Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS

Ci a ion: Cuella -Pompa, L.; Rod íguez-Gómez, J.Á.; No o-Muñoz, M.M.; Rod íguez-No o, N.; Rod íguez-No o, Y.M.; Ma ínez- Albe o, C.-E. Desc ip ion and Analysis o Resea ch on Dea h and Dying du ing he COVID-19 Pandemic, Published in Nu sing Jou nals Indexed in SCOPUS. Nu s. Rep. 2024,14, 655–674. h ps:// doi.o g/10.3390/nu s ep14020050 Academic Edi o : Richa d G ay Recei ed: 15 Decembe 2023 Re ised: 25 Feb ua y 2024 Accep ed: 11 Ma ch 2024 Published: 22 Ma ch 2024 Copy igh : © 2024 by he au ho s. Licensee MDPI, Basel, Swi ze land. This a icle is an open access a icle dis ibu ed unde he e ms and condi ions o he C ea i e Commons A ibu ion (CC BY) license (h ps:// c ea i ecommons.o g/licenses/by/ 4.0/). A icle Desc ip ion and Analysis o Resea ch on Dea h and Dying du ing he COVID-19 Pandemic, Published in Nu sing Jou nals Indexed in SCOPUS Le icia Cuella -Pompa 1,*, José Ángel Rod íguez-Gómez 2, Ma ía Me cedes No o-Muñoz 2, Na alia Rod íguez-No o 2, Yu ena M. Rod íguez-No o 3and Ca los-En ique Ma ínez-Albe o 4 1 Ins i u o de In es igación en Cuidados del Ilus e Colegio de En e me os de San a C uz de Tene i e, Calle San Ma ín, 63, 38001 San a C uz de Tene i e, Spain 2Depa amen o de En e me ía, Facul ad de Ciencias de la Salud, Sección de En e me ía y Fisio e apia, Uni e sidad de La Laguna, S a. Ma ía Soledad, s/n, Apa ado 456, C. P., 38200 San C is óbal de La Laguna, Spain; [email p o ec ed] (J.Á.R.-G.); [email p o ec ed] (M.M.N.-M.); n [email p o ec ed] (N.R.-N.) 3Hospi al Uni e si a io Nues a Seño a de la Candela ia, Ca e e a Gene al del Rosa io, 145, 38010 San a C uz de Tene i e, Spain; [email p o ec ed] 4Escuela de En e me ía Nues a Seño a de Candela ia, Ca e e a Gene al del Rosa io, 145, 38010 San a C uz de Tene i e, Spain; [email p o ec ed] *Co espondence: [email p o ec ed] Abs ac : Aim: To o e an o e all pic u e o he esea ch published ega ding he di e en aspec s o dea h and dying du ing he COVID-19 pandemic in jou nals co e ing he ield o nu sing in he Scopus da abase. Design: bibliome ic analysis. Me hods: The me ada a ob ained we e expo ed om Scopus o subsequen analysis h ough Bibliome ix. Using he VOS iewe co-wo d analysis unc ion, he concep ual and hema ic s uc u e o he publica ions was iden i ied. Resul s: A o al o 119 pape s we e e ie ed, wi h he pa icipa ion o 527 au ho s. The publica ions we e ound in 71 jou nals co e ing he nu sing a ea. The main lines o esea ch e ol ed a ound he keywo ds “pallia i e ca e” and “end-o -li e ca e” in ega d o he e hical, psychological, and o ganiza ional challenges aced by he heal h p o essionals who ca ed o hese pa ien s. Conclusion: The esul s ob ained o e a ange o da a and images ha cha ac e ize he scien i ic p oduc ion published on his opic, coming o he conclusion ha , due o he mul i ace ed and mul idisciplina y app oach o he expe ience o dea h, ca e, and accompanimen in he dying p ocess, bibliome ic maps imp o e he comp ehensi e unde s anding o he seman ic and concep ual s uc u e o his ield o esea ch. This s udy was e ospec i ely egis e ed wi h he OSF Regis ies on he 14 Ma ch 2024. Keywo ds: nu ses; pallia i e ca e; a i ude o dea h; dea h; bibliome ics; knowledge disco e y 1. In oduc ion Bibliome ics, as a discipline, allows o he desc ip ion and e alua ion o scien i ic publica ions in any ield o knowledge [ 1 ]. This makes i possible o de ine he s a e o esea ch, as well as analyze he di e en cha ac e is ics o scien i ic ac i i y and p edic ends h ough he analysis o di e en indica o s ha a e es ablished om he nume ical da a ex ac ed om academic and scien i ic publica ions [ 2 ], such as he equency o publica ion, au ho ship, collabo a ion, ci a ion o co-ci a ion by coun ies, ins i u ions, e c. Thus, i is also possible o analyze he hema ic de elopmen o he concep ual s uc u e o a ield h ough he analysis o keywo ds. Based on hese conside a ions, his s udy ocused on he analysis o publica ions on dea h and dying du ing he COVID-19 