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In order to change practice and improve patient outcomes, both researchers and advanced practice registered nurses (APRNs) need to disseminate findings from their scholarly and clinical work. APRNs can be educated through master’s or doctoral level programs (DNP or PhD). Historically APRNs were educated at the master’s level, which continues today. Education at the DNP level was added in the early 2000s. Notably, a number of APRNs completed doctoral work in PhD, EdD, or other doctoral programs. Many APRNs start their practice with or return to school to complete a doctor of nursing practice (DNP) or doctor of philosophy (PhD). Regardless of degrees completed, scholarship in the form of disseminating through publication is an integral part of the discipline. For the APRN who is a DNP or PhD student, the scholarly process and the plan for communicating findings is best developed at the time a scholarly project or dissertation is begun. Higher degree completion is accompanied by a parallel increase in expectations for publication and other forms of dissemination of scholarly work. In doctoral education there is an expectation that scholarly work completed in the program should be communicated and shared outside of the program. For those in clinical practice, whether or not enrolled in an additional advanced degree program, scholarly publication supports the foundation and continuance of moving patient care, systems of care, and research forward and further enhances the skills of the practitioner for scholarly work. Sharing scholarly work is a responsibility for all nurses (Kennedy, 2018).

A DNP project typically encompasses quality assurance, practice improvement, evidence-based practice, or policy recommendations (see Exhibit 21.1), while a PhD program includes dissertation research and analysis in qualitative, quantitative, or mixed method design. Both the DNP project and PhD dissertation entail scholarly work, but their focus and scope differ. Projects, theses, and dissertations are forms of scholarship, and practice itself is a form of scholarship, however audience and appropriate methods for dissemination vary considerably. Although the traditional approach to publishing scholarship is through professional journals, other publication options are available, including professional society newsletters, media from institutes or agencies such 400as the Centers for Disease Control and Prevention, the Pew Foundation, conference proceedings, electronic posters, and other media.

■ STARTING THE PROCESS OF PUBLICATION

The main categories for publishing forms include print or electronic, or simultaneously print and electronic. Electronic venues for publication comprise a number of options, including personal and organizational websites, and commercial ventures such as YouTube. Open access publications and web-based publications, such as videos, make up accessible means for nurses to watch and share original information that can be accessed through websites, mobile devices, blogs, and email. Further, surveys can be deployed, and results announced and promoted through social media platforms such as Twitter. Although open and web or mobile access methods greatly enhance the speed and scope of dissemination, there are tradeoffs to consider in selecting these options. It can be difficult to maintain both the integrity and the focus of research dissemination when expanded access occurs. Institutions, particularly for those in tenure-eligible positions, often have constraints or criteria related to publication completion which determine both how dissemination occurs and how it counts toward employment-related requirements. The expansion of options over the last decade also prompts discussion of ethical and scholarly considerations in developing 401a dissemination plan. A too-broad dissemination plan can also decrease the impact of results and potentially increases the risk for insecure sharing or plagiarism.

The multiple decision points, steps, and procedures necessary to ensure successful publication are highlighted in Figure 21.1, with a short annotation on each step. Step one is selecting a journal, triggering next steps included in the diagram. Each of the facets will be explained in detail, with recommendations for completing the process.

■ SELECTION OF PUBLICATION VENUE

Journals

According to the Cumulative Index to Nursing and Allied Health Literature (CINAHL) website (www.cinahl.com), there are over 4,000 journals indexed in the CINAHL repository; only a small percentage are exclusively research journals. In PubMed, which includes MEDLINE and PubMed Central (PMC), there are 30,000 journal records indexed (www.nlm.nih.gov/bsd/serfile_addedinfo.html). There is some overlap between PubMed and CINAHL, but using both when searching for journals or published information will provide comprehensive information regarding what is already published in your field of interest, and where gaps can be explored.

