Transcript
A Conceptual Framework for Scientific
Writing in Nursing
Mary Regan, PhD, RN; and Ricardo Pietrobon, PhD, MD, MBA
ABSTRACT
Formal scientific writing is the central mode of communication used across disciplines to disseminate ideas and
persuade others of the validity of scientific arguments.
Dissemination of knowledge is important because it provides evidence for nursing practices and plays a critical
part in defining the boundaries of the discipline. Despite
its relevance to nursing, education about this essential
skill is not currently evidence based and relies on a combination of mentorship and trial and error. This is problematic because considerable time is required to become
proficient using that method, which slows down the dissemination of knowledge and creates a barrier for many
skilled individuals who aspire to a career in academics.
This article’s aim is to present a conceptual framework for
scientific writing that has been used in medical education
and to demonstrate how it could be used to structure educational programs to teach novice nursing scholars about
scientific writing.
Received: November 2, 2008
Accepted: November 19, 2009
Posted: April 30, 2010
Dr. Regan is Assistant Professor, University of Maryland, School
of Nursing, Baltimore, Maryland. Dr. Pietrobon is Associate Professor and Vice Chair, Department of Surgery, Duke University Health
System, Durham, North Carolina.
The authors have no financial or proprietary interest in the materials presented herein.
Address correspondence to Mary Regan, PhD, RN, Assistant
Professor, University of Maryland, School of Nursing, 655 W. Lombard Street, Baltimore, MD 21201; e-mail:
[email protected].
edu.
doi:10.3928/01484834-20100430-02
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F
or nursing scholars, effective scientific writing
skills are essential to disseminate their research
findings and ideas. By scientific writing, we mean
written scholarly articles, aimed at building knowledge
about a particular subject, that are published in a variety
of professional venues, such as journals. Dissemination of
scientific ideas is necessary to provide an evidence basis
for practice and also to establish a functional definition
of nursing. Shumway and Messer-Davidow (1991) demonstrated how over time the content of articles published in
a discipline’s professional journals promote understanding
about the discipline. That understanding acts to establish
the defining boundaries of the discipline (Gieryn, 1999).
This is evident in nursing, where successful publication
of scholarly papers in professional journals over the past
several decades has contributed to establishing the status
of nursing as a bona fide discipline (Donalson & Crowley,
1978; Fawcett, Watson, Neuman, Walker, & Fitzpatrick,
2001; Newman, Sime, & Corcoran-Perry, 1991).
However, despite the importance of scientific writing, to
date in nursing the majority of programs aimed at teaching novice researchers this essential skill have taken a
mechanical approach. By this, we mean they provide general rules of thumb and broad basic instructions, but they
lack a conceptual or theoretical basis and consequently
fail to provide a scientific justification for the type of writing style or structure that is being recommended. This is
demonstrated in the nursing literature, where a recent review of the related literature conducted in preparation for
writing this article failed to identify a single source aimed
at providing instruction devoted to scientific writing based
on a conceptual or theoretical model or framework. This
notion is further supported by anecdotal evidence that
suggests that most often, junior researchers learn how to
write scientifically through a combination of mentorship
and trial and error. Although it would seem that this approach has been relatively effective in the past, it takes a
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framework for Scientific writing
considerable amount of time and effort to achieve proficiency in this manner. It also slows down the dissemination of scientific knowledge and creates an unnecessary
barrier for many highly skilled individuals who aspire to
a career in academics. However, the lack of an evidencebased framework that could be used to teach this skill is
not warranted because there is a notable body of literature
about scientific writing, and the topic has attracted a significant amount of attention in other disciplines such as
sociology and psychology.
The purpose of this article is to fill that gap. We present
a theoretically based model that can be used for teaching
and analyzing scientific writing in nursing. The model is
taken from psychology, sociology, and rhetoric and is rooted in the view that human communication is a cognitive
phenomenon. We also demonstrate how the model could
be used in nursing to structure educational programming
aimed at teaching novice researchers how to write effectively. A similar framework is currently being used in a
problem-based certificate course about outcomes research
in medical education. The course has proven to be an effective method to expedite knowledge development necessary to increase the conduct and dissemination of clinical
research. Although it has been used in medical education,
to our knowledge it has not been used in nursing.
