Helping nurses avoid some pitfalls on the path to publication: writing for publication is not easy. Members of Kai Tiaki Nursing New Zealand's practice article review commitee provide some suggestions to encourage potential nursing authors to share their practice and/or research with others.

Members of Koi Tiald Nursing New Zealand's practice article review committee review clinical articles sent to the journal by nurses. Currently, we receive a batch of articles two or three times a year and discuss them with the journal co-editors by teleconference. Generally, we reach a consensus on the suitability for publication of each article.

As committee members, we have suggested the review process could be made more robust and timely by following the example of other professional journals and using a blind peer review process. This involves sending out unnamed articles, usually to two nurse reviewers who are experts in the field being written about. Advantages of this system include a quality assurance process similar to other nursing publications and having a wider nursing input into the reviewing process.

We thought it would be timely to share what we have learnt through being on the committee, as we are keen to encourage submissions to the journal. We appreciate the effort required to write publishable articles and have some suggestions to consider if you are thinking about contributing. Our aim is to make the task more manageable and perhaps to convince some of you to share your ideas in Koi Tiaki Nursing New Zealand.

Reasons for non-publication

Not all articles submitted to the journal are published. This is for a variety of reasons--we receive theoretical assignments unsuitable for a wide readership, papers that are difficult to read, exemplars about readily identifiable situations, and articles that do not get through to the publication stage because they are not resubmitted after changes have been requested. And some articles are simply poorly written, with little structure or coherent theme or argument. While writing for publication is rewarding, it is also hard work for most of us and it is disappointing when an article is not published. Publishing also requires courage, as others may well disagree with your position. One suggestion that might cut down the work involved in developing a paper is to write with other people. Co-writing can reduce effort, provide support, and add an element of fun to the process.

Developing ideas over food and coffee or during a writing weekend in some pleasant location adds a social dimension to what is otherwise a solitary venture. This may be a luxury for many working nurses with raft of other responsibilities.

When choosing co-writers, in addition to social compatibility, it is also worth writing with people who have complementary skills. Clinicians, teachers and researchers can make great teams. Nurses employed in clinical practice have a wealth of knowledge about patient experiences, clinical problems and current evidence-based practices. Nurse educators and researchers can assist with literature searches and the writing process. The ongoing peer review process that is part of writing as a team will strengthen the article and increase the likelihood of publication.

Many of the articles we see have been written as assignments for undergraduate or postgraduate courses. Assignments demonstrate knowledge in relation to particular course learning outcomes, generally have a narrow focus and are written for the course teacher. Readers unfamiliar with the course concepts can find assignments difficult to understand. If you are thinking about submitting an assignment, firstly consider if your message will be of interest to the journal readers. The journal is circulated widely to registered and enrolled nurses, nurse assistants and health care assistants working in very diverse areas and the content needs to be of interest to a good proportion of this broad readership. An assignment will also need to be restructured so it reads as a journal article. The introduction should engage the reader's interest through making the connection between the topic, nursing practice and health care, white the discussion should cover up-to-date and useful information for practitioners, along with the latest debate and research in nursing where relevant.

Articles that stand out in the reviewing process are well constructed, welt written and accessible to a wide audience, with clear and simple communication of ideas. As the guidelines for contributors to the journal state, "the essence of good writing is simple, effective communication--a good story well told. Even the most complicated nursing care scenario, theory of nursing practice or research study can be presented in a straightforward, logical fashion". (1)

Principles for creating an easily readable article include using short sentences, an active voice and the simplest word choice. Reading your work aloud can help weed out superfluous words and highlight errors. Articles must also meet scholarly criteria, such as accurate referencing in the journal style.

Once an article has been accepted for publication, there is further editing work to be done by the co-editors. Using their journalistic skills they may re-work the article to ensure it flows well; edit for style, grammar and clarity, seek further clarification or extra information, and talk about possible illustrations. All this is done in consultation with the author/s.

Illustrating ideas and applying theory to practice through stories informed by your practice creates an authentic effect and adds interest. However, there are pitfalls in story telling in a professional context and some articles include an excessive amount of personal information about patients. For example, often descriptive information such as age, gender and ethnicity is included when describing a person in a case study. These descriptions need to serve a purpose in terms of the discussion around a disease process or management of nursing care. It is not enough to state that someone is Maori or Pakeha and then leave the reader to draw their own conclusions about what this means in regards to lifestyle and culture.

