Research Status and Emerging Trends of Ideological and Political Education in Nursing in China: A Bibliometric Analysis

In China, ideological and political education in colleges and universities has always relied on ideological and political theory courses in the curriculum system, but there are few students who can understand the connotation, making it difficult for ideological and political education to fully exploit its own advantages (L​i​a​n​g​,​ ​2​0​1​8).Since the 2016 National Conference on Ideological and Political Work in Colleges and Universities, the teaching mode of "Curriculum ideology and politics" has entered the public spotlight and has became the center of attention from all walks of life (H​u​,​ ​2​0​1​9). The term "Curriculum ideology and politics" refers to the organic integration of professional course teaching and ideological and political education into the teaching process, guiding students to internalize humanities knowledge and sublimate moral sentiments in order to cultivate students' feelings for family and country, social responsibility, and moral norms (Y​i​n​ ​&​ ​Z​h​u​,​ ​2​0​1​8).

Nursing courses are basic, professional, and practical comprehensive courses, which are an important way of establishing nursing students' professional value and professionalism (C​a​o​ ​e​t​ ​a​l​.​,​ ​2​0​2​1). However, for a long time, nursing educators in China prioritized information transfer above value guiding, leaving many nursing students without a clear orientation in terms of attitude on life and values (S​h​i​,​ ​2​0​1​9). One notable example is that, whereas contemporary college students have a pretty high degree of moral cognition, their practice capacity is relatively limited, their self-evaluation, self-judgment, and self-control are unsteady, and they frequently lack the spirit of introspection in actual deeds (L​i​u​,​ ​2​0​1​8). Furthermore, a big fraction of nursing students attend vocational colleges, and their basic knowledge reserves are clearly insufficient. Their learning attitude needs to be improved, their behavior habits need to be standardized and corrected, and their professional competence needs to be developed and regulated. Therefore, the integration of ideological and political content into the nursing professional curriculum in order to cultivate high-quality nursing talents has become a pressing issue.

Currently, schools are attempting to implement the "curriculum ideological and political" teaching mode of nursing majors: Z​h​a​n​g​ ​&​ ​J​i​a​ ​(​2​0​2​0​) used "curriculum ideology and politics" to teach undergraduate internal medicine nursing, emphasizing the curriculum's educational focus. S​u​n​ ​e​t​ ​a​l​.​ ​(​2​0​2​2​) organically integrated ideological and political elements into surgical nursing teaching curriculum, allowing students to get a better grasp of the nursing profession while also invisibly shaping professional ideals and behavioral norms. Research on nursing curriculum ideology and politics in China has been published, but implementation is limited to a single course, with dispersed results that lack systematic integration.

To better understand the development context and prospects for nursing curriculum politics and ideology, this study retrieved and analyzed the research status, hotspots, and development patterns based on the CNKI, Wanfang Database, and VIP Database.

The data used in this study was downloaded from CNKI, Wanfang Database, and VIP Database, the search strategy was as follows: (1) Topic: ("Ideological and political theory course" or "Ideological and political classes" or "Curriculum ideology and politics" or "Ideological and political education") and ("nursing" or "nurse"); (2) The dates of the search were before December 31, 2023. In total, 2668 documents met the selection criteria.

As shown in Figure 1, the search results were independently screened by two researchers from related disciplines, and 1097 irrelevant documents were removed by reading the titles, abstracts, keywords, and full texts of the literature, while 653 duplicate documents. There were a total of 918 articles.

VOSviewer (version1.6.16) and CiteSpace (version6.2R1) were utilized in this study to conduct bibliometric analyses. VOSviewer and CiteSpace were used to analysis various aspects, such as institutions, authors, journals, course type and so on，these tools also facilitated the identification of notable citation bursts associated with specific keywords. In the process of data analysis, the filtered literature data was exported from Noteexpress in Refworks-Citespace format, imported into Citespace. After the "date-import/export" data transformation function of Cite Space software, convert to CNKI format that Cite Space can recognize to import new project, the time span is selected from 2017 to 2023, time slicing is 1 year by default, using Pathfinder to create a network map of country or regional cooperation, the clipping approach use the minimum spanning tree algorithm. "Country" are chosen for Node Types, and the threshold Top N per slice is set to 20, so the top 20 countries in each year are counted. We rigorous data cleaning procedures were implemented to rectify coding errors, wherein synonymous terms like "Child nursing" and "Paediatric nursing" were consolidated into the unified term "Paediatric nursing".

