Abstract

BACKGROUND/AIMS

This bibliometric analysis aims to highlight important trends, research questions and contributions to better understand the academic literature on spiritual healing. Recognized as an important part of holistic nursing care, spiritual healing includes methods of treating spiritual dimensions of health and well-being and is now generally recognized.

MATERIALS AND METHODS

A systematic literature search was conducted to identify articles focussing on spiritual healing in the field of nursing. This search covered publications up to April 2024, and the Web of Science Core Collection database was used. A dataset of 878 articles was obtained as a result of the keyword search. Bibliometric analyses were performed with VosViewer software. Parameters such as number of publications, most productive countries/institutions, most cited articles, and top themes were analysed.

RESULTS

This study revealed that spiritual topics have increased significantly in the nursing literature since 2016. The geographical distribution analysis showed that the United States of America (USA) led the way in this field, with countries such as Iran, the United Kingdom and Brazil also making significant contributions. Loma Linda University and the University of São Paulo stood out among the institutions with the most publications. Keyword analysis highlighted the importance of topics such as “spirituality”, “nursing”, “patients”, and “palliative care”. Findings revealed a growing acceptance of spiritual healing in nursing practice, global collaboration, and research diversity.

CONCLUSION

The study highlights a global increase in nursing research on spiritual healing since 2016, with the USA leading the way.

INTRODUCTION

Human beings are rich in biological, psychological, social and spiritual aspects. While each dimension is important for the well-being and health of the person, it is emphasized that the spiritual dimension, distinct from the physical, emotional, and social domains, plays a significant role. Spirituality is thought to have healing or therapeutic effects in cases of illness.^{1, 2} While there is currently no precise definition of spirituality, it is generally characterized as the process of understanding the meaning of life, setting goals and finding inner peace. Spirituality is also referred to as an integrative force that affects body, and soul.^{3, 4} Spirituality constitutes a fundamental dimension of human existence and involves the process of relating oneself to an infinite being. This process manifests it self as a satisfying experience in the depths of life, a search for meaning and an effort to discover the purpose of life.⁴ In times of crisis or illness, the spiritual needs of individuals become more apparent. During these periods, people seek inner balance, support, and tend to turn to spiritual resources.⁵ In challenging times, such as crises or illness, individuals often turn to spiritual resources to cope.^{6, 7} Prayer and religious practices are among the most common ways to achieve spiritual healing and peace.⁵ Spiritual healing is considered to be the oldest and most universally accepted method of complementary and alternative medicine, and is practiced in every culture worldwide.⁸ Although exactly how spiritual healing works has not yet been fully explained, it is an approach in which healing energy is used to benefit the individual’s mind, body, and spirit.⁹ People can benefit from spiritual healing and other complementary and alternative medicine practices to get rid of diseases or maintain health.^{5, 10} Research in recent years, shows that studies on spiritual healing and/or healing through prayer have increased and positive results have been obtained in this field. These studies examine the effects of people’s spiritual beliefs and prayers on physical and mental health and emphasize the healing potential of such practices.^{5, 10-12} Currently, nursing care also supports the philosophy of holistic care. Spiritual care is an integral part of this approach, which includes mental, physical, and spiritual dimensions. This approach encompasses the treatment process by considering not only the physical needs of patients but also their emotional and spiritual needs.¹³ Nurses need to be prepared and competent to protect, maintain, and improve the integrity of all dimensions of the individual’s being. In this context, it is important that they are trained and equipped to meet the physical, emotional, mental, and spiritual needs of individuals. In particular, being aware of the spiritual needs of individuals and having knowledge about the nature of spirituality enables nurses to provide more effective spiritual care and provide holistic care. Therefore, the spiritual dimension has critical importance in nursing care, and adopting a conscious approach in this area contributes to the full recovery process of patients.^{1, 14} Spiritual healing, as a critical part of holistic nursing care, is now generally recognized as encompassing methods to treat spiritual health and well-being.¹³