It is well documented and acknowledged that labelling, stigma and subtle forms of institutionalised racism shape perceptions about people. (2,3) Therefore, it is important to write within a clear cultural and ethnic context and identify how someone's ethnicity or culture relates to the discussion at hand. For example, an article about a 50-year-old Pakeha man with bowel cancer should [ink this information to relevant research and risk factors associated with ethnicity.

Confidentiality issues

It is also vital to preserve patient confidentiality when writing a case study or a reflective practice piece. We receive many exemplars with explicit details about very specific clinical situations. Even though pseudonyms have been used, the extraordinary nature of some health events mean the people involved would be readily identified by someone familiar with the situation. NZNO has developed useful guidelines, Privacy, confidentiality and consent in the use of exemplars of practice and journaling that are worthwhile reading when thinking about developing an article based on a case study or an exemplar. (4) The guidelines state that "matters of privacy, confidentiality and consent must be paramount in the use of exemplars ... Exemplars and journals use narratives about nurses, colleagues, patients, relationships, care and context. It is all too easy to breach privacy and confidentiality even if pseudonyms are used. A description of the entire context of a situation often results in those involved being identifiable. " (4) Nurse writers need to think carefully about how to construct case studies and practice exemplars. We work within professional and ethical tenets that clearly direct us to adhere to and follow legislation, guidelines and competencies around patient safety, privacy and professionalism. Genuine case studies have a vitality and authenticity which is engaging but details can be generalised to protect peoples' identity, along with describing the clinical context using generic information that does not compromise the privacy of specific patients and families. The article can focus on the management of congestive heart failure, rather than the management of John Doe's congestive heart failure, to demonstrate the knowledge underpinning practice decisions. Using personal details requires permission from the person, after a full explanation of how the information will be used and patients would need to approve the final article. However, white a patient may agree that their personal details can be communicated to others, it is important to consider the power relations between nurse and patient. Is the patient really happy with this or are they agreeing out of a simple willingness to oblige without fully understanding the implications? You would also need to be sure the person understands the consequences of publication in terms of potential toss of privacy. If you have doubts about any of these matters, we believe representative scenarios and case studies should be developed, rather than using stories about a specific person or family situation, to illustrate the application of knowledge in practice.

Research articles need to meet specific criteria before they can be published and, at times, we have had insufficient information to be able to judge the soundness of the research design and adherence to ethical processes. Covering all aspects of a research project can create challenges for the authors, as the journal has quite a tight word limit of about 2500 to 3000 words. A research article needs to provide information about the context of the research, other relevant research, the research design, the ethical review process, research findings and their implications in a concise and readable manner, given the wide array of journal readers. Some researchers have published abbreviated reports in the journal of studies published elsewhere, when copyright permits, in order to disseminate the research findings widely. However, the authors need to inform the journal co-editors if an extended version of the study has been published elsewhere.

It is not good practice for authors to submit the same article to a number of publications simultaneously, as this can result in the same article being published in different publications, undermining the credibility of all publications.

The suggestions raised in this article are in response to the review committee noting some recurring issues during the peer review process. In conclusion, think about your message: it needs to be relevant, contemporary and well researched. Write your article in a readable manner--Kai Tiaki Nursing New Zealand has diverse readers. Consider co-writing to increase the fun quotient along with developing collegial networks. Finally, take care how you represent people--protect confidentiality and avoid stereotypic categorisations. We hope the suggestions made will be useful, as every one involved with Kai Tiaki Nursing New Zealand is keen to encourage and support nurses and other health care team members to publish in the journal.

References

(1) NZNO (2005) Kui Tioki Nursing New Zealand Guidelines for writers, http://www.nzno.org.nz/Site/Professiona|/Kai_Tiaki/Guidelines.aspx. Retrieved 16/11/06.

(2) Dowd, T., Eckermann, A., & Jeffs, L. (2005) Culture and ethnicity. In 3. Crisp & C. Taylor (Eds.) Potter and Perry's Fundamentals of Nursing. (pp.122-142). Sydney: Elsevier.

(3) Wepa, D. (Ed.) (2005) Cultural safety in Aotearoa New Zealand. Auckland: Pearson Education New Zealand.

(4) NZNO (2005) Privacy, confidentiality end consent in the use of exemplars of practice and journaling, http://www.nzno.org.nz/Site/Resources/resource_list.aspx. Retrieved 16/31/06.