Bibliometric analysis of continuous nursing service model in stroke patients

Ya-Nan Zhou,Yu-Shun Cui*

1School of nursing,Yanbian university,Yanji 133002,China.

Abstract Objective: Through the collection and research of literature, analyze the application status,deficiencies, development status, current research hotspots and development trends of stroke patients with continuous nursing care, so as to further develop continuous nursing care for stroke patients. Related research provides reference and clinical nursing work provides the theoretical basis. Methods: Search the relevant literature on continuity care of stroke patients collected from the establishment of the database to November 22, 2020 in CNKI, Wanfang database, PubMed, Embase, Web of science, and Weipu database, and use Note Express to sort the documents that meet the standards, and apply Microsoft Excel software establishes a database for information extraction and statistical description of the included literature. Results:A total of 669 related documents were included. The number of related documents published began in 2008 with the first related introduction articles,which increased year by year from 2014 and reached its peak in 2019; the first author came from 31 provinces, autonomous regions and municipalities directly under the Central Government. It mainly includes Henan, Jiangsu, Shandong, Guangdong and Hubei provinces. A total of 297 articles have been published by authors from related regions; a total of 51 articles have been funded by scientific research funds; the types of literature research are relatively rich, and research institutions are mainly concentrated in hospitals and colleges; There are 1,383 authors published in the literature, and the average number of authors is 2.06 per article; a total of 375 articles have been completed by 2 or more authors,and the co‐authoring rate is 56.05%. Conclusion: The research on continuity care of stroke patients shows an increasing trend, but the quality of literature, research institutions, and scientific research funding are still very small. It is recommended that follow‐up research should pay attention to improving the writing level of thesis, increase funding, expand the cooperation team and establish special Continuous nursing team and scientific research team to improve the psychological and physiological problems of stroke patients, and at the same time improve the quality of papers written by authors.

Keywords:continuous nursing; service model; stroke; bibliometrics

Background

Stroke is due to acute cerebral circulatory disorders caused by localized or comprehensive cerebral dysfunction syndrome. According to the American Geriatric Society's definition of Extended Care Service, extended care ensures that patients return home or go to community hospitals or rehabilitation hospitals after systematic treatment in the hospital. A series of nursing activities designed by medical staff to make the health services received by patients have coordination and continuity [1]. The application of continuous nursing service model for stroke patients has greatly promoted the recovery of patients.

As the country with the largest aging population, China is expected to have 400 million people over the age of 60 by 2050, which is equivalent to the total population of Britain, France, Germany, Italy,and Japan [2]. The aging of the population structure is not only a global public health problem, but also brings great troubles to Chinese society [3]. An epidemiological survey in my country shows that at the same time, stroke is one of the most common diseases among the elderly. The incidence of stroke in my country is higher in the elderly than in middle‐aged people[4];the cold season is significantly higher,and the northern area is higher than the southern area [5].The overall incidence rate is increasing year by year. Statistics show that the current stroke in my country. The annual prevalence rate is 120/100,000 to 180/100,000, and the case fatality rate is 60/100,000 to 120/100,000 [6]. The rehabilitation technology for stroke sequelae is mature at this stage, but the rehabilitation effect of stroke sequelae is not ideal.The main reason is that the implementation effect of many rehabilitation measures is not ideal. Many hospitals emphasize compulsory exercise rehabilitation to ensure adequate exercise rehabilitation, but the quality of the patient's in‐hospital training is acceptable. Once discharged, the out‐of‐hospital rehabilitation training is less effective. Stroke has become the first cause of disability and death in adults [7], the average age of onset of stroke is 66.4 years, and the elderly are a high incidence of stroke patients. The elderly due to physical, disease, psychological and social factors often lead to reduced body resistance, increased vulnerability, and uneven nutritional intake, which can easily cause weakness and malnutrition,which seriously affects the functional recovery and quality of life of patients[8].

Stroke is a common clinical cerebrovascular disease, which has the characteristics of high incidence and disability. Most patients will be out of life‐threatening after treatment, but they will be left with varying degrees of language, cognitive, motor dysfunction, and decreased self‐care ability, resulting in severe negative emotions and affecting their quality of life [9, 10]. Traditional medical care services mean that the relationship between the patient and the hospital ends after the patient is discharged [11]. However, stroke patients have poor compliance behaviors after they are discharged from the hospital. The health education of medical staff has gradually faded[12], increasing their rehospitalization rate [13, 14]. In order to reduce the readmission rate, it is particularly important to strengthen the health care of stroke patients discharged from the hospital.Continuing care refers to a series of activities that promote the continuity and coordination of health care during the peri‐discharge period. The ultimate goal is to promote the safe and smooth transition of patients from the hospital to the family (community) and improve their outcomes after discharge. However, the research on continuity nursing in our country and the related research on continuity nursing of stroke patients have been carried out relatively late, and there is a lack of systematic summary and evaluation. In order to better understand the current research status and existing problems of continuous care for stroke patients in China, this study was searched from the establishment of the database to November 22, 2020 on stroke patients included in the CNKI, Wanfang database and Weipu database. The relevant literature of continuity nursing is analyzed by the method of bibliometrics, which provides further theoretical and practical basis for the development of continuity nursing for stroke patients in my country.

