Karen Roush - A Nurse's Step-By-Step Guide To Writing A Dissertation or Scholarly Project,-SIGMA Theta Tau International (2023)

US $39.
95
A NURSE’S
STEP BY STEP
F eeling overwhelmed by the mere
A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT

thought of writing your dissertation or “Dr. Roush’s book, a must have for GUIDE TO
scholarly project? Wondering how to begin
WRITING A
every doctoral student, provides a
and where to find the time? You are not
alone. Earning your advanced degree is an useful and thoughtful road map for
extraordinary accomplishment, but com- organizing and writing the doctoral
pleting those final stages can be a daunt-
ing task. A Nurse’s Step-By-Step Guide to
dissertation. Dr. Roush has compiled
her years of experience working with DISSERTATION
OR SCHOLARLY
Writing a Dissertation or Scholarly Project, and advising doctoral students into
Third Edition, is a straightforward how-to this superb resource. Her style of
guide. This book is intentionally concise
writing makes you feel like a trusted
PROJECT
because, let’s be honest, the last thing a
busy candidate needs is another unwieldy, friend is by your side, guiding you
doorstop-sized book. through every step of the process.
Beyond being filled with excellent
Packed with practical steps and tools, this writing examples, useful tips, and
THIRD EDITION
fully updated third edition will help you checklists, this book is an easy read
plan, document, organize, and write your
for the busy scholar.”
dissertation or scholarly project. Don’t go
it alone; let author and fellow dissertation –Carl A. Kirton, DNP, MBA, RN, APN
survivor Karen Roush help you get from Editor-in-Chief, American Journal of Nursing
square one to DONE.
KAREN ROUSH, PhD, RN, FNP-BC, is Assistant Professor of Nursing at Pace University
in New York, where she teaches doctoral and graduate students. Roush served for many
years as Editorial Director and Clinical Managing Editor of the American Journal of Nursing
(AJN) and is currently News Director for the journal. She is founder of The Scholar’s Voice,
EDITION
THIRD
which works to strengthen the voice of nursing through writing mentorship for nurses.
ROUSH
SigmaMarketplace.org/Books
KAREN ROUSH
DissertationCover3E.indd 1 1/19/23 10:08 AM

US $39.95
A NURSE’S
STEP BY STEP
F eeling overwhelmed by the mere
A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT

thought of writing your dissertation or “Dr. Roush’s book, a must have for GUIDE TO
scholarly project? Wondering how to begin
WRITING A
every doctoral student, provides a
and where to find the time? You are not
alone. Earning your advanced degree is an useful and thoughtful road map for
extraordinary accomplishment, but com- organizing and writing the doctoral
pleting those final stages can be a daunt-
ing task. A Nurse’s Step-By-Step Guide to
dissertation. Dr. Roush has compiled
her years of experience working with DISSERTATION
OR SCHOLARLY
Writing a Dissertation or Scholarly Project, and advising doctoral students into
Third Edition, is a straightforward how-to this superb resource. Her style of
guide. This book is intentionally concise
writing makes you feel like a trusted
PROJECT
because, let’s be honest, the last thing a
busy candidate needs is another unwieldy, friend is by your side, guiding you
doorstop-sized book. through every step of the process.
Beyond being filled with excellent
Packed with practical steps and tools, this writing examples, useful tips, and
THIRD EDITION
fully updated third edition will help you checklists, this book is an easy read
plan, document, organize, and write your
for the busy scholar.”
dissertation or scholarly project. Don’t go
it alone; let author and fellow dissertation –Carl A. Kirton, DNP, MBA, RN, APN
survivor Karen Roush help you get from Editor-in-Chief, American Journal of Nursing
square one to DONE.
KAREN ROUSH, PhD, RN, FNP-BC, is Assistant Professor of Nursing at Pace University
in New York, where she teaches doctoral and graduate students. Roush served for many
years as Editorial Director and Clinical Managing Editor of the American Journal of Nursing
(AJN) and is currently News Director for the journal. She is founder of The Scholar’s Voice,
EDITION
THIRD
which works to strengthen the voice of nursing through writing mentorship for nurses.
ROUSH
SigmaMarketplace.org/Books
KAREN ROUSH
DissertationCover3E.indd 1 1/19/23 10:08 AM

Praise for the third edition of A Nurse’s Step-By-Step Guide
to Writing a Dissertation or Scholarly Project
“Dr. Roush has produced a remarkable guide for RNs pursuing doctorates, seeking
to submit manuscripts for publication, or producing reports for organizational
purposes. Using clear language and a step-by-step format, the guide is jam-packed
with insightful advice and helpful tips while also signaling common pitfalls and
when to seek faculty advice. For many, writing is daunting; this book provides
tools to stay on track. All this delivered in a tone of encouragement and support.”
–Peri Rosenfeld, PhD, FAAN
Retired Director, Outcomes Research & Program Evaluation
Retired Director, Center for Innovations in the Advancement of Care
Department of Nursing, NYU Langone Health
“Dr. Roush’s book, a must have for every doctoral student, provides a useful and
thoughtful road map for organizing and writing the doctoral dissertation. Dr.
Roush has compiled her years of experience working with and advising doc-
toral students into this superb resource. Her style of writing makes you feel like
a trusted friend is by your side, guiding you through every step of the process.
Beyond being filled with excellent writing examples, useful tips, and checklists, this
book is an easy read for the busy scholar.”
–Carl A. Kirton, DNP, MBA, RN, APN
Editor-in-Chief, American Journal of Nursing
“Once again, Karen Roush has written an insightful, practical guide to

writing a dissertation/scholarly project. The 3rd edition contains sage advice
on how to organize, stay focused, and, most importantly, complete the project
in an efficient, timely way. This is a must read for all doctoral students as well
as faculty mentors.”
–Jane Barnsteiner, PhD, RN, FAAN
Professor Emerita, School of Nursing, University of Pennsylvania
Editor, Research and QI, American Journal of Nursing
“Dr. Roush’s book is an excellent, concise, easy-to-read how-to guide for doctoral
students. The book provides guidance from the start to the end. It is a required
book in our PhD in Nursing program, and we advise students to purchase it upon
entry to the program and to use it throughout. Both student and faculty feedback
is very positive.”
–Sharon Wexler, PhD, RN, GCNS-BC
Amelia A. Gould Endowed Professor for the PhD in Nursing
Chairperson, Department of PhD in Nursing
Pace University College of Health Professions Lienhard School of Nursing
Praise for the previous edition
“Karen Roush provides a comprehensive and insightful framework for writ-

ing a dissertation (traditional or manuscript option) or a scholarly project. The
book guides the reader with specific directions on how best to begin, develop, and
complete the various parts of a dissertation. Whether you need lessons in scientific
writing or sequential steps in organizing your dissertation or project, know that
Roush has written a book that deconstructs the complexities, chaos, and craft of
writing. She has provided the remedy to sleepless nights and blank pages on the
computer screen by offering this book as a real solution.”
–Donna M. Nickitas, PhD, RN, NEA-BC, CNE, FNAP, FAAN
Dean and Professor, Rutgers School of Nursing—Camden
“A Nurse’s Step-by-Step Guide to Writing a Dissertation or Scholarly

Project, Second Edition, is a straightforward resource for students as they proceed
through their scholarly work. Writing in an easy conversational style, Karen
Roush provides specific guidance for completing each chapter of the dissertation
or scholarly project. Her skill and passion for writing show throughout. The new
chapter on writing manuscripts is a great addition. The book is a valuable tool for
both students and faculty.”
–Eleanor T. Campbell, EdD, RN, FAAM
Associate Professor, Nursing Lehman College
Graduate Center of the City University of New York
“This book is a clearly written, comprehensive guide with practical advice for
any doctoral student preparing to write a dissertation or scholarly project. The
content is contemporary, with easy-to-understand examples that help highlight the
main points. The questions embedded in each chapter skillfully guide the student
through the writing process. I will recommend this book to all of my doctoral
students.”
–Kristen Sethares, PhD, RN, CNE, FAHA
Professor of Nursing, PhD Graduate Program Director
University of Massachusetts Dartmouth
“Dr. Roush offers a timely, practical, and all-inclusive writing guide for doctoral
students that provides valuable, easily applied information about writing the
dissertation or scholarly project for academic and, ultimately, publication purposes.
The format of the book promotes understanding of the complementary nature of
the scholarly work undertaken by students in both research- and practice-focused
doctoral programs. I applaud the unifying approach employed by the author.”
–Mary Jo Vetter, DNP, RN, AGPCNP-BC
Director, DNP Program, Clinical Associate Professor
Rory Meyers College of Nursing, New York University
“Roush’s triumph in her quest as writing mentor is sustained in this second edi-
tion. She has further streamlined the process for the most daunting of all graduate
student research projects. This guide concisely outlines elements of chapters, inte-
grates crucial tips for formatting and for preventing common errors, and, most
notably, eliminates the mystery of the construction of a dissertation or scholarly
project, often the greatest obstacle to writing advancement. A Nurse’s Step-By-
Step Guide to Writing a Dissertation or Scholarly Project is a required text
for doctoral nursing students whom I mentor.”
–Donna Rolin, PhD, APRN, PMHCNS-BC, PMHNP-BC
Associate Professor, Director of Psychiatric Nurse Practitioner Program
University of Texas at Austin, School of Nursing
A NURSE’S
STEP BY STEP
GUIDE TO
WRITING A
DISSERTATION
OR SCHOLARLY
PROJECT
THIRD EDITION
KAREN ROUSH, PHD, RN, FNP-BC

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_____________________________________________________________________________
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Publisher: Dustin Sullivan Managing Editor: Carla Hall

Acquisitions Editor: Emily Hatch Development Editor: Jill Leeper Sycamore
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Dedication
This book is dedicated to the upcoming cohorts of doctoral
nursing students who will carry the science forward and improve
healthcare for all of us.
About the Author
Karen Roush, PhD, RN, FNP-BC, is Assistant Professor of
Nursing at Pace University in New York where she teaches doc-
toral and graduate students. Roush served for many years as Edito-
rial Director and Clinical Managing Editor of the American Journal
of Nursing (AJN) and is currently News Director for the journal.
She received her PhD in nursing research and theory development
from the College of Nursing at New York University. She started
her nursing education with an associate degree in nursing from
Adirondack Community College in 1982, went on for her BSN at
Russell Sage College, and then earned a master’s degree at Co-
lumbia University in 1996, where she specialized as a family nurse
practitioner.
Roush is the founder of The Scholar’s Voice, which works to

strengthen the voice of nursing through writing mentorship for
nurses. She is an award-winning writer who has authored multiple
consumer healthcare books, numerous nursing articles in peer-
reviewed journals, essays, and poetry. Roush received the award
for Outstanding Doctoral Graduate at NYU College of Nursing
in 2014 and the Fred Schmidt Award for Humanitarian Focused
Research in 2011. She has traveled to Rwanda, Uganda, and India
as a nursing volunteer and taught nursing students in Ghana. In
addition, she was a visiting scholar in the Department of Human
Resources for Health at the World Health Organization in Ge-
neva, Switzerland.
Additional Book Resources
To download a sample chapter and other free book resources, visit
the Sigma Repository at http://hdl.handle.net/10755/22898 or
scan the QR code below.
Table of Contents
About the Author. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
1 Writing Your Introduction . . . . . . . . . . . . . . . . . . . . 1

You’ve Already Started. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Creating an Outline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Writing the Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Purpose Statements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
PICOT Statements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Your Plan (Methodology) . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Research Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Checking That You’ve Covered Your Purpose Statement. . . . . 17
2 Writing Your Literature Review. . . . . . . . . . . . . . . 21

Begin With an Overview and Definitions. . . . . . . . . . . . . . . . 23
Historical Context or Evolution of the Phenomenon . . . . . . . . 24
Explaining Your Theoretical Framework. . . . . . . . . . . . . . . . . 25
Explaining Your Search Strategy. . . . . . . . . . . . . . . . . . . . . . 28
Critically Appraising the Literature . . . . . . . . . . . . . . . . . . . . 32
Synthesizing Your Literature Review. . . . . . . . . . . . . . . . . . . 33
Summary and Research Gaps. . . . . . . . . . . . . . . . . . . . . . . 38
Purpose Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Research Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Appraisal Tools. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
3 Writing Your Methodology Chapter. . . . . . . . . . . . 47

Explaining the Approach and Design of Your Study . . . . . . . . 48
Establishing Your Study’s Setting. . . . . . . . . . . . . . . . . . . . . 51
Establishing Your Sample. . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Ethical Considerations and Consent. . . . . . . . . . . . . . . . . . . 59
Scholarly Project Planning and Procedures. . . . . . . . . . . . . . 62
Data Collection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Data Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
xii A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
Rigor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
4 Writing Your Results Chapter . . . . . . . . . . . . . . . . 89

Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Don’t Just Throw a Lot of Data at Us!. . . . . . . . . . . . . . . . . . 95
Tables and Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Qualitative Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Scholarly Project Evaluation and Outcomes. . . . . . . . . . . . . 105
Reference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
5 Writing Your Discussion Chapter. . . . . . . . . . . . . 111

A Review of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . 112
Discussing Your Sample . . . . . . . . . . . . . . . . . . . . . . . . . . 114
What Do Your Results Mean?. . . . . . . . . . . . . . . . . . . . . . . 114
When a Project Doesn’t Work . . . . . . . . . . . . . . . . . . . . . . 120
Discussing Implications for Practice, Education, Policy, and
Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Acknowledging Limitations . . . . . . . . . . . . . . . . . . . . . . . . 127
Crafting Your Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . 129
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
6 Writing Manuscript Option Dissertations . . . . . . 133

Introductory Chapter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Summary (Conclusion) Chapter. . . . . . . . . . . . . . . . . . . . . 135
Manuscripts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Types of Manuscripts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Writing the Manuscript . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Publication Basics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
TABLE OF CONTENTS xiii
7 Writing Well: The Basics . . . . . . . . . . . . . . . . . . . 151

Good Writing Characteristics. . . . . . . . . . . . . . . . . . . . . . . 152
Choosing Your Language. . . . . . . . . . . . . . . . . . . . . . . . . . 156
Making Clear Transitions. . . . . . . . . . . . . . . . . . . . . . . . . . 161
Checking Your Grammar. . . . . . . . . . . . . . . . . . . . . . . . . . 163
Revise, Revise, Revise. . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Extraneous Words and Phrases. . . . . . . . . . . . . . . . . . . . . 167
$100 Words and Phrases . . . . . . . . . . . . . . . . . . . . . . . . . 169
Redundant Word Combinations . . . . . . . . . . . . . . . . . . . . . 170
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Introduction
What Is This Book, Anyway?
This is a book about writing your dissertation or scholarly project.
It is intentionally small because the last thing a doctoral student
needs is another doorstop-sized book to buy, read, and lug around.
This is a step-by-step guide to help you write your dissertation or
scholarly project. It will not help you design or conduct research or
quality improvement initiatives, but it will help you plan, docu-
ment, organize, and write your dissertation or scholarly project.
What Will You Get From This Book?

Before I talk about what you’ll get from this book, I want to talk
about two essential things you need to successfully complete a dis-
sertation or scholarly project that you won’t get from this or any
book: perseverance and a community.
Of all the characteristics you need to get through doctoral studies,

the foremost is perseverance. Early in my studies, a student prepar-
ing for his final defense gave me the best piece of advice I ever
received: “Just keep going; it’s all about perseverance.” That advice
has echoed reassuringly for me many, many times through the
years. Because there will be days when you’ll wonder if it’s worth
it, if you’ll ever get there, if you’ll ever hear that coveted title—
Doctor—attached to your name. You will, if you persevere. You’re
smart enough, you already have a lot of the knowledge you need,
and what you don’t have you’ll learn along the way. What really
separates the perpetual ABDs (all but dissertation, three of the most
frustrating words known to doctoral students) from the doctors is
perseverance.
xvi A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
The other essential thing you won’t get from this book is a commu-
nity of fellow students. Hang on to each other, confer, curse, and cry
together. No one else will understand what you’re going through;
people outside the experience have no concept of the exhilarating
but often painful process of reimagining your worldview, of recon-
figuring your brain. At times, it is so intense that you swear you can
feel your synapses breaking and reconnecting in new and different
ways.
So, when it all seems like too much, and when you hit those
unexpected roadblocks and delays—and you will (more revisions
than you anticipated, difficulty recruiting, conflicting advice from
committee members)—gather your community around you and
persevere. You will get there.
OK, now on to what you’ll get from this book.
This book takes you step by step through writing your dissertation
or scholarly project, with chapters that correspond exactly with
the chapters of a dissertation or scholarly project. There’s no fluff
here—no attempt to make the book look bigger to attract atten-
tion. All I intend to do is to help you successfully write your disser-
tation or scholarly project, and I’ve tried to do so in a succinct and
logical way, with only the occasional interruption for important
tips gleaned the hard way.
INTRODUCTION xvii
HOW TO USE THIS BOOK

To get the most out of this book, you want to follow these three steps:
1. Do a quick read-through of the book so that you get an overall picture of
what lies ahead and to check that you have included all required items in
your planning and design.
2. Before you begin writing, read Chapter 7, “Writing Well: The Basics,” on
the craft of writing.
3. Before you start working on a particular section of your paper, carefully

read the chapter in this book that applies to it.
Getting Started
Important note: Start your writing with Chapter Two (Literature
Review), not Chapter One (Introduction). That’s because before you
start writing, you need to know the literature inside out so that you
thoroughly understand your topic, where your work fits in the con-
text of prior research, and what relevant interventions have been
tried. All of that comes from undertaking and writing the literature
review. The introduction and background sections are really a
short synopsis of your literature review, so after you’ve completed
Chapter Two, Literature Review, you’ll have everything you need
to go back and write Chapter One, Introduction.
As mentioned previously, this book is not about how to design and

conduct research or a quality improvement project. However, you
can’t produce a well-written dissertation or scholarly project if gaps
exist in your thinking or planning, and using this book can help
reveal them. When you do a first read-through of the book, note
what is required to be included in each section. Make sure that you
have included all these elements when planning and designing your
study or project.
xviii A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
The Purpose
Nothing is more important than your purpose statement; it is the
whole reason for the dissertation or project. Before doing anything,
make sure that you have a clear, concise purpose statement. Everything
else flows from that.
Defining your purpose is a process that you can’t do quickly or

in isolation. It is refined over time with the help of your mentors
and committee members, through class discussions, in dialogue
with colleagues and fellow students, and through just plain hard
thinking about it again and again. Along the way, you’ll have done
a preliminary literature review to get an idea of the state of the
knowledge and the research gaps.
Once your purpose statement is done, you’re ready to move on to

the more comprehensive literature review and writing the disserta-
tion or scholarly project.
Structure and Components of a Dissertation/Scholarly

Project
The overall structure of a dissertation and scholarly project is
similar. A dissertation is the written report of an original research
project, while a scholarly project is the written report of a quality
improvement or other project that translates evidence into prac-
tice. The structure for both is based on the recommendations of
the International Committee of Medical Journal Editors (ICMJE)
and the Standards for QUality Improvement Reporting Excellence
(SQUIRE) guidelines.
ICMJE is used for reporting original research, and SQUIRE is

used for reporting quality improvement projects. But both follow
INTRODUCTION xix
the IMRAD structure: introduction,

Requirements will vary
methods, results, and discussion. A
TIP
among different pro-
dissertation/scholarly project adds
grams, so confirm your
an additional section: an in-depth, program’s guidelines.
comprehensive literature review.
Dissertation Template
The traditional dissertation is structured as five distinct chapters
corresponding to IMRAD, with the literature review added as the
second chapter. This template is fairly standard regardless of dis-
cipline or school. However, programs often have different specific
requirements within that structure. So before beginning, carefully
review your program’s specific requirements. For the most part,
your dissertation template will follow the outline discussed in this
section.
Some programs have a manuscript option in place of the tradition-

al five-chapter dissertation format. The manuscript option includes
an introductory/background chapter, two or three manuscripts—
one of which must be a data-based report of your dissertation
research—and a discussion chapter that synthesizes all components
of the dissertation. The manuscript option is covered in detail in
Chapter 6, “Writing Manuscript Option Dissertations.”
Chapter One: Introduction

The introduction introduces the topic, provides some background
information, explains why the topic is important, briefly describes
what is known about the topic, states what we need to know, and
concludes with the purpose of the dissertation research.
xx A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
Chapter Two: Literature Review

The literature review (often called a literature survey) gives an in-
depth analysis of what is known about the topic through a review
of the existing literature. It presents and summarizes the current
knowledge on the topic and relevant concepts. It identifies gaps in
knowledge and concludes with identification of a particular knowl-
edge gap, how your dissertation research will address that gap
(purpose), research questions, and any hypotheses. Some programs
also include a section on the historical context or evolution of the
phenomenon being studied in this chapter.
Chapter Three: Methodology

The Methodology chapter describes in detail the study methods,
including the theoretical frameworks, sampling, setting, ethical
approvals, how the data will be collected, instruments that will be
used for data collection, and how data analysis will be conducted.
Chapter Four: Results

The Results chapter presents the findings and includes the final
sample size and demographics. Tables and figures are often used to
report data.
Chapter Five: Discussion

The Discussion chapter interprets the findings and compares them
to findings in prior research on the topic. It also includes limita-
tions and implications for practice and future research. The Dis-
cussion chapter may also include a short conclusion that highlights
the key points and wraps up.
INTRODUCTION xxi
Scholarly Project Template

The scholarly project template is similar to that of the traditional
dissertation, but whereas the structure of a traditional dissertation
is usually standard among different schools and programs,
the structure of the scholarly project varies somewhat. The
IMRAD structure is still the foundation, and all the components
of SQUIRE guidelines are still there, but where they are placed
and what they are called can vary. Some structure the scholarly
project into sections without distinct chapters. Others may use
chapters, but what goes where may vary. For example, the litera-
ture review may be included as part of Chapter One, and Chapter
Two describes the project (methods). The evaluation (analysis) may
be separated from methods in its own chapter, as well. Outcomes
(results) and implications (discussion) are always going to follow
at the end of the paper, although there may be different specific
requirements within them.
This book follows a structure that closely aligns to IMRAD and

the SQUIRE guidelines and is very similar to the dissertation
structure. When it differs, the text alerts you to that fact, and spe-
cific guidelines for scholarly projects are provided where appropri-
ate. The scholarly project template will follow the outline discussed
in this section.
Chapter One: Introduction

This chapter introduces the topic and explains why it is important.
It also gives background information on the local problem (what is
happening in your specific setting that requires improvement). It
usually includes a problem statement section that may include the
purpose of your project, a PICOT question, and specific objectives
and aims.
xxii A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
Chapter Two: Literature Review

This chapter provides an in-depth analysis of what is known about
the topic. It presents and summarizes the current knowledge on
the topic and relevant concepts. It looks closely at the interventions
related to your project that have been used and tested in the past.
It also identifies gaps in knowledge. It concludes with a summary
that leads to the purpose of your project. The theoretical frame-
work is usually discussed in this chapter. It may also include an
evidence-based practice model that will guide the project planning
and implementation.
Chapter Three: Methodology

This chapter describes the project. It includes the setting, people
involved in the project, sample, ethical approvals, resources needed,
outcomes, and how the project will be evaluated, including instru-
ments. It also includes a timeline and budget.
Chapter Four: Results

This chapter presents the outcomes of the project, usually orga-
nized by objective. It includes facilitators and barriers encountered
during implementation and how they were addressed. Tables and
figures are often used to report data.
Chapter Five: Discussion

This chapter discusses the results of the project and the real-world
experience of carrying out the project. It makes recommendations
for the ongoing implementation of the project in your setting and
for application of the project in other settings. It also includes limi-
tations and unforeseen outcomes, both positive and negative. The
chapter may also include a short conclusion that highlights the key
points and wraps up.
INTRODUCTION xxiii
Tenses in a Dissertation/Scholarly Project: Past, Present, or Future?

Which tense you should be writing in can get confusing in disserta-
tion and scholarly project papers. When you begin, you are writing a
proposal for something you are going to do in the future. Once you
complete the study or project, you are writing about something you
did in the past. And then there are the parts of your dissertation or
scholarly project where the tense isn’t affected by whether you have
done the study or project yet. Here are guidelines to follow:
• Introduction: Present tense for background unless you are

talking about what an earlier study found. Then it is past
tense. Future tense for what you propose to do when writing
the proposal and past tense for what you did when writing the
final dissertation/project paper.
• Literature review: Past tense for review of the literature.
Present tense for research gaps. Future tense for how you are
going to address it in the proposal, and past tense for how
you addressed it in the final dissertation/project paper.
• Methodology: Future tense for proposal; past tense for final
dissertation/project paper.
• Results: Past tense.
• Discussion: What was in the literature and what your results
were are in past tense. Implications for practice and research
are in present and future tense.
When you’ve finished the research study or project and are writing
your final paper, remember to go back through the entire paper and
change the tense from future to past where appropriate. You’ll need
to do this primarily in the sections on methodology, data analysis,
and outcomes, but also in parts of your introduction and literature
review where you talked about what you were planning on doing.
xxiv A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
General Tips and Recommendations

Following are some tips that can make the going a little smoother.
Some are general for any writing you do, while others are specific
to the dissertation/scholarly project journey. Taking some time up
front to prepare yourself to write, organize your work and work
space, and use the resources available to you will alleviate some of
the inevitable stress and frustrations ahead.
Read
Ask your committee members to recommend examples of well-
written dissertations or scholarly projects written by former
students. You can find full-text dissertations and scholarly projects
online in the Dissertation Abstracts database (ProQuest), which is
part of many colleges’ digital database collection. You can also find
DNP scholarly projects on online repositories, such as at the Doc-
tors of Nursing Practice, Inc. website. Read through a few to get
an idea of the structure, flow, depth of information, language, and
length overall and of various sections. Keep in mind, though, that
the quality and rigor of dissertations and scholarly projects varies,
so getting recommendations from your committee members is the
best way to ensure that you’re reading high-quality examples.
Also read research and quality improvement project reports in the

biomedical literature. The more you are exposed to the language
and the flow you find in those reports, the more natural they will
be for you.
Befriend Your Research Librarian

Use your research librarian. Research librarians can help you
greatly. They are experts in searching the literature and can help
you set up a search strategy, find articles, and organize the results.
INTRODUCTION xxv
Use a Bibliographic Software Program

Bibliographic software programs are one of the greatest inven-
tions when it comes to writing scholarly papers—especially long,
complex ones like dissertations and scholarly projects. With one
of these programs, such as RefWorks or Zotera (a free program),
you can save articles, organize your articles into folders, and—best
of all—create reference lists in whatever format you need. You
can usually sign up for an account through your school’s library
page; most schools provide student access for free. Don’t be put
off because you think you’ll have to learn a complicated software
program. The programs do have a variety of advanced features,
but even used at their most basic level—saving articles and put-
ting them in folders, formatting reference lists—they will save you
countless hours of work. Here are a few tips for using a biblio-
graphic software program:
• Check with your school’s library for courses on using the

programs or make an appointment with the librarian for a
lesson. An hour or two spent learning a program now will
pay off big later.
• As you do your literature review, throw into your account
every article you come across that relates to your topic. Even if
you don’t think you will use it, you might. On many occa-
sions, you’ll remember reading an article about something
that would be helpful, and you’ll spend far too much time
searching for it, often to never find it again (unless you fol-
low the advice given here).
• Bibliographic programs aren’t flawless. So, always carefully
check your reference list for errors. Most of these are mistakes
with capitalization; the programs don’t always recognize
proper nouns.
xxvi A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
Get to Know Word

Most students have a basic proficiency in Microsoft Word. Un-
less you’re a professional writer, however, you’re probably not
nearly as proficient as you could be. Here again, taking a few hours
in the beginning can save you a significant amount of time (and
keystrokes) down the road. Instead of spending an hour trying to
figure out how to go from portrait to landscape and back again
for that figure or table, it’s done in a minute. Check your college
library for courses and sign up for one. When you’re writing hun-
dreds of pages (yes, with revisions you will be writing hundreds of
pages before you’re done), every keystroke saved makes a differ-
ence in time and frustration.
Get on the Cloud

Set up an account with one of the many cloud file-hosting pro-
grams, such as Google Docs or Dropbox. After you do, you can
access your work anywhere there’s a computer and an internet
connection. When you finish each work session, upload your latest
version to the program. These services also provide other advan-
tages; for example, you can share your work with other people,
such as your committee members or colleagues, and you have the
safety of file backup. If your computer crashes, the files are out
there in cyberland waiting for you.
Designate a Dedicated Work Space

You want a place where you can have your work ready and waiting
for you so that you can dive right in. You’ll be creating all kinds
of piles—types of articles, notes for different chapters, reference
books—and you don’t want to have to pick them all up and put
them away and then take them all out and reorganize them again
for each work session.
INTRODUCTION xxvii
Also, you want a place where your mind and body know exactly
what is expected of them when you are there—like putting on run-
ning clothes and sneakers prepares you for running and putting on
scrubs prepares you to work.
Make the Time

You’ll never “find” time to write. It’s not lost somewhere out there;
it just doesn’t exist. So, you need to make it. And once you do,
prioritize it. Nothing interferes with the time you have reserved
for writing. Period. Not laundry, not that junk drawer you’ve
been meaning to clean out for the past six months, not the really
fascinating list of ingredients on the back of the cereal box. And
especially not the endless distractions to be found on the inter-
net. Banish YouTube from your life. Restrict social media use to a
specific time period each day. Declare a moratorium on those innu-
merable online games calling to you.
There are different online programs that can help you control online distractions
during your designated writing time. Some programs give you the option of
locking yourself out of the internet entirely or only from specific websites, such
as social media accounts, that you designate. Others will track the time you
spend on different programs so you have more awareness of how much time
you’re actually spending on your paper versus wandering around the internet.
Once you know how you’re actually spending your time, you can change your
work habits to be more efficient.
You need to really focus on your work during the time you make
for it. A dissertation or scholarly project is a creative process that
requires a level of critical thinking that can only be achieved with
uninterrupted, focused attention. When your mind starts wander-
ing, take 15 minutes to go for a walk or run, meditate, or take a
nap; then go back to work with 100% concentration.
xxviii A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
Gather
Keep a dissertation/scholarly project notebook. Write down
ideas, quotes, questions, names of people you come across
who are working in your field, programs related to what you are
doing—anything that may be useful, even if indirectly. Developing
a dissertation and scholarly project is an ongoing iterative process;
you’ll find yourself constantly thinking about it, breaking it down,
adding and deleting, and reconfiguring. Have a place to save it all,
and come back to things when needed.
Don’t Start at the Beginning

If you’ve ever attended a writing workshop or read a book on the
writing process, you’ve probably heard this already. Every writer
dreads the blank page, and starting with what feels easiest or is up-
permost in your mind can help overcome that. As noted previously,
when writing a dissertation or scholarly project, it’s preferable not
to start at the beginning since everything you need for the intro-
duction is in the literature review. But you can also start writing
part of the methods section or the theoretical framework or any
other area you feel ready to put down on paper.
Save Every Copy Every Time

Each time you work on your paper, save it as a new version. As
you proceed there will be times you decide that an earlier draft of
something you wrote is actually better, or something you decided
to delete actually belongs in the paper after all. When you save
your changes as separate versions, you’ll be able to go back and
pull out whatever you need. If you’re doing a lot of work at one
sitting with many changes, you may even consider saving multiple
versions during that work period. To save your work as a different
version, use the Save As command and change the name slightly
INTRODUCTION xxix
each time. You can go in alphabetical order and assign a letter to

each version; for example, you can save versions as Lit_Review_a,
Lit_Review_b, Lit_Review_c, and so forth. Or you can use the date
for each version—Proposal_032823, Proposal_033023, and so on.
If there are multiple versions in one day, add a letter to each ver-
sion: Proposal_032823a, Proposal_032823b.
Organize Your Work

Create folders on your computer for all your drafts. Have a folder
for each chapter, for the drafts of the complete proposal (Chapters
One through Three), for each manuscript, and for the drafts of the
final dissertation or scholarly project (Chapters One through Five).
If you print out hard copies of articles included in the literature
review, jot notes on the first page that will tell you at a glance what
key points that article contributes to the review, and organize the
articles in piles by variable, concept, or topic. Organize articles
within each pile in alphabetical order by author. That way you
can quickly find a specific article or flip through the pile and look
at the notes you made to find an article with the information you
need. For example, in my dissertation on intimate partner violence
in the rural setting, I had piles labeled incidence/prevalence, physi-
cal consequences, mental health consequences, economic costs,
isolation, leaving, and risk factors, among others.
Follow Requirements for Your Program

This book presents the most common structures and require-
ments for a dissertation or scholarly project. Your program may
have specific requirements that differ from what is covered here. As
noted previously, make sure that you follow your program’s specific
requirements.
xxx A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
In addition, always follow the directions of your chairperson and other

committee members. If they insist on a particular format or writing
style, do it their way. For example, many academicians still insist
that the first-person point of view should not be used in scholarly
papers. If your committee members are among them, don’t use the
first person.
Remember, the best dissertation is a done dissertation! And your

committee will determine when that is the case. So, cede to their
directives when necessary.
Academic Integrity
Please, please, please pay careful attention to issues of academic
integrity! Don’t be complacent or think this doesn’t apply to
you. Plagiarism is an ongoing problem in academia. Some of it is
intentional appropriation of another’s work, usually when copying
material from a source. But sometimes it is the result of a lack of
understanding of what constitutes plagiarism.
We all know that taking something word-for-word from a pub-

lished or nonpublished source is plagiarism. However, that is only
one type of plagiarism. Other types you have to watch out for are
the use of someone else’s ideas without giving proper attribution or
following too close to the source, such as when paraphrasing.
Make sure you always give credit where credit is due. If you’re
using an argument presented elsewhere or building on another’s
ideas, you must give credit:
Considering the ideas about repressed grief put forth by Smith (1998) . . .
As Smith (1998) argued . . .
I agree with Smith (1998), who posited that . . .

