A bibliometric analysis of nursing research in COVID‑19 in China

Ke PENG, Qiu‑Lu MAI, Mei‑Qi MENG, Dou WANG,Xiao‑Yan ZHANG, Yu‑Fang HAO

School of Nursing, Beijing University of Chinese Medicine,Beijing, China

ABSTRACT

Objective: The objective of this study is to analyze the current status of nursing research in COVID‑19 through literature metrology and provide ideas and references for further research.

Methods: The search terms such as “novel coronavirus/COVID‑19” and “nursing” were used to search the nursing‑related papers published in China National Knowledge Infrastructure, Wanfang Data, VIP Data, SinoMed, Web of Science, and PubMed from October 1, 2019, to March 30, 2020.The bibliometric methods and related software were used for analysis.

Results: A total of 234 articles were included from 48 journals, and core journals accounted for 61.1%.There were five nursing literature topics and 14 document types.There is a cooperative relationship between six institutions.Keywords include nursing staff, nursing management, and protection.

Conclusions: The opening of journal green channels and the establishment of database columns will help the spread of anti‑epidemic academic results.The topics of nursing literature include clinical nursing, nursing management, prevention and control, nursing education, and social surveys.Nursing literature types focus on cross‑sectional research and experience summary; the cooperation between researchers and research institutions has begun to take shape, and it is recommended to strengthen the research on iatrogenic injuries and nurse training in future nursing research.

Keywords: 2019 novel coronavirus, bibliometric analysis, COVID-19, journal, nursing

INTRODUCTION

Since November 2019, there have been outbreaks of novel coronavirus pneumonia (also named COVID‑19)[1]in many places in China.On January 30, 2020, the World Health Organization issued a statement to confirm it as a major public health emergency of international concern.[2]Nursing is an indispensable part of the fight against the epidemic in the field of public health.Faced with the current situation of “no experience” and “no evidence,” we have to start from scratch and cross the river by touching stones.As a carrier of evidence dissemination, medical journals will contribute to communication, catalytic innovation, and guidance in the field of nursing in epidemic situations.[3]This article aims to analyze the nursing literature in the COVID‑19 in China through bibliometric methods, understand the main content and types and hot spots in the current research, and discuss the existing gaps in nursing research.

METHODS

Retrieval strategy

A researcher uses (2019 coronavirus OR novel coronavirus OR COVID‑19) AND (nursing OR nurse OR prevention and control) as search terms in China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Data, Chinese Biomedical Literature Service System, Web of Science, and PubMed for related literature.The language of publication is not limited, and the publication time is from October 1,2019, to March 30, 2020.

Inclusion and exclusion criteria

Inclusion criteria were as follows: (1) the document type is the journal article and (2) the research institutions are in China.Exclusion criteria were (1) nonnursing literature and (2)documents first published online but are withdrawn later.

Literature screening

Two researchers independently completed the literature screening according to the literature inclusion and exclusion criteria.After screening, they conducted cross‑checking.They discussed the decision with the third researcher if they have disagreements.The literature screening is divided into three links: (1) duplicate documents are removed; (2) the titles and abstracts are read; and (3) the full text is read through the selection criteria.

Methods of input data and analysis

Excel was used to extract and analyze data types (expert consensus, clinical research, systematic review, guidelines,etc.), publication dates, and journals.The CiteSpace 5.4 R1 was used to extract and analyze data from literature authors,research institutions, and keywords.CiteSpace software is an information visualization software developed by the American Drexel University Chen Meichao team to predict new trends and demonstrate new trends in a certain research field.It runs in a Java environment and displays the results in the form of a knowledge graph.It has been widely used in medicine, information, statistics, and other fields.[4,5]

RESULTS

Literature search results

The initial acceptance of the literature included 523 articles (230 articles from CNKI, no articles from Wanfang Data, 71 articles from VIP Data, 119 articles from SinoMed, 63 articles from Web of Science, and 40 articles from PubMed),145 duplicate articles were removed, and 142 articles were removed after reading the title and abstract, 2 articles were deleted after going through the full text, and 234 articles were finally included.

Publication of literature

Since October 1, 2019, the number of COVID‑19‑related nursing literature has been increasing.As of March 30, 2020,a total of 234 nursing articles have been published.They derived from 48 journals, including 43 Chinese journals and 5 English journals (Crit Care, Curr Med Sci, J Adv Nurs,JAMA Netw Open, and Psychol Med).There were 17 kinds of nursing journals and 31 kinds of other medical management journals.Of the 48 journals, six kinds of journals with 10 or more COVID‑19‑related articles were as follows: Chinese General Practice Nursing (64 articles, 27.4%), Chinese Nursing Research (34 articles, 14.5%), Journal of Qilu Nursing (16 articles, 6.8%), Journal of Nursing Science (16 articles, 6.8%),Journal of Nursing (14 articles, 6.0%), and Nursing Journal of Chinese People’s Liberation Army (13 articles, 5.6%).The core journals publish 143 articles, accounting for 61.1%.

