A plethora of studies and evidence-based practice initiatives supports the consideration of various holistic approaches in nursing practice.²,³,⁴,⁵,⁶,⁷,⁸,⁹,¹⁰,¹¹ Patient satisfaction surveys conducted to evaluate the quality of care received indicate caring interventions, such as active listening and compassion by healthcare providers, make a positive difference in the healing process of patients¹²,¹³ whereas noninclusion of the patient and family in the care process can lead to devastating outcomes.¹⁴ In addition, the provision of complementary and alternative modalities (CAM) in many healthcare institutions, and the expanding consumer demand for such alternative modalities, continues to proliferate.¹⁵ The realization of
the importance of holistic nursing as essential to effective nursing practice is increasing as demonstrated by the recognition of holistic nursing as a specialty by the American Nurses Association (ANA)¹⁶ and the merging of the American Holistic Nurses Association and ANA scope and standards of practice (see Chapter 2). Despite this evidence supporting the need for nurses to provide high-quality, whole-person caring, room for improvement exists.¹⁷

Rather than waiting until after graduation to teach holistic and quality concepts, schools of nursing are encouraged to integrate this content in undergraduate curricula. The revised 2008 Essentials of Baccalaureate Education for Professional Nursing Practice advocates the preparation of the baccalaureate graduate to practice from a holistic caring framework.¹⁸ It recognizes the importance of baccalaureate nursing curricula content including reflective practice, self-care engagement, CAM, patient teaching and health promotion, spirituality, and caring, healing interventions. Similarly, a National Nursing Advisory Board and the American Association of Colleges of Nursing, funded by the Robert Wood Johnson Foundation, developed six quality and safety education for nurses competencies: patient-focused care, teamwork-collaboration, informatics, safety, quality improvement, and evidence-based practice.¹⁹,²⁰ These competencies provide a framework to enhance the amount of quality and safety content addressed in undergraduate nursing programs. The Institute of Medicine (IOM) in its most recent 2010 report echoes the sentiments regarding new graduate nurse preparation.¹⁷

Holistic caring and QSEN competencies are closely aligned and complement one another in emphasizing compassionate and respectful care in a safe, healing environment. Students need to learn holistic nursing and quality safety as fundamental to practice. The incorporation of holistic and QSEN concepts in an undergraduate curriculum is not adding new content but refers to teaching content in different ways so as to enable students to enhance their clinical reasoning skills creatively to facilitate patient healing and quality safety. This chapter provides nursing faculty with selected teaching/learning strategies that can be used to integrate holistic healing and QSEN concepts into an undergraduate nursing curriculum. Section headings of the chapter reflect the six QSEN competencies. Section content offers nursing faculty examples of effective approaches to teaching/learning holistic and quality safety activities currently incorporated into a class, simulation lab, or clinical component of selected undergraduate nursing courses at Quinnipiac University (QU).

Literature documents a growing interest in patient-focused care.²¹,²²,²³,²⁴,²⁵,²⁶ QSEN highlights patient-focused care as one of the essential competencies for nursing and defines it as the “recognition of the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for a patient’s preferences, values, and needs.”²⁷ Holistic nursing subscribes to a similar definition: “Patient-focused and family focused care actively involves patients and family members or significant others, as the patient desires, in the care process. This type of care provides services based on patient’s needs.”²⁸ These definitions complement one another by demonstrating the blending of Eastern and Western schools of thought and emphasizing the importance of patient empowerment to facilitate healing.

Nursing students at QU begin their initial junior clinical rotation at a long-term care or rehabilitation facility. The first year these sites were used for clinicals, the course coordinator and clinical faculty noted student boredom after 3 weeks as evidenced by negative comments regarding their experiences. Upon asking the students to describe their experiences, a number of them replied working with “old people” was not fun or rewarding. The course coordinator was dismayed by their negativity and decided to design a reflective teaching/learning strategy that would assist students in realizing the individualism, fascination, and wisdom of older adults. Before reviewing the assignment, she entered the classroom and read the following poem to the students:

As the poem was read, not a sound could be heard. A few of the students began to cry as the concepts of authentic presence, patient-focused care, and the nurse as an instrument of healing were brought to life by the interventions used by the nurse in the poem. After reading the poem, the course coordinator assigned the students a writing activity titled “Healing Others” in which each student needed to describe one example of how he or she was an instrument of healing with a patient at the clinical site during the next few weeks. This reflective assignment taught the students the power of caring as they learned how small acts of kindness led to patient smiles and nurse-patient connections that were equally as important and, at times, more healing than medications or treatments. One student beautifully illustrated her reflections in the following poem she wrote: