This concept analysis examines the characteristics and the application of Empowered Holistic Nursing Education (EHNE) nursing theory. A literature review of the chosen scientific evidence demonstrates that EHNE is a middle-range theory with two multifaceted concepts – empowerment and holism. In nursing education, empowerment is both a process and a goal that entails helping student nurses take charge of their learning activities and outcomes. However, the analysis demonstrates that the nurse educators need to be empowered first because otherwise, they can function as hindrances to the independence of the student nurses. On the other hand, holistic nursing education refers to the learning approach that provides comprehensive knowledge related to social, psychological, spiritual, and physiological experiences and perceptions of the student nurse. The paper discusses both the antecedents that precede EHNE and the consequences of its application. Moreover, it relates the EHNE theory to evidence-based practice, presents ways in which the theory can be applied in different environments, and discusses how the student applies the theory and its use in the field of nursing education. Eventually, the paper concludes that EHNE nursing theory could be implemented in any nursing setting and that it is essential for nursing education, practice, research, and even administration.
The proponent of the Empowered Holistic Nursing Education theory held the view that when nursing students have empowering and holistic classroom experiences, they make the experiences of the patients whom they care for empowering and holistic in turn. EHNE is a middle-range nursing theory because it has solid concepts that relate precisely to a small area of nursing practice (Love, 2014). Although their scopes are limited, middle-range theories describe multiple concepts, thus improving their feasibility, utility, and verifiability. The fundamental concepts of the EHNE theory are empowerment and holism, and its primary setting is the classroom (Love, 2014). However, its intended outcome stretches further than just enhancing positive training experience of student nurses since it also influences their practice as caregivers and future trainers. Furthermore, it enables the nurse trainers to direct and define the scope of nursing education and to concentrate their nursing research on measurable objectives that promote efficiency and rigor. Despite its comprehensiveness, the theory has not yet gained popularity in nursing practice because it is relatively new. However, with the ever-increasing pressure on caregivers to shift to integrative care, EHNE theory will soon become the hybrid theory for all medical professions and settings.
EHNE theory offers a new holistic approach to nursing education, practice, and models. It perceives a nursing student as a being with a spirit, body, and mind; a person who is worthy of being in charge of the learning process and of being put into holistic learning setting with a state of wellness and empowerment aimed to create independent knowledge. Notably, holistic practice does not agree with approaches that compartmentalize spiritual care, mental care, and physical care. Instead, it prioritizes interconnectedness, healing presence, and promotion of wellness and disease prevention. Nonetheless, the concept of holism is incorporated into the nursing training to demonstrate to the learners what holistic patient treatment means and how they can include complementary and alternative modalities in their work. Moreover, the theory breaks down the existing information about holism and widens its scope to include emancipatory learning practices, models, and empowerment (Bruce, 2014). It is necessary to integrate the concept of holism into the nurse training because the nurse trainers use their own assumptions to direct the learning activities, putting the class in danger of getting biased content and developing intolerance to diversity. Since the principles that promote patient-centered care can work in enhancing student-centered learning, EHNE outlines the directions that the nurse trainers could take to establish learning environments that meet the requirements of holistic nursing.
One of the basic ideas upon which EHNE is founded is empowerment. In general, to empower a person implies helping them take charge of the issues that affect them. In nursing practice, empowerment means giving patients responsibility and independence in choosing where they seek treatment and how they want it to be administered (Morgan & Yoder, 2012). Thus, it is a process that involves both the contribution of an individual and that of a larger institution or society in putting people in control of their wellness. The attributes of care resulting from patient empowerment have three components — namely, client-related qualities, nurse-related qualities, and those qualities that relate to both the nurse and the client.
Empowering patients to take part in their self-management can actively help to minimize the costs of nursing resources by lowering their demand (Love, 2014). That is particularly true because the available nursing health resources should provide the clients with a high quality of care that revolves around them. However, some nurses contend that this principle cannot reduce resource usage because empowered patients are more demanding. Health professionals who hold this view discourage patient participation in their care by putting barriers on their way (Morgan & Yoder, 2012). Arguably, a critical consideration of empowerment involves resource usage, but in fact, it results in a shift in control of the patient care because when the patients can access the necessary services and facilities, they feel more in charge of their care.
