An overview of patterns and trends in nursing publications from the People's Republic of China

Similar to many countries in the world, nursing has long held a place in the historical fabric of civilization in the People's Republic of China.¹ At present, there are more than 4 million nurses in China; however, the professionalization of nursing is relatively recent, and similarly to many European countries the past two decades have seen an advancement in educational levels for nurses up to and including PhD.² This positive development for nursing arose after the development of the People's Republic of China, however, the exact number of nurses educated to PhD level is not clear. Professional development is ongoing, with desires for increased education and specialism in response to rapidly changing health trends, technological advances, and population changes.³ Indeed, health care reform, and nurses’ key role in this, is high on political agendas in China.⁴

Within this context, much is done to strengthen the work environment for nurses. Leadership is key in this regard and Chinese nursing has a big commitment to the growth and development of nursing leadership. The Chinese Nursing Association, for example, hosts an annual National Nursing Management Reform and Innovation Forum with a clear focus on a professionalizing agenda for nurses in China.⁵ Caring is also developing as a key facet of nursing within both educational curricula and clinical practices.⁵ For example, the Chinese Nursing Development Program (2011–2015) recommended that nursing schools increase the humanities content in their curriculum to strengthen caring consciousness. Increasingly, Chinese nursing scholars have been engaging in research in the field of caring and also in other important facets of nursing.⁵ There is also a growing awareness of the need to encourage improved evidence-based practice among nurses, with increasing efforts in this regard⁶ and an increased number of Chinese peer-reviewed journals, with a distinct focus on nursing research.

However, beyond this, there is little systematic understanding of the patterns and trends of research that are published by Chinese nursing scholars. As a result, this article aimed to provide a brief overview of general patterns and trends in publications from China in nursing journals and suggest ways in which this information could be utilized to develop a successful publication pathway for Chinese nurses in the future.

Overall, there has been a steady increase year by year in publications categorized as nursing from China since 2009, with the majority of published papers categorized as research. This is a very positive finding given the importance of research and scholarly output about the professional development of nursing as an academic discipline.¹⁸ This trend may also be consistent with a generalized trend of ongoing strengthening of Chinese universities and educational reform enacted by the Chinese Ministry of Education of the People's Republic of China over the past 25 years.¹⁹ Indeed, this study revealed that top-ranking Chinese universities¹⁹ such as Peking University and Fudan University score highly in terms of number of publications listed within the database.

This is an important finding as both Peking and Fudan Universities are ranked in the top five universities in China, and they feature among the best in the world (24th and 109th ranks, respectively).¹⁹ Government plans to develop Chinese universities into top-class international universities are ongoing, with the recent development of the Double First Class University Plan (2017) to comprehensively develop Chinese universities and individual university departments into world-class universities and disciplines.²⁰ Certainly, peer-reviewed publication plays an important role in any such development given its potential contribution to strengthening academic reputation and also the potential for citation and impact, both of which are key features of metrics used to determine university rankings.²¹

It is interesting to note that although categorized as nursing, the most common source titles found in this study did not feature the high-ranking nursing journals (Table 1). However, the majority of the source titles were high-ranking journals except for the two Chinese sources (Table 3). The latter journals did not appear to have an impact factor and Scopus citation scores (Cite-Score) indicated with very little citation activity (Table 3). However, there is a claim that the impact factor applies mostly to a “disproportionate representation of Western journals (p. 542).”¹⁹ At the same time, except for the journal Stroke, there was a little variance between impact factor and Scopus citation scores (CiteScore) across the journals.

A closer examination of the trends also revealed that the top five authors (those who published most frequently) in the category of “nursing” did not appear to be affiliated to nursing schools or a nursing professor. This may be due in part to the limited number of nursing scholars with PhD,² however, a deeper analysis of activity within one specific nursing journal, namely the Journal of Nursing Management¹⁵ (Table 1), was more insightful and provided a little more information on the publication of Chinese nursing research activity.

As effective leadership and management play an important part both in the development of nursing as a discipline and as a science and in the professionalization of nursing, exploring scholarly output about nursing management provides additional information about nursing scholars’ activities. In keeping with general trends in the journal, the majority of these papers were research articles.¹⁷ However, very few literature reviews and there were no editorials or something that differs from the usual pattern of publication in this journal.¹⁷ Again a top-ranking university (Fudan University¹⁷) featured highly. Of note, the h-indexes of Chinese scholars appeared modest compared with an average h-index of 12 among international nursing professors,²² and none had been listed in ORCID ID.⁹

