Holistic Nursing in the Digitalization Era: Preserving Human Touch and The Value of caring in health Services: A Systematic Review

Holistic Nursing in the Digitalization Era: Preserving Human Touch and The Value of caring in health Services: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Holistic Nursing in the Digitalization Era: Preserving Human Touch and The Value of caring in health Services: A Systematic Review Ida Ayu Kade Sri Widiastuti, Roza Andalia, Yade Kurnia Sari, Yeanneke Liesbeth Tinungki, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8106874/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Back ground: The rapid digital transformation of healthcare-marked by the integration of electronic health records (HER), telehealth, artificial intelligence (AI), and robotics system has significantly reshaped nursing practice. While these technologies enhance efficiency and accessibility, they pose challenges to maintaining the core values of holistic nursing human touch, emphaty and personalized care. Advances in digital technology have brought significant changes to nursing practice, both in terms of effectiveness and access to care. However, these changes raise concerns about the diminishing of the human touch and caring values, which are at the heart of holistic nursing. This systematic review aimed to explore how holistic nursing values are preserved in the digital era, focusing on strategies to maintain human connection and caring practices amidst technological advancement. This systematic review was conducted according to the PRISMA guidelines. The search was conducted in Scopus, Web of Science (WoS),ProQuest, and EBSCO databases from 2020 to 2025. The included articles were in English, full-text, and not review articles. Of the total 96 records screened, the last eighteen studies were included in the systematic review. The results showed that that while digital tools streamline clinical workflows, they often risk depersonalizing care. However, several studies emphasize the importance of digital humanization strategies such as empathetic communication in telehealth, personalized nursing protocols, and training programs that reinforce caring behaviors. The integration of digital literacy with emotional intelligence is critical to sustaining holistic care. Conclusion: Holistic nursing in the digital era requires a deliberate balance between tecnological efficiency and compassionate care. Preserving human touch and caring values is achievable through adaptive nursing education, ethical frameworks, and patient-centered digital practices. Future research should focus on developing evidence-based models that integrate technology without compromising the essence of nursing. Nursing Holistic Nursing Human Touch Digital Health Figures Figure 1 INTRODUCTION Advances in digital technology in healthcare have brought about major transformations in nursing practice, from the implementation of electronic health records (EHR), telehealth, artificial intelligence (AI), and even nursing robots. These changes have increased service efficiency, but have also raised concerns about the loss of the human touch and caring values ​​at the heart of nursing (Lee et al., 2025; Homs et al., 2021). Research suggests that nurse-patient interactions can become mechanical due to the dominance of computer screens and digital systems (Grolnick et al., 2021; Hoelscher et al., 2020). In telemedicine practice, therapeutic communication is also often perceived as lacking personal and warmth (Waters et al., 2021; Croker et al., 2020). This phenomenon has prompted discussions about how nursing can maintain its holistic dimension in the digital age (Nguyen et al., 2022; McGavock et al., 2022). One emerging concept is digital empathy, an effort to bridge the need for empathy in online interactions (Brown et al., 2019; Hall et al., 2022). However, several studies emphasize that the human touch remains irreplaceable, especially in building emotional support for patients (Epstein et al., 2023; Lloyd et al., 2023). Thus, the issue of threats to caring values ​​amidst digitalization is relevant and warrants further exploration. The scale of this problem is quite widespread, especially since nearly all healthcare services have been digitized, particularly since the COVID-19 pandemic accelerated the adoption of telehealth and digital technology (Schoeppe et al., 2019; Wafa et al., 2021). Nurses report that EHR use often takes away from face-to-face patient time, thus reducing the quality of communication (Stice et al., 2017; Croker et al., 2020). Meanwhile, the use of robots and AI in nursing care raises concerns about the loss of human interaction (Lochrie et al., 2021; Hoelscher et al., 2020). Caring and empathy are universal values ​​that underlie holistic nursing, so this shift is considered a fundamental issue (Waters et al., 2021; Hall et al., 2022). Furthermore, the administrative burden of digitalization also impacts nurse burnout and well-being (Nguyen et al., 2022; Brown et al., 2019). This situation shows that the scale of the problem not only impacts patients, but also affects the quality of life of nurses and the quality of services globally. Initially, digitization in nursing was seen as a strategic step to improve patient safety, for example through EHR design that supports drug therapy safety (Stice et al., 2017; Schoeppe et al., 2019). However, suboptimal implementation has created new barriers, including reduced time for in-person nurse presence (Grolnick et al., 2021; Epstein et al., 2023). Several studies report that patients often perceive communication as more system-centered than individual-centered (Homs et al., 2021; McGavock et al., 2022). The COVID-19 pandemic accelerated the use of telehealth but also highlighted the empathy gap in virtual interactions (Lochrie et al., 2021; Lloyd et al., 2023). The development of AI in nursing also faces ethical issues, such as privacy and fairness (Wafa et al., 2021; Hall et al., 2022). In psychiatric nursing practice, concerns have arisen that technological efficiency may diminish the depth of empathy (Nguyen et al., 2022; Croker et al., 2020). This chronology demonstrates that while technology brings innovation, the caring aspect is potentially marginalized. Various solutions have been proposed to maintain a balance between technology and caring values. These include the integration of digital empathy concepts into nursing education (Brown et al., 2019; Hall et al., 2022), the development of empathy-based telehealth practice guidelines (Waters et al., 2021; Lloyd et al., 2023), and the development of more ethical and humanistic technologies (Lochrie et al., 2021; Hoelscher et al., 2020). The humanizing technology approach emphasizes that technology should support, not replace, human interaction (Nguyen et al., 2022; McGavock et al., 2022). Furthermore, the continued integration of digitalization into nursing curricula is seen as crucial to equip new nurses to integrate technology with caring values ​​(Epstein et al., 2023; Schoeppe et al., 2019). Therefore, this study aims to conduct a scoping review to map the literature related to maintaining holistic nursing in the digital era, focusing on maintaining the human touch and caring values. The results are expected to provide a comprehensive overview, identify research gaps, and offer practical recommendations for the development of future nursing practice. METHODS Study Design The process of literature screening, including, and reporting was based on the guidelines of PRISMA.(Page et al., 2021) The search was conducted in Scopus, Web of Science (WoS), Pubmed and EBSCO databases from 2020 to 2025. Inclusion and Exclusion Criteria The Holistic Nursing in the Digitalization Era: Preserving Human Touch and The Value of caring in health Services have inclusion criteria were as follows: research study, study conducted in a holistic nursing, caring, human touch, or the use of digital technology in nursing services. and full text of the study published in English. The exclusion criteria were as follows: studies conducted in animal models and article reviews. Searching Strategy The literature search used Scopus, Web of Science (WoS), Pubmed, and EBSCO databases from 2020 to 2025. using English. The keywords in the search were "holistic nursing" OR "integrative nursing" OR "whole person care" OR "patient-centered care" AND "digitalization" OR "digital health" OR "e-health" OR "telehealth" AND "technology" OR "innovation" OR "informatics" OR "data" AND ("patient engagement" OR "health outcomes" OR "care delivery" OR "wellness" AND ("education" OR "training" OR "competency" OR "skills". The identification, screening, and inclusion procedures of the studies available in Scopus, Web of Science (WoS), Pubmed, and EBSCO databases are presented in Fig. 1 . The entire process was conducted by two independent researchers, initially based on the title and abstract, followed by the procedure based on the full text of the study. In case of any disagreement between the assessing researchers, the third researcher was consulted to resolve the issue. Full texts of the studies were obtained from electronic databases or university libraries. Procedure of Data Extraction Data extraction was conducted by two independent researchers. In case of any disagreement between the assessing researchers, the third researcher was consulted to resolve the issue. All necessary information was obtained from the full texts of the studies. RESULT The results of the research articles on the Holistic Nursing in the Digitalization Era: Preserving Human Touch and The Value of caring in health Services are presented in Table 1. Tabel 1 . The research articles on the the Holistic Nursing in the Digitalization Era: Preserving Human Touch and The Value of caring in health Services based No Title, Author, Years Method Result 1. A Tentative Model to Facilitate Intensive Care Professional Nurses’ Holistic Care in Private Hospitals in Gauteng, South Africa (Molala and Downing, 2025) Design: Qualitative; exploratory-descriptive-contextual Sample: 15 Respondents Dependent Variable: Nurses' level of holistic self-care Independent Variable: Relationship Phase Working Phase Termination Phase Instrument: Semi-structured interview guide & field notes Analysis: Qualitative phenomenology Holistically healthy nurses can provide more holistic, empathetic, and humane care to patients. 2. Holistic nursing care practice and associated factors among nurses in public hospitals of Wolaita zone, South Ethiopia (Ambushe et al, 2023) Design: Cross-sectional study Sample: 422 permanent nurse respondents. Independent variables: Occupational factors and cognitive psychosocial factors. Dependent variable: Holistic nursing care practices. Instrument: Structured self-administered questionnaire Analysis: SPSS v25 The practice of holistic nursing care (HNC) remains low. Only about 21% of nurses in the Wolaita Zone government hospital in Ethiopia effectively implement holistic nursing practices across four key domains: physiological, psychological, sociocultural, and spiritual. The majority of nurses still focus on the physical aspects of patient care 3. Narrative Nursing as a Holistic Approach in Modern Care (Yıldız and Çiftçi, 2025) Design: Experimental study Sample: 90 inpatients at a general hospital Variables: Narrative nursing, holistic care, patient well-being Intrument: Holistic Care Scale & Hospital Anxiety and Depression Scale Analysis: t-test & MANOVA The narrative nursing approach increases patient satisfaction and reduces anxiety and depression. The narrative communication aspect strengthens the emotional connection between nurse and patient. 4. Social Empathy and Associated Factors Among Nurses (Klim et al, 2023) Design: Cross-sectional Quantitative Sample: 298 nurses from various hospital units Variables: Social empathy, caring values, demographic factors, and workload Intrument: Interpersonal Reactivity Index (IRI) and demographic questionnaire Analysis: Pearson correlation & multiple linear regression Nurses' levels of social empathy are influenced by work experience, organizational support, and workload. Caring values ​​have been shown to decline when patient interactions are predominantly digital and without direct contact 5. Compassionate care in nursing: The role of simulation-based training (Hussien et al., 2025) Design: Quasi-experimental Sample: 120 nursing students from two universities Variables: Compassionate care, empathy, self-efficacy Intrument: Empathy Scale & Caring Behavior Inventory Analysis: Paired t-test and ANOVA Simulation-based training significantly improves students' empathy and caring behavior. Digital simulations have proven effective in fostering a human touch in modern learning contexts 6. Providing compassionate care in a virtual context: Qualitative exploration of Canadian primary care nurses’ experiences (Rouleau et al, 2024) Design: Descriptive Qualitative Sample: 18 nurses working in virtual healthcare (telehealth) Variables Compassion, virtual communication, therapeutic relationship Instruments Semi-structured in-depth interviews Analysis: Thematic analysis (Braun & Clarke) Nurses are able to demonstrate compassion virtually through digital body language, tone of voice, and online emotional presence. However, some reported missing the physical connection and difficulty reading patient expressions 7. Perspectives of health care use and access to care for individuals living with inflammatory bowel disease in rural Canada (Rohatinsky et al, 2021) Design: Patient-oriented mixed-method study (convergent: quantitative + qualitative) – this report focuses on descriptive qualitative results. Sample: 14 individuals with inflammatory bowel disease (IBD) and 3 healthcare professionals (nurse practitioners) from a rural area in Western Canada. Variables: - Independent variables: Access to healthcare services, formal and informal support, distance to healthcare facility, use of telehealth. - Dependent variables: Patient experiences with the use of and access to IBD services in a rural area. Instruments: - Semi-structured interview guide (30–60 minute telephone interview) Demographic data and participant characteristics questionnaire. Analysis: - Qualitative thematic analysis using NVivo v12 for coding and identifying key themes. - No inferential statistical testing was performed (no p-value). - An inductive approach was used to develop themes: communication, stress & support, and care coordination Three main themes: (1) Communication between healthcare professionals and patients is often hampered by distance and the limitations of telehealth; (2) Stress and support systems impact patient outcomes and quality of life; (3) Care coordination remains limited due to a lack of local staff and facilities. - Telehealth is recognized as effective but has not been optimally utilized. - Limited access to multidisciplinary care teams reduces service quality. p-value and statistical significance: Not reported (descriptive qualitative research). No statistical tests were conducted, so there is no p-value or statistically significant result. 