nursing research paper

Best Nursing Research Topics for Students

What is a nursing research paper.

• What They Include
• Choosing a Topic
• Best Nursing Research Topics
• Research Paper Writing Tips

Writing a research paper is a massive task that involves careful organization, critical analysis, and a lot of time. Some nursing students are natural writers, while others struggle to select a nursing research topic, let alone write about it.

If you're a nursing student who dreads writing research papers, this article may help ease your anxiety. We'll cover everything you need to know about writing nursing school research papers and the top topics for nursing research.  

Continue reading to make your paper-writing jitters a thing of the past.

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A nursing research paper is a work of academic writing composed by a nurse or nursing student. The paper may present information on a specific topic or answer a question.

During LPN/LVN and RN programs, most papers you write focus on learning to use research databases, evaluate appropriate resources, and format your writing with APA style. You'll then synthesize your research information to answer a question or analyze a topic.

BSN , MSN , Ph.D., and DNP programs also write nursing research papers. Students in these programs may also participate in conducting original research studies.

Writing papers during your academic program improves and develops many skills, including the ability to:

• Select nursing topics for research
• Conduct effective research
• Analyze published academic literature
• Format and cite sources
• Synthesize data
• Organize and articulate findings

About Nursing Research Papers

When do nursing students write research papers.

You may need to write a research paper for any of the nursing courses you take. Research papers help develop critical thinking and communication skills. They allow you to learn how to conduct research and critically review publications.

That said, not every class will require in-depth, 10-20-page papers. The more advanced your degree path, the more you can expect to write and conduct research. If you're in an associate or bachelor's program, you'll probably write a few papers each semester or term.

Do Nursing Students Conduct Original Research?

Most of the time, you won't be designing, conducting, and evaluating new research. Instead, your projects will focus on learning the research process and the scientific method. You'll achieve these objectives by evaluating existing nursing literature and sources and defending a thesis.

However, many nursing faculty members do conduct original research. So, you may get opportunities to participate in, and publish, research articles.

Example Research Project Scenario:

In your maternal child nursing class, the professor assigns the class a research paper regarding developmentally appropriate nursing interventions for the pediatric population. While that may sound specific, you have almost endless opportunities to narrow down the focus of your writing. 

You could choose pain intervention measures in toddlers. Conversely, you can research the effects of prolonged hospitalization on adolescents' social-emotional development.

What Does a Nursing Research Paper Include?

Your professor should provide a thorough guideline of the scope of the paper. In general, an undergraduate nursing research paper will consist of:

Introduction : A brief overview of the research question/thesis statement your paper will discuss. You can include why the topic is relevant.

Body : This section presents your research findings and allows you to synthesize the information and data you collected. You'll have a chance to articulate your evaluation and answer your research question. The length of this section depends on your assignment.

Conclusion : A brief review of the information and analysis you presented throughout the body of the paper. This section is a recap of your paper and another chance to reassert your thesis.

The best advice is to follow your instructor's rubric and guidelines. Remember to ask for help whenever needed, and avoid overcomplicating the assignment!

How to Choose a Nursing Research Topic

The sheer volume of prospective nursing research topics can become overwhelming for students. Additionally, you may get the misconception that all the 'good' research ideas are exhausted. However, a personal approach may help you narrow down a research topic and find a unique angle.

Writing your research paper about a topic you value or connect with makes the task easier. Additionally, you should consider the material's breadth. Topics with plenty of existing literature will make developing a research question and thesis smoother.

Finally, feel free to shift gears if necessary, especially if you're still early in the research process. If you start down one path and have trouble finding published information, ask your professor if you can choose another topic.

The Best Research Topics for Nursing Students

You have endless subject choices for nursing research papers. This non-exhaustive list just scratches the surface of some of the best nursing research topics.

1. Clinical Nursing Research Topics

• Analyze the use of telehealth/virtual nursing to reduce inpatient nurse duties.
• Discuss the impact of evidence-based respiratory interventions on patient outcomes in critical care settings.
• Explore the effectiveness of pain management protocols in pediatric patients.

2. Community Health Nursing Research Topics

• Assess the impact of nurse-led diabetes education in Type II Diabetics.
• Analyze the relationship between socioeconomic status and access to healthcare services.

3. Nurse Education Research Topics

• Review the effectiveness of simulation-based learning to improve nursing students' clinical skills.
• Identify methods that best prepare pre-licensure students for clinical practice.
• Investigate factors that influence nurses to pursue advanced degrees.
• Evaluate education methods that enhance cultural competence among nurses.
• Describe the role of mindfulness interventions in reducing stress and burnout among nurses.

4. Mental Health Nursing Research Topics

• Explore patient outcomes related to nurse staffing levels in acute behavioral health settings.
• Assess the effectiveness of mental health education among emergency room nurses .
• Explore de-escalation techniques that result in improved patient outcomes.
• Review the effectiveness of therapeutic communication in improving patient outcomes.

5. Pediatric Nursing Research Topics

• Assess the impact of parental involvement in pediatric asthma treatment adherence.
• Explore challenges related to chronic illness management in pediatric patients.
• Review the role of play therapy and other therapeutic interventions that alleviate anxiety among hospitalized children.

6. The Nursing Profession Research Topics

• Analyze the effects of short staffing on nurse burnout .
• Evaluate factors that facilitate resiliency among nursing professionals.
• Examine predictors of nurse dissatisfaction and burnout.
• Posit how nursing theories influence modern nursing practice.

Tips for Writing a Nursing Research Paper

The best nursing research advice we can provide is to follow your professor's rubric and instructions. However, here are a few study tips for nursing students to make paper writing less painful:

Avoid procrastination: Everyone says it, but few follow this advice. You can significantly lower your stress levels if you avoid procrastinating and start working on your project immediately.

Plan Ahead: Break down the writing process into smaller sections, especially if it seems overwhelming. Give yourself time for each step in the process.

Research: Use your resources and ask for help from the librarian or instructor. The rest should come together quickly once you find high-quality studies to analyze.

Outline: Create an outline to help you organize your thoughts. Then, you can plug in information throughout the research process. 

Clear Language: Use plain language as much as possible to get your point across. Jargon is inevitable when writing academic nursing papers, but keep it to a minimum.

Cite Properly: Accurately cite all sources using the appropriate citation style. Nursing research papers will almost always implement APA style. Check out the resources below for some excellent reference management options.

Revise and Edit: Once you finish your first draft, put it away for one to two hours or, preferably, a whole day. Once you've placed some space between you and your paper, read through and edit for clarity, coherence, and grammatical errors. Reading your essay out loud is an excellent way to check for the 'flow' of the paper.

Helpful Nursing Research Writing Resources:

Purdue OWL (Online writing lab) has a robust APA guide covering everything you need about APA style and rules.

Grammarly helps you edit grammar, spelling, and punctuation. Upgrading to a paid plan will get you plagiarism detection, formatting, and engagement suggestions. This tool is excellent to help you simplify complicated sentences.

Mendeley is a free reference management software. It stores, organizes, and cites references. It has a Microsoft plug-in that inserts and correctly formats APA citations.

Don't let nursing research papers scare you away from starting nursing school or furthering your education. Their purpose is to develop skills you'll need to be an effective nurse: critical thinking, communication, and the ability to review published information critically.

Choose a great topic and follow your teacher's instructions; you'll finish that paper in no time.

Joleen Sams is a certified Family Nurse Practitioner based in the Kansas City metro area. During her 10-year RN career, Joleen worked in NICU, inpatient pediatrics, and regulatory compliance. Since graduating with her MSN-FNP in 2019, she has worked in urgent care and nursing administration. Connect with Joleen on LinkedIn or see more of her writing on her website.

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Writing a Nursing Research Paper that Meets Professor's Requirements

As a nursing student, you will spend much time researching, reading, and writing papers. Many students find the entire process of writing research papers challenging.

Imagine on top of spending many hours in clinical practice shifts only to find yourself sparing more time researching and writing, not to mention the overwhelming information condensed in a few hours of in-class lecture sessions. Working shifts and studying while having family duties and obligations worsens it, and when done in a rush, you end up with subpar papers and average grades.

Even though many student nurses find writing research papers tricky and daunting, you can write a perfect paper that ticks all the checkboxes your professor uses to mark them and be sure to get an A+ grade on your nursing paper.