pandemic ha we e published in nu sing jou nals indexed in Scopus. The heal h c isis caused by he pandemic ep esen ed a g ea challenge o heal h sys- ems globally due o he d as ic consequences caused by he sudden hospi al o e load. This scena io inc eased he p essu e on heal hca e p o essionals, wi h he wo kload esul ing in Nu s. Rep. 2024,14, 655–674. h ps://doi.o g/10.3390/nu s ep14020050 h ps://www.mdpi.com/jou nal/nu s ep Nu s. Rep. 2024,14 656 inc eased s ess, physical and emo ional exhaus ion, ea , loneliness, he isk o con agion and dea h [ 3 – 5 ], which led o, acco ding o da a om 44 coun ies, he In e na ional Council o Nu sing announcing a he end o 2020 ha as many nu ses had died om COVID-19 as du ing he Fi s Wo ld Wa [6]. The heal h p o essionals had o dedica e hemsel es ull ime o hei ca e ac i i ies. In his con ex , o he common ac i i ies, including esea ch, we e elega ed o he back- g ound [7]. This was made clea in a s udy in which he au ho s ound a ma ked inc ease in nu sing publica ions ela ed o COVID-19 in he i s mon hs o 2021 compa ed o wha was published du ing 2020 when he wo s s age o he pandemic occu ed [7]. Di e en bibliome ic s udies, whe e he keywo ds o he publica ions on nu sing p oduc ion h oughou he pandemic we e analyzed, ag ee ha , in he i s s age, he esea ch was ela ed o opics on co ona i us in ec ion, in ec ion con ol and heal h and nu sing policy, a e which he ocus changed o he e ec s o he pandemic on men al heal h and quali y o li e, as well as issues ela ed o nu sing educa ion, ypes o online aining, nu sing s uden s, and new expe iences o emo e assis ance [8–10]. Al hough dea h is pa o he li e cycle [ 11 ], he da a on he impac expe ienced by heal h p o essionals and he la ge numbe o dea hs associa ed wi h COVID-19 we e equen ly discussed in he media [ 12 , 13 ]; howe e , he di e en aspec s o he p ocess o dea h and dying du ing his pe iod do no seem o ha e been de eloped in he scien i ic li e a u e. Fu he mo e, he e do no seem o be any bibliome ic s udies add essing his issue, al hough he e a e se e al bibliome ic publica ions on COVID-19 in ela ion o nu sing [10,14]. Nu ses mus p o ide ca e o bo h pa ien s and amily membe s, and hey ha e o deal wi h dea h and he ea o acing his [ 15 ]. On he o he hand, due o he ele ance o bibliome ic esea ch in iden i ying, unde s anding and p omo ing p oblem sol ing [ 16 ], his s udy aims o p o ide a mo e p ecise pic u e o he quan i y and cha ac e is ics o in e na ional scien i ic p oduc ion published in he jou nals co e ing he ield o nu sing in he Scopus da abase, examining all issues ela ed o he p ocesses o dea h and dying. 2. Ma e ials and Me hods The e a e wo me hodological ca ego ies o he de elopmen o bibliome ic s ud- ies [ 17 ], which a e scien i ic pe o mance and scien i ic mapping. Pe o mance analysis is, by i s e y na u e, desc ip i e. I has been es ablished as he dis inguishing ea u e o bibliome ics analyses because i concen a es on he con ibu ions made by he con ibu- o s (au ho , jou nal, ins i u ion, coun y, e c.) o a pa icula ield o knowledge wi hin a gi en discipline [ 18 ]. The maps o science, ocus on he analysis o he connec ions be ween hese con ibu ions in e ms o he analysis o annual p oduc ion, ci a ions, co-ci a ions, co-wo ds, o co-au ho ship. The combina ion o hese analyses wi h ne wo k analysis makes bibliome ics an indispensable ool o p esen ing he bibliog aphic and in ellec ual s uc u e o a esea ch a ea [19,20]. 2.1. Aims • To de elop a s a is ical-desc ip i e analysis o he publica ions e ie ed wi h he sea ch. •To analyze he main indica o s using Bibliome ix 4.1.4. • To isualize he main concep s and ocuses o in e es in he esea ch based on he analysis o co-wo ds in VOS iewe 1.6.16. 