what is holistic case study

The Ultimate Guide to Qualitative Research - Part 1: The Basics

• Introduction and overview
• What is qualitative research?
• What is qualitative data?
• Examples of qualitative data
• Qualitative vs. quantitative research
• Mixed methods
• Qualitative research preparation
• Theoretical perspective
• Theoretical framework
• Literature reviews

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

Applications for case study research, what is a good case study, process of case study design, benefits and limitations of case studies.

• Ethnographical research
• Ethical considerations
• Confidentiality and privacy
• Power dynamics
• Reflexivity

Case studies

Case studies are essential to qualitative research , offering a lens through which researchers can investigate complex phenomena within their real-life contexts. This chapter explores the concept, purpose, applications, examples, and types of case studies and provides guidance on how to conduct case study research effectively.

Whereas quantitative methods look at phenomena at scale, case study research looks at a concept or phenomenon in considerable detail. While analyzing a single case can help understand one perspective regarding the object of research inquiry, analyzing multiple cases can help obtain a more holistic sense of the topic or issue. Let's provide a basic definition of a case study, then explore its characteristics and role in the qualitative research process.

Definition of a case study

A case study in qualitative research is a strategy of inquiry that involves an in-depth investigation of a phenomenon within its real-world context. It provides researchers with the opportunity to acquire an in-depth understanding of intricate details that might not be as apparent or accessible through other methods of research. The specific case or cases being studied can be a single person, group, or organization – demarcating what constitutes a relevant case worth studying depends on the researcher and their research question .

Among qualitative research methods , a case study relies on multiple sources of evidence, such as documents, artifacts, interviews , or observations , to present a complete and nuanced understanding of the phenomenon under investigation. The objective is to illuminate the readers' understanding of the phenomenon beyond its abstract statistical or theoretical explanations.

Characteristics of case studies

Case studies typically possess a number of distinct characteristics that set them apart from other research methods. These characteristics include a focus on holistic description and explanation, flexibility in the design and data collection methods, reliance on multiple sources of evidence, and emphasis on the context in which the phenomenon occurs.

Furthermore, case studies can often involve a longitudinal examination of the case, meaning they study the case over a period of time. These characteristics allow case studies to yield comprehensive, in-depth, and richly contextualized insights about the phenomenon of interest.

The role of case studies in research

Case studies hold a unique position in the broader landscape of research methods aimed at theory development. They are instrumental when the primary research interest is to gain an intensive, detailed understanding of a phenomenon in its real-life context.

In addition, case studies can serve different purposes within research - they can be used for exploratory, descriptive, or explanatory purposes, depending on the research question and objectives. This flexibility and depth make case studies a valuable tool in the toolkit of qualitative researchers.

Remember, a well-conducted case study can offer a rich, insightful contribution to both academic and practical knowledge through theory development or theory verification, thus enhancing our understanding of complex phenomena in their real-world contexts.

What is the purpose of a case study?

Case study research aims for a more comprehensive understanding of phenomena, requiring various research methods to gather information for qualitative analysis . Ultimately, a case study can allow the researcher to gain insight into a particular object of inquiry and develop a theoretical framework relevant to the research inquiry.

Why use case studies in qualitative research?

Using case studies as a research strategy depends mainly on the nature of the research question and the researcher's access to the data.

Conducting case study research provides a level of detail and contextual richness that other research methods might not offer. They are beneficial when there's a need to understand complex social phenomena within their natural contexts.

The explanatory, exploratory, and descriptive roles of case studies

Case studies can take on various roles depending on the research objectives. They can be exploratory when the research aims to discover new phenomena or define new research questions; they are descriptive when the objective is to depict a phenomenon within its context in a detailed manner; and they can be explanatory if the goal is to understand specific relationships within the studied context. Thus, the versatility of case studies allows researchers to approach their topic from different angles, offering multiple ways to uncover and interpret the data .

The impact of case studies on knowledge development

Case studies play a significant role in knowledge development across various disciplines. Analysis of cases provides an avenue for researchers to explore phenomena within their context based on the collected data.

This can result in the production of rich, practical insights that can be instrumental in both theory-building and practice. Case studies allow researchers to delve into the intricacies and complexities of real-life situations, uncovering insights that might otherwise remain hidden.

Types of case studies

In qualitative research , a case study is not a one-size-fits-all approach. Depending on the nature of the research question and the specific objectives of the study, researchers might choose to use different types of case studies. These types differ in their focus, methodology, and the level of detail they provide about the phenomenon under investigation.

Understanding these types is crucial for selecting the most appropriate approach for your research project and effectively achieving your research goals. Let's briefly look at the main types of case studies.

Exploratory case studies

Exploratory case studies are typically conducted to develop a theory or framework around an understudied phenomenon. They can also serve as a precursor to a larger-scale research project. Exploratory case studies are useful when a researcher wants to identify the key issues or questions which can spur more extensive study or be used to develop propositions for further research. These case studies are characterized by flexibility, allowing researchers to explore various aspects of a phenomenon as they emerge, which can also form the foundation for subsequent studies.

Descriptive case studies

Descriptive case studies aim to provide a complete and accurate representation of a phenomenon or event within its context. These case studies are often based on an established theoretical framework, which guides how data is collected and analyzed. The researcher is concerned with describing the phenomenon in detail, as it occurs naturally, without trying to influence or manipulate it.

Explanatory case studies

Explanatory case studies are focused on explanation - they seek to clarify how or why certain phenomena occur. Often used in complex, real-life situations, they can be particularly valuable in clarifying causal relationships among concepts and understanding the interplay between different factors within a specific context.

Intrinsic, instrumental, and collective case studies

These three categories of case studies focus on the nature and purpose of the study. An intrinsic case study is conducted when a researcher has an inherent interest in the case itself. Instrumental case studies are employed when the case is used to provide insight into a particular issue or phenomenon. A collective case study, on the other hand, involves studying multiple cases simultaneously to investigate some general phenomena.

Each type of case study serves a different purpose and has its own strengths and challenges. The selection of the type should be guided by the research question and objectives, as well as the context and constraints of the research.

The flexibility, depth, and contextual richness offered by case studies make this approach an excellent research method for various fields of study. They enable researchers to investigate real-world phenomena within their specific contexts, capturing nuances that other research methods might miss. Across numerous fields, case studies provide valuable insights into complex issues.

Critical information systems research

Case studies provide a detailed understanding of the role and impact of information systems in different contexts. They offer a platform to explore how information systems are designed, implemented, and used and how they interact with various social, economic, and political factors. Case studies in this field often focus on examining the intricate relationship between technology, organizational processes, and user behavior, helping to uncover insights that can inform better system design and implementation.

Health research

Health research is another field where case studies are highly valuable. They offer a way to explore patient experiences, healthcare delivery processes, and the impact of various interventions in a real-world context.

Case studies can provide a deep understanding of a patient's journey, giving insights into the intricacies of disease progression, treatment effects, and the psychosocial aspects of health and illness.

Asthma research studies

Specifically within medical research, studies on asthma often employ case studies to explore the individual and environmental factors that influence asthma development, management, and outcomes. A case study can provide rich, detailed data about individual patients' experiences, from the triggers and symptoms they experience to the effectiveness of various management strategies. This can be crucial for developing patient-centered asthma care approaches.

Other fields

Apart from the fields mentioned, case studies are also extensively used in business and management research, education research, and political sciences, among many others. They provide an opportunity to delve into the intricacies of real-world situations, allowing for a comprehensive understanding of various phenomena.

Case studies, with their depth and contextual focus, offer unique insights across these varied fields. They allow researchers to illuminate the complexities of real-life situations, contributing to both theory and practice.

Whatever field you're in, ATLAS.ti puts your data to work for you

Download a free trial of ATLAS.ti to turn your data into insights.

Understanding the key elements of case study design is crucial for conducting rigorous and impactful case study research. A well-structured design guides the researcher through the process, ensuring that the study is methodologically sound and its findings are reliable and valid. The main elements of case study design include the research question , propositions, units of analysis, and the logic linking the data to the propositions.

The research question is the foundation of any research study. A good research question guides the direction of the study and informs the selection of the case, the methods of collecting data, and the analysis techniques. A well-formulated research question in case study research is typically clear, focused, and complex enough to merit further detailed examination of the relevant case(s).

Propositions

Propositions, though not necessary in every case study, provide a direction by stating what we might expect to find in the data collected. They guide how data is collected and analyzed by helping researchers focus on specific aspects of the case. They are particularly important in explanatory case studies, which seek to understand the relationships among concepts within the studied phenomenon.

Units of analysis

The unit of analysis refers to the case, or the main entity or entities that are being analyzed in the study. In case study research, the unit of analysis can be an individual, a group, an organization, a decision, an event, or even a time period. It's crucial to clearly define the unit of analysis, as it shapes the qualitative data analysis process by allowing the researcher to analyze a particular case and synthesize analysis across multiple case studies to draw conclusions.

Argumentation

This refers to the inferential model that allows researchers to draw conclusions from the data. The researcher needs to ensure that there is a clear link between the data, the propositions (if any), and the conclusions drawn. This argumentation is what enables the researcher to make valid and credible inferences about the phenomenon under study.

Understanding and carefully considering these elements in the design phase of a case study can significantly enhance the quality of the research. It can help ensure that the study is methodologically sound and its findings contribute meaningful insights about the case.

Ready to jumpstart your research with ATLAS.ti?

Conceptualize your research project with our intuitive data analysis interface. Download a free trial today.

Conducting a case study involves several steps, from defining the research question and selecting the case to collecting and analyzing data . This section outlines these key stages, providing a practical guide on how to conduct case study research.

Defining the research question

The first step in case study research is defining a clear, focused research question. This question should guide the entire research process, from case selection to analysis. It's crucial to ensure that the research question is suitable for a case study approach. Typically, such questions are exploratory or descriptive in nature and focus on understanding a phenomenon within its real-life context.

Selecting and defining the case

The selection of the case should be based on the research question and the objectives of the study. It involves choosing a unique example or a set of examples that provide rich, in-depth data about the phenomenon under investigation. After selecting the case, it's crucial to define it clearly, setting the boundaries of the case, including the time period and the specific context.

Previous research can help guide the case study design. When considering a case study, an example of a case could be taken from previous case study research and used to define cases in a new research inquiry. Considering recently published examples can help understand how to select and define cases effectively.

Developing a detailed case study protocol

A case study protocol outlines the procedures and general rules to be followed during the case study. This includes the data collection methods to be used, the sources of data, and the procedures for analysis. Having a detailed case study protocol ensures consistency and reliability in the study.

The protocol should also consider how to work with the people involved in the research context to grant the research team access to collecting data. As mentioned in previous sections of this guide, establishing rapport is an essential component of qualitative research as it shapes the overall potential for collecting and analyzing data.

Collecting data

Gathering data in case study research often involves multiple sources of evidence, including documents, archival records, interviews, observations, and physical artifacts. This allows for a comprehensive understanding of the case. The process for gathering data should be systematic and carefully documented to ensure the reliability and validity of the study.

Analyzing and interpreting data

The next step is analyzing the data. This involves organizing the data , categorizing it into themes or patterns , and interpreting these patterns to answer the research question. The analysis might also involve comparing the findings with prior research or theoretical propositions.

Writing the case study report

The final step is writing the case study report . This should provide a detailed description of the case, the data, the analysis process, and the findings. The report should be clear, organized, and carefully written to ensure that the reader can understand the case and the conclusions drawn from it.

Each of these steps is crucial in ensuring that the case study research is rigorous, reliable, and provides valuable insights about the case.

The type, depth, and quality of data in your study can significantly influence the validity and utility of the study. In case study research, data is usually collected from multiple sources to provide a comprehensive and nuanced understanding of the case. This section will outline the various methods of collecting data used in case study research and discuss considerations for ensuring the quality of the data.

Interviews are a common method of gathering data in case study research. They can provide rich, in-depth data about the perspectives, experiences, and interpretations of the individuals involved in the case. Interviews can be structured , semi-structured , or unstructured , depending on the research question and the degree of flexibility needed.

Observations

Observations involve the researcher observing the case in its natural setting, providing first-hand information about the case and its context. Observations can provide data that might not be revealed in interviews or documents, such as non-verbal cues or contextual information.

Documents and artifacts

Documents and archival records provide a valuable source of data in case study research. They can include reports, letters, memos, meeting minutes, email correspondence, and various public and private documents related to the case.

These records can provide historical context, corroborate evidence from other sources, and offer insights into the case that might not be apparent from interviews or observations.

Physical artifacts refer to any physical evidence related to the case, such as tools, products, or physical environments. These artifacts can provide tangible insights into the case, complementing the data gathered from other sources.

Ensuring the quality of data collection

Determining the quality of data in case study research requires careful planning and execution. It's crucial to ensure that the data is reliable, accurate, and relevant to the research question. This involves selecting appropriate methods of collecting data, properly training interviewers or observers, and systematically recording and storing the data. It also includes considering ethical issues related to collecting and handling data, such as obtaining informed consent and ensuring the privacy and confidentiality of the participants.

Data analysis

Analyzing case study research involves making sense of the rich, detailed data to answer the research question. This process can be challenging due to the volume and complexity of case study data. However, a systematic and rigorous approach to analysis can ensure that the findings are credible and meaningful. This section outlines the main steps and considerations in analyzing data in case study research.

Organizing the data

The first step in the analysis is organizing the data. This involves sorting the data into manageable sections, often according to the data source or the theme. This step can also involve transcribing interviews, digitizing physical artifacts, or organizing observational data.

