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Home / Living Well / A holistic approach to integrative medicine

A holistic approach to integrative medicine

As studies continue to reveal the important role the mind plays in healing and in fighting disease, a transformation is taking place in hospitals and clinics across the country. Meta description: Discover principles and benefits of integrative medicine, a comprehensive approach combining conventional and complementary therapies.

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Interested in integrative medicine? Read the following excerpt from the Mayo Clinic Guide to Integrative Medicine .

People who take an active role in their health care experience better health and improved healing. It’s a commonsense concept that’s been gaining scientific support for several years now.

As studies continue to reveal the important role the mind plays in healing and in fighting disease, a transformation is taking place in hospitals and clinics across the country. Doctors, in partnership with their patients, are turning to practices once considered alternative as they attempt to treat the whole person — mind and spirit, as well as body. This type of approach is known today as integrative medicine.

Incorporate integrative medicine alongside your treatments

Integrative medicine describes an evolution taking place in many health care institutions. This evolution is due in part to a shift in the medical industry as health care professionals focus on wellness as well as on treating disease. This shift offers a new opportunity for integrative therapies.

Integrative medicine is the practice of using conventional medicine alongside evidence-based complementary treatments. The idea behind integrative medicine is not to replace conventional medicine, but to find ways to complement existing treatments.

For example, taking a prescribed medication may not be enough to bring your blood pressure level into a healthy range, but adding meditation to your daily wellness routine may give you the boost you need — and prevent you from needing to take a second medication.

Integrative medicine isn’t just about fixing things when they’re broken; it’s about keeping things from breaking in the first place. And in many cases, it means bringing new therapies and approaches to the table, such as meditation, mindfulness and tai chi. Sometimes, integrative approaches help lead people into a complete lifestyle of wellness.

What types of integrative medicines are available?

What are some of the most promising practices in integrative medicine? Here’s a list of 10 treatments that you might consider for your own health and wellness:

Acupuncture is a Chinese practice that involves inserting very thin needles at strategic points on the body.
Guided imagery involves bringing to mind a specific image or a series of memories to produce certain responses in the body.
Hypnotherapy involves a trancelike state where the mind is more open to suggestion.
Massage uses pressure to manipulate the soft tissues of the body. There are many different kinds of massage, and some have specific health goals in mind.
Meditation involves clearing and calming the mind by focusing on your breathing or a word, phrase or sound.
Music therapy can influence both your mental and physical health.
Spinal manipulation, which is also called spinal adjustment, is practiced by chiropractors and physical therapists.
Spirituality has many definitions, but its focus is on an individual’s connection to others and to the search for meaning in life.
Tai chi is a graceful exercise in which you move from pose to pose.
Yoga involves a series of postures that often include a focus on breathing. Yoga is commonly practiced to relieve stress, as well as treat heart disease and depression.

Who can integrative medicine help?

A number of surveys focused on the use of integrative medicine by adults in the United States suggest that more than a third of Americans are already using these practices as part of their health care.

These surveys demonstrate that although the United States has the most advanced medical technology in the world, Americans are turning to integrative treatments — and there are several reasons for this trend. Here are three of the top reasons why more and more people are exploring integrative medicine.

Integrative medicine for people engaged in their health

One reason integrative medicine is popular is that people in general are taking a greater, more active role in their own health care. People are more aware of health issues and are more open to trying different treatment approaches.

Internet access is also helping to fuel this trend by playing a significant role in improving patient education. Two decades ago, consumers had little access to research or reliable medical information. Today, clinical trials and pharmaceutical developments are more widely available for public knowledge.

For example, people who have arthritis can find a good deal of information about it online. They may find research showing that glucosamine, for example, helps with joint pain and doesn’t appear to have a lot of risks associated with it. With this information in hand, they feel empowered to ask their doctors if glucosamine might work with their current treatment plans.

Integrative medicine for an aging population

A second reason for the wider acceptance of integrative treatments is the influence of the baby boomer generation. This generation is open to a variety of treatments as it explores ways to age well. In addition, baby boomers are often dealing with several medical issues, from weight control to joint pain, high blood pressure and elevated cholesterol. Not everyone wants to start with medication; many prefer to try complementary methods first.

Integrative medicine for the chronically stressed

A third reason for the growth, interest and use of integrative therapies is the degree of chronic stress in the American lifestyle. Workplace stress, long commutes, relationship issues and financial worries are just some of the concerns that make up a long list of stressors.

Although medications can effectively treat short-term stress, they can become just as damaging — and even as life-threatening — as stress itself is when taken long term. Integrative medicine, on the other hand, offers several effective, evidence-based approaches to dealing with stress that don’t involve medication. Many otherwise healthy people are learning to manage the stress in their lives successfully by using complementary methods such as yoga, meditation, massage and guided imagery.

Considering that many healthy people are engaging in integrative practices, it isn’t surprising to find out that they’re turning to these treatments in times of illness, as well. Here are just a few ways integrative medicine is used to help people cope with medical conditions:

Meditation can help manage the anxiety and discomfort of medical procedures.
Massage has been shown to improve recovery rates after heart surgery.
Gentle tai chi or yoga can assist the transition back to an active life after illness or surgery.

Conventional Western medicine doesn’t have cures for everything. Many people who have arthritis, back pain, neck pain, fibromyalgia and anxiety look to integrative treatments to help them manage these often-chronic conditions without the need for medications that may have serious side effects or that may be addictive.

The risks and benefits of integrative medicine

As interest in integrative medicine continues to grow, so does the research in this field. Researchers are studying these approaches in an effort to separate evidence-based, effective therapies from those that don’t show effectiveness or may be risky. In the process, this research is helping to identify many genuinely beneficial treatments. In essence, both consumer interest and scientific research have led to further review of these therapies within modern medicine.

As evidence showing the safety and efficacy of many of these therapies grows, physicians are starting to integrate aspects of complementary medicine into conventional medical care. Ultimately, this is what has led to the current term integrative medicine.

Ask your healthcare team about integrative medicine and wellness

If you’re interested in improving your health, many integrative medicine practices can help. Not only can they speed your recovery from illness or surgery, but they can also help you cope with a chronic condition. In addition, complementary practices such as meditation and yoga can work to keep you healthy and may actually prevent many diseases.

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How a holistic research retreat can help our science

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Örjan Bodin is a senior lecturer in environmental sciences at the Stockholm Resilience Centre at Stockholm University, Sweden.

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In early 2019, we were both at an interdisciplinary workshop to develop new and interesting research agendas that span disciplines. With a couple of decades of research experience each, we realized in a discussion over breakfast that we were both in the middle of an existential crisis. We felt out of touch and disheartened with our scholarship. We were struggling to make sense of what we had achieved in research and what, ultimately, the work was for. Instead of an event that forced us to reach out and work with others, we needed one that would encourage us to look inwards and reflect on our scholarship. So we organized a research retreat.

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Research paradigms and methods for investigating holistic nursing concerns

Affiliation.

1 Beth El College of Nursing and Health Sciences, University of Colorado at Colorado Springs, 1250 Oak Hills Drive, Colorado Springs, CO 80919, USA. [email protected]
PMID: 17544686
DOI: 10.1016/j.cnur.2007.03.004

Holistic nursing is a discipline focused on healing the whole person and dedicated to understanding and supporting the premise of holistic health of the patient and promoting healing in practitioners, patients, families, social groups, and communities. An explication of knowledge related to caring and healing in the human health experience and in holistic nursing is informed by the individual nurse's paradigmatic stance. Holistic nursing research is complex and focuses on healing, particularly healing of self, others, systems, and communities at large. This article discusses the competing paradigmatic perspectives, theoretic perspectives supporting holistic research, fundamental patterns of knowing and knowledge generation, a framework for holistic research, and the challenges of conducting holistic research. Recommendations for future research agenda are presented.

Publication types

Data Collection
Data Interpretation, Statistical
Forecasting
Health Services Needs and Demand
Holistic Health
Holistic Nursing* / organization & administration
Models, Nursing
Nurse-Patient Relations
Nursing Research / methods*
Nursing Research / organization & administration
Nursing Theory
Organizational Objectives
Philosophy, Nursing
Qualitative Research
Research Design*

Holism in Psychology: Definition and Examples

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

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Holism is often referred to as Gestalt psychology . It argues that behavior cannot be understood in terms of the components that make them up. This is commonly described as ‘the whole being greater than the sum of its parts.’

In other words, human behavior has its own properties that are not explicable in terms of the properties of the elements from which it is derived.

A holistic approach, therefore, suggests that there are different levels of explanation and that at each level, there are “emergent properties” that cannot be reduced to the one below.

Holistic approaches include Humanism, Social, and Gestalt psychology and make use of the case study method. Jahoda’s six elements of Optimal Living are an example of a holistic approach to defining abnormality.

Reductionist explanations, which might work in some circumstances, are considered inappropriate to the study of human subjectivity because here, the emergent property that we have to take account of is that of the “whole person.”

Otherwise, it makes no sense to try to understand the meaning of anything that anybody might do.

Holism in Psychology

In psychology, holism refers to an approach or perspective that emphasizes the importance of studying and understanding the whole person or system rather than focusing solely on its individual parts or components.

It suggests that individuals should be viewed as integrated and complex beings, with various interconnected aspects that influence their thoughts, emotions, behaviors, and overall functioning.

Holism in psychology recognizes that human beings are not simply the sum of their individual traits, but rather they are influenced by multiple factors that interact with one another.

These factors may include biological, psychological, social, cultural, and environmental aspects. Holistic psychologists aim to understand how these elements interact and shape an individual’s experiences and behaviors.

The holistic perspective emphasizes the interconnectedness of various dimensions of human functioning. For example, it acknowledges that individual thoughts and emotions do not solely determine psychological well-being but can also be influenced by social relationships, cultural context, physical health, and environmental factors.

Holistic approaches in psychology often strive to consider the whole person in assessment, diagnosis, and treatment. This can involve considering the person’s background, beliefs, values, relationships, and broader social and environmental factors contributing to their well-being or challenges.

By adopting a holistic perspective, psychologists aim to gain a comprehensive understanding of individuals and their experiences, considering both internal and external factors.

This approach recognizes the complexity of human beings and the need to address multiple dimensions for a more complete understanding and effective intervention.

Humanism investigates all aspects of the individual and the interactions between people.

It emerged as a reaction against those dehumanizing psychological perspectives that attempted to reduce behavior to a set of simple elements.

Humanistic, or third force psychologists, feel that holism is the only valid approach to the complete understanding of mind and behavior. They reject reductionism in all its forms.

Their starting point is the self (our sense of personal identity) which they consider a functioning whole. In Carl Rogers’s words, it is an “organized, consistent set of perceptions and beliefs about oneself.”

It includes an awareness of the person I am and could be. It directs our behavior in all the consciously chosen aspects of our lives and is fundamentally motivated towards achieving self-actualization .

For humanists, then, the self is the most essential and unique quality of human beings. It is what makes us what we are and is the basis of the difference between psychology and all-natural science.

Humanistic psychology investigates all aspects of the individual and the interactions between people.

Reductionist explanations undermine the indivisible unity of experience. They run counter to and ultimately destroy the very object of psychological inquiry. A holistic point of view is, thus, in humanist terms, the very basis of all knowledge of the human psyche .

Social Psychology

Social psychology looks at the behavior of individuals in a social context. Group behavior (e.g., conformity, de-individualization) may show characteristics greater than the sum of the individuals comprising it.

Psychoanalysis

Freud adopted an interactionist approach in that he considered that behavior resulted from a dynamic interaction between the id, ego, and superego .

Abnormal psychology

This is where the brain understands and interprets sensory information . Visual illusions show that humans perceive more than the sum of the sensations on the retina.

Looks at everything that may impact behavior.
Does not ignore the complexity of behavior.
Integrates different components of behavior in order to understand the person as a whole.
Can be higher in ecological validity.

Limitations

Overcomplicates behaviors that may have simpler explanations (Occam’s Razor).
Does not lend itself to the scientific method and empirical testing.
Makes it hard to determine cause and effect.
Neglects the importance of biological explanations.
Almost impossible to study all the factors that influence complex human behaviors

Keep Learning

Freeman J. Towards a definition of holism. Br J Gen Pract. 2005;55(511):154–155.
Michaelson V, Pickett W, King N, Davison C. (2016) Testing the theory of holism: A study of family systems and adolescent health. Prev Med Rep, 4, 313–319.

Holistic Approach to Research

First Online: 01 January 2012

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While rapid changes have taken place all over the world in social scientists’ attitude to research, in some quarters, Newtonian notions still dominate the academic mind and organizations. It is truer of the corporate sector, which purports to use research. A typical stance of corporate sector is that what cannot be quantified or measured is no good. Whenever we visit large corporations for studying organizations or manpower systems, almost invariably, we are stuck with the persistence of the question: Can you do the time-and-motion study? When we explain that we do not believe in fragmented or mechanistic approach to studying men and organizations, we find a look of sarcasm saying: ‘It is an unscientific approach’.

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Research Design Review

A discussion of qualitative & quantitative research design, a holistic approach to qualitative analysis.

A holistic approach to analysis acknowledges that (1) these unique contributions to our research are central to why we conduct qualitative research and (2) importantly, qualitative researchers owe it to their participants — who have given so much of themselves for our purposes — to maintain the integrity of their lived experiences.

How does the researcher do this?

