NURSING PROCESS EXPANDED BY ANTHROPOSOPHY: PERCEPTION OF ANTHROPOSOPHICAL NURSES

Martín Hernández, Susana; Sousa, Janaina Meirelles; Casanova Garrigos, Georgina

doi:10.1590/1980-265X-TCE-2024-0328en

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Original Article • Texto contexto - enferm. 34 • 2025 • https://doi.org/10.1590/1980-265X-TCE-2024-0328en linkcopy

NURSING PROCESS EXPANDED BY ANTHROPOSOPHY: PERCEPTION OF ANTHROPOSOPHICAL NURSES

PROCESSO DE ENFERMAGEM AMPLIADO PELA ANTROPOSOFIA: PERCEPÇÃO DAS ENFERMEIRAS ANTROPOSÓFICAS

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to identify the characteristics of the nursing process in the anthroposophic nursing clinical practice.

Method: this is a qualitative, descriptive study of an exploratory nature. Between October 2023 and July 2024, 23 semi-structured interviews were conducted on the anthroposophically-enhanced nursing process with participants from different countries who met the inclusion criteria. Data were analyzed with Thematic Reflective Analysis applying the ATLAS-ti® software.

Results: the codes emerging from the analysis of the interviews describe the nursing process in all its parts: assessment, diagnosis, planning, intervention, and evaluation, with characteristics specific to anthroposophic nursing. Planning and intervention are described as if they were a unit, and codes emerge in reference to annotations and data exploitation.

Conclusion: Nursing assessment is enhanced by data collection based on anthroposophic anthropology; diagnosis is informed using anthroposophic medical terminology, and anthroposophic nursing practices are used for planning and intervention. In this process, evaluation is carried out periodically and often in an interdisciplinary manner, and all anthroposophic nursing actions are recorded, and the data is used to conduct continuing education and research work. Future studies are needed to broaden and deepen the different school and university training methods that influence their understanding, the implementation of the nursing process, and the practice of anthroposophic nursing.

DESCRIPTORS:
Nursing care; Anthroposophic medicine; Nursing theory; Complementary therapies; Nursing process; Nursing records; Patient care planning; Holistic nursing

Codes	Verbatim
Conventional clinical history	We'll take a medical history, right? Your past and previous history, a study of your clinical condition, right? Both your history and physical examination. (INT-15)
Conventional clinical history	Through an evaluation template with manifestations of symptoms that are expected to be obtained after treatment. (INT-13)
Information on Corporalities Vitality Calorific organism	Through the anthroposophical assessment of the patient himself. An extended interview in which the functional four- and three-fold constitution assessment was carried out. (INT-13)
Information on Corporalities Vitality Calorific organism	but also specifically analyzes thermal balance, specifically the vital forces. (INT-06)
Perception of the health expression	And you see a change in posture. You even see how the clothes, the body, the cleanliness change, you know? The person arrived dirty and in a little while that person is all pretty, dressed up, you know? That red lipstick she didn't wear before, that red scarf. (INT-18)
	Through observation. (INT-20)
	in the conversation. (INT-21)
Nurse’s theoretical, empirical, and intuitive knowledge	On one hand there is theory, theoretical knowledge, practical experience, and then intuition. (INT-05)
Multidisciplinary data collection	Because many times there are very complicated cases that sometimes we can't solve alone, right? So I always count on the support of other professionals (…) Other professionals too, especially psychologists, you know? And psychotherapists. And psychiatrists also refer a lot, so often when they come in, I have to take a history, you know? Even more carefully and in depth, to find out if there really is an indication. (INT-17)
Multidisciplinary data collection	Basically the patient comes to us with a referral from the doctor (…) I try, if possible, to talk to the doctor, exchange ideas. (INT-19)
Evaluation guide	And I think now, asking properly, I need like a… a more objective evaluation guide. (INT-09)

Codes	Verbatim
Identification of patient needs	All the information I use is used both to make a diagnosis and to monitor the patient. (INT-15)
Identification of patient needs	(…) the 12 nursing gestures, where in addition to a nursing diagnosis, for example, we develop an attitude towards patients. (INT-08)

