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unavailability of resources,[20] poor professional and administrational perceptions, limited knowledge, and motivational and organizational factors.[4] In view of the great influence of holistic care on treatment and more effective nursing, the health-care systems in many countries in recent decades have tried to promote holistic care by applying changes to the educational and administrational systems,[4] but studies show that their efforts have been fruitless.[21,22] Evidently, there are other factors affecting holistic nursing that must be identified. An investigation into this matter using a qualitative approach that includes multiple methods of data gathering and emphasizes reality experience[23] can help us to obtain meaningful and comprehensive data; it will also clarify the existing background and the real situation surrounding the formation of holistic care. Thus, this is a qualitative study and is based on the experience of nurses, who form the core of holistic care provision. This study was approved by the ethics committee of Tabriz University of Medical Sciences. All the participants were informed of the aim of the study and a written consent was obtained from each of them. Participation in the study was entirely voluntary and the participants could withdraw at any stage of the study. A qualitative content analysis was conducted to develop an in-depth understanding of nurses’ experiences of major factors that affect holistic care formation. This method was used for describing the systematic and objective means of the phenomenon.[24] This study is based on conventional qualitative content analysis in which coding and categorizing are derived directly from the raw data. The advantage of this approach to content analysis is obtaining direct data from participants without imposing pre-supposed categories or theoretical perspectives. Another important attribute of this approach is its emphasis on the subject, context, and differences and similarities among codes and categories.[25] Purposive sampling was used to select 14 participants with abundant information. Three of the nurses selected were male and the others were female. The participants were selected from various wards [intensive care unit (ICU), emergency, general wards] in university hospitals in the Iranian cities of Tabriz, Uremia, Ardebil, and Tehran. Further characteristics of the participants are presented in Table 1. The study lasted 6 months, from May until October 2013. In the first stage, participants were informed of the aim of the study by the researchers; if they agreed to participate in the research, they gave written consent. To respect the privacy of the interviewees, numerical codes are used instead of their names. The data were collected using unstructured interviews. Each interview lasted between 60 and 90 minutes and was performed in a private room in the hospital. Each interview commenced with an opening question such as “what do you do for a patient during your shift?”; this was followed by questions that addressed their experiences of caring for patients and situations and factors which affect the quality of caring and attending to patients’ various needs. Based on the initial data analysis, additional questions were asked of the respondents. A second interview was conducted with four participants to help clarify the initial interpretations of the information and emerging results. To ensure accuracy of the data, the interviews were continued until data saturation: Data collection was ended when no new information could be collected and the data became repetitive. The interviews were tape-recorded, transcribed, and coded line-by-line by MAXQDA 2010 software which was used in the initial stages of coding.[22] The various codes were compared and categorized and themes were constructed based on similar and appropriate categories. In this way, themes and categories were generated inductively from the data. Rigor To increase the dependability of the study, data were collected and analyzed by one of the researchers; the other researchers checked and verified the data, codes, and analyses. The transcripts were read several times and the categories and themes were discussed by the researchers until consensus was reached. The credibility of the results of the study was confirmed through prolonged engagement with participants in the wards. In addition, individual checking was used to examine the accuracy of the findings, and the results of the primary analysis were shared with the participants to validate the compatibility of the codes with their experiences. Transferability of the findings was made possible by the variety of the characteristics of the participants. Following an analysis of the data, three themes were identified as effective factors in holistic care provision: The structure of the educational system, professional environment, and motivational factors. The themes, sub-themes, and codes are shown The structure of the educational system The structure of the educational system was one of the issues which most of the participants talked about. Proper education plays an important role in nurses’ preparation for providing holistic care. This theme consists of three sub-themes: The content of educational programs, the teaching methods, and the educators’ competence. The content of educational programs If the content
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