402Publishing in journals with a less strenuous research emphasis but a heavier emphasis on clinical application allows nurse clinicians and practitioners to report on evidence-based practices that improve health outcomes, but in work that does not necessarily meet the data-based and more highly controlled research methods requirements. Clinical articles often include problem-solving skills, clinical decision making, and discussion and debate regarding professional issues in nursing, all that are critical for nursing knowledge. Such articles focus on a variety of practice topics that improve nursing practice, including examining clinical guidelines in practice, brief reports, innovative clinical practice, case studies, healthcare outcome evaluations, and policy-based implementation strategies. Broome et al. (2013) found in a broad assessment of published DNP projects from 2005–2012 that the percentage published in peer reviewed journals has increased over time and that original clinical investigations were the most frequent, followed in frequency by practice-focused patient and provider studies.

Peer-Review

Peer-review (also called juried review) is the process through which scholarly work is assessed by others who have expertise on the topical content and methods used for the work being reported. Peer review can be an open process (authors and reviewers names are known to each other), a single blind review (reviewer is aware of author identify, but reviewers are unknown to authors), or double-blinded review (authors and reviewers are unaware of each other’s identity) (Baker, 2012). Peer review is one method of assuring heightened accountability and integrity in publication, both linking to credibility of the work published (Dougherty, 2006). The credibility of publishing in a professional journal is based on the peer-review process intended to evaluate the quality of work by peers who are experts in the field (Dougherty, 2006). While peer review process can vary, clear explanation of how peer review occurs and under what criteria is important to assure the author of the integrity of a journal (Edie & Conklin, 2019). Peer review process should be explained in the author guidelines for the journal or site of publication and should include a description of the process, degree of confidentiality of review, and discussion of conflicts of interest, as well as how reviewers can be suggested if needed (Broga et al., 2014; Marusic, 2018; Marusic et al., 2019; Vervaart, 2014). Editors are the gatekeepers of the peer review process and assume the responsibility of selecting reviewers who have demonstrated advanced knowledge or practice in a particular nursing role, such as practice, administrator, researcher, educator, systems focus (e.g., informatics) or specific patient care specialty. Manuscripts are ideally reviewed by at least two reviewers, and often three or more. Reviewers screen the manuscripts for content and process quality, accuracy, timeliness, relevance, and appropriateness prior to the editor’s consideration of the article for publication. Despite its potential weaknesses, peer review is the most appropriate means for selecting manuscripts for publication. Peer review gives readers assurance that the journal’s content meets acceptable standards of scholarship, conferring validity and credibility on an author’s work. Lack of rigorous peer review has also been implicated in the proliferation of predatory journal publications in nursing (Oermann et al., 2018).

Because of promotion and tenure criteria, faculty in institutions of higher education place weight on number and quality of publications, particularly for research intensive positions 403(Oermann & Hays, 2018). Publication metrics can be used to determine the impact of a journal and is also considered in the criteria for some institutions (Carpenter et al., 2014). Although the quality of material published in a non-peer- reviewed journal may not be any different from that in a peer-reviewed journal, choice of a journal should be made in light of current job requirements as well as your planned career track, and always considering the audience intended to reach.

Non-Peer-Reviewed Publications

Non-peer-reviewed publications include many internet sites that report news or healthcare information, magazines, and newspapers as well as some journals (Wood & Ludwig, 2012). However, for journals that do not include peer review, an editor may still review manuscripts and decide which manuscripts will be published, using similar criteria to those used by peer-reviewed journals. A journal editor reviewing a manuscript submitted for publication does not qualify for peer-review status. Although the articles in such journals may be excellent, the lack of peer review other than an editor lessens their credibility. Journals that are peer reviewed will include a statement such as “peer-reviewed journal” somewhere within the journal information provided in each issue and typically on the journal website. If there is a lack of information about peer-review for a journal, or questions about the process, clarification should be done by contacting the editorial office, before completing a submission to the journal. Authors must be patient, because the peer review process takes time, but authors must also be aware that an acceptance for publication within a few days of submission can indicate need to investigate peer review process of the journal. Authors should also receive commentary provided by the peer reviewers, typically labeled for each reviewer (e.g., reviewer one, reviewer two), and the reviewers’ comments.

