An integrative review of the concept of spirituality in the health sciences
Abstract
Spirituality is a universal human phenomenon, yet confusion and incomprehension of the concept is ever-present. The purpose of this study was to explore how research on the concept of spirituality has been reported in the health literature in the past decade and develop an ontological and theoretical understanding of spirituality. The examination was based on quantitative and qualitative integrative review approaches, which integrated empirical research on spirituality. The sample included 73 spirituality research articles, which were published in English between January 1990 and September 2000. An electronic data-collection tool was designed for use in this project and formatted using Excel software for transfer of coded data into the NVivo software for the data analysis. The results identified essential elements of spirituality, current use of operational definitions and instruments, conceptual frameworks used in spirituality research, and cultural aspects of spirituality. Historical comparison among decades and barriers in researching spirituality are discussed.
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Despite the increasing use of the concept of spirituality among health researchers, there is no clear consensus about its definition.
“Despite the increasing use of the concept of spirituality among health researchers, there is no clear consensus about its definition (Chiu et al., 2004; Sessanna et al., 2007; Gall et al., 2011).”
From Defining spirituality in healthcare: a systematic review and conceptual framework. (2021) · cites this paper as Chiu et al., 2004
Cites
Eysenck, H. J. (1985) · Behaviour Research and Therapy · doi:10.1016/0005-7967(85)90087-7 · Cited by 32,026 · see citing works
“Stress: appraisal and coping,”
Folkman, S. (2013) · Encyclopedia of Behavioral Medicine · doi:10.1007/978-1-4419-1005-9_215 · Cited by 27,833 · see citing works
Selye, H. (1956) · Medical Entomology and Zoology · Cited by 5,224 · see citing works
(2019) · doi:10.1188/19.onf · Cited by 3,233 · see citing works
Man's search for meaning; an introduction to logotherapy
FRANKL, V. E. (1971) · Medical Entomology and Zoology · Cited by 3,182 · see citing works
Loneliness: A Source Book of Current Theory, Research and Therapy
Blazer, D. G. (1983) · Journal of Gerontology · doi:10.1093/geronj/38.4.492 · Cited by 2,139 · see citing works
Journal of Transpersonal Psychology
(1977) · Journal of Humanistic Psychology · doi:10.1177/002216787701700308 · Cited by 1,740 · see citing works
Spiritual Well-Being: Conceptualization and Measurement
Ellison, C. W. (1983) · Journal of Psychology and Theology · doi:10.1177/009164718301100406 · Cited by 1,485 · see citing works
The Emerging Meanings of Religiousness and Spirituality: Problems and Prospects
Zinnbauer, B. J., Pargäment, K. I., & Scott, A. B. (1999) · Journal of Personality · doi:10.1111/1467-6494.00077 · Cited by 930 · see citing works
Toward a Humanistic-Phenomenological Spirituality
Elkins, D. N., Hedstrom, L. J., Hughes, L. L., Leaf, J. A., & Saunders, C. (1988) · Journal of Humanistic Psychology · doi:10.1177/0022167888284002 · Cited by 753 · see citing works
Introduction to the Theoretical Basis of Nursing
Rogers, M. E. (1970) · Nursing Research · doi:10.1097/00006199-197011000-00012 · Cited by 604 · see citing works
Spirituality and well‐being in terminally ill hospitalized adults
Reed, P. G. (1987) · Research in Nursing & Health · doi:10.1002/nur.4770100507 · Cited by 485 · see citing works
Nursing Science: Major Paradigms, Theories and Critiques
(1987) · Cited by 426 · see citing works
The Stress-Buffering Role of Spiritual Support: Cross-Sectional and Prospective Investigations
Matón, K. I. (1989) · Journal for the Scientific Study of Religion · doi:10.2307/1386742 · Cited by 390 · see citing works
Health as Expanding Consciousness
Musker, K. M., & Kagan, P. N. (2011) · Nursing Science Quarterly · doi:10.1177/0894318411409430 · Cited by 379 · see citing works
An Introduction to the Theoretical Basis of Nursing
Auger, J. A., & Rogers, M. E. (1971) · AJN American Journal of Nursing · doi:10.2307/3421924 · Cited by 361 · see citing works
Fehring, R. J., Miller, J. F., & Shaw, C. (1997) · PubMed · Cited by 322 · see citing works
Health As Expanding Consciousness
Stec, M. W. (2015) · Nursing Science Quarterly · doi:10.1177/0894318415614901 · Cited by 244 · see citing works
Religiousness among terminally ill and healthy adults
Reed, P. G. (1986) · Research in Nursing & Health · doi:10.1002/nur.4770090107 · Cited by 225 · see citing works
Spiritual Well‐Being, Religiousness and Hope Among Women With Breast Cancer
Mickley, J. R., Soeken, K. L., & Belcher, A. E. (1992) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.1992.tb00732.x · Cited by 216 · see citing works
Hungelmann, J., Kenkel-Rossi, E., Klassen, L., & Stollenwerk, R. M. (1996) · Geriatric Nursing · doi:10.1016/s0197-4572(96)80238-2 · Cited by 190 · see citing works
Re-creating your life: a spiritual/psychotherapeutic intervention for people diagnosed with cancer
Cole, B. S., & Pargäment, K. I. (1999) · Psycho-Oncology · doi:10.1002/(sici)1099-1611(199909/10)8:5 · Cited by 160 · see citing works
Spirituality and serious mental illness: A two-part study.
