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Revista Latino-Americana de Enfermagem

Print version ISSN 0104-1169

Rev. Latino-Am. Enfermagem vol.14 no.3 Ribeirão Preto May/June 2006 



Writing for international publication in nursing journals: a personal perspective (Part 2)


Como escribir para publicacion en enfermeria: una perspectiva personal (Parte 2)



G. Hussein Rassool

Professor in Addiction & Mental Health, University of São Paulo at Ribeirão Preto College of Nursing - WHO Collaborating Centre for Nursing Research Development, e-mail:,



The number of printed and electronic (Internet) academic nursing publications in Brazil and around the world highlight the importance attached to publishing in the field of nursing. Internationally, journals are ranked according to their professional merits and peer review orientations. Financial institutions increasingly value publications in renowned journals as one criterion for granting funds for research. One important reason why many scientific articles do not meet the requirements from international journal reviewers, especially those submitted English, is the result of poor and literal translation of the text. The challenge we are facing in Latin America is to encourage the development of articles for publication in internationally reviewed journals. Co-authorship is a potentially stimulating model for researchers and postgraduate students to publish. This task can be undertaken through the help of international supervisors and researchers, supervisors or postgraduate students with good command of the English language. This article aims to demystify the publication process and present some guidelines on how to publish in international journals.

Descriptors: nursing; research; periodicals


El número de medios de divulgación académica impresos y electrónicos (Internet) de enfermería de alcance nacional e internacional destaca la importancia de publicar entre enfermeros. Alrededor del mundo, las revistas están siendo categorizadas con relación a sus méritos para la profesión y evaluación de los pares. Cada vez más, las instituciones de financiamiento de investigación prestan atención a la publicación en revistas de prestigio académico como uno de los criterios para la concesión del mismo. Un factor importante a ser considerado entre los motivos por los cuales muchos artículos científicos fallan en cumplir los requisitos de evaluación de los revisores de revistas internacionales, principalmente aquellas de lengua inglesa, es la traducción pobre y de manera literal. Nuestro desafío en América Latina es fomentar el desarrollo de artículos para publicación impresa o no en revistas con revisores internacionales. La co-autoría ofrece un modelo potencialmente alentador tanto para el investigador como para el alumno de postgrado publicar. Esa tarea puede ser emprendida con la ayuda de supervisores internacionales e investigadores o estudiantes de postgrado que dominan la lengua inglesa. Este artículo intenta desvelar el proceso de publicación y presentar algunos principios directivos de como publicar en revistas internacionales.

Descriptores: enfermería; publicación periódica; investigación




In the first part of the paper, we examined the writing and publishing process, where to publish, impact factors, literature review, creating an outline of a paper and writing style. In this paper, the purpose is to provide some guidelines on journals' styles and referencing, a framework for writing, the publishing process and some commentaries, in the context of publications in this region, with implications for nursing.



A refereed journal will be explicit about the proper style: American Psychological Association (APA)(1), Chicago Style(2), and Uniform requirements for manuscripts submitted to Biomedical journals(3). Each journal will list important information relating to editorial policy, format and style, how to submit your articles by printed and electronic modes and the process of publication (reviewing process, accepted for publication and editing proofs) on a page typically called "Guidelines for Authors". A value now added to publications in high impact journals is the requirement of the inclusion of statements such as 'What is already known about the topic?' and 'What this paper or study adds?' Authors need to be brief, specific, and accurate in writing two or three clear and statements as bullet points for each question.

Most authors and readers of journals in this region are familiar with the "Vancouver Style"1 or the APA(1) style of referencing . Check how to paraphrase and use quotations from publications manuals in the journal style. Basically, the quotations or sources in the text must match the reference list and credits must be given to the sources (references) whenever you either quote an author directly or paraphrase an author. To present authors' works and ideas without giving credits to them is unethical and is called plagiarism. What sections or sub-headings you start to write about is a matter of personal preference. Below is a brief guideline for writing.



International peer-reviewed journals have a standardised approach in reporting qualitative and quantitative research. The typical structure for a qualitative research report include: 'what is already known about the topic?' and 'what this paper or study adds?' abstract or summary, statement of the problem, aims or objectives, hypotheses, design, methodology of research, Instruments, ethical considerations, results, discussion, conclusion and references.