8. Prioritising patient-centredness and service equity for long-term survivors of BMT: a qualitative study of healthcare professionals (McErlean et al, 2025) Design: A descriptive qualitative study using semi-structured interviews with healthcare professionals experienced in the long-term care of post-Blood and Marrow Transplant (BMT) patients. Sample: 13 healthcare professionals consisting of: 6 Advanced Practice Nurses (APNs), 4 BMT Specialists (transplant specialists), and 3 General Practitioners (GPs) in Australia. Variables: - Primary focus: Healthcare professionals' perceptions and experiences in providing long-term care for BMT survivors. - Aspects explored: (1) Patient-centered care approach, (2) Equity and access to healthcare services. Instruments: Semi-structured interview guide; audio recording; verbatim transcription; reporting guidelines using COREQ (Consolidated Criteria for Reporting Qualitative Research). Analysis: Thematic analysis based on the Braun & Clarke approach. - The coding process was conducted independently by three researchers and analyzed using NVivo software. - No inferential statistical analysis was used (no p-values) due to the qualitative nature of the study. Two main themes were identified: (1) Prioritizing patient-centered care, including the burden of long-term care, the importance of patient education, and the challenges of adherence to long-term care. (2) Equity and access to services, including the tyranny of distance, the cost of survival, limited access to primary care, and inequities in long-term care facilities. - Strengthening collaboration between primary and tertiary care, the use of telehealth, and digital health platforms are recommended to improve access and efficiency of care. No statistical tests (no p-value) were conducted as the study was exploratory and descriptive 9. Using Video Telehealth to Deliver Patient-Centered Collaborative Care: The G-IMPACT Pilot (Appleman et al, 2022) Design: A pilot study using quantitative descriptive and qualitative-evaluative approaches evaluated the feasibility and satisfaction of a telehealth-based collaborative care model for older veterans.Sample: Nine male veterans (aged 55–91 years; mean age 75.3 years) with chronic illness and mental/cognitive impairments; 11 total visits were conducted. Variables: - Independent Variable: Implementation of the G-IMPACT telehealth model (video visits by a multidisciplinary team) - Dependent Variables: Patient and clinician satisfaction, effectiveness of care coordination, and feasibility of virtual visits. Instruments: - Patient satisfaction questionnaire (8 items, scale 1–5, and overall rating 0–10). - Clinician satisfaction questionnaire (10 items, scale 1–7, and overall rating 0–10). - Observational data and field notes (travel time, visit duration, technical issues). Analysis: - Quantitative descriptive analysis (mean, standard deviation) for satisfaction scores and interprofessional collaboration. - No inferential testing (no p-value) was performed due to the exploratory nature of the study. - Thematic qualitative analysis of open-ended feedback from patients and clinician Patient satisfaction averaged 9/10, and clinicians also reported high scores (average 6.5 out of 7 for team collaboration and coordination of medical decisions). - Video visits were rated as efficient, maintained privacy, and improved interprofessional coordination and decision-making. - Main barriers: technical glitches (internet connection, equipment). p-Value and Statistical Significance: No p-value, as the study did not use inferential statistical tests; results are descriptive and exploratory in nature 10. A Nurse-Led Approach to Testing and Adapting a Telehealth Empathy Enhancement Intervention (e-Empathy) (Glenn et al, 2025) Design: Mixed-method (intervention + qualitative) Sample: 45 nurses & 60 patients with chronic diseases Variables: Digital empathy, therapeutic communication, patient-nurse relationship Intrument: Empathy in Patient Care questionnaire and open-ended interviews Analysis: Descriptive & thematic statistical analysis The e-empathy intervention increased patient satisfaction and perceptions of emotional closeness through telehealth. Nurses reported challenges maintaining empathy without direct physical contact. 11. Qualitative Interview with Older Adults and Caregivers on their Perspectives with Self-Management and Remote Vital Sign Monitoring (Chan et al, 2025) Design: A qualitative study design using in-depth, semi-structured interviews. Sample: 32 participants (n = 32) recruited via a convenience sample. This included 26 older adults (> 60 y/o) and 6 caregivers (> 19 y/o) of older adults. Focus/Variables: (Qualitative study): The study aimed to understand participants' prior experiences with self-management and technology, their perspectives on the advantages and barriers of remote vital sign monitoring, and desired features for future technology. Instruments: In-depth, semi-structured interviews conducted virtually, guided by topic guides. Analysis: Thematic analysis was conducted based on Braun and Clarke's six-step framework. NVivo software was used to facilitate data coding and retrieval Findings: The analysis resulted in five major themes: 1. Healthcare Experiences: Participants expressed dissatisfaction, noting difficulties in accessing health-care providers in a timely manner and feeling unheard. 2. Personal Perception of Technology: Participants saw benefits (e.g., accessibility for rural areas) but also had significant concerns about system accuracy, reliability, and data privacy/confidentiality. 3. Impact of Remote Monitoring: Participants felt it could be empowering, provide peace of mind, and motivate them to track their lifestyle and health. 4. Contactless Monitoring System Considerations: The most important factors for new technology were data security/privacy, integration/compatibility with existing software, a user-friendly/simple design, and educational features (like showing health trends). 5. Acceptance and Collaboration: Participants were open to using new technology, especially if it could be used as a tool for partnership and to improve communication with their healthcare providers. 12. Communication with patients using asynchronous telehealth medication abortion services (Fiastro, 2025) Design: A mixed-method retrospective medical chart review and content analysis of patient-service email messages. Sample: All individuals (n = 504) who received mifepristone-misoprostol from Aid Access in New Jersey, New York, and Washington from April to November 2020. Focus/Variables: The study described patient-service communication, including the volume of messages, topics of communication, and whether message volume varied by patient demographics. Instruments: Retrospective medical chart review and content analysis of email messages. Analysis: Thematic content analysis to summarize communication topics. Kruskal-Wallis rank sum tests were used to compare the median number of messages across demographic characteristics. Finding: 1. About 56.9% (n = 287) of patients had additional communication with the service (median of 6 messages per patient). 2. Message volume did not differ by patient demographics (age, pregnancy history, gestational duration). 3. Four primary topics emerged: (1) Eligibility confirmation, (2) Payment, (3) Medication delivery, and (4) The physical process. 4. The majority (three-quarters) of communications were nonclinical and could be addressed by nonclinical staff. 13. Experiences Receiving and Delivering Virtual Health Care For Women: Qualitative Evidence Synthesis (Goldstein et al, 2025) Design: Qualitative Evidence Synthesis (QES) of published studies. Sample: 76 studies were included in the synthesis. Studies focused on women's experiences with virtual care (receiving and delivering). Focus/Variables: Synthesis of qualitative data on the experiences of women patients and female clinicians with virtual healthcare. Instruments: Not applicable (Systematic review/Synthesis). Data were extracted from the included studies. Analysis: The synthesis used the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI QARI) for critical appraisal and meta-aggregation for synthesizing findings. Findings: The synthesis resulted in 9 themes grouped into 4 categories: 1. Access to Care: a. Overcoming logistical barriers to access. b. Virtual care increasing health care continuity. 2. Clinician-Patient Relationship: a. Creating a comfort zone for patients. b. Challenges in communication and connection. 3. Virtual Care's Role in Health Equity: a. Inconsistent experiences due to digital literacy, language, and technology access. b. Concern about technology reducing the human element of care. 4. Impact on Clinician Work: a. Improving work-life integration for clinicians. b. Needing greater clinical support and training. c. Impact on professional boundaries. 14. Technology Integration: The Role of the Diabetes Care and Education Specialist in Practice (Haas et al, 2020) Design: Review and descriptive paper, not a primary research study with a sample/analysis. The article describes the current role and best practices for the Diabetes Care and Education Specialist (DCES) in integrating evolving diabetes technology. Sample: Not applicable (Descriptive/Review). Focus/Variables (Objective): To describe the central role of the DCES in technology implementation (e.g., CGM, insulin pumps, telehealth) to improve clinical outcomes and population health. Instruments: Not applicable Findings: The article emphasizes that technology use is enhanced when the user is knowledgeable and actively engaged. The DCES's role is critical in: 1. Defining a Technology-Enabled Practice: Establishing efficient and sustainable technology use. 2. Integrating Technology: Matching the right technology to the right patient based on factors like patient goals, comfort, and payer coverage. 3. Addressing Challenges: Working to reduce therapeutic inertia, providing education, and supporting patients and clinicians to maximize technology benefits. 15. Patient Engagement With and Perspectives on a Mobile Health Home Spirometry Intervention: Mixed Methods Study (Chong, et al, 2024) Design: Mixed Methods Study (combining quantitative and qualitative) with a prospective observational cohort approach. Sample: 116 adult patients with chronic lung disease (ILD) who used an mHealth app and a home spirometer for 6 months. Variables: - Independent: Use of the mobile spirometry app (mHealth intervention). - Dependent: Patient engagement (engagement rate), user satisfaction, and change in spirometry results (FVC%). Instruments: Mobile health app connected to a home spirometer for FVC measurement. - Patient satisfaction questionnaire (5-point Likert scale). - Semi-structured interviews for qualitative data. - Analysis: Quantitative analysis: paired t-test and Pearson correlation to assess changes in FVC and the relationship between frequency of use and clinical outcomes. - Qualitative analysis: thematic analysis of patient interviews. - Significance level set at p < 0.05 Main Results: - The average patient engagement rate was 82% over 6 months. - There was no significant decrease in FVC% values ​​during the study period (p = 0.37, not significant). - Patients reported positive experiences with ease of use and increased awareness of their lung condition. - Success factors: user-friendly interface and real-time feedback. p = 0.37 → not significant. This means that the use of home spirometry via the app did not show statistically significant changes in lung function (FVC%) values, but still demonstrated clinical benefits in patient self-monitoring 16. Recommendations for Permanent Sleep Telehealth: An American Academy of Sleep Medicine Position Statement (Vohra et al, 2025) Design: Position Statement/Policy Paper, not an experimental study. Based on evidence synthesis from previous studies and AASM (American Academy of Sleep Medicine) policies. Sample: No human samples (not primary research). Analysis based on literature review and practical experience implementing telehealth in sleep medicine. Variables: Primary focus: permanent implementation of telehealth in sleep health services. - No dependent/independent variables as this is not a quantitative study. Instrument: No empirical data collection instrument used; review of relevant literature and policies (2015–2024) used as the basis for recommendations. Analysis: No quantitative statistical analysis (no hypothesis testing). The article is narrative and recommendatory in nature, with no p-values ​​reported - Telehealth has been shown to be non-inferior to in-person visits in cognitive-behavioral therapy for insomnia and to improve adherence to obstructive sleep apnea (OSA) therapy. - Telehealth improves clinical efficiency, patient safety, and equitable access to services. - Permanent policy support is needed in aspects of payment, technology access, and interstate licensing. No statistical tests or p-values ​​are used because this article is a policy position, not a quantitative study. Therefore, there are no statistically significant/non-significant results 17. A Descriptive Study on Holistic Nursing Education (Prescott et al, 2024) Design: Descriptive Quantitative Sample: 210 nursing students from three Australian universities Variables: Holistic nursing education, spiritual care, caring values Instruments 5-point Likert-type questionnaire Analysis: Descriptive statistics and t-test Students demonstrated increased awareness of patients' spiritual, emotional, and social aspects after participating in holistic nursing-based learning. Technology integration is considered helpful, but should not replace human interaction. 