Bibliometric analysis of nursing studies on Corona Virus Disease 2019 in China

Miao Li,Rui-Teng Sun

1Graduate College,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China.

Abstract Objective: To analysis the current status and research focus of Corona Virus Disease 2019 (COVID-19) nursing research in China. Methods: China National Knowledge Infrastructure (CNKI),WanFang,Chinese Scientific Journals Database (VIP) and Chinese Biomedical Literature Service System (SinoMed) databases were searched for the literatures on COVID-19 nursing published from January 1,2020,to May 15,2020.The Bibliographic Items Co-occurrence Matrix Builder was used to perform bibliometric analysis on journals,authors,keywords,etc.of the articles,and SPSS 23.0 was utilized to cluster analysis of high-frequency keywords. Results:A total of 458 related articles and 429 first authors were extracted.There articles were published most in the journal of Chinese General Practice Nursing (12.25%).33 high-frequency keywords were extracted such as “COVID-19”,“nurse”,etc.,accounting for 50.19% of the total frequency.Co-word cluster analysis obtained four research hotspots:the psychological status and psychological care of medical staff fighting COVID-19;the nursing strategy of critically ill patients with COVID-19 and the psychological experience of nurses against COVID-19;operating room emergency management and infection prevention during epidemic;the triage management of novel coronavirus infection in fever clinic. Conclusion: The psychological status,the nursing strategy on critically ill patients,the psychological experience of nurses,operating room emergency management and infection prevention,the triage management of novel coronavirus infection in fever clinic had become hot topics when facing the COVID-19 epidemic.

Keywords:Corona Virus Disease 2019,Nursing,Bibliometrics,Cluster analysis,Research focus

Background

Since December 2019,Corona Virus Disease 2019(COVID-19)caused by novel coronavirus has occurred successively in China and many countries around the world.It has become the largest public health emergency in the world for the strong infectivity nature and no specific drug treatment.Epidemiological characteristics indicate that patients with COVID-19 and asymptomatic infections may become the source of infection,mainly through droplets and contact infection [1].China has included it in the category B infectious diseases as prescribed in Law of the People’s Republic of China on the Prevention and Control of Infectious Diseases and has taken preventive and control measures for category A infectious diseases[2].

As the COVID-19 continues to develop rapidly,China's medical and health system is facing tremendous pressure and challenges.Nursing work is an important part of it.Nurses have made outstanding contributions in treating critically ill patients,improving the treatment effect,increasing the cure rate and reducing the mortality rate.But there may be problems such as ignoring the psychological status of nursing staff and irrational allocation of nursing human resources.This study retrieved the domestic published nursing articles related to COVID-19 and applied the Bibliographic Items Co-occurrence Matrix Builder(BICOMB) [3]and SPSS 23.0 to analyze the current research status,so as to understand the research focus and direction and provide a reference for future nursing and research work.

Resources and methods

Literature source and retrieval strategy

Using China National Knowledge Infrastructure(CNKI),Wanfang,Chinese Scientific Journals Database (VIP) and Chinese Biomedical Literature Service System (SinoMed) as data sources to search the literature about COVID-19 nursing research,the search time was from January 1th,2020 to May 15th,2020.The search terms were “novel coronavirus pneumonia” or “coronavirus disease 2019” or “2019 novel coronavirus” or “2019-nCoV acute respiratory disease” or “COVID-19” or “2019-nCoV” or “NCP”,“nurse” or “nursing”,the two parts of the search terms were connected by“and”.The articles took COVID-19 related nursing content as the main part,types were limited to journals and conference papers.Exclusion criteria:(1) duplicate literature;(2) experience exchange,essay notices,short reports;(3) study unrelated to COVID-19 nursing;(4) unavailable full-text literature.

Methods of analysis

A total of 1,175 articles were retrieved,524 duplicates,193 articles were short reported,no full text and irrelevant to the topic and 458 articles were finally included.Each record included the title,author,journal,keywords,etc.BICOMB was used as the main tool to carry out bibliometric analysis on 458 documents,extracted fields such as year,journal,first author,keywords,etc.and counted the frequency of corresponding fields.After intercepting high-frequency entries according to a certain threshold,an excel table was generated and analyzed.Cluster analysis was conducted with SPSS 23.0 to analyze the relationship between high-frequency keywords and obtain the structure of research hotspots.