Lindgren, K. N., & Coursey, R. D. (1995) · Psychosocial Rehabilitation Journal · doi:10.1037/h0095498 · Cited by 150 · see citing works
Riley, B., Perna, R. B., Tate, D. G., Forchheimer, M. B., Anderson, C., & Luera, G. R. (1998) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(98)90004-1 · Cited by 146 · see citing works
The association between adolescent spirituality and voluntary sexual activity
Holder, D. W., DuRant, R. H., Harris, T. L., Daniel, J. H., Obeidallah, D. A., & Goodman, E. (2000) · Journal of Adolescent Health · doi:10.1016/s1054-139x(99)00092-0 · Cited by 134 · see citing works
Hope, spirituality, sense of coherence, and quality of life in patients with cancer
Post‐White, J. (1996) · Oncology nursing forum · Cited by 129 · see citing works
Spiritual Activities as a Resistance Resource for Women With Human Immunodeficiency Virus
Sowell, R. L., Moneyham, L. L., Hennessy, M. H., Guillory, J. A., Demi, A. S., & Seals, B. F. (2000) · Nursing Research · doi:10.1097/00006199-200003000-00003 · Cited by 119 · see citing works
Spirituality and Quality of Life in Gynecologic Oncology Patients
Gioiella, M. E., Berkman, B., & Robinson, M. (1998) · Cancer Practice · doi:10.1046/j.1523-5394.1998.006006333.x · Cited by 116 · see citing works
Ready-to-wear: Discovering grounded formal theory
Kearney, M. H. (1998) · Research in Nursing & Health · doi:10.1002/(sici)1098-240x(199804)21:2 · Cited by 115 · see citing works
Spiritual Needs and Interventions
Emblen, J. D., & Halstead, L. (1993) · Clinical Nurse Specialist · doi:10.1097/00002800-199307000-00005 · Cited by 115 · see citing works
Self-citationReimbursement issues for advanced practice.
Taylor, E. J., Amenta, M., & Highfield, M. (1995) · PubMed · Cited by 113 · see citing works
Coleman, C. L., & Holzemer, W. L. (1999) · Journal of the Association of Nurses in AIDS Care · doi:10.1016/s1055-3290(06)60231-8 · Cited by 112 · see citing works
The effect of spiritual beliefs on outcome from illness
King, M., Speck, P. W., & Thomas, A. (1999) · Social Science & Medicine · doi:10.1016/s0277-9536(98)00452-3 · Cited by 109 · see citing works
Burkhardt, M. A. (1994) · Holistic Nursing Practice · doi:10.1097/00004650-199407000-00004 · Cited by 106 · see citing works
Spiritual well-being and demands of illness in people with colorectal cancer
Fernsler, J. I., Klemm, P. R., & Miller, M. A. (1999) · Cancer Nursing · doi:10.1097/00002820-199904000-00005 · Cited by 103 · see citing works
A review of spirituality as applied to nursing
Narayanasamy, A. (1999) · International Journal of Nursing Studies · doi:10.1016/s0020-7489(99)00007-3 · Cited by 102 · see citing works
Nurses’ perceptions of spirituality and spiritual care
McSherry, W. (1998) · Nursing Standard · doi:10.7748/ns1998.10.13.4.36.c2537 · Cited by 100 · see citing works
Kaye, J., & Robinson, K. M. (1994) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.1994.tb00317.x · Cited by 99 · see citing works
God and the Search for Meaning Among Hospice Caregivers
Mickley, J. R., Pargäment, K. I., Brant, C. R., & Hipp, K. M. (1998) · The Hospice Journal · doi:10.1080/0742-969x.1998.11882904 · Cited by 98 · see citing works
Spirituality and People With Poetentially Fatal Diagnoses
Fryback, P. B., & Reinert, B. R. (1999) · Nursing Forum · doi:10.1111/j.1744-6198.1999.tb00231.x · Cited by 97 · see citing works