Nursing care and approach within the health system are becoming increasingly important. As with many subjects related to nursing care, it is guiding in terms of the efficiency of scientific studies to reveal existing publications on spiritual health and nursing care from various perspectives is beneficial for understanding the efficiency of scientific studies. This will only be possible by strengthening and enriching the literature. This research aims to evaluate the research productivity on spiritual health and nursing care approaches and to measure the impact of scientific quality. It intends to reveal previously published scientific studies, learn the number and quality of these studies that have the quality of evidence, and determine which types of studies are needed on this subject. Furthermore, it seeks to understand the status of scientific approaches to spiritual nursing care within the framework of different cultures and belief systems, identify trends in the field of research, monitor information dissemination and interaction, understand the collaboration networks of studies, and research needs, scientific insufficiencies and information deficiencies in the literature in the literature.^8-10,14

This bibliometric analysis explores trends, research questions, and contributions to spiritual healing in nursing. This study aimed to provide information about the current status and characteristics of the literature on spirituality in the field of nursing.

MATERIALS AND METHODS

Literature Search

Until April 1, 2024, a search of the Web of Science Core Collection search engine using the keywords MESH found 22,003 publications with titles such as “spiritual” OR “therapies, spiritual” OR “exorcism” OR “exorcisms” OR “spiritual healing” OR “healing, spiritual” OR “spiritual cures”. Of these, 12,556 were identified as articles. Then, 878 articles focusing on the field of nursing were extracted to form the sample of the study. These 878 articles were identified as the data set for all analyses.

The aim of the search technique was to find important material related to spiritual issues in various fields such as exorcism, therapy, and healing methods. Publications in the field of nursing were examined to investigate the link between spirituality and health care, especially in terms of nursing practice. This group of articles provides the basis for further research and analysis on topics such as the role of spirituality in nursing care, its impact on patient outcomes, and its integration into healthcare delivery systems.

Ethical consideration: Ethical approval is not required as this study does not involve human or animal subjects. This publication was made using a free database. It also did not require informed consent as it was a literature review without human and animal samples.

Statistical Analysis

VOSviewer, developed by Van Eck and Waltman¹⁶, is a scientific mapping software that is widely discussed in publications regarding its functioning, data, and bibliometric methods. A VOSviewer manual is available to help users better understand the software. VOSviewer includes bibliometric terms that may not be familiar to some users. Co-authorship refers to collaborative publications among researchers, research centers, or countries. Density visualization maps show the size and impact of an area and are of two types: item and cluster. Item density maps show the density of items at a given point, while cluster density maps examine the density of a cluster.^{15, 16}

The network visualization map shows clusters using a specific color, and each keyword is represented by a node in a color corresponding to its cluster. VOSviewer uses a statistical technique called probabilistic latent semantic analysis to identify important keywords. After this analysis, the relationships are examined in more detail through cluster analysis. Keywords are clustered due to their close relationship with each other, and keywords that appear in similar research are positioned closer to each other. VOSviewer also strives to prevent nodes from overlapping each other and highlights connections when a node is selected, which reduces the visibility of other nodes to show the network more clearly. Frequent use of a node increases the size of the node and the number of connections to other nodes.^{16, 17}

Bibliometrics is a comprehensive quantitative analysis tool used to evaluate research based on research objectives. In this study, a systematic literature search was conducted to identify articles focusing on spiritual healing in the field of nursing. VOSviewer, developed by Van Eck and Waltman¹⁶, is a widely published scientific mapping software on its functioning, data and bibliometric methods. The VOSviewer 1.6.20 software was used to analyze and visualize the data. This approach aims to identify the current status of the field, research trends, and the most influential publications and researchers.^18-20