The major limitation to publishing on websites or online is the lack of peer review which diminishes the credibility of the publication. For online publications not linked with a peer-reviewed journal or process, or from a well-known agency, such as the Centers for Disease Control or National Institutes of Health, control of quality potentially diminishes. Publishing a scholarly project abstract in a repository, which may be maintained by an individual university (Heselden et al., 2019) or a professional association such as Sigma Theta Tau’s Virginia Henderson repository (www.sigmarepository.org) heightens accessibility, but does not include peer review necessarily. Innovation in interactivity is increasing also for repository work (Hodge et al., 2016). Authors must also be aware that works published electronically are used often by others without the author’s knowledge or permissions. Additionally, the work posted is difficult to remove once posted, thus has potential to exist indefinitely. Authors must always be cautious in publication in any venue – once published, works are typically available for a lengthy period of time.

Paper-Print Journals

Publishers provide paper-print journals, but increasingly material in print is also available electronically, and some journals are transitioning to only digital, online access. Electronic access increases entrée to an author’s work via internet searching, but journals provide differing access to publication content. Titles, author listing, abstract, keywords, and other identifying information is routinely available through internet searches. When submitting a manuscript for publication, publishers use web-based systems (i.e., Manuscript Central, Scholar One, etc.) to acquire, review, edit, and produce the journal’s content. The manuscript is submitted electronically to an editor, forwarded by the editor to reviewers electronically, and revised and published electronically.

404Electronic Journals and Open Access

There can be advantages to online publications. Once accepted for publication and processed, articles are often placed in an online database of the journal until it is assigned to an issue of the journal, named in some way for early access, like Online First (tcn.sagepub.com/content/early/recent) or directly into the journal online site. Manuscripts published in early print, or early online print, are considered published articles with an assigned digital object identifier, or DOI number, if the journal subscribed to the DOI system of identification. This reduces the time from generating knowledge to communicating the information to others. Another advantage of electronic systems is that resources are conserved—reducing paper use in generating and photocopying, as well as postage for shipping to publishers. In addition, further content can also easily be updated with new information and hypertext links to other related sites Additionally, readers can enter into a dialogue with the author and the editor through electronic mail or direct website linkage, which can be appended to the electronic article.

Online publishing is an increasing trend, but definitions, processes, parameters, and value are debated. There are journals that were begun as online journals specifically, and there are journals that have transitioned from in-print to online format. An additional model includes journals that are available in hard copy print as well as online, digital access. A fully open access journal is defined as a journal that provides open access to all readers at no charge to readers, and includes that the reader can download, share, distribute, and link the articles (Albert, 2006; Baker et al., 2019; Hua et al., 2017). For these journals, the funding model is typically through author payment directly to the publisher. Advertising and other activities provide additional financial base in this model. Open access journals are different from journals that have the option of in-print or online publications. Although some journals provide an option to authors to enable online access for their publication, the journal might not be completely open access, or it might be accessible only by members of a restricted group, such as a professional association like the Journal of the American Association of Nurse Practitioners (JAANP). JAANP is an example of a journal which has been in-print since its start, and only recently transitioned to online, digitally available content only. Members of AANP have full online access to all journal content, but some editorials and articles are made available online to non-members. There is an option for fully-online availability choice for authors, with monetary payment, or open access for those reports that are required to be made available by funding parameters.

Open access publication can be considered scholarly, and online journals may or may not be affiliated with a publisher, professional organization, or association. Open access journals depend on author payment for their publication funding. Baker et al. (2019) describe common categories of cost coverage – the gold model, green model, platinum, and hybrid model. There is an open access association to which open access journals belong, and within this association guidelines and ethical parameters are set (Albert, 2006; Baker et al., 2019; Hua et al., 2017). Open access journals might or might not include peer review. Most often there is a cost of approximately $500 to $5,000 to the author to submit a manuscript. Upon acceptance of the manuscript and payment if required, the article is published online and readily available for public viewing, thereby decreasing the time it takes for publication. In terms of audience, there is no cost for the reader to view the article or to purchase the article through online publishing companies as this fee is paid by the author to the publisher. There are groups that identify high-quality, peer-reviewed open access research journals and periodicals like the Directory of Open Access Journals (DOAJ) (doaj.org) which provides an ongoing listing of open access journals. The DOAJ is maintained as a non-profit organization, through member funding, and the list changes as updated are made. 405Members are drawn from individuals and groups, including organizations such as libraries, publishers, and government organizations. Removal of a journal from the DOAJ which was previously listed may indicate that is has been identified as a “predatory journal.”

