Challenging a reductionistic paradigm as a foundation for nursing

The value of measurement for development of nursing knowledge: Underlying philosophy, contributions and critiques

AIM

A philosophical discussion of constructive realism and measurement in the development of nursing knowledge is presented.

BACKGROUND

Through Carper's four patterns of knowing, nurses come to know a person holistically. However, measurement as a source for nursing knowledge has been criticized for underlying positivism and reductionist approach to exploring reality. Which seems mal-alignment with person-centred care.

DESIGN

Discussion paper.

DISCUSSION

Constructive realism bridges positivism and constructivism, facilitating the measurement of physical and psychological phenomena. Reduction of complex phenomena and theoretical constructs into measurable properties is essential to building nursing's empiric knowledge and facilitates (rather than inhibits) person-knowing.

IMPLICATIONS FOR NURSING

Nurses should consider constructive realism as a philosophy to underpin their practice. This philosophy supports measurement as a primary method of inquiry in nursing research and clinical practice. Nurses can carefully select, and purposefully integrate, measurement tools with other methods of inquiry (such as qualitative research methods) to demonstrate the usefulness of nursing interventions and highlight nursing as a science.

Patients' perceptions and experiences of patient-centred care in dietetic consultations

BACKGROUND

Patient-centred care (PCC) is essential to quality healthcare. However, there is a paucity of research on PCC in dietetics, particularly regarding patients' experiences and perspectives of PCC. We aimed to enhance our understanding of PCC in dietetics by exploring patients' perceptions and experiences of PCC in individual dietetic consultations.

METHODS

The present study used qualitative methods, situated in a constructivist-interpretivist paradigm. Maximum variation purposive sampling was used to recruit English speaking adult participants who had participated in ≥1 dietetic consultations for nutrition care. Individual semi-structured interviews explored participants' perceptions and experiences of PCC in dietetic consultations. Data were analysed thematically.

RESULTS

Eleven patients were interviewed between September and November 2016. Four overarching themes emerged: (i) fostering and maintaining caring relationships; (ii) delivering individualised care; (iii) enabling patient involvement; and (iv) taking control of one's own health.

CONCLUSIONS

PCC is important to patients. Thus, there is opportunity for dietitians to enhance the care they provide by adopting patient-centred practices. As the first study of its kind, these findings can inform future dietetic practice, education and research by contributing patients' perspectives of PCC. By understanding patients' unique needs and preferences, dietitians can better align their practice with a patient-centred approach. Furthermore, these findings are useful for informing future dietetic research and education.

Ecological caring-Revisiting the original ideas of caring science

The aim of this empirically grounded philosophical paper is to explore the notion of holistic care with the intention to expand it into a notion of ecological care and in such a way revisit the original ideas of caring science. The philosophical analysis, driven by lifeworld theory and especially Merleau-Ponty's philosophy, is firmly rooted in contemporary clinical care. We used interview data from patients in a study at an anthroposophic clinic in Sweden, which forms part of an ecological community with, for example, ecological agriculture. The empirical study is analysed according to reflective lifeworld research. Starting from the fact that illness can be defined as a loss of homelikeness in the body and in the familiar world, our findings illustrate how ecological care helps the patient to once again find one's place in a world that is characterized by interconnectedness. The task of ecological care is thus not only to see the patient within a world of relationships but to help the patient find his/her place again, to understand himself/herself and the world anew. Ecological care is not only about fighting an illness, but also recognizes a patient from inside a world that s/he is affected by and affects, that s/he is understood and understands from. Such care tries to restore this connection by making possible the rhythmical movement as well as the space in-between activity and rest, between being cared for and actively involving oneself in one's recovery and between closing oneself off from the world and once again going out into it.

Living with Experiences Following a Myocardial Infarction

Coronary heart disease is a major cause of sudden death and morbidity in the developed world, as well as a cause of great suffering. Research within this area has primarily focused symptoms, risk factors and treatment. The aim of this paper was to explore women's experiences following a myocardial infarction (MI). Eight women were interviewed; the interviews were audiotaped and transcribed into text and analysed using a phenomenological approach. To explore the meaning that is experienced in the lived world of the patient a method of reflective lifeworld research, based upon phenomenological epistemology has been used. The results indicate that the body is vital for the women in their lifeworlds. After a MI the patient's natural and unreflective relationship with the body and the lived world is interrupted. Uncertainty about life and death as well as the body is experienced as a suffering in the women's lifeworlds. In relation to this, the women's existence is characterised by an uncertainty and a loss of context. It is through reconciliation with their bodies and their illnesses that the women can achieve a sense of well-being and harmony in life. In that process the women can re-establish a natural relationship with their bodies and lifeworlds.

