INTRODUCTION

Nurses are prepared to provide care to help individuals in protecting, maintaining, and achieving the integrity of their existence in all dimensions.1

The concept of holism has a long history. The word was first coined in 1926 by Jan Christian Smuts, a North African philosopher, in his book Holism and Evolution.2 The holism term derives from the ancient Greek word “holos,” which means complete and all, and comes from the same root as the English word “whole.”3 The American Holistic Nurses Association defines good health as the level of harmony between the mind, body, and soul and emphasizes the holistic view that nurses should consider people not just physically but as a whole.4

To improve patient outcomes and satisfaction, holistic nursing considers the “unity, healthiness, and interconnectedness of human beings and their environment.”4 In an effort to give the individual dignity and respect, holistic nursing also advocates participatory person-centered care.5 Holistic nursing care is a special nursing practice that argues that the body, mind, spirit, emotions, environment, relationships, and social and cultural aspects of life are interconnected and should be considered a whole. The holistic nurse focuses on the use of nursing knowledge, theory, expertise, and intuition to provide care to the person during the healing process of the patient.6

Holistic nursing care is based on various theories.6 The holistic approach was also used in ancient civilizations. Treatment and healing with a holistic approach go back to Hippocrates, the founder of medicine, who stated for the first time that the mind and body affect each other. A comprehensive and holistic approach has been shown in the healing of patients, with both the treatment administered by physicians and the practices, such as magic made by the clergy used together, supported by faith for the healing of the disease.7 Founder of modern nursing and the first holistic nurse, Florence Nightingale talked about holistic aspects many years ago.8 Nurses have traditionally provided care with a holistic approach, but the term “holistic care” was introduced into the nursing literature in the 1980s by nurse theorists, such as Rogers, Parse, and Newman.6

This study aims to provide a bibliometric overview of research on holistic nursing and understand the state of holistic nursing. This study will help researchers understand trends and the state in holistic nursing research between January 1, 1970 and March 18, 2023.

MATERIALS AND METHODS Study design

This study, which used science mapping and bibliometric methodology, was an observational, descriptive, and retrospective study.

Data collection

A detailed search was carried out in the Web of Science (WOS) Core Collection (Thomson Reuters, Philadelphia, PA, the USA) online database on March 18, 2023. This is a global database of high-impact, high-quality scientific journals.9

The terms and retrieval techniques used were as follows: The selected keywords (holistic nursing* OR holistic nurse* OR holistic care nursing*) were used. The “Topic” section of the WOS search engine (publication's abstract, titles, keywords, and keyword plus) included the word holistic and related topics in the field of the nursing research area (holistic philosophy: theory and ethics; holistic nursing theories; holistic care process; holistic communication; creating a therapeutic environment; cultural diversity; holistic education and research; and holistic nurse self-care).

The following inclusion and exclusion criteria were applied:

There were no limitations on language or accessibility. The publications other than in nursing area were excluded. Only articles and reviews were chosen according to the document type. Abstracts, congress meeting abstracts, erratum, etc, were excluded from the search.

According to the inclusion and exclusion criteria mentioned above, 3887 publications (articles and reviews) were included in the study.

The data obtained from the WOS database were downloaded to the computer in plain text format and Excel file format. And both qualitative and qualitative analyses were made.

Bibliometric methodology

The study's aim was to analyze all publications on holistic nursing. Many bibliometric parameters were evaluated, such as the distribution of the number of publications over the years since 1970, the authors with the most publications, the countries with the most publications, the institutions/organizations/universities to which the authors are affiliated, the distribution of the publications' citations over the years, the most frequently published journals, the most preferred keywords by the authors, and the Hirsch (H) indexes. As a gauge of the effectiveness of individual researchers, the H index has been proposed. The scientific community has started to use it considerably worldwide. The H index is not significantly affected by those with many low-impact publications or just a few high-impact articles.10,11 The descriptive analysis of the publication years, citation counts, first authors, affiliations, countries, funding sponsors, journals, and highly cited publications were carried out using Microsoft Excel 2010. This software also enabled mapping the historical distribution of the works and citations received according to the scientific category, as well as computing the growth prediction of publications. After the data were downloaded to the computer in Excel format and reviewed by the researchers for duplication, the obtained data were summarized with percentages and numbers in tables and Excel graphics. H indexes, total citations, and average citations were obtained from the analysis of the WOS database. This bibliometric database itself provides graphs after making relevant selections and restrictions (eg, year, document type, and country). There was no usage of advanced statistical analytic tests.