Figure 2 shows the annual number of published papers on nursing curriculum ideological and political during the last seven years, with the horizontal coordinate representing the year of publication. The annual number of papers published was divided into two stages: the first stage lasted from 2017 to 2019. The research on nursing curriculum ideological and political appeared for the first time in 2017, and the number of papers published each year after that was less than 50. The second stage was from 2020 to 2023, with a dramatic increase in the number of annual publications, peaking at 324 in 2023.

The analysis of research institutes reflects some of their influence in this area. As shown in Table 1, there are top three institutions based on publication volume: Sichuan Nursing Vocational college (21, 2.29%), Jiangsu Vocational College of Medicine (11, 1.20%), Henan Vocational College of Nursing (9, 0.98%). All of the top ten institutions are universities, with no hospitals or other associated institutions appearing. As shown in Figure 3, the size of the node font represents the quantity of papers issued, while the link between nodes represents cooperation between them.

In this study, the number of papers published by the top ten authors was mainly concentrated in three or four publications, whereas authors who published a single paper accounted for 84.4% of the total number of authors, indicating a high degree of dispersion. As shown in Table 2, the top five authors are Yaoling Guo (4/4.35%), Pu Wang (4/4.35%), Tongmei Zhu (4/4.35%), Yan Zhang (4/4.35%), and Liping Xia (4/4.35%). As seen in Figure 4, the majority of the writers conducted their research independently, with little collaboration. Notably, all of authors in the top ten had a centrality of 0.

Journals are a key academic communication venue for authors. This study included 22 journals with more than ten publications and 102 journals with more than two. As showed in Table 3, the top ten journals published a total of 402 articles, accounting for 43.8% of the total number of articles included. The top five journals were Health Vocational Education (113/12.46%), Education Science (53/5.84%), Modern Vocational Education (50/5.51%), Chinese Journal of Nursing Education (31/3.42%), The Guide of Science & Education (30/3.31%).

There are numerous courses in the research area of ideological and political education in nursing curriculum. Table 4 displays the top five courses as follows: Fundamentals of Nursing (81/8.82%), Medical Nursing (48/5.23%), Surgical Nursing (39/4.25%), Paediatric Nursing (35/3.81%), Nursing of Gynecotokology (26/2.83%).

Keyword analysis can reflect the hot topics in the research period and explain the formation and development of knowledge in the research field to a certain extent. Table 5 shows the top 10 keywords for ideological and political education in nursing curriculum. As you can see from the table, the search terms are removed "Curriculum of ideology and politics", "Nursing", the top five keywords were "Pedagogical Reform (92)", "Ideological and Political Education (87)", "Fundamentals of Nursing (79)", "Higher Vocational School (74)", "Nursing Education (49)".

Figure 5 displays the keyword co-occurrence cluster view. The link between the keywords indicates their co-occurrence relationship, the label size indicates their frequency, and each circular label represents a keyword. There are nine clusters containing terms related to ideological and political education in nursing curriculum. The keywords with the highest weight are located in the centers of each cluster, which are represented by different colors in the picture. Figure 6 displays the overlay view of the keyword time zone, the terms "hybrid interactive" and "Boppps" are the most recent research hotspots.

The emergence of keywords can reflect the sudden increase of research frequency in a short period of time, representing the research field of concern during this period, and the red line indicates the duration of the burst (F​u​ ​e​t​ ​a​l​.​,​ ​2​0​1​9). As shown in Table 6, the keyword "Higher Vocational School" (1.82) initially emerged with substantial burst intensity, signifying areas of acute attention. Since 2020, "Ideological and Political Elements" (3.51) surfaced with a notable emergence intensity.

The concept of curriculum ideology and politics was first proposed in 2014, but there were few researchers at the time, and the true meaning of curriculum ideology and politics was unclear, so it was easy to confuse "curriculum ideology and politics" with "ideological and political courses" (J​i​a​o​ ​&​ ​F​u​,​ ​2​0​2​1). In 2016, Jinping Xi, the Chinese president, declared at the National Conference on Ideological and Political Work in Colleges and Universities that "it is necessary to make all kinds of courses and ideological and political theory courses go in the same direction to form a synergistic effect" (Y​u​ ​&​ ​Z​h​o​u​,​ ​2​0​2​2). Scholars have begun to study the ideological and political education in nursing curriculum, and related publications appeared for the first time in 2017. In December of the same year, the "Implementation outline of the Project to improve the quality of ideological and political work in colleges and universities" was issued, which clearly proposed to vigorously promote classroom teaching reform with the goal of "curriculum ideology and politics" and realize the organic unity of ideological and political education and knowledge system education (W​a​n​g​ ​&​ ​S​h​i​,​ ​2​0​2​0). Colleges and universities across the country have realized that only by closely aligning with current politics and implementing the notion of ideological and political education would they be able to better support nursing discipline growth. In October 2018, the Ministry of Education's Opinions on Accelerating the Construction of High-level Undergraduate Education and Comprehensively Improving the Ability to Cultivate Talents elevated the concept and deployment of curriculum ideology and politics to the level of the higher education system with Chinese characteristics, and a better understanding of curriculum ideology and politics emerged (O​p​i​n​i​o​n​s​ ​o​f​ ​t​h​e​ ​M​i​n​i​s​t​r​y​ ​o​f​ ​E​d​u​c​a​t​i​o​n​,​ ​2​0​1​8). Since 2019, the number of published papers has rapidly climbed and is predicted to reach a peak of 324 in 2023, with the number of published papers in the subject of ideological and political education in nursing curriculum continuing to rise in the next years.