Spirituality of Patients Recovering from an Acute Myocardial Infarction
Walton, J. (1999) · Journal of Holistic Nursing · doi:10.1177/089801019901700104 · Cited by 97 · see citing works
SPIRITUAL ASPECTS OF LOSS AT THE TIME OF A PARTNER'S DEATH FROM AIDS
FOLKMAN, T. A. R. S. (1997) · Death Studies · doi:10.1080/074811897201769 · Cited by 91 · see citing works
Thomas, J. E., & Retsas, A. (1999) · International Journal of Nursing Studies · doi:10.1016/s0020-7489(99)00012-7 · Cited by 89 · see citing works
Reed, P. G. (1991) · Applied Nursing Research · doi:10.1016/s0897-1897(05)80068-0 · Cited by 87 · see citing works
Spiritual and religious beliefs in acute illness—Is this a feasible area for study?
King, M., Speck, P. W., & Thomas, A. (1994) · Social Science & Medicine · doi:10.1016/0277-9536(94)90260-7 · Cited by 85 · see citing works
"It helps me to be a whole person": The role of spirituality among the mentally challenged.
Sullivan, W. P. (1993) · Psychosocial Rehabilitation Journal · doi:10.1037/h0095669 · Cited by 83 · see citing works
Predictors of oncology and hospice nurses' spiritual care perspectives and practices
Taylor, E. J., Highfield, M. F., & Amenta, M. O. (1999) · Applied Nursing Research · doi:10.1016/s0897-1897(99)80156-6 · Cited by 79 · see citing works
Sense of Coherence as a Mediator of Stress for Cancer Patients and Spouses
Mullen, P. M., Smith, R. M., & Hill, E. W. (1993) · Journal of Psychosocial Oncology · doi:10.1300/j077v11n03_02 · Cited by 78 · see citing works
Spiritual Nursing Interventions
Sellers, S. C., & Haag, B. A. (1998) · Journal of Holistic Nursing · doi:10.1177/089801019801600304 · Cited by 76 · see citing works
Spirituality and the Experience of Cancer in an African-American Community
Potts, R. G. (1996) · Journal of Psychosocial Oncology · doi:10.1300/j077v14n01_01 · Cited by 73 · see citing works
Attitudes and beliefs regarding spiritual care. A survey of cancer nurses.
Taylor, E. J., Highfield, M. E. F., & Amenta, M. O. (1994) · PubMed · Cited by 69 · see citing works
Changes in spiritual beliefs after traumatic disability
McColl, M. A., Bickenbach, J. E., Johnston, J., et al. (2000) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(00)90117-5 · Cited by 68 · see citing works
SPIRITUAL ASPECTS OF LOSS AMONG PARTNERS OF MEN WITH AIDS: POSTBEREAVEMENT FOLLOW-UP
Richards, M. A. T. A. (1999) · Death Studies · doi:10.1080/074811899201109 · Cited by 68 · see citing works
ADOLESCENT SIBLING BEREAVEMENT AS A CATALYST FOR SPIRITUAL DEVELOPMENT: A MODEL FOR UNDERSTANDING
Michelle Batten, K. A. O. (1999) · Death Studies · doi:10.1080/074811899200876 · Cited by 67 · see citing works
Spiritual Awareness, Personal Perspective on Death, and Psychosocial Distress Among Cancer Patients
Smith, E. D., Stefanek, M. E., Joseph, M. V., Verdieck, M. J., Zabora, J. R., & Fetting, J. H. (1993) · Journal of Psychosocial Oncology · doi:10.1300/j077v11n03_05 · Cited by 66 · see citing works
Elderly patients' perceptions of their spiritual needs and care: a pilot study
Ross, L. A. (1997) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.1997.00393.x · Cited by 64 · see citing works
Spiritual high vs high on spirits: is religiosity related to adolescent alcohol and drug abuse?