At the conclusion of each IDI or focus group discussion, the interviewer or moderator should reflect on their understanding of what was learned from the participant(s). To do this, the researcher will use their notes and the audio and/or video recording of the session. It is useful to use Excel or something similar to log the key takeaways associated with the research objectives. By doing this exercise after each IDI or group discussion, the researcher is absorbing a complete “picture” of each participant’s or group’s attitudes, behaviors, and experiences. From there, the researcher can look across participants or groups to contrast and compare.

Crucially, however, the researcher is not necessarily contrasting and comparing simply based on the use of terminology or other obvious, manifest content. Instead, the researcher considers the entirety of what they have learned about each individual or group of participants as revealed in a combination of obvious, subtle, and contextual interconnections within the data.

This holistic approach begins in the beginning — before transcripts and coding — and, with concerted effort, is maintained throughout the analysis process.

Is Holistic Therapy Right for You?

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change.

Maskot / Getty Images

Types of Holistic Therapy

What holistic therapy can help with, effectiveness, things to consider, how to get started.

Holistic therapy, also sometimes referred to as holistic psychotherapy or body-centered psychotherapy, is an integrative type of therapy that incorporates both traditional and non-traditional treatments to help the individual as a whole.

Rather than focusing on a narrow problem, it considers mental, physical, and spiritual factors that influence a person's well-being and seeks to help people heal and thrive on a deeper level.

Holistic therapy combines aspects of traditional talk therapy and non-traditional approaches, including hypnosis, breath therapy, and meditation.

Holistic psychotherapy is an umbrella term that can encompass a number of different types of treatments. Professionals who offer this type of treatment may refer to themselves as holistic therapists, but they may also refer to their practice as:

Eclectic or integrative therapy : An approach that draws on multiple traditions and techniques in order to best address a person’s needs.
Mind-body therapy : This refers to groups of techniques that focus on improving body functioning and inducing relaxations as a way to improve health.
Somatic therapy : A body-centric approach that utilizes strategies such as breathwork, dance, and meditation to heal trauma, stress, and other mental health issues.
Spiritual therapy : An approach that incorporates belief systems and spiritual faith to explore problems that a person faces in their life.

Holistic therapy utilizes a range of techniques to help individuals understand their symptoms. In addition, such strategies are designed to foster a greater sense of self-awareness to better understand the connections between their body, mind, and relationships and how these elements play a role in mental health.

Such techniques are often rooted in mindfulness and bodywork practices. These techniques may include techniques commonly used in complementary and alternative medicine (CAM) that are designed to promote relaxation and help individuals better understand the connection between the body, mind, and spirit. Some of these practices include:

Acupuncture
Biofeedback
Guided imagery
Mindfulness

In addition to these elements, therapists incorporate psychotherapy approaches including cognitive-behavioral therapy (CBT), psychoanalysis , and person-centered therapy .

Holistic therapy may be helpful in the treatment of a number of different psychological conditions. Some of these include:

Emotional difficulties
Family problems
Work-related problems

Since this type of therapy seeks to heal the whole person, it may be helpful for problems that do not have a single, definable cause or those that affect multiple areas of a person's life.

Benefits of Holistic Therapy

The wellness practices that are frequently utilized in holistic therapy are often used more generally to help people deal with tension and stress and to promote overall well-being.

One benefit of holistic therapy is that it is a whole-body approach that addresses mental, physical, and spiritual health. It often allows individuals to better see the connections between these different aspects of their lives and better understand how this affects their health and wellness.

Many holistic techniques are also strategies that people can practice and perform on their own outside of therapeutic sessions. This can be particularly helpful in daily life when people are facing situations that can trigger stress, anxiety, or changes in mood.

By implementing tactics such as deep breathing , mindfulness, or meditation, people can better manage the situations that are contributing to distress.

Holistic approaches are also often centered on prevention in addition to treatment. Rather than waiting until a problem emerges, learning to utilize holistic treatments may be helpful for preventing problems that can harm a person's emotional, physical, social, or spiritual well-being.

Because of the wide variety of techniques and approaches utilized in holistic therapy, it can be difficult to evaluate its efficacy. However, it often incorporates other empirically validated therapies such as CBT and brief dynamic psychotherapy.

Techniques such as acupuncture, yoga, and deep breathing have also been effective for many purposes.

Some research does suggest that integrated, holistic care can have many benefits.

One 2017 article suggested that holistic approaches offer physical and mental benefits that are also cost-effective.
Research has found that mindfulness and meditation are useful for reducing anxiety and stress and can be adapted for various purposes and situations.
Guided imagery, often used in holistic practices, may help improve sleep, improve mood, decrease stress, and improve relaxation.
Research has shown that deep breathing techniques can reduce stress levels and promote relaxation, which can benefit both physical and mental health.

As with other types of therapy, it is essential to be willing to work with your therapist to deal with the emotional and mental conflicts you are facing. Holistic approaches require participation and are often very hands-on.

The non-profit academic medical center Cleveland Clinic notes that holistic therapy should not take the place of traditional medicine but can be used in conjunction with other treatments to help improve the healing process and overall well-being.

In some cases, your therapist may begin with more traditional, psychotherapeutic techniques before moving to other alternative therapies.

It is often helpful to approach treatment with an open mind in order to enjoy the full benefits of the process.

If you are interested in trying holistic therapy, there are a few things you should do before you get started.

Find a Therapist

The first step is to find a professional in your area who practices holistic therapy. Online therapy may be an option in some cases, but many of the more hands-on practices (massage and Reiki, for example) require in-person appointments.

You might start your search by talking to your primary care physician to see if they can refer you to a local holistic therapist. Another idea is to do a general online search or look through a therapist directory.

People who incorporate holistic techniques into their practices may go by other titles including clinical psychologist or marriage and family therapist, so you may need to ask about the techniques that they practice if there is a specific experience you are interested in trying.

Get Help Now

We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you.

What to Expect

During your first session, your therapist will evaluate your current state of functioning and work with you to develop goals for your treatment. Because holistic therapy is flexible, your needs can be evaluated, and your plan adapted as you progress through therapy based on your needs.

You should also find out about insurance and payment options before you begin your treatment. Because many holistic approaches are not covered by insurance, your therapist may not accept insurance as a form of payment. Check with your insurance provider to find out what services are covered before you begin treatment.

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Ma X, Yue ZQ, Gong ZQ, et al. The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults . Front Psychol . 2017;8:874. Published 2017 Jun 6. doi:10.3389/fpsyg.2017.00874

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Home » Research » How We Define Research

How we define research.

The goal of our research is to establish a field for nonviolently inhabiting the Earth. Cooperation and trust are our guiding criteria. By researching the social, spiritual, sexual, ecological, technological and economic areas of life, we work on foundations for a possible new planetary culture. When we live in full trust and cooperation with each other, all life and the Earth, aligning with life’s self-healing powers, violence becomes impossible.

Trust and Cooperation

Tamera is a living laboratory. We’re developing social and ecological conditions in which violence ceases to exist because its underlying root causes have been dissolved.

Our inquiry is: how do we as humanity in the 21st century need to organize our societies so that trust and cooperation arise between children and parents, lovers, all generations, nationalities and cultures, as well as people and nature (plants, animals, etc.)?

This kind of research is a communitarian process of practice-based learning, i.e. trial and error, in which providing mutual feedback, communicating truthfully, reflecting and evaluating are key.

Human-focused research

We don’t separate the research object from the subject. Our deepest research object is ourselves. It’s human beings who have generated the problems of this world, which means we also have the ability to dissolve and heal them when we gain insight into what we’re doing and why.

As Dieter Duhm writes, “If one wants to know how humankind functions, one should learn how a group functions, for a group contains all the light and shadow sides of our human existence within it.”

Raising Consciousness

As we see it, violence results from unconscious habits of thinking and acting. Sabine Lichtenfels says, “Where there’s consciousness there can be no war.”

That’s why research, as we understand it, is a process of raising consciousness. We push the edge of reflective consciousness further and further into those realms so far governed by our collective trauma. Through this phenomenological approach (studying the development of human consciousness and self-awareness) we can see where human social dynamics allow truth among people to emerge and thereby generate lasting trust and healing.

Our research involves generating new experiences and studying the many indicators for the existence of a universal healing matrix around the world, then collectively observing and gaining insight from them. The ability to translate insight into intersubjective language and connect the dots between diverse experiences from various fields into a coherent, sound worldview is what affects sustainable change.

We’ve found that when we truly shift from fear to trust, from exploitation to cooperation, life responds differently. All beings react with gratitude, opening and the mutual offer of cooperation when we enter into full, immediate contact with the living. We’re in a fundamentally different empirical state outside the pattern of fear and violence than in it. This difference is what orients the direction of our research – in all areas.

Cooperation with the Academic World

We’re aware our research doesn’t necessarily fulfill conventional academic epistemological (study of knowledge) approaches. That’s why we welcome the opportunity to collaborate with universities and researchers interested in scientifically documenting our research.

We have entered into such collaborations already, for example with Fundação da Faculdade de Ciências da Universidade de Lisboa (FFCUL) on how our water retention landscape can restore the water cycle and reduce vulnerability to droughts. If you’re interested in collaborating, please reach out to the leaders of each respective research area.

Want to be part of global system change? Stay in touch and receive our regular updates:

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Holistic Nursing Research: Challenges and Opportunities