INTRODUCTION xxxi
Be careful with paraphrasing. It is not good enough to just change

the wording if the material presented is essentially the same as the
original. If it is not your synthesis or interpretation of information,
then you should give attribution to the original source.
With the ability to use cut and paste tools, it is very easy to ac-
cidentally include fragments pasted from other documents in your
own work. Never cut and paste information from an article or
other source directly into your Word document, even with the
intention of rewriting. I’ve heard from many students and authors
who have been caught plagiarizing that they did this and then
either used the wrong draft or, for one reason or another, inadver-
tently overlooked rewriting the pasted material in their own words.
Your program will probably require you to submit your papers

through a plagiarism detection software program, such as Turnitin
or SafeAssign. These programs compare your paper to published
articles and websites and to all the papers, including student assign-
ments, previously submitted through that particular program. Find
out if you can submit a draft through the software program prior
to submitting the final paper so you can check for any writing that
is too close to sources you used for your paper. If not, there are
online programs you can use to check your work.
The best way to avoid plagiarism, though, is making sure that you
are synthesizing information—taking what you have learned from
multiple sources, critically analyzing and interpreting it, and inte-
grating all of it into something new. Don’t risk your degree or your
academic future—watch out for plagiarism!
Working With Your Committee

Professors have different styles and approaches to chairing or
serving on a committee. Understanding their expectations up
front will save you angst and time. Committees are composed of
xxxii A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
a committee chair—who leads the group, is your primary advisor/

mentor, and has the final say on everything—and two to four com-
mittee members. You’ll usually have a content expert and a meth-
ods expert, and, if you’re doing a quantitative study, you may have
a statistician. At defense, all the committee members must approve
your proposal or final paper for you to pass. Once your commit-
tee is formed, meet with your chair and each member to discuss
everyone’s expectations. For example, ask your chair when and how
often you should share drafts with the other committee members.
Some chairs don’t want you to share drafts until you are close
to defense, whether that be your proposal or final defense. They
believe that not sharing drafts earlier avoids confusion, conflicting
advice, and unnecessary revisions. Others will have you involve all
the committee members from the beginning or perhaps bring in
certain ones as needed, such as having you work with the statisti-
cian for data analysis but not for feedback on the first two chapters
(Introduction and Literature Review).
Ask committee members how much time you should allow for
them to review and respond to each draft. Keep in mind that they
are very busy, with multiple responsibilities and deadlines as well
as other students. They won’t be able to turn your paper around in
days—it’s more likely going to be a week or more. It’s OK to send
out a polite follow-up if the agreed upon time has passed by a few
days or a week.
Respect your committee members’ time—once you send them a

draft for review, wait until you get their feedback before making
any other changes on the section being reviewed. With planning,
you can be working on a different section while waiting for feed-
back—that way there won’t be any delays. It’s very frustrating for
your chair to spend time reviewing and marking up pages only to
get an email saying that you’ve changed it—all that work is now for
naught. Don’t frustrate your chair!
INTRODUCTION xxxiii
Stay With It
Getting a doctorate is hard. It’s not that you aren’t capable of
mastering the material, though it will challenge you, as it should—
you are attaining the highest level of education. One of the biggest
challenges is staying focused on your work consistently over time
once you are past the coursework stage and out there doing the
research in what feels like isolation. It’s important to remember
during this time that you are not on your own. You still have the
guidance of your professors, the support of your fellow students,
and other resources—such as your librarian and other mentors—to
rely on. Some strategies to help keep you motivated and moving
forward:
• Schedule a regular check-in with your committee chair. You

are more likely to write knowing that you’ve going to have
to share your progress in an upcoming meeting. It will also
save you from wasted time and effort going off track. Regu-
lar feedback from your chair can redirect you if you start
going down any wrong paths.
• The same goes for your fellow students. Use one of the
social media apps, such as WhatsApp, to do regular check-
ins with each other.
• Create a timeline for yourself. Work backwards from your
defense goal date. Be very specific about what you are going
to accomplish each week. Be realistic, but don’t go too easy
on yourself. Be sure to allow time for your chair to review
drafts.
• Sometimes you just need a break. If you find your produc-
tivity level going way down or you’re getting sloppy, or you
just feel like you can’t face that @*$#! paper another day,
take some time away—a few days or a week—and refresh.
xxxiv A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
Finally . . .
Use the following checklist to set yourself up to succeed.
Checklist for Success
HAVE I . . .
❑ Set up my writing space?
❑ Scheduled dedicated writing times?
❑ Read sample dissertations or scholarly projects?
❑ Reviewed my program’s dissertation or scholarly project requirements
and guidelines?
❑ Set up Google Docs, Dropbox, or a similar cloud account?
❑ Written a clear, focused purpose statement?
❑ Made an appointment with a research librarian?
❑ Reviewed ICMJE and SQUIRE guidelines?
❑ Set up a bibliographic software account?
❑ Met with my committee members and agreed on expectations?
You’ve worked so hard to get to this point. Don’t let writer’s block,
distractions, or an unorganized approach slow you down toward
your goal to get it done! This book will help you in many ways, so
keep it handy at all times. Whenever you get stuck or find yourself
blocked, remember those key elements I mentioned at the begin-
ning of this introduction: perseverance and community.
Now, go forward and do great work!
–Karen Roush, PhD, RN, FNP-BC

1
WRITING YOUR
INTRODUCTION
ELEMENTS OF YOUR INTRODUCTION

1. Provides some background information so
that readers understand the issue
2. Explains why the issue is important
3. Describes what is known about the issue
4. States what we need to find out or what

action needs to be taken and why
5. Presents how you plan to do that (your

study/project)
2 A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT
There’s a good reason you chose your dissertation or scholarly

project topic. Maybe an experience in your personal life left you
determined to make things better for others experiencing the same
thing. Or perhaps you’ve witnessed too many patients having poor
outcomes after a certain procedure and you want to figure out a way
to change that. Maybe you chose your topic in response to a lack of
knowledge or poor attitudes about a particular condition that causes
unnecessary suffering for those who experience it. Or perhaps
you’ve noticed a systems issue that is creating increased work stress
for fellow nurses.
Whatever it is, something made you sit up and pay attention. The
introduction is your opportunity to make the reader do the same. In
this part of the dissertation, you tell readers why you care about this
topic, and even more important, why they should care, too.
In dissertation/project speak, we call this establishing significance. In

plain English, we’re saying, “Hey, listen up! This is important, and
here’s why.”
Of course, you can’t expect readers to just take your word for it.
You need to first give them information so that they understand the
problem, and you need to back up that information with evidence.
After you do that, you can ask them to consider your idea for what
we need to do next, whether that is gathering more information or
trying out a solution.
You’ve Already Started

Good news: You’ve already done most of the work for this chapter!
Much of the introduction will come from all the information you
gathered when you did your literature review. What you want to do
CHAPTER 1 • WRITING YOUR INTRODUCTION 3
is summarize the literature review. As you do so, include enough

information to familiarize readers with your topic and to convince
them of its importance without extensive details or an in-depth
review of individual studies.
Creating an Outline
You can begin by developing an outline based on the required
elements. To do so, first answer each of the following questions
(which correlate with required elements 1 through 4 listed at the
beginning of this chapter) with one or two sentences:
1. What is happening?
2. Why should we care?
3. What do we know now?
4. What do we need to find out and why? or What do we need

to do to address this?
If you have a hard time keeping your answers to one or two

sentences, you might need to refine your study/project to focus it
more. Get rid of any noise—all that extraneous information that is
not really bringing value to the paper. It’s the old need to know vs.
nice to know. In a dissertation/project, we only want the need to know
stuff. If information doesn’t add value to the paper, it detracts from
it and may even confuse the reader. So be sure to stay focused, like
a photographer focusing in on the intended subject and letting
everything else blur out so that the viewer’s eyes go right to what’s
important.
KEEP IT OR DELETE IT?

Remember: Stay focused on your purpose statement. Keep it in sight—prop
it up next to your computer or tape it to the wall in front of you. Go back to it
whenever you start adding information to the paper and ask yourself these two
questions:
1. Is this information directly related to my purpose statement?
2. Does it add to the reader’s understanding of the problem, topic,

or concept?
If the answer to either one of these questions is no, delete the new information.
Be ruthless with yourself. Conciseness means clarity—make that your mantra.
After you’ve answered the questions, read your answers in order.

Each answer should connect with what comes before, and all of
them should lead you straight to a logical therefore statement.
Therefore, I am going to conduct a study to…
Therefore, I designed a quality improvement project to…
If the answers don’t lead directly to the therefore statement, what’s

missing? Where does the connection get lost? If you haven’t gotten
the reader to care, then it doesn’t matter what you know and what
you want to do. Or maybe now the reader cares but wonders why
you need to do this particular study at this particular time, because
it doesn’t seem to be the next logical thing to do based on what’s
already been done. Or you haven’t shown how the solution you
propose could effectively address the problem you’ve identified.
Here’s an example of what the answers to these questions might be

for a dissertation proposal on intimate partner violence (IPV) in
the rural setting:
IPV is a pervasive health and social problem in the United
States. One out of three women experience IPV in their
lifetime.

IPV causes tremendous physical and emotional suffering
and even death. It’s costly to individual women and society.

Women in the rural setting who experience IPV face unique
challenges. Current support and resources are inadequate
and ineffective.
4. What do we need to find out and why?

There is little research on the lived experience of IPV for
women in the rural setting. We need to understand this so
we can develop effective services and provide appropriate
resources and support.
Therefore, I propose a qualitative descriptive study of the lived

experience of women who experience intimate partner violence in
the rural setting.
Here’s an example for a scholarly project to decrease the rate of

central line-associated bloodstream infections in an ICU:
Rates of central line-associated bloodstream infections
(CLABSI) in the intensive care unit are higher than national
benchmarks.

CLABSI is associated with higher morbidity rates and
a mortality rate of 10% to 20%. It leads to an increased
length of stay for the patient and costs the hospital over
$28,000 per patient. CLABSI costs the U.S. healthcare
system close to 2 billion dollars annually.

CLABSIs are preventable. Evidence-based protocols reduce
the rate of CLABSIs. The Comprehensive Unit-based
Safety Program (CUSP) toolkit has reduced the national
rate of CLABSIs by 41%.
4. What do we need to do to address this?

Follow evidence-based protocols in caring for patients with
central lines.
Therefore, I am going to lead a team to modify the CUSP toolkit to

meet the needs of the ICU and implement it on the unit.
After you’ve answered the questions

satisfactorily, have someone unfa- You need to consider
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miliar with the topic review it. Does these questions and
that person agree that the therefore review your answers
statement makes perfect sense? If carefully. They repre-
not, it’s back to the drawing board. sent the very basis for
your study or project.
If they do, brava!—you’re on your
way.
How you proceed at this point depends on your own writing work
style. Some people prefer to work from a detailed outline. If you
do, you can now begin to fill in your answers with more particulars.
If you are not an outline type of worker, you can move on to writ-
ing the introduction, as described later in this chapter.
Filling In the Outline

Under each question, list the different pieces of information that
you need to add. Depending on your topic and purpose, your
outline should include some or all of the following information:
a. Condition, problem, issue
i. Definition or brief description
ii. Population affected
b. Epidemiology
i. How many
ii. How often
iii. Where (e.g., United States, globally, developing
countries, hospital or community)
iv. Mortality rates
c. Local problem (for quality improvement project)
d. Associated concepts necessary to understanding of
problem or approach

a. Morbidity and mortality
b. Pain and suffering it causes
c. Economic costs
i. Individual
ii. Organization/institution
iii. Society
d. Increasing or worsening?
e. Consequences/impact of local problem

a. Recent research
b. Current treatments or interventions
i. Outcomes
ii. Limitations
4. What do we need to find out and why?

a. Questions that still need to be answered
b. Interventions to be trialed
c. Factors or outcomes in a specific population
d. Benefits to be gained
i. Better patient outcomes
ii. More effective interventions
iii. Improved services
iv. Workforce issues
v. Improved systems
Writing the Introduction

When you start writing this part of your dissertation, remember
that each section is an introduction to the material included. So, don’t
get too detailed. The important thing is that you adequately and
succinctly cover all these areas. In your Literature Review (Chapter
Two), you critically review prior research and cover the individual
studies in depth. In the Introduction, in contrast, you present what
is known with appropriate citations of the evidence but don’t get
into detailed information about that evidence.
In addition, you’ll notice some overlap among the four questions.

Don’t try to adhere to a structure that rigidly partitions answers
to each question. For example, when you talk about prevalence in
answer to the “What is happening?” question, you are beginning to

make a case for significance.
What Is Happening?
The first paragraph introduces your topic and makes a brief state-
ment about its significance. Within the first two sentences, the
reader should know what the topic is. Don’t take the reader on a
roundabout trip to your topic. If your topic is stress incontinence
in older women, start with a statement about stress incontinence.
Don’t start by talking about the aging of the population and then
explain how older people have more problems with incontinence
and that there are different types of incontinence, one of which is
stress incontinence. Try to get the topic in the first sentence. After
we know you’re talking about stress incontinence, you can go on to
tell us that it is more common in older women and that its preva-
lence is increasing with the aging of the population.
Describe the population that is affected and provide statistics on the

prevalence:
• How many people are affected, or how often does it happen?

• How big is this problem?
• What population is primarily affected?
• What are the mortality and morbidity rates?
• Is the problem increasing, or is its impact becoming greater?
Most of the time, you should write from the general to the specific.
So, your first paragraph will state the problem and its prevalence
and make a general statement about its impact. Then succeeding
paragraphs will provide more details that add to the reader’s under-
standing of the topic, its significance, and related concepts. In some
cases, though, you may want to

start a paragraph or section by first
Check with your
stating the specific topic and then
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committee chair about
pull back to provide context, as in
using the name of your
the previous example of a study on facility or organiza-
stress incontinence in older women. tion in your paper.
Guidelines on this vary. If
In a scholarly project, you also your program’s guidelines
have to give the reader background recommend using the
information on the “local problem.” name, then also check
What is happening in your specific with administration at
setting that compels you to do this your facility or organiza-
quality improvement project? How tion for what their policy
do you know there is a problem? is regarding using the
name in papers and
What is the population affected?
publications.
What are the consequences of the
problem?
C O M M O N M I S TA K E S
This is particularly true in a scholarly project; make sure you get to

the specific problem you are addressing early in the introduction. A
common mistake people make is starting with general background information
and not mentioning the problem until many paragraphs or even pages into the
introduction.
For example, if your project is looking at the role of teamwork in improving

patient safety in the operating room (OR), state that in the first paragraph. Don’t
go on for a paragraph or two talking about patient safety in general or the
importance of teamwork in healthcare overall. You can include that information
in your literature review, but in the introduction, you want to make sure that
your reader knows exactly what your topic is from the beginning. So, you could
begin your introduction with a statement about patient safety and the high rate
of medical errors, particularly in high-risk environments such as the operating
room. Then continue with information specific to the OR, including teamwork.
Why Should We Care?

Now that readers know what you’re going to be talking about,
you need to convince them of its importance. You do this by talk-
ing about its impact on those affected by it and on society. If you
haven’t talked about prevalence, an important aspect of a problem’s
significance, you’ll want to discuss it here.
The impact on those it affects is the other important aspect of a

problem’s significance. Depending on your topic, this may include
any of the following:
• Physical and mental health effects

• Social implications
• Economic impact on the individual and society
• Contribution to healthcare costs
• Healthcare system implications
• Patient safety outcomes
• Impact on the nursing profession
Be careful how and where you talk about the economic costs of a
problem. You don’t want it to appear that you are prioritizing cost
over people. If your purpose is related to a health systems problem,
economic costs may be a primary factor. However, if it is related
to a patient outcomes problem, cost may be one of the reasons we
should care, but it should not be the primary one. You can make
this clear in the wording and where in the text you place informa-
tion. If it is a patient-related problem, talk about cost last and begin
with a transitional phrase such as in addition to or along with [the
impact on patients]:
In addition to the decrease in patient suffering and lower risk
of death, improving our CLABSI rates will result in significant
cost savings to the hospital.
What Do We Know Now?

You will have included some of what we know now in answering
the first two questions. In answering this question, though, you
want to talk about what is known in relation to the specific purpose of
your study or project. This will then lead the reader to what we need
to find out, which is the knowledge or practice gap that your dis-
sertation or project is trying to fill.
If your study or project is looking to better understand a problem

or discover more information about the impact of a problem, then
in this section you’ll describe current understanding or informa-
tion. If you are doing an interventional study or quality improve-
ment project that looks at how to address a problem, you also need
to describe what we currently know about what works or doesn’t
work (in other words, what’s already been tried and how it worked
out).
What Do We Need to Find Out and Why?

Now that you’ve established where we’re at currently, it’s time to
let the reader know what the next step should be. This is where
you introduce the knowledge or practice gap that you are going
to address in your study or project. This will be a shorter version
of what you discuss in the literature review, but the same format
applies. Use a transitional sentence to move from what is known to
what we need to find out or from what is known about a problem
to what you are proposing to do about the problem. Then tell the
reader why the knowledge or project is necessary.
But remember, keep it brief. One or two sentences should cover it.
For example:
Though there is evidence from studies of disenfranchised grief

to suggest that parents who experience the death of an estranged
son or daughter may suffer complicated grief and receive less
support than other bereaved parents, there is little research that
explores this experience in this population. Understanding the
lived experience of grief after the death of an estranged son or
daughter is needed for us to develop effective counseling and sup-
port services for these parents.
And finally, what you are going to do:
Therefore, I am going to conduct a qualitative phenomenological

study of the meaning of grief in parents following the death of
an estranged son or daughter.
If you’ve done your job well, the therefore statement is inevitable.

The reader is already there thinking, well, of course now you have
to do that! Everything that came before has led directly to it.
PAST, PRESENT, OR FUTURE?

When writing your dissertation/project proposal, the statement will be in the
future tense. After conducting the study, you’ll go back and revise it to be in the
past tense for your final paper:
• Therefore, I propose a quasi-experimental study to examine the effect

of simulation teamwork exercises on the perception of teamwork
among interprofessional operating room staff.
• Therefore, I developed and implemented a school-based obesity

prevention program for school-aged children in an underserved
community.
Purpose Statements
Your therefore statement may be worded as a purpose statement
(the therefore is implied). Either way, make sure to state it clearly
and concisely.
PURPOSE STATEMENT EXAMPLES

The purpose of this quality improvement project is to determine whether
biweekly home visits to heart failure patients post hospital discharge conducted
by a nurse practitioner will decrease 30-day readmission rates.
The purpose of this study was to determine the IPV-related knowledge,

attitudes, beliefs, and behaviors of nurse practitioners practicing in a rural
outpatient clinic.
After you have your purpose statement, print it in large font and prop it up or
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pin it on a bulletin board in front of you while you’re working. Everything in

your paper should be directly connected to that purpose statement. It’s easy
to go off on tangents as you get into the literature, so make sure that you can
trace everything back to your study/project purpose statement.
PICOT Statements
You may be directed to write a PICOT problem statement, partic-
ularly if you are doing quantitative research or a quality improve-
ment project. Here’s what a PICOT statement covers:
Population: Who is the focus of your study or project?
Intervention: What activity/behavior is being tested?
Comparison: What group are you comparing your population to?

Outcome: What are the outcomes you are examining?
Time: What is the duration of the intervention or study period?
PICOT STATEMENT EXAMPLE

Patients with heart failure have high readmission rates. I propose implementing
a discharge follow-up program that provides biweekly post-discharge home
visits by nurse practitioners for 2 weeks following hospital discharge. I will
compare 30-day readmission rates for patients during the 6 months prior to
initiation of the program and for the 6 months after initiation of the program.
Population: Patients discharged from the hospital with a diagno-

sis of heart failure
Intervention: Biweekly home visits by nurse practitioners
Comparison: Patients discharged prior to implementation of the

intervention versus patients discharged after implementation
Outcome: 30-day readmission rates
Time: 2 weeks
Not all purpose statements or research questions can be

formulated into a PICOT problem statement. If you are doing a
qualitative study, you might not have an intervention, comparison,
outcome, or time.
Your Plan (Methodology)

After you state your purpose, you need to briefly describe how you
propose to accomplish it. If you are doing a research study, your
purpose statement usually includes the methodological approach
you plan to use (as shown in the preceding examples). You should
then describe your design in one or two sentences. Are you going
to use a survey? Conduct interviews? Do focus groups? What is
the sampling frame? What’s the duration of the project or study
period? For example:
Therefore, I propose a discharge follow-up program for heart

failure patients that provides biweekly home visits by nurse prac-
titioners for 2 weeks following hospital discharge. I will compare
30-day readmission rates for patients during the 6 months prior
to initiation of the program and for the 6 months after initiation
of the program.
Research Questions
Finally, you include your specific research question or questions.
This is usually your purpose statement reformulated as a question
but may also include additional questions that drill down into more
specifics:
What is the lived experience of IPV for women in the context of

the rural setting?
What are the IPV-related knowledge, attitudes, beliefs, and

behaviors of healthcare providers in the rural setting?
Will biweekly home visits conducted by nurse practitioners for 2

weeks post hospital discharge reduce readmission rates for heart
failure patients?
Does participation in simulation teamwork exercises improve the

perception of teamwork among interprofessional operating room
staff?
If you have specific hypotheses, you include those in this section as

well.
For a scholarly project, you’ll need to include measurable objec-

tives also. How much improvement are you looking for? Your
measurement may be a certain percentage change in a rate or a
benchmark to be reached. For example, in the previous heart fail-
ure project, the objective might read: In the 6 months following the
establishment of nurse practitioner post-discharge home visits, the average
30-day HF readmission rate will be no greater than 18%.
When you write your objectives, don’t include the actions you are going to
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take to achieve them. For example, suppose the purpose of your project is to
improve nutritional knowledge in adolescents with obesity, and you are going
to develop an interactive online program that will be used as the intervention.
Your objective would be to increase knowledge, not to develop an evidence-
based, interactive online program. (And make sure you include how much of a
knowledge increase you’re looking for—such as a mean increase in scores on
the posttest of 20 points.)
Checking That You’ve Covered Your Purpose

Statement
When you finish the introduction, go back and check that you’ve
covered all aspects of your purpose or therefore statement. Break
the purpose statement into questions and check that each question
is answered, albeit briefly, in the introduction. Not knowing the
answer to any of the questions reveals gaps in your thinking or in
your review of the literature.
Nothing about your purpose statement should be arbitrary. You

should be able to clearly see where it came from: What in the
literature or your practice supports your decisions about variables,
time duration, and outcome measures?
So, let’s look at the example of the discharge follow-up program

for heart failure patients:
Therefore, I propose a discharge follow-up program that provides

biweekly home visits by nurse practitioners for 2 weeks following
hospital discharge. I will compare 30-day readmission rates for
patients during the 6 months prior to initiation of the program
and for the 6 months after initiation of the program.
For this purpose statement, you would want to be able to answer

the following questions:
• Why look at a discharge follow-up program for HF

patients?
• Why post-discharge home visits as the follow-up
intervention?
• Why make the visits biweekly?
• Why by nurse practitioners (versus other healthcare
personnel)?
• Why 2 weeks duration following hospital discharge?
• Why 30-day readmission rates as the outcome measure?
Of course, you will only be able to answer all the questions if your
literature review was comprehensive and complete. If you haven’t
answered all these questions in the introduction, go back to your
literature review and see whether the answers are there. If not,
you’ve got to get back into the literature and find them and revise
your literature review to include that information before moving on.
If you can answer all the questions, then onward to Chapter 2,

“Writing Your Literature Review”!
Chapter Checkup
❑ Have I convinced the reader of the importance of the study or project?
❑ Have I included enough background information for readers to under-
stand the problem or issue and its context?
❑ Does the information provided lead logically and inevitably to the purpose
statement?
❑ Is all the information directly related to my purpose statement?
❑ Have I clearly identified the research gap?
❑ Have I provided adequate support for my chosen intervention?
❑ Have I included all the information needed to support all the components
of my purpose statement?
❑ Have I gotten feedback?
2
WRITING YOUR
LITERATURE
REVIEW
ELEMENTS OF THE LITERATURE

REVIEW
1. Overview of what the chapter covers
2. Definitions of variables and concepts
3. Theoretical framework
4. Review of the literature
5. Summary
6. Research gaps
7. Purpose statement
In Chapter Two, Literature Review, you give readers everything

they need to know to understand what you are researching or the
issue you are addressing and why. Chapter Two provides context
for your study or project, establishing significance for the topic
and answering the question of why your study or project should be
done. It does this through a comprehensive literature review (un-
less you’re doing a grounded theory or phenomenological study—
read on for more info). The purpose of the literature review is for
you to critically analyze and synthesize all the available literature
on your topic, in addition to literature on important concepts
related to what you are doing.
If you’re doing a grounded theory study or phenomenologi-

cal study, you may not be completing a comprehensive literature
review in Chapter Two. There is continuing debate about how in-
depth of a literature review should be done prior to data collection
in these traditions, with some arguing against any review of the
literature. How much of a literature review you do for your disser-
tation will be determined by the specific approach being followed
(e.g., Glaser and Strauss vs. Charmaz) and the guidance of your
chairperson. In most cases, you’ll need to do at least a limited re-
view to establish the gap you’re addressing and provide background
information on the phenomenon and related concepts. Other than
the comprehensiveness of the literature search and review, infor-
mation in this chapter is still applicable to writing your review.
A literature review is not an annotated bibliography of studies or a collection of

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synopses of studies. You don’t need an extensive description of the design and
conduct of each study. Keep it brief. Include the details readers need to under-
stand how the study contributes to your literature review and is connected to
your purpose.
CHAPTER 2 • WRITING YOUR LITERATURE REVIEW 23
Chapter One and Chapter Two

of the proposal, the Introduction Remember to check
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and the Literature Review, are your school’s guidelines
very similar. In Chapter One you for specifics on the
introduce the topic to your readers required organization of
and convince them of its impor- the literature review.
tance and of the necessity of your
study or project. You will do the same here in the literature review,
but whereas the introduction “introduces” the study or project
and provides a brief summary of relevant literature, the literature
review goes into much greater detail and provides an in-depth
analysis of the literature. Both the Introduction and the Literature
Review chapters end with the purpose of your study or project.
All the information and how it is organized should lead readers
directly and logically to that purpose.
Begin With an Overview and Definitions

You want to begin your Literature Review chapter with a one-
paragraph (or short) overview of what the chapter includes, de-
scribing specific areas that you’ll cover.
OVERVIEW EXAMPLE
Chapter Two includes a description of the theoretical framework and a review
of the literature on intimate partner violence (IPV) in general and in women who
experience IPV in the rural setting specifically. This review is divided into the
following sections: a) Epidemiology, b) IPV Risk Factors, c) Help-Seeking and
Leaving Abusive Relationships, d) Physical and Mental Health Consequences,
e) Economic Costs of IPV to Society and to Women Who Experience IPV, f) IPV
in Women in the Rural Setting, and g) Interactions with the Healthcare System.
Before proceeding with the literature review, you must define all
the variables (operational definitions) and concepts included in
your study/project to ensure that everyone is working from the
same definitions. You can begin the definitions with the phrase
“For the purposes of this study/project, [concept] is defined as…,”
or you can simply state the definition. If there are a lot of terms to
be defined, use a bulleted list.
Some programs require you to include a separate list of definitions in the

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introduction or literature review or in an appendix. Check your program’s

guidelines. Even if this is not a requirement, you might want to do so if your
paper contains many technical terms or complex concepts that could be
unknown to or misinterpreted by the reader.
TERM/CONCEPT DEFINITIONS EXAMPLE

For the purposes of this study, the CDC definition of IPV, “physical, sexual
or psychological harm by a current or former partner or spouse,” is used
(CDC, 2010, p. 1).
An area is considered rural if it does not contain any core urbanized areas,
defined as a “Census Bureau delineated urbanized area of at least 50,000 or a
Census Bureau delineated urban cluster of at least 10,000 population” (Office
of Management and Budget, 2010, p. 37249).
Historical Context or Evolution of the

Phenomenon
Some programs require a section on the historical context or
evolution of the topic or phenomenon under study, particularly
if you’re doing a qualitative study. That would usually go at the
beginning of the Literature Review chapter.
It’s easy to get carried away writing this section—you are not
expected to, nor should you, write a broad historical treatise. Stay
focused on your purpose. What historical context does the reader
need to fully understand your phenomenon as it’s situated in the
present? How did the phenomenon you’re studying evolve over
time in relation to your purpose? For example, if you’re study-
ing nurses’ attitudes, beliefs, and behaviors related to transgender
people, you will describe how the concept of transgender evolved
over time—when was it first recognized, what were the beliefs
about it early on, and how did those beliefs change over time. You
would talk about how societal perceptions and treatment of trans-
gender people evolved over time.
You would look at the history of
healthcare for transgender people, Don’t include anything
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particularly related to nursing in the introduction or

the literature review
care. Eventually you would bring
that you didn’t know
the reader to today with a deeper
before you conducted
insight into the phenomenon and
your study or implement-
appreciation of the purpose of your ed your project.
study.
Explaining Your Theoretical Framework