Pullen, L. M., Modrcin-Talbott, M. A., West, W. R., & Muenchen (1999) · Journal of Psychiatric and Mental Health Nursing · doi:10.1046/j.1365-2850.1999.00161.x · Cited by 63 · see citing works
Spirituality and the Treatment of the Dually Diagnosed:
McDowell, D. M., Galanter, M. S., Goldfarb, L., & Lifshutz, H. (1996) · Journal of Addictive Diseases · doi:10.1300/j069v15n02_05 · Cited by 63 · see citing works
Health for People With a Terminal Diagnosis
Fryback, P. B. (1993) · Nursing Science Quarterly · doi:10.1177/089431849300600308 · Cited by 59 · see citing works
Attitudes and beliefs regarding spiritual care
Taylor, E. J., Highfield, M. E. F., & Amenta, M. O. (1994) · Cancer Nursing · doi:10.1097/00002820-199412000-00005 · Cited by 58 · see citing works
The Power of Nurse-Client Encounters
Sherwood, G. D. (2000) · Journal of Holistic Nursing · doi:10.1177/089801010001800207 · Cited by 55 · see citing works
Lived Experience of Spirituality in Taiwanese Women with Breast Cancer
Chiu, L., Clark, M. B., & Daroszewski, E. B. (2000) · Western Journal of Nursing Research · doi:10.1177/019394590002200104 · Cited by 51 · see citing works
Self-citationThe Correlation between Spiritual Well-Being and Health Behaviors
Waite, P. J., Hawks, S. R., & Gast, J. A. (1999) · American Journal of Health Promotion · doi:10.4278/0890-1171-13.3.159 · Cited by 51 · see citing works
The essential elements of spirituality among rural Thai elders
Tongprateep, T. (2000) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.2000.01212.x · Cited by 48 · see citing works
A Phenomenological Description of the Experience of Spiritual Distress
Smucker, C. J. (1996) · International Journal of Nursing Terminologies and Classifications · doi:10.1111/j.1744-618x.1996.tb00297.x · Cited by 48 · see citing works
God and the Search for Meaning Among Hospice Caregivers
Mickley, J. R. (1998) · The Hospice Journal · doi:10.1300/j011v13n04_01 · Cited by 48 · see citing works
Characteristics of Spirituality in the Lives of Women in a Rural Appalachian Community
Burkhardt, M. A. (1993) · Journal of Transcultural Nursing · doi:10.1177/104365969300400203 · Cited by 44 · see citing works
Religious Faith in Mexican‐American Families Dealing with Chronic Childhood Illness
Rehm, R. S. (1999) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.1999.tb00417.x · Cited by 43 · see citing works
Nurses' Willingness to Care for AIDS Patients and Spirituality, Social Support, and Death Anxiety
Sherman, D. W. (1996) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.1996.tb00353.x · Cited by 42 · see citing works
Robinson, K. M., & Kaye, J. (1994) · Research and theory for nursing practice · doi:10.1891/0889-7182.8.4.375 · Cited by 42 · see citing works
Testing two elements of spirituality in depressed and non-depressed elders.
