Shi-Fan Han ,Rui-Fang Zhu ,Jiao Zhao

aFirst Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China

bCollege of Nursing,Shanxi Medical University,Taiyuan,Shanxi 030001,China

cShanxi Medical University,Taiyuan,Shanxi 030001,China

1.Introduction

Changes in medical models have caused a shift in nursing toward the biological-psychological-social nursing model.Clinical psychological nursing notonly focuses on the patient's illness but is also involved in the entire clinical nursing process.Word frequency analysis arranges subject words or keywords concerning research topics on the basis of their frequency of appearance,and visualized network diagrams enable direct observation and formal presentation of the results of co-word analysis.This study used clinical psychological nursing research literature from Wanfang Data for the period of 2007-2015,dividing the data into the three periods of 2007-2009,2010-2012,and 2013-2015.This study's word frequency analysis and visualization analysis sheds light on the state of development of clinical psychological nursing research in China and changes in hotspot research,and its results have reference and predictive value regarding future research hotspots.

2.Data and methods

2.1.Data source

The main goal of this study was to employ bibliometric methods to investigate clinical psychological nursing research hotspots and their variation trends in China,and Wanfang Data were chosen as a data source.After reviewing a large number of studies,it was found that papers containing “psychological nursing”in their titles or keywords generally related to clinical psychological nursing and largely focused on psychological nursing in connection with a certain disease or certain type of patient.Furthermore,because titles or keywords tended to provide a highly concise summary of the papers'content,a search approach of“title or keyword=psychological nursing(exact)”was employed.The type of literature was defined as journal paper,and the search period was set as 2007-2015.A total of 27,890 papers were returned up to the ending date of January 10,2016.The Note first format was used to store bibliographic information,including paper titles,authors,author affiliations,abstracts,keywords,and journals.This study mainly analyzed and discussed keywords,and stored bibliographic information in the Note first format in three-year units.

2.2.Method and software

Word frequency analysis is a bibliometric method relying on the frequency with which key content keywords or subject words used in the literature appear in a certain research domain to determine research hotspots and their development trends.This study used a co-word matrix discovery tool-the bibliographic cooccurrence analysis system BICOMB 2.0-to perform word frequency analysis of keywords in bibliographic information.The information stored in the Note first format was divided among the three time periods 2007-2009,2010-2012,and 2013-2015(referred to below as the “three periods”).Bibliographic information from the three periods was entered into BICOMB 2.0,and word frequency analysis performed for keywords during each time period.After combination of the data,only the 20 leading keywords extracted for each time period were retained,as shown in Table 1,due to manuscript space constraints.

The co-occurrence of keywords was found by determining the frequency with which pairs of keywords appeared in the same paper,and BICOMB was used to establish a co-occurrence matrix for keywords.Subsequently,the integrated analytical software Ucinet 6.0's two-dimensional data analysis tool Netdraw was used to draw visualized network diagrams based on the important keyword co-occurrence matrix.1The visualized network diagrams were drawn on the basis of keyword co-occurrence,and the number of co-occurring keywords to be extracted was generally determined by the default extraction number.While this default number was generally set as 50,because word frequencies tended to be low in the 2007-2009 time period,the default value for co-occurring keywords was changed to 25.The default value for co-occurring keywords remained set as 50 for the periods 2010-2012 and 2013-2015,however.A total of 39 keywords were shown as co-occurring in 2007-2009,48 were shown as cooccurring in 2010-2012,and 66 were shown as co-occurring in 2013-2015.The resulting visualized network diagrams had the following characteristics:(1)the closer the network nodes were to the center in each diagram,the closer they tended to be to the center of the connection network as a whole;(2)the distance between network nodes re flects the closeness of keywords;and(3)the thickness of the lines connecting the nodes expresses the strength of the relationship,where the thicker the line,the stronger the mutual relationship.2

3.Results

3.1.Distribution of clinical psychological nursing research literature in China

Using Wanfang Data as a data source,this study collected clinical psychological nursing research literature in China during the period of 2007-2015,retrieving a total of 27890 papers.Because 2015 papers had not been fully accepted for publication at the time of this search,significantly fewer papers were collected for 2015 than for other years(Fig.1).

3.2.Table of high-frequency keywords for the three time periods

Due to limitations to the length of this paper,after performing word frequency analysis using BICOMB,only the top 20 keywords were retrieved for each period of time(Table 1).

