ANATOMY OF RESEARCH ARTICLE
APA FORMAT
The following items delineate the sections of the Project Paper:
a Title page, telling others the title of the project, your name and the director’s name of project.
Abbreviations used.
Table of contents.
List of figures.
List of tables.
Abstract: Should not exceed 300 words (one page summary of your project) and should convey the main point of the project work, outline the results and conclusions and explain the significance of the results.
Introduction to the Problem: that should include clear statements about the problem that you are trying to solve, the characteristics that you are trying to discover or the proofs that you are trying to establish. This section broadly introduces the topic while laying the foundation for the development of the problem statement. The literature is used to support the identification of this issue as a problem. It may include a brief overview of relevant statistics and other data. Information may be presented from a global to a regional or local perspective. At the end of the section, clearly describe the problem that the project addresses.
Statement of Purpose: A purpose statement indicates the intent or aim of the project. It gives the reader a beginning idea of what the project will accomplish. Further, relevance of the project to the problem is addressed.
Theoretical Framework/Model: This section discusses the organizing framework or theory selected to support the project. Exploration and discussion of the framework as well as a clear delineation of how the theory applies to the project is addressed.
Literature review refers to any collection of materials on a topic, to summarize and synthesize the arguments and ideas of others. The literature review should be organized to include an introductory paragraph that discusses information to be presented in the section. Appropriate heading and subheadings should be used to guide the reader. Extensiveness of the review will be determined by the project, and the amount of information available related to the topic. The literature review must focus on current research related to the project. A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information.
Methodology section includes an introductory paragraph that discusses information to be presented in this section.
Design of the Project: Re-state the purpose. What are you proposing to do? How are you proposing to develop the project?
Project Participants: Who is the target audience? Where and when will you access them?
Implementation: How and when are you planning to implement your project?
Evaluation: What is the plan for evaluation?
Results: What are the results of your implementation?
The methodology section describes the “who”, “what”, “when”, and “where” of the project. Description of expert panel consultation and small pilot studies are included in this section. Scope of implementation of the project will be determined by the committee. The methodology section describes implementation efforts as well as formative and summative evaluation. It may also include any pertinent information regarding meetings, memos, minutes of meetings, educational materials, or any other informatioecessary for understanding the process undertaken to accomplish the project. The use of appendices is recommended for the ordering of this additional information.
Results Discussion Section includes an introductory paragraph that discusses information to be presented in this section. Discuss the findings or results of your project, show illustrative examples of the main results of the work with verification of most significant results. Be specific. Utilize the literature review to address your findings or results.
Conclusion and Recommendations section, list the main findings of your study, and the plan of intervention you think should be done to solve the problem. Be ready to defend your points.
Conclusion: Discuss the conclusions that may be drawn from the implementation & evaluation of the project.
Implications: Discuss the implications of this project for nursing practice.
Recommendations: State your recommendations for future nursing project implementation and/or future nursing research.
Appendices and Reference List: Follow the current APA guidelines for formatting. Make sure that all references cited in the body of the paper are included on the reference list. Similarly, be sure that all items on the reference list are actually cited in the paper.
A research article is usually arranged into 6 sections with the following headers:
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1. |
Abstract |
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2. |
Introduction |
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3. |
Methods |
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4. |
Results |
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5. |
Discussion |
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6. |
References |
Sometimes, the header for one or some of these sections is slightly different. For example, ‘methods’ might be called ‘material and methods’ or ‘methodology;’ or ‘results’ might be called ‘findings.’ When present, these alternate names are usually close enough to the above names that the reader will not be confused.
Purpose of Each Section
1. Abstract: The main purpose of the abstract is to summarize the entire research article. The value of the abstract is that when you are doing a literature search and trying to find all articles dealing with a particular topic, reading the abstract can help you decide if that particular article will be useful to you. In other words, the abstract can potentially save you from reading the entire paper only to find out that the article does not address the topic you are investigating.
2. Introduction: The introduction is just that; it introduces you to the topic of the research study of the article. Often the introduction lays out the history of the research studies done in the past for this particular topic, stating what was found in them. It then continues to explain why this particular study is valuable or needed. It will usually also state what the specific objective of this research study is.
3. Methods: the methods section explains the nuts and bolts of how the research study was conducted. It states how many participants were in the various groups, how they were chosen, what the exact procedure was for the treatment group and the control group, etc. One can look at the methods section as being like a recipe that was followed.
4. Results: As the name implies, the results section states the results of the study. This section refrains from drawing any subjective conclusions as to the meaning of the results; it merely objectively states what the findings were.
5. Discussion: The discussion section now discusses the results that were stated in the results section. This is where the meaning of the results is interpreted and conclusions are drawn. This section will hopefully also state whatever limitations the study was found to have. It will usually also state what the implications of the findings of the research study are; i.e. what the implications might be for the massage therapist practicing massage (if the research study involved massage), as well as what the implications are for future research studies involving this topic.
6. References: This section is valuable for two reasons. It tells the reader how thorough and current the people conducting the research project were in reading the literature before choosing to conduct their study. The references section also gives the reader a list of other articles that cover the same topic; for anyone doing a literature search, this is extremely valuable because it points to other research articles that may be of value.
Some Key Terms Defined
There are certain terms that are often used in a research article. Following are the meanings of some of the more common terms that you are likely to encounter:
1. Hypothesis: A hypothesis is the premise/idea that the research study is attempting to prove or disprove. In effect, it is the theme or purpose of the study. An example of a hypothesis might be: ‘massage therapy decreases the pain level in people with low back pain.’ The study would then be designed to try to find the answer that either proves this to be true or proves this to be not true.
2. Population: The term population is used to describe the population of people that can participate in the study. For example, the population for a particular study might be adults between the ages of 25 and 60 who have low back pain. (Note: The population is defined by inclusion and exclusion criteria; see below.)
3. Inclusion criteria (singular, criterion): The inclusion criteria are the criteria or parameters that a participant must have to be included within the study. For example, following the example above, a criterion is that the participant must have low back pain; another criterion is that the person must be between the ages of 25 and 60.