Health-care encounters create both discontinuity and continuity in daily life when living with chronic heart failure-A grounded theory study

Living with chronic heart failure (CHF) often involves lifelong contact with health care, more or less frequently, depending on fluctuating health-generating disruptions in everyday life. To reduce the influence on continuity in life, health-care professionals should preferably focus on supporting patients in managing their daily lives, based on their perspective. The aim of this study was to describe how the interaction in health-care encounters contributes to either continuity or discontinuity in the daily life for persons with CHF. Interviews with 18 participants were carried out, using the grounded theory method, through data collection and analysis. Two core concepts were constructed from data which reveal a model that illuminates the characteristics of the encounters, the actions of health-care professionals and the normative discourse. Patient-centred agenda consists of the categories: "Experiencing a subordinate approach," "Objectifying during the encounter" and "Expected to be compliant." This describes how health-care professionals enhance discontinuity in daily life by using a paternalistic approach in the encounter. Person-centred agenda consists of the categories: "Experiencing an empowering approach," "Person-centredness during the encounter" and "Expected to be capable." It describes how participants perceive that health-care professionals enable them to deal with everyday life which enhances continuity. The findings highlight the importance of health-care professionals' attitudes and communication in encounters with patients. Health care must be designed to support and promote patients' own strategic thinking by strengthening their self-image to enhance continuity in everyday life. The experience of discontinuity is based on the prevailing health-care culture which focuses on disease and medical treatment and regards it as superior to the illness experience in an everyday life context. We therefore strongly suggest a paradigm shift in the health-care organisation and culture in order to support the patients in their efforts to live a meaningful, rich life, in spite of the chronic illness CHF.

"Is that my leg?" patients' experiences of being awake during regional anesthesia and surgery

Most knee or hip replacement surgery is performed under regional anesthesia, when patients are awake. Previous research has primarily focused on patients' experiences during general anesthesia. The aim of this study was to uncover the meaning of being awake during regional anesthesia and surgery. Nine interviews with patients undergoing knee or hip replacement surgery comprise the data. The phenomenological analysis shows that being awake during surgery can be compared with walking a tightrope because of ambiguous feelings. Four interrelated constituents further elucidated the patients' experiences: balancing between proximity and distance in the operating theater, balancing between having control and being left out, my partly inaccessible body handled by others, and the significant role of the carer. Anesthesia providers and perioperative nurses need to understand the awake patients' intraoperative experiences to support and confirm them when they can no longer experience or have full access to their body.

Patients' perceptions of living with epilepsy: a phenomenographic study

AIM

The study aimed to describe how patients with epilepsy perceive living with epilepsy.

BACKGROUND

Epilepsy signifies a medical diagnosis as well as a social label. Persons living with epilepsy have more psychosocial problems compared with the general population, and stigma is often experienced. Few studies address patients' life situations as a whole, and there are no studies on how patients perceive living with epilepsy.

DESIGN

This was a qualitative interview study where 19 outpatients were purposively chosen and interviewed.

METHOD

A phenomenographic approach was used for interviewing and for analysing the interviews.

RESULTS

Living with epilepsy was perceived in two different ways depending on the person's feelings towards the condition. A positive feeling signified 'Living with epilepsy means living a normal life - gaining and maintaining control' with the descriptive categories: 'Accepting the person with epilepsy', 'Taking responsibility' and 'Appreciating the good things'. A negative feeling signified 'Living with epilepsy means living with focus on the condition - conflict and avoidance or resigning to fate' with the descriptive categories: 'Struggling with feelings of stigma, prejudices and loss of control' and 'Giving up hope of recovery, accepting loss of control'.

CONCLUSION

The findings indicate that patients' perceptions of living with epilepsy are closely related to their feelings towards the condition. There is a need for further exploration of the relationship between perceptions of epilepsy as a phenomenon, perceptions of living with epilepsy and feelings related to the condition. Relevance to clinical practice.  The findings demonstrated how important feelings and perceptions are to how patients with epilepsy regard themselves. This knowledge is essential for nurses when helping patients to better understand underlying reasons for their reactions to various situations. Forming interventions to help patients with epilepsy to find coping strategies that enhance self-esteem and self-value is another area of relevance.