Materials and methods

Literature search strategy

Select CNKI, Wanfang database, and Weipu database as the source of statistical data. The retrieval time is from the establishment of the database to November 22, 2020. The search method is advanced search. The search keywords or subject terms are: ((Subject = Stroke or Title = Stroke or v_subject = Chinese and English expansion(Stroke) or title = Chinese and English expansion (Stroke)) and(Subject = Continuous Nursing or Title = Continuing nursing or v_subject = Chinese and English expansion (continuing nursing) or title = Chinese and English expansion (continuing nursing))). A total of 421 articles were retrieved from CNKI, 658 articles from Wanfang database, 362 articles from VIP database, totaling 1441 articles. After two‐person screening, 714 after eliminating duplicate documents, a total of 669 papers were finally included in the research and analysis after screening, including 11 dissertations, 2 conference papers, and 656 journal papers.

Inclusion criteria: journal papers, conference papers, and dissertations related to the topic of "Continuing Care for Stroke Patients". Exclusion criteria: repetitive documents, newspapers and periodicals, popular science documents, unavailable full text,documents with obvious errors in information. If there is a duplication between a journal paper and a conference paper or a dissertation, the one with more complete information shall be selected.

Data analysis method

The documents that meet the inclusion criteria are imported into the document manager Note Express for document sorting, and the Microsoft Excel software is used to establish a database. The 669 documents that meet the inclusion criteria are extracted from the publication year, author's geographic distribution, institution and fund support, etc. Statistical description. In order to ensure the accuracy of the information, the literature search, information entry and statistics in this study were all checked by two persons.

Results

Distribution of publication time

The following is the time map of the publication of the literature through the analysis of CNKI, Wanfang and Weipu Figure 1‐3.

The publication time of 669 articles is from 2008 to 2020; the amount of articles published in 2008‐2013 was 10 or less; since 2014,the amount of articles published began to increase, including 46 articles in 2015, 69 articles in 2016, and 116 articles in 2017 The number of articles published in 2018 was 117, and the amount of articles published was the highest in 2019. A total of 128 articles were published, accounting for 19.13% of the total number of articles included.

Geographical Distribution of Literature Authors

Based on the statistical analysis based on the area where the first author is located, the authors of 669 articles come from 31 provinces,autonomous regions and municipalities directly under the Central Government. Sorted according to the amount of articles published by region, the top 5 authors are located in Henan, Jiangsu, Shandong,Guangdong, Hubei and other provinces. Authors in related regions have published a total of 297 articles, accounting for 34.37% of the total included articles. Among them, Hubei The province's publication volume accounted for 44.39% of the total included documents. It is not difficult to see that related articles were still in a barren stage before 2008. Nowadays, domestic scholars have conducted more and more studies on stroke continuity nursing, and more people have realized the great role and application prospects of this theory.

Figure 1 Trends in academic output and citations in CNKI

Figure 2 Trends in academic output and citations in wangfan

Figure 3 Trends in academic output and citations in Weipu

Funding status of scientific research funds

Among 669 articles, 51 articles were funded by scientific research funds. Among them, 7 are funded by the National Natural Science Foundation of China, 5 are scientific and technological public relations projects, 2 are health science and technology research, 2 are science and technology research, 2 are natural science foundations,and 1 is a special science and technology fund. The distribution of funded projects by the year is: 5 in 2013, 5 in 2014, 8 in 2015, 5 in 2016, 4 in 2017, 2 in 2018, 9 in 2019, and 13 in 2020. Regarding the funding of scientific research funds, from the beginning of the imperfection and lagging development of the theory, as time goes by,the state is increasing financial support and assistance, and it can also be seen from the side that the state’s attention is gradually increasing.

