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Editorial Advisory Board Virtual Meetings

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Editorial Advisory Board Virtual Meetings

Julia Muennich Cowell and Martha Dewey Bergren

Nurse Author & Editor, 31(1), 1

A recent discussion on the International Academy of Nursing Editors (INANE) email update list revealed editors’ experiences with virtual meetings. The discussion was reminiscent of a distance school nursing education program study published years ago using teleconferencing.1 The study reported on the uptake of course program objectives and the use of a teleconference strategy. Students were in place at the university and at a distance across the state. The syllabus contained a weekly study guide with topical content, reading material, and objectives for the week. The class began with an introduction and presentation from faculty, followed by discussion. The class protocol included speakers introducing themselves before speaking in the discussion with the intent to become familiar with all class members.

The study of the teleconference program preceded an online program. The assessment and adoption of new school nursing strategies were evaluated and revealed that the strategies were adopted similarly among students regardless of the mode of content delivery. The experience with teleconferencing among learners in place and at a distance revealed a few issues.  Students reported satisfaction with the content of the class and the format of a short presentation followed by discussion. They reported that the pace of the teleconference class needed to be slower to allow ample time for discussion. There was some dissatisfaction with the use of technology among in place students—they reported it was bothersome to be required to introduce themselves before speaking.1 That evaluation provides some direction for editorial board advisory board meeting assessments for editors. Consider: What is the purpose of the meeting and the expected outcomes? How do participants rate the meeting?

Journal of School Nursing Experience

The Journal of School Nursing Editorial Advisory Board and Editorial Panel meetings are held throughout the year and have several purposes. For example, the first meeting (one hour in length) is introductory and serves as an orientation to the role of members. Another hour-long meeting is scheduled to select winners of the writing awards. To prepare for this meeting, members rate the nominated authors’ work using specific criteria. The ratings are discussed at the meeting and the award decisions are finalized. To facilitate the participation of all members, two meetings times are scheduled, thus the editor conducts two award meetings. For 10 years (from 2010 to spring 2020), these meetings were held online, using the National Association of School Nurses subscription to GoToMeeting. Editorial board members are in Europe, Africa and across the United States so we had to be mindful of time zones across the world.2 Considering that, this series of meetings were scheduled at 9 am, Pacific time.

Prior to June 2020, the third meeting of the year was in-person and scheduled during the annual conference. It was 4 to 5 hours in length and included a meal and snacks. The in-person meeting agenda included issues arising throughout the year, such as recruitment and retention of reviewers, the frequency of declined review invitations, and the response time for requested reviews. At the face-to-face meeting, there was lively discussion and lots of great ideas and advice were generated. For example, one member recommended shortening the stated turn-around-time for reviewers, suggesting that people wait until the reminder email is sent out—so, give them less time and send out the reminder sooner! We have also discussed letters received by the editor, with responses crafted by the Editorial Advisory Board. This came up recently when the editor shared a private email she received on the topic the interprofessional rosters of authors in the journal. The letter writer had a concern that the focus on school nursing in the journal might be lost. The editorial advisory board was eager to respond to this issue. Unfortunately, the author of the letter declined the invitation to publish the letter and subsequent response from the advisory board. An interesting opportunity was missed. Discussion of this issue, and strategies to prevent a re-occurrence are on the agenda for the next Editorial Advisory Board meeting.

Expanding Virtual Meetings

A continuing problem with the face-to-face meeting is exclusion of the members, particularly those who live outside of the United States, because of travel expense. A teleconferencing option for these members was not available at the face-to-face meeting, primarily because of logistics and the expense to set up such a meeting in a hotel conference room. Still, international members provide important perspectives on school health and school nursing research and subsequent school nursing implications that benefit readers and might not be apparent to editors and reviewers and we were eager to involve them as full participants. Now with readily available and affordable online meeting services, the inclusion of international members can be offered in the future. Because of the COVID-19 pandemic, this year’s meeting was held virtually, as the Annual Conference was postponed. From this experience, we learned a great deal.

Tips for Success

With any virtual meeting platform such as GoToMeeting, Skype, Microsoft Teams, or Zoom, there is the risk of technical difficulties.3,4 The screen sharing feature of many platforms requires practice and a bit of know-how. For example, in Zoom, a person has to be a host or co-host to be able to share their screen.5 Editors and board members recognize that expertise may not be equal, thus you should consider if the content to be shared during a meeting should be provided in advance. This can minimize technical difficulties at the time of the meeting and give members the opportunity to prepare in advance. Ideally, one board member should manage the screen sharing feature, and you, as editor should lead the meeting. Virtual meeting technologies all offer recording functions that allow the meeting to be viewed later by those who cannot attend. Of course, watching a recording and not being able to participate in the discussion is not the same for a participant, but it is better than not attending at all! Conducting a dry run can help to avoid annoying connection issues and delays for stressed and busy board members.6

Like distance education, virtual meetings require careful planning. The geographic distribution of members will guide your scheduling options.2 You can check with participants in advance about their experience with virtual meetings. Try to anticipate difficulties members may experience and plan accordingly. Agendas and meeting materials should be sent in advance. Many people are suffering from “Zoom fatigue,” so more frequent, shorter meetings are an alternative that you should consider.3,7 While there are reports from Zoom attendees that being continually “on camera” is intrusive, others complain that posting one’s photo to provide a break indicates disengagement. Negotiating camera participation and allowing times with cameras off in advance alleviates tension and fatigue.3 Keep in mind that having the camera/video on uses more bandwidth. If you are having problems with “freezing” during the meeting, you might ask all participants to turn their cameras off. Likewise, it is a best practice to ask all participants to mute their microphones unless they are speaking. This eliminates background noise and feedback.

As an editor, you should choose and shape the meeting space just as you would for an in-person meeting. Lighting should be arranged so your face is clearly visible to participants.6 The camera and screen should be at eye-level so you are looking straight ahead into the camera. If the camera is down low or at the bottom of your screen (a notorious feature on certain older Dell computers8), then prop your computer up on some books to get the camera in the right place. Sit close enough to the screen so that your head and shoulders fill the screen.9 Similar to preparing a conference room prior to a meeting, your screen background should be tidy and uncluttered.9 Consider where you are sitting and what’s behind you, and use a virtual background if necessary. If possible, sit in a private space/room so that family members, colleagues, or co-workers are not walking behind you, particularly if they are in a state of déshabillé.

To encourage participation of all members, open up the meeting 15 minutes early and prompt casual conversation among those who log in.6 Start the meeting by asking participants how they are doing or consider an ice-breaker activity.10 Online platforms offer the option of assigning the participants into different “rooms” to collaborate on issues more suited to a smaller group; participants can then report on their discussion to the larger group. Start on time and avoid lengthy overviews before getting to the heart of the meeting.6 Follow the agenda and keep the meeting moving. These are all best practices for face-to-face meetings—just because you are online, some things don’t change. These standards still apply.

Conclusion

While in-person meetings offer many opportunities for meeting leaders to “read” participants, use of technology has necessitated communication approaches that stimulate our creativity. Preparations for hosting an online meeting that is efficient, engaging, and cost-effective are the same as those for an in-person meeting. You must plan carefully, provide content prior to the meeting, start on time, stick to the agenda, and use strategies that promote collaboration. All crises accelerate innovation, and the COVID-19 pandemic has permanently changed how business is accomplished. Going forward, the lessons learned from mastering virtual meeting technology will enhance inclusivity, flexibility, participation, and productivity of Editorial Advisory Board meetings held virtually or in-person.

References

  1. Cowell JM, Kahn EH, Bahrawy AA. The school nurse development program: an experiment in off-site delivery. J Contin Educ Nurs. 1992;23(3):127-133. https://www.ncbi.nlm.nih.gov/pubmed/1573069
  2. Robb M. Timing it right: Tips for planning remote meetings across time zones. Nurse Author Ed. 2020;(nae2.10). doi:10.1111/nae2.10
  3. Reinach Wolf C. Virtual platforms are helpful tools but can add to our stress. Psychology Today Blog. Published May 14, 2020. Accessed June 20, 2020. www.psychologytoday.com/ca/blog/the-desk-the-mental-health-lawyer/202005/virtual-platformsare-helpful-tools-can-add-our-stress
  4. Henry A, Shellenbarger T. To Zoom or not to Zoom? Choosing a videoconferencing platform. Nurse Author Ed. 2020;30(4):3. Accessed November 18, 2020. https://naepub.com/wp-content/uploads/2020/10/2020-30-4-3-Henry-Shellenbarger.pdf
  5. Sharing your screen, content, or second camera. Accessed December 23, 2020. https://support.zoom.us/hc/en-us/articles/201362153-Sharing-your-screen-content-or-second-camera
  6. Zoom. Online event best practices: A Zoom success guide. Published online January 2020. https://support.zoom.us/hc/en-us/article_attachments/360047066292/Zoom_Online_Event_Best_Practices.pdf
  7. Wiederhold BK. Connecting through technology during the Coronavirus Disease 2019 pandemic: Avoiding “Zoom fatigue.” Cyberpsychol Behav Soc Netw. 2020;23(7):437-438. doi:10.1089/cyber.2020.29188.bkw
  8. Gartenberg C. Dell fixes its XPS 13 webcam, putting it on the top of the screen where it belongs. The Verge. Published January 8, 2019. Accessed December 23, 2020. https://www.theverge.com/2019/1/8/18167246/dell-xps-13-2019-update-webcam-top-display-price-release-date-ces
  9. Schwartzberg J. How to elevate your presence in a virtual meeting. Harvard Business Review. Published online April 8, 2020. Accessed December 23, 2020. https://hbr.org/2020/04/how-to-elevate-your-presence-in-a-virtual-meeting
  10. Mrvova K. 20 best virtual icebreakers for your Zoom meetings. Published September 3, 2020. Accessed December 23, 2020. https://blog.sli.do/virtual-icebreakers/

About the Authors

Julia Muennich Cowell, PhD, RN, FNASN, FAAN is Professor Emerita, Rush University College of Nursing and Editor Emerita, The Journal of School Nursing.

Martha Dewey Bergren, DNS, RN, NCSN, PHNA-BC, FNASN, FASHA, FAAN is Professor Emerita, University of Illinois at Chicago College of Nursing and Editor, The Journal of School Nursing.

2021 30 1 1 Cowell Bergren

Copyright 2021: The Authors. May not be reproduced without permission.
Journal Complication Copyright 2021: John Wiley and Sons Ltd.

 


Featured: Two Sides of Editorial Queries: Editors and Authors

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Two Sides of Editorial Queries: Editors and Authors

Cynthia Saver and Julie Cullen

Nurse Author & Editor, 2021, 31(1), 2

Editorial queries refer to the questions asked of authors during the editing process. They’re an essential tool to creating an effective final published piece. The editor is able to look at an author’s manuscript with fresh eyes, catching mistakes that may have been missed. The editor also knows the publication’s readers, so can anticipate what they might find unclear or want more information about.

By honing their skills, editors can create editorial queries that obtain the needed response while respecting authors’ work and expertise. And writers can learn how to respond to queries so that the final product shines, enhancing their reputations.

Crafting an Effective Editorial Query: For Editors

Effective editorial queries save the author and editor time by avoiding the back-and-forth that frequently follows an unclear query.

Before writing a query, however, consider if you can quickly resolve the issue yourself. For example, perhaps a statistic from the Centers from Disease Control and Prevention seems too high or low, and the author has provided the link to the relevant website. You can easily check for yourself, and then simply highlight the change so the author sees it.

If a query is needed, consider applying this three-step process:

  1. Highlight the text in question.
  2. Concisely state the issue, and, if appropriate, make a suggestion to resolve it.
  3. Ask for a specific response.

Here’s a closer look at each step. Keep in mind that you want to make it as easy as possible for an author to respond to a query

  1. Highlight the text in question.

In many cases, you’re asking about a word or phrase, not the entire sentence. Highlighting the relevant section allows the author to easily see what’s at issue. Color highlighting is preferable to italics, which are harder to read and can’t be used if something is already italicized in the existing text.

  1. Concisely state the issue.

Editors commonly start queries with “AU” for author, but new authors may not understand this abbreviation. Therefore, it’s a good idea to define it on first use. For example: “AU (author): Please provide page numbers.” Starting each query with AU makes it easy for authors to search for queries, an important consideration for long documents.

Once you have the author’s attention, you’re ready for the next step. If you simply want the author to verify that your edit didn’t affect meaning, you can simply state something like, “Edit OK?” and skip the details.

In many cases, however, you need to explain the problem, such as “I’m not sure our readers, who are general practitioners rather than specialists, will understand your meaning.” Avoid unhelpful one-word comments, such as “unclear” or “revise,” that leave authors puzzled and unsure about how to respond. The key is to be specific. If the editor omits “who are general practitioners rather than specialist,” which explains why the text is being questioned, the author might be tempted to reply with, “Yes, they will understand.”

Be tactful when questioning authors about information they likely perceive themselves to be expert in. “Given that breast cancer also occurs in men, would you want to include any diagnostic considerations related to that patient population?” is an example of a gentle way to raise an issue.

Most authors will welcome your addition of a suggestion to resolve the query. For example, in an article about postdural puncture headache (PDPH), after “I’m not sure our readers, who are general practitioners rather than specialists, will understand epidural blood patch,” you might suggest: “Perhaps add description: ‘For debilitating PDPH that doesn’t respond to conservative treatment, the anesthesia provider may place an epidural blood patch (injection of a small amount of autologous blood into a patient’s epidural or spinal space to stop a leak of cerebrospinal fluid).’” Try to provide only one option, two at the most. Too many options can be confusing.

If appropriate, you also may consider adding a positive note. For example, “This table provides a great summary of the pharmacologic options. Could you strengthen it by adding the administration route for each drug?” Brenner1 notes that praise should be sincere, but not overdone.

Perhaps the most important consideration when writing a query is to keep it as short as possible. Follow good writing principles: Use active voice and review each query to ensure it will be clear to the author. You edit the author, so be sure to edit yourself.

  1. Ask for a specific response.

Whenever possible, use questions that authors can answer “yes” to if they agree. For example: “OK to change percentage to match what you use in the first paragraph under results?”

If the decision is up to the author, say so. For example, “You may want to define …,” or “Consider defining ….” On the other hand, if something needs to change, say so, “Please define …”

Returning Queries: For Editors

When the editor returns the edited manuscript, the email should set a positive tone, help the author understand what they’re receiving, and instruct them in how to respond. Here’s an example:

Attached is your edited manuscript for review. Please check carefully to ensure your intended meaning hasn’t been altered. You’ll find queries that require your response. The text in question is highlighted in blue followed by blue queries addressed to AU (author). Please insert your responses directly in the text in a red font so they can be easily seen.

Please return the manuscript with your responses by October 15.

Thank you again for your submission. We know our readers will find the information on managing pain in older adults helpful to their practice. If you have any questions, please don’t hesitate to ask.