Dilemmas, tetralemmas, reimagining the electronic health record

With the transition from paper-based to computer-based records, nursing practice shifts to computerized documentation of care in the electronic health record (EHR). Viewed not only as an electronic document, but as an instrument of modern economic and technological ideology that serves organizational goals of cost-efficiency, the EHR can be perceived as creating a dilemma for a patient-centered nursing practice. Viewing the EHR as relying solely on the use of standardized languages begets a number of questions and furthers the dilemma for nurses. Through a discussion that draws on the Indian tradition of the tetralemma, authors transcend the EHR/nursing dilemma.

Embodying Nursing Openheartedness

In this article, the authors attempt to articulate one view of the nature of nursing openheartedness and its central role for guiding caring in complex nursing situations. To do this, vignettes of everyday nursing life situations are used to illustrate the following three essential dimensions that constitute nursing openheartedness: (a) the infinity of otherness: keeping open the other's difference, (b) embodiment: our shared vulnerable heritage, and (c) practical responsiveness: embracing the value of the objectified gaze and technology. Each of these dimensions is philosophically informed by distinctive insights from the work of Heidegger, Levinas, and Merleau Ponty. Furthermore, guided by Gendlin's contributions regarding the nature of embodied understanding, a writing style that attempts to present the nature of nursing openheartedness as a possible experience rather than as an abstract theory is employed.

Relatives in end-of-life care ? part 2: a theory for enabling safety

AIM

To develop a goal-oriented praxis theory for enabling safety for relatives when an adult or older patient is close to end-of-life.

BACKGROUND

This is the second part of a project focusing on the situation and needs of relatives in end-of-life care. Our interpretation of the existing corpus of knowledge pertaining to the needs of close relatives in this situation showed the significance of relatives' need for safety.

METHOD

The theory was developed step-by-step, through triangulation of critical review of empirical research in the field, our own clinical experiences from end-of-life care, renewed literature searches and theoretical reasoning.

THEORY

The foundation for the theory is taken from the ethical intention of the philosopher Paul Ricoeur. From this, the theory focuses on relatives in the context of end-of-life care with the goal of enabling safety. This is proposed by four aphorisms functioning as safety enablers and these are directed towards the professional's approach and attitude, the relative's concern for the patient, the specific situation for the relative and the patient's end-of-life period as a period in the life of the relative.

RELEVANCE TO CLINICAL PRACTICE

Implications for end-of-life practice are considered and include aspects for promotion of just institutions in end-of-life care, the significance of negotiated partnership in end-of-life care, enabling safety for relatives living in existential and practical uncertainty in connection with end-of-life care and diversity of relatives' preferences as they live through this particular period.

Patients longing for authentic personal care: a phenomenological study of violent encounters in psychiatric settings

This article focuses on patients' violence against caregivers. Several studies show that violence and threats within the health care setting are an increasing problem. Encounters that become violent have been the issue of many debates but the phenomenon is still not fully understood. It is important to understand the course of events in violent encounters, both for the sake of the patients and the caregivers' well-being. The aim of this study was to describe the essence of violent encounters, as experienced by nine patients within psychiatric care. Guided by a phenomenological method, data were analyzed within a reflective life-world approach. The findings explicate violent encounters characterized by a tension between "authentic personal" and "detached impersonal" caring. "Authentic personal" patients are encountered in an undisguised, straightforward, and open way, and they sense unrestricted respect that caregivers would show another human being. In these encounters violence does not develop well. However, in caring that is "detached impersonal," the encounters are experienced by the patients as uncontrolled and insecure. These encounters are full of risks and potential violence.

Understanding paradigms used for nursing research

AIMS

The aims of this paper are to add clarity to the discussion about paradigms for nursing research and to consider integrative strategies for the development of nursing knowledge.

BACKGROUND

Paradigms are sets of beliefs and practices, shared by communities of researchers, which regulate inquiry within disciplines. The various paradigms are characterized by ontological, epistemological and methodological differences in their approaches to conceptualizing and conducting research, and in their contribution towards disciplinary knowledge construction. Researchers may consider these differences so vast that one paradigm is incommensurable with another. Alternatively, researchers may ignore these differences and either unknowingly combine paradigms inappropriately or neglect to conduct needed research. To accomplish the task of developing nursing knowledge for use in practice, there is a need for a critical, integrated understanding of the paradigms used for nursing inquiry.