Our expert nursing research writers, who have written thousands of BSN, MSN, DNP, and Ph.D. papers, have compiled this comprehensive guide to help you write a strong nursing research paper that leaves a lasting impression on your professor.

Having marked many papers and supervised many theses, capstone projects, and dissertations, you can trust that the information herein is valuable and timely in your pursuit of nursing career success.

What is a Nursing Research Paper?

A nursing research paper is a scholarly and thesis-driven paper that a nursing student (at ADN, BSN, MSN, DNP, or Ph.D. level) writes to comprehensively explore a specific nursing research topic either of their choice or one that the professor assigns.

To write a perfect research paper, the student has to provide concrete, reliable, and trustworthy evidence. In most cases, even professionals such as RNs undertaking clinical practice, nursing education training, clinical studies and evaluations, and nursing research can also write research papers published in journals or conferences to advance and disseminate nursing knowledge. The typical length of most nursing papers ranges from 5 pages to 20 pages, depending mainly on the complexity of the subject, the word count limits, and the requirements. Nurses and nursing students write research papers to share their insights as they learn more about nursing processes and practices. Nursing research papers are used to: document research, organize information, advance nursing scholarship, and improve the writing skills of nurses. Students in the USA, Australia, Japan, and Canada write their research papers in the American Psychological Association (APA) format, while those in Australia and the UK write them in Harvard formats. The research papers fall under three main categories:

• Analytical research papers. These papers present an analysis of the topic using evidence, facts, and examples.
• Argumentative research papers. These research papers are analytical but with a twist where the writer uses evidence to reinforce their opinion and persuade the reader.
• Expository research papers. This category of nursing research papers explains the subject matter using credible evidence such as examples, facts, statistics, and other pieces of evidence.

Structure and Format of a Nursing Research Paper

A simple nursing research paper, especially an expository or informative type, can have 5 paragraphs, like a typical essay. However, longer research papers have additional sections.

Scientific Nursing Research Paper Structure

Here is a breakdown of how a well-formatted and scientific nursing research paper should look like.

• Title Page. The title page comprises the research paper title, details of the student or professional writer, course details, details of the school or institution, and the date. The cover page is the first contact point with the reader. It is brief.
• Abstract. The abstract summarizes the nursing research paper. It is 200-250 words long and should be focused on what the reader expects. It is a condensed version of the paper, which is critical to help professors know what your paper is about. It should not have acronyms. Note that the word count of the abstract is not considered part of the research paper.
• The Introduction. The introduction should have an attention-getter or a hook that can be a statement, statistic, or fact. It should be 10% of the entire word count. It also has background information that details the nursing issue or topic you are exploring. It also comprises a well-thought-out thesis statement related to the topic. If you have a long paper, ensure that your problem and purpose statements are part of the introduction. It should also list your PICOT question .
• Literature Review. This is a critical section of the research paper. Here, you should explore other nursing scholars' thoughts and scholarly findings. Focus on peer-reviewed scholarly articles that address the same issue as your thesis statement or topic. Explore your topic's theories, theoretical frameworks, and other facts. Do it so well that your professor marvels at your research, organization, and writing prowess. Consider the levels of evidence as you choose selection criteria for the papers to include in your nursing literature review.
• Research Methodology. This section of the research paper details the data collection methods, such as ethnographic studies, secondary data collection, literature review, quasi-experimental research, correlational studies, descriptive research, ethnography, phenomenology, grounded theory, meta-analyses, systematic reviews, or experiments. Ensure that you state and give a rationale for your research design (qualitative, quantitative, or mixed-methods). If you are writing a quantitative paper, explain how you tested the hypotheses. Also, report the sampling frame and the sampling strategy.
• Results and Discussion. This section of the paper presents the findings. You can use visual aids such as charts and graphs for a quantitative research paper. If you are writing a qualitative research paper, present the evidence chronologically. When presenting the findings, avoid making definitive facts. Instead, ensure that the results suggest something is true or false, even when testing a hypothesis.
• Conclusion and Recommendations. The conclusion should be 10% of the entire word count. You should restate the thesis and give a summary of your entire paper. Explore the recommendations for future research on the topic.
• Ensure that your reference list is arranged alphabetically. The list should adhere to the formatting requirements (Harvard, ASA, or APA formats). Only use scholarly peer-reviewed references.

Format for a General Nursing Research Paper

If you are writing a non-scientific nursing research paper, you will only have three sections as follows:

• Introduction. The introduction paragraph should introduce the topic by providing an attention-getter, background information, and a thesis statement.
• Body of the paper . The body paragraphs should have strong topic sentences, supporting details (examples, evidence, and explanation), and concluding sentences. It should also portray a good use of transition words. You should analyze the topic and use evidence to support the arguments, and give enough explanation. Use in-text citations within the body paragraphs.
• Conclusion. End the paper by recapping the main points, reasserting the thesis statement, and signaling the end of the paper to give your readers good closure.

An excellent nursing research paper follows this structure as long as it is not research-based. The three-part approach is super recommended if you did not conduct any study. In most cases, when assigned to write those 5-12 pages of nursing school research papers, you will be using this format.

So, what are the steps for writing a good nursing research paper? Let’s find out in the next section.

The 6 Main Steps for Writing a Nursing Research Paper

Writing assignments are an essential training aspect for nursing students. No wonder professors will stress that you write essays, discussion posts, responses, or proposals well. They are doing so to prepare you for research roles somewhere in your nursing career.

According to our most successful research paper writers, writing a top-grade research paper involves decoding the instructions, selecting a good topic, planning, researching, writing, and polishing the paper.

Here is a breakdown of each step for clarity and deeper understanding.

Step #1: Understand the Prompt or Instructions

You can only perfect what you know! Therefore, you can begin the research writing process by reading, analyzing, and understanding the instructions. It is an essential pre-writing stage process where you carefully read the instructions.

Although it sounds obvious, most nursing students who write off-topic and subpar research papers jump into writing without reading to understand the instructions.

You need to skim through the instructions on the first attempt, then read keenly and critically as you take note of the scope of the assignment, the topic, and other things you must fulfill in the paper. Take note of the:

• The number of words.
• Type of research paper (argumentative, analytical, exploratory, or persuasive).
• The structure of the paper (thesis-driven or research/study-based (scientific) research paper.
• The deadline.
• Whether you need to draft an outline.
• Reading materials.
• Whether you need external sources.
• Which sources to use and how many?
• The theoretical constructions or conceptual frameworks.
• The age limit of the scholarly sources.

If you need further clarification, ensure that you ask your peers, professor, or a professional writer in time.

Step #2: Select a Good Nursing Research Topic

Compared to average students, top nursing students always remember to select a research topic they are comfortable handling. When you are confident with a topic, you can develop it without procrastinating.

Sometimes you are given a list of nursing research paper topics, issues, and ideas to consider. Other times, you come up with the topic and consult your professor/educator for approval.  

Choose topics related to patient safety, nursing processes, nurse staffing, nursing policies, nurse privileges, nursing legislations, nursing ethics, mental health, health promotion, chronic disease management, healthcare systems, health informatics, changes in healthcare, and working conditions.

Choose any nursing topic that resonates with your specialization interests. It should be manageable, relevant, and explorable.

Related Readings:

• Nursing informatics research topics
• Capstone project ideas and topics for BSN, MSN, and DNP students
• Mental health nursing topics
• Epidemiology nursing topics
• List of the best nursing research paper topics
• Evidence-based nursing topics and ideas
• Nursing ethical dilemmas

Step #3: Plan your Paper

Create a thesis statement for your research paper if it is thesis-driven rather than study-based or scientific (experimental). After writing the thesis, like any of our nursing assignment slayers, write a good outline using Roman numbers and numbers.

List the ideas you wish to have in your paper in chronological order, starting with the introduction, body, and concluding paragraphs. As you outline, do some preliminary research so that you develop arguments the right way.

Include the in-text citations in your nursing research paper outline to simplify the writing process.

Step #4: Research and Organize Resources

Doing in-depth research as you refine the draft would be appropriate because you know what you want the paper to look like. Use scholarly nursing databases for research and limit yourself to topic-related scholarly articles published within the last 5 years.

You can read the abstracts of the articles to determine if they are fit to use in your paper. If you find the best articles, list them using online citation management tools such as RefWorks, Zotero, EndNote, Citefast, or any of your choice.