4. Exclusion criteria: The exclusion criteria are the criteria or parameters that a participant is not allowed to have to participate in the study. Continuing with our example, an exclusion criterion is that the person cannot be younger than 25 or older than 60. Exclusion criteria often become much more specific: another exclusion criterion might be that the participant cannot have a herniated lumbar disc.
5. Random sample: It is not feasible for a research study to be done on the entire population because it is usually too large. In our example, there might be tens of millions of people between the ages of 25 and 60 who have low back pain; it is simply too difficult and expensive to do a study on that many people. Therefore, to do this study it is necessary to take a ‘sample’ of those people. Hence, a sample is a smaller subgroup of the entire population being studied. The term ‘random’ refers to the sample of people from the population being chosen at random. In other words, no bias was used in choosing the participants who will be in the study; this means that everyone within the population that you want to study has an equal chance of being a participant in the study. Having a random sample increases the likelihood that the sample group is representative of the larger population and is therefore valid. This means that whatever results are obtained for the sample group will also be true for the entire population.
6. Criterion/parameter: A criterion or parameter is one aspect, characteristic, or standard of something. For example, a participant’s height, weight, age, or whether s/he has a certain medical condition, or whether or not s/he receives treatment are all examples of criteria/parameters. It is usually desirable to have all parameters of the treatment and control groups identical except for one. This way, any difference in results found between these groups can be confidently attributed to the one parameter that was different. This one different parameter is usually the treatment being studied, in our example, low back massage.
7. Treatment Group and Control Group: The random sample of people (of the population) that is involved in the study is divided into two groups of participants: the treatment group and the control group. The treatment group is the group of participants who receive the treatment; in our example, they receive massage therapy to the low back. The control group is the group of participants who do not receive the treatment; i.e. they do not receive massage therapy to the low back. The idea is that there should be only one parameter that is different between the treatment and control groups; that parameter is the treatment (low back massage therapy) of which the research study is trying to determine efficacy/value. Note: Just as the sample group is supposed to be chosen at random from the population, the treatment and control groups should essentially be chosen at random from the sample group.
8. Placebo: The term placebo refers to a ‘sham’ treatment that has no effect that is of interest upon the outcome of the study. The placebo treatment is given to the participants in the control group; its purpose is to keep the participants in the control group from knowing that they are not in the treatment group. For example, when a research study is done to test the efficacy of a drug, the placebo given to the control group is usually a sugar pill that looks identical to the real drug. Placebo sham treatments keep the participants ‘blind’ to which group they are in.
9. Double blind: The term ‘double blind’ refers to both the participants and the examiners (i.e. the people conducting the study) not knowing which group, treatment or control, the participants are in. In effect, both participants and examiners are ‘blind’ to this knowledge. Having a double blind study is considered to be the ‘gold standard’ in research. A problem for the massage world is that it is virtually impossible to have a double blind study with massage therapy because it is difficult to have a placebo sham treatment. The participants in the treatment and control groups pretty much know whether or not they received massage.
A Few Statistics Terms:
10. Standard deviation: A standard deviation measures how similar the results are relative to the average result. In other words, if the average participant in the treatment group reported a decrease in low back pain from a level of 7 (on a scale of 0-10) to a level of 3, then the average pain decrease was measured as 7-3 = 4 degrees of improvement. One standard deviation in each direction would be the amount of pain decrease that captures 68% of all the participants in the treatment group. In example #1, one standard deviation might be 1 degree of improvement in each direction; this would include all participants who reported a pain level between 2 and 4 (remember, the average was 3). This shows that 68% of the participants improved to between 2 and 4. In this case, having a small standard deviation of one in each direction shows that the improvement of the group is very consistent (i.e. the results are very similar to the average). In example #2, the standard deviation in each direction might be 3; this would include all participants who reported a pain level between 0 and 6 (again, the average was 3). In this case, 68% of the participants improved to between 0 and 6, which is a larger and more diverse span. In this case, having a larger standard deviation shows that the improvement of the group is much less consistent (i.e. the results are not very similar to the average). (Note: 1 standard deviation in each direction is defined as comprising 68% of the group; 2 standard deviations in each direction is defined as comprising 95% of the group; and 3 standard deviations in each direction is defined as comprising 99.7% of the group.)
11. Mean: The term ‘mean’ is synonymous with the term ‘average.’
12. Median: The term ‘median’ is not the same as mean/average. The median of a group of numbers is the middle score. Let’s look at example #1 with the following group of 5 numbers: 2, 4, 6, 8, and 10. These numbers add up to 30. The mean of this group is computed as 30 divided by 5 = 6; and the median is the middle of the five numbers, which is also 6. In this example, the mean and the median happen to be the same. Now let’s look at example #2, also with 5 numbers that add up to 30: 1, 1, 1, 12, and 15. Now, the mean is still computed as 30 divided by 5 = 6. However, the mediaumber is now 1, which is quite different than the meaumber of 6. When interpreting results, usually either the mean or the median is used to describe the results. When the scores are very similar (i.e. homogeneous), the mean is usually used because it well represents the results of the group. When the scores are quite dissimilar (i.e. heterogeneous), the median is usually used because it better represents the results of the group.
SOURCES
APA format for your project report see http://webster.commnet.edu/apa/ for the proper formatting of your paper.
Introduction
Writing is a skill born from practice. The first step to becoming a good writer is becoming an avid and careful reader. A researcher’s early experiments in writing should include multiple rewrites, with constructive criticism from a mentor. Imitating a writing style that feels comfortable and reaches your intended audience may be a good way to begin.
Publishing a paper is the logical result of any research project. After all the effort required for design, implementation, data collection, and data analysis, publication is the crucial end point. Publishing serves to share important information with the scientific community and results in personal satisfaction and professional advancement. An author who routinely submits only abstracts without follow-up publication is revealing either a lack of commitment or lack of confidence in study design or results.
An important part of the publication process is scrutiny of the design, methods, data collection, and statistical analysis used in the study. Careful review of the study leads the investigator to discover flaws in the process and clarify the original thought process. It is better to identify shortcomings yourself than to have them pointed out for you by a peer-reviewer pre-publication or in a letter to the editor post-publication.
The mechanics of writing a paper are typically spelled out by each individual journal. RESPIRATORY CARE offers an author’s guide online.
