Family Health Medical Practices and Nursing Care : a Bibliometric Approach

Methods: This is a bibliometric study carried out in the ISI Web of Knowledge/Web of ScienceTM in the temporal cut between the years 1957 and 2016, using the following search topics: “family health” and “nursing”. The search results were analyzed according to the temporal evolution of the publications records; The most prominent magazines; The most productive authors; The articles with the highest number of citations and the most productive institutions and citation relations among the most cited groups of articles in global and local relations.


Introduction
Nursing occupies an important space within human care and has stood out as fundamental in the care providers environments so that "caring" and the professions of care are confused.Actually, care has been described in the literature as an object of nursing study and work [1], which stands out in several areas such as the promotion of popular education in health in primary care contexts [2].
From this point of view, thus caring is part of nursing and moves on to a humanistic perspective at the expense of biologicist ideology with an appreciation of the particularities of the human being inserted in a historical and social context, so that the subjective aspects of each individual are taken into account [3].
The Brazilian context shows that nursing care has been prominent in its work with public health programs, included in the Unified Health System (Sistema Único de Saúde-SUS), such as the Family Health Strategy FHS (Estratégia Saúde da Família-ESF) in which the nurse practitioner joins as a member of the multiprofessional health team [3].The SUS is the world's largest program of public health.
The FHS has began in 1994 as a program launched by the Brazilian Ministry of Health under the name of Family Health Program (Programa Saúde da Família-PSF), which began to assume a fundamental role in the health care of families in the most varied social and geographical Brazilians contexts so that the program evolves a strategy towards reorientation the health system [4].
The FHS currently contributes to the consolidation of primary health care in the country, based on health promotion and prevention with a focus on community and individualized and humanistic attention in order to create a link with users and improve the quality of care provided [4], so that user satisfaction is related to the quality of services provided [5].In this sense, the SUS has given priority to the FHS so that the financial incentives coming from the Brazilian Ministry of Health have increased [6,7].
In this process of implementing the FHS to the reorganization of primary care, the nurse acts directly in the promotion and prevention of community health and establishes links that improve the users' confidence.In the primary care of European countries, such as England, the nurse's role is broad and diversified so that it articulates with clinical and social demands with social service agencies.It also works extended to the promotion and prevention of health based on constant evaluations as well as the promotion of self-care [8].
Among communities with a culture different from the average, such as the Hmong in the United States, nurses based on knowledge about cultural and social peculiarities will be more successful in health promotion and recovery so that the well informed nurse service provides users with confidence and their specific needs can be met [9].In this sense, it is observed the relevance of the nurses' work with Family Health with a differentiated approach to health issues and individualized attention considering the users as a historical being inserted in a cultural context in order to promote prevention, promotion and recovery of Health of people inserted in a family context.Thus, the study aims to map the scientific production on Family Health and Nursing.

Method
This is a bibliometric study on Family and Nursing Health conducted in the Web of Science TM .Bibliometric studies have been used to map the scientific production of a certain area of knowledge and provide the identification of prominent authors of the area, topics covered, most cited articles as well as major journals that stand out in the publication of articles of high impact [10].In addition, it has been used to identify the annual evolution of publications of a given subject [11].
The choice of the Web of Science TM as a database for the bibliometric survey is based on its academic relevance and global reach, in addition to the considerable number of journals indexed to it [12].The following steps were followed: delimitation of the problem; choice of database; data collect; presentation and analysis of data [13].The following topics were used to search on the database: "family health" and "nursing".
After the search the data were exported to the software Histcite, a bibliometric data processing software, to improve the organization and analysis of the data.The data were organized and analyzed considering: number of articles retrieved in the database; journals with more publications; more productive authors; annual evolution of publications; main countries; institutions with the most published papers and cited references.
In addition to these data, the relationships between the 19 articles with the greatest impact were explored, that is, the most cited among the 594 articles in the sample.In order to make this analysis feasible, the 19 articles were divided into two groups: Group 1-Articles that received more citations from other works throughout ISI Web of Science, called Global Citation Score (GCS) and Group 2 -articles that received more citations of the work that compose the sample of this bibliometric study, that is, the 594 articles, denominated as Local Citation Score (LCS).These papers were read in full and had its content analysided through content analysis techniques [15,16,17].

