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Brazilian Nursing and Production in Palliative Care: A Bibliometric Study

Objective: This study aims to quantify and describe the characteristics of scientific production in Brazilian Nursing on Palliative Care between the years 2015-2020. Methodology: This is a descriptive, bibliometric study. At the end of the selection stage, the final sample of 98 publications emerged. Mini-review Article Carvalho et al.; JPRI, 33(25A): 1-9, 2021; Article no.JPRI.67228 2 Results: Of the total number of publications, 28 (28.57%) in the VHL database and 70 (71.43%) in SciELO. Most publications occurred in 2018 with 26 (26.53%) and 2016 with 19 (19.39%) publications, followed by 2017 with 16 (15.36%) publications. Conclusion: The findings in this study show that in the past 5 years, Brazilian nursing has been discussing and researching palliative care. However, it was also observed that the concentration of Brazilian nursing publications in palliative care is in the Southeast and South regions of Brazil, with the North region falling far short of study in the area.


INTRODUCTION
The word "palliative" comes from the Latin word pallium, which means cover, protection, that is, protecting those that curative medicine can no longer help [1]. The most current definition for Palliative Care (CP) was developed through a project involving more than 400 members from 88 countries of the International Association for Hospice & Palliative Care (IAHPC), which defines CP as "active holistic care, offered to people of all ages who are in intense suffering related to their health, resulting from serious illness, especially those who are at the end of life" [2].
This type of therapy, whose approach is aimed at improving the quality of life of the patient and his family in the face of a disease that jeopardizes the continuity of life, aims at the prevention and relief of suffering, involving early identification, rigorous evaluation and treatment of pain and other biopsychosocial and spiritual problems [3] in conditions where the death process is irreversibly triggered and the prognosis of life can be defined in months, weeks or days, palliation is essential [4].
Care in this final period of the life cycle includes measures to improve the quality of life, wellbeing and comfort of patients, in all dimensions of being (social, physical, psychological, spiritual, ecological) [5]. In the midst of this context, nursing, as a profession that has the prescription of care as an instrument, plays a fundamental role in palliative care, and for this reason, it must have assistance that follows the model established in the bioethics of Palliative Care [6].
The nurse plays a crucial role in the intermediation between the team and the family and to provide good assistance to the patient in palliation, this professional must understand the philosophy and precepts of the PC and adhere to this proposal so that he can assist in the reflection and adhesion of patients and family, since their personal beliefs directly influence this process [5].
Therefore, the nurse must provide his assistance individually, offering favorable conditions for the patient's well-being beyond the possibility of cure, as well as providing comfort, basic and pathophysiological care and paying attention to the patient's desires, desires and desires [7].
It is reiterated that knowing and understanding the different profiles of patients in which they are undergoing palliative therapy is necessary in order to offer the patient and their family members a more adequate understanding of the progress of the disease so that they can participate in decisions related to therapeutic alternatives for symptom control [8].
Given this context, this study aims to quantify and describe the characteristics of the scientific production of Brazilian Nursing on Palliative Care between the years 2015 to 2020.

MATERIALS AND METHODS
This is a descriptive study, bibliometric and based on documents. Bibliometrics is a statistical and quantitative technique with the objective of presenting indices of production and dissemination of scientific knowledge about a given theme [9].
The guiding question that guided this study was elaborated through the PICo strategy (P: Patient, I: Intervention, Co: Context) "What is the scientific production of Brazilian nursing in palliative care in the period from 2015 to 2020?". Data collection was carried out in November 2020, on the Virtual Health Library (VHL) portal and on the Scientific Electronic Library Online (SciELO). To enhance and guarantee the direction to the relevant studies, the selection of the articles occurred through the combination of descriptors registered in the DeCS (Health Sciences Descriptors) "Nursing" and "Palliative Care" mediated by the Boolean operators "AND" and "OR ".
It was established as inclusion criteria for sample selection: full articles available in the databases, review articles, reflective articles, editorials, letters to the editor, theses and dissertations of Postgraduate Nursing Programs that addressed the theme palliative care and publications between the years 2015 to October 2020. The exclusion criteria used were: articles unavailable online or with closed access, productions from other areas of knowledge or that did not address the topic satisfactorily.
At the end of the selection stage, 2,315 publications were found in the referred databases. Then, the duplicates were removed, leaving a total of 2,301 publications. After this phase, the articles underwent an evaluation regarding the title and abstract and of this total, 2,170 were excluded from the screening process, where at the end 131 were eligible for careful evaluation. The assessment during this phase had the purpose of discarding irrelevant articles and after thorough analysis and following the exclusion criteria, 33 publications were excluded, thus emerging the final sample consisting of 98 publications.
The articles selected for the qualitative synthesis were evaluated submitted to the Microsoft Excel® software, using the following variables: year; title; type of publication; state of the authors; region of Brazil; approach; periodical; data base; QUALIS 2013-2016; occupation area; Country of publication and language. After that moment, a descriptive statistical analysis was performed, with records of the frequencies of the information obtained. The data are arranged and presented in the form of graphs and tables. The article selection process is shown in Fig. 1 (prism diagram). As this is a study with data available for public consultation and does not involve human beings, there was no need for submission and appreciation by the Research Ethics Committee (CEP).