The address of the journal

According to statistics, the magazines with the largest number of publications mainly include the following magazines and 28 electronic journals on practical clinical nursing. 23 articles on China's health and nutrition. 22 guides to health care. 16 nursing research articles. Qilu Nursing Journal 16 articles. 16 articles on general nursing. 15 articles about diet and health care. It can be seen from the publication of the literature that the quality of paper writing should be improved, and the writing level of authors should be checked, and the number of relevant papers in the field of stroke continuous nursing should be published in core journals. So as to improve the quality and level of the paper.

Document types

According to statistics by Excel software, there are 130 experimental papers, accounting for 19.43%. There were 222 randomized controlled studies, accounting for 33.18%. There were 182 such tests,accounting for 27.20%. There are 41 descriptive studies, 48 reviews,and 12 systematic reviews. It can be seen from the data that most of the experiments are based on experimental and randomized controlled experimental studies. However, most of the samples included in the experiments conducted by the author are very small, which is easy to cause systematic errors and deviations, lack of representativeness, and the experimental results are also accidental. It is recommended that follow‐up studies increase the use of sample sizes, not just rely on dozens of sample sizes to draw conclusions.

Affiliation

The affiliated institution, the Hospital of Traditional Chinese Medicine issued the largest number of articles, with 530 articles(79.22%) in the community and health service centers with 39 articles. There are 66 articles in the colleges and universities, 2 articles in the prevention and control center, 11 articles in other institutions. Among them, the number of documents issued by hospitals is the most. This is because hospital nurses work in related departments and it is more convenient to collect the data sources needed. But nowadays, most stroke patients are elderly people. There is still a lack of research in community neighborhoods and health service centers in this area, and the investment is not enough. It may be related to the required software facilities, costs, manpower and material resources. The community and other departments have not paid enough attention and research to this part. Therefore, in future research, community departments can invest more in stroke continuation care, train community specialist nurses and service teams, etc., to provide faster services for the development of community work.

Frequency of keyword usage

The following Table 1 is a statistical icon and cloud chart of the frequency of use of keywords for stroke continuation care. From the figure, it can be seen more intuitively that stroke (403), continuation care (368) and quality of life (102), the relevant research is mainly on the quality of life and rehabilitation, continuous nursing intervention,daily living ability, etc., which also provides a reference for future research, follow‐up experiments can be carried out more and more detailed from these aspects Discuss and enrich the research in this field.

Discussion

Current status of stroke continuation nursing application

Yang Lin et al. [15] used comparative research methods to conduct routine discharge guidance and continuous nursing intervention on 164 patients with ischemic stroke. The results showed that continuous nursing intervention can effectively improve the self‐care of stroke patients and their families.ability.Zhang Ni[16] selected 122 cases of stroke patients discharged from hospital with tracheotomy and tube as the research object in the article The application effect of continuous nursing intervention based on root cause analysis in elderly stroke patients with tracheotomy and tube. The group was given routine continuous nursing intervention, and the observation group was given continuous nursing intervention based on RCA on the basis of the control group. After the intervention, the cognition, behavior and status scores of the two groups increased, and the observation group was higher than the control group (P＜0.05). The incidence of pipeline adverse events, aspiration, lung infection, and rehospitalization rates in the observation group were lower than those in the control group (P＜0.05). The nursing satisfaction of the observation group was better than that of the control group (P＜0.05).

Li Han [17] set up a control group in the application of hospital‐community‐family continuity care in stroke rehabilitation patients: this group of patients adopts routine follow‐up care: establish a health record for the patient before discharge, and After the patient was discharged from the hospital, he called regularly for follow‐up visits. Research group: This group of patients adopts hospital‐community‐family connection for continuous care: (1)Establish a nursing team; (2) Establish a shared network; (3)In‐hospital care; (4) According to Fugl‐Meyer motor function score 1d before discharge The scale and Barthel index scale evaluate the motor function and activities of daily living scores of the 2 groups of patients; (5) follow‐up care and other measures, it is concluded that hospital‐community‐family connection continuation care is of great significance in stroke patients during rehabilitation, Which effectively improves the patient's motor function and living ability, and has a good application prospect.

Insufficient application of continuous care in stroke patients

To a certain extent, there are too few funded projects for continuing care of stroke patients, and the quality of the literature needs to be improved. Funding support from 5 articles in 2013, 5 articles in 2014,8 articles in 2015, 5 articles in 2016, 4 articles in 2017, 2 articles in 2018, 9 articles in 2019, and 13 articles in 2020. Financial support is not yet sufficient.

The continuity nursing method is too single, the nursing content is formalized, the quality of the nursing staff is not high, and the nurses sent out by the hospital have problems such as low qualifications and less experience, and the continuity nursing measures are often not in place [18]. Therefore, continuing nursing services requires the joint support of three aspects: the social health service mechanism, the medical‐society linkage mechanism, and the information sharing mechanism. It is necessary to continuously meet the health needs of the people, strengthen the development of continuous nursing, train nursing professionals, and make the model of continuous high‐quality nursing service more and more perfect.

