Dear NANN Colleagues,
Please take a few moments to reflect on these questions:
- As you flip through the pages in a journal, what makes you stop and read an article?
- Do you stop because of the title or authors?
- Do you stop because the topic is one that you have recently seen in your clinical practice?
- Or, do you stop because the pictures, figures, tables, and graphs catch your eye?
Depending on your purpose for paging through the latest issue of Advances in Neonatal Care (ANC), your answer could be all of these reasons. However, for the purposes of this editorial, we believe that most often the reason you stop to read an article is the figures, tables, or graphs that caught your eye. We purposely used a bulleted list at the beginning of this editorial to make the questions standout—again to catch your eye as you glance through the pages. Using different type styles such as bulleted lists, bolding, or italics can make your words stand out. However, boxes, tables, and figures are even more powerful communication tools that attract and sustain the interest of readers. Choosing to use these items in your manuscript does not need to be difficult; be fearless and creative in the process. Page through this edition of ANC and take a few moments to look at the figures, tables, and graphs in each of the articles. What do you see that you like? Which ones make you stop and take a second look? What would you do differently if you had been the author? We will direct you to some examples within this issue as we discuss each of the different types of visual images used to support your manuscript content.
Pictures are often noted to “say a thousand words,” and so it is with images added to enhance the content in articles. We wrote this editorial to answer the questions we often have as we edit manuscripts for ANC. We also address areas where we most often need revisions in the submission of pictures, figures, tables, and graphs. While much of the information included in this editorial is reflected in the ANC author guidelines,1 we felt an editorial focused on these essential and visually appealing items within a manuscript would be important and helpful to many of our readers and authors. Even authors with excellent writing expertise often struggle with how and when to use these items to accentuate the significance of the work or data. Using images needs to be thought of as essential, not additive, because they make what we read really stick with us and increase our learning of the topic.2
Writing in academic programs does not always provide a foundation for knowing how and when to best use pictures and/or creating figures, tables, and graphs to enhance the content of the text in a published article. Students are not typically required to add these materials to their classroom work. Many times we receive a well written clinical manuscript submitted with no pictures, tables, figures, or graphs, and consequently, our reviewers critique it as a student paper. This may or may not be the case, but the reviewer critiques often suggest where the text could be decreased with a table or box and how a figure of the relationships described could enhance the manuscript. Furthermore, figures, tables, and graphs often give a manuscript a more professional feel.3 Most often when we request the addition of these items during the publication process, authors struggle with these requests. We hope the questions and answers addressed in this editorial will help you understand when and how to best use pictures, figures, tables, and graphs to enhance your work.
WHY SHOULD YOU ADD PICTURES OR FIGURES?
Most people are visual learners as opposed to auditory learners. Advances in Neonatal Care is, for the most part, not an auditory learning experience, unless of course you read your journal out loud. Thus, adding images such as pictures and figures can enhance visual learning, reinforcing a point by providing a visual perspective of the content found in the text. Pictures or figures also can demonstrate relationships between variables or concepts more clearly than text alone. Descriptions of relationships can easily become long and confusing to readers. Thus, creating a figure or using a picture can help readers better understand complex concepts and relationships. Images created to enhance the text within a manuscript should not repeat everything that is in the text and vice versa. Figures, graphs, and tables should draw attention to significant findings or relationships and key points, but they should not wholly repeat everything that is already detailed in the text.
On a side note, there are ways to add auditory pieces to enhance your work. Please see our author guidelines for methods authors can use to add auditory and video content to manuscripts. We would really like to see more of this type of content in the future. If you need help with these manuscript features, just let us know.
WHAT ARE GOOD PRACTICES FOR INCLUDING PICTURES AND FIGURES?