In addition to helping authors meet the journal’s formatting requirements, the author’s guide also serves as a rough outline for the paper. Using an outline to write a paper may seem like an undergraduate exercise, but the outline is an important tool for organizing your thoughts.
This article describes the anatomy of a research paper, discusses common mistakes, reviews some science-writing rules, and provides some science-writing tips.
The Title Page
The Title
A good title is important for several reasons. The title alerts the reader to the topic of your paper. A well written or phrased title creates curiosity and draws readers to investigate the substance of your paper. However, the main function of the title is to describe your research. Titles should describe the research succinctly; long titles provide no advantage. The title should avoid overstating what resides within and of course should avoid marketing themes.
As with any part of the research paper, research and read other titles on a similar topic. Make note of the wording, length, and syntax. Be specific! The title should let the reader know if your paper is a human, animal, or bench study. As an example, if your title is “Moisture Output of 2 Humidification Systems,” it is incomplete. Give more information; for example, “Moisture Output of 2 Humidification Systems for Use With Mechanically Ventilated Patients,” or “Comparison of the Moisture Output of 2 Humidification Systems With a Lung Model.” The title tells the reader what to expect in the paper and thus whether the paper really pertains to his literature-search. If you are looking for data on humidification studies with mechanically ventilated patients, the first title is more germane to your topic. Respect the reader: briefly, but clearly, explain the paper’s content in the title.
Authors
It may seem self-evident who the authors of a paper are, but authorship has become an issue of concern in recent years. 2–10 Part of the issue is the complexity of medicine and technology; completing a research project often requires experts from several fields. Research across disciplines has become a funding priority and also leads to one paper having numerous authors. Unfortunately, politics also appears to play a major role.
In 1997 the International Committee of Medical Editors published guidelines for authorship, which were recently extensively revised:
Authorship credit should be based on 1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data;
2) drafting the article or revising it critically for important intellectual content; and
3) final approval of the version to be published. Authors should meet conditions 1, 2, and 3.
Interestingly, Durack found that 98% of papers published in the Boston Medical and Surgical Journal (predecessor of The New England Journal of Medicine) had only one author. This contrasts sharply with today’s statistics, wherein only 5% of papers have only one author.
The original articles section of The New England Journal of Medicine averages 6 authors per article.
Huth provided authorship guidelines that are based on the contribution of the individual investigators. In that system individuals responsible for data collection are not justifiable authors. Many respiratory therapists begin their forays into research as data collectors, and this can be the start of a publishing career. Individuals who collect data can earn authorship by participating in one of the other 4 activities in the aforementioned guidelines. Table 1 describes the principles and rationale for authorship.
From a practical standpoint, most papers are written by 1 or 2 primary authors. The remaining authors have reviewed the work and/or aided in study design or data analysis. Frequently, other members of a research group are included as authors because of their positions and the pressure to publish in pursuit of promotion and tenure. It is a good habit to agree to authorship only if you have met the principles in Table 1. It is also a good habit to ask only co-authors who have met those standards.
Determining the order in which to list the authors may be simple or complex. Generally speaking, the individual responsible for the majority of the work is the first author.
Authors are then listed in order of contribution. The exception to that rule is the last author listed; in many instances the senior author is listed last. The senior author is often the most experienced member of the group, the administrative leader, and/or the person who directs or is responsible for funding at the facility where the research was done.
Key Words
The key words cannot be picked simply at the author’s discretion; instead, they must be terms that appear in the National Library of Medicine’s list of Medical Subject Headings (at http://www.nlm.nih.gov/mesh/MBrowser.html). However, in the near future it is likely that few journals will list key words, because when conducting a MEDLINE literature search, it is necessary to search all fields (ie, the titles, abstracts, journal names, journal volumes/numbers/ page numbers) in order not to miss documents of interest, and since (1) all the key words appear in the title and abstract and (2) the Medical Subject Headings list is very incomplete, the key words are superfluous.
Corresponding Author
The title page should give the full name and affiliation of each author and specify which is the corresponding author; the corresponding author is the primary contact for the journal’s editorial office and the contact person for individuals who have questions about the research. If the corresponding author is at a hospital or an academic institution, list his or her full name (including middle initial), professional or postgraduate degree (eg, “MD”), title, department, hospital, university (if applicable), mailing address, telephone number, assistant’s name and telephone number, facsimile number, pager number, and e-mail address. If the corresponding author is at a company, list his or her full name (including middle initial), professional or postgraduate degree (eg, “MD”), title, department (if applicable), company name, mailing address, telephone number, assistant’s name and telephone number, facsimile number, pager number, and e-mail address.
Financial and Equipment Support
The title page should also list specific information about organizations, agencies, or companies that supported the research, either financially or by providing equipment, services, or personnel. If the research was supported by a grant, give the grant number.
Conflicts of Interest
The title page should also list and explain conflicts of interest. The most common conflict of interest is that one of the authors has a financial affiliation with a company that produces one of the products tested or discussed in the research. Explicitly state any affiliations or interests that could be perceived as creating a conflict of interest. However, if there are no such affiliations or interests, there is no need to include a general statement of “innocence” such as, “The authors have no financial affiliation with any of the organizations or products mentioned in this report.”
The Abstract
Nearly all journals require that research papers include abstracts. The abstract appears following the title page. Recently, the structured abstract (ie, an abstract that has 5 sections: introduction, objective, methods, results, and conclusions) has become the standard for most research articles (whereas reviews, case reports, and certain other types of special articles have nonstructured abstracts). The abstract must accurately reflect the content of the paper; nothing can be included in the abstract that does not appear in the body of the paper. Therefore, it is best to write the abstract after you have written and carefully edited your paper. The abstract is a synopsis of the paper, and many readers will never read any more than the abstract, so it is very important that the abstract be absolutely accurate and concisely convey the paper’s most important data and conclusions. If the journal that publishes your paper is indexed by Index Medicus(MEDLINE), the paper will be locatable via the National Library of Medicine’s PubMed search engine (at http://www.pubmed.gov) and the abstract will be viewable at that Web site. MEDLINE’s size limit for abstracts is 4,096 characters (approximately 600 words), but most journals prefer their abstracts to be 300 words.
