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Holistic Approaches to Mental Health & Well-Being for Nurses & Patients

Enjoy these Articles from AHNA's Beginnings Magazine

Click the images below to read, download or print each article.

Meditation for Well-Being

Compassion Fatigue

Music for Anxiety Depression Treatment

Holistic Nursing in Mental Illness

Highest Version of Ourselves

Vulnerability in Mental Health Challenges

Engaging the 5 Senses for Emotional Well Being

Stress and Resilence

References

Akachukwu, J. (2017, June). Music: The Underdog of Anxiety and Depression Treatment. American Holistic Nurses Association (AHNA). Beginnings, 37(3) 12-13.

Gutierrez, C. (2017, June). Holistic Nursing: Engaging the Five Senses for Emotional Health (AHNA). Beginnings, 37(3) 6-7, 24-25.

Johnson, B. (2016, December). Holistic mental health nursing: Manifesting the highest version of ourselves. American Holistic Nurses Association (AHNA). Beginnings, 36(6), 8-9.

Lehmann, K. (2014, December). Is There a Place for Complementary and Integrative Therapies in Long-term Psychiatry? (AHNA). Beginnings, 14-16.

Rosa, W. (2014, August). Caring science and compassion fatigue: Reflective inventory for the individual processes of self- healing. American Holistic Nurses Association (AHNA). Beginnings; 34(4), 18-20.

Rosa, W. (2016, December). Vulnerability and mental health challenges: Three case studies from local to global. American Holistic Nurses Association (AHNA). Beginnings, 36(6), 16-17, 22.

Rovinsky, P. (2015, December). Stress and resiliency: Challenges of 21st century living. American Holistic Nurses Association (AHNA). Beginnings, 35(6), 18-20.

Schroeder, T. (2017, June). Meditation for emotional well-being. American Holistic Nurses Association (AHNA). Beginnings; 37(3), 10-11.

Evidence for Practice: Research Abstracts from the Journal of Holistic Nursing

Anxiety, Depression & PTSD

Title: Association of Complementary and Alternative Therapies With Mental Health Outcomes in Pregnant Women Living in a Postdisaster Recovery Environment

Authors: Barcelona de Mendoza V, Harville E, Savage J, Giarratano G
Purpose: The objective of this study was to determine if complementary and alternative medicine therapies are associated with mental health in postdisaster environments
Design: Pregnant women (N = 402) were interviewed between 2010 and 2012 as part of a larger cross-sectional study on hurricane recovery and models of prenatal care
Methods: Symptoms of depression (Edinburgh Postnatal Depression Screen), prenatal anxiety (Revised Prenatal Distress Questionnaire), posttraumatic stress (PCL-S), and perceived stress (PSS) were examined. Logistic regression was used to adjust for income, race, education, parity, and age. The most commonly reported therapies were prayer, music, multivitamins, massage, and aromatherapy. 
Findings: Mental illness symptoms were common (30.7% had likely depression, 17.4% had anxiety, and 9.0% had posttraumatic stress). Massage was protective for depression (Edinburgh Postnatal Depression Index [EDSI] >8; adjusted odds ratio [aOR] = 0.6, 95% confidence interval [CI] = 0.3-0.9), while use of aromatherapy (aOR = 1.9, 95% CI = 1.1-3.2) and keeping a journal (aOR = 1.9, 95% CI = 1.1-3.2) were associated with increased odds of depression. Aromatherapy was associated with symptoms of pregnancy-related anxiety (aOR = 2.0, 95% CI = 1.1-3.8). 
Conclusions: Symptoms of mental illness persist after disaster, when untreated. Nurses should consider assessing for complementary and alternative medicine utilization in pregnancy as a potentially protective factor for mental health symptoms. 
Keywords: women; group/population; alternative/complementary therapies; common themes; trauma/posttrauma; specific conditions
 

J Holist Nurs. 2016 Sept;34(3):259-270. doi: 10.1177/0898010115609250


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Title: Depression in Older Adults in Primary Care

Authors: Lill S

Depression in older adults is a problem often encountered in primary care. While depression is evident in all populations in the primary care setting, assessment and care are more complicated in the older adult due to factors such as comorbidities, clinical presentation, adverse drug effects and drug interactions, and psychosocial factors. Due to these complications, it is essential to incorporate both conventional and alternative methods in assessment and treatment. This article aims to define depression in older adults, present the epidemiology, discuss clinical presentation and screening, and offer an integrative approach to intervention, including both pharmacological and nonpharmacological methods. Providing holistic and integrative care to older adults diagnosed with depression in the primary care setting is essential to promote healing and recovery. This article aims to provide insight for nurses, nurse practitioners, and other providers regarding the holistic and integrative care of depression in older adults in the primary care setting.

