Fostering Resilience in the Face of Adversity:

A Holistic Approach to Nursing Care Brittany Fehr – Honors Program – MidAmerica Nazarene University, Olathe KS

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Abstract: Research has identified a link between chronic physical

diseases and mental illness, underscoring a nurse’s

responsibility to care for more than just the physical body in

order to promote total wellness. By providing holistic care

nurses can help patients achieve higher levels of resilience,

thereby improving total wellness; Swanson’s Theory of

Caring can effectively guide nurses in this effort.

Research Concern: By providing holistic care – caring for the mental,

emotional, social, and spiritual needs of a client rather

than only the physical – the nurse fosters resilience,

empowering the patient to better cope with the

difficulties of life. This research depicts holistic care in

practice and provides practical suggestions to nurses

seeking to care for each patient as a whole person rather

than simply as a disease process.

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Swanson’s Theory of Caring

Caring is a nurturing way of relating to a valued other toward

whom one feels a personal sense of commitment & responsibility

Knowing Being

With

Doing

For Enabling

Maintaining

Belief

Striving to understand

an event as it has

meaning in the life of

the other.

Being emotionally

present to the other.

Doing for the other as

he/she would do for the

self if it were at all

possible.

Facilitating the other’s

passage through life

transitions & unfamiliar

events.

Sustaining faith in the

other’s capacity to get

through an event or

transition & face a

future with meaning.

Andershed, B., & Olsson, K. (2009). Review of research related to Kristen Swanson’s middle-range theory of caring. Scandinavian Journal of Caring Sciences, 23 , 598-610.• Bailey, D. N. (2009). Caring defined: A comparison and analysis. International Journal for Human Caring, 13(1), 16-31. • Battey, B. W. (2012). Perspectives of spiritual care for nurse managers. Journal of Nursing Management, 20, 1012-1020. • Caldeira, S., & Hall, J. (2012). Spiritual leadership and spiritual care in neonatology. Journal of Nursing Management, 20, 1069-1075. • Cross, K. L. (2011). The biochemistry of hope. Journal of Palliative Medicine, 14(9), 982-983. • Daaleman, T. P. (2012). A health services framework of spiritual care. Journal of Nursing Management, 20, 1021-1028. • Edward, K. (2013). Chronic illness and wellbeing: using nursing practice to foster resilience as resistance. British Journal of Nursing, 22, 741-746. • Galvin, K. T. (2010). Revisiting caring science: Some integrative ideas for the ‘head, hand and heart’ of critical care nursing practice. Nursing in Critical Care, 15(4), 168-175. • Harris, G. M. (2014). Family-centered rounds in the neonatal intensive care unit. Nursing for Women’s Health, 18(1), 19-27. • Matteliano, M. A., & Street, D. (2011). Nurse practitioners’ contributions to cultural competence in primary care settings. Journal of the American Academy of Nurse Practitioners, 24, 425-435. • McLaughlin, K., Melby, V., & Coates, V. (2013). Family-centered care during resuscitation events. Emergency Nurse . • Nilsson, S., Hallqvist, C., Sidenvall, B., Enskär, K. (2010). Children’s experiences of procedural pain management in conjunction with trauma wound dressings. Journal of Advanced Nursing, 67(7), 1449-1457. • Portillo, M. C., & Cowley, S. (2010). Working the way up in neurological rehabilitation: The holistic approach of nursing care. Journal of Clinical Nursing, 20, 1731-1743. • Richardson, P. (2012). Assessment and implementation of spirituality and religiosity in cancer care: Effects on patient outcomes. Clinical Journal of Oncology Nursing, 16(4), 150-155. • Rock, L. F. (2014). Sedation and its association with posttraumatic stress disorder after intensive care. Critical Care Nurse, 34(1), 30-37. • Smith, S., & Kirkpatrick, P. (2013). Use of solution-focused brief therapy to enhance therapeutic communication in patients with COPD. Primary Health Care, 23(10), 27-32. • Swanson, K. (1991). Empirical development of a middle range theory of caring. Nursing Research, 40(3), 161-166.

Research Method: Three case studies involving interactions of the

researcher with a patient are reviewed by qualitative

analysis. Verbal and nonverbal aspects of the

interactions are documented in tables (process

recordings), and the researcher evaluates the

interactions to provide practical suggestions for

applying concepts of holistic care to nursing practice.

Research Questions: 1) How can a nurse provide holistic care to meet the needs and

promote the resilience of a terminally ill cancer patient and her

spouse?

2) How can a nurse provide holistic care to meet the needs and

promote the resilience of a post-operative thoracotomy client

facing intense pain, procedural anxiety, and a new diagnosis?

3) How can a nurse provide holistic care to meet the needs and

promote the resilience of a mentally ill client recovering from a

suicide attempt and an eating disorder?

Case #1: Terminal Cancer Effective holistic strategies to promote resilience include…

Prioritizing the client’s goals (including comfort) first

Remaining optimistic that progress towards those goals is

possible, despite the fact that recovery is not expected

Using active listening & nonverbal communication techniques

(especially silence & therapeutic touch) to convey empathy

Avoiding judgment of the client’s expressions of emotion

Case #2: Procedural Pain & Anxiety Effective holistic strategies to promote resilience include…

Recognizing that spiritual care can involve a wide variety

of interventions

Recognizing that not all clients will prefer the same level of

spiritual intervention

Recognizing the client’s unique perspective on his/her care

Using nonverbal communication techniques (especially

therapeutic touch) to convey empathy

Case #3: Suicide Attempt Recovery Effective holistic strategies to promote resilience include…

Asking open-ended questions to explore emotions without

probing

Paraphrasing the client’s statements to convey active

listening & interest

Avoiding judgment of the client’s expressions of emotion

Using nonverbal communication techniques (especially

intermittent eye contact & facing the client at eye level) to

convey empathy & equality

Conclusions: All identified holistic interventions fall into one of Swanson’s

five caring processes; these case studies do effectively depict

holistic nursing theory in practice. The strategies listed can be

performed even during short interactions with the client to

convey genuine interest in the client’s wellbeing and build

rapport. In this context the nurse is able to individualize the

provision of holistic care to foster a greater level of resilience.