May/June Supplement 2001, Volume 5, Number 3

Researching and Reference

Patricia Buchsel, RN, MSN, FAAN

Documenting references in a journal article or textbook chapter requires an organized approach of selecting appropriate sources, citing the content correctly, and formatting the text and references properly. Using computerized databases to conduct a literature search can make the process of researching a topic more manageable. Once information that will be included in a manuscript has been identified, the author must pay careful attention to citing the original author's work in a mindful way to avoid scientific misconduct. Permission to use copyrighted work must be obtained, and all statements requiring a reference must include a source citation.

One of the greatest satisfactions that nurses can have is realizing the joy of their first publication. This accomplishment is born from countless hours of creative thinking, library searches, writing, and rewriting. Much is learned during this process as knowledge is transferred to paper. However, excellent content alone is not sufficient to ensure publication. An author soon learns that bringing a manuscript to publication is largely dependent on well-researched work supported by reputable and accurate information sources.

References often are falsely seen as a secondary concern of writers, but they are critical components of a manuscript. References or citations are used not only to document information sources but also to expand and confirm the author's knowledge and acknowledge others' prior work (Iverson et al., 1998). Editors and reviewers often scan a manuscript's references for clues about the overall quality of the manuscript. References that are obscure, outdated, poor in quality, or in improper format alert the editorial board to the possibility that weaknesses also may be present elsewhere in the manuscript.

Nurse authors of today, in contrast to those of even a decade ago, have numerous resources for literature searches within easy reach. In fact, selecting the most pertinent materials from the critical mass of healthcare information initially may appear to be overwhelming.

The most common resources for literature searches are biomedical textbooks, journal articles, abstracts from scientific meetings, and monographs. Novice nurse authors have a tendency to rely on these resources for their literature searches and should not overlook other types of work that are rich sources of information (see Table 1). For example, letters to the editor provide scholarly discussions about published articles or pertinent healthcare issues (see Ream & Richardson, 2000; Winningham, 2000). Editorials often are overlooked information sources; they may be inspirational (see Baird, 1985), address current or provocative issues (see Carroll-Johnson, 2000), discuss ethical issues (see Angell, 2000), or comment on controversial therapies (see Gluck & Stewart, 2000). Other examples of less commonly used but valuable information sources include package inserts, which provide comprehensive drug and product information, and patients' medical records, which may provide guidance for developing a case study.

A practical but only an initial approach in conducting a literature search is using electronic medical libraries to scan journal abstracts, university library book lists, and other sources. Most university and public libraries offer classes in conducting basic and advanced literature searches, and medical librarians are available to offer assistance to nurse authors.

Identifying a reputable Internet site is imperative to access authoritative and ethical information on the World Wide Web. Gomez, DuBois, and King (1998) recommended accessing individual and organized groups of cancer-care providers such as ONS Online, hospital and government healthcare agencies (such as the National Institutes of Health), and universities. Anonymous sources should be avoided.

Textbooks

Textbooks are an important source of information for authors developing manuscripts and can serve as an excellent starting point in the information gathering process. Textbooks are especially helpful to authors writing about an unfamiliar topic because a textbook provides a global overview of a particular topic. The major disadvantage of textbooks is that the content becomes outdated rapidly, making it incumbent upon the author to complement data taken from books with more current information from journals and other sources. Most medical libraries have computerized indexes of textbooks, and the most widely used texts often are kept in a reserved area and not circulated.

Journals

Journals are the most easily accessed and current sources of scientific information. The National Library of Medicine contains more than 11 million articles from more than 4,000 biomedical journals and can be accessed online at http://www.nlm.nih.gov/siteindex.html/. Important to note, however, is that all journals are not created equal. In other words, the quality of a particular journal is based on objective and subjective opinions. Many authors agree that the most respected journals are those that have a rigorous peer-review process. "Peer review" refers to the process of using peers to review manuscripts. For instance, oncology nurses volunteer to serve as reviewers for oncology nursing journals. Nonspecialty journals may have a vast array of reviewers but send manuscripts only to those reviewers with expertise in the manuscript's content area. Some journals use a "blind peer-review" process in which the reviewers' names are not made known to the author. Others use a "double-blind peer-review" process in which the reviewers' names are not made known to the author and the author's name is not revealed to the reviewers. Some journals are not peer reviewed but have an editor and editorial board with expertise in the topic areas that the journal addresses.

