More strategies for enhancing your message
Article Outline
Readers absorb information through words and images. When used together, these two elements can increase the effectiveness of your article and enhance readers' retention of key points. Last month's column discussed tables and basic figures, such as line, pie, and bar graphs and how to submit them. Now that you have a handle on the basics, you can consider more intricate figures, as well as illustrations and photographs.
Graphs: Beyond the Basics
Two types of two-axis graphs you might want to include in your menu of choices are histograms and scattergrams, also called scatter plots. You may want to consult a statistician or an experienced researcher to determine whether these graphs are appropriate for your article.
Use histograms (Figure 1) to show frequency distribution. To create this type of graph, divide the range of the variable into class intervals. These intervals are groups of data points for each variable, and each group is a range of values. Then use vertical bars to represent how often each class occurs. Each bar will have the same width, but the height will vary to reflect the frequency for each class interval. Unlike a simple bar graph, the bars in a histogram touch each other because the measurement is continuous (eg, the sequential months in Figure 1).
Figure 1.
Number of falls for patients undergoing surgery during a six-month period in a 10-hospital health system. (Note: data are not real.)
Histograms, which commonly are used to show the distribution of cases for quality improvement studies, easily point out the outliers and help identify data distribution trends. For example, in the figure, you can see a spike in the incidence of falls in March and April, which might lead you to reexamine reports for those months to detect patterns and external factors that could account for the change, such as unusually high staff vacancies in those months.
Choose a scattergram when you want to show whether two variables correlate. A straight regression line through the data points shows a linear (ie, strong) correlation (Figure 2). The independent variable is on the horizontal axis and the dependent variable is on the vertical axis. The correlation coefficient (eg, “R” in the figure) is a number between −1 and 1 that indicates the strength of the relationship between the two variables. A zero indicates no linear correlation.
Figure 2*
Illustrations
Illustrations such as flowcharts, decision trees or algorithms, and drawings can clarify complex processes for readers. Use flowcharts to show a sequence of complex events or processes. For example, flowcharts are helpful in presenting steps in a research protocol and recruitment and retention of study participants (Figure 3).
Figure 3.
Flow Diagram of Participant Status During the Study
A flowchart that shows decision points is commonly called an algorithm. Many nurses are familiar with the advanced cardiac life support algorithms. Each algorithm offers a decision tree for managing patients who have a serious cardiovascular problem. In an algorithm, a decision point usually is phrased as a question, followed by choices linked to the options for the answer, which is commonly “yes” or “no”. An example of an algorithm is shown in Figure 4.
Figure 4.
Malignant Hyperthermia (MH) Flow Chart
Drawings are ideal for depicting a device or how it works. Use them in tandem with the text to explain procedures. Figure 5, for example, shows the location of an intra-aortic balloon pump (IABP) catheter inside a patient and how it works. The authors of the article about IABP presented information in the text and used drawings to give the reader a visual image to emphasize the explanation. Be sure the explanation in your article matches the figure.
Figure 5.
Photographs
Photographs can replace many words of text, for example, when you discuss equipment, wound types, and physical outcomes. In Figure 6, the author uses a photograph to illustrate the advantages of using a custom cradle tray to hold specialty instruments. You can label elements in the photograph for additional clarification.
Figure 6.
In Mooney KL, Valdez S, Peña, D. Custom cradle trays: secure instrument storage. (Figure 4) AORN J. 2006;84:101. Reprinted with permission from AORN, Inc, Denver.
Most journals request that you submit high-resolution, digital photographs that you can send by e-mail or post on a journal's manuscript submission web site. If you submit hard copy photographs, make sure they are of good quality. Do not send Polaroid photographs because they are not of sufficient quality to print.
Submit close-up photographs that highlight the procedure or device, and be sure the image is well lit. Obtain permission from staff members, patients, or anyone else in the photograph in accordance with the journal's guidelines. Many journals, such as the AORN Journal, have a permission form you can use; otherwise, contact the media relations department of the organization where the photograph was taken for a release form, and submit a signed copy to the journal. It is best not to take photographs that identify patients, even if they sign a release form.
Image Creation
Be creative with illustrations and photographs. For instance, consider using a map to highlight the prevalence of obesity by state when writing about the increase in bariatric surgery. For an article on positioning, you might submit diagrams of the skin's layers to illustrate the changes that occur with pressure. Some journals have a graphics department that can help you create illustrations, so you do not have to be an artist.
You also can search the Internet for ideas. Most of the images you will find have a copyright, so you will need to obtain permission if you want to use the exact image. In addition, you will need to obtain a high-resolution version of the image from the source because online images typically have low resolution. In fact, most journals avoid using these images, but they can be helpful in communicating to a designer the concept and style of the image you would like created.
There are many sources of stock images online (ie, photographs and illustrations that can be used in print or online either for a fee or at no cost). The US National Library of Medicine has links to image sources at http://www.nlm.nih.gov/services/stockshot.html. You must check each web site carefully to determine if the image is in the public domain and, therefore, not subject to copyright protection. The National Cancer Institute (http://visualsonline.cancer.gov/) and the Centers for Disease Control and Prevention (http://phil.cdc.gov/phil/home.asp) offer photographs that can be used without permission, although you still need to give credit to the source.
Wrapping Up
During the past year, we have covered many facets of writing and submitting an article that will help you in your endeavors to publish successfully. This series ends next month with a wrap-up of key points and how to avoid common errors that novice and even experienced writers sometimes make.
Editor's note: This is the 11th in a series of articles on writing for publication. The first article was published in the March 2006 issue of the Journal.
PII: S0001-2092(07)60018-0
doi:10.1016/S0001-2092(07)60018-0
© 2007 AORN, Inc. Published by Elsevier Inc All rights reserved.