Ensure to list them in the most appropriate formatting styles. Take notes and list the points and ideas in your outline. Do your research meticulously and ensure that you organize the process to avoid any confusion.

Step #5: Write the First Draft

With the research, synthesis, and outline, you are now left with the chance to put rubber on the road. Use the Pomodoro technique, where you spend stretches of 25 minutes of focused work and have minor 5-minute breaks.

Ensure you cover as much ground in your research paper as possible before three-quarters of the deadline. When writing the paper, and considering that you have the outline, you can start chronologically from the introduction to the appendices.

Most research paper writing pros prefer working on the body section and conclusion before writing the introduction and finalizing the abstract. Whatever works best for you, adopt it. When writing the first draft, focus on piecing together the information rather than perfection.

Ensure you research lightly as you write and assert your voice while giving the right in-text citations for every idea you paraphrase from a source to avoid plagiarism. Each body paragraph should only have one idea.

Step #6: Edit, Proofread, and Polish the Paper

The final step towards completing your nursing research paper is ensuring everything is in its rightful place. A polished research paper scores 90% and above, which is an A. Begin by reading the paper aloud to identify areas that do not make sense.

If there is a need, do not hesitate to rewrite an entire section so that you have the right flow of information.

Check the grammatical, spelling, and syntax errors and make necessary corrections. You should also check the tenses used in the paper. If you feel like polishing the essay is too much work, you are better off hiring a nursing paper proofreader/editor.

When you receive feedback from your educator or professor, address the changes and resend the paper for grading.

Related Reading: How to write an evidence-based nursing paper.

Valuable Tips to Consider as You Write Your Nursing Research Paper

Nursing schools and educators have their standards and guidelines for writing a research paper. Therefore, ensure that before everything else, you familiarize yourself and adhere to these instructions, which include word count and citation styles.

Do not assume anything when writing a paper. You should also access and understand suggestions from your school’s writing lab. Apart from these essential tips, also ensure that you follow the insights we give below:

• Write your paper using a formal tone. Do not use passive voice when writing the paper. Instead, use active voice.
• Your paper should have a good organization from the introduction to the conclusion.
• Whenever you borrow ideas from a scholarly source, ensure you cite them correctly.
• Have a well-thought-out thesis statement that clarifies your arguments.
• Create a complete outline during the early stages of writing. It gives you a roadmap to follow as you write the paper. Organize the ideas chronologically based on their strength and weaknesses.
• Have a plan and schedule to trace your progress with the paper.
• If you have a more extended deadline, contribute to your research paper daily.
• When writing the paper, start with the body, the conclusion, and the introduction last.
• If you are writing a study-based research paper, include the literature review, methodology, discussion, and conclusion sections per the IMRAD format. A general nursing research paper follows the essay structure: introduction, body section, and conclusion.
• Use peer-reviewed scholarly sources from CINAHL, PubMed, Nursing Reference Center, Cochrane Library, MEDLINE, and other nursing research databases with peer-reviewed articles. Credible sources mean your research paper has rigor since you have strong points.
• Proofread and edit the paper thoroughly to remove any mistakes to signal your seriousness to your professor. If possible, use professional editing services.
• Have a compelling conclusion that is elaborate, clear, and concise.
• Read your paper aloud to identify mistakes.
• Revise the paper, and do not fear rewriting an entire section.

When writing a research paper, adhere to the writing conventions. You should also read well and understand how to communicate through academic writing effectively. Your paper should document evidence that supports your arguments and topic.

Write concisely, coherently, and accurately. It is not all in vain; you are training for your future role as a nurse when you will write conference papers, white papers, essays, policy documents, letters, blog posts, and professional nursing articles.

Checklist for a Great Research Paper in Nursing

Now that you have written your paper, you must align a few things to make it the best your professor will read. Most nursing classes, especially at the graduate levels (MSN, DNP, and Ph.D. levels), have small class sizes, and the professors spend time reading the papers from start to end. This means that you should leave nothing to chance.

Nursing research asserts professional identity, ensures accountability in nursing decision-making, and expands nursing practice. You have to be meticulous when writing a research paper in nursing.

A good research paper demonstrates a complete understanding of nursing knowledge, topic exploration, advanced organization, proper formatting, and mature academic writing skills. The following checklist enlists some main aspects to countercheck before hitting the submit button.

• Have I followed all the instructions outlined in the assignment prompt or rubric?
• Does my paper have the right title page?
• Does the paper have a written title that resonates with the thesis and the research question?
• Is the introduction presenting an attention grabber, background information, and a signpost of the ideas in the paper?
• Is the thesis statement well-thought-out, clear, concise, and elaborate?
• Is the problem statement clearly stated?
• If it is a PICOT-based research paper, is the PICO question well-outlined?
• Does the paper touch well on the nursing issue that the topic needs it to address?
• Is there a logical flow of the paragraphs?
• Are the words in each paragraph balanced?
• Does the paper have correctly formatted headings and subheadings?
• Are the in-text citations done correctly and consistently?
• Does every paragraph in the body of the paper build on the thesis?
• Does the paper demonstrate a mature choice of words and uses nursing lingo?
• Is the literature review section comprehensive? Does it have a theoretical and conceptual framework or constructs?
• Are the data and information presented in the literature review current?
• Has the methodology section listed the sample, sampling strategy, data collection and analyses, and rationale for each?
• Does the discussion section interlink the concepts from the literature review with the findings?
• Does the conclusion offer good closure to the readers? Does it restate the thesis? Does it summarize the recommendations?
• Is the entire paper formatted correctly? Does it follow the formatting guidelines?
• Is the paper devoid of spelling, syntax, and mechanical mistakes?

If your answer to all these questions is a resounding YES, you are sure it will fetch your professor a good grade. Our nursing writers, most of whom are alumni from top nursing universities and colleges such as Chamberlain, Capella, Herzing, Vanderbilt, SFU, Rutgers, Yale, Duke, NYU, UCLA, University of Pennsylvania, University of Toronto, McGill, Ottawa, Queens, and other best colleges in the USA, UK, Canada, and many other places. Besides, they are nursing educators in different capacities, and a couple are nursing professors with big titles; you can trust the checklist to guarantee you an excellent grade.

Where to Get Help When Writing Research Paper

As a nursing student, writing a research paper is something you will most likely enjoy doing. However, unforeseen things happen, prompting you to search the internet for sites to help you do your nursing research paper. NurseMyGrade.com is one such place to pay a nursing writer to do your paper.

Expect a paper that meets all the requirements, is written by a human rather than AI software, and is uniquely tailored to your requirements.  Our rates are affordable, and our writers cover diverse fields. Apart from offering advice about research, writing, and formatting papers, we have resourceful writers whom we allow you to communicate directly with via our platform.

We also maintain high levels of secrecy because we care more about your privacy and confidentiality of your details. Not even your professor can tell you got help from our website because we advise on specific strategies to use the paper. We have assisted students in various levels of nursing education with their writing, and we can do yours too.

Get affordable, well-researched, formatted, and organized nursing research papers done for you today by filling out the order form. Nursing research papers are a chance to stand out. Let our professionals help you achieve your nursing school goals.

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A practice‐based model to guide nursing science and improve the health and well‐being of patients and caregivers

Sherry s. chesak.

1 Nursing Research Division, Mayo Clinic, Rochester MN, USA

Lori M. Rhudy

Cindy tofthagen.

2 Nursing Research Division, Mayo Clinic, Jacksonville FL, USA

Linda L. Chlan

Associated data.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Aims and Objectives

The purpose of this paper is to describe a model to guide nursing science in a clinical practice‐based setting. Exemplars are provided to highlight the application of this nursing research model, which can be applied to other clinical settings that aim to fill evidence gaps in the literature.

Nurse scientists are well positioned to develop new knowledge aimed at identifying global health solutions to multiple disparities. The generation and application of this knowledge are essential to inform and guide professional nursing practice. While a number of evidence‐based practice models exist to guide the integration of literature findings and other sources of evidence into practice, there is a need for additional models that serve as a guide and focus for the conduct of research in distinct scientific areas in practice‐based settings.

Model development and description.

