The Clinical Inquiry Process Resource Guide

Once, the practice change has been implemented and found to be a success, the next step in the process is to disseminate your findings.  This is important because it adds to the knowledge base of patient care and allows others to contemplate implementing the practice change in their environment.  The way to reach the largest audience is by publishing your work.  Many find this process intimidating but if you break it down and plan accordingly the process can be a bit easier.  

Anytime you decide to publish, it is always good to talk with colleagues on your unit or in the organization that has published. These individuals can serve as mentors and answer any questions you may have.  

 A good set of criteria for determining who should be an author on a paper are the criteria that have been established by the International Committee of Medical Journal Editors (ICMJE).  The ICMJE has four stated criteria for authorship:

1)  Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for        the work; AND

2)  Drafting the work or revising it critically for important intellectual content; AND

3)  Final approval of the version to be published; AND

4)  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.

All of those who are authors need to meet all four criteria and anyone else involved with the publication should be acknowledged (International Committee of Medical Journal Editors).   Establishing authorship early is a good way to help plan out a paper and assign different tasks to various team members as authorship brings with it responsibility. 

When it comes to determining where to submit a manuscript there are several things to consider:

• Who is your audience and will they have access to your work?
  • What group(s) or profession(s) are you trying to reach?  Is the audience one that is interdisciplinary? 
    • The topic or message of your paper may mean that you choose to publish in a journal that is more broad and outside of nursing in order to have the greatest impact.
  • Will the audience be able to discover and access the work?
    • Open Access: Consider if you want to publish in an open access journal.
    • Must Be Indexed in PubMed: The journal needs to be indexed in PubMed.  PubMed is the largest biomedical database and is freely accessible around the world.  Being in PubMed means that more people will be able to discover the work but may still need to take extra steps to get a full-text copy.
• What Journal Publishes on the Particular Topic Covered?
  • Do a quick search of either PubMed or CINAHL on your topic.  Look at the articles that are related to your topic.  Which journals appear to publish on your topic? 
  • Once you have identified 2 to 3 viable journals you should do the following:
    • Read several article from the journal(s) and see how the articles are laid out and the style that authors use.
    • Review the table of contents of the journal(s) for the last two years.  See if the journal publishes a great deal on the topic or if the article you found is the only one.  If a journal has published recently on the topic of your paper, the editor may be less receptive to considering your submission.
    • Go to the website for the journal and review the mission statement and author guidelines for this journal.  Be sure that your paper aligns with the mission of the journals as well as that work will meet the author guidelines for length, citation style, etc.               (Saver, 2011)
• What is the Journal’s Impact Factor?
  • While the impact factor for a journal should not be the main consideration for where to publish it is something to consider if you are wanting your work to be discovered and used.  
  • A journals impact fact can be found by accessing the Journal Citation Reports which is a resource available through VCU Libraries.   Below is a link to a description of what a journal impact factor is along with links to the two types of journal citation reports where impact factors can be found. 

What is a Journal Impact Factor?

Journal Citation Reports (JCR) - Science Edition / JCR Tutorial
Provides citation data on 5,700+ journals including highest impact journals, most frequently used journals. 

Journal Citation Reports (JCR) - Social Sciences Edition / JCR Tutorial
Provides citation data on 1,700+ journals including highest impact journals, most frequently used journals.    

• Query the Journal About Potential Interest:  Once a journal has been identified it may be a good idea to query the journal to see if the editor is interested in your manuscript. The reason this is a good idea is because:

1. Time will not be wasted writing and submitting to an editor/journal that is not interested in the topic of the paper.
2. The editor can provide feedback on the idea for the paper and help with tweaking the paper topic to be of more interest to the journal's audience.
3. Increase the likelihood of the paper being published, even though just because the editor is interested does not mean that the paper is ensured of getting published.

                            (Saver, 2006)

 Most journals are open to queries from potential authors but some are not.  To determine how open a journal is to queries, go to the journals website and read the author guidelines section.  Many times the query policy will be stated as well as what should be included in the query as well as who all queries should be addressed to, which is normally the editor of the journal.   (Milner, 2014) 

• Title:  No more than 15 words is ideal, be specific, PICO question.  The title should be one that could stand alone when trying to understand what the manuscript will address.
• Introduction:  Needs to focus on the key points of the project/study. It should, at least, cover the following:
  • Problem:  Define the practice problem addressed.
  • Background:  Provide a synopsis of the literature on the problem and previous intervention used to address it. 
• Methods:  This section is one that should cover several things.
  • Literature Search:  Where did you search and how.
  • Process of Reviewing & Evaluating the Evidence:  What tools or process was used to gauge the quality of the articles?  Were articles reviewed by more than one person?
  • Evidence:  What type of evidence was used to determine the practice (level/quality)
• Implementation Plan and the Type of Pre-Intervention Data Gathered: 
  • Process/Plan: What was the process that was used to implement the practice change? 
  • Data: What sort of data was created to establish a baseline? Why was it chosen? 
• Results of the Project
  • Findings:  What were they?  Was it what was expected?
  • Data: What data was used to evaluate the effectiveness of the practice change or intervention?
• Limitations/Unintended Consequences
  • Participants/Team: What were the perceptions of those who participated in the practice change?
  • Limitations: Be sure that any limitations are clearly stated.  Can this practice change be translated and implemented in other practice environments? 
• Sustainability of the Practice Change
  • Be sure to discuss the plan to ensure the practice change will carry forward and be monitored.
• Conclusion/Recommendations/Implications for Practice Change(s)
  • What practice change(s) are you recommending? 
  • What is the benefits of making these change(s)?  Drawbacks? 
  • What key points do you want the reader to take away from the article?   People only tend to take one or two sentences away from what is written, just need to think about what you want them to take away.
• Visuals: 
  • When it comes to visuals, whether it is a graph or illustration, it needs to add either enhance a point or add something to the publication. 
  •    Be sure that you provide a brief caption for any visuals.  If the visual is a graph be sure that you include a title and labels on each axis of the graph.

(Milner, 2014;Alexander, 2011;CTSA, 2011)

All manuscripts, when submitted to a journal, are reviewed by peer reviewers who are in the field and know something about the topic of the manuscript.  Many times during the peer review process the author(s) will receive feedback concerning what reviewers liked and what they did not in reference to the manuscript.  Until the critical comments are addressed to the satisfaction of the editor, the paper will not be published. When responding to reviewers, be sure to keep in mind the following:

• Always maintain a respectful and courteous tone when responding reviewers and/or the editor of the journal. 
  • Find a way to detach and be able to evaluate comments in a productive way.
• Must Address Each Comment Made By the Reviewer(s)
  • Categorize Changes - Those You Can Live With and Those You Cannot Live With
  • Address each point and provide some commentary as to whether you agree or with the point or not. 
    • For Those Agreed Upon - Be sure to state how you have addressed the change.  Highlight the change in the manuscript.
    • For Those Disagreed Upon – Be sure to state why.
• Contact the editor directly when you feel suggestions or comments are unfair or not acceptable.
• Be sure to meet any deadline for resubmission.