Historical Development of
Scientific Writing
Robert Boyle is credited with formalizing the structure
of the scientific manuscript (Sharpin, 1984). Boyle was a
seventeenth-century scientist whose experiments covered
a wide range of phenomenon from mechanics to alchemy
(Newman & Principe, 2002). He was troubled that the conduct of research was not uniform across scientists and by
the limited availability of historical data that could be used
to compare findings. To remedy this problem, he proposed
a systematic and objective approach to conduct research
and report experimental findings. The method he developed for conducting his own research included witness observation and meticulously detailed descriptions for the
experiments that he used to demonstrate rigor and build
credibility for his own experiments. His efforts established
a reproducible, nonmystical way to describe research that
differentiated science from other areas of investigation,
such as alchemy. Boyle applied the same precise principles
to his written reports, a practice that was soon emulated
by other scientists and that over time generated a formalized structure for scientific manuscripts.
Boyle’s original rules are still identifiable in modernday scientific articles (Knorr-Cetina, 1999), providing tangible evidence for the idea that certain text structures and
writing styles are adopted across disciplines over time.
This occurrence is congruent with selection theory that
was initially articulated by Toumlin (1972) and later extended by Campbell (1990) and Heyes and Hull (2001).
Selection theory asserts that in many domains, including
science, standardization results from the cumulative pro438
JNE0810REGAN.indd 438
cess of privileging certain styles (Bickhard, & Campbell,
2003). The theory challenges the notion that the practice
of science is purely objective, and it demonstrates how social constructions of science have evolved over time. As the
process of selection unfolds, variation is systematically
eradicated, leaving only styles that conform to the preferred standard for the group (Giere, 1987).
Selection theory was further refined by Gross, Harmon,
and Reidy (2002), who demonstrated how groups develop
preferred standards for scientific writing tailored to their
specific preferences through social pressure in the form
of collegial expectations. These expectations result in the
development of a set of rules for scientific writing that define the preferred standard for a particular group. Generally, the rules guiding development of preferred standards
across disciplines include unity of purpose; stylistic and
presentational simplification; model-based studies, using
mechanical and mathematical explanations; and the use
of visual illustrations such as figures, graphics, and models. These commonalities across publications foster “more
efficient communication, and produce stronger, more flexible argumentative strategies” (Swale, 1990, p. 43).
Preferred standards vary widely between disciplines,
due to the process of speciation (Swale, 1990). Speciation
refers to the refinement of a group’s preferred standard
for scientific writing that evolves among subspecialized
groups within a discipline. It results from increasing
specialization, which causes like cohorts to cluster into
groups, each requiring their own particular writing standard. Speciation is a relatively new occurrence in the field
of biomedical research; until recently, biomedical articles
largely converged to a single standard, but the increasing volume of research, as well as the emergence of new
fields of specialization, has prompted the rise of speciation. Slight initial differences in preferred standards for
the various subspecialties ultimately result in a unique
rhetorical style specifically suited to each of the subspecialty’s particular needs. By rhetoric, we mean the use of
formal arguments to persuade readers about the validity
of a finding or viewpoint. Therefore, rhetorical standards
are styles of structuring a formal argument that are privileged by a discipline (e.g., Boyle’s rules).
In scientific articles, the progress of speciation is seen
most clearly in the Introduction section, where multiple
studies have shown a progression toward what is commonly called the three-step formalism (Swale, 1990). In
this rhetorical style, the author first identifies the study’s
area of significance, which Swale (1990) termed “claiming
centrality” (p. 141). Then a critical gap is isolated in the
existing body of knowledge, so the author can present a
hypothesis that closes the gap or simply state the research
aim and questions that logically achieve the same goal.