An explanation of the theoretical framework of your dissertation/
project is usually included as part of the Literature Review chap-
ter, although some programs might require you to include it as a
separate section in the Introduction or in the Methodology chapter
(Chapter Three). As part of this explanation, you need to describe
what theoretical model you are using, including its origin and pre-
cepts. Explain your rationale for using it and how it applies to your
study or project.
When explaining how the theoretical framework applies to your

study or project, include examples from the literature where the
framework was used in similar research. This can be research that

examined the same or a similar phenomenon or asked a similar
research or PICOT question. For example, if you’re doing a qual-
ity improvement project to develop and implement a palliative
care program in an intensive care unit and are using Jean Watson’s
theory of caring, discuss how other QI projects or research related
to development of a palliative care program used Watson’s theory.
If there is literature where it has been used in the context of critical
care, great, but if not, you can talk about its use in initiating pallia-
tive care for other patient populations or in other settings.
EXAMPLES OF THEORETICAL FRAMEWORK

I am using the Roy Adaptation Model (RAM) to guide this study. Developed
by Sister Callista Roy in 1976, the model is derived from systems theory and
humanism. It considers individuals as adaptive systems in constant interaction
with their environment. The model posits the goal of nursing as promoting an
individual’s adaptation to an ever-changing environment. An individual uses
coping processes to interact with a stimulus from the environment. These
coping processes happen in the regulator (neural, chemical, and circulatory)
and cognator (perception, learning, judgment, and emotion) subsystems.
There are four adaptive modes that individuals may use: 1) the physiologic,
2) self-concept, 3) role function, which is the need for social integrity, and 4)
interdependence, which is the need for relational integrity.
I am using RAM because it provides a holistic systems framework for

examining the adaptation to the role of caregiver in young adults with a spouse
or significant other with a brain injury. Literature on family caregivers in general
suggests that they face significant stressors in each of the domains related to
the four adaptive modes [citations]. For example, . . .
A narrative inquiry informed by Connell’s Theory of Gender and Power will be

conducted. Connell (1987) developed an integrative theory of gender power
that considered the “interweaving of personal life and social structure” (p. 61).
He identified three structural elements of gender relations: labor, power, and

cathexis, all of which are embedded in a particular historical process. At the
societal level, the sexual division of labor includes paid and unpaid work, the
sexual division of power includes influence and ability to act, and the element
of cathexis includes affective attachments and social norms. All three elements
are actualized at the institutional level through social structures such as
kinship, employment, relationships, religion, and health practices.
The framework was further operationalized for this project. Using information
from the literature, constructs specific to sub-Saharan African society were
developed for each of the structural elements (see Figure 1). Constructs were
not limited to those known to directly impact childbirth practices so that the
inquiry could explore the broader context of gender relations and allow the
women to determine what to include in the narrative.
For scholarly projects that are quality improvement or evidence-

based practice (EBP) initiatives, you’ll also include a description
of the EBP practice or change model you use, such as the Iowa
Model of Evidence-Based Practice, Johns Hopkins Evidence-
Based Practice Model, Stetler Model of Evidence-Based Practice,
PRECEDE-PROCEED Model, or Plan-Do-Study-Act, among
others. In this chapter you’re only describing the model—you’ll
talk about what you did in each step of the model in the Methodol-
ogy chapter.
Include an illustration that shows the theoretical framework/model

as it applies to your project. Insert the study variables or concepts
into the appropriate areas of the model. For example, the theo-
retical model for the IPV study was Bronfenbrenner’s ecological
systems model. The figure with the concepts applied looks like
Figure 2.1.
Figure 2.1 Theoretical model illustration example.
C O M M O N M I S TA K E
Be careful with terminology when talking about your theoretical

framework versus the evidence-based practice approach used for a project. For
example, the Johns Hopkins Nursing Evidence-Based Practice Model is not a
theoretical framework. Nor is the Plan-Do-Study-Act tool. They are structured
approaches to engaging in evidence-based practice or systems change.
Explaining Your Search Strategy

Doctoral programs differ in whether they expect you to include
the detailed search strategy in the literature review, so refer to
your program’s requirements to determine whether you need to
describe yours in your paper. Regardless of whether the search
strategy needs to be included, it is very important that you do your
literature search in a systematic way to avoid bias. This way you
won’t “cherry pick” the studies that support your point of view or
the preconceived ideas you have about your topic. As noted earlier,
having a research librarian help you is the best way to ensure that
you complete a comprehensive search of the literature.
A well-written search strategy is described in such a way that

anyone replicating your search would come up with the same re-
sults. Read through a number of integrative literature reviews and
systematic reviews and you’ll see that there is a certain formula to
describing search strategies.
Elements of a well-reported search strategy include the following:
1. What topic you searched for
2. What databases you searched
3. Other sources searched, including gray literature
4. What keywords were used
5. What date delimitations were set and why
6. Number of studies found
7. Inclusion criteria that were applied and why
8. Number of studies remaining after inclusion criteria applied
9. Hand searching of bibliographies of remaining studies
10. Number of studies found with hand searching
11. Exclusion criteria that were applied and why
12. Number of studies remaining after exclusion criteria applied
13. Any of these studies that were not included and why
14. Total number of studies included in review

15. General information on

studies included (type, If you had the help of
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samples) a librarian, include that
fact in the description
16. What of importance was not of your search strategy
found with a statement such
as “Research librarian
You can see some of these elements assisted in the search.”
numbered in the search strategy
description that follows.
SEARCH STRATEGY DESCRIPTION

I performed a literature search for all English-language studies on IPV in
the rural setting (1). I searched Medline, PsycINFO, CINAHL, PubMed, and
Google Scholar (2) for original research studies on IPV in the rural setting
using the keywords “intimate partner violence,” “domestic violence,” “spousal
abuse,” and “battered women” combined with the keyword “rural” (4). Date
delimitations were 1990 to the present, as sociocultural norms and IPV-related
policies change over time (5). The search yielded 537 studies (6). After applying
the inclusion criteria as outlined below, there were 76 studies remaining (8).
Inclusion criteria were original research studies or systematic reviews in peer-

reviewed journals that examined IPV in adult women (18 years and older)
in the rural setting in Western countries. Non-Western countries were not
included because of differences in sociocultural norms that would influence the
understanding and experience of IPV (7). Exclusion criteria were studies that
had a narrow focus, such as smoking in rural pregnant women experiencing
IPV; studies that were conducted in a rural setting but did not consider its
implication, such as those that looked at instrument development; and studies
with a narrow focus on specific populations in the rural area, such as migrant
farm workers, where the findings were not generalizable to a broader rural
population of women (11). In addition, studies of prevalence and incidence from
prior to 2010 were excluded to include only more recent statistics (11).
After applying exclusion criteria, there were 36 studies remaining (12). Of

these, 27 were quantitative, five were qualitative, one was ethnographic, and
three were mixed-methods studies (15).
The literature review should include current research on your

topic (usually articles published within the past five years), in addi-
tion to classic and seminal articles. You decide what dates to set as
parameters when searching the literature (date delimitations). You
must have a reason for choosing those dates; they are not arbitrary.
For example, the dates might reflect when a policy change took ef-
fect, when a seminal study changed practice (such as the Women’s
Health Initiative studies did for use of postmenopausal hormone
therapy), or when a new treatment became the standard of practice.
If you decide to include a seminal or classic article that lies out-
side the date delimitations, just state that in the description of the
search strategy.
If you include gray literature, you need to clearly identify it as

such. Gray literature is information found outside of the usual bib-
liographic sources. This might include non-peer reviewed articles,
technical reports, conference reports, reports from recognized
organizations working in the topic area (such as NGOs), commit-
tee reports, white papers, or unpublished research reports.
Exclusion criteria are not the opposite of inclusion criteria. They are
applied after inclusion criteria. So, if a characteristic is not present in what you
include, it should not be part of the exclusion criteria. For example, if one of your
inclusion criteria is studies that examined chronic pain management in patients
with substance misuse disorder, you would not have acute pain management
as exclusion criteria because, once you’ve applied inclusion criteria, there won’t
be studies on acute pain management in the sample to exclude.
GETTING ORGANIZED
As you search your literature, save a PDF copy of each article to your computer
and organize the articles into folders by topic. For example, for a scholarly
project that addresses patient education in heart failure patients, you might
have folders for epidemiology, patient education, heart failure readmissions,
self-management in heart failure, medication adherence, measurement of
patient education outcomes, and so on. If you print articles, write a brief note in
large print on the front page that clearly indicates what the article contributes
to the review. Then place them in piles by topic and clip an index card with the
topic on the top article. (If you like working with hard copies, you’ll find that the
piles quickly become too large for actual folders.) If possible, clear space on
the floor next to where you work and keep the piles spread out, or, if there isn’t
enough room (or you have a small child or dog that will think the piles are great
play material), then pile them in alphabetical order. The key is to make it quick
and easy to find any article by topic when it’s needed.
Critically Appraising the Literature

You must critically read each study that you include in the review
of your literature. Refer to your program’s guidelines for specific
instructions on whether it is necessary to grade the evidence or in-
clude an evidence table in your literature review. Even if you don’t
need to, you should comment on the quality of the studies, when
appropriate, in the review.
Along with critically appraising individual studies, you need to

appraise each study against the body of research. This is part of
synthesizing the literature. If the results of one study conflict
with multiple other studies, comment on this and consider
possible explanations. If there are a number of weak studies on
a phenomenon but all had the same results, note that. As you
synthesize the literature, note where the supporting evidence
is weak or strong and any limitations that might have affected
outcomes that are related to your study or project. Also note when
results might or might not be applicable to your study setting or
population.
Numerous tools are available for appraising research reports (see the end of
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this chapter). These tools are also great for appraising your own work. After
completing the Methodology chapter of the proposal, check the completeness
and rigor using an appraisal tool that is appropriate for the type of study or
project you are doing. You can do the same with the Results and Discussion
chapters when you finish the study or project.
CRITICAL APPRAISAL EXAMPLES

The low response rate of 21% raises the possibility of the presence of
respondent bias that could have affected the outcomes.
The researchers did not consider differences in cultural norms that would
influence participants’ willingness to disclose information related to family
members with mental illness.
However, the study was conducted in a large urban facility; therefore, its results
might not be applicable to this project’s setting.
Though the study participants reported low satisfaction with the intervention,
they also reported higher levels of chronic pain, and this might have affected
the outcome.
However, these findings must be considered in the context of other studies,

which consistently find that….
Synthesizing Your Literature Review

Synthesis is the bigger picture that is created when information
from individual studies is woven together and presented in the
context of your study/project. It’s like constructing a jigsaw puzzle;
all the studies are individual pieces, and you have to fit them to-
gether to create the bigger picture.
You want to organize your literature review around the variables,

concepts, and factors involved in your study. The most common
mistake people make is talking about each study individually with-
out ever integrating the information from the studies together to
create an understanding of or to make a statement about a variable,
concept, or factor. If your literature review reads like a list of stud-
ies, talking about each study separately, one after the other, then
you are not synthesizing.
A FEW WORDS ABOUT DIRECT QUOTES

Synthesis is your analysis and interpretation of the literature. As such, you
should use very few, if any, direct quotations in your review. There are only a
couple of good reasons to use a direct quotation in a literature review:
• The original is worded in an especially engaging or insightful way
• To rewrite would risk misinterpretation or loss of meaning
And remember, any time you use a direct quote, you must put it in quotation
marks and include a page number with the citation. Just citing the source is
not enough; without quotation marks it’s considered plagiarism. (Be sure to
read the information on plagiarism and proper attribution in Chapter 7, “Writing
Well: The Basics.”)
Analysis and synthesis are the hallmarks of scholarly writing. You need to sift
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through the research for what is relevant, critically appraise it to see whether
you can use the findings with confidence, and pull it all together to create a
new understanding in the context of your research question.
Also, research is a building process. Each study builds on what came before.
In a dissertation literature review, you show how your work is the logical next
building block in that process.
One approach to help you synthesize is to begin the section about

a particular variable or concept with a general summary statement
about that variable or concept and then follow with pertinent
details from individual studies.
Synthesis is difficult. Everyone struggles with it in the beginning.

Here is one technique to try:
• Make a list of the variables and concepts that are involved in

your study/project. Write each one at the top of a separate
piece of paper.
• Go through the studies you found and see what each said
(relevant findings) about that particular aspect of the topic
and write it down on the paper. Use charts, tables, and dia-
grams to organize what you found or to illustrate connec-
tions. (These are just for your use; they are not part of the
paper.)
• Examine what you have on the page. What does all that
information tell us about that particular variable/concept?
Write that up as a section of your literature review.
• Now pull it all together and tell the reader accurately,
clearly, and directly what the current knowledge is on your
topic. Don’t be afraid to make definitive statements when
you can support them with evidence.
SYNTHESIZING EXAMPLE
The following example of synthesizing research is from an integrative review
of the social implications of obstetric fistula, a devastating childbirth injury
that occurs in low-income countries. This paragraph describes the role
stigmatization plays in isolating the women studied.
There were consistent reports across all studies of stigmatization coming from
the woman’s own family, who may give her food and shelter but segregate her
for eating and sleeping and not allow her to participate in household activities.
Women in the Turan et al.19 study reported that family members made them
live separately due to their smell; Ojanuga18 related how one woman’s family
mocked her; Muleta et al.20 quoted a woman as saying, “My parents really
disliked me for the stench coming from me; they made me sleep on a bare
floor”; and the Women’s Dignity Project and EngenderHealth study16 related the
case of a 20-year-old woman whose grandmother told her, “Get lost, I am fed
up. I can’t put up with your smell!” Quantitative data from Murphy15 indicate
that, like that of the husband’s support, the family’s support diminishes over
time; for the first hospital visit, 27% of the women arrived alone, and on subse-
quent visits, 78% arrived alone.
Excerpt from Roush (2009).
When talking about each study, think Introduce, Explicate, Con-

nect. State the study and provide some contextual information.
Make sure the connection with your study or project purpose is
clear to the reader; if not, make it explicit.
Remember, you have all the background information in your head

but readers do not. They are not privy to your thought process,
only what is on the page. Make sure the connections between stud-
ies in your literature review and your purpose are clear.
The details you include will vary for each study, depending on
what the study contributes to the review. However, in most cases
you should include the study purpose and the sample size and
population along with the relevant findings. Following are some
templates to get you started:
In a [type of study] study that examined [purpose of

study] in a sample of [sample size and population], Smith
et al. (2022) found [pertinent results].
In a study of [sample size and population], Smith et al.

(2022) compared [variables]. They found that [pertinent
results].
This was consistent with the results of a study of [purpose of

study] in [sample size and population] that found [find-
ings] (Smith et al., 2022).
Here’s a longer example:
Evidence consistently indicates that low income increases the

risk of IPV. In a study of socioeconomic predictors among
1,440 white, Black, and Hispanic couples in the US, Cun-
radi et al. (2002) found that annual household income was
“the most important influence on the probability of IPV” (p.
385). In their study of respondents to the Behavioral Risk
Factor Surveillance System, Breiding et al. (2008) found
increasing odds ratios as income decreased (reference income
$50,000): 1.66 OR (95% CI, 1.45–1.90) from $25,000 to
$35,000; 1.74 OR (95% CI, 1.52–1.99) from $15,000 to
$24,999; and 2.51 OR (95% CI, 2.14–2.95) at less than
$15,000. This was consistent with the 1.99 OR (95% CI,
1.33–2.96) McCloskey and colleagues (2005) found for risk
of IPV in women making less than $20,000 among 2,465
women surveyed in seven metropolitan hospitals (reference
income $50,000). Finally, in a cross-sectional study of 1,257
Australian women in a general medical practice, 15.4% of
abused women received income assistance versus only 4.1% of
the women not reporting abuse (Hegarty et al., 2008).
Studies often disagree, and that is OK. Part of your job in the
review is to point out inconsistencies in the literature. Lack of con-
sensus in itself is an important piece of information; it strengthens
your argument that further research (your study) is needed.
Summary and Research

Gaps If you say something is
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supported by findings
At the end of the literature review, from studies—
write a brief summary that pulls ev- plural—make sure
erything together and highlights the you cite more than
important findings of the literature one study. If you are
review. Note any areas where there basing something on only
is little information or conflicting one study, that should
information. In a dissertation, you be clear to the reader
will then identify the research gaps as well. For example,
when you say evidence
and make a statement about why it is
indicates . . . it implies
important to address those gaps. In a
consistent findings across
scholarly project, you’ll tie together
more than one study.
what is known about the problem
and strategies used to address it. Use
a transitional sentence to move into this paragraph, one that clearly
connects the “what we know” with the “need to know” or project
plan. For example:
We know this works in [specific population], but no one has

tested it in [your population].
We know [these things about the topic], but no one has looked
at [your aspect].
Even though we know that…we haven’t examined it in this

context…
Despite the evidence of the problems this causes, we’ve never

looked at it from this angle…
Considering the importance of [concept] in other areas, it is

time we looked at it in relation to this problem…
Considering the evidence that [strategy/practice] improves

outcomes in [population] …
Along with stating what we need to find out or do next, you need
to tell us why. Curiosity is not enough; the knowledge/results you
are seeking have to serve a purpose. What are the benefits of hav-
ing this new knowledge? How will this project improve patient
outcomes? How will this new understanding help us in providing
care? How will it help us improve the healthcare system?
SUMMARY EXAMPLE
This literature review provides compelling evidence of the devastating impact
of IPV on the lives of the women and the particularly difficult challenges faced
by rural women who experience IPV. Women in rural settings must overcome
multiple barriers to getting help and leaving an abusive relationship, including
isolation, lack of resources, limited access to help, economic constraints, and
sociocultural factors [citation].
Isolation in particular creates multiple hardships for rural women. It limits social
support, increases vulnerability, decreases economic opportunities, and makes
it difficult to access resources [citation]. In addition, a unique combination
of privacy norms and patriarchal attitudes in rural settings can result in a
culture of nonintervention [citation]. This is especially concerning because it
has been shown that nonintervention norms constrict women’s help-seeking
behaviors and decrease societal restraints on the violence. [citation] used social
disorganization theory to explore the effects of collective efficacy on women’s

response to IPV. He found that nonintervention norms were associated with
higher rates of nonlethal severe IPV, though not intimate-partner homicide,
through their effect of lowering collective efficacy and social support in a
community. He posited that violent relationships “may remain private (and
persist) in part because women perceive their social environment as being
unable or unwilling to provide effective social support” (p. xx).
Women’s interactions with the healthcare system continue to be problematic.

Women report that they will disclose abuse if providers are nonjudgmental,
supportive, and knowledgeable [citation]. Yet studies consistently find negative
attitudes, discomfort addressing IPV with women, and lack of knowledge
among healthcare providers [citation]. Concerns identified by the women in
their interactions with the healthcare system, particularly related to safety and
confidentiality, take on greater significance in the rural setting, where women
are isolated, the response of law enforcement may be prolonged, and people
are likely to know each other or have relationships in common [citation].
RESEARCH GAPS EXAMPLE

Little recent research looks at the lived experience of IPV in rural women living
in the community other than that focused on specific subpopulations or narrow
topics. Yet evidence suggests these women face unique and extraordinary
challenges associated with IPV. Understanding the lived experience of IPV is
crucial in improving outcomes for rural women who experience IPV. Effective
programs must be based on the realities of their everyday lives, what resources
they believe would be most valuable and how they would use them, and what
they see as facilitators and barriers to ending the violence.
ORGANIZE YOUR LITERATURE REVIEW

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Use sticky notes to help organize sections of your literature review. Each
paragraph should have one main idea that can be written in one sentence.
Write that main idea for each paragraph in plain language on an individual
sticky note and line up the sticky notes in the order of the paragraphs. Now
read through them in order. Does it make sense? Does it flow from one idea to
the next? Are there any gaps in the flow of information? Rearrange your sticky
notes to optimize the flow, and then move your paragraphs around in the text
accordingly.
USE MANY SUBHEADINGS

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The Literature Review chapter is likely to be the longest one of the dissertation
or project paper. And you’re probably going to cover a lot of different concepts
and multiple variables. Subheadings can help you organize the information and
can help guide the reader through complex material.
Unfortunately, using lots of headings also makes it hard to keep track of which
level of heading you’re at so that you adhere to APA formatting guidelines. For
easy reference, write out the heading levels in correct APA formatting (as shown
in the following sidebar) in a Word document and print it. After you finish the liter-
ature review, list all the headings you use in the order you use them in a separate
Word document. Then go through and, using your printout of the heading levels
as a guide, assign the appropriate level to each and format it accordingly in the
list (capital letters or lowercase, italicized or not, bold or not, ending with a period
or not, and so on). Now you can go back to the literature review and make sure
that you’ve got all the headings right.
APA HEADING LEVELS

1 Centered, Bold, Title Case
2 Flush Left, Bold, Title Case

3 Flush Left, Bold Italic, Title Case
4 Indented, Bold, Title Case Ending with a Period.
5 Indented, Bold Italic, Title Case Ending with a Period.
(American Psychological Association, 2010)
TRANSITIONS
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Transitions are particularly important when writing a complex paper that ad-
dresses multiple concepts, such as a literature review. Transitions guide the
readers through the various ideas and help them understand the connections.
Take a few minutes to read the section on transitions in Chapter 7 for help on
creating an organized paper that flows smoothly.
Purpose Statement
This is it. Everything that came before should lead directly to the
purpose of your study or project. You’ve convinced the reader of
the importance of your topic. You’ve summarized what is known
and pointed out what is not. Now you tell the reader clearly and
concisely what you plan to do next.
Therefore, I am going to conduct a quality improvement

project to…
The purpose of this project is to…
Therefore, I propose a qualitative study to…
The purpose of this study is to….

If you’ve done your job well, readers will be nodding their heads in
agreement.
Research Questions
Finally, you include your specific research/PICOT question or
questions. This is usually your purpose statement reformulated as
a question but might also include additional questions that drill
down into more specifics:
• What is the lived experience of IPV for women in the con-

text of the rural setting?
• What are the IPV-related knowledge, attitudes, beliefs, and
behaviors of healthcare providers in the rural setting?
• Will biweekly home visits conducted by nurse practitioners
for two weeks post hospital discharge reduce readmission
rates for heart failure patients?
• Does participation in simulation teamwork exercises im-
prove the perception of teamwork among interprofessional
operating room staff?
If you have specific hypotheses, which is likely if you are doing

a quantitative research study, you include those in this section as
well.
Now you need to tell readers just how you’re going to answer the
questions (that is, your methodology), which is the subject of the
next chapter.
Chapter Checkup
DID I …
❑ Provide an overview of what is included in the chapter?

❑ Establish the scope and severity of the issue?
❑ Define all the variables, concepts, and factors?
❑ Describe the theoretical framework and how it applies to my study or
project?
❑ Point out and discuss inconsistencies in the literature?
❑ Include a critical appraisal of the research?
❑ Include only information directly related to my study or project and
clearly show how it’s related?
❑ Synthesize information rather than list each study separately?
❑ Build a strong case for the importance of the topic or issue?
❑ Clearly show that my study or project is the logical thing to do?
❑ Formulate PICOT or research questions and hypotheses that are derived
from the purpose of the study or project?
❑ Make sure all the citations in the text are in my reference list and vice
versa?
References
American Psychological Association. (2010). Publication manual of the American Psycho-
logical Association. Author.
Centers for Disease Control and Prevention. (2010). Intimate partner violence:
Definitions. http://www.cdc.gov/violenceprevention/intimatepartnerviolence/
definitions.html
Office of Management and Budget. (2010). Standards for delineating metropolitan

and micropolitan statistical areas. Federal Register, 75(123), 37249.
Roush, K. M. (2009). Social implications of obstetric fistula: An integrative review.

Journal of Midwifery and Women’s Health, 54(2), e27. https://doi.org/10.1016/j.
jmwh.2008.09.005
Appraisal Tools
Consolidated Criteria for Reporting Qualitative Research (COREQ): COREQ
provides a checklist for appraising qualitative research reports.
http://intqhc.oxfordjournals.org/content/19/6/349.long
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualita-
tive research (COREQ): A 32-item checklist for interviews and focus groups.
International Journal for Quality in Health Care, 19(6), 349–357. https://doi.
org/10.1093/intqhc/mzm042
CONsolidated Standards of Reporting Trials (CONSORT): This group provides

a checklist and flow sheet for appraising reports of clinical trials.
http://www.consort-statement.org/consort-2010
Critical Appraisal Skills Program (CASP): CASP has free tools for appraising dif-
ferent types of research, including systematic reviews and quantitative and qualita-
tive research studies.
http://www.casp-uk.net/#!casp-tools-checklists/c18f8
JBI Manual for Evidence Synthesis: The manual has chapters on conducting differ-
ent types of systematic reviews and includes appraisal checklists for appraising the
studies included in the reviews.
https://jbi-global-wiki.refined.site/space/MANUAL
Aromataris, E., & Munn, Z. (Eds.). (2020). JBI manual for evidence synthesis. https://doi.
org/10.46658/JBIMES-20-01
Preferred Reporting Items for Systematic Reviews and Meta-Analyses

(PRISMA): PRISMA provides a checklist and flow sheet for appraising systematic
reviews and meta-analyses.
http://www.prisma-statement.org
Standards for QUality Improvement Reporting Excellence (SQUIRE): The

SQUIRE guidelines provide a checklist for appraising quality improvement
projects.
http://squire-statement.org/
Strengthening the Report of Observational Studies in Epidemiology

(STROBE): STROBE has free checklists for appraising various types of
observational studies.
http://www.strobe-statement.org/index.php?id=available-checklists
3
WRITING YOUR
METHODOLOGY CHAPTER
ELEMENTS OF YOUR METHODOLOGY

CHAPTER
1. Design of the study or project 8. Instruments
2. Planning activities (project) 9. How data analysis will be
3. Setting conducted
4. People involved and resources 10. How rigor will be ensured

needed (project) 11. Anticipated and actual barriers
5. Sample, including access and (project)
recruitment methods 12. Strategic plan and budget
6. Ethical considerations, including (project)
consent 13. Timeline (project)
7. How the data will be collected
This chapter covers how to write up the components of the study’s

or project’s methodology, including the approach, the sample and
setting, and procedures of recruitment and data collection. You will
also learn what to include regarding instruments and tools used and
data management. The chapter ends with a description of how to
write up the data analysis.
Chapter Three, Methodology, is where you get down and dirty.

It’s a detailed account of exactly what you are going to do or, after
completing the study or project, what you did. It’s actually a pretty
straightforward chapter to write because it’s very concrete. The key
is to be very specific and not miss anything. What you write in your
Methodology chapter will tell your readers whether your results are
valid, reliable, and able to be used with confidence.
Because this is a dissertation or

scholarly project, you also need When you’re writing
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to explain why you are doing the your proposal, you’ll

study or project this particular way, use the future tense to
much more so than if you were describe your method-
writing an article about a study ology. After you finish
or project. You have to show your the study or project and
professors that you know the ratio- are writing the final paper,
nale behind what you’re doing and you need to return to the
Methodology chapter and
that each of your choices, from the
change everything to the
design to the sampling frame to the
past tense.
statistical method, was a conscious
and correct choice.
Explaining the Approach and Design of Your Study

The first thing you have to tell the reader is what kind of study
or project you’re doing and why it’s a good fit for your research
question. This includes the broader approach, or tradition, of
qualitative, quantitative, or mixed methods, and the specific design,
CHAPTER 3 • WRITING YOUR METHODOLOGY CHAPTER 49
such as descriptive, phenomenological, grounded theory, narrative,

or ethnographic for qualitative studies or experimental, quasi-
experimental, or correlational for quantitative research. You can
include a little bit of information about how you’re going to do it
as well:
The proposed study will use a descriptive qualitative approach

using multiple focus groups of newly licensed RNs working in
critical care.
The proposed study will use a quasi-experimental design with

electronic surveys distributed to participants before and then
six months following the implementation of the new discharge
teaching program.
If you’re doing a qualitative study for your dissertation, you’ll have

to include an in-depth description of the tradition you are using
that demonstrates your understanding of it. The same is true for
the evidence-based practice model you use in a scholarly project.
DESCRIPTION OF TRADITION
Narrative research uses stories as data to uncover the meaning people give
to their lives (Duffy, 2007). It is rooted in a critical theory view of linguistics
that sees language as both a reflection and a determinant of how individuals
“interpret both nature and themselves in their environment” (Habermas, 1987,
p. 17). Stories are told within a historical and temporal structure, requiring the
storyteller to represent experiences as sequential events with connections,
causality, and actions (Czarniawska-Joerges, 1995). Narrative inquiry is a
particularly valuable approach in marginalized and silenced populations, such
as women with obstetric fistula, as it engages participants in a critical reflection
of their experience, leading to a new and transformative understanding (Duffy,
2007).
There are a number of different approaches to narrative research (Creswell &

Poth, 2018). In this study I will be using the three-dimensional space approach
for narrative inquiry described by Clandinin and Connelly (2000), which has
three aspects: interaction, temporality, and situation. Interaction includes both
the personal, as one engages in self-reflection, and the social, as they engage
in interactions with others. Temporality (also referred to as continuity) considers
the narrative from the perspective of the past, present, and future. And finally,
situation examines the context within which the narrative occurs, including the
physical space. In narrative inquiry, analysis leads to emplotted narratives “that
give meaning and understanding” (Kelly & Howie, 2007, p. 141) to the data.
You need to provide information

Some programs might
about the approach and design that
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require you to include

explains why it is the best approach
the theoretical frame-
at this time to answer your re-
work or philosophical
search question or to address your underpinning in the
local problem. You can use expert- Methodology chapter
authored articles or books on your rather than in the Litera-
approach to back up your choices ture Review. In that case,
in your Methodology chapter. it would go here, at the
beginning of the chapter.
EXPLANATION OF CHOICE OF APPROACH EXAMPLE

Ethnonursing methodology is very compatible with what this study sought to
discover. This method facilitated the discovery and exploration of the meaning
of values, beliefs, and health practices of agrarian elders in the rural context
from their perspective. The method helped tease out what influence and impact
the rural agrarian culture has on the worldview of agrarian elders. In addition,
this method helped discover the culture care experiences that have been both
helpful and hindering to the well-being of elder agrarians (Witt, 2006).
Establishing Your Study’s Setting

Where is your study going to take place? You need to place it
within its geographic setting as well as the local (that is, facility or
organization) setting if appropriate. Provide enough background
information about the setting that the reader understands the
context in which the study or problem is taking place. These details
might include the population demographics and socioeconomic,
environmental, and cultural factors. If the setting is integral to the
purpose of the study—for example, a study that looks at a topic
specifically related to it happening in a rural area—you’ll want to
include more details.
DESCRIPTION OF SETTING FOR STUDY OF IPV IN A RURAL

SETTING
This study was conducted in Warren, Hamilton, and Essex counties in the
Adirondack Mountains region of northeastern New York State. All of Hamilton
and Essex counties and parts of Warren County meet eligibility requirements
for rural health grants according to the Health Resources and Services
Administration.
Warren County is the southernmost county in the Adirondacks. It covers 867
square miles and has a population of approximately 66,000 people, with
one metropolitan area, the city of Glens Falls (US Census Bureau, 2012). The
majority of residents are white, 96.8%, with 1% Hispanic, and less than 1%
two or more races, African American, or American Indian. The median age is
39, and 85% of residents older than 25 have at least a high school diploma,
and 23% have at least a bachelor’s degree. The median household income
from 2006 to 2010 was $51,619, and the average weekly wage was $645,
well below the national average of $891 (Bureau of Labor Statistics, 2012; US
Census Bureau, 2012). The 2010 estimated number of families living below the
poverty level was 1,474 when the householder was female with no husband
present compared to 243 when the householder was male with no wife present
(US Census Bureau, 2010).
(Continues with description of Hamilton and Essex counties.) (Roush, 2014)

If you’re doing a quality improvement project or a study in a

clinical setting, include all the facility or organization information
that the reader needs to understand the problem. This includes a
description of the organizational culture in addition to information
related to administration, management, and nursing leadership
structures; financial data; staffing patterns; and patient population.
You should discuss anything that could influence the implementa-
tion or outcomes of your project, for better or worse.
For a scholarly project, this is where you are most likely required
to describe the people involved in your project. (Again, check your
program’s specific instructions.) You need to work in partnership
with key stakeholders in the organization where the project is tak-
ing place:
• Who are these people?