RESULTS
98 scientific productions were identified on the proposed theme, 28 (28.57%) in the VHL Regarding the origin of the publications, it was evidenced that the majority originated from researchers from the Southeast Region of Brazil with 43 (43.88%) publications, followed by the South Region with 28 (28.57%) publications, as shown in Table 2.
Regarding the language, there was a predominance of the Portuguese language with 94 (94.95%) of the total number of publications, as can be better observed in the Graph 2.
Regarding the type of publication, it was observed that the vast majority of publications are of the original article type with 77 (77.78%) of the publications, followed by integrative reviews with 20 (8.08%) publications. The distribution of publications by type can be better observed in the Table 3.

DISCUSSION
The term palliative care was first cited by (WHO) in 1990 and updated by the institution in 2002 [10]. Since then, this type of care has been discussed and studied more expressively by researchers from all over the world and by nursing in Brazil, which demonstrates the growing number of publications in the last 5 years, as shown in Graph 1.
Palliative care is offered through a multidisciplinary team and among these professionals, nursing stands out. The nurse has as an instrument the provision of care, to patients with chronic diseases and in the process of finitude [6]. Thus, nursing care for palliative patients should be performed immediately after the diagnosis of the disease, together with curative and / or medication care and continue throughout the treatment, individual administrative and centered on the patient and family, with the objective of providing care in a timely manner. integral and holistic [11].
With regard to Qualis, this can be defined as a means of communication and dissemination of intellectual scientific production resulting from scientific investigations classified in quality strata and classified in extracts A1 and A2 (superior) and B1, B2, B3, B4, and B5 (intermediate) and C (lower) [1].
In addition, we observed that the journals with the largest number of publications are found in extract A, showing the quality of Brazilian nursing publications on the subject. It is noteworthy in this study that there were no publications in Qualis B5 and C journals, in addition, 1 publication in an international magazine was not classified as Qualis, according to the Sucupira Platform, therefore, the classification in none of the Qualis extracts.
Regarding the region of the country with the largest number of publications, there is the southeastern region of Brazil, with emphasis on the states of Rio de Janeiro and São Paulo, both with 37 publications. The findings corroborate with the study that states that the Southeast region is the region of Brazil that gathers the largest number of research groups, it should be noted a greater dedication of researchers from this Brazilian territory in the production of knowledge related to the study in palliative care [1].
Regarding the language, the vast majority of publications included in this research were in at least 2 languages, with the largest number of publications in Portuguese, but it was also identified simultaneously in the vernacular and English (56 publications). This fact can be explained by a number of reasons, and one of them is that the countries that have a more developed level of palliative care offer and more research in this area are mostly English-speaking countries [12].
Furthermore, the worldwide trend is to establish the English language as an international language in science, since studies show that articles published in English receive more citations, therefore, they are more read, disseminating knowledge on a larger scale, which leads researchers to seek journals and publications in the English language [13].
It is also observed that the largest number of articles are of the original type, coming from studies mostly of field research and that the countries with the largest number of publications are in Brazil. This fact can be observed because the selection originated in Brazil. The indicators show us that the largest number of publications are studies with a qualitative approach and coming from graduate programs in Nursing that make up the Southeast Region and having the hospital environment as a scenario.
The data indicate that this type of approach requires from the researcher the capacity for abstraction, analytical competence, respect for the uniqueness of the experience of the other, broad theoretical reflection, among others, being, therefore, a complex approach and that the majority of scientific production is develops through the qualitative approach and presents the hospital as a research setting [11].

CONCLUSION
The findings in this study fulfilled the objectives of quantifying and describing the characteristics of the scientific production of Brazilian nursing on Palliative Care between the years 2015 to 2020. In this context, in the last five years it has been noted that nursing has been discussing and researching care palliative. However, it was also observed that the concentration of publications on the subject is in the Southeast and South regions of Brazil, with other regions such as the North falling far short of studies in the area.
The limitation of the study was configured in the existence of gaps in national productions and in the knowledge of the nursing professional when talking about palliative care throughout Brazil, especially in the North Region, so more investment in studies on the theme is necessary, aiming to increase the in the area and, thus, improving health services.
It is noteworthy that the contributions of this study to nurses and society in general consist of updating the data on palliative care in the country, as well as demonstrating the number of publications on the subject in question, so that indicators on national production can emerge nursing in palliative care and also, to stimulate future research on the topic addressed.

CONSENT
It is not applicable.

ETHICAL APPROVAL
It is not applicable.