The structured abstract demands the author be concise. Do not include background information, do not use abbreviations or acronyms (unless the acronym will appear 4 times in the abstract), and delete any word that is not necessary to convey information. Don’t go too far, however, and eliminate the essential structure and elements that make a complete sentence. Also, don’t use phrases such as “Results will be provided,” when you could write a phrase that describes a key finding, such as “The treatment group had significantly lower mortality.” Don’t speculate or include opinion in the abstract. The abstract is a “just the facts” presentation of your research.
The abstract’s major emphasis should be the methods and the main results. The introduction or purpose can often be stated in a single sentence. The objective should be stated in one imperative-style sentence; for example: “Objective: Compare the moisture output of 2 humidification systems, using a lung model.”For the abstract that is plenty.
Describe the methods and the main results in 3–4 sentences each. Carefully select the most important data and statistics to show and/or describe in the results section. Just state the main results. The conclusion, like the introduction can typically be handled in 1 or 2 sentences. Try summing up the findings in the first sentence and then make a conclusion in the second. For our example, “Moisture output from these 2 humidification systems was not statistically different. Both systems meet the standards for humidifiers used during mechanical ventilation.” In that example, the objective and conclusions are stated in only 35 words. That leaves well over 200 words to describe your methods and results.
The Introduction Section
The introduction section (in some journals this section is called “background”) lays the foundation for the paper. Some authors write long, heavily referenced introductions, but most authors save the heavy detail and description of previous related research for the discussion section. The classic introduction is 2 or 3 paragraphs. The first paragraph provides the background information, with a few seminal references. It’s not necessary to introduce every paper on the topic in the introduction. Mention the most important references and state the research problem. The second paragraph can elaborate on the importance of the problem and list unresolved issues. The final paragraph describes the rationale for the current study and should contain the research question and the hypothesis. A common error of novice authors is to forget to include the hypothesis.
Of course, you should have a hypothesis prior to starting a study. Keep the hypothesis in mind as you write the paper. Those who review the paper will ask, “Will the chosen methods adequately answer the research question?
Do the results definitively refute or support the hypothesis? Is the conclusion (based on the hypothesis) supported by the results?”
In the introduction you can include more background information if you think it is imperative to educate the reader, but remember, the reader is busy too, and a long introduction may turn readers away. As a rule, keep the introduction to 3 paragraphs, with the following information:
1. What is the problem or issue? Mention 3–5 of the most important references.
2. What is the importance of the problem or issue? You can include a few recent references here to demonstrate that research is active on the subject.
3. State your research question and hypothesis.
The Methods Section
The methods section should describe in detail how the study was performed. Ideally, after reading your methods section another researcher could duplicate your study. Remember when writing the methods section, it should be clear how your methods will answer the research question and refute or support your hypothesis.
Structured methods sections (ie, with subheadings such as “subjects,” “treatment protocol,” and “statistical methods”) are popular, and some prestigious journals, which have limited print space, provide an expanded, online methods section. The number of subheadings in the methods section depends on the type of paper. A study that involves human subjects should include the subheading/section “subjects.” An equipment evaluation should include a subheading/section entitled “equipment.” The most common methods subheadings are discussed below.
Subjects
Describe the study subjects (ie, normal volunteers, patients, or animals). If you have a control group, describe those subjects as well. Describe how the subjects were recruited and selected. Describe the inclusion and exclusion criteria. In a small study it may be helpful to include a table that lists the relevant characteristics (eg, age, sex, treatment group, diagnosis) of each patient. In larger trials, the paper should include a table that summarizes the demographic data of the study groups.
If your study involved human subjects, you must include a statement that you obtained approval from your institutional review board, and you should describe, in a general way, how you obtained informed consent from the study subjects. Indicate who signed the consent form: the subjects or their legal representatives (which is common in critical care). As an example, “The protocol was approved by the
Institutional review board approval is absolutely required to conduct studies with human subjects, so if your research did not have approval, your paper will be returned without review.
Equipment
Describe the equipment used in the study. Be sure to describe how the equipment was calibrated and, if necessary, validated. Validation is different than calibration. As an example, you may calibrate a flow-measurement device using the manufacturer’s suggested technique (eg, using a super syringe). You can then validate the flow-measurement device by comparing it to measurements from the type of device that is used to obtain the accepted standard measurement (eg, rotameter). If your study is an equipment evaluation, give detailed descriptions of the devices.
Equipment evaluations should also include data related to costs.
Some journals require a “product sources” page (at the end of the paper) that lists (in alphabetical order), for each device or supply used in the study, the name/model, manufacturer, and city and state of the manufacturer. Conversely, some journals state that information parenthetically at first mention of each device or supply. For example, “We used the same type of ventilator (Veolar, Hamilton Medical,
Interventions or Study Procedures
This section describes what clinical procedures or interventions were done and what data were collected. Depending on the type of study, this section may include a description of the experimental protocol and a timeline for procedures and measurements. It is important to provide thorough details. A diagram of the study protocol along a timeline, showing the timing of interventions and the time of measurements, can be particularly instructive. Use of high-quality figures can reduce the length of the methods section and make your methods easier to understand.
Data Analysis
Data analysis is another part of research where novice authors often stumble. First, be clear that even some of the most prolific authors are “statistically challenged.” Get help from a mentor regarding statistics before you finish the protocol and meet with them regarding data collection.
Consulting a statistician early is well worth the time and expense. The data analysis section should describe how data were handled, what statistical tests were done, and what p value was deemed to indicate a statistically significant difference. If necessary, explain why the statistical tests you selected were appropriate. Citing a reference for the appropriate statistical test is a good idea, if one is available, as it helps limit questions from the reviewers.
The Results Section
Though it may seem self-explanatory that the results section should include only the results, many authors place opinion and discussion in the results. The results section should simply state the findings, without bias or interpretation. If the methods section has listed experiments in order, the results section should follow the same sequence. At the very least the results should be provided in a logical sequence, often along the time line of the study. For instance, the results of the baseline measurement period should be presented prior to the results obtained after the intervention.
The results section lends itself to any number of potential constructs. Use tables or graphs to represent large volumes of data. If you use a table or graph, don’t repeat the information in the paragraph. Paragraphs that include large volumes of data read like the Book of Numbers. After the fourth generation, the reader can’t remember which result matches which experiment, and loses interest. A table can be as onerous as the paragraph form if the table is allowed to “grow unchecked.”