• Who is instrumental in moving implementation of the
project forward?
• Who will ensure you have the resources, including staff,
that you need to proceed?
• Who will provide access to necessary data (such as admis-
sion reports or readmission rates)?
These are just some of the people who might be identified as key
stakeholders and on board from the planning stages.
In addition, for a project this is also where you describe what re-
sources are needed to implement the project. This includes human
resources, such as increased nursing staff or expert consultants, and
material resources, such as access to a simulation lab, computer
programs, or patient teaching supplies.
Establishing Your Sample

What population are you drawing your sample from? Who is go-
ing to participate in your study or project? How many participants
do you need and how are you going to get them? These are the
main questions you’ll be answering in this section.
Before answering these questions

about the sample, you need to first When talking about
TIP
tell us what type of sampling you’re the people who are
going to do, such as convenience, in a sample for a
purposive, random, or stratified. quantitative study, you
You should also briefly describe the usually refer to them
sample design and why you’re using as subjects or, in surveys,
respondents. When talk-
that design for your study.
ing about the people in
a qualitative study, you
Next you establish your sampling
usually refer to them as
frame, the general population from
participants.
which you’ll recruit your partici-
pants. So, for the study of IPV in
the rural setting, the sampling frame was women living in the
Adirondack region of New York State who experienced IPV. For
a study of bereaved parents of estranged children, the sampling
frame might be parents attending grief support groups in a particu-
lar region of the United States.
Then you tell us who you want to recruit from that population.
You need to specify exactly who qualifies to participate. This
is done by establishing inclusion and exclusion criteria, similar
to what you did to find articles in your literature search for the
literature review. If it’s not obvious from the study purpose, you
also need to explain why you’re including or excluding people with
those particular traits.
Characteristics that might be part of inclusion and exclusion crite-

ria include the following:
• Demographics (sex, age, educational level, marital status,

and so on)
• Presence or absence of an illness or health condition
• Duration of illness or health condition
• Number of years since experiencing phenomenon being
studied
• Professional role
• Primary language (English speaking?)
• Literacy
• Previous experience with intervention
• Location
INCLUSION AND EXCLUSION CRITERIA EXAMPLES

The study will include a purposive sample of women in western Uganda who
have experienced obstetric fistula. Inclusion criteria are women 18 years of age
and older with a vesicovaginal or rectovaginal fistula secondary to prolonged
obstructed labor. Exclusion criteria will be women who have had their fistula for
longer than five years so that the data reflect current sociocultural norms.
Nurses working on the cardiac care unit during the transition to the new
rounding protocol will be asked to complete surveys two, four, and eight weeks
after initiating the rounding. Inclusion criteria are RNs who have at least one
year of experience on the unit and provide direct patient care. Exclusion criteria
are advanced practice nurses and nurses who are not dedicated staff for the
unit (work on other units as well).
Exclusion criteria are not the opposite of inclusion criteria. They

are applied after inclusion criteria. So, if a characteristic is not present in
participants that you want to include, you should not list it as part of the
exclusion criteria. For example, if one of your inclusion criteria is women
between the ages of 18 and 35, don’t list women younger than 18 or older
than 35 as exclusion criteria because there won’t be anyone younger than 18
or older than 35 to exclude.
Noting Sample Size

Now you have to tell your readers how many participants you want
to have in your sample. Of course, the answer to this is very differ-
ent for a quantitative versus a qualitative study.
If you’re doing a quantitative study, you not only have to tell us

what your sample size should be but also have to show how you
came up with that number. The reader needs to know that you
have enough participants to establish whether the study results will
have statistical significance. Therefore, you need to tell us what
formula you used to determine the power of the study and report
the power, probability, and effect size calculated and the minimum
sample needed to achieve that.
You should also report the expected response rate and provide
support, usually based on other studies that used similar sampling
frames. Finally, you need to report how much you’ll increase the
final sample size to account for attrition if you’re taking into
account loss of subjects during the study period. All these
calculations—power, response rate, and attrition—then yield the
targeted number of subjects to be recruited.
SAMPLE SIZE FOR QUANTITATIVE RESEARCH EXAMPLE

I used G*Power to conduct an a priori power analysis to calculate sample size.
For a power of 0.80 with an alpha of 0.05 and a moderate 0.5 effect size,
it was determined that a sample of 45 patients was needed. To account for
attrition if patients were discharged from the unit during the study period, an
additional 15% was added, bringing the total sample needed to 52.
For a qualitative study, there usually is not a predetermined sample

size; you continue to add participants until you get data satura-
tion (that is, you’re not finding any new information with further
sampling). However, you can give an estimate based on previous
studies of the same or similar topic or phenomenon or with similar
participants. State why you’re not giving an exact number and how
you arrived at the estimate. Support this with expert-authored
articles or books.
SAMPLE SIZE FOR QUALITATIVE RESEARCH EXAMPLE

Purposive sampling will continue until saturation is reached. Based on a review
of the literature of narrative studies in marginalized populations of women
[cite studies], the initial estimated sample size is 10 to 15 women. However,
due to the uniqueness of individual stories and the emergent process intrinsic
to qualitative research, the final sample size cannot be determined until data
collection and analysis are underway [cite expert sources].
If you’re doing focus groups, tell the reader how many groups
and how many participants will be in each group. You can give a
minimum and maximum rather than an exact number. But remem-
ber, nothing in a study is arbitrary, so here also you want to support
with evidence, by using expert-authored publications, how you
came up with the numbers.
Describing Recruitment
Finally, you need to describe just how you’re going to get the
people you need to participate in your study or project. How are
you going to reach people who are eligible to participate? How are
you going to ask them to participate? It is very important that you
describe your recruitment strategy accurately because recruitment
always involves some ethical issues, particularly around questions
of coercion and vulnerability. You must address these directly and
clearly in describing your recruitment strategy. For example, in a
study involving patients undergoing a limited course of treatment,
you might indicate that recruitment was done after treatment was
completed so that there was no question of coercion:
Waiting until treatment is completed to recruit participants

reduces the possibility that patients may feel coerced to participate
to receive optimal care.
In general, you need to address the following when describing

recruitment:
• Delivery of information: Describe how you will deliver the

information about the study to potential participants. You
might be using posters, newspaper ads, postal mail, emails,
social media, or asking people directly.
• Where you will recruit: Describe exactly where the re-
cruitment will take place, including locations where post-
ers or flyers will be placed or handed out and by whom. If
you’re using mail (postal or electronic), describe how many
notices will be sent out and on what schedule. If you’re us-
ing social media, provide specifics, such as which Facebook
or Twitter accounts or pages you’ll be posting on.
• What recruitment methodology used (if any): If you’re
following a particular method, such as Dillman’s (2007),
include that fact with a description of the method and a

reference.
DESCRIPTION OF RECRUITMENT STRATEGY EXAMPLE

As suggested by Dillman (2007), there were five contacts with the subjects,
including a presurvey email sent a week before the email with an enclosed $5
gift certificate and a web link to the questionnaire, and three reminder emails
at two, four, and eight weeks from the initial contact with the subjects (Djukic,
2009).
• Contact information: Describe how potential participants

will get in touch with you.
• Compensation: State what compensation participants will
receive and why. For example, it might be to cover transpor-
tation costs or compensate them for their time or simply as
an incentive.
• Snowballing: If you plan on using or allowing snowball
recruitment, you must include that. This is also called referral
sampling; participants refer people they know who meet the
criteria to the study.
Sometimes you might face challenges in accessing the population

under study. In those cases, you need to describe how you’re going
to gain access, such as using a facilitator or gatekeeper. If you’re
conducting a study with a vulnerable population or participation
could increase or create risk for the participants, describe how you
plan to manage that risk during recruitment to protect, to the best
of your ability, potential participants.
You need to include a copy of any recruitment materials in the ap-

pendix. This includes any email text, letters, posters or flyers, and
telephone or in-person scripts.
You don’t report information on the actual sample (including the

final sample size and demographics) that you ended up recruiting in your
Methodology chapter. Anything you didn’t know until after you started
conducting the study goes in your Results chapter (Chapter Four), not the
Methodology chapter (Chapter Three).
Ethical Considerations and Consent

Now that your readers know who you are recruiting and how, you
need to tell them about how you’re going to protect your subjects
or participants. This information includes review by the appropri-
ate institutional review board or boards and consent of participants
or subjects.
If your study includes a vulnerable population, you must include

detailed information about how you’re going to protect them. A
population may be considered vulnerable due to increased suscep-
tibility to coercion or an inability to provide informed consent.
The US Department of Health and Human Services, Part 46,
Protection of Human Subjects (2009), has designated certain popu-
lations as particularly vulnerable and requires that you demonstrate
that their inclusion in a study is justified and that you have taken
additional measures to lower their risk. These populations include
the following:
• Children
• Prisoners
• Pregnant women
• Mentally disabled persons
• Economically or educationally disadvantaged persons
However, keep in mind that people outside of these designated

groups may also have increased vulnerability when participating in
research. If your study population is part of a stigmatized group,
such as transgender individuals, or those who have a stigmatized
condition, such as a mental illness, they also face increased vulner-
ability, and issues of confidentiality and privacy take on added im-
portance. In some other situations, participation in a study might
place people at increased risk of harm, such as victims of intimate
partner violence. In any situation where your participants face
increased vulnerability, you need to describe how your procedures
are designed in such a way to mitigate that risk as much as possible.
For example:
I will place recruitment flyers in area health centers

and in public settings such as laundromats, convenience
stores, grocery stores, and libraries. As a precaution, the
flyer will be titled Women’s Health Study and will not
specify intimate partner violence so that participants
will not be put at risk if perpetrators see the flyer. The
flyer will include tear-off slips of paper across the bot-
tom with the researcher’s telephone number. Interested
women will be directed to call me, at which time I will
explain the study in detail.
At the completion of the interview, women will receive

information about safety planning based on recom-
mendations from the National Center on Domestic
and Sexual Violence. The women will also receive a
handout with a list of general women’s health resources
in the community, such as access to breast and cervical
cancer screening services, along with the local domestic
violence shelter and hotline numbers. This handout is
designed to support women who have told their abusers
they are participating in a women’s health study while
also giving them the hotline number.
Don’t wait until you’re ready to submit to learn about the institutional review
TIP
board (IRB) process at your school or organization. Do this early in the

process. This is particularly important if you’re doing anything that involves
a vulnerable population, settings outside of the United States, or more than
minimal risk to participants. You don’t want to find out after putting in count-
less hours and great effort that your study or project is not going to get through
IRB or could get stalled in the approval process for an unacceptable amount of
time. (It could take many months in complex situations.) If you’re doing a study
or project in a clinical setting, make sure that you know what the procedures are
for both your school and the clinical setting.
Writing a Consent Form

Most institutional review boards have specific language for con-
sent forms. Refer to your school’s or organization’s IRB website
and your program’s handbook. In general, a consent form needs to
include the following:
• Who is conducting the study, including yourself and your

committee members, and their contact information
• Brief introduction of yourself and the study
• Purpose of the study
• What the participant is being asked to do and how long it
will take
• A statement that the participant can change their mind,
refuse to answer any of the questions, or withdraw from the
study at any time
• A statement that their decision to participate or not will not
affect treatment where appropriate
• What the risks are to the participant
• What the benefits are to the participant (Most of the time

there are no direct benefits to the participant [incentives or
compensation are not benefits], but you can say that it might
benefit others with similar conditions in the future.)
• Whether their participation in the study will be anonymous
or confidential and how that will be accomplished to the
best of the researcher’s ability
• How long and where information about the study (data) will
be kept
• Contact information for the IRB approving the study
You need to include a copy of your consent form in the appendix.
Scholarly Project Planning and Procedures

In the Methodology chapter (or section) of a scholarly project,
along with information about data collection and analysis, you
need to take the reader through the planning of the project,
describe in detail the implementation procedures, and provide
a budget and timeline. When doing a quality improvement or
evidence-based practice (EBP) project, it’s helpful to organize the
write-up by following the steps of the EBP model you’ve selected
to guide the project.
• Planning: Who are the key stakeholders? Who was in-

volved in the planning and what were their roles? Was a
committee formed? Who were the members and what were
their responsibilities? How will you get buy-in from the
organization? Did you do any kind of needs assessment?

What resources do you need, and how are you going to get
them? Did you create a marketing strategy or develop a
business plan?
• Implementation: This is the nitty-gritty of the project.
You need to give your readers a detailed, step-by-step
account of what you’re going to do or did. You should in-
clude all the information needed to replicate your project in
another facility or organization.
• Outcomes: You also need to tell us how you are going to
know whether your project was successful:
• What outcomes will you measure and how?
• What data are you collecting prior to initiation of the
project?
• Are data coming from a public performance reporting
survey, such as the Hospital Consumer Assessment of
Healthcare Providers and Systems (HCAHPS)?
• Are there benchmarks that you want to meet or ex-
ceed, and how or by whom were they established?
• Barriers and facilitators: What factors will facilitate suc-
cessful implementation of the project? What are potential
barriers you may encounter, and how do you plan to address
them?
BARRIERS AND PLAN TO ADDRESS EXAMPLE

Other barriers included existing time pressures and scheduling demands for
primary care providers. Given the number of patients scheduled on a daily
basis, practice managers expressed a need to keep the program limited to
no greater than 90 minutes, and each required sufficient advance notice to
schedule a date and time that would allow for all practice providers and staff
to attend during office hours. This would limit financial implications such as
avoiding paying overtime for hours outside of regular working hours. With this
in mind, scheduling was adjusted for each practice setting to allow for the
program to be delivered during office hours (Surreira, 2014).
If there are written agreements with the organization or stakehold-

ers, include a copy in the appendix.
Educational Interventions
Many quality improvement projects are educational interventions
or include an educational component, whether for patients and
families or nurses and other healthcare providers. If your project is
one of these, you need to include detailed, evidence-based informa-
tion about the content and delivery method, such as:
• What sources of information did you use to develop the

educational program?
• What is the delivery method? (online, face-to-face, webinar,
etc.)
• How many educational sessions will be conducted? You
also need to provide details about how you’re assessing the
effectiveness of the education. Usually this is done using a
pretest/posttest format.
• Are you using an established knowledge assessment instru-

ment for the pre- and posttests? If yes, did you get permis-
sion to use it from the person who created it?
• Are you developing your own pre- and posttests? If yes,
make sure you discuss validity and reliability, reading level,
and pilot testing.
• How will you match individuals’ pretests and posttests?
• When will the posttest be administered (i.e., immediately
following the education session, after a certain period of
time, one time or repeated)?
• Include copies of PowerPoint slides, handouts, and pre- and
posttests in the appendixes.
If you’re conducting staff education to address a practice problem, make sure

TIP
you include how you know that a lack of knowledge is the underlying cause
of the problem in your introduction and literature review. And when you write
your Discussion chapter (Chapter Five), make sure you talk about applica-
tion of the knowledge gained to practice or if it is likely to result in desired
behavior change (supported by evidence, of course).
REMEMBER
Details! You have all the little ins and outs in your head, and it’s easy to skip
over what seems inconsequential to you. Read your Methodology chapter
(section) for gaps and fill them in. Try to anticipate questions. Better yet, have
nurses working elsewhere read your methodology and tell you what’s missing
for them to be able to implement the project on their unit or at their facility.
Budget
You need to provide a budget of expenses for you to do the project.
Include estimated costs in the proposal and final costs after com-
pleting the project, with an explanation of any major discrepancies
between the two. Costs might include labor costs to pay nurses for
time spent in educational meetings or extra staffing to cover the
nurses while they are off the floor for the meetings, educational
materials for staff or patients, computer software programs, lab
tests, and equipment. If you don’t have exact figures—for example,
the current hourly rate for staff—then estimate based on national,
state, or local averages and cite the sources for those estimates.
If your project involves significant costs to the organization, you

also need to include a cost-benefit analysis. Provide a breakdown of
the costs to the organization to implement the project and to sus-
tain the program going forward. Then tell us how the organization
will recoup those costs or benefit financially in the long term.
BUDGET EXAMPLE
The budget for implementing the pressure ulcer prevention patient education
comprises the cost of educational materials, including tablets for patient use,
and nursing time to attend the information/training sessions. (See the following
table for detailed costs.) I will cover initial costs for the tablets, development
of the educational program, and printing of handouts. I have applied for grant
funding to cover these costs (see Appendix F). The clinic will cover the nurses’
time for the training.
Clinic administration has agreed to cover ongoing costs to sustain the program
if it is effective in decreasing the incidence of PUD. These costs will include
replacement of lost or nonfunctioning tablets and printing of handouts.
However, the cost for educating nurses will be eliminated as the training will be
incorporated into new hire orientation.
Estimated Costs for Patient Education Program

Activity/Materials Cost per Estimated Time/ Totals
Unit Number
Tablets for patient use $335.00 4 $1,340.00
Development of educational
program:
• Information technology $110.00/hour 4 hours $440.00

consultant
• Video $325.00 1 $325.00
• Photo rights $65.00 1 $65.00
Printing of handouts $0.15/page 240 $36.00
Nursing time $32.00 16 nurses attending $512.00

(mean) 1-hour educational session
Total Cost $2,718.00
Timeline
You need to include a timeline of the project, beginning with the
planning stages and going through evaluation of outcomes. You
usually do this in a table format, though you can also use a flow-
chart or list. Here is a sample timeline.
Completion Planning Pre- Implementation Evaluation

Date implementation
10/1/2022 Meet
with key
stakeholders
individually
to obtain
their support
10/7/2022 First
planning
meeting
Completion Planning Pre- Implementation Evaluation

Date implementation
10/14/2022 Meet with
Ed. Dept.
to develop
educational
sessions
10/15/2022 Begin tracking of

CAUTIs on unit
10/21/2022 Meet with

IT Dept.
re: adding
CAUTI Alert
screen
10/25/2022 Submit IRB

application
10/31/2022 Pilot test CAUTI

Alert Screen (not
activated)
4/15/2023 End tracking of

CAUTIs on unit
4/15/2023 Conduct Pretest and posttest

educational of educational
to sessions on unit sessions
4/30/2023
4/15/2023 Place posters on

units
4/15/2023 Activate CAUTI

Alert screen on
computer
4/30/2023 Begin tracking use

of CAUTI Alert screen
4/30/2023 Begin tracking

CAUTIs on unit
10/30/2023 End tracking CAUTIs

on unit
10/30/2023 Survey nurses on

perception of CAUTI
Alert screen
Data Collection
OK, so now your readers know where you’re going to do the study
or project, who you’re going to recruit and how, and how you’re
going to protect those participants. If it’s a scholarly project, we
know exactly what you’re going to do and how. Now it’s time to
tell your readers how you’ll collect data to answer your research
question or evaluate the outcomes of your project. This discussion
covers this topic in two separate sections for dissertation research:
first for qualitative studies, and then for quantitative studies. It will
also talk about what you need to cover if you’re collecting data
through chart reviews.
Most of this information is applicable to data collection for schol-

arly projects as well. Just as with a research study, you need to show
that your data collection methods are rigorous so readers know
they can feel confident in the validity and reliability of the out-
comes of your project.
Qualitative Data Collection

The two most common methods used to collect data in qualita-
tive studies are interviews and focus groups, and those are what is
discussed here.
When describing qualitative data collection, you need to include

the following:
• Interviews: Who will conduct the interviews, and where

will they be conducted? If there are interviewers other than
the researcher, will they be trained? How? Is there a specific
timetable for scheduling interviews? How will the interview
proceed? Are the interviews structured or unstructured?
If you’re doing online interviewing, is it synchronous or
asynchronous? How many exchanges will there be with par-
ticipants, and what is the schedule for them? Will the online
interviews take place through a video conferencing service
such as Skype or Zoom, or via email exchanges? If using a
video conferencing service, do participants have the option
to conduct the interview with their camera off?
• Focus groups: Who will conduct the focus groups, and
where will they be conducted? How many people will be
in each group, and how many total groups will there be?
Provide an explanation for the size of the groups. Are you
going to configure the groups around certain characteristics
of the participants? If groups are not homogeneous, explain
why because homogeneous focus groups are considered by
many to be optimal.
• Interview guide or questionnaire: Describe your inter-
view guide or questionnaire. Are you using a previously
tested interview guide or questionnaire? If so, what popula-
tion and for what purpose was it developed and used? Did
you obtain any needed permissions to use it? If you devel-
oped the guide or questionnaire yourself, what was it based
on (the literature, your theoretical model, a pilot study,
and so on)? For unstructured interviews, what is the broad
opening question?
• Pilot interviews: Are you going to conduct any pilot inter-

views? What are the specific purposes of the pilot inter-
views? In the final paper (after conducting the study), you
need to include what, if any, changes you made based on the
pilot interviews.
• Audio recording: Will the interviews or focus groups be
recorded? If yes, indicate whether participants will be asked
for permission, unless this was a criterion for inclusion.
When will the recordings be transcribed (immediately, or
within a certain time period)? Will you be reviewing all
transcriptions or a percentage of the transcriptions for ac-
curacy?
• Post-interview or post-focus group: Will there be a
debriefing? Will you take notes or do summary sheets after
each interview or focus group? Will participants be given an
opportunity to review their transcripts?
Quantitative Data Collection

In quantitative research, data are usually collected and measured
using an instrument (or tool), whether it’s some type of question-
naire completed by subjects or a tool used by the researcher to
gather and organize observed data. You need to describe in detail
each instrument you’re using in your study and why it’s a good
measurement tool for your purpose.
EXAMPLE OF SURVEY DATA COLLECTION

Data will be collected using an electronic survey administered with Qualtrics. I
will use a modified version of the survey on domestic violence developed and
tested by Maiuro et al. (2000) to measure healthcare providers’ knowledge,
attitudes, beliefs, and self-reported behaviors about IPV (Appendix 6). The
tool was originally developed and tested with nurse practitioners, physicians,
physician assistants, and medical assistants and demonstrated good internal
reliability with Cronbach’s alpha of 0.88 and good criterion-related concurrent
validity. Permission to use the instrument was received from [Name], one of the
original developers. It has six domains:
1. Perceived self-efficacy
2. System support
3. Blame victim
4. Professional role/fear of offending patient
5. Victim/provider safety
6. Frequency of IPV inquiry
You also need to include how the instruments were developed, what
studies they have been used in, reliability and validity in prior study
populations, and any psychometric testing that was done specifically
for your study and the results. If you’re adapting an instrument for
use in your study, you need to describe exactly what was changed and
why. State whether permission to use or adapt a preexisting instru-
ment was required and, if so, that you received it and from whom.
Describe how the instruments will be administered and how they will
be scored.
Make sure to report reliability and validity in your study population. If

the instrument has not been used in similar populations in prior studies, you
need to conduct tests to establish reliability and validity with your population.
Here’s what to include regarding quantitative data collection:
• Questionnaires/Surveys: You need to describe question-

naires in detail. What are the questions trying to get at?
What type of questions (Likert-type, multiple-choice,
dichotomous, forced-choice, and so on) are there and how
many? How is the questionnaire structured and formatted?
How will the questionnaire or survey be distributed? Will

you be using an electronic survey program like Survey-
Monkey or Qualtrics? If yes, you need to describe how the
instrument is structured, including how many screens and
whether subjects will be able to skip screens or move back-
ward and forward. How will you ensure that each person
completes the instrument only one time?
• Observations: Describe the instrument you are using to re-
cord your observations and the protocols for data collection.
If more than one person is doing the observations, how are
you going to address interrater reliability? Are observations
being recorded, via either audio or video?
• Biophysiologic: You need to report what tests are being
done and by whom. Be precise in describing protocols.
What equipment will be used to collect the data, and how
will accuracy and precision be ensured? If a laboratory is
being used to analyze urine or blood samples, you need to
establish the normal values for that laboratory.
• Pilot testing: Are you going to conduct any pilot testing of
the instruments? If yes, who will participate in the pilot test-
ing? What in particular are you looking to learn from the
pilot testing? In the final paper, after the study is completed,
you’ll have to describe the results of the pilot testing and
any changes that were made based on those results.
EXAMPLE OF INSTRUMENT DESCRIPTION

The Katz Index of ADL [citations] is one of the most common instruments
used to measure functional status. It was developed by Katz and colleagues
in 1963 for use in a chronic care hospital to observe recovery from stroke,
hip fracture, and rheumatoid arthritis. It is a six-item, clinician-administered
tool that measures adequacy of performance in six functions: eating, dress-
ing, toileting, transferring, bathing, and continence. Each function is measured
on a dichotomous scale of “independent” or “dependent,” with independent
receiving 1 point and dependent receiving zero points. The scores from each of
the six domains are added together for a total score. A score of 6 indicates full
function, a score of 4 indicates moderate impairment, and a score of zero indi-
cates severe impairment. Functional decline or improvement can be measured
by comparing these scores at two or more points in time. Test-retest reliability
ranges from .95 to .98 [citations]. Despite its widespread use for many years
in many clinical settings, there is little documented validity for this instrument
[citations]. However, according to Doran (2003), the Katz Index of ADL is sensi-
tive to the quality of nursing care in that the activities of daily living reflect the
foci of nursing care.
A limitation of the Katz ADL is that it is based on the perception of the nurse
and interview of the patient rather than on actual performance [citations]. It is
also insensitive to low levels of disability; minor illness or disability often does
not translate into the limitations in basic activities of daily living covered in this
scale. Additionally, the Katz ADL is often completed at the time of admission to
the healthcare setting, when the patient is ill. Therefore, it may not provide a
true reflection of the patient’s activities (Wexler, 2007).
Chart Reviews
Most of the data collected from chart reviews is quantitative; how-
ever, on occasion you may use a qualitative approach to examine
narrative notes in charts. When describing the collection of data
from a chart review, be sure to include the following:
• Date parameters
• Number of charts that will be included in the review
• How you’ll gain access to the charts

• If you are using a chart review tool, and if so, how it was
developed
• If the tool will be piloted first on charts that won’t be in-
cluded in the data analysis
• Dates that the chart review will take place
• Variables that you’re looking at and how they were defined;
for example, for depression are you only including patients
with a diagnosis or those with reported symptoms?
• Patient identifiers and how you’re protecting patient confi-
dentiality
• If more than one person is abstracting the data, how you
will determine interrater reliability
Do not confuse anonymous with confidential. If participation is

confidential, then only the researchers involved with the study, such as yourself
and your committee members, know who the participants are. If participation
is anonymous, then no one, including you, knows who the participants are.
For example, if you are conducting in-person interviews, you can make them
confidential by not disclosing names or other identifying information, but they
will not be anonymous.
General Elements Needed for Qualitative and

Quantitative Data Collection
In addition to the elements previously discussed in this chapter,
you need to address the following, regardless of the type of study
or project you’re doing:
• Demographic data: What demographic data will be

collected, and at what point in the study? Will it be done
before or after the interview or questionnaire or survey is

completed?
• Privacy: How will the participant’s privacy be protected?
How will confidentiality or anonymity be achieved? For
example, names and any other identifying information will
be redacted from recordings or transcripts.
• Storage: Where will the data, both audio recordings and
transcripts, be kept? How will it be secured for privacy’s
sake? How long will it be kept before being destroyed?
STORAGE EXAMPLE
Recordings will be kept on a password-protected laptop computer in a locked
drawer in my home. The audio recordings will be destroyed after publication
of findings. No identifying information will be included with the interview data;
each interview will be assigned a number, and demographic data will be kept
separate from interview data. I will redact any names or specific locations the
participant mentions during an interview from the interview recordings before
transcription.
Data Analysis
In the previous sections, you told
your readers what data you planned
to collect and how and by whom. When you’re writing
TIP
Now you need to tell your readers your proposal, this

how you are going to analyze that section will be in the
data. future tense. After you
complete data col-
There are a number of approaches lection, you’ll need to go
to be taken in qualitative data analy- back and change it to the
sis and different types of statistics past tense.
that can be run on quantitative data.
Of course, you’ve already determined which approach you’re going

to use based on your research question and theoretical framework
or philosophical underpinning. Here you’re going to explain the
mechanics.
Qualitative Analysis
Begin with a general statement about the approach you’re tak-
ing and describe briefly how data analysis is done when using that
approach. Talk about the ongoing iterative process—that analysis
begins in the field and will inform data collection as it proceeds, in-
cluding refining questionnaires or interview guides for subsequent
interviews. Provide expert-authored resources to support your
choices and the process.
There are several different approaches to analysis of qualitative

data depending on the type of study and method. If you’re follow-
ing a recognized researcher’s method, such as Creswell, describe
the step-by-step process for analysis. This often will include some
or all of the following in a similar order:
• Immersion in the data

• Reading through the lens of the research question or theo-
retical framework
• Constant comparison
• Coding
• Alternating between parts and the whole
• Repeating the process
• Identification of themes and patterns
It is helpful to give an example of how items are coded.

