Visualization analysis of the study of fund-sponsored clinical nursing papers

The fund-sponsored clinical nursing literatures that were published in the core journals of nursing (Chinese Journal of Nursing, Chinese Nursing Research, Journal of Nursing Science, Chinese Journal of Practical Nursing, Chinese Journal of Modern Nursing, Journal of Nurses Training, Nursing Journal of the Chinese People’s Liberation Army, Journal of Nursing (China), Chinese Nursing Management, Journal of Nursing Administration, Modern Clinical Nursing, and Shanghai Nursing) were used as study subjects. All of the core journals were included in the 2015 edition of “Chinese Science and Technology Journal Citation Reports (Core edition)”. We searched a digital journal full-text database (Wanfang database) according to journal titles, and the paper publication time was set between 2012 and 2016. The papers retrieved from searched results were read one by one and were manually screened and evaluated strictly according to inclusion and exclusion criteria. Ultimately, 7742 fund-sponsored clinical nursing papers were included as the sample data for this study.

Fund-sponsored clinical nursing papers related to basic nursing, health assessment, internal medicine care, surgical care, obstetric and gynecological care, pediatric care, otorhinolaryngological care, dermatological care, emergency care, intensive care, psychological care, Chinese medicine care, humanistic care, other clinical nursing theory and technology, and novel medical technology-aided care were included. Papers discussing nursing education; nursing management; care provided outside of the hospital, such as stricken area, community, and home care; knowledge links; tips; seminars; minutes; notices; humanistic excellence; book reviews; and other column literature were excluded.

The visualization software CiteSpace, which was developed by Dr. Chaomei Chen at Drexel University in the United States, was used in this study. The 7742 included literatures were selected through the Wanfang database, and the bibliographical reference data were exported in the RefWorks plain text format. The data were imported into the CiteSpace software, the literature publication time selected was between 2012 and 2016, and the time interval was set as 1 year. The selected node types were author, institution, and keywords. The top 50 data entries that had the highest frequencies of node type of various time intervals were selected, the default value was selected for term sources, the minimum spanning tree simplification algorithm was selected for map pruning, the visualization view was the classical view, and the mapping knowledge domains were shown after running. The calculated data were exported through the backstage of CiteSpace, and the results were analyzed together with the map.

There was a total of 183 nodes (N) and 112 links (E) in the mapping knowledge domains of author collaborations (Figure 1), with a density of 0.0067. In the figure, each node represents an author, the size of the node represents the publication frequency of the author, and the thickness of the circle is positively proportional to the publication frequency of the corresponding year. The number of lines represents the collaborations between authors, and the thicknesses of the lines represent the closeness of the collaborations between authors. Yan Hu, Qixia Jiang, and Weili Wang occupy relatively important node weights in the author co-occurrence map. Through the connection lines between nodes, we can intuitively observe that there are apparent collaborations between authors in the clinical nursing field. Yan Hu, Zhenqi Lu, Huiling Li, Yuxia Zhang, and Ying Gu form the first author collaboration group, with Yan Hu as the center. Qixia Jiang, Qing Peng, Xin Zhou, and Li Liu form the second author collaboration group, with Qixia Jiang as the center. Weili Wang and Jingfang Hong form the third author collaboration group, with Weili Wang as the center. In addition, the map indicates that small academic groups with fewer collaborators are scattered around.

Figure 1

There were a total of 120 nodes and 66 links in the mapping knowledge domains of the collaborations between institutions (Figure 2), with a density of 0.0092. In the map, each node represents an institution, and the larger the node, the more the papers published by the institution. The number of lines represents the collaboration between the institutions, and the thicknesses of the lines represent the closeness of the collaborations between the institutions. The institution whose frequency was ranked at first was the School of Nursing of Fudan University, followed by the First Hospital of Shanxi Medical University and the School of Nursing of Anhui Medical University. A total of 28 research institutions had more than 20 publications, and the institutions were distributed in 13 provinces, cities, and autonomous regions. In terms of region, Jiangsu province had the most, with eight institutions, followed by Shanghai, with five institutions; Guangdong province, with three institutions; and Hubei province and Guangxi Zhuang autonomous region, each with two institutions; Shanxi province, Anhui province, Heilongjiang province, Sichuan province, and Henan province and the municipalities of Chongqing, Beijing, and Tianjin had one institution each. In terms of the types of institutions, among the 28 listed, 11 were medical schools, accounting for 39.29%, and 17 were hospitals, accounting for 60.71%; 16 of the 17 hospitals were affiliated to medical schools (Table 1).

Figure 2

Table 1

Statistics of publication frequencies of research institutions.