Codes	Verbatim
Selection of interventions	The concept of the four essential members and the three members, which always helps us find the right care for the patient as a whole and select our interventions accordingly and return the patient to health. (INT-08)
Choosing the 12 NA Gestures	In fourfold and threefold constitution, the gesture of care, Rolf Heine's 12 gestures of care. (INT-10)
Choosing the 12 NA Gestures	Working with gestures is a very complex job, but also a very beautiful job to simply realize what the gesture really means. (INT-01)
Choosing External Applications: Infusions, immersion baths, compresses, oil treatments, honey therapy…	We do a foot bath procedure, full body oiling, yarrow compresses or wet compresses and hot compresses. (INT-09)
	External therapies. We have cold wet compresses, hot compresses, warm compresses, ointments, medicinal tea, you know? We also have poultices, foot baths, intestinal baths, rhythmic gliding baths, immersion baths. There is honey therapy, nourishing baths, bandages, organ rubs. (INT-20)
Choosing Conventional Nursing Practices	...the normal part of the nurse with the vital signs… (INT-20)
Choosing Conventional Nursing Practices	You have to do everything traditional, right? Anthropometric measurements and everything we have to do. (INT-21)
Knowledge of indications, contraindications, and side effects of treatments	Yes, we monitor these contraindications, indications, and side effects for all the external applications we perform... (INT-05)
	external applications have few side effects, it really has to be said, most are well tolerated. (INT-08)
	very rarely can it cause any harm. So, it is a safe procedure. (INT-14)
Information on treatments	I'm investigating... we share with other colleagues too, or with the people from Vade mecum, whom we can consult.(INT-11)
Information on treatments	...I read first and then I see what I can do... (INT-03)
Guidance for Health and Self-Care	also grounded little advice to talk about nursing. (INT-23)
	We always think about dietary guidance. (INT-18)
	Emphasis on self-care. (INT-12)
Guidance on other anthroposophic therapies	...massages such as rhythmic massage… (INT-15)
	...within conversations, events specific to people's biographies. (INT-13)
	guidance on meditation exercises. (INT-18)
	In psychiatry, psychosomatics, the so-called soul exercises, that is, in a broader sense, concentration and mindfulness exercises. (INT-07)

Codes	Verbatim
Observation of results	The evaluation I do is this follow-up by filling out the form, right? And observing, mainly the details, right? What is your dream? Eliminations, sleep, and also noticing vitality. (INT-17)
	First, we are the ones who observe the external application during the treatment. Even after the break, you can get an idea of the effect and ask very careful questions about the patient's condition. (INT-05)
	But when we realized that it didn't fit at all, or that we had to do something different, then, of course, we change. (INT-06)
Conversation with the patient	I evaluate them and how? I go, always in constant conversation with the patients. (INT-10)
Conversation with the patient	For me, the best evaluation is that of the patient himself (INT-04)
Record of interventions	We make reports every time we do a series of treatments that become part of the person's file. (INT-22)
	It is the entire follow-up, both of the history and the evolution, the diagnosis, and everything is filled out electronically or in the patient's history. (INT-15)
	I make a small evaluation sheet in which we collect data before the application, and three weeks later there is something in the area of pain, heat, mood, sleep, there are changes compared to before the application. (INT-03)
	once designed a protocol to specifically document external applications (INT-02)
Care Follow-up	Then, he follows up, as a communication, on how he woke up and slept, and in the next session, generally the person can also evaluate, if there is any difference between before and after. (INT-11)
	Then when we see the patient again, we briefly evaluate the previous treatment. (INT-05)
	So we only saw patients in the outpatient setting (..) you have a completely different process than someone who is in an acute care hospital. (INT-06)
Feedback, mail and/or apps	Sometimes the evaluation is by phone call or WhatsApp. (INT-12)
Feedback, mail and/or apps	I think the clinic sometimes sends a questionnaire home. (INT-08)
Interdisciplinary or medical follow-up	We do it as a group because we end up discussing the most serious cases (…) also of some colleagues who work there. (INT-19)
Interdisciplinary or medical follow-up	I do a simple evaluation, or the doctor, because, for example, she always brings me comments from patients. (INT-21)
Institutional instrument	In our hospital, certain departments receive training in selected external applications and these applications are evaluated. (INT-05)

Codes	Verbatim
Validation of nursing interventions	I have the nursing record that I keep, and I print it out and I go, I write down the date, the name, and what, what I did to him. (INT-09)
	I try to keep a record of them and the changes they've had, you know?, of the applications I made. (INT-11)
	It is the entire follow-up, both of the history and the evolution, the diagnosis, and everything is filled out electronically or in the patient's history (…) We take notes of what we’ve received by phone, in the case of a call made in person to the patient’s home. He comes to your office, what has he complained about, you should write it all down, right? You must also report everything you have advised. (INT-15)
	through this history taking form. (INT-17)
	So we put something with the patient's name, age, substance and therapy. First session, what did you use, what did you do? And the patient's observations? (INT-20)
Continuing education with case studies	And also sometimes, the person in charge of suggesting the case study tries to find out if that patient you have seen has done such and such a thing, if you would not like to present him together with the doctor, together with the masseuse, together with the therapist. (INT-19)
Continuing education with case studies	Absolutely, because as we work in an interdisciplinary team, everyone uses it to get to know the patient, to understand them, and then we look at it in all ways, all specialties. (INT-21)
Verification for charging insurers	I know that the data is used at least for coding, i.e. for payment, so that it can be billed. (INT-08)
Patient’a long-term follow-up	They can be seen by everyone involved in the treatment and, when patients return after a long time, of course, you can see them. (INT-06)

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Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[TFN1] *INT: participating nurse