Types of Editorial Queries: For Editors and Authors

Here are 6 types of queries, followed by examples from American Nurse Journal articles.2

References

These queries may relate to incomplete, incorrect, or missing information. Here are two examples:

  1. The Joint Commission. Root causes of maternal deaths & injuries. Available from: www.jointcommission.org/NR/rdonlyres/960276C4-1957-4C78-983D-681124E70D1E/0/se_rc_maternal_deaths_inj.jpg //AU: Highlighted URL goes to “page not found.” We’re not able to find an alternative URL; can you provide another?//
  2. National Kidney Foundation. Immunosuppressant. 2017. org/atoz/content/immunosuppression //AU: This URL goes to a page titled “Care after kidney transplant.” The copyright date on it is 2015. Is this the page intended?//

Terminology

Authors may be familiar with terminology or phrasing that the journal’s readers are not. For example:

With nearly half of healthcare staff reportedly experiencing violence in the workplace, organized mechanisms to address behavioral health emergencies in a trauma-informed manner //AU: I’m not sure readers will know what “trauma-informed manner” means. Please briefly define.// have never been more relevant.

Or, the context of a term may be unclear. For example:

Sharing HTN care responsibilities can be implemented as part of a multifaceted approach, with system support //AU: Please clarify what system support means in this context?// for clinical decision-making, collaborating, and monitoring.

Verification of editing changes

The editor may want to verify that the changes made don’t affect the meaning of the text. For example:

Original

Many patients fear side effects from ICSs and will not take them daily. Focus education on how ICSs reduce swelling in the lungs, leading to better symptom control and better quality of life.  Many people mistake corticosteroid side effects for those of anabolic steroids.  These medications differ, and side effects are not the same.

Edited

Many patients don’t take ICSs as prescribed because they mistakenly believe these medications have the same side effects as anabolic steroids (hair loss, liver and kidney disease, increased aggression). To encourage adherence, explain the difference between the medications, focusing on how ICSs reduce swelling in the lungs, which leads to better symptom control and better quality of life. //AU: Edit OK?//

Additional text

Editors may suggest additional text to clarify points. For example:

Multiple chronic conditions may compete for the patients’ attention, and depression, social isolation, and financial challenges are common in older adults, making them less likely to engage in self-care. //AU: Addition OK?//

Or, an editor may request that the author provide additional text. Here are three examples:

  1. Focus your teaching on taking the medication as prescribed and preventing side effects. //AU: Please provide some specifics. What are some of the side effects? How are they prevented?//
  2. Help patients recognize situations that place them at risk for diverging from their dietary or physical activity goals (for example, having guests over for dinner, celebrating holidays, travelling) and how to use behavioral strategies //AU: Please share a few examples// to handle these circumstances.
  3. Current evidence-based guidelines //AU: Which guidelines are referred to here?// recommend including cardiac rehabilitation (rehab), but many patients with end-stage HF can’t tolerate these activities.

Clarification

The editor may ask the author to clarify text. Here are two examples:

  1. The first recognizable symptomatic stage of dementia is called mild cognitive impairment (MCI), which is characterized by subjective complaints of cognitive changes and objective deficits that are detectable during cognitive testing; everyday functioning remains mostly normal. MCI was operationalized //AU: What is meant by operationalized?// in sentinel articles by Petersen and is now widely regarded as a risk state for AD, in recently published practice guidelines.
  2. Thiazolidinediones. Pioglitazone, a thiazolidinedione, //AU: Only pioglitazone or all thiazolidinediones?// is metabolized entirely by the liver; no dose adjustments are recommended in patients with CKD.

Inconsistencies

The editor may pick up on contradictory information. For example:

This article explains the differences between primary and specialty //AU: Both specialty and secondary palliative care were used in the article. We changed everything to specialty for consistency.// palliative care and when a consult is appropriate.

Responding to Editorial Queries: For Authors

Depending on the journal or publication, you will receive your edited document, with queries, in Word or as a PDF file. Authors should follow the editor’s instructions for responding to queries.

Word

A Word document will look similar to the manuscript submitted, but with queries inserted within the text or via the “insert comment” function in Word. (In some cases, the editor will have used Word’s track changes feature so you can see the editing that has been done.)

When track changes are used, if you simply need to answer yes or no, enter your response in the comment “bubble.” If you need to alter text, the editor will usually want you to use the Track Changes feature (with “Show Markup” turned on) so they can see your changes.

Other editors prefer to avoid Track Changes, which can be difficult to follow if there are multiple changes. These editors will ask you to respond in the text, using a different font color, and leaving the query in place. For example:

Editor’s query

Proper training creates a positive environment for volunteers and improves retention. Develop an onboarding program and designate an organization member with the appropriate skills to facilitate it. Do you have reference materials for your volunteer to use to help them execute their role? //AU: Please clarify. Are these reference materials for the person facilitating the onboarding program or reference materials for volunteers?//

Author’s response

Proper training creates a positive environment for volunteers and improves retention. Develop an onboarding program and designate an organization member with the appropriate skills to facilitate it. Create reference materials and how-to guides for your volunteers to refer to as they execute their roles. //AU: Please clarify. Are these reference materials for the person facilitating the onboarding program or reference materials for volunteers?//

Editor’s query

In addition, racial differences found in epidemiological studies are more likely to reflect the effects of racism rather than race itself. The allostatic load//AU: Please clarify meaning for readers unfamiliar with this term// associated with lifelong toxic stress, rather than genetic predisposition, may lead to health disparities.

Author’s response

In addition, racial differences found in epidemiological studies are more likely to reflect the effects of racism rather than race itself. The allostatic load (the cumulative effects of chronic exposure to stress) //AU: Please clarify meaning for readers unfamiliar with this term// associated with lifelong toxic stress, rather than genetic predisposition, may lead to health disparities.

No matter how you respond, answer promptly to keep your article on its publication path.

PDF Files

A PDF file may be partially (or completely) formatted to journal style—even so, there will be queries and edits that you need to respond to by using an application such as Acrobat Reader or Adobe Acrobat. Acrobat Reader is free and allows you to view, print, and annotate documents, which should be adequate for responding to queries. There are also several paid versions of Adobe Acrobat, which start at $14.99/month for a subscription. You may have access through a subscription from your employer, especially if you work at a school of nursing at a college or university. In lieu of that, the free version will probably be fine for simple queries in an edited manuscript. The examples provided earlier are still relevant—you just need to use the annotation features of Acrobat Reader rather than commenting and using track changes in Word.

Timing: For Authors

Most queries come at the initial editing stage, so authors see them in a Word document or PDF. Supplemental material—such as tables, figures, and sidebars—may be inserted at the end of the document or sent as separate files. If your publication is to be posted on a website, you may receive a URL to the article for review. No matter how you receive the document, it is important to carefully review and respond to all queries. You can also correct any typos or other errors that you see. However, this is not the time for re-writing your manuscript. If you see sections that need major changes—major enough to delay publication—you should contact the editor immediately to discuss.

The time you have to review the edited manuscript and respond to queries varies depending on the type of planned publication. For a blog, you might have only a few hours. For a journal, you might have 5 to 10 days at the initial editing stage and 2 to 3 days for a final review. For a book or a chapter in a book, you might have 2 to 4 weeks. Be sure to note the deadline and return on time to keep the publication process moving forward.

Kindness: For Authors and Editors

A successful editor-author partnership requires mutual respect—and a little kindness.3–5

Some editors are tempted to explain the rationale behind each change, providing grammar lessons that illustrate how much the editor knows, but slow the author’s response time. The editorial query isn’t the time to educate—or pontificate. It’s a time to resolve issues as quickly as possible.

Some authors respond to queries curtly, conveying their annoyance at being questioned. Keep in mind that the editor is the reader’s advocate and that you both have a mutual goal: a high-quality article. As with the editor, this isn’t the time to educate about your specialty. For example, if you’re asked to clarify the difference between two types of receptors in “one or two sentences,” don’t provide an entire paragraph.

As with most relationships, respect and courtesy will foster a successful partnership.

Conclusion

Receiving and responding to queries is an essential part of the publication process. However, until you have an actual article “in press” you may never have seen an AU: query. And if you are a new editor, you might be unfamiliar with some of these “best practices” to make sure your queries are clear and concise. Consider your role and carefully craft your queries and responses to make sure the article shines as a professional publication.

References

  1. Brenner E. 4 tips to using praise in author queries. ACES: The Society for Editing. Published October 1, 2019. Accessed January 18, 2021. https://aceseditors.org/news/2019/4-tips-to-using-praise-in-author-queries
  2. Saver C. 6 types of editorial queries and how to respond. American Nurse Journal. Published online December 1, 2020. Accessed January 18, 2021. https://www.myamericannurse.com/6-types-of-editorial-queries-and-how-to-respond
  3. Montgomerie A. 10 ways to word a sensitive query. ACES: The Society for Editing. Published October 1, 2019. Accessed January 18, 2021. https://aceseditors.org/news/2019/10-ways-to-word-a-sensitive-query
  4. Ozunal B. Quills and Queries. ACES: The Society for Editing. Published October 6, 2020. Accessed January 18, 2021. https://aceseditors.org/news/2020/quills-and-queries
  5. Pfefferle BE. How to soften the red pen’s blow: Tips for editing a colleague’s work. Medical Writing. 2018;27(3). https://journal.emwa.org/editing/how-to-soften-the-red-pen-s-blow-tips-for-editing-a-colleague-s-work/article/3979/how-to-soften-the-red-pen-s-blow_-tips-for-editing-a-colleague-s-work.pdf

About the Authors

Cynthia Saver, MS, RN, is president of CLS Development, Inc., which provides writing and editorial management services to leading publishers of nursing content. She is editor of Anatomy of Writing for Publication for Nurses, 4th ed., editorial director for American Nurse Journal, and a member of the Nurse Author & Editor Authors-in-Residence. She also presents writing workshops for nurses. You can contact her at csaver@clsdevelopment.com

Julie Cullen, BA, is a healthcare writer and editor and managing editor for American Nurse Journal.

2021 31 1 2 Saver Cullen

Copyright 2021: The Authors. May not be reproduced without permission.
Journal Complication Copyright 2021: John Wiley and Sons Ltd.

Featured: Reporting Nursing Research, An Essay on Style: Beginnings

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Reporting Nursing Research, An Essay on Style: Beginnings

John Eric Bellquist

Nurse Author & Editor, 2021, 31(1), 3

Like any science, doing nursing research requires writing about it. The better the writing, the more effective the dissemination of the research and its findings. Yet apart from Nurse Author & Editor, little literature focuses on writing about research in nursing specifically, and the few handbooks on writing for nurses (eg, Oermann & Hays1; Saver2; Tornquist3) address much more than style. Nonetheless, students in nursing research, even if skilled at writing clinical notes, may need to refine or refresh their mastery of style for writing research papers and dissertations. Their professors may need resources to teach style too.

Here I suggest a principle of English sentence structure as a pedagogical and evaluative tool to address the mechanics of writing for nursing research. In the world of English composition, drawing on the work of linguists (eg, Prince4), it is usually spoken of as the given–new or old–new model of sentence structure, or the knownnew contract between writer and reader.5 I draw especially on  Williams’6 elaboration of the model, which tells us that well-written sentences present two types of information, “given” and “new,” which together inform a logical, iterative sequence that yields what is often called the “flow” of written thought. This model is useful, because most of us intuitively recognize whether or not a text “flows” well, regardless of “grammar.” But few have consciously acquired an analytical model that tests how well writers establish and maintain that written flow of thought.

The given–new model of sentence structure is grounded in the communication of context—the idea that whenever we write, we present contexts that we share with readers. Written words, sentences, and paragraphs create and iteratively re-create those contexts, sequentially establishing, re-establishing, and maintaining them so that they remain in the reader’s mind without interruption of thought. In this article, I apply the model to beginnings; in a future article, I will develop its use beyond that.

The First Sentence

As an example, let’s assume that you are submitting a grant application for a research project, an intervention for a sample of people living with diabetes.  You begin your proposal with the project’s background: diabetes is the topic, and the background will justify what you plan to do. Here are two possible opening sentences, each well written. Which would you choose?

According to the CDC, more than 30 million people are living with diabetes in the United States today.

 In the United States today, more than 30 million people are living with diabetes.

Now consider the context that each sentence sets. The first sentence begins by referring to the Centers for Disease Control and Prevention (CDC); the second, to the United States at present. The first begins by indicating that a statement from the CDC will follow; the second, that we will learn something about the US today. In the first sentence, the author (you) seems to emphasize the CDC’s announcement; in the second, you introduce a current American situation. Which sentence immediately and clearly guides the reader in the right direction—the direction you want them to go in? Which sentence sets the context best?

Before we answer these questions, it is helpful to consider published examples. Each sentence begins its respective article:

The past two decades have seen extraordinary advances in our understanding of human immunodeficiency virus (HIV).7

United States and international guidelines for the treatment of mild persistent asthma recognize three distinct goals of therapy: to relieve and control symptoms, to prevent exacerbations, and to reduce loss of lung function, with minimal side effects.8

In 2002, Knowler et al. reported results of a landmark study—a large, randomized, controlled trial comparing a behavioral intervention with medical therapy in the prevention of diabetes.9

Note that each sentence sets the context first: the past two decades, United States and international guidelines, the year 2002. In each, the context (the time or place) is familiar to the reader. Next, having established that shared context, the author proceeds to tell the reader something about it: advances in our understanding of HIV, three goals for asthma therapy, and the design of Knowler et al.’s study.

Beginning with a shared context in this way reflects the given–new model as Williams6, p. 48 formulates it:

Put at the beginning of a sentence those ideas that you have already mentioned, referred to, or implied, or concepts that you can reasonably assume your reader is already familiar with, and will readily recognize.

In the three published examples above and the two hypothetical opening sentences for your grant application, nothing has previously been mentioned, referred to, or implied, because each sentence begins its respective document. But each sentence does begin, to repeat Williams’6 words, with a concept that we “can reasonably assume” our readers are “already familiar with”: the CDC, the United States today, the last 20 years, the United States and the world, and 2002.

Now we can evaluate the choices for the grant application’s opening sentence. With respect to the first choice, one might argue that NIH reviewers are familiar with the CDC, so why not begin with the CDC as a context that applicants to the NIH and their grant referees share? However, the phrase “according to the CDC” might suggest that you are mainly interested in the CDC’s opinion, contributing perhaps to an ongoing conversation in which the CDC’s statement is one of many sources of information under discussion. That is, the CDC may be a relevant context, but is it the best context to guide the reader toward your purpose? Indeed, why even mention it? The CDC’s information is not what your application will be about; you are not going to evaluate the CDC’s assertion about diabetes’ prevalence. The sentence that begins with “In the United States today,” on the other hand, establishes a better shared context for the information that will follow: you are going to tell the reader something about what is taking place in the United States. With that context established, you have better prepared your reader for what comes next. The CDC is merely your information’s source; it could simply be a citation at the end of the sentence.

continuing this thought…

Williams6, p. 48 supplements the preceding principle with another; together, they constitute a single recommendation:

Put at the end of your sentence the newest, the most surprising, the most significant information—information that you want to stress—perhaps the information that you will expand on in your next sentence.

Now, consider again the two possible opening sentences for your grant application. The first ends by referring to the United States today, the preferable context that the author and the reader share. But what is the important information about that context that you want to present to the reader? It is the current prevalence of diabetes, which is experienced by more than 30 million people. For emphasis, that information belongs at the sentence’s end. Were  you to choose the first of your two alternatives, thus defining the prevalence of diabetes as the prevalence in the United States today, you would be preparing the reader for several potential possibilities: the prevalence of diabetes in the past as opposed to the present; the current prevalence of diabetes in other countries; or perhaps data from sources other than the CDC for a further discussion of population statistics. Your second alternative, on the other hand, begins with the United States today as your shared context and then provides specific new information about it. This makes the reader wonder what will be said about those 30 million people living with diabetes. By readying your readers to receive information about that population, it points specifically toward the fact that you will ultimately address some group or groups of those living with diabetes in your grant proposal. In this way, you can proceed easily from your first sentence to the next, smoothing the flow of thought. With this analysis, it is clear that the second opening sentence is surely the best.