Categorizing and coding the data

Once the data is organized, the next step is to categorize or code the data. This involves identifying common themes, patterns, or concepts in the data and assigning codes to relevant data segments. Coding can be done manually or with the help of software tools, and in either case, qualitative analysis software can greatly facilitate the entire coding process. Coding helps to reduce the data to a set of themes or categories that can be more easily analyzed.

Identifying patterns and themes

After coding the data, the researcher looks for patterns or themes in the coded data. This involves comparing and contrasting the codes and looking for relationships or patterns among them. The identified patterns and themes should help answer the research question.

Interpreting the data

Once patterns and themes have been identified, the next step is to interpret these findings. This involves explaining what the patterns or themes mean in the context of the research question and the case. This interpretation should be grounded in the data, but it can also involve drawing on theoretical concepts or prior research.

Verification of the data

The last step in the analysis is verification. This involves checking the accuracy and consistency of the analysis process and confirming that the findings are supported by the data. This can involve re-checking the original data, checking the consistency of codes, or seeking feedback from research participants or peers.

Like any research method , case study research has its strengths and limitations. Researchers must be aware of these, as they can influence the design, conduct, and interpretation of the study.

Understanding the strengths and limitations of case study research can also guide researchers in deciding whether this approach is suitable for their research question . This section outlines some of the key strengths and limitations of case study research.

Benefits include the following:

• Rich, detailed data: One of the main strengths of case study research is that it can generate rich, detailed data about the case. This can provide a deep understanding of the case and its context, which can be valuable in exploring complex phenomena.
• Flexibility: Case study research is flexible in terms of design , data collection , and analysis . A sufficient degree of flexibility allows the researcher to adapt the study according to the case and the emerging findings.
• Real-world context: Case study research involves studying the case in its real-world context, which can provide valuable insights into the interplay between the case and its context.
• Multiple sources of evidence: Case study research often involves collecting data from multiple sources , which can enhance the robustness and validity of the findings.

On the other hand, researchers should consider the following limitations:

• Generalizability: A common criticism of case study research is that its findings might not be generalizable to other cases due to the specificity and uniqueness of each case.
• Time and resource intensive: Case study research can be time and resource intensive due to the depth of the investigation and the amount of collected data.
• Complexity of analysis: The rich, detailed data generated in case study research can make analyzing the data challenging.
• Subjectivity: Given the nature of case study research, there may be a higher degree of subjectivity in interpreting the data , so researchers need to reflect on this and transparently convey to audiences how the research was conducted.

Being aware of these strengths and limitations can help researchers design and conduct case study research effectively and interpret and report the findings appropriately.

Ready to analyze your data with ATLAS.ti?

See how our intuitive software can draw key insights from your data with a free trial today.

The Advantages and Limitations of Single Case Study Analysis

As Andrew Bennett and Colin Elman have recently noted, qualitative research methods presently enjoy “an almost unprecedented popularity and vitality… in the international relations sub-field”, such that they are now “indisputably prominent, if not pre-eminent” (2010: 499). This is, they suggest, due in no small part to the considerable advantages that case study methods in particular have to offer in studying the “complex and relatively unstructured and infrequent phenomena that lie at the heart of the subfield” (Bennett and Elman, 2007: 171). Using selected examples from within the International Relations literature[1], this paper aims to provide a brief overview of the main principles and distinctive advantages and limitations of single case study analysis. Divided into three inter-related sections, the paper therefore begins by first identifying the underlying principles that serve to constitute the case study as a particular research strategy, noting the somewhat contested nature of the approach in ontological, epistemological, and methodological terms. The second part then looks to the principal single case study types and their associated advantages, including those from within the recent ‘third generation’ of qualitative International Relations (IR) research. The final section of the paper then discusses the most commonly articulated limitations of single case studies; while accepting their susceptibility to criticism, it is however suggested that such weaknesses are somewhat exaggerated. The paper concludes that single case study analysis has a great deal to offer as a means of both understanding and explaining contemporary international relations.

The term ‘case study’, John Gerring has suggested, is “a definitional morass… Evidently, researchers have many different things in mind when they talk about case study research” (2006a: 17). It is possible, however, to distil some of the more commonly-agreed principles. One of the most prominent advocates of case study research, Robert Yin (2009: 14) defines it as “an empirical enquiry that investigates a contemporary phenomenon in depth and within its real-life context, especially when the boundaries between phenomenon and context are not clearly evident”. What this definition usefully captures is that case studies are intended – unlike more superficial and generalising methods – to provide a level of detail and understanding, similar to the ethnographer Clifford Geertz’s (1973) notion of ‘thick description’, that allows for the thorough analysis of the complex and particularistic nature of distinct phenomena. Another frequently cited proponent of the approach, Robert Stake, notes that as a form of research the case study “is defined by interest in an individual case, not by the methods of inquiry used”, and that “the object of study is a specific, unique, bounded system” (2008: 443, 445). As such, three key points can be derived from this – respectively concerning issues of ontology, epistemology, and methodology – that are central to the principles of single case study research.

First, the vital notion of ‘boundedness’ when it comes to the particular unit of analysis means that defining principles should incorporate both the synchronic (spatial) and diachronic (temporal) elements of any so-called ‘case’. As Gerring puts it, a case study should be “an intensive study of a single unit… a spatially bounded phenomenon – e.g. a nation-state, revolution, political party, election, or person – observed at a single point in time or over some delimited period of time” (2004: 342). It is important to note, however, that – whereas Gerring refers to a single unit of analysis – it may be that attention also necessarily be given to particular sub-units. This points to the important difference between what Yin refers to as an ‘holistic’ case design, with a single unit of analysis, and an ’embedded’ case design with multiple units of analysis (Yin, 2009: 50-52). The former, for example, would examine only the overall nature of an international organization, whereas the latter would also look to specific departments, programmes, or policies etc.

Secondly, as Tim May notes of the case study approach, “even the most fervent advocates acknowledge that the term has entered into understandings with little specification or discussion of purpose and process” (2011: 220). One of the principal reasons for this, he argues, is the relationship between the use of case studies in social research and the differing epistemological traditions – positivist, interpretivist, and others – within which it has been utilised. Philosophy of science concerns are obviously a complex issue, and beyond the scope of much of this paper. That said, the issue of how it is that we know what we know – of whether or not a single independent reality exists of which we as researchers can seek to provide explanation – does lead us to an important distinction to be made between so-called idiographic and nomothetic case studies (Gerring, 2006b). The former refers to those which purport to explain only a single case, are concerned with particularisation, and hence are typically (although not exclusively) associated with more interpretivist approaches. The latter are those focused studies that reflect upon a larger population and are more concerned with generalisation, as is often so with more positivist approaches[2]. The importance of this distinction, and its relation to the advantages and limitations of single case study analysis, is returned to below.

Thirdly, in methodological terms, given that the case study has often been seen as more of an interpretivist and idiographic tool, it has also been associated with a distinctly qualitative approach (Bryman, 2009: 67-68). However, as Yin notes, case studies can – like all forms of social science research – be exploratory, descriptive, and/or explanatory in nature. It is “a common misconception”, he notes, “that the various research methods should be arrayed hierarchically… many social scientists still deeply believe that case studies are only appropriate for the exploratory phase of an investigation” (Yin, 2009: 6). If case studies can reliably perform any or all three of these roles – and given that their in-depth approach may also require multiple sources of data and the within-case triangulation of methods – then it becomes readily apparent that they should not be limited to only one research paradigm. Exploratory and descriptive studies usually tend toward the qualitative and inductive, whereas explanatory studies are more often quantitative and deductive (David and Sutton, 2011: 165-166). As such, the association of case study analysis with a qualitative approach is a “methodological affinity, not a definitional requirement” (Gerring, 2006a: 36). It is perhaps better to think of case studies as transparadigmatic; it is mistaken to assume single case study analysis to adhere exclusively to a qualitative methodology (or an interpretivist epistemology) even if it – or rather, practitioners of it – may be so inclined. By extension, this also implies that single case study analysis therefore remains an option for a multitude of IR theories and issue areas; it is how this can be put to researchers’ advantage that is the subject of the next section.

Having elucidated the defining principles of the single case study approach, the paper now turns to an overview of its main benefits. As noted above, a lack of consensus still exists within the wider social science literature on the principles and purposes – and by extension the advantages and limitations – of case study research. Given that this paper is directed towards the particular sub-field of International Relations, it suggests Bennett and Elman’s (2010) more discipline-specific understanding of contemporary case study methods as an analytical framework. It begins however, by discussing Harry Eckstein’s seminal (1975) contribution to the potential advantages of the case study approach within the wider social sciences.

Eckstein proposed a taxonomy which usefully identified what he considered to be the five most relevant types of case study. Firstly were so-called configurative-idiographic studies, distinctly interpretivist in orientation and predicated on the assumption that “one cannot attain prediction and control in the natural science sense, but only understanding ( verstehen )… subjective values and modes of cognition are crucial” (1975: 132). Eckstein’s own sceptical view was that any interpreter ‘simply’ considers a body of observations that are not self-explanatory and “without hard rules of interpretation, may discern in them any number of patterns that are more or less equally plausible” (1975: 134). Those of a more post-modernist bent, of course – sharing an “incredulity towards meta-narratives”, in Lyotard’s (1994: xxiv) evocative phrase – would instead suggest that this more free-form approach actually be advantageous in delving into the subtleties and particularities of individual cases.

Eckstein’s four other types of case study, meanwhile, promote a more nomothetic (and positivist) usage. As described, disciplined-configurative studies were essentially about the use of pre-existing general theories, with a case acting “passively, in the main, as a receptacle for putting theories to work” (Eckstein, 1975: 136). As opposed to the opportunity this presented primarily for theory application, Eckstein identified heuristic case studies as explicit theoretical stimulants – thus having instead the intended advantage of theory-building. So-called p lausibility probes entailed preliminary attempts to determine whether initial hypotheses should be considered sound enough to warrant more rigorous and extensive testing. Finally, and perhaps most notably, Eckstein then outlined the idea of crucial case studies , within which he also included the idea of ‘most-likely’ and ‘least-likely’ cases; the essential characteristic of crucial cases being their specific theory-testing function.

Whilst Eckstein’s was an early contribution to refining the case study approach, Yin’s (2009: 47-52) more recent delineation of possible single case designs similarly assigns them roles in the applying, testing, or building of theory, as well as in the study of unique cases[3]. As a subset of the latter, however, Jack Levy (2008) notes that the advantages of idiographic cases are actually twofold. Firstly, as inductive/descriptive cases – akin to Eckstein’s configurative-idiographic cases – whereby they are highly descriptive, lacking in an explicit theoretical framework and therefore taking the form of “total history”. Secondly, they can operate as theory-guided case studies, but ones that seek only to explain or interpret a single historical episode rather than generalise beyond the case. Not only does this therefore incorporate ‘single-outcome’ studies concerned with establishing causal inference (Gerring, 2006b), it also provides room for the more postmodern approaches within IR theory, such as discourse analysis, that may have developed a distinct methodology but do not seek traditional social scientific forms of explanation.

Applying specifically to the state of the field in contemporary IR, Bennett and Elman identify a ‘third generation’ of mainstream qualitative scholars – rooted in a pragmatic scientific realist epistemology and advocating a pluralistic approach to methodology – that have, over the last fifteen years, “revised or added to essentially every aspect of traditional case study research methods” (2010: 502). They identify ‘process tracing’ as having emerged from this as a central method of within-case analysis. As Bennett and Checkel observe, this carries the advantage of offering a methodologically rigorous “analysis of evidence on processes, sequences, and conjunctures of events within a case, for the purposes of either developing or testing hypotheses about causal mechanisms that might causally explain the case” (2012: 10).

Harnessing various methods, process tracing may entail the inductive use of evidence from within a case to develop explanatory hypotheses, and deductive examination of the observable implications of hypothesised causal mechanisms to test their explanatory capability[4]. It involves providing not only a coherent explanation of the key sequential steps in a hypothesised process, but also sensitivity to alternative explanations as well as potential biases in the available evidence (Bennett and Elman 2010: 503-504). John Owen (1994), for example, demonstrates the advantages of process tracing in analysing whether the causal factors underpinning democratic peace theory are – as liberalism suggests – not epiphenomenal, but variously normative, institutional, or some given combination of the two or other unexplained mechanism inherent to liberal states. Within-case process tracing has also been identified as advantageous in addressing the complexity of path-dependent explanations and critical junctures – as for example with the development of political regime types – and their constituent elements of causal possibility, contingency, closure, and constraint (Bennett and Elman, 2006b).

Bennett and Elman (2010: 505-506) also identify the advantages of single case studies that are implicitly comparative: deviant, most-likely, least-likely, and crucial cases. Of these, so-called deviant cases are those whose outcome does not fit with prior theoretical expectations or wider empirical patterns – again, the use of inductive process tracing has the advantage of potentially generating new hypotheses from these, either particular to that individual case or potentially generalisable to a broader population. A classic example here is that of post-independence India as an outlier to the standard modernisation theory of democratisation, which holds that higher levels of socio-economic development are typically required for the transition to, and consolidation of, democratic rule (Lipset, 1959; Diamond, 1992). Absent these factors, MacMillan’s single case study analysis (2008) suggests the particularistic importance of the British colonial heritage, the ideology and leadership of the Indian National Congress, and the size and heterogeneity of the federal state.

Most-likely cases, as per Eckstein above, are those in which a theory is to be considered likely to provide a good explanation if it is to have any application at all, whereas least-likely cases are ‘tough test’ ones in which the posited theory is unlikely to provide good explanation (Bennett and Elman, 2010: 505). Levy (2008) neatly refers to the inferential logic of the least-likely case as the ‘Sinatra inference’ – if a theory can make it here, it can make it anywhere. Conversely, if a theory cannot pass a most-likely case, it is seriously impugned. Single case analysis can therefore be valuable for the testing of theoretical propositions, provided that predictions are relatively precise and measurement error is low (Levy, 2008: 12-13). As Gerring rightly observes of this potential for falsification:

“a positivist orientation toward the work of social science militates toward a greater appreciation of the case study format, not a denigration of that format, as is usually supposed” (Gerring, 2007: 247, emphasis added).

