Nursing Informatics Competencies: Bibliometric Analysis

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1 342 Nursing Informatics 2014 K. Saranto et al. (Eds.) 2014 The authors and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms of the Creative Commons Attribution Non-Commercial License. doi: / Nursing Informatics Competencies: Bibliometric Analysis Peter KOKOL a,1, Helena BLAŽUN b, c, Janez VOŠNER a and Kaija SARANTO c a Univerity of Maribor, Faculty of Electrical Engineering and Computer Sciences, Maribor, Slovenia b Univerity of Maribor, Center for International Cooperation, Maribor, Slovenia c University of Eastern Finland, Department of Health and Social Management, Kuopio, Finland Abstract: Information and communication technology is developing rapidly and it is incorporated in many health care processes, but in spite of that fact we can still notice that nursing informatics competencies had received limited attention in basic nursing education curricula in Europe and especially in Eastern European countries. The purpose of the present paper is to present the results of a bibliometric analysis of the nursing informatics competencies scientific literature production. We applied the bibliometrics analysis to the corpus of 332 papers found in SCOPUS, related to nursing informatics competencies. The results showed that there is a positive trend in the number of published papers per year, indicating the increased research interest in nursing informatics competencies. Despite the fact that the first paper was published in Denmark, the most prolific country regarding the research in nursing informatics competencies is United States as are their institutions and authors. Keywords: Nursing informatics, competencies, health informatics, bibliometrics Introduction Information communication technology (ICT) is developing rapidly and it is incorporated in practically all health care professional and research fields. Main focus of the ICT employment is to build nursing information systems for better support of modern nursing, its implementation and in finding key issues for its use of the implementation and standard-based practice which can improve clinical and management nursing functions and patient safety [1]. Skiba, Blažun, Ehrenberg et al. on the post conference of NI 2009 defined and pointed out some main issues regarding personal health information management systems and how to prepare nurses to practice in a wired world[2]. But in spite of all those efforts and facts we can still notice that nursing informatics competencies had received limited attention in basic nursing education curricula in Europe and especially in Eastern European countries. On the other hand nursing informatics is a specialty recognized by the American Nursing Association more than 12 years ago; additionally in Canada in 2011, competence and performance indicators were revised with the aim to include nursing informatics [3], indeed 636 biomedical and health informatics courses are offered just in United States 1 Corresponding Author.

2 P. Kokol et al. / Nursing Informatics Competencies: Bibliometric Analysis 343 [4]. Nevertheless, findings within literature review search by using the terms "informatics competencies" and "nursing informatics competencies" in databases PubMeb and CINAHL (37 articles captured, 6 relevant) revealed that there is a major variation among published informatics competencies in regard to content, presentation, and audience. Even more, the literature review showed that a general list of competencies which could be utilized by nurses, at all levels of engagement is needed [5]. In addition, the results of a recent study show that, even if nursing students feel competent using informatics in nursing, they still lack important resources for developing ICT competencies [6]. A more specific study focused on nursing leaders defined a list of 92 competencies needed by nursing leaders (24 addressed computer skills, 40 informatics knowledge, and 28 informatics skills) [7]. Thereafter it is clear that inclusion of nursing informatics competencies into basic nursing curricula, assessment of nursing informatics skills, lists of needed competencies and the research differs largely between countries, institutions and researchers, thus we performed a bibliometrics study to analyze the intensity and diffusion of research in this area. While numerous bibliometric studies have been conducted in various fields, surprisingly few have been done on the nursing literature and none on nursing informatics competencies. However, much can be learned about nursing and their specialty areas by analyzing published articles and their citation records. Bibliometrics is defined as a quantitative analysis of the bibliographic features of a body of literature and is based on the assumption that most scientific discoveries and research results eventually are published in international scientific journals [8]. Bibliometrics techniques applied to nursing literature could reveal much of how research is performed and communicated to nurses [9, 10]. Bibliometric assessments are based on the assumption that most scientific discoveries and research results eventually are published in international scientific journals where they can be read and cited by other researchers [11]. The purpose of bibliometrics is to map the literary production in a given field and to determine the structure of a field of study. It uses quantitative methods to analyze books, journals, conference papers and other publications. Using this analysis researchers can identify patterns in the literature like most prolific authors, institutions, countries and journals in a selected field, types of works cited, the rates of literary production over time, the patterns of communication and collaboration of authors [12]. Bibliometric studies are used also to examine the history and structure of a field, the flow of information into a field, the growth of the literature, patterns of collaboration among scientists, impact of a journal, and long term citation impact of the work [13]. Research questions and hypothesis The objective of the present paper and the underlying study was to analyze different types of information sources/scientific papers used to develop the research on nursing informatics competencies by using the bibliometric analysis in the manner to answer the following research questions (RQ1, RQ2) and hypothesis (H1): RQ1: What are the bibliometrics characteristics of the published papers in the area of nursing informatics competencies? RQ2: Which are the main research entities in the area of nursing informatics competencies and how research related to them is distributed?

