RHS. Revista. Humanismo. Soc. 12(1), e2/1-20, ene.- jun. 2024 / ISSNe 2339-4196
Artículo de Investigación Científica y Tecnológica
RHS. Revista. Humanismo. Soc. 12(1), e2/1-20, ene.- jun. 2024 / ISSNe 2339-4196
Artículo de Investigación Científica y Tecnológica
Trends of Publications on Humanism in Nursing: A Bibliometric Analysis
Tendencias de las publicaciones sobre humanismo en enfermería: un análisis bibliométrico
Ana Luiza Ferreira Aydogdu1
https://orcid.org/0000-0002-0411-0886
https://doi.org/10.22209/rhs.v12n1a02
Recibido: 17 de junio de 2023.
Aceptado: 16 de enero de 2024.
Para citar: Aydogdu Ferreira, A. L. (2024). Trends of Publications on Humanism in Nursing: A Bibliometric Analysis. RHS-Revista Humanismo y Sociedad, 12(1), 1-20. https://doi.org/10.22209/rhs.v12n1a02
Abstract
Humanism has significantly shaped modern nursing practices by emphasizing on the crucial value of providing patient-centered care and acknowledging the innate worth of human dignity. That is why this paper aims to explore and assess the existing framework of knowledge within publications that address humanism in nursing, as well as trace its evolutionary trajectory. The present document shows the results of a descriptive bibliometric study based on a data retrieval conducted from the Web of Science (WoS) Core Collection database and its subsequent analysis made using Excel and VOSviewer. The study encompassed 135 documents published from 1993 to 2021 in 82 journals, authored by 390 researchers from 33 countries. Notably, 79.3% of these works were classified as original articles, 53.3% belonged to the nursing category, and 86.7% were published in English. The existence of a strong connection between humanism, ethics, care, and nursing education was observed in all the works analyzed.
Keywords: Bibliometrics, Humanism, Nursing, Research trends, VOSviewer, Web of science.
Resumen
El humanismo ha influido de manera significativa y moldeado las prácticas de enfermería contemporáneas al resaltar el valor crucial de brindar atención centrada en el paciente y reconocer la dignidad inherente del ser humano. Este artículo tiene como objetivo explorar y evaluar el marco de conocimiento existente de las publicaciones que abordan el humanismo en enfermería, así como rastrear su trayectoria evolutiva. Realizado como un estudio bibliométrico descriptivo, la recopilación de datos se llevó a cabo el 17 de diciembre de 2022, a partir de la base de datos Web of Science (WoS) Core Collection, y el análisis subsiguiente se realizó con programas como Excel y VOSviewer. El estudio abarcó 135 artículos escritos por 390 investigadores, abarcando el período de publicación desde 1993 hasta 2021. Notablemente, el 79.3% de estos trabajos se clasificaron como artículos originales, con un 53.3% perteneciente a la categoría de enfermería, y un 86.7% publicado en inglés. Los estudios fueron publicados en un conjunto variado de 82 revistas y contaron con la participación de investigadores de 33 países diferentes. Se observó la existencia de una fuerte conexión entre el humanismo, la ética, la atención y la educación en enfermería.
Palabras clave: bibliometría, humanism, enfermería, tendencias de investigación, Vosviewer, Web of science.
Background
The term “humanism” has diverse interpretations across several fields: In philosophy, it emphasizes human dignity; in education, defines student-centered approaches; in the arts, refers to cultural movements; in religion, indicates an emphasis on human dignity and redemption; in psychology, highlights personal growth; in secularism, represents an ethic based on reason (Copson, 2015; Davis, 1997). The term can also be found in nursing, in which it is associated with a philosophy that places the patient as the core of care (Cunha et al., 2017).