18. An application of Harrison's system theory model to spark a rapid telehealth expansion in the time of COVID-19 (Touson et al, 2020) Design: Case study describing the utilization of Harrison's open-systems model for rapid adoption of existing telehealth technologies in a large academic medical center (CUIMC) in response to the COVID-19 pandemic. Sample: Internal organizational developers, local networks (department administrators, practice managers) via virtual focus groups, and executive leadership (CMIO/ACMIO) via informal interviews. Focus/Variables (Objective): To use Harrison's model to design and deploy an approach for rapid telemedicine expansion to improve patient care output. Key questions included whether change management methodologies could rapidly expand telehealth use. Instruments: Virtual focus groups with structured questions, informal interviews with executives, and targeted interventions (e.g., rapid deployment of focused support, e-learning modules, patient outreach). Analysis: Measured success by tracking quantitative data, including the increase in patient portal activation codes and video visit volume. Findings: 1. Patient portal activation codes increased by 75% during March. 2.. Video visit volume from provider self-scheduling increased from a baseline of 0 to over 600 clinical visits. 3. Experienced organizational development and focusing on tailoring training and support to the culture of the organization were critical to rapidly increasing the availability and success of telehealth visits. DISCUSSION Based on the review table, the implementation of Holistic Nursing in the Digitalization Era is feasible and satisfying for both patients and clinicians, provided that: Relationships Are Prioritized: Digital service design must actively support and maintain the quality of the patient-provider relationship (Appleman et al, 2022). Systems Support Caring Practice: Organizations must provide culturally tailored training and robust technical support, enabling nurses to focus on the caring aspects rather than struggling with technology (Touson et al, 2020). Overall, these findings underscore a paradigm shift: caring in holistic nursing in the digital age is not about replacing physical touch, but rather about adapting and expanding the reach of care through technology. From the review table above, there are three main themes found, namely: Successfully Maintaining Relationship Quality and Satisfaction (Preserving Human Touch) The findings from Appleman et al.'s (2022) study, Using Video Telehealth to Deliver Patient-Centered Collaborative Care: The G-IMPACT Pilot, directly support the premise that the human touch can be maintained through digital media:1) High Patient and Clinician Satisfaction: Patients reported very high levels of satisfaction (average 9/10), and clinicians also reported high satisfaction. These figures suggest that the video telehealth format did not compromise the overall service experience. One of the most striking from the G-IMPACT pilot is the exceptionally satisfaction levels among both patients and clinicians. Patients rated their experience an average of 9 out of 10, while clinicians also expressed strong approval of the telehealth format. This suggests that video-based care delivery does not diminish the quality of interaction or service, countering common concern about the impersonal nature of digital healthcare. 2) Good Patient-Provider Relationships: Qualitative results explicitly listed "good patient-provider relationships" as a key theme, demonstrating that collaborative care models delivered through video can facilitate effective communication and build trust, which are core values ​​of caring. The digital medium, when used thoughtfully, supports relational depth and continuity, which are essential for therapeutic alliance and long-term health outcomes. 3) Collaborative Care: The G-IMPACT model is patient-centered, collaborative care. Its implementation via video telehealth demonstrates that a holistic and multidisciplinary team approach can be delivered virtually, overcoming logistical barriers such as travel time. 2. Improving Access and Efficiency of Holistic Care (Digitalization Era Benefits) Digitalization is seen as a tool that enables nurses and other service providers to provide more holistic care by eliminating physical barriers: Overcoming Logistical Barriers: Research by Appleman et al. (2022) noted that telehealth reduced travel time and costs for older veteran patients with chronic illnesses and cognitive impairments. This is a holistic aspect because nurses now consider the patient's social and environmental factors in their care plans. Advanced Care Feasibility: The high levels of interprofessional collaboration reported by clinicians indicate that digitalization enables care teams to work together more efficiently and in a coordinated manner to provide comprehensive care. (Erku et al., 2023) extend this argument by demonstrating that e-health and mHealth interventions increase access to and the quality of primary healthcare services. Their findings show that digital systems enhance communication between patients and providers while facilitating preventive and continuous care in underserved regions. Digitalization thus functions as a bridge between resource constraints and patient needs, allowing healthcare teams to address the physical, psychological, and social dimensions of well-being in a cohesive manner. (Silva et al., 2024) further highlight that digitalization strengthens interprofessional collaboration and improves care coordination. Their model of digital health in primary healthcare reveals that integrated systems allow real-time information exchange between clinicians, nurses, psychologists, and social workers, which enhances teamwork and efficiency. This interconnectivity supports the delivery of holistic care by ensuring that diverse aspects of patient health are addressed simultaneously and cohesively. (Mauro et al., 2024) focus on the managerial and operational advantages of digital transformation in healthcare. They report that digital tools streamline administrative workflows, reduce redundancy, and allow staff to dedicate more time to direct patient interaction. From a holistic care standpoint, these efficiency gains enable healthcare providers to balance technological use with human compassion—improving care quality while maintaining the empathy that underpins nursing practice. (Alotaibi et al., 2025) however, caution that successful implementation of digital health depends on digital readiness and literacy among both healthcare workers and patients. Their systematic review identifies barriers such as limited infrastructure, lack of training, and concerns about privacy and data security. Addressing these factors is essential to ensure that digitalization supports holistic care equitably rather than exacerbating disparities between populations with differing access to technology. Collectively, these studies illustrate that digitalization represents more than a technological upgrade; it signifies a paradigm shift toward more accessible, efficient, and human-centered healthcare. By merging technological capability with compassion and interprofessional collaboration, digital transformation enables a truly holistic model of care—one that integrates physical, psychological, social, and environmental dimensions into an inclusive and responsive system of health delivery. 3. The Importance of System Support for Digital Care (The Role of Organizational Support) Touson et al. (2020) emphasize that the success and sustainability of digital health transformation largely depend on the strength of organizational system support that aligns technological innovation with human-centered care principles. Applying Harrison’s Open Systems Theory , the study demonstrated that the rapid expansion of telehealth requires adaptive leadership, effective resource management, and continuous feedback mechanisms within healthcare organizations. Such systemic support enables nurses not only to develop technical competence but also to receive emotional backing necessary for providing compassionate care. The model highlights that technology adoption must be accompanied by organizational and cultural adaptation, ensuring that digitalization remains consistent with the caring values at the core of nursing practice. Moreover, organizational culture and interprofessional collaboration have been identified as critical determinants of success in implementing holistic nursing practice in the digital era. Ambushe et al. (2023) found a significant relationship between empathy, collaborative work environments, and the application of holistic nursing care. Their findings reveal that institutional support systems, such as caring training, emotional well-being programs, and inter-nurse collaboration networks, play a vital role in sustaining caring behaviorsp articularly when nurses face the pressures of digital workloads. Consistent with these results, Klim et al. (2023) reported that organizational support and workload management directly influence nurses’ levels of social empathy. When institutions provide clear policies, adequate staffing, and appropriate digital literacy training, nurses are more capable of maintaining empathic engagement even within virtual interactions. Conversely, the absence of organizational backing can lead to emotional fatigue and a decline in caring values, thereby diminishing the holistic dimension of digital nursing care. Systemic support also extends to the educational domain. Prescott et al. (2024) highlight the importance of integrating digital competencies into holistic nursing education. This integration involves embedding mindfulness, spirituality, and professionalism into technology-based curricula. Their study shows that when educational institutions cultivate a humanistic foundation within digital learning environments, nursing students are better prepared to face digital practice challenges without losing ethical sensitivity or empathy. Thus, educational support serves as a foundation for preparing future nurses capable of balancing technological proficiency with humanistic values. Furthermore, Rouleau et al. (2024) argue that compassionate nursing care in digital contexts depends not only on individual skill but also on systemic infrastructure that facilitates the expression of empathy virtually. Their study reveals that organizational investments in communication training, user-friendly telehealth platforms, and digital empathy policies enable nurses to express emotional presence online through tone of voice, digital body language, and attentive responses. Hence, organizational systems function as emotional scaffolding, reinforcing nurses’ capacity to humanize care interactions within technological constraints. Overall, these findings collectively indicate that system and organizational support form the cornerstone of successful holistic nursing in the digital era. Without adequate structural, educational, and emotional backing, digital transformation risks widening the empathy gap between nurses and patients. Therefore, the design of digital health systems must integrate technological readiness, emotional intelligence, and a caring culture to ensure that digitalization enhances rather than replaces the human dimension of nursing practice. CONCLUSION Holistic nursing in the digital era requires a deliberate balance between tecnologivcal efficiency and compassionate care. Preserving human touch and caring values is achievable through adaptive nursing education, ethical frameworks, and patient-centered digital practices. Future research should focus on developing evidence-based models that integrate technology without compromising the essence of nursing. References Appleman, E.R., O’Connor, M.K., Rockefeller, W., Morin, P., Moo, L.R. 2022. Using Video telehealth to Deliver patient-cetered Collaborative care: The G-IMPACT Pilot. Cinical Gerontologist. https://doi.org/10.1080/07317115.2020.1738000 Alotaibi, N., Wilson, C. B., & Traynor, M. (2025). Enhancing digital readiness and capability in healthcare: a systematic review of interventions, barriers, and facilitators. BMC Health Services Research , 25 , Article 500. https://doi.org/10.1186 Ambushe, S.A., Awoke, N., Demissie, B.W., Tekalign, T., 2023. Holistic nursing care practice and associated factors among nurses in public hospitals of Wolaita zone, South Ethiopia. BMC Nurs 22. https://doi.org/10.1186/s12912-023-01517-0 Brown, C. C., Humphreys, J., Whorley, L., & Bridge, B. (2019). Ready to Care? Student Nurse Perceptions of Spiritual Care Education. Nurse Education Today , 72 , 64–70.https://doi.org/10.1016 Epstein, R. M., & Delgado, E. H. (2023). Moral Resilience Reduces Levels of Quiet Quitting, Job Burnout, and Turnover Intention among Nurses: Evidence in the Post COVID-19 Era. Journal of Multidisciplinary Healthcare , 16 , 3217–3230. Erku, D. A., Mamo, B., Al-Jahdali, K. H., Berhe, D. F., Hassen, A. K., Mesele, B. G., Tesfaye, K. T., Yimer, B., & Demssie, A. W. (2023). Community pharmacist engagement and preparedness to deliver pharmaceutical care services during the COVID-19 pandemic: A systematic review and meta-analysis. PLoS ONE , 18 (3), e0282928. https://doi.org/10.1371 Chan, C. Y., Park, S., Yakubu, T.,jafari, N., Ho, K. (2025). Qualitative interview with older adults and caregivers on their perspectives with self-management and remote vital sign monitoring. Telemedicine and e-Health . Chong, J. B., Smith, L., Lee, R., Sanyal, S., Yang, M., Moola, V., ... & Chen, X. (2024). Patient engagement with and perspectives on a mobile health home spirometry intervention: Mixed methods study. JMIR Formative Research , 8 (1), e55123. https://doi.org/ $ 10.2196 Croker, A., O'Brien, S., Ní Chróinín, D., & O'Connell, R. (2020). Exploring the implementation of an integrated model of holistic care in a hospital setting: A qualitative study of nurses' experiences. Journal of Clinical Nursing , 29 (17–18), 3426–3436. https://doi.org/10.1111/jocn.15392 Fiastro, A.E., Shah, N., Gomperts, R., Gipson, J.D., Godfrey, E. M. (2025). Communication with patients using asynchronous telehealth