Predatory Journals

Increasing availability of predatory journals is a major concern in publishing, and a concern to most disciplines, including nursing (INANE Predatory Publishing Practices Collaborative, 2014; International Academy of Nursing Editors Predatory Publishing Practices, 2015; Kearney & INANE Predatory Publishing Practices Collaborative, 2015). Research completed in the area of predatory journals indicate an increasing problem in nursing and other disciplines (Baker et al., 2019; Mercier et al., 2018; Oermann et al., 2016; Wahyudi, 2017). A predatory journal is one that charges fees for publishing and for editorial services, but without providing those services expected, resulting in a substantial lack of rigor (Baker et al., 2019; Beall, 2012; Beall, 2016; Strinzel et al., 2019; Wahyudi, 2017). Typically, predatory journals are online and open access, and prey upon naïve authors, or authors seeking a quick publication. Predatory journals are often fleeting and locating a home address for the journal is difficult. These online journals exploit authors by using an open access publishing model that involves illegitimate journals, journals that actually do not exist, or a journal created specifically to exploit unsuspecting authors. Invitation to publish from predatory journals, or to participate in their editorial board, appear in seemingly random emails or spam from a predatory journal may seem quite legitimate at first. Mercier et al. (2018) demonstrated predatory journals targeting new, novice professionals with promises of publication, conference presentations, and editorial board positions. Many professionals feel honored to have been asked to serve on editorial boards and often agree, unaware that their name is being used to support an illegitimate journal (Wahyudi, 2017).

Although there is discussion about the use of the term predatory in publishing, with concern that fledgling journals or smaller publishers are at risk of being mislabeled with this negative term, there is a general consensus that authors must be aware of exploitative practices in publishing, most notably with journals that provide little attention to rigor, questionable business practices, and poor service overall to science (Baker et al., 2019; Memon, 2019; Mercier et al., 2018; Oermann et al., 2016). Lack of focus by a journal on a particular clinical area or content focus has been identified as a common characteristic of predatory journals (Baker et al., 2019; Oermann et al., 2016). There is evidence of heightened plagiarism in predatory journals. Plagiarized content was identified in a descriptive comparative study of three nursing journals that represented authors from 26 countries (Owens & Nicoll, 2019).

Determining the status of a journal as predatory is challenging. Beall’s List of Predatory Journals, formerly developed by Beall, is now a compilation online that is periodically updated by an anonymous source (beallslist.weebly.com/contact.html) after the original list was described by Beall (2016). Strinzel et al. (2019) reported a descriptive mixed method study of journals, and demonstrated 72 journals from 42 publishers were included in predatory and non-predatory journal lists. Peer review, editorial services, policies, and business practices were some of the factors explored by Strinzel et al. (2019). Oermann et al. (2016) investigated predatory journals in nursing, identifying in descriptive research a total of 140 predatory journals involving 75 publishers. Noted by the Oermann team (2016) was a pattern of journals publishing only a few issues and then stopping, as well as relative youth of 1 to 2 years of age for the journals. Commentary by Baker et al. (2019), and research reported by Cobey et al. (2019) and Wahyudi (2017) provide lists of items that should raise question regarding the status of a journal as predatory. The initiative 406Think. Check. Submit (thinkchecksubmit.org) provides guidance for those seeking to submit to a legitimate journal, and offers checklists and helpful questions to ask when evaluating potential options for publication. Exhibit 21.2 includes several of the most frequently acknowledged characteristics of predatory journals found in research of predatory journals (Baker et al., 2019; Mercier et al., 2018; Oermann et al., 2016, 2019; Wahyudi, 2017).