Mayo Clinic is a large, comprehensive healthcare system with a mission to address unmet patient needs through practice, research and education. PhD‐prepared nurse scientists engage in practice‐based research as an integral component of Mayo Clinic's mission. A practice‐based nursing research model was developed with the intent to advance nursing research in a clinical setting.

The components of the Mayo Clinic Nursing Research model include symptom science, self‐management science and caregiving science. The generation of nursing science is focused on addressing needs of patients with complex health conditions, inclusive of caregivers.

Conclusions

While clinical settings provide rich opportunities for the conduct of research, priorities need to be established in which to focus scientific endeavours. The Mayo Clinic Nursing Research model may be applicable to nurses around the globe who are engaged in the generation of knowledge to guide practice.

Relevance to Clinical Practice

The Mayo Clinic Nursing Research model can be used by nurse scientists embedded in healthcare settings to address clinically relevant questions, advance the generation of new nursing knowledge and ultimately improve the health and well‐being of patients and caregivers.

What does this paper contribute to the wider global clinical community?

• There is a need for additional models to guide the conduct of nursing research in clinical settings.
• The Mayo Clinic Nursing Research Model was developed as a model to guide the generation of new nursing knowledge in a clinical, practice‐based setting.
• The model can be used in a variety of clinical settings for researchers who aim to fill evidence gaps in the literature.

1. INTRODUCTION

Nursing is the largest profession in health care, with continued growth expected over the next several years (Grady & Hinshaw, 2017 ). Nursing science plays a critical role in addressing health challenges, generating new knowledge and translating evidence to practice to improve patient outcomes (Grady, 2017 ; Powell, 2015 ). Furthermore, nursing science integrates biobehavioural approaches to better understand patients' needs and preferences, develop individualised symptom management interventions (Trego, 2017 ), advance interventions to promote self‐management of chronic conditions and thus promote well‐being and quality of life (Grady, 2017 ; Powell, 2015 ). Patients' healthcare needs are becoming increasingly more complex, giving rise to the need for practice‐based research. The clinical practice setting provides an opportunity to conduct research, by which patients' and caregivers needs and outcomes may be addressed and improved.

The purpose of this paper is to present the Mayo Clinic Nursing Research (MCNR) model (Figure ​ (Figure1)—a 1 )—a model developed to guide and focus nursing science generation in a practice‐based setting with an emphasis on promoting the health and well‐being of patients and caregivers with complex needs. The components of the model are described, and exemplars of the generation of practice‐based nursing knowledge are presented.

Mayo clinic nursing research model [Color figure can be viewed at wileyonlinelibrary.com ]

2. BACKGROUND

Over a century ago, Florence Nightingale recognised not only the need for formal training for nurses but also the power of the nurse to improve patient outcomes (Nightingale, 1992 ). This is still true in today's healthcare environment. Nurses can help fill a critical need not only for the education and training of healthcare workers, but also for the design and testing of solutions to common health problems (National Institutes of Health, 2015 ). As noted by Dr. Patricia Grady, director emeritus of the National Institute of Nursing Research (NINR), ‘…nurse scientists can use their expertise in clinical research and their understanding of the relationship between behaviour and biology to further expand the reach and impact of nursing science in the larger community’ (National Institute of Nursing Research, 2016 , p. 6). However, recommended models for the structure and organisation of nursing research in clinical settings are scarce.

PhD‐prepared nurse scientists (sometimes referred to as nurse researchers) design and implement research studies to improve health‐related outcomes. Although most nurse scientists are employed in academic settings such as schools/colleges of nursing, there is an emerging trend for nurse scientists to have full‐time appointments in practice settings (Robichaud‐Ekstrand, 2016 ). The nurse scientist role has wide variability in how it is operationalised but can be described in three ways. First, in academic settings, Boyer's model of scholarship includes discovery, integration, application and teaching to frame the discussion of discovery and practice in nursing (Boyer, 1990 ; Hickey et al., 2019 ). Academic service partnerships have emerged as strategies to close the academic‐practice gap by connecting clinical practice with academia in order to meet mutually beneficial goals (Sadeghnezhad et al., 2018 ). Examples of programmes in academic‐service partnerships include preparation of new graduate nurses, patient safety initiatives, transitions‐in‐care programmes, advancement of evidence‐based nursing and opportunities for clinical research (Sadeghnezhad et al., 2018 ). While such programmes inform the advancement of nursing research as a component of evidence‐based practice in clinical settings, they are less informative in guiding the generation of knowledge among nurse scientists embedded in clinical settings.

In a second approach, a nurse scientist supports evidence‐based practice, quality improvement, the conduct of research by clinical nurses and, if applicable, ANCC Magnet Recognition Program® activities (Kowalski, 2020 ). A third approach similarly involves embedding nurse scientists in clinical practice settings but the role is focused on the conduct and facilitation of nursing‑oriented research, rather than simply providing support for research conducted by others (Chan et al., 2010 ). This third approach is used in the setting in which this model was developed.

Evidence‐based practice models such as the Iowa Model and the Johns Hopkins Nursing Evidence‐Based Practice Model have been adopted to guide translation of evidence to practice but they have limited utility in describing the infrastructure, focus and outcomes of nursing research in a clinical setting. The Iowa Model Revised: Evidence‐Based Practice to Promote Excellence in Health Care uses an algorithm to guide evidence‐based practice processes from identification of a trigger to integrating and sustaining a practice change (Buckwalter et al., 2017 ). The conduct of research is included in the Iowa Model as a strategy to be used when insufficient evidence exists to recommend a practice change. The Johns Hopkins Nursing Evidence‐Based Practice Model (Dang & Dearholt, 2018 ) includes a patient‐centred approach and incorporates a continuum of Inquiry–Practice/Learning–Practice Improvement as a method to ensure that best practices are applied to patient care. However, the model is centred on an evidence‐based practice approach, which differs from research in that research involves systematic investigation of phenomena to discover new information or reach new understandings and conclusions to generate new knowledge (Cohen et al., 2015 ; Hickey et al., 2019 ). The Joanna Briggs Institute (JBI) (Joanna Briggs Institute, 2016 ), based in the Faculty of Health and Medical Sciences at the University of Adelaide, South Australia, aims to promote evidence‐based decision‐making by promoting the use of the best available evidence. JBI, through its JBI Collaboration, works with universities and hospitals around the world to synthesise, transfer and implement evidence that is culturally relevant and applicable across diverse healthcare settings internationally.

The NINR sets strategic funding and training priorities that advance nursing science to enhance the health and well‐being of individuals across diverse populations (National Institute of Nursing Research, 2016 ). Current research priorities established by the NINR include four scientific foci: symptom science, wellness, self‐management of chronic conditions, and end‐of‐life and palliative care (National Institute of Nursing Research, 2016 ). In addition, all areas of NINR's research programmes place an emphasis on promoting innovation and developing the nurse scientists of the 21st century (National Institute of Nursing Research, 2016 ). Recognising that symptoms are the primary reason patients seek care, the NINR developed the symptom science model to advance research. The symptom science model describes an analytical sequence beginning with a sequelae or cluster of symptoms, which are then characterised into a phenotype with biological correlates, followed by the application of research methods that can be used to identify targets for therapeutic and clinical interventions (Cashion & Grady, 2015 ).

Nurse scientists are well positioned to develop new knowledge aimed at identifying global health solutions to social, economic, psychological and biological disparities. The generation and application of this knowledge are essential to provide the best available evidence to inform and guide professional nursing practice. While a number of evidence‐based practice models exist to guide the integration of literature findings and other sources of evidence into practice, there is a need for additional models that serve as a guide and focus for the conduct of research in distinct scientific areas in practice‐based settings. Therefore, the project team identified a need for the development of a model articulating the goals and strategies to advance nursing research within their institution, and which would have broad applicability to other institutions and nurse scientists embedded in the clinical practice.

Mayo Clinic is a large academic medical centre that incorporates practice, education and research into its mission, which has been emulated in the Department of Nursing and the Division of Nursing Research for over three decades. Today, the Mayo Clinic Nursing Research Division is an enterprise‐wide unit providing infrastructure and support for nursing research at its sites in Mayo Clinic. A cadre of PhD‐prepared nurse scientists lead independent programmes of research and provide consultation to all staff in research‐related matters, including scientific review of research protocols. In addition, small cadres of registered nurses providing direct patient care conduct research studies under the mentorship of a nurse scientist. These clinical nurse scholars identify clinically relevant questions that are investigated by an independent research study (Chlan et al., 2019 ). Details of this programme are described elsewhere (Chlan et al., 2019 ; National Institute of Nursing Research, 2016 ).