Keywords: older adults; nurses (advanced practice); psychosocial/mental health; integrative

 

J Holist Nurs. 2015 Sept;33(3):260-268-270. doi: 10.1177/0898010115569350


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Title: How Spirituality Protects Palliative Care Clients and Caregivers From Depression

Authors: Penman J

Purpose: The aims of this article are to explore the experience of depression among palliative care clients and caregivers, describe the strategies they use in coping with depression, and clarify the role of spirituality in preventing and/or overcoming depression. This article discusses an aspect of the findings of a larger doctoral study that explored the nature of spirituality and spiritual engagement from the viewpoint of individuals with life-limiting conditions and their caregivers.
Design: van Manen’s phenomenology was used in the study.
Methods: The methodology underpinning the secondary analysis was phenomenology also by van Manen. Fourteen clients and caregivers from across regional and rural South Australia informed the study. Data collection involved in-depth nonstructured home-based interviews that were audiotaped and transcribed verbatim.
Findings: The findings highlighted relate to participants succumbing to depression, but having spiritual beliefs and practices helped them cope.
Conclusions: One of the most insightful understanding was the role spirituality played in protecting individuals from depression, encapsulated in the theme “finding paradise within.” Spirituality, understood from a religious or secular perspective, must be embedded in palliative care as it assisted in preventing and overcoming depression. 
Keywords: depression; palliative care clients; caregivers; spirituality
 

J Holist Nurs. 2017 ;XX(X):1-12. doi: 10.1177/0898010117714665


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Title: Use of Mindfulness, Self-Compassion, and Yoga
Practices With Low-Income and/or Uninsured Patients
With Depression and/or Anxiety

Authors: Falsafi N, Leopard L

Purpose: This pilot study was conducted to determine the effectiveness of mindfulness practices, including self-compassion and yoga, on depression and/or anxiety in uninsured and/or low-income patients.
Design: The design was repeated measures with one group.
Methods: Patients received 8 weeks of mindfulness training including self-compassion and yoga. Depression and anxiety symptoms, self-compassion, and psychological well-being were measured four times.
Findings: Interventions were effective in helping uninsured and low-income patients reduce depression and/or anxiety symptoms.
Conclusions: This study may have implications for a cost-effective treatment for these disorders. The findings from this study can provide useful information to health care providers.
Keywords: mindfulness practices; self-compassion; yoga; depression; anxiety; low-income/uninsured; adults
 

J Holist Nurs. 2015 Dec;33(4):289-297. doi: 10.1177/0898010115569351


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Title: Exploring Self-Reported Benefits of Auricular
Acupuncture Among Veterans With
Posttraumatic Stress Disorder

Authors: King H, Moore C, Spence D
Purpose: Auricular acupuncture treatments are becoming increasingly available within military treatment facilities, resulting in an expansion of nonpharmacologic treatment options available to veterans with posttraumatic stress disorder (PTSD). This study aimed to explore the self-reported benefits of auricular acupuncture treatments for veterans living with PTSD.
Design:A qualitative research methodology, thematic content analysis, was used to analyze data.
Methods: Seventeen active duty veterans with PTSD provided written comments to describe their experiences and perceptions after receiving a standardized auricular acupuncture regimen for a 3-week period as part of a pilot feasibility study.
Findings: A variety of symptoms experienced by veterans with PTSD were improved after receiving auricular acupuncture treatments. Additionally, veterans with PTSD were extremely receptive to auricular acupuncture treatments. Four themes emerged from the data: (1) improved sleep quality, (2) increased relaxation, (3) decreased pain, and (4) veterans liked/loved the auricular acupuncture treatments.
Conclusions: Veterans with PTSD reported numerous benefits following auricular acupuncture treatments. These treatments may facilitate healing and recovery for veterans with combat-related PTSD, although further investigations are warranted into the mechanisms of action for auricular acupuncture in this population.
Keywords: posttraumatic stress disorder; auricular acupuncture; Veterans
 

J Holist Nurs. 2016 Sept;34(3):291-299. doi: 10.1177/0898010115610050


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Title:Tai Chi for Posttraumatic Stress Disorder and Chronic Musculoskeletal Pain

Authors: Tsai P, Kitch S, Chang J, James G, Dubbert P, Roca J, Powers C

Purpose: Explore the feasibility of a Tai Chi intervention to improve musculoskeletal pain, emotion,cognition, and physical function in individuals with posttraumatic stress disorder.
Design: Two-phase,one-arm quasi-experimental design.
Methods: Phase 1: 11 participants completed one Tai Chi session, feasibility questionnaire, and were offered participation in Phase 2, a 12-week Tai Chi intervention. Ten participants participated in Phase 2. Pain intensity, interference, physical function scales, an emotional battery, and cognition tests were used for pre- and postintervention outcome measures. Paired t tests and thematic analysis were used for analysis.
Findings: In Phase 1, most felt Tai Chi would benefit health (90.9%) and expressed interest in continuing Tai Chi (6.73 out of 7). Phase 2 results showed improvement in fear-affect (raw t = −2.64, p = .03; age adjusted t = −2.90, p = .02), fear–somatic arousal (raw t = −2.53, p = .035), List Sorting Working Memory (raw t = 2.62, p = .031; age adjusted t = 2.96, p = .018), 6-Minute Walk Test (t = 3.541, p = .008), and current level of Pain Intensity (t = −4.00, p = .004).
Conclusions: Tai Chi is an acceptable, holistic treatment to individuals with musculoskeletal pain and posttraumatic stress disorder. It may reduce pain, improve emotion, memory, and physical function.
Keywords: pain and pain management; psychosocial/mental health; trauma/posttrauma; Tai Chi
 

J Holist Nurs. 2017;XX(X):1-12. doi: 10.1177/0898010117697617


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Title:The Emotional Freedom Technique: Finally, a Unifying Theory for the Practice of Holistic Nursing, or Too Good to Be True?

Authors: Rancour P

Purpose: The Emotional Freedom Technique (EFT) is defined and described as a clinical procedure for the relief
of psychological and physical distress that patients often bring to the attention of nurses.
Design: Two-phase,one-arm quasi-experimental design.
Methods: Phase 1: 11 participants completed one Tai Chi session, feasibility questionnaire, and were offered participation in Phase 2, a 12-week Tai Chi intervention. Ten participants participated in Phase 2. Pain intensity, interference, physical function scales, an emotional battery, and cognition tests were used for pre- and postintervention outcome measures. Paired t tests and thematic analysis were used for analysis.
Findings: In Phase 1, most felt Tai Chi would benefit health (90.9%) and expressed interest in continuing Tai Chi (6.73 out of 7). Phase 2 results showed improvement in fear-affect (raw t = −2.64, p = .03; age adjusted t = −2.90, p = .02), fear–somatic arousal (raw t = −2.53, p = .035), List Sorting Working Memory (raw t = 2.62, p = .031; age adjusted t = 2.96, p = .018), 6-Minute Walk Test (t = 3.541, p = .008), and current level of Pain Intensity (t = −4.00, p = .004).
Conclusions: Tai Chi is an acceptable, holistic treatment to individuals with musculoskeletal pain and posttraumatic stress disorder. It may reduce pain, improve emotion, memory, and physical function.
Keywords: pain and pain management; psychosocial/mental health; trauma/posttrauma; Tai Chi
 

J Holist Nurs. 2017;XX(X):1-12. doi: 10.1177/0898010117697617


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Title:The Emotional Freedom Technique: Finally, a Unifying Theory for the Practice of Holistic Nursing, or Too Good to Be True?