RESULTS

Publication Trends

The analysis of spiritual-themed articles in the nursing research field revealed a wide diversity spanning various historical periods. There had been a significant increase in nursing research on spiritual topics, with the highest percentages found to be 7.403%, 7.062%, and 7.403% in 2023, 2022, and 2021, respectively. The number of publications started to increase in 2016 and peaked in 2023. With the exception of a few publications dating back to 1978, there were far fewer publications before 1978. From 1978 to 2005, the number of spiritual themes in nursing research gradually increased, but the number of publications remained at low levels. From 2006 to 2015, there was a low-level increase, indicating that spiritual aspects in nursing care were receiving increasing attention. However, from 2016 onwards, there was a marked increase in the number of publications, with an upward trend in each year after 2016 (Figure 1).

According to the Web of Science database, articles on spirituality in the field of nursing research showed various distributions in different indexes. The majority of articles in this field were published in journals indexed in the Social Sciences Citation Index (68.679%) and journals indexed by the Science Citation Index Expanded (62.756%).

Citing Analysis

The study of spirituality in nursing research, found that religion was the most common citation topic, accounting for 75.171% of the total. Palliative care was the most significant topic, with 61 articles (6.948% of the total sample) indicating the connection between spiritual healing and end-of-life care. Nursing itself was a significant citation topic, with 25 articles (2.847%) highlighting its role in spiritual care. Other meso-level themes included psychiatry (1.822%), management (1.367%), obstetrics and gynecology (1.025%), and social psychology (0.911%). Niche areas like human immunodeficiency virus, substance abuse, cancer care, and complementary medicine were also included. This highlights the multifaceted nature of spiritual healing in nursing and its relevance across various healthcare contexts (Table 1).

The study analyzed citation topics at the micro-level, revealing spirituality as the most prominent, accounting for 74.829% of the total. Other notable topics included palliative care, cancer survivors, and nursing. Mindfulness, job satisfaction, dementia caregivers, and breech presentation were also significant. Niche areas like peritoneal dialysis, post-traumatic stress disorder, autobiographical memory, and shared decision-making were also present. These findings highlight the multifaceted nature of spiritual healing research within nursing, encompassing various healthcare and human experiences (Table 2).

Top Cited Articles

Between 1970 and 2024, these works received a total of 15063 citations. The average number of citations for each item was 17.16, which shows how influential and relevant it was in its respective field. The current h-index is 56. There were 60 publications and 2582 citations in 2023. There were 65 publications and 2591 citations in 2021. As shown in Figure 1, most citations occurred in these particular years in Figure 1. Table 3 lists the top cited articles in spiritual healing-related literature in the nursing field. The top cited articles include “an online survey of nurses’ perceptions of spirituality and spiritual care” by McSherry and Jamieson²¹ from the Journal of Clinical Nursing, “spiritual care in nursing: an overview of the research to date” by Linda Ross²², “the crescent and Islam: healing, nursing and the spiritual dimension” by Rassool²³, “spiritual care in nursing: a concept analysis” by Ramezani et al.²⁴ from the International Nursing Review, and “The construct validity of a rating scale designed to assess spirituality and spiritual care” by McSherry et al.²⁵ from the International Journal of Nursing Studies.

Geographical Distribution, Co-Authorship Analysis Among Countries

A total of 60 countries had contributed to the literature on spiritual healing in nursing.

The top 10 countries in terms of document contributions were the United States of America (USA) (331 documents, 37.70%), Iran (70 documents, 7.98%), England (68 documents, 7.74%), Brazil (61 documents, 6.95%), Canada (47 documents, 5.35%), Taiwan (46 documents, 5.24%), Türkiye (37 documents, 4.21%), Australia (36 documents, 4.10%), Norway (33 documents, 3.76%), and South Korea (33 documents, 3.76%).