The Rest of the Paragraph

How, then, might you develop the rest of your opening paragraph? Here are two hypothetical versions, adapted from the CDC’s National Diabetes Statistics Report10; this time, however, I begin not just with diabetes “in the United States today,” but as the CDC gives it for 2015:

In the United States in 2015, an estimated 30.3 million people (9.4% of the US population) were living with diabetes. This total included 30.2 million adults 18 years of age or older (12.2% of U.S. adults), of whom 7.2 million (23.8%) were undiagnosed. The percentage of those living with diabetes increased with age, and the prevalence of diabetes is higher among ethnic and racial minorities than among non-Hispanic whites.

 In the United States in 2015, an estimated 30.2 million adults 18 years of age or older (12%) had diabetes. This prevalence increases with age, and it is higher among ethnic and racial minorities than among non-Hispanic whites. Among non-Hispanic Blacks as opposed to whites, it is nearly twice as great (17.7% vs. 9.3%).

Both examples illustrate the givennew sentence structure: each sentence begins with familiar or shared information and proceeds to present something new about it. The first alternative begins with the United States in 2015 as the context; the prevalence of diabetes within the US at that time follows (an estimated 30.3 million people, 9.4% of the population). With that prevalence established, the second sentence begins by referring to it as this total, which is next elaborated in greater detail, broken down into the number and percentage of adults with diabetes (30.2 million, 12.2%), including those with diabetes who are nevertheless undiagnosed (7.2 million, 23.8%). These statistics are then further defined by the next sentence in terms of age and racial or ethnic group. Thus, after the first sentence in the paragraph, the beginning of each succeeding sentence recalls what was said at the end of the sentence just before it while at the same time directing us toward something new; the new information that concludes each sentence informs the beginning of the sentence that comes next. After the last sentence in the sequence, the reader assumes that whatever follows will be related to at least one of the populations indicated, though not yet specified, at the end of the paragraph.

This raises a question: How much information does the reader need? In the second version, I have therefore cut much, yet I have added new information. This time, I refer to the US context in 2015 and move to the national prevalence but only for adults. I next begin with the prevalence just mentioned, which is defined in terms of general differences according to age and race or ethnicity (ethnic and racial minorities vs. non-Hispanic whites). The third sentence continues this topic by focusing on the difference between two population groups (non-Hispanic Blacks vs. whites) and specifies their relative prevalence. In the end, this suggests that I will proceed to address the chronic illness of diabetes among non-Hispanic Blacks in some way. Thus the sentences in the two paragraphs above are both sequentially coherent according to the givennew model, but for a grant application, the shorter version might be more helpful.

Conclusion

Conversations about writing often touch on the difficulties of beginnings: How does one get started? When researchers write about their research, they already know what has been done and found, so that writing the Methods and Results is a relatively straightforward task. In the Introduction, on the other hand,  you have to justify the research, and in Discussion section, you must present implications, justifying the research further and likely establishing a context for what might be done next. In all of these sections, the givennew model can shape sentences. It implicitly defines the choices that a writer makes, and it can enable us to evaluate how effective those choices are. But especially in opening paragraphs, it offers a guideline for getting started, and a means of analysis for revision of your beginnings after that.

References

  1. Oermann MH, Hays, JC. Writing for publication in nursing. 4th ed. Springer; 2019.
  2. Saver C. Anatomy of writing for publication for nurses. 3rd ed. Sigma Theta Tau International; 2017.
  3. Tornquist EM. From proposal to publication: An informal guide to writing about nursing research. Addison-Wesley; 1986.
  4. Prince E. Towards a taxonomy of given–new information. In Cole P, ed. Radical pragmatics. Academic Press; 1981: 223-255.
  5. Kolln M, Gray, L. Rhetorical grammar: Grammatical choices, rhetorical effects. 8th ed. Pearson Education; 2018.
  6. Williams JM. Style: Toward clarity and grace. University of Chicago Press; 1990.
  7. Justman JE, Mugurungi O, El-Sadr WM. HIV population surveys—bringing precision to the global response. N Engl J Med. 2018;378(20):1859-1861. doi:10.1056/NEJMp1801934
  8. Lazarus SC. On-demand versus maintenance inhaled treatment in mild asthma. N Engl J Med. 2018;378(20):1940-1942. doi:10.1056/NEJMe1802680
  9. Pryor K, Volpp K. Deployment of preventive interventions—time for a paradigm shift. N Engl J Med. 2018;378(19):1761-1763. doi:10.1056/NEJMp1716272
  10. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. National diabetes statistics report, 2017: Estimates of diabetes and its burden in the United States. 2017; https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.

About the Author

John Eric Bellquist, PhD, serves as editor and as lecturer in writing for nursing research at the University of Texas at Austin School of Nursing. Formerly the managing editor for the journals of the Psychonomic Society, he has authored books as well. You can contact John at jbellquist@mail.nur.utexas.edu.

2020 31 1 3 Bellquist

Copyright 2021: The Author. May not be reproduced without permission.
Journal Complication Copyright 2021: John Wiley and Son Ltd.

 

 

 

 

Featured: Writing for Nursing Research, An Essay on Style: Continuities

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Writing for Nursing Research, An Essay on Style: Continuities

John Eric Bellquist

Nurse Author & Editor, 2021, 31(1), 4

In my previous article,1 I illustrated a model of writing sentences drawn from Joseph Williams’2 discussion of style, which I suggested might be useful in teaching and evaluating writing for nursing research. The model describes the successive iteration of given (familiar) and new information within sentences and from sentence to sentence, supporting an implicit contract between writer and reader.3

In the givennew model of sentence structure, each sentence begins with a context that the author and reader share, and each sentence concludes with new information, which also suggests how the next sentence will begin. As a result, the reader’s experience is never interrupted, so that consecutive sentences “flow.” As Williams recommends, “generally, use the beginning of your sentences to refer to what you have already mentioned or knowledge that you can assume you and your reader readily share”2, p. 64 This is the given information, which points toward the new information at the sentence’s end. You could also define this movement as a patterned sequence, as A–B, B–C, C–D, and so forth, where each pair of letters represents a sentence, and each letter after the first in a pair is new and then in the next sentence familiar. We can put this more generally: In formal academic writing, we write linearly, such that each sentence should prepare the reader for the next, resulting in a continuous, logical development. This is one way to achieve coherence in what we are saying and satisfy our readers’ expectations.

Some will object that such a practice is too mechanical. Indeed if every sentence simply matched the model as I have defined it so far, that might be so. But nothing is ever so simple. Williams says that the familiar given information should “generally” come at the sentence’s beginning, and in referring to the new information at the end of the sentence, he uses the word perhaps: it will be “perhaps the information that you will expand on in your next sentence.”2, p. 48 This is because the movement from sentence to sentence implicates many more patterns than a simple progression from familiar to new. Consider the following example, adapted from the World Health Organization’s Global Report on Diabetes:4

Worldwide in 2014, an estimated 422 million people had diabetes, for a prevalence of 8.5% among adults. In the Eastern Mediterranean, the prevalence was highest, at 13.7%; in Africa, it was lowest, 7.1%. From 1980 to 2014, in all regions, prevalence of diabetes increased; from country to country, it increased or at best remained the same.

This example begins with shared information (the world in 2014), followed by new information: the number of those with diabetes and the prevalence of diabetes among adults. But the next sentence does not start with adult prevalence. Instead it repeats the first sentence’s pattern more specifically. In two statements, the world is replaced by the geographical regions of the Eastern Mediterranean and Africa, and their respective prevalences follow. This second sentence thus reiterates the pattern of the first, moving twice from familiar to new information, but it does so by giving greater specificity and detail for both the familiar and the new. The third sentence repeats that pattern, beginning with the period from 1980 to 2014 instead of just 2014 and concluding with the increase in prevalence in all regions; after that, it narrows the focus once more to countries rather than regions, and it adds new information about the prevalence of diabetes in countries. Thus each sentence begins with shared, given information, and after the first sentence, each subsequent sentence begins by naming a subset of the first shared information. Applying our A–B formula, we might describe this pattern as  A–B. A1–B1; A2–B2. A3–B3; A4–B4. In this example, the given–new structure is developed through stylistic parallelism.

Now for a published paragraph:

Prostate cancer is the most commonly diagnosed cancer in US men and the second leading cause of cancer death. It has been estimated that in 2018, approximately 165 000 US men will be diagnosed with prostate cancer and 29 000 men will die of prostate cancer. Prostate cancer incidence is 74% greater among African American than white men and is also relatively greater in men with vs men without a family history of prostate cancer.5

Here the authors go straight to the point; they are writing for their peers, and prostate cancer, a familiar disease, is the given information at the start. The subsequent new information is prostate cancer’s prevalence, presented in two ways without numbers: the frequency of prostate cancer diagnosis in US men and of prostate cancer as a cause of cancer death. The next sentence then reexamines the information in the first sentence, providing greater specificity in parallel: prostate cancer for 2018, and estimates for diagnoses and deaths in that year. Estimation echoes the preceding information about prostate cancer’s frequency, and together with the year 2018 it constitutes familiar information. The estimated numbers now become the new information, stated in parallel with the more general statements of prevalence for diagnosis and death in the opening sentence. The third sentence takes up prostate cancer’s incidence, this time for African American versus white men and for men with versus without a family history of the disease. Thus each sentence follows the givennew model, each one adding specificity, and all three sentences are parallel in style.

What happens when such sentence patterns are not followed carefully? Here is another published example:

The past two decades have seen extraordinary advances in our understanding of human immunodeficiency virus (HIV). The global scale-up of access to antiretroviral therapy (ART) for people living with HIV is perhaps the greatest of these advances. As of the end of 2017, more than 20 million of the world’s 37 million people with HIV were taking ART, often in the form of a single pill a day. Despite this major public health achievement, almost 2 million new infections continue to occur each year, leaving many countries, primarily in sub-Saharan Africa, with a daunting epidemic.6

The first sentence of this paragraph begins with a familiar context, the past 20 years. It then gives us new information: remarkable advances in our understanding of HIV. The second sentence then begins by referring to “the global scale-up of access” to ART. But is this “scale-up” an advance in our “understanding”? An increase in access is certainly an advance, but not in scientific knowledge. The “global scale-up” does not accurately echo the new information at the end of the preceding sentence. Nevertheless, the second sentence concludes with the claim that the global scale-up is one of those advances after all. But the advances are not new information. So, as readers, we are returned, inaccurately and redundantly, to the information at the end of the first sentence. Instead of proceeding from A to B (familiar to new) and from B to C (familiar to new), these sentences move from A to B, and from C back to B (new to familiar), rendering their meanings in a circle. Leaving aside the issue of access versus understanding, a better order of this material might read like this:

The past two decades have seen extraordinary advances in our understanding of human immunodeficiency virus (HIV). Perhaps the greatest of these advances is the global scale-up of access to antiretroviral therapy (ART) for people living with HIV.

Now the familiar, given information comes first (A; the past two decades); the new information follows (B; extraordinary advances); and the subsequent given information (B; the greatest of the advances), which recalls the preceding new information, points to the new information that follows it (C; the global scale-up). These sentences now fit the iterative givennew model.

However, further improvement remains possible. When we begin a sentence with familiar information that derives from the end of the preceding sentence, it is best to avoid redundancy, so consider joining the two sentences, preserving the A–B, B–­C sequence yet cutting superfluous words:

The past two decades have seen extraordinary advances in our understanding of human immunodeficiency virus (HIV), perhaps the greatest of which is the global scale-up of access to antiretroviral therapy (ART) for people living with HIV.

This in turn leads very well into the original third sentence, which begins in parallel with the first by specifying a year (the end of the two decades) and then provides more detail about the prevalence of ART:

As of the end of 2017, more than 20 million of the world’s 37 million people with HIV were taking ART, often in the form of a single pill a day.

So far, the revision reads as follows; how well does the final sentence fit?

The past two decades have seen extraordinary advances in our understanding of human immunodeficiency virus (HIV), perhaps the greatest of which is the global scale-up of access to antiretroviral therapy (ART) for people living with HIV. As of the end of 2017, more than 20 million of the world’s 37 million people with HIV were taking ART, often in the form of a single pill a day. Despite this major public health achievement, almost 2 million new infections continue to occur each year, leaving many countries, primarily in sub-Saharan Africa, with a daunting epidemic.

According to the givennew model, the phrase “this major public health achievement” does echo the preceding details about the scale-up of ART. But that now familiar achievement is negated by the word despite, which seems to reject the preceding information, so that the reader stumbles. Why? The answer is simple: We have words or phrases (e.g., and, but, however, therefore) to signal breaks or shifts in the sequence of givennew sentences and complement the flow of thought:

The past two decades have seen extraordinary advances in our understanding of human immunodeficiency virus (HIV), perhaps the greatest of which is the global scale-up of access to antiretroviral therapy (ART). As of the end of 2017, more than 20 million of the world’s 37 million people with HIV were taking ART, often in the form of a single pill a day. Nevertheless [However, Yet], despite this major public health achievement, almost 2 million new infections continue to occur each year, leaving many countries, primarily in sub-Saharan Africa, with a daunting epidemic.

By adding a single connecting word with the right logical implication at the start of the final sentence, we enable the reader to expect a contrast that continues to recognize the preceding new information as given but that will provide very surprising new information about it. This is yet another tool in the mechanics of style.

What, then, is the purpose of such a model of writing sentences? Presumably, the best writers write this way intuitively. Can the model be used consciously as a tactic while you write? Perhaps not. Yet once you have written a few sentences, a paragraph, or a longer document, you can use the model to diagnose your written work. If sentences, when read, present a sequential, continuous development according to the givennew pattern, they will better support the logical unfolding of your topic and thoughts. They will fulfill your—the author’s—contract with the reader. Nor is this approach entirely novel or unfamiliar: Every research article, structured as Background, Methods, Results, and Discussion, presents a logical sequence of sections that, like the givennew sentence structure, proceed from a shared context and point toward what comes next. The Background establishes the shared context. The Methods present how one addresses that shared context. The Results present the Method’s outcomes, and the Discussion evaluates the Method’s results and often concludes with recommendations for future research. Thus the scientific conversation continues, from sentence to sentence, from article section to article section, from study to study, and from research project to research project, looking forward but also looking back.

References

  1. Bellquist JE. Writing for nursing research: an essay on style. Beginnings. Nurs Auth Ed. 2021;31(1)3.
  2. Williams JM. Style: Toward clarity and grace. University of Chicago Press;1990.
  3. Kolln M, Gray, L. Rhetorical grammar: Grammatical choices, rhetorical effects. 8th ed. Pearson Education; 2018.
  4. World Health Organization. Global report on diabetes. 2016, http://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.pdf;jsessionid=8EB4FB5B8434A10F0895F8AEC9915DEE?sequence=1.
  5. Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J. Prostate-specific antigen-based screening for prostate cancer: Evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;319(18):1914–1931. https://doi.org/10.1001/jama.2018.3712
  6. Justman JE, Mugurungi O, El-Sadr, WM. HIV population surveys—bringing precision to the global response. N Engl J Med. 2018;378(20):1859–1861. https://doi.org/10.1056/NEJMp1801934

About the Author

John Eric Bellquist, PhD, serves as editor and as lecturer in writing for nursing research at the University of Texas at Austin School of Nursing. Formerly the managing editor for the journals of the Psychonomic Society, he has authored books as well. You can contact John at jbellquist@mail.nur.utexas.edu.