DESCRIPTION OF DATA ANALYSIS EXAMPLE

Data analysis followed processes outlined by Creswell (2007). I began with
immersion in the data, reading and rereading the entire text of interviews and
field notes several times and making notes. Constant comparison was then
done to code data, comparing all the pieces of data against each other and
against the text in its entirety. For example, if women stated that there were
no nearby neighbors, that the closest town was out of reach, or that they did
not have transportation to go visit family, it would be coded as isolation. Or
if women stated that their family tells them to accept the violence to stay in
the relationship or their neighbors refuse to help, it would be coded as lack
of support. After I did initial coding, a second coder read and assigned initial
codes to 20% of the data, and then she and I sat together and went through
the interviews to challenge the coding (Roush, 2014).
Tell us how you’ll know when coding is completed. Will there be

additional coders? Where in the process will they be involved, and
what percentage of the data will they analyze?
Will you do a member check? How will that be done, and how
many of the participants will be asked? If there is a member check,
you need to make a statement about the feedback in your final
paper.
State whether you’re using a software program, such as ATLAS.ti

or NVivo, to analyze the data or whether you will do it manually.
Quantitative Data Analysis

It’s hard to imagine nowadays how researchers managed quantita-
tive data analysis without the statistical software programs that are
available to us. Now all we have to do is plug in our data and click
on the appropriate tabs and voilá! In a matter of seconds, we are
presented with the results we need.
Of course, it’s not quite that simple. The programs can’t tell us
what tests to run in the first place or why. That’s where your critical
thinking and research knowledge come in. And that’s what you’re
going to explain in detail here:
• Type of statistical analysis: Begin by stating the type of

statistical analysis you’ll be performing and what you have set
for your alpha value. State whether you’re using a statistical
software program such as Statistical Package for the Social
Sciences (SPSS) or the Statistical Analysis System (SAS).
STATISTICAL ANALYSIS EXAMPLES

Path analysis was used to construct a model identifying significant predictors
of the major dependent variable (QOL). Bivariate correlation measures
were performed to determine what relationships, if any, exist between the
independent variables. An alpha of 0.05 was used for all statistical tests in this
study (Hay, 2005).
I will perform descriptive analysis of the data, including frequency distribution,

dispersion, and measures of central tendency.
Bivariate inferential statistical analysis will include independent t-tests and

multiple linear regression.
• Coding: Describe the coding scheme that you used and who
did the coding. If more than one person coded, did you assess
intercoder reliability? How? Include the coding instructions
and codebook in the appendixes. Was any recoding of data
done? If you used a Likert scale, will you do reverse coding
for negatively worded items?
If you’re using a Likert-type scale, you also need to describe
the scale, including whether there is a neutral response (if not,
you should explain why because it’s generally considered best
to include one) and the strength and direction of the choices.
What is the range of possible scores for the complete scale?
• Preliminary analysis: Describe any preliminary analyses

that will be done. This includes data cleaning for code er-
rors, missing values, and outliers. In the final paper, tell your
readers what values were missing, any patterns or rationale
for them, and what strategy you used to deal with them.
How will you determine whether there is normal distribu-
tion of the variables, in addition to other assumptions, for
inferential tests? Describe what possible biases (e.g., non-
response bias) you looked for in the data and how that was
done. If there is a question of
bias, how did you address it?
If you do find evidence
• Analysis: Finally, describe in
TIP
of biases, you do not

detail each type of analysis
discuss them in the
that was done in the order Methodology chapter
that it was done for each of (Chapter Three).
the variables or for each hy- Instead, you do so in
pothesis. If you’re doing any the Discussion chapter
multiple regression analysis, (Chapter Five) when
state in what order the vari- you talk about study
ables were entered into the limitations.
equation.
Use of Information Technology and Social Media

Researchers are increasingly using video-conferencing and social
media for recruitment and data collection. If you are doing so for
your dissertation or scholarly project, there are certain aspects that
must be addressed in your paper.
Social Media
As always, specificity is essential. It is not enough to state the
platform you’re using, such as Facebook, Twitter, or LinkedIn;
you need to name the specific organizations or pages where you’re

posting recruitment information. Provide basic information about
each organization, including a link to its website and relevant
information about its page (number of followers, private or public,
etc.).
Be clear whether you are passively recruiting—putting the recruit-

ment materials out there and waiting for potential participants
to contact you—or actively recruiting—reaching out to specific
individuals on the sites.
In addition, include the following:
• Do you need permission from the organization or page

administrator to post a recruitment notice? If yes, did you
get permission?
• What will you be posting on the site—for example, the re-
cruitment flyer, a link to the flyer, your contact information,
or other text about the study?
• Will you repost the recruitment information? If yes, how
many times and at what time intervals?
• Do you plan on paying for a targeted post or to “boost”
your post on Facebook (essentially turning your post into an
ad)?
• Are you linking directly to an online survey from the re-
cruitment post?
• How will you ensure that people don’t participate more
than once? This can happen if the recruitment post includes
a link directly to an online survey and especially if there is
an incentive.
If you use social media for recruitment or data collection, be sure

to address any related ethical considerations in your Ethics section.
These may be related to “bystanders” (other followers or friends
on a targeted social media site), transparency (being clear about
who you are and your presence on a site), and how you use person-
al information shared on sites not intended for research purposes.
Video-conferencing
If you are conducting interviews via a video-conferencing platform,
describe the following:
• Instructions given to participants on connecting to and us-

ing the platform
• Any assessment of users’ comfort with the technology prior
to the interview
• Alternate plan if the chosen technology doesn’t work
smoothly (i.e., FaceTime or phone call)
• Will interviews be audio- or video-recorded?
• Note if the platform used is an IRB-approved version
Rigor
By now, your readers have a good idea of how rigorous your study
is based on everything you’ve told them about your methodology.
However, there are additional measures you need to talk about,
particularly for qualitative research, that are specifically meant
to enhance the study’s rigor. This last part of your Methodology
chapter will describe these for the reader.
Qualitative
There continues to be debate about how to assess rigor, or even if
you can, in qualitative research, so it’s important to acknowledge
and briefly discuss this in the beginning of this section. You should
cite expert-authored texts for this discussion. If you’re following
a particular expert’s framework, such as Lincoln and Guba (1985),
state that and structure your discussion by the relevant criteria.
At a minimum, tell your readers how you’ll establish trustworthiness

and credibility. Possible strategies that you should describe include
the following:
• Triangulation
• Engaging in reflexivity
• Prolonged engagement
• Looking for disconfirming evidence or negative cases
• Keeping an audit trail
• Using thick description and verbatim quotes
• Doing a member check
• Using an independent coder
• Getting peer review
Quantitative
In quantitative research, you need to convince the reader of the
reliability, validity, and generalizability of your study. Much of this
is related to how you sample and which instruments you use. Using
instruments that have been shown to be valid and reliable in your
population, whether in previous studies or through psychometric
testing you perform, is critical; therefore, make sure you talk about
that either here or earlier when you discussed the instruments.

(If you don’t do psychometric testing in your specific population,
make sure to include that in the Limitations section of your Dis-
cussion chapter.) In this section you can also be explicit about how
your sampling and recruitment techniques will help avoid potential
bias and increase generalizability.
If you’re doing a quality improvement project, you’re not looking

for generalizability beyond your setting but will still need to ad-
dress rigor in the evaluation of your outcomes.
Scholarly Projects
For scholarly projects, you must demonstrate rigor in the design
and implementation of any intervention or practice change and
the evaluation of outcomes. Though you aren’t concerned with
generalizability beyond your setting, you must still address how
you avoided bias and ensured accuracy in collection and analysis of
pre- and post-intervention data. As discussed above in quantitative
studies, this will be apparent in your discussion of your sampling
and instruments. Additionally, you should discuss:
• Timing of collection of pre- and post-data

• Design and psychometric testing of pre- and post-tests for
educational interventions
• Measures to avoid contamination and carryover bias
• Consideration of outside influences that may have affected
outcomes (such as change in leadership, staffing deficits,
patient treatments received outside the project, etc.)
• Performance bias in care provided as part of an intervention
Congratulations! You’ve reached an important milestone: The pro-

posal for your dissertation or scholarly project is done! You are now
ready to defend it. After that, you’ll get IRB approval, and then on
to the fun stuff: implementation and data collection.
Then, after you’ve collected all your data, onward to the next chap-
ter/section, Results.
Chapter Checkup
❑ Did I clearly explain why I chose the study design?
❑ Did I describe the intervention in enough detail for others to replicate it?
❑ Did I describe the sampling method?
❑ Are the sample exclusion and inclusion criteria clear?
❑ Did I report validity and reliability of the instruments being used?
❑ Have I described the resources needed for a quality improvement
project?
❑ Have I described the educational content and materials for an educational
intervention and what they are based on (i.e., evidence or guidelines)?
❑ Have I clearly described how I will evaluate the outcomes of my project?
❑ Did I describe ethical considerations and IRB approval?
❑ Have I provided enough information about the coding scheme?
❑ Have I described what preliminary analysis was done, including tests of
assumption for inferential statistics?
❑ Have I described in detail each statistical test being done?
❑ Have I included copies of the following in the appendix: consent forms,
recruitment materials, interview guides, surveys, instruments/tools, and
educational materials?
References
Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five tradi-
tions. Sage Publications.
Dillman, D. A. (2007). Mail and internet surveys: The tailored design method. John Wiley
& Sons.
Djukic, M. (2009). Physical work environment: Testing an expanded job satisfaction model in
a sample of hospital staff registered nurses (Doctoral dissertation). ProQuest Disserta-
tions and Theses (3382425).
Hay, C. G. (2005). Predictors of quality of life of elderly end-stage renal disease patients:
An application of Roy’s model (Doctoral dissertation). ProQuest Dissertations and
Theses (304999693).
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage Publications.
Roush, K. (2014). The experience of intimate partner violence in the context of the rural set-
ting (Doctoral dissertation). ProQuest Dissertations and Theses (1551746532).
Surreira, C. (2014). Culturally competent LGBT care. Doctor of Nursing Practice

projects, University of Massachusetts Amherst. http://scholarworks.umass.edu/
nursing_dnp_capstone/34
US Department of Health and Human Services. (2009). 45 CFR 46: Protection of hu-
man subjects. https://www.hhs.gov/ohrp/regulations-and-policy/regulations/
45-cfr-46/index.html
Wexler, S. (2007). A comparison of nurse sensitive outcomes of an acute care for the elderly
(ACE) unit and a regular inpatient medical unit (Doctoral dissertation).
Witt, D. E. (2006). Growing old on the farm: An ethnonursing examination of aging and
health within the agrarian rural subculture (Doctoral dissertation). https://dsc.duq.
edu/etd/1377/
Resources
Arigo, D., Pagoto, S., Carter-Harris, L., Lillie, S. E., & Nebeker, C. (2018). Using
social media for health research: Methodological and ethical considerations for
recruitment and intervention delivery. Digital Health, 4, 2055207618771757.
https://doi.org/10.1177/2055207618771757
Creswell, J. W., & Miller, D. L. (2000). Determining validity in qualitative inquiry.

Theory Into Practice, 39(3), 124–130. https://doi.org/10.1207/s15430421tip3903_2
Franzke, A. S., Bechmann, A., Zimmer, M., Ess, C., & the Association of Internet
Researchers. (2020). Internet research: Ethical guidelines 3.0. https://aoir.org/
reports/ethics3.pdf
Gelinas, L., Pierce, R., Winkler, S., Cohen, I. G., Lynch, H. F., & Bierer, B. E. (2017).
Using social media as a research recruitment tool: Ethical issues and recommenda-
tions. The American Journal of Bioethics, 17(3), 3–14. https://doi.org/10.1080/15265
161.2016.1276644
Mays, N., & Pope, C. (1995). Qualitative research: Observational methods in health
care settings. British Medical Journal, 311(6998), 182–184. https://doi.org/10.1136/
bmj.311.6998.182
Miles, M. B., & Huberman, A. (1994). Qualitative data analysis: An expanded sourcebook.
Sage Publications.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for
nursing practice (10th ed.). Wolters Kluwer.
Polkinghorne, D. E. (2007). Validity issues in narrative research. Qualitative Inquiry,

13(4), 471–486. https://doi.org/10.1177/1077800406297670
Pope, C., Ziebland, S., & Mays, N. (2000). Analyzing qualitative data. British Medical
Journal, 320(7227), 114–116. https://doi.org/10.1136/bmj.320.7227.114
Sandelowski, M. (1995). Sample size in qualitative research. Research in Nursing &

Health, 18(2), 179–183. https://doi.org/10.1002/nur.4770180211
4
WRITING YOUR RESULTS
CHAPTER
ELEMENTS OF YOUR RESULTS

CHAPTER
1. Response rate
2. Final sample size
3. Demographics with descriptive statistics
4. Results of preliminary statistical tests
5. Results of all final statistical analyses
6. Results of qualitative analyses
7. Outcomes of project implementation and
evaluation in a scholarly project
This chapter covers how to write up your results, including quan-

titative and qualitative results and the evaluation of a scholarly
project.
Congratulations! You’ve finished collecting your data and analyzing

it or have fully implemented your scholarly project. Now you have
to tell your readers what you found or how successful the project
was. If you did a quantitative study, this is usually fairly straight-
forward and standardized. It can get a little more complicated for
quality improvement (QI) projects, when you have results across
multiple phases to report on. And it can get even more complicated
in qualitative research, when you can have hundreds of pages of
interview data to sift through to decide what to include in your
Results section/chapter.
First you want to go back and change all the wording on data analy-
sis to past tense. It’s no longer something you’re going to do; it’s
something you did (feels good, right?).
The most important thing to keep in mind as you write up your

results is that you are only reporting the results in this chapter. You
are not interpreting or discussing them. That comes in the Discussion
chapter (Chapter Five).
Begin as usual with a short paragraph describing what you’re going

to cover in this chapter.
EXAMPLE OF INTRODUCTION TO RESULTS CHAPTER

This chapter presents the results of the data analysis, including the quantitative
survey results and answers to the open-ended qualitative questions.
Demographics are described and key findings highlighted.
CHAPTER 4 • WRITING YOUR RESULTS CHAPTER 91
Results
In reporting your results, follow your process of analysis and build
a case as you answer each research question or address each aim or
hypothesis of your study. You are logically leading the reader to the
conclusions that you will present in the Discussion chapter.
You should provide the dates of data collection. For a QI project,

give dates for data collection before implementation, dates of
implementation, and dates for data collection after implementa-
tion. On what dates was the survey open? Over what period of time
did interviews take place? What were the date parameters for chart
reviews, and when did the actual reviews take place?
The following subsections outline a way to organize the findings

under subheads commonly needed in reporting results. Remember,
though, to always check your specific program’s guidelines.
Preliminary Analyses
Report the results of any preliminary analyses you completed and
actions taken as a result (change in statistical test performed, items
deleted or added, changes made to instruments, variables excluded
from analysis, and so on). Provide details on missing values and
how you dealt with them. When using multiple instruments, you
could report the psychometric results for all of them in a paragraph
up front, or report on each when you present the results of the
analysis that was done using that instrument.
Describe the results of the tests you ran to check that assumptions
were met for each of the statistical tests you used. You can do this
in the text by simply stating which tests of assumptions were met
and which were not. You could also include histograms or prob-
ability plots in your paper that support your statements. Provide a
reference for cutoff values. For example, if you considered a skew
ratio greater than 2 as the cutoff for normal distribution, provide

the rationale and cite an expert-authored source to support it. If
assumptions were not met, you need to give more details, including
how you addressed it.
In a qualitative study, you need to report the results of any pilot

tests you did on your interview guide or questionnaire, along
with any changes that were made based on the pilot tests. Also,
because of the iterative nature of qualitative research, where data
analysis begins with data collection and can create the need for
methodological changes along the way, you must report on any
adjustments you made to the method from how it was originally
described in your proposal and what triggered those adjustments.
EXAMPLE OF REPORT OF CHANGES DUE TO PILOT TESTING

I began with a scripted introduction of the study, followed by general questions
about IPV in the local community. In initial interviews, I then asked structured
questions to elicit an exploration of the participants’ experiences.
Two pilot interviews were conducted to get a better estimate of how long
the interviews would take and to see whether there were any unforeseen
difficulties with any of the questions. Based on these interviews, I changed
the interview approach to more of a narrative format. I asked participants to
tell their story and asked for clarification or more details. When participants
finished telling their story, I returned to the interview guide to ensure that all
questions had been addressed. The interviews were transcribed, and I reviewed
all transcriptions, checking accuracy against the recording (Roush, 2014).
Response Rate
You should state what the response rate was in sample recruitment
and how you calculated it. How many of the surveys returned were
incomplete? Did nonresponders differ at all from responders? Did
anyone leave a focus group or decline to continue after starting an
interview? Did you make any adjustments in recruitment based on

early response rates?
Sample Size and Demographics

State your final sample size and the numbers in any subgroups. If
participants were recruited from different types of settings that
could have a meaningful effect on results (e.g., acute-care hospital
or a long-term care facility), tell your readers how many were from
each setting. You may report the final sample size and response rate
together if there were no special considerations, such as a dispro-
portionate response rate from a particular subgroup. Describe
in the text any demographics that are relevant to the meaning of
the study, and include a table with descriptive statistics of all the
sample demographics.
EXAMPLE OF REPORT OF RESPONSE RATE, SAMPLE SIZE,

AND DEMOGRAPHICS
A total of 108 advanced practice nurses (APNs) responded to the survey for a
response rate of 52%. Ten of the surveys were not completed, and these were
removed from analysis, leaving a final sample size of 98 APNs. Family nurse
practitioners represent the highest proportion of respondents (58%), followed
by adult-gerontology nurse practitioners (32%). Most were female (88%),
white (89%), and between 30 and 59 years of age. Sample demographics are
in Table 1. Among the 94 APNs who responded to the question on practice
setting, physician-owned private practice and long-term care facilities (LTCF)
were the most represented clinical practice areas (n = 44 and n = 27,
respectively).
Report aggregate demographics for each characteristic; don’t list

demographic information for each participant. You don’t want to
compromise confidentiality by unintentionally providing identify-
ing information.
Be consistent in reporting. For example, if you report standard deviation

from the mean for one set of descriptive data, you need to report it for all. Use
the same number of decimal places for all numbers (usually two).
Findings
Provide a general statement of the results for each hypothesis or
statistical test that was done and specific details that you think
should be highlighted. You can point out items in a Likert scale
that had the highest and lowest scores, the factors with the highest
or lowest frequency, what significant correlations were found and
their intensity (weak, moderate, strong), and important negative
findings. Include the tests of statistical significance that were used
and the values (alpha, chi square, or confidence interval) in paren-
theses after each result. All the detailed results should then be in
tables.
When reporting results, make sure that the reader has the informa-
tion to know what they mean. For example, in a Likert scale, you
must indicate what the values for each item represent.
EXAMPLE OF DESCRIPTION OF LIKERT SCALE

Attitudes and beliefs were measured with 5-point Likert scale questions with
a range from 1 = strongly disagree to 5 = strongly agree, including a middle
neutral option. Mean scores above the midpoint of 2.5 reflect more favorable or
objective attitudes or beliefs, whereas those below 2.5 indicate less favorable
or less objective attitudes or beliefs (Roush, 2014).
Don’t Just Throw a Lot of Data at Us!

Make sure that each result you report is logical and meaningful to
your study. That includes negative findings as well. After all, know-
ing what doesn’t work can be as important as knowing what does.
When you did the analysis, for example, you might have found
results that were not related to your research question or hypothe-
ses. (They might be something to consider for another study.) This
is where critical thinking and discrimination come into play. Just
because SPSS or SAS spits out a table doesn’t mean it necessarily
belongs in your paper.
This is true for qualitative results as well, and perhaps even more
so. Your data will include a tremendous number of quotations. You
want to pull out and include those that best represent the results,
not just give readers an endless litany of quotations. For more on
this, see the section on qualitative results later in this chapter.
You could also include a diagram of your theoretical framework

from earlier in the paper and insert key findings in the appropri-
ate areas (see Figure 4.1). This will not work with all theoretical
frameworks, but when it does, it can be a nice way of illustrating
the operational application of the framework as you carried out the
study.
Figure 4.1 Theoretical model illustration with findings inserted.
Tables and Figures

Tables and figures are used to provide readers with an accurate,
intuitive depiction of the data and to highlight your key findings.
Tables list and tabulate results, and figures provide a visual repre-
sentation of data. Figures are great for illustrating trends or patterns.
For example, if you want to show the changing rate of CAUTIs on
your unit over the duration of your QI project, a graph will do that
much better than a list of numbers in a table (see Figure 4.2). If
you just want to show the difference between the rate at the begin-
ning and the rate after implementation, a table is the better choice
(see Table 4.1).
Figure 4.2 Number of new CAUTIs.
Table 4.1 Number of New CAUTIs

Unit January 2023 April 2023
14 South 4 0
23 South 7 0
18 North 5 0
15 West 3 1
Pie graphs are rarely a good choice for representing statistical results.
They are just not precise enough. Avoid them.
In a quantitative study, you’ll likely have numerous tables in the

Results chapter/section. You’ll include the major findings and any
other findings you think should be highlighted in the text, but
you’ll present many of the results of the statistical tests in table
form. One way to determine what belongs in the text is whether
you plan to talk about it in the Discussion chapter; if so, you should
report it in the text, not just in a table. You usually embed tables in
the text close to where you refer to them. As always, though, check
the requirements of your program; some might want all the tables
placed at the end of the paper after the references or in an appen-
dix (although you will still refer to the table by number in the text
and refer readers to the appendix).
Tables and figures should enhance readers’ understanding of

information, not just repeat what you told them in the text. There may be some
repetition between what you state in the text and what you include in a table
or figure, but if the table or figure doesn’t provide any additional information,
then there’s no reason to include it. And vice versa, if you’re going to illustrate
trends or patterns in a figure, you don’t need to list all the data points in
the text.
You can combine factors or characteristics in a table when there

are relatively few in each group and when such a combination of
factors won’t affect reader understanding or the meaning of results.
For example, if you are reporting on comorbidities in patients with
heart failure and there are large proportions of patients with lung
disease, diabetes, anemia, and renal insufficiency, and then just a
few who have one of a dozen other conditions, you want to list
lung disease, diabetes, anemia, and renal insufficiency in their own
rows or columns and then collapse the others into another row or
column. There is no hard and fast number for when you would
collapse a category; it depends on the overall sample size and the
average size of the groups. If there

are 10 or 20 in a group, you might
Don’t just automati-
want to collapse those with less than
TIP
cally transpose the
5, but if there are hundreds of par-
output from SPSS or
ticipants in each group, you might SAS as your tables.
combine groups that have only 10 Some will work fine
or 20. as is, but you should also
create your own tables
Be sure to highlight statistically from the results or revise
significant findings for the reader. where needed to present
You do this by placing an asterisk the results in a way that
(*) next to significant p values in the best addresses your
body of the table and in a key at the research questions and
bottom. Use one asterisk for *p ≤ enhances your readers’
understanding.
0.05 and two asterisks for **p ≤ 0.01.
Refer to the appropriate formatting guide (most likely APA) for

how to construct tables. General rules include the following:
• Each table must be able to stand alone. That means that you
must spell out acronyms and explain symbols even if you’ve
already used them in the text or another table.
• Be consistent in style across tables.
• Use a legend or key to explain symbols or abbreviations.
Qualitative Results
Writing up qualitative results is challenging. You might have
hundreds of pages of data from interviews even after you complete
coding. The specific mechanics of how you write up your qualita-
tive results will depend first on the type of qualitative research
you did and second on the analysis method you are following. For
example, in phenomenology you’ll present themes, in grounded
theory you’ll present a theory, and in narrative you may present the
results as an emplotted story. However, some guidelines cut across
all the approaches. In one form or another, you will be telling a story,
and the data you collected—the quotations and observations—are
the building blocks of that story; they shape and support it.
You can organize your paper by the themes you identified. Start
with a general statement about the findings and list the themes
and subthemes that you identified in your analysis. Then, using a
subhead for each theme, provide detailed findings for each with the
supporting data (such as quotes and observations).
EXAMPLE OF ARRANGING FINDINGS BY THEMES

The participants described a complex web of intersecting factors at all levels of
the ecological model, from internal struggles with self-identity at the individual
level to abuses of power and control in relationships at the microsystem,
macrosystem, and exosystem levels. They all also described efforts to prevail
over the abuse they suffered and multiple barriers they encountered in trying
to create a life separate from the abuser. The result is a picture of isolated
lives circumscribed by violence and efforts to stay safe while at the same time
engaged in a dynamic search for understanding and eventually a better life.
Six major themes were identified:
1.
Living with violence, which describes the participants’ relationship with
the abuser and the day-to-day experience of abuse and includes sub-
themes of history of childhood abuse, being taken by surprise, physical
abuse, psychological abuse, substance abuse, and impact of physical
violence
2.
Protect self, which details the participants’ efforts to decrease the abuse
and stay safe
3.
Isolation, which focuses on the isolating factors associated with the abuse
and includes subthemes of social isolation, small town, and stigma
4.
Search for understanding, which describes the participants’ efforts to
understand their situation
5.
System level abuse, which illustrates the role of community and societal
factors and includes subthemes of blame the victim, law enforcement,
and legal system
6. Creating a new life, which expresses the participants’ efforts to escape

the abuse and create a better life for themselves and, where appli-
cable, their children; it includes subthemes of on again, off again; finally
“done”—leaving for good; finding support; making it on their own; the
abuse still just continues—staying safe; and “I’ll be alright. It’ll just take
time”—resilience and recovery
Following is a detailed description of each of the themes and subthemes with

supporting data (Roush, 2014).
How many quotations should you include in your paper? The

answer: There is no set number. You need to include enough
.
quotations—and the right quotations—to support your results in

a way that causes readers to trust those results. This is called thick
description, and it is one of the ways you show the rigor of your
study and convince the reader that your results are reliable. One or
two quotations do not establish a theme. However, you don’t want
to list every quotation that resulted in a theme or a pattern being
established. Choose the quotations that most powerfully demon-
strate the theme or pattern that you’re presenting. You can inter-
weave some quotations into the text, and others you can separate
from the body of the text.
EXAMPLE OF PRESENTATION OF QUOTATIONS

The reluctance to share their experiences with others, even friends, meant that
the women were not able to access potential sources of support and increased
their perception that they needed to face their situation alone. Participants
repeatedly talked about not making friends or reaching out to others because
of shame and embarrassment: “I still didn’t have any friends I could go to
because I was embarrassed, I was ashamed, I just, I didn’t want to admit to

myself much less anybody else,” and, “I was ashamed of even admitting it
to myself much less anybody else.” They also perceived that they would not
receive support if they did.
You don’t talk about it, you don’t tell anybody about it . . . you just suffer
the abuse, you don’t tell anybody about it because no one’s going to
be sympathetic to you. No one’s going to admit to it because it’s one of
those things, that it’s weakening (Roush, 2014).
Be precise when writing the quotations from participants. Don’t

embellish or amplify. If you conducted face-to-face interviews,
note interviewee nonverbal expressions of emotions that the reader
needs to be aware of to have a full and accurate understanding of
what the participant is conveying. This might include facial expres-
sions, such as smiles or grimaces; laughter or crying; and physical
actions such as clenching their fists, hiding their face, and shaking
or nodding their head.
You can remove words that are extraneous if doing so doesn’t

change the meaning, and you can add words for context or under-
standing, again so long as it doesn’t change the meaning. However,
you have to indicate that you have done so by using an ellipsis (…)
where you have removed words and brackets ( [ ] ) around words
you’ve added.
It also helps to provide context for some of the quotations by add-

ing information about the participant or the situation. This can add
depth to the report of the findings. Be careful, though, that you are
not compromising confidentiality by adding identifying informa-

tion or too many details about a participant’s situation. You might
need to give a general rather than specific age and redact dates or
places in the description or in the quote itself.
EXAMPLE OF ADDING CONTEXT TO QUOTATIONS

One of the participants, a woman in her early twenties who had left her
husband six months prior to the focus group, talked about an earlier attempt
she made to leave her marriage:
I left him in [year] for eight or nine months and got an apartment out
by [town] with just the baby and me, but he would come over, then call
three, four, five times a day begging us to come back. So I went back to
him. ‘Cause I was trying to work and take care of the baby and all. And
then being harassed on top of everything. It was easier to go back than
to deal with it.
Remember, the quotations are the data. They are not the results.
The results, depending on the type of qualitative study you’re doing,
are the synthesis, themes, patterns, or theories that come from ana-
lyzing the quotations. When writing, you state the results and then
add the quotations—the data—that support the results.
Avoid the use of adjectives. Let the power of the participants’ words convey
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emotion and intensity. And remember, you are presenting data, so you don’t
want to unduly influence readers’ responses by telling them how to think or
feel about it.
If you did a grounded theory study, include a graphic representation

(model) of your theory. If you did thematic analysis, particularly for
a phenomenological study, it’s helpful to include a table illustrating
how you arrived at one or two of the themes (see Table 4.2).
Table 4.2 Example Thematic Analysis Table

Data (Participant Level 1 Codes Level 2 Codes Theme
quotes) (Name of code) (Name of merged
codes)
Finally, give yourself plenty of time. Writing up qualitative results

is time-consuming if you are going to do it well. You’ll need to
go back and revise, again and again, adding in quotations, taking
others out, and moving things around, to arrive at the composition
that best tells the story of your results. Get feedback from your
committee or other qualitative researchers as you work.
Scholarly Project Evaluation and Outcomes

The evaluation of a scholarly project is a detailed report of how
the implementation process proceeded, step by step, as well as the
outcomes. What happened after you started the intervention? Were
there any major changes to the proposal timeline, and if so, why? De-
scribe the facilitators and barriers you encountered and what adjust-
ments you made as a result. What about unintended consequences?
If your project is a QI initiative or other practice change, your evalu-

ation will follow many of the principles of reporting quantitative
studies discussed in this chapter. Report your data analysis, response
rate, and final sample following the preceding guidelines.
Don’t forget to address the assumptions of the statistical tests that you
use for analysis, particularly if you have small sample sizes. If you had planned
on using parametric testing but the assumptions are not met, state that and
then report the results of the nonparametric testing.
EXAMPLE OF ADDRESSING ASSUMPTIONS OF STATISTICAL

TESTS
The results of the Shapiro-Wilk’s test established that the data were not
normally distributed; therefore, I conducted nonparametric analysis using the
Wilcoxon Signed Rank test. There was a statistically significant decrease in
emergency department visits in patients in the nurse practitioner follow-up
group (z = –3.8, p = .04).
Table 4.3 Types of Handoff Problems

Baseline Weeks Post-Implementation
2 4 6 8 10
Admission or discharge delays 2 3 2 4 3 3
Medications not given 2 2 1 0 0 0
Medical orders not received 1 0 0 1 0 0
Care not documented 1 2 1 1 0 0
Family member communication 3 2 1 2 1 2

missed
Change in patient status not 2 1 2 0 1 0

updated
Concerns not communicated 3 1 2 1 1 1
Missed care 2 1 1 0 0 0
Total 16 12 10 9 6 6
Describe incremental outcomes that you measured and what, if any,

actions you took as a result. Use a graph to show changes over time,
and note on the graph when you took particular actions (see Figure
4.3). Use tables to present results of quantitative measurements that
you took (see Table 4.3).
If you had participants answer open-ended questions at the end of a

survey or in addition to completing a measurement tool or pretests/posttests,
remember that the answers are the data, not the results, and you need to
analyze them, not just list them.
12 14 16 18 20 22 24
2 1 1 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 0 0 0 0 0
1 0 1 0 1 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
3 2 2 0 1 0 0
18
16 16
14
12 12
10 10
9
8
6 6 6
4
3
2 2 2
1
0 0 0 0
e 2 4 6 8 0 2 4 6 8 0 2 4
se
lin eek eek eek e ek k1 k1 k1 k1 k1 k2 k2 k2
ee ee ee ee ee ee ee ee
Ba W W W W W W W W W W W W
Figure 4.3 Number of shift handoff problems.