Authors: Rancour P

The Emotional Freedom Technique (EFT) is defined and described as a clinical procedure for the relief of psychological and physical distress that patients often bring to the attention of nurses. Frequently referred to as “tapping,” this technique combines the cognitive reprocessing benefits of exposure and acceptance therapy with the energetic disturbance releases associated with acupuncture and other energy therapies. More than 60 research articles in peer-reviewed journals report a staggering 98% efficacy rate with the use of this procedure from psychological distress (posttraumatic stress disorder, phobias, anxiety, depression, etc.) to physical conditions (asthma, fibromyalgia, pain, seizure disorders, etc.) to performance issues (athletic, academic). Perhaps because of this, this technique has encountered a fair degree of skepticism within the health care community. Easily taught as a self-help aid that patients can administer to themselves, EFT becomes an efficacious tool in the hands of nurses who are seeking whole person approaches for the healing of a wide variety of psychological and physical conditions. A conceptual framework, mechanisms of action, evidence of safety, literature review, and case studies are also included.
Keywords: emotional freedom technique (EFT); healing modalities; energy-based therapies; energy
work; healing modalities
 
J Holist Nurs. 2017;XX(X):1-12. doi: 10.1177/0898010117697617


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Compassion Fatigue

Title: Evaluation of a Meditation Intervention to Reduce the Effects of Stressors Associated With Compassion Fatigue Among Nurses

Authors: Hevezi JA
Purpose: This pilot study evaluated whether short (less than 10 minutes) structured meditations decrease compassion fatigue and improve compassion satisfaction in oncology nurses.
Design: A nonrandomized, pre-post intervention study.
Methods: Participants used specific meditations designed to establish a sense of calm, relaxation, and self-compassion 5 days a week for 4 weeks. Meditations were provided on an audio-CD after brief individual instruction. The Professional Quality of Life Survey, Version 5, was administered pre and post intervention along with supplementary questions. 
Findings: Fifteen nurses participated in the study over a 6-month period in 2014. Paired t test revealed that the intervention demonstrated a statistically significant increase in Compassion Satisfaction scores (mean difference = −2.66, 95% confidence interval [CI] = [−4.98, −0.36], t[14] = −2.48, p = .027, d = 0.63) and decreases in Burnout (mean difference = 4.13, 95% CI = [1.66, 6.60], t[14] = 3.581, p = .003, d = 0.92) and Secondary Trauma (mean difference = 3.00, 95% CI = [0.40, 5.96], t[14] = 2.174, p = .047, d = 0.56) scores. All participants reported increased feelings of relaxation and wellbeing on supplemental questions. 
Conclusions: Even in this small sample, the practice of short breathing and meditation exercises was effective in improving nurse outcomes. A larger study is warranted including tracking sustained effects relative to maintaining a meditation practice. 
Keywords: compassion fatigue; nurses; stress and coping
 

J Holist Nurs. 2016 Dec;34(4):343-350. doi: 10.1177/0898010115615981

Dementia

Title: Continuity and Change in Life Engagement Among People With Dementia

Authors: Kuosa K, Elstad I, Normann HK
Purpose: To explore the change and continuity in the engagement in life of people with advanced dementia. The idea of meaningful activities is commonly used in nursing research, but few studies have been performed on what makes activities meaningful. This study aims to shed light on the meaning of activities in a life course context, changes in activity patterns due to dementia disease, and the significance of narratives told by close relatives.
Design: Life story/life history; narrative.
Methods: The 11 stories of activities were analyzed using thematic narrative analysis with Leontyev’s activity theory as a theoretical framework.
Findings: Several types of changes: slow and abrupt changes in everyday and physical activities, changes in the person’s level of awareness, and changes in habits in new care settings and environments.
Conclusions: The meaningfulness of activities was connected to a person’s background, his/her motives, lifestyle and identity, and the contextuality of activities. Through the narratives, nursing care personnel could acquire a nuanced picture of the person and his/her engagement in life. These narratives are vital to helping people who have dementia to keep up with meaningful activities and enhance their quality of life, especially when the person has deficiencies in communication.
Keywords: older adults; dementia, family; nursing interventions; gerontologic nursing; activities; life story; narrative
 

