Anthroposophic nursing

Nursing care supports healthy and unhealthy people in meeting physical, mental, spiritual and social needs as they would if they were able to do so themselves. The intent is that those who depend on external care can (re)gain the greatest possible independence (2). Professional nursing uses specialized knowledge to identify and anticipate nursing needs. Nursing measures are applied with a view to their physical, mental, social and spiritual effects and interactions, and they are adapted to the individual situation of the person in need. The preference of the patient is given special emphasis when selecting and planning what is to be done.

Caregiving in general has a cultural significance that goes far beyond tending to those who are ill. Ultimately, it protects and maintains the culture that human beings have created. Caring for the environment and the social conditions in which we live is as much a part of this as supporting human development on all levels—individual, spiritual, mental and physical. Obviously, caregiving is not restricted to a specific profession or field of activity (1).

Health care and nursing care integrate therapeutic interventions into the patient’s everyday life in such a way that they can become effective over the long term. This includes medical prescriptions, the integration of self-care strategies, coordination with other therapies, and consideration of social, spiritual, mental and physical conditions and developments in the one receiving care.

Illness and disability are possibilities of human existence. Caring treatment makes it possible to experience them with dignity. In this sense, illness, old age and suffering are not events that can be prevented or avoided per se, but they should be understood as constellations in a person’s biography in which a sufferer can still experience dignity and humanity as much as any healthy person. An essential prerequisite is that there be circumstances where appreciative, loving encounters are possible. Any system of health and social care contributes significantly to this—it is also, naturally, a responsibility of nursing.

Current culture and medicine are not very aware of this definition of care. Nursing is therefore generally appreciated as a necessity for those in need of care, and its emotional commitment is valued, but its specific and relevant contribution to physical, mental and social healing (peace) is hardly noticed. Anthroposophy wants to create awareness and understanding for the healing and peace potential of nursing care. Anthroposophic nursing stands alongside the renewal movements inspired by Rudolf Steiner for education, agriculture, nutrition, economics, social sciences, art, religion and especially medicine. Its specific therapeutic instruments are compresses, poultices (moist, soft masses applied to the skin) and rhythmical oil applications (a special form of massage therapy developed in Europe known as Rhythmische Einreibung). Anthroposophic nursing shapes nursing processes in accordance with the conceptual background of Anthroposophic Medicine. Its deliberately cultivated nursing attitudes affect the energetic field surrounding the patient.

Diagnostics in nursing

Consideration of a patient’s medical history and social, spatial and temporal environment plays a central role within the nursing process. The first impression gives an important, often impressive picture of the patient that is not yet aligned with any medical findings. The nurse acquires a foundation for further examination by screening the medical, psychological and social findings, the resulting prescriptions for nursing care, and planned medical measures. The nurse looks at the patient’s need for physical, mental and social support.

The nurse works to gain insight into the patient’s relationship to dissolving and hardening processes, as well as their rhythmic balancing (through a threefold understanding of the human being).  This comes to expression in the relationship of the body to the environment in terms of heaviness and lightness, flow and stasis, compression and dissolution, heat and cold. Out of these observations the nurse fine-tunes the needed nursing measures, the coordination of treatment processes, and her or his nursing attitudes.

With patients who have cognitive impairments this kind of systematic observation also proves useful for clarifying their resources and needs in the field of senses.

Nurses find the appropriate attitude by empathetically immersing themselves in the condition of the patient—without losing themselves in any powerlessness the patient may be experiencing or any pathologic one-sidedness.

Nursing diagnostics must always consider the person’s age, their physical, mental and spiritual development, and their social environment.

Therapeutic method

Nursing care prepares the ground for therapy, contributes to the therapeutic process and helps make its effects lasting. Nursing is thus fully involved in the healing process. It contributes by means of therapeutic interventions, process structuring and inner attitudes.

External applications are interventions specific to anthroposophic care. They are used for the regulation of what are recognized as life processes, such as respiration, temperature, nutrition and excretion. External applications can also be used to support restorative sleep and wound healing. Their application helps reduce complications from an illness and supports a healthy lifestyle by maintaining a rhythm of movement and stillness, work and rest.

Through taking responsibility for comprehensive coordination of a patient’s different areas of life, nursing care stands as a central process in hospitals, nursing homes and family settings. Its therapeutic approaches include intercession, communication, coordination and conflict management.

The inner attitude that a caregiver brings to his or her work has a profound effect. The nurse’s attitude makes an activity gentle or coarse, friendly or repulsive, easy or difficult, warm or distant. Attitude creates an atmosphere in which the patient can recover and develop. Such awareness of the effect of inner attitudes—and deliberate training of them—makes them an additional, potent, therapeutic factor. Anthroposophic nursing has developed a systematic concept of the range of different attitudes and caregiving actions involved (3).

Active principles

The effect of nursing can be seen in that it

  • does things for the patient that he would do himself if he were able (substitution),
  • regulates the patient’s life processes (respiration, warmth regulation, nutrition, excretion, etc.),
  • ensures a sense of security, confidence, courage, self-confidence, etc., by means of attention, conversation and touch,
  • aims for self-reliance, self-efficacy, creative power, added experience and maturity within the patient’s process of biographical development and freedom.

External applications work in the same way

  • on physiological processes via active ingredients on the skin,
  • on the body’s self-regulation through warmth, cold, and moisture,
  • on the person’s mental state by consciously shaping the environment,
  • on the person’s biographical development by modeling self-care and showing that he or she is worthy of the therapeutic attention experienced.

Research

Nursing science research has been underway especially in English-speaking regions since the end of the 19th century. It was not until the 1980s that a chair in nursing science was established in Germany. The academic and scientific side of anthroposophic nursing has only been marginally developed worldwide. There have been several studies on the efficacy of external applications in the context of Anthroposophic Medicine. Particularly noteworthy is Dr Tessa Therkleson’s work on ginger applications (4). Reports of experiences with compresses, baths, bed baths and rhythmical oil applications (Rhythmische Einreibung) are reviewed by an editorial group and published online as a handbook of external applications (5). Vidarklinik in Sweden has conducted studies of environments and processes in anthroposophic nursing in terms of symptom relief and patient satisfaction (6). Mathias Bertram has studied effects in anthroposophic nursing that can be explained phenomenologically (7).

 

1 Heine R (Hg). Pflege als Übungsweg. Anthroposophische Pflegepraxis. Berlin: Salumed Verlag; 2017.

2 Henderson V. Basic Principles of Nursing Care. American Nurses Association 1997.

3 Heine R (Hg). Das Konzept der Pflegerischen Gesten. Anthroposophische Pflegepraxis. Berlin: Salumed Verlag; 2017.

4 Therkleson T. Ginger compress therapy for adults with osteoarthritis. Journal of Advanced Nursing 2010;66(10):2225-2233.

5 www.pflege-vademecum.de, abgerufen am 12.7.2017.

6 Arman M, Rehnsfeldt A, Wode K. Anthroposophic health care – Different and home-like. Scandinavian Journal of Caring Sciences 2008;22(3):357-366.

7 Bertram M, Kolbe HJ. Entwurf eines ökologischen Modells therapeutischer Prozesse. Dimensionen therapeutischer Prozesse in der Integrativen Medizin. Wiesbaden: Springer Fachmedien; 2016: 1-28.