The project team developed a model of nursing research to guide the foci for nurse scientists' research at the institution and to generate new nursing knowledge based on needs that arise from the practice setting. The model was also intended to encompass strategic priorities established both by the institution and the field of nursing science. No ethics approval was required for this project.

The team started the process of model development by conducting a literature review regarding (1) existing models of nursing research and evidence‐based practice, (2) nursing science, (3) the nurse scientist role, (4) national and international nursing research strategic priorities and (5) research strategies to transform health care. In addition, the team sought input from multidisciplinary stakeholders at the institution regarding their perception of the current and potential future contributions of nursing science to the practice. Finally, organisational resources describing the research environment were used to inform the model. Thus, it is a model rooted in practice, rather than a theory‐based model.

4.1. The Mayo Clinic nursing research model

The MCNR model is focused on three primary areas across multiple diseases, illnesses, and healthcare settings: symptom science, self‐management science and caregiving science. With a focus in these areas, nurse scientists leverage team science, big data, innovation and technology to move knowledge generation quicker along the discovery, translation and application continuum to meet the needs of patients and caregivers.

The following assumptions informed the development of the model. First, nursing research is vital for the generation of new knowledge to improve the health and well‐being of patients and their caregivers. Second, the health and well‐being of individuals with complex conditions are enhanced by developing and testing patient‐centred interventions through research that focuses on the science of symptom assessment and management, self‐management and caregiving. The MCNR model was developed to guide how this vision will be implemented in a clinical setting with programmes of nursing research aligned to inform and transform health care.

4.2. Patients and caregivers as the focal point of the model

At the centre of the model (Figure ​ (Figure1) 1 ) are the patient and caregiver with complex needs—medical, physical or psychosocial—around which all other elements in the model centre. The nurse scientist focuses on a better understanding of those needs and the testing of interventions used to address them, with the definitive goal of improving patients' and caregivers' health and well‐being. For the purposes of this model, health is defined from a holistic, phenomenological perspective of optimal overall physical, mental, spiritual, social and role functioning (Saylor, 2004 ; Watson, 2008 ); and well‐being is designated as individuals' perceptions, judgements and expectations regarding their health (Saylor, 2004 ; Sullivan, 2003 ). These foci are consistent with the patient‐centred model of care in which patients are viewed as a whole and their individual viewpoints and characteristics are taken into consideration when making decisions regarding care (Zhao et al., 2016 ). It is also congruent with the mission and values of Mayo Clinic (Mayo Clinic, 2021 ), as well as the profession of nursing (Spurlock, 2019 ).

4.3. MCNR model scientific foci

The generation of symptom science, self‐management science and caregiving science are the scientific foci that promote the health and well‐being of patients and caregivers in a practice‐based, patient‐centred clinical setting. It is through the conduct of scientific investigation in these three main areas, described below, that nursing research seeks solutions to unmet, complex health needs of patients and caregivers.

Symptom science seeks to transform the practice using biological, clinical and/or behavioural approaches to investigate symptoms aiming to individualise care and assess patient‐reported outcomes such as quality of life and well‐being (Grady, 2017 ). Self‐management science is based on a complex set of cognitive and behavioural self‐regulation responses that individuals engage in to manage chronic illnesses or factors that increase the risk for illness (Araújo‐Soares et al., 2019 ). Research to support self‐management includes developing and evaluating a broad range of interventions often focused on providing education and guidance for managing specific illnesses, partnering with healthcare providers and coping with challenges of living with chronic illness (Allegrante et al., 2019 ).

Caregiving science is research that explores effective approaches to reduce burden on and promote the health and well‐being of professional and lay caregivers (Grady, 2017 ). Research that examines methods to include caregivers in the care process and to design and test interventions that include them has the potential to significantly contribute to improved patient outcomes and patient‐centred care (Littleton‐Kearney & Grady, 2018 ).

4.4. Leveraging team science, big data, innovation, and technology

In addition to cutting‐edge research methods, nurse scientists leverage team science, big data, innovation and technology as tools, resources and methods to seek solutions to unmet health needs of patients and caregivers (Brennan & Bakken, 2015 ; Conn, 2019 ; Grady & Gough, 2018 ). Within the MCNR model, these four resources and methodologies contribute to the advancement of nursing science in the areas of symptom, self‐management, and caregiving. Team science leverages the strengths and expertise of professionals trained in different disciplines or nursing specialties through a collaborative effort to address a scientific challenge (Bennett & Gadlin, 2012 ). Team‐based research initiatives can be uni‐ or multidisciplinary groups, and teams can be large or small (Conn, 2019 ). In team science, multiple stakeholders contribute unique perspectives on the topic at hand and are deeply engaged in the project (Bennett et al., 2018 ). The World Health Organisation has acknowledged the importance of team‐based research through implementation of nursing collaborating centres, which focus on collaborative research of global or regional importance (National Institutes of Health, 2015 ).

Big data science allows researchers to analyse large and complex volumes of information that are newly available at unprecedented rates from sources such as electronic health records, large databases, sensor‐enabled equipment, imaging techniques, smart devices and high‐throughput genetic sequencing methods (Fernandes et al., 2012 ). Through the application of big data research methods, including artificial intelligence, researchers can discover new ways of understanding and addressing the needs of the patient (Fernandes et al., 2012 ). For example, big data methodologies can be implemented to maximise the utility of patient‐reported outcome data in order to capture the patients' perspectives on how their disease, and the treatment of their disease, is impacting their lives. These data can be used to inform clinical decision‐making, predict long‐term outcomes and identify future innovations in health technologies and other interventions (Calvert et al., 2015 ). This patient‐centric approach ultimately allows healthcare providers to have a better understanding of how individuals are living with and managing their illness, and to make more informed decisions regarding personalised interventions that will have a measurable impact on the patient experience (Brennan & Bakken, 2015 ).

Innovation is defined as a creative, fast‐moving endeavour that involves scientific methods and improvisation to design unique solutions that change the world (Mayo Clinic Center for Innovation, 2020 ). Innovative research uses novel theoretical concepts, methodologies and interventions to challenge current clinical practice paradigms. Innovations in health care can be seen in product innovation for the introduction of new types of goods and services, and in process innovation, which is centred on enhancing internal processes for the production of high‐quality care (Arshad et al., 2018 ; Govindasamy & Wattal, 2018 ; Thune & Mina, 2016 ).

Technology in medical research involves innovations that impact health or healthcare delivery (Healthcare News & Insights, 2020 ; Martins & Del Sasso, 2008 ). Biotechnology, machine learning, pharmaceuticals, information technology, remote monitoring and medical devices are examples of technology. Other technologies include software and applications for self‐management and symptom tracking. Technologies can maximise efficiency and access to health care, such as digital solutions to connect patients to the appropriate provider (National Institute of Mental Health, 2020 ).

4.5. Discovery‐translation‐application continuum

Research conducted at Mayo Clinic occurs along a continuum to address unmet patient needs. The process by which new information makes its way into practice along this continuum is through discovery, translation and application, depicted in the outermost ring of the model in Figure ​ Figure1. 1 . Discovery uses scientific methods to seek solutions to improve the health and well‐being of patients with complex conditions; translation is the development and testing of possible solutions; and application is the dissemination, integration, and evaluation of solutions into practice (Ammerman et al., 2014 ).

Nursing research contributes to innovation at all points along the discovery‐translation‐application continuum, continually advancing science, transforming patient care and improving outcomes (Grady, 2017 ). Guided by the MCNR model, nurse scientists discover answers to puzzling clinical questions that can be translated and applied directly to clinical practice to improve patient care as rapidly and as safely as possible. There are at least seven implementation science models or frameworks available to guide translation of findings to practice. Systematic reviews show variability in their scope and application so selection of an implementation framework according to the context of change is key (Dintrans et al., 2019 ; Moullin et al., 2015 ). In our setting, translation is achieved through clinical partnerships where the department's evidence‐based practice model is used to guide implementation. As depicted in the model in circular form (Figure ​ (Figure1), 1 ), this process is iterative rather than linear. Discoveries are made through observation, discussion or other forms of data. These discoveries, seen through the nursing lens, may have broader applications to be considered. Further, empirical evidence is needed prior to implementing new discoveries into practice. During implementation, new discoveries and applications may come to light.

