Nurse, Are you a Healer?
by Nancy Rainville Oliver, RN, PhD
The concept of ”nurse as healer” is in itselfvague and illusive. It is, however, a concept that is
Nancy Rainville Oliver, RN, PhD is Assistant Professor, Department of Nursing, California State University, Long Beach. CA.
beginning to emerge in practice and in the literature. To begin to develop an understanding of “nurse as healer”, the following questions are addressed: Are nurses identifi’ed as healers in the nursing literature? In today’s world of nursing practice, do nurses consider themselves to be healers? What healing practices do nurses engage in?
” T h e nurse as healer” is a new concept in nursing. Healing techniques, practices, and behaviors are not traditionally included in nursing education, and the concept of ”nurse as healer” is in itself vague and illusive. The concept is most frequently associated with holistic nursing, where the nurse is defined as a facilitator of healing (Dossey, Keegan, Guzzetta, & Kolkmeier, 1988); and with the healing intervention of Therapeutic Touch (Krieger,1979). To understand the concept of “nurse as healer”, the following questions were asked: Are nurses identified as healers in the nursing literature? In today’s world of nursing practice, do nurses consider themselves to be healers? What healing practices do nurses engage in? This article ~ECUSSS the extent and manner to which the notion of “nurse as healer’’ has been presented in nursing journals from 1966 through 1989. In addition, it includes the results of an informal survey of practicing nurses who were asked to i d e n e their own healing behaviors. The Literature Three computerized literature searches were conducted to answer the question, “Are nurses idenhfied as healers in the nursing literature?” For each search the terms “healer”, healing”, and ”behavior”, coupled with ”nurse”, ”nurses”, and “nursing” were used. The author selected only publications from the United States and Canada, and only those written in English. The following searches were conducted: 1. Index Medicus (1966-March,1989) 2. Cumulative Index to Nursing and Allied Health Literature (CINAHL)(1983-1988) 3. Medical Subject Headings (MESH) (1986-1988) In the literature search of Index Medicus for the 24year period, six articles were identified. Two of the arti-
Nursing Forum
Volume 25, No. 2,1990
11
Nurse, Are You a Healer?
cles were experiential accounts of the nurse authors’ explorations of their roles as healers (Moore, 1988; @inn, 1979). The article by Gunn (1966) focused on the mystical, non-nurse healer, while the role of the more recent”fo1k healer” was described by Searle (1980). Laney (1969) did not explicitly identify nurses as healers but the use of hope was implicitly identified as a healing intervention available to nurses. Sexual deviance and sexual healing were discussed by Cole (1985). The CINAHL data base included more than 300 nursing, allied health, and health-related journals published in English, as well as publications of the American Nurses’ Association and the National League for Nursing. CINAHL also included many of the journals indexed in Index Medicus. Only one additional article was found; it described the visualization of God in the healing process (Lawless, 1986). MESH, a data base of the National Library of Medcine Publications, is similar to Index Medicus but includes additional nursing journals. A total of 24 articles were identified; 12 discussed wound healing and one dealt with healthcare policy. These 13 articles were excluded because they did not address the role of nurse as healer. Of the 11 remaining articles, one described holistic nursing interventions such as touch, imagery, and music (Keegan, 1987).Three articles focused on the healing power of interventions available to nurses: faith (Kennison, 1987), the human voice (Clarke, 1987), and touch (Kratz, 1986). The use of therapeutic touch as a healing intervention was discussed in seven articles (‘Jurgens, Meehan, & Wilson, 1987; Keller & Bzdek, 1986; Quinn, 1988; Reisser, Reisser & Weldon, 1986; WoodaSmith, 1988; Wright, 1987; Wuthnow & Miller, 1987). Cumulatively, the 14 articles that discussed ”nurse as healer” or ”healing” interventions included:
1.Four articles on specific healing modalities: hope, faith, touch, and the human voice 2. One article specific to holistic nursing interventions 3. Two personal accounts of nurses as healers 4. Seven articles on therapeutic touch. 12
As revealed in this search, the concept of ”nurse as healer” and “healing” behaviors or interventions used by nurses are addressed infrequently in the nursing literature. The next questions to be addressed are: ”In today’s world of nursing practice, do nurses consider themselves to be healers?” and, “What healing practices do nurses engage in?”