2.2. S udy Desing This is an explo a o y, desc ip i e, longi udinal, and e ospec i e s udy abou he di e en aspec s o he p ocess o dea h and dying du ing he COVID-19 pandemic. I was conduc ed h ough wo bibliome ic ools o analyze he publica ions o he jou nals o nu sing indexed in he Scopus da abase. E hical app o al was no equi ed o his Nu s. Rep. 2024,14 657 s udy as i did no in ol e he use o da a om human pa icipan s, elying solely on bibliog aphic da a. 2.3. In o ma ion Sou ces The Scopus da abase was selec ed, as i is a undamen al sou ce o in o ma ion o he e alua ion o he esea ch and also con ains all he bibliog aphic da a a ailable. The eco ds we e downloaded in May 2023. Fi s ly, a sea ch s a egy was designed o ob ain he co pus o in o ma ion using he ollowing ields: i le, abs ac and keywo ds. The sea ch was limi ed o he yea s 2020–2023 and he subjec a ea “Nu sing”. The sea ch s a egy and he esul s a e shown in Table 1. Table 1. Sea ch s a egy pe o med in Scopus on 9 h May 2023. No. Que y Resul s #5 (LIMIT-TO ((PUBYEAR, 2023) OR LIMIT-TO (PUBYEAR, 2022) OR LIMIT-TO (PUBYEAR, 2021) OR LIMIT-TO (PUBYEAR, 2020)) AND LIMIT-TO (SUBJAREA, “NURS”)) 119 4 #1 AND #2 AND #3 665 3 TITLE-ABS-KEY (g ie OR be ea emen OR mou ning OR “End o li e ca e” OR end-o -li e OR “end o li e” OR “End o li e decision-making” OR suicide OR “T auma ic Dea h” OR dea h- ela ed OR “Dea h and Dying” OR “A i ude o dea h” OR “Dea h educa ion”) 253,309 2 TITLE-ABS-KEY ( hana ology OR eligion OR eligious OR spi i ual OR spi i uali y OR philosophy OR an h opology OR sociology OR socializa ion OR cul u al OR e hical OR legal OR ins i u ional OR “Li e Span” OR “Legal Aspec s” OR “His o ical Pe spec i es” OR “Con empo a y Pe spec i es” OR “P o essional Issues”) 2,695,503 1 TITLE-ABS-KEY (pandemic OR co id-19 OR sa s-co -2 OR “Se e e Acu e Respi a o y Synd ome Co ona i us 2” OR “NCOV” OR “2019 NCOV” OR 2019-nco OR “No el Co ona i us” OR “Co ona i us disease 2019”) 570,295 2.4. Bibliome ic Da a Analysis The analysis pa ame e s included he da a co esponding o p oduc ion by coun ies, au ho s, jou nals, and ins i u ions. In addi ion, he main concep s and ocuses o in e es we e iden i ied h ough he co-occu ence analysis o he indexed keywo ds (IKs), which a e e ms chosen by Scopus and s anda dized based on he ocabula y o he Else ie hesau us [21]. The me ada a ob ained we e expo ed om Scopus, in x o ma , o subsequen anal- ysis h ough Bibliome ix, an open-sou ce p og am, de eloped in R, which p o ides a se o ools o he scien ome ic analysis o he li e a u e. This p og am allows o he analysis o a ious bibliome ic indica o s wi hin a co pus o bibliog aphic in o ma ion [22,23]. In he same way, using he VOS iewe co-wo d analysis unc ion [ 24 , 25 ], he con- cep ual and hema ic s uc u e o he publica ions was iden i ied by means o he g aphic ep esen a ion o he di e en lines o esea ch [ 26 , 27 ]. Labeled and densi y maps we e chosen om he ypes o ep esen a ions a ailable. The o me uses labels wi h he names o each e m, and he sizes o hese labels a e p opo ional o hei weigh ( equency). Densi y maps a e cha ac e ized by he ep esen a ion o nodes in colo s anging om blue o g een and yellow o ed. These colo s e lec he densi y o he ela ionships be ween he e ms (co-occu ence). When he densi y o co-occu ence is highe , he hue on he map will be close o ed; in con as , wi h g ea e dispe sion and, he e o e, less co-occu ence, he hue on he map will u n blue [25]. Nu s. Rep. 2024,14 658 VOS iewe combines isualiza ion and clus e ing echniques o a o he analysis; hus, o he posi ioning o he IKs on he map, he VOS ( isualiza ion o simila i ies) echnique was used [ 28 ], which builds a simila i y ma ix om he ma ix o co-occu ence, using he Associa ion S eng h measu e as a simila i y index o no malize he bibliome ic ne wo k [ 29 ]. The Associa ion S eng h is based on he no maliza ion o co-occu ence alues and is applied so ha hese alues adequa ely ep esen he analyzed co pus and acili a e clus e ing. As a phase p io o he analysis in VOS iewe , he ile wi h he keywo ds was sub- jec ed o a no maliza ion p ocess wi h he aim o cleaning he in o ma ion collec ed o imp o e i s quali y. In his p ocess, he duplica e elemen s and hose ha ep esen ed he same concep (bu we e w i en di e en ly) we e uni ied, while hose ha con ained e o s in w i ing we e co ec ed. A hesau us was hen c ea ed wi h his da a, which was hen uploaded o VOS iewe o p omo e cla i y in he ep esen a ion o he maps. Likewise, some e ms used in he sea ch s a egy (COVID-19, co ona i us, pandemic, e c.) we e dispensed wi h, as well as hose e ms e e ing o ypes o publica ion (a icle o clinical a icle, e c.) and he s udy design ( e iew, quali a i e esea ch, su eys, ques ionnai es, e c.). Simila ly, high- equency IKs wi h ze o inpu in o he ep esen a ion, such as he keywo ds human o humans, we e emo ed om he analysis. Finally, in his case, due o low equency, he names o coun ies (USA, Canada) we e also elimina ed. Se e al ials we e ca ied ou whe e di e en equency h esholds we e es ed un il i was e i ied ha he map wi h he bes isualiza ion c i e ia was ob ained by limi ing he equency pa ame e o ≥ 4 appea ances. Thus, i was possible o dis inguish he hema ic s uc u e o he analyzed esea ch mo e clea ly based on he eigh y- wo mos equen e ms. A clus e ing algo i hm was execu ed [ 30 ], using he VOS echnique, ha posi ions and classi ies he keywo ds o be mapped. This algo i hm allows o di e en esolu ion pa ame e s depending on he alue p o ided o hei con igu a ion; hus, a low esolu ion pa ame e simul aneously implies a dec ease in he numbe o gene a ed clus e s and ice e sa. A e se e al es s applying di e en esolu ion alues, and once he di e en es esul s we e analyzed, i was decided ha he esolu ion pa ame e should be kep wi h a alue o 1, which is con igu ed by de aul in VOS iewe . The minimum size o he clus e s was con igu ed o a alue ≥ 3 IK, gua an eeing a minimum o consis ency in he hema ic g oups. 3. Resul s 3.1. Desc ip i e Analysis A o al o 119 [ 31 – 149 ] wo ks we e e ie ed by he sea ch s a egy in Scopus. The com- ple e me ada a, expo ed om Scopus, is a ailable in he supplemen a y ma e ial a ached o his publica ion (File S1) [ 31 – 149 ]. The da a ob ained showed ha hese documen s we e published in 71 jou nals in he nu sing a ea, ea u ing he pa icipa ion o 527 au ho s. An amoun o 549 signa u es we e coun ed, which comes o an a e age o 4.43 au ho s pe documen . The e we e 89 egis e ed a icles and 14 e iews in addi ion o less- equen documen a y ypology. The Uni ed S a es and he Uni ed Kingdom we e, espec i ely, he coun ies wi h he highes numbe o publica ions. Table 2shows an o e iew o he main esul s o he analysis. The mos p oduc i e yea was 2021, wi h 45 publica ions. In 2020, 19 wo ks we e published, and 16 e e ences ha e been egis e ed o da e (9 May) in Scopus in 2023 ela ed o he subjec o s udy. Nu s. Rep. 2024,14 659 Table 2. Main In o ma ion abou he collec ion, om Biblioshiny o Bibliome ix. Desc ip ion Resul s Main In o ma ion abou Da a Timespan 2020:2023 Sou ces (Jou nals, Books, e c.) 71 Documen s 119 A e age yea s om publica ion 1.6 A e age ci a ions pe documen s 7.4 A e age ci a ions pe yea pe doc 2.3 Re e ences 4191 Documen Types a icle 89 book 2 book chap e 3 edi o ial 6 le e 2 no e 3 e iew 14 Documen Con en s Keywo ds Plus (ID) 750 Au ho ’s Keywo ds (DE) 350 Au ho s Au ho s 527 Au ho Appea ances 549 Au ho s o single-au ho ed documen s 12 Au ho s o mul i-au ho ed documen s 515 Au ho s Collabo a ion Single-au ho ed documen s 12 Documen s pe Au ho 0.23 Au ho s pe Documen 4.43 Co-Au ho s pe Documen s 4.61 In e na ional co-au ho ships (%) 22.7 Collabo a ion Index 4.81 3.2. Jou nals Analysis B ad o d’s law is a use ul ool o analyzing he dis ibu ion o in o ma ion, as well as o be e unde s and i s s uc u e and how he di e en aspec s o a opic a e ela ed o one ano he . Taking his in o accoun , he p esen analysis es ablished ha , o he 71 jou nals epo ed, he Jou nal o Pain and Symp om Managemen (Q1) wi h 11 publica ions [57,62,65,70,77,81,87,99,103,109,124], he Jou nal o Pallia i e Medicine (Q2) wi h 10 [ 59 , 71 , 89 , 91 , 93 , 96 , 98 , 131 , 148 ], he Jou nal o Religion and Heal h (no JCR) wi h 7 [ 58 , 63 , 67 , 78 , 107 , 