2020 31 1 4 Bellquist

Copyright 2021: The Author. May not be reproduced without permission.
Journal Complication Copyright 2021: John Wiley and Son Ltd.

 

 

Featured: Return on Time Investment: Writing Resources

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Return on Time Investment: Writing Resources

Leslie H. Nicoll

Nurse Author & Editor, 2021, 31(1), 5

In the world of business, a common metric is “return on investment” (ROI). People use this to determine if their investments are yielding a return that is worthwhile and makes them happy. They also might calculate an anticipated ROI to determine whether they want to invest in something. The formula is simple:

The result is a percentage. So, if I spent $1000 on something, and one year later it was worth $1200, then my ROI would be 20%. Is that acceptable? I’ll leave that decision up to the financial wizards who might be reading this to determine if they want to take that risk.

I bring this up because recently a friend was musing on ROI which turned into “return on time investment” (ROTI). If you think of your time as money, then you might want to consider how long it takes you to learn or do something and if it will be worth it in terms of making a job more efficient, faster, or easier. This offhand comment got me thinking about ROTI for nurse authors.

Every manuscript I receive—whether for this publication, the other journal I edit (CIN: Computers, Informatics, Nursing), or from another source—has been produced using a word processor, most commonly Word (Microsoft, Inc., Redmond, WA, USA). I am regularly surprised—and dismayed—at how many people use their word processor like a typewriter—indenting paragraphs with the space bar (instead of using the tab key) or formatting references with spaces, tabs, and the enter key (instead of creating a hanging indent), to use two common examples. (Given that typewriters have not been commonly used for 30-plus years I am not sure where people are picking up these habits, but that’s a different story for another day!) While it might be easy enough at the outset to create a reference list with tabs and spaces, fixing it after changes from a co-author or revisions requested by a journal is time consuming. And then, consider the number. Do you need to fix 5 references, or 50? This becomes an ROTI issue.

Return on Time Investment

Learning Curve

Using the same formula as ROI, consider this:

With software or other computer applications, you need to consider the learning curve as part of the “time to learn” denominator. Some programs are intuitive upon opening while others are baffling from the get-go. Microsoft Paint (Microsoft Inc., Redmond, WA, USA), a very easy-to-use graphics program that comes packaged with Windows, has a fairly flat (small slope) and time-limited (short period) learning curve. Adobe Illustrator (Ai; Adobe Systems, San Jose, CA, USA), on the other hand, has a sharp curve (steep slope) that can go on for weeks, months, or years (long period), depending on how much you use it and how often they make upgrades, which might require new learning. In other words, you can probably be a Paint “expert” in a few hours. Ai might require a few months just get to “advanced beginner” status. See Figure 1.

Figure 1. Learning Curve and Time Period for Paint and Ai

Continuing with this example, what do you need to do? If your project is to simply re-size a picture to post on a website or include in a manuscript, then you will probably never get a positive ROTI from spending hours learning Ai for this task. Even if you need to create a simple figure for an article, or perhaps a flowchart, I would be hard pressed to say that learning Ai would pay off, even in the long run. If you have a task that requires Ai level resources and expertise, it might be worth it to find someone who can help you—and you might need to pay for this service. When you consider this as an ROTI issue, this may be money well spent.

Hours Saved

I believe people should use a long lens to consider hours saved. Many people have said to me, “This is just a short article with only a few references, so I really don’t need to learn how to…” (insert the thing they didn’t learn to do). While that might be true for a particular project, if you are in a position where professional writing is an expectation of your job, then you need to think beyond the “short article.” Likewise, even if you are in the middle of a big project, such as a dissertation, it is worth it to learn what you didn’t learn at the beginning and make the fixes. As Benjamin Franklin said, “Don’t put off until tomorrow what you can do today.” This is always good advice!

Prioritizing What to Learn

We are all busy people who don’t have enough hours in the day to accomplish all we want to get done, but even so, we have lots of work to do. With that in mind, how do you prioritize what to learn and the hours to spend on that learning process? What will result in the best ROTI for you? Assuming that anyone reading this is either a nurse author or editor, I am going to make a few suggestions based on a job, position, or career where scholarly writing is an expectation.

Word Processing Programs

If you are a writer, then using a word processor in your day-to-day work will be the norm. Thus knowing how to use it well and taking advantage of all its features will contribute to a positive ROTI. I believe that word processing programs have a learning curve that starts low and gradually increases (moderate slope) over a moderate to long period. In other words, you can turn the program on and immediately start typing, but there are myriad features and helpful tricks that you can be learning for years. This point is key: consider that every time you turn on your word processor is a learning opportunity. Try to learn something new every time you write something, which will likely be every day.

In terms of what to learn, I would suggest looking at a journal article and noting the elements. They don’t vary much from journal to journal. Analyzing an article provides a road map of what you should be able to do with your word processor. Consider:

  • Setting up a page, with margins, fonts, and line spacing. Most journals want manuscripts to be double spaced for submission, so you should know how to do that from the outset—it’s easier than fixing line spacing later on.
  • Creating and format a bulleted list (like this one) as well as a numbered list.
  • Creating a table. Know how to format that table to meet APA or AMA requirements—that is: changing borders, width of columns, and spacing. Know how to add a table legend.
  • Inserting a figure or picture (which may have been created in another program). Know how to align the figure/picture on the page and adjust margins and fonts. Add a figure legend, both above and below the figure.
  • Knowing how to use tabs, whether at the beginning of a sentence or to create indented paragraphs for quotes.
  • Properly formatting a reference list, using hanging tabs and indentation.

Outside of a journal article, when you are in the preparation stage, you also want to know how to:

  • Edit a manuscript using track changes and then accept/reject changes to create a clean copy.
  • Leave comments for a co-author (or to yourself) and then resolve/delete comments.
  • Set tabs, especially “special” tabs such as those with “dot leaders” to use on a table of contents (important for dissertations).
  • Create headers and footers, with page numbers.

Word (Microsoft) is the dominant word processor on the market today. If this is the program you are using then you will have lots of resources, include Microsoft support and YouTube videos to help you learn. Other popular word processors include Google Sheets (part of the Google Business family of products) and Pages (for Mac users). Given that Word is so ubiquitous, I would suggest that even if you are using another program, you should still have a general familiarity with Word.

Citation Managers

Citation managers, also called Bibliography Database Managers, are programs such as Endnote and Paperpile that have two major functions: 1) maintain a library of references; and 2) in conjunction with your word processor, create citations in the text and a reference list. I consider these programs essential for scholarly writing, but many people balk at them. Why? I suspect that all citation managers (and there are many on the market) require time to learn and from an ROTI perspective, authors aren’t convinced that time investment will be worth it. I beg to differ. This is a perfect example of why investing in yourself to master something will have long-term benefits. Furthermore, all citation managers work more or less the same way, just like word processors. Once you get the hang of one program, you will be able to transfer that knowledge to another program you may opt to use.

What are the advantages? There are many. Consider:

  • Styling references is tedious. Making sure the right elements are italicized, capitalization is correct, you have periods and commas in the right places—all of this takes time and is boring. Why not let your computer do the work?
  • Every time you re-key (re-type) a reference, you increase the probability that an error will be made. An incorrect page number or year, or misspelled author name, can make a citation irretrievable. You want to avoid these types of mistakes. Having an accurate library where citations are simply inputted, not re-typed, dramatically reduces the error rate.
  • Changing reference style, from APA to AMA, for example, is relatively quick and easy to do when using a citation manager.
  • Most journal sites, as well as databases such as MEDLINE and Scopus, are optimized for citation managers. That means if you are reading an article and you want to save the citation in your library, doing so can be as simple as clicking a button or two. Figure 2 shows how a citation from the Journal of Nursing Scholarship would be imported into a number of programs, including Paperpile.
Figure 2. Importing a Citation from the Journal of Nursing Scholarship

I also think that it is not possible anymore for one person to memorize all the citation styles that exist. Back in the day, things that got cited were fairly limited: journal articles (which were all in print), books, edited books, and theses and dissertations. While there might be the occasional oddball citation, such as a public law or government document, an author wasn’t spending hours looking up every single citation in a style manual. That’s not the case anymore. Given this, it again makes sense to let the computer do the work which increases the accuracy of the citations and saves you time.

Which program should you choose? That’s a good question and a full evaluation of every citation manager that is available is beyond the scope of this article. If you are just getting started, then it is worth it to do your research and select a program that is right for you. This table from Wikipedia is a good starting point to learn names and some basic features. As you think about citation managers, also keep the following in mind:

  • EndNote (Clarivate Analytics, Philadelphia, PA, USA) is a legacy program, founded in 1988 and regularly updated. EndNote is expensive and they charge for updates—usually annually. However, lots of schools and colleges of nursing buy institutional licenses and make the program available to their faculty and students. If that is the case for you and EndNote is what everyone around you is using, then you should probably jump on the bandwagon. Decision made!
  • I like Paperpile (Paperpile LLC, Cambridge, MA, USA) and have been using it for 8 years. They recently came out with a Word plug-in which eliminates one of the previous drawbacks of the program—that it only worked with Google Docs. They have also come out with a mobile version that will work on a tablet. Chinn1 wrote a review which has more detail about the program. It has a 30-day free trial period and the annual cost is a modest $39/year.
  • PERRLA (PERRLA, LLC, Murfreesboro, TN, USA) is an affordable program ($49.95/annual subscription) that is popular with students. Oddly, it is not included on the Wikipedia list. The biggest drawback of PERRLA is that it only formats in APA and MLA, so it doesn’t have the versatility that an author who is submitting to journals (not writing student papers) might need. It has an interesting development history which you can read at the website: https://www.perrla.com/#/about
  • Mendeley (Elsevier, Amsterdam, Netherlands) and Zotero (RRCHNM, George Mason University, Fairfax, VA, USA) have both been around for about 15 years, are popular, and free. If you are completely starting cold with a citation manager, looking at these two programs might be a good place to begin.

Graphics Programs

As you look at a journal article, you may see figures, illustrations, tables, and charts. Does that mean you need to learn to use a graphics program to create these elements? Perhaps. As noted earlier, MS Paint is a very easy-to-use but surprisingly robust graphics application. It’s been around since 1985. A few years ago, there was a scare that it would be discontinued,2 but to everyone’s great relief, including mine, that didn’t happen. MS Paint is my “go-to” program for simple graphics and resizing and fixing photos. I created Figure 2 in this article using “print screen” to capture the image, resized it in MS Paint, and saved it as a .png file. The whole process took about 90 seconds.

Word also has very good graphics capabilities. Using resources such as “shapes” and “Smart Art” you can create flowcharts, such as a PRISMA diagram or an illustration of a conceptual model. I would suggest that you create your chart or illustration as its own file and save it, then insert into your document at the appropriate point (either within the text or at the end of the document). Many journals want figures submitted as separate files, anyway, so this is another good reason to create them this way.

Word works with Excel to create charts so again, you may be able to do everything you need to do right within the program.  That is how I created Figure 1, which took about 5 minutes. To get the chart to look the way you want it to may take some time—but that’s the whole point. Invest in the time to learn how to create the chart the first time and with each subsequent use the process will be quicker and easier.

Speaking of Excel, many people are tempted to use that program to create tables, but I advise against that. Even through Excel looks like a table, it’s not—it’s a spreadsheet. A “table” created in Excel is not going to have the properties that will allow you to format it easily and correctly to meet APA or AMA guidelines. You can make fantastic, complicated tables right in Word. Read a few help files, watch a few YouTubes videos and get to work. It will be worth your time!

Conclusion

Your time is valuable, and you want to use it to your best advantage. As an author, you need to decide the best way to produce manuscripts that meet journal guidelines and reduce time and effort making corrections and revisions at the later stages of the submission process. Using ROTI as a metric, you will be well served by comprehensively learning and using your word processor of choice and a citation manager. Having a basic knowledge of a simple graphics program will also come in handy. In subsequent articles, determining ROTI for research resources, as well as time management and organization will be discussed.

Acknowledgement

Thanks to Gareth Pronovost of GAP Consulting, Denver, CO for his suggestion of “return on time investment.”

References

  1. Chinn PL. Paperpile and Google Docs. Nurse Author Ed. 2016;26(4):4. Accessed October 10, 2020. http://naepub.com/wp-content/uploads/2016/11/NAE-2016-26-4-4-Chinn.pdf
  2. Scotti A, Feldman K. Microsoft Paint won’t be discontinued after all. New York Daily News. https://www.nydailynews.com/life-style/microsoft-paint-discontinued-article-1.3351697. Published July 25, 2017. Accessed October 10, 2020.

About the Author

Leslie H. Nicoll, PhD, MBA, RN, FAAN is the Editor-in-Chief of CIN: Computers, Informatics, Nursing and Nurse Author & Editor. In the mold of Florence Nightingale, she is a lifelong learner and uses every opportunity to determine her ROTI. She lives in Maine with her husband, rescue pets, and adult children close by. You can reach her at Leslie@medesk.com. ORCiD: https://orcid.org/0000-0003-2149-7856.

2021 31 1 5 Nicoll

Copyright 2021: The Author. May not be reproduced without permission.
Journal Complication Copyright 2021: John Wiley and Son Ltd.

 

Featured: Return on Time Investment: Research Resources

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Return on Time Investment: Research Resources

Leslie Nicoll, Sulochana Naidoo, Qing Yang

Nurse Author & Editor, 2021, 31(1), 6

In an earlier article,1 the concept of “return on time investment” was introduced (ROTI) to consider the time it takes to learn and use a software program or application, balanced against the hours saved for your work or project. For people in academia, or those who anticipate a career that will involve writing on a regular basis, having a strong knowledge of a word processing program and a citation manager is essential. These programs have a high ROTI—that is, it is worth the time investment to learn to use them well, as they will save you many hours of effort in the long run.

What if your career will involve active engagement in research activities? Or perhaps you are a student, embarking on a PhD dissertation or DNP capstone project. These types of projects usually involve data-related activities—typically data collection, management, and analysis. There are myriad applications for each of these tasks. Sorting out the pros and cons of each—and balancing that against cost and ROTI—can be overwhelming. In this article, we will provide a framework that can be used as a starting point for thinking through some of these issues. Note that a comprehensive review of the various applications available is beyond the scope of this article.  Our goal, instead, is to give some representative examples and provide criteria that you can use to guide decision-making.

Decision Making Algorithm

Figure 1 is a starting point for evaluation. Note that your goal should always be to increase your efficiency and accuracy. This is balanced against availability, cost, frequency of use, and the learning curve of the application you plan to use. All of this taken together will help you determine your ROTI.