3 344 P. Kokol et al. / Nursing Informatics Competencies: Bibliometric Analysis H1: Trend of number of published articles related to the research on nursing informatics competencies is positive. 1. Materials and Methods The initial step in completing the bibliometric analysis of the nursing informatics competencies in nursing literature was compiling a comprehensive list of papers. The papers were gathered by searching through the online SCOPUS bibliographic database using the search string nursing informatic* competenc* (* being a wild character) in article title, abstract and keywords. We were interested in all the papers found; therefore besides defining keywords string, we didn t set any other inclusion nor exclusion criteria Data extraction and data analysis From each paper common elements of bibliographic data were extracted using a Java text parser implemented by one of the authors, namely: authors, institution and nationality of authors, the year of the publication, the name of the paper source, number of citations, the total number of reference, type of the document and the age of a references. The extracted bibliographic data were recorded in Excel document; preprocessed using built in Excel functions and then transferred into SPSS for further analysis. Within the data analysis we performed descriptive methods and correlations Bibliometric measures Within the bibliometric analysis we used the following bibliometric measures: number of articles per year; number of articles per paper type; number of publications per country; most prolific authors; most prolific journals; most citied papers. 2. Results In our sample we extracted altogether 332 articles. The descriptive analysis of basic bibliographic demographics is shown in Table 1 and the number of papers per year in Figure 1. The large standard deviations presented in Table 1 reveals the great diversity between papers in the number of citations and the number of references. Additionally, we found out that average age of references is quite old, more than 11 years. From the Figure 1 it is quite obvious that in general the total number of published papers on nursing informatics competencies was increasing till the year 2008; however after that year the number of published papers dropped and stayed more or less constant after that drop. Looking at the other two curves representing the number of published papers in the United States (US) and the number of papers published in the rest of the world, it is interesting to note that after 2007 there were more papers published in the US than in the rest of the world together, but in comparison, the trends of the number of published papers are opposite in the US the trend after 2007 is negative, and the trend in the rest of the world is positive. This contradiction is probably due to new countries publishing in the area of nursing informatics (Brazil, India) and the increasing production of

4 P. Kokol et al. / Nursing Informatics Competencies: Bibliometric Analysis 345 papers in Taiwan. Another interesting observation is that in spite of the leadership of the US in the paper production on nursing informatics competencies, the first published paper did not appear there, but in Denmark. Despite changing trend and differences between US and the rest of the world, the Pearson correlation between publishing year and the number of published papers (Total, US, Rest of the world) is significant (p < 0.01); meaning that we proved the hypothesis H1. Table 1. Descriptive statistics of basic bibliographic data Minimum Maximum Mean Std. deviation Number of authors ,38 1,70 Number of citations ,41 14,95 Number of references ,86 18,89 Average age of references 5,10 24,65 11,55 4,07 Above presented results provide the answer to the first research question. Figure 1. Number of papers per year From the Table 2 it is evident that most of the papers were published in journals as research papers (240) or review papers (49), comparing to only 26 papers presented at conferences. Additionally, the detailed analysis of the 7 editorials showed that following journals, namely Journal of Professional Nursing, European Journal of Oncology Nursing, Journal of Gerontological Nursing, Advances in Nursing Science, Pediatric Nursing, Nurse Education Today and Pediatric Nursing even devoted a special issue to nursing informatics competencies (Table 2). Table 2. Number of papers per paper type Type of paper Number of papers Article 240 Review 49 Conference Paper 26 Editorial 7 Note 5 Short Survey 2 Article in Press 2

5 346 P. Kokol et al. / Nursing Informatics Competencies: Bibliometric Analysis The papers within conducted bibliometric analysis were published in 21 different countries and the most prolific countries and institutions are shown in Table 3. The vast majority of papers were published in the United States, followed by Australia, United Kingdom, Canada and Taiwan. 160 different institutions published papers on nursing informatics competencies; most papers are located in US. Indeed, first 25 most prolific are US institutions, and the first non US is on the 26th place with 3 published papers (National Yang-Ming University Taiwan). Table 3. Most prolific countries (left) and institutions (right) Country Number of papers Institution Number of papers United States 139 University of Utah 10 Australia 13 Columbia University in the City of New York 8 United Kingdom 12 Ohio State University 6 Canada 7 Cerner Corporation 6 Taiwan 7 Villanova University 5 Finland 4 Vanderbilt University 5 Sweden 4 University of Colorado Health Sciences Center 5 Ireland 3 University of Minnesota Twin Cities 5 Papers on nursing informatics competencies were published in 124 different journals by 152 different authors and most prolific journals and authors are shown in Table 4. As expected the most prolific journals are from the fields of health informatics, education, management and administration and the most prolific authors are from the US institutions (Table 4). Table 4: Most prolific journals (left) and authors (right) Journal title Number of papers Author CIN Computers Informatics Nursing 30 Bakken, S. 11 Studies in Health Technology and Informatics 30 Simpson, R. L. 10 Journal of Nursing Education 17 Skiba, D. J. 7 Nursing Outlook 13 Bickford, C. J. 6 Nurse Education Today 13 Weiner, E. 6 Nursing Administration Quarterly 11 Curran, C. 6 International Journal of Medical Informatics 10 Gassert, C. A. 5 Nursing Management 9 Fetter, M. S. 5 Nursing Education Perspectives 7 Trangenstein, P. 5 Nurse Educator 6 Barton, A. J. 5 Number of papers Altogether papers from the corpus were cited 2131 times. Four most cited papers are as follows: 1. Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D. T., Warren, J. Quality and safety education for nurses (2007) Nursing Outlook, 55 (3), pp Cited 215 times.