Holistic Nursing Research: Challenges and Opportunities Rothlyn P. Zahourek Nurse Healer OBJECTIVES Theoretical Discuss ways holistic philosophy and theoretical frameworks are reflected in holistic nursing research (HNR) priorities. Discuss the recent NCCAM strategic plan and its impact on holistic nursing research. Discuss the complexity of determining adequate evidence for holistic nursing research. Explore the challenges for holistic nursing research. Compare and contrast a variety of research methods. Clinical Explore how holistic nursing research questions can be developed in your clinical setting. Read a research article related to a modality you use in your holistic nursing practice. Collect data from various clients who are participating in some form of holistic therapy to determine their subjective evaluations of the experience and outcome. Discuss ways to enhance practice through holistic research with colleagues and nurse researchers. Devise a holistic nursing research question and propose a method of research that would best explore that question. Personal Contemplate how a conceptual framework of holism is the foundation for holistic nursing research and practice. Clarify your own personal definition of holism and holistic nursing. Consider that you do research every day in clinical practice as you assess patients and their situations, make diagnoses, plan and follow through on actions, and evaluate those actions. Plan time to learn how to form a research question. Attend a research conference or a section on research at the American Holistic Nursing Association (AHNA) annual conference or at a local networking meeting. DEFINITIONS Bias: Having preconceived ideas and expectations about a research study’s outcome. May be overt or more subtle as a hope or expectation. Bracketing: Characteristic of qualitative research. The researcher outlines in writing his or her philosophies, biases, or concerns and expectations about the research project process and/or outcome. Credibility: A term used in qualitative research that accounts for the researcher’s trustworthiness in demonstrating the process of data collection and interpretation of results. Hawthorne effect: When people know they are being observed in a study, their behavior is affected simply by being observed. Healing: Both a process and result; defined by the individual as perception of shift or meaningful change. The central concept in holistic nursing research. Healing relationship: The quality and characteristics of interactions between healer and the one being healed (healee) that facilitate healing, including empathy, care, love, warmth, trust, confidence, honesty, courtesy, respect, and communication, as well as compassion, presence, intent, and intentionality. Heisenberg’s Uncertainty Principle: The principle that observation of phenomena or objects changes the nature of what is studied. Integral: The appreciation for the interactions and interrelationships of the many parts within the whole of a system. Meta-analysis: A statistical technique that combines the results of many studies related to one topic to establish an overall estimate of the therapeutic effectiveness of an intervention. Mixed methods research: A type of research that combines paradigms, philosophies, and methods on a specific topic to grasp a more complete representation of reality and/or confirm the credibility of the research findings; also may be referred to as triangulation. Placebo: A medically inert medication, preparation, treatment, technique, or ritual that has no intended effects on the person and no actual therapeutic value. The fact that the placebo is inert is now in question based on the impact of suggestion and intention. Praxis: The bringing together of practice and research. It is a synthesizing and reflective process in which theory is dynamic and practice reflects research and theory in a unified whole. Qualitative research: A systematic, subjective research approach that describes life experiences and searches for how participants find meaning in their experiences; based on philosophical, psychological, and sociological theory; focuses on understanding the whole, which is consistent with the philosophy of holistic nursing. Quantitative research: A systematic, formal, reductionistic, objective approach in which numerical data are used to obtain and interpret information about the world. It embodies the principles of the scientific method and describes variables, examines relationships among variables, determines cause-and-effect interactions between variables, and predicts future responses. Reductionism: The approach of breaking down phenomena to their smallest possible parts; also called positivism and equated with the linear, logical nature of the scientific method. Reliability: Generally associated with quantitative research and the ability of a scale or a tool to consistently measure a phenomenon when used repeatedly. Research: A diligent, systematic inquiry or investigation to validate and refine existing knowledge and generate new knowledge. Systematic review: A specific form of review of research studies that yields more convincing evidence. Several methods exist; these are invaluable in discovering what has already been discovered about a particular phenomenon. Translational research: Taking basic bench highly reductionist (molecular or cellular) research and translating that into clinical application. It generates new research questions that are fed back to the bench. More broadly, translating any research into practice. Unitary: The recognition that parts cannot be separated from the whole because the whole is greater than, and different from, the parts; contention that separating phenomenon into parts undermines the understanding of the whole. Validity: Generally associated with quantitative research; internal and external; relates to the interpretation of data; meaningful, appropriate, and useful results are required for validity. Internal validity is related to the controls placed on the research design and process and ensures that the effects of the independent variable are causing the results in the dependent variable. External validity ensures that the results are generalizable to other populations, settings, and times and depends on internal validity. ▪ HOLISTIC NURSING RESEARCH As human beings, we are driven to explore. We strive to understand ourselves and our world and thereby construct belief systems that we want others to accept and act on. Historically, mystics and shamanic healers believed in the healing power of ecstatic experiences of a unified cosmic whole. Pagans believed that all matter, living and nonliving, had spirit and a life force that could communicate. Now philosophers, theoretical physicists, and behavioral scientists study “subtle energy” and theorize about the nature of and actions by consciousness. 1 In the 1600s, Descartes’ notion of reductionism separated soul from body by breaking down every research subject into its smallest parts. This liberated medicine from religion and advanced the use of the scientific method in medical research. Since then, science developed and humans become smug about being rational creatures. Depending on the logic of the scientific method, A plus B has to equal C; such logical relationships have to behave predictably to be considered credible and valid. Impassioned controversy wages between a belief in only that which is visible and proven, and faith in what is unseen, experienced, but poorly understood. Is the world flat as it appears to the naked eye, round as the globe in the classroom, or egg shaped as seen from space? Does energy exist as quantifiable sound waves, electrons colliding, or as something nonlocal that we cannot see, touch, or, at present, measure? Surprisingly, invisible cyberspace e-mail messages become visible when they are transduced into images on a computer screen. Holistic nursing research (HNR), as well as the fields of complementary and integral medicine and complementary and integral nursing, are on the cusp of such a conundrum. Much of what nurses value in interventions and holistic nursing process can’t be seen or measured. Often, effects take time to be realized and are unpredictable. Many concepts that nurses want to study remain ill defined, and some holistic practices appear to others as based in mysticism, magic, or paranormal phenomena. Others use nursing theories to explain holistic nursing practice as well as abstract theories from quantum physics and evolving theories on the nature of consciousness and reality. Although holistic nurses may continue to believe in the power of spirit and unexplained forces, we have a duty to understand the nature of such phenomena and to ethically demonstrate their safety and efficacy in clinical practice. The nurse’s primary mission is to foster healing and, therefore, we must develop a body of credible, reliable, and valid research and sound scholarship. In 2003, a stellar multidisciplinary group of scholars met to determine the definitions and standards for healing research. Their work continues to influence holistic nursing research. The authors insisted that the healing relationship be the focus for healing research. Healing is both a process and result. “Those physical, mental, social, and spiritual processes of recovery, repair, renewal, and transformation that increase wholeness, and often (though not invariably), order and coherence. Healing is the emergent process of the whole system.” 2 Healing is perceived by the individual as a shift, meaningful change, or transformation and is experienced as restored balance or sense of wholeness. 3 Quinn and nurse colleagues provide a definition of healing relationship for nursing research: “the quality and characteristics of interactions between healer and healee that facilitate healing. Characteristics of this interaction involve empathy, caring, love, warmth, trust, confidence, honesty expectation, courtesy, respect, and communication.” 4 Holistic nurses also consider compassion, presence, and intent and intentionality as components of the relationship and process of healing. The purpose of this chapter is to provide a matrix framework for HNR that is based on definitions of wholeness and healing, and nursing theories that are based on ways of knowing and viewing the world. We consider the third National Center for Complementary and Alternative Medicine (NCCAM) strategic plan for 2011-2015 and its influence on HNR, review the status of HNR and approaches to HNR, and consider the challenges and opportunities for the future. In addition to the standard approaches of qualitative, quantitative, and mixed methods designs, other approaches are discussed. ▪ WHAT IS HOLISTIC NURSING RESEARCH? How do we understand and connect science and spirit? How do we explore the healing relationship and healing itself? What is different about holistic nursing research? Enzman-Hagedorn and Zahourek emphasize that although holistic nurses use a variety of integrative and complementary modalities, HNR must occur within a framework of theory and practice that accepts holism as its base. 5 , 6 The American Holistic Nurses Association (AHNA) white paper on holistic nursing research adopts this caveat: “Solid evidence for the effectiveness of these approaches is often dependent on the interplay of relationships, the passage of time, and interaction of many variables some of which are not easily controlled using standard methods or a conventional scientific frame work.” 7 Simply evaluating a modality or providing evidence of safe, effective practice is not necessarily true HNR. The AHNA recognizes two definitions of holism: The whole is viewed as a relational integration of parts (i.e . , integral ), or the whole is separate from and greater than the parts (i.e., unitary ). 8 A researcher using the integral framework values interactions, influences, and outcomes and most often utilizes quantitative, mixed methods, evidence-based practice research, meta-analyses, and surveys. The unitary researcher recognizes that separating phenomena into parts undermines total understanding. Research in this framework is most often qualitative, including hermeneutic, phenomenologic, ethnographic, and grounded theory methods, as well as mixed methods and aesthetic, historical, and other approaches. For nursing research to be holistic, it must clearly incorporate one of these frameworks into the question, design, method, analysis, and interpretation of findings. Integrating one framework or developing a unique definition of holism should be evident in the research question and interpretation of results. The research gold standard, the randomized controlled trial (RCT), is reductionistic as opposed to holistic in nature. However, such a study could be considered holistic if the researcher acknowledges that there is a whole context, or experience, that is greater than, and possibly different from, the smaller interactions of specific variables. The researcher might skillfully qualitatively study a phenomenon by describing the individuals’ experiences and interpreting results in a holistic framework. For example, several patients react positively to Healing Touch treatments. Their reactions remain for that selected population. From such data, however, a beginning theory or hypothesis might emerge. When we use observations and descriptors, devise measurement tools, and quantitatively measure outcomes, we have increasingly reliable, valid, and generalizable results. However, we may have missed understanding the nature of a person’s total experience and the subsequent implications for practice. ▪ BASICS OF HOLISTIC NURSING RESEARCH: WAYS OF KNOWING AND NURSING THEORIES Holistic nursing research is based in a holistic paradigm. Nurse theorists such as Rogers, Newman, Parse, Watson, and Leininger developed a wealth of unitary and integral theories as they struggled to understand caring, healing, and the nature of the whole. (See Chapter 5 .) In addition, they and their protégés created methodologies and tools to conduct research. For example, Margaret Newman developed the theory of Health as Expanding Consciousness (HEC). Newman conceptualizes a unitary time framework that illuminates “the meaning of a person’s present situation within the context of the past and anticipating future action.” 9 She proposes a qualitative “hermeneutic, dialectic method,” which is used to “allow the pattern of the person and environment to reveal itself without disrupting the unity of the pattern. The process culminates in intuitive apprehension and expression.” 10 For Newman, research is praxis and, therefore, based in practice. Research emanates from the nurse’s engagement with participants during important events and within significant relationships; it “enables pattern recognition and expanding consciousness to occur.” 9 Pattern recognition acknowledges the whole. In a classic text on research based on Newman’s work, Jones and Picard present numerous research examples using Newman’s framework including the pattern of letting the past go in order to move on for parents of persons with bipolar illness 11 and recognizing life patterns in women with multiple sclerosis. 12 Measurement tools are beginning to appear to document behaviors that illustrate caritas in Jean Watson’s evolving Theory of Caring. 13 , 14 Richard Cowling has developed a research framework, Unitary Appreciative Inquiry, based on Martha Rogers’s Science of Unitary Man. This framework considers the pattern of the unitary whole as the orientation and process for “uncovering human wholeness and discovering life patterning in individuals and groups” 15 His unitary pattern recognition with women experiencing despair utilizes data synopses rather than data analysis. Worldviews and Ways of Knowing All research is based on a philosophy or worldview. Although differing in language, these systems all tend to view a bifurcated, or particulate, reality in which humans and their world are portrayed through such descriptors as subjective and objective ; individual-intrapersonal ; interpersonal and cultural ; and aesthetic and ethical . Few paradigms try to address the whole other than by describing parts and their relationships. Pattern may be one concept that captures a unitary whole. However, when posing a research question, choosing one of the following ways of knowing can help researchers frame their studies. (See Chapter 1 for more discussion on ways of knowing.) The AHNA recognizes various patterns of knowing including rational or scientific, intuitive, and aesthetic. Intuitive and aesthetic are emphasized because these approaches are needed to understand the “multidimensional nature of our work, which encompasses the art of care; the wholeness of the client’s experiences and meaning of patterns that emerge; the beauty of authentic interaction; and the knowledge of that which is perceived through nonverbal, nonobjective expression.” 16 Historically, nursing research and theory generation have been based on Carper’s classical work. She proposed a system of four ways of knowing : 17 Empirical: Objective, logical, and positivistic science Ethical : Obligations, what should be done in a given situation; what is acceptable practice; requires openness to differences in philosophical positions 18p12-13 Personal: Self-knowledge; determined by ability to self-actualize; comfort with ambiguity; commitment to patience and self-care Aesthetic : Artful knowledge; abstract; defies formal description and measurement; understanding of subjective experiences; creative pattern Porter recently argued that these patterns are linear and hierarchical rather than holistic. 18pp3-14 He critiques both evidence-based practice and Carper’s framework as reductionist, linear, and too weighted in the empirics and simplistic in logic. He believes that too little weight has been given to the personal, aesthetic, and ethical, all of which fall into the ineffable. He advocates for “practice based evidence” 18p12 in which “nonempirical patterns of knowing animate practice” and become documented and thereby empirical. The role of empirics, then, is demonstrative rather than deterministic. 18p13 Fawcett developed a classic paradigmatic system that describes three frameworks of increasing degrees of abstractness: 19 Particulate-deterministic. Reductionist, concrete 2 . Interactive-integrative. Reality is multidimensional and contextual; reciprocal relationships Unitary-transformative. Human beings are unitary, evolving, self-organizing fields, and defined by pattern; highly abstract 19 Nurse theorists Watson, Newman, Parse, and Rogers are associated with the unitary-transformative paradigm. Enzman-Hagedorn and Zahourek developed an integrated model that combines Carper’s and Fawcett’s paradigms with specific research approaches for holistic nursing research. 20 Mariano provides a slightly different framework described as four “attributes of scholarship”: wide awake, reflective, caring, and humorous. 21 By keeping ourselves wide awake, we become aware of our place in humanity, are open to possibility, are attentive to others, and are conscious of our evolving experiences. In research, we are sensitized to ask unexplored questions with which we discover the unique and novel. Reflection is an introspective thoughtful process in which one’s philosophical stance, values, assumptions, biases, and decision-making process become more evident. The third attribute for scholarship is caring. Drawing from Jean Watson, 22 Mariano explains that our research should be ethical, moral, and based on pressing human needs. We must be intellectually empathic, just, and fair minded. Finally, she states that true scholars have a sense of humor. We should expect and embrace the unexpected, keep our goals and accomplishments in perspective, and be willing to admit when we are wrong. 21 Munhall describes one additional worldview useful to HNR: the pattern of unknowing . Unknowing captures intuitive experiences. 23 Knowledge is shaped, but not completely defined, by the process or context in which it occurs. Larry Dossey continues to discuss the local and nonlocal aspects of healing, arguing that we must grapple with these areas of mystery to understand such fundamental concepts as compassion and intentionality. 24 Schwartz and Dossey discuss the unexpected confounds of the observer effect and intention on prayer, “distant healing,” and intention research outcomes. 25 Braud and Anderson developed transpersonal research methods based on such alternative ways of knowing as altered levels of consciousness, intuition, setting intention, knowing through art, feminine spirituality, and knowing through movement and through listening. 26 Jonas and Crawford analyzed more than 220 reports on nonlocal healing effects (122 controlled laboratory studies and 80 randomized controlled trials). 27 Their results support that these unexplainable phenomena do exist, but inconsistently. Any energy-based research must struggle with the inability to see and measure process and effects accurately and consistently. Finally, Ken Wilber developed yet another integral model of how people experience their world that is useful for holistic nurses. 28 (See Dossey’s Theory of Integral Nursing in Chapter 1 for a full discussion of this model.) These frameworks provide a malleable matrix on which to ground HNR. Each framework acknowledges holism and reductionism. All include experiential qualitative approaches that enrich our understanding of complex phenomena as well as the quantitative comparative approaches, program evaluation, and other forms of evidence from practice. We need better and more diversified approaches and more sensitive instruments to assess and document the interactive nature of holistic nurses with each client’s bio-psycho-social-spiritual patterns in wellness and in illness. Table 34-1 summarizes these paradigms and provides a reference for holistic nurse researchers’ planning, executing, and interpreting their research. In addition, research frameworks from the behavioral and social sciences and psychoneuroimmunology provide useful methods, theories, and models for HNR. ▪ IMPACT OF THE NCCAM 2011 STRATEGIC PLAN The National Center for Complementary and Alternative Medicine (NCCAM) is the agency dedicated to scientific research on complementary and alternative medicine (CAM). CAM is defined by NCCAM as a group of diverse medical and healthcare interventions, practices, products, and disciplines that are not generally considered part of conventional medicine. 29p1 Early in 2011, NCCAM released its new strategic plan. Because many of the interventions classified as CAM are also holistic nursing interventions, this plan has implications for holistic nurse researchers. The plan will shape not only what NCCAM and other government agencies fund but also the national direction and focus of research for the next few years. In her introduction, NCCAM Director Josephine Briggs states that the previous plans emphasized that CAM research focus on basic evidence to discover biological properties of interventions and conduct RCTs to ensure effectiveness and safety. In this current plan, translational research, effectiveness and outcomes research, and real-world results are emphasized. Training new researchers and multidisciplinary teams is encouraged. NCCAM Strategic Plan: Goals and Objectives Within the strategic plan are three goals and five strategic objectives. The three overarching goals are the following: Advance the science and practice of symptom management. Develop effective, practical, personalized strategies for promoting health and well-being. TABLE 34-1 Summary: Ways of Knowing Theoretical Frameworks Research Approach Carper’s Ways of Knowing: Fawcett’s Paradigms Wilber’s Integral Model AHNA’s Way of Knowing Mariano’s Attributes of Scholarship Quantitative: RCT, EBP, experimental, quasi-experimental, descriptive Empirical Objective, logical, positivistic; provides measurement and generalizability Particular-Deterministic: Reductionist, concrete Objective “it,” material body, biochemistry, behaviors, scientific observations on time and space Rational/Scientific Quantitative: Descriptive, correlational Mixed methods Interactive and Integrative: Multidimensional reality, contextual, reciprocal relationships Objective “its,” collective exterior, social systems, regulatory structures Rational/Scientific Being Wide Awake: Thinking about our place in humanity, open to possibility, attentive to others and conscious of our evolving experiences, posing questions from descriptive data TRANSITION TRANSITION TRANSITION TRANSITION TRANSITION TRANSITION Qualitative: Postmodern feminist mixed method approaches Ethical: Obligation about what should be done, open to different philosophies Interactive and Integrative or Unitary Transformative: Human beings are unitary, evolving self-organizing fields defined by patterns Subjective “I” and subjective “we,” imagination, internal experience Intuition Caring: Ethics, fair mindedness, human and society needs, intellectually empathic Qualitative: Reflective, transpersonal Mixed methods Personal: Self-knowledge, ability to self-actualize, comfort with ambiguity, commitment to patience and self-care Unitary Transformative: Human beings are unitary, evolving self-organizing fields defined by patterns Subjective “I” and subjective “we,” shared values and meaning Reflective: Introspection, displays one’s thought process, values, biases, ethics, etc., to others; critical thinking Qualitative: Transpersonal, aesthetic creative approaches Aesthetic: Artful knowledge, abstract, defies formal description, creative Unitary Transformative: Human beings are unitary, evolving self-organizing fields defined by patterns Subjective “I” and subjective “we,” changing states of consciousness and emphasis Aesthetic Humor: Expect and embrace the unexpected, willingness to admit when we are wrong or failed Enable better evidence-based decision making regarding CAM use and its integration into health care and health promotion. These goals resonate with holistic nursing philosophy, research, and practice. The plan stresses research to understand more clearly how, and if, interventions augment other treatments. For example, does yoga practice augment standard approaches for treating back pain? According to the NCCAM plan, recent epidemiologic data indicate that people who use CAM engage in other health-seeking behaviors. 29p5 At present, this remains a good hypothesis that needs further testing. Health promotion is a standard nursing (especially holistic) practice, goal, and activity on which we also are compiling research evidence. Currently, the term evidence based is being expanded to include multidisciplinary research teams conducting research “across the continuum of basic, translational and efficacy and effectiveness research.” 29p11 The definitions of those terms according to the new strategic plan are useful in that they are now used with increasing frequency: 29p11 Basic science: Investigates biological effects and mechanisms of action; it clarifies hypotheses and answers the question: “How does it work?” Translational research: May identify markers of biological effect; develops and validates measures of outcome; develops algorithms and preliminary clinical efficacy; estimates sample size for future studies. Answers the question: “Can it be studied in people?” Efficacy studies: Highly controlled studies to determine specific effects of an intervention. Answers the question, “What are the specific effects?” Effectiveness and outcome studies: What is the usefulness and safety of the intervention in general populations and healthcare settings? Answers the question: “Does it work in the real world?” The five strategic objectives of the 2011-2015 NCCAM plan are as follows: Advance research on mind and body interventions, practices, and disciplines. Advance research on CAM natural products. Increase understanding of real-world patterns and outcomes of CAM use and its integration into health care and health promotion. Improve the capacity of the field to carry out rigorous research. Develop and disseminate objective, evidencebased information on CAM interventions. Holistic nurse researchers already are addressing many of these strategies. The following discussion gives specific examples of selected strategies. Researchers, educators, and clinicians are all encouraged to become aware of this plan as it relates to a portion of what holistic nurses do and how they might consider crafting their research. Recognizing national trends helps frame potential problems to be studied and provides additional research methods to use. The following discusses the strategic objectives and provides examples of related holistic nursing research. Strategic Objective 1: Advance the Research on Mind-Body Interactions This objective includes elucidating biological effects and mechanisms of action. Developing a greater understanding of the placebo response, the influence of expectancy and the relationship, and discovering creative and innovative research designs that account for issues of treatment burden and the ethics of random assignment are included in this category. Coakley and Duffy report a pilot study to investigate the effect of a single Therapeutic Touch treatment on pain perception and biological markers of stress such as cortisol and natural killer cells (NKCs) in patients recovering from vascular surgery. 30 The design incorporated both physiologic measures as well as subjective reports of pain. Their sample included 21 patients, 12 in the experimental group and 9 in the control usual treatment group. After adjusting their statistics using standard approaches, the results indicated that preoperative pain and cortisol levels dropped significantly and NKC levels increased significantly. The authors recommend that further study be done in a more controlled fashion.