Nursing literature types and topics

There are 14 types of nursing literature, but there is a large gap in the number of documents among different types.The document type with the largest number of articles is experience summary (100 articles, 42.7%), and the document types with the smallest number are case series (1 article, 0.4%)and cohort study (1 article, 0.4%).The document types with the number of documents ＞10 are experience summary (100 articles), cross‑sectional studies (48 articles), reviews (17 articles), qualitative studies (14 articles), case reports (13 articles), and case–control studies (13 articles) [Table 1].

Table 1: The types and number of nursing literature in COVID‑19 in China

There are five topics in nursing literature, and the topic with the most number of articles is clinical nursing (119 articles, 50.9%), followed by nursing management (66 articles, 28.2%), prevention and control (38 articles, 16.2%),nursing education (7 articles, 3.0%), and social surveys (4 articles, 1.7%).Among them, there are 12 document types on clinical topic, four document types on management topic,eight document types on prevention and control topic, four document types on teaching topic, and one document type on social survey topic [Tables 2].

Table 2: The document type distribution on the literature topics

Authors’ cooperation

The authors’ cooperation network map has 110 nodes and 207 connections, with centrality of 0.0345 [Figure 1].Each node in the graph represents an author, the size of the node represents how many articles the author has published, and the connection indicates that these authors have cooperative relationship.The thicker the connection, the closer the cooperation between the authors.In Figure 1, there are multiple closely‑working scientific research teams, the largest of which is Hui WANG team, composed of Jun‑Huan CHEN,Tie‑Ying ZENG, Shi‑Yu YIN, etc., followed by Xin ZHANG,Su‑Hong CHEN team which composed of Yan‑Bo YU and Ya‑Jin XUE, and the research team composed of Yun‑Yan XIAN YU,Xue‑Fen WANG, Zhong‑Xiang CAI, and Xin YANG, all have more than five participants.In addition, papers wrote by two authors are more commonly.At the same time, there are also some authors who have few cooperative relations but have many articles, such as Yuan‑Yuan MI.

Institutional cooperation

The institutional cooperation network map has 40 nodes and 6 connections, with centrality of 0.0077 [Figure 2].Each node represents an organization, and the size of the node is proportional to the number of documents published by the organization.The connection indicates that there is a cooperative relationship between the organizations.The thicker the connection, the closer the cooperation between the organizations.From the perspective of cooperation, independent institutions published more documents, and there are only six pairs of documents issued by mutual cooperation.Among them, there are three pairs of the cooperation of different departments in the same hospital, one pair of the cooperation between the college of nursing and affiliated hospitals of a university,one pair of the cooperation between affiliated hospitals of the same university, and one pair of the cooperationbetween the affiliated hospitals of different universities.In terms of institutional attributes, hospitals/nursing departments (88.5%) account for more than nursing colleges (11.5%).In terms of the number of articles published,West China Hospital of Sichuan University (26 articles), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology (25 articles), Union Hospital of Tongji Medical College of Huazhong University of Science and Technology (18 articles), Fifth Medical Center of PLA General Hospital (6 articles), The Third Affiliated Hospital of Sun Yat‑Sen University (5 articles), and Renmin Hospital of Wuhan University (5 articles) all have five or more articles.

Figure 2: Organization cooperation knowledge map

Keyword clustering

There are 55 nodes and 184 lines in the knowledge map with a centrality of 0.1239 [Figure 3].Each node represents a keyword,and the size of the node represents the frequency of keyword occurrence.After COVID‑19 and nursing words were removed and the words with the same meaning were removed, the top five keywords in the order of high frequency to low were nursing staff, nursing management, protection, nosocomial infection, and mental health, as shown in Table 3.