In contrast to the applications discussed previously (word processors, citation managers, and graphical design programs) which are widely available and may be free, low cost, or affordable, programs used for research are less ubiquitous and often expensive. Therefore, availability and cost are both important considerations and may drive your decision making. If your employer has an institutional license for program “X,” then you need a really good reason to buck the system to use program “Y.” Institutionally licensed programs may also include training options and support. On the other hand, if nothing is available to you locally, then cost may very well be the deciding factor as to which program you choose, which is why it is the first column in Figure 1.

Figure 1. Decision Making Algorithm

Form Development and Data Collection

There are several applications that can be used to create forms for data collection, such as Survey Monkey, Qualtrics, JotForm, and Wufoo (which is owned by Survey Monkey). All these applications work basically the same way and allow you to create forms quickly and easily. They have pre-set fields such as name, address, email address, and phone number, which you can drag and drop onto your form. They also all have branching logic, which means that if a person answers a question a certain way (eg, yes or no) other fields for answers may be displayed or hidden. Most include a feature to integrate with a payment system, such as Stripe or PayPal. This is likely not important for research purposes, but if you become proficient with a form application, you may find yourself developing forms for conference registrations or to sell tickets to an event. Once a form has been developed, it can be embedded on a website or a link for completion can be sent to by email to identified participants.

In our experience, these programs are quite intuitive and easy-to-use—in fact, developing a questionnaire or survey can be fun. That said, it is important to keep in mind good survey principles. If you are developing something from scratch, you want to be thinking of pilot testing your survey and establishing reliability and validity. If you are using a pre-existing survey, make sure you have permission to reproduce it in another format and use it in your study.

Many institutions have licenses for Qualtrics and Survey Monkey, so by default, you may be using one of those applications. But if you need to search further afield, the good news is that you will not necessarily be deterred by the cost as prices vary widely. Many applications have a free trial period to let you test the program; after that they are priced per month which means you can cancel your subscription when your project is done without being tied into an expensive long-term contract. Different price points may be determined by the number of questions on a survey or the number of responses you can receive in a month. Payment integration and HIPAA security are usually features offered at slightly higher price points. With free trial periods and flexible payment options, you should be able to find something that works for your particular situation—but you need to do your homework to find the best solution. Spend some time doing your research on this issue!

REDCap

One application you may have heard a lot about (or be familiar with) is Research Electronic Data Capture (REDCap).2 This is a web-based application to collect data for clinical research, create databases, and produce simple reports, graphs, and descriptive statistics. It was developed in 2004 at Vanderbilt University by a group of clinical researchers who needed a secure, HIPAA compliant resource for data collection. REDCap is a little different from the previously discussed form development programs in that it is data driven and has a different underlying architecture from software that generates forms.

REDCap has many positive features for data collection and management:

  • It is HIPAA compliant and highly secure, so it is an excellent choice if your study contains sensitive data.
  • It can be easily organized by different instruments or case report forms (demographic, medical history, and so on). Many clinical research related instrument forms are available to help orient you to the database building process.
  • While REDCap is useful for collecting survey data from study participants, it can also be used for data entry by study team members.
  • If your study has a longitudinal design, that is, collecting data on the same variables at different times, it can be easily incorporated in the REDCap database design. Doing so ensures that all the records collected at different times can be linked appropriately and accurately.
  • You can automatically produce an easy-to-read data dictionary or code book.
  • You can produce simple reports, graphs, and descriptive statistics.
  • Data from REDCap can be exported into a wide range of formats that are used by different statistical software programs, including: EXCEL, IBM SPSS Statistics, R, STATA, and SAS.

Things you need to consider before using:

  • REDCap is free, but to use it, there needs to be a license agreement between your institution and REDCap. There are over 3200 institutions worldwide that have license agreements. You should check if it is available at your institution before you consider using REDCap for data collection, storage, and analysis. This licensing structure, unfortunately, makes REDCap inaccessible to those who are not at an institution with a license—it is available to non-profits only. Keep this in mind as you consider your options.
  • REDCap is intuitive to use, but there is a learning curve. The best way to get started is watch from videos that are offered by REDCap (https://projectredcap.org/resources/videos/). You should be able to get started with building a basic database in a few days. More advanced functions may take longer to learn over time.

Compared to other data collection resources, REDCap has many appealing features for researchers. If you have a working knowledge about study design, have also used other data collection resources, and have it available to you at your institution, then it is worth it to learn REDCap which should prove to be a good ROTI. On the other hand, if it is not available to you then you may need to consider another option, as previously discussed.

Data Analysis: Qualitative Data

If your research data frequently includes open-ended responses to interviews and survey questions, or other forms of text such as journal articles, you value the richness and comprehensiveness of qualitative data. You probably also appreciate how cumbersome and time-consuming the subjective process of manually organizing and analyzing qualitative data can be. If you value time as a precious commodity, then using software for qualitative data analysis is highly recommended. Such software helps to keep data organized, enables more methodical and effective analysis, and consequently yields richer insights into the  phenomena being studied.

The NVivo software package (QSR International, Melbourne, Australia) is one of the most widely used qualitative and mixed-methods data analysis tools in academia and healthcare. It offers the convenience of seven interface languages and audio transcription services in 28 languages.

NVivo facilitates qualitative and mixed methods research by allowing you to:

  • Import text, image, audio, and video data from multiple sources including reference management software.
  • Organize data from multiple sources within a project file.
  • Code data to specific nodes to better recognize inherent trends and themes.
  • Record insights and interpretations in memos, and link them to specific data, to create the basis for your written project.
  • Query and search data and save the results.
  • Create data visualizations such as word clouds, word trees, concept maps and graphs to illustrate trends and relationships.
  • Work collaboratively in teams of up to five people with options to upgrade for larger teams.

Qualitative data analysis is typically an immersive process. It is very likely, therefore, that researchers will want to use NVivo themselves rather than handing off the analysis to a consultant. Thus, having a working knowledge of NVivo before using it is essential. This knowledge may be gained by enrolling in workshops offered at your institution (if there is an institutional subscription), tutorials offered by QSR international, and paid or freely available online tutorials. You may also have the opportunity to become familiar with NVivo through collaboration with someone else—for example, being a graduate assistant on a faculty member’s qualitative research project.

NVivo will prove to be intuitive and user friendly for researchers with an understanding of how to process qualitative data manually, and who are familiar with the interface of commonly used computer programs. Learning how to utilize its various unique features and applications requires a moderate initial time investment.  The learning curve will continue with use but will flatten considerably.

NVivo is sold through both institutional and individual licenses; the cost for a non-academic, individual purchase is approximately $1250. Learning how to use NVivo is undoubtedly a high gain ROTI for qualitative and mixed-method researchers.

Data Analysis: Quantitative Data

Nowadays, you almost always need to collect quantitative data in your research. That means you will have to perform some level of statistics, from just describing your sample characteristics by using descriptive statistics, to hypothesis testing between two variables by using bivariate inferential statistics, and to trying to explore more complex relationships among multiple variables by using advanced statistical models. Before doing any of this, you may also need to do some simple data cleaning and data management, such as taking care of missing data or outliers, and creating new variables. Statistical software is crucial in all of these processes.

There are many statistical software programs on the market and those most frequently used by nursing researchers are IBM SPSS Statistics (IBM Inc., Armonk, NY, USA), SAS (SAS Institute, Cary, NC, USA), and Excel (Microsoft, Inc., Redmond, WA, USA). You may need to have taken at least one statistical course so you can try to do some descriptive and bivariate inferential statistics yourself. For more complex inferential statistics or models, you may need more systematic training or consultation with a statistician. The table below compares three of the most frequently used software programs. Use this to decide which one to choose according to what types of statistics you are trying to generate. You can use this table together with Figure 1 to make the best ROTI decision for yourself.

Table 1. Comparison of Statistical Programs

Cost and availability Data Management Descriptive Statistics

 

Inferential Statistics Modeling Techniques Learning Curve
Excel Included in Windows Office Fair Yes Some No Easy to learn
SPSS Expensive but academic discounts can make the price reasonable for students. May be available through an institutional license. Good Yes Yes Most Moderate:

Can self-teach by using online resources if you already have some statistical knowledge. Many stats courses include using SPSS as part of the course.

SAS Expensive, but sometimes free if your institution already has a license Excellent Yes Yes Yes Very steep:

Recommend a formal training program

Conclusion

When you embark on a project that involves data collection, storage, manipulation, and analysis, you need to think very carefully about how you will manage each step. You could ask participants in study to complete a questionnaire using pencil and paper, but what would be your next step? Similarly, if they complete a survey electronically, where do the data go from there and how will they be stored and analyzed? If you interview people and tape record the interviews, who will do the transcription? How will interviews move from a conversation log to a program such as NVivo? You need visualize each of these steps, how the work will be managed, and who will do it. Taking the time to learn a program such as NVivo or SPSS might be a worthwhile investment in yourself, because you can use this knowledge to consult with others and maybe even become a research collaborator on a variety of projects. On the other hand, if you are a conceptual “big thinker” and not a detail-oriented analyst, then your time might be better used in another way, while you use financial resources to hire expert consultants for handle this aspect of the project. Whatever path you choose, what is most important is to have a clear understanding of the issues at play and use this knowledge to make an informed decision about your ROTI.

References

  1. Nicoll LH. Return on Time Investment: Writing Resources. Nurse Author Ed. 2021;31(1):5. Accessed March 12, 2021. https://naepub.com/wp-content/uploads/2021/03/2021-31-1-5-Nicoll.pdf
  2. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. doi:10.1016/j.jbi.2008.08.010

About the Authors

Leslie Nicoll, PhD, MBA, RN, FAAN, is Editor-in-Chief of Nurse Author & Editor and CIN: Computers, Informatics, Nursing. She is co-author of The Editor’s Handbook, 3rd ed. which was published in July 2019. You can reach Leslie via the contact form on this site, and she will respond to you directly.

Sulochana Naidoo, PhD, MS, serves as the Associate Director, Global Education for Duke- NUS.  In this role she oversees and supports the medical education collaboration between Duke University School of Medicine and Duke-NUS Medical School (Singapore).

Qing Yang, PhD, is an Associate Professor and Biostatistician at Duke University, School of Nursing. She teaches statistical courses to PhD students and DNP students. She also serves as statistical co-investigator on many NIH and DOD funded grants.

2021 31 1 6 Nicoll Naidoo Yang

Copyright 2021: The Authors. May not be reproduced without permission.
Journal Complication Copyright 2021: John Wiley and Son Ltd.

 

 

 

 

 

 

 

Featured: Return on Time Investment: Productivity Resources  

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Return on Time Investment: Productivity Resources

Peggy L. Chinn

Nurse Author & Editor, 2021, 31(2), 1

When I was in 4th or 5th grade, my favorite book was Cheaper by the Dozen, the semi-autobiographical novel by two of the dozen children raised by their efficiency expert parents.1 The authors tell hilarious tales of being raised in a household that served as a sort of laboratory to test their parent’s educational and efficiency ideas. Of course, the stories must have entertained me, but their ideas of efficiency made a major impression on my young brain. As a result, to this day I will eagerly turn my attention to any method, device, or app that promises to help me do a job better. Let’s admit it—we all wish we had more hours in a day, but we don’t!

The fact remains that in this day of amazing digital resources that are designed to help us save and manage time more efficiently, we still need to learn how to use them. Following on the previous two articles in this series2,3 you need to consider your personal “return on time investment” (ROTI) to decide if any of the myriad productivity tools that are on the market are going to work for you. While many of these programs are intuitive—a digital calendar looks like a paper calendar, for example—they all have quirks and a learning curve.2 So the question remains: what is the ROTI and is it worth your time and energy to learn to use one or more of these applications? The sections that follow describe three categories of productivity apps (with specific examples) to consider. You may want to refer back to the decision-making algorithm presented in Return on Time Investment: Research Resources3 to help you think through the pros and cons and why you might, or might not, consider adopting one or more of these for your writing and scholarly life.

Interactive Digital Calendar

Many among us who are digital immigrants5—that is, those of us who have not grown up using digital tools for our entire lives—find that one of the hardest things to give up from the paper environment is our calendar or daily diary. Like a physical book it feels familiar, allows “thumbing through” to quickly scan for events, and has a notation system that satisfies a sense of pattern and order. Shifting to a digital calendar is perhaps one of the most difficult changes to make and at first glance may not appear to be much of an efficiency tool. But there are many advantages, some of them “baked in” for work environments, so that a paper calendar or diary might already be a thing of the past for you.

 Many office suites come with a calendar application by default: Google Business, Microsoft Office, and Apple iOS all have calendar programs built-in. Many work environments use Outlook for email for their employees and automatically insert all organizational events that appear on everyone’s calendar making sure you never a miss a meeting. Google Calendar is also popular and used by many schools, community organizations, and businesses, with the option for students or employees to share selected calendars. For Mac users, the Apple iOS software comes with a calendar—this same calendar is also present on iPhones and iPads. As noted in the previous articles,2,3 if your work environment is providing you with a business suite and associated calendar, then you should think long and hard about “bucking the trend” and using something else. Events can be scheduled by colleagues and supervisors and if your calendar is not on the network—or doesn’t synchronize with the network—you may miss important notifications and meetings.

So, why transition from paper? One major advantage is that a digital calendar allows you to move things around easily when dates change. Most calendars can include geographic information such as the address and link to a map showing you how to get to events that require travel. It is also easy to set up recurring meetings, meaning that you can set up a year’s worth of board or committee meetings with just a few clicks. Because of the COVID-19 pandemic, many of us are living a remote life, attending meetings via Zoom, Microsoft Teams, or Google Meet.4 With a digital calendar, when you accept an invitation to an electronic meeting, all the details are automatically included with the event. When the time comes for the meeting, all you have to do is click on the link in your calendar to join.

Digital calendars give you the option to set up several calendars that serve different purposes—color coded so that you see which events fit into a certain category. For example, on my calendars, social activities show up in yellow, work events are red, personal appointments are blue, and travel itineraries are orange. Each calendar item can be shared with someone in your household or work environment—I share my travel calendar with everyone in my family and my social activities with my partner. Once I enter an event in these shared calendars, the event automatically appears on the calendar of the people who are sharing that particular calendar with me.

One of the standard features that work environments use is the ability to schedule and invite individuals to a planned meeting. Once an invitee (you) accepts the invitation, the event is automatically entered on your calendar, along with meeting details and information about the other attendees. This works (for the most part) for people who use different digital calendars because the invitations issued from a calendar can “talk” to any other calendar. One important hint: if you are meeting with people in different time zones, then make sure to set your calendar to your correct time zone. That way, if you issue an invitation to others, the event will show the correct time on their calendar.4 Most calendars have many other settings that can be customized but from an ROTI point-of-view, start with the basics and learn the more advanced features later.

One of these basic calendars may be all you need. Because they are so ubiquitous, their parent companies are constantly adding features and upgrading their products, to ensure that they integrate with other applications and sync among all your devices. But you may have a specialized need beyond what is routinely available. In that case, again, look at what is available and assess the ROTI. Is the need worth the effort to learn and use a product that may be less mainstream?

In my case, after doing quite a bit of research, I said “yes” to Fantastical (https://flexibits.com/fantastical). A drawback is that it works only with the Apple iOS—and for some reason, the Windows lookalikes aren’t very good. However, if you are a “half-Apple, half-Windows” person (ie, you have an iPhone or iPad, but Windows computer) then you can install Fantastical on your iOS device. It will sync with your other calendars, including those on your non-iOS machine. For me, I use the Apple Calendar (because everyone in my family uses it), Google calendar (because it interfaces easily with all of the other Google apps and with Chrome, which is my browser of choice), and Fantastical. Fantastical is where I keep everything together and the calendar I use to manage all of the other calendars (which happens automatically).

