Improving Care of Older Adults: You Can Make a Difference

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• The Benefits of Publication
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• Dr. Barbara Resnick

We are all acutely aware of the increasing numbers of older adults both in the United States and internationally. At the same time, we are continually faced with challenges to providing optimal care to these individuals. With the impending implementation of Medicare Part D, we must now monitor what drugs will be covered for patients depending on their pharmacy coverage and take care to respect the cap on Medicare Part B days of physical, occupational, and speech therapy. In the face of these challenges, it is particularly important to share innovative tricks of the trade and strategies to overcome the many care-related challenges we face. That sharing is best done through development and publication of manuscripts.

Geriatric Nursing (GN) is committed to providing timely information on new and innovative programs and practices in clinical care and administration. We also report clinical research findings that are applicable to practice. GN strives to provide pertinent, pragmatic and newsworthy information; continuing education; and resources and guidelines to maximize caregivers’ ability to help elders capitalize on their achievements, prevent or modify ill health, and complete the tasks of late life in ways that add to its enjoyment and meaning. We invite you to share your clinical knowledge, experiences, and pilot research of new and innovative strategies of care through publication. In so doing, your work is disseminated to 5,702 subscribers, with almost 2,000 of those going to institutions; it is accessed online with more than 28,000 full-text downloads and is noted in reference managers such as PubMed.

Take a moment and evaluate your motivation, specifically, your self-efficacy and outcome expectations for writing. How confident are you that you can develop a manuscript and successfully submit it for review and withstand the potential criticism? How strongly do you believe there is a benefit to publishing? Do you feel stressed and uncomfortable just at the thought of writing? What is it that truly stops you as you sit down and try to put pen to paper? These issues must be addressed on an individual basis and attempts made to overcome the unpleasant sensations associated with writing while strengthening your belief in your ability to author a paper as well as in the benefits of publication to you, your institution, and the care of older adults.

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The Benefits of Publication 

I will not reiterate the benefits of writing at the academic level, for these may or may not be valid beyond the individual academician. More important, publications on specific clinical problems or innovative interventions generally help the writer codify and confirm practice beliefs and activities and correct any lingering misconceptions. Sometimes, for example, we believe we understand a clinical process or procedure until we try to write it down or explain it to someone else. I recently had this experience writing a paper about screening for physical activity. Although I was aware of the many musculoskeletal risks associated with exercise, I was not aware of the vast amount of clinical evidence to support this. At the same time, there was excellent support for how to prevent these complications. Reviewing this work strengthened my convictions and allowed me to make a more cogent argument in support of exercise for older adults.

Publication on a topic of clinical or research interest opens the possibility that others will read and respond to that work. This helps writers identify new ideas and initiate a dialogue and debate on the topic and also helps them expand and grow professionally. Sometimes it is the review process itself that leads to these wonderful discoveries through the suggestions of an astute reviewer. Other times it is after publication and through letters from interested individuals. These comments can stimulate a reanalysis of the data and encourage the writers to move beyond their current thoughts and practices. It is through such reviews and publications that I have been stimulated to revise measures, complete alterative methods of reliability and validity testing, and learn new management of clinical problems.

Acceptance of a manuscript for publication is rewarding in and of itself. I fondly remember my first acceptance, which was from GN. I thought I had reached the peak of my career. Although there likely will not be any financial reward for your work, seeing the published paper is reward in itself.

So how does one get started? The first requirement is a passion and an idea in a specific area of practice—clinical or administrative—related to the health care system, teaching, or research. Review the work that has been done previously and make sure you are adding to that work, rather than simply reiterating what others have said. Articulate in your own mind the point(s) you want to make. This might be a new way of assessing or managing pain with positive clinical outcomes you have noted in your practice or an exercise intervention that effectively decreases falls. It might be new way to consider staffing and setting staff ratios. This purpose should remain central to how you proceed and will help prevent tangential writing. Review the guidelines for authors for GN at www.gnjournal.com, as well as some additional references if it is your first time writing a manuscript for publication (Table 1). The article by Davidson and colleagues, for example, in Annals of Behavioral Medicine provides an excellent overview of how to write up a research report that is focused on clinical interventions. Adhere to the recommended length and formatting (e.g., numbered references) to increase your likelihood of success in the submission process. Ask a colleague who has published to review the manuscript for you with regard to the formatting, and if possible, find an expert in the content area to be sure that the work is relevant and up to date. Submission itself is then easy. Manuscripts can be sent to Geriatric Nursing via e-mail to gneditor@gmail.com. However, we anticipate going to an electronic submission process with the year. Information on this process will be available on the Web page, in the journal, and as part of the submission process.

Table 1. Useful Resources to Help With Writing and Understanding the Publication Process

All submitted manuscripts that are consistent with the goals of GN and meet the author guidelines are sent out to 2 individuals for peer review. The reviewers are given a set of criteria and encouraged to provide the author with specific recommendations and suggestions for how the manuscript might be revised if so indicated. The reviews and the manuscript then undergo additional review by the editor, and a decision is made to accept as is, to accept with minor revisions, or to invite the author to consider revising the manuscript based on suggestions and then resubmitting this for another review; the manuscript may also be rejected with suggestions for revision or to submit it to an alternative journal. Being open to these reviews and willing to address the comments in a resubmission is crucial. We encourage authors for GN to resubmit revisions within 6 to 8 weeks of receiving the reviews. This prevents the long lapses of time that can occur and the risk that your findings will no longer be new and innovative. It also serves as an external motivator to prevent the possibility that the manuscript will get put on the shelf and forgotten. In a cover letter to the editor, be sure to address all of the recommendations provided by the reviewers and provide a rational for either why they were not addressed or how you addressed them. This review and revision process may be iterative in that the reviewers may have additional suggestions or responses to your revisions. Moreover, it is possible that over the course of time new knowledge has informed the subject and additional revisions that incorporate these new findings are needed. In the event that your manuscript is rejected, hang on to the wonderful, encouraging words of Beverly Baldwin who always reminded me, “the world just isn’t ready for you yet!” It may be that with some revisions another journal may be interested in publishing your manuscript.

Like your first catheterization or insulin injection or the first time you placed an intravenous line, writing gets easier and improves with practice. I challenge you to overcome your own personal barriers to writing, and to strengthen your self-efficacy in your ability to engage in this activity by actually doing it. Writing about your work is crucial to the advancement of nursing knowledge and will help you as a professional continue to learn and grow in your practice. My goal is to see GN be a part of the future of geriatric nursing as the population of older adults increases and care of these individuals must increasingly be addressed at an individual, family, system, and societal level. Decimating exemplary practices through publication will help to optimize care of older adults nationally and internationally. I look forward to receiving your submissions to GN in 2006. Stay tuned for our exciting movement to electronic submissions.