Figure 3: Keywords cooccurrence knowledge map

Table 3: High‑frequency keywords in COVID‑19 nursing literature

DISCUSSION

The opening of journal green channels and the establishment of database columns contribute to the spread of anti‑epidemic achievements.With the development of medical technology and the increase of scientific researchers in China, the output of medical papers is also increasing, even exceeding the demand of journals for manuscripts and increasing the workload of reviewing manuscripts, which makes the publishing cycle of papers relatively longer;[6]however, too long publishing delay will have a negative impact on the development of disciplines and the productivity of scientific and technological achievement transformation.To avoid the loss of timeliness of high‑quality innovative and prospective papers, different journals will open “green channel” for papers of their own topics.After the outbreak of COVID‑19,publication strategies in view of COVID‑19, for example,Chinese General Practice Nursing opened the green channel and Chinese Journal of Modern Nursing eliminates the layout expense, solved the status of “zero experience” and “zero evidence” of the COVID‑19 to a great extent.The first nursing literature[7]on epidemic situation in China and measures to prevent the epidemic from spreading rapidly was published at 13:19 on January 31, 2020, in Chinese General Practice Nursing, from when the COVID‑19 was reported only 2 months.The establishment of COVID‑19 research results first published on open access (OA) network platform of CNKI can also accelerate the spread of academic results of anti‑epidemic.Among China’s four major databases, CNKI has the highest volume of literature.However, with the rapid publication of journal papers on OA, the number of papers voluntarily withdrawn by authors is also increasing.The withdrawal statement is roughly “some contents need to be modified” or “at the request of authors,” which will undoubtedly make other researchers question the reliability of papers on OA and the authority of journals.Therefore, it is suggested that researchers should pay attention to the integrity of scientific research in the process of writing and publishing papers; journals should improve the peer‑review process, establish a complete and comprehensive paper supervision system, and make up for the loopholes in the publishing process; and the government should improve relevant academic laws and regulations to jointly create a real and friendly academic environment.[8]

There is a wide range of topics in nursing literature.Because nursing is a unique and independent scientific knowledge system, which can explain and illustrate the relationship among human, society, environment, and health, as well as guide and promote the development of nursing practice,[9]the 2019 novel coronavirus‑related nursing researches include not only clinical nursing, nursing management, and nursing education, but also prevention and control and social investigation.However, the number of documents under different topics shows unbalanced development that the average number of clinical nursing,nursing management, and prevention and control literature was 74.3, while the average number of nursing education and social investigation literature was 5.5.Clinical nursing,as the first line of fighting against the epidemic, has become an important topic in nursing literature by constantly raising nursing questions and summarizing experiences on the nursing contents of COVID‑19 patients through practice so as to reduce complications and improve cure rate.[10]As an important part of hospital management, nursing management that how to control clinical nursing through planning, organizing, and guiding human, material, and financial resources to provide effective and economical nursing services for patients[11]has become the second major topic in nursing literature.Since COVID‑19 was incorporated into Class B infectious diseases stipulated in the Law of the People’s Republic of China on the Infectious Disease Prevention and Control[12]and preventive and control measures for Class A infectious diseases were adopted, how to set up emergency wards, monitor and manage nosocomial infections,formulate plans, and train and rehearse personnel and other prevention and control measures in designated hospitals also need to be studied.[13]Therefore, prevention and control has become the third major topic in nursing literature.Nursing education is the basis for training high‑level and high‑quality nursing personnel.The epidemic situation has exposed the lack of emergency and psychological crisis management in nursing curriculum.At present, studies have shown that the COVID‑19 epidemic situation has a certain impact on the occurrence of anxiety and depression symptoms of nursing undergraduates.In the view of this, effective psychological intervention measures are needed to promote their mental health.[14]Coupled with the government’s call to “suspend classes and study continuously”under the epidemic situation, whether students can fully adapt to online teaching is worth considering in nursing education.

Although it is not possible to have face‑to‑face communication and interviews with students nowadays, online tools such as WeChat, telephone, video, and electronic questionnaire can be adopted for research.Less research on social investigation may be due to busy clinical front‑line work and the risk of infection in the community.It is suggested that community nurses with spare capacity carry out research and analysis on epidemic situation cognition, lifestyle changes, disease prevention, and other aspects of community residents while ensuring their own safety.