Journal articles can be searched via computerized databases at medical libraries or from home. MEDLINE (http://igm.nlm.nih.gov/) and PubMed (http://www.ncbi.nlm.nih.gov/PubMed/) are two recognized databases that are accessible online at no charge via the National Library of Medicine. The Cumulative Index of Nursing and Allied Health Literature can be accessed online for a fee at http://www.cinahl.com/.

Journal Articles

Various categories of journal articles exist. Distinguishing among them accelerates the author's review of the literature and final article selection. Journals generally contain review articles, empirical studies of original research, or theoretical articles (American Psychological Association [APA], 1994; Iverson, Flanagin, & Fontanarosa, 1997). The electronic age has made it tempting to read the article abstract and not the entire article; however, this approach is problematic. Failure to read the original work in its entirety can produce a weak manuscript because the author may miss valuable information or misinterpret information.

Review Articles

Reading the most current review articles is an excellent start for those researching the literature. These articles can guide readers to important histories, research reports, and classic papers that have shaped the state of the art for many disciplines. Many times, a review article will reveal gaps in the discipline. For example, the bone marrow transplant literature seldom has addressed donor concerns. Thus, an author may wish to explore this subject. The goals of a review article are to

• Define and clarify the problem.
• Summarize prior research to illustrate the state of the subject.
• Illustrate relationships, contradictions, gaps, and inconsistencies in the literature.
• Suggest the need for future work in the subject matter (APA, 1994).

Research Articles

A review of the most current research is mandatory when writing a manuscript because published research reports are the mainstay of clinical communication (APA, 1994; Iverson et al., 1997). Major components of a research article are written in a consistent format, and their consistent organization makes it easy for readers to find specific information (see Table 2). One of the most overlooked areas of research articles is the discussion section, which elucidates the study's strengths and weaknesses, implications of the study findings, and need for further research. These areas may prompt ideas for manuscript topics.

Descriptive Articles

Descriptive articles describe a certain topic, such as a disease, treatment, or clinical phenomenon, and are more limited in their scope than a review article. A description of a new procedure, a case study, and a review of a particular medication are all examples of descriptive articles.

Theoretical Articles

Theoretical articles are those in which the author extrapolates from existing research in a given subject to the formation of new theory or an analysis of an existing theoretical construct. The sections of the theoretical article are presented by relationships rather than chronology (APA, 1994; Iverson et al., 1997).

One of the most sensitive and confusing areas of publishing is proper use of another author's work. Quotations, artwork, and ideas always must be cited. Items not requiring citations are factual information in the public domain and commonly held knowledge (APA, 1994; Iverson et al., 1998).

Quotations

The original author's specific words always are noted in the style format indicated by the journal or book editor. For example, APA format differs slightly from the American Medical Association's guide for authors (APA, 1994; Iverson et al., 1998). Direct quotations should be limited because numerous or lengthy quotes give the impression that the manuscript author is taking a less than creative or well-researched approach to presenting the subject topic.

Paraphrased Material

Accurate distinctions between directly quoted and paraphrased material is another area that requires close scrutiny. Paraphrased work is a restatement of a passage from an original published author's work into a manuscript and must be cited. Furthermore, the manuscript author must be extremely careful that words or word groupings expressing ideas are not almost identical to the cited source. This practice is referred to as a mosaic because the original author's unique ideas and words are moved around without being cited. This strategy implies plagiarism (Ingelfinger, 1976).

Reproduced Works

Sometimes an author may locate a table, illustration, flowchart, or figure that would be ideal to include in his or her own manuscript. To publish a previously published item, the author must secure permission to reproduce the work. The permission request is directed to the entity holding the copyright to the original work; in many instances, this is the publisher. However, in certain instances, such as a symptom assessment tool, the copyright might be held by the individual who created the tool or by the institution employing that individual. Occasionally, the copyright symbol (^©) is contained within the item that an author wishes to secure permission to use. If this is the case, the name of the person or entity holding the copyright will appear along with the copyright symbol and the author must contact that party directly to request permission to reproduce the item. If the copyright symbol does not appear within the item, the author should consult a journal's masthead (the page that lists the journal's editor and editorial board) or a nearby page and look for information on the process for securing permissions (this information is often under the heading "Permissions and Reprints"). If the item appeared in a textbook, the author must contact the publisher of the text (contact information and the procedure for securing permissions often is available on textbook publishers' Web sites). Although some publishers and individuals holding copyrights will grant permission without charging a fee to the author, others charge a fee, which typically ranges from $25-$50. The entity holding the copyright usually dictates the language to be used in the manuscript to acknowledge that permission to reproduce an item has been sought and granted. A commonly observed statement is "reproduced with permission of X Company. All rights reserved."

