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Editorial

Reporting on Quality Improvement Projects

Where's the Quality?

Kennedy, Maureen Shawn MA, RN, FAAN; Barnsteiner, Jane PhD, RN, FAAN

Author Information
AJN, American Journal of Nursing: September 2016 - Volume 116 - Issue 9 - p 7
doi: 10.1097/01.NAJ.0000494669.77723.54
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Abstract

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Figure.:
Maureen Shawn Kennedy

It's September, and nursing faculty and students are heading back to school. Faculty are likely applying finishing touches to course objectives and resource materials. And students in the final year of their master's degree or doctor of nursing practice (DNP) program may be preparing a final paper describing their “capstone” project. We receive many such papers and, given our mission to publish evidence-based information to assist nurses in providing quality care, we actively seek well-written papers about quality improvement (QI) initiatives.

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Figure.:
Jane Barnsteiner

Increasing submissions is something all editors strive for. Yet far too many of the QI papers we receive are poorly written and based on projects that are ill-conceived and poorly executed. When papers are inherently flawed, they take up editors’ and reviewers’ time. And what's worse, student authors—who are under the illusion that their papers are of high quality because they were encouraged to submit by faculty advisers—remain unequipped to mount QI initiatives or to publish scholarly work.

Like most other peer-reviewed nursing journals, AJN follows guidelines for the preparation of scholarly papers; and for reporting QI initiatives, there are the newly revised Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines. These guidelines were revised to allow for a wider array of QI formats and for a more user-friendly experience, including a checklist for authors (see http://bit.ly/2a3WuRh). It's apparent that many students are unaware of these guidelines, which suggests faculty are failing to provide students with the information they need to succeed.

Of 67 papers submitted as QI reports to AJN between June 2014 and June 2016, 40 were rejected outright because they weren't really QI papers or lacked critical details. For example, authors failed to do baseline measurements before their project or didn't account for other variables and often overstated the significance of the intervention. Many projects were little more than a one-time education intervention in one setting with no measurement of impact on outcomes or no evidence of sustainability over time. Many lacked detail about the intervention or information about the validity and reliability of the measurement tool. Of the remaining 27 papers, 18 were eventually rejected because authors didn't revise sufficiently to meet SQUIRE guidelines or declined to revise altogether, two were accepted after revision, and seven are still pending revisions.

AJN isn't alone—many other nursing journal editors report similar experiences, so much so that some of us who are members of the International Academy of Nursing Editors (INANE) have spearheaded an initiative to raise awareness of these issues. A survey of INANE members revealed that most of the “problem papers” were written by students in doctoral programs, notably DNP programs, in which they are often required to submit papers for publication as part of course requirements.

The Essentials of Doctoral Education for Advanced Nursing Practice, the document guiding curriculum development for DNP programs, identifies manuscripts submitted for publication as an appropriate final outcome to demonstrate scholarship. But how many schools follow the qualifying caveat, that this final DNP project be a “tangible and deliverable academic product that is derived from the practice immersion experience and is reviewed and evaluated by an academic committee”? Judging from some of the papers we've received, it's hard to believe they passed the muster of an academic committee.

Schools requiring students to write and submit a publishable paper need to support that objective, just as they need to support clinical learning objectives. The first step is ensuring that the student's project is well designed and executed—no amount of good writing can fix a fatally flawed project. Second, schools need to support scholarly writing as a learned skill that requires knowledge, critique, and coaching over time; it cannot be a one-shot, one-paper process. Third, faculty need to have the ability and availability to assist students. Not to provide the necessary support sets students up to fail, and in the end, diminishes the depth, breadth, and quality of scholarly nursing work.

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