Workshop Survey The author and a colleague conducted a workshop on ”Alternative Healing Interventions for Nurses” where the topics of imagery and therapeutic touch were introduced.
As revealed in this search, the concept of ”nurse as healer” and ”healing” behaviors or interventions used by nurses are addressed infrequently in the nursing literature. In planning the workshop the author became curious about whether nurses considered themselves to be healers. The workshop audience would conceivably be biased toward “healing” by their very presence at such a program.Nevertheless, the decision was made to explore the concepts of ”nurses as healers” and “healing behaviors.” Method. The workshop was conducted in the spring of 1988 at a Department of Nursing in a private college in the northeast. Attending the workshop were 50 graduate nursing students and five faculty. The majority of the 50 students were employed full-time or part-time in a variety of clinical specialty areas ranging from home health care to intensive care nursing. There were 53 females and two males. After the introductions, the audience was asked to respond to the following question by raising their hands: “As a nurse, do you consider yourself to be a healer?” The number of raised hands was counted. Nursing Forum
Volume 25, No. 2,1990
The next question asked was: “What healing behaviors do you engage in?” There were no qualifiers added, such as, “in your practice” or ”in your personal life.” The responses were written on the blackboard by one of the workshop leaders in the sequence in which they were reported. Results. In response to the first question, 52 of the 55 nurses raised their hands. No one questioned what was meant by ”healer.” Asked to identify “healing behaviors” they used, the first 10 behaviors cited were related to healing others.
These were touching, listening, praying, caring, laughing, crying, using music, dancing, using colors, and holding/hugging. These were touching, listening, praying, caring, laughing, crying, using music, dancing, using colors, and holding/hugging. As group members continued to name healing behaviors, there was a shift away from healing directed toward others to healing directed toward the self. Nurses named the following additional healing behaviors: meditating, sleeping, exercising, relaxing, eating, playing, massaging, engaging in sex, chanting, using a mantra, loving, using herbs, breathing, using hobbies, being alone, daydreaming, doing treatments, using faith, shopping, cleaning, communicating, reading, and practicing rituals. Neither imagery nor therapeutic touch were identified as behaviors used by these nurses.
Discussion and Conclusion When the nurses were asked to identdy themselves as “healers“, no one questioned what was meant by “healer.” One explanation might be that we were tapping into what Carper (1978) referred to as personal Nursing Forum
Volume 25, No. 2,1990
knowledge: to know the self. The author believes that the nurses did know themselves as healers, and the meaning of “healer” to each individual was sufficiently understood to allow a response to the question. Many of the healing behaviors reported here are not ”new” behaviors. They are used in current nursing practice, and a number of them have been documented in the literature. More than 1,500 nurses are active members of the American Holistic Nurses’ Association (B. Becker, personal communication, December 4,1989), which advocates the use of such behaviors. Noncontact touch as an intervention has been well documented as it is used in therapeutic touch (Quinn, 1988).Touch is also associated with therapeutic use of self and with therapeutic massage (White, 1988).Caring, as a concept, is the basis for Watson’s (1988) theory of nursing. Humor as a nursing intervention is appearing more frequently in the literature (Ruxton, 1988)as is music (Zimmerman, Pierson, & Marker, 1988).Relaxation has evolved from the traditional backrub to a well-developed therapeutic intervention (Tittlebaum,1988). When the literature searches were done and ”healing” was used as a descriptor with ”nurse”, the only behavior that was identified in that list that was similar to the 33 behaviors identified by these nurses was “faith.” There is a continuum of ”personal”healing behaviors ranging from least to most intimate, for example, from massage to sexual activity. If nurses engage in these behaviors for “their own good, perhaps there is a place for these behaviors as nursing interventions. After all, if nurses use them, they may be behaviors that will also benefit patients who may chose to use them. Nurses may thus be able to facilitate patients using such behaviors. Finding an environment in which ”healing” can be discussed, shared, and acknowledged is difficult. The experience related here, albeit limited, demonstrates that given the opportunity, many nurses are willing to ”come out” as ”healers.” Assessing patients‘ healing behaviors and supporting their efforts to engage in these behaviors seems as logical as supporting patients’ efforts to cry, laugh, and daydream. 13
Nurse, Are You a Healer?
