Scientific publications in nursing journals from Mainland China, Taiwan, and Hong Kong: a 10-year survey of the literature

Introduction

China is a rapidly progressing developing country, with a population of over 1.3 billion people. In this context of rapid economic development, China has played an increasing role in medicine and science in the recent decades (Tong, Wang & Jiang, 2013; Cyranoski, 2004; Ding, Jia & Liu, 2015; Liang et al., 2015; Luo et al., 2015). A similar trend has also been observed with China’s contribution to nursing research (Li et al., 2009; Li, 2014; Kalisch & Kalisch, 2009). Moreover, there are more than 2 million registered nurses in China (Gao, Chan & Cheng, 2012). China may become an important hub in worldwide nursing research, given the emerging status and large community of practitioners found in the country.

There are three major Chinese-speaking regions: Mainland China, Taiwan, and Hong Kong. Although people in these regions share the same ethnic origin of Han Chinese, they have distinct political regimes, economic status, and health care systems (Xu, Xu & Zhang, 2000; Lin et al., 2014). These characteristics may lead to different scientific research productivity outputs in these regions. Publication, as a central part of scientific research, is an important indicator of research productivity. Recently, it has been widely used to compare the scientific productivity of these three regions in many medical fields (Gao, Liao & Li, 2008; Li et al., 2010; Zheng et al., 2011; Cheng & Zhang, 2010). However, as far as we are aware, the quantity and quality of nursing research production in these Chinese-speaking regions have not yet been reported. Therefore, the present study aimed to investigate the characteristics of scientific publications in the field of nursing from the major Chinese-speaking regions, specifically Mainland China, Hong Kong, and Taiwan, over a ten-year period.

Materials and Methods

Results

Total number of articles

From the 110 nursing journals assessed between 2005 and 2014, a total number of 2,439 publications originated from China. The annual total numbers of articles from China increased significantly from 2005 to 2014 (from 105 to 364; p = 0.000), with a 3.47-fold increase experienced. Taiwan published the largest number of articles in this time (1,506/2,439; 61.75%), followed by Hong Kong (495/2,439; 20.30%) and Mainland China (438/2,439; 17.96%). Figure 1 shows the published articles from Mainland China, Hong Kong, and Taiwan. Mainland China had the most rapid increase in the number of annual publications (from 2 to 119; p = 0.000), which is a 59.50-fold increase, followed by Taiwan (from 68 to 195; p = 0.001) and Hong Kong (from 35 to 50; p = 0.017). From 2011, the number of papers published from Mainland China exceeded those from Hong Kong; however, Mainland China had fewer publications than Taiwan.

Discussion

To our knowledge, this is the first study to analyze the quantity and quality of articles in major nursing journals that have been published from three major Chinese regions, namely Mainland China, Taiwan, and Hong Kong, during a ten-year period. This survey provides a general picture of Chinese research output in the field of nursing. This study revealed that China became increasingly productive from 2005 to 2014 in major nursing journals, particularly Mainland China. Scientific production in the field of nursing from Mainland China exceeded the output from Hong Kong since 2011. Taiwan is the most prolific region in China. However, Hong Kong published the highest-quality nursing research, according to the analysis of mean journal impact factor, and mean citation count per paper.

China’s increasing contribution to scientific research has been demonstrated in many biomedical fields (Gao, Liao & Li, 2008; Li et al., 2010; Zheng et al., 2011; Cheng & Zhang, 2010). This also holds true for the field of nursing, according to the present findings. Although Mainland China has lagged behind Taiwan and Hong Kong in terms of scientific productivity for many years, since 2011, scientific research production in the field of nursing from Mainland China has exceeded production from Hong Kong (Gao, Liao & Li, 2008; Li et al., 2010; Zheng et al., 2011; Cheng & Zhang, 2010). Furthermore, the most rapid increase in the number of nursing publications was seen in articles emanating from Mainland China. There are several possible reasons for these findings. First, a central reason may be the rapid development of China’s economy, which has induced increased funding to the field of nursing (Kalisch & Kalisch, 2009; Gao, Chan & Cheng, 2012). Second, Chinese nursing researchers have more experience than before, and the ability of nurses in conducting research has been improved (Li, 2014; Kalisch & Kalisch, 2009; Gao, Chan & Cheng, 2012). Third, high-level research institutions are increasingly being established in China, and the education level of nursing is rapidly rising (Kalisch & Kalisch, 2009; Gao, Chan & Cheng, 2012). The improvement of research infrastructure and the quality of researchers may have prompted the high-level research output observed in this study. Fourth, language has previously constituted an important barrier for most Chinese nursing researchers. However, with increasing international knowledge-exchange, more authors from China have recently published their work in international journals, thanks to increased English proficiency, and developments in the experience of medical research (Cheng, 2012; Jia et al., 2015; Tong, Wang & Jiang, 2013). For these reasons, China will be able to contribute more to scientific publication in the field of nursing.