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April 23, 2024

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Ecosystems are deeply interconnected—environmental research, policy and management should be too

by Rebecca Gladstone-Gallagher, Conrad Pilditch and Simon Francis Thrush, The Conversation

Why are we crossing ecological boundaries that affect Earth's fundamental life-supporting capacity? Is it because we don't have enough information about how ecosystems respond to change? Or are we unable, even unwilling, to use that information better?

We have a lot to learn still, but as we show in our research , using current ecological knowledge more effectively could deliver substantial environmental gains.

Our work focuses on improving links between research and ecosystem management to identify key trigger points for action in a framework that joins land, freshwater and sea ecosystems.

Specifically, we investigate solutions to environmental and societal problems that stem from the disparities between scientific research , policy and management responses to environmental issues.

We need managers and policy makers to consider ecological tipping points and how they can cascade though ecosystems from land into rivers and lakes and, ultimately, the ocean.

Our work's standing among global research aimed at stopping ecosystem collapse has been recognized as one of 23 national champions in this year's Frontiers Planet Prize .

Cyclones as a real-world example

As a result of massive soil erosion on the east coast of the North Island during Cyclone Bola in 1988, steep hillsides were retired from grazing and converted to pine plantations to help stabilize the land.

Fast forward three decades and a large proportion of the forest reached harvest at the same time. The exposed soil associated with clear felling was left draped in woody debris to protect it from rain.

However, Cyclone Gabrielle hit in February last year, with extreme rainfall washing both soil and woody debris into streams.

This destroyed habitats, transported vast amounts of silt and wrecked lowland farms, orchards and critical infrastructure. The debris also clogged harbors and coastal beaches, smothered seafloor habitats, destroyed fisheries and affected cultural and recreational values.

This real-world example demonstrates the severe consequences of lags in information flow and management responses. If land-use management decisions had considered the effects on other connected ecosystems and the potential for climate change to intensify those connections, the outcomes could have been different.

We could have implemented more diverse strategies in land use and put emphasis on restoring native forest and coastal wetlands.

Living with nature, not off it

Our vision is one where social and ecological connections across ecosystem domains are at the forefront of moving to a more sustainable future.

Living within planetary boundaries requires a paradigm shift in behaviors, including the way we link science and management to on-the-ground action. Crucially, we need to increase the speed at which new research is taken up and rapidly transition this into action that improves environmental outcomes at local scales.

This behavioral shift underpins the way to a more integrated, broad-scale ability to act and stay within planetary boundaries.

Our research shows we can, with trust and open minds, transcend the disciplinary silos to support new forms of research organization. The challenge now is to extend holistic approaches into new practices.

This means identifying opportunities where connected research can alter behaviors across society, from individuals to global finance and governance. Central to this transition is recognizing we are part of complex social and ecological systems and our actions have indirect effects and long-term consequences.

We need new research to provide this evidence. It will inevitably lead to new questions about fundamental ecological and integrated Earth processes.

We believe these holistic approaches will allow science to be more readily incorporated into decision making and ensure environmental perspectives are captured. This will lead to relevant, locally appropriate, integrated and robust environmental management actions.

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What Is Holistic Design? The Future of UX or a Buzzword?

mins to read

“Holistic design” sounds like a new flashy trend that’s used here and there without a real meaning behind it. However, the term was present long before UX design was born. Some say it was on the scene before the product design became a thing in the 1920s.

Nowadays, when we started using “product design” for digital products and “industrial design” for furniture, gear, and other hardware things, “holistic design” makes a comeback to UX design. Or has it never gone?

We are an agency full of seasoned UX designers , but “holistic design” is not very easy to explain. Let’s start with the main question:

What is holistic design?

Holistic design is a design approach that suggests looking at the product from different angles, considering all the aspects, stakeholders, and the environment.

However, the definition of holistic design is not enough to really understand the phenomenon. The holistic design combines the approach, practices, and the philosophy.

Holistic design is not something that happens solely in the design department. It is a synchrony of all the company processes: to provide a holistic user experience, a good-looking UI is not enough, you need a holistic mindset.

The term “holistic design” is often used in architecture, urbanism, and interior design. For example, ancient Greek tractates about urban planning suggested that architects should consider the directions of the winds when projecting the streets of the city in order to create the most comfortable air circulation.

Some of the problems related to holistic design in other spheres can help better understand how holistic design can be applied in the modern digital world.

When projecting an interior, designers should not only think of the clients’ tastes and general style consistency. Here are some of the questions designers have to consider while developing a holistic design:

Is the neighborhood noisy? Does the apartment need noise isolation?
Are the materials sustainable? If we put this vintage fridge, would it be possible to fix it if it breaks in 5 years?
Is the furniture resistant enough to the cat’s claws?

Holistic design is not something that every client wants. It is a long process and requires not only the budget but also time and will to change the corporate processes and even culture. Of course, the company aiming for holistic design should have a high level of UX maturity .

When the decision to adopt a holistic approach is well thought, you can start shifting to new design practices.

Rules of the holistic design approach

Take into consideration all the stakeholders , not only users or customers. It doesn’t mean that we have to solve everyone’s problems with our product. Yet, we have to be aware of all things happening around us.
Research methods . When we focus solely on users, individual interview s are a golden standard of UX research. When we decide to take a holistic approach, we have to add other methods to our research, such as ethnographic research. We have to go out in the field to better understand the environment.
Participative practices . A step forward from taking into account all of the stakeholders is to involve them in the design process. It is likely to be tricky and even messy, but giving such approach a try doesn’t cost much. The promoter of design thinking , David Kelley, pointed out that involving people of different backgrounds significantly benefits the process.
Sustainability . Most modern companies want to appear sustainable. They introduce the principle in various parts: from corporate responsibility programs to even the production process. There is always room for improvement in sustainability, and holistic design naturally raises the company standards.
Ecosystem , not just design system. A design system is a great tool for the company, but it applies mostly to the design sphere. It is often used to simplify and unify UI/UX design. Holistic design implies an ecosystem including values, philosophy, and attention to every detail.
Going beyond digital . Even if we are talking about a highly digitalized company, in the absolute majority of cases holistic design solutions will change physical items, such as offices, and also the human capital.

Real companies. Holistic or not?

As we say that holistic is an idealistic term, it is hard to say that any company at all is really holistic. Yet, there are some that move in that direction. Sometimes these are the same companies that invest in the petroleum industry (nobody said “holistic” was simple).

Let’s go through some examples to see how far famous companies can get on their way to becoming “holistic”. Is there a way to avoid mentioning Apple in an article about design? Not that we know.

Holistic style. Apple

Apple stands quite close to the holistic design approach. All the products have a clear consistent line, the company has a recognizable style and philosophy. All Apple products sync naturally and gather in an ecosystem: they look similar, they use the same software and user interface, they feel the same. Once people get used to the Apple ecosystem, they have hard times abandoning it.go on using the same products.

However, the sustainability of Apple design is questionable. The company is constantly using the principle of planned obsolescence and its products are not very easy to repair. Also, the well-known method of Apple is to create users’ needs rather than satisfying existing ones. Products are often designed with limitations that require users to adapt to them rather than adapting to users: for example, new Iphones have no power adapters.

Design thinking applied. Bosch

The spectrum of holistic design approach is large. It might be unexpectable to see this company as an example, but there is something we can learn from Bosch, a company with over 150 years history and quite a traditional line of products.

Apart from quality electro domestics, Bosch is known for its success in applying design thinking throughout a large established company. They started with launching a whole “design thinking department” and it changed the processes in the company leading to the redesign of office interiors to adapt to the reshaped collaboration models.

Bosch is now producing a wide range of products apart from washing machines. They construct smart buildings that promote sustainable living. This is a classic understanding of holistic design approach in modern times.

One of the good practices that Bosch adopted is involving people of various profiles in the design process, such as engineers, testers, marketers, scientists. Diverse teams provide the best ground for innovative solutions.

How holistic is Bosch’s approach? They mostly declare the design thinking approach, but being an old German company working with product design, they are well familiar with the notion of holistic design from the first sources. How sustainable is their product? Well, we'll leave it to the environmentalists.

Holistic path of small companies

In this article, we’ll leave apart the interior Feng Shui design companies and will focus on UX.