Try to keep tables to a single page. If that is not possible, consider dividing up the data among multiple tables (split along the experimental time line) or using graphs.
The results section should be written in the past tense. For example, “Moisture output was greater with system A than with system B.” This may seem confusing to novice authors and readers, but the rationale is sound. If you were to write, “Moisture output is greater,” it would imply a generalizability to situations outside of the experiment. In your experiment the moisture was greater with system A under the conditions studied, but that does not imply that the moisture would be greater with system A under all other conditions in which the devices might be used. This is a subtle but important point; use the past tense form in the results section.
Chatburn made the important observation that the results of a study do not prove anything. Research results can only confirm or reject a hypothesis. Each individual study adds to the collective understanding of the problem and adds evidence to support or refute a given interpretation.
Major faux pas in the results section include: failure to provide the data that is critical to answering the research question; adding interpretation to the findings; and failure to address the statistics. If in the methods section you listed the statistical tests and the p value that was deemed to indicate a statistically significant difference, don’t forget to address those in the results section.
The Discussion Section
When starting the discussion consider the research question first. You posed the research question, explained your methods for answering it, and provided the results; now answer the question. The discussion is the place for interpreting the results. Use the statistical results to make conclusions regarding the research question. In other words, if the hypothesis is statistically confirmed by the results, what does that mean?
The discussion is usually the easiest section to write, and there is no “magic formula.” From my standpoint, if you are having trouble with the discussion, you can use the simple construct in Table 2. The most common mistake in the discussion section is overstating the findings. For instance, if you found that high-frequency ventilation improved oxygenation, you cannot infer that other outcomes (eg, mortality) are also improved. If a new bronchodilator reduces airway resistance faster than the old one, you cannot infer that patients will come off the ventilator faster.
That type of unjustified inference appears to indicate that the authors knew what they wanted the results to be prior to the study and that they set out to prove that the new treatment is better, not to find out whether the new treatment is better. Such bias is apparent in phrases such as “We have demonstrated that…. ”
The reader should easily follow the research question through the methods, results, discussion, and to the conclusion. As a good test, read your hypothesis and conclusion out loud. If you do not see an obvious logical connection between the two, there is a problem.
The preponderance of references should be cited in the discussion section. A few historical references may be helpful for perspective. Most of the references should be recent and aid in the interpretation of your results. If a report you cited disagrees with your findings, clearly explain why.
The discussion section is your chance to review the current knowledge and explain how your study’s findings add to the body of knowledge. You can provide opinion as long as you identify it as such.
The Conclusions Section
Many journals require a conclusions section. State your conclusions in clear, simple language. Do not reiterate the data or the discussion. Then you can state your hunches and inferences, making very clear that they are speculation only (eg, “Though the difference between the treatment groups was statistically significant, we suspect that the difference will not influence hospital mortality.”). Finally, in the conclusions section you should indicate what research questions should be answered next (eg, “We are currently designing a study to determine whether the statistically significant difference identified in the present study significantly affects hospital mortality.”).
Acknowledgements
The acknowledgements sectioames people who contributed to the work but did not contribute sufficiently to earn authorship. Such individuals may include an in-house reviewer, data-collection personnel, statistical consultant, or typist.
You must have permission from any individuals mentioned in the acknowledgements section. Do not make long dedications; keep acknowledgements short and to the point (eg, “Thanks to Jane Smith PhD, of the Respiratory Care Department,
Summary
Writing a research paper requires patience and practice. There are some simple rules that can assist the novice author in constructing a paper, and there are common pitfalls to be avoided. I would caution that the proper planning of a study is the best way to avoid problems at the writing stage. No amount of clever writing can cover for poor study design or execution.
Summing It Up to Critical Thinking
Here are some questions to ask to help you think critically about the research you are reviewing and how to check that the evidence is credible and represented accurately:
X Are the research goals properly explained? Is the literature review relevant and up-to-date?
X Is the methodology clearly described and implemented? Is there information on sample size and quality (i.e., how the sample was selected)? Is there information on how the data was checked for accuracy?
X Is there a rationale given for the data gathering methods, analysis methods and statistical tests chosen?
X Does the evidence justify the conclusions and interpretations?
While you may not have the expertise to determine the credibility of the study, these are just some key questions you may want to consider or discuss with proficient colleagues.
Research in Context
What is the role of research in family support or social care? Research can help you understand:
X The social world in which service users (e.g., families) live and why positive and negative events occur in the lives of some families and not others.
X The relative success of interventions and their impact on participants and the society at large.
Yet, it is very important to understand that research is only one source of knowledge and, in terms of the policies and practices of organizations and governments which intervene in the lives of vulnerable people, not necessarily the most influential. That’s because research has to compete with other sources of varying reliability including personal experience, the influence of colleagues, the media, organizational and government norms, policies, procedures, and priorities. In the relationship between research, policy, and practice, it is important to keep in mind too that research is often retrospective (i.e., examining an event that has already occurred). When research is prospective, the questions with which it is concerned may seem distant from practice realities. Moreover, it is important to realize the inherent challenge that lies in evidence-based practice. That is, the concept of evidence-based practice is rooted in a scientific world-view that depends on elements of practice being measurable, quantifiable, and controllable. However, the reality is that practice is often complex and untidy. Therefore, any unbiased research or evaluatioeeds to confront scientific rationality in understanding social problems and their solutions.
Anatomy (Critique) of a Research Paper
Before you start
7. What is the title of the article?
8. What is the journal?
9. Who are the authors?
10. Describe author’s expertise in this specific topic.
11. Are any conflicts of interest disclosed? If not, explain if there are any potential conflicts of interest OR why none are suspected.
12. What information do you need to know before you can understand the article?
Introduction
13. What is this article about; what research question is asked?
14. Is evidence provided to establish initial support for the hypothesis? How strong is this evidence? Is it logical or is it simplistic?