Results
After the bibliometric search was carried out in the main collection of the Web of Science TM , 594 articles on Family and Nursing Health were identified.These articles are published in 175 different journals indexed to the database and were written by 1769 authors who have links to 671 institutions, located in 42 countries, among which the University of São Paulo stands out because it is the most productive with 74 articles.For the achievement of these arti-cles, 14,473 references were used, with an average of approximately 24 references per article.In Table 1, these results are presented below.
The first publication record is from the year 1957, a paper that discussed the role of nurses in the health context of Israeli families emphasizing the importance of the patient as an individual inserted in a historical and social context [17].The scientific production remained low until the year 2006 and reached its peak in the year of 2012 where were registered 77 publications, relatively high when compared to the year of 2006 that had only 10 records of publications.Despite of the decrescent levels between 2012 and 2014, the growth path started again in 2014.(Figure 1) Table 2 illustrates the journals with more papers published on the subject between the years of 1957 and 2016 as well as the amount of citations that each group of articles received.Among the 11 journals with the most published papers on the subject, 8 are Brazilian and the Revista da Escola de Enfermagem da USP was the one that has the largest number of published papers on the subject, 82.Among the Brazilian journals are the main nursing journals of the country, with emphasis on the Revista Latino-Americana de Enfermagem, classified as the best Brazilian nursing journal according to the evaluation of the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior -CAPES, which is the agency for assessment of graduate courses.
However, although most journals are Brazilian nationals, it is an international journal that stands out with the largest number of citations, Journal of advanced nursing, with 20 articles published on the subject that together received 437 citations.It is important to emphasize that the Brazilian journals identified in this study are relevant vehicles for dissemination of the national scientific production with indexation in bases of global reach.Among them, the most received quotations in their articles was the Revsita de Saúde Pública.(Table 3).
Among the 1,769 authors of the 594 papers in the study sample, 11 stand out as the ones with the highest academic output on the subject.Schimied V is the most prominent researcher on productivity presenting 19 articles published among those selected in this study, the author is a nurse midwife and has a link with the University of Technology, Sydney, Australian institution, being a professor at the School of Nursing and Obstetrics and Of the Family and Community Health research group.
The second author in order of importance for the number of articles published is Fowler C with 12 publications, also an Australian researcher at the Faculty of Health, University of Technology.The researcher in question is a nurse and stands out for working with families and children up to five years of age.
As for the most productive Brazilian authors, it is intriguing to highlight two, Marcon SS and Mishima    4).
Brazil stands out as the country with the highest number of publication records on the subject with 293 published papers representing almost 50% of the sample of this study.The United States and Australia are the other two countries that stand out in the scientific production related to the subject in question.(Figure 2).

Discussion
Although the present research does not contemplate all studies on Family Health and Nursing, it was possible to identify high quality scientific papers indexed to the Web of Science TM and, from them, to map the world scientific production on the subject, since the database in which the search for the papers occurred has global coverage as described by Sousa et al. [11].
According to the initial part of the mapping on the scientific production on Family Health and Nursing, the annual evolution of the production is observed with the first publication record identified in the year of 1957 that approached the nursing work in the context of family health in Israel and describing the patient as a being inserted in a historical and social context [17].However, the increase in scientific production has grown considerably since 2009, registering 46 publications, almost double the previous year and 2016 stands out as the year in which the scientific production was more considerable, with 66 registrations.
The first article identified with a date of 1957 was published by an American journal, but the Bra-  zilian scientific journals stand out as to the number of publications of scientific papers that discuss the subject, among the 11 journals with the largest number of articles published, 8 are Brazilian and 4 aong them are specific journals with nursing care as main theme.
The Revista da Escola de Enfermagem da USP leads production with 82 publication records, but the highlight is a foreign journal with 20 publication records and the lagerst citations per published article score.The journal is the Journal of advanced nursing, the 20 articles published in this journal received 437 citations.
As for the most productive authors among the 1769 identified, the most productive authors are two Australian nurses who have their research concentrated in the theme of Family Health.However, it is important to highlight the prominence of two Brazilian nurses who appear among the 11 most productive authors of the sample, both with research in the field of Family Health.
In this way, Brazil is the most important country in terms of scientific production on the subject, covering almost half of all articles identified in the present investigation, followed by the United States of America and Australia.
On the relation between the most cited articles in the Web of Science (Global Citation Score) and the most cited articles within the group of articles selected (Local Citation Score), it is noticed that in the GCS the ten articles most cited do not present any relation [18,19,20,21,22,23,24,25,26,27].
In the GCS, the most cited article discuss the thematic field of postpartum depression and the implications for the health of the family [23], becoming the most cited article in the entire Web of Science among the group of selected papers in this study.The second most cited article in the Web of Science, in the GCS relation, is a study that evaluated the impact of the Family Health Program in Brazil on infant mortality rates and shows the direct contribution of the Family Health Program to the reduction of infant mortality in Brazil, indicating that as the program coverage increased infant mortality rates declined [26].
Several studies have addressed the FHP implementation process and the improvements in health indicators of the assisted population, as well as the tendency to change the care model based on the biological perspective focused on the disease, although the process of implantation and coverage of the program was low in its first years [28,29].
However, the coverage of the Family Health Strategy in Brazil in recent years has seen considerable growth encouraged by the Brazilian Ministry of Health, since it is considered the main gateway to the Unified Health System and constitutes an important strategy in the reorganization of primary health care in Brazil [30,31].Studies indicate that FHS coverage has increased in recent years so that more than half of the Brazilian population is enrolled in the Family Health Basic Units, indicating an important evolution in the consolidation of primary care in the country [32].
In the relation between the most cited articles in the group of selected papers (Local Citation Score) among the selected set, two studies stand out [33,34] because they are very cited among the selected set and still present a list of citation among the ten most cited in the group of articles selected (Local Citation Score).
The first study [33] addresses the construction of care by nurses in partnership with the family from the phenomenological approach.The paper is cited in a study published in 2008, that writes theoretical assumptions that support the development of dialogues for health promotion used in the communication of nurses in the relations with patients and relatives [35].
In the Brazilian context, the implementation of the FHS is guided in part by the establishment of links between health professionals and users in order to improve the quality of care and satisfaction of users.In the establishment of those bonds, the