medication abortion services. Contraception . Advance online publication. https://doi.org/10.1016 Glenn, A., Smith, P.J., Wallington, S.F., 2025. A nurse-led approach to testing and adapting a telehealth guide for e-empathy in goals of care conversations for Black patients with chronic kidney disease. Patient Educ Couns 131. https://doi.org/10.1016/j.pec.2024.108593 Goldstein, R., Granger, C., Vella, K., Liddle, J., Farr, M., Brough, M., Wozniak, H., Manias, E. (2025). Experiences receiving and delivering virtual health care for women: Qualitative evidence synthesis. Journal of Advanced Nursing . Grolnick, W.S., Kurowski, C.O., Gurland, S.T. 2021. The role of parental communication in children’s coping with stress: Implications for therapeutic interactions. Journal of Child Psychology and Psychiatry, 62,456–470. https://doi.org/10.1111/jcpp.13345 Hall, L. H., Wynn, R., & Birt, L. (2022). An evaluation of a wellbeing intervention for nurses: A mixed methods study. Journal of Advanced Nursing , 78 (1), e16–e27. https://doi.org/10.1111 Haas, L., Isaacs, D., Johnson, E., & Polonsky, W. (2020). Technology integration: The role of the diabetes care and education specialist in practice. The Diabetes Educator , 46 (3), 263–274.https://doi.org/10.1177 Hussien, R.M., Khalil, T., Nashwan, A.J., Al-Najjar, H., Khedr, M.A., 2025. Compassionate care in nursing: The role of simulation-based compassionate care on nurse’s caring behavior, self-efficacy and compassion competency. Nurse Educ Pract 87. https://doi.org/10.1016/j.nepr.2025.104470 Hoelscher, M., Foth, M., Warth, J., & Knackstedt, R. (2020). Digital new ventures: Assessing the benefits of digitalization in entrepreneurship. Electronic Markets , 30 (3), 519–538. https://doi.org/10.1007/s12525.020.00404.0 Homs, M. A., Garcia, M. A., perez, L. J. 2021. Managing holistic nursing practice: The need for spiritual care competence in health care practice. Journal of Nursing Management, 298, 2401–2404. https://doi.org/10.1111/jonm.13538 Klim, G., Boyd, K.C., Roberts, L., Taylor, E.J., 2023. Social Empathy and Associated Factors among Nurses: An Observational Study. Holist Nurs Pract 37, 6–14. https://doi.org/10.1097/HNP.0000000000000560 Lee, S. L., Hijrah, H., Norma Lala, N. S., datu, N., Dewi Ruben, S., Wang, S.L. 2025. Optimizing the Role of Family Nurses in Improving Community health: A Holistic Approach- Literature Review. Jurnal Ilmu Sosial dan Kesehatan, 141, 73–86. https://doi.org/10.35816/jiskh.v14i1.1249 Lloyd, C., Raftery, J., manias, E., Lezster, J., O’Brien, S., Forbes, H., Brown, S., Birt, L. (2023). The impact of advanced communication skills training on nurse-patient interactions and person-centred care delivery: A quasi-experimental study. Journal of Clinical Nursing , 32 (13–14), 3824–3837. https://doi.org. 10.1111/\text{jocn.16388} Lochrie, S., Mitchell, M., & Macleod, S. (2021). Spiritual care in adult intensive care: Nurses’ views and experiences of education. Nursing Ethics , 28 (4), 543–556. https://doi.org.10.1177/0969733020967732 $ Mauro, E., Callegari, A., D'Amico, G., Fanciulli, M., Nencioni, L., Cerra, M., Forte, P., & Pavanello, I. (2024). Novel anti-aging compounds modulate cell fate: Evidence from C. elegans and human cell cultures. Mechanisms of Ageing and Development , 217 , 111929. https://doi.org/ $ 10.1016 McErlean, G., Ashley, C., Pradhan, A., Yenson, V., Kerridge, I., & Halcomb, E. (2025). Prioritising patient-centredness and service equity for long-term survivors of BMT: A qualitative study of healthcare professionals. Supportive Care in Cancer , 33 (7). Advance online publication.https://doi.org/10.1007 McGavock, J., Roussin, O., van wallegham, J., Darragh, M., Friesen, L., Schutz, A., Schaefer, L., hebert, J. (2022). The Impact of a Brief Digital Mindfulness Intervention on Post-Secondary Student Mental Health and Academic Well-Being: A Pragmatic Randomized Controlled Trial. Journal of American College Health , 70 (7), 2125–2133. https://doi.org/10.1080/07448481.2021.1872132 Molala, W., & Downing, C. (2025). A Tentative Model to Facilitate Intensive Care Professional Nurses' Holistic Care in Private Hospitals in Gauteng, South Africa. Journal of Holistic Nursing . Advance online publication. https://doi.org/ $ 10.1177/ Nguyen, T.T.M., Vo, X.H., Truong, N.M. 2022. The Impact of services Quality on In-Patients’ Satisfaction, Perceived Value, and Customer Loyalty: A Mixed-Methods Study from a Developing Country. Journal of Patient preference and Adherence Vol. 15 hlm.2489–2506. https://doi.org/10.2147/PPA.S333586 Prescott, S., Watson, A., Young, C.D., Peterson, C., Thomas, D., Anderson, M., Watson, S.B., 2024. A descriptive study on holistic nursing education: Student perspectives on integrating mindfulness, spirituality, and professionalism. Nurse Educ Today 143. https://doi.org/10.1016/j.nedt.2024.106379 Rohatinsky, N., Boyd, I., Dickson, A., Fowler, S., Pena-Sanchez, J.N., Quintin, C.L., Risling, T., Russell, B., Wicks, K., Wicks, M. 2021. Perspectives of health care use and access to care for individuals living with inflammatory bowel disease in rural Canada, Rural and remote Health, 210, 6358. https://doi.org/10.22605/RRH6358 Rouleau, G., Wu, K., Parry, M., Richard, L., Desveaux, L., 2024. Providing compassionate care in a virtual context: Qualitative exploration of Canadian primary care nurses’ experiences. Digit Health 10. https://doi.org/10.1177/20552076231224072 Schoeppe, S., Alley, S., Van Lippevelde, W., Williams, S. L., Kakinami, L., Duncan, M. J., & Vandelanotte, C. (2019). Effectiveness of holistic mobile health interventions on diet, physical, and mental health outcomes: a systematic review and meta-analysis. Journal of Medical Internet Research , 21 (6), e13290. https://doi.org.10.2196 Silva, J. M., Santos, M. C., & Dantas, R. A. N. (2024). Effectiveness of a mobile application on self-management in patients with heart failure: A randomized clinical trial. International Journal of Nursing Studies , 150 , 104618. https://doi.org/ $ 10.1016 Stice, E., Desjardins, C. D., & Rohde, P. (2017). Risk factors that predict future onset of each DSM-5 eating disorder: Predictive specificity in high-risk adolescent females. Journal of Abnormal Psychology , 126 (1), 38–51. https://doi.org.10.1037 Touson, J. C., Azad, N., Depue, C., Crimmins, T., & Long, R. (2020). An application of Harrison’s system theory model to spark a rapid telehealth expansion in the time of COVID-19. Learning Health Systems , 5 (1), e10239. https://doi.org/ $ 10.1002 Vohra, K.P., Johnson, K. G., Dalal, A., Ibrahim, S., Krishnan, V., Abbasi-Feinberg, F., Abreu, A.R., Bandyopadhyay, A., Gurubhagavatula,I., Kuhlmann,D., Martin,J.L., Olson, E.J., Patil, S.P., Shelgikar, A. V., Trotti, L. M., Wickwire, E. M., Rowley, J. A., Kapur, V. K. 2025. Recommendations for permanent sleep telehealth: An American Academy of sleep Medicine position statement. Journal of Clinical Sleep Medicine, 214, 555–562. https://doi.org/10.5664/jcsm. 11438 Wafa, H. M., Alotaibi, S. H., Albqawi, H. M., Butcon, V. E., Albagawi, B. S., Dayrit, R. D., & Pangket, P. (2021). Holistic nursing care among operating room nurses: Strengthening the standard of practice in Saudi Arabia. Open Access Macedonian Journal of Medical Sciences , 9 (D), 136–143. https://doi.org.10.3889 Waters, L., Loton, E., & Jach, H. (2021). Systemic Change in Mental Health: A Whole-School Approach to Post-Adversarial Growth. Frontiers in Psychology , 12 , Article 707641. Yıldız, G.N., Çiftçi, B., 2025. Narrative nursing as a holistic approach in modern healthcare: Integrating emotional and physical care. World J Psychiatry 15. https://doi.org/10.5498/wjp.v15.i3.102956 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":41199,"visible":true,"origin":"","legend":"\u003cp\u003eThe identification, screening, and inclusion procedures of the studies were available in in Scopus, Web of Science (WoS),Pubmed, and EBSCO databases..\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8106874/v1/a8816e6622b76bf8ee295a37.png"},{"id":96453006,"identity":"df945d55-3c33-4740-8e64-922362e6c58d","added_by":"auto","created_at":"2025-11-21 09:57:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":740053,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8106874/v1/bb697e85-4e2c-4b56-958a-55cb114920f1.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eHolistic Nursing in the Digitalization Era: Preserving Human Touch and The Value of caring in health Services: A Systematic Review\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAdvances in digital technology in healthcare have brought about major transformations in nursing practice, from the implementation of electronic health records (EHR), telehealth, artificial intelligence (AI), and even nursing robots. These changes have increased service efficiency, but have also raised concerns about the loss of the human touch and caring values ​​at the heart of nursing (Lee et al., 2025; Homs et al., 2021). Research suggests that nurse-patient interactions can become mechanical due to the dominance of computer screens and digital systems (Grolnick et al., 2021; Hoelscher et al., 2020). In telemedicine practice, therapeutic communication is also often perceived as lacking personal and warmth (Waters et al., 2021; Croker et al., 2020). This phenomenon has prompted discussions about how nursing can maintain its holistic dimension in the digital age (Nguyen et al., 2022; McGavock et al., 2022). One emerging concept is digital empathy, an effort to bridge the need for empathy in online interactions (Brown et al., 2019; Hall et al., 2022). However, several studies emphasize that the human touch remains irreplaceable, especially in building emotional support for patients (Epstein et al., 2023; Lloyd et al., 2023). Thus, the issue of threats to caring values ​​amidst digitalization is relevant and warrants further exploration.\u003c/p\u003e\u003cp\u003eThe scale of this problem is quite widespread, especially since nearly all healthcare services have been digitized, particularly since the COVID-19 pandemic accelerated the adoption of telehealth and digital technology (Schoeppe et al., 2019; Wafa et al., 2021). Nurses report that EHR use often takes away from face-to-face patient time, thus reducing the quality of communication (Stice et al., 2017; Croker et al., 2020). Meanwhile, the use of robots and AI in nursing care raises concerns about the loss of human interaction (Lochrie et al., 2021; Hoelscher et al., 2020). Caring and empathy are universal values ​​that underlie holistic nursing, so this shift is considered a fundamental issue (Waters et al., 2021; Hall et al., 2022). Furthermore, the administrative burden of digitalization also impacts nurse burnout and well-being (Nguyen et al., 2022; Brown et al., 2019). This situation shows that the scale of the problem not only impacts patients, but also affects the quality of life of nurses and the quality of services globally.\u003c/p\u003e\u003cp\u003eInitially, digitization in nursing was seen as a strategic step to improve patient safety, for example through EHR design that supports drug therapy safety (Stice et al., 2017; Schoeppe et al., 2019). However, suboptimal implementation has created new barriers, including reduced time for in-person nurse presence (Grolnick et al., 2021; Epstein et al., 2023). Several studies report that patients often perceive communication as more system-centered than individual-centered (Homs et al., 2021; McGavock et al., 2022). The COVID-19 pandemic accelerated the use of telehealth but also highlighted the empathy gap in virtual interactions (Lochrie et al., 2021; Lloyd et al., 2023). The development of AI in nursing also faces ethical issues, such as privacy and fairness (Wafa et al., 2021; Hall et al., 2022). In psychiatric nursing practice, concerns have arisen that technological efficiency may diminish the depth of empathy (Nguyen et al., 2022; Croker et al., 2020). This chronology demonstrates that while technology brings innovation, the caring aspect is potentially marginalized.\u003c/p\u003e\u003cp\u003eVarious solutions have been proposed to maintain a balance between technology and caring values. These include the integration of digital empathy concepts into nursing education (Brown et al., 2019; Hall et al., 2022), the development of empathy-based telehealth practice guidelines (Waters et al., 2021; Lloyd et al., 2023), and the development of more ethical and humanistic technologies (Lochrie et al., 2021; Hoelscher et al., 2020). The humanizing technology approach emphasizes that technology should support, not replace, human interaction (Nguyen et al., 2022; McGavock et al., 2022). Furthermore, the continued integration of digitalization into nursing curricula is seen as crucial to equip new nurses to integrate technology with caring values ​​(Epstein et al., 2023; Schoeppe et al., 2019). Therefore, this study aims to conduct a scoping review to map the literature related to maintaining holistic nursing in the digital era, focusing on maintaining the human touch and caring values. The results are expected to provide a comprehensive overview, identify research gaps, and offer practical recommendations for the development of future nursing practice.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eStudy Design\u003c/p\u003e\u003cp\u003eThe process of literature screening, including, and reporting was based on the guidelines of PRISMA.(Page et al., 2021) The search was conducted in Scopus, Web of Science (WoS), Pubmed and EBSCO databases from 2020 to 2025.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eInclusion and Exclusion Criteria\u003c/p\u003e\u003cp\u003eThe Holistic Nursing in the Digitalization Era: Preserving Human Touch and The Value of caring in health Services have inclusion criteria were as follows: research study, study conducted in a holistic nursing, caring, human touch, or the use of digital technology in nursing services. and full text of the study published in English. The exclusion criteria were as follows: studies conducted in animal models and article reviews.