One of the companies that declare holistic design to be a cornerstone of their work is Tactile design firm. They see UX as a cross-pollination of various disciplines, from architecture to marketing. No surprise that half of the company consists of industrial designers and engineers.

Ideal cross-pollination: UX design with other disciplines

Designers at Tactile dedicate a lot of attention to studying the context of the product they are working on. Also, they surely go beyond digital as they work a lot on physical interfaces and innovative technologies.

As a UI/UX design agency , we are far from claiming ourselves holistic. However, we do like the approach and it is present in our work.

We always try to do a bit more than the client asks us. Solving the problem is good, but our objective is also to simplify the implementation of the design and think of design accessibility even when it is not in the brief.

Take a look at the case study of Handprinter , a lifestyle app. As the product itself is quite holistic, our approach was similar: we thought about all the stakeholders, thought not only about the principal user’s goal – decreasing the handprint - but also about other aspects, such as a social network of like-minded people.

What to start with?

If you are more than just curious about a holistic approach and want to try adopting it in your company, our advice is to start slow. Here are few steps that will get you closer on the way to holistic design:

Apply design thinking (you might think it is another buzz word and you’ve heard of it a thousand times already… But check out these design thinking examples from top companies if you have doubts).
Design system . It’s likely that you already have one, but look at it closer: is it a real system based on philosophy or more of a visual components library? Are the principles of the design system used outside of design software?
Check if your design is inclusive . Without being inclusive, there is no thinking of a holistic user experience.
Provide consistent user experience. Make sure that your customers are enjoying interacting with the product at every moment of their journey. Every little thing is important for a holistic user experience. How to get there? Dig deeper into UX research , go beyond competitors’ analysis and user interviews.

The most complicated thing about holistic design is that different people have very different images of it. The second most complicated thing is that the idea of holistic design is rather idealistic: each goal is never final, the path is ongoing. Yet, following this path would bring many pleasant bonuses on the way.

Let me finish with a quote from Karthik Vijayakumar, Founder and Principal, DYT Studios & Host of The Design Your Thinking Podcast.

Holistic design is to see and think of the world in two broad dimensions – as interconnected and evolving systems. Holistic design is formed by and leads to interconnected systems. Evolving nature of holistic design is when the design leads to the evolution of the interconnected systems.

And if you want to talk more about holistic design — or about anything else — we are here .

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From Amazon to Uber: Why Platform Accountability Requires a Holistic Approach

April 22, 2024 • 5 min read.

Platform companies like Uber, Amazon, and Instacart wield immense influence over workers. New research co-authored by Wharton’s Lindsey Cameron offers a framework that integrates different approaches to level the playing field for all users.

Uber driver driving in the car and tapping their phone screen for the next customer

Public Policy

In a significant move this month, European Union ministers ratified rules that grant essential labor rights to some 28 million “gig economy” workers on platforms like Uber and Deliveroo. These regulations are poised to classify gig workers as employees, ensuring they can access benefits such as paternity leave and holiday pay.

This development underscores the ongoing efforts within the EU and globally to regulate digital platform companies and gig work. These platforms wield immense influence, reshaping how individuals work, innovate, and seek employment. Facilitating connections between various stakeholders, from buyers and sellers on e-commerce giants like eBay and Amazon to linking passengers and drivers using ride-hailing services such as Lyft and DiDi, platform companies generate staggering revenues, surpassing $7 trillion annually, solidifying their status as some of the world’s most valuable companies.

However, concerns are mounting regarding the unchecked power amassed by platform companies, leading to precarious situations for gig workers, app developers, and other stakeholders dependent on the platforms. Consequently, calls for accountability measures to hold these platforms responsible for their actions are intensifying.

“There is a worldwide call to action. The platforms are here, they are restructuring society, but we cannot just let them disregard those who depend on them,” said Lindsey Cameron, a Wharton management professor. In response to this call, she collaborated with two other researchers — Hatim Rahman from Northwestern University and Arvind Karunakaran from Stanford University — to review the existing literature about how to hold platform companies accountable, and propose a framework for action. Their paper , recently published in the journal Academy of Management Annals , proposes a novel approach to foster fairness on platforms.

Platform Company Accountability

In recent years, a chorus of concern has emerged surrounding the accountability of platform companies, spurred by high-profile controversies at organizations like Uber, which faced a significant legal defeat at the U.K.’s highest court in 2021, which determined that its drivers are considered workers and are entitled to labor rights, such as receiving the minimum wage. As the scrutiny intensifies worldwide, regulators and other stakeholders are exploring avenues to ensure platforms play fair. There are two primary approaches: bottom-up (led by workers) and top-down (led by regulators), both identified in the review by Cameron and her co-authors.

“Looking at it only from a top-down perspective doesn’t work, as the platforms play a cat-and-mouse game with regulators.” — Lindsey Cameron

The bottom-up approach centers on how ordinary platform users, such as delivery drivers on sites like Instacart, advocate for equitable treatment by challenging platform policies collectively. Through grassroots efforts, these individuals coordinate collective actions via online forums and forge alliances with external entities like unions and nonprofits.

However, grassroots efforts face big challenges like the platforms’ strong network advantages, and problems in keeping everyone working together as algorithms and platform tactics change.

Conversely, the top-down approach focuses on legal, regulatory, and governance changes to ensure fairness and transparency on platforms, encompassing government regulations and internal platform policies. Yet, existing regulations often fall short in addressing platform-specific challenges, prompting experts to advocate for tailored approaches to tackling issues like data privacy and vertical contracting, when one party places trade restrictions on the other.

However, traditional regulatory frameworks face resistance and circumvention from powerful platform companies, raising questions about their efficacy in curbing platform dominance and ensuring accountability. For instance, the platforms have so much power that they can influence or even control local rules in their favor through tactics like lobbying and public relations campaigns.

“Looking at it only from a top-down perspective doesn’t work, as the platforms play a cat-and-mouse game with regulators — whenever there is a new rule, they play to the letter and not the spirit of the law,” said Cameron.

“So often, the finger pointing is at the platforms…. But accountability is multi-sided and there needs to be a more holistic approach.” — Lindsey Cameron

Is there a better way?

Cameron and her co-authors think so. In their review, the academics propose a “multi-sided accountability” framework that integrates both bottom-up and top-down strategies. This means platform owners and users would work together to make sure the rules are clear and consistently applied for everyone involved, ensuring that the outcomes are distributed fairly among all parties.

“So often, the finger-pointing is at the platforms; people argue they need to be more heavily regulated. But accountability is multi-sided and there needs to be a more holistic approach. Each user in this multi-sided network has responsibilities to ensure there’s a level playing field,” Cameron said.

The paper’s authors suggest several strategies that online platforms can adopt to ensure fairness and trust among users. Firstly, they suggest that platform owners can ensure equal opportunities for success by avoiding favoritism towards their own products and ensuring prompt and fair payment for all participants. Additionally, the researchers advise platforms to establish transparent rules and procedures, allowing users to report any instances of unfair treatment.

Furthermore, they say platform owners should refrain from exploiting their power, such as favoring certain sellers or competing unfairly with their own products.

Beyond this, the authors note that customers also play a pivotal role in maintaining fairness on these platforms by adhering to rules, reporting suspicious behavior, and providing honest feedback. Ultimately, the paper concludes that fairness on platforms hinges on everyone’s commitment to following the rules and looking out for each other. As digital platforms continue to reshape the economic landscape, ensuring accountability is likely to remain a top concern.

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Title: holistic safety and responsibility evaluations of advanced ai models.

Abstract: Safety and responsibility evaluations of advanced AI models are a critical but developing field of research and practice. In the development of Google DeepMind's advanced AI models, we innovated on and applied a broad set of approaches to safety evaluation. In this report, we summarise and share elements of our evolving approach as well as lessons learned for a broad audience. Key lessons learned include: First, theoretical underpinnings and frameworks are invaluable to organise the breadth of risk domains, modalities, forms, metrics, and goals. Second, theory and practice of safety evaluation development each benefit from collaboration to clarify goals, methods and challenges, and facilitate the transfer of insights between different stakeholders and disciplines. Third, similar key methods, lessons, and institutions apply across the range of concerns in responsibility and safety - including established and emerging harms. For this reason it is important that a wide range of actors working on safety evaluation and safety research communities work together to develop, refine and implement novel evaluation approaches and best practices, rather than operating in silos. The report concludes with outlining the clear need to rapidly advance the science of evaluations, to integrate new evaluations into the development and governance of AI, to establish scientifically-grounded norms and standards, and to promote a robust evaluation ecosystem.

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Occup Ther Int
v.2023; 2023
PMC10599905

“Being Holistic Is a Lot to Ask”: A Qualitative, Cross-National Exploration of Occupational Therapists' Perceptions and Experiences of Holistic Practice

Mona asbjørnslett.

1 Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Norway

Lisebet S. Skarpaas

Linda stigen.

2 Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway

Associated Data

Data is available on reasonable request.

Being holistic is often used by occupational therapists to describe their practice and philosophy worldwide. This study explores the perspectives of 33 occupational therapists, working in 13 different countries, on their understanding of holistic epistemology and practice and how they seek to incorporate holism in their work. On the basis of a qualitative study design, individual interviews were conducted with the participants by 18 Norwegian undergraduate occupational therapy students, supported by their supervisors. The authors subsequently analyzed the transcribed data, using a thematic analysis approach. Three principal themes emerged: (1) holism as a broad and narrow concept, (2) being holistic spans from treating body parts to teaching marginalized children, and (3) being holistic is a lot to ask. When talking about holism and holistic practice, participants described their holistic practices in various ways, and their accounts reflected different understandings and cultural contexts. Participants characterized a holistic approach as one emphasizing the importance of occupations and activities and helping patients regain independence in their everyday lives. However, they also highlighted the specific challenges they faced, including cultural factors and inadequate resources. Significantly, participants from both Western and non-Western contexts emphasized the importance of holistic practice, suggesting that a dichotomous understanding of Eastern versus Western philosophical approaches does not necessarily make sense in occupational therapy interventions. Therapists' degree of commitment to client-centered practice appears of greater relevance. With its international perspective, our study sheds light on important areas of contemporary occupational therapy practice, including the difficulties occupational therapists face when seeking to cover “everything” in an effort to be more holistic.

1. Introduction

Holistic approaches and epistemology are featured in the practice of occupational therapy in different parts of the world. In this study, we define epistemology as a specific way of knowing the world and how knowledge is constructed [ 1 ]. As such, clinical practice in occupational therapy is constructed around a core value of being holistic, which is widely present in the occupational therapy literature. For example, in a USA-based national survey, more than 80 percent of occupational therapists using the Model of Human Occupation (MOHO) in their practice reported that this model supported holistic, occupation-focused, client-centered, and evidence-based practice [ 2 ]. Research involving Swedish occupational therapists suggests that these practitioners distinguish between a holistic, socially oriented approach on health and a biomedical one [ 3 ]. A study from the UK [ 4 ] explored how occupational therapists aspired to be holistic and claimed a holistic perspective as a part of their identity and self-definition. However, these therapists often struggled to define the meaning of holism. As they negotiated the tension between theory, beliefs, and practice, they found that holism could at times appear “an illusion” [ 4 ].

Historically, holism is an idea that occupational therapists often use to describe and characterize their practice: one where the individual is viewed as an integrated being [ 5 ]. In the late 1980s, groundbreaking research by Cheryl Mattingly, an occupational therapist, and Maureen Hayes Fleming, an anthropologist, explored the thought processes of occupational therapists when treating patients and what they thought about their practice, language, and values [ 6 ]. As the researchers noted, “occupational therapists have always presented themselves as concerned with the patient's relationship with the disease, as well as with the ‘whole person'” ([ 6 ], p.74.). On the basis of our own experience of the relationship between disability and meaningful occupations, we share the view that occupational therapists seek to treat the whole person [ 6 ].

For Hasselkus and Dickie, a holistic view of disability differs sharply from a medical understanding. With reference to McColl, she emphasizes that, from a holistic view, disability can be seen as normal experiences of life and with opportunities for personal growth, development, and a unique way of being in the world. From this, it follows that the task becomes one of achieving a balance and living one's life within the constraints of the disability [ 5 , 7 ].

Holistic ideas and approaches are also evident in recent occupational therapy literature, including that relating to occupation-focused medical rehabilitation [ 7 , 8 ]. In the book edited by Huri [ 8 ], holistic influences are evident in studies that argue for the unique quality of occupational therapy and suggest that a holistic approach enhances patients' life skills to enable participation in everyday life activities [ 9 ]. For instance, in her study on psychomotor therapy, Probst employs a holistic view of a unified body and mind, with a focus on movements, in her exploration of the treatment of patients with severe mental health disorders [ 10 ].

Akyruek and Bumin [ 11 ], whose research focuses on community participation for people with disabilities, refer to Hussey et al. [ 12 ] and argue that a holistic approach in occupational therapy involves the following:

The handling of occupational therapy in all directions of humankind is called holistic approach. Holistic approach emphasizes the organic and functional relationships between whole and parts. This approach assumes the person as a whole as biological, psychological, sociocultural and spiritual . ([ 11 ], p. 83)

Recent literature also emphasizes the central role played by meaningful activity and occupations within the profession. Fisher and Martella argue that a person-, environment-, and activity-centered approach lies at the root of occupational therapy. They stress the importance of understanding occupation as a transactional whole in which occupational and situational elements are always intertwined [ 13 ].