In terms of topics (according to Weberg et al.'s¹⁴ outline of the leadership role in nursing), two of the main foci of these Chinese papers in the Journal of Nursing Management were navigating care networks/creating the context for professional practice and staffing, scheduling, and patient care assignments (Table 6). This is consistent with the general patterns and trends of publication in the journal.¹⁷ However, a particular focus in the publications on policy, legislation, licensing, and professional nurse roles, becoming a professional nurse and principles of ethical decision-making (Table 5), revealed higher than usual trends. Overall 15 papers were published on these topics, accounting for more than one-third of all papers arising from China. These are areas that receive limited attention overall in the Journal with less than one quarter (n = 145) of all papers published in the last 5 years in the Journal dedicated to these topics.¹⁷ However, only one paper was observed to have dealt with change and innovation, a feature that is less prominent than overall patterns in the Journal where >7% of papers dedicated to this topic.¹⁷ Areas that are replete of publications (delegation and supervision, negotiation, and accountability and ownership) are not addressed frequently in the journal.¹⁷ However, the absence of papers in the fields of leadership and practice partnerships, and managing your career and resources for health care excellence certainly would receive more attention in the Journal overall and are likely areas that could be developed more in the future.¹⁷

China, similar to the rest of the countries in the world, is facing unprecedented demographic and technological changes for the future. The consistently changing nature of health care requires a skilled workforce who can provide evidence-based practice. Nurses are required to understand and use research, and fundamentally nursing scholars ought to be leading and driving research and evidence-based practice in the field.^23,24 There is clear evidence of scholarly activity in nursing in China, both in the published literature and anecdotally in practice. However, nursing scholars need to do more to increase dissemination and ensure that nursing professors are leading and driving nursing research,¹⁸ albeit in a multidisciplinary context. There is also a need for increased exposure of Chinese nursing scholarship in high-ranking nursing journals. Ongoing governmental activity²⁰ will likely support capacity building within the nursing profession, and targeted efforts to accelerate PhD numbers among nurses and publication would likely have a positive influence on the impact of the profession internationally.¹⁸ Nursing scholars can also contribute to raising their profile by registering for an ORCID ID⁹ that can be linked to their work. This is especially useful to identify single researchers where there are similarities in names or where there are changes in affiliation or names/titles.

The large population in China makes it an exceptional forum for research and development, particularly in the field of nursing management. Researchers ought to continue to focus on their strengths about policy, legislation, licensing, and professional nurse roles, becoming a professional nurse and principles of ethical decision-making, and they also seek to research in areas such as delegation and supervision, negotiation, accountability and ownership leadership, and practice partnerships and managing your career and resources for healthcare excellence to address current gaps. In China, patients and staff numbers in hospitals can be up to (and sometimes more than) 10 times the size of those in the UK or USA, rendering a remarkable opportunity for nursing research and especially for the understanding, application, and evaluation of nursing management. The numbers of staff on duty per clinical area far outweigh many hospitals internationally and thus offer a unique and valuable insight into patient care and management. Although journal citations have a rich contribution to the measurement of quality of scholarship^11,15,16 and are therefore an important component of building excellence in terms of university rankings,²¹ the potential bias of database repositories toward Western journals could likely negatively impact on perceptions of quality research. Additional measures to support Chinese scholars to publish peer-reviewed publications within these high-ranking journals are needed and the number of Chinese journals currently listed needs to be increased. However, English is considered the “language of health science,”²³ thus English as a second language may be a barrier for Chinese scholars⁵ and resources and investment in translation and publication support are likely to be a requirement for facilitating future success in addition to other capacity-building measures.

A single author collected the data. However, both Scopus and Web of Science analytics are comprehensive and reliable, cross-checking of individual results was not required. Furthermore, given the level of sophistication of these analytical tools manual cross-checking would not be feasible. The analysis of patterns and trends using Weberg et al.'s framework,⁵ although consistent with other trends,¹⁷ could have benefited from cross-checking in terms of reliability. However, the purpose of this phase of the research was exploratory. It was largely for information purposes to provide broad guidance to authors and editors regarding patterns and trends, potential information, and gaps in the published research. Absolute reliability with regard to emerging trends was not required.

The broad categorization of journals within the category of nursing with the Scopus database⁷ limits the generalizability of the findings. Furthermore, while the overarching findings of the first phase of this research were interesting in terms of the patterns and trends that emerge, it is difficult to have full confidence in the findings in terms of an accurate picture of nursing scholarship in China, given the broad conceptualization of nursing within the database.⁷

Although the majority of data presented were largely reliable, it might be useful for analytics to support greater thematic analysis within journals for the future, and the categorization of nursing within Scopus would benefit as it is more focused on nursing-specific journals.