Pictures of infants and families require permission for use, even for educational purposes. Families will often give consent when they understand that the image will be used to help others better care for infants in the future. Consent should be signed at the time the photo is taken, so parents do not feel their child is being “used” for our purposes. Figure 4 in the article by Siewert et al4 in this issue is a good example of a high quality photo that has been used to enhance the content of the article. If a hospital consent form is used, please make sure the language is broad enough to cover the usage of the photo in an educational publication such as ANC. If pictures are not available, there are also freely available (royalty free) stock photos and artwork on the Internet that can be used to enhance your manuscript, but please be careful to check to make sure the copyright protection covers use in an educational journal. If you do choose to use pictures you have taken or from the internet please make sure they are the appropriate pixels for them to print clearly in the journal. Poor quality pictures can actually detract from the work, so this is an important issue to consider. Pictures found in other books and journals can also be used to enhance your work, but permission from the copyright holder (usually the publisher) will be required and must be secured by the author before the manuscript can be accepted for publication. Even if the picture is a reprint from another publication, quality of the artwork must also be considered; please see our author guidelines for more details about picture quality.1 As is true for most journals, ANC cannot absorb the costs of the use of previously published work; however, it is important to note that the costs are usually minimal or may not exist at all, depending on the source of the artwork.
Photos used in ANC must meet standards for developmentally appropriate care, including appropriate resting position, lighting, devices to support care, and positioning for feeding or procedures. Photos must also depict safe environments for infants. For example, a more mature stable infant shown in a crib should not be positioned prone, there should not be pillows or bumper pads, and crib rails should be up. In addition, all photos must show complete compliance with infection control standards for a neonatal intensive care unit setting: simple rings only, no bracelets, short natural nails, and full barrier precautions for any invasive procedures (sterile drapes, gowns, hats, masks, gloves). We evaluate historic photographs on their own merits, given the relevance to the manuscript context.
Figures are often used to demonstrate trends, patterns, and relationships among concepts. Figures frequently provide a visual explanation of the sequence of events; for example, flow diagrams enhance understanding of caregiving protocols and bundles, especially when several decisions need to made along the way. For example, Figure 1 in the article by Siewert et al4 in this issue provides an easy to follow illustration of the sequence of the intervention sessions. Figures also can be used to describe sample selection in a research study or sample attrition that occurs after a sample has been recruited. Selection of colors and shapes is important and can make your figure either easier or more difficult to understand. A figure with lots of different shapes that are not meaningfully chosen can seem beautiful to you and too busy to a reader. Beware, and please have others look at your figure. Ask them to make sure they can easily understand the image without the supporting manuscript text. Figures should be able to stand alone. Figures are easily created in PowerPoint. Artwork generated from office suite programs such as CorelDRAW, MS Word, and Excel and artwork downloaded from the Internet (JPEG or GIF files) cannot be used because the quality is poor when printed. Creating and saving a figure in a single PowerPoint slide is best for uploading with your manuscript. If you are not comfortable creating your figure in this way, try to get some help from your institution. There are also tutorials available online for creating figures, such as http://xcorr.net/2010/06/19/video-tutorial-adobe-illustrator-for-scientists/. Or another place to check out is YouTube.com. There are several tutorials available through the site to help you with creation of illustrations for your manuscripts. Last but not least, our journal uses the American Medical Association (AMA) standards for publication, and they provide good examples for creating figures.5 All pictures and figures must be labeled with a title that describes the image. Titles should be short, clear, and informative.
WHAT MAKES A GOOD TABLE?
As with figures and images, tables can be used to enhance the text of your manuscript and should not be repetitive of content in the text or a figure or graph. Data presented in tables often allow for easier comparison of results rather than when presented in a long list of items and detailed in the manuscript. For example, each of the 4 tables found in the article by Vance et al6 in this issue provides clear concise information that adds to the content of the article. Please review these tables; the authors chose different styles to best highlight the data presented. There is no one style for a table, although there are recommended methods for presenting some statistical results (see the AMA guidelines for details about table styles). Tables need to be clear and concise, with well-labeled columns. However, too many columns or rows can detract from the clarity of your table, so think about what data are essential to present in your table. To increase clarity, present all data in a consistent fashion to minimize confusion for the reader. For example, you should portray all similar data in a table in the same format; do not use means with percentiles, but instead choose to use one or the other. Every table must have a title and must be referred to in the body of the manuscript. Tables must be numbered in order of appearance and should be included in separate Word files whenever possible, rather than in the same file as the manuscript. Putting all images (tables, figures, pictures, and graphs) in separate files makes formatting the files easier at later stages in the publication process.
