The United Nations Sustainable Development Goals: The Ethic and Ethos of Holistic Nursing.

Holistic nursing is founded on the values of integrality and the awareness of whole-people and whole-system interconnectedness. These concepts are foundational to the broader global health agendas and initiatives of our time, which seek to improve human, animal, and planetary health. The United Nations 2030 Agenda for Sustainable Development represents the most remarkable transnational initiative in history: a 15-year plan (2015-2030) rallying the efforts of all countries, governments, and concerned citizens worldwide to foster human-planet thriving and survival. The purpose herein is to substantiate the United Nations 2030 Agenda as a holistic nursing priority and theory-practice opportunity for current and future professional maturation. This article provides a background of the 17 Sustainable Development Goals (SDGs), a discussion regarding their relevance to holistic nursing, and an explanation of the essential nature of partnerships in attaining each of these "Global Goals." We link the discussion of the SDGs directly to the American Holistic Nurses Association's Core Values and identify implications for practice, education, research, and policy. Holistic nursing is ideally situated throughout the health care system and in the broader global context to advocate and advance the SDGs.

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Transfusiones sanguíneas en pacientes testigos de Jehová / Blood transfusions in Jehovah´s Witness patients

La negativa a las transfusiones sanguíneas por parte de los testigos de Jehová produce en ocasiones un choque entre las creencias del paciente y lo que los profesionales sanitarios consideran adecuado para el mismo. Esta negativa se fundamenta en textos del Antiguo y Nuevo Testamento y se extiende más allá del proceso de hospitalización, siendo la base de un conjunto de valores y creencias que configuran todo un estilo de vida. La problemática se puede analizar desde diferentes perspectivas, y es motivo de conflicto ético, jurídico/legal, económico y sanitario. Desde una perspectiva holística, conlleva tener en cuenta las creencias espirituales o religiosas del paciente y el respeto a su voluntad y decisiones sobre su propia salud. Desde un enfoque biomédico, esta visión holística resulta más difícil de alcanzar y los aspectos emocionales y espirituales se tienen en ocasiones en menor consideración, a pesar de que estos aspectos también repercuten en el estado de salud de los pacientes. Por ello, en los últimos años encontrar alternativas y soluciones que satisfagan las necesidades tanto de los testigos de Jehová como de los profesionales de la salud se ha convertido en un auténtico reto. El objetivo del presente trabajo es analizar las distintas lecturas que se pueden hacer sobre el fenómeno de las transfusiones sanguíneas entre los testigos de Jehová desde diferentes perspectivas, así como valorar las alternativas y soluciones que existen actualmente

The refusal to receive blood transfusions by Jehovah’s Witnesses will occasionally lead to a clash between patients’ beliefs and what healthcare professionals consider adequate for them. This refusal is based upon texts from the Old and New Testament, and extends beyond the hospitalization process, being the basis of a set of values and beliefs which form a complete way of life. This problem can be analyzed from different perspectives, and it is the cause for ethical, legal, economic and healthcare conflicts. From a holistic perspective, it entails taking into account the spiritual or religious beliefs of the patient, and respect to their will and decisions about their own health. From a biomedical approach, this holistic perspective is more difficult to achieve, and emotional and spiritual aspects are often taken into lower consideration, even though these aspects will also have an impact on patient’s health. Therefore, in recent years it has become a challenge to find alternatives and solutions to satisfy the needs of Jehovah’s Witnesses as well as the needs of healthcare professionals. The objective of the present paper is to analyze the different interpretations that can be made about the issue of blood transfusions among Jehovah’s Witnesses from different perspectives, as well as to assess any current alternative options and solutions

Passionate scholarship or academic safety: an ethical issue.

Are we passionate scholars or is academic safety something to which we aspire? Do we teach our students one thing and practice another? Are some forms of scholarship more acclaimed than others, some methodologies more acceptable? What are the ethical implications in these various questions? In this article, I outline my experiences, both as a student researcher and as an educator, that have brought me to ask these things. Holism is an ideal that many nursing students are taught and encouraged to bring to their practice, and yet holism does not seem, in many instances, to be supported in academia or in bedside practice. I suggest the possible causes for these difficulties and propose solutions. I suggest that the bedrock of ethical practice, both in the academy and with patients, is to bring all of who we are, the alchemic mystery of holism, to everything we do.

Should prayer be used in medicine?

This brief article discusses the use of prayer in nursing and medicine. Although many believe prayer is a valuable tool, there is still much controversy. This author offers some insight into the value of prayer.

