Luz Muñoz-Valera,1 José Juan Castillo-Pérez,1 Alejandro Villatoro-Martínez,1 Francisco García-Gómez1
1Grupo de Estudios Métricos de la Investigación, Distrito Federal, México
Correspondence: José Juan Castillo-Pérez
Received: December 9th 2014
Judged: February 13th 2015
Accepted: March 16th 2015
Most of nursing staff does not write to publish. Nursing professionals conducting research, experience the need to communicate their research results in the scientific forum. This can be regarded as an oblivious responsibility beyond its training formation; however, it is not like that: a scientific paper is considered essential for the professional development of nursing. The aim of this document is to show to the nursing staff how to prepare a scientific document that will be submitted to an academic journal. We discussed about what are the benefits gained by writing an article, and, therefore, we encourage the nursing professionals to communicate their results under the structure of the original article.
Keywords: Publishing; Scientific writing; Nursing
Communication is a fundamental part of scientific research. It is said that a research project is not complete until the results are published in any of the usual academic forums, conferences, journals, books, and so on.
Despite the obvious importance of publication in academic journals in nursing, there is a notable absence of specific training in this area in the various post-technical courses in this discipline. There are no bibliometric studies suggesting to us why nursing research has not taken off at the Instituto Mexicano del Seguro Social (IMSS), despite it being more than 20 years since Claudine Palazuelos’ initiative.1
Moreover, in most post-technical courses in nursing research students are asked to develop a protocol, a scientific report, an executive summary, a conference poster and in some cases a publication in a scientific journal for course credit. At this, the nursing professionals panic and are confused, wondering how to phrase the request, which subject to choose, what kind of literature to search for, where to look, what references are appropriate, why they need to write a report or research protocol, and more.
It is noteworthy that scientific writing is not an addictive need, it is a learning process for which very few educational and research institutions provide formal instruction.2 Although some authors suggest that this activity is a creative work, it follows a set of guidelines and protocols, it is an intellectual activity that they recognize, especially in terms of publication ethics.3
Nurses starting to write scientific papers and those already writing, should know some procedures about publishing articles such as recommendations on behavior, reporting, editing and publishing academic papers in medical journals (established by the International Committee of Medical Journal Editors, ICMJE). This document has been gradually expanded to issues beyond the format of manuscripts, such as the review by outside experts, criteria for authorship, situations of scientific misconduct, conflict of interest, the protection of people being studied, the registration of clinical trials in publicly accessible repositories on the Internet, the relationships between the proprietary entities of journals and publishers’ independence, good editorial practices, solvency requirements for electronic magazines, and other topics.4
Another guideline is issued by the Committee on Publication Ethics (COPE), whose mission is to discuss issues related to the integrity of scientific research submitted or published in an academic journal.5,6
The objective of this review is to provide a useful tool to nurses to serve as a guide for writing a scientific paper, the main steps for publication and how to avoid errors so your articles are not rejected by scientific journals; it also seeks to contribute to the quality of reports, to increase ability in the assessment of patients and to systematically analyze and communicate the nursing care plan.
There are several motivations for writing a scientific article. It is not only to share information with the academic community and to contribute to the wealth of knowledge with new information to provide quality of life to patients. The publication serves as much to present the results to the scientific community as to claim priority for a discovery or a contribution.
Publishing scientific articles in reviewed journals is a means to belong to academic associations or the national union of researchers,7 to obtain a position as a researcher in an institute,8 to get financing, to present keynote speeches, to gain academic prestige, to be part of an editorial board, to achieve academic or job promotions, and other benefits. After all, the phrase "publish or perish"9 continues to be used in academia.
The publication of results from research conducted in nursing, either quantitative or qualitative, should be seen as an obligation rather than as a media instrument, since this knowledge will bring nursing staff up to date and will be transformed into information available to the scientific, clinical or social community.
Writing scientific reports give you the ability to clearly and concisely communicate health care to patients and their families, as both demand technical knowledge and appropriate expression of ideas. In addition, nursing notes are legal forms of documentation.10
There are several types of scientific papers. These include original articles, editorials, letters to the editor, case reports, and so on. An original article is one that contributes to the wealth and advancement of scientific knowledge; a review paper is a review of a particular subject, which should include all relevant and available information of the subject; objective criticism serves to update the reader on the subject; a clinical case or case report is a summary of an individual patient or group of patients that provide a substantial piece of knowledge of some condition that is often rare or unusual.11
This work is a guide to writing an original article, with the structure that of most scientific journals, the famous IMRD (introduction, methods, results and discussion) format.