Since ancient times, several philosophical approaches, such as natural philosophy, have influenced the practice of nursing, emphasizing on the importance of prevention and health promotion. The philosophical influence of idealism, which states that beliefs and religious values are more important than the essence of the body and the human being, defined nursing as a profession that was aimed at helping human beings as a religious mission in the years between 1850 and 1880. The emergence of romanticism around 1890, highlighted the relevance of emotions and feelings, turning nurses’ intuition and experience into an asset valued by physicians. In the 1950s, pragmatism, in turn, emphasized on the importance of usefulness. In this case each professional was encouraged to perform on the functions for which he/she had more ability. This philosophical approach influenced nursing and gave rise to specific areas of study and practice in the field. Critical philosophy has also been important for nursing, developing a critical and reflective approach to care (Sendir, 2017). Over time, humanistic philosophy has substantially influenced modern nursing practices, has reshaped the nurse-patient relationship, and has increasingly focused on individual-centered care and human dignity (Cunha et al., 2017).
This humanist nursing approach, therefore, focuses on nurse-patient interaction and on the principle that nurses must respect patient’s choices and offer emotional support during the care process. Humanized care has proven to be essential for faster recovery as it increases the quality of life of individuals (Franzon et al., 2022). The existing approach of humanized nursing, further developed and applied round 1960, emphasizes on the role of the caregiver and fosters dialogue and communion. The evolution of nursing into a profound relationship with humanism and philosophy has enabled a deeper reflection on its essential role in providing care to society (Cruz et al., 2017; Cunha et al., 2017) because it entails concepts such as clinical literacy, affection, human dignity, effective presence, and effective communication (Taghinezhad et al., 2022). Additionally, it is important to keep in mind that humanized care and ethics are closely related, as both value the dignity and rights of patients. While humanized care seeks to ensure that patients receive quality care, ethics seeks to guarantee that such care is provided fairly and equitably (Yáñez et al., 2021).
Patient-centered nursing care is widely discussed in academic literature (Santos et al., 2017; Taghinezhad et al., 2022) revealing that it not only benefits patients but also nurses, who feel more fulfilled and satisfied (Taghinezhad et al., 2022) by providing humanized assistance to a population increasingly in need of care and more aware of their rights (García-Moyano et al., 2019; Shohani & Zamanzadeh, 2017). The COVID-19 pandemic evidenced that care, nursing, the basic skills of nurses worldwide and their multifaceted duties were even more important during a period of fear and uncertainty (Zhou & Zhang, 2022). Thus, it became even more essential for governments, doctors and nurses to provide humanized care during periods of crisis (Dias et al., 2022; Rivi et al., 2021).
The field of nursing has been the focal point of extensive discussions that delve in the concept and application of humanism since the mid-1970s. One of the first works published on the subject of humanism in nursing in the Web of Science Core Collection database is titled Nursing’s Syntax Revisited: A critique of Philosophies Said to Influence Nursing Theories. The paper, authored by Gortner, was published in 1993 and marked the inception of the discourse in the area. In 2012, Oliveira et al. identified, in an integrative review, that most of the studies on humanism in nursing were limited to pediatric or intensive care units and emphasized that priority was mainly given to hospital environments. That fact revealed that there were gaps in the approach to the subject in primary health care. Since then, particularly from 2018 onward, there has been a notable surge in the number of related studies, which indicates a growing interest in the matter. For example, in 2019 McCaffrey stated that the significance of humanism in nursing – a variant of humanism that places a strong emphasis on the pivotal role of relationships in nursing practices and underscores the necessity of critical and reflective awareness – must be renewed.
The literary review has showed not only the immense research related to humanism in nursing, but also the gaps or areas that need attention. Addressing them is crucial for uncovering the structural elements of the knowledge related to humanism in nursing. A comprehensive bibliometric analysis, like the one proposed for this study, becomes essential to recognize the pivotal role of humanism in enhancing the quality of care. This analysis offers insights into the evolution of the concept, key themes, and the interdisciplinary connections. Additionally, it helps identify gaps in the knowledge, guides future research and contributes to a nuanced understanding of the scholarly nursing discourse. This study not only enhances academic scholarship but also holds practical implications for shaping nursing practices, enriches professional education and, ultimately, improves patient care through a humanistic lens. Consequently, this paper aims to explore and assess the existing framework of knowledge within the publications that address humanism in nursing, as well as trace its evolutionary trajectory.