Methods
15. What kind of study design was used?
16. Is it appropriate for the research question being asked?
17. What types of subjects were used?
18. Would this allow the findings to be applied to a more general population?
19. Was the number of subjects adequate for the design? Did the authors do a power analysis?
20. Were the groups randomly assigned to treatments?
21. Were the groups similar in clinical characteristics? Was there a control group?
22. What kind of data was collected? Is it appropriate? Is it sufficient to answer the research question(s) posed?
23. What statistical methods were described? Were they appropriate for the data collected and can they answer the research question?
24. Was there Human Subjects approval?
Results
What were the results of the study; what data was presented?
25. Were the data presented clearly or were they confusing?
26. Were specific comparisons made or were the authors on a fishing expedition and all possible comparisons made? Were the comparisons appropriate? Do they make sense in terms of the hypothesis or research question?
27. Were results presented separately from the discussion?
Discussion
28. Were all of the results discussed, or just those in support of the research question(s)?
29. Were the results discussed in relation to the existing literature? What did the comparisons to the literature show?
30. Was the discussion adequate or were observations left unexplained?
31. Did the authors distinguish between statistical significance and clinical significance?
32. Did the authors consider any alternate explanations for the data, or did they provide just one vision? Did the authors recognize any existing limitations to their research?
33. Were the conclusions supported by the data presented? Were the conclusions appropriate for the level of differences and/or support for the data?
After you choose a structure for your article, you are ready to begin writing. This chapter concentrates on the elements of good writing. Good writing is a basic skill you use in practice and to communicate with patients and those external to the nursing profession. Consider this: The modern pioneers of nursing believed so strongly in communication that patient education remains central in the science and art of healing.
Take a look at some basic tools related to language skills that will help you write more effectively. These include voice, bias-free language, technical language, acronyms and abbreviations, parts of speech, and transitions.
Voice can refer to a grammatical construction with verbs in the active or passive voice, or the author’s personality. Voice can also refer to how sentences are constructed and deliberately presented to craft your message.
Verbs have ail active or passive voice. Active voice occurs when the subject drives the action with a verb; conversely, passive voice occurs when the subject receives the action through the verb. Sportswriters plunge readers into highly descriptive texts to recapture the physicality of a game; their active voices reach beyond the nature of scientific explanations. Passive voice is appropriate for clear definitions and emphasis on a subject instead of an object. The best voice for the verb depends on its purpose in a sentence. The examples below show how you can easily change passive voice into active voice.
• Passive: The vital signs were monitored.
• Active: The nurse monitored the vital signs.
• Passive: The unique function of the nurse is to assist the individual, sick or well.
• Active: The nurse assists the individual, sick or well.
Use active voice when possible because it is more direct. You see active voice in general nursing publications, Web sites, and educational tools. Scholarly or research articles that de- scribe results tend to use more passive voice
Authors express personality through their choice of words. Nurses may write in a variety of voices, including empathy, strength, or support. An essay on health policy might be dispassionate; or, it might be political, cutting, and caustic. Nursing articles in lay publications might contain overtly expressive and colloquial phrases that in a scientific journal would be considered subjective. Even the most scientific articles bear traces of personality, if only— and importantly—the author’s values. Match your voice to the tone of the publication or Web site.
Bias-Free Language
Researchers have long agreed that public discourse can marginalize a person or group in society through the use of stereotypes or stigmas (Allport, 1954; Biernat & Dovidio, 2000; Goffman, 1963). The most frequent stereotypes include generalizations about a person’s age, race, sex, or religion. Writers often struggle to find gender-neutral nouns and pronouns that help avoid sexist stereotypes. Try to be aware of unintended meanings when writing about a disease or disability. Don’t define anyone by a deficit, such as “the blind person.” Instead, choose a more descriptive reference, such as “the individual with a visual impairment.” Your decision to describe a person by an impairment or disease, of course, would be based on the relevance to your other content.
Sometimes, bias is just as hard to see as it is to repair in your text. Here are some strategies for averting bias:
• Change a singular noun to plural, if appropriate and factual, to eliminate feminine and masculine pronouns. For example, change
How can a nurse respond in a disaster, when he or she has no emergency kit? to
How caurses without emergency kits respond to a disaster?
• Evaluate pictures for bias, incorrect characterizations, and nonfactual or harmful depictions.
• Assess whom and what are included or excluded in the texts and images.
• Vary anecdotes for diversity and use them only if they represent the content. Avoid outliers, which address rare occurrences instead of representing the majority population.
• Use humanistic language that treats a person as an individual, not a category, and does not inadvertently embarrass or humiliate
El I thought I’d eliminated bias from a recent paper for a contributed book, but the editor returned it to me asking for a rewrite. What can I do to better learn to spot this problem?
When in doubt, have a colleague give your writing a read to see whether he or she can spot biases or prejudices you might have inadvertently added. Eventually, you’ll be able to spot them while you’re writing—and fix them as you go.
Technical Language
Scientific definitions serve a critical purpose for members of the same discipline, but if writing for a general audience, technical language will put off readers. Who comprises your general audience might not always be obvious and will vary from publication to publication. For example, a blog for a Web site targeting new mothers or a health column for a local newspaper will be written in lay language. However, as savvy Internet users, these readers will likely survey the health literature and expect and accept some scientific terms if terse translations are included. The following examples show how you can succinctly provide scientific definitions:
• a myocardial infarction, or heart attack,
• circadian rhythm—a person’s physiological time clock—
Proper names can be just as arcane as technical terms. Unless you’re writing for a small group of readers who all know each other, explain in a few words the relevance of the person who you cited. Here is an example where the author went ahead and clarified the organization:
Mary Tolle Wright, one of seven founders of Sigma Theta Tau International, the honor society of nursing, traveled to
Remember that a paragraph full of proper names or unfamiliar terms and numbers will slow down the reader. Give facts and unfamiliar terms some breathing space by intermixing explanations and familiar prose. A few new words can be captivating, but too many will increase anxiety. In short, avoid fact-packing and jargon-junking.