In summary, the various forms of single case study analysis can – through the application of multiple qualitative and/or quantitative research methods – provide a nuanced, empirically-rich, holistic account of specific phenomena. This may be particularly appropriate for those phenomena that are simply less amenable to more superficial measures and tests (or indeed any substantive form of quantification) as well as those for which our reasons for understanding and/or explaining them are irreducibly subjective – as, for example, with many of the normative and ethical issues associated with the practice of international relations. From various epistemological and analytical standpoints, single case study analysis can incorporate both idiographic sui generis cases and, where the potential for generalisation may exist, nomothetic case studies suitable for the testing and building of causal hypotheses. Finally, it should not be ignored that a signal advantage of the case study – with particular relevance to international relations – also exists at a more practical rather than theoretical level. This is, as Eckstein noted, “that it is economical for all resources: money, manpower, time, effort… especially important, of course, if studies are inherently costly, as they are if units are complex collective individuals ” (1975: 149-150, emphasis added).

Limitations

Single case study analysis has, however, been subject to a number of criticisms, the most common of which concern the inter-related issues of methodological rigour, researcher subjectivity, and external validity. With regard to the first point, the prototypical view here is that of Zeev Maoz (2002: 164-165), who suggests that “the use of the case study absolves the author from any kind of methodological considerations. Case studies have become in many cases a synonym for freeform research where anything goes”. The absence of systematic procedures for case study research is something that Yin (2009: 14-15) sees as traditionally the greatest concern due to a relative absence of methodological guidelines. As the previous section suggests, this critique seems somewhat unfair; many contemporary case study practitioners – and representing various strands of IR theory – have increasingly sought to clarify and develop their methodological techniques and epistemological grounding (Bennett and Elman, 2010: 499-500).

A second issue, again also incorporating issues of construct validity, concerns that of the reliability and replicability of various forms of single case study analysis. This is usually tied to a broader critique of qualitative research methods as a whole. However, whereas the latter obviously tend toward an explicitly-acknowledged interpretive basis for meanings, reasons, and understandings:

“quantitative measures appear objective, but only so long as we don’t ask questions about where and how the data were produced… pure objectivity is not a meaningful concept if the goal is to measure intangibles [as] these concepts only exist because we can interpret them” (Berg and Lune, 2010: 340).

The question of researcher subjectivity is a valid one, and it may be intended only as a methodological critique of what are obviously less formalised and researcher-independent methods (Verschuren, 2003). Owen (1994) and Layne’s (1994) contradictory process tracing results of interdemocratic war-avoidance during the Anglo-American crisis of 1861 to 1863 – from liberal and realist standpoints respectively – are a useful example. However, it does also rest on certain assumptions that can raise deeper and potentially irreconcilable ontological and epistemological issues. There are, regardless, plenty such as Bent Flyvbjerg (2006: 237) who suggest that the case study contains no greater bias toward verification than other methods of inquiry, and that “on the contrary, experience indicates that the case study contains a greater bias toward falsification of preconceived notions than toward verification”.

The third and arguably most prominent critique of single case study analysis is the issue of external validity or generalisability. How is it that one case can reliably offer anything beyond the particular? “We always do better (or, in the extreme, no worse) with more observation as the basis of our generalization”, as King et al write; “in all social science research and all prediction, it is important that we be as explicit as possible about the degree of uncertainty that accompanies out prediction” (1994: 212). This is an unavoidably valid criticism. It may be that theories which pass a single crucial case study test, for example, require rare antecedent conditions and therefore actually have little explanatory range. These conditions may emerge more clearly, as Van Evera (1997: 51-54) notes, from large-N studies in which cases that lack them present themselves as outliers exhibiting a theory’s cause but without its predicted outcome. As with the case of Indian democratisation above, it would logically be preferable to conduct large-N analysis beforehand to identify that state’s non-representative nature in relation to the broader population.

There are, however, three important qualifiers to the argument about generalisation that deserve particular mention here. The first is that with regard to an idiographic single-outcome case study, as Eckstein notes, the criticism is “mitigated by the fact that its capability to do so [is] never claimed by its exponents; in fact it is often explicitly repudiated” (1975: 134). Criticism of generalisability is of little relevance when the intention is one of particularisation. A second qualifier relates to the difference between statistical and analytical generalisation; single case studies are clearly less appropriate for the former but arguably retain significant utility for the latter – the difference also between explanatory and exploratory, or theory-testing and theory-building, as discussed above. As Gerring puts it, “theory confirmation/disconfirmation is not the case study’s strong suit” (2004: 350). A third qualification relates to the issue of case selection. As Seawright and Gerring (2008) note, the generalisability of case studies can be increased by the strategic selection of cases. Representative or random samples may not be the most appropriate, given that they may not provide the richest insight (or indeed, that a random and unknown deviant case may appear). Instead, and properly used , atypical or extreme cases “often reveal more information because they activate more actors… and more basic mechanisms in the situation studied” (Flyvbjerg, 2006). Of course, this also points to the very serious limitation, as hinted at with the case of India above, that poor case selection may alternatively lead to overgeneralisation and/or grievous misunderstandings of the relationship between variables or processes (Bennett and Elman, 2006a: 460-463).

As Tim May (2011: 226) notes, “the goal for many proponents of case studies […] is to overcome dichotomies between generalizing and particularizing, quantitative and qualitative, deductive and inductive techniques”. Research aims should drive methodological choices, rather than narrow and dogmatic preconceived approaches. As demonstrated above, there are various advantages to both idiographic and nomothetic single case study analyses – notably the empirically-rich, context-specific, holistic accounts that they have to offer, and their contribution to theory-building and, to a lesser extent, that of theory-testing. Furthermore, while they do possess clear limitations, any research method involves necessary trade-offs; the inherent weaknesses of any one method, however, can potentially be offset by situating them within a broader, pluralistic mixed-method research strategy. Whether or not single case studies are used in this fashion, they clearly have a great deal to offer.

References 

Bennett, A. and Checkel, J. T. (2012) ‘Process Tracing: From Philosophical Roots to Best Practice’, Simons Papers in Security and Development, No. 21/2012, School for International Studies, Simon Fraser University: Vancouver.

Bennett, A. and Elman, C. (2006a) ‘Qualitative Research: Recent Developments in Case Study Methods’, Annual Review of Political Science , 9, 455-476.

Bennett, A. and Elman, C. (2006b) ‘Complex Causal Relations and Case Study Methods: The Example of Path Dependence’, Political Analysis , 14, 3, 250-267.

Bennett, A. and Elman, C. (2007) ‘Case Study Methods in the International Relations Subfield’, Comparative Political Studies , 40, 2, 170-195.

Bennett, A. and Elman, C. (2010) Case Study Methods. In C. Reus-Smit and D. Snidal (eds) The Oxford Handbook of International Relations . Oxford University Press: Oxford. Ch. 29.

Berg, B. and Lune, H. (2012) Qualitative Research Methods for the Social Sciences . Pearson: London.

Bryman, A. (2012) Social Research Methods . Oxford University Press: Oxford.

David, M. and Sutton, C. D. (2011) Social Research: An Introduction . SAGE Publications Ltd: London.

Diamond, J. (1992) ‘Economic development and democracy reconsidered’, American Behavioral Scientist , 35, 4/5, 450-499.

Eckstein, H. (1975) Case Study and Theory in Political Science. In R. Gomm, M. Hammersley, and P. Foster (eds) Case Study Method . SAGE Publications Ltd: London.

Flyvbjerg, B. (2006) ‘Five Misunderstandings About Case-Study Research’, Qualitative Inquiry , 12, 2, 219-245.

Geertz, C. (1973) The Interpretation of Cultures: Selected Essays by Clifford Geertz . Basic Books Inc: New York.

Gerring, J. (2004) ‘What is a Case Study and What Is It Good for?’, American Political Science Review , 98, 2, 341-354.

Gerring, J. (2006a) Case Study Research: Principles and Practices . Cambridge University Press: Cambridge.

Gerring, J. (2006b) ‘Single-Outcome Studies: A Methodological Primer’, International Sociology , 21, 5, 707-734.

Gerring, J. (2007) ‘Is There a (Viable) Crucial-Case Method?’, Comparative Political Studies , 40, 3, 231-253.

King, G., Keohane, R. O. and Verba, S. (1994) Designing Social Inquiry: Scientific Inference in Qualitative Research . Princeton University Press: Chichester.

Layne, C. (1994) ‘Kant or Cant: The Myth of the Democratic Peace’, International Security , 19, 2, 5-49.

Levy, J. S. (2008) ‘Case Studies: Types, Designs, and Logics of Inference’, Conflict Management and Peace Science , 25, 1-18.

Lipset, S. M. (1959) ‘Some Social Requisites of Democracy: Economic Development and Political Legitimacy’, The American Political Science Review , 53, 1, 69-105.

Lyotard, J-F. (1984) The Postmodern Condition: A Report on Knowledge . University of Minnesota Press: Minneapolis.

MacMillan, A. (2008) ‘Deviant Democratization in India’, Democratization , 15, 4, 733-749.

Maoz, Z. (2002) Case study methodology in international studies: from storytelling to hypothesis testing. In F. P. Harvey and M. Brecher (eds) Evaluating Methodology in International Studies . University of Michigan Press: Ann Arbor.

May, T. (2011) Social Research: Issues, Methods and Process . Open University Press: Maidenhead.

Owen, J. M. (1994) ‘How Liberalism Produces Democratic Peace’, International Security , 19, 2, 87-125.

Seawright, J. and Gerring, J. (2008) ‘Case Selection Techniques in Case Study Research: A Menu of Qualitative and Quantitative Options’, Political Research Quarterly , 61, 2, 294-308.

Stake, R. E. (2008) Qualitative Case Studies. In N. K. Denzin and Y. S. Lincoln (eds) Strategies of Qualitative Inquiry . Sage Publications: Los Angeles. Ch. 17.

Van Evera, S. (1997) Guide to Methods for Students of Political Science . Cornell University Press: Ithaca.

Verschuren, P. J. M. (2003) ‘Case study as a research strategy: some ambiguities and opportunities’, International Journal of Social Research Methodology , 6, 2, 121-139.

Yin, R. K. (2009) Case Study Research: Design and Methods . SAGE Publications Ltd: London.

[1] The paper follows convention by differentiating between ‘International Relations’ as the academic discipline and ‘international relations’ as the subject of study.

[2] There is some similarity here with Stake’s (2008: 445-447) notion of intrinsic cases, those undertaken for a better understanding of the particular case, and instrumental ones that provide insight for the purposes of a wider external interest.

[3] These may be unique in the idiographic sense, or in nomothetic terms as an exception to the generalising suppositions of either probabilistic or deterministic theories (as per deviant cases, below).

[4] Although there are “philosophical hurdles to mount”, according to Bennett and Checkel, there exists no a priori reason as to why process tracing (as typically grounded in scientific realism) is fundamentally incompatible with various strands of positivism or interpretivism (2012: 18-19). By extension, it can therefore be incorporated by a range of contemporary mainstream IR theories.

— Written by: Ben Willis Written at: University of Plymouth Written for: David Brockington Date written: January 2013

Further Reading on E-International Relations

• Identity in International Conflicts: A Case Study of the Cuban Missile Crisis
• Imperialism’s Legacy in the Study of Contemporary Politics: The Case of Hegemonic Stability Theory
• Recreating a Nation’s Identity Through Symbolism: A Chinese Case Study
• Ontological Insecurity: A Case Study on Israeli-Palestinian Conflict in Jerusalem
• Terrorists or Freedom Fighters: A Case Study of ETA
• A Critical Assessment of Eco-Marxism: A Ghanaian Case Study

Please Consider Donating

Before you download your free e-book, please consider donating to support open access publishing.

E-IR is an independent non-profit publisher run by an all volunteer team. Your donations allow us to invest in new open access titles and pay our bandwidth bills to ensure we keep our existing titles free to view. Any amount, in any currency, is appreciated. Many thanks!

Donations are voluntary and not required to download the e-book - your link to download is below.

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

Research Guides

Multiple Case Studies

Nadia Alqahtani and Pengtong Qu

Description

The case study approach is popular across disciplines in education, anthropology, sociology, psychology, medicine, law, and political science (Creswell, 2013). It is both a research method and a strategy (Creswell, 2013; Yin, 2017). In this type of research design, a case can be an individual, an event, or an entity, as determined by the research questions. There are two variants of the case study: the single-case study and the multiple-case study. The former design can be used to study and understand an unusual case, a critical case, a longitudinal case, or a revelatory case. On the other hand, a multiple-case study includes two or more cases or replications across the cases to investigate the same phenomena (Lewis-Beck, Bryman & Liao, 2003; Yin, 2017). …a multiple-case study includes two or more cases or replications across the cases to investigate the same phenomena

The difference between the single- and multiple-case study is the research design; however, they are within the same methodological framework (Yin, 2017). Multiple cases are selected so that “individual case studies either (a) predict similar results (a literal replication) or (b) predict contrasting results but for anticipatable reasons (a theoretical replication)” (p. 55). When the purpose of the study is to compare and replicate the findings, the multiple-case study produces more compelling evidence so that the study is considered more robust than the single-case study (Yin, 2017).