Great things start with small things. It is true that scientific writing is an intellectual activity and is also a process that requires daily practice. There is a considerable amount of literature that discusses how to write a scientific article,3,10-17 or websites that provide suggestions for this process.18,19
Institutional nursing research has focused on the level of knowledge20-22 or fitness of nursing staff23,24 on a given topic; however, there are many research topics not yet covered, such as patient safety, education for family members of obese or diabetic patients, or nursing workload,25,26 to name a few.
The first step is the most important: think of the topic, how you want to reach the nursing community (with a new or different or even controversial concept), if there are theoretical advances or if it is the first observation or exploration of a health phenomenon3 or if it deals with the implementation of a nursing procedure. The subject should be as specific as possible, because we have to consider the audience to which it is addressed, from nurses and first level nursing students to decision-makers in nursing. A scientific paper should be developed under a logical sequence, the objective must be written with precision, and key messages to be communicated to readers should be written in third person.
A second step should be a review of the literature through a systematic search in different bibliographic databases, such as PubMed27,28 Scopus29 or Web of Science,30 as a single database does not contain all current scientific information; thus, the consultant will be familiarized with recent advances by the selected theme, as well as the important historical references. When doing that search, the consultant must select a journal to which they will submit their scientific paper, plus they should check the instructions for authors for the font size and type, the maximum number of words as well as figures and tables because each journal has its own editing style.
The third step is to sort the ideas following the IMRD structure, either in a text file or on scrap paper, writing the title of each section on a different page. You should also begin writing in each section ideas derived from the literature or simple observation in the service; these ideas need not have an order and with the passage of time they will turn into a scientific manuscript. In the event that you have a poster, this could be the basis of a more detailed research report.
The fourth step involves writing the first draft. Dr. Brown31 suggests writing naturally, without worrying about writing style, spelling or typographical errors; the idea is to have the first draft. After some daily sessions you will have a scientific report ready for submission to a journal.
You should also consider the conclusions of the article before you start typing, answering the questions: Why is this project novel, what makes it different from other published research on the subject, why is it clinically important or relevant.
This should be written in the present tense. The first paragraph should mention the most important references and contextualize the research problem, highlighting the unsolved problems and if your work addresses them, i.e., it should answer the question, why did I do the research?
You should not write a review of the issue, as the reader does not care how many articles you reviewed (a very common error in nursing); rather, we must summarize the main results and conclusions of other works. The introduction should let the reader understand the fundamental biological, clinical, or methodological aspects of the study.
The final section describes the rational exposition of the study and should end with the same objective: a hypothesis about what we expect to find. This will inform the reader what the article is about, for them to decide to use it as a reference.
Obviously before you start writing your draft and analyze the data, you must have formulated a hypothesis. The observed results may not correlate with the expected results when making the data analysis; that will be discussed in the appropriate section. The introduction should have a maximum of words ranging between 10 and 15% of the total words of the document32
This section answers the question: What did I do? It is written in the past and it is advisable to start with the study type and population. It includes details of technical specifications, resources and quantities of materials used, the bias control and validation tools for the data collection instrument. If it is a study on humans, the necessary authorizations of the Committee for Research and Ethics must be declared, including the selection criteria of patients, the type of selection (random, systematic or non-probabilistic) and the final sample size.
If you are going to use a previously validated or published instrument, you need only refer to it, do not describe or summarize it.
The last paragraph should describe the statistical analysis performed. This includes the type of test used, the p-value that determines the statistical significance for the study, how the sample size was determined (power analysis), and statistical software used.
In short, we must describe in detail the methods so that they could be reproduced and for external validity to be given to the study. This should be done like a recipe, in which the order in which the study was conducted is provided. This will increase reliability. In fact, many articles are often rejected because this section does not contain all the details of the study.33
This section presents the findings. It is written in the past and does not include references or personal interpretations of the data, only facts which are supported by the survey data. Of all the information derived from the statistical analysis, you must carefully select the most important and how they shall be presented: text, tables or figures. Do not use acronyms; this will avoid confusion for readers.