Results

High-frequency journal statistics

These articles were published in 150 journals,among the top 12 with a frequency of more than 7 times.Chinese General Practice Nursing topped the list publishing 56 pieces (12.25%),then came Chinese Nursing Research,36 pieces (7.88%),Journal of Nursing Science followed with the amount of 32(7.00%),as shown in Table 1.

Author analysis

High-frequency first author statistics.A total of 429 first authors were extracted in this study.As the first author,27 people published 2 or more “COVID-19”nursing articles,from high to low X Liu (3),L Liu (3),H Wang (2),YY Mi (2),N Li (2),L Zhang (2),etc.These 27 first-author publications accounted for 12.23%of the total literature.

High-frequency author statistics.This study involved 1999 authors.The authors who published 5 or more articles from high to low were:H Wang (16),L Shen(7),Y Wang(7),YY Mi(6),R Liu(6),X Liu(5),L Liu(5),etc.The frequency of occurrence of 20 authors who published 5 articles or more at the ratio of 4.94%,and 31 authors with 4 articles or more at the ratio of 6.77%.

High-frequency keywords and cluster analysis

High-frequency keywords and co-word matrix.

Through the extraction of keywords,a total of 724 keywords were extracted,with a total frequency of 2,068.We identified high-frequency keywords based on the Donohue formula [4].The formula is as follows:

Where “I” was the number of words whose word frequency was 1.“T” is the term frequency critical value of high-frequency and low-frequency words.

Table 1 Top 12 journals issuing 7 pieces or more

After calculating,the value ofTwas 31,which identified high-frequency keywords with a frequency higher than 31 times,but only 4.Therefore,to ensure the comprehensiveness of literature inclusion,the words with the cumulative percentage in the top 50%were used as high-frequency keywords in this study.Eventually,33 high-frequency keywords were extracted,accounting for 50.19%of the total frequency,as shown in Table 2.A 33 * 33 co-word matrix was constructed by using the co-word analysis method.Part of the co-word matrix was shown in Table 3.

High-frequency keywords cluster analysis.Using

SPSS 23.0 to carry out high-frequency keywords clustering analysis of COVID-19 nursing research [5],combined with professional knowledge,a total of 4 research hotspots were summarized.These research hotspots were the psychological status and psychological care of medical staff fighting COVID-19(keywords:7,14,19,22,16,21,32),the nursing strategy of critically ill patients with COVID-19 and the psychological experience of nurses against COVID-19(keywords:12,27,17,6,31,4,11,28,1,2,5,23,25),operating room emergency management and infection prevention during epidemic(keywords:9,24,3,13,15,26),the triage management of novel coronavirus infection in fever clinic(keywords:18,30,8,29,10,33,20),as shown in Figure 1.

Discussion

Clinical nurses are an indispensable group in fighting COVID-19.In the first-line isolation wards of the COVID-19 outbreak,clinical nurses were in direct contact with patients,working long hours,doing a lot of work and suffering from great mental stress.COVID-19 nursing research becomes particularly crucial at this time.Not only is there a need for careful and scientific care of COVID-19 patients,but the health of medical personnel is an essential part of the research.Up to May 15,2020,458 articles have been published.Many nursing experts and managers were involved in COVID-19 nursing research.

The results of this study indicated that the list of authors who have published two or more COVID-19 nursing studies as first authors was inconsistent with that of high-frequency authors.The authors H Wang and YY Mi appeared 14 times and 4 times more frequently in the author list than in the first author,indicating that these two authors cooperated with others more often.The authors of 7 authors,including L Liu,X Liu,N Li,and L Zhang,were 1 to 2 times higher,indicating that there may be collaborators.Still,the number of collaborations was relatively small and unstable.And most authors such as M Feng,Z Jiang,X Ye,etc.appeared on the author list as often as the first author,indicating that they were more focused on independent research and rarely cooperated.The results could guide other researchers to find experts and cooperation in the field of COVID-19 nursing studies.

From the high-frequency keywords,the research objects of COVID-19 nursing were mostly first-line nurses,medical staff,and critically ill patients,while the research tended to focus on psychological nursing,infection prevention and control,human resources,emergency management,etc.It reflected the currenthot spots of COVID-19 nursing research in China.In terms of journals,Chinese General Practice Nursing and Chinese Nursing Research were the leading research journals,followed by Journal of Nursing Science and Journal of Qilu Nursing,reflecting the continuous exploration of COVID-19 nursing in China by nursing staff.