Although China has increasing contributions to the field of nursing, several current problems facing the discipline should be recognized. First, shortages of nurses are a global problem, and China faces a severe shortage (Zeng, 2009). Nurses in China may lack sufficient time to perform high-quality research. Second, although nursing education in China has developed rapidly, the overall level of nursing education is still relatively low, requires improvement (You et al., 2015). Having said this, these problems are being addressed in China (Zeng, 2009; You et al., 2015). It is hoped that, through medical reforms, the status of nursing research in China will be improved in the future (Chen, 2009; Liu, 2009).

In this study, journal impact factor and citation count were selected as measures, as they have been widely used to evaluate the quality of articles, as seen in similar studies (Gao, Liao & Li, 2008; Li et al., 2010; Zheng et al., 2011; Cheng & Zhang, 2010). Taiwan has the largest numbers of total journal impact factor and total citation count among the three regions, indicating that it is the most influential region in China. This could be due to Taiwan having the highest number of total articles, far exceeding those from the other two regions. However, Hong Kong ranks the first among the three regions when mean journal impact factor and mean citation count are used. It may suggest that Hong Kong published higher-quality nursing research than Mainland China and Taiwan did. Moreover, Mainland China has the lowest mean journal impact factor and mean citation count. These findings indicate that, despite the rapid increase in the number of publications from Mainland China, articles from this region may be of lower quality and require improvement, compared to those from Taiwan and Hong Kong. Nevertheless, it should be recognized that the optimal tool for assessing the quality of publications remains controversial. The impact factor is intended to assess the quality of a journal, but not the quality of an individual article published in the journal (Li et al., 2010; Grzybowski, 2009). In general, the impact factors of the journals in which the articles were published suggested similar academic levels (Lin et al., 2011). Additionally, citation count may not be evenly distributed amongst articles in a journal, as a small number of articles would probably attract the bulk of citations (Weale, Bailey & Lear, 2004; Seglen, 1997). Moreover, the citations for an article are highly related to the quality of the article and the novelty of the findings. However, the number of citations is influenced by many factors, such as journal impact factor, geographic origin of the authors, whether they are English speaking, and the gender of the authors (Eyre-Walker, 2013; Paris et al., 1998; Opthof, 1997; Leimu & Koricheva, 2005).

Journal of Clinical Nursing was the most popular nursing journal in all the three regions. This result indicates that Journal of Clinical Nursing is the most influential journal in China. Journal of Clinical Nursing, Journal of Advanced Nursing, International Journal of Nursing Studies, and Cancer Nursing appeared in all top five journals listings in the three regions. It suggests that these journals may play an important role in promoting nursing research from China in knowledge-sharing efforts.

This study has some limitations. First, the data of another region in China, Macau, was collected, but the present study did not analyze it due to the low number of articles originating from this region. Second, the Web of Science database was used to identify nursing publications. Articles published in journals not cited in Web of Science were not included, although they might contribute to quantifying scientific production. Third, there is still no consensus on the indicators for assessing the quality of articles. The use of journal impact factor and citation count might not have been optimal in assessing some of the included articles. Fourth, although each included article was published in nursing journals, some articles may have other topics as their focus. Fifth, the journals were collected from the nursing category of the JCR, but multidisciplinary journals may also publish articles related to nursing, and such journals were not included in this study. Nevertheless, the 110 subspecialty nursing journals included in this survey represent the major international journals devoted to the discipline of nursing.

Conclusion

There has been a significant increase in contributions to the field of nursing from China in the past decade, particularly from Mainland China. Taiwan is the most prolific publication region in China. Hong Kong had the highest-quality research outputs in terms of mean journal impact factor and mean citation count per article.

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