To write a multiple-case study, a summary of individual cases should be reported, and researchers need to draw cross-case conclusions and form a cross-case report (Yin, 2017). With evidence from multiple cases, researchers may have generalizable findings and develop theories (Lewis-Beck, Bryman & Liao, 2003).

Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Los Angeles, CA: Sage.

Lewis-Beck, M., Bryman, A. E., & Liao, T. F. (2003). The Sage encyclopedia of social science research methods . Los Angeles, CA: Sage.

Yin, R. K. (2017). Case study research and applications: Design and methods . Los Angeles, CA: Sage.

Key Research Books and Articles on Multiple Case Study Methodology

Yin discusses how to decide if a case study should be used in research. Novice researchers can learn about research design, data collection, and data analysis of different types of case studies, as well as writing a case study report.

Chapter 2 introduces four major types of research design in case studies: holistic single-case design, embedded single-case design, holistic multiple-case design, and embedded multiple-case design. Novice researchers will learn about the definitions and characteristics of different designs. This chapter also teaches researchers how to examine and discuss the reliability and validity of the designs.

Creswell, J. W., & Poth, C. N. (2017). Qualitative inquiry and research design: Choosing among five approaches . Los Angeles, CA: Sage.

This book compares five different qualitative research designs: narrative research, phenomenology, grounded theory, ethnography, and case study. It compares the characteristics, data collection, data analysis and representation, validity, and writing-up procedures among five inquiry approaches using texts with tables. For each approach, the author introduced the definition, features, types, and procedures and contextualized these components in a study, which was conducted through the same method. Each chapter ends with a list of relevant readings of each inquiry approach.

This book invites readers to compare these five qualitative methods and see the value of each approach. Readers can consider which approach would serve for their research contexts and questions, as well as how to design their research and conduct the data analysis based on their choice of research method.

Günes, E., & Bahçivan, E. (2016). A multiple case study of preservice science teachers’ TPACK: Embedded in a comprehensive belief system. International Journal of Environmental and Science Education, 11 (15), 8040-8054.

In this article, the researchers showed the importance of using technological opportunities in improving the education process and how they enhanced the students’ learning in science education. The study examined the connection between “Technological Pedagogical Content Knowledge” (TPACK) and belief system in a science teaching context. The researchers used the multiple-case study to explore the effect of TPACK on the preservice science teachers’ (PST) beliefs on their TPACK level. The participants were three teachers with the low, medium, and high level of TPACK confidence. Content analysis was utilized to analyze the data, which were collected by individual semi-structured interviews with the participants about their lesson plans. The study first discussed each case, then compared features and relations across cases. The researchers found that there was a positive relationship between PST’s TPACK confidence and TPACK level; when PST had higher TPACK confidence, the participant had a higher competent TPACK level and vice versa.

Recent Dissertations Using Multiple Case Study Methodology

Milholland, E. S. (2015). A multiple case study of instructors utilizing Classroom Response Systems (CRS) to achieve pedagogical goals . Retrieved from ProQuest Dissertations & Theses Global. (Order Number 3706380)

The researcher of this study critiques the use of Classroom Responses Systems by five instructors who employed this program five years ago in their classrooms. The researcher conducted the multiple-case study methodology and categorized themes. He interviewed each instructor with questions about their initial pedagogical goals, the changes in pedagogy during teaching, and the teaching techniques individuals used while practicing the CRS. The researcher used the multiple-case study with five instructors. He found that all instructors changed their goals during employing CRS; they decided to reduce the time of lecturing and to spend more time engaging students in interactive activities. This study also demonstrated that CRS was useful for the instructors to achieve multiple learning goals; all the instructors provided examples of the positive aspect of implementing CRS in their classrooms.

Li, C. L. (2010). The emergence of fairy tale literacy: A multiple case study on promoting critical literacy of children through a juxtaposed reading of classic fairy tales and their contemporary disruptive variants . Retrieved from ProQuest Dissertations & Theses Global. (Order Number 3572104)

To explore how children’s development of critical literacy can be impacted by their reactions to fairy tales, the author conducted a multiple-case study with 4 cases, in which each child was a unit of analysis. Two Chinese immigrant children (a boy and a girl) and two American children (a boy and a girl) at the second or third grade were recruited in the study. The data were collected through interviews, discussions on fairy tales, and drawing pictures. The analysis was conducted within both individual cases and cross cases. Across four cases, the researcher found that the young children’s’ knowledge of traditional fairy tales was built upon mass-media based adaptations. The children believed that the representations on mass-media were the original stories, even though fairy tales are included in the elementary school curriculum. The author also found that introducing classic versions of fairy tales increased children’s knowledge in the genre’s origin, which would benefit their understanding of the genre. She argued that introducing fairy tales can be the first step to promote children’s development of critical literacy.

Asher, K. C. (2014). Mediating occupational socialization and occupational individuation in teacher education: A multiple case study of five elementary pre-service student teachers . Retrieved from ProQuest Dissertations & Theses Global. (Order Number 3671989)

This study portrayed five pre-service teachers’ teaching experience in their student teaching phase and explored how pre-service teachers mediate their occupational socialization with occupational individuation. The study used the multiple-case study design and recruited five pre-service teachers from a Midwestern university as five cases. Qualitative data were collected through interviews, classroom observations, and field notes. The author implemented the case study analysis and found five strategies that the participants used to mediate occupational socialization with occupational individuation. These strategies were: 1) hindering from practicing their beliefs, 2) mimicking the styles of supervising teachers, 3) teaching in the ways in alignment with school’s existing practice, 4) enacting their own ideas, and 5) integrating and balancing occupational socialization and occupational individuation. The study also provided recommendations and implications to policymakers and educators in teacher education so that pre-service teachers can be better supported.

Multiple Case Studies Copyright © 2019 by Nadia Alqahtani and Pengtong Qu is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

Share This Book

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.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

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.

On This Page:

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.

Related Articles

Social Science

Hard Determinism: Philosophy & Examples (Does Free Will Exist?)

Functions of Attitude Theory

Understanding Conformity: Normative vs. Informational Social Influence

Social Control Theory of Crime

Emotions , Mood , Social Science

Emotional Labor: Definition, Examples, Types, and Consequences

Famous Experiments , Social Science

Solomon Asch Conformity Line Experiment Study

The Impact of WeFuture’s ‘Challenge Your World’ Workshop in Amsterdam | Case Study

Holistic thinking: what it is, why it’s important, and how to do it.

• Holistic Thinking
• World Conservation

We humans like to simplify things. And that's a good thing, to begin with, because this characteristic protects us from too many stimuli, excessive demands and overload. We develop routines that help us cope with everyday life without having to expend a lot of thought and energy. We build a microcosm around ourselves, focusing on people and things in our immediate environment. We know our family and friends, our city and our work so well that we think we know how life works.

Sometimes, however, we find that things are not as simple as we would like to believe. Namely, when we encounter complex problems. Abruptly, we tend to realize that our individual view of the world can be one-sided. For example, we can feel quite uncomfortable when we realize that climate change is a real threat. Here, our microcosm with its usual solution patterns suddenly reaches its limits. We are faced with a problem that seems so complex and abstract that it can (and often does) make us feel overwhelmed.

But in this, there is creative power. In chaos lies the chance of creativity. Why? Because it forces us to step back from familiar perceptions. Because it allows us to see that our ‘individual’ world, to which we devote all our attention, is only a part of reality. And we see that we, as individuals, are a part of the whole of nature in its beauty. Changing our perspective from the individual details to the whole forms the basis for a way of thinking that aims to help solve problems in a more cohesive way: Holistic thinking.

What Is Holistic Thinking?

Holistic thinking means having a holistic approach by contemplating the bigger picture. "Holistic“ derives from the Greek word "holos", which stands for "whole" and "comprehensive". "Holistic" therefore, means "wholeness."

Aristotle, the famous Greek philosopher, has a quote that provides a great description of how the holistic way of thinking works: "The whole is more than the sum of its parts." To help explain the impact of this quote, let’s break the process down using a simple example:

• Collect all of the ‘parts’ of something - eg. building blocks.
• Sum them up by adding them together, ordering, and arranging them in a way that makes sense - eg. build up walls, create windows, and doors.
• After summing up the parts, we create a whole. - eg. a house
• However, the ‘whole’ (or in this case, the house) is more than that because we get more value and understanding through the ‘summing’ process. By adding these parts up together, we may now better understand: - Physical structures eg. the best way to build walls so they are insulated. - Scientific principles eg. balancing the weight of the house so gravity won't tear it down. - Human Impact eg. Once we move into the house, it becomes a home. We now have shelter, security, and an increased likelihood of survival.

By summing these parts, we have received so much more - the intangible assets like understanding, value, and meaning - about the whole that was not available to its parts alone. The holistic approach leads us to truly appreciate and comprehend the sum of parts, thus making it "more than".

How is Holistic Thinking Applied?

Holistic thinking can be applied to many systems; such as biological, social, mental, economic or spiritual systems.

It is a way of thinking that has been practiced by many indigenous people for many, many years - especially when it comes to health and wellness (an example of biological, mental, and spiritual systems). Whatsmore, some traditional health care systems that are rooted in holistic principles, such as the Ancient Indian Ayurveda and Amazonian Shamanism, are still practiced today!

One of the famous personalities associated with a holistic vision was Leonardo Da Vinci, the well-known Italian painter of the Mona Lisa, living in the Renaissance. He is admired by the world for his multidisciplinary approach to connecting logic and creativity. His holistic perspective of knowledge gathering was based on thinking beyond limits and resulted in iconic creative expression that has stood the test of time.

Holism was also the core of the worldview of another famous individual - Alexander von Humboldt, German naturalist and explorer. He didn’t see organisms, geological structures, weather phenomena, or human activities as detached; but as interacting entities of a larger complex system. He shaped the scientific perception of how everything is connected. Both Da Vinci and von Humboldt showed with their interdisciplinary approach how existing ideas and new concepts complement each other.

From ancient practices to famous personalities, the application and outcomes of holistic thinking is timeless. And this is most likely because this way of thinking stems from something bigger; Holism.

The Significance of Holism

“Holism (noun): the idea that the whole of something must be considered in order to understand its different parts” - Oxford Advanced American Dictionary

While clearly defined by man, Holism is by no means a thought construct of man. Nature exemplifies and dictates holism to us; every part needs the whole and the whole needs every part. Balance, cooperation, symbiosis and synergy defines life. From animate and inanimate nature to ecosystems, physiology of organisms to climate or social interactions - every single piece of a system affects the others and the whole.

This complexity becomes particularly clear when we consider the big challenges of today. The major challenges humanity is facing are on a global scale. If we look at climate change, for example, we often think of industry and mobility. The fires in the Amazon rainforest? The (majorly illegal) deforestation of the rainforest for the cultivation of palm oil or soy and loss of biodiversity? Corruption, the displacement of the local population or conflicts with indigenous groups? All of these aspects are also defined as climate change.

It’s not possible to break the world down into its components. Whether it is climate change, mass poverty or mass extinction – there are no simple solutions to global crises. Holistic thinking makes us realise the complexity of all of the issues we face. It aims to help us to identify different perspectives and needs. Furthermore, it helps us to develop and create long-term solutions for these global challenges. Creativity, interdisciplinarity, participation and collaboration are important prerequisites to try to achieve this.

The United Nations established a plan of action for sustainable development, known as the 2030 Agenda , and is an example of a holistic approach to multilateral sustainability policy. The agenda is based on the three dimensions model of sustainability: economy, society and the environment, which are interrelated. The Agenda is broken down into Sustainable Development Goals (SDGs) , which are considered universal and apply equally to all countries when striving for a balance between the three dimensions.

Holistic thinking is the prerequisite to the 2030 Agenda and is a necessary consequence of the cooperation between all countries working towards the SDGs. It’s the key to tackling our global challenges.

WeFuture Global’s guide to holistic thinking

Many people have learned to solve a problem where it appears visibly and tangibly for everyone. While this approach may well lead to initial successes – these are not long-lasting, since the core of the problem is often hidden at first glance.

For example, In order to contribute to the fight against climate change by reducing carbon emissions, it makes sense to use the bicycle more often than a car. But, if we really want to make a difference, we should look further than just at one piece of the puzzle and adopt a holistic approach. This can be done in many ways, such as questioning our own consumption in all areas of life (not just with personal transportation), taking a look at the sustainable practices implemented on other sides of the globe, and increasing the pressure on businesses and politicians to implement sustainable practices, to name a few.

Looking at the details is not wrong – but it’s not enough either. Holistic thinking goes beyond, it means breaking free from your mindset. This requires awareness, consideration and communication. But how to put this into practice?

To assist our community in developing this important skill, we have developed the WeFuture Global guideline to help our community think holistically.

The WeFuture Global Guideline to Holistic Thinking

Step 1. awareness.

• First, take a step back from what you are doing.
• Change your perspective from detail-oriented to the whole.
• Define the exact problems / challenges.
• Define the overall objective / the end-goal.

Step 2. Consideration

• Consider and define the individual parts of the overall system.
• Look for recurring patterns and interfaces.
• See how the interfaces affect the overall objective.
• Define your role in the overall system.
• Search for the lever (area or action) with the greatest impact.

Step 3. Communication

• Showcase the importance of the single to all partners in the system.
• Facilitate and implement new and stronger relationships.

Holistic thinking is a continuous process of changing perspectives, brainstorming and critical questioning. By that, it forms the basis for decisions on concrete action and next steps.

It is of fundamental importance to identify the real problem first. It is worthwhile to pause and get an overall view: Look at the whole instead of single details, push comprehension instead of actionism and focus on strategic thinking instead of operational hectic. By looking closely at the interrelationships, the system's biggest levers can be identified. And only those will affect a real change. During the entire process, it is always important to critically question the solution statements and yourself.