On my Mac, Fantastical shows up as an icon in my menu bar, so regardless of what I am working on, I always see the icon and can pull down the calendar to not only view, but also to add, edit, or delete events. As soon as I make any changes, all of the changes show up on my Apple calendar and selected events also show up on my Google calendars. On my Apple watch and iPhone, I find that Fantastical is easier to use to add and edit events than the other calendars I use.

Fantastical isn’t free—it costs about $40/year, although it does have a free two-week trial. It also requires time to learn and become familiar with all of its features. But for me, once I discovered Fantastical, the ROTI was worth the time and money since it has so many useful features that other calendars don’t provide.

This complicated profile of digital calendars is probably more than you can even contemplate! Never fear—this happens gradually, almost without even recognizing what has now become part of your everyday life. The truth is that this challenge of new digital tools is a constant feature of our virtual reality—there is always another resource that appears on your radar, tempting you to give it a try, or evoking an immediate “leave me alone” response. Your decision: what is the ROTI? Is this worth my time and effort? When it comes to calendars, I believe that everyone should using something digital, even if they back it up with a paper schedule. But you need to assess if you will be satisfied with the calendar that is presented to you through an office suite or your employer, or if you need something a bit more sophisticated to meet your needs.

Task Management and Productivity: For Yourself

“Task management and productivity” is just a fancy way of saying “to-do list.” The time-honored scrap of paper jotted with what you need to accomplish in the next hour, day, or week might be serving you well, and a digital to-do list may not be worth your time to learn and set up. If, however, you find that you are missing deadlines, forgetting about something you promised to pull together for your co-author, or suddenly realizing that a meeting is tomorrow—and you are not prepared—these are all clues that you need help and that it might be worth learning a new digital resource to keep track of things. Look at your daily workflow and consider what you do—if you are a “multi-tasker” (and aren’t we all?) then a to-do list may be an essential resource for you.

Similar to the calendar programs previously discussed, most office suites come with some sort of reminder list function. In Google it is “My Tasks”; Microsoft calls their version “To-Do” and iOS has “Notes” and “Reminders.” Again, because one or more of these programs might be sitting right there on your desktop (or in the case of Google, it shows up on the right in its email program), you may as well dive in and give them a try.

Beyond the basics, there are dozens of productivity apps available, ranging in price from free to annual subscriptions of approximately $100. Many have cute names (“Remember the Milk”; “TeuxDeux”) and feature sets that vary widely. Some may be iOS only while others run on all platforms and machines. It is important to make sure that whatever program you opt for, it synchronizes among all your devices. What’s the point of having a to-do list if it resides only on your desktop computer?

The productivity tool that I used is called “Toodledo” (yes, another cute name). Toodledo is very intuitive (meaning you don’t need to read a user manual to learn to use it!), and you can start with the simplest features and build from there as you get more familiar with the app.

A common feature of all of these apps is that you can rank items by priority, schedule tasks for a particular day (even several years in the future), set up “repeat” dates and frequencies, and group tasks by category. The category feature is particularly helpful. When I want to know what tasks are on my list related to managing a website, I can quickly look at just the tasks for that category to see where I am in the larger project. In Toodledo, there are two features that I depend on as vital to keeping things organized and efficient:

  • Each task accommodates detailed information in the “notes” section, including URLs for web information that is important to the task; and
  • Files can be uploaded and attached to a task.

Here is an example: when I accept a request for review of a manuscript, I immediately download the manuscript and attach it to the task, note the due date of the review in the “task title,” copy the journal URL in the task details, and schedule the date for completing the review several days before the review is due. This takes a few minutes to set up, but when the time comes to tackle the review, all the details I need are there to finish the job.

One other indispensable feature: when an email comes to my inbox that needs a response other than an on-the-spot “reply,” I forward the email to Toodledo. Automatically, the program creates a task with the email subject as the task title, and the body of the email in the task details.

You might be wondering about the efficiency of keeping a task list separate from a calendar. The way I think about it is that tasks are things that I have to get done—they might have a day deadline, but that do not have a specific commitment for a time of day. I can work these tasks in and among my calendar events—the things that demand my physical or virtual presence at a particular time. This way, calendar events show me a visual of what my day is like, without the clutter of all the to-do list of things that I need to squeeze into my free blocks of time.

To-Do List Rabbit Hole

While editing this manuscript and getting it ready for publication, I was busy researching and testing many of the programs that are mentioned. In the process, I found myself falling into a “rabbit hole” of to-do list programs specific to groceries. The COVID-19 pandemic has dramatically altered the shopping patterns in our home: my husband is the one going to the grocery store 100% of the time. Meanwhile, I was acting as the Quartermaster, busy with inventory management. It was a source of frustration when I would say, “We need coconut,” multiple times but it never appeared in our kitchen. I solved this problem by ordering things from Amazon, but when I realized we had 10 pounds of organic oatmeal, 2 cases of cream of mushroom soup, and 8 bottles of barbecue sauce (among lots of other stuff), I decided that bulk purchasing might not be the best approach!

This set me on a quest to find a grocery to-do list that would work for us. After reading many reviews, we have been putting “Our Groceries+” through its paces. Some of the features that are particularly appealing are:

  • It is very easy to add and delete items from your list.
  • Common items are automatically categorized; for those that aren’t, it is easy to assign them to a category which the app remembers for the future.
  • There is a preset list of categories (dairy, bakery, meat, etc.) and it is easy to create new ones. Oddly, there wasn’t a “seafood” category, which is essential for those of us in New England!
  • You can add pictures, to make sure the shopper gets the exact item you want.
  • It has a barcode scanner, so when you take the last of an item out of your pantry, you can scan it and add to the shopping list. According to the developer, OurGroceries+ has a database of 17 million products and their barcodes (UPC).
  • You can use voice-activated devices, such as Amazon Alexa, Google Assistant, Google Home, and Siri to add items to your shopping list.

Using the app among multiple devices is easy. You create a master account under one email address, and then install the app on the various devices in your household. It syncs every 20 seconds so if necessary, you can add items while the shopper is at the store and they will appear on the list. The basic program is free; having pictures and barcodes are premium features that require a subscription ($6/year or $10 for a lifetime membership). There is also a recipe feature which I haven’t spent too much time with—that’s on my “to-do” list.

—Leslie H. Nicoll, Editor-in-Chief

Task Management and Productivity: For Teams

To-do lists are great, but what about if you need to organize more than yourself? Then you may want to consider a team-based productivity app. This is where it starts to get complicated and you really need to balance your ROTI against what the program does and how valuable it will be to you. Recognize that teams have different priorities depending on job at hand: tasks, projects, time, communication, or collaboration. You might not find an all-in-one solution—in fact, you might decide that many of these programs are not worth your time and effort to learn. On the other hand, you may be working with others who are using them and you will need to have a working knowledge to be part of the team. For example, Dropbox, Box, OneDrive, and Google Drive are all widely used to share files among team members, rather than emailing various versions back and forth. Using a central storage area helps the team leader manage version control. On a multi-author project, it is very frustrating when one person makes extensive edits on the wrong or early version of a manuscript. Therefore, even if you are still using a thumb drive to save your files (and back them up), if the team is using cloud-based storage then you need to know how to find, retrieve, and save files from whatever application that is being used.

Table 1 shows different programs that tackle different components of team-based work. A discussion of all of them is beyond the scope of this article, so you will need to do some research. Note that prices range from free to several hundred dollars per year, depending on the number of collaborators on an account. As has been noted repeatedly in this series of articles: if your workplace is using one (or more) of these programs, then you may want to investigate those first before you venture further afield to learn about others.

Table 1. Examples of Programs for Team-Based Work

Dimension of Work Example Programs
Tasks ·         Todoist

·         Trello

·         Any.do

·         Hitask

Projects ·         ClickUp

·         Asana

·         Zenkit

·         Flow

·         Airtable (note that Airtable has automations built-in)

Time Management ·         Toggl:

·         Clockify

·         Harvest

Communication ·         Slack

·         Chanty

·         Google Meet

·         Microsoft Teams

·         Zoom

Collaboration ·         Dropbox

·         Box

·         Google Drive

·         OneDrive

·         Endnote (for managing references; special use case)

·         Paperpile (for managing references; special use case)

·         Zotero (for managing references; special use case)

·         Mendeley (for managing references; special use case)

Automation ·         Zapier

·         IFFTT

With that caveat in mind, I want to highlight two programs that I use frequently: Trello and Airtable. I use Trello to organize projects. It uses the concept of a Kanban board, which was first developed by Japanese manufacturers to efficiently pass along information on a production line as to what steps are needed next to complete a task. The concept is also used in work environments where a white board has sticky notes pasted on it. These notes can easily be moved around as various project tasks are completed. As an interesting historical aside, the American Journal of Nursing used “The Board” to plan out issues.6 It was essentially a Kanban board with cards that were accessed and moved by everyone involved in the production of the journal. Although it is no longer in use, it still hangs on the wall at the AJN office.

Trello uses boards, cards, and lists to organize information. You can set up a project using any conceptual approach that works for you. If your project has a completion date, for example, you can organize the tasks on a timeline, showing what tasks need to be finished and when. The board can be shared by everyone who is working on the project, and each task (shown as a “card” on a list) can be assigned to a particular team member. Trello is criticized by many because of its simplicity—which is why I like it! It is also remarkably versatile. At the Portland Community Free Clinic, my colleague developed a scheduling system back in 2014.7 It is still working well with very few modifications, 7 years later. Although I find Trello to be intuitive, I have gotten pushback from colleagues that I have invited to Trello boards for project management, such as the workflow I use for the journal I edit, Advances in Nursing Science. That said, if you have a team and can get everyone “on board,” Trello can be extremely effective.

Another program I use for collaboration is Airtable, which has been described as a database for people who are used to spreadsheets. The Directory of Nursing Journals, which is a collaborative effort between the International Academy of Nursing Editors and Nurse Author & Editor is maintained in Airtable. Click here to see it.  This is a “Gallery” view in Airtable. The behind-the-scenes database in Airtable maintains all journal information which is linked among various tables. Thus if a journal editor retires, the name of the new editor only needs to be typed in one place and it will update throughout the system, including the Directory.

Figure 1. Entry Form for Airtable

A recently added feature of Airtable is automations (see Table 1) which allows repetitive tasks to be completed in just a few steps. With this, it is easy to send a mass email to all journal editors in the Directory asking them to review and update their journal information which will be recorded automatically in the database. The City of Portland (Maine) has recently adopted a COVID screening tool for city employees that allows them to enter their temperature and presence (or absence) of COVID symptoms when they come to work. For employees whose answers fall outside of a specified range, an automated alert is sent to their supervisor for immediate follow-up. The screen that is shown to employees is simple and uncluttered (see Figure 1) and can be accessed on a smartphone, tablet, or computer. The application is built on three tables, one form, and an automation and was developed by city employees.

Airtable also includes mathematical functions and graphs, so it can be used in a rudimentary way for research applications—about at the same level as Excel can be used for statistical analysis. Three recent project teams I have been part of, for work on bibliometric analysis, have used Airtable to maintain the research databases and conduct the analysis.8,9,10

Conclusion

There is tremendous opportunity in our digital environment for efficiency, productivity, and time savings. At the same time, expending too much time learning a program or application that will not help you in the long run is a poor ROTI. In this article, I have tried to make it clear that a digital calendar is essential and productivity tools are also very high on the list. You need to think about your own personal workflow and balance that against short- and long-term career plans and goals. It may be the case that resources available to you, either because they are affordable or given to you by your employer, are all you need to use. But if you must venture further afield, considering ROTI provides a framework for decision-making and adoption of applications that I hope will be beneficial.

References

  1. Gilbreth FB, Carey EG. Cheaper by the Dozen. Open Road Media; 1948/2013.
  2. Nicoll LH. Return on Time Investment: Writing Resources. Nurse Author Ed. 2021;31(1):5. Accessed March 12, 2021. https://naepub.com/wp-content/uploads/2021/03/2021-31-1-5-Nicoll.pdf
  3. Nicoll LH, Naidoo S, Yang Q. Return on Time Investment: Research Resources. Nurse Author Ed. 2021;31(1):6. Accessed March 24, 2021. https://naepub.com/wp-content/uploads/2021/03/2021-31-1-6-Nicoll-et-al.pdf
  4. Robb M. Timing it right: Tips for planning remote meetings across time zones. Nurse Author Ed. 2020; 30(4), 4.
  5. Nicoll LH, Chinn PL. Writing in the Digital Age: Savvy Publishing for Healthcare Professionals. Wolters Kluwer Health/Lippincott, Williams & Wilkins; 2015.
  6. Nicoll LH, Chinn PL. The Editor’s Handbook. 3rd edition. Wolters Kluwer Health; 2019.
  7. Nicoll LH. Creating a scheduling system on a budget. Comput Inform Nurs. 2015;33(11):473-477. doi:10.1097/CIN.0000000000000202
  8. Nicoll LH, Carter-Templeton H, Oermann MH, Ashton KS, Edie AH, Conklin JL. A bibliometric analysis of 81 articles that represent excellence in nursing publication. J Adv Nurs. 2018;74(12):2894-2903. doi:10.1111/jan.13835
  9. Chinn PL, Nicoll LH, Carter-Templeton HD, Oermann MH. An analysis of nursing citations and disciplinary characteristics in 79 articles that represent excellence in nursing publication. Nurs Inq. 2019;26(3):e12296. doi:10.1111/nin.12296
  10. Nicoll LH, Oermann MH, Carter-Templeton H, Owens JK, Edie AH. A bibliometric analysis of articles identified by editors as representing excellence in nursing publication: Replication and extension. J Adv Nurs. 2020;76(5):1247-1254. doi:10.1111/jan.14316

About the Author

Peggy L. Chinn, RN, PhD, DSc(Hon), FAAN is Editor-in-Chief of Advances in Nursing Science, author of a few books, and manager or co-manager of several websites/blogs, including INANE. She is co-author of The Editor’s Handbook, 3rd ed., published in July, 2019. She is an Author-in-Residence for Nurse Author & Editor. You can reach Peggy directly at: peggychinn@gmail.com

Conflict of Interest

The author and editor note that they have no financial or commercial interest in any of the products mentioned in this article. They have not received complimentary versions/subscriptions for review and have not been asked to endorse or otherwise recommend any of these products/applications.

2021 31 2 1 Chinn

Copyright 2021: The Author. May not be reproduced without permission.
Journal Complication Copyright 2021: John Wiley and Son Ltd.

Featured: Writing Productivity Strategies

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Writing Productivity Strategies

 Heather Carter-Templeton

Nurse Author & Editor, 2021, 31(2)2

Published scholarship is a crucial expectation for faculty working in colleges and universities throughout the world. And, published scientific literature is the way in which members of a discipline share their theories, research, and findings to support knowledge used in practice.1 However, many academics identify perceived barriers to their lack of scholarly productivity. Lack of time to dedicate to writing as well as lack of experience in writing have been cited as obstacles to successful publication and scholarship. In addition, due to various forms of preparation to serve as a faculty member in nursing, some may not have had adequate education regarding the processes surrounding writing for scholarship.2 Therefore, many schools of nursing apply strategies such as writing groups, encouraging team writing, or other tactics to support faculty in their scholarship endeavors.