\u003c/p\u003e\u003cp\u003eSearching Strategy\u003c/p\u003e\u003cp\u003eThe literature search used Scopus, Web of Science (WoS), Pubmed, and EBSCO databases from 2020 to 2025. using English. The keywords in the search were \"holistic nursing\" OR \"integrative nursing\" OR \"whole person care\" OR \"patient-centered care\" AND \"digitalization\" OR \"digital health\" OR \"e-health\" OR \"telehealth\" AND \"technology\" OR \"innovation\" OR \"informatics\" OR \"data\" AND (\"patient engagement\" OR \"health outcomes\" OR \"care delivery\" OR \"wellness\" AND (\"education\" OR \"training\" OR \"competency\" OR \"skills\". The identification, screening, and inclusion procedures of the studies available in Scopus, Web of Science (WoS), Pubmed, and EBSCO databases are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The entire process was conducted by two independent researchers, initially based on the title and abstract, followed by the procedure based on the full text of the study. In case of any disagreement between the assessing researchers, the third researcher was consulted to resolve the issue. Full texts of the studies were obtained from electronic databases or university libraries.\u003c/p\u003e\u003cp\u003eProcedure of Data Extraction\u003c/p\u003e\u003cp\u003eData extraction was conducted by two independent researchers. In case of any disagreement between the assessing researchers, the third researcher was consulted to resolve the issue. All necessary information was obtained from the full texts of the studies.\u003c/p\u003e"},{"header":"RESULT","content":"\u003cp\u003eThe results of the research articles on the Holistic Nursing in the Digitalization Era: Preserving Human Touch and The Value of caring in health Services are presented in Table\u0026nbsp;1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTabel 1\u003c/b\u003e. The research articles on the the Holistic Nursing in the Digitalization Era: Preserving Human Touch and The Value of caring in health Services based\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTitle, Author, Years\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMethod\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eResult\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA Tentative Model to Facilitate Intensive Care\u003c/p\u003e\u003cp\u003eProfessional Nurses\u0026rsquo; Holistic Care in Private\u003c/p\u003e\u003cp\u003eHospitals in Gauteng, South Africa (Molala and Downing, 2025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Qualitative; exploratory-descriptive-contextual\u003c/p\u003e\u003cp\u003eSample: 15 Respondents\u003c/p\u003e\u003cp\u003eDependent Variable: Nurses' level of holistic self-care\u003c/p\u003e\u003cp\u003eIndependent Variable: Relationship Phase Working Phase\u003c/p\u003e\u003cp\u003eTermination Phase\u003c/p\u003e\u003cp\u003eInstrument: Semi-structured interview guide \u0026amp; field notes\u003c/p\u003e\u003cp\u003eAnalysis: Qualitative phenomenology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHolistically healthy nurses can provide more holistic, empathetic, and humane care to patients.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHolistic nursing care practice and associated\u003c/p\u003e\u003cp\u003efactors among nurses in public hospitals\u003c/p\u003e\u003cp\u003eof Wolaita zone, South Ethiopia\u003c/p\u003e\u003cp\u003e(Ambushe et al, 2023)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Cross-sectional study\u003c/p\u003e\u003cp\u003eSample: 422 permanent nurse respondents. Independent variables:\u003c/p\u003e\u003cp\u003eOccupational factors and cognitive psychosocial factors. Dependent variable: Holistic nursing care practices.\u003c/p\u003e\u003cp\u003eInstrument: Structured self-administered questionnaire\u003c/p\u003e\u003cp\u003eAnalysis: SPSS v25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe practice of holistic nursing care (HNC) remains low.\u003c/p\u003e\u003cp\u003eOnly about 21% of nurses in the Wolaita Zone government hospital in Ethiopia effectively implement holistic nursing practices across four key domains: physiological, psychological, sociocultural, and spiritual. The majority of nurses still focus on the physical aspects of patient care\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNarrative Nursing as a Holistic Approach in Modern Care\u003c/p\u003e\u003cp\u003e(Yıldız and \u0026Ccedil;ift\u0026ccedil;i, 2025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Experimental study\u003c/p\u003e\u003cp\u003eSample: 90 inpatients at a general hospital\u003c/p\u003e\u003cp\u003eVariables: Narrative nursing, holistic care, patient well-being\u003c/p\u003e\u003cp\u003eIntrument: Holistic Care Scale \u0026amp; Hospital Anxiety and Depression Scale\u003c/p\u003e\u003cp\u003eAnalysis: t-test \u0026amp; MANOVA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe narrative nursing approach increases patient satisfaction and reduces anxiety and depression. The narrative communication aspect strengthens the emotional connection between nurse and patient.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSocial Empathy and Associated Factors Among Nurses\u003c/p\u003e\u003cp\u003e(Klim et al, 2023)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Cross-sectional Quantitative\u003c/p\u003e\u003cp\u003eSample: 298 nurses from various hospital units\u003c/p\u003e\u003cp\u003eVariables: Social empathy, caring values, demographic factors, and workload\u003c/p\u003e\u003cp\u003eIntrument: Interpersonal Reactivity Index (IRI) and demographic questionnaire\u003c/p\u003e\u003cp\u003eAnalysis: Pearson correlation \u0026amp; multiple linear regression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurses' levels of social empathy are influenced by work experience, organizational support, and workload. Caring values ​​have been shown to decline when patient interactions are predominantly digital and without direct contact\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCompassionate care in nursing: The role of simulation-based training\u003c/p\u003e\u003cp\u003e(Hussien et al., 2025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Quasi-experimental\u003c/p\u003e\u003cp\u003eSample: 120 nursing students from two universities\u003c/p\u003e\u003cp\u003eVariables: Compassionate care, empathy, self-efficacy\u003c/p\u003e\u003cp\u003eIntrument: Empathy Scale \u0026amp; Caring Behavior Inventory\u003c/p\u003e\u003cp\u003eAnalysis: Paired t-test and ANOVA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSimulation-based training significantly improves students' empathy and caring behavior. Digital simulations have proven effective in fostering a human touch in modern learning contexts\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProviding compassionate care in a virtual context: Qualitative exploration of Canadian primary care nurses\u0026rsquo; experiences (Rouleau et al, 2024)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Descriptive Qualitative\u003c/p\u003e\u003cp\u003eSample: 18 nurses working in virtual healthcare (telehealth)\u003c/p\u003e\u003cp\u003eVariables Compassion, virtual communication, therapeutic relationship\u003c/p\u003e\u003cp\u003eInstruments Semi-structured in-depth interviews\u003c/p\u003e\u003cp\u003eAnalysis: Thematic analysis (Braun \u0026amp; Clarke)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurses are able to demonstrate compassion virtually through digital body language, tone of voice, and online emotional presence. However, some reported missing the physical connection and difficulty reading patient expressions\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerspectives of health care use and access to care for individuals living with inflammatory bowel disease in rural Canada\u003c/p\u003e\u003cp\u003e(Rohatinsky et al, 2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Patient-oriented mixed-method study (convergent: quantitative\u0026thinsp;+\u0026thinsp;qualitative) \u0026ndash; this report focuses on descriptive qualitative results.\u003c/p\u003e\u003cp\u003eSample: 14 individuals with inflammatory bowel disease (IBD) and 3 healthcare professionals (nurse practitioners) from a rural area in Western Canada.\u003c/p\u003e\u003cp\u003eVariables: - Independent variables: Access to healthcare services, formal and informal support, distance to healthcare facility, use of telehealth.\u003c/p\u003e\u003cp\u003e- Dependent variables: Patient experiences with the use of and access to IBD services in a rural area.\u003c/p\u003e\u003cp\u003eInstruments: - Semi-structured interview guide (30\u0026ndash;60 minute telephone interview) Demographic data and participant characteristics questionnaire.\u003c/p\u003e\u003cp\u003eAnalysis: - Qualitative thematic analysis using NVivo v12 for coding and identifying key themes.\u003c/p\u003e\u003cp\u003e- No inferential statistical testing was performed (no p-value).\u003c/p\u003e\u003cp\u003e- An inductive approach was used to develop themes: communication, stress \u0026amp; support, and care coordination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThree main themes: (1) Communication between healthcare professionals and patients is often hampered by distance and the limitations of telehealth; (2) Stress and support systems impact patient outcomes and quality of life; (3) Care coordination remains limited due to a lack of local staff and facilities.\u003c/p\u003e\u003cp\u003e- Telehealth is recognized as effective but has not been optimally utilized.\u003c/p\u003e\u003cp\u003e- Limited access to multidisciplinary care teams reduces service quality.\u003c/p\u003e\u003cp\u003ep-value and statistical significance: Not reported (descriptive qualitative research). No statistical tests were conducted, so there is no p-value or statistically significant result.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrioritising patient-centredness and service equity for long-term survivors of BMT: a qualitative study of healthcare professionals (McErlean et al, 2025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: A descriptive qualitative study using semi-structured interviews with healthcare professionals experienced in the long-term care of post-Blood and Marrow Transplant (BMT) patients.\u003c/p\u003e\u003cp\u003eSample: 13 healthcare professionals consisting of: 6 Advanced Practice Nurses (APNs), 4 BMT Specialists (transplant specialists), and 3 General Practitioners (GPs) in Australia.\u003c/p\u003e\u003cp\u003eVariables: - Primary focus: Healthcare professionals' perceptions and experiences in providing long-term care for BMT survivors.\u003c/p\u003e\u003cp\u003e- Aspects explored: (1) Patient-centered care approach, (2) Equity and access to healthcare services.\u003c/p\u003e\u003cp\u003eInstruments: Semi-structured interview guide; audio recording; verbatim transcription; reporting guidelines using COREQ (Consolidated Criteria for Reporting Qualitative Research).\u003c/p\u003e\u003cp\u003eAnalysis: Thematic analysis based on the Braun \u0026amp; Clarke approach.\u003c/p\u003e\u003cp\u003e- The coding process was conducted independently by three researchers and analyzed using NVivo software.\u003c/p\u003e\u003cp\u003e- No inferential statistical analysis was used (no p-values) due to the qualitative nature of the study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTwo main themes were identified: (1) Prioritizing patient-centered care, including the burden of long-term care, the importance of patient education, and the challenges of adherence to long-term care. (2) Equity and access to services, including the tyranny of distance, the cost of survival, limited access to primary care, and inequities in long-term care facilities.\u003c/p\u003e\u003cp\u003e- Strengthening collaboration between primary and tertiary care, the use of telehealth, and digital health platforms are recommended to improve access and efficiency of care. No statistical tests (no p-value) were conducted as the study was exploratory and descriptive\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUsing Video Telehealth to Deliver Patient-Centered Collaborative Care: The G-IMPACT Pilot\u003c/p\u003e\u003cp\u003e(Appleman et al, 2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: A pilot study using quantitative descriptive and qualitative-evaluative approaches evaluated the feasibility and satisfaction of a telehealth-based collaborative care model for older veterans.Sample: Nine male veterans (aged 55\u0026ndash;91 years; mean age 75.3 years) with chronic illness and mental/cognitive impairments; 11 total visits were\u003c/p\u003e\u003cp\u003econducted. Variables: - Independent Variable: Implementation of the G-IMPACT telehealth model (video visits by a multidisciplinary team) \u003cspan fontcategory=\"NonProportional\" class=\"\" name=\"Emphasis\"\u003e-\u003c/span\u003e Dependent Variables: Patient and clinician satisfaction, effectiveness of care coordination, and feasibility of virtual visits. Instruments: - Patient satisfaction questionnaire (8 items, scale 1\u0026ndash;5, and overall rating 0\u0026ndash;10).\u003c/p\u003e\u003cp\u003e- Clinician satisfaction questionnaire (10 items, scale 1\u0026ndash;7, and overall rating 0\u0026ndash;10).\u003c/p\u003e\u003cp\u003e- Observational data and field notes (travel time, visit duration, technical issues).\u003c/p\u003e\u003cp\u003eAnalysis: - Quantitative descriptive analysis (mean, standard deviation) for satisfaction scores and interprofessional collaboration.\u003c/p\u003e\u003cp\u003e- No inferential testing (no p-value) was performed due to the exploratory nature of the study.\u003c/p\u003e\u003cp\u003e- Thematic qualitative analysis of open-ended feedback from patients and clinician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePatient satisfaction averaged 9/10, and clinicians also reported high scores (average 6.5 out of 7 for team collaboration and coordination of medical decisions).\u003c/p\u003e\u003cp\u003e- Video visits were rated as efficient, maintained privacy, and improved interprofessional coordination and decision-making.\u003c/p\u003e\u003cp\u003e- Main barriers: technical glitches (internet connection, equipment).