112 , 118 ], Nu sing E hics (Q1) wi h 6 [ 39 , 56 , 69 , 73 , 75 , 104 ], Jou nal o Med- ical E hics (Q1) wi h 4 [ 53 , 100 , 102 , 106 ] and BMJ Suppo i e and Pallia i e Ca e (no JCR) wi h 3 publica ions [ 68 , 85 , 97 ] we e he cen al sou ces, wi h accoun ing o only 8.5% o he o al. See Figu e 1. All he abo e-men ioned jou nals a e on he hema ic a ea o nu sing, which includes gene al nu sing; p oblems, e hics and legal aspec s; medical and su gical nu sing; and oncology nu sing, ga he ed om he Scopus da abase. Nu s. Rep. 2024,14 660 Nu s. Rep. 2024, 14, FOR PEER REVIEW 6 Figu e 1. B ad o d’s Law, applied o a icles on dea h and dying published in he Scopus nu sing jou nals be ween 2020 and 2023. All he abo e-men ioned jou nals a e on he hema ic a ea o nu sing, which includes gene al nu sing; p oblems, e hics and legal aspec s; medical and su gical nu sing; and oncology nu sing, ga he ed om he Scopus da abase. The heme add essed in he pape s published by hese six cen al jou nals e ol ed a ound end-o -li e ca e, pallia i e ca e, pa ien digni y, and he e hical challenges in c i i- cal ca e and end-o -li e ca e du ing he pandemic. In addi ion, suppo o g ie , dea h anxie y, men al heal h in ela ion o s ess, as well as he mo al con lic s expe ienced by nu ses in he mids o he si ua ion gene a ed by he heal h c isis, we e also add essed. Se e al s udies ha e been de eloped on he pe spec i e o nu sing s uden s and medical esiden s in ega d o dea h and dying and he e hical challenges ela ed o end-o -li e ca e. O he issues de eloped had o do wi h spi i uali y and eligion as coping s a egies in he mids o he heal h eme gency si ua ion. 3.3. Au ho ship and P oduc i i y Analysis The mos p oduc i e au ho s we e Be y R. Fe ell and William E. Rosa, each wi h h ee co-au ho ed publica ions [51,114,124]. Two pape s we e published by 3.4% o he au ho s, while 96.2% o he au ho s had only one publica ion. These esul s co espond o he p emise o Lo ka’s Law ega ding he unequal dis ibu ion o p oduc i i y. This law s a es ha a ew au ho s publish mos o he pape s on a esea ch opic, while he majo i y publish a minimum numbe o s udies. See Table 3. Table 3. Au ho P oduc i i y Using Lo ka’s Law. Documen s W i en No. o Au ho s P opo ion o Au ho s 1 507 0.962 2 18 0.034 3 2 0.004 3.4. Scien i ic P oduc ion by Coun ies Only 10.5% (Uni ed S a es, Canada, Spain, and Uni ed Kingdom) ou o a o al o 38 coun ies published app oxima ely 49% o he wo ks. See Figu e 2. Figu e 1. B ad o d’s Law, applied o a icles on dea h and dying published in he Scopus nu sing jou nals be ween 2020 and 2023. The heme add essed in he pape s published by hese six cen al jou nals e ol ed a ound end-o -li e ca e, pallia i e ca e, pa ien digni y, and he e hical challenges in c i ical ca e and end-o -li e ca e du ing he pandemic. In addi ion, suppo o g ie , dea h anxie y, men al heal h in ela ion o s ess, as well as he mo al con lic s expe ienced by nu ses in he mids o he si ua ion gene a ed by he heal h c isis, we e also add essed. Se e al s udies ha e been de eloped on he pe spec i e o nu sing s uden s and medical esiden s in ega d o dea h and dying and he e hical challenges ela ed o end-o -li e ca e. O he issues de eloped had o do wi h spi i uali y and eligion as coping s a egies in he mids o he heal h eme gency si ua ion. 3.3. Au ho ship and P oduc i i y Analysis The mos p oduc i e au ho s we e Be y R. Fe ell and William E. Rosa, each wi h h ee co-au ho ed publica ions [ 51 , 114 , 124 ]. Two pape s we e published by 3.4% o he au ho s, while 96.2% o he au ho s had only one publica ion. These esul s co espond o he p emise o Lo ka’s Law ega ding he unequal dis ibu ion o p oduc i i y. This law s a es ha a ew au ho s publish mos o he pape s on a esea ch opic, while he majo i y publish a minimum numbe o s udies. See Table 3. Table 3. Au ho P oduc i i y Using Lo ka’s Law. Documen s W i en No. o Au ho s P opo ion o Au ho s 1 507 0.962 2 18 0.034 3 2 0.004 3.4. Scien i ic P oduc ion by Coun ies Only 10.5% (Uni ed S a es, Canada, Spain, and Uni ed Kingdom) ou o a o al o 38 coun ies published app oxima ely 49% o he wo ks. See Figu e 2. Nu s. Rep. 2024,14 661 Nu s. Rep. 2024, 14, FOR PEER REVIEW 7 Figu e 2. Dis ibu ion o publica ions acco ding o he coun y o he co esponding au ho . 