6 P. Kokol et al. / Nursing Informatics Competencies: Bibliometric Analysis Staggers, N., Gassert, C. A., Curran, C. A Delphi study to determine informatics competencies for nurses at four levels of practice (2002) Nursing Research, 51 (6), pp Cited 81 times. 3. Staggers, N., Gassert, C. A., Curran, C. Informatics competencies for nurses at four levels of practice (2001) Journal of Nursing Education, 40 (7), pp Cited 72 times. 4. Gosling, A. S., Westbrook, J. I., Spencer, R. Nurses' use of online clinical evidence (2004) Journal of Advanced Nursing, 47 (2), pp Cited 48 times. From the above discussion on main research entities in the area of nursing informatics competencies and how research related to them is distributed we provided the answer to the second research question. 3. Discussion and conclusions The results showed that there is a positive trend in the number of published papers per year, indicating the increased research interest in nursing informatics competencies. The drop in the trend in the last years in United States might be due to the fact that after the health reforms the use of ICT by nurses became more or less a routine and as a consequence nursing informatics competencies were also included in the required basic nursing competencies and performance indicators sets. The positive trend in other countries might reveal that other countries are still not there, but are following the US example. Despite the fact that the first paper on nursing informatics competencies was published in Denmark, the most prolific country regarding the research in nursing informatics competencies is United States as are their institutions and authors. This might be due to the fact, that the education in USA was always more competence oriented than the outcome oriented curricula in the rest of the world, and additionally, in US the ICT development and employment was more intense compared to other countries. The last but not least, we can conclude that the bibliometrics is a promising methodology for analyzing nursing research and that it revealed some interesting trends and distribution patterns in nursing informatics competencies paper production. References [1] Marin H, Rodrigues RJ, Delaney C. Building Standared-Based Nursing Information Systems. Washington: Pan Americal Health Organization pp [2] Skiba D, Blažun H, Ehrenberg A, Marin H, Moen A. Personal Health Information Management Systems and Education: Preparing Nurses to practice in a Wired World. In K. Saranto, P. Flatley Brennan, C. A., K. Saranto, P. Flatley Brennan, & C. A. (Eds.), Personal Health Information Management: Tools and Strategies for Citizens' Engagement. 2009; pp Kuopio: University of Kuopio. [3] Wahoush O, Banfield L. Information literacy during entry to practice: Information-seeking behaviors in student nurses and recent nurse graduates. Nurse Education Today. 2013; e14. [4] Kampov-Polevoi J, Hemminger B. A curricula-based comparison of biomedical and health informatics programs in the USA. Journal of the American Medical Informatics Association - BMJ. 2011; 18(2): [5] Carter-Templeton HP. An analysis of published nursing informatics competencies. Studies in health technology and informatics. 2009; 146:

7 348 P. Kokol et al. / Nursing Informatics Competencies: Bibliometric Analysis [6] Jetté S T. Nursing students' perceptions of their resources toward the development of competencies in nursing informatics. Nurse Education Today. 2010; 30(8): [7] Westra BL, Delaney CW. Informatics Competencies for Nursing and Healthcare Leaders. 2008; IMIA. [8] Hawkins D T. Information Research. 2001, October. Retrieved September 20, 2013, from Bibliometrics of electronic journals in information science: [9] Niederhauser VP, Kohr L. Research endeavors among pediatric nurse practitioners (REAP) study. Journal of Pediatric Health Care. 2005; 19(2): [10] Yucha CB, Schneider BS, Smyer T, Kowalski S, Stowers E. Methodological quality and scientific impact of quantitative nursing education research over 18 months. Nursing Education Perspectives. 2011; 32(6): [11] Rehn C, Kronman U. Bibliometric handbook for Karolinska Institutet. Solna: Karolinska Institutet University Library [12] Bellis D. Bibliometrics and Citation Analysis: From the Science Citation Index to Cybermetrics. Plymouth: Scarecrow Press [13] Garfield E. The History and Meaning of the Journal Impact Factor. Journal of American Medical Association. 2006; 295(1): Commentary.

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