3.3.Visualized network diagrams for high-frequency co-occurring keywords during the three time periods

After the selection of default values,39 high-frequency cooccurring keywords were found for 2007-2009,48 high-frequency co-occurring keywords were found for 2010-2012,and 66 high-frequency co-occurring keywords were found for 2013-2015.The co-occurrence matrix generated using BICOMB was input into Ucinet,and the two-dimensional data analysis tool Netdraw was used to draw network diagrams showing the relationships between co-occurring words.The results are shown in Figs.2-4.It can be observed that these three diagrams all show keywords radiating outward from the central keyword of psychological nursing.Those keywords connected to psychological nursing have a relatively high frequency of co-occurrence,and the thicker the connecting line,the higher the co-occurrence frequency,which can also be considered a research hotspot for this period of time.

High-frequency keywords in 2007-2009 included anxiety,depression,the elderly,health education,and surgery;highfrequency keywords in 2010-2012 included anxiety,depression,health education,perioperative period,expectant women,breast cancer,and surgery;and high-frequency keywords in 2013-2015 included anxiety,depression,health education,perioperative period,quality of life,and efficacy.

4.Discussion

4.1.The quantity of clinical psychological nursing research literature in China has stabilized

This study's sample consisted of clinical psychological nursing literature in China during the period of 2007-2015.However,from the perspective of quantity of literature,the amount of literature increased steadily starting in 2007,exhibiting a significant upward trend.However,while the amount of literature peaked in 2013 and decreased slightly in 2014,the number of papers remained at approximately 4000.Because 2015 papers had not been fully accepted for publication at the time of the search,there is no final data for that year in this study.Overall,this study shows that the quantity of literature rose starting in 2007 and stabilized during the last several years.It is possible that the quantity of literature will remain stable during the next several years.

4.2.Changes in high-frequency keywords during the three periods

Due to limitations of space,only the 20 keywords with the highest frequency were selected for each of the three periods of time.Analysis of the extracted high-frequency keywords reveals that a new high-frequency keyword,quality of life,appeared in 2010-2012.Quality of life is based on standard of living and emphasizes satisfaction of higher needs,such as spiritual culture and assessment of environmental conditions.In contrast to previous periods of time,in addition to clinical observation of the efficacy of therapeutic nursing measures,quality of life must also include concern for how well patients can live in society,and the effect of psychological nursing on patients'quality of life must therefore be emphasized during the current period.Various scales are typically used to assess quality of life,the most commonlyused are the Short-Form Health Survey(SF-36),3QLQ-C30 quality of life questionnaire,4and General Quality of Life Inventory-74(GQOLI-74).5One hospital conducted a controlled study of clinical psychological nursing in the case of patients receiving radiation therapy for esophageal cancer.Two months after the conclusion of radiation therapy,the functional scale score and overall health score of the observation group were both higher than those of the control group,and on the symptom and single measurement item scale,the observation group exhibited lower fatigue,insomnia,and loss of appetite scores than the control group.This indicates that clinical psychological nursing can improve negative emotions in esophageal cancer patients receiving radiation therapy and improve quality of life.5

Compared with keywords for 2010-2012,we found that new high-frequency keywords for 2013-2015 consisted of efficacy,effect,psychological state,coronary heart disease,and clinical efficacy.Research on psychological state has mainly examined the effect of psychological nursing on patients'psychological states,6-8which also implies investigation of the efficacy of clinical psychological nursing measures.This suggests that clinical psychological nursing should not be concerned exclusively with the implementation of psychological nursing procedures and measures but must also emphasize the efficacy of psychological nursing.As people's standard of living rises and their pace of life accelerates,various lifestyle-related diseases have appeared,and hyperlipidemia,hypertension,diabetes,psychological stress,and habitual smoking are closely linked with the occurrence of coronary heart disease.As a result,the incidence of coronary heart disease has been rising steadily.9Furthermore,patients will have complex psychological reactions when they discover they have coronary heart disease,and typical clinical manifestations include anxiety and depression,which may in turn cause the patients'conditions to worsen.10As a consequence,psychological nursing can maintain a positive psychological state in coronary heart disease patients and help them cultivate healthy living habits.

4.3.Changes in research hotspots during the three periods

Analysis of research hotspots in this study involved the use of Ucinet software's Netdraw tool to create visualized network diagrams from high-frequency keyword co-occurrence matrices.It can be observed from the results that the network diagrams surround psychological nursing during all three periods.The thicker the lines in the diagrams,the higher the frequency of cooccurrence with the central keyword,indicating a research hotspot in that period of time.Research hotspots in 2007-2009 consisted of anxiety,depression,elderly patients,health education,and surgery;research hotspots in 2010-2012 consisted of anxiety,depression,health education,perioperative period,surgery,and breast cancer;research hotspots in 2013-2015 consisted of anxiety,depression,perioperative period,health education,quality of life,and efficacy.

