W. Richard Cowling

A nursing manifesto: an emancipatory call for knowledge development, conscience, and praxis

The purpose of this paper is to present the theoretical and philosophical assumptions of the Nursing Manifesto, written by three activist scholars whose objective was to promote emancipatory nursing research, practice, and education within the dialogue and praxis of social justice. Inspired by discussions with a number of nurse philosophers at the 2008 Knowledge Conference in Boston, two of the original Manifesto authors and two colleagues discussed the need to explicate emancipatory knowing as it emerged from the Manifesto. Our analysis yielded an epistemological framework based on liberation principles to advance praxis in the discipline of nursing. This paper adds to what is already known on this topic, as there is not an explicit contribution to the literature of this specific Manifesto, its significance, and utility for the discipline. While each of us have written on emancipatory knowing and social justice in a variety of works, it is in this article that we identify, as a unit of knowledge production and as a direction towards praxis, a set of critical values that arose from the emancipatory conscience-ness and intention seen in the framework of the Nursing Manifesto.

Editorial: What Makes a Manuscript Holistic?

One of the biggest issues that I face as Editor of the Journal of Holistic Nursing is determining whether a manuscript is holistic. This is difficult in part because of the ambiguity in the scholarship of nursing and other health-related disciplines concerning holism and the nature of holistic science and practice. Occasionally, I have resorted to forwarding a manuscript about which I am uncertain to associate editors and reviewers in the hopes of gaining a broader perspective. I do sometimes get letters of inquiry about a manuscript before it is submitted and I use the tactic of referring the inquirer to the Sage Web site, which has extensive information that I composed on the Aims and Scope of the journal found at http://www .sagepub.com/journalsProdAims.nav?prodId=Journa1 200847. However, while this Web site describes in detail the various forms of scholarship we seek, it is not very explicit about holistic nursing. In this editorial, I have challenged myself to be clearer and more specific without limiting the possibilities for advancing holistic nursing knowledge. More importantly, I hope to provide useful information for potential authors who wish to craft their writing toward a holistic perspective. There are many sources of descriptions of holistic nursing. However, two of the best are an editorial by Vicki Slater titled “Holistic Nursing Practice,” published in the journal in 2005, and the recently released Holistic Nursing: Scope and Standards of Practice (American Nurses Association [ANA] and American Holistic Nurses Association [AHNA], 2007). I have used these extensively in building a case for what counts as holistic nursing scholarship—the nature of the work and its representation in writing for publication. Referring to the AHNA description of holistic nursing, Slater (2005) described two vantage points from which to consider holistic nursing—understanding the interrelationships of various dimensions of a person in seeing the whole as greater than the sum of the parts, and accepting integration, or wholeness, as a given. She wrote that any description of the practice of holistic nursing must take both of these into account. She went on to give a detailed analysis of these viewpoints and their implications for holistic nursing practice. I highly encourage anyone thinking about how to conceptualize holism in relation to health or nursing to take a good look at Slater’s editorial. Two of Slater’s (2005) conclusions have relevance for the development of manuscripts for JHN. First, writing from a holistic perspective is as unique as the person doing the writing. Second, a writer, like a physicist or a holistic nurse, “is able to see both the individual and global perspectives while focusing on one” (p. 262). What is missing from the vast majority of manuscripts that we receive for review is an explicit expression of the writer’s unique holism and a specific accounting of how the work is grounded in a holistic perspective. Writers are strongly encouraged to consider both of these elements in the creation of their manuscripts, whether that work focuses on research, practice, education, or aesthetics. Another common problem in manuscripts is that writers assume that some topics are implicitly holistic— prime examples are those that deal with spirituality and complementary and alternative modalities. While these topics are commonly the concern of holistic practitioners, educators, researchers, and artists, they are not consistently presented from an explicitly holistic perspective. When writers fail to present work in these areas within a holistic perspective, the advancement of knowledge relevant to holism and holistic health and nursing is greatly diminished. There is also the possibility that, in fact, the work reported in the manuscript was not conceptualized as holistic and more accurately represents a different perspective not consistent with a holistic view. The new Holistic Nursing: Scope and Standards of Practice (ANA & AHNA, 2007) provides the most comprehensive description to date of the field of holistic nursing. It should be a primary reference for anyone considering submission of a manuscript to JHN. It presents important elements for holistic writers to consider when determining how to situate their work within a holistic nursing frame of reference:

Where Is Holistic Nursing

Holistic nursing has been persistent in its reach and innovation in addressing the fragmentation of the human experience in the delivery of health care. Holistic nursing has offered alternatives that not only account for and appreciate the wholeness of human beings but also demonstrate higher degrees of satisfaction and improved patient outcomes. However, there are few examples of the presence and impact of holistic nursing in helping people who suffer three of the greatest problems facing men, women, and children today. It is reported by the National Institute on Drug Abuse (2018) that around 90,000 people die in the United States every day due to overdosing on opioid drugs. Nearly half of all women in the workforce have been sexually harassed—and that only accounts for those willing to report it (Landrum, 2017). The aftermath of sexual abuse and harassment are infused in the stories of both men and women who have had the courage to speak up and speak out. Finally, there are an estimated 20.9 million people trapped in some form of slavery today (End Slavery Now, 2018). Often referred to as “human trafficking,” slavery today takes a variety of forms including domestic servitude, sex trafficking, bonded labor, forced labor, child labor, and forced marriage. Any one of these is a huge crisis in scope and intensity for the individuals and populations involved as well as those who support their health care. All are of national and international in magnitude. The American Nurses Association and the American Holistic Nurses Association have supported the role of nurses in targeting the opioid crisis. There has been a particular emphasis on holistic pain management by nurses. Implicitly there has been a call to attend to the needs of those individuals, families, and groups living with opioid addiction and its aftermath from a holistic perspective. It appears the main target has been appropriately on prevention by finding alternatives to opioids or better management of the use of opioids to alleviate pain. The specialization of pain management in nursing has improved understanding, research, and practice in this area. How can we elevate and advance the science and practice of holistic nursing to explore, examine, and appreciate the holistic nature of the human experience associated with opioid use encompassing, yet going beyond, pain management? The role of nursing in sex trafficking is mostly defined in the contexts of forensic and psychiatric mental health nursing specialties. Although frequently described as a situation that requires holistic approaches there is little evidence of full-on development of holistic theory, practice, or research in this area. Additionally, sex trafficking is the major focus of attention with little or no reporting on other forms of human slavery rampant today. Likewise, the role of nursing is not well developed in the area of sexual harassment in the workplace and beyond, except as it relates again to forensic and psychiatric mental health nursing. Sexual harassment and workplace violence aimed at nurses is often described in similar contexts. How can we elevate our attention to the development and advancement of holistic nursing knowledge to improve the care of victims of these horrendous experiences as well as to change the conditions that perpetuate them? The major health crises of opioid addiction, sexual harassment in the workplace, and human slavery are complex and perplexing. Nurses have historically taken on pandemics of all sorts and have been in the forefront of community health 758426 JHNXXX10.1177/0898010118758426Journal of Holistic Nursing editorial2018

Reflections on holism and the passing of Nelson Mandela.

Stories of Liminality: Living With Life-Threatening Illness 35 Anne Bruce, Laurene Sheilds, Anita Molzahn, Rosanne Beuthin, Kara Schick-Makaroff, and Sheryl Shermak Leadership Lessons in Global Nursing and Health From The Nightingale Letter Collection at the University of Alabama at Birmingham 44 Doreen C. Harper, Kimberly S. Davey, and Pamela N. Fordham Practice The Feasibility of a Holistic Wellness Program for HIV/AIDS Patients Residing in a Voluntary Inpatient Treatment Program 54 Vanessa Morgan jh n