The VOSviewer program reveals that the USA leads in co-authorship among countries, with 331 documents and 5376 citations. Iran, England, and Brazil also show significant activity in co-authorship efforts. Türkiye and South Korea, though with fewer documents and citations, still participate in collaborative efforts. Iran has 70 documents and 927 citations, followed by England with 68 documents and 2315 citations. Brazil has 61 documents and 804 citations, and Canada rounds out the top five with 47 documents and 841 citations, demonstrating its significant role in fostering global research partnerships. According to the analysis using the VOSviewer program, the co-authorship analysis between countries is visualized in Figure 2. The visualization uses frame sizes to represent variation in publication counts among countries, and larger frames indicate greater disparity in publication counts. Color coding represents collaborative authorship, with nodes of the same color indicating partnerships. The edges, representing total link strength, illustrate the intensity of collaboration between countries. Stronger connections are represented by thicker, more prominent edges. This visualization technique provides a scientific approach to understanding publication counts, collaborative authorship relationships, and partnerships among nations.

Top Published Organisations

A total of 1098 organizations contributed to the literature on spiritual healing in nursing, and at least 59 of them had 5 or more articles. The detailed publication and citation counts of the top 10 institutions contributing to the literature on spiritual healing were as follows: Loma Linda University with 34 publications and 720 citations, followed by the University of São Paulo with 21 publications and 505 citations. The University of Malta ranked third with 14 publications and 575 citations, while Staffordshire University ranked fourth with 13 publications and 543 citations. The Catholic University of Portugal had 13 publications and 155 citations, while Azusa Pacific University was in fifth place with 12 publications and 206 citations. Sahmyook University, Shaqra University, Case Western Reserve University, and Chang Gung University of Science and Technology ranked 12^th with 12, 12, 11, and 11 publications respectively. The visual in Figure 3 visualizes the density visualization analysis of the top published organizations related to spiritual healing in nursing.

Top Journals

A total of 146 journals published articles on spiritually themed nursing research. In the list of journals where the most publications, “Journal of Holistic Nursing” is the most productive journal writing 61 articles and citing them 1061 times. “Journal of Christian Nursing” followed, with 57 publications and 247 citations. Other significant inputs were “Journal of Clinical Nursing” publishing 50 articles and citing them 2179 times, and “Journal of Advanced Nursing”, with 47 documents and 1895 citations. The other journals include “Journal of Hospice and Palliative Nursing” were published 29 articles and used 163, “Nurse Education Today” they published 27 articles and cited them 963, and “International Journal of Palliative Nursing” they published 26 documents and quoted 306 one time. The names, the number of publications, and the number of citations of journals publishing the most articles are previously summarized in Table 4.

Top Themes

First of all, the analysis using VOSviewer helped to identify many keywords that are most often repeated and play an important role in the analysis results. These words include spirituality 405 times, spiritual care (226 times), nursing (140 times), nurses (66 times), religion (63 times), palliative care (61 times), spiritual well-being (61 times), cancer (44 times), quality of life (33 times), nurse (32 times), nursing education (31 times), holistic care (30 times), depression (27 times), and qualitative research (27 times), spiritual needs (25 times), nursing students (23 times), nursing care (21 times), anxiety (20 times), and education (18 times). These words are often encountered in studies on spiritual and nursing topics, and therefore have an important role in the literature. In-depth analysis using the “topic modelling” text analysis method identified the main topics associated with the keywords. The analysis results reveal that the keywords, spirituality and spiritual care, define spiritual topics and issues in the care sphere, such as spiritual well-being and palliative care. Those such as nursing education are associated with topics on nursing education and care, such as nursing students, nursing care, and quality of life. Keywords like cancer and oncology are associated with topics related to cancer, while depression and anxiety are associated with psychological health. Thus, this analysis clarifies certain points in studies on spiritual and nursing topics (Figure 4).