Moreover, empowerment shapes the nurse-patient relationship (Love, 2014). The role of the nurses goes beyond enhancing patient participation because it includes the provision of information regarding the treatment process and their possible biases. As the nurse reveals these details to the patient, they get to interact and share their self-reflections in a way that reorganizes the actions of the patient. In the process, both the patient and the nurse gain new knowledge as they relate past assumptions to new empirical insights. As a result, the patient gets to see their health needs in new perspectives that are related to their worldviews. On the other hand, nurses need to be sensitive during the empowerment process and interpret the information from the patients accurately (Morgan & Yoder, 2012). Nurses must recognize that despite the need to empower the patient, different nursing circumstances require unique approaches that need their professional discretion. Therefore, letting the patients determine care in complex situations can lead to overloading them with information, which may only make them more anxious. It means that there are times when the nurses must apply their professional experience and expertise when evaluating and attending to individual needs of the patients.
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The other concept that the theory emphasizes is holism. When holism is used in the nursing education setting, the word itself refers to comprehensiveness of learning approach. As a profession, nursing is holistic in nature because it traditionally looks at an individual as a whole, focuses on the interrelationship between the spirit, the mind, and the body, and promotes physical and psychological health in dynamic economic and socio-political care environments (Papathanasiou, Sklavou, & Kourkouta, 2013). However, the concept is not only limited to nursing — it has been used in other disciplines like investment analysis and early childhood education methods. Furthermore, nurses need to be conscious of their patients’ and their possible wholeness to put the concept of holism into practice. People tend to perceive wholeness according to other individuals’ views and their personal weaknesses. Those who can reflect on themselves treat others in a harmonious way because they can set a balance between their selves and their surroundings (Love, 2014). There is a level of professional, intellectual, and personal maturity that one must attain to gain self-awareness that can lead to personal harmony. In the nursing practice, caregivers who incorporate holism in patient treatment are influenced by intuition and experience.
The primary goal of holism in care is to enable the clients to apply their innate abilities to making their life better and when managing their sickness (Papathanasiou, Sklavou, & Kourkouta, 2013). Empowerment is a nursing concept that is commonly used in quality care, which is the primary mission of nursing. Thus, the work of the nurses is changing from that of caretakers to the initiators of empowerment. Moreover, the emergence of specialist nurses begins to eliminate the standard nursing roles (Papathanasiou, Sklavou, & Kourkouta, 2013). As the nursing field keeps improving, the scope of the nurses’ roles keeps widening. Today, apart from treating patients, the nurses have to spearhead disease prevention and health promotion. Holism requires that nurses nurture their reflective and clinical skills, as well as the expertise they need to meet the patients’ needs in a wholesome way. It takes the application of practice and discretion within a clear framework to make care holistic.
The concept analysis notes such key attributes of the EHNE theory as spirit, body, mind, harmony, wholeness, autonomy, discretion, responsibility, control, information, classroom pedagogy, and healing. These attributes are repeatedly mentioned in the literature review, and they relate to the conventional views about the concepts of holism, empowerment, and nursing pedagogy.
Antecedents of EHNE Theory
First, holistic empowerment in nursing education requires that the nurse educator and the student understand and trust one another (Papathanasiou, Sklavou, & Kourkouta, 2013). Trust is based on mutual relationship, open communication, authenticity, and integrity. The nurse educator has to trust the capabilities of the student to make a right decision and accept responsibility and accountability. Likewise, in order to gain the trust of their students, the nurse educators should possess competent communication skills, knowledge, and expertise in the profession. They should also be able to use education to implement holistic empowerment.