Adapted Works

Adapted works usually are published illustrations, figures, or tables created by an original author and changed in minor ways for the use of the manuscript author. The nature of an adapted work can be difficult to assess and often is subject to judgments by authors, reviewers, and editors. When in doubt, a prudent author requests permission to use adapted material and includes a statement acknowledging the original source of the information in the manuscript. For example, an adapted table might include the statement, "Adapted with permission from Smith (2000)." If a manuscript author creates a table that incorporates information based on the narrative text of multiple journal articles, then the sources are cited but permission is not required. For instance, the legend that appears below a table might say "Based on information from Jones, 2001; Lee, 2000; Marks, 2001." Authors often overlook the fact that it may be easier to create original tables and graphics, thereby avoiding the time and expense of obtaining permission.

Plagiarism

Using authors' published or unpublished ideas without crediting them is a serious misconduct called plagiarism. Plagiarism occurs when the author presents as his or her own the sequence of ideas, the arrangement of material, and/or the pattern of thought of another author without giving credit to the original author.

A general area not requiring documentation is factual information that is considered to be in the public domain. Examples are birth and death dates of well-known figures and generally accepted dates of historical events. For example, if an author wrote "Florence Nightingale was born in 1820" or "the Oncology Nursing Society was founded in 1974," citations are not required. In general, factual information contained in multiple standard reference works usually can be considered in the public domain (Iverson et al., 1997).

Information that is well known and non-controversial also does not require a reference. For example, statements such as "venous access devices are used to deliver chemotherapy" or "nurses conduct physical assessments and provide teaching" do not require references. Figure 1 outlines questions that assist in determining whether a reference is needed.

Just as it is important to appropriately reference the sources of information, authors also must not over-reference a manuscript. Most statements are followed by a single reference; in some cases, more references are needed, but, generally, two or three are suficient to support an author's contention. Multiple instances of citing multiple references at the end of a statement may raise an editor's concern about an author's ability to cite information sources appropriately.

Primary and Secondary References

Another potentially confusing area is distinguishing between a primary and secondary reference. A primary reference is the original source and must be read by the manuscript author before it is used as a reference in the manuscript. A secondary citation refers to information taken from an article or textbook in which the author has cited an earlier source. The following are two fictitious examples.

• Statement in a textbook: Approximately 15,000 women were diagnosed with cervical cancer in 2000 (American Cancer Society, 2000). Reference: American Cancer Society. (2000). Cancer facts and figures--2000. Atlanta: Author.

This is an example of a primary source; the textbook author is referring to the original, or primary, source of the information.

• Statement in a manuscript: Approximately 15,000 women were diagnosed with cervical cancer in 2000 (Jones, 2001). Reference: Jones, E. (2001). Cervical cancer. A comprehensive text. City, state: Publisher.

This is an example of a secondary source; the manuscript author is referring to a textbook for this cancer statistic.

These concepts confuse many writers and are the cause for manuscripts to be revised and delayed publication. Using secondary references alerts an editor that the author may not have a grasp of the subject material, thereby raising questions about the overall accuracy and validity of the submitted work. Insensitivity to distinguishing between primary and secondary references can be the cause of considerable discussion between the author of the original source and the manuscript author (see Ream & Richardson, 2000; Winningham, 2000).

Currency of References

Two general rules exist about the publication dates of references. The first is that a quality manuscript cites references that are as timely and current as possible, and a general rule of thumb is that references published within the past four to five years are used. The second rule permits articles of any age to be cited as a reference as long they are "classics," or articles that describe landmark studies, present information that had a significant impact on healthcare delivery, or contributed greatly to the knowledge base of nursing or another discipline.

Accuracy in a manuscript refers to the correctness of the subject matter cited; the precision with which the references, tables, and figures agree with the text; and conformity with the format dictated by the editor or publisher. Accuracy in reporting content and citations is critical to publication. The reputation of the author, editor, and publication is largely dependent on manuscripts that faithfully and consistently report accurate data. Bibliographic inconsistencies, such as an incorrect volume or year, frustrate those seeking additional information (Iverson et al., 1997). Missing data has a direct reflection on the author and also alerts the reviewers and editor that the author may be equally remiss in misquoting or misrepresenting the content material, thereby raising concern about the worthiness of the entire manuscript.