METHODS

We describe the evolution and influence of positivist, postpositivist, interpretive and critical theory research paradigms. Using integrative review, we compare and contrast the paradigms in terms of their philosophical underpinnings and scientific contribution.

FINDINGS

A pragmatic approach to theory development through synthesis of cumulative knowledge relevant to nursing practice is suggested. This requires that inquiry start with assessment of existing knowledge from disparate studies to identify key substantive content and gaps. Knowledge development in under-researched areas could be accomplished through integrative strategies that preserve theoretical integrity and strengthen research approaches associated with various philosophical perspectives. These strategies may include parallel studies within the same substantive domain using different paradigms; theoretical triangulation to combine findings from paradigmatically diverse studies; integrative reviews; and mixed method studies.

CONCLUSION

Nurse scholars are urged to consider the benefits and limitations of inquiry within each paradigm, and the theoretical needs of the discipline.

Violent encounters in psychiatric care: a phenomenological study of embodied caring knowledge

This article focuses on encounters that become violent, a problem in health care that has been the issue of many debates but is still not fully understood. Violent encounters refer to events where the patient expresses an aggressive and hostile attitude toward the caregiver. This study is part of a bigger project that aims to elucidate violent encounters from the caregivers' as well as the patients' perspectives. The purpose of this particular study was to describe the essence of violent encounters from the caregivers' perspective. Guided by a phenomenological method, data were analyzed within a reflective lifeworld approach. The essence of a violent encounter between caregivers and patients, as experienced by the caregivers, is a critical moment characterized by a tension between presence and distance, a moment where everything is happening at the same time. There are important meaning differences in relation to the violent encounter being viewed as positive rather than negative, based on the caregivers' ability to be present and their capacity in these trying situations to manage their fear. The findings also make explicit the particular knowledge that is needed for the caregiver to manage the threat of violence in a creative way.

Fuzzy logic and nursing

In empiricism, there are only two answers for a question: black or white. Yet, subjective meanings of human behaviours and responses toward health and illness cannot be simply explained with black and white. Gray zones are needed because they are characterized by complexity and require a contextual understanding. In this paper, we present and suggest fuzzy logic as an example of theoretical bases that help transcend the conflicts between objectivity and subjectivity, respect gray zones between black and white answers for questions, and provide a contextual understanding of complex nursing phenomenon. A historical review of fuzzy logic is followed by a definition of fuzzy logic. Then, fuzzy logic is discussed in terms of its compatibility with nursing epistemological views and philosophical thoughts. Fuzzy logic agrees with three categories of epistemological views of nursing, including correspondence, coherence and pragmatism. Fuzzy logic also agrees with four major philosophical thoughts in nursing, including postempiricism, pragmatism, feminism, and postmodernism. Based on the discussion, we propose that fuzzy logic be further explored, used and developed in research and practice in the nursing areas/situations/phenomena that are characterized by complexity, ambiguousness, and vagueness.

Feeling understood: a melody of human becoming

This phenomenological-hermeneutic study centered on the phenomenon of feeling understood, which was conceptualized by the researcher as a melody of human becoming significant to quality of life. For the first time the Parse research method was used with music as part of the dialogical engagement. The study was conducted with 10 women living with an enduring health situation who volunteered to be in tape-recorded dialogue with the researcher to discuss feeling understood and to create a musical expression of this phenomenon. The finding of this study, which is the structure of the lived experience of feeling understood, surfaced from the dialogues and musical expressions: Feeling understood is an unburdening quietude with triumphant bliss arising with the attentive reverence of nurturing engagements, while fortifying integrity emerges amid potential disregard.

The meaning of mental health from elderly women's perspectives: a basis for health promotion

PROBLEM

To gain a deeper understanding of the meaning of mental health.

METHODS

Qualitative interviews with 16 women between the ages of 71 and 92. The data were collected and analyzed using a phenomenological approach.

FINDINGS

The essence of mental health is the experience of confirmation, trust and confidence in the future, as well as a zest for life, development, and involvement in one's relationship to oneself and to others.