J Holist Nurs. 2015 Dec;33(3):205-227. doi: 10.1177/0898010114564684

Holistic Mental Health Services

Title: Delivering Mental Health Services to OEF/OIF Veterans

Authors: Signoracci GM, Bahraini NH, Matarazzo BB, Olson-Madden JH, Brenner LA
Purpose: To explore the change and continuity in the engagement in life of people with advanced dementia. The idea of meaningful activities is commonly used in nursing research, but few studies have been performed on what makes activities meaningful. This study aims to shed light on the meaning of activities in a life course context, changes in activity patterns due to dementia disease, and the significance of narratives told by close relatives.
Design: Qualitative research methodology, specifically qualitative description, was used to explore VHA MH clinicians’ experiences providing MH services to OEF/OIF veterans.
Methods: Thirteen VA MH providers participated in semistructured interviews, which included questions regarding the following areas: psychiatric needs of OEF/OIF veterans; collaboration and referral; needs and resources; and the personal/professional impact of providing services to this cohort.
Findings: Themes emerged which highlighted complex challenges faced by OEF/OIF veterans, barriers associated with matching the unique needs of these veterans with existing treatments, and the challenges and rewards associated with providing care to members of this population.
Conclusions: Capturing provider perspectives within MH services suggest potential areas for innovation aimed at providing patient-centered care to this cohort of veterans. Results may also inform future work aimed at meeting the needs of both OEF/OIF veterans and MH providers.
Keywords: veterans; mental health; narratives
 

J Holist Nurs. 2014 Sept;32(3):161-172. doi: 10.1177/0898010114524484

Identity & Relationships

Title: "I Am a Nice Person When I Do Yoga!!!" A Qualitative Analysis of How Yoga Affects Relationships


Authors: Ross A, Bevans M, Friedmann E, Williams L, Thomas S.

Purpose: To develop a better understanding of how yoga practice affects one's interpersonal relationships.

Design: Qualitative.

Method: Content analysis was used to qualitatively analyze written comments (n = 171) made regarding yoga improving interpersonal relationships in a large cross-sectional survey of yoga practitioners (N = 1,067).

Findings: Four themes were identified: Yoga practice leads to personal transformation, increases social interaction, provides coping mechanisms to weather relationship losses and difficulties, and leads to spiritual transcendence. Practitioners believed that their interpersonal relationships improved because their attitude and perspective had changed, making them more patient, kind, mindful, and self-aware. They expressed an aspect of community that was both practical (they met new friends) and spiritual (they felt they belonged). They thought they could better weather difficulties such as divorce and death. A number discussed feeling a sense of purpose and that their practice contributed to a greater good.

Conclusions: There appears to be an aspect of community associated with yoga practice that may be beneficial to one's social and spiritual health. Yoga could be beneficial for populations at risk for social isolation, such as those who are elderly, bereaved, and depressed, as well as individuals undergoing interpersonal crises.

Keywords: clinical/focus area; conceptual/theoretical descriptors/identifiers; healing modalities; interpersonal; psychosocial; yoga

J Holist Nurs. 2014 Jun;32(2):67-77. doi: 10.1177/0898010113508466. Epub 2013 Oct 28.

PMID: 24166108; PMCID: PMC4196270; DOI: 10.1177/0898010113508466


Mindfulness

Title: Intentionality in Healing—The Voices of Men in Nursing


Author: Zahourek RP
Purpose: The purpose of this study was to evaluate and potentially modify or expand a previously developed theory: Intentionality: The Matrix of Healing (IMH) using a sample of men in nursing.
Design: A modified grounded theory approach described by Chen and Boore (2009) and by Amsteus (2014). 
Method: Twelve men in nursing were recruited. Each was interviewed at least once and their feedback solicited to determine accuracy of interpretation. Results were compared and contrasted to those obtained from the earlier research with six female nurses and their patients. 
Results: Both groups viewed intentionality as different from, and greater than, intention. Intentionality reflects the whole person’s values, goals, and experiences. The men emphasized the importance of reflective spiritual practices, developing self-awareness, being aware of the stress experienced by males in a female profession, and the role of action in manifesting intentionality in healing. 
Conclusions: The theory is substantiated with minor changes in emphases. Further study is warranted to expand the understanding of this basic concept in nursing and healing.
J Holist Nurs. 2015 Dec;33(4):308-323. https://doi.org/10.1177/0898010115573665 

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Title: Mindfulness-Based Stress Reduction in Advanced Nursing Practice: A Nonpharmacologic Approach to Health Promotion, Chronic Disease Management, and Symptom Control

