Nursing the Whole Person: Reconciling the Mind-Body Split in Times of Collective Crisis
By Michelle Danda, MN MPN RN CPMHN(C)
We are living through two public health emergencies, the COVID-19 pandemic and the opiate poisoning crisis. Direct care nurses are feeling the pressure of a healthcare system strained by a sharp increase in critically ill patients, with no certainty about when these syndemic crises will end. As patients visit emergency rooms, critical care centres and clinics there is pressure to quickly diagnose and treat. The focus becomes the physical, the symptoms in the body. Within this medically driven model of care there is a split between the mind and the body, with the body given priority. However, in this time of collective crises, where many of us may be feeling stressed out and sometimes helpless, the divide between the physical experience of illness in the body and the psychological illness experience can become more profound, with the patient suffering. The result is that the mental piece of the crisis is often thought to be delivered by a specialized clinician in specialized mental health space. The siloed services perpetuate a dichotomy of physical and mental health, construction of separate entities that are related, but treated differently. The nursing profession is perfectly poised to reconcile this artificial divide, bringing together physical and mental illness as part of single health experience. With this we can foster a resurgence in the necessity of holistic nursing practice.
In this COVID-19 crisis patients may arrive at the emergency department in respiratory distress who are also impacted by social isolation, illness of their loved ones, loss of their job, and other changes in their lives. We see patients who are living with increased uncertainty, anxiety, suffering, and grief; the physical and the mental symptoms are inextricably connected, each affecting the other in a way that cannot be neatly disentangled. I often hear nurses say that they could never work in mental health, not realizing that they already do provide mental health care because mental health is a part of health and cannot be isolated.
Highlighting the Nursing Perspective
When people are experiencing a crisis in an emergency department or following a diagnosis of diseases like cancer or diabetes, they are not compartmentalizing their physical health and mental health care needs, despite the sometimes compartmentalized care that is delivered. As nurses part of our role is to help patients navigate the difficult times of health crisis, walking that journey with them, especially in times when friends and family might not be permitted to be by their side. The philosophical position that underlies nursing care is holistic. We care for the whole patient because we recognize that they are more than a set of problems, an illness or a diagnosis, they are a person with a context, a story, a lived experience that is not just of value but essential to the caring experience. In my area of practice, mental health, we talk about the value of hearing a person's story, understanding the importance of individualized experience. But, this is not relegated to nurses caring for patients in the mental health system. The building blocks of the nursing perspective is the relationship between the nurse and patient, knowing the patient beyond a set of symptoms or problems, we value the lived experience.
Dichotomies That Divide Us
Nurses are collectively living through a pandemic that is impacting the way that everyone is experiencing their lives. COVID-19 is a virus that causes physical symptoms, however, it is imperative to recognize that there are multiple impacts including mental health (Tsamakis et al, 2020). While much of the focus is on physical outcomes, we must also pay attention to the mental health impacts that result from stressors like physical and social isolation, fear of being infected, and grief in seeing the death of loved ones. Similarly, the physical toll experienced by nurses providing direct care in this historical moment is tough, entire shifts of work wearing Personal Protective Equipment (PPE), working short-staffed, working longer hours. However, we cannot forget about the mental toll that nurses may be experiencing seeing increasing acute illness and the death of their patients in hospitals and extended care homes. Nurses are experiencing unprecedented ethical decisions like deciding which patients are assigned ventilators (Peterson, Largent & Karlawish, 2020). Do the separation and siloing of mental health and physical health benefit the patients and families that we care for? Or, does it perpetuate the divide between the body and the mind, when we know that we cannot have one without the other? The split can feel exponentially large when the focus is a cure rather than care when the goal is to fix rather than support.
Reconciling Mental and Physical Health
At times in nursing history the concept of holism has been used to carve out a professional identity as distinct from medicine (Boschma, 1994). We are on an ongoing journey to bring a unique and valuable framework of holism into all aspects of modern healthcare. Nurses can take a leadership role in the recognition that we are all mental health nurses because the philosophical underpinning of our profession supports the provision of care for the whole patient, their embodied experience. Our goal to provide ethical care entails that we consider the patient within the context of their life, body, and mind. When we treat the body in isolation from the mind, what may we miss? When we are caught in a high stress, low resourced workplaces we can begin to feel worn down by the burden of the structure of the healthcare system, where a reductionist view of the patient as a set of parts needing treatment and lose focus of the person beyond the symptoms. To protect ourselves, and take an objective stance we can lose sight of the shared experience in which we provide care for the person. To provide ethical and competent care we must understand the patients we care for as embodied individuals with unique experiences whose lives are impacted in multiple ways from their illness experiences (Keller, 2019). We do not simply treat the symptoms, or treat the illness, we care for the patient, in part, by understanding their illness experience. In reality, we are all mental health nurses.
Boschma, G. (1994). The Meaning of Holism in Nursing: Historical Shifts in Holistic Nursing Ideas. Public Health Nursing, 11(5), 324–330.
Keller, K. G. (2019). The body as machine and the lived body in nursing. Collegian.
Peterson, A., Largent, E. A., & Karlawish, J. (2020). Ethics of reallocating ventilators in the COVID-19 pandemic. BMJ, 369.
Tsamakis, K., Triantafyllis, A. S., Tsiptsios, D., Spartalis, E., Mueller, C., Tsamakis, C., ... & Rizos, E. COVID‑19 related stress exacerbates common physical and mental pathologies and affects treatment. Experimental and Therapeutic Medicine.
Michelle Danda MN MPN RN CPMHN(C) is currently a Clinical Informatics Specialist with the Clinical and Systems Transformation (CST) project located in the Lower Mainland and has been working in mental health throughout her nursing career. Since early 2017 she has worked at the Carlile Centre which is an Adolescent Concurrent Disorder Inpatient Program (services youth between the ages of 13-18 who are living with mental health and substance use issues). Michelle has been an instructor on an Inpatient Adult Acute Mental Health program at South Health Campus in Calgary, AB and has served as Clinical Instructor for the UBC School of Nursing. She is currently an Instructor for the Stenberg College RPN program and is also part of the NNPBC Mentorship program as a mentor to new graduate nurses.