Conclusion
A clear definition of “nurse as healer” has yet to emerge in the profession. There are, however, a group of healing behaviors used by nurses in both their professional and personal lives. Continued exploration of these valuable concepts is essential in the ever-changing and expanding role of ”nurse” in today‘s world.
to beal. Englewood Cliffs, NJ: Prentice-Hall. Laney, M. (1969).Hope as a healer.Nursing Outlook, 27(1),4546. Lawless, J. (1986).Visualizing the healer. lournal of Christian Nursing, 3(3),12-14.
Moore, V. (1988).Personal views and insights on nursing. Mother, sister, healer, friend-nurse. Nursing 88, 18(1),10.
Quinn,J. (1979).One nurse’s evolution as a healer. Anierican ]ournal .f
Acknowledgement The author wishes to acknowledge Dr. Raymond Berger of California State University for his assistance in the preparation of this manuscript. References Carper, B. (1978). Fundamental patterns of knowing in nursing. Adzmces in Nursing Science, 1(1),13-23.
Nursing, 79,662-664.
Quinn,J. (1988).Building a body of knowledge: Research on therapeutic touch 1974-1986.Journal ofHolistic Nursing, 6(1),37-45. Reisser, I?, Reisser, T., & Weldon, J. (1986). Holistic healers and therapeutic touch. journal ofChristian Nursing, 3(2),23-26. Ruxton, J. (1988). Humor intervention deserves our attention. Holistic Nursing Practice, 2(3),54-62. Searle, C. (1980). International Cancer Nursing Conference, 5. The power of the folk healer. Nursing Mirror, 151(23),30-34.
Clarke, B. (1987). The healing power of the human voice. RN, 50(1), 19.
Tittlebaum, H. (1988).Relaxation.Holistic Nursing Practice, 2(3),17-25,
Cole, A. (1985).Sexual deviancy. Sexual healing. Nursing Times, 81(14), 19-20.
Watson, J. (1988).Nursing: Human science and human care. New York: National League for Nursing.
Dossey, B., Keegan, L., Guzzetta, C., & Kolkmeier, L. (1988).Holistic nursing: A handbookfor practice. Rockville, M D Aspen.
White, J. (1988).Touching with intent: Therapeutic massage. Holistic Nursing Practice, 2(3), 63-67.
Gunn, A. (1966). ‘’I swear by Apollo the Healer.” Nursing Mirror and Midwives lournal, 222(18),501-502.
Wooda-Smith, D. (1988). Therapeutic touch A healing experience. Maine Nurse, 74(2),3,7.
Jurgens, A,, Meehan, T., & Wilson, H. (1987).Therapeutic touch as a nursing intervention. Holistic Nursing Practice, 2(1),1-13.
Wright, S.(1987).The use of therapeutic touch in the management of pain. Nursing Clinics of North America, 3,705-714.
Keegan, L. (1987). Holistic nursing. An approach to patient and selfcare. AORNlournal, 46,499-506.
Wuthnow, S., & Miller, A. (1987). Should Christian nurses practice therapeutic touch?Iourml of Christian Nursing, 4(4), 15-19,29-30.
Keller, E., & Bzdek, V. (1986).Effects of therapeutic touch on tension headache pain. Nursing Research, 35(2),101-106.
Zimmerman, L., Pierson, M., & Marker, J. (1988). Effects of music on patient anxiety in coronary care units. Heart & Lung, 27,560-566.
