumptions and generated uncertainty. When supported through reflection and relational engagement, these experiences contributed to self-awareness, internal grounding, and students' capacity for presence, compassion, and engagement in care.ConclusionsFindings challenge the assumption that clinical exposure alone supports students' spiritual development. The MAMA-BEAR model offers a substantive grounded theory explaining how academic and clinical environments may support spiritual development as part of holistic professional formation, with implications for curricula, educator preparation, and whole-person care.
BackgroundThis study examined the feasibility and preliminary outcomes of a nurse coaching (NC) intervention for well-being, resilience, and perceived stress among undergraduate nursing students.MethodA convergent parallel mixed-methods design was employed. Quantitative data were analyzed using descriptive statistics and exploratory paired sample t-tests. Qualitative data were collected and analyzed using photovoice methods. Metainferences were developed to integrate quantitative and qualitative findings.ResultsPerceived stress showed a preliminary decrease, while resilience and well-being demonstrated small, nonsignificant increases. Three major themes emerged from the photovoice data: (a) broadening perspectives, (b) developing self-care practices, and (c) managing the doing and being.ConclusionNC shows promise as a holistic, student-centered approach that may support well-being, resilience, and perceived stress in undergraduate nursing students. Although preliminary, these findings highlight the potential value of nursing coaching in academic settings. Recruitment and retention challenges revealed valuable feasibility considerations for planning future larger-scale studies.
Purpose To develop a professional nursing professional practice model (PPM) to guide performance at a university hospital. Design Sequential multimethod design for theory development. Method The study was executed in four sequential phases: (1) identification of the need for a PPM; (2) preliminary model design; (3) internal and peer validation; and (4) evaluation against international standards. Findings This PPM prioritizes holistic care for patients and their families to ensure clinical excellence and safety in nursing services. It integrates synergistic management, organizational structures, and continuous quality improvement to address contemporary healthcare challenges within a holistic care philosophy. Conclusions The “Bonds that Transform, Care that transcends” model provides a new framework for holistic hospital nursing practice. Grounded in humanistic perspectives, the model posits that therapeutic relationships transcend clinical procedures through high-quality interactions among staff, patients, and families. By fostering mutual growth, this care extends beyond the hospital to transform individuals, strengthen autonomy, and dignify the human condition. Broadly, this framework bridges theoretical holism with clinical pragmatism, promoting nursing leadership, facilitating education, advancing research, and offering a scalable roadmap for humanizing high-complexity healthcare institutions.