3.5. Ins i u ional Scien i ic P oduc ion Bibliome ix pe o ms a disambigua ion ask wi h he goal o cleaning he da a o accoun o single ins i u ions. The ambigui y in his case e e s o he di e en ways o ep esen ing he ins i u ional names in he bibliog aphic me ada a, which can in ol e misspellings o he w i ing o ac onyms o abb e ia ions o he name, which makes hem seem di e en when hey e e o he same ins i u ion. O he 234 ins i u ions, he 10 mos ele an we e selec ed (see Table 4). Se en we e uni e si ies, while he es we e medical cen e s o hospi als. Table 4. F equency o publica ion o he 10 mos p oduc i e ins i u ions in he analyzed pe iod. A ilia ion F eq. Uni e si y o Cali o nia, San Diego 12 Massachuse s Gene al Hospi al 10 Uni e si y o To on o 10 King’s College, London 9 Maas ich Uni e si y Medical Cen e 9 Mayo Clinic 9 Maas ich Uni e si y 8 Icahn School o Medicine a Moun Sinai 7 The Ohio S a e Uni e si y 7 Uni e si y o Michigan Medical School 7 3.6. Main Topics O he 119 documen s eco e ed, 14.3% [17] did no ha e IKs, so hey we e no in- cluded in he analysis. A e applying he clus e ing algo i hm, wi h a esolu ion pa ame e o one, i e clus- e s we e gene a ed ha e lec ed he deg ee o simila i y be ween he IKs. The clus e s we e isualized by a labeled bibliome ic map and a bibliome ic densi y map. The size o he clus e s in he labeled bibliome ic map was de e mined by di e en ac o s, such as he numbe o IKs wi hin each g oup, as well as he equency and he weigh o simila i y index. The colo o each clus e was andomly assigned by he p o- g am (see Figu e 3). The i e clus e s ep esen ed on he map de ined he main opics published in Scopus nu sing jou nals in he de ined pe iod and on he subjec s ela ed o dea h and dying in imes o pandemic. 0 5 10 15 20 25 30 35 40 USA Canada Spain UK F ance Japan Aus alia Aus ia China Denma k I eland I aly Ne he lands Swi ze land A gelia Chile E hiopia Geo gia Ge many India Co esponding au ho ’s coun y Single Coun ies Publica ion Mul iple Coun ies Publica ion Figu e 2. Dis ibu ion o publica ions acco ding o he coun y o he co esponding au ho . 3.5. Ins i u ional Scien i ic P oduc ion Bibliome ix pe o ms a disambigua ion ask wi h he goal o cleaning he da a o accoun o single ins i u ions. The ambigui y in his case e e s o he di e en ways o ep esen ing he ins i u ional names in he bibliog aphic me ada a, which can in ol e misspellings o he w i ing o ac onyms o abb e ia ions o he name, which makes hem seem di e en when hey e e o he same ins i u ion. O he 234 ins i u ions, he 10 mos ele an we e selec ed (see Table 4). Se en we e uni e si ies, while he es we e medical cen e s o hospi als. Table 4. F equency o publica ion o he 10 mos p oduc i e ins i u ions in he analyzed pe iod. A ilia ion F eq. Uni e si y o Cali o nia, San Diego 12 Massachuse s Gene al Hospi al 10 Uni e si y o To on o 10 King’s College, London 9 Maas ich Uni e si y Medical Cen e 9 Mayo Clinic 9 Maas ich Uni e si y 8 Icahn School o Medicine a Moun Sinai 7 The Ohio S a e Uni e si y 7 Uni e si y o Michigan Medical School 7 3.6. Main Topics O he 119 documen s eco e ed, 14.3% [ 17 ] did no ha e IKs, so hey we e no included in he analysis. A e applying he clus e ing algo i hm, wi h a esolu ion pa ame e o one, i e clus e s we e gene a ed ha e lec ed he deg ee o simila i y be ween he IKs. The clus e s we e isualized by a labeled bibliome ic map and a bibliome ic densi y map. The size o he clus e s in he labeled bibliome ic map was de e mined by di e en ac o s, such as he numbe o IKs wi hin each g oup, as well as he equency and he weigh o simila i y index. The colo o each clus e was andomly assigned by he p og am (see Figu e 3). The i e clus e s ep esen ed on he map