A recent inquiry was made to ten productive faculty members and nurse researchers from the United States to find out more about the advice and suggestions they would offer faculty about remaining productive in their writing. Seven responded to this query and offered feedback. These scholars had varying backgrounds and research areas and most worked in academic environments. Their feedback was reviewed and organized into themes including concepts related to being: aware, intentional, goal-oriented, pragmatic, and persistent (see Figure 1).

Figure 1. A Model for Writing Productivity

Be Aware

Several scholars suggested to start by being aware of the appropriate journals for your idea and learning more about recent publications on the topic. Therefore, identifying the best journal for your manuscript is a crucial early step in the writing process. While many would see this as obvious advice, it is often a step that is skipped, to an author’s eventual dismay. Some writing guides such as Manuscript Success3 and Writing in the Digital Age4 advise authors to do their due diligence in identifying the most appropriate journal for their work. The manuscript should be matched with the topic, the type of article, and the intended audience. You should ask yourself what new ideas your work presents. Furthermore, you should review your target journal for recent publications on the topic to avoid rejection due to redundancy. On the topic of target journals, one scholar noted, “It does matter where you publish.” The target journal may increase visibility among certain audiences. And, finally, one scholar suggested the idea of being aware of the excitement an author’s writing might bring to the body of literature. She suggested recording a reading of the final product and noted, “If you are not excited when you listen, the reader won’t be excited either.”

Be Intentional

Another identified theme was intention. Several scholars suggested protecting writing time; one even suggested finding strategies to get into “writing mode.” How to do this? One respondent plays the piano; another had a ritual cup of tea and sat in a specific chair. It is important to identify the time when you write best—think of this as your “A” time, the time when you are most productive and have the most energy.5 Although competing demands may conflict with your best writing time, you should make every effort to protect this time without apology.

Another idea within the theme of intention was to develop an outline with realistic due dates prior to starting the writing project. Be intentional and review the author guidelines so they may be followed “exactly” for manuscript preparation. This activity can be used for planning and goal setting. Another scholar stated that she has developed ways, such as highlighting and making comments in the text, to help her re-orient herself to her work. This is helpful if she has had to put a manuscript away for a time to address other work activities. Being able to do this helped her not lose time upon re-starting the writing project.

Be Goal Oriented

A number of strategies were shared related to the idea of goal setting. Some of these ideas varied among scholars who suggested that authors must establish patterns and workflows related to writing that work best for them. For example, some scholars noted that it was important to not procrastinate, so that goals could be met. However, there was some conflicting advice about how many articles a person (or writing team) should have under review. One scholar suggested finishing one manuscript at a time while another suggested preparing multiple manuscripts to create a “pipeline.” With a pipeline, manuscripts might be at different stages of preparation, review, and revision so it is important to have a tracking system and be organized. Having daily or weekly writing goals is important. Some suggested allocating a set number of minutes per day or week to dedicate to writing, while others advised committing to writing a specific number of words during each reserved writing time. Nevertheless, the notion of establishing a goal to accompany scheduled writing time was a constant.

Be Pragmatic

Being practical and pragmatic with scholarship was mentioned by many by respondents. Several suggested that it is important to maximize work efforts. For example, you should commit to converting any presentation, whether podium or poster, into a publication. Another suggestion was to attempt to present and/or publish any project, not just research endeavors. An interesting idea was to flip the process—write the manuscript first, then work to prepare a speech or poster. Additional advice was offered related to expand effort on topics prepared for presentations. One scholar suggested making each presentation unique even when the topic is similar. “Freshening” presentations forces you to stay current on the topic and keep references up-to-date, which is important when writing a manuscript. Last, use social media to promote your publications—there are a lot of articles available, competing for a reader’s attention. You should do whatever you can to make sure that yours is noticed.

Be Persistent

The notion of persistence was noted by several respondents. One suggested, “Write something every day,” while another suggested writing in small increments of time. It is useful to learn how to write in small blocks of time which helps with procrastination. It may be hard to set aside an 8 hour block for writing so the ability to be productive in an hour here and there is important.

The idea of persistence was not exclusively related to habitual writing practice either. Persistence in the form of determination was also mentioned. One respondent advised to resubmit any rejected manuscript after modifying based on the review and new guidelines. Another respondent stated, “Submit in one week after a rejection.” This strategy may also assist in avoiding further delays that may occur when new literature updates are needed if written work becomes dated. Persistence is also key when your writing plans do not always work out the way you expect, but you need to continue to plan.

Team Writing and Group Writing

The topic of team writing and group writing was mentioned by multiple respondents. To clarify, team writing is working with a team to complete a project, whereas group writing may be an activity or a time dedicated to writing, with authors working on various or individual projects. Respondents indicated that teams have the potential to be helpful and assist in accomplishing writing goals. However, with a writing team, having clear communication among the members, determining authorship early on in the project, and having agreed upon deadlines are essential for success.

Writing groups were also mentioned as methods to assist in meeting writing goals. These groups may occur in different places other than the typical work environment, with many being offered as a retreat. Time intervals for meetings and due dates may vary among members of the writing group but the group may help offer accountability to authors. One responded, “Group writing is not for everyone. Some people truly enjoy the solitude of writing…and they are always the most prolific,” again supporting the notion that writers—you—must consider your personal styles and understand the ways in which you work best.

Conclusion

The need to increase writing productivity throughout the nursing discipline remains a challenge. Nurse researchers and scholars are constantly bombarded with competing demands of workload, likely resulting in tension as you balance writing with other expectations. Disciplined writing habits coupled with strategies to support personal needs and obligations may assist you to establish consistent writing patterns, ultimately resulting in a positive impact on your writing productivity.  While the advice and strategies shared differed among colleagues, it was clear that each of them had specific guidelines and “rules” for themselves. Many of their strategies were personal and creative. Their adherence to these personal procedures has likely contributed to their success and offers an example for others.

Acknowledgement

The author would like to acknowledge the following scholars for responding to the query referenced above and for their dedication and commitment to supporting and encouraging nurse authors.

  • Norma Cuellar, PhD, RN, FAAN
  • Gwen Hooper, PhD, RN, FNP, APRN-BC
  • Leslie Nicoll, PhD, RN, MBA, FAAN
  • Marilyn Oermann, PhD, RN, ANEF, FAAN
  • JoAnn Oliver, PhD, RN, ANP-BC, CNE
  • Felecia Wood, PhD, RN, CNL
  • Tami Wyatt, PhD, RN, CNE, CHSE, ANEF, FAAN

References

  1. Oermann MH, Nordstrom CK, Wilmes NA, et al. Dissemination of research in clinical nursing journals. J Clin Nurs. 2008;17(2):149-156. doi:10.1111/j.1365-2702.2007.01975.x
  2. Dhakal K, Tornwall J. The Scholarship Circle: an introduction to writing for publication for nursing faculty. J Med Libr Assoc. 2020;108(1):98-105. doi:10.5195/jmla.2020.685
  3. Nicoll LH. Manuscript Success: A Systematic Approach to Publishing in the Professional Literature. Bristlecone Pine Press; 2012.
  4. Nicoll LH, Chinn PL. Writing in the Digital Age: Savvy Publishing for Healthcare Professionals. Wolters Kluwer Health/Lippincott, Williams & Wilkins; 2015.
  5. Clutter L. Guard your academic writing “A” time. Nurse Author Ed. 2018;28(4):2. Accessed April 6, 2021. https://naepub.com/wp-content/uploads/2018/09/2018-28-4-2-Clutter.pdf

About the Author

Heather Carter-Templeton, PhD, RN-BC, FAAN is Chairperson of the Adult Health Department and an Associate Professor at West Virginia University, School of Nursing in Morgantown, WV. She is also the ANI Connection Editor for CIN: Computers, Informatics, Nursing. Contact Heather by email at heather.cartertempleton@hsc.wvu.edu

2021 31 2 2 Carter-Templeton

Copyright 2021: The Author. May not be reproduced without permission.
Journal Complication Copyright 2021: John Wiley and Son Ltd.

 


Featured: Letters to the Editor: Processes and Pitfalls

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Letters to the Editor: Processes and Pitfalls

Jacqueline K. Owens and Vickie Thaw

Nurse Author & Editor, 2021, 31(2), 3

Letters to the editor (LTE) offer journal readers the opportunity to engage in continued scholarly dialogue in response to a published article. A previous discussion on this topic considered steps to write a letter and tips for success targeted to letter writers.1 In this article, our focus is on letter related tasks for journal editors. We will offer process guidelines for editors to consider for letter submissions and thoughts about several potential pitfalls, such as the effect on journal impact factor; possible conflict of interest or bias; and concerns about factual accuracy.

Considering a Letter for Publication

Letters to the editor should be reserved for comment or critique of a previously published piece in a journal. Some journals might permit LTEs for a short communication written on a topic of interest to the author and within the scope of the target journal, but we suggest that is better covered under an “Editorial” or “Opinion” article type. It is often the responsibility of the Editor/Editor-in-Chief to review letters and determine suitability for publication. Some potential pitfalls can be avoided with intentional consideration about areas of common concern. Table 1 lists basic questions for reflection and possible courses of action for editors to inform preliminary LTE review.

Table 1. General LTE Considerations for Editors

Questions for Reflection Possible Courses of Action
What is the overall value of the letter content to the journal readers? If the original authors decline to respond, determine whether the letter still warrants publication.
Does the LTE contain serious allegations? Consider if the original article needs an erratum or a corrigendum.
Have the LTE authors raised something of importance, but their LTE is not published? If the original article is revised in some manner, but no letter is published, determine how the writer who raised the issue can/should be credited.
Is the tone of the letter constructive and scholarly? If not, suggest revisions.
Is the length of the letter a concern? Consider an exception from published length limit, if warranted.
Is there a limit to the number of LTEs that can be published in response to a given article? Avoid ongoing dialogue. Establish a policy for the number of LTEs. If more than one LTE is permitted, limit letters to one from each responding author(s), with one response from original author(s) to any given letter.
Is the letter content complex enough to require additional peer review? Seek additional expertise from external reviewers and/or other members of the editorial team.
Are there any potential conflicts of interest? If so, are these transparent? Require disclosure of any conflicts of interest. Request that the EIC is copied on any author-to-author communication.

 Developing a Process for Letters to the Editor

Although it is beneficial and desirable to encourage scholarly discourse about published content, difficulties can arise when LTEs create certain types of conversation between the article authors and the letter writers.2 An example of this is when a letter author circumvents the traditionally accepted process to respond to published content in an LTE and makes direct contact with the article author. This can happen if authors perceive a lengthy delay or barrier to moving forward with publication, and is not without at least some support.3 However, the rationale for using the editor as first contact to voice concerns is an assurance of impartiality and adherence to processes considered by many as best practice. Unfortunately, there are often instances where LTEs are confrontational and negative and this suggested process helps to monitor and control such exchanges.

Including information as described in Table 2 in the Author Guidelines for a journal should prevent many concerns. Formal processes about authorship and the publishing cycle are useful to consult before or after letter submission to inform the editorial decision-making process. This process is based on best practices developed over time in the experiences of the authors. Journal editors are welcome to adopt or adapt these guidelines, as deemed appropriate.

Table 2. Examples of Letter to the Editor Process Statements for Author Guidelines

Letter Authors
If you wish to dispute or comment on a published article in the journal, that is done via a Letter to the Editor (LTE).
If your LTE is accepted for publication, the author(s) of the article you are discussing will have an opportunity to review your LTE and respond if desired. These author LTEs are usually accepted for publication. You, as the author of the original LTE, will not be given another opportunity to respond.
Publishing Cycle for LTEs
An LTE may or may not be accepted for publication. They are reviewed prior to acceptance, but not necessarily through full standard peer review. The editor/editor-in-chief might choose to accept or reject the letter, consult with board members, or send the letter for full peer review, at their discretion.
The journal reserves the right to select, edit, and condense LTEs for publication.
Author responses to LTEs that dispute content within the original article are usually accepted for publication. However, these LTE responses also undergo the types of review described above.
The journal editor can decide to hold the disputing letter and the author response letter so that they publish online or in print at the same time. They can then go into the same issue; publish online independently and in separate issues; and be published online only, if the journal is still in print.
Corresponding LTEs can also be linked online, publishing systems permitting, to allow ease of access for readers. As such, the letter is communication between the author and reader of the journal.
An LTE that is accusatory or is based on conjecture are not typically considered for publication.

Developed from Editage Insights,4 ICMJE,2 and Owens1

Potential Pitfalls

Effect on Journal Impact Factor

Editors have voiced concerns about the quantitative effect of LTEs on the Journal Impact Factor (i.e., dilution of the factor with publication of many letters). The standard for LTEs is to omit an abstract and many journals permit five or less references. As such, Clarivate5 will then likely classify the LTE as Editorial Material (in the numerator of the Impact Factor calculation only) versus Articles/Reviews/Proceedings (in the numerator and the denominator) listed as items on their website.

Possible Conflict of Interest or Bias

All published content, including LTEs, is subject to author conflict of interest or bias. The International Committee of Medical Journal Editors2,6 acknowledges this potential pitfall and suggests that an actual conflict or bias or a perception of such are of equal importance. This difference becomes important because an actual relationship or activity may not be unethical or of concern, but even the perception of misconduct can diminish trust in scientific evidence. Thus, authors of both the original article and any letters must disclose potential conflicts. Editors should assure this disclosure within the processes related to LTEs. For example, The New England Journal of Medicine7 offers the following guidelines for authors related to disclosure:

Disclosure of all financial associations or other possible conflicts of interest (to be published with the letter) for each author. For authors of journal articles who are responding to letters, NEJM publishes only new relevant relationships that have developed since publication of the article.

The reviewing editor(s) should also disclose any potential conflicts and withdraw from participating in the publishing process of this content.

The Council on Publication Ethics (COPE)8 describes a conflict of interest as a situation with a potential to impact the motivation of an individual or organization in an unethical way. Examples could be financial or other competing interests such as personal relationships or academic competition. Conflicts of interest are present whether or not there is misconduct. COPE recommends a transparent policy related to disclosure of potential conflicts of interest. Potential conflicts by letter writers should be disclosed with the publication of the letter.

Factual Accuracy

Letters go through rigorous review, but often internally with evaluation by the editor or editorial team. An LTE is typically reviewed for factual accuracy, writing tone, and criticism based on established scientific evidence, such as conflicting findings from other publications. If an LTE does undergo peer review, the process may include fewer reviewers than used for an article.9 However, peer review is always an option; if the editor has concerns about the factual accuracy of a letter under consideration, seeking additional peer review by experts is appropriate. Another course of action is to request citation support from the letter author for the content in question.

Concerns related to LTEs are not uncommon. Resolving or preventing potential pitfalls can be time consuming. Personalities can quickly become a factor. Managing the timeline to address concerns quickly is of benefit. Editors have noted that it can be difficult to resolve complex concerns. Table 3 offers additional considerations and actions for editors to avoid potential pitfalls.