In terms of collaborations between institutions, there were apparent collaborations between the School of Nursing of Fudan University, the School of Nursing of Nanjing University, the Nursing College of Nantong University, the Children’s Hospital of Fudan University, Fudan University Shanghai Cancer Center, Huadong Hospital of Fudan University, the First Affiliated Hospital of Nanjing Medical University, and Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. The Second Military Medical University had apparent collaborations with the School of Nursing of Shanghai University of Traditional Chinese Medicine, the Sixth Affiliated People’s Hospital of Shanghai Jiao Tong University, and Harbin Medical University Daqing Campus. There were collaborations between the School of Nursing of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, and Nanjing General Hospital of the Nanjing Military Region. In addition, some institutions that scattered around with more publications were mainly medical colleges, which had collaborations with their affiliated hospitals, such as Shanxi Medical University and the First Hospital of Shanxi Medical University, the School of Nursing of Sun Yat-Sen University, and the First Affiliated Hospital of Sun Yat-Sen University.

Keyword analysis is a word frequency analysis method that can be used to determine the hotspots, knowledge structure, and development trends of certain research fields.2 There were a total of 100 nodes and 211 links in the co-occurrence mapping knowledge domains of keywords (Figure 3), with a density of 0.0426. In the map, larger nodes suggest the higher co-occurrence frequency of a given keyword and also indicate that the study objective of the literature associated with the keyword is a hotspot of clinical nursing research. From the map, it can be found that a total of 46 keywords appear 20 or more times. “Quality of life” has the highest frequency, with 273 occurrences. Keywords with occurrence frequencies of more than 100 times include “quality of life”, “nursing intervention”, “health education”, “influencing factor”, “diabetes”, “the elderly”, “stroke”, “complications”, and “breast cancer”. In the mapping knowledge domains, the meanings of certain keywords are extremely close or they are different expressions of synonyms; these words should be merged, including “the elderly” and “the elderly patients” and “extended care” and “continuity of care”. After merging similar words and exporting data backstage, the results are shown in Table 2.

Figure 3

Table 2

Statistics of high-frequency keywords in clinical nursing.

The CiteSpace software was used to investigate the keywords, and five bursting keywords were identified: “laparoscopy”, “catheterization”, “ventilator-associated pneumonia”, “Chinese medicine care”, and “peritoneal dialysis” (Table 3).

Table 3

Burst degree and burst year of keywords.

The type of study that uses visualization means to describe author structure has become the forefront of bibliometrics and has begun to attract the attention of scientific researchers. The in-depth analysis of high-frequency authors in the clinical nursing field and the analysis of the associations between authors with close collaborations allow the investigation of the research themes and academic thoughts of the collaboration groups. The collaboration groups of Yan Hu mainly come from the School of Nursing of Fudan University, Fudan University Shanghai Cancer Center, and the Children’s Hospital of Fudan University. By searching relevant works and the literature, a certain academic association between the authors in the collaboration group was noted. Professor Yan Hu and Zhenqi Lu undertook the chief editorial work of the monograph “Practical Cancer Care”; Yuxia Zhang and Ying Gu participated in the writing of “Pediatric Nursing (bilingual)”, which was edited by Professor Yan Hu; and Ying Gu participated in the writing of “The Theory and Practice of Evidence-based Nursing”, which was edited by Yan Hu. The research projects of Professor Yan Hu included the study of evidence-based nursing, evidence translation, and a series of studies on improving the quality of life of breast cancer patients. In recent years, Yan Hu has been the editor of “Evidenced-based Nursing”, “Nursing Research”, “Practical Cancer Care”, and other teaching materials and has had a great influence in the field of clinical nursing research. By searching for other authors in the collaboration group, the themes of the literature published by the collaboration group were identified as mainly cancer care, evidenced-based nursing practice, and pediatric care, including studies of social support and quality of life for breast cancer and acquired immune deficiency syndrome (AIDS) patients, the care for children with congenital heart disease, and premature infant- and other pediatric-related care.

Qixia Jiang edited and published the monographs “Pressure Ulcer Nursing”, “A Practical Guide for the Prediction and Prevention of Pressure Ulcers in Adults”, and “A Clinical Practical Guide of Wound Care”. Her nursing research projects are mainly related to wound care. Some time ago, she began studying various methods for pressure ulcer-based wound care, and she has rich experience in treating various wounds; in particular, she conducted an in-depth study on the diagnosis and treatment of pressure ulcers, diabetic foot ulcers, traumatic ulcers, and postoperative wounds that are difficult to heal and introduced the negative pressure wound therapy concept. The institutions of the authors of the Qixia Jiang collaboration group mainly include Nanjing General Hospital of Nanjing Military Command and Jiangsu Provincial Hospital of Traditional Chinese Medicine, and the themes of papers published through collaborations mainly include prevention and treatment of pressure ulcers, prevention and treatment of diabetic foot ulcers, and the diagnosis and treatment of other chronic wounds that are difficult to heal. The published papers described wound treatment, infection prevention, wet therapy, vacuum-assisted closure, and other treatment methods.