de ined he main opics published in Scopus nu sing jou nals in he de ined pe iod and on he subjec s ela ed o dea h and dying in imes o pandemic. Nu s. Rep. 2024,14 662 Nu s. Rep. 2024, 14, FOR PEER REVIEW 8 Figu e 3. Labeled bibliome ic map whe e he 82 analyzed IKs a e ep esen ed. The labels and he size o he ci cles e lec he weigh o he IK, while he colo o he ci cles shows he hema ic g oup which each IK belongs o. VOS iewe assigns he colo o he clus e s au oma ically by applying he VOS algo i hm, as explained in he me hods sec ion. The ollowing sec ion p o ides a de ailed desc ip ion o he con en s o each clus e . Table 5 displays he mos signi ican IKs wi hin each clus e , along wi h hei equency o appea ance and co esponding hema ic g oup colo . Table 5. IKs wi h he g ea es weigh wi hin each clus e ( he colo co esponds o he di e en iden i ied hema ic g oups). Clus e Colo Indexed Keywo ds Occu ences 1 Psychology 15 1 G ie 12 1 Be ea emen 11 1 Pneumonia, i al 11 2 Adul 28 2 Aged 19 2 Religion 14 2 Epidemiology 11 3 End-o -li e ca e 28 3 Heal h ca e pe sonnel 15 3 In ensi e ca e uni s 12 3 In e pe sonal communica ion 10 4 Spi i ual ca e 13 4 Pe sonal expe ience 6 4 Mo ali y 5 4 Dying 5 5 Pallia i e he apy 35 5 Pallia i e ca e 26 5 Child 5 5 Pallia i e nu sing 4 Clus e 1 ( ed): in gene al, publica ions we e ound on amily, social, and heal hca e suppo in he ace o loss and mou ning, as well as e hical, cul u al, and psychological ac o s ela ed o a i udes owa ds dea h and ad anced ca e planning. Figu e 3. Labeled bibliome ic map whe e he 82 analyzed IKs a e ep esen ed. The labels and he size o he ci cles e lec he weigh o he IK, while he colo o he ci cles shows he hema ic g oup which each IK belongs o. VOS iewe assigns he colo o he clus e s au oma ically by applying he VOS algo i hm, as explained in he me hods sec ion. The ollowing sec ion p o ides a de ailed desc ip ion o he con en s o each clus e . Table 5displays he mos signi ican IKs wi hin each clus e , along wi h hei equency o appea ance and co esponding hema ic g oup colo . Table 5. IKs wi h he g ea es weigh wi hin each clus e ( he colo co esponds o he di e en iden i ied hema ic g oups). Clus e Colo Indexed Keywo ds Occu ences 1 Psychology 15 1 G ie 12 1 Be ea emen 11 1 Pneumonia, i al 11 2 Adul 28 2 Aged 19 2 Religion 14 2 Epidemiology 11 3 End-o -li e ca e 28 3 Heal h ca e pe sonnel 15 3 In ensi e ca e uni s 12 3 In e pe sonal communica ion 10 4 Spi i ual ca e 13 4 Pe sonal expe ience 6 4 Mo ali y 5 4 Dying 5 5 Pallia i e he apy 35 5 Pallia i e ca e 26 5 Child 5 5 Pallia i e nu sing 4 Nu s. Rep. 2024,14 663 Clus e 1 ( ed): in gene al, publica ions we e ound on amily, social, and heal hca e suppo in he ace o loss and mou ning, as well as e hical, cul u al, and psychological ac o s ela ed o a i udes owa ds dea h and ad anced ca e planning. Clus e 2 (g een): publica ions on spi i uali y and he eligious pe spec i e in he ace o anxie y, anguish, dep ession, and s ess, as well as he ole o empa hy, human ela ions, and coping beha io s in he men al heal h o adul s and he elde ly, in addi ion o he de elopmen o ca e by heal h pe sonnel and he p oblema ic issue o suicide in nu ses. Clus e 3 (blue): his co e s he o ganiza ional and adminis a i e poin o iew ega ding ca e o he c i ically ill and hose a end o li e in in ensi e ca e uni s om he pe spec i e o heal h pe sonnel, pa icula ly nu ses, in ela ion o policies, p ocedu es, heal h ca e sys ems and se ices, as well as access o he apeu ic measu es o alle ia e su e ing in c i ical pa ien s when aced wi h he challenge o communica ion wi h he pa ien and he amily in he mids o con inemen and s ic isola ion measu es du ing he pandemic. Clus e 4 (yellow): Publica ions on dea h and dying om a clinical, spi i ual and psychosocial pe spec i e. The p oblema ic issue o he well-being o pa ien s in ega d o he con ol o symp oms and complica ions de i ed om COVID-19, as well as he si ua ion o loneliness and isola ion du ing he dying p ocess in he pe