There are plenty of hot spots in nursing research.Keywords are a concise summary of the core content of a document.Through the analysis of keywords, hot spots and development trends in the nursing research field of COVID‑19 can be found.[15]At present, there are various hot spots in nursing research, mainly including nursing staff, nursing management, prevention and protection, hospital infection, disinfection and isolation, and mental health, among which the first five hot spots coincide with the first three research topics (clinical nursing, nursing management, and prevention and control).Nursing staff is the practitioner of clinical nursing; prevention and protection,hospital infection, and disinfection and isolation are the specific aspects of prevention and control; nursing management is the challenge and responsibility that nursing managers have to take to protect patients and nursing staff from epidemic situation.The above three are indispensable.Mental health has become a hot research topic in the epidemic situation, which is the concrete manifestation of expressing humanistic care to patients and medical staff.This is consistent with the research by Maet al.[16]in 2020.The research trend in the future is also generally clinical holistic control based on clinical nursing, nursing management,and prevention and control measures.However, stress injuries,primary hospitals, large general hospitals, and cognition, which have the least occurrence of keywords, are easy to be neglected in clinical nursing.Due to the limitations of external environment and material supply, frontline nurses often need to continuously wear isolation protective articles for 4–8 h or longer.Long‑term wearing of medical protective masks, goggles, protective masks,and protective clothing in the hot and humid environment are extremely easy to cause nasal and facial pressure injuries.[17]How to help nurses reduce iatrogenic injuries is also worth researchers’ consideration.Different types of hospitals, such as grass‑root hospitals and large general hospitals, have different responsibilities in the face of the epidemic.Management modes and prevention and control measures should also be adapted to local conditions to maximize the role of each hospital.By understanding the cognition of community residents, medical students, and nursing staff on the epidemic situation of COVID‑19, we can help them to eliminate panic psychology,observe safety discipline, and promote the implementation of prevention and control measures, providing the basis for relevant departments to further adopt epidemic prevention and control strategies.[18]It is suggested that nursing researchers should pay attention to nurse safety, localization of prevention and control,and social investigation.

There are various types of nursing literatures.There are 14 kinds of literature types, both quantitative and qualitative.According to the five topics, the literature types of clinical nursing are mainly cross‑sectional research and experience summary; the literature types of nursing management and prevention and control are mainly based on experience summary; the literature types of nursing education are mainly based on review and case–control; the literature types of social survey literature are all cross‑sectional study.Overall, experience summary and cross‑sectional studies account for half of the nursing literature, which may be related to the purpose and methodological characteristics of the research types.First‑hand information on COVID‑19 prevention and control needs to be received, absorbed,and transmitted in the hands of nursing staff in a real,fast, and refined way.However, complicated experimental processes such as the design of research, ethical review,and controlling research obviously cannot meet the requirements of rapid transmission.Therefore, it is also very important to write experience summary articles with lower level of evidence in public health emergencies.Cross‑sectional study can not only describe the factors related to COVID‑19, evaluate the prevention and treatment measures and effects, but also provide basic data for disease monitoring or other epidemiological studies.It is also a good choice to write nursing documents related to epidemic situation.Due to its large sample size, long‑time consumption, ethical review, and other factors, there is currently only one randomized controlled trial (RCT) on the effect of preventing nasal and facial pressure injury of medical staff.[19]However, RCT, as the “golden standard”for clinical efficacy evaluation, has the least risk of bias to research and is an important method to obtain high‑quality evidence.It is suggested that more attention should be paid to RCT in future nursing research in COVID‑19.

The cooperation between researchers and research institutions has begun to take shape.By analyzing the cooperation degree between the author groups and the institutions, we can grasp the depth and breadth of scientific research activities in related fields as a whole.[15]There have been many closely‑coordinated teams.Among them, the cooperation between the two authors is the most common form, and there are three teams for more than five authors to publish their papers in cooperation.The current author cooperation network is characterized by scattered and small scale.According to the knowledge map of institutional cooperation, six‑pair institutions of the 40 scientific research institutions cooperate with each other, and the cooperation tends to be within hospitals, between nursing colleges and their affiliated hospitals, and between affiliated hospitals of the same university, which is consistent with the conclusion drawn by Houet al.[20]from the analysis of China’s nursing scientific research team in 2015.So far, researchers and research institutions are in the initial stage of cooperation.It is suggested that researchers or research institutions should take advantage of the epidemic situation to encourage nurses and nursing institutions of different sizes, different regions, and different specialties to cooperate in scientific research practice,which will be beneficial to broaden researchers’ vision, collision of thinking, and innovation of scientific research.

CONCLUSIONS

Under the COVID‑19 epidemic situation, researchers, periodical workers, database platforms, and the Chinese government are working together to fight the epidemic.The opening of the periodical green channel and the establishment of the database column have promoted the spread of anti‑epidemic achievements and broken the status of “zero evidence.” The topics of nursing literature are mainly distributed in clinical nursing, nursing management, and prevention and control work.In the future, research on nursing education and social survey should be strengthened.There are many types of nursing literature researches, but there is still a lack of RCTs with less bias risk in clinical nursing.The cooperation between researchers and research institutions has begun to take shape.In addition, it is suggested that researchers should not neglect iatrogenic injury, nursing training and education, and sociological investigation while paying attention to clinical,management, prevention and control, and psychology.This article focuses on analysis of the nursing documents in the early and middle stages of COVID‑19 epidemic, hoping to inspire the future research on nursing and anti‑epidemic.It will be a valuable anti‑epidemic wealth to analyze all the related nursing documents after the epidemic is over.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.