The secondary outcome was to investigate international collaborations, to make bibliographic coupling, co-citations, and keyword co-occurrence analysis. The VOSviewer software (version 1.6.18) was used for this analysis and to build the triage literature maps. This method, including co-citation, bibliographic coupling, and keyword co-occurrence, refers to the frequency with which 2 units are cited together, indicating similarity between them. When 2 publications are coupled together bibliographically, the number of references they have in common is used as a proxy for how similar they are to one another.12 By employing the most crucial phrases or keywords in the texts, co-occurrence, on the other hand, identifies word connections when they co-occur, enabling researchers to examine the conceptual structure of a research topic.13

Ethical Approval

The present study complied with the Helsinki Declaration, revised in 2013. Ethics committee approval was not required as there was no human or animal research. An ethics committee document (dated November 10, 2022, and numbered 71089) was obtained from the university.

RESULTS Distribution of published articles and cited papers

A total of 3887 documents obtained in the search for holistic nursing have been published since 1970 and they have been cited 45 843 times (the average of 11.79 citations per document) and the total H index was 71. The first article on holistic nursing was published in 1978. Between 1978 and 2000, there was little literature regarding holistic nursing. Overall, the number of publications increased since 2012 (more than 100 articles per year), but the number continues to grow. A total of 2716 (69 875%) of all publications on holistic nursing were published since 2013. The highest number of publications was in 2021 (407 publications). These articles had been cited 37 782 times since 2013, which is 77.832% of all citations. Figure 1 shows the holistic nursing publications and citations by years from 1970 to the present.

FIGURE 1.:

Holistic nursing publications and citations by years from 1970 to the present.

Geographical distribution of the articles

The works on holistic nursing involved 110 countries globally, although only 21 countries contributed more than 50 articles and 11 countries contributed more than 100 articles (Figure 2). The top 5 countries that made the highest number of contributions were the United States (1259 documents), England (457 documents), Australia (380 documents), Canada (253 documents), and Sweden (183 documents). The top 5 most cited countries in the retrieved documents from the WOS database on holistic nursing-related publications are shown in Table 1.

FIGURE 2.:

Most publishing countries of holistic nursing publications.

TABLE 1. - Citation Numbers and H Indexes of the Top 5 Most Publishing Countries Country Number of Publication Total Citation Numbers H Index The USA 1259 14 346 49 England 457 8 968 46 Australia 380 5 574 36 Canada 253 3 215 30 Sweden 183 2 405 25

The publications from the United States had the highest number of citations (n = 14 346, and H index = 49) (Table 1). These results were automatically extracted from the WOS database website.

A total of 1521 of these publications were supported by the funding institution. The United States Department of Health and Human Services was the leading funding sponsor of holistic nursing studies and funded 97 of the work cited in the publications (Table 2).

TABLE 2. - Funding Agenciesa Funding Agencies Record Count % of 3.887 United States Department of Health Human Services 97 2.495 National Institutes of Health, USA 81 2.084 National Institute for Health Research 33 0.849 National Institute of Nursing Research 24 0.617 Australian Government 21 0.540 Canadian Institutes of Health Research 14 0.360 National Health and Medical Research Council of Australia 11 0.283 National Cancer Institute 11 0.283 National Institute on Aging 10 0.257 Chief Scientist Office 9 0.232 Netherlands Organization for Health Research and Development 9 0.232 United Kingdom Research Innovation 9 0.232 European Commission 8 0.206 National Natural Science Foundation of China 8 0.206 Tehran University of Medical Sciences 8 0.206 Agency for Healthcare Research Quality 7 0.180 Department of Health Ageing 7 0.180 Isfahan University of Medical Sciences 7 0.180 Ministry of Education Culture Sports Science and Technology Japan (MEXT) 7 0.180 Ministry of Science and Technology, Taiwan 7 0.180 NIH National Center for Complementary Alternative Medicine 7 0.180 Projekt DEAL 7 0.180 Swedish Research Council 7 0.180 Grants in Aid for Scientific Research (KAKENHI) 6 0.154 Japan Society for the Promotion of Science 6 0.154

aShows 25 out of 1521 funders.