CONCLUSIONS

Creating arenas for encounters confirming the individual's human existence and dignity is an important basis for the psychiatric nurse's health-promotion work.

Encountering violence and aggression in mental health nursing: a phenomenological study of tacit caring knowledge

Violence is a growing psychosocial problem in the health care working environment. Literature shows that nurses are physically assaulted, threatened, and verbally abused more often than other professionals. However, some nurses are able to relate to clients in a way that produces positive resolution. This study explored the phenomenon of positive encounters with aggressive and violent clients. Guided by a phenomenological method, data were analyzed within a lifeworld perspective. The essential meaning of the phenomenon of caregivers' experiences of encountering violent clients is described as an "embodied moment," which is explicated by seven themes of meaning, "respecting one's fear and respecting the client," "touch," "dialogue," "situated knowledge," "stability," "mutual regard," and "pliability." The authors discuss the meaning of the outcome and propose both theory and praxis-oriented activities toward decreasing aggression and violence in health care.

Biomedicine, genetics and disability: reflections on nursing and a philosophy of holism

This article critically explores the notion of those sociopolitical spaces that are 'disability', 'holism' and 'genetics', arguing from the perspectives of someone who identifies as having a disability. Medical genetics is seen to reflect the ideology and dominant biomedical reductionist thought. In contrast with this, it is proposed that disability and health are inherently social. A nursing approach is seen to recognize the social and holistic nature of the human person and to present a critical reflection on the reductionistic applications of medical genetics.

Being a close relative of a dying person. Development of the concepts "involvement in the light and in the dark"

The current study is based on an earlier article in which relatives' involvement in care was described as "involvement in the light" or "involvement in the dark." Involvement in the light was characterized as the relative being well informed and experiencing a meaningful involvement. The relatives involved in the dark felt uninformed, that they were "grouping around in the dark" when they tried to support the patient. The present study analyzed further the meaning of "involvement in the light" and "involvement in the dark," and investigated whether two different care cultures, the relationship with the staff, and a rapid course of illness influence the involvement of relatives. Relatives of 52 patients who died, 30 at a surgical department and 22 in a hospice ward, were interviewed after the patients' deaths. All the relatives of the patients in the hospice ward and 13 of those in the surgical department were judged to be involved in the light. Of the relatives judged to be involved in the dark, 12 either had a sick relative with a rapid course of illness or felt that the sick relative had died unexpectedly. A pattern was clearly observed: The relatives involved in the light described being met with respect, openness, sincerity, confirmation, and connection, whereas the opposite was experienced by those involved in the dark.

At what cost care?

This paper looks at the concept of care in nursing and considers the ever-changing focus relative to the meaning of the term care and how this care is delivered by nursing staff. In the process of looking at these issues it examines the theoretical and practical issues and how these factors have changed considerably over the last twenty-five years. This examination touches upon some of the intermingled and not mutually exclusive issues which surround care and caring such as technology, stress and burnout, bureaucracy, fiscal policy, the humanness of the nurse and the ever changing nature of care delivery. Many readers will be able to relate to the issues discussed and understand how some of these factors tend to get in the way of one another and affect good patient care and outcomes.

The patient's perceived caring needs: measuring the unmeasurable

The aim of this study is to elucidate the phenomenon of the caring need in the life-world of the patient and, on the basis of this, to compare patients' perceived caring needs with the six areas of need contained in a new instrument for patient classification, the Oulu Patient Classification (OPC). A total of 75 patients were interviewed and the data were analysed by means of a phenomenological-hermeneutical method. Seventeen perceived caring needs emerged from the process of interpretation. The patients experienced themselves as an indivisible unit that contained existential/spiritual needs and desires. The patients' caring needs are constituted from their problems, needs and desires, where human desire for life, love and meaningfulness may, express itself as bodily, psychical and existential/spiritual needs. A comparison between the patients' perceived caring needs and the OPC shows that patients' existential/spiritual needs do not emerge clearly enough and that the instrument should be supplemented by a caring perspective.

The Heideggerian view of person: a perspective conducive to the therapeutic encounter

The artistry of the therapist finds its origins in the therapist's authentic presencing of self and in the philosophical assumptions that constitute the therapist's perception of human beings. Based in existential phenomenology, Heidegger's view of person nurtures a conceptualization of individuals complimentary to the art of person-centered psychotherapy. Heideggerian hermeneutic phenomenology encourages ontological self-reflection and potentiates meaningful appreciation of one's "being-in-world." This study describes Heidegger's view of person as one that offers therapists and their patients an advantageous clinical orientation and an anesthetically comfortable realm from which the art of the therapeutic encounter can originate, be nurtured, and grow infinitely, thereby supporting patients' self-transcendence, self-love, and well being.