Acronyms and Abbreviations
Acronyms (pronounced like they look HIP- PA, for Health Insurance Portability and Accountability Act of 1996) and abbreviations (pronounced by their letters, as in F-D-A, for Food and Drug Administration) can be one of the most confusing style issues to conquer. On first reference, as a general rule, include the complete title of a proper name before reducing it to letters. However, some nursing acronyms are the same, or similar, such as the American Association of Critical-Care Nurses (AACN) and the American Association of Colleges of Nursing (AACN). Find every opportunity to refer to an organization by its common purpose. For example:
ANCC, the world’s largest nurse credentialing organization, is a subsidiary of the American Nurses Association. (In this case, you would have already defined ANCC as the
Parts of Speech
As mentioned in Chapter 1, sometimes even the best writers need to brush up on their grammar. You know the basics of grammar, but sometimes the basics are worth revisiting to help you gain confidence in your ability to arrange words in sentences to sharpen their meanings.
A basic sentence consists of:
• A noun (actor) as the subject
• A verb (action)
Example: 1 ate.
That’s it: a basic sentence. Of course, such simplicity doesn’t give you much information. You’re undoubtedly familiar with a more complex sentence that also contains the following:
• A verb as predicate and often a direct object (receiver of the action)
Example: 1 ate lunch.
and maybe
• An adjective and/or adverb (qualifiers)
Example: I ate a light lunch.
Exceptions might include a subject or predicate that is understood but not written: for example, the command (sometimes called an imperative) Go! The subject is understood to be You, so what you’re really writing is You go! In a broader context, the subject might be a specific person.
Subject-verb-object word order is the easiest and most basic sentence form to understand. For example: The nurse filled the syringe with saline.
The key functions in a sentence convey some or all of the following information: who, did what, to whom/what, what kind, why, when, and how. Consider the following example and see how to break it down into the parts of speech:
On Tuesday, a nurse administered crushed aspirin through the patient’s nasogastric tube and observed for signs of bleeding.
• When: On Tuesday = prepositional phrase
• Who: (a) nurse = subject
• Did what: administered = verb
• What kind: crushed = adjective (for aspirin)
• What: aspirin = direct object
• How: through the patient’s nasogastric tube = prepositional phrase
• Did what: observed = verb
• What: signs = direct object
• Why: of bleeding = prepositional phrase
See Appendix A for more parts of speech.
Transitions
Transitional words and phrases link thoughts between sentences and paragraphs, interpret the relationship of two parts of the text, and offer information about the next idea. Transitions can also be ordinal (first, second, third) or cardinal (1, 2, 3), repeat a keyword or thought, or paraphrase a thought with the addition of new content. You can use certain words to cue the reader that you are making a transition.
Here are examples of transitions and what they convey:
• Conclude: as a result, consequently, finally
• Contrast, subtract: although, however, nevertheless
• Compare, add: also, by comparison, in addition
• Impart a sense of time:just as, meanwhile, then
• Show: for example, such as, to demonstrate
Pick out the transitional words in this excerpt:
Cigarette smoking is the highest risk factor for developing chronic obstructive pulmonary disease (COPD). In addition, inhaled pollution, whether indoor or outdoor, can contribute to COPD.
With emphysema, a type of COPD, alveolar septa are destroyed, resulting in a smaller surface area for gas exchange.
Corticosteriods reduce inflammation; however, they are not that helpful in COPD.
The transitional words are in addition, resulting, and however.
What else can 1 do to make my writing effective?
Seek out workshops and continuing education courses on writing for publication, some of which are specifically geared for nurses. Joining a writing group is another way to learn. Form a writing group; your colleagues might also want to improve their writing skills.
Sharpening Your Writing
In addition to the tools just discussed, you can improve your writing through variety, accuracy, revising, and editing.
Variety
One easy route to sharper writing is through the use of diverse sentence structures and word choice. Although subject-verb-object order offers the greatest clarity, varying your writing by using independent and dependent clauses helps as well. See Appendix A for examples of clauses.
Also, vary the first word in consecutive paragraphs to add fresh words to new thoughts. As you proofread, check whether your paragraphs start the same. The words in the last sentence of a paragraph should differ as much as possible from the words in the first sentence of the next paragraph. To freshen your vocabulary, create a lexicon of words that you like from your own readings and include at least one new word each time you write. Finally, don’t forget to use tried-and-true reference works, such as a dictionary and thesaurus, many of which are available online. A quick and easy search with an online thesaurus can make your writing sing.
Accuracy
Provide sources for your data to strengthen your credibility, prevent errors, and credit other authors. Correct information trumps all other aspects of writing. Double-check facts for accuracy and relevancy. When introducing data, place facts in a separate sentence or paragraph from the opinions and interpretations. Over-citing isn’t a substitute for real substance—and can cause its own problems—but a fair number of citations to back up your research and facts will make your paper a reliable and trusted source.
Revising
While you write your first draft, don’t be too critical of your work. After the draft is done, go back and question everything, revising as needed to make the text clearer to the reader. Revising is the most challenging part of writing. Try to be objective and see your words as if for the first time. This is an excellent time to get feedback from others.
Facts, Opinions, Interpretation: What’s the Difference?
Clearly separate your facts from your opinions and interpretations to enable readers to know the difference.
• Facts con vey i nform ati on attributed to th e sou rces.
• Opinions place value judgments on people, places, things, or institutions.
• Interpretationsconnect the facts to provide understanding based upon the best kn o wl ed g e a vai la ble. Th e art of interpretati on musf be obviou s to be scientifically valid and responsible.
You can setoff opinions and interpretations with such words as discussion, explanation, I believe, we think, based upon the best evidence this evidence leads me to consider the possibility, these facts suggest, and so on. Opinions suggest a heavy use of value judgments and perspective.The interpretation needs to be set in a separate paragraph before or after the facts. You can also expand on your interpretations again in a discussion section. Interpretation can follow a list of clinical procedures to explain why you chose such methods. Making distinctions in the facts, opinions, and interpretations requires your highest levels of consideration.
Here is an example:
Opinion: When I entered the hospital room and introduced myself, the child wouldn’t look at me. He was angry.
Fact: When I entered the hospital room and introduced myself, the child did not look at me or respond.
Fact: When I entered the hospital room, the patient winced and said that his pain was unbearable.
Interpretation:The child’s lack of interaction with me and his repetitive twisting with hi s bl an ket may su g g est a uti sm or aoth er cogiti ve impa i rment. Ou r in abi I ity to know how he feels concern us.