The value of holistic approaches has been highlighted by research in other fields, where dichotomous understanding of body and mind is addressed. For example, a study of cancer survivors suggests that mindful engagement in everyday occupations can help such individuals unlock their core self and enjoy enhanced quality of life [ 14 ]. It has also been found that to achieve holistic mind-body connection and well-being for women who have suffered childhood abuse, mindful engagement in daily activity can promote a “journey to wholeness” [ 15 ].

A persistent claim made in the literature is that there is a gap between Western approaches to healthcare (often characterized as “reductionist”) and Eastern perspectives judged to be more holistic. Tsipris seeks to narrow this perceived gap by advocating the introduction of yoga to an occupational therapy program [ 16 ]. Twinley questions the adequacy and holistic depth of the terminology used by therapists, notwithstanding our tendency to view activity and occupations as health-promoting and positive [ 17 ].

In general, holistic approaches are sensitive to cultural differences and human diversity; they take into account how people think and feel about health and illness and how they use available health services [ 18 , 19 ]. Morrison argues for the adoption of a pragmatic epistemology by occupational therapists, one which enables us to see new connections and understand occupations as social phenomena, integral to the way society constructs and reconstructs itself [ 20 ].

As a profession characterized by theoretical, ethical, and cultural diversity, occupational therapy can only be enriched by critical perspectives [ 21 ]. As Hammell notes, building on our diversity may well enable our work to have a global impact [ 22 ]. Despite the presence of holism in occupational therapy literature for several decades, the authors of this study were unable to identify research with an international perspective: that is, research that attempts to explore the ways in which holism is understood and applied by occupational therapists in different parts of the world.

1.1. Holistic Philosophy

The premise of our study (project) is that occupational therapy is embedded in an occupation-based and holistic epistemology [ 23 ]. For Di Stefano, the holistic philosophy is the basis of complementary and alternative medicine in the West, where being holistic is directed towards understanding a whole system rather than selected events or phenomena. For Di Stefano, being holistic is complementary to biomedical approaches and traditions. Holistic philosophy sees life as influenced by many factors, including those beyond the purview of scientific notions of rationality, materiality, and mechanism [ 24 ]. For Di Stefano (citing Jan Christian Smuts), holism has come to signify a philosophical position that acknowledges the central unity of creation. Holistic is a powerful term and carries the synergetic understanding that “wholes are greater than the sum of their parts” ([ 24 ], p. XVIII).

With this background, it is evident that the idea of holism has been present in occupational therapy for many years and that it remains a relevant philosophical foundation for our practice. However, we have been unable to locate any previous studies exploring how occupational therapists apply the concept of holism in practice. The research question addressed in the study that forms the basis of this paper is therefore “How do occupational therapists in different practice contexts around the world understand and use the term ‘holistic' in relation to their practice?”

2. Design and Methods

The initial stages of this qualitative project were carried out by a team of bachelor students, employing a qualitative descriptive research design [ 25 ]. In qualitative descriptive studies, researchers stay close to their data and to the surface of words and events; this is the method of choice when straight descriptions of phenomena are desired [ 26 ]. The initial aim of this project was to explore the experiences, reflections, and taken-for-granted ideas of occupational therapists representing different countries and cultures where the meaning of context is particularly relevant [ 27 ]. Open, semistructured interviews were conducted with a total of 33 participants, located in a range of different countries.

2.1. Participants and Recruitment

The participants comprised 27 female and 6 male occupational therapists, working in Chile, Canada, Australia, Iran, Abu Dhabi, Palestine, Israel, Tanzania, Romania, Germany, the Netherlands, the United Kingdom, and Norway (see Table 1 for participants' demographic characteristics). Three researchers (the authors of this study), together with the undergraduate students involved in this project, used their international networks to recruit participants. The recruitment criteria was that the participants were performing occupational therapy in their present country.

Participants' demographic characteristics.

2.2. Interviews

Interviews were conducted between 2019 and 2021. Occupational therapy undergraduate students from Norway conducted all 33 interviews as part of their bachelor thesis in occupational therapy. The interviews lasted from 35 to 97 minutes. While some students were able to interview their informants in person, most of them used digital platforms such as WhatsApp, Zoom, and Skype to conduct the interviews. All interviews took the form of life world explorations, described by Brinkmann and Kvale as semistructured interviews. The aim was to illuminate themes of everyday life in an attempt to understand the perspectives of the informants [ 28 ]. During the interviews, the students followed an interview guide structured around an open, narrative approach with a focus on events and happenings. They started the interviews with a sequence of open questions, as in the following:

“Can you tell me what happened yesterday at work (a regular weekday)? Let us start with when you came to work. Describe what first happened when you came to work – tell me about your morning routine? Who did you meet? Is that usual?” The students were asked to continue the interviews along these lines, exploring at greater depth activities, situations and/or events, and relationships with other people (positive or negative) that informants saw as central to their occupational therapy practice.

2.3. Data Analysis

Initial analysis of the interviews was carried out by a total of 18 undergraduate occupational therapy students for their bachelor degree theses. Seven pairs of students focused on single countries, while a further two pairs analyzed material from two countries. During this primary phase, the focus was on occupational therapists working within specific national contexts.

In order for a subsequent meta-analysis to be carried out, anonymized copies of all transcribed interviews were kept by the principal researchers (the authors of this paper). We then engaged in an inductive, explorative approach to gain an overall view of the topics of concern and taken-for-granted ideas in a thematic analysis, as recommended by Stanley [ 25 ].

In the next phase of the analysis, all interviews were uploaded into the NVivo software and coded inductively by adding open codes to participants' words or phrases [ 25 , 27 ]. During this process, it became clear that holistic ideas and holistic practice were topics which appeared in most of the interviews. Regarding this as a “taken-for-granted idea,” we then returned to the raw material and read it afresh through the lens of holism. During this phase, we also had several discussions on the dimensions of holism and being holistic. On this basis, we highlighted passages which described or offered reflections on this concept.

Text condensation and line-by-line coding were then applied to these passages, so that we could build codes inductively and evaluate in detail participants' statements related to the holistic approach.

In the third phase of the analysis, similar codes were brought together to form categories [ 25 ]. The categories were divided into holistic epistemology and holistic practice. We further discussed the coding and categories and agreed on three main themes: (1) being holistic as a broad and narrow concept, (2) being holistic spans from treating body parts to teaching marginalized children, and (3) being holistic is a lot to ask. Through further analyses and abstraction of the results, the authors of this paper were inspired to develop a conceptual model illustrating the idea of holism as employed and described by the participants. The aim of this visualization was to facilitate the conceptualization of how occupational therapists apply holistic ideas in practice.

2.4. Trustworthiness and Validation Strategies

Several methodological concerns about trustworthiness and processes of validation can be raised regarding this study. Firstly, all the interviews were conducted by undergraduate students. It is a strength of the research that the data collection is done by different interviewers, thereby potentially enabling a more broad-based exploration of occupational therapy worldwide than one limited to a single researcher's perspectives. Several of the students involved in the project themselves had a foreign background, enriching the multicultural dimension of the research.

However, according to Brinkmann and Kvale, validation is related to craftsmanship [ 28 ]. The undergraduate students lacked research experience, which raises questions about the quality and depth of the data gathered. While some students performed their interviews in English, others interviewed in their native language, subsequently translating the transcription into Norwegian or English. This, too, raises questions regarding the degree to which the results represent an accurate interpretation of participants' meanings [ 29 ].

We would argue that our study is strengthened by the richness and diversity of the data collected, enabled by our decision to reach out to occupational therapists across the world: professionals with different educational, cultural, and practical backgrounds and experience. On the other hand, the validity of interview data gathered across countries, cultures, and languages may suffer through loss of accuracy and nuance in cultural or linguistic translation. Given that the students handled both the transcription and translation of the interviews they conducted, linguistic inaccuracies and misunderstandings may have crept in.

To strengthen trustworthiness for the student projects, member checking via supervision, methodological decisions, discussions, and presentations to other students was introduced at the start [ 25 ]. To minimize the risk of misunderstanding the content of participants' responses, most students worked in pairs, discussing the process with costudents and also their supervisors. Another criterion of validation is authenticity: the degree to which researchers capture the multiple perspectives and values of their participants [ 29 ]. Given the international scope of our study, we would argue that this criterion is met to some extent.

Questions about reliability arise from the fact that the authors of this study conducted only the secondary analysis of the data; they did not carry out interviews and transcribe or interpret the primary data themselves [ 29 ]. However, all three authors supervised the students during the research and were very familiar with the research process, thereby strengthening their credibility as researchers [ 28 ]. The authors also engaged in a long process of reading the material, coding its content, and discussing and interpreting emerging themes, all of which strengthen the validity of the results [ 30 ].

2.5. Ethics and Ethical Considerations

Approval for collecting and storing the data was granted by the Norwegian Center for Research Data (project number 100341). The participants were informed that participation in the interviews was voluntary, their responses would be treated in confidence, and there would be no negative consequences from participating in the study. Written informed consent was provided from all participants. All methods were carried out in accordance with relevant guidelines and regulations.

In the presentation of the results, excerpts from interviews are set in cursive, with the nationality of the participant added, in brackets, at the end of the quote. As they explained their own practice of holistic occupational therapy, their accounts reflected different understandings and cultural contexts.

3.1. Holism as a Broad and Narrow Concept

Holism was described and explained in a variety of ways, taking both a broad occupational perspective, such as in community practices, and a narrow understanding, such as in individual physical training, but despite their quite different practices and cultural contexts, the concept seemed to be a central part of occupational therapists self-understandings worldwide.

When discussing the concept and use of holistic approaches, participants spoke of how theories within occupational therapy, such as in the Model of Human Occupation, were associated with holistic perspectives. As participants explained, such theoretical perspectives helped them take into consideration the environment and not only the personal factors (Palestine), by taking into account factors beyond the purely medical/physical aspects. In this quote, it is evident that considering the environment was always present in a holistic approach.

Even though not all the participants distinguished holism in occupational therapy from forms of medical treatment, other participants sometimes divided between what they saw as holistic and more focused on a specific injury, diagnosis, or impairment. This latter type of focus was seen to represent a pathological and reductionistic view of clients, rather than the broader, activity-based perspective they themselves employed. Turning to one of the broad explanations of being holistic, one of the informants put it like this:

I would explain this holistic because we see a full view of the person. And we take more of an approach to look at all aspects instead of a lot of other professions, focus more on the injury, the diagnosis or the impairment, whereas we see the individual as a whole, which includes their environment and their activities or occupations and everything else about them. (Canada)

Holism also seemed to be included when the therapists explained their skills and expertise when helping people with activity problems. One informant also believed that people outside the profession acknowledge how occupational therapists see and focus on the whole person: the participant put it like this:

And I think we have the lucky position of being able to understand our client holistically and how we can help them be able to do what they want to do and use our expertise and creativity to help enable them to get back to those activities. (Australia)

Explanations of holism does necessarily inherit what a full view of a person or looking at all aspects means, but when therapists add the environment, doing, and occupation, this makes more meaning to our specific professional viewpoints. Thus, taking an overly broad or holistic view of our profession may make it more difficult for occupational therapists to explain what exactly it is that they do—and may reinforce views at large in society to the effect that occupational therapy is vague and nebulous.

3.2. Being Holistic Spans from Treating Body Parts to Teaching Marginalized Children

A holistic approach was generally seen as one stressing the importance of occupations and activities and helping patients regain independence in their everyday lives. At the same time, holistic treatment and therapy was explained in many ways, depending on social and cultural understandings, as well as possibilities within different countries. Since most participants worked in hospitals or other medical facilities (including private clinics), their perspective on holistic practice tended to be influenced by the health systems operating in their particular country. In addition, the context in which rehabilitation treatment unfolded (in many cases clinics and hospitals) had an impact on individual treatment.

Some participants argued that holistic occupational therapy meant treating individual body parts, while others were concerned with the way specific social and cultural understandings of disability and illness influenced their practices. In Norway, as an example, rehabilitation treatment and assistive technology are paid for by the government, where occupation-based intervention towards the goal of enabling clients to live independently in their own homes is an important aim. However, elsewhere in the world, occupational therapy treatment and assistive technology could be less of a priority. In Iran, for instance, rehabilitation treatment did usually not receive government funding, leaving many people unable to afford assistive technology or therapy. With medical doctors presiding over the allocation of occupational therapy, treatment and goals like independent living might be given a lower priority or even described as a waste of resources. One Iranian participant spoke of the emphasis placed on getting patients with cerebral palsy or in stroke rehabilitation to walk again:

It is expected that the family of a patient who is unable to walk will ask: “when will he start walking?” This is disappointing. In our culture, disabled people are not accepted. A person doing his work while sitting in a wheelchair is not acceptable for the society. This means that the opportunities for disabled people are limited. I always ask clients and their families what they mean by getting well, or healing: what does it mean to them? (Iran)

In this example, occupation-based values were not always visible in treatment strategies. Some participants problematized, while wishing to be “more holistic,” and felt limited by their specific work context such as the hospital where they were based, or a country representing a marginalized view on disability as treatable or nontreatable.