5. EXEMPLARS OF THE MAYO CLINIC NURSING RESEARCH MODEL

The overall purpose of the MCNR model is to provide a coordinated focus and consistent approach that guides and prioritises practice‐based nursing research. Nurse scientists use the model in their own focused areas of research as well as to guide nurses in the conduct of research that arises from their practice. Outlined below are exemplars of how the MCNR model guides the conduct of practice‐based research among nurse scientists at Mayo Clinic. Examples of how the model has informed research are presented. Not all aspects of the model are evident in each exemplar.

The first nursing research exemplar, within the domain of symptom science (second ring of the MCNR model), aims to address unmet needs of critically ill patients (centre of model) related to comfort‐promoting interventions. Under the mentorship of a PhD‐prepared nurse scientist, this descriptive, cross‐sectional study is being conducted by two practising ICU nurses who first identified in their own clinical setting the problems of: (1) numerous sources of discomfort among ICU patients; (2) the absence of objective assessment of these discomforts as distinct from objective assessment of pain; and (3) the inability to intervene appropriately with effective comfort‐promoting interventions. Next, they identified the distinction between discomfort and pain. They are currently assessing, describing and quantifying the contributing sources of discomfort experienced by nonmechanically ventilated ICU patients using the Discomforts Perceived by ICU Patients instrument, a modified version of the French instrument Inconforts des Patients de REAnimation (IPREA) questionnaire (Baumstarck et al., 2019 ). The end‐product of this study will be the discovery of new knowledge (outer ring of model) to inform ICU nursing practice regarding discomfort‐producing stimuli. Future areas of investigation would include developing and testing interventions (translation of possible solutions through clinical trials), of which those that are found to be effective would then be directly applied in the setting of ICU clinical nursing practice contributing to symptom science for critically ill patients.

An exemplar within the domain of caregiving science (second ring of MCNR model) is a multidisciplinary trial co‐led by a nurse scientist and physician (team science—third ring of model). The investigators noted that patients with advanced cancer or those nearing the end‐of‐life experience significant, unique distress related to their disease, treatment and impending mortality. In addition, they noted a lack of evidence on best methods to manage psychosocial distress in patients and caregivers with complex needs (centre of model). Thus, they designed a study to determine the feasibility of a modified version of the Resilient Living Program (The Resilient Option, 2020 ) that is tailored to the needs of patients with advanced cancer and their adult caregivers. Outcomes of the study include feasibility of participant recruitment, acceptability of the intervention and self‐reports of resilience, quality of life, stress, anxiety, sleep, fatigue and caregiver role overload. Findings from this study will lead to the discovery (outer ring of model) of best practices for integrating a resilience training programme within the care of patients with complex needs (centre of model), and their caregivers. Future studies will examine the outcomes of revised training programmes that are more effectively tailored to the unique needs of these populations.

Recognising the emotional distress their patients endure, a group of nurses working on the bone marrow transplant (BMT) unit expressed interest in specific nursing interventions to support their patients' emotional well‐being. Although they knew from their clinical experience that hospitalisation for BMT is quite stressful, they wanted to have a better understanding of when the most distressing times were for the patients, and what aspects of undergoing BMT were the most stressful. A review of the literature did not identify the specific information they were seeking. In collaboration with a nurse scientist and social workers on the unit, they implemented a descriptive study aimed at answering their questions. The study is in progress, and when finished, the results will inform both nursing and social work practice. This is an example of how clinical nurses identified a need centred around the health and well‐being of complex patients (centre of the MCNR model), focused on symptom science (second ring of the model), and used team science (third ring of the model) to discover new information (outer ring of the model) from which nursing interventions can be developed and tested.

The final nursing research exemplar is within the domains of symptom science and self‐management science (second ring of the MCNR model) to address the unmet needs of complex critically ill patients (centre of model). As of this writing, a randomised controlled clinical trial is testing the efficacy of self‐administered versus intensive care unit (ICU) nurse‐administered sedative therapy for anxiety in critically ill patients receiving mechanical ventilatory support (1R01 {"type":"entrez-nucleotide","attrs":{"text":"HL130881","term_id":"1051909465","term_text":"HL130881"}} HL130881 ). Primary outcomes of the study include anxiety, duration of mechanical ventilation, delirium, level of arousal, alertness and sedative exposure. Post‐ICU outcomes are also being examined and include functional status, depression and health‐related quality of life. Findings from this clinical trial will be applied to the practice setting (outer ring of the model) to implement patient‐centred interventions that improve not only ICU outcomes but also quality of life during the trajectory of recovery from critical illness and injury.

6. DISCUSSION

The MCNR model guides nursing research across settings and prioritises inquiry on symptom science, self‐management science and caregiving science. The model is unique in that it specifically focuses on generation of nursing knowledge through the focus and conduct of research in a practice‐based clinical setting. Few such models have been found in the literature; those that are available focus on advancing bedside nurses' involvement in research (Brewer et al., 2009 ; Stutzman et al., 2016 ). Robust programmes of nursing research remain relatively uncommon in clinical settings (Robichaud‐Ekstrand, 2016 ). Availability of time and resources needed to facilitate clinical research are often constrained. Even in large academic medical centres with institutional commitment, the contributions of nursing research often go unrecognised, even from within the nursing profession. The MCNR model can be used to communicate the scope and focus of nursing research, from which studies can be developed to address significant problems impacted by nursing practice.

In creating the MCNR model, we sought to demonstrate the unique contributions of nursing research at our institution and develop a framework to guide the overall direction of nursing research. This model may have limited application in nonclinical settings; however, other institutions may glean information to develop similar models tailored to their settings. Adaptation of the model to fit a specific organisational context and available resources may be necessary. Although the model is implemented in a setting rich in human and other resources to guide nursing science, it could easily be used in settings with more limited resources to help frame the scope and function of nursing science. However, this model was primarily developed for use in clinical settings in which some resources for the conduct of research exist. Unfortunately, there are still many settings where the resources needed to facilitate nursing research are sparse or non‐existent.

The MCNR model can also be integrated with existing models of nursing research. The National Institutes of Health Symptom Science Model is one example of a complementary model that can be used in tandem with the MCNR. The Symptom Science Model provides a guide for researchers to study complex symptoms experienced by individuals and incorporates the components of phenotypic characterisation, biomarker discovery and clinical application, with an overall goal of symptom reduction and improvement (Cashion et al., 2016 ). These methodologic components can be used to advance the care of patients with complex needs in the context of the institutional priorities and infrastructure described in the model. The MCNR model can be applied in several ways to advance scientific knowledge in the areas of symptoms, self‐management and caregiving. The model incorporates advancements in biological sciences, technology and big data methods to meet the needs of patients in a holistic way using nursing's unique body of knowledge (Henly et al., 2015 ). While nurse scientists may not have extensive expertise in all areas, collaborating with other scientists and clinicians who have complementary expertise ensures that investigations incorporate the best science and technology from other fields to inform nursing knowledge and practice.

As nurse scientists are increasingly employed in clinical settings, it will become more important to evaluate and publish outcomes of models, including this one. Nursing research within our institution is evolving to best meet the needs of patients. The MCNR model is a step in the process to define our direction and differentiate our areas of expertise from those of other disciplines.

The model is not without limitations. The MCNR Model was developed by nurse scientists within the Division of Nursing Research to serve as a guide and focus for our conduct of research, and to communicate our work with others. It is a reflection of the current foci of nursing research at a single institution and, as noted earlier, may need to be adapted to meet the needs of other institutions. It is intended to serve as a starting point for the infrastructure needed to generate research ideas and to serve as a guide to focus the conduct of research in distinct scientific areas in practice‐based settings. It is not intended to constrain research foci that are outside of this model. The model may be of lower utility in settings where nurse scientists are not available. It will be revisited periodically by the research team and stakeholders to ensure that it reflects the current focus of nursing research throughout the institution.