Holistic World Conservation

The holistic approach makes us realize that we humans ourselves are a part of the whole. It not only makes each of us responsible but also empowers us to make a difference. Just like in a huge ecosystem, everyone and everything can understand that the overall result is bigger than individual contributions. Holistic thinking is the core of world conservation.

To solve interrelated problems, we need to work together. Individuals, civil society organizations and the private sector are indispensable for the success of world conservation as innovation can and does arise from the collaboration of these entities. If we want to change a system, we need to work on all levels. Therefore we need a strong network of symbiotic relationships, varying expertise and sector access. We need to identify the right problems, understand the connections, and each of us needs to be aware of our role in complex challenges.

Through the holistic thinking approach, we can lose the fear of complexity and be empowered to make a difference. By understanding that the whole is more than the sum of the parts, we can learn to look at problems differently and change perspectives, allowing us and our way of thinking to evolve. The holistic way of thinking can transform our lives as we question our attitudes and gain inspiration to break out of recurring patterns in our everyday life. And by collaborating with all members and groups within society, we can innovate sustainable solutions that contribute to impactful world conservation.

Be open to change. Strive for balance. Think beyond.

To become a part of the change, see all the ways that you can contribute to wefuture global..

Related posts

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Indian J Palliat Care
• v.21(2); May-Aug 2015

Effective Factors in Providing Holistic Care: A Qualitative Study

Vahid zamanzadeh.

Faculty of Nursing and Midwifery, Tabriz university of Medical Sciences, Tabriz, Iran

Madineh Jasemi

1 Uremia University of Medical Sciences, Iran, Iran

Leila Valizadeh

Brian keogh.

2 Trinity College Dublin24 D ‘Olier Street, Dublin, Ireland

Fariba Taleghani

3 Isfahan University of Medical Sciences, Iran

Background:

Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses’ provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring.

Materials and Methods:

A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software.

Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits.

Conclusion:

Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

INTRODUCTION

Holistic care is a comprehensive model of caring which is believed to be the heart of the science of nursing.[ 1 ] 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.[ 2 ] Holistic care is described as a behavior that recognizes a person as a whole and acknowledges the interdependence among one's biological, social, psychological, and spiritual aspects. Holistic care includes a wide range of approaches, including medication, education, communication, self-help, and complementary treatment.[ 3 ] In holistic nursing, all aspects of patients and their effects on the treatment process are considered and the patients’ thoughts, emotions, cultures, opinions, and attitudes are factored in as contributing to recovery, happiness, and satisfaction.[ 4 ] Holistic care respects human dignity[ 5 ]: The relationship between the providers of health care and the patients is based on respect, relative openness, equality, and mutuality[ 2 , 5 ] and patients participate in decision making in this kind of caring.[ 6 ]

Providers of holistic care consider a patient as a whole within his/her environment and realize that a patient is made up of a body, mind, and spirit. Respecting the patient's role in the treatment process, having him/her take part in the process and encouraging self-care is another aspect of holistic care which leads to therapeutic consultation, hope, dignity, self-discipline, social growth, a sense of autonomy, vigor, and vitality.[ 7 ]

Holistic care increases the depth of care providers’ understanding of patients and their needs. Educating patients about self-care and helping them to perform their daily activities independently is part of holistic care. Palliative care is part of holistic care which improves the quality of a patient's life and their emotional and physical well-being. Holistic care increases self-awareness[ 8 ] and self-confidence in patients[ 9 ] and causes nurses to better understand the effects of an illness on a person's entire life and his/her true needs. It also improves harmony between mind, body, emotions, and spirit in an ever-changing environment;[ 10 ] The American Association of Holistic Nurses supports this belief and points out that holistic nursing includes all the nursing practices that heal the whole of a person.[ 5 ]

In many hospitals, nurses do not have the freedom to perform their tasks independently and their actions are often observed by doctors. Using holistic care as the framework will result in major changes in the treatment process,[ 11 ] a better public view of the nursing profession, and nurses’ autonomy.[ 10 ] The holistic care paradigm has been presented to the health-care systems in many cultures[ 4 ] and it can be used in every area of nursing.[ 12 ] Holistic care is not a new method; Florence Nightingale developed this type of nursing as a better model of caring;[ 4 ] many other nursing theorists, e.g. Ragers, Newman, and Parse have also emphasized holistic care.[ 13 ]

Unfortunately, there is compelling evidence that most nurses have been educated with a biomedical allopathic focus and do not have a good understanding of the meaning of holistic care. Furthermore, it has been suggested that nurses are not familiar with holistic care, neglect this model of caring,[ 4 , 6 ] do not use this method,[ 2 ] and consider patients’ corporeal needs only. In this regard, patients’ other needs and sometimes more serious problems are not addressed.[ 6 ] The mental, spiritual, and social needs of patients are neglected[ 14 ] and patients are considered as biological machines.[ 15 ]

Using the ordinary medical model alone for treatment exposes patients to serious threats, prolongs hospitalization, and raises treatment costs.[ 6 ] In many countries, such as the UK,[ 6 ] Australia,[ 16 ] and Iran,[ 12 ] holistic aspects of patients’ needs are often overlooked.[ 6 , 16 ] Similar studies conducted in the USA have revealed that 67% of American patients in hospitals do not receive holistic care,[ 17 ] and a study conducted in England showed that only 5% of hospitalized patients were subject to holistic care.[ 6 ]

This presents as a major crisis for the nursing profession.[ 18 ] Considering the beneficial effects of holistic care, the identification of contributory factors is of importance for providing this method of caring. A review of literature in this field shows that most studies have been limited to specific areas, such as operating rooms or older patients who were terminally sick.[ 4 , 19 ] Other studies attempt to explain the concept of holistic nursing and nurses’ perception of it,[ 1 , 2 ] or the reasons for failure to employ this method.[ 4 , 6 ] According to the results obtained from several studies, holistic care is adversely affected by such factors as inadequate time, improper professional relations, incomplete reports from nurses, inadequate clinical control, 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.

MATERIALS AND METHODS

Ethical considerations.

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.

Participant characteristics ( n =14)

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.

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 in Table 2 .

Identified effective factors on holistic care: Themes, sub-categories, and codes

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 of educational programs is comprehensive and includes the philosophy of holistic care, it will enable nursing students to address the various needs of patients and provide holistic care. One of the nurses emphasized the role of education in providing holistic care and said:

The content of the courses deeply affected my attitude toward patients and their needs; the courses on “nursing procedures” and “psychological disorders” made me stop looking at a patient only in terms of physicality and understand that an individual is more than a body with certain needs; it made me consider a patient's entire dimensions; I realized that health is the equivalent of harmony and balance among a patient's whole dimensions, not simply physical well-being. (Participant 8)

The above quotation points to the important role of designed courses in training nurses in holistic care. Another participant, similarly, referred to the importance of “nursing procedures” in creating an inclusive perception and promoting holistic care:

The course on nursing procedures broadened my horizons about patients and made me see aspects that I had been unaware of; I understood that well-being is the result of meeting a patient's various needs, from physical needs through emotional and spiritual needs to social, cultural and economic needs. (Participant 2)

The same participant, however, observed that the course of “nursing procedures” did not have enough credits and that they were not adequately trained in providing holistic care:

The course was too short and the training was not enough. But I was interested and regarded it as a specialized part of nursing; I practiced a lot and gradually learned how to exercise it. I wish the trainers had instructed us properly; then I would have realized the importance of it sooner.

Unfortunately, the data show that the content of the educational program is poor and lacks material on the various needs of patients. Regarding this issue, one of the nurses explained:

More than 90% of our lessons were about the physical problems of patients, and their other needs were usually neglected. (Participant 5)

Another participant expressed:

During the course, most of our education was about the physical problems of patients and dealing with them. So, by the end of the course, our knowledge of the physical needs of patients had increased, but we didn’t know anything about the whole needs of patients and their role in the treatment. (Participant 6)

Another nurse explained:

Clinical training was too short and we didn’t have enough time to establish a relationship with the patients to recognize their various problems. (Participant 13)

Teaching methods

Teaching methods are part of the educational structure and play an important role in holistic care formation. But, according to the results, the teaching methods are not designed to demonstrate holistic care. In this regard, one of the participants said:

The teaching methods were often educator-centered; a limited number of tasks were dictated and we were expected to do them only; we were not free to consider the other needs of patients and satisfy them. (Participant 3)

Practice-based teaching can increase nursing students’ understanding of holistic care, but the data showed that the nursing educators did not consider this matter and focused on theory-based teaching. One of the nurses stated:

We did not receive any practical training in considering patients’ various needs. In our education, we were not told that a patient is a whole with many different aspects and whose treatment requires that we consider all those aspects; although some of the educators advised us to consider the secondary needs of patients, there was no practical training in this field. (Participant 9)

The educators’ competence

The educators’ characteristics and competence have been introduced as a component of the educational structure in this study; educators can provide the trainees with a practical model from which to learn the principles of holistic care in practice. A participant said regarding this issue:

One of our educators was sensitive to the various needs of patients, treated them with respect and attended to their various needs. Her manners influenced my behavior. Now, I try to use her lessons in practice and provide my patients with comfort by addressing their various needs. (Participant 6)

Similarly, a participant referring to her trainer's holistic perception and emphasis on holistic care remarked:

One of our trainers always stressed that we view a patient as a whole that has different needs; she was trying to have us realize that well-being is the result of creating a harmony among the various parts of the whole and not just the physical dimensions. My trainer's attitude greatly affected my manner of nursing: I try to attend to my patients’ entire needs, not just the physical ones, and consider their emotional, spiritual, cultural and social needs. I believe that meeting all these needs at the same time rather than separately is much more effective.

But the results show that most of the participants had no practical model for learning holistic care during their education. One of the nurses said:

Most of our educators had limited knowledge of the various aspects of patients’ needs and their effects on health recovery and paid little attention to these matters. They paid more attention to routine tasks, and we didn’t have an actual 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, 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—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)

Limited conformity of the clinical environment with professional norms

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 matters in nursing is another component of negligence of proper nursing principles. Many nurses are guilty of such disregard and ignore their patients and their various needs. In this regard, one of the participants stated that:

I used to work in ICU and I often witnessed the nurses’ lack of care about professional ethics. They were indifferent to those of the patients’ needs which were not physical; if the orderly was away and a patient had a basic need, they wouldn’t care; if a patient was in pain, they were not quick enough to administer a painkiller. In many cases they weren’t honest: They would write down things they hadn’t done; they would turn a blind eye to the patients’ needs. If a patient, for example, wished to see his or her family, they wouldn’t allow it. They would close the doors and drink tea and chat away! It was not easy to act morally under those circumstances: You could be ostracized. It was like swimming against the current. Unfortunately, many of my friends would imitate them, too, and were totally indifferent to the patients and their needs, as if they were machines. (Participant 8)

Motivational factors

Motivational factors play an important role in encouraging nurses to provide holistic care as well as facilitating such provision. Motivational factors include personality traits, personal experiences of hospitalization, and input sources.

Personality traits

Personality traits, identified as one of the sub-categories of motivational factors, are among the major factors generating internal motives: They encourage and facilitate holistic care, influence nurses’ performance and relations with patients, and help develop rapport between nurses and patients. According to the participants, sociability and sensitivity to people's needs—which go under the subcategory of personality traits—are influential in encouraging attention to patients’ various needs, thus nurses’ developing holistic perception.

Sociable and genial nurses are more likely to establish a close rapport with patients, which results in a better identification and holistic perception of patients’ needs. One of the participants pointed out that:

I’m a very good mixer, highly sociable; I make sure to greet my patients warmly; I even shake hands with the old patients, because I believe that lifts their spirits and makes them trust me and cooperate. For example, if they won’t let others perform venipuncture on them, they will definitely let me. They also confide in me, which lets me know about and satisfy many of their needs. This quickens the treatment process, because attending to a patient's physical needs alone won’t lead to recovery. My sociability has helped me realize the importance of knowing about and satisfying the patients’ needs and how it affects the recovery process; now I believe that human is a complicated creature with many different needs all of which should be taken care of before complete recovery is achieved. (Participant 7)

Being sensitive and compassionate contributes to providing holistic care on the part of nurses. The more emotional a nurse is, the more sympathy he/she will feel for patients, which in turn will result in feeling more responsible for patients: The nurse will not simply perform the routine tasks but try to identify and satisfy his/her patients’ whole needs. One of the nurses stated:

Well, I’m quite emotional and love to help others if I can. I help my family too and enjoy being a comfort. That's why I feel good when my patients are satisfied. Satisfying my patients’ needs gives me a feeling of pleasure; the feeling is so strong that I believe my best moments are when I’m with my patients and helping them. (Participant 9)

Personal experiences of hospitalization

Nurses’ personal experiences of hospitalization is another factor which enhances nurses’ sympathy for and understanding of patients and their needs; it also contributes to regarding a patient's whole needs as important and refusing to attend to the physical needs alone. Naturally, being subject to similar experiences leads to a better understanding of patients’ needs. Most of the participants referred to their personal experiences of hospitalization as unpleasant ones in which their needs or their families’ needs—physical or otherwise— were not satisfied.