This strategy is effective because it presents the argument
logically, first establishing the topic’s importance and then
situating it within the context of the field of research. In
this way, the reader is led naturally toward the research
aim and questions. The strategy is also effective because
it emphasizes the value of progressively building on preCopyright © SLACK Incorporated
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regan & pietrobon
vious studies. An example
Table
of the three-step formalization is provided in the
Dissection of the Introduction of a Published Report (Hodnett, 2002)
Table, dissecting the inText
Structural Role
troduction of a published
“In
recent
decades,
the
importance
of
measuring
satisfaction
Step
1:
Significance
research report (Hodnett,
with health care has been recognized. Patients’ views are
2002) to demonstrate the
Women’s satisfaction with the birth
being used by health care managers in assessing the quality
rhetorical standard in conexperience is important because (1)
of care, and by policy makers in making decisions about
temporary scientific writ“childbearing is the most common
the organization and provision of health services. Since
ing in nursing.
childbearing is the most common reason for accessing health reason for accessing health” and (2)
Although the mechaservices, assessments of women’s satisfaction with their care measures of satisfaction drive health
policy and the administration of care.
nism of speciation is
during labor and birth are relevant to health care providers,
clearly understood, it is
administrators, and policy makers” (Hodnett, 2002, p. 160).
not clear why one rhetori“Reviews of patient satisfaction studies indicate that patient
Step 2: Critical information gap
cal standard (e.g., threedemographics are among the most important determinants
The gap is that it is “unclear
step formalism) is selected
of satisfaction. However, it was unclear whether the findings
whether the findings of general
over another. We speculate
of general patient satisfaction studies were applicable to
patient satisfaction studies were
that the particular writing
satisfaction with the childbirth experience. Particularly
applicable to satisfaction with the
controversial
were
questions
about
the
influences
of
labor
styles of key researchers
childbirth experience.”
pain and pain relief methods on satisfaction with their
may influence that process.
childbirth”
(Hodnett,
2002,
p.
161).
It is likely that researchers
who use easy-to-read lan“Through a systematic review of the childbirth satisfaction
Step 3: Hypothesis
literature, I addressed the following questions: What has
guage and a clear writing
been measured, and how and when has it been measured?
style would be emulated
What roles do pain, pain relief, the use of specific pain relief
by others and their style
methods, and other factors play in determining how satisfied
could become a preferred
a woman will be? How is satisfaction with childbirth related to
standard over time. In adother childbirth outcomes?” (Hodnett, 2002, p. 161).
dition, researchers who
work with many students
or associates are likely to
be perceived as leaders in their fields and subsequently,
ticularly common in western industrialized cultures is
their style could be judged as influential or advantageous,
the three-step formalism. Use of that form allows readwhich would prompt others to duplicate it, thereby propaers to anticipate what will come next, which in turn frees
gating the writing style. Finally, decision makers such as
cognitive energy so that they can concentrate on the
journal editors are also likely to privilege rhetorical styles
content. The application of similar principles can be found
that they find effective, increasing the likelihood that it
in other mediums. For example, television advertisements
will be replicated. Ultimately, whatever the forces drivuse a similar standard structure that is aimed at showing speciation in nursing, more than a century of scientific
ing how a product is relevant to us, why we need it, and
publication and the recent explosion of available informahow happy we will be once we have it. What is important
tion have set the stage for the powerful, cumulative effects
to note is that strategies such as these may not be truly
of selective forces.
universal, as other cultures may have different messagResearch about reader expectations (Gopen & Swan,
ing structures. However, they are effective in Western
1990) provide another important factor related to preindustrialized societies and are well represented in the
ferred rhetorical styles. Gopen and Swan (1990) demonpreferred standards across the health science disciplines,
strated that certain rhetorical or writing structures can
including nursing.
actually improve reader understanding. They showed that
Reader expectations and preferred standards also rewhen reading a scientific text, readers must divide their
late to scientific writing on a much more basic level and
attention between understanding the content and parsare pivotal factors that influence the publication success
ing the structure. Because an individual’s cognitive enthat novice researchers achieve. This is because reader
ergy (e.g., memory, attention) is more or less fixed, when a
expectations play such a key role in comprehension, and
reader spends more energy navigating the structure, less
preferred standards establish the structure to which manremains to understand the content. Consequently, the
uscripts must conform. The relevance of this is demonmore that an article is structured using a common format,
strated in anecdotal evidence that shows that even when
the more cognitive energy is available for the reader to
novice researchers include all the relevant facts in their
comprehend what the content means.
