The biomedical model has traditionally been the dominant model of health for modern medicine. This model views health as merely the absence of illness, while illness is seen as any deviation from the normal healthy lives of individuals (Farre & Rapley, 2017). This model of caring has several flaws and sees patients as either healthy or sick persons. What if a patient comes in for a routine check-up, feels fine, but on review of his laboratory results, his cholesterol levels and Hgb A1C are abnormal? Or it could be another way around, where a visibly sick patient in the hospital has normal chest x-rays, normal ABGs, normal bloodwork, but she still complains of not feeling well? This is the paradox of the biomedical model since the provider does not see the patient as a whole person, but instead, the provider focuses on what is only abnormal.

Holistic caring, on the other hand, is approaching “the individual in their totality, and viewing their brain, spirit, body, mind, reason and emotion” as an interconnected whole, not separate entities, and treating the patient as a whole (Facione, Crossetti, & Riegel, 2017). Most of the time, the qualities of sociability, professional commitment, and ethical practice are the qualities that are present in a nurse who practices holistic nursing (Jasemi, Valizadeh, Zamanzadeh, & Keogh, 2017). For example, when we encounter an obese patient suffering from type 2 diabetes, hypertension, and stage 2 chronic kidney disease, a holistic caring nurse practitioner will investigate what psychosocial factors or living conditions might have contributed to the patient’s current state of health. She then finds out that the patient is from a low-income household but earns just enough that he does not qualify for Medicaid, that his diet consists of processed foods high in sugar, carbohydrates, and sodium, which made him gain weight. The patient rarely exercises, so the weight increases, which led to his type 2 DM, which is uncontrolled due to poor food choices and non-compliance with meds because he cannot sometimes afford them due to low income. Uncontrolled type 2 DM leads to renal artery stenosis, hypertension, and decreased kidney function. Because of his poor state of health, the patient turns to food for comfort, thus it is a never-ending cycle of poor choices and health, which a holistic caring nurse can see and can intervene in different stages.

The Circle of Caring Model takes concepts from both the holistic caring model and the biomedical nursing model and adds a new view of the patient’s health. The Circle of Caring Model can be described as a harmonization of the holistic caring model and the biomedical model where a thorough nursing history assessment that includes the social determinants of health is used, diagnosis and treatment are synthesized using the biomedical model using evidence-based practice, use of complementary medicine and non-pharmacological therapy are considered, and the involvement of the patient in determining what is a positive outcome. At the core of this model is the basis of nursing itself, which is the ability to care for the patient in contrast to only curing the patient. Nursing care is practiced in this model through courage, authentic presence, advocacy, knowing, commitment, and patience (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Courage is the nurse’s ability to perform his or her duties despite certain obstacles or challenges in a patient’s care. When a nurse practitioner practices cultural competence and does away with his biases and prejudice and cares for the patient with genuine concern, he is making his presence with authenticity. Advocacy occurs when a nurse speaks up on behalf of a patient when the nurse feels that there are alternative ways of dealing with the patient’s condition. Learning when to be aggressive in treatment, or to back off from attempting to have a patient stop smoking when the patient is not receptive to such action, simply listening to a patient in grief and not being judgmental, make up the art of knowing. Commitment entails choosing to see patients as a whole and including their family, environment, and social conditions as part of the plan for care, not as an economic opportunity for gain. Patience involves not rushing patients into what is a healthy lifestyle that the NP sees might benefit the patient, but trusting and allowing the patient to make the best-informed choice while the NP remains actively engaged with trying to steer the patient into a healthy life, and not giving up easily.

References

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary Care: The Art and Science of Advanced Practice Nursing 4th Ed. Philadelphia, PA: F.A. Davis Company.

Facione, P. A., Crossetti, M. d., & Riegel, F. (2017). Holistic Critical Thinking in the Nursing Diagnostic Process. evista Gaucha De Enfermagem, 38(3), e75576. https://doi.org/10.1590/1983-1447.2017.03.75576.

Farre, A., & Rapley, T. (2017). The New Old (and Old New) Medical Model: Four Decades Navigating the Biomedical and Psychosocial Understandings of Health and Illness. Healthcare, 5(4), 88. https://doi.org/10.3390/healthcare5040088.

Jasemi, M., Valizadeh, L., Zamanzadeh, V., & Keogh, B. (2017). A Concept Analysis of Holistic Care by Hybrid Model. Indian Journal of Palliative Care, 23(1), 71–80. https://doi.org/10.4103/0973-1075.197960.