Wen-Jiao Li,Hui-Min Zhang,Xue-Chao Liu,Chang-De Jin,＊

1Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, China; 2School of Nursing, Tianjin University of Traditional Chinese Medicine,Tianjin,China.

Abstract Aims:To analyze the research status and development trend of nursing qualitative research in China from 2013 to 2019.Method: China national knowledge infrastructure (CNKI),Wanfang Data and VIP database were researched to include all related articles which were published from 2013 to 2019 about nursing qualitative research literature.NoteExpress literature management software and Excel were used to organize literature from annual distribution region, organization, core periodical, as well as the research object, research methods, data collection method and sampling method for metrology analysis. Results:2194 articles met the inclusion criteria, the number of articles is increasing year by year.Most of them come from Shanghai, Beijing, zhejiang and other developed areas.The top three institutions were the Huazhong University of Science and Technology, Tongji Medical College, Affiliated Union Hospital, Fudan university and Shanghai jiao tong university.And 835 of them were published in core journals.Research object are mainly divided into patient, nurses, nursing managers, etc.The included literature mainly adopts phenomenological research methods.Interview is the mainly data collection methods, and Colaizzi method is the mainly data analysis methods.Most articles use the method of purpose sampling. Conclusion: The qualitative research is becoming more and more attention by researchers in China.Qualitative research has covered clinical nursing, nursing education, nursing management, nursing psychology and other different nursing field.However,the selection of qualitative research methods,data analysis methods and related reports need to be further improved and standardized.

Keywords:Qualitative research,Nursing,Bibliometrics analysis,Literature analysis

Introduction

Qualitative research is a research method that describes and gives meaning to life experience through systematic and subjective methods [1].In the early 1980s, it was introduced into the nursing field by American scientists [2].In 2003, li chunyu et al.[3]introduced qualitative research into the nursing field in China.The development of taking patients as the center of the medical model, qualitative research is also getting more and more attention from the holistic and human-centered nursing community, especially in recent years [1].Qualitative research in the field of nursing plays a more and more important role,therefore, this study will from the perspective of bibliometrics analysis to analysis the present situation and development of qualitative research to provide the reference for the application of qualitative research in nursing field in China.

Methods

Literature source and search strategy

Using CNKI,Wanfang Data and VIP as data sources to search the literature.Logically searched for the terms“qualitative research” and “nursing”.As relevant literature has conducted related studies of bibliometrics analysis before 2013, the retrieval time of this study was 2013 and 2019, and the retrieval was completed on November 17,2019[4,5].

Inclusion criteria and exclusion criteria

Inclusion criteria: nursing related qualitative research literature officially published in Chinese database in 2013 and 2019;Exclusion criteria:duplicate literatures,review, Conference papers, dissertation, articles introducing theory.

Literature analysis method

Note Express software and Excel were used to establish a database, which was screened independently by two researchers according to the inclusion and exclusion criteria.The final results were compared, and the inconsistencies were discussed with a third researcher to solve the problem.Finally, 2,194 articles were included.Bibliometrics analysis was conducted on the included literatures from the aspects of external characteristics (the annual change of literature quantity, journal distribution, regional distribution, institutional circulation and citation volume) and internal characteristics (research objects,methods of data collection, methods of data analysis,methods of sampling).

Outcome

Annual distribution of publications

Through the summary, it was found that in 2013 and 2019, a total of 3,167 literatures related to nursing quality research were published in China, and 2,194 literatures were finally included according to the inclusion and exclusion criteria.Compared with previous years, the number of literatures related to nursing quality research increased significantly.The detailed results are shown in Figure 1.

Distribution of the author's region and institution

According to the first authors' address, results show that the literature in 31 provinces, municipalities or autonomous regions.However, there is a certain difference in the number of publications among different regions.The top 10 publication regions are listed in Figure 2.The main publishing institutions are medical schools and their affiliated hospitals.The top 10 publication institutions are listed in Table 1.

Figure 1:Published time

Figure 2:Distribution of region

Table 1:Major institutions included in the literature(Top 10)

Distribution of literature journals

The included 2194 literatures were distributed in more than 100 domestic journals, 835 articles were published in statistical source journals in nursing,among which the Journal of Modern Chinese Nursing published the most literature, accounting for 7.43%.The amount of papers in nursing statistical source journal is shown in Figure 3.

Research objects

The research subjects included in the literature were mainly patients, in which 694 (31.63%) patients with different disease types were mentioned.Nurses were included in 643 (29.31%) articles, nursing students were included in 356(16.23%)articles.The subjects of the 183 (8.34%) articles were patients' family members or caregivers, 71 articles (3.24%) were nursing managers, and 48 articles (2.19%) were nursing managers.Other subjects involved in the study are graduate students in nursing, master's supervisors,nursing assistants and so on.

Figure 3:Distribution of nursing statistical source journals

Research methods

Among the included literatures, 1573 (71.70%)explicitly stated that phenomenological research methods were used.53 (2.42%) used the grounded theory approach.Although qualitative research methods are used in other literatures, specific research methods are not explained.

Methods of data collection

In the included literature, interview method and observation method were mainly adopted.A total of 1,958 (89.24%) literatures used interview method.Among them, there are 70 (3.58%) references using structured interview method, 984 (50.26%) references using semi-structured interview method, 29 (1.34%)references using non-structured interview method, and 73 (3.38%) using focus group method.A total of 81(3.69%) articles adopted the observational method,while the other 155(7.06%)did not specify the method of data collection.