first manuscripts, peer reviewers often report a perception
There are many examples of rhetorical strategies that
that something is wrong with the manuscript. The perare used to manage the cognitive burden imposed by text
ception is generally subliminal; reviewers simply report
structure. As previously described, the one that is parfeeling tired, bored, or bothered, although the underlyJournal of Nursing Education • Vol. 49, No. 8, 2010
JNE0810REGAN.indd 439
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framework for Scientific writing
ing cause is not clear to them. This so-called “doesn’t look
right” phenomenon occurs because the structure is unfamiliar, which forces the reviewer to focus more intently to
grasp the content (Gopen & Swan, 1990). This phenomenon is not evident when the writing style conforms to the
standard preferred by that discipline.
When considering a theoretical framework for scientific writing, it is important to remember that because
text structures are socially determined, they are specific
to certain types of research and historical moments. Subsequently, educational programs about scientific writing
must be tailored to meet current preferred standards for
the specific discipline. Biomedical computational ontology
is one method that has been used to identify the preferred
standards for a specific discipline or target journal or audience (Pietrobon et al., 2007). The process breaks down the
structure of various types of scientific studies (e.g., random
controlled trials) into discrete, interrelated informational
units, revealing the underlying structure organizing the
content. In this way, the text structures that comprise the
preferred standards can be made readily apparent.
A Conceptual Framework to Teach
Novice Researchers Scientific Writing
The conceptual framework that we are proposing to
teach novice nursing researchers scientific writing has
been used to structure the scientific writing components in
a problem-based certificate course in outcomes research.
The international program targets medical education and
is hosted by Duke University Medical Center. It is composed of a total of 14 modules, 4 of which directly relate
to scientific writing. Although the program has not been
empirically tested, its effectiveness has been demonstrated by the impressive volume of publications in multiple
fields produced by participants who have completed the
program (Pietrobon et al., 2007).
The framework we are proposing comprises four principles that direct distinct learning activities in sequential
phases. The first is the Rhetoric Principle, which concerns
the relationship between structure and content. Although
the content of a text is immediately apparent, the structure is a latent characteristic that may not be evident
until it is deliberately identified. Furthermore, each discipline’s preferred standards favor specific structures; for
example, in the biomedical sciences, the most commonly
used sequence for the introduction is a statement of significance, followed by the identification of an information
gap and a review of the pertinent literature. The format
may vary somewhat in different journals, but in general,
potential authors need to conform to that standard structure. Identifying the preferred standard and teaching
novice researchers how to use it in their writing increases
the likelihood that their manuscripts will be accepted for
publication.
Learning activities in this phase are intended to help
students clarify the difference between content and structure. This is a complex task, given that the two can be
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hard to tease apart; however, it is fundamental to teach
novice researchers about scientific writing. For example,
when a manuscript begins by stating that “Social determinants and intractable health disparities among different
populations rank at the top of challenges for health care
leaders” (Lucey & Maurana, 2007, p. 179), the authors
are commenting on health disparities (content) while also
stating the significance of their topic (structure). Structure
differs from content in that a given structural framework
can be made to fit any type of content. Similarly, the sentence “Pressure ulcers are complex chronic wounds and a
frequent cause of morbidity in elderly subjects in hospitals and nursing homes” (Barrois et al., 2007, p. 267), like
the previous example, is also a statement about the significance of the topic, but in this case the content is completely different. Understanding the difference between
content and structure is the first step toward effective scientific writing. It is important for students to learn that
fundamental distinction before moving on to the second
principle.
