ABSTRACT Emphasis on humanistic values and personal experience in nursing has led to the popularisation of holistic nursing approach to nursing care. Although holistic nursing care as a construct is widely discussed in nursing literature. Contextual clinical application has been difficult, in the absence of guiding conceptual framework and guidelines that directs nursing practice. In this study, the purpose was to examine the meaning of holistic nursing care and develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing in academic hospitals. To achieve this aim, qualitative methodological perspectives were employed based on careful selection of the population, sampling, collection and analysis of data and trustworthiness. To enable the accomplishment of the purpose, the study objectives were formulated into two phases. Phase one objective enabled the identification of the characteristics of the concept holistic nursing care through concept analysis and by obtaining the emic viewpoints of the paediatric nurses working in academic hospitals. A philosophical inquiry was employed using Rodgers’ evolutionary method of concept analysis. To elucidate the concept holistic nursing care a qualitative, interpretive, explorative and contextual research design was employed. Holistic nursing care was interpreted as whole care fostering person-centred and family-centred care. The results confirm the current discourse in nursing literature with respect to “person-centred”, “family-centred care” as opposed to “patient-centred care”. The emphasis is on recognition of the need to transform current linguistic ontology from “patient care” towards the provision of “whole-person” care. Participants’ interpreted v holistic nursing care as whole care directed towards a unique and complex human being. The dynamic, which is the driving force for the achievement of whole care, is established through enabling goal-directed nurse-family relationships. One of the key finding is the prominence of spirituality and the inclusion of spirituality in different aspects of child nursing. The dependency of individual nurses to spiritual sources for personal strength and support was recognised and acknowledged. Knowledge of disease, person and “know how” are necessary for the acomplishment of ethically, safe person-centred whole care. Attributes of holistic nursing care yielded two dimensions; whole person and mind-body-spirit dimension. The decriptors of whole person include physical, mental, emotional, spirit and spitual being. Spirituality is the predominant antecedent. Holistic nursing care is initiated by the recognition of the individual, in need of health care, as a spiritual being with mind-body-spirit dimension. Spirituaity is an ever-present force pervading all human experience. Complimentary alternative medicine (CAM) was identified as a surrogate term. The connection of CAM with holistic nursing care is the focus of therapetic interventions that are directed to the mind-body-spirit domain. The emphasis is on health rather than curing. Preventative therapeutic interventions are desingned to meet the needs of the whole-person. Caution is advocated in the use of CAM therapies in child nursing, as CAM efficacy has not been sufficiently investigated in child health care. The conceptual framework is presented as unique contribution to nursing. The framework may be introduced at undergraduate teaching of child and family nursing care and in specialists’ paediatric nurse education. Recognition of the human being as a whole person with mind-body-spirit dimension is not restricted to a child or family care. Therefore, the vi framework is presented as a fundamental structure that can be used generally to all intervention activities in relation to human–human interactions. Its use may be broadened to any therapeutic environments. The framework may be tested in adult nursing in variety of settings in health care. There is a potential to expand and transfer certain elements of the framework to other discipline beyond nursing: in doctor-patient relationships, manager-employee relationships, and person-to-person interactions. Perhaps the South African Nursing Council, as the regulating body responsible for developing the educational framework of nursing education in this country may adopt this framework in line with their philosophy of nursing to articulate with their intended goal of providing holistic nursing care for the people of this nation. Adoption of the framework may require a shift from the current “patient-centred care” towards “person-centred care”.

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Spirituality is an integral part of a persons wholeness and therefore has an effect on and plays an important role in health and illness. Nurses are required by national and international nursing bodies as well as hospital accreditation agencies, to identify patients spiritual needs and intervene by integrating spiritual care into their nursing care. However, to date, no nursing studies have described Tanzanian nurses experiences of spirituality and spiritual care. The qualitative method of interpretive description was used. A purposive sample of fifteen registered nurses who were engaged in direct clinical practice at one of the private not-for-profit hospitals in Dar es Salaam, Tanzania was drawn. In-depth interviews using open-ended questions were carried out, tape-recorded, and transcribed verbatim. The data collection and analysis occurred concurrently. The transcripts were coded using inductive analysis. Themes related to spirituality and spiritual care that emerged from data were: meaning of spirituality, meaning of spiritual care, recognition of spiritual needs, interventions to respond to spiritual needs, challenges addressing spiritual care, and factors positively influencing the provision of spiritual care. Several recommendations for enhancing spiritual caregiving practices were given by participants. The findings from this study offer a basis for assessment, planning, and intervention strategies that nurses can apply in integrating spiritual care in clinical practice.

Philosophiae Doctor - PhD (Nursing) / Man is a bio-psycho-social-spiritual being, and his needs are informed by all these elements. The need for spiritual care in nursing education and practice is no longer a new concept in developed countries, nor even in some developing countries. However, in Nigeria, there is no consistent evidence of how spirituality is taught within the nursing curriculum nor how it is practised. The literature review also confirms that no existing set of rules or models for integrating spiritual care into the curriculum of nursing exists in the country. If nursing care is to be holistic, concerted attention must be paid to spiritual care, and to the training of nurses so that they can provide spiritual care within the context of holistic care for patients in the healthcare system. The main purpose of this academic work was to develop a model for the integration of spiritual care-giving into the nursing curriculum. This cross-sectional study used adapted modified Intervention Mapping (IM) strategies with a mixed method approach, to collect in-depth information.

The theme was chosen on the basis of their own experience, when new treatments, tools and nurses appear in the workplace, which are also required to constantly improve the quality of nursing care. The state approach to the patient forms the philosophical basis of nursing care. To give nurses of quality pastry about the bio-psycho-social and spiritual needs of the patient, it is necessary to have the knowledge, conditions and personal relationship to provide holistic care. At present, it is not possible that these are health and safety risk factors. Aims, research questions and hypotheses: The subject of the research is to find out the interest of nurses to apply a holistic approach in practice considering the current situation in nursing. Three objectives were set based on the subject of the research. Goal 1: Find out, if nurses are interested in providing modern nursing care based on patient needs. Goal 2: Identify nurses' personal views on providing holistic care. Goal 3: Determine the satisfaction level among nurses about the nursing care provided with regard to the current situation in practice. Methods and research file: Quantitative data collection method was used for the research. Anonymous questionnaire was distributed to nurses in selected healthcare facilities (Liberec Hospital, Turnov Hospital, Jablonec nad Nisou Hospital). The survey sample size is 180 respondents. Findings and conclusion: It follows from the research, that more than half of the respondents have already encountered the concept of holistic nursing care and they also understand what needs should be met by patients/clients and how to satisfy them. Some of them have already used the help of a social service or psychologist. However, it has turned out, that more than half of the responding nurses are not interested in spiritual needs. It has not been confirmed, that nurses' interest in providing this modern nursing care based on patient needs would depend on capacity of staff. The survey also shows, that the holistic care is provided in their hospitals according to one third of responding nurses. Nevertheless, the respondents think, that a holistic approach cannot be applied in their workplace because of lack of time, lack of staff and time consuming administration. Based on the results of Hypothesis 2, we can confirm, that nurses' opinion on the implementation of noursing care provided is influenced by the workload of nurses. The holistic approach moderately affects the job satisfaction level of nurses according to the survey. However, more than half of the responding nurses are satisfied with care they provide at their workplace, because they can see satisfied patients/clients. Hypothesis 3 has not proved any relationship between the satisfaction level of nurses and current situation in health care, where a holistic approach can be effectively applied. There will be a seminar for general nurses within the lifelong learning of nurses focusing on holistic care as an outcome of this diploma thesis.