Editorial: On Spirituality and Holism

The research section of the journal features four articles related to spirituality and holism in some form. This was not by design but by happenstance because my editorial practice has been to publish articles based on dates of submission rather than on topics. This is done for three reasons. First, there is no guarantee at any one time that there will be manuscripts accepted for publication that are related to the same topic. Second, I have tried to be fair to authors who are awaiting the publication of their articles. Third, it is important to disseminate new information in a timely manner. I have been asked to consider specific topics for single issues, but the solicitation of enough manuscripts would be highly unpredictable, and the peer review process focusing on quality standards could not assure acceptance of the required number to constitute an issue. So, it is fortunate that the research section happens to feature articles connected to spirituality. As I have described in a previous issue, the topic of spirituality by itself does not constitute a holistic perspective, and thus a manuscript focused on spirituality may or may not fall within the aims and scope of the Journal of Holistic Nursing. The primary determining factors on whether a manuscript on spirituality qualifies as holistic is the author’s perspective of spirituality— that is, the conceptualization of spirituality as a holistic phenomenon or within a holistic theoretical framework—and how the author relates spirituality to holistic health and holistic nursing and health care. In my estimation, addressing one or both of these issues in a manuscript qualifies it as being holistic in viewpoint. There is also room for manuscripts that provide diverse perspectives and dialogue concerning the positioning of spirituality within a holistic or nonholistic frame of reference. This type of argumentative exposition—I mean that in a positive context—could lead to deeper understandings of spirituality. The four articles published in the research section of this issue demonstrate distinct ways that spirituality may be addressed and illuminated. Vance, Struzick, and Rapper provide a critical analysis of literature related to spirituality in adults aging with HIV. They tie their analysis to the provision of holistic care and advancing holistic science, noting the positive effects of spirituality on biopsychosocial functioning in aging according to research. Witte, van der Wal, and Steyn describe a phenomenological research study of the relationship of mystical experience to health and health care, in particular nurse–patient relationships. Borman, Thorp, Wetherell, and Golsham report on a quantitative study designed to examine the impact of a spiritually based intervention involving mantram for combat veterans with posttraumatic stress disorder. Finally, Tzeng and Yin describe an exploratory survey of Taiwanese patients regarding the practice of religious activities, including prayer, and its association with health problems and coping. These manuscripts demonstrate some of the possibilities for contributing to holistic knowledge regarding spirituality, religion, and holistic health and health care. Each offers a distinct contribution through its focus and approach to understanding spirituality. Each opens the door to further inquiry and understanding. Each makes a case for the relevance of the study of spirituality, in some form, to advance holistic nursing. In addition to the research focus, articles in the areas of education, practice, and aesthetics could further elaborate the role and potential of spirituality and spiritual practices in holism and holistic health care and nursing. The interest of holistic nurses in spirituality calls for further contributions and for reviewers with expertise in these areas. I call on scholars from research, practice, education, and the arts to offer their expertise in assisting in reviewing manuscripts by contacting me at jhn@uncg.edu. The advancement of holistic knowledge to serve humans requires attention to spirituality and spiritual practices as demonstrated by the research section of this issue, as well as the vast and growing body of research and knowledge on these topics.

A Health Care World Divided and the Hope of Wholeness

Baby Charlie Gard, the fragile infant at the heart of a debate about parents’ rights to determine treatment options, died today after life support was withdrawn. Earlier this morning, the Senate failed to advance a bill to partially repeal the Affordable Care Act. For most of us our cell phones and televisions provided a week of heart wrenching coverage of these two events. While these seem unrelated, they focus our attention on a common question: what kind of health care should people expect that is politically and socially mandated? Charlie’s parents were not able on their own to decide about the course and conditions under which his life would unfold – it is clear government intervention was at play in a country where universal health care is the norm. The US Congress grappled in their deliberations in essence how the government and its social policies might influence the kind of health care people would get and ultimately the course and conditions under which the lives of a country’s people would unfold. What was evident from coverage in all forms of media, social and general, are two things. The most obvious one is the extent of extreme polarization in human responses regarding how the government should be involved in our health care. The second, more subtle, is the entrenchment of beliefs expressed as extreme cynicism and contempt for opposite points of view. The purpose of this brief editorial is not to take or argue for any stance, but rather to share thoughts and welcome others to share thoughts on the hope of wholeness as a point of view and to promote the common cause of human betterment as the focus for dialogue. I am not naïve enough to believe that I have the answers to a health care world divided, nor does any individual, organization, or group. What I call for is a willingness to examine the way we live, interact, and respond to one another. Holistic nursing is animated by a set of ideals and holistic nurses form a tribe, a community, a sister-brotherhood of sorts, who for the most part live with a fairly high degree of harmony, even joy, because of our willingness to strive to live by these ideals. I would argue we have competencies formed from examining and immersing ourselves in these ideals that could benefit the societal discourse on health care. May we do our best to leverage our ideals and competencies to promote a world where participation in social dialogue transcends divisiveness, discord, and distress evident in the current social climate? May we listen understandingly and think appreciatively about the variety of viewpoints that exist with the intent of upholding human betterment? The American Holistic Nurses Association describes its vision as “a world in which nursing nurtures wholeness and inspires peace and healing” (American Holistic Nurses Association, 2017). This is a worthy ideal from which to imagine what is possible and be stirred to act accordingly. The Scope and Standards of Practice: Holistic Nursing (2013) espouse holistic nurses “participating in the positive transformation of systems” (p. 8) and advocate for education that “values all the ways of knowing and learning” (p. 18) and research on “healing relationships and healing environments” (p. 20). These public statements are some of the few examples that express the crucial role holistic nursing plays in upholding human betterment worthy of societal aspiration. Using the lens of wholeness to reflect on the discord and divisiveness concerning the ways in which health care is executed and subsidized by the government may bring deepened understanding and forge common ground. Positioning responses based on the ideals of human betterment, peace-making, and positive transformation may encourage actions that overcome the stalemates and mutual contempt that now exists. Perhaps we could even have reason 727381 JHNXXX10.1177/0898010117727381Journal of Holistic Nursing editorial2017