DISCUSSION

Despite the growing importance of spirituality in the field of health, bibliometric analyses on this topic are rare.^{26, 27} This is because spirituality is a complex and multifaceted concept that cuts across different disciplines. The lack of standardized terms and the personal nature of the topic also contribute to the paucity of such analyses. However, with spirituality becoming increasingly recognized in health, more bibliometric studies are needed to better understand research in this area. As these intersections can be researched by scholars, we should expect an increasing amount of bibliometric research. The current bibliometric study has allowed the scrutiny of all spiritually themed works on the topic of nursing. Considering the above, search results from the Web of Science Core Collection database were filtered using the selected keywords to find published articles on the Web of Science platform. As a result, 878 articles relevant to nursing were obtained, although the inclusion of arbitrary selection criteria and varying proportions is noted. Publications on the topic of spirituality, relevant from the point of view of nursing, indicate an annual increase in articles. The number of publications appears to have increased significantly from year to year until 2016. The tendency to increase the number of literature on the topic of spiritual studies in nursing testifies to the increased importance and use of spirituality in nursing practice. Thus, spirituality as a need corresponding to a person’s organism is increasingly performing a significant role, which demonstrates the importance of considering spirituality not only to account for the sensory feature of residents but also related medical and practical aspects of the treatment conflict.

We were mainly interested in spirituality research in the context of nursing. Demir²⁶ also conducted a bibliometric analysis of documents about spirituality, religion, and health in general. However, since our works explored different subfields, the insights they provide appear unique. Demir²⁶ presented a more general picture, whereas our research centered on a more specific area. Demir’s²⁶ research presents a bibliometric analysis of published documents on spirituality, religion and health. The research covered articles published between 1975 and 2017. A total of 1674 publications were found, of which 818 were articles. Between 1999 and 2013, a study showed that research in the field of spirituality and religion increased significantly.²⁷ This bibliometric analysis by Lucchetti and Lucchetti²⁷ revealed a marked increase in studies published in English, led by the USA and the United Kingdom (UK). Emerging countries such as India, Brazil, Israel and Iran have also made notable contributions to the field.

In Demir²⁶ study, the USA was identified as the most productive country, followed by the UK and Canada. Similarly, in our own study, the USA was found to be the largest contributor. However, in addition to these results, we also found that developing countries made significant contributions. For example, we found that countries such as Iran, Brazil, India, Saudi Arabia, and South Africa also contributed significantly to the literature. This suggests that participation in mental wellbeing research in nursing is widespread globally and is not limited to developed countries.

Citation analysis further illuminates key themes in the literature, highlighting the centrality of religion and its connection to palliative care. This highlights the profound impact of spiritual healing on end-of-life care, underscoring the importance of providing solace and support, especially to individuals struggling with terminal illnesses. Additionally, the analysis reveals the multifaceted nature of spiritual healing research in nursing by identifying micro-level issues such as mindfulness and job satisfaction. This detailed research encompasses multiple dimensions of human experience and well-being, reflecting the complexity of spiritual care.

Additionally, analysis of geographic distribution and collaboration across countries reveals a global collaborative effort to advance research on spiritual recovery in nursing. The leadership of countries such as the USA, Iran, the UK, and Brazil encourages cross-cultural dialogue and knowledge exchange, emphasizing the diverse and inclusive nature of this research environment. This global collaboration signals a shared commitment to exploring the intersection between spirituality and healthcare and transcends geographic boundaries to address universal human needs. Demir²⁶ reported that the country with the most publications was the USA (60.5%) and the most prolific journal was Journal of Religion and Health. The leadership of these countries may be based on different factors. The USA leadership role can be attributed to its extensive research infrastructure and access to funding sources, as well as its comprehensive universities and health systems. Iran’s leadership position, along with its cultural and religious context, can be attributed to increased investments in health research and international cooperation efforts. The UK’s leadership can be based on having a long history in healthcare and academia, and strong links to international research networks. Brazil’s leadership position can be attributed to its large population and innovative approaches to healthcare. Canada’s leadership role may be based on factors such as government support for health research and strong university-hospital collaborations. The leadership of these countries may reflect their emphasis on health research and particularly the field of spiritual healing, and their commitment to advancement in this field.