According to the input from many of the participants’ experiences, when a participant or a family member was hospitalized, he/she was frustrated at the neglect of their basic and secondary needs. The participants stated that the unpleasant experience influenced their perception of patients and their various needs. One of the participants stated that:

I had to undergo cholecystectomy last year. Now I realize how painful an operation can be. Though I was in great pain, the nurses often neglected me and didn’t give me painkillers. I understand now what a patient goes through. I promised myself I would never be indifferent to my patients’ pain. If every nurse had a taste of his/her patient's trouble, that’d make a difference! You would understand your patients better and treat them as humans with a variety of needs all of which should be satisfied; you wouldn’t focus on one aspect only, and you’d recognize the importance of attending to all one's needs simultaneously rather than one at a time. (Participant 1)

Another participant pointed out that after the experience of the hospitalization of a family member; she began to view holistic care in a different light:

One of the reasons why I attend to my patients’ needs more carefully now is my Dad's time in hospital. He had to undergo a heart surgery and we were worried to death. I was waiting nervously outside the operation room, but the ICU nursing staff did not treat me well. Though I was one of their colleagues, they weren’t very nice to me, and didn’t allow me to see my father, nor did they give me any hope. I was totally anxious; now I understand patients and their families better. I put myself in their shoes and that makes me feel closer to them. This can help one understand patients and their multiple dimensions a lot better. (Participant 13)

Input sources

Input sources—which include religious beliefs, the participants’ upbringing, and commitment—constitute another major factor in holistic care provision. Regarding religiousness, one of the participants stated:

My religious beliefs help me to consider a patient's various needs despite the problems at work. I believe God has given me the power to give care to my patients; this idea gives me more energy for a better caring for the patients. (Participant 7)

The same participant mentioned that religiousness can lead to recognition of the greater effectiveness of meeting a patient's whole needs simultaneously rather than separately:

By satisfying their needs and witnessing the effect of that on their recovery, I now see every patient as a whole with a number of needs all of which should be taken care of as a whole, and not individually, to quicken treatment.

Another nurse stated:

My beliefs make me attend to the different needs of the patients. Neglecting a patient's needs makes me feel guilty, and I try to keep my conscience clear by satisfying my patients’ needs. (Participant 4)

The manner in which one has been reared has an important impact on the formation of these beliefs. In this regard, one of the participants said:

My father usually advised me to view the patients as my own family and provide the best possible caring for them and attend to all their needs. (Participant 8)

Commitment, which can increase during work, is usually effective before entering the nursing profession; it is considered as a component of input sources that plays a key role in the formation of holistic care. One of the nurses remarked:

I try to perform my duties in the best way. I think our duty is not limited to some routine tasks. Addressing all of the needs of my patients is my duty as a nurse and I try to resolve their entire problems. When I resolve them, I feel good and my interest in my profession increases. In addition to giving me a sense of fulfillment, satisfying the patients’ various needs is so effective that I’ve grown more attentive to my patients’ multiple dimensions and try to have an overall view of them. (Participant 3)

The results of the study show that factors that affect holistic care provision the most are the educational structure, professional environment, and motivational factors.

Educational structure

Educational structure—which includes the content of educational programs, teaching methods, and educators’ competence—has an important impact on the adoption of holistic care by nurses. Ahmadi et al. , reach similar results in their study and introduce educational structure as an effective factor in the quality of care and extent of attending to patients’ different problems.[ 26 ] The results of this study show that none of the components of the educational structure in Iran are appropriate enough to prepare nurses for holistic care. The content of educational programs is not based on the philosophy of holistic care. King and Gates’ study points to the same results and shows that teaching holistic nursing to undergraduate nursing students is ignored in the curriculum of nursing and the content of educational programs emphasizes the medical model of.[ 27 ] Similarly, the results of Strindberg's study in Sweden show that most nursing lessons are based only on biological science. Revising nursing lessons seems to be required for the inculcation of holistic care in nursing students. Strandberg has also suggested this matter in his study.[ 1 ] Robinson, likewise, emphasizes the role of the lessons’ content in the adoption of holistic care by nursing students and suggests using art and behavioral lessons in nursing courses.[ 18 ]

Teaching methods and educators’ competence, the other components of the educational structure, play an important role in learning and the transference of theoretical knowledge of holistic care into clinical practice. However, according to the findings of this study, most nurses believe that their main concern in their courses has been with becoming competent in doing routine tasks and that they had little opportunity to consider the other needs of patients. If educators provide practical models of holistic care, students’ confidence will increase and they will be able to provide holistic care. Meleis (1975) and Davies (1993) referred to this issue and emphasized its importance. King and Gates, also, stress the role of practical models, teaching methods, and explaining the philosophy of holistic care in the formation of holistic care (King and Gates, 2006). Similarly, Henderson's study suggests that defective teaching methods and educators’ incompetence are barriers to holistic care provision.[ 16 ]

Professional environment, which consists of workload, management, and the limited conformity of the clinical environment with professional norms, can affect the formation of holistic care and act as a barrier or facilitator to it. When unsuitable, these components are identified as barriers to holistic care provision in this study. Workload is one of the aspects of practice in nursing environments which affects the quality of caring. In his study, Ahmadi refers to the effects of workload and states that most Iranian nurses suffer from heavy workload and do not have the opportunity to consider patients’ various needs and provide holistic care.[ 26 ] Similarly, Olive introduces workload as a barrier to the formation of holistic care.[ 6 ] Management, another component of professional environment, includes various domains such as evaluation methods, orientation programs for staff and management approaches. The results of this study show that nursing management is inefficient and that the nurses in this study were dissatisfied with the style of management, and do not have any orientation programs. The above-mentioned issues play an important role in the formation of holistic care and, when suitable, can enhance the provision of this mode of caring by creating motivation in nurses and increasing their knowledge. Strindberg's study in Sweden confirms this fact and emphasizes the role of management in promoting holistic care.[ 1 ] Duffy and McEvoy, likewise, call attention to the importance of professional environment and its various effects on nurses’ performance; they consider a suitable environment as a prerequisite of holistic care.[ 10 ]

Clinical environments’ lack of conformity with professional norms is another factor which makes nurses loose interest in professional and ethical values, and acts as a disincentive to providing holistic care.[ 28 ] The results show that most nurses have encountered this problem and experienced it on the first days of working. Various studies—e.g. Silva,[ 29 ] Abedi[ 30 ] and Valdez[ 31 ]—recognize the limited conformity of the clinical environment with professional norms as a big challenge which most novice nurses encounter. Many of the participants in the study referred to clinical environments’ poor conformity with professional and ethical norms as a deterrent to providing holistic care; they also stated that many of the novice nurses would follow their colleagues’ example and neglect patients and their needs. Henderson, likewise, points out in his study that clinical environments’ poor conformity with norms greatly contributes to novice nurses’ disregard for holistic care and encourages them to stick to the routine duties and ignore the patients’ various needs.[ 16 ]

The findings of this study prove that motivational factors—input data, personality traits, and personal experiences—are influential in identifying patients’ various needs and generating holistic perceptions of the patient, which in turn encourage nurses to attend to patients’ diverse needs and provide holistic care. Personality traits play a major role in expanding relationship with patients, identifying their various needs and developing holistic perception on the part of nurses. Also, religiousness and morality can induce one to satisfy patients’ needs and provide holistic care, and in many cases overcome the defects in the educational and clinical systems. Obviously, one's behavior is decided by his/her personality traits; thus, a nurse's performance, behavior toward patients, and attempts at expanding relationship with them are decided by his/her personality traits. As the most important internal factor influencing motivation, personality traits are influential in achieving success at college and at work by creating intimacy, commitment and conscientiousness.[ 13 ] Studies show that nurses who are temperamentally sociable and emotional tend to be cheerful at work and more capable at identifying patients’ needs and nursing. The same studies reveal that these nurses, compared to their colleagues, are not only more dependable, intelligent, flexible, and conscientious, but also more highly motivated.[ 32 ] McEvoy and Duffy point to the importance of compatibility between personality and profession as well as the impact of beliefs and principles on a nurse's performance, and regard them as vital to the provision of holistic care.[ 10 ]

Nurses’ personal experiences of hospitalization, either on their own part or their families’, can also lead to a better understanding of patients’ needs, or encourage holistic perception. In other words, such experiences can lead to viewing a patient as a whole whose needs should be met in their entirety rather than separately, hence the need for holistic care. Not many studies have addressed the effects of nurses’ personal experiences of hospitalization on their perception of patients’ needs and the need for holistic care; however, it has been revealed that such experiences can enhance nurses’ attention to their patients’ various needs and induce them to provide holistic care. Gates and King[ 27 ] and Strandberg,[ 1 ] for instance, point to the influence of nurses’ knowledge and experiences on their understanding of patients’ various needs and the importance of holistic care. McEvoy and Duffy believe that sympathy for and a better understanding of patients can lead to the provision of holistic care.[ 10 ]

The results of the study show that the educational system, working environment, and motivational factors are major factors in providing holistic care. However, the findings reveal that these factors are not appropriate enough in Iran to lead to holistic care, and Iranian nurses tend to stick to their routine duties and satisfy patient's clinical needs only. Earlier studies conducted in other countries—e.g. Strindberg (2007), King (2006), Henderson (2002), Olive (2003)—have attested to the importance of the above-mentioned factors in the provision of holistic care, hence the need for closer attention to the compatibility of the educational system with the idea of holistic care, revision of the contents and methods of education, and modification of the conditions at work in order to encourage holistic care. Personality traits, personal experiences of hospitalization, and beliefs and principles—which go under the heading of motivational factors—also contribute to and facilitate holistic care. McEvoy and Duffy (2008) suggest that these factors are vital to holistic care. As a result, to develop holistic care it is necessary to attach more importance to motivational factors, compatibility between nurses’ personalities and their profession, improvement of nurses’ communicative skills, promoting religiousness, and encouragement of commitment in practicing nurses and nursing students alike.

ACKNOWLEDGMENT

This study is part of a larger study conducted for a doctoral dissertation that was approved by the ethical committee and was supported with a research grant (number 350) for Ph.D. thesis from Nursing Research Team affiliated to Tabriz University of Medical Sciences, Iran. The authors would like to express their sincere gratitude to this center and all the participants for cooperating in this study.

Source of Support: This study is part of a larger study conducted for a doctoral dissertation that was approved by the ethical committee and was supported by a research grant (number 350) for Ph.D. thesis from Nursing Research Team affiliated to Tabriz University of Medical Sciences, Iran

Conflict of Interest: None declared.

• Emergency information
• Increase Font Size
• Decrease Font Size

What is a holistic approach?

​at a glance.

A holistic approach means to provide support that looks at the whole person, not just their mental health needs. The support should also consider their physical, emotional, social and spiritual wellbeing.

Each person will have a different experience of mental illness and a path to recovery that is influenced by their age, gender, culture, heritage, language, faith, sexual and gender identity, relationship status, life experience and beliefs.

It is important not to assume that how you interpret situations will be the same as the person you are supporting. Listening, asking and checking are key skills to be able to provide a holistic service. A holistic approach focusses on a person’s wellness and not just their illness or condition.

The whole person This is a link to Pat’s story and his journey to turn his life around. Type: Web page Estimated reading time: 10 minutes Produced by: Mental Health Commission of NSW

Definition of 'holistic' This web page includes a summary of how to respond holistically to a client. Scroll down for a useful case study. In order to access the page, you will need to set up an account. Type: Web page Estimated reading time: 10 minutes Produced by: QCOSS Community Door

Respond holistically to client issues This is a free online training course designed to assist in establishing relationships with clients and responding holistically to their issues. In order to access the training, you will need to set up an account. Type: eLearning Produced by: QCOSS Community Door

Get help now

• Mental Health Line 1800 011 511 Open 24/7
• Emergency 000
• Lifeline 13 11 14
• Kids Helpline 1800 551 800
• Other 24/7 crisis lines

In this section

Principles for effective support

• What is a recovery oriented approach?
• What is a person-centred approach?
• What is trauma-informed care?
• What is empowerment?
• What are human rights?
• What are restrictive practices in the NDIS?
• What are a worker’s responsibilities in relation to quality and safety of supports?

20 episodes

DNP Unlocked is a pioneering podcast that stands as a beacon for immigrant nurses, advocating for their rights and recognition within the healthcare sphere. Our mission extends beyond the surface, encompassing a holistic approach to support and empower immigrant nurses at every step of their journey. Through candid conversations and expert insights, we address a myriad of crucial topics, including immigration pathways, job opportunities, career advancement, entrepreneurial endeavors, legal considerations, and the paramount importance of mental health. But our mission doesn’t stop there. DNP Unlocked is also a staunch advocate for Diversity, Equity, and Inclusion (DEI) in the healthcare industry. We firmly believe that every nurse, regardless of their background, should have a seat at the table, contributing to the diverse tapestry of healthcare. With each episode, we strive to break barriers, dismantle biases, and open doors for immigrant nurses to thrive and excel. Join us in this transformative journey as we unlock not only the potential but also the dreams and aspirations of immigrant nurses. Together, we’re shaping a more inclusive, equitable, and empathetic healthcare landscape for all.