Introduction of Guest Editorial

I am pleased to share this guest editorial written by Billy Rosa with you. The focus on the relationship of creativity and healing is specifically relevant to holistic nursing and to writing for publication. In the health care culture of today, so much depends on making decisions based on objective, prescribed individual health data or large generalizable data sets. Oftentimes, that data have minimal relevance to a person’s human life experience. Thinking about how creativity informs practice and encourages healing provokes new ways of understanding holistic nursing. It also has relevance to the creativity inherent in writing of all kinds, including the type of writing that is supported by the Journal of Holistic Nursing. I welcome your ideas for further editorial topics. Please reach out to me at rcowling@chamberlain.edu.

Theoretical Grounding of Holistic Nursing Scholarship

A group of researchers conducted a study to determine whether nursing scientists’ research articles in leading nursing journals were based on theory (Bond et al., 2010). A total of 2,587 articles were reviewed that were published in seven major journals, from 2002 through 2006, with most (76%) being research articles. It was discovered that 837 (38%) authors used theories, and of those, 460 (55%) used nursing theories and 377 (45%) used other theories. The researchers reported that closer analysis revealed theory principles were implicitly implied even though the author(s) did not refer explicitly to a theory. What is the role of theory in the scholarship of holistic nursing? Core Value 1 of the scope and standards of holistic nursing practice states that the “philosophical, theoretical, and ethical foundations define the who and why of holistic nursing—who holistic nurses are and their raison d’être” (American Holistic Nurses Association & American Nurses Association, 2013, p. 9). Furthermore, the scope and standards suggest that practice is built on both science (theory, research, evidence-based/informed practice, critical thinking, reflection) and art (relationship, communication, creativity, presence, caring). “Holistic nursing is grounded in nursing knowledge and skill and guided by nursing theory” (American Holistic Nurses Association & American Nurses Association, 2013, p. 9). Since theory is deemed foundational to holistic nursing practice as supported both by the American Nurses Association and American Holistic Nursing Association, it would seem reasonable that theory be made explicit in the scholarship of holistic nursing. This would also be of worth to those using scholarship to support their nursing practice and those pursuing certification. An intriguing article by Nickitas and Fredrickson (2015) call out the economic value of nursing knowledge and theory. Defining the economic value of nursing has become ever more critical with changes in reimbursement and the focus on value-based purchasing. Understanding and appreciating nursing science is a requisite in explaining and documenting the value of nursing knowledge and theory within the health care system. There is further legitimization when it is shown to be relative to nursing’s unique theoretical knowledge. “For nursing care to be valuable in today’s value-based environment, nursing theory must be fully realized. It requires the rich and continued development of the discipline where there is a body of knowledge that is uniquely recognized as nursing” (Nickitas & Fredrickson, 2015, p. 239). It seems that one of the journals most enduring contributions is to contribute to the explication of holistic nursing knowledge and theory and thus to the elaboration of its value in the healthcare system. Anne Wilson Schaef (1992), a renowned psychotherapist in the field of addictions, articulated the critical importance of acknowledging the assumptions inherent in one’s education, experience, and worldview. In this acknowledgement, she began to question her own practices that were sometimes counter to the healing and helping she sought to perpetuate in her work. She posed the following:

What Makes a Manuscript Holistic? Revisited and Still Relevant

I originally published this editorial in 2007 (Cowling, 2007) but believe it warrants revisiting because it is still relevant today. One of the biggest issues that I continue to face as editor of the Journal of Holistic Nursing (JHN) is determining whether a manuscript is holistic. This is difficult in part because of the ambiguity in the scholarship of nursing and other health-related disciplines concerning holism and the nature of holistic science and practice. Consistently, I have resorted to forwarding a manuscript about which I am uncertain to associate editors and reviewers in the hope of gaining a broader perspective. I continue to recieve letters of inquiry about a manuscript before it is submitted, and I use the tactic of referring the inquirer to the Sage website, which has extensive information: https://us.sagepub.com/en-us/ nam/journal-of-holistic-nursing/journal200847. It is important to refer to the following tabs at this link: About the Journal; Manuscript Submission, and Aims and Scope. However, while this website describes in detail the various forms of scholarship we seek, it is not very explicit about holistic nursing. In fact, often I get manuscripts that make no reference to holistic nursing or holistic health care at all. In this editorial, I have challenged myself to be clearer and more specific, without limiting the possibilities for advancing holistic nursing knowledge. More important, I hope to provide useful information for potential authors who wish to craft their writing toward a holistic perspective. There are many sources of descriptions of holistic nursing. However, two of the best are an editorial by Vicki Slater titled “Holistic Nursing Practice,” published in the journal in 2005 (Slater, 2005), and the recently released Holistic Nursing: Scope and Standards of Practice (American Nurses Association & American Holistic Nurses Association [AHNA], 2013). I have used these extensively in building a case for what counts as holistic nursing scholarship—the nature of the work and its representation in writing for publication. Referring to the AHNA description of holistic nursing, Slater describes two vantage points from which to consider holistic nursing—understanding the interrelationships of various dimensions of a person in seeing the whole as greater than the sum of the parts, and accepting integration, or wholeness, as a given. She says that any description of the practice of holistic nursing must take both of these into account. She goes on to give a detailed analysis of these viewpoints and their implications for holistic nursing practice. I highly encourage anyone thinking about how to conceptualize holism in relation to health or nursing to take a good look at Slater’s editorial. Two of Slater’s (2005) conclusions have relevance for the development of manuscripts for JHN. First, writing from a holistic perspective is as unique as the person doing the writing. Second, a writer, like a physicist or a holistic nurse, “is able to see both the individual and global perspectives while focusing on one” (p. 262). What is missing from the vast majority of manuscripts that we receive for review is an explicit expression of the writer’s unique holism and a specific accounting of how the work is grounded in a holistic perspective. Writers are strongly encouraged to consider both of these elements in the creation of their manuscripts, whether that work focuses on research, practice, education, or aesthetics. Another common problem in manuscripts is that writers assume that some topics are implicitly holistic—prime examples are those that deal with 597377 JHNXXX10.1177/0898010115597377Journal of Holistic NursingCowling research-article2015

Three Simple Guideposts to Successful Publishing: A Journal of Holistic Nursing Perspective:

the manuscript there is no reference to the term holism or holistic. This suggests that the linkages do not exist. In other cases, the linkages are not clearly articulated. • Making sure the content is based on relevant and current sources of support: It is very important that the author address the foundational knowledge that grounds the work described. The editorial staff of the journal recognizes and appreciates a variety of forms of knowledge that include empirical, theoretical, experiential, aesthetic, and personal. However, it is expected that the author relies on a systematic review of existing knowledge related to the topic and documents the sources of that knowledge in making a case for the significance and credibility of his or her work. The standards of significance and credibility have relevance for one of the major purposes of the journal to advance knowledge in the field. • Identifying the appropriate category and keywords that distinguish the content: The journal has four basic categories of manuscripts that are published: research, practice, education, and aesthetics. Research manuscripts are also designated as quantitative, qualitative, mixed methods, concept/theory development, and critical literature review.