The presentation of the results begins with a description of the demographic characteristics of the sample studied in a single table. The text in this section should not be redundant, that is, what is in tables, graphs and figures should explain itself, should not be described again (there should be a complementary relationship between the text and those graphic elements); figure and table headings should also be used appropriately. Importantly, the word ‘significance’ refers to statistical significance and is not synonymous with ‘importance.’ You should include the point value of the p-value, and if the results are not significant you only have to put in parentheses NS. It is important to note that a result with no significance reflects the lack of evidence rather than a lack of difference.34 You should avoid using the term quasi or marginally significant. The statistical results should be consistent; there is a close relationship between the size of the sample, the p-value, and confidence intervals. In a well-designed study the statistical interpretation is related to the clinical or biological interpretation.
This section answers the question, What do the results mean? Here it is evaluated how the results answer the research question, and the study data are compared with previous work: if they were similar (consistent), better (findings) or deficient (loss of external validity). It should establish or suggest what was found and why it was found. When describing your study you should use the past tense and when alluding to other works, use the present.35
You can start by describing the most important results of your study and relate them to the working hypothesis. Discuss both limitations and implications of the results or the potential problems of the subject of study and how they should be resolved; explain the findings or why your study is better. If the study generated a new hypothesis, express it to avoid an explanation that fits your preconceived ideas, exaggeration, or suspicion of your work; include recommendations or suggestions where these are appropriate.12 Each argument must be supported by the survey data. One of the reasons for which articles are rejected is because in the discussion section there are conclusions not supported by the results of a study.2 It is important to discuss the clinical relevance of the results and how patients can benefit.36
Previous studies have shown that health professionals, particularly those who have no formal training in epidemiology and biostatistics, are limited in interpreting study results.37-38 Note that in the nursing area, decisions are frequently made based on review of literature for managing patient care.39 An article reports that 58% of residents used statistical information to make a decision.40
A good original article is one that is written with every intention of developing and promoting substantive aspects of the nursing process. These aspects should be based on a review of current literature, evidence, and clinical-practical or theoretical arguments, and the results must be reproducible based on the evidence and robust statistical analysis.
Many nurses starting research spend much time thinking about the title of their work. It is advisable to start with a given title and change it until the document has finished. The title should accurately describe the subject of the article, it must be clear and appeal to the reader as it is the first thing that appears. When you want to publish an article you should employ marketing research and see the scientific work as a product that has to sell immediately and be accepted by the customer.
As for the summary, despite being one of the first components of a scientific manuscript, it must be written at the end, once you have all the elements of the article. The summary must mention the important points of each section, according to IMRD structure. At first, and after the introduction paragraph, include an introductory phrase followed by the study objective. Statements made in this component do not require references.41 Summaries of scientific journals often may not be longer than 250 words.
The title and abstract are the most important parts of the scientific paper, so you have to take the time to write them. With these two components publishers make decisions to send the item to external reviewers, so the first impression they get from that document lies precisely in the title and abstract. Try to avoid abbreviations of names or concepts. You also have to determine what aspects make this work unique, and that must be expressed in the title. Remember that for readers, the title, abstract, and key words are the parts accessible on the Internet.42
It is worth noting that writing for the scientific forum is an intellectual process from the generation of an idea to the publication of the document in a reviewed journal. This article aims to provide information on each section of an original manuscript under the IMRD structure.
Once you have a first draft of the article, leave it for a couple of days, and meanwhile recheck guidelines or rules for authors of the journal to which you are submitting your manuscript or original (font size, spacing, word count, reference style, etc.). You can also ask a colleague to review your document to give feedback. This will refine the work when you re-read it with a critical or very critical eye.
In the event that there are several authors, it is important before writing the final document to define who is the first author, and the order of the collaborators; you should also determine who is the corresponding author. Each of the authors should have a clear and shared understanding of the purpose of the research and key findings.
It is highly recommended that you first perform a wide search in national databases on the subject you want to address in both English and Spanish; this will identify whether the subject has already been addressed in Mexico or if it is an original work. Next, conduct a systematic search of the international bibliographical data bases such as PubMed to identify the academic scope of your work. Do not take references by one author or research group, as this may skew the interpretation you make of the results in his study.
Finally you should know that the rate of acceptance of manuscripts or originals submitted to a scientific journal varies between 30 and 40 %.2 This figure should not be taken negatively, but should identify a window of opportunity to improve your research work. If your manuscript is accepted at first or with slight modifications, congratulations: you can consider yourself a researcher within the global scientific community.