The nursing profession values the ideal of viewing patients as whole persons which claims having a distinct focus on understanding, knowing, and caring for the whole person. Holism, from the Greek ’holos’ and ’hale’ meaning whole, can in modern time be traced back to the Gestalt psyckologists regads an internal and external horizon of awareness in the 1920 (Max Wertheimer, Wolfgang Köhler, and Kurt Koffka) here turning to Gurwitch, 2012/1974) influencing nursing, According to Sarkis & Skoner (1987) the term holism was mentioned in psychological and philosophical settings before making an entrance into nursing referring to Dr. Myra Levine, who, in turn, refer to Erikson’s (1964) followed by Rogers (1970), the view on wholeness as an open system start to became influential, as opposite to a reductionist view dominating the medical paradigm at the time...Thus, the nursing profession have over time increasingly developed a more holistic view concerning an approach in nursing practises, and in the 1980s, the ideal of holism was further emphasized in nursing as a response to and as a discourse against - the still prevailing medical model that mainly focused on diseases and diagnoses (Kim 2006; Smart 2005). The idea of a more holistic view was to avoid a reductionist trend and approach in nursing and care, since the medical model derives from the tradition of natural science regarding the human body as a physical object, where diseases can be objectified and measured (mostly statistically) physically and biological (Artioli, Foà & Taffurelli, 2016). Today the intention of a holistic approach and holism related to contemporary nursing and its practice are advocated in many health caring contexts, but the meaning and understanding of holism varies widely, as shown in Larsen and Borup’s (2011) review of 23 Nordic articles and McMillan et al’s (2018) concept analysis of holism in nursing practice. As in another study by McEvoy and Duffy (2008) performed a concept analysis including 27 articles concerned with nursing and allied health literature. We address underlying questions concerned with nurses epistemological and ontological understandings related to holism and a transformed holistic approach in nursing, as mirrored in contemporary research. More specifically, we address the following main research questing aiming to identify and describe nurses’ awareness related to their approaches in nursing related to a globalised/internationalised world perspective. Underpinning explorative questions are: What are the epistemological assumptions underpinning the nurses’ meanings/understandings? What are the ontological assumptions underpinning the nurses’ meanings/understandings? What are the nurses’ knowledge and understanding(s) about holism and a holistic approach in nursing and health care practices? What does holism/holistic approach mean according to nurses? and What does it mean in health care and nursing contexts? We make no claim about presenting the meaning/understandings of ‘true’ holism/holistic approach’, also, we have avoided any core predefinition or the ‘word meaning’ except for the described historical dichotomy concerning the holistic versus reductionist approach in nursing, in order to maintain an open explorative approach. Thus aiming at describing and demonstrate the current and practicing holistic understanding(s) and approach in healthcare from the nurses’ perspective based on the contents presented in our material. Said this, we however turn to Heidegger’s (1953;1971b,c...) view (as a theoretical frame) on holism when interpreting the results as a possible and reasonable suggestion for developing a more aware understanding of a holistic approach. 

A literature search was conducted in CINAHL Complete (EbscoHost, inception to present), MEDLINE (EbscoHost, 1947-present) and PsycInfo (EbscoHost, inception to present). EbscoHost interface was used to search the databases simultaneously, and the search was conducted March 9, 2022. The search strategy was developed in collaboration with a librarian. Filters English and Academic journals was used to focus the search result on peer reviewed publications. The search resulted in 420 records. Duplicates between the included databases was automatically removed in the simultaneous search. EndNote identified 35 additional duplicates, resulting in n=385 papers/…After full text review, 109 papers were selected for further screening to identify descriptions of holism or descriptive themes. 1 paper was identified as duplicate, 2 had wrong topic (chemistry or similar), 50 papers described holism through teamwork and the nurse’s perspective was not explicit. 34 papers did not have the nurses approach in focus, 7 papers only addressed holism vaguely, in total 109 papers were excluded after full text review. 17 papers were eligible for thematic analysis and synthesis. An explorative inductive approach inspired by Thomas & Harden (2008) and Braun & Clarke (2006) a thematic synthesis analyses was conducted using several stages in the process. In line with Thomas & Harden the synthesis include: …”the idea or step of 'going beyond' the content of the original studies [and] has been identified by some as the defining characteristic of synthesis” and...”the equivalent stage in meta-ethnography is the development of 'third order interpretations' which go beyond the content of original studies [32,11]”, as in our study this involves interpretation of the results turning to Heidegger and the view and understanding of holism emerged from the data and described in (our) themes, and in our study became the focus on epistemological and ontological perspectives related to the meaning and understanding of holism, when interpreting and discussing the developed themes. The synthesis took the form of three stages which overlapped to some degree: the free line-by-line identifying key characteristics and sentences of the findings in the review studies results; the organisation of these 'key characteristics and sentences' into related areas/domains to construct 'descriptive' themes; and finally the development of 'analytical' contextual themes. Three temes emerged