Professor Weili Wang serves as the dean of the School of Nursing of Anhui Medical University and serves as the chief editor or associate editor of “Theory and Practice of Psychological Nursing”, “Clinical Nutrition”, “Introduction to Nursing”, “Thinking and Communication”, “Interpersonal Relationship and Communication”, and other teaching materials. The institutions of the authors in his collaboration group mainly include the School of Nursing of Anhui Medical University. The papers published by the collaboration group of Professor Weili Wang mainly cover digestive system cancer care and gynecologic and breast cancer care, which include the quality of life, self-efficacy, psychological distress, coping styles, therapeutic communication, and other related content of cancer patients. In addition, there are scattered collaborations between authors in the map; there are fewer authors in Professor Wang’s collaboration group, and the collaborations are mainly within the same institution or between the Medical University and its affiliated hospitals.

The quantity and quality of research papers are important scales to measure the scientific research level, performance, and strength of researchers.3 Among the top 28 institutions ranked by their publication numbers, the institutions with frequencies more than 20 can be divided into two major categories: hospitals and medical universities, to a certain extent because the subjects of this study are clinical care papers. There are 120 institution nodes in the map, while there are only 66 collaboration connection lines between them, suggesting that the collaborations between institutions were not very close and that the collaborations were scattered, rather than forming a large collaboration network. The collaborations were mainly regional within a certain area, and cross-province and cross-city collaborations between institutions were rare.

The research hotspot in a field refers to the topics and views that are discussed in a large number of research papers with the same theme in a certain period of time.4 Keywords are an important component of the literature: relevant literature in certain directions can be searched through keywords, and the study focus of the literature can also be understood through the keywords. Therefore, the network knowledge domains formed by the CiteSpace software analyzed the co-occurrence frequencies of the same groups of keywords in the literature. From the sizes of the nodes in the map, we can intuitively identify the scales of the occurrence frequencies of keywords in clinical nursing studies in the past 5 years, which represent how much attention is paid to the contents of these keywords in a certain period of time. Thus, the hotspots and foci of nursing research in a certain period of time can be obtained through keyword analysis. By merging similar words, the following four hotspots in clinical nursing research were ultimately classified and summarized.

Burst word refers to a term for which the occurrence frequency increases faster over a shorter period of time or the growth rate of its usage frequency increases significantly. Burst words have the property of dynamic change and can accurately reflect the frontiers of the relevant discipline.19 In this study, we used the burst word detection technology of CiteSpace software, the knowledge domains, and bursting keywords to discover research frontiers in the clinical nursing field.

By analyzing visualization maps and burst words, the development trends of research in the clinical nursing field can be obtained. In 2012, the burst words were “laparoscopy” and “catheterization”. Laparoscopic surgery, as a relatively new surgical procedure, is different from traditional surgery. It has the advantages of less trauma, less pain, quick recovery, and low recurrence rate and has been widely used in the diagnosis and treatment of diseases.20 Intravascular catheterization is now widely used clinically and has provided an ideal channel for patients for infusion, parenteral nutrition, tumor chemotherapy, thrombolysis, and others. With the clinical application of new medical technologies, laparoscopy, and catheterization-aided care, complication prevention care and perioperative care have gradually become the new research trends. In 2013, the burst words were “ventilator-associated pneumonia” and “Chinese medicine care”. The “National Nursing Profession Development Plan (Year 2016-2020)”21 emphasizes that Chinese medicine should actively provide dialectical care and specialized care with traditional Chinese medicine characteristics, innovate the Chinese medicine care model, improve the Chinese medicine care level 21, and make a full play of Chinese medicine care in disease treatment and rehabilitation promotion. In addition, with the wide use of ventilators, preventing and treating ventilator-associated pneumonia have become keys of clinical nursing. These findings suggest that studies on Chinese medicine care and ventilator-associated pneumonia care have been further developed. In 2014, the burst word was “peritoneal dialysis”, due to the aging trend of the population and the increase in the number of patients with uremia caused by various diseases over the years; the burst word represents an important treatment method for the advanced stages of renal disease, and diet management, complication prevention, treatment, and care of peritoneal dialysis patients will become the development trends of the clinical nursing field in the future.