In Iran, physical training for patients prioritized for occupational therapy was usually associated with intensive individual training to gain independence:

I always warm up my hands by putting on cream and massaging them. Then we start by moving the joints in all fingers, thumbs included, folding the hand by bending all the fingers. Hand power, such as squeezing a small ball for about five seconds. (Iran)

Participants working in other parts of the world had different perspectives. Two participants, the first from Tanzania and the second from Germany, saw a holistic approach to rehabilitation as involving adapting therapy to meet the patient's own needs, requests, and understandings of OT:

What we do is, we make sure that our therapy is going to focus on helping the client's needs. If the client is having a problem with their hand, then we make sure our therapy is based on that. (Tanzania)

And if the patient has another problem --he can be here because of his shoulder but has a back pain – I will treat his back, I do not care, it is just like that. Or if he says “my hand hurts today”, I will do something with his hand. If he has a problem with his psyche, I will talk to the patient in a therapy session. (Germany)

Another participant, such as one who worked in a community health center, and using a family health model, described how she had adopted to a more holistic practice . For her, this meant addressing more than the individual person; it involved working with the client's whole family and wider environment.

Other, such as in a case from Romania, occupational therapists followed up on everyday occupational needs for marginalized children during the COVID-19 pandemic lockdown, where occupational therapists together with other professionals arranged for online schooling in order to prevent the children from dropping out of school. In this example, the occupational therapists used their creative skills not simply to meet children's educational needs but also to help children acquire what the therapists called life and recreational skills, such as serving food and learning about hygiene, where helping children live independent every day is visible through addressing occupational problems.

As a last point in this part, it is important to stress that occupational therapists not necessarily find it satisfying to work only in the environment, because their expertise is also identified with individual treatment approaches, which is problematized from Chile, from a therapist working with children with autism and sensory integrative problems:

Well, another challenge is that it's difficult to withdraw myself from wanting to do clinical treatment. Wanting to take a child out of the classroom and be able to do a session with him, because sometimes I feel that I have the time. But what is required of me is something else. I don't take a child out of his classroom to do an individual sensory integration session with him, even though I would love to have a ball pool or swings to work with. To be frank, I'm not cut out to work in a purely clinical way. (Chile)

Like in this quote, participants' accounts of holistic practice within occupational therapy included diverse social and cultural understandings, where they also touched on the limitations and possibility characteristic of communities, hospitals, and rehabilitation centers in their abilities to perform holistic occupational therapy, which was explained as both treating the individual person and working in a broader environment.

3.3. Being Holistic Is a Lot to Ask

Some of the participants questioned if our profession is holistic or if the idea of being holistic is too much to ask. Several participants did in fact speak of the difficulty of being holistic in their practices. One informant reflected on the complex foundations of occupational therapy, noting that being holistic, covering a lot, becomes difficult, because occupational therapy needs to adapt to a particular context and then narrows what occupational therapy is about:

We have to include the whole person, as we are used to doing as OTs. But we also have to be good at not treating the whole person, as that is the responsibility of all the community services. (Chile)

For the participants, occupational therapy principally involved thinking and acting from an occupation-based perspective. While being holistic could be “a lot to handle,” informants agreed that ideas about how occupations affect our lives formed the core of occupational therapy.

Being holistic, however, was trying to see what the patient needs and educate the family and the caregiver about the recourses that can help the patient on things and that may make his life better, make his life easier, and improve life, for example. Working with a patient with a spinal cord injury exemplifies this dilemma:

It's really difficult to explain to them that this is things that happen when you have a kind of spinal cord cut. You will not gain your old skills before, right now our goal that the wheelchair will be a part of your body, you need to understand that. You need to have a good skill and maneuvering or manipulate the wheelchair, you need to strength the upper body, right now your skills is good you can climb use only your hands, you need to go transfer yourself from the wheelchair down or up or from the wheelchair to the bed and from the wheelchair to the car. Your life will be continued and ok, but there is an extra part added to your life called the wheelchair, you need to understand this. (Abu Dhabi)

Furthermore, the participant elaborated and continued:

So when I try to explain this to the patient, the whole goal of the family and the patient is shifted from taking medication, trying to find a solution or waiting for a miracle, to another goal, a functional goal that make his life better -- he's moving on, he's trying to think “I will return to work again, I want to continue my life, to have my own home, I will get married soon”. So this is a kind of shifting the goals or trying to broaden the patient's tunnel vision … this kind of feeling I believe in more than other theory. (Abu Dhabi)

Questioning the wide-ranging expectations, including families and patient surrounding their work as occupational therapists, participants observed that attempting to apply a holistic approach could make life even more difficult for them. They suggested that a holistic approach always needed to be limited to a particular context or situation and that the field in which they worked usually limited their opportunity to treat the whole person.

They also described dealing with multiple challenges on a daily basis, constantly aware of the high expectations surrounding them. While their occupational therapy services often adapted to environmental expectations and community and workplace possibilities, this could create more problems for therapists wishing to be more holistic while at the same time meeting the requirements of real world practice.

As highlighted by a Canadian occupational therapist, to remain client-centered and know and use those holistic theories and principles of OT, and then balance that with what the hospital is asking you to do in a hospital setting is difficult (Canada). She further elaborated and problematized being holistic while having to treat patients at a hospital under strict time constraints:

And I think it can become hard to balance that holistic, client-centered model and then the pressure from the hospital and management and administration to get people out as quickly as possible. And you have very limited time with each person because caseloads are so large it can become overwhelming. So I think it's definitely a balancing act…. (Canada)

As in this case, when the main goals of therapy are being able to go to the bathroom by themselves, get dressed, and make a simple meal, where leisure activities are less important in the hospital setting, being holistic is questioned by the therapist. The participant problematized how hospital settings and a medical context could make it difficult to follow patients' own needs, or being holistic and client-centered. An occupational therapist working in Gaza also gave an example of what happened when a client's individual priorities were overlooked during rehabilitation:

The client told me:“You did me lot of good and I learned how to eat, how to dress, how to transfer, how to move with a chair, and it is very good. But I don't even know how to do my prayers, how to go to the mosque, you know, for Friday prayers, how to perform this.” (Palestine).

As suggested above, many participants identified the attitude of being client- or family-centered as part of holistic practice. Being client-centered was seen to involve meeting clients where they were at a particular moment and addressing their priorities, interests, and needs.

As the participants pointed out, individual training may not necessarily conform with holistic practice, particularly where therapists are required to work within many different domains. In such situations, was working holistically too much to ask?

4. Discussion

The aim of this study was to explore the perspectives of occupational therapists in different parts of the world on holism and being holistic in their everyday practice. Three main themes emerged from the analysis of interview data: (i) holism as a broad and narrow concept, (ii) being holistic spans from treating body parts to teaching marginalized children, and (iii) being holistic is a lot to ask.

In Figure 1 , we bring together in the form of a conceptual model the various perspectives provided by our participants on what holism is, how it is practiced, what it takes from the therapist, and the challenges and dilemmas related to holistic occupational therapy.

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Conceptual model of participants' descriptions of holistic occupational therapy practice.

The participants' strong expressions of the perception of holism as a core concept in occupational therapy place holism at the center of our model. Furthermore, the participants' value of holism extended beyond occupational therapy literature and practice to wider society and culture. When considering holism in relation to their clients, the participants offered a variety of perspectives, whether related to body and mind or to the different arenas in which clients lived their everyday lives. Their ideas, summarized in the client square at the bottom right side of the model, are captured in the theme “holism as a broad and narrow concept.”

Participants' reflections on what holism demands of them as therapists, including the skills required of them, are summarized in the therapist square at the bottom left side of our model and are presented in greater detail in the theme “being holistic is a lot to ask.”

Participants also provided a range of perspectives on how holism related to their practice as occupational therapists. The square labelled “practice” at the top of our model presents some broad areas mentioned by participants in relation to their practice, including challenges to holistic work posed by their specific work context and the complexity of applying a holistic approach when working in different settings. This is described in the theme “being holistic spans from treating body parts to teaching marginalized children.”

Separating the three large squares circling our model's core theme are three smaller elliptical bubbles, shaded green. These represent three dilemmas or conflicting viewpoints that the participants seem to juggle in their practice. Firstly, there is the question of whether to practice in a clinical setting or a more “natural” one, such as the client's home. Secondly, therapists may find themselves having to choose between a strictly medical focus and an approach more geared to activity and occupation. Thirdly, therapists are confronted by the gap between their desire to be more client-centered and the limited resources at their disposal. These dilemmas represent some of the tensions experienced by the participants regarding their holistic practices, as captured in the theme “being holistic is a lot to ask.”

4.1. Findings in relation to the Existing Literature

Our themes illustrate and shed light on the ways in which occupational therapists in different parts of the world understand the term “holism” and the concept of “being holistic.” In general, their perspectives reflect those found in occupational therapy literature [ 6 – 8 ]. Their descriptions also accord with the findings of studies [ 3 – 5 , 31 ] which highlight how holism is frequently used to describe and characterize occupational therapy practice and thereby to inform practice.

When describing what they understand by the meaning of “being holistic,” occupational therapists tend to use broad, even lofty, definitions. They talk about their efforts to be “holistic thinkers” and capable of “seeing and treating the whole person.” This in turn raises questions such as what does it mean to “see the whole person.” One answer suggested by the participants is having the aim of helping people do what they want to do. This is consistent with what is generally understood as client-centered occupational therapy: working closely with clients and having respect for their preferences, values, and choices [ 13 ].

Our themes, particularly the second one, illustrate the diversity of settings in which occupational therapists seek to apply holistic approaches. These attempts unfold in family homes and local communities; they can extend to school-based work with marginalized children requiring help with basic life skills. There are similarities here with an occupation-based understanding of working in tandem with clients who are actively engaged in real occupations [ 13 ]. Here, cultural variations emerge as significant. While some countries and cultures emphasize the importance of independent living, others may not see this as the main goal of occupational therapy interventions. This does not mean that occupational therapists working in such contexts do not have a holistic approach but rather that they must operate within broader social parameters (for example, in relation to disability and illness). While some societies may view disability as an opportunity for growth and development [ 7 ], it can also be understood as a hindrance to independent living and in some cases not worth treating.

The meaning of occupations in everyday life finds emphasis in occupational therapy literature [ 6 – 8 , 13 ]. However, less attention has been paid to what practicing occupational therapy might mean in different contexts: in hospitals versus medical clinics, for example, or in different cultural settings. Perhaps as a result of this, occupational therapists explain holistic therapy in a variety of ways; for our participants, massaging a hand, treating a back pain, and asking a patient to squeeze a ball are all examples of holistic practice. To justify that this can be a holistic approach, we can turn to Di Stefano saying that treatment is judged to be holistic as long as it is connected or complementary to a broader unity [ 24 ]. In this case, holistic practice can be seen as something that leads to further functional opportunities for the patients.

Significantly, occupational therapists working in both Western and non-Western societies spoke of the link between physical training and holistic practice. This suggests that a dichotomous understanding of Eastern versus Western philosophy and practices does not necessarily make sense in occupational therapy interventions. More relevant is the commitment to practice that is essentially client-centered. As Fisher and Martella [ 13 ] note,

Client-centered practice requires that occupational therapists develop therapeutic rapport and a collaborative relationship with their clients, and then work with their clients in a manner that is respectful of their clients' own perspectives, preferences, values and choices. ([ 13 ], p. 64)

Our final theme captures the challenge implicit in attempting to “see the whole person,” which is indeed a lot to ask. In Finlay's [ 4 ] study, some therapists found the challenge so great as to suggest that holism might be an illusory goal [ 4 ]. Across the world, resources available for occupational therapy are limited, suggesting that asking practitioners to cover “everything” in their effort to be more holistic may be unrealistic. Perhaps in some cases, our services would benefit from some degree of narrowing, when working with physical impairment and illness. We end this discussion with a definition, drawn from the literature of medical rehabilitation. For Akyurek and Bumin, a holistic approach involves “the handling of occupational therapy in all directions of humankind” ([ 11 ], p. 83). This definition is consistent with our analysis, which underlines the multidimensional character of holism and the fact that a holistic approach includes adapting to diverse social understandings of disability and illness. At the same time, this understanding is vague and its meaning is not clear. This raises the following questions: how helpful is our holistic epistemology of “covering everything” to an understanding of what occupational therapy is about? Does it act to support the work of therapists in the field or does it make their work even more complicated?

4.2. Conclusion and Looking Ahead to Future Research

In this study, we have investigated the perspectives of occupational therapists located in different parts of the world regarding their understanding of holism as an epistemology and the ways in which they attempt to apply this philosophy in their work. Our analysis leads us to conclude that holism is a many-faceted and broadly understood term which can be interpreted in a variety of ways, according to cultural and social context, political systems, and economic factors such as resource availability. We look forward to further research on the use of theoretical perspectives within our profession, including core ontological and epistemological ideas of what occupational therapy is all about. We recommend that such researches embrace the performance of occupational therapy in different contexts and cultures.

While not covering all cultures and countries, our study indicates that there are significant variations in occupational therapist's understanding and application of holism. We view our research as a contribution to the ongoing debate around the concept of holism and how we, as occupational therapists, might better incorporate holistic approaches in our practice. If we continue to claim that occupational therapy is a holistic profession, we need to clarify our own understanding of holism—and the extent to which it can inform therapeutic practice across a range of different contexts and circumstances.

Acknowledgments

We would like to thank all the bachelor students in occupational therapy, who participated in this project. The study is funded by the Oslo Metropolitan University and Norwegian University of Science and Technology.

Data Availability

Conflicts of interest.

The authors declare no conflicts of interests.

Marquette receives $1.5 million gift to fund College of Health Sciences research and future expansion of Athletic and Human Performance Research Center

April 23, 2024
4 min. read

Bob and Kim Eck, an alumni couple, have made a $1.5 million gift to Marquette University through the Eck Family Foundation that will impact two areas across campus, President Michael R. Lovell shared today. The gift will provide seed funding and focus on highly innovative projects within the College of Health Sciences aimed at applying new technologies, novel therapies and research to help address substance abuse disorders.

