Standards and holism: a reframing.

Abstract

In summary, measurement of standards needs to be reframed and rearticulated. If nurses move toward using measurable standards as well as holistic standards, the goal of standards will be refocused appropriately. The standards will articulate the specifics and the whole of nursing to members of society in need of health care. Nurses will also be able to hold each other accountable not only for specific procedures but also for delivering caring, as perceived by the client. The latter is unfortunately lacking in present performance appraisals. There needs to be increasing value given to nursing's unique holistic contribution to the health care of humans, which should be evident in standards. Nurses need not be at the mercy of the quantitative paradigm; neither should they alienate themselves from it. Nurses can use this paradigm to support its value and can become courageous enough to attempt describing our holistic contribution, then to research resulting outcomes. Nurses can and should relate resource consumption, not only to established quality indicators, but also to clients' perceptions of receiving holistic nursing care. As expressed by the ANA in the 1973 standards, the main reason for standards is to hold nurses accountable to what nursing is and to communicate to our clients and other disciplines what they can expect from nurses. If nursing's voice supporting holistic quality of care is to be heard in a consumer-driven health care market, it must not be shy about giving voice to its contribution through articulation of holistic standards. The foundation provided by the ANA and the subsequent work of Paulen, Benner, AHNA, and the upcoming revisions of the ANA standards are applauded.(ABSTRACT TRUNCATED AT 250 WORDS)