In total, 1098 organizations contributed to nursing literature in the field of spiritual recovery. Of these, there are 59 organizations have published at least five articles. These institutions are Loma Linda University (USA), University of São Paulo (Brazil), University of Malta (Malta), Staffordshire University (UK), Portuguese Catholic University (Portugal), Azusa Pacific University (USA), and Sahmyook University (South Korea). The institutions include Shaqra University (Saudi Arabia), Case Western Reserve University (USA), and Chang Gung University of Science and Technology (Taiwan). Loma Linda University ranks first with 34 publications and 720 citations, followed by the University of São Paulo, the University of Malta, the University of Staffordshire, and the Portuguese Catholic University. Reasons for these results may include factors such as the existence of universities’ research centers or institutes focusing on spiritual healing, access to health systems in certain geographical regions, areas of expertise of researchers and academics, financial resources, research infrastructure, and international cooperation opportunities. In Demir²⁶ study, Duke University was identified as the top contributing institution, followed by the University of Michigan.²⁶ In our study, Loma Linda University stood out as the most productive institution, followed by the University of São Paulo. This shows that different universities are prominent in psychological recovery research in the field of nursing.

Most of the keywords mentioned in Demir’s²⁶ study were similar to those in our study. Both studies emphasize that spiritual and religious issues are important for a healthy life. Nevertheless, such words as happiness, religious coping, adolescence, and health-related quality of life were not included in our study. However, the observed difference may be due to the variation in subtopics and the repetition of concepts in the studies. As for our study, the following keywords were mostly repeated: spirituality, spiritual care, nursing, religion, palliative care, and quality of life. These keywords indicate the main focus of the research and the role of spiritual care performed by the nurse in the context. Religion characterizes its general role and influences in health care. Palliative care describes the importance of the spiritual layer of care in the last stages of the disease, quality of life, and patients, and highlights the differences in health care in this aspect. However, words such as nurses, mental health, well-being, and happiness are central to the study’s concept because the nurses’ mental health, general health status, life satisfaction, and happiness are the analyzed measures. These keywords further describe the scope of the study and the wide range of mental care within the healthcare field.

Study Limitations

Limitations of this study include dependence on the Web of Science Core Collection search engine, which may exclude relevant publications that are not indexed in this database. Additionally, focusing solely on publications in English may have excluded valuable contributions in other languages, which may limit the comprehensiveness of the analysis. Additionally, it focused only on the field of nursing, and only articles were chosen as the document type. Additionally, although the use of bibliometric techniques may provide quantitative insights, they may not capture the nuanced qualitative aspects of spiritual healing research in nursing. Moreover, interpretation of results depends on the accuracy of keyword selection and clustering algorithms, which may neglect bias or emerging themes. Finally, the scope of the study was limited to articles specifically addressing spiritual healing in nursing, which may exclude related topics or interdisciplinary perspectives but still offer valuable insights into holistic care practices.

CONCLUSION

To conclude, the bibliometric analysis discussed in this paper presents several trends and contributions of spiritually themed articles in “nursing.” Particularly, the trends show that spiritually-related issues began to be published starting in 2016. This may suggest that more holistic care provision, that is, including spiritual domains and satisfying patients’ needs, became even more available. In terms of the research compass, the findings of this research address global collaboration in spirit medicine, including the most fruitful years (e.g., 2023), leading journals (e.g., Journal of Holistic Nursing), the leading institutions (e.g., Loma Linda University), and the leading country (e.g., USA).

It is important to better understand the issue of spiritual health and nursing care, as well as to reflect the obtained data on patient care. In this context, it is recommended to identify relevant literature, diversify data sources, utilize advanced statistical methods, and take into account international perspectives due to the cultural diversity of the spiritual approach. Additionally, ensure the use of continuously updated data and examine previous studies in depth, since thematic mapping is an indispensable part of the spiritual approach.