Authors from 4000 different institutions/organizations/universities have contributed to the literature on holistic nursing. The University of London from England was the top institute focused on holistic nursing. But, the top 15 institutions/organizations/universities with the highest number of publications on holistic nursing were frequently located in the United States. Institutions in the UK, Canada, and Australia were also in the top 15. Other top institutions/organizations/universities with the highest number of publications on holistic nursing are summarized in Table 3.

TABLE 3. - Top 15 Publishing Institutions/Organizations/Universities on Holistic Nursinga Ranking Affiliations, Country n % of 3.887 1 University of London, England 80 2.058 2 The University of Texas System, the USA 67 1.724 3 State University System of Florida, the USA 54 1.389 4 The University of North Carolina at Chapel Hill, the USA 49 1.261 5 National University of Singapore, Singapore 46 1.183 6 King's College London, England 42 1.081 7 Karolinska Institutet, Sweden 39 1.003 8 Monash University, Australia 38 0.978 9 University of Pennsylvania, the USA 36 0.926 10 University System of Ohio, the USA 36 0.926 11 The University of California, the USA 34 0.875 12 The University of Sydney, Australia 34 0.875 13 The University of Minnesota System, the USA 33 0.849 14 The University of Toronto, Canada 33 0.849 15 University of Collage London, England 32 0.823

aShows 15 out of 4000 entries.

Publications on holistic nursing were published in 919 different journals. The journals that published the most publications on holistic nursing were the Journal of Holistic Nursing (257 documents), the Journal of Advanced Nursing (215 documents), the Journal of Clinical Nursing (203 documents), Holistic Nursing Practice (117 documents), and Nurse Education Today (84 documents). The articles on holistic nursing published in the Journal of Advanced Nursing received the highest number of citations (5841 citations). The top 10 publishing journals and citation numbers on holistic nursing are noted in Figure 3.

FIGURE 3.:

Top 10 publishing journals on holistic nursing.

The most cited article on holistic nursing was published in 2007 by Davidson et al.14 This article has received a total of 751 citations and an annual average of 44.18 citations since its publication. A summary of articles with a total of 100 or more citations is given in Table 4.

TABLE 4. - Highly Cited Documents on Holistic Nursing Authors Journal Title Publication Year DOI Total Citations Average per Year Davidson et al Critical Care Medicine 2007 10.1097/01.CCM.0000254067.14607.EB 751 44.18 Davis-Floyd, R International Journal of Gynecology & Obstetrics 2001 10.1016/S0020-7292(01)00510-0 259 11.26 McMullan et al Journal of Advanced Nursing 2003 10.1046/j.1365-2648.2003.02528.x 252 12 Wojnar et al Journal of Holistic Nursing 2007 10.1177/0898010106295172 233 13.71 Biagi et al Age 2012 10.1007/s11357-011-9217-5 229 19.08 Cowan et al Nurse Education Today 2005 10.1016/j.nedt.2005.03.002 205 10.79 Foureur et al Contemporary Nurse 2013 10.5172/conu.2013.45.1.114 200 18.18 Haboubi et al Disability and Rehabilitation 2003 10.1080/0963828021000031188 195 9.29 Kennedy et al Pediatrics 2011 10.1542/peds.2010-1722N 187 14.38 Dyer et al Journal of Sexual Medicine 2013 10.1111/j.1743-6109.2012.02856.x 184 16.73 Grundy, E; Sloggett, A Social Science & Medicine 2003 10.1016/S0277-9536(02)00093-X 183 8.71 Dyson et al Journal of Advanced Nursing 1997 10.1111/j.1365-2648.1997.tb00811.x 183 6.78 Ross, Linda Journal of Clinical Nursing 2006 10.1111/j.1365-2702.2006.01617.x 168 9.33 Ryan, Polly Clinical Nurse Specialist 2009 10.1097/NUR.0b013e3181a42373 167 11.13 Takeda et al Cochrane Database of Systematic Reviews 2012 10.1002/14651858.CD002752.pub3 158 13.17 Baldacchino, D; Draper, P Journal of Advanced Nursing 2001 10.1046/j.1365-2648.2001.01814.x 156 6.78 Tully et al American Journal of Obstetrics and Gynecology 2017 10.1016/j.ajog.2017.03.032 150 21.43 Mok et al Journal of Advanced Nursing 2004 10.1111/j.1365-2648.2004.03230.x 149 7.45 Ramezani et al International Nursing Review 2014 10.1111/inr.12099 133 13.3 Kolcaba, KY Journal of Advanced Nursing 1994 10.1111/j.1365-2648.1994.tb01202.x 132 4.4
Collaborative Co-author Network Analysis