iod o he pandemic; he pe sonal expe iences o bo h pa ien s and hei amilies ega ding he medical ca e ecei ed; spi i ual ca e in his en i onmen , he impo ance o aining nu sing s a in spi i ual ca e, and he esou ces and ba ie s o p o iding spi i ual ca e o expe iences wi h spi i uali y in clinical p ac ice we e some o he issues add essed, in addi ion o he psychosocial pe spec i e o ca e in he mids o mobili y and accompanimen o dying pa ien s’ es ic ions. Clus e 5 (pu ple): IKs ela ed o di e en aspec s o pallia i e ca e we e included in his clus e . Di e en nuclei ela ed o he mos de eloped hemes we e iden i ied in he bibliome - ic densi y map (see Figu e 4). The ields wi h he g ea es IK impac we e iden i ied in he cen e o he map (in ed), and se e al oci o in e es we e ound. These cen al g oups a e connec ed o one ano he by di e en b idge nodes, as well as wi h he es o he g oups on he pe iphe y o he map, which p esen less in e ac ion (in yellow, g een, and blue). Nu s. Rep. 2024, 14, FOR PEER REVIEW 9 Clus e 2 (g een): publica ions on spi i uali y and he eligious pe spec i e in he ace o anxie y, anguish, dep ession, and s ess, as well as he ole o empa hy, human ela- ions, and coping beha io s in he men al heal h o adul s and he elde ly, in addi ion o he de elopmen o ca e by heal h pe sonnel and he p oblema ic issue o suicide in nu ses. Clus e 3 (blue): his co e s he o ganiza ional and adminis a i e poin o iew e- ga ding ca e o he c i ically ill and hose a end o li e in in ensi e ca e uni s om he pe spec i e o heal h pe sonnel, pa icula ly nu ses, in ela ion o policies, p ocedu es, heal h ca e sys ems and se ices, as well as access o he apeu ic measu es o alle ia e su e ing in c i ical pa ien s when aced wi h he challenge o communica ion wi h he pa ien and he amily in he mids o con inemen and s ic isola ion measu es du ing he pandemic. Clus e 4 (yellow): Publica ions on dea h and dying om a clinical, spi i ual and psy- chosocial pe spec i e. The p oblema ic issue o he well-being o pa ien s in ega d o he con ol o symp oms and complica ions de i ed om COVID-19, as well as he si ua ion o loneliness and isola ion du ing he dying p ocess in he pe iod o he pandemic; he pe sonal expe iences o bo h pa ien s and hei amilies ega ding he medical ca e e- cei ed; spi i ual ca e in his en i onmen , he impo ance o aining nu sing s a in spi - i ual ca e, and he esou ces and ba ie s o p o iding spi i ual ca e o expe iences wi h spi i uali y in clinical p ac ice we e some o he issues add essed, in addi ion o he psy- chosocial pe spec i e o ca e in he mids o mobili y and accompanimen o dying pa- ien s’ es ic ions. Clus e 5 (pu ple): IKs ela ed o di e en aspec s o pallia i e ca e we e included in his clus e . Di e en nuclei ela ed o he mos de eloped hemes we e iden i ied in he biblio- me ic densi y map (see Figu e 4). The ields wi h he g ea es IK impac we e iden i ied in he cen e o he map (in ed), and se e al oci o in e es we e ound. These cen al g oups a e connec ed o one ano he by di e en b idge nodes, as well as wi h he es o he g oups on he pe iphe y o he map, which p esen less in e ac ion (in yellow, g een, and blue). Figu e 4. Bibliome ic densi y map showing he 82 analyzed IKs. The colo s close o ed show he a eas wi h he highes densi y o IKs co-occu ences; he colo s close o yellow and g een show he a eas wi h he lowes densi y IKs co-ocu ences. Figu e 4. Bibliome ic densi y map showing he 82 analyzed IKs. The colo s close o ed show he a eas wi h he highes densi y o IKs co-occu ences; he colo s close o yellow and g een show he a eas wi h he lowes densi y IKs co-ocu ences. Nu s. Rep. 2024,14 670 51. De Campos, A.P.; Le oy, K.; Pandey, S.; Wisniewski, R.; Dimau o, P.; Fe ell, B.R.; Rosa, W.E. In eg a ing Pallia i e Ca e in o Nu sing Ca e. Am. J. Nu s. 2022,122, 40–45. [C ossRe ] [PubMed] 52. Bou maleau, J.; Mailla d, S. Nu ses in Mul i-Disciplina y Team o Face Sa s-CoV-2 in In ensi e Ca e. Re . 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