Secondly, for holistic empowerment, mutual respect is crucial. Both the student nurse and the educator must respect and be sensitive of one another’s values and beliefs (Love, 2014). Both the student nurse and nurse educator must share a commitment to common values because it determines their contribution and the level of inspiration toward the process. Awareness of beliefs also entails knowledge of how to approach behavior change, the consequences of behavior change, and how to handle issues related to the goal of behavior change. Thirdly, the nurse educator must nurture and use specific form of understanding, skills, and manners that enhance holistic empowerment in classroom settings. The nurse educator needs to be holistically empowered to be able to relate power distribution and communication to their past experiences. Therefore, holistically empowered trainers have a basis on which their experiences are founded and they can appreciate the role of their sources of power. In the future, the educators might improve their relationships with the student nurses by holistically empowering them. However, nurse educators who lack knowledge of holistic empowerment, their roles, and that of the patients can only demonstrate vague understanding that does not entail responsibility. Such nurses feel insecure about holistically empowered patients.
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The consequences of a nursing education theory concept are its outcomes for the student nurse and the nurse educator. One of the most important results of EHNE theory is that it boosts the self-confidence of the student nurse. Empowered holistic classes give the student nurse a sense of being in charge of their training and its outcomes. The realization of their capability to set goals and achieve them makes the student appreciate independence. Therefore, holistic empowerment validates the students’ values, beliefs, principles, and thought patterns.
Subsequently, the student nurses promote holistic empowerment to their clients when they get the opportunity to treat them (Papathanasiou, Sklavou, & Kourkouta, 2013). Consequently, this outcome eventually validates and encourages patient-centered care. The benefits of holistic patient empowerment stretch further rather than merely giving patients positive health outcomes. They make the work of the doctor easier, diminish the costs of the healthcare, make the work of professional caregivers more rewarding, and build the image of the clinical organization. Moreover, holistic empowerment reduces the patients’ feeling of being indebted to their nurses, making them accept help more readily.
For the nurse educator, holistic empowerment results in professional and personal development. Competence and confidence make a professional more satisfied with their jobs. Similarly, the student nurses will find their classroom experience more fulfilling, meaning that they are more likely to get job satisfaction in their practice after the training. Ultimately, the student nurses will provide their person-centered care to their patients, resulting in better care outcomes. A caring approach that is centered on the patient identifies personal needs and attends to them, taking the perceptive of the clients in consideration when deciding the peculiarities of their care. Accordingly, the process of holistic empowerment challenges the existing knowledge, hence altering personality toward greater transparency.
A recent study demonstrated that using empowerment without incorporating holism in the rehabilitation of people with labor disabilities makes them feel excluded from their societies (Van Hal, Meershoek, Nijhuis, & Horstman, 2012). In most parts of Europe and America, professional rehabilitators use client empowerment as a method of restoration in vocational rehabilitation. The rehabilitators apply the concept in helping individuals take deliberate independent decisions aimed to help them return to the process of labor. The practice is based on some studies that have been done on holism and empowerment inpatient care. One study that is commonly referred to is a conceptual analysis of empowerment done by Tengland, which concluded that empowerment could be used as a process and a goal aimed to stimulate change (Van Hal et al., 2012). As a process, vocational rehabilitators create a work environment where the clients take change. At the same time, empowerment is perceived as a goal of vocational rehabilitation because it makes the clients responsible for the management of the quality of their wellness. The use of empowerment as a process is the one applied in vocational rehabilitation because it is considered a useful point where exploration of the relationship between professional practice and empowerment can start.
However, some scholars criticize the activation method as being non-client-centered and one-sided (Van Hal et al., 2012). It is also the position of this conceptual analysis that using an empowerment approach that is not holistic can partly alienate the clients from their internal or external environments. Accordingly, a study was recently done to evaluate the particular role of empowerment on labor activation (Van Nal et al., 2012). After analyzing narratives of five cases of participants who had some work disability and had taken part in vocational rehabilitation, the study found that when activation strategies focus on empowerment only, they tend to exclude the participant from their societies. Therefore, vocational rehabilitation should include holism when implementing empowerment in order to solve the problem of client exclusion.
Based on the study used to propose EHNE theory, nurse educators are beginning to incorporate practices that support holistic empowerment of student nurses. The two most common modalities that research has found effective are praxis and complementary and alternative modalities (CAM) (Love, 2014). Praxis involves making the students take time to reflect on their existing beliefs, past experiences, and biases in their classrooms. When the students have engaged in deep thinking, the nurse educator helps them develop new knowledge from their reflections. In addition to thinking in classrooms, the students incorporate actions that aim to support diversity in their learning environments by working in groups with colleagues from different social backgrounds, classes, and races, and with different religious beliefs. The action part of the modality makes the student nurse appreciate diversification of nursing and also helps them learn how to interact and handle patients from diverse backgrounds.