In addition, a portion of the gift will support a new men’s basketball practice facility in a future expansion of the Athletic and Human Performance Research Center. Bob, who served as the chair of Marquette’s Board of Trustees from 2020-23, graduated in 1980; Kim completed her degree in 2013.

“Like so many families, ours has felt the impact of addiction and the difficulty in finding effective treatment,” Bob and Kim Eck said. “Finding funding for early-stage research can be very challenging. Our hope is that our gift leads to progress in developing new treatments that may free so many people from suffering.”

Driving holistic wellness

President Lovell shared details of the university’s new strategic plan, Guided by Mission, Inspired to Change , at his recent Presidential Address. He highlighted that the Eck’s gift would also take a step toward growing a campus of “thriving students” as Marquette strives to be a nationally recognized leader in the integration of student wellness, transformation and success.

“We are grateful for this remarkable, mission-focused gift from the Eck family. Their generosity will make a major impact on a pressing societal issue,” President Lovell said. “This gift will further our progress as a research university known for excellence and innovation — an important theme in our new strategic plan — and take our Athletic and Human Performance Research Center to the next level.”

The Eck family has helped drive wellness progress across campus in recent years. In September 2022, Bob Eck announced the university’s plans to honor President Lovell and First Lady Amy Lovell within the university’s planned wellness tower in the newly renovated Wellness + Helfaer Recreation facility in recognition of their “tremendous leadership to address mental health across Milwaukee and the region.” Within four months, the university raised $5 million in honor of the Lovells .

Turning seed money into major grant funding

Philanthropic seed funding like the Ecks’ often helps researchers advance scientific progress in ways they can then leverage into larger grant awards from the National Institutes of Health or other funding sources. Part of the Ecks’ gift will be dedicated to developing a network of collaborating scientists within the College of Health Sciences’ Integrative Neuroscience Research Center, including neuroscientists, clinicians and pharmaceutical experts focused on cognitive, emotional and motivational regions of the brain to understand and address depression, neuropsychiatric disorders, addiction, spinal cord research and bodyweight regulation.

““We have made a very intentional investment spanning more than a decade to grow our world-class scientists in the critical areas of neuroscience,” said Dr. William E. Cullinan, dean of the College of Health Sciences. “We sincerely appreciate this gift from the Eck family, which will accelerate our research efforts. Our vision is ultimately to take the discoveries in our labs and translate them into breakthroughs for families who are searching for solutions.”

Campaign momentum continues

Marquette’s historic Time to Rise fundraising campaign is the most ambitious in the university’s 143-year history. In February, President Lovell announced that the university surpassed its $750 million goal , and he challenged the Marquette community to drive toward completion of the campaign in June 2024.

“We are very fortunate to have had two philanthropic leaders in Bob and Kim throughout our historic Time to Rise campaign,” said Vice President for University Advancement Tim McMahon. “This most recent gift reflects their values and beliefs both in the way we pursue scientific discoveries to treat addiction and the way we work to enhance the home for our flagship men’s basketball program.”

The Eck family is committing a portion of their gift to a future project to expand the university’s Athletic and Human Performance Research Center, which will include a new practice facility for the men’s basketball program and academic resources for student-athletes. In January, President Lovell shared that Marquette alumnus and NBA Hall of Famer Dwyane Wade made a gift to the project while also contributing to literacy and scholarship efforts.

The expansion will free up highly utilized space in the Al McGuire Center for the women’s basketball and volleyball programs, and increase tutoring, advising and study space for all student-athletes. The first phase of the AHPRC opened in 2019. As the university community continues to build momentum in its Time to Rise campaign, donors have expressed a philanthropic interest in supporting the second phase of the AHPRC. The facility remains in the fundraising and development phase.

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The five strategies compared.

We examined a baseline of traditional investment strategies and then compared them against those that also factor in PLI and DIAs with IIP:

EY strategies and product specifications

For strategies that include PLI and a DIA with IIP, the value of these products is included in the total financial assets and considered part of the fixed income allocation. Thus, for strategies where an investor allocates a portion of their wealth to an insurance product, the amount invested in bonds decreases compared to the investment-only strategy.

In our analysis, PLI cash value (accessed via surrenders or loans) are used to fund retirement income during periods of market volatility, allowing investors to avoid liquidating assets from their traditional investments that have fallen in value.

We divided the investor’s assets between the investments and the insurance products. Different product allocation combinations were simulated in increments of 10% of total annual savings for PLI and projected wealth at age 55 for DIA with IIP. Allocation percentages were capped at 60% for PLI and 30% for DIAs with IIP. For each allocation combination, we calculated the after tax retirement income that an investor can sustain in over 90% of the market return scenarios. We also calculated the legacy value at the end of the time horizon.

The benefit to investors

Following this methodology, strategies involving PLI and DIAs with IIP excelled overall against investment-only approaches — although the implications must be couched in a bit of nuance, depending on whether the investor is focused more on retirement income than legacy. Here are six key insights on how the strategies compare:

1. PLI + investments strategies outperform investment-only and term life + investments strategies.

PLI tends to provide superior returns over fixed income in long-run scenarios, while the term premium acts as a drag on portfolio performance. PLI loans act as a buffer against market volatility as well, improving returns since the investor does not have to sell and realize losses on investments.

2. DIA with IIP + investments strategies outperform other strategies in retirement income.

With DIAs with IIP + investments, the investor uses a portion of the balance to purchase the DIA with IIP and does not receive that balance upon death, boosting retirement income compared to other strategies. Projected legacy tends to be lower than PLI + investments but higher than the legacy from the investment-only strategy. The latter observation is a result of the DIA with IIP outperforming fixed income due to mortality credits and dividends.

3. Integrated strategies are more efficient than investment-only strategies.

For example, a strategy allocating 30% of annual savings to PLI and 30% of assets at age 55 to a DIA with IIP produced 5% higher retirement income and 19% more legacy than the investment-only strategy, because PLI and DIA with IIP both outperform fixed income.

4. For investors with a higher risk appetite, integrated strategies remain better.

We performed the same exercise described above, except that we calculated the retirement income (and legacy values) based on the amount that the investor can sustain in over 75% of the market return scenarios, reflecting the expectations of an investor with higher risk. Income and legacy do not improve as much, yet an integrated portfolio still provides benefits relative to an investment-only strategy.

5. Integrated strategies provide investors with the flexibility to focus on the financial outcomes most important to them: retirement income, legacy or a balance in between.

We found that PLI and a DIA with IIP mix well together, whether a person is focused on retirement income, legacy or a balance. Higher allocations to a DIA with IIP emphasize retirement income, while higher PLI boosts legacy protection. The right mix depends on the investor’s preferences.

6. Allocation up to 30% of annual savings to PLI and up to 30% of wealth at age 55 to DIA with IIP may be appropriate when optimizing retirement income and legacy value outcomes.

Results varied by investor starting age. But the projected retirement income and legacy values generally supported allocations of 10% to 30% to both PLI and DIAs with IIPs. An investor solely focused on maximizing legacy may still opt to allocate more to PLI, but when that allocation redirects too many assets away from equities, the reduction to retirement income can be substantial.

The results point to the value of PLI and DIAs with IIPs in a retirement plan: an integrated approach can give comfort and peace of mind to retirement investors by providing legacy protection, tax-deferred savings growth, and guaranteed income for life without sacrificing their present lifestyle. Insurers can use these products to strengthen their relationships with investors, seizing upon the possibilities in a marketplace that has proved challenging.

This article has been authored by Christopher Raham, Justin Singer, Ben Yahr, Ben Lee, and Annie E Mayer.

Investment-only approaches do not deliver as promising returns as those that are combined with PLI and DIAs with increasing income potential, an EY analysis shows, although there are distinctions to consider depending on whether more retirement income or legacy value is desired. Allocation levels should be approached with care.

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Remote locations are ideal venues for holistic discussions without distractions. Credit: Getty. In early 2019, we were both at an interdisciplinary workshop to develop new and interesting research ...
Research paradigms and methods for investigating holistic ...
Research Design*. Holistic nursing is a discipline focused on healing the whole person and dedicated to understanding and supporting the premise of holistic health of the patient and promoting healing in practitioners, patients, families, social groups, and communities. An explication of knowledge related to caring a ….
A Brief History and Overview of Holistic Nursing
Holistic nurses understand the scope of practice for conventional and non-conventional providers of health care and medicine. They provide information, guidance and counseling to help people coordinate their care and to navigate the complexities that exist between the various healthcare and healing professions. e.g., MD's, ND's, DC's, DO's, L.Ac's, LMT's etc.
The Holistic Approach to Development Research
This paper will discuss a paradigm which considers the economic system as a subsystem of the complex social system. It will emphasise that development research must adopt a holistic approach which considers the political, social, cultural, environmental, religious, geographical, educational and economic dimensions of ecologically sustainable ...
Holism in Psychology: Definition & Examples
Holism is often referred to as Gestalt psychology. It argues that behavior cannot be understood in terms of the components that make them up. This is commonly described as 'the whole being greater than the sum of its parts.'. In other words, human behavior has its own properties that are not explicable in terms of the properties of the ...
Holistic Approach to Research
1 Introduction. While rapid changes have taken place all over the world in social scientists' attitude to research, in some quarters, Newtonian notions still dominate the academic mind and organizations. It is truer of the corporate sector, which purports to use research. A typical stance of corporate sector is that what cannot be quantified ...
A Holistic Approach to Qualitative Analysis
A Holistic Approach to Qualitative Analysis. When conducting a qualitative analysis of in-depth interview (IDI) and focus group discussion data, the first step is to maintain the completeness of each case or research event. This means developing and maintaining a holistic understanding (including the contextual nuances) pertaining to each ...
Effective Factors in Providing Holistic Care: A Qualitative Study
INTRODUCTION. Holistic care is a comprehensive model of caring which is believed to be the heart of the science of nursing.[] The philosophy behind holistic care is based on the idea of holism which emphasizes that for human beings the whole is greater than the sum of its parts and that mind and spirit affect the body.[] Holistic care is described as a behavior that recognizes a person as a ...
Holistic Therapy: Definition, Types, Techniques, and Efficacy
Holistic therapy, also sometimes referred to as holistic psychotherapy or body-centered psychotherapy, is an integrative type of therapy that incorporates both traditional and non-traditional treatments to help the individual as a whole. Rather than focusing on a narrow problem, it considers mental, physical, and spiritual factors that ...
What are the holistic care impacts among individuals living through the
Are there clear research questions, S2. Do the collected data allow to address the research questions, 1.1. Is the qualitative approach appropriate to answer the research question, 1.2. Are the qualitative data collection methods adequate to address the research question, 1.3. Are the findings adequately derived from the data, 1.4.
Holistic Research
That's why research, as we understand it, is a process of raising consciousness. We push the edge of reflective consciousness further and further into those realms so far governed by our collective trauma. Through this phenomenological approach (studying the development of human consciousness and self-awareness) we can see where human social ...
Holistic Nursing Research: Challenges and Opportunities
Holistic nursing research is based in a holistic paradigm. Nurse theorists such as Rogers, Newman, Parse, Watson, and Leininger developed a wealth of unitary and integral theories as they struggled to understand caring, healing, and the nature of the whole. (See Chapter 5.) In addition, they and their protégés created methodologies and tools ...
Ecosystems are deeply interconnected—environmental research, policy and
More holistic solutions. This issue came into focus when New Zealand set up research collaborations known as national science challenges a decade ago to solve "wicked" social and ecological ...
What Is the Holistic Design Approach and How Can You Adopt It?
Holistic design is a design approach that suggests looking at the product from different angles, considering all the aspects, stakeholders, and the environment. However, the definition of holistic design is not enough to really understand the phenomenon. The holistic design combines the approach, practices, and the philosophy.
From Amazon to Uber: Why Platform Accountability Requires a Holistic
The researchers propose a novel solution: a holistic approach to platform governance involving all stakeholders working together. Related articles Finance & Accounting
Holistic Safety and Responsibility Evaluations of Advanced AI Models
Safety and responsibility evaluations of advanced AI models are a critical but developing field of research and practice. In the development of Google DeepMind's advanced AI models, we innovated on and applied a broad set of approaches to safety evaluation. In this report, we summarise and share elements of our evolving approach as well as lessons learned for a broad audience. Key lessons ...
"Being Holistic Is a Lot to Ask": A Qualitative, Cross-National
1. Introduction. Holistic approaches and epistemology are featured in the practice of occupational therapy in different parts of the world. In this study, we define epistemology as a specific way of knowing the world and how knowledge is constructed [].As such, clinical practice in occupational therapy is constructed around a core value of being holistic, which is widely present in the ...
Marquette receives $1.5 million gift to fund College of Health Sciences
Driving holistic wellness. President Lovell shared details of the university's new strategic plan, ... to developing a network of collaborating scientists within the College of Health Sciences' Integrative Neuroscience Research Center, including neuroscientists, clinicians and pharmaceutical experts focused on cognitive, emotional and ...
How insurance and investments can improve financial wellness
Here are six key insights on how the strategies compare: 1. PLI + investments strategies outperform investment-only and term life + investments strategies. PLI tends to provide superior returns over fixed income in long-run scenarios, while the term premium acts as a drag on portfolio performance. PLI loans act as a buffer against market ...
Dr. Robert G DeBease, ND, DC
1,106 likes, 92 comments - docrob.holistic on April 24, 2024: "The international Agency for Research on Cancer has placed processed meat in the same category as ...