Accuracy of references is the responsibility of the author and can be ensured in only one way. Each reference must be rechecked with the original article or source for content, author, year of publication, title, and publishing data (APA, 1994). Information referenced to an Internet site must be rechecked just before the manuscript is sent off for review to ensure that the Web site address is still current. Reviewers and editors often read cited references and check their citations to assess the accuracy of the author. Thus, careful attention to detail will spare the author embarrassment and not delay publication.

One nurse author described the writing process as "the agony and the ecstasy" (Maxwell, 1980). The "agony" can include reading numerous articles, searching for missing volume and page numbers, attempting to obtain permissions from unresponsive publishers, and dealing with technical difficulties. The "ecstasy" is reading one's own publication and being acknowledged as an expert. In between these two stages are the life-long relationships built from interactions with mentors and supportive editors. Rose Mary Carroll-Johnson, RN, MN, editor of the Oncology Nursing Forum (ONF), encourages authors to speak up for the support needed to prepare manuscripts (Carroll-Johnson, 1993). Susan Baird, RN, MPH, MA, former ONF editor, applauds published and unpublished writers in her classic editorial, "Unsung Heroes." She stated, "This is . . . about . . . people who have gathered their courage, perseverance, inspiration, or whatever it takes, and have put fingers to pen or word processor. They have actually submitted something for publication consideration. Authors are the unsung heroes of our specialty. They give us new ideas, broaden our horizons, and frequently provide assurance that we are on the right track in our practice after all" (Baird, 1985, p. 11).

American Psychological Association. (1994). Publication manual of the American Psychological Association (4th ed.). Washington, DC: Author.

Angell, M. (2000). The pharmaceutical industry--To whom is it accountable? New England Journal of Medicine, 342, 1902-1904.

Baird, S. (1985). Unsung heroes [Editorial]. Oncology Nursing Forum, 12 (2), 11.

Carroll-Johnson, R. (2000). Financial disclosure: Why we should care [Editorial]. Oncology Nursing Forum, 27, 421.

Carroll-Johnson, R. (1993). An economy of words. Oncology Nursing Forum, 20, 1153.

Gluck, S., & Stewart, D. (2000). High-dose therapy in breast cancer. Out of favor but not out of promise. Bone Marrow Transplantation, 25, 1017-1019.

Gomez, E.G., DuBois, K., & King, C.R. (1998). Improving oncology nursing practice through understanding and exploring the Internet. Oncology Nursing Forum, 25 (Suppl. 10), 4-10.

Ingelfinger, F.J. (1976). The case of the Hoover paper. [Editorial]. New England Journal of Medicine, 14, 896-897.

Iverson, C., Flanagin, A., & Fontanarosa, P.B. (1997). American Medical Association manual of style: A guide for authors and editors (9th ed.). Philadelphia: Lippincott, Williams & Wilkins.

Iverson, C., Flanagin, A., Fontanarose, P.B., Glass, R.M., Glitman, P., Lantz, J.C., Meyer, H.S., Smith, J.M., Winker, M.A., & Young, R.K. (1998). American Medical Association manual of style: A guide for authors and editors (9th ed.). Chicago: Williams and Wilkins.

Maxwell, M. (1980). The agony and the ecstasy: How to successfully write and publish your paper. Oncology Nursing Forum, 7 (3), 41-47.

Ream, R.E., & Richardson, A. (2000). The authors repond. [Letter to the editor]. Oncology Nursing Forum, 27, 425-426.

Winningham, M. (2000). Reader clarifies concepts of structured exercise programs in managing fatigue. [Letter to the editor]. Oncology Nursing Forum, 27, 425.

Patricia C. Buchsel, RN, MSN, FAAN, is an oncology nurse consultant and a clinical nurse instructor in the School of Nursing at the University of Washington in Seattle. She also serves as chair of the ONS Publishing Council.

Author Contact: Patricia C. Buchsel, RN, MSN, FAAN, can be reached at 18503 SE 64th Way, Issaquah, WA 98027 or at pbuchsel@nwlink.com.

Researching and Referencing

• Excellent content alone is not enough to ensure publication; publication also depends on well-researched writing supported by reputable and accurate references.
• Information sources for manuscripts include biomedical textbooks, journal articles, Internet sites, meeting abstracts, letters to the editor, editorials, package inserts, and medical records, among others.
• Editors and reviewers often scan a manuscript's references for clues about the overall quality of the manuscript.
• Careful attention must be given to correctly referencing information sources to cite them appropriately and avoid allegations of plagiarism.
• Using primary references in which original work is cited is preferable to using secondary references.
• References must be current (published within the past four to five years unless a classic), accurate, and cited appropriately to enhance the likelihood of publication success.

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