Methods
Design
This is a descriptive study in which the bibliometric method was used. Descriptive studies are used to learn and analyze facts and events (Sahin & Mete, 2021). Bibliometric methods are used in quantitative studies to divulge state-of-art existing scientific findings in a specific field and demonstrate emerging trends concerning a topic or area of interest (Donthu et al., 2021; Pessim et al., 2022). Bibliometric research facilitates identifying nascent trends within particular subject domains while also unveiling collaboration patterns among authors and institutions. Applying a bibliometric analysis can help researchers and scholars to develop a comprehensive understanding of a given topic, enabling them to identify potential research gaps and unexplored avenues and to assess the contributions made by various studies in the field (Donthu et al., 2021). These methodologies align with the goals of this study because they facilitate an in-depth analysis of the composition and the developmental trends of the publications.
Data Collection
Data were collected from the Web of Science (WoS) Core Collection on December 17, 2022. The WoS database was chosen because it contains high quality publications and it allows documents to be imported in a simple and fast way (Adriaanse & Rensleigh, 2011; Meho & Yang, 2007).
In the initial search, 164 documents that contained the descriptors “nurs*” and “humanism” across all fields were identified. Upon excluding the studies published in 2022, the number decreased to 151. The search was then refined by including specific index categories, such as Science Citation Index Expanded, Social Sciences Citation Index, Emerging Sources Citation Index, Conference Proceedings Citation Index-Social Sciences and Humanities, and Conference Proceedings Citation Index-Science, resulting in a further reduction to 148 documents. Subsequently, the search was narrowed down by selecting specific document types, including only “article”, “review”, “publishing material”, “meeting abstracts”, and “conference papers”, which resulted in a final count of 139 documents. The data were then saved as an Excel file and subjected to scrutiny for potential typographical errors and duplicates. Subsequently, one duplicated entry and three anonymous documents were excluded. The titles and abstracts of the remaining 135 publications underwent analysis and were all deemed relevant to be included in this study. The Excel file was formatted appropriately to be used in the VOSviewer program. The entire process of searching and selecting publications is illustrated in Figure 1.
Data Analysis
Excel and VOSviewer were used to analyze the collected information. VOSviewer is a free and easy-to-use program that allows analyzing network data and creating visual material through which it is possible to learn the characteristics of publications such as authors, citations, countries, and keywords, among others (Van Eck & Waltman, 2020).
VOSviewer facilitates the exploration of connections or Links (L) among characteristics of the publications, such as authors, institutions, countries of origin, and journals associated with the articles. Each item is depicted as a circle, whose size reflects its frequency or incidence. These items are organized into distinct clusters, which are represented with different colors. The lines on the maps show the connections between these items and the thickness of the lines represent the strength of the connection. Each link is assigned a value, called Total Link Strength (TLS), which indicates its robustness. The spatial proximity between entities on the map signifies their closeness in relation to the researched factor (Van Eck & Waltman, 2020).
Validity and Reliability
The robustness and reliability of the study were guaranteed through the transparency of the methodology employed in the selection process, thereby enabling its reproducibility. The analytical framework known as Search, Appraisal, Synthesis and Analysis (SALSA) was used to ensure rigor (Grant & Booth, 2009). See Figure 1.
Figure 1. Flow chart of the studies considering the SALSA steps of data selection and analysis procedure
Results
The database for this study included 135 documents published between 1993 and 2021. However, it is worth highlighting that most of the documents were published after 2018. Before that year, the highest number of articles were published in 2006, compared to 2005 and 2007. On the other hand, 2015 presented fewer studies than 2014 and 2016. The discussions about the subject began to increase in the academic literature from 2018. Most studies were published in 2021 (n=18), 2019 (n=13), 2020 (n=11), and 2018 (n=11). Figure 2 shows the distribution of the 135 studies by year of publication. Most publications belong to the “nursing” category (n=72). Figure 3 shows the six most productive categories. The studies were published in English (n=117), Spanish (n=8), French (n=4), Portuguese (n=3), Russian (n=2), and Slovene (n=1). Figure 4 presents the distribution of the publications by language. The documents are classified in the following types: Article (n=107), publishing material (n=15), review (n=9), proceedings paper (n=3), and meeting abstract (n=1). Figure 5 shows the distribution of the documents by type.