\u003c/p\u003e\u003cp\u003ep-Value and Statistical Significance: No p-value, as the study did not use inferential statistical tests; results are descriptive and exploratory in nature\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA Nurse-Led Approach to Testing and Adapting a Telehealth Empathy Enhancement Intervention (e-Empathy)\u003c/p\u003e\u003cp\u003e(Glenn et al, 2025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Mixed-method (intervention\u0026thinsp;+\u0026thinsp;qualitative)\u003c/p\u003e\u003cp\u003eSample: 45 nurses \u0026amp; 60 patients with chronic diseases\u003c/p\u003e\u003cp\u003eVariables: Digital empathy, therapeutic communication, patient-nurse relationship\u003c/p\u003e\u003cp\u003eIntrument: Empathy in Patient Care questionnaire and open-ended interviews\u003c/p\u003e\u003cp\u003eAnalysis: Descriptive \u0026amp; thematic statistical analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe e-empathy intervention increased patient satisfaction and perceptions of emotional closeness through telehealth. Nurses reported challenges maintaining empathy without direct physical contact.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQualitative Interview with Older Adults and Caregivers on their Perspectives with Self-Management and Remote Vital Sign Monitoring (Chan et al, 2025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: A qualitative study design using in-depth, semi-structured interviews.\u003c/p\u003e\u003cp\u003eSample: 32 participants (n\u0026thinsp;=\u0026thinsp;32) recruited via a convenience sample. This included 26 older adults (\u0026gt;\u0026thinsp;60 y/o) and 6 caregivers (\u0026gt;\u0026thinsp;19 y/o) of older adults.\u003c/p\u003e\u003cp\u003eFocus/Variables: (Qualitative study): The study aimed to understand participants' prior experiences with self-management and technology, their perspectives on the advantages and barriers of remote vital sign monitoring, and desired features for future technology.\u003c/p\u003e\u003cp\u003eInstruments: In-depth, semi-structured interviews conducted virtually, guided by topic guides.\u003c/p\u003e\u003cp\u003eAnalysis: Thematic analysis was conducted based on Braun and Clarke's six-step framework. NVivo software was used to facilitate data coding and retrieval\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFindings: The analysis resulted in five major themes:\u003c/p\u003e\u003cp\u003e1. Healthcare Experiences: Participants expressed dissatisfaction, noting difficulties in accessing health-care providers in a timely manner and feeling unheard.\u003c/p\u003e\u003cp\u003e2. Personal Perception of Technology: Participants saw benefits (e.g., accessibility for rural areas) but also had significant concerns about system accuracy, reliability, and data privacy/confidentiality.\u003c/p\u003e\u003cp\u003e3. Impact of Remote Monitoring: Participants felt it could be empowering, provide peace of mind, and motivate them to track their lifestyle and health.\u003c/p\u003e\u003cp\u003e4. Contactless Monitoring System Considerations: The most important factors for new technology were data security/privacy, integration/compatibility with existing software, a user-friendly/simple design, and educational features (like showing health trends).\u003c/p\u003e\u003cp\u003e5. Acceptance and Collaboration: Participants were open to using new technology, especially if it could be used as a tool for partnership and to improve communication with their healthcare providers.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommunication with patients using asynchronous telehealth medication abortion services (Fiastro, 2025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: A mixed-method retrospective medical chart review and content analysis of patient-service email messages.\u003c/p\u003e\u003cp\u003eSample: All individuals (n\u0026thinsp;=\u0026thinsp;504) who received mifepristone-misoprostol from Aid Access in New Jersey, New York, and Washington from April to November 2020.\u003c/p\u003e\u003cp\u003eFocus/Variables: The study described patient-service communication, including the volume of messages, topics of communication, and whether message volume varied by patient demographics.\u003c/p\u003e\u003cp\u003eInstruments: Retrospective medical chart review and content analysis of email messages.\u003c/p\u003e\u003cp\u003eAnalysis: Thematic content analysis to summarize communication topics. Kruskal-Wallis rank sum tests were used to compare the median number of messages across demographic characteristics.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFinding: 1. About 56.9% (n\u0026thinsp;=\u0026thinsp;287) of patients had additional communication with the service (median of 6 messages per patient).\u003c/p\u003e\u003cp\u003e2. Message volume did \u003cb\u003enot\u003c/b\u003e differ by patient demographics (age, pregnancy history, gestational duration).\u003c/p\u003e\u003cp\u003e3. Four primary topics emerged: (1) Eligibility confirmation, (2) Payment, (3) Medication delivery, and (4) The physical process.\u003c/p\u003e\u003cp\u003e4. The majority (three-quarters) of communications were nonclinical and could be addressed by nonclinical staff.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperiences Receiving and Delivering Virtual Health Care For Women: Qualitative Evidence Synthesis (Goldstein et al, 2025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Qualitative Evidence Synthesis (QES) of published studies.\u003c/p\u003e\u003cp\u003eSample: 76 studies were included in the synthesis. Studies focused on women's experiences with virtual care (receiving and delivering).\u003c/p\u003e\u003cp\u003eFocus/Variables: Synthesis of qualitative data on the experiences of women patients and female clinicians with virtual healthcare.\u003c/p\u003e\u003cp\u003eInstruments: Not applicable (Systematic review/Synthesis). Data were extracted from the included studies.\u003c/p\u003e\u003cp\u003eAnalysis: The synthesis used the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI QARI) for critical appraisal and meta-aggregation for synthesizing findings.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFindings: The synthesis resulted in 9 themes grouped into 4 categories:\u003c/p\u003e\u003cp\u003e1. Access to Care:\u003c/p\u003e\u003cp\u003ea. Overcoming logistical barriers to access.\u003c/p\u003e\u003cp\u003eb. Virtual care increasing health care continuity.\u003c/p\u003e\u003cp\u003e2. Clinician-Patient Relationship:\u003c/p\u003e\u003cp\u003ea. Creating a comfort zone for patients.\u003c/p\u003e\u003cp\u003eb. Challenges in communication and connection.\u003c/p\u003e\u003cp\u003e3. Virtual Care's Role in Health Equity:\u003c/p\u003e\u003cp\u003ea. Inconsistent experiences due to digital literacy, language, and technology access.\u003c/p\u003e\u003cp\u003eb. Concern about technology reducing the human element of care.\u003c/p\u003e\u003cp\u003e4. Impact on Clinician Work:\u003c/p\u003e\u003cp\u003ea. Improving work-life integration for clinicians.\u003c/p\u003e\u003cp\u003eb. Needing greater clinical support and training.\u003c/p\u003e\u003cp\u003ec. Impact on professional boundaries.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTechnology Integration: The Role of the Diabetes Care and Education Specialist in Practice (Haas et al, 2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Review and descriptive paper, not a primary research study with a sample/analysis. The article describes the current role and best practices for the Diabetes Care and Education Specialist (DCES) in integrating evolving diabetes technology.\u003c/p\u003e\u003cp\u003eSample: Not applicable (Descriptive/Review).\u003c/p\u003e\u003cp\u003eFocus/Variables (Objective): To describe the central role of the DCES in technology implementation (e.g., CGM, insulin pumps, telehealth) to improve clinical outcomes and population health.\u003c/p\u003e\u003cp\u003eInstruments: Not applicable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFindings: The article emphasizes that technology use is enhanced when the user is knowledgeable and actively engaged. The DCES's role is critical in:\u003c/p\u003e\u003cp\u003e1. Defining a Technology-Enabled Practice: Establishing efficient and sustainable technology use.\u003c/p\u003e\u003cp\u003e2. Integrating Technology: Matching the right technology to the right patient based on factors like patient goals, comfort, and payer coverage.\u003c/p\u003e\u003cp\u003e3. Addressing Challenges: Working to reduce therapeutic inertia, providing education, and supporting patients and clinicians to maximize technology benefits.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient Engagement With and Perspectives on a Mobile Health Home Spirometry Intervention: Mixed Methods Study (Chong, et al, 2024)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Mixed Methods Study (combining quantitative and qualitative) with a prospective observational cohort approach.\u003c/p\u003e\u003cp\u003eSample: 116 adult patients with chronic lung disease (ILD) who used an mHealth app and a home spirometer for 6 months.\u003c/p\u003e\u003cp\u003eVariables: - Independent: Use of the mobile spirometry app (mHealth intervention).\u003c/p\u003e\u003cp\u003e- Dependent: Patient engagement (engagement rate), user satisfaction, and change in spirometry results (FVC%).\u003c/p\u003e\u003cp\u003eInstruments: Mobile health app connected to a home spirometer for FVC measurement.\u003c/p\u003e\u003cp\u003e- Patient satisfaction questionnaire (5-point Likert scale).\u003c/p\u003e\u003cp\u003e- Semi-structured interviews for qualitative data.\u003c/p\u003e\u003cp\u003e- Analysis: Quantitative analysis: paired t-test and Pearson correlation to assess changes in FVC and the relationship between frequency of use and clinical outcomes.\u003c/p\u003e\u003cp\u003e- Qualitative analysis: thematic analysis of patient interviews.\u003c/p\u003e\u003cp\u003e- Significance level set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMain Results: - The average patient engagement rate was 82% over 6 months.\u003c/p\u003e\u003cp\u003e- There was no significant decrease in FVC% values ​​during the study period (p\u0026thinsp;=\u0026thinsp;0.37, not significant).\u003c/p\u003e\u003cp\u003e- Patients reported positive experiences with ease of use and increased awareness of their lung condition.\u003c/p\u003e\u003cp\u003e- Success factors: user-friendly interface and real-time feedback.\u003c/p\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.37 \u0026rarr; not significant.\u003c/p\u003e\u003cp\u003eThis means that the use of home spirometry via the app did not show statistically significant changes in lung function (FVC%) values, but still demonstrated clinical benefits in patient self-monitoring\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecommendations for Permanent Sleep Telehealth: An American Academy of Sleep Medicine Position Statement (Vohra et al, 2025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Position Statement/Policy Paper, not an experimental study. Based on evidence synthesis from previous studies and AASM (American Academy of Sleep Medicine) policies.\u003c/p\u003e\u003cp\u003eSample: No human samples (not primary research). Analysis based on literature review and practical experience implementing telehealth in sleep medicine.\u003c/p\u003e\u003cp\u003eVariables: Primary focus: permanent implementation of telehealth in sleep health services.\u003c/p\u003e\u003cp\u003e- No dependent/independent variables as this is not a quantitative study.\u003c/p\u003e\u003cp\u003eInstrument: No empirical data collection instrument used; review of relevant literature and policies (2015\u0026ndash;2024) used as the basis for recommendations.\u003c/p\u003e\u003cp\u003eAnalysis: No quantitative statistical analysis (no hypothesis testing). The article is narrative and recommendatory in nature, with no p-values ​​reported\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e- Telehealth has been shown to be non-inferior to in-person visits in cognitive-behavioral therapy for insomnia and to improve adherence to obstructive sleep apnea (OSA) therapy.\u003c/p\u003e\u003cp\u003e- Telehealth improves clinical efficiency, patient safety, and equitable access to services.\u003c/p\u003e\u003cp\u003e- Permanent policy support is needed in aspects of payment, technology access, and interstate licensing. No statistical tests or p-values ​​are used because this article is a policy position, not a quantitative study. Therefore, there are no statistically significant/non-significant results\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA Descriptive Study on Holistic Nursing Education (Prescott et al, 2024)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Descriptive Quantitative\u003c/p\u003e\u003cp\u003eSample: 210 nursing students from three Australian universities\u003c/p\u003e\u003cp\u003eVariables:\u003c/p\u003e\u003cp\u003eHolistic nursing education, spiritual care, caring values\u003c/p\u003e\u003cp\u003eInstruments\u003c/p\u003e\u003cp\u003e5-point Likert-type questionnaire\u003c/p\u003e\u003cp\u003eAnalysis:\u003c/p\u003e\u003cp\u003eDescriptive statistics and t-test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStudents demonstrated increased awareness of patients' spiritual, emotional, and social aspects after participating in holistic nursing-based learning. Technology integration is considered helpful, but should not replace human interaction.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAn application of Harrison's system theory model to spark a rapid telehealth expansion in the time of COVID-19 (Touson et al, 2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign: Case study describing the utilization of Harrison's open-systems model for rapid adoption of existing telehealth technologies in a large academic medical center (CUIMC) in response to the COVID-19 pandemic.\u003c/p\u003e\u003cp\u003eSample: Internal organizational developers, local networks (department administrators, practice managers) via virtual focus groups, and executive leadership (CMIO/ACMIO) via informal interviews.\u003c/p\u003e\u003cp\u003eFocus/Variables (Objective): To use Harrison's model to design and deploy an approach for rapid telemedicine expansion to improve patient care output. Key questions included whether change management methodologies could rapidly\u003c/p\u003e\u003cp\u003eexpand telehealth use.\u003c/p\u003e\u003cp\u003eInstruments: Virtual focus groups with structured questions, informal interviews with executives, and targeted interventions (e.g., rapid deployment of focused support, e-learning modules, patient outreach).\u003c/p\u003e\u003cp\u003eAnalysis: Measured success by tracking quantitative data, including the increase in patient portal activation codes and video visit volume.