Table 3. Considerations to Avoid Potential Pitfalls

Nature of Concern Considerations Possible Editor Actions
Inappropriate LTE Content Does the letter focus on the article content, as opposed to inflammatory or anecdotal information, or comments about the authors or funders?
  • Seek consultation from the legal department of the publisher.
  • Suggest revisions to the letter to remove content of concern.
  • Reject the letter if concerns are not resolved.
Lack of Supporting Evidence Does the letter offer data to support the critique of the original published article?
  • Inquire of authors about evidence to support their assertions.
  • Require citations if  appropriate/possible.
  • Consider peer review for additional expertise.
Assertion of Fraud or Data Fabrication If this assertion appears valid, when and how is it appropriate to communicate this to relevant persons, such as institutional administrators?
  • If the letter asserts fraud or data fabrication in the original publication, refer to COPE guidelines.
  • Collaborate with publisher and legal team.
Author Disputes Have the author(s) of the letter been in contact with the author(s) of the original publication? Has the contact been collegial in nature? If the parties cannot reach consensus, does the editor or editorial team still feel that publication of the LTE is valuable to readers?
  • If author-to-author contact has not occurred, traditionally the editor serves as a mediator and unbiased reviewer for LTE assertions. As such, the editor usually manages the communication process.
  • If author-to-author contact has occurred, and is collegial, all parties can reach consensus on a potential amendment such as a corrigendum correction or retraction. In this case the LTE is typically not published.
  • If author-to-author contact has occurred and there is no resolution, transparent communication about the procedure for review and potential publication of the LTE and any amendments to the original article is warranted.
  • If author-to-author contact is appropriate, an anticipated timeline for the process can be useful to prevent delays in the process by the original authors.

Conclusion

Intentional inclusion of processes related to publication of LTEs can offer guidance and a helpful framework, especially if multiple editors are responsible for this decision. These processes are journal or publisher specific but should reflect best practices about who can author letters and the LTE publishing process. Editor concerns about potential pitfalls such as bias or content accuracy can also be addressed with careful attention to established guidelines from committees such as ICJME and COPE.

References

  1. Owens JK. Writing a letter to the editor: tips for success. Nurse Author Ed. 2020;30(3):15-17. doi:10.1111/nae2.5
  2. International Committee of Medical Journal Editors. Correspondence. ICJME. Accessed April 7, 2021. http://www.icmje.org/recommendations/browse/publishing-and-editorial-issues/correspondence.html
  3. Mestre LM, Dickinson SL, Golzarri-Arroyo L, Allison DB. Tortuous and torturous: Why publishing a critical letter to the editor is so difficult. Retraction Watch. Published June 22, 2020. Accessed April 7, 2021. https://retractionwatch.com/2020/06/22/tortuous-and-torturous-why-publishing-a-critical-letter-to-the-editor-is-so-difficult/
  4. Editage Insights. How do I write a letter to the editor around a subject? Published January 16, 2020. Accessed April 7, 2021. https://www.editage.com/insights/how-do-i-write-a-letter-to-the-editor-around-a-subject
  5. Clarivate. Journal citation reports: estimated impact factors. Clarivate. Accessed April 7, 2021. https://support.clarivate.com/ScientificandAcademicResearch/s/article/Journal-Citation-Reports-Estimated-Impact-Factors?language=en_US
  6. International Committee of Medical Journal Editors. Disclosure of financial and non-financial relationships and activities, and conflicts of interest. ICMJE. Accessed April 7, 2021. http://www.icmje.org/recommendations/browse/roles-and-responsibilities/author-responsibilities–conflicts-of-interest.html
  7. New England Journal of Medicine. Letters to the editor. New England Journal of Medicine. Accessed April 7, 2021. https://www.nejm.org/author-center/letters-to-the-editor
  8. Committee on Publication Ethics. Handling competing interests. January 2016. Accessed April 7, 2021. https://publicationethics.org/node/34936
  9. Editage Insights. Should letters to the editor be checked for factual accuracy before publication? Published June 15, 2017. Accessed April 7, 2021. https://www.editage.com/insights/should-letters-to-the-editor-be-checked-for-factual-accuracy-before-publication

About the Authors

Jaqueline K. Owens, PhD, RN, CNE is an associate professor of nursing at Ashland University Schar College of Nursing and Health Sciences in Ashland, OH. She is Editor-in-Chief of OJIN: The Online Journal of Issues in Nursing. Prior to this position, she served as Associate Editor from 2007-2011 and became the journal’s first Editorial Assistant in 2003. Jackie has presented many writing workshops for nurses at regional research days throughout Ohio. Particular areas of interest are online scholarly publishing, predatory publishing practices, and novice author publication. She is also a member of the Authors-in-Residence for Nurse Author & Editor.

Vickie Thaw is a publisher at Wiley, Inc. and is the team leader for the company’s nursing journal portfolio. Prior to this position, she has served in various professional health science publishing roles since 1990. Particular areas of interest are the continued growth of digital publishing and how that intersects with journals that are also still in print, and how she can generally support nurses – the largest professional segment in the health sciences.

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Copyright 2021: The Authors. May not be reproduced without permission.
Journal Complication Copyright 2021: John Wiley and Son Ltd.

 

 

 

Featured: Empty Systematic Reviews

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Empty Systematic Reviews: Identifying Gaps in Knowledge or a Waste of Time and Effort?

Richard Gray

Nurse Author & Editor, 2021, 31(2), 4

Rejection is a fairly standard part of academic life, so when I received an email from a well-known nursing journal rejecting a recent submission, my initial reaction was to shrug my shoulders and ponder where to submit next. As a diligent researcher, I thought I would look at the feedback from the reviewers and editors, thinking that I might incorporate relevant points into my revised manuscript. A particular comment from the editor: “the ‘systematic’ review cannot be published because there were no eligible studies identified in the search” gnarled me. Is this editor actually arguing that a review that does not identify any papers is somehow unpublishable? The editor was clearly wrong because we resubmitted the paper—which was focused on nursing skill mix in mental health settings—that was duly published.1 Nevertheless, there are particular issues and challenges with empty reviews that are the focus of this article.

Lang et al.2 were the first to draw attention to empty reviews and define them as reviews “with no eligible studies retrieved or located by the review authors.”2,p. 595 Empty reviews are seemingly quite prevalent, at least in the Cochrane database of systematic review. A study by Yaffe et al.3 estimated that 1 in 10 Cochrane reviews, as of 2010, were empty. However, in nursing, empty reviews are seemingly rare; a review of 293 systematic reviews published in nursing science journals found none that included no studies.4

Authors contend that empty reviews are important because they tell the research community which colleagues are interested in the topic, demonstrate important gaps in knowledge and establish the state of knowledge about a topic at a point in time.3 That said, if a review is too narrowly defined, it might be contended that the value of an empty review is so niched as to make no meaningful contribution.

An illustrative way to consider the issues allied with empty reviews is to review a case example; for convenience, I have picked a second empty review my group have just reported.5 I intend to use this example to reflect on the decisions taken in planning, conducting and reporting, what turned out to be, an empty review. The study aim was to systematically review randomized controlled trials of adherence therapy compared to any comparator intervention in people with type 2 diabetes. We undertook the review as part of a program of work developing novel interventions to improve treatment adherence in people with diabetes.

It could be argued that we should have undertaken a scoping rather than a systematic review. Scoping reviews can be helpful in identifying and mapping available evidence on a given topic.  Munn et al.6 provide helpful guidance about deciding between doing a systematic or scoping review. They contend that if authors are intent on making recommendations to inform clinical practice, then a scoping review may not be appropriate because there is no critical appraisal or synthesis of the evidence.7 As the purpose of our adherence therapy review was to justify a clinical trial, arguably, a scoping review would have enabled us to undertake a reconnaissance of the literature.

Before conducting our review, we quite deliberately did not undertake any preliminary searches. I am aware that many researchers do do this, maintaining that such checks are essential in informing decisions to investing time and resource in undertaking a full systematic review. Whilst I can see the need to undertake some limited searching to make a scientific case for the review and inform the study methodology (particularly the inclusion criteria), detailed preliminary checking of the literature may be more problematic. If researchers decide not to do a review because they already know there are no eligible studies, this introduces a form of reporting bias; potentially informative reviews are not undertaken because the reviewers do not think the review will have an adequate number of papers to get published in a good journal.

Our diabetes review was pre-registered with PROSPERO (registration number: CRD42019115216). By pre-registering, we locked our methodology; this is—in principle—good because it should minimize reporting bias (when the primary outcome listed in the registry is changed or omitted in the paper). By pre-registering our study, reviewers and editors can reconcile the registry entry and paper to confirm no post-hoc amendments to the review methodology. We would hope that reviewers and editors of our manuscript would give us credit for our methodological rigour. We also note that the manipulation of outcomes is prevalent (see, for example, Gray et al.8; Gray, Mackay, Waters and Brown9; Gray, Mackay, Waters, and Brown,10) in nursing science and can and does distort the evidence base.

We searched six databases and used the Covidence review software package to undertake title and abstract and full-text screening (https://www.covidence.org/) in our review example. From an initial list of 4229 papers, we identified no studies that met our inclusion criteria. A fairly substantial amount of time and effort was spent doing this review; what do we report? Do we simply conclude that “no studies were included?” Lang et al.2 observe that authors seemingly struggle to write up empty reviews and highlight examples where authors have made unjustified recommendations for clinical practice. Whilst tempting, conclusions cannot be based on an absence of evidence.11 Yaffe et al.3 note that empty reviews often have papers that make it to full-text screening and, whilst not meeting inclusion criteria, potentially contained valuable and informative information related to the review question. In our review,5 thirteen studies made it to full-text screening, of which four were considered relevant to the review question. We summarised these studies in our manuscript and noted that these studies seemingly provide some useful, albeit limited, evidence supporting the adherence intervention that was the focus of our review.

As the author of several empty reviews, I can confirm that getting them published is a challenge. Feedback from editors and reviewers not dissimilar to the “cannot be published” comment from the beginning of this article is not uncommon. I have no empirical evidence—beyond my anecdotes—but I get a strong sense that journal editors and reviewers do not like empty reviews. Whilst many journal editors assert in their author guidelines that they “publish rigorously conducted research,” I am not entirely convinced this is true. Would a more truthful statement be: “We publish studies with interesting findings, and if they are methodologically rigorous, that is all to the good!” There is seemingly also a difference in editorial practices between open access and subscription journals. From my experience, open access journals have an editorial stance that is more focused on methodological rigor, but I am cognizant that this might simply be my own bias. A scientiometric study testing if there are real differences might be illuminating.

Systematic reviews are a grind. Did our empty review contribute to knowledge? I would argue that it did. At the start of the process, we could not say with certainty if there have been previous trials of adherence therapy in people with type 2 diabetes. We are now confident that there have not. There was also evidence that elements of the adherence interventions seem acceptable in this group of people. We have also informed colleagues of our interest in pursuing research in this area. We are now in the process of completing a feasibility trial of adherence therapy in this population.12

Reflections and Suggestions

I have chalked up three empty reviews and struggled to write each one.1,5,13 That said, my reflection is that empty reviews can help identify gaps in knowledge. I am also mindful of the fact that empty reviews are rare in nursing science, and that is, perhaps, concerning. Likely, researchers are doing reviews, findings no studies and sticking the work in the bottom drawer of the virtual filing cabinet for the work never to see the light of a computer screen again. If true, this is a sort of self-imposed publication bias.

In my view, it would be helpful if nursing journals had an explicit editorial position on empty reviews. For example, I am drafting a statement about empty reviews for inclusion in the author guidelines of the journal I edit. Essentially, as long as the review was pre-registered, does not have an overly niche focus, and has been conducted to a robust methodological standard, we will publish empty reviews.

It might be informative if there were reporting guidelines for empty reviews (perhaps an extension to the new PRISMA guidelines.14 I get a sense that reviewers and editors find it hard to review reviews with no studies and wonder if clear reporting guidelines might not make this job a whole lot easier.

Conclusion

This article aimed to use a real case example to work through the trials and tribulations of reporting an empty systematic review. If I had the chance to do it again, what would I do differently? I am pretty comfortable with the paper we produced. It will be fascinating to see what, if any, feedback we receive about the work.

References

  1. Moyo N, Jones M, Kushemererwa D, et al. The Association between the Mental Health Nurse-to-Registered Nurse Ratio and Patient Outcomes in Psychiatric Inpatient Wards: A Systematic Review. Int J Environ Res Public Health. 2020;17(18). doi:10.3390/ijerph17186890
  2. Lang A, Edwards N, Fleiszer A. Empty systematic reviews: hidden perils and lessons learned. J Clin Epidemiol. 2007;60(6):595-597. doi:10.1016/j.jclinepi.2007.01.005
  3. Yaffe J, Montgomery P, Hopewell S, Shepard LD. Empty reviews: a description and consideration of Cochrane systematic reviews with no included studies. PLoS One. 2012;7(5):e36626. doi:10.1371/journal.pone.0036626
  4. Gray R. Why do all systematic reviews have fifteen studies? Nurse Author Ed. 2020;30(4):1. https://naepub.com/wp-content/uploads/2020/09/2020-30-4-1-Gray.pdf
  5. Alenazi F, Bressington D, Shrestha M, Peddle M, Gray R. Effectiveness of Adherence Therapy in Adults with Type 2 Diabetes: A Systematic Review. Int J Environ Res Public Health. 2021;18(9). doi:10.3390/ijerph18094397
  6. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. doi:10.1186/s12874-018-0611-x
  7. Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. International Journal of Evidence-Based Healthcare. 2015;13(3):141-146. doi:10.1097/xeb.0000000000000050
  8. Gray R, Mackay B, Waters A, Brown E. The influence of physical activity in water on sleep quality in pregnant women: A case study in salami slicing? Women Birth. 2021;34(3):e330-e331. doi:10.1016/j.wombi.2020.12.010
  9. Gray R, Mackay B, Waters A, Brown E. Effectiveness of auriculotherapy on anxiety during labor: did the authors switch outcomes or salami slice their trial? Rev Lat Am Enfermagem. 2020;28:e3381. doi:10.1590/1518-8345.4697.3381
  10. Gray R, Mackay B, Waters A, Brown E. Effect of interactive cognitive-motor training in older adults: did the authors selectively report outcomes? Comment on Kao et al (2018). Int J Nurs Stud. 2020;111:103775. doi:10.1016/j.ijnurstu.2020.103775
  11. Slyer JT. Unanswered questions: implications of an empty review. JBI Database System Rev Implement Rep. 2016;14(6):1-2. doi:10.11124/JBISRIR-2016-002934
  12. Alenazi F, Peddle M, Bressington D, Mahzari M, Gray R. A study protocol for a feasibility trial of telephone-delivered Adherence Therapy for adults with type 2 diabetes. Nurs Open. Published online January 20, 2021. doi:10.1002/nop2.735
  13. Hardy S, White J, Deane K, Gray R. Educating healthcare professionals to act on the physical health needs of people with serious mental illness: a systematic search for evidence. J Psychiatr Ment Health Nurs. 2011;18(8):721-727. doi:10.1111/j.1365-2850.2011.01722.x
  14. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71

ABOUT THE AUTHOR

Richard Gray, RN, PhD is Professor of Clinical Nursing Practice, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia. He is also an Author-in-Residence for Nurse Author & Editor. You can contact him via email at: r.gray@latrobe.edu.au.

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Copyright 2021: The Author. May not be reproduced without permission.
Journal Complication Copyright 2021: John Wiley and Son Ltd.

 

 

 





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