Network visualization map of co-authorship among countries (Figure 2), citation map among countries (Figure 3), and among authors (Figure 4) are summarized in Figures 2–4. Thicker lines indicate stronger collaborations between authors or countries. Countries/author names represented by larger circle sizes or font sizes have a higher number of publications or citations.

Figure 2 and Figure 3 shows that the country with the largest bubble is the USA, which means that the USA has the highest number of publications and citations.

Figure 3 shows that Australia and European countries have citation cooperation. Also this figure shows that countries such as the USA, Brazil, Turkey, Twain have citation cooperation.

FIGURE 4.:

Network visualization map of coauthorship among countries.

FIGURE 5.:

Network visualization map of citation map among countries.

Keyword mapping

Keyword mapping also is summarized in Figure 5. Figure 5 depicts the keyword visualization map of articles with a minimum of 20 occurrences on holistic nursing. While selecting the minimum threshold value in occurrence, a restriction was made to visualize the keywords that are most frequently used during usage so that the keywords are visible in the mapping created. Keywords represented with larger circle size or font size had relatively more occurrence in the articles. Lines connecting are indicative of occurrence relations in articles.

DISCUSSION

To evaluate the scientific impact of any scientific publication, bibliometric methods are frequently utilized. The bibliometric analysis uses a quantitative approach to describe, assess, map, visualize, couple, and track published research on a particular subject. Large-scale mapping and visualization of the scientific literature published in a particular field of study are made easier by bibliometric analysis.15–19

The nursing process cannot be separated from holistic assessment and care. The interconnectedness of body, mind, and spirit is acknowledged by holistic nursing practice, which is based on a holistic philosophy that balances art and science. The practice of holistic medicine uses knowledge, theories, skill, intuition, and creativity. Process and presence are integrated into delivering care in a holistic nursing approach.20 Because of the emphasis holistic nurses place on patient-centeredness, self-care, and self-responsibility as well as on understanding the interconnectedness of all people and their environments, the American Nurses Association has recognized holistic nursing as a specialty.4 There have been many bibliometric studies on various medical topics and nursing research area, recently. However, to our knowledge, in the existing literature, there is no bibliometric analysis study on holistic nursing themes. Thus, the current study is the first bibliometric analysis of holistic nursing research and may serve as a beneficial resource for researchers seeking to delve deeper into hot themes in this area. In this study, the most prolific authors, affiliations, countries, funding sponsors, journals, and top-cited articles on holistic nursing topics were identified.

Although the concept of holism has a history of more than 100 years, it has been determined that publications increased, especially in the last 20 years. Over the years, there has been a steady rise in the number of articles in this area. More attention was being paid to this issue, as seen by the gradual increase. Since 2000, many articles have been published, especially since 2014 when more than 100 articles were published each year. The United States, as the leading country, published the most articles and England ranked second. It should be noted that although the United States published one-third of articles in this field, “the University of London” from England was the top institute focused on this topic. The works on holistic nursing involved 110 countries globally, although only 21 countries contributed more than 50 articles and 11 countries contributed more than 100 articles. According to our study of the top 11 publishing countries, some institutions in European countries and Australia also work in the field, but most of the affiliations are from the United States. Most nations in the world—nearly three-quarters—have not made any contribution in this area. This study reveals that despite being a widespread issue, the value of holistic nursing is not recognized by researchers. It was observed that holistic nursing studies, which were initiated around the turn of the century, are still in their infancy and have not yet reached their full potential. However, there is an urgent need for more research on it, given the rise of holistic nursing studies globally in this century.