DNP Unlocked DrNursePaul

• MAY 9, 2024

DNP UNLOCKED Ep 20: Legal Documentation

Prepare to navigate the complexities of legal documentation with precision and expertise on DNP UNLOCKED. Join hosts DrNursePaul, Nurse Anna, and TravelNurseHacker in Episode 20, where we delve into the crucial topic of "Legal Documentation" with professionalism and proficiency. Key Focus Areas: Gain comprehensive insights into the essential legal documents required for immigrants, ensuring compliance and peace of mind. To provide strategic guidance on navigating legal processes, empowering immigrants to navigate bureaucratic hurdles confidently. Offers compassionate support and practical advice, ensuring immigrants understand the significance of legal documentation in their journey. There will be a special guest so set the foundation for your legal journey with DNP UNLOCKED Ep. 20. RECORDED ON: February 28, 2024

• 1 hr 13 min

DNP UNLOCKED Ep 19: Budgeting for Immigrants

Embark on a journey to financial empowerment with DNP UNLOCKED! Join hosts DrNursePaul, Nurse Anna, and TravelNurseHacker in Episode 19, where we make Budgeting for Immigrants an engaging blend of professionalism and excitement. Unlocking Financial Success: Navigate the intricacies of budgeting with expert insights, professional advice, and a touch of enthusiasm. Hosts will share tech-savvy tips to streamline your budgeting process for a seamless financial experience. RECORDED ON: February 11, 2024

DNP UNLOCKED Ep 18: Workplace Violence

Get ready for a Sunday wake-up call like never before with DNP UNLOCKED! Join the fantastic trio – DrNursePaul, Nurse Anna, and TravelNurseHacker – for Episode 18: Workplace Violence. We're turning a serious topic into a Workplace Violence. What's in the Funhouse: Tackle Workplace Violence with a dash of humor, insights, and unexpected twists – because every serious issue deserves a playful perspective! Engaging banter, laughter-packed discussions, and a pinch of joy to make your Wednesday morning feel like a walk in the amusement park. RECORDED ON: February 4, 2024

DNP UNLOCKED Ep 17: Reporting Immigration Fraud

Wake up and smell the excitement with DNP UNLOCKED! Episode 17 is here, and we're turning Sunday into a Reporting Immigration Fraud with hosts extraordinaire – DrNursePaul, Nurse Anna, and TravelNurseHacker! What's on the Radar: Dive into the world of Reporting Immigration Fraud with a twist of fun, laughter, and unexpected shenanigans. Engaging banter, lively discussions, and a pinch of humor – because reporting fraud doesn't have to be a snooze fest! RECORDED ON: January 28, 2024

• 1 hr 43 min

DNP UNLOCKED Ep 16: Immigration Fraud Case Studies

Gear up for a morning of intrigue, laughter, and revelations as DNP UNLOCKED brings you Episode 16: Immigration Fraud Case Studies! Join our dynamic hosts, DrNursePaul, Nurse Anna, and TravelNurseHacker, as they turn complex cases into a carnival of fun and learning! What's in the Briefcase: Immersive exploration of real-life Immigration Fraud Case Studies, dissected with humor and a dash of wit. Engaging banter, unexpected twists, and laughter-packed moments to make your Sunday morning truly enjoyable. Exclusive giveaways that could turn your day from good to great! Get ready to turn your morning routine into an exciting adventure! RECORDED ON: January 21, 2024

DNP UNLOCKED Ep 15: Immigration Fraud

Join the ultimate immigrant talkshow party with DrNursePaul, Nurse Anna, and TravelNurseHacker! Episode 15 is all about Immigration Fraud, but we promise, it's going to be anything but dull. Why You Can't Miss It: Dive into the serious topic of Immigration Fraud with a splash of humor – because laughter makes everything better! Expect fun anecdotes, witty banter, and a dose of positivity that will kickstart your Sunday morning. RECORDED ON: January 14, 2024

• © DrNursePaul 2023

Top Podcasts In Education

A comprehensive approach to phytochemical analysis of macromolecular composites that protect tubers: case studies in suberized potato periderm tissues

• Published: 15 May 2024

Cite this article

• Keyvan Dastmalchi 1 ,
• Van Chanh Phan 2 ,
• Subhasish Chatterjee 1 , 3 ,
• Bingwu Yu 1 ,
• Mercè Figueras 4 ,
• Olga Serra 4 &
• Ruth E. Stark   ORCID: orcid.org/0000-0002-3132-4580 1 , 5 , 6  

Terrestrial plants rely on protection conferred by their outer coverings to defend against desiccation, bruising, and microbial invasion. For food staples such as potato tubers, the periderm contains the phellem (tuber skin) which creates a hydrophobic barrier by depositing macromolecular composites comprised of waxes, soluble phenolics, and a complex aliphatic suberin polyester (or suberin aliphatic domain) and lignin-like biopolymer (or suberin polyphenolic domain) within the previously formed polysaccharide cell wall. The antibacterial activity of both the soluble chemical constituents and their solid polymeric assemblies provides essential plant defense; their antioxidant and waterproofing properties also offer practical potential for sustainable food preservation and packaging applications. To characterize these phytochemical composites comprehensively and in molecular detail, we developed an approach that coordinates ‘bottom-up’ analysis of extracted metabolites that include suberin precursors, solid-state NMR spectroscopy of the polymers in intact skins or solid suspensions, and ‘top-down’ analysis of chemical breakdown products of suberin. The usefulness of analytical methods that include LC–MS, GC–MS, multivariate analysis, solid-state NMR, SEM, and TEM is illustrated for studies of molecular and supramolecular structures that underlie protective function in three potato periderm systems: (1) native tuber periderms versus suberized wound-healing tissues including closing layer and wound periderm; (2) metabolites unleashed in rapid response to wounding prior to formation of suberized tissues; (3) wild type versus genetically modified potato varieties with altered suberin deposition. We also demonstrate how enrichment with stable 13 C and 15 N isotopes can improve our understanding of how the suberin biopolymer molecular structure develops, increasing the reach of MS, 2D solid-state NMR, and dynamic nuclear polarization spectroscopic methods and revealing phenolic amide constituents that could represent an underappreciated part of the plant’s defensive arsenal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Copyright 2015 Elsevier

Copyright 2014 American Chemical Society

Copyright 2019 Elsevier

Copyright 2015 American Chemical Society

Copyright 2018 Elsevier

Copyright 2020 Elsevier

Abbreviations

Cross polarization magic-angle spinning

Dipolar-assisted rotational resonance

Double cross polarization

Dynamic nuclear polarization

Fatty ω-hydroxyacid/fatty alcohol hydroxycinnamoyl transferase

Gas chromatography

Infrared spectroscopy

Liquid chromatography

Mass spectrometry

Orthogonal partial least-squares discriminate analysis

Principal component analysis

Phenylalanine

Scanning electron microscopy

Solid-state NMR

Saturation-Pulse Induced Dipolar Exchange with Recoupling

Time-of-flight mass spectrometry

Addison B, Stengel D, Bharadwaj VS, Happs RM, Doeppke C, Wang T, Bomble YJ, Holland GP, Harman-Ware AE (2020) Selective one-dimensional 13 C- 13 C spin-diffusion solid-state nuclear magnetic resonance methods to probe spatial arrangements in biopolymers including plant cell walls, peptides, and spider silk. J Phys Chem B 124(44):9870–9883. https://doi.org/10.1021/acs.jpcb.0c07759

Article   CAS   PubMed   Google Scholar  

Baldus M, Geurts DG, Hediger S, Meier BH (1996) Efficient 15 N- 13 C polarization transfer by adiabatic-passage Hartmann-Hahn cross polarization. J Magn Reson Ser A 118(1):140–144. https://doi.org/10.1006/jmra.1996.0022

Article   CAS   Google Scholar  

Bernards MA (2002) Demystifying suberin. Can J Bot 80:227–240. https://doi.org/10.1139/b02-017

Bernards MA, Lewis NG (1996) Suberin: an hydroxycinnamic acid-derived polymer. Polyphen Actual 14:4–7

CAS   Google Scholar  

Bernards MA, Lopez ML, Zajicek J, Lewis NG (1995) Hydroxycinnamic acid-derived polymers constitute the polyaromatic domain of suberin. J Biol Chem 270:7382–7386

Borg-Olivier O, Monties B (1993) Lignin, suberin, phenolic acids and tyramine in the suberized, wound-induced potato periderm. Phytochemistry 32(3):601–606

Company-Arumi D, Figueras M, Salvado V, Molinas M, Serra O, Antico E (2016) The Identification and quantification of suberin monomers of root and tuber periderm from potato ( Solanum tuberosum ) as fatty acyl tert-butyldimethylsilyl derivatives. Phytochem Anal 27:326–335. https://doi.org/10.1002/pca.2625

Correia VG, Bento A, Pais J, Rodrigues R, Halinski LP, Frydrych M, Greenhalgh A, Stepnowski P, Vollrath F, King AWT, Silva Pereira C (2020) The molecular structure and multifunctionality of the cryptic plant polymer suberin. Mater Today Bio 5:100039. https://doi.org/10.1016/j.mtbio.2019.100039

Dastmalchi K, Cai Q, Zhou K, Huang WL, Serra O, Stark RE (2014) Solving the jigsaw puzzle of wound-healing potato cultivars: metabolite profiling and antioxidant activity of polar extracts. J Agric Food Chem 62(31):7963–7975. https://doi.org/10.1021/jf501330h

Article   CAS   PubMed   PubMed Central   Google Scholar  

Dastmalchi K, Kallash L, Wang I, Phan VC, Huang W, Serra O, Stark RE (2015) Defensive armor of potato tubers: nonpolar metabolite profiling, antioxidant assessment, and solid-state NMR compositional analysis of suberin-enriched wound-healing tissues. J Agric Food Chem 63:6810–6822. https://doi.org/10.1021/acs.jafc.5b03206

Dastmalchi K, Rodriguez MP, Lin JN, Yoo B, Stark RE (2019) Temporal resistance of potato tubers: antibacterial assays and metabolite profiling of wound-healing tissue extracts from contrasting cultivars. Phytochemistry 159:75–89. https://doi.org/10.1016/j.phytochem.2018.12.007

Dastmalchi K, Chira O, Rodriguez MP, Yoo B, Serra O, Figueras M, Stark RE (2021) A chemical window into the impact of RNAi silencing of the StNAC103 gene in potato tuber periderms: soluble metabolites, suberized cell walls, and antibacterial defense. Phytochemistry 190:112885. https://doi.org/10.1016/j.phytochem.2021.112885

Dominguez E, Heredia-Guerrero JA, Heredia A (2017) The plant cuticle: old challenges, new perspectives. J Exp Bot 68(19):5251–5255. https://doi.org/10.1093/jxb/erx389

Duan P, Schmidt-Rohr K (2017) Composite-pulse and partially dipolar dephased multiCP for improved quantitative solid-state 13 C NMR. J Magn Reson 285:68–78. https://doi.org/10.1016/j.jmr.2017.10.010

Duncan T (1990) Compilation of chemical shift anisotropies.

Ferreira R, Garcia H, Sousa AF, Guerreiro M, Duarte FJS, Freire CSR, Calhorda MJ, Silvestre AJD, Kunz W, Rebelo LPN, Pereira CS (2014) Unveiling the dual role of the cholinium hexanoate ionic liquid as solvent and catalyst in suberin depolymerisation. RSC Adv 4(6):2993–3002. https://doi.org/10.1039/c3ra45910a

Fich EA, Segerson NA, Rose JK (2016) The Plant Polyester Cutin: Biosynthesis, Structure, and Biological Roles. Annu Rev Plant Biol 67:207–233. https://doi.org/10.1146/annurev-arplant-043015-111929

Franke R, Briesen I, Wojciechowski T, Faust A, Yephremov A, Nawrath C, Schreiber L (2005) Apoplastic polyesters in Arabidopsis surface tissues–a typical suberin and a particular cutin. Phytochemistry 66:2643–2658. https://doi.org/10.1016/j.phytochem.2005.09.027

Fraser CM, Chapple C (2011) The phenylpropanoid pathway in Arabidopsis. Arabidopsis Book 9:e0152. https://doi.org/10.1199/tab.0152

Article   PubMed   PubMed Central   Google Scholar  

Garcia H, Ferreira R, Petkovic M, Ferguson JL, Leitao MC, Gunaratne HQN, Seddon KR, Rebelo LPN, Pereira CS, Leitão MC, Silva Pereira C (2010) Dissolution of cork biopolymers in biocompatible ionic liquids. Green Chem 12:367. https://doi.org/10.1039/b922553f

Ghassemi N, Poulhazan A, Deligey F, Mentink-Vigier F, Marcotte I, Wang T (2022) Solid-state NMR investigations of extracellular matrices and cell walls of algae, bacteria, fungi, and plants. Chem Rev 122(10):10036–10086. https://doi.org/10.1021/acs.chemrev.1c00669

Graça J (2015) Suberin: the biopolyester at the frontier of plants. Front Chem 3:62. https://doi.org/10.3389/fchem.2015.00062

Graça J, Pereira H (2000) Methanolysis of bark suberins: analysis of glycerol and acid monomers. Phytochem Anal 11:45–51

Article   Google Scholar  

Graça J, Santos S (2007) Suberin: the biopolyester of plants’ skin. Macromol Biosci 7:128–135

Article   PubMed   Google Scholar  

Graça J, Cabral V, Santos S, Lamosa P, Serra O, Molinas M, Schreiber L, Kauder F, Franke R (2015) Partial depolymerization of genetically modified potato tuber periderm reveals intermolecular linkages in suberin polyester. Phytochemistry 117:209–219. https://doi.org/10.1016/j.phytochem.2015.06.010

Guzman-Puyol S, Benitez JJ, Heredia-Guerrero JA (2021) Sustainable bio-based polymers: towards a circular bioeconomy. Polymers (Basel). https://doi.org/10.3390/polym14010022

Holloway PJ (1983) Some variations in the composition of suberin from the cork layers of higher plants. Phytochemistry 22:495–502

Huang WL, Serra O, Dastmalchi K, Jin LQ, Yang LJ, Stark RE (2017) Comprehensive MS and solid-state NMR metabolomic profiling reveals molecular variations in native periderms from four Solanum tuberosum potato cultivars. J Agric Food Chem 65(10):2258–2274. https://doi.org/10.1021/acs.jafc.6b05179

Jin LQ, Cai Q, Huang WL, Dastmalchi K, Rigau J, Molinas M, Figueras M, Serra O, Stark RE (2018) Potato native and wound periderms are differently affected by down-regulation of FHT, a suberin feruloyl transferase. Phytochemistry 147:30–48. https://doi.org/10.1016/j.phytochem.2017.12.011