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In nursing education, complementary and alternative modalities are practices that qualified nurse educators can integrate into their classrooms to make the students comfortable and help them experience relaxation of the spirit, mind, and body, and to promote harmony. Such modalities can come at strategic moments such as at the beginning of a class session and before a test. They include activities such as yoga, meditation, deep breath aromatherapy, guided imagery, etc. CAMs promote holistic empowerment because they allow the student nurses to choose how they want to enhance their emotional, mental, or physical wellness, and put them in control of the actual process. Consequently, CAMs are seen as both comprehensive in nature and empowering.
In the nursing practice, CAMs are used in place of or alongside the traditional clinical therapeutic methods for the similar purposes. There is a lot of empirical evidence that supports modalities in both nursing education and practice, and public health agencies rely on the evidence to regulate the usage of CAMs (Love, 2014). The United States, for instance, has an agency known as National Center for Complementary and Alternative Medicine, which is charged with the duty of ensuring that the caregivers use CAMs according to the law. The agency allows nurses to merge CAMs with the usual medical care in integrative care. It classifies CAMs into four categories, such as Energy Medicine, Bucolically-Based Approaches, Mind-Body Medicine, and Body-Based and Manipulative Practices.
Application of the Theory in My Practice
Evidently, EHNE theory is not only limited to nursing education, as it can also be applied in nursing practice. Therefore, as a health reform promoter, I have found the theory crucial in the delivery of the integrated care. Integrated care is an approach to nursing that involves a lot of communication and collaboration efforts across diverse medical professions (Morgan & Yoder, 2012). Integrated care is a distinctive care approach because it involves the exchange of patient care information among the medical team from different disciplines. Moreover, it establishes a complete care plan that meets the patient’s social, psychological, and biological needs (Morgan & Yoder, 2012). As such, it ensures that all health needs of the patient that can be identified are addressed in a single treatment. Hence, it promotes holism in healing because it cares for the soul, the mind, and the body of the patient. However, integrated care has the pitfall of centering the attention on the collaborating professionals rather than on the patients themselves, and that is where I find EHNE theory to be a vital framework for delivery of the integrated care. The theory requires that the two concepts of empowerment and holism be applied together in nursing education and care. Besides, it reminds me of the importance of educating the patients about their health needs, their treatment, and about the possible management of their wellness.
I also apply the theory in the justification of the campaigns aimed to persuade nursing institutions to adopt integrated care. The concept can work for patients of all ages and it can be used to enhance care in nearly all settings, including community-based care, long-term care, specialized medical care, and primary care. The members of an integrated care team function differently in different environments, and just like the patients, they also need empowerment and holism from those they work with.
Application of Theory in Nursing Education
EHNE theory can be applied in nursing education and research in many ways. The concepts of empowerment and holism are already being integrated into the classroom and in the nursing practicum attachments. As previously discussed in this concept analysis, nurse educators use complementary and alternative modalities, reflection, and social interaction to promote positive classroom outcomes that address the whole being of student nurses and their worldviews. Apparently, a student who studies in a class that incorporates the concepts of EHNE theory does not only acquire knowledge but also benefits from its resultant medical values. With first-hand experiences of how the modalities, autonomy, and learning associated with empowerment and holism can be beneficial, the students become motivated to provide their clients with empowered holistic care during their nursing practice.
The Empowered Holistic Nursing Education theory comprises two complex nursing concepts that are empowerment and holism. The two concepts are complementary, and they should always be applied together in all nursing settings. The holistic empowerment of student nurses significantly influences the quality of care they deliver in their practice and the way they relate to other professionals in the integrated care settings. Besides, EHNE theory is in line with the integrated care approach, which is the recommended nursing method for modern nurses. Finally, the theory can be applied in any nursing setting, and it is essential for nursing education, practice, research, and administration.