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example of someone who considered all the needs of patients and provided holistic care. (Participant 6) An educator's good relationship with students is an effective factor in attracting attention to the educator's training, as well as motivation for learning. In this regard, one of the nurses stated: Our educators didn’t usually have a suitable relationship with us and reproached us for unimportant matters, so we didn’t have any motivation for learning. (Participant 14) Professional environment Professional environment is another factor which most participants emphasized as being important to considering the patients’ different needs and providing holistic care. This theme consists of three sub-themes: Workload, management, and the gap between clinical performance and academic learning. Workload Workload, one of the components of professional environment, was referred to by most of the participants as a restriction in holistic care provision. Concerning this issue, one of the participants said: Sometimes, the ward is too crowded and busy; although I understand that patients have different needs, and I want to meet them, but I don’t get the opportunity to do it (Participant 2). Another participant explained: If the numbers of patients were smaller in the ward, we would have more opportunities to provide better care and we could attend to all of our patients’ needs (Participant 12). One of the participants referred to the sheer number of her working shifts and said: Because of the huge number of shifts, we are always tired and don’t have the required energy for providing suitable care. (Participant 9) Management Management—with its different domains, such as evaluation, orientation programs for staff and management approaches—plays an important role in the formation of holistic care. Most of the participants emphasized its impact on the quality of nursing. To quote one of the nurses: There is no difference between a nurse who considers and attends to the patients’ different needs and another who only does the routine tasks. Ironically, the latter is more popular with the managers. Routine tasks are considered as evaluation criteria. (Participant 8) Another nurse mentioned: Our head nurse and the supervisors emphasize the routine tasks and unimportant stuff and there is no incentive for considering the patients’ secondary needs. (Participant 5) Orientation programs and managers’ competence can decrease nurses’ stress and obsession with routine duties and encourage them to consider the patients’ other needs and provide holistic care. But data show that the professional environment in Iranian hospitals lacks orientation programs for novice nurses and that most of the managers lack competence for their positions. One of the nurses stated: We didn’t have any orientation programs when we began to work in the hospital and our head nurse was very strict and belittled us for unimportant matters. It was very difficult for me. I was under pressure and lost my motivation to continue my profession, provide proper care and pay attention to the patients and their needs. (Participant 7) Conformity of the clinical environment with professional and ethical norms results in nurses’ treating patients as human beings with human needs, all of which should be taken into account; upon observing the beneficial effects of holistic care on the treatment process, nurses will acquire a holistic perception: They will realize the importance of attending to patients’ needs from various aspects and experience the effectiveness of meeting those needs as a whole compared to satisfying them separately. However, the participants declared that upon entering the clinical environment, they were faced with the limited conformity of their environment with professional norms. Disregard for the principles of proper nursing forms a sub-category of this phenomenon. The participants stated that upon embarking on their careers, they were faced with a prevalent disregard for the principles of proper nursing, at both the professional and ethical level. Obviously, such disregard for professional and ethical principles leads to professional shortcomings and negligence of nursing ideals, which in turn results in nurses’ failure to provide proper care and attend to patients’ needs in their entirety. Attention to professional principles is the prerequisite of holistic care; but in most cases they are ignored. To quote a participant: When I started, I saw that many of the points that were stressed during our education were simply ignored here. For example, we were always told to sterilize a catheter before placing it, but nobody in the ward followed the principle; or antibiotics weren’t administered at the right times. It made me feel guilty to witness all the carelessness; they didn’t care about the patients and couldn’t wait for their shifts to end! Many novice nurses would adopt the same wrong practices and ignore the professional principles; the standards and techniques were pushed aside and the patients forgotten. (Participant 6) As the above response indicates, disregard for professional principles at work results in novice nurses’ loss of interest in professional values and prevents them from attending to patients’ various human needs and encourages them to stick to their routine duties. Disregard for ethical
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