If you find it difficult to organize all the moving parts of your

project evaluation, think about the writeup in a Plan-Do-Study-
Act (PDSA) framework. You might have used this framework for
your project to begin with, so reporting the Do-Study-Act of each
phase is straightforward. Even if you didn’t follow this framework,
though, you can use it as a writing tool to help you organize all the
pieces of information of the project in a clear, easy-to-follow struc-
ture and ensure that you’re covering everything you need to cover.
The preimplementation data and activities are the Plan aspect of
this framework. You then report on the initial implementation
(Do) and the early evaluation (Study), including any data you had
collected at that point and outcomes such as responses from staff
or patients, challenges you encountered, and unforeseen complica-
tions. Tell your readers about adjustments you made in response
to those outcomes (Act). Repeat this sequence as often as needed
to describe all the activities and interim evaluations of the project
period.
Ensure that the final outcomes pertain directly to the problem

statement and the purpose of the project as you stated it in your
Introduction chapter (Chapter One). And go back through your
goals and aims and make sure that you’ve addressed each of them
in the evaluation as well.
OK, now that you’ve finished telling your readers what your study
found or what happened with your project, you need to tell them
what it all means. Move on to Chapter 5, “Writing Your Discussion
Chapter,” to find out how.
Chapter Checkup
❑ Are findings clearly and logically organized?
❑ Are graphics (tables, figures, graphs) used appropriately?
❑ Are readers able to understand tables and graphs without having to
refer back to the text?
❑ Did I describe the final sample and any subgroups?
❑ Did I provide a summary of the demographics?
❑ Did I present the findings without interpretation or comments on their
implications?
❑ Did I include all relevant results and only relevant results?
❑ Was I consistent in how I reported statistical results?
❑ Did I protect the confidentiality of participants in writing up interview
results?
❑ Did I address each of the research questions or hypotheses?
❑ Did I address the barriers and facilitators and adjustments made to
address them?
❑ Did I address all the goals and objectives of the project?
❑ Are the outcomes of my project directly related to the problem
statement?
Reference
Roush, K. (2014). The experience of intimate partner violence in the context of the rural
setting (Doctoral dissertation). ProQuest Dissertations and Theses (1551746532).
Resources
Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five
traditions. Sage Publications.
Institute for Healthcare Improvement. (2011). How to improve. http://www.ihi.org/

resources/Pages/HowtoImprove/default.aspx
International Committee of Medical Journal Editors. (2017). Recommendations for the

conduct, reporting, editing, and publication of scholarly work in medical journals. http://
www.icmje.org/icmje-recommendations.pdf
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage Publications.
Miles, M. B., & Huberman, A. (1994). Qualitative data analysis: An expanded sourcebook.
Sage Publications.
Polit, D. F., & Beck, C. T. (2012). Nursing research: Principles and methods (9th ed.).
Lippincott, Williams, & Wilkins.
Pope, C., Ziebland, S., & Mays, N. (2000). Analysing qualitative data. British Medical
Journal, 320(7227), 114–116.
SQUIRE. (2017). Revised standards for quality improvement reporting excellence:

SQUIRE 2.0. http://www.squire-statement.org/index.cfm?fuseaction=Page.
ViewPage&pageId=471
Van Manen, M. (1990). Researching lived experience: Human science for an action sensitive
pedagogy. State University of New York Press.
5
WRITING YOUR
DISCUSSION CHAPTER
ELEMENTS OF YOUR DISCUSSION

CHAPTER
1. A summary review of the problem
2. Key findings
3. What the findings mean in context of what
is already known
4. Implications for practice, education, and
policy
5. Future research
6. Sustainability of practice change (scholarly
project)
7. Limitations
8. Conclusion
This chapter covers how to write up your discussion. In this chap-

ter, you’ll learn how to write up a discussion of quantitative and
qualitative results of a dissertation study and of the outcomes of a
scholarly project.
Here you are. You started out to make a meaningful contribution to

nursing science and healthcare outcomes and have spent years and
untold effort on this work. Now you get to tell us all about it. The
Discussion chapter (Chapter Five) is your opportunity to lay out
for your readers what your outcomes mean in the context of what is
known or what is needed. And you explain how to take it and move
forward to create or sustain changes or answer the next big ques-
tion. The results you reported in the previous chapter (your Results
chapter, Chapter Four) are only raw material; the discussion is
where you use that material to build something meaningful.
Begin this chapter as you have each of the others, with a brief de-
scription of what the chapter will cover.
A Review of the Problem

Begin with a brief review of what the problem is, a summary similar
to what you did in the introduction, but much shorter. You need to
remind readers of where it all began; they’ve probably read about
100 pages in between your introduction to the problem and this
point. By reviewing some information here, you are reinforcing for
the reader how what you discuss in this section relates to the pur-
pose of your study or project.
Don’t self-plagiarize from your introduction or literature review.

You need to pull together the information from those chapters/sec-
tions and summarize them in one paragraph, two at the most.
Follow this summary with a restatement of your purpose state-

ment, but now in the past tense. Then make a clear statement about
CHAPTER 5 • WRITING YOUR DISCUSSION CHAPTER 113
what your key findings are and point out what contribution your
study makes to the literature (what your study adds) or your project
makes to healthcare. The key findings should all relate to your
research questions or the purpose of your project. The remaining
findings, including insignificant ones and incidental findings that
are not directly related to your research questions, will be included
in the discussion that follows, but they are not included here as a
key finding.
EXAMPLE OF SUMMARY REVIEW AND KEY FINDINGS

This study, using both qualitative and quantitative methods, sought to
understand the lived experience of women who experience IPV in a rural setting
and the knowledge, attitudes, beliefs, and behaviors of healthcare providers.
The findings support and further illuminate results of the small body of
research specific to IPV in a general population of women in a rural setting. Key
findings include the self-imposed isolation that women engage in to manage
stigma, the system-wide abuse by law enforcement and the legal system, and
the resilience women demonstrate in overcoming multiple barriers to creating
a new life separate from the abuser. Additionally, an encouraging key finding
was the positive results of the healthcare provider survey, which found good
knowledge, attitudes, beliefs, and behaviors related to IPV. Results of this study
indicate that it is important that healthcare providers see their role in IPV as
part of a broader integrated approach (Roush, 2014).
Don’t be afraid to clearly state for readers exactly what you are telling them
TIP
so that there is no chance of confusion:
The key findings of this study are….
The contributions this study is making to the literature are….
The outcomes of this project indicate that implementing [your

intervention] is an effective approach to….
Discussing Your Sample

Were there any interesting or surprising characteristics of your
sample? For example, if a study in your topic area usually has a
fairly even distribution between male and female participants and
yours has a much higher percentage of men, you would point this
out and refer to other studies to back up your claim that this is
unusual and then discuss possible
reasons why it is different in your
Any aspects of your
study.
TIP
sample that are
discussed here will
Sample characteristics may also
probably also need to
need to be discussed as you present
be discussed in the
your findings if you did subgroup “Acknowledging Limita-
analyses based on demographics. tions” section at the end
However, you should weave those of this chapter.
into the discussion that follows.
What Do Your Results Mean?

This is the heart of the Discussion chapter. Here you tell your
readers what the findings mean and put those findings in con-
text of what is already known. Address each research question or
variable that was in your study and each objective in your project.
Make sure that you discuss all the findings related to the questions,
variables, or objectives, including results that are not statistically
significant. Point out surprising findings and talk about possible
explanations for the results.
Avoid absolutisms. It is the rare study that can state anything

categorically on its own. So, don’t use words like unquestionably,
undeniably, absolutely, definitely, or certainly when talking about your
findings. Also, be careful using terms such as clearly shows or strongly
indicates. Does the strength of your findings (consider your study

limitations here) support their use? Perhaps suggests or simply
indicates without the qualifier would be a more accurate depiction
of your findings?
EXAMPLE OF DISCUSSION OF SURPRISING FINDINGS

One of the most surprising findings of this investigation was the lack of
correlation between levels of consistency with guidelines and clinical outcomes.
Several plausible explanations for this finding exist.
One factor that could have influenced these results was that there was less
variability in the levels of consistency than anticipated. Fairly high levels
of consistency between key elements of the CPTs and the interventions
statements were found among all three intermediate clinical outcomes.
The Principal Investigator anticipated that there would be some subjects
who did not receive care that was consistent with guidelines; instead, all
subjects received care that was above the 50th percentile, making it harder to
determine differences (Cunningham, 2003).
If you used a theoretical framework, discuss your results through

the lens of the framework. There are a few different ways to ac-
complish this:
1. You can do this by focusing a paragraph or two on how the

results fit into the model.
2. You can organize your discussion within the structure of the

framework.
3. You can integrate statements about how particular findings

fit with the framework throughout the discussion.
EXAMPLE OF FOCUSING A PARAGRAPH ON HOW THE

RESULTS FIT INTO THE MODEL
The findings clearly fall within Bronfenbrenner’s ecological systems model
highlighting the need for a contextual approach to the problem of IPV in a
rural setting. Acts of violence and patterns of abuse were made possible,
and sustained, through cultural and societal archetypes at the macrosystem
level. These archetypes—patriarchy, stigma, and discrimination—exerted a
powerful influence on the women’s lives through their impact on the exosystem
and microsystem. At the exosystem level, they created financial hardship and
difficulties with law enforcement and the legal system. At the microsystem
level, they reinforced women’s isolation from friends and family or colleagues,
preventing them from developing a support system or social network of any
kind. For some women, it meant the loss of their children. A lack of a social
network constricted their opportunities to improve their economic situation and
enabled problems with law enforcement and the legal system at the exosystem
level. When caring for women who experience IPV, healthcare providers must
consider elements of all these systems and be prepared to connect women
with resources outside of the healthcare arena (Roush, 2014).
EXAMPLE OF INTEGRATION OF THEORETICAL FRAMEWORK

IN DISCUSSION
In accordance with the relationship between concepts contained in Bandura’s
theory, there is a reciprocal relationship between strong self-efficacy beliefs
and the accomplishment of determined behaviors or tasks whereby an
increase in one enhances the other as well. People with high conviction in their
capabilities sustain their efforts and are sure that they can exercise control
(Bandura, 1982, 1997, 2000). Not only are self-efficacy beliefs and physical
activity moderately positively correlated, but self-efficacy was the only variable
that contributed to predicting physical activity. Nine percent of the variance in
physical activity in the sample of Puerto Rican adults with type 2 DM can be
explained by their self-efficacy beliefs (Davila, 2010).
Put your results in the context of what we already know and

compare them to the results of previous studies or similar quality
improvement initiatives. Don’t just say that they were consistent
or not consistent; instead, give details. If the results are consistent
with previous studies, provide examples of those studies, with
details about the sample, method, and findings. Discuss how the
congruency of results builds on or supports a particular hypothesis,
existing practices, or the current understanding of a phenomenon.
EXAMPLE OF CONSISTENT FINDINGS

One striking similarity between this study and Sellers et al. was that informants
delay seeking out healthcare, especially during planting or harvest, and equate
health with working or doing. Bushy (1997) has also identified that rural clients
wait longer before they seek out healthcare. I found that in general these elders
wait to go to the doctor until they can no longer do what they want to do and
they define health as the ability to do. Pierce (2001), Weinert and Burman
(1994), and Long and Weinert (1989) also identify that rural dwellers define
health as the ability to do (Witt, 2006).
If the findings differ from previous findings, give examples, as well,

but also tell your readers how they differ and what your thoughts
are about why. What are the possible explanations for the differ-
ence? Was it related to different study populations or settings? Was
it related to how a variable was measured or the instrument that
was used? Does it have anything to do with changes in practice or
policy since the earlier studies were done? Also discuss whether the
differences bring into question existing practices or understanding
of a phenomenon.
EXAMPLE OF EXPLANATION OF INCONSISTENT FINDINGS

There are several probable explanations for divergence in findings from
multivariate analysis between this study and other studies available in the
literature. First, control of confounders was either not present (Janssen et al.,
2001; Shepley et al., 2008) or limited (Alimoglu & Donmez, 2005; Parish et
al., 2008) in studies that found significant relationships between individual
PWE features and job satisfaction, while the current study provided control of
multiple confounders. Next, the current study used different PWE measures
than measures used in other studies in which researchers either constructed
their own measures (Janssen et al., 2001; Parish et al., 2008) or adapted
existing measures without confirming validity and reliability of the adapted
measure in the studied sample (Shepley et al., 2008; Djukic, 2009).
You can refer readers back to a table or figure, or you can include
data or details from your results when needed to enhance the dis-
cussion. For example, a quotation that wasn’t included in the Results
chapter/section could be added to illustrate a point being made.
EXAMPLE OF DATA USED IN DISCUSSION

Women in this study did not have confidence in a protective order, viewing it as
just “a piece of paper,” a common perception among women who experience
IPV. Women participating in a study of protective orders by Logan et al. (2005)
also felt that the protective order was ineffective, viewing it as “just a piece
of paper” (p. 891) as well. They reported that it was not enforced when there
was a violation, a view also shared by women in this study. Women in Logan’s
study also cited fear of retaliation as a reason for not getting an order, a point
of view noted very clearly by a woman in this study who said, “What are they
going to do, slap them on the wrist and go yeah don’t do it again? … Order of
protection is just a piece of paper, and that’s all it is, a piece of paper that sets
people off more” (Roush, 2014).
Your discussion can expand into related areas to add context where
appropriate. For example, in the example cited here (related to
women not getting an order of protection, along with previous
studies on how often women seek an order of protection), you
could also bring in some of the research that looks at the effective-
ness of protective orders, thus putting their decision in context of
what we know.
EXAMPLE OF RELATED RESEARCH

Women’s perceptions are supported by research that shows that the order
of protection is generally ineffective in preventing future violence (McFarlane
et al., 2004; Strand, 2012), except in cases where there was a low to
moderate risk of repeated violence, though even then the effect was small.
In the McFarlane et al. (2004) study, the researchers found that though there
was no difference in subsequent violence against women who applied and
got a restraining order and those who applied and did not get one, all of the
women who applied experienced a lower level of violence in the following 18
months. They posited that the contact with the legal system may prevent future
violence, but this is not consistent with the findings here, where most of the
women had negative experiences with the legal system that further empowered
the abuser. It may be characteristics of women who take the initiative to apply
for a restraining order or the dynamics of their relationships that account for
the differences (Roush, 2014).
As you talk about specific results, you can discuss ideas for possible
solutions. Building on the protective order example, you can then
go on to talk about strengthening the response of the legal system
in enforcement of orders of protection to help change the percep-
tion women have about their effectiveness and thus increase their
safety.
When a Project Doesn’t Work

In the real world, sometimes even the most well-thought-out ideas
don’t work out the way we hoped for or intended. The literature
may provide strong evidence that a certain approach or strategy is
likely to be effective, but even slight differences in organizations,
systems, or people can result in very different outcomes, or unfore-
seen circumstances can interfere with effective implementation.
Do not despair. Yes, it’s disappointing, but now is when your criti-
cal thinking skills have a chance to shine. Knowing what doesn’t
work is valuable information if we understand why—providing that
insight is your job in the discussion of a project that is not success-
ful in achieving the outcomes you were seeking.
Begin by contrasting your results with those of studies or quality

improvement projects in the literature, particularly the ones you
used to support the choice of this intervention in the first place.
What differences in setting, people, organizational culture, or
other factors could account for the difference in outcomes?
Then look at factors specific to your project that may have in-
fluenced the outcomes. Were there any recent changes in the
organization that could have affected the project? For example, a
new electronic medical record system was installed or there was a
change in leadership. Were there unexpected delays that pushed
implementation into a time period that constrained recruitment or
data collection?
Other factors to consider:
1. Differences in morbidity or acuity of patient participants
2. Change in staffing patterns

3. Access to resources
4. Unexpected resistance
5. Surprising participant characteristics
6. Conflicting demands on participants’ time
7. Loss of support by management or others integral to the

project
Finally, you have to consider that perhaps your approach itself

was not an effective strategy. This doesn’t mean your thinking was
flawed to begin with (which should be clear from your literature
review if, as noted in Chapter 2, it led logically to the choice of
intervention) but rather that what you learned from implementa-
tion of the project and critical analysis of the outcomes gives new
insight on how to approach the problem or situation. The follow-
ing sidebar is a good example of this from an article on a quality
improvement initiative to address interruptions during medication
administration by using the sterile cockpit approach.
EXAMPLE OF AN INEFFECTIVE STRATEGY

A flawed approach? Our outcomes raise questions about the effectiveness of
using an adaptation of the sterile cockpit rule to decrease interruptions during
medication administration…
Why is the sterile cockpit approach more challenging in the healthcare

setting than it appears to be in the airline industry? The two environments are
different in many ways. While the pilot and copilot are physically isolated in the
cockpit…nurses administering medications don’t do so in a physically isolated
environment and may not appear to others to be engaged in a critical task
that requires their full attention. The procedure occurs at constantly changing
times and locations, and many different people, including physicians, other
patients, and family members, routinely seek information or assistance from
nurses...On a unit where length of stay ranges from one day to several months,
new patients and family members are constantly arriving, making it difficult
to ensure that all are aware of Medication Quiet Time. Furthermore, recent
emphasis on patient- and family-centered care encourages nurses to address
the needs of a family member even during medication administration.
Implications. The limitations of the sterile cockpit approach raise questions

about its value as a strategy for decreasing interruptions during medication
administration on medical–surgical nursing units. Any strategy aimed at
reducing errors and increasing patient safety must consider nursing culture
(Federwisch, Ramos, & Adams, 2014).
In addition to discussing why the intervention was not success-

ful, you need to talk about next steps. Okay, this approach didn’t
work—what now? This depends on whether you think certain
factors specific to your implementation affected the outcome, or if
the intervention itself was not the right approach. What changes
would you make to the intervention to address possible underlying
factors?
When you are very invested in a project or passionate about an idea,

it’s difficult to accept that it doesn’t work. Be careful that you don’t allow your
bias to influence how you present your results. Use objective reasoning and
language. The worst thing you can do is appear to be trying to convince the
reader that it was successful when it was not.
Discussing Implications for Practice, Education,

Policy, and Research
Another important part of the discussion is telling your readers
what the results mean out in the real world: the implications. What
are your recommendations for applying the results to practice,
education, policy, and research? You can talk about implications
of each of the findings as you discuss them, or you can do it all
together under a separate subsection. Either way, in most cases,
you should address all four domains: practice, education, policy,
and research. Not all the findings will have implications for all four
domains, but you should address each of the four at some point.
Practice
Do your findings raise questions about current standards of prac-
tice? Should current practice be changed based on your findings?
If yes, how should it change? (Keep in mind, though, that it is rare
that practice should be changed based on the results of just one
study.) What specific actions should nurses take based on your
findings? Do the findings reinforce current practice or changes to
practice that were proposed prior to your study?
For a quality improvement initiative or practice change, you need

to address sustainability. Should the practice change be incorporat-
ed across units or organizations? What are the barriers to sustain-
ability? What resources are needed to sustain the practice change?
If you will not be involved in the ongoing practice change, who
will facilitate it?
Education
How do findings affect how nurses are being educated? Do
they call for changes in prelicensure curriculum, and if yes, what
changes? Do the findings suggest that a gap exists in nursing edu-

cation? Do the findings indicate that current educational prepa-
ration related to your topic is not effective or that it is effective?
What are the implications for continuing education?
Policy
What policy changes need to happen based on your findings?
What actions can nurses, at different levels or in varied settings,
take to create needed policy changes?
Research
What is the next step in the research on this topic based on what
your study has added to the knowledge? What do we need to know
from here? Does this study need to be replicated with a larger
sample or after addressing limitations you encountered? Does it
need to be conducted in a different population or setting?
EXAMPLE OF RECOMMENDATION FOR RESEARCH

It was very difficult to recruit women for this study. It took 10 months to recruit
the ultimate sample of 12 women needed to achieve saturation. Even then, all
but two of the women had already left the abusive relationship. A challenge
for future research is finding a way to include the most marginalized women
in studies on IPV, including those who are still in the abusive relationship.
Understanding their experiences is essential if we are to provide care and
services that address the full spectrum of IPV experiences (Roush, 2014).
Don’t get carried away with implications and recommendations. Make

sure that you can trace every implication and recommendation directly back
to a finding in your study and that the finding is strong enough to support the
recommendation.
You can organize your implications in a few different ways:
1. All together in their own subsection at the end of the

discussion
2. Integrated into the discussion as you talk about each finding
3. A mix of the first two, with the domain (practice, education,

research, policy) having the primary implications talked
about as you go along and the others in a separate subsec-
tion at the end
For example, if you are doing a study or project that focuses on

clinical care, it might flow better if you include the implications
for practice for each finding as you talk about it, because the major
implications are probably going to be those in the practice domain.
Then, at the end of the discussion, you can include a subsection on
implications for education, policy, and research.
Write out your implications on a separate document before starting the

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Discussion chapter/section. Make a table with five columns (see Table 5.1):
Findings, Practice Implications, Education Implications, Policy Implications,
and Research Implications. List your findings in the first column. Then list all
the possible implications and recommendations for each of the domains in
the other columns.
Table 5.1 Table of Findings and Implications

Implications
Findings
Practice Education Policy Research
Self- Public health Educate Recruit most
imposed outreach community marginalized
isolation
Universal screening Advocacy Develop and test
interventions
Survivors speak to effectively
out improve
healthcare
providers’ skills
in identifying and
managing IPV
Use of internet
to reach
and support
marginalized
women
System- Teams that include Educate law Access to Develop and test
wide abuse law enforcement, enforcement legal services prequalification
social workers, education
Accountability Mandated
advocates, programs
healthcare health
Interprofessional provider Epidemiological
providers, and education of law education studies of
survivors enforcement, outcomes of
healthcare National IPV-related
providers, and instead interactions with
Include information others of state law enforcement
about legal level policy and justice
resources on regarding system
handouts given in adjudication
clinical settings
Resilience Train survivors Funding for Test programs

to lead support services that facilitate
groups grassroots
organization of
survivors
In a scholarly project, the implications include addressing sustain-

ability of the quality improvement in your setting. Are you going
to continue or expand on the project in your setting? As you move
forward, how do you plan to address any of the challenges you
encountered? If outcomes were not as anticipated or did not meet
the goals, what are the plans for moving forward? In addition, you
should discuss implications your project has outside of your im-
mediate setting or with other patient populations.
Acknowledging Limitations
There is no such thing as a perfect study. Of course, you have done
everything you could to ensure that you conducted a rigorous
study, and you stand by your results. However, there will still be
weaknesses. And that’s OK as long as you take them into consid-
eration and tell us what they are and what it means for the results.
Talk about the limitations in an objective tone. You are not making
excuses for them; instead, you are just stating what they are and
what effect they may have on the results. If you took any actions to
mitigate the effect, state those as well.
The following subsections describe some of the more common

limitations that come up in studies.
Bias
Discuss anything that may have introduced or allowed for bias in
your results. This might be related to your sample (for example,
convenience sample), setting (one local urban clinic and, therefore,
may not be representative of other settings), recruitment strategy
(email, so only reached those who use email), or final sample (high
or low percentage of certain demographic characteristics). Bias can
also be related to your method of data collection (computer-based,
for example, so only those with computers could participate; or

people were asked to remember something, so there may be recall
bias).
Generalizability
Can your findings be generalized outside of the sample group
and setting? If not, why not? This would not apply to qualitative
research, but you should still address it and make a statement that
generalizability is not sought in qualitative research and cite an
expert-authored text to support that.
Reliability and Validity

Was there anything about the data collection that may have affect-
ed the reliability or validity of your results? Were the instruments
used tested in your sampling population? Was interrator reliability
a consideration?
EXAMPLES OF REPORT OF LIMITATIONS

There was the risk of response bias since the sample was women who
volunteered to participate, and they may differ from those who would not
volunteer: They recognize that their experiences constituted IPV and they had
the resources to respond. Also, the women who have the resources and ability
(such as transportation) to participate may not represent the more marginalized
population of abused women, nor do they represent women who experience
IPV yet do not label it as such (Roush, 2014).
Another limitation is that patients in the datasets can be represented more than
one time. The unit of analysis for developing and evaluating the indices was
episode of care defined as a maximum of 60 days. This could bias results, as
patient health characteristics could be correlated from one episode to another
(Heckman, 1990). However, as previously mentioned, 67% of the patients were
on their first episode. Furthermore, there was only an average of 1.5 episodes
per patient. Therefore, correlated episodes are unlikely to bias the results found
in this dissertation (Scharpf, 2005).
Don’t confuse limitations with challenges or barriers that you encountered in

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collecting data or implementing a quality improvement project. Limitations

are factors that may have influenced the objectivity or validity of the findings.
A challenge or barrier may be an underlying cause of those factors, but it
is not the limitation. For example, if there was a staffing shortage that pre-
vented nurses from attending a program and you ended up with a small sample,
the limitation was the small sample size, not the staffing shortage.
Crafting Your Conclusion

This is it: the final word. When you started out with a germ of an
idea related to something you felt strongly about, you made us care
about it, too. You designed a study or project, collected and ana-
lyzed data, and interpreted the results. What are the major points
you want readers to take away from this work? This is your final
opportunity to drill it home.
You may want to begin your conclusion with a clear restatement of

the major finding of your study or the major implication of your
scholarly project before going to the take-home message:
This study indicates that post-discharge follow-up care by a nurse

practitioner can improve outcomes for heart failure patients and
reduce readmissions.
The outcomes of this project reinforce the importance of involv-

ing all members of the healthcare team in transitional care
communication strategies.
The conclusion should not be much more than a few paragraphs.

Be concise and clear. Don’t be afraid to make strong statements
based on the evidence you’ve generated. Remember, you’re an expert
now.
Don’t just restate your key findings and summary from the discussion.
That’s all been said already. Pull it all together and take it up a notch. Imagine
you are telling someone about your study or project and they look at you
somewhat skeptically and ask, “So what?” Then write your answer.
EXAMPLE OF CONCLUSION
Intimate partner violence is a public health problem that requires a coordinated
interprofessional approach to prevention and management. The results of this
study illustrate the complex web of individual, social, cultural, economic, and
political factors that create and feed the problem. Many of the issues raised by
the participants, such as discrimination, social isolation, financial constraints,
and problems with the legal system, originate outside of the healthcare system.
Therefore, the solution must go beyond one-on-one interactions between
victims and their healthcare providers, no matter how knowledgeable and well
intentioned the provider may be. Healthcare providers must provide care within
a network of social workers, law-enforcement personnel, judiciary officials,
counselors, and advocates. Ideally, whomever a victim first engages with
should be able to facilitate connections with resources anywhere within such a
network.
Finally, until we address the sociocultural factors of oppression and patriarchy

that underlie much of the discrimination and disparities encountered by the
women in this study, intimate partner violence will continue to be a devastating
health and social problem for so many women. Advocacy and policy
development must be undertaken as part of a comprehensive public-health
approach (Roush, 2014).
That’s it. You’re done with the write-up. Next step—your oral de-
fense. Nerve-wracking, yes, but you are ready, and you’ll do great.
You’ll walk into that room a doctoral candidate, an ABD. And
you’ll walk out as one of a very select group—currently less than
1% of nurses, as a matter of fact…
You’ll walk out of there as a doctor.
Good luck and congratulations!
Chapter Checkup
❑ Have I provided a brief review of the problem?
❑ Have I highlighted the key findings?
❑ Have I noted any unusual characteristics in the sample population?
❑ Have I discussed how the findings fit into the theoretical model?
❑ Have I discussed how my findings are similar to or different from those
of previous studies and provided possible explanations for those differ-
ences?
❑ Does everything I discuss directly relate to the purpose statement or
provide context that enhances the reader’s understanding of the
findings?
❑ Have I included implications for practice, education, policy, and re-
search?
❑ Are recommendations consistent with the findings?
❑ Have I addressed how I plan on sustaining practice or process changes
for a quality improvement project?
❑ Have I addressed unanticipated outcomes of a quality improvement
project?
❑ Have I included plans for addressing challenges encountered during

implementation of a quality improvement project?
❑ Have I described the study limitations?
❑ Is my conclusion consistent with and supported by the findings?
References
Cunningham, R. S. (2003). Advanced practice nursing interventions and outcomes: An
exploration of transitional care services post prostatectomy (Doctoral dissertation).
Retrieved from ProQuest Dissertations and Theses. (305307337).
Davila, N. (2010). Physical activity in Puerto Rican adults with type 2 diabetes mellitus
(Doctoral dissertation). University of Arizona.
Djukic, M. (2009). Physical work environment: Testing an expanded job satisfaction model
in a sample of hospital staff registered nurses (Doctoral dissertation). New York
University.
Federwisch, M., Ramos, H., & Adams, S. C. (2014). The sterile cockpit: An effective
approach to reducing medication errors? American Journal of Nursing, 114(2),
47–55.
Roush, K. (2014). The experience of intimate partner violence in the context of the rural
setting (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses.
(1551746532).
Scharpf, T. P. (2005). Functional status and quality in home health care (Doctoral
dissertation). Retrieved from ProQuest Dissertations and Theses. (3169277).
Witt, D. E. (2006). Growing old on the farm: An ethnonursing examination of aging and
health within the agrarian rural subculture (Doctoral dissertation). Retrieved from
https://dsc.duq.edu/cgi/viewcontent.cgi?article=2393&context=etd
Resources
Polit, D. F., & Beck, C. T. (2012). Nursing research: Principles and methods (9th ed.).
Philadelphia, PA: Lippincott, Williams, & Wilkins.
Polkinghorne, D. E. (2007). Validity issues in narrative research. Qualitative Inquiry,

13(4), 471–486.
6
WRITING MANUSCRIPT
OPTION DISSERTATIONS
This chapter goes over the writing of the

manuscript option dissertation. But don’t
skip it if you’re doing a traditional disser-
tation or if you’re a DNP student—much
of the information in this chapter applies
to you as well. It’s vitally important to
get new knowledge disseminated and to
share methods for translating evidence
to practice through publication. You’ve
put a lot of thought and effort into your
research or project and have valuable
information to contribute to nursing and
healthcare—don’t just file it away in a
drawer after graduation!
The format for manuscript dissertations varies, but most will consist
of an introductory chapter, two or three manuscripts, and a sum-
mary, or conclusion, chapter, as well as the standard preliminary
pages and appendixes. One of the three manuscripts must be a data-
based paper—the research report of your dissertation study. The
other one or two can vary; a literature review, a concept analysis, a
methods paper, or a report of a pilot study to test an instrument or
collect preliminary data are different types of papers that are often
included. However, there must be a coherent, meaningful connec-
tion among the components—all the manuscripts and the first and
last chapters.
Read your program’s handbook before starting and talk to your

committee chair about the expectations for each part of a manu-
script dissertation. The manuscript option is still relatively new,
and the format will vary across programs and even within programs.
Make sure you know your program’s expectations regarding publication.