Klaas, D. (1998) · PubMed · Cited by 39 · see citing works
Benzein, E., Norberg, A., & Saveman, B. (1998) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.1998.00820.x · Cited by 38 · see citing works
RECOVERY FROM ALCOHOLISM: A SPIRITUAL JOURNEY
Bowden, J. (1998) · Issues in Mental Health Nursing · doi:10.1080/016128498248971 · Cited by 36 · see citing works
van Wegberg, B., Bacchi, M., Heusser, P., et al. (1998) · Annals of Oncology · doi:10.1023/a:1008343219970 · Cited by 36 · see citing works
Pa, S., Gelberg, L., & Brown, M. (1994) · PubMed · Cited by 34 · see citing works
Christian Patients' Views of Spiritual Care
Conco, D. (1995) · Western Journal of Nursing Research · doi:10.1177/019394599501700303 · Cited by 30 · see citing works
Power and Spirituality in Polio Survivors: A Study Based on Rogers' Science
Smith, D. W. (1995) · Nursing Science Quarterly · doi:10.1177/089431849500800309 · Cited by 28 · see citing works
Mental Health Nurses' Spiritual Perspectives
Pullen, L. M., Tuck, I., & Mix, K. (1996) · Journal of Holistic Nursing · doi:10.1177/089801019601400202 · Cited by 27 · see citing works
Spirituality, aging, and the community-dwelling caregiver and care recipient
Forbes, E. J. (1994) · Geriatric Nursing · doi:10.1016/s0197-4572(09)90096-9 · Cited by 25 · see citing works
Pace, J. C., & Stables, J. L. (1997) · Journal of the Association of Nurses in AIDS Care · doi:10.1016/s1055-3290(97)80056-8 · Cited by 23 · see citing works
Faith, Prayer, and Health Outcomes in Elderly Native Americans
Meisenhelder, J. B., & Chandler, E. N. (2000) · Clinical Nursing Research · doi:10.1177/105477380000900207 · Cited by 23 · see citing works
Spiritual care for the critically ill
Clark, C., & Heidenreich, T. (1995) · American Journal of Critical Care · doi:10.4037/ajcc1995.4.1.77 · Cited by 22 · see citing works
Having Faith: Experiencing Coronary Artery Bypass Grafting
Camp, P. E. (1996) · The Journal of Cardiovascular Nursing · doi:10.1097/00005082-199604000-00006 · Cited by 22 · see citing works
For whenever I am weak, I am strong…
Cornette, K. (1997) · International Journal of Palliative Nursing · doi:10.12968/ijpn.1997.3.1.6 · Cited by 21 · see citing works
Making the Most and Making Sense: Ethnographic Research on Spirituality in Palliative Care
O’Connor, T. S. J., Meakes, E., McCarroll-Butler, P., et al. (1997) · Journal of Pastoral Care · doi:10.1177/002234099705100104 · Cited by 17 · see citing works
Women's mid‐life experience: an evolving consciousness of self and children
Dobbie, B. J. (1991) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.1991.tb01763.x · Cited by 16 · see citing works
Cancer Practice: A Multidisciplinary Journal of Cancer Care
Bennet, C. L. (1996) · JAMA · doi:10.1001/jama.1996.03530340074042 · Cited by 16 · see citing works
Religiosity as a Dimension of Well-Being
Åstedt-Kurki, P. M. (1995) · Clinical Nursing Research · doi:10.1177/105477389500400405 · Cited by 15 · see citing works
Spiritual and Coping Needs of Critically III Patients
Twibell, R. S., Wieseke, A., Marine, M. B., et al. (1996) · Dimensions of Critical Care Nursing · doi:10.1097/00003465-199609000-00002 · Cited by 15 · see citing works
Development of Brief Pictorial Instruments for Assessing Spirituality in Primary Care
McBride, J. L., Pilkington, L., & Arthur, G. (1998) · Journal of Ambulatory Care Management · doi:10.1097/00004479-199810000-00004 · Cited by 12 · see citing works
Nursing science: Major paradigms, theories, and critiques
Kieckhefer, G. M. (1990) · Journal of Pediatric Nursing · doi:10.5555/uri:pii:0882596390900336 · Cited by 5 · see citing works
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- Authors
- Chiu, L., Emblen, J. D., Van Hofwegen, L., Sawatzky, R., & Meyerhoff, H.
- Affiliations
- University of British Columbia (CA)
- Portland Community College (US)
- School of Nursing, Trinity Western University, Langley, Canada
- Trinity Western University, Langley, Canada
- Trinity Western University (CA)
- Venue
- Western Journal of Nursing Research
- Publisher
- SAGE Publications
- Published
- 2004-06
- Volume
- 26
- Issue
- 4
- Pages
- 405-428
- ISSN
- 0193-9459 (ISSN-L)
- 1552-8456
- OpenAlex
- W2114979604
- Cited by
- 269
- References
- 91
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 4 · 2023: 7 · 2022: 9 · 2021: 10 · 2020: 17 · 2019: 18 · 2018: 7 · 2017: 10 · 2016: 15 · 2015: 9 · 2014: 24 · 2013: 15 · 2012: 22
- FWCI
- 2.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Western Journal of Nursing Research (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Social Sciences › Demography › Workplace Spirituality and Leadership
- Social Sciences › Arts and Humanities › Philosophy › Study and Philosophy of Religion
- Keywords
- spirituality, health sciences, operational definitions, conceptual framework
- MeSH terms
- Culture, Humans, Models, Psychological, Terminology as Topic, Research Design, Spirituality
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