Figure 2. Distribution of the documents by year
Figure 3. Distribution of the documents by category
Figure 4. Distribution of the documents by language
Figure 5. Distribution of the studies by type
The 135 documents were published by 390 different authors. The three most productive authors were Cara, C. (n=3), Leutourneou, D. (n=3), and Hanna, D. R. (n=3). The network of authors is presented in three clusters. Lefebvre, H., had the highest number of L (=20) and highest TLS (=20). Figure 6 illustrates the network of highly prolific authors in the field.
Figure 6. Network of the most productive authors
The documents encompass contributions from 33 countries. The top five most prolific are the United States (n=40), Canada (n=16), England (n=11), Australia (n=11), and Brazil (n=7). The visualization that features the network of the most productive countries reveals four distinct clusters. The United States, identified as the most prolific country, holds the highest number of links (L=4) and the greatest TLS (=4). Refer to Figure 7 for an overview of the network of the most productive countries.
Figure 7. Network of the most productive countries
The publications originated from a diverse set of 226 institutions. The institutions with the most publications were the University of Montreal (n=4), The University of Sydney (n=4), The University of Humanist Studies (n=3), and La Trobe University (n=3). Of these, The University of Humanist Studies stands out with the highest number of links (L=11) and the greatest TLS (12). The network of institutions with the most publications depicts four clusters. Refer to Figure 8 for a visual representation of the network involving the institutions with the most publications.
Figure 8. Network of the institutions with the most publications
The documents were published in 82 different journals. Academic Medicine (n=12), Journal of Advanced Nursing (n=10), and Nursing Science Quarterly (n= 7) were the journals with the most publications. Their network is distributed in 11 clusters. Journal of Advanced Nursing presented the most L (=20) and TLS (=88). Figure 9 shows the network of the journals with the most publications.
The total number of citations in the included documents amounted to 1,586. Strikingly, the 12 most cited documents collectively contribute to 54.1% of the total citations. The most cited document was The Technocratic, Humanistic and Holistic Paradigms of Childbirth by Davis-Floyd (2001), published in the International Journal of Gynecology & Obstetrics, which was cited in a total of 254 documents up to December 17, 2022. Table 1 shows the general characteristics of the 12 most cited studies.
Figure 9. Network of the journals with the most publications
The authors of the 135 studies employed a total of 393 keywords. “Humanism” (n=45), “Nursing” (n=17), “Caring” (n=10), “Education” (n=5), “Ethics” (n=5), and “Nursing Theory” (n=5) emerged as the most frequently selected keywords. The co-occurrence network of keywords is organized into 31 clusters. The two largest clusters contains 17 keywords each. “Humanism” stands out with the highest number of L (=165) and the greatest (=206). Figure 10 provides a visual representation of the co-occurrence network of keywords.
Figure 10. Keywords co-occurrence network
Table 1. Most cited studies (until December 17, 2022)
|
Reference |
Title |
Journal |
Citations |
|
Davis-Floyd (2001) |
The technocratic, humanistic, and holistic paradigms of childbirth |
International Journal of Gynecology & Obstetrics |
254 |
|
Birden et al. (2014) |
Defining professionalism in medical education: A systematic review |
Medical Teacher |
109 |
|
Barnard and Sandelowski (2001) |
Technology and humane nursing care: (ir)reconcilable or invented difference? |
Journal of Advanced Nursing |
104 |
|
Cleary et al. (2013) |
Mental health nurses’ views of recovery within an acute setting |
International Journal of Mental Health Nursing |
69 |
|
Archibald & Barnard (2018) |
Futurism in nursing: Technology, robotics and the fundamentals of care |
Journal of Clinical Nursing |
54 |
|
Hewitt et al. (2002) |
A critical review of the arguments debating the role of the nurse advocate |
Journal of Advanced Nursing |
50 |
|
Gunther & Alligood (2002) |
A discipline-specific determination of high-quality nursing care |
Journal of Advanced Nursing |
40 |
|
Pesut (2008) |
A conversation on diverse perspectives of spirituality in nursing literature |
Nursing Philosophy |
37 |
|
Kim et al. (2013) |
Working hours and depressive symptomatology among full-time employees: Results from the fourth Korean National Health and Nutrition Examination Survey (2007-2009) |
Scandinavian Journal of Work Environment & Health |
37 |
|
Coulon et al. (1996) |
The pursuit of excellence in nursing care: What does it mean? |
Journal of Advanced Nursing |