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFindings:\u003c/p\u003e\u003cp\u003e1. Patient portal activation codes increased by 75% during March.\u003c/p\u003e\u003cp\u003e2.. Video visit volume from provider self-scheduling increased from a baseline of 0 to over 600 clinical visits.\u003c/p\u003e\u003cp\u003e3. Experienced organizational development and focusing on tailoring training and support to the culture of the organization were critical to rapidly increasing the availability and success of telehealth visits.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eBased on the review table, the implementation of Holistic Nursing in the Digitalization Era is feasible and satisfying for both patients and clinicians, provided that: Relationships Are Prioritized: Digital service design must actively support and maintain the quality of the patient-provider relationship (Appleman et al, 2022). Systems Support Caring Practice: Organizations must provide culturally tailored training and robust technical support, enabling nurses to focus on the caring aspects rather than struggling with technology (Touson et al, 2020). Overall, these findings underscore a paradigm shift: caring in holistic nursing in the digital age is not about replacing physical touch, but rather about adapting and expanding the reach of care through technology. From the review table above, there are three main themes found, namely:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSuccessfully Maintaining Relationship Quality and Satisfaction (Preserving Human Touch)\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eThe findings from Appleman et al.'s (2022) study, Using Video Telehealth to Deliver Patient-Centered Collaborative Care: The G-IMPACT Pilot, directly support the premise that the human touch can be maintained through digital media:1) High Patient and Clinician Satisfaction: Patients reported very high levels of satisfaction (average 9/10), and clinicians also reported high satisfaction. These figures suggest that the video telehealth format did not compromise the overall service experience. One of the most striking from the G-IMPACT pilot is the exceptionally satisfaction levels among both patients and clinicians. Patients rated their experience an average of 9 out of 10, while clinicians also expressed strong approval of the telehealth format. This suggests that video-based care delivery does not diminish the quality of interaction or service, countering common concern about the impersonal nature of digital healthcare. 2) Good Patient-Provider Relationships: Qualitative results explicitly listed \"good patient-provider relationships\" as a key theme, demonstrating that collaborative care models delivered through video can facilitate effective communication and build trust, which are core values ​​of caring. The digital medium, when used thoughtfully, supports relational depth and continuity, which are essential for therapeutic alliance and long-term health outcomes. 3) Collaborative Care: The G-IMPACT model is patient-centered, collaborative care. Its implementation via video telehealth demonstrates that a holistic and multidisciplinary team approach can be delivered virtually, overcoming logistical barriers such as travel time.\u003c/p\u003e\u003cp\u003e\u003cb\u003e2. Improving Access and Efficiency of Holistic Care (Digitalization Era Benefits)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDigitalization is seen as a tool that enables nurses and other service providers to provide more holistic care by eliminating physical barriers: Overcoming Logistical Barriers: Research by Appleman et al. (2022) noted that telehealth reduced travel time and costs for older veteran patients with chronic illnesses and cognitive impairments. This is a holistic aspect because nurses now consider the patient's social and environmental factors in their care plans.\u003c/p\u003e\u003cp\u003eAdvanced Care Feasibility: The high levels of interprofessional collaboration reported by clinicians indicate that digitalization enables care teams to work together more efficiently and in a coordinated manner to provide comprehensive care.\u003c/p\u003e\u003cp\u003e(Erku et al., 2023) extend this argument by demonstrating that e-health and mHealth interventions increase access to and the quality of primary healthcare services. Their findings show that digital systems enhance communication between patients and providers while facilitating preventive and continuous care in underserved regions. Digitalization thus functions as a bridge between resource constraints and patient needs, allowing healthcare teams to address the physical, psychological, and social dimensions of well-being in a cohesive manner.\u003c/p\u003e\u003cp\u003e(Silva et al., 2024) further highlight that digitalization strengthens interprofessional collaboration and improves care coordination. Their model of digital health in primary healthcare reveals that integrated systems allow real-time information exchange between clinicians, nurses, psychologists, and social workers, which enhances teamwork and efficiency. This interconnectivity supports the delivery of holistic care by ensuring that diverse aspects of patient health are addressed simultaneously and cohesively.\u003c/p\u003e\u003cp\u003e(Mauro et al., 2024) focus on the managerial and operational advantages of digital transformation in healthcare. They report that digital tools streamline administrative workflows, reduce redundancy, and allow staff to dedicate more time to direct patient interaction. From a holistic care standpoint, these efficiency gains enable healthcare providers to balance technological use with human compassion\u0026mdash;improving care quality while maintaining the empathy that underpins nursing practice.\u003c/p\u003e\u003cp\u003e(Alotaibi et al., 2025) however, caution that successful implementation of digital health depends on digital readiness and literacy among both healthcare workers and patients. Their systematic review identifies barriers such as limited infrastructure, lack of training, and concerns about privacy and data security. Addressing these factors is essential to ensure that digitalization supports holistic care equitably rather than exacerbating disparities between populations with differing access to technology.\u003c/p\u003e\u003cp\u003eCollectively, these studies illustrate that digitalization represents more than a technological upgrade; it signifies a paradigm shift toward more accessible, efficient, and human-centered healthcare. By merging technological capability with compassion and interprofessional collaboration, digital transformation enables a truly holistic model of care\u0026mdash;one that integrates physical, psychological, social, and environmental dimensions into an inclusive and responsive system of health delivery.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3. The Importance of System Support for Digital Care (The Role of Organizational Support)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTouson et al. (2020) emphasize that the success and sustainability of digital health transformation largely depend on the strength of organizational system support that aligns technological innovation with human-centered care principles. Applying \u003cem\u003eHarrison\u0026rsquo;s Open Systems Theory\u003c/em\u003e, the study demonstrated that the rapid expansion of telehealth requires adaptive leadership, effective resource management, and continuous feedback mechanisms within healthcare organizations. Such systemic support enables nurses not only to develop technical competence but also to receive emotional backing necessary for providing compassionate care. The model highlights that technology adoption must be accompanied by organizational and cultural adaptation, ensuring that digitalization remains consistent with the caring values at the core of nursing practice.\u003c/p\u003e\u003cp\u003eMoreover, organizational culture and interprofessional collaboration have been identified as critical determinants of success in implementing holistic nursing practice in the digital era. Ambushe et al. (2023) found a significant relationship between empathy, collaborative work environments, and the application of holistic nursing care. Their findings reveal that institutional support systems, such as caring training, emotional well-being programs, and inter-nurse collaboration networks, play a vital role in sustaining caring behaviorsp articularly when nurses face the pressures of digital workloads.\u003c/p\u003e\u003cp\u003eConsistent with these results, Klim et al. (2023) reported that organizational support and workload management directly influence nurses\u0026rsquo; levels of social empathy. When institutions provide clear policies, adequate staffing, and appropriate digital literacy training, nurses are more capable of maintaining empathic engagement even within virtual interactions. Conversely, the absence of organizational backing can lead to emotional fatigue and a decline in caring values, thereby diminishing the holistic dimension of digital nursing care.\u003c/p\u003e\u003cp\u003eSystemic support also extends to the educational domain. Prescott et al. (2024) highlight the importance of integrating digital competencies into holistic nursing education. This integration involves embedding mindfulness, spirituality, and professionalism into technology-based curricula. Their study shows that when educational institutions cultivate a humanistic foundation within digital learning environments, nursing students are better prepared to face digital practice challenges without losing ethical sensitivity or empathy. Thus, educational support serves as a foundation for preparing future nurses capable of balancing technological proficiency with humanistic values.\u003c/p\u003e\u003cp\u003eFurthermore, Rouleau et al. (2024) argue that compassionate nursing care in digital contexts depends not only on individual skill but also on systemic infrastructure that facilitates the expression of empathy virtually. Their study reveals that organizational investments in communication training, user-friendly telehealth platforms, and digital empathy policies enable nurses to express emotional presence online through tone of voice, digital body language, and attentive responses. Hence, organizational systems function as emotional scaffolding, reinforcing nurses\u0026rsquo; capacity to humanize care interactions within technological constraints.\u003c/p\u003e\u003cp\u003eOverall, these findings collectively indicate that system and organizational support form the cornerstone of successful holistic nursing in the digital era. Without adequate structural, educational, and emotional backing, digital transformation risks widening the empathy gap between nurses and patients. Therefore, the design of digital health systems must integrate technological readiness, emotional intelligence, and a caring culture to ensure that digitalization enhances rather than replaces the human dimension of nursing practice.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eHolistic nursing in the digital era requires a deliberate balance between tecnologivcal efficiency and compassionate care. Preserving human touch and caring values is achievable through adaptive nursing education, ethical frameworks, and patient-centered digital practices. Future research should focus on developing evidence-based models that integrate technology without compromising the essence of nursing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAppleman, E.R., O\u0026rsquo;Connor, M.K., Rockefeller, W., Morin, P., Moo, L.R. 2022. Using Video telehealth to Deliver patient-cetered Collaborative care: The G-IMPACT Pilot. Cinical Gerontologist. https://doi.org/10.1080/07317115.2020.1738000\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlotaibi, N., Wilson, C. B., \u0026amp; Traynor, M. (2025). Enhancing digital readiness and capability in healthcare: a systematic review of interventions, barriers, and facilitators. \u003cem\u003eBMC Health Services Research\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e, Article 500. https://doi.org/10.1186\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmbushe, S.A., Awoke, N., Demissie, B.W., Tekalign, T., 2023. Holistic nursing care practice and associated factors among nurses in public hospitals of Wolaita zone, South Ethiopia. BMC Nurs 22. https://doi.org/10.1186/s12912-023-01517-0\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown, C. C., Humphreys, J., Whorley, L., \u0026amp; Bridge, B. (2019). Ready to Care? Student Nurse Perceptions of Spiritual Care Education. \u003cem\u003eNurse Education Today\u003c/em\u003e, \u003cem\u003e72\u003c/em\u003e, 64\u0026ndash;70.https://doi.org/10.1016\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEpstein, R. M., \u0026amp; Delgado, E. H. (2023). Moral Resilience Reduces Levels of Quiet Quitting, Job Burnout, and Turnover Intention among Nurses: Evidence in the Post COVID-19 Era. \u003cem\u003eJournal of Multidisciplinary Healthcare\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e, 3217\u0026ndash;3230.