Table1 Statistical icon and cloud chart of the frequency of use of keywords for stroke continuation care

The National Health and Family Planning Commission intends to formulate corresponding specifications and service methods.Currently, clinics often use free nurse specialist outpatient clinics and hotlines to provide consultations for discharged patients. The service content of home visits is limited to intubation, skin care, etc., and the service scope is relatively narrow. Only focus on a certain point,confined to the unilateral problems that need to be solved in specialist nursing. Secondly, because the health authorities have not unified the charging system and standards for continual nursing services,provinces and cities have greater arbitrariness in providing continual nursing services [19, 20]. Telephone follow‐up and specialist outpatient consultation are basically free. The lack of incentive mechanism cannot guarantee the continuity and stability of nursing services. Third, the qualification review as a follower has become another difficulty. In‐service nursing staff in hospitals visit homes,whether their qualifications are reasonable, and who bears the risks when problems arise. These problems have plagued the healthy development of continuing nursing services. Fourth, Internet medical services can effectively supplement traditional medical services. The inevitable trend in the development of medical services in my country at this stage is to give full play to effective Internet resources.

Current development status of stroke continuation nursing

The concept of continuity care was first born in the 1940s. For the first time, Forest Harriet and others at the University of Pennsylvania attempted to establish cooperation between hospitals and community nursing institutions, extending the rehabilitation and nursing care of patients after discharge to the family and the community [21]. In the late 1980s, the University of Pennsylvania School of Nursing, Naylor,and others conducted a survey on after‐hospital care interventions for elderly patients with chronic diseases and found that after a series of interventions were implemented, the number of second admissions for patients with chronic diseases decreased. In 2002, Canadian scholars reported an example of nurses and family doctors cooperating in case continuation care [22]. There are literatures suggesting that continuation of care services improves the patient's quality of life and satisfaction with hospital medical staff, reduces the possibility of re‐admission, and reduces hospitalization costs[23‐25].

Japan has launched continuous nursing training content including:elderly rehabilitation services, hospice care services, Alheimer's disease response services, day care services, family visits, counseling and guidance, health care, etc. South Korea's home care received attention in the late 1970s, and the content of nursing services is basically a treatment project that nurses can complete independently.It satisfies some specialist needs of patients after hospital, such as maintenance of intestinal stoma, various injection treatments,psychological adjustment, various catheter replacements, skin wound care and rest care, etc. [26].

Continuous nursing is a practical and effective intervention to improve patient compliance, strengthen self‐management and restraint, and specialist nurses play a leading role in the health guidance of patients during hospitalization and after‐hospital health follow‐up [27]. Domestic research on continuity care for discharged patients has just started. For example, the Zhujiang Hospital of Southern Medical University and the First Affiliated Hospital of Jinan University established the "Continued Nursing Service Center for Discharged Patients. The nursing experts of Wuhan Tongji Hospital set up after‐hospital care consultation clinics and hotlines. , To provide help for discharged patients.

Ma Bo [28], in the article on the demand status and effect evaluation of continuous care services for stroke patients, he set up a questionnaire about stroke continuous care. Through the use and research of this questionnaire, it was found that the blood biochemical indicators of patients were significantly improved. The blood pressure is lowered to varying degrees, and the ability to take care of themselves is improved, which reduces the occurrence of stroke recurrence or complications. Patient satisfaction has been improved,and the doctor‐patient relationship has been harmonized. The number of re‐hospitalization is reduced, the economic burden of family members and society is reduced, the limited medical resources are fully utilized, and a certain basis is provided for the formulation of feasible medical‐care integration policies. Therefore, the importance of continuous care is fully explained.

Research hotspots of stroke continuation nursing

In the early days, because the literature was very scarce, influential research hotspots were rare. In the mid‐term, the number of documents continued to increase, and the research topics were relatively concentrated on elderly rehabilitation, quality of life,treatment compliance, and community care models are the main research hotspots. Research results include demand analysis for continual nursing rehabilitation interventions for discharged patients and treatment compliance And the quality of life. Up to the present stage, the research topics have been more extensive and the depth of research has increased. Among them, research topics such as neurological rehabilitation and care ability, WeChat platform,post‐hospital patient mental state, community continuity nursing, and high‐quality nursing services have become more prominent.