35 |
|
Gortner (1993) |
Nursing’s syntax revisited: a critique of philosophies said to influence nursing theories |
International Journal of Nursing Studies |
35 |
|
Playle (1995) |
Humanism and positivism in nursing - contradictions and conflicts |
Journal of Advanced Nursing |
34 |
Discussion
Humanism as a philosophy has widely influenced nursing, as it states that human beings are unique and should be treated according to their needs and individual characteristics (Kowalik, 2016; Morais et al., 2014). In accordance with that belief, nurses are nowadays trained to provide humanized assistance to the population (Taghinezhad et al., 2022). It is generally acknowledged, as well, that humanized care brings benefits not only to patients but also to nurses who feel more fulfilled at work (Zamaniniya et al., 2021). Thus, it is important to analyze the characteristics of publications produced on humanism in nursing so that more ideas can be generated to improve nursing practices and education in accordance with humanistic approaches (Zamaniniya et al., 2021). That is why the study described in this paper aims to explore and assess the existing framework of knowledge in publications that address humanism in nursing, as well as trace its evolutionary trajectory.
A total of 135 documents were included. The number of publications is a relevant indicator, as it shows the productivity of the researched topic (Ertekin, 2014). The documents included were published between 1993 and 2021. Even though the number of studies published has changed over the years, 2006 evidenced a higher number of publications compared to the immediately preceding and subsequent years. An integrative review conducted by Morais et al. (2014), discussing the humanistic theory in nursing, utilized search descriptors different from those employed in this bibliometric analysis. Nevertheless, it identified similar findings. Conversely, 2015 witnessed a lower number of publications in comparison to both 2014 and 2016. It is noteworthy that a surge in the volume of publications on humanism in nursing began to emerge from 2018 onwards. This upturn in publications may be attributed to the fact that the International Council of Nurses (ICN) chose “Nurses: A Voice to Lead - Health is a Human Right” as the theme for the International Nurses Day that year as a way to reinforce nurses’ understanding of the philosophical basis of the nursing practice (ICN, 2018).
The nursing category included 53.3% of the documents. This was an expected finding given the descriptors that were used to search for the documents. It is worth highlighting that “nursing” was followed by categories such as palliative care, healthcare policy, education, and psychiatry. These findings were also expected since the documents that discuss the care of terminal and psychiatric patients, health policies, and nursing education, widely address humanism in nursing (Taghinezhad et al., 2022; Wu & Volker, 2012).
The majority of the documents examined, 86.7%, were published in English. The prevalence of documents published in this language aligns with the findings of numerous other bibliometric studies conducted across diverse fields (Cicek & Altuntas, 2022; Hebebci, 2021; Mervar & Jokić, 2022). English is the language in which most of the scientific and academic research is disseminated and authors are increasingly looking to publish in English to propagate their work and findings more widely and quickly (Hoppen & Vanz, 2023; Pessim et al., 2022).
Most publications included in this study are original works of research and a significant proportion of them were conducted by authors in institutions from countries such as the U.S., Canada, England, Australia, Brazil, and Spain. Similar findings were observed in previous bibliometric analyses that employed similar methodological approaches (Akyüz & Ozlu, 2022; Cicek & Altunbas, 2022; Devos & Menard, 2019; Roychowdhury et al., 2022). Needless to say, funding is essential for researchers, that is why the U.S. is the leader in research. The country provides essential financial support for researchers, fostering new generations of scientific studies (Hutton, 2018; United States Congressional Research Service, 2022).
The publications analyzed for this study were published in 82 different journals. The most cited journals were the Academic Medicine, the Journal of Advanced Nursing, and the Nursing Science Quarterly. The journal with the most publications is not aimed directly to the nursing area but to healthcare sciences in general. The Academic Medicine is a journal rated Q1 (SCImago, 2021), with a Journal Citation Indicator (JCI) worth 2.13 (Web of Science, 2021). The second most cited journal is directed to nursing, is classified as Q1 (SCImago, 2021) and has a JCI evaluated at 1.32 (Web of Science, 2021).