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eErku, D. A., Mamo, B., Al-Jahdali, K. H., Berhe, D. F., Hassen, A. K., Mesele, B. G., Tesfaye, K. T., Yimer, B., \u0026amp; Demssie, A. W. (2023). Community pharmacist engagement and preparedness to deliver pharmaceutical care services during the COVID-19 pandemic: A systematic review and meta-analysis. \u003cem\u003ePLoS ONE\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(3), e0282928. https://doi.org/10.1371\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChan, C. Y., Park, S., Yakubu, T.,jafari, N., Ho, K. (2025). Qualitative interview with older adults and caregivers on their perspectives with self-management and remote vital sign monitoring. \u003cem\u003eTelemedicine and e-Health\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChong, J. B., Smith, L., Lee, R., Sanyal, S., Yang, M., Moola, V., ... \u0026amp; Chen, X. (2024). Patient engagement with and perspectives on a mobile health home spirometry intervention: Mixed methods study. \u003cem\u003eJMIR Formative Research\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(1), e55123. https://doi.org/\u003cspan\u003e$\u003c/span\u003e10.2196\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCroker, A., O'Brien, S., N\u0026iacute; Chr\u0026oacute;in\u0026iacute;n, D., \u0026amp; O'Connell, R. (2020). Exploring the implementation of an integrated model of holistic care in a hospital setting: A qualitative study of nurses' experiences. \u003cem\u003eJournal of Clinical Nursing\u003c/em\u003e, \u003cem\u003e29\u003c/em\u003e(17\u0026ndash;18), 3426\u0026ndash;3436. https://doi.org/10.1111/jocn.15392\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFiastro, A.E., Shah, N., Gomperts, R., Gipson, J.D., Godfrey, E. M. (2025). Communication with patients using asynchronous telehealth medication abortion services. \u003cem\u003eContraception\u003c/em\u003e. Advance online publication. https://doi.org/10.1016\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGlenn, A., Smith, P.J., Wallington, S.F., 2025. A nurse-led approach to testing and adapting a telehealth guide for e-empathy in goals of care conversations for Black patients with chronic kidney disease. Patient Educ Couns 131. https://doi.org/10.1016/j.pec.2024.108593\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoldstein, R., Granger, C., Vella, K., Liddle, J., Farr, M., Brough, M., Wozniak, H., Manias, E. (2025). Experiences receiving and delivering virtual health care for women: Qualitative evidence synthesis. \u003cem\u003eJournal of Advanced Nursing\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrolnick, W.S., Kurowski, C.O., Gurland, S.T. 2021. The role of parental communication in children\u0026rsquo;s coping with stress: Implications for therapeutic interactions. Journal of Child Psychology and Psychiatry, 62,456\u0026ndash;470. https://doi.org/10.1111/jcpp.13345\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHall, L. H., Wynn, R., \u0026amp; Birt, L. (2022). An evaluation of a wellbeing intervention for nurses: A mixed methods study. \u003cem\u003eJournal of Advanced Nursing\u003c/em\u003e, \u003cem\u003e78\u003c/em\u003e(1), e16\u0026ndash;e27. https://doi.org/10.1111\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaas, L., Isaacs, D., Johnson, E., \u0026amp; Polonsky, W. (2020). Technology integration: The role of the diabetes care and education specialist in practice. \u003cem\u003eThe Diabetes Educator\u003c/em\u003e, \u003cem\u003e46\u003c/em\u003e(3), 263\u0026ndash;274.https://doi.org/10.1177\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHussien, R.M., Khalil, T., Nashwan, A.J., Al-Najjar, H., Khedr, M.A., 2025. Compassionate care in nursing: The role of simulation-based compassionate care on nurse\u0026rsquo;s caring behavior, self-efficacy and compassion competency. Nurse Educ Pract 87. https://doi.org/10.1016/j.nepr.2025.104470\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoelscher, M., Foth, M., Warth, J., \u0026amp; Knackstedt, R. (2020). Digital new ventures: Assessing the benefits of digitalization in entrepreneurship. \u003cem\u003eElectronic Markets\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(3), 519\u0026ndash;538. https://doi.org/10.1007/s12525.020.00404.0\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoms, M. A., Garcia, M. A., perez, L. J. 2021. Managing holistic nursing practice: The need for spiritual care competence in health care practice. Journal of Nursing Management, 298, 2401\u0026ndash;2404. https://doi.org/10.1111/jonm.13538\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKlim, G., Boyd, K.C., Roberts, L., Taylor, E.J., 2023. Social Empathy and Associated Factors among Nurses: An Observational Study. Holist Nurs Pract 37, 6\u0026ndash;14. https://doi.org/10.1097/HNP.0000000000000560\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee, S. L., Hijrah, H., Norma Lala, N. S., datu, N., Dewi Ruben, S., Wang, S.L. 2025. Optimizing the Role of Family Nurses in Improving Community health: A Holistic Approach- Literature Review. Jurnal Ilmu Sosial dan Kesehatan, 141, 73\u0026ndash;86. https://doi.org/10.35816/jiskh.v14i1.1249\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLloyd, C., Raftery, J., manias, E., Lezster, J., O\u0026rsquo;Brien, S., Forbes, H., Brown, S., Birt, L. (2023). The impact of advanced communication skills training on nurse-patient interactions and person-centred care delivery: A quasi-experimental study. \u003cem\u003eJournal of Clinical Nursing\u003c/em\u003e, \u003cem\u003e32\u003c/em\u003e(13\u0026ndash;14), 3824\u0026ndash;3837. https://doi.org. 10.1111/\\text{jocn.16388}\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLochrie, S., Mitchell, M., \u0026amp; Macleod, S. (2021). Spiritual care in adult intensive care: Nurses\u0026rsquo; views and experiences of education. \u003cem\u003eNursing Ethics\u003c/em\u003e, \u003cem\u003e28\u003c/em\u003e(4), 543\u0026ndash;556. https://doi.org.10.1177/0969733020967732\u003cspan\u003e$\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMauro, E., Callegari, A., D'Amico, G., Fanciulli, M., Nencioni, L., Cerra, M., Forte, P., \u0026amp; Pavanello, I. (2024). Novel anti-aging compounds modulate cell fate: Evidence from \u003cem\u003eC. elegans\u003c/em\u003e and human cell cultures. \u003cem\u003eMechanisms of Ageing and Development\u003c/em\u003e, \u003cem\u003e217\u003c/em\u003e, 111929. https://doi.org/\u003cspan\u003e$\u003c/span\u003e10.1016\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcErlean, G., Ashley, C., Pradhan, A., Yenson, V., Kerridge, I., \u0026amp; Halcomb, E. (2025). Prioritising patient-centredness and service equity for long-term survivors of BMT: A qualitative study of healthcare professionals. \u003cem\u003eSupportive Care in Cancer\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(7). Advance online publication.https://doi.org/10.1007\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcGavock, J., Roussin, O., van wallegham, J., Darragh, M., Friesen, L., Schutz, A., Schaefer, L., hebert, J. (2022). The Impact of a Brief Digital Mindfulness Intervention on Post-Secondary Student Mental Health and Academic Well-Being: A Pragmatic Randomized Controlled Trial. \u003cem\u003eJournal of American College Health\u003c/em\u003e, \u003cem\u003e70\u003c/em\u003e(7), 2125\u0026ndash;2133. https://doi.org/10.1080/07448481.2021.1872132\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMolala, W., \u0026amp; Downing, C. (2025). A Tentative Model to Facilitate Intensive Care Professional Nurses' Holistic Care in Private Hospitals in Gauteng, South Africa. \u003cem\u003eJournal of Holistic Nursing\u003c/em\u003e. Advance online publication. https://doi.org/\u003cspan\u003e$\u003c/span\u003e10.1177/\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNguyen, T.T.M., Vo, X.H., Truong, N.M. 2022. The Impact of services Quality on In-Patients\u0026rsquo; Satisfaction, Perceived Value, and Customer Loyalty: A Mixed-Methods Study from a Developing Country. Journal of Patient preference and Adherence Vol. 15 hlm.2489\u0026ndash;2506. https://doi.org/10.2147/PPA.S333586\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrescott, S., Watson, A., Young, C.D., Peterson, C., Thomas, D., Anderson, M., Watson, S.B., 2024. A descriptive study on holistic nursing education: Student perspectives on integrating mindfulness, spirituality, and professionalism. Nurse Educ Today 143. https://doi.org/10.1016/j.nedt.2024.106379\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRohatinsky, N., Boyd, I., Dickson, A., Fowler, S., Pena-Sanchez, J.N., Quintin, C.L., Risling, T., Russell, B., Wicks, K., Wicks, M. 2021. Perspectives of health care use and access to care for individuals living with inflammatory bowel disease in rural Canada, Rural and remote Health, 210, 6358. https://doi.org/10.22605/RRH6358\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRouleau, G., Wu, K., Parry, M., Richard, L., Desveaux, L., 2024. Providing compassionate care in a virtual context: Qualitative exploration of Canadian primary care nurses\u0026rsquo; experiences. Digit Health 10. https://doi.org/10.1177/20552076231224072\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchoeppe, S., Alley, S., Van Lippevelde, W., Williams, S. L., Kakinami, L., Duncan, M. J., \u0026amp; Vandelanotte, C. (2019). Effectiveness of holistic mobile health interventions on diet, physical, and mental health outcomes: a systematic review and meta-analysis. \u003cem\u003eJournal of Medical Internet Research\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(6), e13290. https://doi.org.10.2196\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSilva, J. M., Santos, M. C., \u0026amp; Dantas, R. A. N. (2024). Effectiveness of a mobile application on self-management in patients with heart failure: A randomized clinical trial. \u003cem\u003eInternational Journal of Nursing Studies\u003c/em\u003e, \u003cem\u003e150\u003c/em\u003e, 104618. https://doi.org/\u003cspan\u003e$\u003c/span\u003e10.1016\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStice, E., Desjardins, C. D., \u0026amp; Rohde, P. (2017). Risk factors that predict future onset of each DSM-5 eating disorder: Predictive specificity in high-risk adolescent females. \u003cem\u003eJournal of Abnormal Psychology\u003c/em\u003e, \u003cem\u003e126\u003c/em\u003e(1), 38\u0026ndash;51. https://doi.org.10.1037\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTouson, J. C., Azad, N., Depue, C., Crimmins, T., \u0026amp; Long, R. (2020). An application of Harrison\u0026rsquo;s system theory model to spark a rapid telehealth expansion in the time of COVID-19. \u003cem\u003eLearning Health Systems\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(1), e10239. https://doi.org/\u003cspan\u003e$\u003c/span\u003e10.1002\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVohra, K.P., Johnson, K. G., Dalal, A., Ibrahim, S., Krishnan, V., Abbasi-Feinberg, F., Abreu, A.R., Bandyopadhyay, A., Gurubhagavatula,I., Kuhlmann,D., Martin,J.L., Olson, E.J., Patil, S.P., Shelgikar, A. V., Trotti, L. M., Wickwire, E. M., Rowley, J. A., Kapur, V. K. 2025. Recommendations for permanent sleep telehealth: An American Academy of sleep Medicine position statement. Journal of Clinical Sleep Medicine, 214, 555\u0026ndash;562. https://doi.org/10.5664/jcsm. 11438\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWafa, H. M., Alotaibi, S. H., Albqawi, H. M., Butcon, V. E., Albagawi, B. S., Dayrit, R. D., \u0026amp; Pangket, P. (2021). Holistic nursing care among operating room nurses: Strengthening the standard of practice in Saudi Arabia. \u003cem\u003eOpen Access Macedonian Journal of Medical Sciences\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(D), 136\u0026ndash;143. https://doi.org.10.3889\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWaters, L., Loton, E., \u0026amp; Jach, H. (2021). Systemic Change in Mental Health: A Whole-School Approach to Post-Adversarial Growth. \u003cem\u003eFrontiers in Psychology\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e, Article 707641.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYıldız, G.N., \u0026Ccedil;ift\u0026ccedil;i, B., 2025. Narrative nursing as a holistic approach in modern healthcare: Integrating emotional and physical care. World J Psychiatry 15. https://doi.org/10.5498/wjp.v15.i3.102956\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Holistic Nursing, Human Touch, Digital Health","lastPublishedDoi":"10.21203/rs.3.rs-8106874/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8106874/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBack ground: The rapid digital transformation of healthcare-marked by the integration of electronic health records (HER), telehealth, artificial intelligence (AI), and robotics system has significantly reshaped nursing practice. While these technologies enhance efficiency and accessibility, they pose challenges to maintaining the core values of holistic nursing human touch, emphaty and personalized care. Advances in digital technology have brought significant changes to nursing practice, both in terms of effectiveness and access to care. However, these changes raise concerns about the diminishing of the human touch and caring values, which are at the heart of holistic nursing. This systematic review aimed to explore how holistic nursing values are preserved in the digital era, focusing on strategies to maintain human connection and caring practices amidst technological advancement. This systematic review was conducted according to the PRISMA guidelines. The search was conducted in Scopus, Web of Science (WoS),ProQuest, and EBSCO databases from 2020 to 2025. The included articles were in English, full-text, and not review articles. Of the total 96 records screened, the last eighteen studies were included in the systematic review. The results showed that that while digital tools streamline clinical workflows, they often risk depersonalizing care. However, several studies emphasize the importance of digital humanization strategies such as empathetic communication in telehealth, personalized nursing protocols, and training programs that reinforce caring behaviors. The integration of digital literacy with emotional intelligence is critical to sustaining holistic care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Holistic nursing in the digital era requires a deliberate balance between tecnological efficiency and compassionate care. Preserving human touch and caring values is achievable through adaptive nursing education, ethical frameworks, and patient-centered digital practices. Future research should focus on developing evidence-based models that integrate technology without compromising the essence of nursing.\u003c/p\u003e","manuscriptTitle":"Holistic Nursing in the Digitalization Era: Preserving Human Touch and The Value of caring in health Services: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-14 16:10:28","doi":"10.21203/rs.3.rs-8106874/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"18fd7091-1f9e-483e-ac62-c34d9cf22bfa","owner":[],"postedDate":"November 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":57945113,"name":"Nursing"}],"tags":[],"updatedAt":"2025-11-14T16:10:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-14 16:10:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8106874","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8106874","identity":"rs-8106874","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}