Authors: Williams H, Simmons LA, Tanabe P
Purpose: The aim of this article is to discuss how advanced practice nurses (APNs) can incorporate mindfulness-based stress reduction (MBSR) as a nonpharmacologic clinical tool in their practice. 
Summary: Over the last 30 years, patients and providers have increasingly used complementary and holistic therapies for the nonpharmacologic management of acute and chronic diseases. Mindfulness-based interventions, specifically MBSR, have been tested and applied within a variety of patient populations. There is strong evidence to support that the use of MBSR can improve a range of biological and psychological outcomes in a variety of medical illnesses, including acute and chronic pain, hypertension, and disease prevention. This article reviews the many ways APNs can incorporate MBSR approaches for health promotion and disease/symptom management into their practice. The authors conclude with a discussion of how nurses can obtain training and certification in MBSR.
Conclusions: Given the significant and growing literature supporting the use of MBSR in the prevention and treatment of chronic disease, increased attention on how APNs can incorporate MBSR into clinical practice is necessary. 
Keywords: psychosocial/mental health; health promotion; meditation/mindfulness; alternative therapies; chronic disease; holistic nursing; mind–body techniques
J Holist Nurs. 2015 Sept; 33(3):247-259. https://doi.org/10.1177/0898010115569349 

Suicide Prevention

Title: Listening to Our Patients: Learning About Suicide Risk and Protective Factors From Veterans With HIV/AIDS


Author: Signoracci GM, Stearns-Yoder KA, Holliman BD, Huggins JA, Janoff EN, Brenner LA

Purpose: To gather perspectives of veterans with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) regarding suicide risk factors, warning signs, and protective factors. We also aimed to modify an existing Veterans Health Administration tool, the Suicide Risk Assessment Guide Pocket Card, for HIV/AIDS provider use.
Design: Semistructured interviews (Baumbusch, 2010; DiCicco-Bloom & Crabtree, 2006; Whiting, 2008) and the descriptive qualitative approach (Sandelowski, 200, 2010) 
Method: Twenty male veterans participated in audio-recorded semistructured interviews that were transcribed and coded for themes. 
Results: Veterans highlighted personally relevant psychosocial stressors (i.e., poverty, social isolation and loneliness, and physical health). Although the concept of warning signs did not seem salient to participants, they named indicators of elevated imminent risk for self-directed violence (i.e., “relapse,” “not take’n medications,” and “miss’n appointments”) and few protective factors. No themes emerged regarding recommended pocket card changes.
Conclusions: This sample of veterans identified selfdirected violence risks noted in the general population and others with HIV/AIDS, as well as proximal events associated with increased risk. Care providers are encouraged to explore the relevance of noted imminent and persistent indicators of increased risk with veterans seeking care.
Keywords: veterans; HIV/AIDS; psychosocial/mental health
J Holist Nurs. 2016 Dec;34(4):318-328. https://doi.org/10.1177/0898010115610688 

Well-Being

Title: Five Dimensions of Wellness and Predictors of Cognitive Health Protection in Community-Dwelling Older Adults: A Historical COLLAGE Cohort Study


Author: Strout KA, Howard EP

Purpose: Wellness is associated with cognitive health protection; however, findings are limited because they only examine variable(s) within one dimension of wellness.
Design: This research examined the association between multiple dimensions of wellness and cognition among aging adults. 
Method: The sample included 5,605 male and female community-dwelling adults 60 years and older. 
Results: Four dimensions of wellness demonstrated a statistically significant higher mean difference in cognitively healthy older adults compared to cognitively impaired older adults, F(4, 5,595) = 47.57, p < .001. Emotional wellness demonstrated the strongest association with cognitive health, followed by physical and spiritual wellness, F(5, 5,372) = 50.35, p < .001. 
Conclusions: Future research is needed to examine the cognitive protective benefits of wellness using longitudinal, prospective designs that control for the potential temporal relationship between wellness and cognition.
Keywords: older adults; health promotion; cognitive impairment; spirituality; holistic; health and wellness coaching; holistic scholarship; holistic inquiry; holistic theories and practices 
J Holist Nurs. 2015 March;33(1):6-18. https://doi.org/10.1177/0898010114540322