Editing
After you revise your article, the next step is editing. As mentioned in Chapter 1, editing works like the kidneys, filtering out what isn’t needed. It is like polishing a gem until it shines. You can take your writing to the next level with good editing. For example, vague and nonessential words in a sentence can obscure the main idea and tire your readers. The choice of the vague pronoun it at the beginning of a sentence can leave a reader wondering who or what it is. For example, the first five words of the following draft sentence offer little information, and the subject remains undefined—who or what is the actor? And it does not make decisions. The revision places the key information at the beginning of the sentence.
Draft: It was decided that the teenager’s body mass index was the primary determinant of the nurse selecting to use a 25-millimeter needle for giving an intramuscular injection at the patient’s deltoid site.
Revision: The teenager’s body mass index guided the nurse’s decision to use a 25 mm needle for an intramuscular injection at the deltoid site.
Draft: Such as it is, when a patient hopes to psychologically return back to the phase preceding the accident, this is so very unfortunate, because that situation will never be able to be repeated again.
Revision: A patient may hope to reestablish the same lifestyle that preceded the accident, but unfortunately, his physical abilities will never be the same.
Fora quick edit, look for redundancies (for example, returning back, or repeating again) and extra words or fluffy phrases (such as it is, so very unfortunate, needless to say) without meaning. Here are some examples of fluffy modifiers, nonessential phrases, and common redundancies. In the case of phrases, the words in italics are unnecessary.
Merely, simply, surely, very, truly, just, most ever, the best ever, as it were, such as it is, originally began, during the course of, my personal opinion, entered into, off of the end result, over-exaggerate, mutual regard for each other, still continues, bridges across, examines with scrutiny
ES 2 spent last semester working on an article for a journal, only to have it returned to me with a note from the editor asking that it be revised to house style. What is house style?
Publishers adhere to a broad style guide for references and general structure, such as the American Psychological Association (APA) or American Medical Association (AMA) stylebooks, but they likely also have additional clarifications for their own organization, considered house style. For example,
APA style, the style guide for all Sigma Theta Tau International (STTI) journals and books, specifies a particular order for academic degrees and titles. However house style for STTI requires that RN is always the first title after any nurse’s name.
Before submitting an article, request information about the style to use and any house style specifics.
The grammatical structure and content of a sentence depends on a consistent language pattern, referred to as parallelism. For example, if writing about an occurrence in the present, do not switch the tense to a past or future verb within the same sentence. See the following examples:
Draft (tense)
Janet Sanchez, RN, was named Nurse of the Year and is a community health practitioner.
Revision 1
Janet Sanchez, RN, community health practitioner, is Nurse of the Year.
Revision 2
A series or pattern based on one part of speech also needs to continue with the same form.
Draft (active/passive verb)
The researcher collects sensitive data, is assessing it, and stores it outside the building.
Revision
The researcher collects, assesses, and stores sensitive data outside the building.
Proofreading
After you revise and edit your work, you are just about ready to submit! Before you do, whether electronically or via hard copy (paper), the final step of editing is proofreading. Use this check list to ensure that you take care of every last detail. If you can answer yes to these questions, your content is ready for publication.
□ Are the facts and characterizations of all people, groups, and institutions presented accurately and without bias?
□ Are the references accurate and formatted in the appropriate style?
□ Are your meaning and purpose clear?
□ Do the visual content and captions work?
□ Do you have all necessary consents and permissions? (Refer to Chapter 10 for more information on legal and ethical issues.)
□ Have you checked for spelling and grammatical errors? (Remember to always run the spell check and grammar check in your word processing program. However, such tools don’t replace a keen eye. For example, a spell check won’t pick up the error in this sentence: There [instead of Their! anxiety over the drug’s recall grew rapidly.)
□ Have you confirmed the spelling of proper titles/names with primary sources?
□ Have you read for and corrected any potentional, unintentional harms or insults?
□ Have you verified the accuracy of statistics and all numbers in the text?
□ Is your wording concise?
EB I used to think writing was easy until I tried to write a brief information sheet for home care after one of our treatments. My writing wasn’t clear and raised more questions than it answered. At that time, someone more skillful rewrote the information, but I would like writing to be one of the ways how I contribute to patient care. What do you suggest?
It’s trite, but true: Practice, practice, practice. Writing is a skill that can be learned but then also needs practice. Through practice, you can improve your writing skills and increase your comfort level with disseminating health information through writing.
Communication as a Tool
The modern pioneers of nursing believed that communication held a pivotal role for nurses in managing disease and improving health. Consequently, nurses have arrived in the Information Age understanding the art of interpersonal communications that benefit patients. The opportunities to extend a nurse’s effectiveness through new media tools and traditional ones remain limitless but require attention to language skills.
Write Now!
1. Think of a somewhat complicated message that you want to convey to a colleague. Take no more than three minutes to write, and then stop. Did your writing convey your message clearly and concisely? If yes, congratulations! If no, go back to see how to make your message more clear. Perhaps unnecessary words are muddying the message.
2. Select a small health-related topic and then write about it for two audiences. One audience is the general public, and one is a peer-reviewed journal.
How to Read a Scientific Paper
The above gives you a sense of how scientific research (and other type) papers are constructed. But how should you, as a user of said papers, go about reading them?
One recent tend in undergraduate scientific literacy education is the “C.R.E.A.T.E” approach. This has to do not so much with reading the paper per se, but with attitudes to take when approaching reading science. This (admittedly forced, as are most such things) acronym stands for:
- Consider the topic
- Read the paper itself
- Elucidate the hypotheses. That is, determine precisely what the authors were trying to test.
- Analyze and interpet the data. In other words, see how they tested the hypotheses, whether they were effective in do so, what conclusions they made from it, etc.
- and Think of the next Experiment. Nearly all scientific studies result iew lines of reserach being opened up; think about how one would then approach those new questions.
The stereotyped approach to reading a paper is “abstract, then conclusion, then the stuff in between if you are interested in it”. This obviously isn’t the way the papers are organized, and is a bit unfair to the researchers’ work, but at least it is very quick. However, this is by no means the only way. For instance, here is an essay about a different approach to reading a paper.
As with most written documents, there is no one single proper way to read them. Find what works best for you.