Writing an abstract first, in breaking the traditional convention, does work for some types of publications. A good abstract can be the most important paragraph in the article and should be coherent and precise. Sometimes, the abstract appears in the form of a single paragraph. In most high quality international nursing journals the structure of an abstract is provided in the guidelines for authors. Check the journal to see the requirements for submitting an abstract and make sure you make a note of the number of words you require for an abstract (120 to 250 words, depending on the journals). Abstract are not referenced and can be used to guide the writing of the paper itself. Remember that the whole of the abstract and title are used by International Nursing Index, Medline, Pubmed or Latindex, Lilacs etc, to source key words for their indexing process.



Dividing the Methods up into sub-sections is a good idea. The contents of the methods section should include the following: aim, design, sample of participants, instruments, ethical considerations, data analysis and data collection. If you have a research proposal, you already have got the information, but this will probably need to revised .The Results section is usually the shortest section of the paper, but you will need to have some ideas about how you will present your data visually. There is a different set of skills needed in creating tables, histograms, bar charts and other kinds of visual presentations. Ask for help at the audio-visual departments or libraries but keep the visual presentations simple but effective. Interpretation and discussion of results should be avoided. Next, it will be the discussion section to complete.



There are many variations in how the Discussion section can be written but the first paragraph can serve as a summary for the study in question or the statement of the problem. The inclusion of key findings of your study and their analyses, in relation to the relevant literature, should be presented here. Discuss about the strengths and limitations of the study and suggest future research studies. You should always state explicitly the implications of your study for nursing education, management or clinical practices.



By the time you have covered most of the writing, the Introduction section should be fairly uncomplicated. Basically, you are setting an agenda and will develop the themes later. This is where you want to set the context of the paper and introduce the reader to the general issue: a general introduction of the theme you are writing about, the issue(s) or statement(s) of the problem(s) and a theoretical framework if appropriate. Whatever type of journal you are writing for, always define or operationalise the terms or concepts used in the paper. Give an explanation to all abbreviations at first mention in the text.



Editing the paper

Editing can be quite enjoyable when the final draft of the paper is complicated. It is recommended to have someone else read your paper, looking for basic organisational, grammatical and spelling errors. Do not expect the spell and grammar check programmes on your computer to address all your spelling mistakes, especially when dealing with a number of languages. At the same time, examine some of the sections of the article for readability and accuracy. Remove any irrelevant or "unfinished business" statements, literature and quotations from your paper. This is a continuing process.

The problems are faced by many of us at this stage of having a research report about 5-6 thousand words, when we need to submit a paper for 3,000 words maximum. The dilemma is whether to send the paper to another journal (maximum of 5000 words) or reduce the number of words. This is a personal choice and the decisions should be based upon the nature of the research or paper, the quality of the journal and the audience to be targeted. This is the "pruning" stage in the editing process in the conversion of the valuable and relevant 5-6 thousand-word paper into the final stage of the publication process. In this example, the literature review, result and discussion section should be examined and edited. Whilst editing, some of the quotations or statements or analyses may become redundant. It is stated that the failure to proofread is like preparing a magnificent dinner and forgetting to set the table, so that the wretched guests have to scramble for food as best they can(3). Do not send your first (or even second) draft to the publisher! There is also consideration to be given to having the paper translated into English or any other international language. This is dealt elsewhere in the paper.

Finalising part of the process of publication

It is courteous to write a polite cover letter to the editor, stating that the article is not being simultaneously submitted to another journal and that the text has not been previously published. Some journals require, as part of the submission process, a statement of financial or other relationships that might lead to a conflict of interest and the extent and nature of the authors' involvement in the study and paper. The name, address, and telephone number of the corresponding author should also be included. Some international journals also request the provision of additional information such as indicating where your paper fits in their journal sections, to match their categories or types of articles (Short research paper, reviews, updates, innovations in practice, commentaries).

The paper is ready and complete according to guidelines for authors. Your paper can be sent by electronic means or in printed forms. The number of printed copies to be sent to the editors of journals varies from 3 to 4 copies and with the same information saved on a diskette, usually in Word for Windows 95 or an updated version. Some international journals use a web-based submission and peer review system, which is fast and convenient for both authors and reviewers. You will need to go to the website of the journal and follow their instructions and it is usually free to register. You submit a copy of your paper by e-mail or other electronic means to the journal. This rapid process enables the journals to reduce the time it takes to make a decision on a manuscript by reducing postal and other delays throughout the editorial process. The review process varies widely and journals offer different types of reviews, such as double blind peer review (2 reviewers plus a statistical reviewer), non-blind (open) review and author's choice between blind and open review.