Methods of data analysis

Colaizzi data analysis was used in 754 (34.37%)literatures and Giorgi data analysis was used in 31(1.41%) literatures.In addition, 541 (24.66%)literatures only explained that phenomenological analysis method was adopted, but did not specify which data analysis method was adopted.Meanwhile,content analysis was used in 182 (8.30%), genus analysis was used in 31(1.41%),thematic analysis was used in 28 (1.28%), and ensemble method was used in 12 (0.55%).The rest of the literature does not specify which method of data analysis was used.

Sampling method

Purpose sampling was used in 308 (14.04%), random sampling was used in 39 (1.78%), stratified sampling was used in 29 (1.32%), convenience sampling was used in 24 (1.09%), snowball sampling was used in 6(0.27%), and cluster sampling was used in 5 (0.23%).The rest of the literature did not specify the sampling method.

Discussion

The literature volume has been increasing steadily,covering a wide range of research objects

The number of published quality studies in nursing increased from 257 in 2013 to 322 in 2019, and the number of related literatures increased year by year.In particular, compared with the number of literatures published before 2013 [5], the number of literatures significantly increased, which indicates that qualitative research is increasingly valued in nursing science, and qualitative research methods are playing an increasingly important role in nursing research.At the same time, with the transformation of the physical -psychological - social medical model, clinical nursing workers not only pay attention to the physical health of patients, but also pay more and more attention to the psychological experience of patients, such as the study on patients'illness and treatment experience [8-10].In addition, the mental health status of patients' family members and their caregivers should also be paid attention to by nurses, and a lot of relevant studies have emerged, such as the nursing experience of patients'caregivers and the changes of their roles and functions [11, 12].The subjects included in the literature covered all types of population involved in the nursing industry.The subjects were mainly patients,followed by nurses, nursing students and nursing managers.Other subjects involved include clinical teachers and university teachers, graduate students in nursing, master's supervisors and nursing assistants in the study.For example, related studies involve nurses'psychological experience of nursing work and work expectations [13], nursing managers' feelings on nursing team management [14, 15] and nursing students' feelings on teaching methods and clinical work etc[16,17].

Regions, institutions and core journals are widely distributed

The research of qualitative research has cross-regional characteristics in China, covering 31 provinces,municipalities or autonomous regions.The literature mainly focuses on Shanghai, hubei, zhejiang, Beijing and other places with strong economic foundation and faculty.And the publishing institutions mainly focus on medical universities and their affiliated hospitals, such as affiliated Huazhong University of Science and Technology, Tongji Medical College, Affiliated Union Hospital, Fudan university, Shanghai jiao tong university, etc.However, the volume of publications varies greatly between regions and between institutions,so it is suggested that scholars should conduct extensive cross-regional cooperation to promote faster development of qualitative research in the future.The included 2,194 nursing qualitative research literatures were distributed widely in more than 100 domestic journals, among which 835 were from nursing statistics source journals, accounting for 38.06%.Among them, China modern nursing journal published the most articles, followed by China practical nursing journal.The influence of statistical source journals is relatively high, which can reflect that the development of qualitative researches attracts researchers' attention in nursing field.

Qualitative research methodology has shortcomings,and the quality of qualitative research literature still needs to be improved

There are many methods of qualitative research.However, most of the qualitative research literatures published have not clearly explained the methods of qualitative research in the field of nursing in China.In this study, qualitative research methods are relatively simple, there are many literatures using phenomenological research methods, and data collection methods are mostly limited to interview methods, which is consistent with the research results of Xu Q,et al.[5] Zheng XN,et al.[18].Phenomenology is the most commonly used qualitative research method in the field of nursing in China whose purpose is to explore the intrinsic significance of studying phenomena.In addition to phenomenological research methods, there are many qualitative research methods, including grounded theory, ethnography,historical research, action research, case analysis and so on.What matters is to choose different research methods according to different research purposes.Similarly, data collection methods include: interview(structured interview, semi-structured interview,unstructured interview, focus group interview) and observation (participatory observation,non-participatory observation), etc.In this study,Colaizzi data analysis method was used in most data analysis methods.Relevant studies also show that many methodological inaccuracies exist in the current qualitative research literature [19].This may have something to do with the fact that qualitative research is part of the curriculum of higher nursing education in China.In the United States, Britain,Australia, Canada and other countries, there are qualitative research-related methodological courses in the master's education system [20].However, in China, although the undergraduate textbooks cover relevant chapters of qualitative research, few institutions carry out qualitative research courses in graduate education [2,21].Most clinical nurses have little involvement in qualitative research in their education system.However, it is important to teach qualitative research methods to nursing students [22, 23].Therefore, the lack of understanding of its qualitative research, the understanding and application of its theory and research methods related to the misunderstanding.It has something to do with the lack of the understanding of the qualitative research and they have some mistakes in the understanding and application of the theory and research methods.A study investigated the cognitive status of qualitative research on nurses in a class in zhejiang province, showing that nurses have a low cognitive level of qualitative research, and the main source of relevant knowledge for them is journals[24].Therefore, medical schools and medical institutions should pay enough attention to strengthen the study of qualitative research, especially the application of its methodology.

Conclusions

There are some limitations in this study.In the econometric analysis, the dissertation and the review research were not included, which may result in the relevant literature related to qualitative research not included in the data analysis.It is suggested that the following researchers should expand the scope of literature types to show the development of qualitative research in China.In recent years, qualitative research has developed rapidly in China, and nursing researchers have realized the importance and necessity of qualitative research.However, there are still some deficiencies in the understanding and application of relevant knowledge.Therefore, the study of theoretical knowledge and scientific research methods should also be strengthened to promote the development of qualitative research on nursing in China.