7. CONCLUSION

Nurse scientists embedded in healthcare settings are uniquely positioned to inform translation of research findings to practice. As health care evolves and the needs of patients and caregivers become more complex, the importance of studying symptoms, self‐management and caregiving is becoming increasingly critical. Nurse scientists leverage team science, big data, innovation and technology to move knowledge generation along the continuum of discovery, translation and application. The MCNR model can be used to advance generation of new nursing knowledge to improve the health and well‐being of patients and caregivers.

8. RELEVANCE TO CLINICAL PRACTICE

The MCNR model can be used by nurse scientists embedded in healthcare settings to address clinically relevant questions and ultimately improve the overall physical, mental, spiritual, social and role functioning of patients and caregivers, as well as to enhance individuals' perceptions, judgements and expectations regarding their health. The model provides a structure for addressing nursing science priorities through the discovery, translation and application continuum, and advancing the generation of new nursing knowledge.

CONFLICT OF INTEREST

The authors report no conflicts of interest with this manuscript.

AUTHOR CONTRIBUTIONS

Conception and design of the work, drafting of the article, critical revisions of the article and final approval of the version to be published: All authors.

DATA AVAILABILITY STATEMENT

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Writing Your Manuscript

Structure and style.

Roush, Karen PhD, RN, FNP

Karen Roush is an assistant professor at Lehman College, Bronx, NY, and the Graduate Center, City University of New York. She is also founder of The Scholar's Voice, which works to strengthen the voice of nursing through writing mentorship for nurses. Contact author: [email protected] . The author has disclosed no potential conflicts of interest, financial or otherwise.

This is the second in a series of articles to help nurses share their knowledge, skills, and insight through writing for publication. Nurses have something important to contribute no matter what their nursing role. This series will help nurses develop good writing habits and sharpen their writing skills. It will take nurses step by step through the publication process, highlighting what gets published and why, how to submit articles and work with editors, and common pitfalls to avoid. For the previous article in this series, see http://bit.ly/2lhnYKJ .

Good scholarly writing is difficult to do and often time consuming. Don't get discouraged when you're starting out. No one sits at a keyboard and hammers out a well-organized, in-depth, engaging article in one or two tries. In this article, I'll outline what constitutes good writing and provide some tips and tools to help you improve your writing skills.

GETTING STARTED

The hardest part of writing a manuscript is getting started. There is nothing more intimidating than a blank page. This is because we believe we have to come up with the right words in the perfect order from the very first sentence. No one does that. Letting go of this expectation is one of the best things you can do for yourself as a writer. Give yourself permission to write a bad first draft. The key is to get something on the page that gives you an entry into the paper. It doesn't have to be good, and you don't even have to start at the beginning. You can start with whatever section of the paper is easiest for you, or with the section you feel most passionate about. Or start by writing random thoughts that you think should be included in the paper. For example, for this article, I had multiple false starts, rambled between ideas, moved passages around, deleted sentences and paragraphs (then cursed myself for deleting some of them), wrote a half dozen sentences that were more appropriate for a motivational speech than for an article, and finally, a few hours in, came up with a rough draft of this article.

Outlining and mind mapping. Creating an outline can help you get started on and organize your paper. If you're writing a research or quality improvement (QI) report, go to the International Committee of Medical Journal Editors (ICMJE) Web site ( www.icmje.org ) and select “Manuscript Preparation” and then “Preparing for Submission” under the “Recommendations” menu. You can then use the IMRAD (Introduction, Methods, Results, and Discussion) structure described on that page as an outline and fill in the pertinent information under each heading. As you fill in your outline, refer to the detailed guidelines for QI reports on the Standards for Quality Improvement Reporting Excellence (SQUIRE) Web site ( www.squire-statement.org ) or for research reports on the ICMJE Web site to ensure that all the required information is included and in the correct section of the paper. Write your outline without formatting it as a numbered or bulleted list so you don't spend time reformatting it as you move sections around.

You can also create a mind map—a diagram that presents all the information, ideas, themes, and concepts that need to be included in your article. A visual representation of a complex article can help you figure out how to organize it. A mind map can also be a good brainstorming tool as you plan the content of your paper. There are numerous online resources to help you create a mind map (see Mind Mapping ).

MANUSCRIPT STRUCTURE

The structure of your manuscript will depend on the type of article you're writing. (The next installment in this series will review different types of articles.) However, research and QI reports, reviews, and clinical papers have a number of components in common. These include the introduction and background, a review of the literature (what is known about the topic), and the discussion and conclusion. Research reports and QI projects also include sections on methodology and results (the IMRAD structure noted above) and systematic and integrative reviews also include the search strategy and a section on critical appraisal of the studies included in the review.

Before writing your article, or during an early draft, take a look at similar articles published in the journals you're considering submitting to. Although journals also follow established guidelines such as SQUIRE and ICMJE, they vary slightly within these guidelines. For example, some combine the introduction and background sections, and some give limitations its own section rather than including limitations in the discussion section.

Introduction and background. The purpose of the introduction is to establish the significance of the topic or study and to provide background information. In this section, your job is to get the reader to care about the topic. Use strong statements to immediately establish its importance. A common mistake is to “talk around” the topic or provide too much preliminary material before getting to the paper's focus. This can mislead and confuse the reader. Present your topic right away, ideally within the first paragraph.

Include up-to-date epidemiologic data that show how many people are affected by the issue and its consequences. These data may include morbidity and mortality rates, psychological and social sequelae, and the economic costs for the individual and society. Background information should include what the reader needs to know to understand the issue. This may include pathophysiology, history, previous research, related concepts, and the social and cultural context, among other information. Importantly, everything in your introduction should be leading to the purpose statement you make at the end of this section. Keep your purpose statement in front of you as you write, and make sure all the information you provide is directly related to the purpose.

Literature review. A review of the literature is an examination of what is known about the topic as it relates to your purpose. The extent and depth of the literature review varies depending on the paper. (If you're writing a systematic or integrative review, this section includes the results of your review and as such is not covered in this article. For guidance on writing a systematic review, see the AJN series Systematic Reviews, Step by Step : http://bit.ly/1BPyKnM .)

Don't list, synthesize . The most difficult part of writing a literature review is synthesis; everyone struggles with it. Good synthesis pulls together information from diverse sources, finds connections, and creates an overarching understanding of the material. Don't describe studies one by one when synthesizing. Pull out related information from different studies, integrate it, and tell the reader what it means. You will still give examples from specific studies and analyze them, but their meaning will be presented in relation to the overall understanding you have provided.

For example, suppose you're doing a literature review on family presence during resuscitation and you have a section on how clinicians feel about it. You would look to see what each study found in relation to this and then decide what their findings tell us overall. Perhaps some researchers reported that clinicians felt family members got in the way during resuscitation, others found that clinicians’ concerns about liability issues affected the way they performed, and one study found that clinicians worried that the family's emotional responses would distract them. In your synthesis you might state that clinicians felt that family presence may adversely affect their performance during resuscitation, discuss the different ways, and then support your statements with details from the individual studies.

Clinical reviews . In a clinical review you probably won't write an extensive literature review—and may not do a literature review at all. Instead, these papers include sections on pathophysiology, signs and symptoms, diagnosis, nursing management, and patient teaching, among others. Though clinical reviews have no formal literature review section, you must use the most up-to-date evidence to support your content. Don't rely on textbooks as sources; information should go beyond the basics a reader can get from a textbook.

Methods and data analysis. There is a specific and technical approach to writing the methods and data analysis sections that are outside the scope of this article—other than to say that you must be precise and objective. Do not comment on the findings when you present them. That comes in the next section, the discussion.

Discussion. The discussion is where you tell the reader what your study means and what she or he should do about it. In a clinical paper this section may be called “nursing implications” or “implications for practice.” It answers the question: how would nurses use this information in their practice?

In a research paper, the discussion usually begins by restating the purpose of the study and briefly highlighting key findings. The remainder of the discussion is a comparison of your findings with those of prior research. If these are significantly different, you will need to provide potential explanations for the differences. Discuss any unexpected results and provide some explanation for why they occurred. You will cover the same ground in the discussion section of a QI report.

Limitations . For research and QI reports, limitations are usually given in the discussion section, although sometimes they are presented under their own subheading. In this section, you can point out the weaknesses of your study and tell the reader any strategies you used to address them.

Conclusion. The conclusion is your opportunity to leave the reader with a strong message. Succinctly highlight key takeaway points, but don't waste this section with a reiteration of content. Make sure your conclusion is supported by your findings and that it speaks directly to the purpose of the paper.