Johnson RL, Schmidt-Rohr K (2013) Quantitative solid-state 13 C NMR with signal enhancement by multiple cross polarization. J Magn Reson 239:44–49. https://doi.org/10.1016/j.jmr.2013.11.009

Kang X, Kirui A, Dickwella Widanage MC, Mentink-Vigier F, Cosgrove DJ, Wang T (2019) Lignin-polysaccharide interactions in plant secondary cell walls revealed by solid-state NMR. Nat Commun 10(1):347. https://doi.org/10.1038/s41467-018-08252-0

Kelly JE, Chrissian C, Stark RE (2020) Tailoring NMR experiments for structural characterization of amorphous biological solids: a practical guide. Solid State Nucl Magn Reson 109:101686. https://doi.org/10.1016/j.ssnmr.2020.101686

Kim HK, Choi YH, Verpoorte R (2010) NMR-based metabolomic analysis of plants. Nat Protocols 5:536–549

King RR, Calhoun LA (2005) Characterization of cross-linked hydroxycinnamic acid amides isolated from potato common scab lesions. Phytochemistry 66:2468–2473. https://doi.org/10.1016/j.phytochem.2005.07.014

Kolattukudy PE (1984) Biochemistry and function of cutin and suberin. Can J Bot 62:2918–2933

Kolattukudy PE (2001) Polyesters in higher plants. Adv Biochem Eng Biotechnol 71:1–49

CAS   PubMed   Google Scholar  

Landgraf R, Smolka U, Altmann S, Eschen-Lippold L, Senning M, Sonnewald S, Weigel B, Frolova N, Strehmel N, Hause G, Scheel D, Böttcher C, Rosahl S (2014) The ABC transporter ABCG1 is required for suberin formation in potato tuber periderm. Plant Cell 26:3403–3415. https://doi.org/10.1105/tpc.114.124776

Li-Beisson Y, Shorrosh B, Beisson F, Andersson MX, Arondel V, Bates PD, Baud S, Bird D, Debono A, Durrett TP, Franke RB, Graham IA, Katayama K, Kelly AA, Larson T, Markham JE, Miquel M, Molina I, Nishida I, Rowland O, Samuels L, Schmid KM, Wada H, Welti R, Xu C, Zallot R, Ohlrogge J (2013) Acyl-lipid metabolism. Arabidopsis Book 11:e0161. https://doi.org/10.1199/tab.0161

Lulai EC (2007) Tuber quality. Potato biology and biotechnology: advances and perspectives. Elsevier, Amsterdam

Google Scholar  

Marques AV, Pereira H (2019) A methodological approach for the simultaneous quantification of glycerol and fatty acids from cork suberin in a single GC run. Phytochem Anal 30(6):687–699. https://doi.org/10.1002/pca.2846

Moire L, Schmutz A, Buchala A, Yan B, Stark RE, Ryser U (1999) Glycerol is a suberin monomer. New experimental evidence for an old hypothesis. Plant Physiol 119:1137–1146

Morcombe CR, Gaponenko V, Byrd RA, Zilm KW (2004) Diluting abundant spins by isotope edited radio frequency field assisted diffusion. J Am Chem Soc 126:7196–7197. https://doi.org/10.1021/ja047919t

Moreira CJS, Bento A, Pais J, Petit J, Escorcio R, Correia VG, Pinheiro A, Halinski LP, Mykhaylyk OO, Rothan C, Silva Pereira C (2020) An ionic liquid extraction that preserves the molecular structure of cutin shown by nuclear magnetic resonance. Plant Physiol 184(2):592–606. https://doi.org/10.1104/pp.20.01049

Negrel J, Pollet B, Lapierre C (1996) Ether-linked ferulic acid amides in natural and wound periderms of potato tuber. Phytochemistry 43:1195–1199

Perez Rodriguez M, Dastmalchi K, Yoo B, Stark RE (2020) Needle in a haystack: antibacterial activity-guided fractionation of a potato wound tissue extract. Bioorg Med Chem 28(9):115428. https://doi.org/10.1016/j.bmc.2020.115428

Philippe G, Sorensen I, Jiao C, Sun X, Fei Z, Domozych DS, Rose JK (2020) Cutin and suberin: assembly and origins of specialized lipidic cell wall scaffolds. Curr Opin Plant Biol 55:11–20. https://doi.org/10.1016/j.pbi.2020.01.008

Ranathunge K, Schreiber L, Franke R (2011) Suberin research in the genomics era—new interest for an old polymer. Plant Sci 180:399–413. https://doi.org/10.1016/j.plantsci.2010.11.003

Razem FA, Bernards MA (2002) Hydrogen peroxide is required for the poly(phenolic) domain formation during wound-induced suberization. J Agric Food Chem 50:1009–1015

Rodrigues R, Palma SI, Correia VG, Padrao I, Pais J, Banza M, Alves C, Deuermeier J, Martins C, Costa HM, Ramou E (2020) Sustainable plant polyesters as substrates for optical gas sensors. Mater Today Bio 8:100083. https://doi.org/10.1016/j.mtbio.2020.100083

Schaefer J, McKay RA, Stejskal EO (1979) Double cross-polarization NMR of solids. J Magn Res 34:443–447

Schmidt-Rohr K, Mao JD (2002) Selective observation of nitrogen-bonded carbons in solid-state NMR by saturation-pulse induced dipolar exchange with recoupling. Chem Phys Lett 359:403–411

Schreiber L, Franke R, Hartmann K (2005) Wax and suberin development of native and wound periderm of potato ( Solanum tuberosum L.) and its relation to peridermal transpiration. Planta 220:520–530. https://doi.org/10.1007/s00425-004-1364-9

Serra O, Soler M, Hohn C, Franke R, Schreiber L, Prat S, Molinas M, Figueras M (2009a) Silencing of StKCS6 in potato periderm leads to reduced chain lengths of suberin and wax compounds and increased peridermal transpiration. J Exp Bot 60:697–707. https://doi.org/10.1093/jxb/ern314

Serra O, Soler M, Hohn C, Sauveplane V, Pinot F, Franke R, Schreiber L, Prat S, Molinas M, Figueras M (2009b) CYP86A33 -targeted gene silencing in potato tuber alters suberin composition, distorts suberin lamellae, and impairs the periderm’s water barrier function. Plant Physiol 149:1050–1060. https://doi.org/10.1104/pp.108.127183

Serra O, Hohn C, Franke R, Prat S, Molinas M, Figueras M (2010) A feruloyl transferase involved in the biosynthesis of suberin and suberin-associated wax is required for maturation and sealing properties of potato periderm. Plant J 62:277–290. https://doi.org/10.1111/j.1365-313X.2010.04144.x

Serra O, Chatterjee S, Huang W, Stark RE (2012) Mini-review: what nuclear magnetic resonance can tell us about protective tissues. Plant Sci 195:120–124. https://doi.org/10.1016/j.plantsci.2012.06.013

Serra O, Chatterjee S, Figueras M, Molinas M, Stark RE (2014) Deconstructing a plant macromolecular assembly: chemical architecture, molecular flexibility, and mechanical performance of natural and engineered potato suberins. Biomacromol 15:799–811

Serra O, Mahonen AP, Hetherington AJ, Ragni L (2022) The making of plant armor: the periderm. Annu Rev Plant Biol 73:405–432. https://doi.org/10.1146/annurev-arplant-102720-031405

Soler M, Verdaguer R, Fernandez-Pinan S, Company-Arumi D, Boher P, Gongora-Castillo E, Valls M, Antico E, Molinas M, Serra O, Figueras M (2020) Silencing against the conserved NAC domain of the potato StNAC103 reveals new NAC candidates to repress the suberin associated waxes in phellem. Plant Sci 291:110360. https://doi.org/10.1016/j.plantsci.2019.110360

Stark RE, Yu B, Zhong J, Yan B, Wu G, Tian S (2013) Environmental NMR: high-resolution magic-angle spinning. eMagRes. 2:377–388

Stark REYB, Yu B, Zhong J, Yan B, Wu G, Tian S (2014) Environmental NMR: high-resolution magic-angle spinning. In: Simpson MJS, André J (eds) NMR spectroscopy: a versatile tool for environmental research. John Wiley and Sons Ltd, New York, pp 87–102

Takegoshi K, Nakamura S, Terao T (2001) 13 C– 1 H dipolar-assisted rotational resonance in magic-angle spinning NMR. Chem Phys Lett 344:631–637

Tedeschi G, Benitez JJ, Ceseracciu L, Dastmalchi K, Itin B, Stark RE, Heredia A, Athanassiou A, Heredia-Guerrero JA (2018) Sustainable fabrication of plant cuticle-like packaging films from tomato pomace agro-waste, beeswax, and alginate. Acs Sustain Chem Eng 6(11):14955–14966. https://doi.org/10.1021/acssuschemeng.8b03450

Wiklund S (2008) Multivariate Data Analysis and Modelling in “Omics”.228

Worley B, Powers R (2013) Multivariate analysis in metabolomics. Curr Metabol 1:92–107. https://doi.org/10.2174/2213235X11301010092

Yan B, Stark RE (1998) A WISE NMR approach to heterogeneous biopolymer mixtures: dynamics and domains in wounded potato tissues. Macromolecules 31:2600–2605

Yan B, Stark RE (2000) Biosynthesis, molecular structure, and domain architecture of potato suberin: A 13 C NMR study using isotopically labeled precursors. J Agric Food Chem 48:3298–3304. https://doi.org/10.1021/jf000155q

Yang WL, Bernards MA (2007) Metabolite profiling of potato ( Solanum tuberosum L.) tubers during wound-induced suberization. Metabolomics 3:147–159. https://doi.org/10.1007/s11306-007-0053-7

Yu B, Vengadesan G, Wang H, Jashi L, Yefremov T, Tian S, Gaba V, Shomer I, Stark RE (2006) Magic-angle spinning NMR studies of cell wall bound aromatic-aliphatic biopolyesters associated with strengthening of intercellular adhesion in potato ( Solanum tuberosum L.) tuber parenchyma. Biomacromol 7:937–944. https://doi.org/10.1021/bm050812t

Zhao W, Deligey F, Chandra Shekar S, Mentink-Vigier F, Wang T (2022) Current limitations of solid-state NMR in carbohydrate and cell wall research. J Magn Reson 341:107263. https://doi.org/10.1016/j.jmr.2022.107263

Download references

Acknowledgements

The authors thank Drs. Hsin Wang and Lijia Yang for valuable technical assistance with the NMR and GC-MS instrumentation, respectively, at The City College of New York (CCNY). We express our appreciation to Dr. Boris Itin for technical assistance with the ssNMR and DNP instrumentation at the New York Structural Biology Center (NYSBC). Contributors to our previously published work described in this review included Drs. Wenlin Huang and Barney Yoo, Ph.D. students Liqing Jin and Qing Cai, undergraduate Mathiu Perez Rodriguez, and high school student Janni Lin. This work was supported by grants from the U.S. National Science Foundation (NSF award MCB-1411984 to R.E.S.), the U.S. Department of Agriculture (2022-67014-36387 to R.E.S.), and the Spanish Ministerio de Ciencia, Innovación y Universidades (PID2019-110330GB-C21/MICIU/AEI/10.13039/501100011033) to M.F. and O.S.). The Q-TOF MS instrument was acquired through NSF award CHE-1228921 and is operated by the CUNY Hunter College Department of Chemistry. The GC-MS instrument was acquired through NSF award CHE-0840498. Infrastructural support for the solid-state NMR spectrometer was provided by The City College of New York, the CUNY Institute for Macromolecular Assemblies, and a grant from the U.S. National Institutes of Health (5G12MD007603-30, National Institute on Minority Health and Health Disparities). The NMR instruments at the NYSBC were obtained through a grant from the New York State Office of Science, Technology and Academic Research, an NIH Office of Research Infrastructure Program Facility Improvement Grant (CO6RR015495), and an NIH Equipment Grant (S10RR029249).

Author information

Authors and affiliations.

Department of Chemistry and Biochemistry, The City College of New York, City University of New York (CUNY) and CUNY Institute for Macromolecular Assemblies, 85 Saint Nicholas Terrace, New York, NY, 10031, USA

Keyvan Dastmalchi, Subhasish Chatterjee, Bingwu Yu & Ruth E. Stark

Department of Natural Sciences, CUNY Hostos Community College, 500 Grand Concourse, The Bronx, NY, 10451, USA

Van Chanh Phan

Department of Chemistry and Physics, Kean University, 1000 Morris Avenue, Union, NJ, 07083, USA

Subhasish Chatterjee

Laboratori del Suro, Departament de Biologia, Universitat de Girona, Carrer Maria Aurèlia Campmany 40, 17003, Girona, Spain

Mercè Figueras & Olga Serra

Program in Biochemistry, The Graduate Center of the City University of New York, 365 Fifth Avenue, New York, NY, 10016, USA

Ruth E. Stark

Program in Chemistry, The Graduate Center of the City University of New York, 365 Fifth Avenue, New York, NY, 10016, USA

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Ruth E. Stark .

Ethics declarations

Conflict of interest.

The authors have no competing interests to declare that are relevant to the content of this article.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Dastmalchi, K., Phan, V.C., Chatterjee, S. et al. A comprehensive approach to phytochemical analysis of macromolecular composites that protect tubers: case studies in suberized potato periderm tissues. Phytochem Rev (2024). https://doi.org/10.1007/s11101-024-09974-4

Download citation

Received : 01 April 2023

Accepted : 08 April 2024

Published : 15 May 2024

DOI : https://doi.org/10.1007/s11101-024-09974-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Solanum tuberosum
• Solid-state 13 C NMR
• Feruloyl transferase
• Find a journal
• Publish with us
• Track your research