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Do you have to have one or more accepted for publication or is it enough to

have submitted to a journal? Can an article published prior to your proposal
defense be included? Check your program’s handbook and talk to your chair
early in your program. It can take months for a journal to review a manuscript,
and you don’t want to delay graduation waiting to hear back from an editor.
Introductory Chapter
The introductory chapter in the manuscript option has many of the
elements of the Introduction chapter of a traditional dissertation.
However, in addition to the standard introductory information that’s
discussed in Chapter 1 of this book, the introductory chapter of a
manuscript dissertation will also introduce the different components
of the dissertation—that is, the manuscripts and any supplemental
materials—and establish the connections among them.
CHAPTER 6 • WRITING MANUSCRIPT OPTION DISSERTATIONS 135
ELEMENTS OF THE INTRODUCTORY CHAPTER

• Introduction to the topic
• Significance of the topic
• Background information
• Overview of the literature to identify the knowledge gap: Each of the

manuscripts will include a focused literature review, but in the introduc-
tion you need to do an overview of the body of literature to establish the
knowledge gap.
• Purpose of the study
• Research questions
• How the researcher is going to answer the research questions
• Theoretical framework
• Description of the manuscripts included in the dissertation and their

contribution to addressing the purpose and research questions
When describing the manuscripts, present them as part of an integrated ap-

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proach that addresses the purpose and research questions, not as separate
pieces that have relevancy only on their own.
Summary (Conclusion) Chapter

The final chapter of a manuscript dissertation corresponds to the
Discussion chapter in a traditional dissertation and will include all
the elements covered in Chapter Five. The difference here is that
you also need to make sure you present a cohesive discussion of the
different manuscripts and show how they contribute to the science
as a unified whole. Just as you synthesized articles when you wrote
your literature review, you need to synthesize your own articles/

manuscripts when writing your discussion.
Manuscripts
In a manuscript option disserta-
tion, the Literature Review, Meth-
Your committee may
odology, and Results chapters are
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want more detailed
replaced with manuscripts that are information about your
suitable for publication. A manu- methodology, data
script differs from a school paper analysis, or findings
in important ways. In this section than you’ll have room for
I’ll go over those differences and in a manuscript. You can
give you some guidance on writing include this information in
manuscripts. If you haven’t already, the appendixes as sum-
mary pages or additional
read Chapter 7, “Writing Well: The
tables and figures.
Basics,” before you start writing;
clear and concise writing is key to
producing publishable manuscripts.
Authorship
Talk to your committee members about the expectations for au-
thorship before you start the manuscript-writing stage of your
dissertation, and make sure the expectations are clear with every-
one. There are ethical standards for authorship in scholarly publi-
cation to ensure that readers can have confidence in the objectivity
and accuracy of the information presented. All authors of a manu-
script have to be willing and able to stand behind every word and
statistic in the paper. Only people who were actively involved in
the work and the writing should be listed as an author.
All credible nursing and biomedical journals follow the Inter-

national Committee of Medical Journal Editors (ICMJE, 2017)
criteria for authorship:
1. Substantial contributions to the conception or design of the

work; or the acquisition, analysis, or interpretation of data
for the work
2. Drafting the work or revising it critically for important

intellectual content
3. Final approval of the version to be published
4. Agreement to be accountable for all aspects of the work in

ensuring that questions related to the accuracy or integrity
of any part of the work are appropriately investigated and
resolved
Your dissertation or project chair has probably worked very closely

with you from conception and design through the writing of the
manuscript. If so, that person would meet the criteria for author-
ship. You’ll need to consider the individual contributions of your
other committee members to determine if they meet the criteria.
Feedback here and there does not make someone a coauthor.
Remember, each author has to meet all four of the criteria. You can
include an acknowledgment for committee members who do not
meet the criteria for authorship.
MANUSCRIPT VERSUS SCHOOL PAPER: WHAT’S THE

DIFFERENCE?
Writing manuscripts for publication differs from writing papers for school. When
you write a school paper, your purpose is to demonstrate that you understand
information and have acquired the necessary cognitive skills. When you write
a manuscript for publication, your purpose is to share information with readers
that they can use. With school papers, the length depends on the minimum
number of pages that your professor requires, and you write until you meet that
number, often with some padding thrown in to get there! With a manuscript,
your struggle won’t be with filling enough pages; it will be figuring out what to
cut out to stay within the page limits of the journal you’re submitting to.
Purpose
The purpose of a manuscript is narrower than that of your overall
dissertation. It may focus on a specific set of outcomes or objec-
tives rather than the entire study or project. For example, it may
report the results of an integrative review you conducted as part
of your literature search. Write down the manuscript’s purpose and
keep that in front of you (like you did with the purpose for your
dissertation) so that you stay focused on the perspective of this
manuscript. It will help you figure out what stays and what goes as
you tighten and shorten the manuscript.
Author Guidelines
Before you start writing, look at the author guidelines for the jour-
nals you are considering for submission of your manuscript. You
don’t want to spend many hours writing many drafts only to find
out you have to make major changes in formatting or delete hun-
dreds of words. The next few sections cover some of the important
information you need to know before you start to write.
Publishing Standards
Journals adhere to established publishing standards, such as the
ICMJE and SQUIRE guidelines. These standards are in place
to enhance clarity, accuracy, transparency, and replicability. The
following sidebar lists the publication standards used for different
types of articles.
PUBLICATION STANDARDS
• International Committee of Medical Journal Editors (ICMJE):
Overall standards for biomedical and nursing publication. Developed
for use with research but applicable to different types of articles. http://
www.icmje.org
• Preferred Reporting Items for Systematic Reviews and Meta-

Analyses (PRISMA): Standards for writing reports of systematic
reviews and meta-analyses. Can be applied to integrative reviews as
well. http://prisma-statement.org
• Consolidated Standards of Reporting Trials (CONSORT):

Standards for reporting of randomized clinical trials. http://www.
consort-statement.org
• Transparent Reporting of Evaluations with Nonrandomized

Designs (TREND): Standards for writing research reports for quantita-
tive studies that use nonrandomized designs. https://www.cdc.gov/
trendstatement/index.html
• Standards for QUality Improvement Reporting Excellence

(SQUIRE): Standards for writing reports of quality improvement and
evidence-based practice initiatives. http://www.squire-statement.org
Formatting Style
Most nursing journals want manuscripts submitted in American
Psychological Association (APA) format, but there are a few that
ask for American Medical Association (AMA) formatting. Make
sure you go by what is in the author guidelines, not what you see in
published articles. Some journals require you to submit in APA for
ease of editing and checking references and then change the for-
matting to AMA in the final editing process. Or they may require
APA style but also have specialized
formatting for specific sections
or components, such as headings. Each page of writing
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These will be described in detail in in a double-spaced
the author guidelines. Microsoft Word
document averages
between 250 to 300
Word or Page Count words. A published print
Check if the word or page count journal page averages
between 650 to 700
includes the reference list and any
words.
tables and figures (it often doesn’t).
Abstract Format
Abstracts may be structured or unstructured. Most journals require
a structured abstract for research reports. Again, check the guide-
lines, as the components may vary. Check the word count for the
abstract as well; it can vary from as little as 100 up to 300 words.
STRUCTURED ABSTRACT EXAMPLE

Objective: To understand the lived experience of intimate partner violence (IPV)
for women living in a rural setting to inform efforts to provide effective care,
support, and resources.
Design: Qualitative descriptive.

Setting: Adirondack Mountain region of upstate New York.
Participants: Twelve women with recent experiences of IPV living in a rural
area.
Methods: In-depth interviews were conducted.
Results: Key findings were the self-imposed isolation women engage in to
manage stigma and the system-wide abuse by law enforcement and the legal
system.
Conclusion: The results of this study illustrate the complex web of individual,
social, cultural, economic, and political factors that create and perpetuate the
problem of IPV. It is critical to eliminate IPV-related stigma, cut through isola-
tion, and address the ongoing system-wide abuse and discrimination women
face. Finally, many of the issues raised by the participants, such as discrimina-
tion, financial constraints, and problems with the legal system, originate outside
the healthcare system. Therefore, nursing care must be provided as part of a
comprehensive public health approach (Roush & Kurth, 2016).
UNSTRUCTURED ABSTRACT EXAMPLE

Despite over 40 years of research, there has been little progress in the preven-
tion of obstetric fistula, and women continue to suffer in unacceptable num-
bers. Gender power imbalance has consistently been shown to have serious
implications for women’s reproductive health and is known to persist in regions
where obstetric fistula occurs. Yet, there is limited research about the role
gender power imbalance plays in childbirth practices that put women at risk for
obstetric fistula. This information is vital for developing effective maternal health
interventions in regions affected by obstetric fistula (Roush, Kurth, Hutchinson,
& Van Devanter, 2012).
The bottom line: Carefully read author guidelines for your select-
ed journal and follow them!
Types of Manuscripts
Every major paper you write in your doctoral program has the
potential of being a publishable paper. The papers most likely to
be acceptable manuscripts for a dissertation are research reports,
concept analyses, literature reviews, methods papers, and clinical
application papers.
Research Report
This is the major manuscript to come out of a dissertation. It is the
report of the key findings of your study. It should follow ICMJE
guidelines as well as CONSORT guidelines if it’s a randomized
control trial, or TREND guidelines if it’s a nonrandomized design.
Concept Analysis
If you are in a PhD program, you probably conducted a concept
analysis prior to doing your literature review. For good examples
of published concept analyses, take a look at those in the Journal of
Advanced Nursing.
Literature Review
Systematic reviews are the highest level of review, but it’s unlikely
that you’ll be conducting one in addition to your dissertation; a
rigorous systematic review is conducted by a team of researchers,
not an individual. After that are integrative reviews, sometimes
referred to as a state of the science paper. It’s likely that you com-
pleted one of these during your program. Well-executed integra-
tive reviews on a topic of importance have excellent potential to
be published. If you did a comprehensive literature review of your
topic but did not use the systematic search methodology of an inte-
grative review, you may be able to rewrite that as a narrative review
for a manuscript, though there is less potential for publication.
Methods Paper
If there are unique or challenging aspects to your research meth-
odology, then a methods paper may be a good option for one of the
manuscripts.
Clinical Application Paper

Some doctoral programs will accept a clinical application paper
as one of the manuscripts. Though you’ll include implications
for practice in your research report manuscript, it’s not detailed
enough for nurses to apply your research findings in the clinical
setting.
Writing the Manuscript

The structure of a manuscript will vary depending on the type
of paper you’re writing, but there are certain components that
all the previously mentioned papers, except for the clinical ap-
plication paper, have in common. These include an introduction
and background section, literature review, findings or results, and
discussion. Research and quality
improvement reports also have a
section on methods. You should Read some examples
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organize your manuscript using the of the type of article

IMRAD structure recommended you’re writing in the
by ICMJE. Look at the chapters of journal you’re planning
this book that correspond to each to submit to before
of the following sections—the same you start writing the
recommendations apply. The big manuscript. Look at how
difference is the level of depth and they’re structured and
what headings are used.
breadth that you’ll have the space
to cover in a manuscript versus a
dissertation.
Introduction
The first paragraph of your introduction is critical—it must engage
readers and convince them of the importance of your work. If you
did a comprehensive literature review, this is the section that will
present the greatest challenge in cutting it down to size. Keep
referring back to the purpose of this particular manuscript to fig-
ure out what stays and what has to go. Synthesizing the literature
becomes even more critical in order to concisely summarize what
is known while still being thorough. In some cases, you’ll com-
bine the background with either the introduction or the literature
review sections.
Methodology
The important thing here is that readers have the information they
need to replicate your study or implement your project in their
setting.
Results
Just as you would in a Results chapter of a traditional disserta-
tion, here you’ll do a straightforward presentation of your results
without any interpretation or editorializing. Making good use of
tables and figures can help keep the word count down and pres-
ent the findings in a visually engaging format that helps the reader
understand the results.
Discussion
The discussion in a manuscript is similar to that in a traditional
dissertation, but again, it’s usually much shorter. Clearly state the
key findings and keep the discussion focused on them. Just as in the
introduction, keep referring back to the purpose of this particular
manuscript to stay on target.
Length of the Manuscript

As noted previously, the length Stay focused! This
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will depend on the guidelines for takes on even more
importance when
the journal you’re considering for
writing a manuscript
publication. There’s a saying among
because both clarity
poets—sometimes you have to kill and conciseness are criti-
your darlings. Don’t get too at- cal. Keep the manuscript
tached to anything in your paper— purpose in front of you as
everything you write has to add to you write and keep ask-
the reader’s understanding of the ing yourself the question:
topic, or it has to go. That will be Is this information need to
your biggest challenge, chipping know or nice to know? If
away at your hard-earned pages to it’s nice to know, delete it.
cut them down to manuscript size.
Publication Basics
Scholarly publication is a time-consuming process with lots of
moving parts. This section covers some basics so you understand
what to expect.
What Editors Want

Editors want well-written manuscripts that provide information
that is useful to their readers. Other criteria include:
• Information has to be evidence-based.

• Research reports or integrative and systematic reviews have
to reflect the highest standards of methodological rigor.
• References should be recent primary sources—usually
within 5 years, but this is not a hard and fast rule. It depends
on the subject and what the state of the science is. Older
seminal and classic studies are acceptable.
• Conclusions have to be earned.

• The topic/information is something the journal hasn’t
recently covered (check the table of contents for the last 2
years).
• The information provided is new and adds to the literature.
Highlight value. It’s your job to convince the editor and reviewers, and your
TIP
future readers, of the importance of your manuscript. This starts with your
introduction, where you establish significance. You want the reader caring
about the topic by the end of the first paragraph, so make your case from the
first sentence. The other place you have an opportunity to convince them is
in the discussion. Make sure you clearly lay out why your results matter with the
journal’s readers in mind.
Sending a Query
Since it can take months for you to hear back after you submit a
manuscript, you want to make sure that the journal you’re submit-
ting to has interest in publishing a manuscript on your topic. You
can send queries to as many journals as you’d like, but you can only
submit to one journal at a time. Check the author guidelines to see
who to send the query to; usually it’s the editor-in-chief, but not
always.
SAMPLE QUERY LETTER

Dear Dr. [address Editor-in-Chief by name],
I am an Assistant Professor of Nursing at the University of Massachusetts

Dartmouth. I am writing to ask if you would be interested in a qualitative study
on the lived experience of intimate partner violence (IPV) in the rural setting.
Intimate partner violence presents unique challenges to women in rural areas,
yet the voices of rural women are negligible in the IPV literature. Understanding
their experience is critical to developing effective interventions and providing

appropriate resources and support.
The manuscript is 6,000 words without references or tables (there is one

table). An abstract and outline are attached.
Please let me know if you would be interested. Thank you for consideration of
this manuscript, and I look forward to your response.
Peer Review
Scholarly work should always be published in peer-reviewed jour-
nals. After you submit your manuscript, the editor will send it out
to be reviewed by content or method experts—usually three. These
reviewers will advise the editor on whether to accept or reject the
manuscript and make recommendations for revision. Most peer
review is double-blinded.
Decisions
There are three possible decisions that you’ll get on your manu-
script: reject, revision, or accept.
Reject
It’s hard to get a rejection letter after working so hard on some-
thing you’re passionate about. It’s OK to be disappointed, but keep
in mind that acceptance rates for high-quality journals average be-
low 30%, and even the most accomplished scholars get rejections.
And just because one journal has rejected the manuscript doesn’t
mean it’s not publishable. Read through any feedback you get and
consider revising and sending it back out to another journal.
Revision
This is good news! It means the editor wants to publish your
manuscript. Manuscripts are rarely accepted without some revi-
sions needed; that’s how peer review works to improve the quality
of scholarly publication. Your job now is to carefully consider the
recommendations and revise the paper accordingly. If you’re not
going to make a recommended change, make sure you explain why
in your response to the editor.
Accept
First, celebrate! Then get ready for a little more work. Once you
get an acceptance notice, your manuscript will be scheduled for
an issue and put into the production process. The editing process
varies among journals, but all will have at least a copy editor work
on it. You’ll then get an edited version to review. There may be
questions (called queries in editing) from the editor that you have to
address. Once there’s a final version, you’ll receive “pages” to sign
off on. These will usually be PDFs of the finished article ready for
publication.
Publishing Models
There are two major models in journal publishing: subscription
and open access. In the subscription model, readers pay to read
articles, either through an individual subscription or through an
institutional subscription, like your college’s library. The costs of
publication are covered by the subscription fees (and some adver-
tising). With the open access model, there is no cost to the reader
to access any article online. The costs of publication are covered
by the authors, who pay an article processing charge (APC), which
can range from $1,500 to $3,500 depending on the journal. Yes,
that’s a lot of money, so researchers build it into their grants or, less
frequently, it’s paid by their institutions.
Most journals now have hybrid models. When your article is ac-
cepted, you’ll be asked if you want to publish it as open access or
traditional. The primary advantage to open access is that more
people may read your article since they can access it for free.
However, unless you have funding to cover the cost, the traditional
option will be fine for disseminating your work.
Beware of predatory publishers! Unfortunately, the open access model

has spawned a vast number of publications that want to make easy money but
have no interest in advancing science. Predatory journals claim to be peer-
reviewed but are not. They will publish any manuscript that is submitted to
them regardless of quality. In fact, there have been “sting” submissions where
researchers submitted gibberish, and it was published! They also falsely claim
to have impact factors.
Don’t submit your manuscript to any journal you’re not familiar with. If in doubt,
ask your chair and committee members. Don’t submit to journals that send
you an email asking for you to submit to them; credible journals may have a
general call for manuscripts, but they never send out individual emails soliciting
manuscripts. Take a look at the website Think. Check. Submit. for guidance:
https://thinkchecksubmit.org
Copyright
If any of your manuscripts are published prior to completing your
dissertation, you have to get permission from the publishing jour-
nal to include the article in your dissertation. Unless you published
in an open access journal, where the author retains copyright, the
journal now “owns” that article. You should do this as soon as your
manuscript is accepted for publication. The process varies, so con-
tact the publishing journal for specific instructions.
You chose to do this work because you know it’s important. You’ve
spent years planning, implementing, collecting and analyzing data,
and figuring out what it all means. Now it’s time to send it out into
the world!
Chapter Checkup
❑ Do all the authors of each manuscript meet the ICMJE criteria for
authorship?
❑ Have I clearly presented all the components as an integrated, unified
approach to addressing the purpose and the research questions?
❑ Have I followed the author guidelines for the journal?
❑ Is all the information in each manuscript directly related to the purpose
of that manuscript?
❑ Is all the information essential to understanding the topic and the
research?
❑ Have I convinced readers of the importance of the study and the
results?
❑ Have I made sure the journal is not a predatory publication?
❑ Have I gotten journal permission to include published articles in my
dissertation?
References
International Committee of Medical Journal Editors. (2017). Recommendations for
the conduct, reporting, editing, and publication of scholarly work in medical jour-
nals. Retrieved from http://www.icmje.org/icmje-recommendations.pdf
Roush, K., & Kurth, A. (2016). The lived experience of intimate partner violence
in the rural setting. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 45(3),
308–319
Roush, K., Kurth, A., Hutchinson, K., & Van Devanter, N. (2012). Obstetric fistula:
What about gender power? Women’s Health International, 33(9), 787–798.
7
WRITING WELL:
THE BASICS
Contrary to popular belief, scholarly

papers don’t have to be dull and tedious.
You’re writing about something you
think is important. So, you want to com-
municate that importance. The way to do
that is through writing that has energy
and voice—your voice. In the process of
doing a dissertation or scholarly project,
you’ll become an expert in your topic;
you’ve read all the literature and been
out in the field. So, write with a strong
voice. Be direct and confident.
Good scholarly writing engages readers and holds their attention

from the first sentence to the last. It doesn’t leave the slightest
room for misinterpretation. You accomplish that by using language
that is clear, engaging, and straightforward and by organizing the
paper so that your readers are carried along smoothly through the
material. Along with these elements that are essential to all writing,
scholarly writing requires that you are accurate and avoid bias.
Good Writing Characteristics

Four key characteristics are present in all good writing, and you
need to strive for these in yours: clarity, conciseness, specificity, and
good organization.
Achieving Clarity
Clarity ensures that what you write will be understood the way
you mean it to be by everyone who reads your paper. Clear writing
doesn’t leave room for confusion or error. You can ensure clarity
in a number of ways. One of the most important is your use of lan-
guage. Along with language is the importance of correct grammar,
particularly sentence structure (see the later sections on language
and grammar). Being concise, specific, and organized will also en-
hance clarity, as you will see in the following sections.
Being Concise
Concise writing is accurate, clear, and engaging. Every word in
your paper should be doing a job. Don’t leave it up to the reader to
try to separate the superfluous from the important; that is your job.
If a lot of “stuff” clutters your message, the message loses power
and may get lost completely. Two of the biggest culprits are extra-
neous words and phrases and redundancy.
CHAPTER 7 • WRITING WELL: THE BASICS 153
Extraneous words are those that don’t add anything to a reader’s

understanding. These include qualifiers (such as somewhat or sort
of) and intensifiers (very or really). Take a look at the list included at
the end of this chapter. It’s not that you should never use the words
on this list—there are times when they are needed for accuracy or
clarification. But first try removing them from your drafts and see
what happens.
It is important to note that in order to make your writing quite a lot

more concise, you really need to find and eliminate extraneous
words—like those in this sentence! Try reading the sentence with-
out the italicized words.
You also need to be on the lookout for redundancy. We often

repeat information or say the same thing in different ways when
we’re trying to ensure clarity. In actuality, though, repetition is
more likely to muddy the picture. If you use specific details and
straightforward language, you’ll be clear and you will only need to
say something once.
In addition, we use many redundant expressions in our speech and

writing. Consider, for example, the following statement:
There was general consensus among the committee members that

staffing needed to be increased during the night shift.
Consensus means general agreement. So, when you write that there
was general consensus, you are saying that there was general general
agreement. You can simply say there was consensus.
A list of commonly used redundant phrases and terms is included

at the end of this chapter.
Use of straightforward language and an active voice are also key to

concise writing. We’ll talk about them in more detail later in the
chapter.
Being Specific
Generalities leave a lot of room for misinterpretation or mis-
direction. You may begin a section or paragraph with a general
statement, but you then need to drill down into specific details.
Scientific writing needs to be precise. Studies need to be reported
with a level of detail that will allow others to replicate them; the
same is true of quality improvement projects. The use of concrete
nouns (see the “Be Concrete” section later in the chapter) is
essential for specificity.
Lacking specificity: Members of the committee held training sessions

to introduce the new policy. The sessions took place over two weeks and
were scheduled so that they were available for all the nurses. The com-
mittee members focused training on the parts of the policy that nurses
needed—either the new parts or the entire procedure—and made sure all
the nurses knew the evidence behind it. They also posted information on
the units.
Version with specificity: Members of the committee held one-hour

training sessions over two weeks to introduce the new policy. They sched-
uled the sessions at varied times so that nurses on all shifts were able to
attend. If nurses were familiar with the new policy, we focused on the
changes. If nurses were not familiar with the new policy, we reviewed
the entire policy and highlighted the changes. All the training sessions
included an overview of the evidence used to develop the policy. In addition
to training sessions, information sheets were posted in each of the nursing
stations next to the medication cart.
Specificity helps us achieve precision in our writing. Precision

means choosing words that focus in on a concept or thought and
most accurately portray the idea you’re trying to express. The
more specific a detail, the more precise your writing. Think about
the difference as you move from the first sentence to the last in the
following:
The foliage transformed the atmosphere as you approached

the house.
The flowers transformed the atmosphere as you approached

the house.
Bright rows of multicolored tulips transformed the atmo-

sphere as you approached the house.
In the first sentence, the nonspecific detail, foliage, gives us very

little information, and we can’t form an image of the scene. We
don’t know whether the transformation was for the better. Perhaps
the foliage is overgrown and encroaching on the drive up to the
house.
In the second sentence we have a little more information. So, the

foliage are flowers, which would give us the idea that the trans-
formation was a positive one. However, it’s still hard to form an
image; everyone will imagine what comes to their own mind when
they think of flowers, which may not be anything like what you are
trying to describe in the sentence.
In the final sentence, we now have more specific information—

bright rows of multicolored tulips. Everyone reading it will form
the same image, and it’s clear that the transformation is a positive
one. We have communicated precisely what we want the reader to
take away from the sentence.
Getting Organized
When your paper is well organized, the reader will move through
it smoothly: no bumps, disruptions, or surprises. Each idea, sen-
tence, paragraph, and section logically connects to what came
before and what follows:
• Ideas should flow from gen-

eral to specific. Read your paper to a
TIP
friend or colleague as
• Make sure that no ideas if you’re telling them
or statements come out of a story. Go through it
nowhere; introduce an idea and say in everyday
or concept before you discuss language what is being
it. Double-check this when- conveyed in each para-
graph, and then the next
ever you move things around
and the next. Make sure
during revisions.
that there is one idea to a
• The opposite is true as paragraph, each leading
well—any idea or concept logically to the next, and
directly related to your that no gaps in informa-
purpose needs to be threaded tion exist between them.
through to the end of the
paper. Don’t leave a concept hanging in the introduction or
literature review—if that happens it probably doesn’t belong
in the paper. Close the loop.
• If you state you’re going to cover a, b, and c, then discuss a,
b, and c in that order. Don’t talk about b, then a, and then c.
• There should be only one main idea to a paragraph.
Choosing Your Language

There is a saying among writers that you should never use a $100
word when a $5 word will do. This is a particular problem in
academic writing, where we are trying to communicate complex
information and often think we need to use big, important words
to do it when, actually, simple, everyday language is always best.
Straightforward language is more concise and specific. I’m not
talking about “dumbing down” information or not using technical
or medical terms where needed. It’s about writing use instead of
utilize or agree instead of are in agreement.
Here are a couple of examples:
Overly complex and awkward: Subsequent to commencing the inter-

vention, we procured two weeks of discharge data.
Simple and clear: After starting the intervention, we collected two weeks
of discharge data.
Overly complex and awkward: Findings were positive for the presence
of lower rates of fall incidents in the intervention group.
Simple and clear: There were lower rates of falls in the intervention
group.
As you write, keep in mind that your goal is to communicate clearly,

not to impress readers with your vocabulary. You’ll find a list of $100
words and phrases and their alternates at the end of the chapter.
The following sections discuss other important aspects of choosing

your language.
Use the Active Voice

The active voice injects energy into your writing. In the active voice,
the subject acts upon the object. In contrast, in the passive voice, the
subject is being acted upon:
• Passive: The medication was injected by the nurse.

• Active: The nurse injected the medication.
The active voice is strong, direct, and concise. The passive voice
lacks energy, is wordier, and can obscure meaning. However, in a
couple of situations, you might want to use passive voice: if the sub-
ject (doer) is unknown or unimportant, or if you want to emphasize
the action or object rather than the subject.
For example, in a paper on medication errors, a sentence talking

about an incident involving a child could be written in passive voice
to emphasize that this was a child whose life was endangered, rather
than to emphasize who made the error:
A 3-year-old child was given an adult dose of the medication….
When you do a spell and grammar check, it will usually indicate

which sentences are in passive voice and make suggestions for re-
writing them in active voice. Don’t automatically follow spell check
recommendations; make sure that it works for your sentence. It will
also give you an overall percentage of sentences that are in passive
voice. You want to aim for as close to zero as you can get, but defi-
nitely keep it under 10%. If it comes out higher, read through the
document and look for sentences that contain any version of be (is,
was, were, am, are, or been) or that contain the word by.
Use “I” (It’s OK!)

A myth in academic writing holds that it is not scholarly to use
personal pronouns. When you read some research reports, it’s as if
no humans were involved in conducting studies or analyzing results.
Avoiding the use of personal pronouns leads to all kinds of bad
writing: passive voice, less clarity, anthropomorphization, and lots
of extra words. Take a look at the following to see the difference:
A study was conducted by the author to determine whether ….
I conducted a study to determine whether ….

AVOIDING ANTHROPOMORPHIZATION
Anthropomorphization is giving human characteristics to nonhuman entities.
Here are a couple of examples of how it can manifest in a dissertation or
project report:
Incorrect: This research found a correlation between nurse fatigue and

medication error rates.
Correct: The researchers found a correlation between nurse fatigue and

medication error rates.
Incorrect: This project will attempt to increase medication adherence through

the use of telephone follow-up post-discharge.
Correct: The purpose of this project is to increase medication adherence

through the use of telephone follow-up post-discharge.
One caveat, though: Follow the instructions of your professor. There are
still many academicians who insist that using personal pronouns is forbidden.
If members of your committee are among them, remember that they have the
final word on your paper.
Check Your Adjectives at the Door

When it comes to adjectives, the fewer the better. You rarely need
more than one, at most two, descriptors. Also, be careful with qual-
ifiers—words such as somewhat, seems, or basically. Not only are they
inexact and subjective, they also imply uncertainty or a reluctance
to commit to a statement. (When talking about research, however,
it’s appropriate to use indicates or suggests rather than absolutisms
like proves.) And avoid intensifiers—words such as quite, really, and
very. They are rarely appropriate in an academic paper.
Don’t slip into hyperbole. Words such

as distraught, catastrophic, devastating, Go through your paper
TIP
and remove all the ad-
or agony lose meaning and power
jectives, qualifiers, and
unless used sparingly and appropri-
intensifiers. Now read
ately. There are health problems that the paper. Put back
are devastating, and patients’ pain in only those that are
may reach the level of agony, but you essential for an accurate,
will lose credibility if you overstate objective understanding
descriptions of situations. of the material.
Be Concrete
Avoid abstract nouns. Abstract nouns represent things that are
intangible; you can’t see, hear, touch, smell, or taste them. Abstract
nouns are subjective; they are interpreted through the lens of each
reader’s own experiences, and the meaning readers give to them
may differ from what you intended. Concrete nouns represent
something tangible; you can see, hear, touch, smell, or taste them.
When you use concrete nouns, you control the image created in
the reader’s mind. See Table 7.1 for some examples.
Table 7.1 Examples of Concrete and Abstract Nouns
Concrete Nouns Abstract Nouns

Child Excitement
Women Health
Man Caring
Nurse Patience
Stretcher Energy
Building Independence
Juice Kindness
Suture Love
Clock Time
Avoid Jargon
Jargon is specialized vocabulary used by members of a group.
Nursing has a lot of jargon (such as call a code, draw blood, run fluids,
and stat), and for most of us it has become such an engrained part
of our vocabulary that we don’t even realize it’s jargon anymore.
There are a couple of problems with jargon:
• It is exclusionary; people outside of the group don’t under-

stand it.
• It leaves room for misinterpretation.
Some of the healthcare jargon can be so specialized that people

outside of a region or particular healthcare setting may
misinterpret it. When I worked in upstate New York, we referred
to a cardiac arrest in the hospital I worked in as a Dr. Cor because
that was how it was called over the hospital-wide intercom system.
I never realized that it was a local expression until I moved away
and started working at another hospital, where a cardiac arrest was
called a Code Blue, and no one had ever heard the term Dr. Cor.
Also, avoid the use of euphemisms. Euphemisms are terms we use in

place of words or phrases that communicate something that is dif-
ficult to talk about. For example, one of the most common euphe-
misms is the term passed away in place of died.
Making Clear Transitions

In a well-organized paper, readers are prepared for changes in ideas
or focus as they move through the paper. This is accomplished with
the use of transitional devices: words and phrases that connect ideas,
paragraphs, and sections. Transitional devices do more than just
connect these elements; they also indicate relationships between
them. They guide the reader in how to think about the relation-
ships. For example, however tells the reader, “Wait a minute, there’s
also this,” which makes us think a little differently about that.
Be careful with transitional devices. Don’t just pop in the first one that
comes to mind or use the same one over and over. A common mistake is the
use of transitions that indicate relationships where none exist or that are not
what the transitional word or phrase indicate. The use of therefore is a common
example of this; it indicates that because of that, we can now think or do this.
Make sure that such a relationship really exists.
Transitional words and statements are also used when there is a

shift in focus between paragraphs and sections. They summarize
what was just said, prepare the reader for what comes next, and
make a connection between them. They say, “Pay attention here,
we were talking about that, but now we are going to talk about this,
which is connected in this way.” Notice how the first sentence of the
second paragraph in the following excerpt from an article on the
social implications of obstetric fistula does this:
Obstetric fistula is an outcome of obstructed labor; labor that

will sometimes go on for days. The prolonged pressure of the
infant’s skull against the soft tissue of the birth canal leads to
ischemia and necrosis of the surrounding tissue, leaving a hole
between the bladder and vagina (vesico-vaginal) or sometimes
between the rectum and vagina (recto-vaginal), or both. The
woman is left with constant leakage of urine or feces and
develops an offensive odor, sores on her perineum and upper
legs, and infections. Most of the women are also grieving the
loss of their baby; studies report infant mortality rates from
85% to 100% in cases of childbirth that result in an obstetric
fistula. [1], [3], and [4]
The worst suffering for these women though may not be the
physical manifestations of obstetric fistula or grief over the loss
of their baby, but rather the social repercussions that follow.
The majority of women who suffer an obstetric fistula already
live in precarious socioeconomic circumstances complicated by
the low status of women in sub-Saharan Africa; they are usu-
ally poor, uneducated, from a rural area of subsistence farmers,
and unskilled. [1] … Their value in society is derived from their
roles as wife and mother, both of which are severely threatened
when obstetric fistula occurs (Roush, 2009, p. e21).
The first paragraph is talking about the physical consequences

of obstetric fistula, including infant death. The second paragraph
begins with a sentence that tells us what we just read (physical suf-
fering and grief related to obstetric fistula); prepares us that there
are other, perhaps worse, things to consider; and then goes on to say
what those are (social implications).
You’ll find a table of transitional words and phrases at the end of

this chapter.
MEDICAL ABBREVIATIONS AND ACRONYMS

Use abbreviations or acronyms for lengthy terms or titles that you will be using
more than three times in your paper. But do so judiciously, keeping conciseness
and ease of reading in mind. Too many acronyms can have the opposite effect.
Certain topics, such as those related to governmental organizations or the military,
have a lot of specialized abbreviations and acronyms, and it’s easy for a reader to
get lost in a sea of letter combinations. Spell out the full word or title followed by
the abbreviation or acronym in parentheses the first time it’s used, and then use
the abbreviation or acronym consistently through the rest of the paper.
Checking Your Grammar