The second principle is called the Ethnographic Principle because its methodology is derived from ethnographic
studies. It is related to computational ontology in that its
purpose is to identify the best way to construct a formal
argument within a specific discipline (Pietrobon et al.,
2007). This principle focuses on the identification of a
given field’s preferred standard text structure. As stated
previously, the development of preferred standards is a
social, rather than objective, process; researchers conducting similar analyses in different fields might present their
findings in completely different ways. It is for this reason
that universal guidelines are not applicable to scientific
writing because although general rules for effective writing can provide useful advice for scientific writing in general (Alley, 1996; Matthews, 2007), they are insufficient
for the particulars of each discipline. Instead, in order to
make apparent the specific structures and standard that
are preferred, it is necessary to analyze a series of texts
from target journals to identify their underlying structure.
In this phase, students analyze a report that is similar,
in terms of structure and target journal, to the paper they
intend to write, although it can be different in terms of
content. For example, a student preparing a qualitative
study for publication in the Journal of Nursing Education
would examine a previously published qualitative article
from that journal, without regard to its content. The analysis is aimed at dissecting the manuscript in a linear fashion to identify the structure. This process starts by first
identifying discrete informational components, or text
blocks. Text blocks are defined as groups of words or sentences that play a single rhetorical role or purpose within
a manuscript (Hoey, 2001). For example, most scientific
articles will contain text blocks related to the significance
of the topic, background to the problem, research method,
and so on. Identification of the text blocks provides important insights about the structure that helps build an understanding about the underlying structure. In particular,
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Figure. Examples of rhetorical purpose and their relationships of the main text blocks across sections of a published article.
this analytic step will make apparent the relationships between text blocks. The relationships between text blocks
include descriptions that provide the basis for a claim or
compliment it, report a result, or provide additional support for an argument. For example, text blocks that define the information gap also lay the groundwork for the
block dedicated to presentation of the research question.
An example of rhetorical purpose of text blocks and their
relational nature across a manuscript is presented in the
Figure.
Cross-checking students’ coding of text blocks is timeintensive—a commodity that few instructors have in
abundance. One way to speed up this process is to use
papers that have been precoded. The students then code
a blank version of the article and then compare their findings against an answer key. There will always be small
discrepancies across coders, given that the exact boundaries and purposes of text blocks are somewhat subjective;
however, the strategy helps manage the workload for the
instructor, which is an equally important consideration for
any educational framework. The point of the exercise is
not to achieve complete agreement, but rather that the
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students learn the general principles about structuring
written content by actually identifying text blocks in published work and then comparing their findings. In this
way, they will be guided to review the rationale behind the
answers that will promote a better understanding about
text structure.
Although it may seem on the surface that the first two
principles are similar, the second principle builds essential
knowledge for several reasons. First, students may appear
to understand the differences between structure and content, but the analytic process provides tangible evidence of
their application of that knowledge. Commonly, students
do not succeed in their initial attempts to analyze manuscripts for structure. This may be because it is normal to
read for understanding, rather than performing a metareading to understand why we understand. Students may
require several sessions to learn this technique. Second,
students are typically surprised by how much they can
learn about text structure by formally coding each portion
of text. This type of analysis uncovers the nuts and bolts
of various rhetorical strategies, as well as common flaws
in their application. Past practice has made us realize that
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is helpful if the analyzed texts are similar to the student’s
target texts in terms of structure, the target journal, and
if possible, content because preferred structures do vary
among journals and even fields of research.
The third principle is the Recognition Principle. It is
focused on the fact that effective writing requires the ability to distinguish between optimal and suboptimal writing
styles. Given that what is considered an “optimal style”
will vary over time and in response to social developments, it is vital to use contemporary publications. In this
phase, students are taught how to distinguish between
good and below average text blocks by analyzing each
section of a manuscript (Introduction, Methods, Results,
and Discussion). The Introduction and Discussion sections
can be analyzed in a fairly standard fashion because they
tend to be similar across research fields, but the Methods
and Results sections are highly specialized for each field
and research method. For those sections, it is necessary to
provide specific examples for each type of report, such as
qualitative research, randomized clinical trial, or cohort
study.