Kennison, M. (1987). Faith: An untapped health resource. Journd of Psychosocial Nursing and Mental Health Services, 25(10),28-30. Kratz, C. (1986, January 8). Matters of concern: The healing touch. Community Outlook, 4. Krieger, D. (1979).The tkapeutic touch: How to use your bands to help or
14
Nursing Forum
Volume 25, No. 2,1990
by Nancy Rainville Oliver, RN, PhD
The concept of ”nurse as healer” is in itselfvague and illusive. It is, however, a concept that is
Nancy Rainville Oliver, RN, PhD is Assistant Professor, Department of Nursing, California State University, Long Beach. CA.
beginning to emerge in practice and in the literature. To begin to develop an understanding of “nurse as healer”, the following questions are addressed: Are nurses identifi’ed as healers in the nursing literature? In today’s world of nursing practice, do nurses consider themselves to be healers? What healing practices do nurses engage in?
” T h e nurse as healer” is a new concept in nursing. Healing techniques, practices, and behaviors are not traditionally included in nursing education, and the concept of ”nurse as healer” is in itself vague and illusive. The concept is most frequently associated with holistic nursing, where the nurse is defined as a facilitator of healing (Dossey, Keegan, Guzzetta, & Kolkmeier, 1988); and with the healing intervention of Therapeutic Touch (Krieger,1979). To understand the concept of “nurse as healer”, the following questions were asked: Are nurses identified as healers in the nursing literature? In today’s world of nursing practice, do nurses consider themselves to be healers? What healing practices do nurses engage in? This article ~ECUSSS the extent and manner to which the notion of “nurse as healer’’ has been presented in nursing journals from 1966 through 1989. In addition, it includes the results of an informal survey of practicing nurses who were asked to i d e n e their own healing behaviors. The Literature Three computerized literature searches were conducted to answer the question, “Are nurses idenhfied as healers in the nursing literature?” For each search the terms “healer”, healing”, and ”behavior”, coupled with ”nurse”, ”nurses”, and “nursing” were used. The author selected only publications from the United States and Canada, and only those written in English. The following searches were conducted: 1. Index Medicus (1966-March,1989) 2. Cumulative Index to Nursing and Allied Health Literature (CINAHL)(1983-1988) 3. Medical Subject Headings (MESH) (1986-1988) In the literature search of Index Medicus for the 24year period, six articles were identified. Two of the arti-
Nursing Forum
Volume 25, No. 2,1990
11
Nurse, Are You a Healer?
cles were experiential accounts of the nurse authors’ explorations of their roles as healers (Moore, 1988; @inn, 1979). The article by Gunn (1966) focused on the mystical, non-nurse healer, while the role of the more recent”fo1k healer” was described by Searle (1980). Laney (1969) did not explicitly identify nurses as healers but the use of hope was implicitly identified as a healing intervention available to nurses. Sexual deviance and sexual healing were discussed by Cole (1985). The CINAHL data base included more than 300 nursing, allied health, and health-related journals published in English, as well as publications of the American Nurses’ Association and the National League for Nursing. CINAHL also included many of the journals indexed in Index Medicus. Only one additional article was found; it described the visualization of God in the healing process (Lawless, 1986). MESH, a data base of the National Library of Medcine Publications, is similar to Index Medicus but includes additional nursing journals. A total of 24 articles were identified; 12 discussed wound healing and one dealt with healthcare policy. These 13 articles were excluded because they did not address the role of nurse as healer. Of the 11 remaining articles, one described holistic nursing interventions such as touch, imagery, and music (Keegan, 1987).Three articles focused on the healing power of interventions available to nurses: faith (Kennison, 1987), the human voice (Clarke, 1987), and touch (Kratz, 1986). The use of therapeutic touch as a healing intervention was discussed in seven articles (‘Jurgens, Meehan, & Wilson, 1987; Keller & Bzdek, 1986; Quinn, 1988; Reisser, Reisser & Weldon, 1986; WoodaSmith, 1988; Wright, 1987; Wuthnow & Miller, 1987). Cumulatively, the 14 articles that discussed ”nurse as healer” or ”healing” interventions included:
1.Four articles on specific healing modalities: hope, faith, touch, and the human voice 2. One article specific to holistic nursing interventions 3. Two personal accounts of nurses as healers 4. Seven articles on therapeutic touch. 12
As revealed in this search, the concept of ”nurse as healer” and “healing” behaviors or interventions used by nurses are addressed infrequently in the nursing literature. The next questions to be addressed are: ”In today’s world of nursing practice, do nurses consider themselves to be healers?” and, “What healing practices do nurses engage in?”