Numerous good resources are available, both online and in print,
for checking punctuation and grammar. Use them. This section
examines a couple of areas where new writers often make errors

that can result in confusion and misunderstanding for the reader:
differentiating between the use of colons, semicolons, and commas
and using misplaced modifiers and dangling participles.
Punctuation
Punctuation clarifies meaning in a sentence, guides the reader
through the material, and alerts the reader to where the emphasis is.
Punctuation is straightforward for the most part, but three punctua-
tion marks that are used frequently and often incorrectly are com-
mas, colons, and semicolons.
The colon has a simple purpose: introduction. Most often it is used

to introduce a list of things—Marla gathered all the supplies for
the dressing change: sterile gloves, sterile saline, gauze pads, an ace
wrap, and tape—but it can also be used to introduce a single thing,
adding emphasis (as in the first sentence of this paragraph). Howev-
er, you should not use a colon after a verb—Marla gathered: sterile
gloves, sterile saline, gauze pads, an ace wrap, and tape.
The semicolon gets a little more complicated because its usage is of-
ten confused with that of the comma. The semicolon is used when
two related sentences are connected in a single sentence without
using a conjunction; a comma is used when two sentences are
connected with a conjunction. The semicolon is also used when a
sentence lists multiple complex items that have commas. It tells the
reader what goes together—Marla gathered what she needed for
the dressing change, including sterile gloves, saline, and gauze pads;
an ace wrap and tape; and a disposal bag for the old dressing.
The comma is the most complicated of all because it has many uses.
It is used to separate items in a series, separate two complete sen-
tences with the use of a conjunction, separate a nonessential phrase
in the middle of a sentence, and attach words to the beginning or

end of a sentence.
Misplaced Modifiers and Dangling Participles

A modifier is a word or phrase that modifies a noun or verb. A
participle is a particular type of modifier, usually ending in –ing.
The modifier should be as close as possible to what it is modifying.
When it’s not, that’s when you get into trouble.
Take a look at the following sentence and think about what it is

actually saying:
Simulation is used in various nursing and medical specialties

including critical care and surgery to enhance clinical judg-
ment, critical thinking, and communication.
The modifier is “to enhance clinical judgment, critical thinking,

and communication.” The closest thing to it is “surgery,” so that is
what it is modifying. According to this sentence, there is surgery
that will enhance clinical judgment, critical thinking, and commu-
nication!
Here is the sentence corrected so that the modifier is closest to

what it is actually modifying: “simulation.”
Simulation is used to enhance clinical judgment, critical

thinking, and communication in various nursing and medical
specialties, including critical care and surgery.
It’s hard to catch your own misplaced modifiers. You know what
you’re trying to say, so you read what you’ve written as saying what
you intended it to say instead of reading what it actually says. This
is one of the reasons it’s so important to get others to read your
drafts and give you feedback.
Revise, Revise, Revise

Leave yourself plenty of time for multiple revisions. When you fin-
ish a draft of a chapter, set it aside for a few days. Then come back
to it and read it out loud. Reading aloud requires more attention
and gives you a sense of the flow. You will hear or feel the places
where it isn’t working: the gaps you fall into, the places where you
get lost in endless sentences, the bumpy connections. Then revise
and do the same thing again. When your entire dissertation or
project is finished, read it out loud again (yes, the entire thing).
You should also get two other people to read your work and give
you feedback. One should be a person who knows the topic well
and who can give you feedback on accuracy and point out gaps in
information. The other should be someone who knows nothing
about the topic (in fact, preferably someone outside of nursing or
healthcare). If your second reader can follow and understand it,
you know your writing is clear and complete.
You’ll find a proofreading checklist at the end of this chapter.
Double-check that all the references you list in your reference list are in the
TIP
final paper and vice versa. It’s easy for some to get missed—either left out or
not deleted when they should be—when you do multiple revisions. Print out
your reference list. Use the Find Command (Ctrl+F) to look for each reference
on the list, and then check it off. Then go back through the paper and check
that each reference cited is on the list.
Following is a list of writing tips based on errors often seen in dis-

sertations and scholarly projects:
• Data is plural. Datum is singular.

• Et al. has a period only after the al.
• Only capitalize proper nouns. This might seem like an easy

one, but a lot of people get it wrong. When talking about a
theory, you capitalize only the name of the person involved,
not each word of the theory. So, you would write Bronfen-
brenner’s ecological systems model, not Bronfenbrenner’s
Ecological Systems Model. The same is true of conditions
and diseases. You don’t write Alzheimer’s Disease or Cogni-
tive Behavioral Therapy. You do write Alzheimer’s disease
and cognitive behavioral therapy.
• Go through your final paper carefully to make sure that all
the tenses in each chapter are correct. See the guidelines in
Chapter 2, “Writing Your Literature Review,” for guidance.
It’s easy to miss a few in a paper of 100 or more pages when
you are going back to change them after you’ve completed
your study.
• Check your it’s and its. It’s is a contraction of it is. Its is a
possessive.
• Use the same term for a concept or variable throughout
the paper. You can even keep a list of such key concepts or
variables to ensure you use them consistently throughout.
• Avoid long, overly complex sentences. The reader can get
lost or confused wading through them.
• Avoid labels. They introduce bias. For example, instead of
“disabled patients,” write “patients with disabilities.”
Extraneous Words and Phrases

Actually
Truly
Really
Basically
Obviously
Practically
In terms of
It goes without saying
In the area of
It is necessary to
All in all
In order to
All things considered
I think
In my opinion
Qualifiers Intensifiers
Somewhat Very
Sort of Really
May, Might A lot
Can, Could Quite
Some, Most, Many, Few So
Commonly Too
Sometimes, Usually Ever
Probably, Possibly
Unlikely
Seems, Appears
Basically
Mostly
Virtually
Rather
$100 Words and Phrases

A large majority of = most
Are in agreement = agree
At this point in time = now
Attempt, endeavor = try
Be in the possession of = have, own
Be of the opinion = think, believe, feel
By means of = by
Commence = begin
Due to the fact that, owing to the fact, in light of the fact, in
view of the fact = because, since
Facilitate = help, assist, ease
For the purpose of = for, to
Has the capacity of = can
Implement = do, perform, carry out
In the event that = if
Incentivize = motivate, stimulate, spur
Individual = person, woman, man (unless you are distin-

guishing a person from a group)
On a daily basis or on a regular basis = daily or regularly
Optimize/maximize = increase, improve, expand

Possess = have
Prior to, previous to, in advance of = before
Subsequent to = after, following
Take into consideration = consider
Utilization = use (noun)
Utilize = use (verb)
With the exception of = except
Redundant Word Combinations

A new initiative
Absolutely necessary
Artificial prosthesis
Completely full
Each and every
Exact duplicates
General consensus
Interact with each other
Interact with one another
Just recently
Repeat again
Self-confessed
Sufficient enough
The reason is because
Transitional Words and Phrases

Compare Contrast Time Addition Effect
Similarly Yet While Furthermore Therefore
Likewise However After Additionally Consequently
In the same way Though Following Finally Accordingly
Comparatively But Subsequently Also As a result
Just as…so too In contrast Currently In addition Because
Chapter Checkup
❑ Organization
Do ideas flow from general to specific?
Do ideas follow through from the beginning?
Do any ideas/statements come out of nowhere?
Are there redundant statements?
Is there one main idea in each paragraph?
❑ Transitions
Are there transitional statements between ideas?
Are there transitional statements between paragraphs and sections?
Have I used transitional words correctly?
❑ Have I used the correct tense for each section of the paper?
❑ Language
Is the language straightforward?
Is the language free of jargon?
Is the language concise?
Are there redundant word combinations?
Are the nouns I use concrete and specific?
Have I avoided using hyperbole?
Are all adjectives and adverbs necessary?
Have I avoided using qualifiers and intensifiers?
Have I used the same term for a concept throughout?
❑ Have I used primarily the active voice?
❑ Grammar
Have I checked for misplaced modifiers and dangling participles?
Does punctuation use meet accepted standards?
Is it clear who or what each pronoun is referring to?
❑ Synthesis
Have I synthesized information vs. listing information?
Remember: CLARITY IS KEY.
The Scholar’s Voice© 2017
References
Roush, K. (2009). Social implications of obstetric fistula in women in sub-Saharan
Africa: An integrative review. Journal of Midwifery and Women’s Health, 54(2),
e21–e33. https://doi.org/10.1016/j.jmwh.2008.09.005
INDEX
A B
abbreviations, 163 background information, 10, 36
abstract nouns, avoiding, 160 barriers
abstracts, formatting, 140–141 examples, 64
acceptance of manuscripts, 148 projects, 63
acronyms, 163 biases, 127–128
active voice, 157–158 biophysiological, 73
adding Bronfenbrenner’s ecological systems
context, 103 model, 27
information, 4 budgets
adjectives, avoiding, 103, 159–160 examples, 66–67
American Medical Association methodologies, 66–67
(AMA), 140
American Psychological Association
(APA), 41–42, 140 C
analyzing. See also synthesizing change models, 27
assumptions, 105 characteristics of good writing,
concept analysis, 142 152–156
data analysis, 76–80 chart reviews, 74–75
literature reviews, 34 choice of approach, 50
preliminary analysis, 80, 91–92 citations, 38
qualitative analysis, 77–78 clarity
quantitative data analysis, 78–80 transitions, 161–163
themes, 103, 104 writing, 4, 38, 152, 157
anonymous participation, 75 clinical application papers, 143
answering questions, 12, 18 coding, 79
anthropomorphization, 158, 159 coercion, 57
appendices, 24 collection, data. See data collection
appraisals colons, 164
examples, 33 commas, 164
literature reviews, 32–33 common mistakes
tools, 45–46 assumptions, 105
approach to studies, 48–50 background information, 10
choice of approach examples, 50 conclusions, 130
flaws in, 121–122 consistency, 94
assumptions, 105 exclusion criteria, 31, 55
ATLAS.ti, 78 figures/tables, 98
audio recordings, 71, 76 following instructions, 159
author guidelines, 138–141 open-ended questions, 106
participation, 75
pie graphs, 97
INDEX 175
predatory publishers, 149 criteria

project failures, 122 for authorship, 137
recommendations for research, exclusion, 31, 54
125 inclusion, 31, 54
samples, 59 critical appraisal, 33. See also
study populations, 72 appraisals
terminology (theoretical Critical Appraisal Skills Program
frameworks), 28 (CASP), 45
transitional devices, 161–163
comparisons, 15. See also PICOT
statements D
compensation, 58 dangling participles, 165
concept analysis, 142 data analysis, 76–80
conciseness, 4, 152–153 descriptions, 78
conclusions qualitative analysis, 77–78
common mistakes, 130 quantitative data analysis, 78–80
examples of, 130 data collection, 69
summary (conclusion) chapters, chart reviews, 74–75
135–136 elements, 75–76
writing, 129–131 qualitative, 69–71
confidential participation, 75 quantitative, 71–74
Connell’s Theory of Gender and storage, 76
Power, 26, 27 surveys, 71–72
consent forms, 61–62 date delimitations, 31
consistency, 38, 94 decision-making, manuscripts, 147
consistent findings, 117 definitions, 23–24. See also
Consolidated Criteria for Reporting descriptions
Qualitative Research (COREQ), deleting information, 4
45 delivery
CONsolidated Standards of of content, 64
Reporting Trials (CONSORT), of information, 57
45, 139 demographic data, 75–76
contact information, 58 examples, 93
content, delivery, 64 results, 93–94
context descriptions
adding, 103 data analysis, 78
historical, 24–25 instrument, 74
results, 117 introductory chapters, 135
copyrights, 149–150 Likert scale, 94
costs, 67. See also budgets recruitment strategies, 58
creating. See formatting; writing search strategies, 30–31
study settings, 51 evolution of the phenomenon,

thick, 101 24–25
traditions, 49–50 examples
design of studies, 48–50 of APA heading levels, 41–42
direct quotes, 34 of appraisals, 33
discussions, 111–112 of barriers, 64
conclusions, 129–131 of budgets, 66–67
data used in, 118 of choice of approach, 50
education, 123–124 of conclusions, 130
limitations, 127–129 of consistent findings, 117
manuscript option, 144 of data analysis, 78
meaning of results, 114–119 of data used in discussions, 118
policies, 124 of definitions, 24
practice, 123 of demographic data, 93
project failures, 120–122 of exclusion criteria, 54
research, 124–127 of focusing paragraphs, 116
reviews, 112–113 of inclusion criteria, 54
samples, 114 of inconsistent findings, 118
surprising findings, 115 of ineffective strategies, 121–122
dissertations, value to, 3 of instrument description, 74
duration of projects, 17. See also time of integration of theoretical
frameworks, 116
of key findings, 113
E of limitations, 128–129
editors, desires of, 145–146 of managing findings, 100–101
education, discussions, 123–124 of models, 28
educational interventions, 64–65 of overviews, 23
effect size, 55 of pilot testing, 92
elements of plan to address, 64
of data collection, 75–76 of projects, 5
in introductory chapters, 135 of query letters, 146–147
of outlines, 3, 7–8 of quotations, 101–102, 103
of search strategies, 29–30 of recommendations for research,
establishing 124
samples, 53–55 of recruitment strategies, 58
significance, 2 of research, 119
ethics, methodologies, 59–61 of research gaps, 40
evaluation of response rates, 93
of outcomes, 67 of results, 90
scholarly projects, 105–108 of sample sizes, 56, 93
evidence, supporting, 32–33 of statistical analysis, 79
evidence-based practice (EBP), 27, of storage, 76
62 of structured abstracts, 140–141
INDEX 177
of summaries, 39–40 frameworks

of summary reviews, 113 Plan-Do-Study-Act, 27, 28, 108
of surprising findings, 115 theoretical, 25–28
of survey data collection, 71–72
of synthesizing, 35–36
of theoretical frameworks, 26 G
of timelines, 67–69 generalizability, 128
of unstructured abstracts, 141 grammar, 163–164
exclusion criteria, 31, 54, 55 graphs, 97
extraneous words, 167–168 gray literature, 31
guidelines
author, 138–141
F definitions, 24
Facebook, 80–82
facilitators, projects, 63
failures, projects, 120–122 H
figures handoff problems, types of, 106, 107
common mistakes, 98 headings
results, 96–99 APA heading levels, 41–42
findings. See also results subheadings, 41
consistent, 117 historical context, 24–25
examples, 113 humanism, 26
implications, 126 hypotheses, specific, 43
inconsistent, 118
managing, 100–101
results, 94 I
strength of, 115 implementation of projects, 63
surprising, 115 implications
theoretical frameworks, 96 findings, 126
focus groups, 17, 70, 71 managing, 125
focusing paragraphs, 116 writing, 125
formatting importance of topics, 11
abstracts, 140–141 inclusion criteria, 31, 54
American Medical Association inconsistent findings, 118
(AMA), 140 ineffective strategies, 121–122
American Psychological inquiries, narrative, 49, 50
Association (APA), 140 institutional review board (IRB)
APA heading levels, 41–42 process, 61
manuscript option, 133–134 (see instrument description examples, 74
also manuscript option) integration, theoretical frameworks,
outlines, 3–6 116
styles, 140 International Committee of Medical
subheadings, 41 Journal Editors (ICMJE), 137,
tables, 99 139
forms, consent, 61–62 intervention, 15. See also PICOT
statements
interventions, educational, 64–65 L

interviews, 17, 70 language, selecting, 156–161
pilot, 71 length of manuscripts, 145
post-interviews, 71 levels, APA heading, 41–42
questionnaires, 70 Likert scale, 79, 94
introductions limitations, 127–129
answering questions, 12 LinkedIn, 80–82
creating outlines, 3–6 literature reviews, 2, 3, 142
elements of outlines, 3, 7–8 appraisals, 32–33
importance of topics, 11 common mistakes, 31
knowledge/practice gaps definitions, 23–24
attained, 12–13 evolution of the phenomenon,
manuscript option, 144 24–25
methodologies, 15–16 historical context, 24–25
PICOT statements, 14–15 managing, 41
purpose statements, 14, 17–19 overviews, 23–24
research questions, 16–17 purpose statements, 42–43
sections, 8, 9 research gaps, 38–42
starting, 2–3 research questions, 43
writing, 2, 8–9 search strategies, 28–32
introductory chapters summaries, 38–42
description, 135 synthesizing, 33–38
elements, 135 templates, 36–38
writing, 134–135 theoretical frameworks, 25–28
Iowa Model of Evidence-Based writing, 22–23
Practice, 27 logical results, 95
J M
jargon, avoiding, 161 managing
JBI Manual for Evidence Synthesis, findings, 100–101
45 implications, 125
Johns Hopkins Evidence- Based literature reviews, 34, 41
Practice Model, 27, 28 search strategies, 32
manuscript option, 133–134
author guidelines, 138–141
K authorship, 136–138
Katz Index of ADL, 74 copyrights, 149–150
key findings, 113. See also findings discussions, 144
key stakeholders, 52 introductions, 144
knowledge in introductions, 12–13 introductory chapter, 134–135
length, 145
methodologies, 144
INDEX 179
publishing, 145–150 N
purpose of, 138 narrative inquiries, 26, 27, 49, 50
results, 144 NVivo, 78
summary (conclusion) chapters,
135–136
types of manuscripts, 142–143 O
writing, 143–145 objectives, writing, 17
meaning of results, 114–119 observations, 73
measurements, 74. See also open-ended questions, 106
evaluation organizing. See managing
medical abbreviations, 163 outcomes, 15. See also PICOT
methodologies, 15–16 statements
approach/design of, 48–50 evaluation of, 67
budgets, 66–67 projects, 63
chart reviews, 74–75 results, 105–108
consent forms, 61–62 outlines
data analysis, 76–80 answering questions, 12
data collection, 69 elements of, 3, 7–8
educational interventions, 64–65 formatting, 3–6
elements for data collection, importance of topics, 11
75–76 knowledge/practice gaps
establishing samples, 53–55 attained, 12–13
ethics, 59–61 overviews, literature reviews, 23–24
manuscript option, 144
philosophical underpinnings, 50
project planning, 62–64 P
recruitment, 57–59 page counts, 140
rigor, 82–85 paragraphs. See also sections
sample sizes, 55–56 focusing, 116
social media, 80–82 introductions, 9, 10
study settings, 51–52 participants, recruitment, 57–59
theoretical frameworks, 50 participation, common mistakes, 75
timelines, 67–69 partnerships, 52
video-conferencing, 82 passive voice, avoiding, 157
writing, 47–48 patterns, 96
methods papers, 143 peer reviews, 147
misplaced modifiers, 165 periods, study, 17
models philosophical underpinnings, 50
change, 27 phrases, 167–170
evidence-based practice (EBP), PICOT statements, 14–15, 26
27, 62 pie graphs, 97
examples, 28 pilot interviews, 71
publishing, 148–149 pilot testing, 73, 92
Plan-Do-Study-Act, 27, 28, 108
planning, 67 rigor, 84–85

projects, 62–64 settings, 127
studies, 52 pronouns, 158
plan to address example, 64 proposals
policies questions for, 4, 5
discussions, 124 studies, 49
implications, 125 publishing
populations, 9, 15, 49, 59, 72. See also manuscripts, 145–150
PICOT statements models, 148–149
post-focus groups, 71 standards, 139
post-interviews, 71 punctuation, 34, 164–165
power, 55 purpose of manuscripts, 138
practice, discussions, 123 purpose statements, 4, 14, 17–19, 23
practice gaps, 12–13 literature reviews, 42–43
PRECEDE-PROCEED Model, 27 restatements of, 112
predatory publishers, 149
Preferred Reporting Items for
Systematic Reviews and Meta- Q
Analyses (PRISMA), 45, 139 qualitative analysis, 77–78
preliminary analysis, 80, 91–92 qualitative data collection, 69–71,
prevalence, 9 75–76
privacy, 76 qualitative descriptive studies, 5,
probability, 55 49, 53
problems qualitative research
reviews, 112–113 rigor, 83
stating, 9 sample sizes, 56
processes. See also strategies qualitative results, 99–104
analysis, 77–78 (see also data quality improvement (QI), 52, 90
analysis) quantitative data
institutional review board (IRB), analysis, 78–80
61, 62 collection, 71–74, 75–76
synthesizing, 35 quantitative research
projects rigor, 83–84
barriers, 63 sample sizes, 56
data collection (see data queries, sending, 146–147
collection) questionnaires, 70, 73
duration of, 17 questions
examples of, 5 answering, 12, 18
facilitators, 63 open-ended, 106
failures, 120–122 PICOT, 26, 43 (see also PICOT
implementation, 63 statements)
methodologies (see for proposals, 4, 5
methodologies) research, 16–17, 43
outcomes, 63 quotation marks, 34
planning, 62–64 quotations, examples, 101–102, 103
quality improvement (QI), 52
INDEX 181
R meaning of, 114–119

recommendations for research, 124 meaning to studies, 95–96
recordings outcomes, 105–108
audio, 71 preliminary analysis, 91–92
storage, 76 project evaluation, 105–108
recruitment, 57–59 qualitative, 99–104
settings, 57 response rates, 92–93
strategies, 58 sample sizes, 93–94
redundancy, 153, 170–171 theoretical frameworks, 115, 116
references, 166 reviews
referral sampling, 58 chart, 74–75
rejection letters, 147 discussions, 112–113
related research, examples, 119 literature, 2, 3 (see also literature
reliability, 128 reviews)
reports peer, 147
appraisal tools, 33 summaries, 113
common mistakes, 94 revising
pilot testing, 92 manuscripts, 148
research, 142 writing, 166–167
research rigor, 82–85
appraisal tools, 33 qualitative research, 83
data collection (see data quantitative research, 83–84
collection) scholarly projects, 84–85
discussions, 124–127 Roy, Callista (Sister), 26
examples, 119 Roy Adaptation Model (RAM), 26
questions, 16–17, 43 rural settings, 51. See also settings
recommendations for, 124
reports, 142
sample sizes, 56 S
research gaps samples. See also examples
examples, 40 common mistakes, 59
literature reviews, 38–42 discussions, 114
respondents, 53 establishing, 53–55
response rates sample sizes, 55–56
examples, 93 examples, 56, 93
results, 92–93 qualitative research, 56
results, 89–91 quantitative research, 56
context, 117 results, 93–94
demographic data, 93–94 sampling frames, 17, 53
examples, 90 scholarly projects
figures/tables, 96–99 evaluation, 105–108
findings, 94 rigor, 84–85
focusing paragraphs, 116 school papers, comparing to
manuscript option, 144 manuscripts, 138
search strategies, 28–32 Statistical Package for the Social

sections. See also elements; specific Sciences (SPSS), 79, 95, 99
sections statistics, 9, 78–80
APA heading levels, 41–42 Stetler Model of Evidence-Based
introductions, 8, 9 Practice, 27
literature reviews, 22–23 storage, 76
subheadings, 41 strategies
topics, 9, 10 ineffective, 121–122
selecting recruitment, 57–59
language, 156–161 revision, 166–167
tenses, 13 search, 28–32
semicolons, 164 synthesizing, 35
settings Strengthening the Report of
projects, 127 Observational Studies in
recruitment, 57 Epidemiology (STROBE), 46
studies, 51–52 structure, of introductions, 8.
significance See also
establishing, 2 elements
of topics, 9 structured abstracts, examples,
sizes 140–141
effect size, 55 studies
samples, 55–56 appraisals, 32–33
Skype, 70 choice of approach examples, 50
snowballing, 58 citations, 38
social media, 80–82 flaws in approaches to, 121–122
software, data analysis, 78–80 limitations of, 127–129
specific hypotheses, 43 meaning to, 95–96
specificity, 154–155 methodologies (see
stakeholders, 52 methodologies)
standards, publishing, 139 planning, 52
Standards for QUality Improvement populations, 72
Reporting Excellence (SQUIRE), proposals, 49
45, 139 qualitative descriptive, 5, 49, 53
starting introductions, 2–3 quality improvement (QI), 52
statements recruitment, 57–59
PICOT, 14–15, 26 search strategies, 28–32
purpose, 4, 14, 17–19, 23, 42–43 settings, 51–52
therefore, 4–6, 13, 17 synthesizing, 33–38
stating problems, 9 Women’s Health Initiative, 31
statistical analysis study periods, 17
assumptions, 105 styles
examples, 79 American Psychological
types of, 79 Association (APA), 41–42
Statistical Analysis System (SAS), 79, formatting, 140
95, 99 subheadings, 41
INDEX 183
subjects, 53 therefore statements, 4–6, 13, 17

submitting manuscripts, 149. See also thick description, 101
manuscript option time, 15. See also PICOT statements
summaries timelines
examples, 39–40 examples, 67–69
literature reviews, 3, 38–42 (see methodologies, 67–69
also literature reviews) tools, appraisal, 33, 45–46
reviews, 113 topics, 3
summary (conclusion) chapters, evolution of/historical context of,
135–136 24–25
supporting evidence, 32–33 importance of, 11
surprising findings, 115 sections, 9, 10
surveys, 16, 53, 71–72, 73 significance of, 9
synthesizing traditions, descriptions, 49–50
examples, 35–36 transcript storage, 76
literature reviews, 33–38 transitional devices, 161–163
strategies, 35 transitional sentences, 38, 42
systems theory, 26 transitions, clarity, 161–163
Transparent Reporting
of Evaluations with
T Nonrandomized Designs
tables (TREND), 139
common mistakes, 98 trends, 96
formatting, 99 Twitter, 80–82
results, 96–99 types
themes, 104 of handoff problems, 106, 107
technology, video conferences, 70 of manuscripts, 142–143
templates, 36–38. See also examples; of statistical analysis, 79
sections
tense selection, 13
testing U
assumptions, 105 unstructured abstracts, examples,
findings, 94 141
pilot, 73 US Department of Health and
themes Human Services, 59
analysis, 103, 104
managing findings, 100–101
theoretical frameworks, 50 V
common mistakes, 28 validity, 128
findings, 96 video conferences, 70, 82
focusing paragraphs, 116
integration, 116
literature reviews, 25–28
results, 115, 116
W language selection, 156–161

Watson, Jean, 26 misplaced modifiers, 165
Women’s Health Initiative, 31 phrases, 167–170
words punctuation, 164–165
counts, 140 revising, 166–167
selection, 114, 153 transitions, 161–163
writing
active voice, 157–158
authorship, 136–138 X–Y–Z
characteristics of good, 152–156 Zoom, 70
clarity, 152
conciseness, 152–153
conclusions, 129–131
consent forms, 61–62
consistency, 38
definitions/overviews, 23–24
discussions, 111–112
implications, 125
introductions, 2, 8–9
introductory chapters, 134–135
language selection, 156–161
literature reviews, 22–23
manuscript option, 133–134,
143–145 (see also manuscript
option)
methodologies, 47–48
objectives, 17
organizing, 155–156
redundancy, 153, 170–171
results, 89–91
search strategies, 28–32
specificity, 154–155
subheadings, 41
summary (conclusion) chapters,
135–136
tense selection, 13
transitional sentences, 38, 42
word selection, 114
writing well, 151–152
characteristics of good writing,
152–156
dangling participles, 165
extraneous words, 167–168
grammar, 163–164

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A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT

DissertationCover3E.indd 1 1/19/23 10:08 AM

A NURSE’S STEP-BY-STEP GUIDE TO WRITING A DISSERTATION OR SCHOLARLY PROJECT

DissertationCover3E.indd 1 1/19/23 10:08 AM

“Once again, Karen Roush has written an insightful, practical guide to

“Karen Roush provides a comprehensive and insightful framework for writ-

“A Nurse’s Step-by-Step Guide to Writing a Dissertation or Scholarly

KAREN ROUSH, PHD, RN, FNP-BC

Sigma Theta Tau International

Library of Congress Control Number: 2022951641

First Printing, 2023

Publisher: Dustin Sullivan Managing Editor: Carla Hall

Roush is the founder of The Scholar’s Voice, which works to

1 Writing Your Introduction . . . . . . . . . . . . . . . . . . . . 1

2 Writing Your Literature Review. . . . . . . . . . . . . . . 21

3 Writing Your Methodology Chapter. . . . . . . . . . . . 47

4 Writing Your Results Chapter . . . . . . . . . . . . . . . . 89

5 Writing Your Discussion Chapter. . . . . . . . . . . . . 111

6 Writing Manuscript Option Dissertations . . . . . . 133

7 Writing Well: The Basics . . . . . . . . . . . . . . . . . . . 151

What Will You Get From This Book?

Of all the characteristics you need to get through doctoral studies,

OK, now on to what you’ll get from this book.

HOW TO USE THIS BOOK

3. Before you start working on a particular section of your paper, carefully

As mentioned previously, this book is not about how to design and

Defining your purpose is a process that you can’t do quickly or

Once your purpose statement is done, you’re ready to move on to

Structure and Components of a Dissertation/Scholarly

ICMJE is used for reporting original research, and SQUIRE is

the IMRAD structure: introduction,

Some programs have a manuscript option in place of the tradition-

Chapter One: Introduction

Chapter Two: Literature Review

Chapter Three: Methodology

Chapter Four: Results

Chapter Five: Discussion

Scholarly Project Template

This book follows a structure that closely aligns to IMRAD and

Chapter One: Introduction

Chapter Two: Literature Review

Chapter Three: Methodology

Chapter Four: Results

Chapter Five: Discussion

Tenses in a Dissertation/Scholarly Project: Past, Present, or Future?

• Introduction: Present tense for background unless you are

General Tips and Recommendations

Also read research and quality improvement project reports in the

Befriend Your Research Librarian

Use a Bibliographic Software Program

• Check with your school’s library for courses on using the

Get to Know Word

Get on the Cloud

Designate a Dedicated Work Space

Make the Time

Don’t Start at the Beginning

Save Every Copy Every Time

each time. You can go in alphabetical order and assign a letter to

Organize Your Work

Follow Requirements for Your Program

In addition, always follow the directions of your chairperson and other

Remember, the best dissertation is a done dissertation! And your

3. Before you start working on a particular section of your paper, carefully

4. States what we need to find out or what

5. Presents how you plan to do that (your

4. What do we need to find out and why? or What do we need

2. Does it add to the reader’s understanding of the problem, topic,