Check that you have completed the copyright declarations and any other forms required by the journal. Only original forms should be sent by mail to the Journal. When you have submitted your manuscript to the editor of the journal, make sure that you keep copies of the manuscript and all your notes and references, as you might need it at a later stage. For some journals, the acknowledgements of receipt of manuscript are usually done by electronic mail systems. This is a fast system and the process of submission, reviewing and publication of your article can now be monitored on line at the journal's Internet website. When you are contacted by the editor, you will be given editorial feedback or a check-list and comments from the reviewers. Your paper may be given a category of acceptance, acceptance with modifications, or not accepted or relevant to this journal and other categories. Most papers never meet the hurdle of first time acceptance for publication without any modifications. The majority of papers usually go through a number of revisions before they are acceptable for publication. The length of this process depends upon whether there are minor or major editing or revisions to be undertaken. If your paper needs further revisions to be of an acceptable quality, you will be required to make some revisions to the text. Always ensure that you undertake all the revisions required by the reviewers and editors. As with all stages of the writing process, check repeatedly for errors. It is worth noting that the resubmission of an article does not imply than an offer is being made to publish. The main objective here is to make the process as easy as possible for the editor and this may speed the route to printed publication. A covering letter is needed, with all the changes you have made and note where they appeared in the revised manuscript (page number, paragraph and line). Near the time of publication, some journals send a proof for correction and the time given for this final editing is usually within 3 days of receipt. Authors publishing in Latin-American journals may or may not be familiar with the process of receiving proofs from production editors and the subsequent editing of proofs before final printing. Sometimes, a paper does not meet the high standard of presentation or academic content and does not get published even after several revisions. This in itself is part of the learning process and all authors at some point in their writing careers in nursing publications have had many rejection letters. However, a rejected manuscript does not indicate that the paper is a bad one or a poor one. There are reasons for rejections of publications and a list of potential risk factors for the rejection of manuscripts is presented in Figure 1. The main reasons why editors like your paper is because of the following contents2. It covers an important subject; the message is original, relevant to general readers; editors are impressed by the careful methods; some of the material is fascinating; it is well presented; it is an interesting read; it covers a topical subject and it covers a neglected area. This list is not exhaustive.



Some biomedical and nursing journals offer fast track publications or early on line publications. Primary research studies are fast track through a rapid peer-review process and The Lancet, prestigious medical journal, guarantees to publish such manuscripts within 4  weeks of receipt3. Other groups have introduced e-journals (electronic journals) as a means of increasing the speed with which new ideas are disseminated4. Some publishers estimate that this can be as quick as 35 days5. However, there are dangers of publishing in non-peer reviewed electronic journals and this analysis is beyond the content of this paper. In some nursing journals, accepted manuscripts can be guaranteed for publication within six months of submission. But in most nursing journals, it may take between 1 and 2 years before your paper is in print.



Despite the globalisation of nursing journals, partnerships between editors and authors are being addressed through electronic means and media outreach. This is a positive development and should be adopted by other journals. Criticisms have been raised in this region and in other developing nations about the low acceptance rates of their publications in international nursing journals published in English language. Written feed-back is given to authors to improve their poorly translated manuscripts and sometimes they are referred to local or national editors for further help. From my experiences, journal editors have often advised authors whose first language is not English to use an appropriate professional translator or editor, one who is familiar with the type of material in the paper as well as being fluent in English, but they have to choose the right people6, and preferably with substantial experiences in the healthcare context. The failure to meet the requirements of the peer-review international journals may be the result of poor and literal translations of papers submitted. The Scandinavian have managed to overcome these difficulties by employing professional translators and their rate of published papers has grown considerably over the years with publications in high impart quality of nursing journals.