Workshop Survey The author and a colleague conducted a workshop on ”Alternative Healing Interventions for Nurses” where the topics of imagery and therapeutic touch were introduced.
As revealed in this search, the concept of ”nurse as healer” and ”healing” behaviors or interventions used by nurses are addressed infrequently in the nursing literature. In planning the workshop the author became curious about whether nurses considered themselves to be healers. The workshop audience would conceivably be biased toward “healing” by their very presence at such a program.Nevertheless, the decision was made to explore the concepts of ”nurses as healers” and “healing behaviors.” Method. The workshop was conducted in the spring of 1988 at a Department of Nursing in a private college in the northeast. Attending the workshop were 50 graduate nursing students and five faculty. The majority of the 50 students were employed full-time or part-time in a variety of clinical specialty areas ranging from home health care to intensive care nursing. There were 53 females and two males. After the introductions, the audience was asked to respond to the following question by raising their hands: “As a nurse, do you consider yourself to be a healer?” The number of raised hands was counted. Nursing Forum
Volume 25, No. 2,1990
The next question asked was: “What healing behaviors do you engage in?” There were no qualifiers added, such as, “in your practice” or ”in your personal life.” The responses were written on the blackboard by one of the workshop leaders in the sequence in which they were reported. Results. In response to the first question, 52 of the 55 nurses raised their hands. No one questioned what was meant by ”healer.” Asked to identify “healing behaviors” they used, the first 10 behaviors cited were related to healing others.
These were touching, listening, praying, caring, laughing, crying, using music, dancing, using colors, and holding/hugging. These were touching, listening, praying, caring, laughing, crying, using music, dancing, using colors, and holding/hugging. As group members continued to name healing behaviors, there was a shift away from healing directed toward others to healing directed toward the self. Nurses named the following additional healing behaviors: meditating, sleeping, exercising, relaxing, eating, playing, massaging, engaging in sex, chanting, using a mantra, loving, using herbs, breathing, using hobbies, being alone, daydreaming, doing treatments, using faith, shopping, cleaning, communicating, reading, and practicing rituals. Neither imagery nor therapeutic touch were identified as behaviors used by these nurses.
Discussion and Conclusion When the nurses were asked to identdy themselves as “healers“, no one questioned what was meant by “healer.” One explanation might be that we were tapping into what Carper (1978) referred to as personal Nursing Forum
Volume 25, No. 2,1990
knowledge: to know the self. The author believes that the nurses did know themselves as healers, and the meaning of “healer” to each individual was sufficiently understood to allow a response to the question. Many of the healing behaviors reported here are not ”new” behaviors. They are used in current nursing practice, and a number of them have been documented in the literature. More than 1,500 nurses are active members of the American Holistic Nurses’ Association (B. Becker, personal communication, December 4,1989), which advocates the use of such behaviors. Noncontact touch as an intervention has been well documented as it is used in therapeutic touch (Quinn, 1988).Touch is also associated with therapeutic use of self and with therapeutic massage (White, 1988).Caring, as a concept, is the basis for Watson’s (1988) theory of nursing. Humor as a nursing intervention is appearing more frequently in the literature (Ruxton, 1988)as is music (Zimmerman, Pierson, & Marker, 1988).Relaxation has evolved from the traditional backrub to a well-developed therapeutic intervention (Tittlebaum,1988). When the literature searches were done and ”healing” was used as a descriptor with ”nurse”, the only behavior that was identified in that list that was similar to the 33 behaviors identified by these nurses was “faith.” There is a continuum of ”personal”healing behaviors ranging from least to most intimate, for example, from massage to sexual activity. If nurses engage in these behaviors for “their own good, perhaps there is a place for these behaviors as nursing interventions. After all, if nurses use them, they may be behaviors that will also benefit patients who may chose to use them. Nurses may thus be able to facilitate patients using such behaviors. Finding an environment in which ”healing” can be discussed, shared, and acknowledged is difficult. The experience related here, albeit limited, demonstrates that given the opportunity, many nurses are willing to ”come out” as ”healers.” Assessing patients‘ healing behaviors and supporting their efforts to engage in these behaviors seems as logical as supporting patients’ efforts to cry, laugh, and daydream. 13
Nurse, Are You a Healer?