Journal publication is the most frequent method for scholarly dissemination because many nurses and others can be reached by one effort—publishing a high-quality, focused manuscript that will remain accessible by others on a long-term, stable basis. To increase the chance of having your manuscript accepted for publication (Happell, 2005, 2012; Oermann, 2018; Oermann & Hays, 2018; Price, 2010; Yancey, 2016), following critical factors for successful publishing is vital (Exhibit 21.3). Several of these factors are discussed in more detail in the upcoming sections.

■ JOURNAL SELECTION

Audience

Knowing the audience reading the journal is an important first step in selecting a journal for publication, and then selecting a journal based on that audience is critical. Additionally, determining who would most readily benefit from gaining the information being published is the basis for 407determining an appropriate audience. Editors know their journal audience and will reject outright an article that is inappropriate for the journal audience.

Choosing a high-quality journal to publish a manuscript is important. There is a variety of publication metrics to measure the productivity of the journal. The first and most common is the impact factor (IF), produced by the Institute for Information Science, held by Thompson-Reuters. The IF is an objective indicator of the relative importance of a journal, thus is linked to the article published in the rated journal. The higher the IF, the greater the importance of the journal in its field. The IF reports are available at the Institute of Scientific Information (ISI), owned by Thompson-Reuters. An author can find out how many times a paper was cited and in which journals. Nursing is challenged with strengthening citation of publications, thus also with strengthening IFs for nursing journals. The criteria remain debatable in the publishing world (Carpenter et al., 2014). Meeting with a medical librarian can assist in evaluation of a prospective journal, including the impact of its authors and its publications. Medical libraries, such as that found at Cornell University, have a wealth of resources on their websites to evaluate and better understand the IF (guides.library.cornell.edu/impact). There are also tools such as JANE (Journal Author Name Estimator; jane.biosemantics.org/) which pull from PubMed to identify journals for good fit based on input of the abstract or proposed subject, using an article influence calculation indicator measuring how often articles in the journal are cited after their first five years of publication.

■ AUTHORSHIP

Identifying authors and contribution for the manuscript is a critical step in developing a manuscript for publication. Authorship implies significant involvement in writing an article and in the work that led to that writing. The reality is that authorship is often given to (or insisted on by) people with minimal involvement in the writing project—perhaps a supervisor, a data collector, or a statistician. The International Committee of Medical Journal Editors (ICMJE, 2019) authorship guidelines recommend that authorship be based on the following four criteria: (a) substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; (b) drafting the work or revising it critically for important intellectual content; (c) final approval of the version to be published; and (d) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (ICMJE, 2019). Brand and colleagues (2015) detail specific information about contribution, collaboration, and credit allocation that is helpful for determining authorship as well. Ascertaining steps in the project or research endeavor, along with steps in the dissemination process, and delineating responsibilities early on in the work will facilitate decision-making regarding dissemination.

In large, multi-site research projects, it is becoming common to list the research group as the author, with individuals mentioned in a footnote. When this is the case, all members of the group still must meet the stringent requirements for authorship. There is no specific rule for order of authorship (Bosch et al., 2012; Brand et al., 2015; Cleary et al., 2012; ICMJE, 2019), but authorship must be related to contribution to the work being published. Ideally, the order of authorship should be discussed before beginning the writing process, which helps to expedite the writing process overall and diminishes conflicts later in the writing process. The joint decision of the co-authors, after analysis of each author’s contribution to the work, can further determine whether adjustments should be made. Order of authorship in nursing journals often indicates greatest to smallest contribution, paralleling first to last author. This order might be 409based on the amount of time given or on the importance of the contribution. In other journals, authorship may be alphabetically ordered, but alphabetical listing does not align with recommendations for appropriate attribution (Brand et al., 2015; ICMJE, 2019). An additional model includes the practice of listing the senior investigator as the last author. Most journals request identification of the corresponding author, which is typically the first author who has primary responsibility for managing all activities related to the publication, ensuring all parameters are met, guidelines followed, and timelines achieved. Although timing of authorship decisions is often begun with planning of the manuscript, the process can be changed through the point of submission, and should be changed if there is shifting contribution (Brand et al., 2015; ICMJE, 2016).