Spiritual care: evangelism at the bedside.

News media stories about Christian nurses sharing religious beliefs with patients raise questions about ethical spiritual care and the appropriateness of sharing one's faith at the bedside. The purpose of this article is to explore the ethics of faith sharing in the context of Christian nursing and offer guidance for ethical spiritual care.

Social justice advocacy in nursing: what is it? How do we get there?

Social justice advocacy is an expectation of all nurses as expressed in the professional codes that guide nursing practice. Nursing literature reflects this shift in the focus of nursing advocacy, providing insight into the potentials and challenges associated with nursing's evolution toward a broader social justice advocacy model. This article describes the concept of social justice advocacy as currently reflected in professional codes and nursing literature and contrasts this with the individual patient-nurse advocacy model, which continues to dominate in nursing practice today. Challenges associated with movement toward a social justice advocacy model and options for addressing these hurdles are also discussed.

Knowledge mobilized by a critical thinking process deployed by nursing students in practical care situations: a qualitative study.

AIM: This paper is a report of a qualitative study of mobilization of knowledge within the critical thinking process deployed by female undergraduate nursing students in practical care situations. BACKGROUND: Holistic practice is based on variety of knowledge mobilized by a critical thinking process. Novices and, more specifically, students experience many difficulties in this regard. Therefore, a better understanding of the knowledge they mobilize in their practice is important for nurse educators. DESIGN: A qualitative study, guided by grounded theory, was carried out. Sixteen nursing students, registered in an undergraduate programme in an Eastern Canadian university, were recruited. Descriptions of practical care situations were obtained through explicitation interviews in 2007. A sociodemographic questionnaire, semi-structured interviews and field notes were also used. Data were analysed using an approach based on grounded theory. An additional stage of analysis involved data condensation. FINDINGS: Various types of knowledge guide nursing students' practice. These include intrapersonal, interpersonal, perceptual, moral/ethical, experiential, practical, scientific and contextual knowledge. The mobilization of these types of knowledge is only possible when the process of critical thinking has attained a higher level, giving rise to a new knowledge that we have termed combinational constructive knowledge rather than aesthetic knowledge. CONCLUSION: Clarification of the types of knowledge guiding the practice of student nurses and of the role of critical thinking in their mobilization could lead to innovative educational strategies. The findings provide guidance for the revision and development of both academic and clinical training programmes.

Measures assessing spirituality as more than religiosity: a methodological review of nursing and health-related literature.

AIMS: This paper is a report of a methodological review conducted to analyse, evaluate and synthesize the rigour of measures found in nursing and health-related literature used to assess and evaluate patient spirituality as more than religiosity. BACKGROUND: Holistic healthcare practitioners recognize important distinctions exist about what constitutes spiritual care needs and preferences and what constitutes religious care needs and preferences in patient care practice. DATA SOURCES: Databases searched, limited to the years 1982 and 2009, included AMED, Alt Health Watch, CINAHL Plus with Full Text, EBSCO Host, EBSCO Host Religion and Philosophy, ERIC, Google Scholar, HAPI, HUBNET, IngentaConnect, Mental Measurements Yearbook Online, Ovid MEDLINE, Social Work Abstracts and Hill and Hood's Measures of Religiosity text. REVIEW METHODS: A methodological review was carried out. Measures assessing spirituality as more than religiosity were critically reviewed including quality appraisal, relevant data extraction and a narrative synthesis of findings. RESULTS: Ten measures fitting inclusion criteria were included in the review. Despite agreement among nursing and health-related disciplines that spirituality and religiosity are distinct and diverse concepts, the concept of spirituality was often used interchangeably with the concept religion to assess and evaluate patient spirituality. The term spiritual or spirituality was used in a preponderance of items to assess or evaluate spirituality. CONCLUSIONS: Measures differentiating spirituality from religiosity are grossly lacking in nursing and health-related literature.

The place of dignity in everyday ethics.

Although ethics is often thought of in terms of "life-and-death" matters, many everyday situations involve ethics. Human dignity, a more recent way of expressing the belief that humans are made in the image of God (Genesis 1:26), captures the controversial notion that all humans are uniquely valuable and ought to be esteemed highly. Nurses have great opportunity to promote or demote dignity. A Christian holistic approach to ethics, exemplified by the narrative of the Good Samaritan (Luke 10:25-37), acknowledges the difficulty of always being ethical and integrates feeling, thinking, acting, and spirituality.