Table 2 Top 33 high-frequency keywords in the field of COVID-19 nursing

Table 3 Co-word matrix of high-frequency keywords

In this study,the co-word cluster analysis was applied to the research of COVID-19 nursing,and four research hotspots were summarized according to the content.

The four research hotspots were as following:firstly,the psychological status and psychological care of medical staff fighting COVID-19 was a research hotspot in this field.Yuan and Huang et al.found through investigation that medical staff under COVID-19 epidemic were prone to unhealthy emotional problems such as anxiety and depression.The incidence of nurses’anxiety was higher than that of doctors.Gender and working years were also factors that affected bad mood.They proposed that the government and medical institutions should strengthen the psychological skills training of medical staff,and guide them to adopt positive coping methods to reduce psychological pressure [6,7].The results of the study showed that the use of intervention methods such as narrative nursing and psychological crisis three-level intervention could effectively relieve the psychological pressure of clinical nurses,reduce negative emotions and promote mental health [8-10].Yu et al.[11]suggested that psychological interventions such as psychological crisis interventions,strengthening emergency drills for public health emergencies,establishing professional beliefs,and strengthening female nurses ’labor protection should be initiated as early as possible to protect the physical and mental health of front-line female nurses.

Secondly,the nursing strategy of critically ill patients with COVID-19 and the psychological experience of nurses against novel coronavirus pneumonia was a research hotspot in this field.The researchers summarized the clinical nursing experience for patients with severe COVID-19.Including comprehensive treatment and nursing such as respiratory support nursing,psychological counseling,prevention of complications,anti-virus,anti-infection,nutritional support,etc.,could ultimately improve the clinical symptoms of patients and reduce the mortality of severe cases [12-14].Through understanding the psychological experience of nurses who fought against COVID-19 epidemic,we found that nurses have positive experiences of work responsibility,mission and confidence during work.At the same time,negative experiences of stress caused by the work environment and the psychological stress caused by new infectious diseases,insufficient ability to respond to public health emergencies and other experiences[15,16].Hospitals should strengthen psychological assistance and humanistic care for nurses,promote emergency disaster rescue nursing training,and improve hospital emergency management capabilities and levels.

Thirdly,operating room emergency management and infection prevention during epidemic was a hot research topic in this field.The operating room is an important place for patients to undergo surgical treatment and rescue.How to do emergency management during the epidemic,standardize the infection prevention and control process in the operating room,and effectively protect patients with suspected or diagnosed COVID-19 during surgery were the keys to avoiding cross-infection link.Zhu and Yu et al.believed that the emergency management of the operating room during the epidemic should mainly include strengthening relevant knowledge training for nurses and other personnel,doing a good job of human resources,materials,and environmental management,and formulating and initiating emergency treatment procedures related to surgery,etc.,so as to ensure the safety of patients and medical personnel [17,18].Other researchers believed that the focus of infection prevention and control was to do a good job of human resource deployment,operating room and equipment preparation,medical staff and patient protection,safe patient transfer,and post-operative air and object surface disinfection,etc.,to prevent and control patients from causing cross-infection during surgery[19,20].

Fourthly,the triage management of novel coronavirus infection in fever clinic was a hotspot in this field.Chen believed that we should scientifically build a one-stop hot clinic,standardize the pre-screening and triage process,screen for suspected cases and infections as early as possible,early detection,early reporting,early isolation,and early treatment to avoid cross-infection,so as to promote the smooth progress of epidemic prevention and control work [21].Chen thought that it was necessary to rationally arrange fever clinics,intelligently allocate human resources,strengthen relevant personnel training,and strictly implement hospital prevention and control measures,etc.,to effectively improve the nursing staff's ability to respond to COVID-19 epidemic and ensure the safety of nursing [22].Other researchers had also put forward their own experience in the management of triage of fever outpatient pre-examination,striving to achieve early detection,early isolation and early treatment of novel coronavirus infection cases[23,24].

This study has certain limitations.We only searched the Chinese databases.The next step should be to expand the search scope for domestic and foreign COVID-19 nursing research hotspot analysis,compare the differences between home and abroad and provide suggestions for China’s COVID-19 scientific nursing.

Conclusion

COVID-19 nursing research was an important research content since the outbreak of novel coronavirus pneumonia.This research revealed the current status of research in this field through the bibliometric analysis and co-word clustering analysis of COVID-19 nursing related literatures and summarized four research hotspots,which helped to clarify the development status of COVID-19 nursing research and hot spots,provided some references for nursing work and research.