InternatIonal archIves of MedIcIne sectIon: PublIc health & health ManageMent
ISSN: 1755-7682 good communication between professionals and users, based on active listening, and valuing the user as unique individual being inserted in a historical and social context.Authors claim [36] that the implementation of FHS caused significant changes in primary health care in Brazil, with emphasis on the proximity of health services and professionals to the community.The second article [34] that presents a citation relationship was published in 2010 and is cited by a study in 2011 [37], here it is interesting to note that a self-citation occurs.Thus, this author presents two articles among the most cited by the 594 articles that were part of this study, indicating a productive and highly referenced author.
The study cited in 2011 [34] addresses women's health care in the gestational stages as well as the health of the child in the family context and the collaboration between the different levels of care known as reference and contra-referral and emphasize that good communication among health professionals of different types of services contributes to the improvement of universal care.
In 2011, the author autocitizes in a paper that discusses the context of public policies available in Australia for the health care of pregnant women and children [37].In the other articles of the Local Citation Score, they do not present a citation relation [26,38,39,40,41,42].
In order to ensure the health care of the community, the ESF, in the context of primary health care, has the task of presenting a resolution to approximately 90% of the cases occurring in the community and mediating the reference and counter-referral of health care services and be responsible for the comprehensive health care of users, even when they are at other levels of attention other than primary care, setting themselves up as the mediator of reference and counter-referral [43].

Conclusion
Brazil has been outstanding in relation to family care since 1994 with the implementation of the Family Health Program and the evolution of the program for Family Health Strategy with wide national coverage.This fact provided the opening of a vast and study scenario for several researchers from different areas of knowledge, especially for nurses, so that it has become an important field of work and scientific research due to the relevance of the nursing profession to the Family Health Strategy .
The Family Health Strategy -FHS stands out as a main activity that promotes family health care in the Brazilian context and the group of most cited paper within the international scenario ensure the relevance of Brazilian studies.The world largest system of public health care, the Brazilian system called SUS, provides the financial and organizational suport the FHS and the international academic field of family health care portrays their impact and recognization.International Archives of Medicine is an open access journal publishing articles encompassing all aspects of medical science and clinical practice.IAM is considered a megajournal with independent sections on all areas of medicine.IAM is a really international journal with authors and board members from all around the world.The journal is widely indexed and classified Q2 in category Medicine.

Figure 1 :
Figure 1: Yearly output distribution of publications on Family Health and Nursing (1957-2016).

SM with 9
and 8 publication records respectively.Marcons SS is a nurse and has a link with the State University of Maringá as Full Professor of the Nursing Department in the Public Health Nursing discipline with emphasis on family health.Mishima SM is a nurse linked to the University of São Paulo and director of the School of Nursing of Ribeirão Preto of the University of São Paulo with research in the area of family health.(Table

Figure 2 :
Figure 2: Top 10 most cited papers within the Web of Science TM (Global Citation Score) and top 10 most cited papers within the group of selected paper for this study (Local Citation Score).

Table 1 .
General Outcomes of the Bibliometric Search on Family Health and Nursing (1957-2016).
Source: Own elaboration based on data from the Web of Science

Table 3 .
Top journals with more published papers.
Source: Own elaboration based on data from the Web of Science.

Table 2 .
Top journals with more published papers.
Source: Own elaboration based on data from the Web of Science.

Table 4 .
Number of papers by authors' country of origin.
Source: Own elaboration based on data from the Web of Science.