The research hotspots of stroke continuation care are now mainly concentrated in the following aspects. (1) The needs and influencing factors of continuous care for stroke patients. Stroke is more complicated. Involvement of the central nervous system of the brain will hinder functional recovery and may affect the rehabilitation effect. (2) The evaluation index of the effect of continuous nursing for stroke patients. At present, the content of effect evaluation of stroke continuation care in my country is relatively limited, and there is a lack of evaluation of information, management and relationship continuity [29]. (3) The prognostic effect and model exploration of continuous nursing intervention. In 2016, the National Health Commission proposed to gradually improve the integrated management of the hospital‐community health service center (family),and improve and play the important role of continuity care in the rehabilitation of patients after treatment [30]. (4) Establish a service platform for continuous nursing demonstration projects.

Compared with the United States and the United Kingdom and other countries, due to the late start of the use of continuity care in my country, the establishment of various theories and practices, and the government's policy investment in this field, the level of attention is not perfect enough, and it takes a certain time to coordinate According to the plan, nowadays, due to the uneven knowledge level of the elderly, the relatively backward cultural knowledge, and the insufficient use of various information, continuous nursing has become more and more important for the follow‐up life and psychological problems of stroke patients. Important. At this time, the emergence of a professional continuity care demonstration project team is particularly important and convenient. It not only greatly facilitates stroke patients, but also saves a large amount of other expenditures for the country, and improves stroke patients’ health even more. Quality of life and degree of satisfaction.

Evaluation index of stroke continuation nursing

At present, my country's existing stroke continuity nursing evaluation indicators include the following aspects: (1) Service quality evaluation indicators. Studies have shown that using the Del.phi method to constructmaturequalityevaluationindicatorscovering"structure‐process‐result" will help patients improve ADL, IADL,cognitive functions, communication skills, etc., and promote continuous improvement of the quality of continuity care. Promote the establishment of a sound supervision mechanism and reduce the readmission rate of stroke patients. (2) Structural quality indicators.According to the characteristics of continuation care, a clear, specific and feasible nursing process is established on the basis of comprehensive community health assessment, home care assessment and patient's own health assessment, which is conducive to the smooth development of continuation care. (3) Process quality indicators. Evaluate patients' diet, activities, mood, medication,symptom management, and review. (4) Result quality index.Comprehensive evaluation of the effects of continuity care for stroke patients through aspects of service quality, structure quality, process quality, and result quality [31‐33].

Conclusion

Based on the theory of continuation of care, stroke patients may have psychological and physical problems. After the process of admission‐hospitalization‐discharge, most hospitals in China have ended patient care and nursing. Although the patient's illness has improved after treatment, some complications may occur after the operation, such as anxiety, stigma, etc., which will bring mental torture to the patient, make the patient's condition worse, and continue the nursing model The emergence of the disease has greatly promoted the postoperative care of the sick patients. After the patients have recovered and discharged from the hospital,they will continue to follow up with the patients, so that the patients can get a sense of physical and mental security, and it is also a help and promotion for the recovery of the disease. The continuous nursing care model that has emerged in recent years is more and more used in stroke patients.However, due to the short use of this nursing service model in my country, there is no complete system construction yet. In the future development, increasing the development of this nursing model and applying it to related diseases will play a key role in the recovery of patients' health, and at the same time promote the work of clinical staff. Therefore, this study uses bibliometrics to analyze the relevant literature on continuity care of stroke patients in recent years. The results show that the number of literature is increasing year by year,the number of funded projects continues to increase, and the type of research is mainly experimental research. However, the quality of the literature needs to be improved,and there is a lack of multi‐center and large sample research. It is suggested that in future research, attention should be paid to research design and the quality of literature should be improved. With the continuous advancement of my country's aging process, patients and their families have an increasing demand for stroke functional rehabilitation exercises. Continuous nursing has become an important part of stroke patients' functional rehabilitation.Establish and complete a stroke continuation care program in line with China’s national conditions, do a good job in the continuation of out‐of‐hospital care for patients, and enhance their confidence in the prognosis of recovery. Due to my country's large population base and limited medical resources, the seamless connection between hospitals and family communities has not yet been achieved. Adding a hospital‐based community‐based continuation care model to the nursing process of stroke patients can effectively improve the patient’s quality of life, help patients obtain a good prognosis, and suggest that the continuation care model is effective, reliable and ideal Clinical application value. Continuing care mode is an important component of holistic care, that is, the extension of hospital care, which ensures that patients can still get continuous health care after they are discharged from the hospital, thus speeding up the recovery process of patients' illnesses. Establishing a continuous care service model for stroke patients is a major challenge and opportunity facing today. The establishment of this model will bring the development of the national care industry to a higher level.