According to the results of this search, using the same key words on the same date in the “title, abstract and keyword” section of the Scopus database search engine, we reached 10 301 articles and reviews. The first article in the Scopus database was published in 1971. As with our WOS database results, there has been an upward trend in the number of publications since 2012, never falling below 80 publications per year; 2022 was the year with the highest number of publications (499 publications) (Figure 6). Beginnings (American Holistic Nurses Association) was the journal with the highest number of publications on holistic nursing with 617 articles. When the number of publications by country was analyzed, similar to our WOS results, the countries with the highest number of publications were the United States (3053 publications), the United Kingdom (1369 publications), Australia (548 publications), Canada (400 publications), and Sweden (259 publications). These differences in the databases varied due to the difference in journals they indexed. The higher number of publications in Scopus was attributed to the fact that the Scopus database includes a greater number of journals.

FIGURE 6.:

The number of holistic nursing publications by year (Scopus database).

The number of citations to previously published work is a gauge of its significance and eventual acceptance in a field of study.21 Over time, there has been an increase in citations in the holistic nursing specialty, with particularly strong development over the last 10 years, which might be due to the rise in the number of papers and researchers interested in this subject. Our results showed that, 2716 (69 875%) of all publications on holistic nursing were published since 2013. The highest number of publications was in 2021 (407 publications). These articles were cited 37 782 times since 2013, which is 77.832% of all citations (Figure 1).

With the bibliometric method, it is also possible to evaluate the most cited articles on a subject. In our study, we analyzed the most cited articles with the data obtained from the WOS database.22,23 The most cited article on holistic nursing was published in 2007 by Davidson et al.14 This article was a guideline for holistic practices in the intensive care unit. This article has received a total of 751 citations and an annual average of 44.18 citations since its publication.

In this study, we conducted a network analysis by using the VOSviewer program (Figures 4, 5, and 7). We evaluated the nodes that are situated in the network's center and may be in a better position to disseminate information throughout the entire system. The nodes inside these clusters are extremely tightly coupled, making an information diffusion within them highly plausible. Because clusters are connected by bridges, the network also exhibits significant clustering and strong global connections.24 This study's network analysis results showed that the country with the largest bubble is the United States, which means that the United States has the highest number of publications, citations and global connections.

FIGURE 7.:

Citation visualization map among authors.

The 5 core principles and standards of practice for holistic nursing are highlighted. These include holistic care processes, holistic communication, therapeutic environments and cultural diversity, holistic education and research, and holistic nurse self-care. Holistic philosophy, theory, and ethics are also included.25 Our keyword mapping analyses also are summarized in Figure 8.

FIGURE 8.:

Keyword visualization map of articles.

Limitations and superiority

In recent years, bibliometric analyses have taken place frequently in the field of nursing.26,27 However, no similar bibliometric analysis study has been published on holistic nursing, which is one of the main building blocks of nursing practices. This study, which is the first bibliometric analysis study available on holistic nursing, unfortunately, has some limitations. First, it was not possible to read all of the published articles to provide more details. The options offered by database applications also impose restrictions on types of factors that can be examined in bibliometric research. In future research, other databases can be examined. In addition to Thomson Reuters Web of Science. The number of citations and publication frequency in holistic nursing may have been influenced using only one database search (WOS) in the current study. The reason that we did not choose an additional database other than WOS was that it was not possible to merge the data of other databases with the visualization program we used in our study. On the other hand, one of the most used databases for bibliometric analysis is the WOS database. In the selection of keywords, we chose the topic part of the search engine. This was because we aimed to reach the articles on holistic nursing in the title, abstract, and keywords. We included only research articles and reviews as the type of publication. We wanted the scientific value to be higher, as other types of publications rank lower in the science pyramid. We conducted the literatu