WRITING WELL

Good scholarly writing has a number of attributes, but chief among them is clarity. Scholarly writing should be so clear that there is no room for misunderstanding. The writing must also be concise. Readers should have all the information they need—and only the information they need—to understand the subject. To write an excellent scholarly article, you need two things: an in-depth understanding of the material and good writing skills. Here I'll discuss how to make choices about language and organization—the two primary elements of good writing in any genre. (Of course, good grammar is also essential, and there are many print and online grammar resources to help with this; see “Becoming a Published Writer,” March.)

Language. Clarity requires the use of language that is concrete and specific. The language must also be precise—each word should be carefully chosen to ensure that nuances don't muddle your message. Finally, it must be concise, using the fewest words to clearly communicate the ideas and information.

Use simple language . Too many scholarly articles are weighted down with “academic” language in the form of big words and pretentious phrases. After reading countless articles written like this, many authors think pretension is a requirement of good scholarly writing, that it's how we must write to present ourselves as knowledgeable. However, the opposite is true. The ability to write complex ideas and information in simple, straightforward language demonstrates a deep understanding of the material. Don't be mistaken—simple doesn't mean simplistic. It also doesn't mean avoiding sophisticated or technical language when that's appropriate. See Straightforward Language for examples of pretentious words and phrases and possible substitutions. As you can see from these examples, not only is the preferred language simpler, it's also more concise.

Use precise language . Precise language ensures that what you write is understood exactly as you intended. You can accomplish this by using concrete nouns and being as specific as possible. For example, when talking about quantities or size, don't use abstract terms like the majority , many , or few if you know the exact number or percentage. Make sure you know the definition of every word you choose as well as any connotations. For example, childish has a negative connotation while childlike does not.

Avoid technical jargon . Jargon is specialized language used by a group or profession. Nursing uses a lot of jargon and it can easily slip into your writing. Jargon detracts from clarity because it is exclusionary: those outside the group may not understand it. Jargon can be misunderstood even within a group, because it can vary by regions or specialty.

Use qualifiers sparingly . Qualifiers indicate a lack of certainty. There are times when certainty doesn't exist and using a qualifier is appropriate. For example, when there isn't strong evidence for a statement, you might say it may be the case, or when reporting study results you might say something appears to be the case. But using qualifiers too often in a paper can make you sound unsure and your writing lack authority. Intensifiers—words that add emphasis—are also best to avoid; they are rarely appropriate in a scholarly paper. Go through your drafts and check for the words listed in Qualifiers and Intensifiers and make sure each is warranted.

Avoid redundancy . The biggest threat to a concisely written paper is redundancy. This happens when we repeat ideas, information, or arguments either verbatim or by using different wording. Sometimes it is intentional: we are trying to emphasize an important point so readers will remember it. Don't. Write it clearly and precisely once. Redundancy is more likely to confuse than to clarify.

Another way redundancy enters our work is through word combinations. For example, a common term, one you've probably used, is absolutely necessary . But absolutely is part of the definition of necessary, which means “absolutely needed”—so it's unnecessary to add it. Start paying attention to redundant phrases people use when conversing and check for them in your writing. More examples can be found in Examples of Redundant Phrases .

Don't overuse adjectives and adverbs . These should be used sparingly in any writing, but especially in scholarly writing where we want to avoid editorializing or dramatizing. Replace adverbs with strong verbs. For example, change held tightly to gripped , or quickly moved forward to lunged . Be careful, though, that the meaning matches the strength of the language; do not choose strong words merely for effect.

Use the active rather than the passive voice . The active voice is direct, less wordy, and has more energy than the passive voice. In the active voice the subject acts upon the object: the nurse counseled the patient rather than the patient was counseled by the nurse . The active voice also enhances clarity, because it forces the subject—who's doing the counseling, in this example—to be identified, which might be important. Look through your drafts for sentences where you use the words be , is , was , were , been , am , or are followed by a verb ending in ed . Usually these indicate you used the passive voice.

It's also OK to use first-person pronouns in scholarly writing. Using first-person pronouns has many advantages, particularly in avoiding the awkward constructions used to circumvent their use. First-person pronouns allow you to construct sentences using the active rather than the passive voice ( We conducted a study versus A study was conducted by ), produce prose that is less wordy, and avoid pretentious phrases like this researcher and anthropomorphisms (when human characteristics or behaviors are given to nonhuman things), such as this study determined that .

Organization. An author is like a travel guide taking readers on a journey: you want the trip to be interesting and smooth. Your readers should always know where they are and where they're going. The way to accomplish this is to write good paragraphs, place them in the right order, and connect them with transitional words or statements.

Paragraphs . Each paragraph should have one main idea and stay focused on that idea. There should be a topic sentence, usually at the beginning, that clearly expresses the main idea. Each subsequent sentence develops the idea in a logical way through the use of analysis, description, examples or data, or other methods. Sometimes, to adequately develop a complex idea, you need to break it into more than one paragraph. Make sure you establish and maintain a coherent order within each paragraph; this may be chronological, cause and effect, by importance, or by listing steps in a process, among others.

Getting the order right . Complex papers can be difficult to organize effectively; sometimes it's not immediately obvious whether certain concepts are primary or a subset of others. There are a couple of strategies you can use. When starting a paper, use an outline or a mind map. Once you have a first draft, try one of the following methods. Write the main idea of each paragraph in each section on a sticky note and lay these out, moving them around until they're in the best order to tell your story. You can also talk through your paper aloud as if you're telling the story, expressing the main idea in each paragraph in plain language. The sticky note method helps you see any gaps, missteps, and redundancies, and the storytelling method helps you hear them.

Transitions . One of the best tools we have to guide a reader through a paper is the use of transitions. Transitions prepare readers for changes in focus or ideas, show relationships between ideas, and move the reader smoothly from one paragraph or section to the next.

You are probably familiar with many of the commonly used transition words and phrases, such as therefore , however , and in addition . Be careful to use the one that best indicates the relationship or connection you mean to establish. For example, however is used to establish contrasting ideas, similarly to compare those that are alike, and therefore to establish an effect. (The Purdue Online Writing Lab presents a comprehensive list of transitional devices and when to use them: https://owl.english.purdue.edu/owl/resource/574/02 .)

When shifting focus between paragraphs or sections of a paper, we often need more than a word or phrase to make sure the transition goes smoothly. In that case you need to start the new paragraph with a sentence or two that summarizes what was just covered, prepares readers for what is coming next, and shows them how the two are connected.

REVISIONS AND FEEDBACK

You have to allow enough time for multiple revisions of your paper. Save each draft with a different name or date so you can access a previous version in case you want to restore something that was changed or deleted. It helps to take a short break in between drafts to hit the reset button and come back to your work with a fresh eye. When you get close to the final version, print it out and read it. When you think you have the final version, read it aloud slowly. Reading aloud helps you hear any gaps, awkward constructions, or choppy transitions.

Most importantly, get feedback! When we are immersed in a paper for a period of time we begin to read what we think we wrote instead of what we actually wrote. We also have all the information in our head—we don't realize when we have made assumptions or connections that are not clear to the reader. Ask two people to read your manuscript and give you feedback—one who is an expert in your field and one who knows nothing about the topic. The first can speak to the accuracy and completeness of the information and the second to the clarity of the writing.

DEVELOPING YOUR WRITING SKILLS

The only way to develop your writing skills is to write. A lot. But you also have to read. Reading well-written articles helps you develop an ear for good scholarly writing. Take time to read articles in AJN and other quality journals with an eye to how they are written. Note how the authors engage your attention. Did they make a good case in their introduction for the necessity of the article? How did they use transitions to guide you through the article? How did their language choices affect clarity? Did they provide all the information you needed to understand the material? Did they stay focused on their purpose throughout?

Now that you know the basic skills needed to write well, in the next installment I'll review the different types of articles journals publish, and offer tips to increase the likelihood of producing a publishable manuscript. Now, get back to writing!

Mind Mapping

A list of helpful Web sites on mind maps and how to create them.

https://coggle.it

http://creately.com

https://bubbl.us

www.gliffy.com

www.lucidchart.com

Mindmeister

www.mindmeister.com

http://popplet.com

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