Acknowledge Appropriately

If not everyone who contributed to a research endeavor is entitled to authorship, then certainly each person who contributed substantially should be acknowledged (Bosch et al., 2012; Brand et al., 2015; Cleary et al., 2012; ICMJE, 2019). There is almost as much controversy about who is entitled to acknowledgment as there is to authorship entitlement. As a rule of thumb, acknowledgments are reserved for those who have made a substantial contribution to the project being reported in an article, including editorial and writing assistance (ICMJE, 2016, 2019). Those who might be acknowledged are data collectors, a project director, an editorial assistant, or a faculty advisor. The primary author must also ensure that acknowledgments are acceptable to those who will be acknowledged, because not everyone wishes to be acknowledged publicly. Obtaining written permission ahead of manuscript submission from those named in an acknowledgment is best practice to ensure approval of the acknowledgment, and that the acknowledgment will be included in often widely disseminated materials.

■ CONSTRUCTING AND SUBMITTING THE MANUSCRIPT

Title

A well-written title is a product of both science and art, as well as patience. Crafting the perfect title starts with a working title and ends with finalizing at completion of the manuscript. A clearly written title will draw the searcher or reviewer into the work and stimulate interest, while a poorly written title will not. Recommendation for the appropriate number of words for a title is equivocal, with general guidelines recommending between 10 to 15 primary terms (i.e., American Psychological Association [APA] guidelines), relevant concepts and variables of interest, and terms related to design and sample (Alexandrov & Hennerici, 2007; Langford & Pearce, 2019). Research is indeterminant regarding influence of sub-titles, semi-colons, dashes, but these can be easily used if appropriate for the work being published.

Formatting and Abstract Development

Every journal will provide parameters for formatting citations and the reference list, as well as for general writing of the article. In nursing, citations and the manuscript body typically, but not always, follow the APA format. However, even when the format is clearly a published format such as APA, each journal will have specific and often nuanced items the journal requires that are 410different than published formats like APA. The specific guidance regarding journal expectations for format and structure is typically located in author guidelines included on the journal website or located in a print journal issue.

The abstract is one of the most important aspects of the manuscript because it is one of the related items seen in electronic searches, and provides the information a searcher will use to make a decision regarding locating and reading the related article (Alexandrov & Hennerici, 2007; Pearce & Ferguson, 2017; Pierson, 2016). An abstract is required with submission of any manuscript. Since the recommendation to use a standardized reporting structure for scientific abstracts in the 1940s, many journals use some variation of the IMRAD (Introduction, Methods, Results, Discussion) format for abstracts and publications (Nakayama et al., 2005; Sollaci & Pereira, 2004). Components of IMRAD are detailed in Exhibit 21.4. The introduction includes a brief background of the topic and the study purpose(s). Methods comprise the design, setting, sample description, intervention, measurement tools, and outcome measures. Results include the primary findings. Finally, the discussion is the section in which conclusions and implications for practice and research are presented.

Specific journal format for the abstract should be detailed in the author guidelines for the particular journal, and can require a word count of approximately 100 to 750 words that provides key 411information about the work being reported, and serves to invite the reader to read the manuscript (Alexandrov & Hennerici, 2007; Pearce & Ferguson, 2017). Abstract format can range from an unstructured paragraph to a structured paragraph, but to ensure all information is placed properly, using the headers found in a structured abstract is helpful, with removal of those headers if the journal requires an unstructured abstract (Alexandrov & Hennerici, 2007; Pearce & Ferguson, 2017). The abstract is an exceedingly important aspect of publication because it is often the first thing a reader will assess, and will serve as the basis for the reader’s decision to further pursue information housed in the article; a poorly written abstract does not invite the reader to pursue more information on the topic, and ends up being rejected by a reader (Alexandrov & Hennerici, 2007; Pearce & Ferguson, 2017; Pierson, 2016).

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