The guidelines for authors should be regarded as a blueprint for writing papers. A number of papers are rejected by editors because of their failure to comply with the authors' guidelines. The abstract presented is inadequate or poorly translated. There is a common assumption that if an abstract is poor, the article is likely to be of the same quality. However, there is some evidence to suggest that there is another explanation for non-publication of papers, that is, publication bias, but this is rare in nursing publications when compared to other medical and other journals. Publication bias may occur because of a tendency for journals to accept only papers that have statistically significant results and not to report non-significant effects(3). However, getting a paper published may depend not only on the intrinsic quality of the paper, but also whether it is submitted to the 'right' academic journal(4). Moreover, if journals do not take certain papers (for example, ones with negative findings or those reporting multi-disciplinary studies), then this can lead to publication bias(4).

The process of publication and the delay caused before a manuscript gets into print is a major concern in this region. The implications of such delays increase the time it takes to get papers published or leaves important research findings unavailable to inform clinical practices. The findings may even be out of date by the time they are published(5). In this region, there is room for expansion in our process of submitted papers, reviewing process and publication in print. We need to learn the lessons from publishing houses for enabling topical or important practice-based papers for rapid track publications. Electronic submissions of papers should be part of our strategy in publication development.

Currently, some of the journals in this region have too many barriers. Perhaps we need to reflect on our journals' styles, formats, nature and quality of published papers and re-examine our missions and scopes to make our journals more visible to international audiences. The significant factor is the provision of flexible and accessible journals to potential authors and the general nursing readership. An added inhibitory factor is the requirement of some form of membership or being a subscriber for potential publications in the journals. Memberships are not a requirement for submission of papers for potential publications in most international nursing or healthcare sciences journals. Whether the payment of a fee for submitting your article limits the accessibility of the journals to a potential pool of authors needs to be analysed.



With the globalization of communications and journal publications, the big conglomerates have the means and technologies to improve the accessibility of the journals to a wide international readership. This should be seen in the occasional translation of abstracts in different languages if the information reported is of high quality and relevant to an international nursing audience. This remains to be seen. Guidelines for authors on how to submit a manuscript in different languages should be provided by electronic means to potential readers of the journals and authors.

There is concern about the lack of published papers in English from Latin America. It seemed that, although many nurses in Latin America have worked on research for years, there is little evidence of this effort in English language publication(6). Our challenge here in Latin America is to enhance our development of publishing papers and other non-printed materials in international nursing journals, but with the same efforts to promote quality studies in our respective published languages. In addition, our journals need to increase the promotion of commissioned papers written in English or any other language. There are lost opportunities in international networking and collaborations in the potential publications from national and international nursing experts in a particular field. We need to explore this avenue. Social marketing of the journals is needed and visibility of our journals to international audiences needs to be promoted, to make them more attractive and accessible, not only to the subscribers but to the majority of researchers, academics and clinicians. Journals should be transparent with publications of literary criticism, analysis of limitations of research designs and findings or the examination of alternative perspectives.

New generations of nurses need to be primed at an early stage of their professional development in publications' skills. Co-authoring offers a potentially supportive model of postgraduate writing for publication(7). Co-authoring may be undertaken with international supervisors and researchers, supervisors and postgraduate students. Co-authorship in action is seen in the number of publications accepted and submitted to international nursing journals from nurses in the Department of Psychiatric Nursing and Human Sciences at the University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Brazil. Perhaps academic institutions need to provide more visiting professorships to national and international English speaking experts and facilitators in publications skill developments. Experiential learning workshops and seminars about the publication process should be part of the continuing professional development of nurses. Educational development and co-authorship are the steps in the right direction.

For most of us, there is a long journey to travel to develop our potential capacity for self-awareness and the mastery to publish in English in high quality nursing journals. Writing for publication in international journals is also about being acculturated in the language of the journal and the process of publication. Learning about publications is a life long process. However, we must listen to our hearts, learning from the omens strewn along life's path and above all follow our dream(8). Desvanecimento ou compromisso? (complacency or commitment?).



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1 International Committee of Medical Journal Editors. Med Educ 1999; 33(1): 66-78 British Medical Journal
2 British Medical Journal - oct.2004
3 The Lancet
4 Jones S, Cook C. Electronic journals: are they a paradigm shift? Online Journal of Issues in Nursing (2000) 5, Manuscript 1. Available at: BioMed Central. What Is BioMed Central? BioMed Central Ltd. 2001. Available
5 The Lancet
6 Webb C. (2004) Personal communication. October 2004



Recebido em: 5.1.2005
Aprovado em: 22.11.2005