The authors of the 135 included documents employed a total of 393 keywords in their studies. “Humanism”, “nursing”, “caring”, “education”, “ethics”, and “nursing theory”, were the most used keywords. Among them, those that were not used as descriptors for the search for publications stand out: “caring”, “education”, and “ethics”. Several studies address the importance of the practice of care teaching based on the humanistic philosophy (Létourneau et al., 2022; Meng, 2019). Ethical issues are also widely addressed when discussing humanized care. In a study conducted in 2022, nursing students reported having observed non-humanized nursing practices during their internships (Létourneau et al., 2022). The results of a scoping review, also published in 2022, revealed the need to guarantee the inclusion of the ethics of care in curriculums that promote humanistic behavior during medical practices (Doukas et al., 2022). In addition to addressing humanized care, studies also discuss the importance of humanized teaching to provide nurses with skills such as effective communication and empathy towards patients to provide quality care (Berrerril, 2016). Thus, in the scientific literature, terms such as “caring”, “education”, “ethics”, and “humanism” are intertwined at all times, justifying the prevalence of such keywords in the publications included in this study. It is important to emphasize that the second most cited publication included in this database is a systematic review of medical education (Birden et al., 2014) and the most cited study, discussed, among others, the humanistic paradigm in childbirth, therefore addressing humanized care (Davis-Floyd, 2001).
It is my belief that humanized care and ethics in the area of nursing will become increasingly addressed issues in the coming years, especially after the COVID-19 pandemic, which evidenced the need to deepen humanistic approaches based on ethical principles to ensure the safety of healthcare workers and patients.
This study presents the following limitations: Only studies published up to 2021 found in one database were included and the descriptors used in the search in all fields were limited and may have allowed including documents that are not directly associated with nursing. Thus, for future research, I recommend using more comprehensive search strategies that include other databases that may generate wider results.
Conclusion
This study offers a comprehensive overview of the evolution of research on humanism in nursing in the last 30 years. The scientific and academic production regarding humanism in nursing was evaluated and analyzed, allowing me to identify the impact of researchers, journals, institutions, and countries concerning the topic. Through the results of this study, researchers will be able to learn about trends in research on humanism in nursing and identify areas that need to be more widely addressed, which can be useful for planning future research. Health administrators and educators in the nursing field can be inspired by the results of this study, promoting professional training in humanized care in educational and health institutions, since this approach brings benefits to patients and also to nurses.
The existence of a strong connection between humanism, ethics, care, and nursing education was evidenced in the results. The increasing number of publications on humanism in nursing is noteworthy, evidencing the significance of establishing a scientific foundation for the application of this approach in nursing practice. The highlighted importance of humanism in nursing serves as a paradigm that contributes to the enhancement of quality care. Therefore, it is crucial to promote research and the continuous updates of scholars and professionals in the field on the subject of humanism in nursing, given the growing significance of the topic in the current scenario.
It can be asserted that the studies incorporated into this bibliometric analysis intricately explore the connections between humanism, ethics, and care. They underscore the vital role of robust training to equip nurses with the necessary skills to deliver humanized care. The continued development of a framework of knowledge related to humanism in nursing is imperative, particularly in light of the emergence of novel diseases and advancements in health technology, which underscore the growing significance of prioritizing humanized care.
The information provided by this study enriches the scientific literature on humanism in nursing by offering a historical context, highlighting its global impact, emphasizing on its thematic focus, and guiding future research endeavors. This comprehensive perspective contributes to the ongoing development and refinement of humanistic approaches in nursing practice and education.
Future research should be conducted to explore how humanism in nursing intersects with other disciplines and why this interdisciplinary perspective is significant. This broader approach would allow for a more comprehensive understanding of the relationships between humanism in nursing and other fields of knowledge, providing valuable insights into how the humanistic philosophy can influence and be enriched by diverse disciplines. Examining interdisciplinary connections could highlight potential synergies, foster innovative collaborations, and broaden the impact of humanism on nursing practices and research.
References
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