Conclusion
A clear definition of “nurse as healer” has yet to emerge in the profession. There are, however, a group of healing behaviors used by nurses in both their professional and personal lives. Continued exploration of these valuable concepts is essential in the ever-changing and expanding role of ”nurse” in today‘s world.
to beal. Englewood Cliffs, NJ: Prentice-Hall. Laney, M. (1969).Hope as a healer.Nursing Outlook, 27(1),4546. Lawless, J. (1986).Visualizing the healer. lournal of Christian Nursing, 3(3),12-14.
Moore, V. (1988).Personal views and insights on nursing. Mother, sister, healer, friend-nurse. Nursing 88, 18(1),10.
Quinn,J. (1979).One nurse’s evolution as a healer. Anierican ]ournal .f
Acknowledgement The author wishes to acknowledge Dr. Raymond Berger of California State University for his assistance in the preparation of this manuscript. References Carper, B. (1978). Fundamental patterns of knowing in nursing. Adzmces in Nursing Science, 1(1),13-23.
Nursing, 79,662-664.
Quinn,J. (1988).Building a body of knowledge: Research on therapeutic touch 1974-1986.Journal ofHolistic Nursing, 6(1),37-45. Reisser, I?, Reisser, T., & Weldon, J. (1986). Holistic healers and therapeutic touch. journal ofChristian Nursing, 3(2),23-26. Ruxton, J. (1988). Humor intervention deserves our attention. Holistic Nursing Practice, 2(3),54-62. Searle, C. (1980). International Cancer Nursing Conference, 5. The power of the folk healer. Nursing Mirror, 151(23),30-34.
Clarke, B. (1987). The healing power of the human voice. RN, 50(1), 19.
Tittlebaum, H. (1988).Relaxation.Holistic Nursing Practice, 2(3),17-25,
Cole, A. (1985).Sexual deviancy. Sexual healing. Nursing Times, 81(14), 19-20.
Watson, J. (1988).Nursing: Human science and human care. New York: National League for Nursing.
Dossey, B., Keegan, L., Guzzetta, C., & Kolkmeier, L. (1988).Holistic nursing: A handbookfor practice. Rockville, M D Aspen.
White, J. (1988).Touching with intent: Therapeutic massage. Holistic Nursing Practice, 2(3), 63-67.
Gunn, A. (1966). ‘’I swear by Apollo the Healer.” Nursing Mirror and Midwives lournal, 222(18),501-502.
Wooda-Smith, D. (1988). Therapeutic touch A healing experience. Maine Nurse, 74(2),3,7.
Jurgens, A,, Meehan, T., & Wilson, H. (1987).Therapeutic touch as a nursing intervention. Holistic Nursing Practice, 2(1),1-13.
Wright, S.(1987).The use of therapeutic touch in the management of pain. Nursing Clinics of North America, 3,705-714.
Keegan, L. (1987). Holistic nursing. An approach to patient and selfcare. AORNlournal, 46,499-506.
Wuthnow, S., & Miller, A. (1987). Should Christian nurses practice therapeutic touch?Iourml of Christian Nursing, 4(4), 15-19,29-30.
Keller, E., & Bzdek, V. (1986).Effects of therapeutic touch on tension headache pain. Nursing Research, 35(2),101-106.
Zimmerman, L., Pierson, M., & Marker, J. (1988). Effects of music on patient anxiety in coronary care units. Heart & Lung, 27,560-566.
Kennison, M. (1987). Faith: An untapped health resource. Journd of Psychosocial Nursing and Mental Health Services, 25(10),28-30. Kratz, C. (1986, January 8). Matters of concern: The healing touch. Community Outlook, 4. Krieger, D. (1979).The tkapeutic touch: How to use your bands to help or
14
Nursing Forum
Volume 25, No. 2,1990