(1)Ontological Awareness – philosophical roots and holistic oriented: Nurses approaches care situations and the patients with openness, trust and attentiveness based on a pre-reflective knowledge about a meaning of holism. Deep wonder includes a ‘being-mode’ of an existential awareness involving ‘being-alongside and being-with’. Being-with involved a sincere presence and open mind. Nurses were engaged in the idea of meaning and mindfulness towards patient care and nursing and the awareness of spiritual and existential and social dimensions. (2)The ideological partnership – mostly situational and alliance oriented: Nurses’ approaches in nursing focuses on forming a partnership. Focus was on the engagement with the patient in alliance and supported by the idea of helping others, such as the patient in question. (3)To help – mostly situational and need oriented: The importance of being a good listener and showing emphatic response and forming an understanding of the patients’ needs in order to help related to a patient-, person-oriented discourse. These 3 approaches differ and can be understood as a hierarchic ladder with three steps (where ontological awareness represents a holistic and higher order of understanding and the focus primarily on responding to needs a reductionist and lower order of understanding). It is possible to visualize a "direction of development" between the three themes, moving from a needs approach to a consciousness view, in line with Heidegger's "being open and openness", suggesting that this opens up a wider contextual and holistic understanding. Thus, we will imply that understanding not merely the ‘word or conceptual meaning’ of holism and holistic care is sufficient when conceptualizing an authentic meaning involving the transition into nurses’ approaches in care situations. Suggesting that also a deeper ontological awareness is necessary and central in order to avoid/eliminate a reductionist understanding and approach concerning the phenomenon ‘holism related to nursing’.

Short ref list. Artioli, Foà & Taffurelli, 2016… An integrated narrative nursing model: towards a new healthcare paradigm Acta Biomed, 22, pp. 13-22. Polvsen & Borup’s (2011) Holism in nursing and health promotion: distinct or related perspectives?--A literature review, Scand J Caring Sci., pp. 25(4):798-805. Braun & Clarke (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), pp. 77-101 HEIDEGGER, M. Being and time. Albany: State University of New York Press, 1953. p.5-227. HEIDEGGER, M. Building dwelling thinking. In: HEIDEGGER, M. Poetry, language, thought. London: Harper and Row, 1971a. p.143-161. HEIDEGGER, M. ... poetically, Man dwells... In: HEIDEGGER, M. Poetry, language, thought. London: Harper and Row, 1971b. p.211-229. HEIDEGGER, M. The origin of the work of art. In: HEIDEGGER, M. Poetry, language, thought. London: Harper and Row, 1971c. p.17-78. Kim H. (2016). The concept of holism. In: Kim H, Kollak I (eds). Nursing Theories: Conceptual and Philosophical Foundations. London, Springer: 89-108. Kleppe et al (2016). Nursing textbooks’ conceptualization of nurses’responsibilities related to the ideal of a holistic view of the patient: A critical analysis. Journal of Nursing Education and Practice 6 (3), pp. 106-115. McMillan et al (2018). Holism: A Concept Analysis. DOI:10.15344/2394-4978/2018/282 McEvoy, L. and Duffy, A. (2008) Holistic practice—A concept analysis. Nurse Education in Practice, 8, 412-419. http://dx.doi.org/10.1016/j.nepr.2008.02.002 Thomas & Harden (2008). Methods for the thematic synthesis of qualitative research in systematic reviews…DOIhttps://doi.org/10.1186/1471-2288-8-45 Vallega-Neu (2004). Body and Time-Space in Heidegger and Merleau-Ponty. DOI: 10.1163/15691640-12341409