It is fitting that the chapter on self-care is the last chapter in this text because for nurses to practice this core value, they need to incorporate the other core values as well—truly a holistic approach. Previous discussions of nursing theory, holistic self-assessment, coaching, self-reflection, nutrition, exercise, integrative therapies, healing environment, therapeutic communication, diversity, spirituality, evidencebased practice, and education could easily be repeated in the context of self-care and enhancing the role of the nurse as an instrument of healing.

The Scope and Standards of Practice of the American Holistic Nurses Association and American Nurses Association (see Chapter 2) reiterates the necessity of nurses being on their own healing journeys if they are to be instruments of healing as they partner with others. This lifelong process requires education, practice, and selfwork, translating into the very knowledge, skills, presence, and attitude of holistic nurses. Along with the focus on self-care is the focus on health versus illness on a continuum where the individual, a microcosm of the universe, and society are constantly fluctuating in various stages of health and illness. There is no stasis in the universe, in Nature, or in humans: no static state of health that may be achieved and never lost. Hence, the concept of self-care is continuous, with the goal of a healthy lifestyle being a lifelong practice. The self-care work of the holistic nurse involves continual holistic self-assessment and the redefining of self-care plans to facilitate balance in one’s life. The nurse’s ability to focus on and provide attention to self-care is affected by health, personal thoughts, practices, behaviors and actions, others, and the environment. Each nurse’s life, in constant interaction with the universe, evolves as the nurse participates in transpersonal caring throughout life’s journey. Thus, the practice of self-care involves the development of lifelong health-promoting behaviors.

The holistic nurse uses more than laboratory results and physical parameters in assessment of self and others and freely incorporates modern medicine, functional medicine, and evidencebased practices with other traditional forms of healing. Evidence-based practices such as energy work, acupuncture, imagery, and body work may be used in assessment, treatment, and promotion of self-care and wellness. Additional healing paradigms include whole medical systems, both ancient such as Traditional Chinese Medicine (TCM) and ayurvedic medicine, and modern systems such as homeopathy and naturopathy.⁶ From a holistic standpoint, the focus is balancing, healing, partnering with, and coaching to reach the person’s potential. The other end of the spectrum may involve support as the person transitions from this life. The standards of holistic nursing practice guide self-care, recommending that nurses identify at-risk patterns; develop practices that enhance whole-person healing; recognize the individual capacity to heal; create a conscious awareness and understanding of their purpose, meaning, and connection with a greater being/force; and develop an understanding that crisis creates opportunity as they continually evolve.^7p88

A focus on self-care, involving health promotion and healthy behaviors, reflects both international and national trends. On an international level, the United Nations (UN), formed in 1945, created the World Health Organization (WHO) 3 years later to meet global health goals. The UN and the WHO continue to partner and recently formed the Eight Millennium Development
Goals. These goals focus on global health problems and aim to improve well-being by 2015 in eight different areas.⁸

In the United States, Healthy People 2020 builds on 3 decades of prevention and wellness activities with a vision of a society where everyone lives long, healthy lives. The Institute of Medicine (IOM) Committee on Leading Health Indicators for Healthy People 2020 developed recommendations that integrate the life course model with a model of health determinants and health outcomes.⁹ These indicators and objectives guide the national agenda. Many of these topics include areas of self-care: healthy behaviors, healthy physical environment, healthy social environment, positive mental health, responsible sexual behavior, and avoidance of tobacco use. One of four goals of Healthy People 2020 is a life course perspective to “promote quality of life, healthy development and healthy behaviors across all life stages.”^9p8 Additional indicators and objectives in Healthy People 2020 include a focus on quality of life (QOL). Overall, QOL is conceptualized as well-being, which may be described as thriving and flourishing; it is assessed through happiness and life satisfaction tools.¹⁰

Thus, through both international and national agendas the need to focus on health, healthy behaviors, and responsibility for self-care is highlighted. Nurses, as instruments of healing, must follow the recommendations for consumers and assume responsibility for self-care and health promotion.⁷ Nurses—in the most trusted profession— now have the opportunity to model selfcare for others and assist in coaching the nation and the world in self-care.

In the development and evaluation of selfcare for wellness activities and programs, it is important to be guided by nursing theories and use valid evaluation tools to support evidencebased practice. Earlier discussions address grand nursing theories such as the Science of Unitary Human Beings, Caring Science, and Integral Nursing, which individually and collectively support the concept of self-care and the caring process. These theories direct nursing assessment, reflection, presence, coaching, therapeutic relationships, holistic communication, healing environments, and nursing education and research. They support the nurse as an instrument of healing, honoring therapeutic presence, intuition, caring science, and the integral role of the nurse in relationship with others, society, and the world. Grand nursing theories define many methods of assessment on both physical and energetic levels and support the concept of “being” with the client as opposed to the frequent focus on “doing.” In holistic nursing, it is paramount to honor and support the individual’s goals based on that person’s situation, culture, beliefs, and capabilities. The “being” is further enhanced because the theories support the concept of coaching, or working with an individual to hold the space to allow the person’s inner wisdom to unfold and guide the development of a personal wellness plan. Advances in science support the wisdom of the energetic effect a therapeutic presence can have on self and others, identifying basic cellular changes resulting from “heart-based living” (feelings of love and appreciation vs. anger and stress).¹¹ The plan for self-care can be as varied as the grand nursing theories that support each of the many strategies used to heal body, mind, and spirit.

Programs focusing on self-care are also supported by midrange theories such as the Health Promotion Model.³ The Health Promotion Model offers a holistic approach to self-care as perspectives from nursing and behavioral sciences are integrated into factors that may influence health behaviors. Nurses can practice and direct these practices, identifying interpersonal influences, interventions for health behavior change, and individual needs in tailoring the path to reach the necessary and desired changes. This model is congruent with holistic nursing because it guides data collection, processing, nursing activities, and possible client outcomes.¹²

In the Health Promotion Model, the motivation for behavior is neither fear nor threat and is not disease or injury specific. The approach seeks to expand the potential for health, not prevent the occurrence of imbalances or disease. Health is influenced by multidimensional factors and is viewed as greater than the absence of disease. The person’s desire for an active role in promoting health is honored because the individual can express his or her own unique health potential, assess his or her own competencies,
value growth in positive directions, achieve balance, and desire to regulate his or her own behaviors.^3p7 This description of health promotion may be applied to an individual or family, community, or society. Health may be improved as risks are assessed and interventions are suggested to change perceptions, decrease barriers, gather support, and improve health-promoting behaviors. The Health-Promoting Lifestyle Profile Tool (HPLPII), often used in this model, identifies six behaviors or subscales to measure interpersonal relations, nutrition, health responsibility, physical activity, stress management, and spiritual growth.¹³ Evaluating, addressing, and incorporating health-promoting behaviors into daily activities creates a lifestyle representing selfcare or self-management of health promotion.