Health visiting as therapy: a phenomenological perspective

In the course of their work British health visitors encounter many individuals and families with problems. Support is usually offered, but if that support is for psychological health needs, it is less likely to be accepted as legitimate health visiting practice. Where a referral is either not accepted, or placed on a waiting list, the health visitor will support the client through a holding relationship until the other appropriate professionals can accept the referral. From a literature review, helping styles and holding relationships provide a 'listening to' opportunity, a 'being there for' and an exploration of the presenting problems. This paper aims to explore the practice of health visiting as therapy and urges health visitors to expand their psychological support of clients in preference to other role developments.

Seeking balance to dialectic tensions in teaching through philosophic inquiry

PURPOSE

To propose a plausible means of cultural criticism of nursing's educational environment for preparing new nurses by exploring epistemological tensions and their consequences from the perspective of educators.

DESIGN

Naturalistic, qualitative, philosophic.

METHOD

Six nurse educators teaching in a university-based traditional BSN program were interviewed in one southeastern state of the United States about their experience as creative, innovative teachers during 1991.

FINDINGS

Three major themes were reflections of the positivist work culture of teaching, reconciliation of tensions, and repercussions from personal choices. Educators reconcile dialectic tension by suppression, subordination, or equilibrium and are influenced by their sense of tension and willingness to be risk takers.

CONCLUSIONS

Philosophical conflicts are inherent in nursing when commitments to empirical knowledge and personal meaning are both valued. A plausible means for moving beyond this tension is to increase awareness of the dynamics and consequences that occur when perspectives seem contradictory. Schools of nursing socialize future nurses. Calling into question the context in which the professional nursing culture is transmitted and reproduced is necessary if nurses of the future are to be in the forefront of changing health care.

Expanding self-awareness through exploration of meaningful experience

In a phenomenological investigation of nurses' meaningful experiences with patients, the author continued investigation of caregiver/patient interaction reported in two previous studies of confirmation and exclusion. Exploration of meaningful experience is presented as an avenue for greater self-awareness for the caregiver. Findings include description of study participants' lived meaningful experiences and the essential structures of experiencing meaningfulness. The lived meaningful experiences were characterized by intense emotion, implicit experiencing, and relating. The essential structures of experiencing meaningfulness were found to be a temporal process of reflecting and articulating the discovery of self and the function of meaningful experience as a template for both future and past experiences. Expanded self-understanding through exploration of meaningful experience is discussed for its significance in nursing practice and education.

A lifeworld paradigm for nursing research

This article is a companion to an earlier article entitled "Challenging a Reductionistic Paradigm as a Foundation for Nursing," which appeared in the December 1995 issue of the Journal of Holistic Nursing. The authors discuss how five concepts-encounter, openness, immediacy, uniqueness, and meaning-which constitute their philosophy for nursing practice, also comprise a foundation for human sciences research. In the first article, encounter was presented as the core concept for practice. In the present work, openness is the central idea in a lifeworld research paradigm, with encounter, immediacy, uniqueness, and meaning as supporting concepts. Openness is explicated with the notions of open-mindedness, open-heartedness, phenomenological questioning, and preunderstanding. A lifeworld paradigm for research is based on phenomenological philosophy and the understanding that the conduct of research is guided by the researcher's openness to the phenomena of the everyday world.

Health risks of homeless adolescents. Implications for holistic nursing

Although the exact number of homeless adolescents is unknown, it is estimated that this population may exceed 2 million. Literally living on the streets, homeless youth are at risk for a variety of physical, psychosocial, and spiritual health problems. Many engage in "survival sex," exchanging sexual favors for necessities of food, clothing, and shelter. Such risky sexual behaviors make them vulnerable to sexually transmitted diseases, including human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and unintended pregnancies. Many have serious, diagnosable mental health problems, whereas others suffer various consequences of substance abuse. There is a need for comprehensive and holistic health care services, for which the majority of homeless youth have very limited access. Holistic nursing can provide creative interventions for thus vulnerable population.