Maintaining patients' dignity during clinical care: a qualitative interview study.

AIM: This article is a report of a study undertaken to understand how nurses maintain patients' dignity in clinical practice. BACKGROUND: Dignity is a core concept in nursing care and maintaining patients' dignity is critical to their recovery. In Western countries, measures to maintain dignity in patients' care include maintaining privacy of the body, providing spatial privacy, giving sufficient time, treating patients as a whole person and allowing patients to have autonomy. However, this is an under-studied topic in Asian countries. METHODS: For this qualitative descriptive study, data were collected in Taiwan in 2009 using in-depth interviews with a purposive sample of 30 nurses from a teaching hospital in eastern Taiwan. The audiotaped interviews were transcribed verbatim and analysed using content analysis. FINDINGS: Nurses' measures to maintain dignity in patient care were captured in five themes: respect, protecting privacy, emotional support, treating all patients alike and maintaining body image. Participants did not mention beneficence, a crucial element achieved through the professional care of nurses that can enhance the recovery of patients. CONCLUSION: In-service education to help nurses enhance dignity in patient care should emphasize emotional support, maintaining body image and treating all patients alike. Our model for maintaining dignity in patient care could be used to develop a clinical care protocol for nurses to use in clinical practice.

Nursing 1000: a mosaic of lessons learned from patients.

Throughout my nursing career, I have been most grateful for the education and lessons that I received from the many gifted women and men faculty in the nursing programs I attended. From learning how to give a bed bath and intramuscular injections to writing a doctoral research proposal, the information, wisdom, guidance, and resources they shared with me are invaluable. I also am fortunate to have had the privilege of caring for many patients from whom I also learned invaluable lessons. Together, this latter group of women and men formed the faculty of Nursing 1000. They are the patients who were instrumental in shaping me and my nursing career. Many of them are no longer alive, and all of our paths have diverged, yet they remain influential in how I work with patients on a daily basis. The lessons they taught me form a most special montage. This mosaic article is a way to share with others what the faculty of Nursing 1000 taught me. It is also, in a small way, a tribute to all of the unique men and women with whom, as a nurse, I have shared transpersonal caring experiences and from whom I have learned much. The faculty of Nursing 1000 is composed of a variety of patients for whom I cared and who taught me valuable lessons that guided me in how to better care for patients in the future. Although the Nursing 1000 faculty are no longer physically part of my life, each day they continue to influence how I interact with others. The lessons they taught form a very special mosaic. To protect their confidentiality, all patient names are pseudonyms.

Ontologies of nursing in an age of spiritual pluralism: closed or open worldview?

North American society has undergone a period of sacralization where ideas of spirituality have increasingly been infused into the public domain. This sacralization is particularly evident in the nursing discourse where it is common to find claims about the nature of persons as inherently spiritual, about what a spiritually healthy person looks like and about the environment as spiritually energetic and interconnected. Nursing theoretical thinking has also used claims about the nature of persons, health, and the environment to attempt to establish a unified ontology for the discipline. However, despite this common ground, there has been little discussion about the intersections between nursing philosophic thinking and the spirituality in nursing discourse, or about the challenges of adopting a common view of these claims within a spiritually pluralist society. The purpose of this paper is to discuss the call for ontological unity within nursing philosophic thinking in the context of the sacralization of a diverse society. I will begin with a discussion of secularization and sacralization, illustrating the diversity of beliefs and experiences that characterize the current trend towards sacralization. I will then discuss the challenges of a unified ontological perspective, or closed world view, for this diversity, using examples from both a naturalistic and a unitary perspective. I will conclude by arguing for a unified approach within nursing ethics rather than nursing ontology.

Physical restraint in acute care psychiatry: a humanistic and realistic nursing approach.

Despite the many advances in psychiatry, violence in acute care settings continues and may be increasing. This is particularly problematic, considering the desire of mental health professionals to attain the goal of a restraint-free environment. Respecting the inherent worth, dignity, and autonomy of the patient is necessary if a therapeutic outcome is to be achieved; however, protecting the safety of the patient, other patients, and the caregivers is of no less importance, yet this responsibility also carries with it legal and ethical implications. Balancing these two responsibilities can be realized even in a situation where supportive therapeutic interventions have been ineffective in de-escalation of an aggressive patient. When used with a compassionate, humanistic approach, restraint can achieve a therapeutic outcome for the patient while protecting the safety of others.