Anxiety and depression are the most frequent psychological problems occurring in clinical psychological nursing research and are negative emotions are commonly observed in clinical patients.There are several relatively mature scales used to study such problems,among the most mature of which are the Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),Hamilton Anxiety Rating Scale(HAMA),and Hamilton Rating Scale for Depression (HAMD).Anxiety and depression consequently remained research hotspots in all three periods,and the two typically appear together.Another consistent research hotspot is health education because one of the roles of nurses is to serve as health advocates,and there is relatively more contact between nurses and patients.Health education is involved with regard to patients with different illnesses and different ages and must be implemented to target speci fic individuals.11-13Surgery patients are a group for whom psychological nursing is particularly important.Surgery is a traumatic treatment,and patients inevitably experience fear and apprehension with regard to surgical treatment,giving rise to different degrees of anxiety and depression,which may cause adverse reactions such as unstable blood pressure,agitation,and feelings of oppression.These effects may cause difficulties during surgery and also be detrimental to postoperative recovery.14Psychological nursing mainly seeks to provide necessary psychological guidance and psychological intervention addressing the psychological states that appear in preoperative patients and is intended to eliminate or ease these patients'psychological burden.Psychological nursing should appropriately continue throughout the perioperative period,and nurses should strive to gradually in fluence patients'moods through their words and actions.15Nurses should therefore skillfully use psychological nursing to perform psychological interventions with regard to patients in the perioperative period.

Psychological nursing in cases of breast cancer was a research hotspot that emerged in the 2010-2012 period.Breast cancer is a malignant cancer common worldwide.The incidence of breast cancer is rising at the rapid rate of 2%globally,while in China it is increasing at an annual rate of up to 3-4%.16Breast cancer not only affects women's physical health;due to the bodily changes that occur in the wake of breast cancer surgery along with the greater sensitivity of women compared with men as well as women's mood swings,patients commonly experience negative emotions such as pessimism and hopelessness,which may have a severe effect on the efficacy of patients'recovery.17Because of the rate at which the incidence of breast cancer is increasing in China,there is a large number of breast cancer patients,and the psychological nursing of breast cancer patients has become a research hotspot in clinical psychological nursing.The psychological nursing of breast cancer patients should emphasize individualized care and family support.Multi-angle,all-round psychological guidance and intervention can help patients defeat their negative emotions at an early stage and return to their families and society.18

Compared with 2010-2012,new research hotspots during the 2013-2015 period included quality of life and the efficacy of clinical psychological nursing.Quality of life has already become an area of common concern for the health community worldwide.Apart from the need to enhance the quality of life of regular individuals,improving the quality of life of patients is an area of concern in clinical nursing.19As people's material standard of living rises,there has been growing attention to psychological satisfaction.This is a necessary criterion for holistic nursing.The improvement of quality of life should no longer be limited solely to enhancement of material standards,and efforts to improve the quality of life of clinical patients should include both promotion of health and also psychological nursing,with the goal of maintaining patients in a sound psychological state,so that they can engage in normal activities in society.20Furthermore,a new research hotspot consists of the efficacy of clinical psychological nursing measures.This re flects the importance of the assessment step in nursing procedures.Only by assessing and analyzing results can we observe whether psychological nursing measures are effective and make adjustments.Scales are currently used to assess the efficacy of clinical psychological nursing measures,and randomized controlled trials are also commonly employed for this purpose.21

5.Conclusions

As described above,the quantity of clinical psychological nursing research literature in China has grown steadily.Frequency analysis of keywords during the three time periods revealed that the most common psychological problems in psychological nursing research primarily consisted of negative emotions,mainly anxiety and depression.The populations with which psychological nursing research is mainly concerned consisted of the elderly,expectant women,and perioperative period patients,while the patient groups with relatively great need for clinical psychological nursing consisted of coronary heart disease patients,diabetes patients,and breast cancer patients.With regard to changes in research hotspots,long-term research hotspot included anxiety,depression,perioperative period psychological nursing,and health education,while new research hotspots that have appeared over time included breast cancer,quality of life,and psychological nursing efficacy.It was found that research hotspots,important concerns,and incidence of disease are closely related to people's attitudes towards health.Therefore,future clinical psychological nursing research hotspots will tend to change based on health issues generated by societal development.

Conflicts of interest

All contributing authors declare no Conflicts of interest.

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