WHAT MAKES A GOOD GRAPH?
Graphs are used to summarize research results or quality improvement findings when the general pattern of the findings is more important to increasing understanding than the exact data values. Most statistical software programs will create graphs upon request with statistical computations. Depending on the results, data can be depicted in several different formats, such as bar or line graphs, data plots, maps, and pie charts. Each format can be visualized in the statistical program, and the one that best depicts the data can be chosen to be included in your manuscript. An example of a well-designed bar graph is provided in the Figure in the article by Bosque7 in this issue. Well-designed examples of line graphs that show trends and patterns of feeding behaviors over time can be found in the article by Medoff-Cooper et al8 in this issue. Graphs can easily be created with data in PowerPoint, regardless of the statistics that have been obtained within other software. Graphs for ANC should be created in full color and should be well labeled on both the X and Y axes. Graphs also require short, clear, and informative titles, and finally, graphs need to be able to stand alone. Remember that some readers will look at your graphs, or even tables, without reading your manuscript, and they should be able to understand the image without having to search through the manuscript for more information.
HOW MANY TABLES, FIGURES, AND GRAPHS SHOULD I ADD?
It has been suggested that 1 picture, figure, table, or graph be used for every 1000 words in a manuscript,2 which translates to about 2 visual images for every 3 pages of print materials, given that about 750 words make up 1 page in ANC. We suggest you think about an image for every other print page, that way there is an image on each 2-page spread of the journal. Having an image breaks the text and briefly rests the brain. Moreover, during this pause, there is the opportunity for the materials from both the text and the image to be merged and absorbed comprehensively as a whole, furthering the learning of the material. As noted above, these images, when created properly, add to the understanding of the content in the manuscript. Images also make the journal pages visually appealing. Some journals limit the number of images (pictures, figures, tables, and graphs) submitted with a manuscript; at this point, ANC does not have a limit within our guidelines but we would recommend not exceeding 5 to 6. Additional images may be considered for supplemental digital content that will be available online only (see the ANC author guidelines1 for more details).
Please do not be afraid of the writing process; we are here to help you through this journey. Please do add pictures, figures, tables, and graphs to your manuscript as appropriate for your topic. If you cannot find the right figure or picture to enhance your manuscript, please let us know in your cover letter so we can assist you in finding an appropriate image or so we can suggest something else that might work even better. If you share your questions about artwork we can work with you to produce the best manuscript for publication. Please refer often to our author guidelines during the writing process; details for using pictures, figures, tables, and graphs are outlined within the guideline. Finally, remember that ANC is a 4-color journal. We would like to use that feature to enhance your work, so submitting your pictures, figures, and graphs in full color is important. However, more importantly making sure you follow the guidelines about the quality of pictures is essential, so the images we use are clear and easy for our readership to understand. In the editorial process we will do everything we can to help you enhance your work and increase its scholarly application to improving neonatal care and outcomes.
If you are a reviewer for ANC, the next time you are asked to review a manuscript, please consider the visual quality of the manuscript and make recommendations to improve the images and artwork. Help us and the authors to increase their creativity and enhance their work. We want ANC to be the best journal in neonatal care, with articles that help us to enhance our caregiving and patient outcomes.
Thank you for your support!
Jacqueline M. McGrath, PhD, RN, FNAP, FAAN
Co-Editor; Advances in Neonatal Care
Debra Brandon, PhD, RN, CNS, FAAN
Co-Editor; Advances in Neonatal Care