According to the authors of the papers, the top ten authors in this study published three to four papers, while the authors who published a single paper accounted for 84.4% of the total number of authors, indicating a significant degree of dispersion and the absence of a core academic community. It is worth noting that the majority of the top ten authors have a centrality of zero, indicating that their impact in this field needs to be increased, and researchers from all regions should be encouraged to engage in more academic activities while also strengthening cooperation and exchanges. According to the institutions who produced the papers, the top ten are all universities, and we have yet to see hospitals or other connected institutions. Nursing is a relatively practical discipline, and it is necessary to consider not only the teaching of theoretical knowledge, but also the importance of clinical practice when developing teaching resources (P​a​n​,​ ​2​0​1​9), so scholars should be encouraged to experiment with the hospital-school linkage mechanism, invite medical staff to participate in classroom teaching, capitalize on their respective resource advantages, and strive to improve students' overall quality.

In terms of published publications, the top ten journals published 402 articles, accounting for 43.8% of the total number of papers covered. Among them, the number of published articles in Health Vocational Education (113/12.46%) is much higher than that of other journals, indicating that the journal is the main journal in the field of ideological and political research of nursing professional courses, and Health Vocational Education features columns on higher education research, principal's forum, educational management and evaluation, modern educational technology, teaching discussion, nursing education, and more. Readers include medical education and clinical workers (H​e​a​l​t​h​ ​V​o​c​a​t​i​o​n​a​l​ ​E​d​u​c​a​t​i​o​n​,​ ​2​0​2​3). Furthermore, we discovered that only "Chinese Journal of Nursing Education" and "Education Science" are Peking University core journals, with the rest being provincial or ordinary journals, indicating that the quality of literature publication is currently low, and the depth of relevant research needs to be improved in the future.

Integrating ideology and politics into the nursing curriculum can help students develop a stronger sense of professional identity, patriotism, and cultural self-esteem. According to our analysis of nursing professional courses, the top three are fundamentals of Nursing, medical nursing, and surgical nursing. Fundamentals of Nursing is the core course of the nursing profession, the most fundamental and important course in the nursing curriculum system, the first course for nursing students to learn various clinical specialties of nursing, and the prerequisite for engaging in clinical nursing (Z​h​a​n​g​ ​e​t​ ​a​l​.​,​ ​2​0​2​1). However, the majority of teaching courses are theoretical, lacking a combination of practical courses, probably due to the lack of cooperation and communication between universities and hospitals. To meet the needs of students' growth and development, teachers should incorporate clinical teaching into the theoretical teaching process, try to change traditional teaching modes. For example, through project-based, role-playing, flipped classroom and other teaching forms, the ideological and political teaching of the curriculum is practiced, such as through role-playing, giving students a project task, communication, disinfection and positioning before injection, so that students can experience the love, patience and responsibility of nurses through playing patients. After the class, through clinical observations, we will experience the precautions that should be paid attention to when injecting special patients such as extreme emaciation and advanced disease (L​i​ ​e​t​ ​a​l​.​,​ ​2​0​2​3).