Exercises aimed at teaching students about the Recognition principle involve asking questions such as:
A randomized controlled trial is focusing on the comparison between two prevention strategies for falls in the
elderly, and you are writing the Introduction section focusing on the significance of your topic. Based on the following
examples, please select the one that would best fit the purpose of the significance section within the manuscript.
Students then choose from a set of paragraphs that all
pertain to the same content but that serve different structural roles describing, for example, the study’s objective or
a literature review in support of the information gap.
Although it would be ideal if students write their own
sentences, reviewing them would require a vast amount of
instructor time. Therefore, strategies such as standardized
answers and computer grading allow this type of activity
to be scalable. An example of a program aimed at achieving this purpose was developed by a group of researchers
at Duke University. WriteSim TCExam is an “open source
text simulation environment for training novice researchers in scientific writing” (R. Pietrobon, personal communication, July 6, 2009). It is a Web-based program that
provides participants with a set of examples from published manuscripts and requires them to select the best
answer. The program provides the students with feedback
on the answer they selected and a test result summary.
The program is being implemented as part of certificate
course in outcomes research at Duke-NUS Graduate Medical School in Singapore. In a preliminary evaluation of
WriteSim, 70% of the participants (n = 14) reported that
they thought their understanding of the rhetorical purpose of the types of sections in scientific manuscript was
improved, and that overall completion of the program improved their understanding of scientific writing (Shah,
Shah, & Pietrobon, 2009).
The fourth principle is called the Practice Principle. It
is focused on recognition of the difference between learn442
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ing to recognize text structure patterns and actively using
those models in our own writing. In this phase, students
write a scholarly article. It is only in this final phase that
mentors are required to provide guidance. The role of mentor requires a large commitment of time and energy that
greatly increases the cost of a program such as this. The
program that we are proposing here purposively stages
the first three phases to serve as a screening mechanism,
as less dedicated students tend to drop out earlier and
therefore the instructor is unlikely to waste time in the
final phase. In addition, the initial phases introduce students to essential new knowledge, saving the mentor the
need to teach expository material.
Mentor critique of the students’ written work helps students to recognize optimal and suboptimal text structures
as they work to conform to their field’s preferred standards. As they write, they need to break their project down
into discrete text blocks, which they title with appropriate
subheadings. The subheadings serve two purposes: they
ensure that students adhere to the prescribed sequence
and they expedite the mentors’ assistance, helping them
judge whether the student’s text conforms to the proper
structure. The discrete text blocks should relate to the
basic structural elements of the manuscript and include
subheadings specific to the section. For example, in the
Introduction text block section, the student should include
the significance of the topic and what is currently known
about it, and identify the gap. Similarly, in the Literature
Review section, students should report the literature supporting the topic and information lag or gap. The same
principle should be applied for the Methods, Results, and
Discussion sections of their article. To further facilitate
the student-mentor exchange, texts can be written in virtual environments, which are accessible simultaneously
by both parties at times that work best within their schedules.
We would suggest a Web-based platform for this program. It could consist of four stages, each representing the
principles discussed above. These are not the only valid
principles on which to form the basis of such a program,
nor do the steps outlined above represent the single best
means of teaching them. Rather, we consider this lesson
plan to be one of many possible teaching strategies, each
of which should be empirically tested to determine its suitability for a given set of educational goals.
Conclusion
The four-phase educational program that we propose
here is an attempt to formalize, and proportionately scale,
an effective training regimen for novice researchers. It is
intended to establish a conceptual foundation for education about scientific writing using an evidence-based approach, rather than traditional methods that rely on subjective rules of thumb. Systematic study of the underlying
text structure allows us to better understand the writing
process and may explain outstanding questions. For example, in the problem-based certificate course used in
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medical education, we found that participants often fully
grasp the difference between structure and content, yet
they often could not demonstrate that in practice. Research is needed to understand the discrepancy between
understanding and doing. Research about this topic may
also help explain how it is that expert scientific writers
can apply these concepts unconsciously, with little awareness of their underlying thought processes. We propose
this conceptual framework as a starting point to begin the
process of rigorously evaluating the topic in order to determine the most effective way to teach nursing researchers
this fundamental skill.
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