In terms of keywords, "higher vocational school" (1.56), as the first keyword to appear, received a lot of attention in the early days, probably because, with the rapid development of the information age, higher vocational students are confronted with the impact of diverse social trends and thoughts, and are prone to incorrect value orientation, which needs to be correctly guided by science (D​u​ ​e​t​ ​a​l​.​,​ ​2​0​2​2). Furthermore, by the end of 2020, the total number of registered nurses in China had surpassed 4.7 million, and the majority nurses came from higher vocational nursing institutions. Health vocational colleges are an important base for cultivating health technology and skilled talents, which must fully embrace the role that political and ideological education plays in nursing education to ensure talent for the achievement of "Healthy China". The term "Ideological and political elements" (3.51) showed a significant burst of intensity in 2020. Different from ideological and political courses, "Curriculum ideology and politics" requires teachers of professional courses to fully understand the differences between different types of courses in order to explore the ideological and political elements contained in the curriculum. Schools can attempt to provide training, invite ideological and political teachers to conduct collective training, preach, and analyze policy documents.Second, a curriculum ideological and political teaching studio can be established to exchange teachers' practical results, and teachers with extensive teaching experience and outstanding results can be organized to conduct face-to-face demonstrations on resource mining, instructional design, element integration, and teaching by word and deed (P​u​ ​&​ ​H​e​,​ ​2​0​2​1).

From the overlay view of keyword time zones, the terms "Boppps" and "hybrid interactive" are the most recent research hotspots. The COVID pandemic broke out in 2020, colleges and universities have postponed the start of the next semester. In order to reduce the impact of the epidemic on teaching and learning, universities have adopted online teaching. However, in the learning process, students' enthusiasm and autonomy are not strong, and teachers are unable to participate and supervise in person, resulting in teachers being unable to correctly understand and evaluate teaching results (L​i​ ​e​t​ ​a​l​.​,​ ​2​0​2​1). At the moment, some scholars have attempted to rely on the Boppps teaching model to teach ideology and politics in nursing courses such as internal medicine nursing and acute and critical care nursing, and integrate course ideology and politics into the whole process of teaching before, during, and after class through online and offline channels, so as to guide students to realize the internalization of humanistic knowledge and the sublimation of moral sentiments, realize the integrated teaching of "informed intention and action", and evaluate its practical effect. Research shows that ideological and political teaching of nursing courses based on BOPPPS can not only improve students' academic performance and teaching satisfaction, but also improve students' self-directed learning ability to a certain extent (S​h​a​n​g​,​ ​2​0​2​3; Z​h​a​n​g​ ​e​t​ ​a​l​.​,​ ​2​0​2​4). Furthermore, some academics have used the blended teaching mode to conduct ideological and political education in nursing courses (Y​a​n​g​ ​e​t​ ​a​l​.​,​ ​2​0​2​3), which not only improves students' autonomous learning ability but also helps to develop students' core competencies as nurses. Online and offline blended teaching is a novel teaching method that mixes the advantages of modern information technology and traditional classroom education, and it may guide students from simple to deep learning. Network platforms, live lectures, and simultaneous courses are among the most used online teaching approaches. Offline teaching methods primarily consist of case teaching, scenario simulation, group teaching, and interactive teaching methods (L​i​u​,​ ​2​0​1​8).

Diverse teaching methods can be actively exploited to achieve method innovation in future curriculum construction. For example, the combination of explicit education and invisible education can be developed to actualize the benign interaction between ideological and political education and specialized courses, in order to properly integrate ideological and political education into the overall process of students' growth. In addition, it can also promote the combination of traditional teaching methods and new media technologies, and use new media and new technologies through various methods such as smart classrooms and blended teaching. Through recording videos, making 3D animations, designing models, etc., the intuitive feeling, professional self-confidence and ideological identity of "course ideology and politics" are enhanced. Convert a straightforward lecture into a soft, silent education. To make the interaction between teachers and students equal and friendly. The intellectual and political education from a few people's business to the duty of everybody.

The data sources of bibliometric research methods are published papers, excluding reports, monographs and other forms of written communication, so the coverage of the measurement system is incomplete. In addition, the parameter setting of Cite Space software is very complex, and different time slices or different threshold settings will also affect the research results to a certain extent. Nevertheless, bibliometric methods and Cite Space visual analysis provide a reliable perspective for us to study the research hotspots and frontier issues in a certain field.

Based on CNKI, Wanfang Database and VIP Database, this paper uses CiteSpace and VOSviewer software to objectively analyze the development status of ideological and political education in nursing curriculum. Although research in related subjects in China began relatively late, it is now in a state of rapid development and is projected to continue to expand in the future. Cooperation between research institutions and personnel is limited, and it should be strengthened in future study. The quality of literature publication is now low, and the depth of relevant study must be increased in the future. The courses offered by teachers are primarily theoretical, and the teaching process should be supplemented with clinical practice. Furthermore, teachers should improve the curriculum's ideological and political ability, actively employ diverse teaching techniques, and integrate ideological and political elements into various curriculum teaching in order to give talent guarantee for the fulfillment of "Healthy China".