Received: 4 May 2017
|
Accepted: 4 May 2017
DOI: 10.1002/nur.21803
EDITORIAL
The Discussion Section Tells Us Where We Are K E Y W O R D S : publishing, research dissemination, scholarly communication, scholarly writing
In the Discussion section of a research report, the study’s results are
the Background is limited to the narrow question pursued in the study,
situated for the reader in the context of past and future research,
and almost all related literature is saved for the Discussion. Either way,
clinical evidence, and theory. The author must look forward and
when the Background has not provided the state of the science on
backward to demonstrate to what degree, if any, the present work has
which the present work was based, to learn of it later can frustrate an
moved the science forward, and where the field should go next. This
invested reader.
section may require more thought and effort than any other part of a manuscript. If science is a long and winding road, and research is how we move forward on that road, then the Discussion section should show the
Overplaying significance of findings, particularly when not significant
reader on a roadmap (or GPS system) how far we have moved after
Reviewers and editors are particularly unhappy when authors claim
the present study, if we have moved at all. Keeping this principle in
some kind of importance for findings that fail to reach the previously
mind, writers can craft accurate and useful Discussions.
identified indicator of statistical significance, are in fact only a very small contribution to the literature, or could have been predicted by someone familiar with the field. This occurs in both qualitative and
TH ESE O BS CU RE OU R LOCAT I ON O N T HE ROAD OF SCIENCE
quantitative reports. It conveys wishful thinking or naiveté at best, and deception at worst. Another version of this risk is claiming to have conducted the first study of its kind. This claim does not augment the importance of the contribution and cannot reliably be known,
Repeating the results
regardless of the level of expertise and seniority of the authors.
Many authors begin the Discussion by summarizing the study’s results. This is rarely necessary. Although the author may have produced the results many months ago and believe that reminders are needed,
Downplaying or ignoring significance of findings when lessons can be learned
the reader has just read them in the preceding section. If the results were extremely complex and occupied many pages of text, it may be helpful to clarify the most important findings, as discussed later, but in a terse manuscript, it is frustrating for readers to re-read what they
On the other hand, authors may be so close to their work that they fail to see a contribution to the larger understanding in the field that is worthy of discussion. Pointing out lessons learned from a failed intervention or lack of support for a hypothesized relationship may
have just read.
enable others to avoid pursuing the same path. By the same token, an atypical or unexpected finding may hold the key to an important new
Introducing new results
direction. When the relevance of the present work to the larger field is
To emphasize a point or explain a puzzling outcome, authors may offer
not accurately portrayed, readers may doubt the authors’ depth of
findings from an aspect of the project that was not described in the
familiarity with the field.
methods or results sections. This irritates readers who thought they already had been given an understanding of the project as a whole and do not have enough information to evaluate the credibility of
Over-reaching or under-reaching in suggesting future research or clinical applications
the new data. Over-reaching is much more common than under-reaching. Authors
Introducing literature that was needed earlier
may see this content as required, or feel an obligation to provide some kind of useful recommendations in return for their own and others’
Perhaps most commonly when a study is a multi-year project, the
investment in the study. One example of over-reaching is presuming
Background section of the report may have reflected only what was
causality based on statistical association. When the recommendations
known at the outset of the project. In some journals’ stylistic traditions,
are to conduct studies for which a foundation does not exist or use
Res Nurs Health. 2017;9999:1–3.
wileyonlinelibrary.com/journal/nur
© 2017 Wiley Periodicals, Inc.
|
1
2
KEARNEY
|
clinical practices that were not actually tested, reviewers and editors
from the minute facts of the results just presented and readies them to
worry a great deal, because readers who skipped the method section
learn what can be gained from these results in the context of the
or lack training to understand it may take unsound recommendations
study’s purpose, design, and methods.
at face value. Even when work is clearly groundbreaking and important, readers should beware when the author indicates that
Effectively placing results in context
they “must” change an approach or adopt a practice. One study is rarely sufficient evidence on which to base a change. On the other extreme, when authors offer no implications of their work for future research or practice, reviewers and editors may question the authors’ familiarity with the pressing issues of the discipline. This can occur when the authors are not immersed in the study’s field, as when social scientists study nursing practice because they have access to data but are not immersed in the literature of the discipline.
The context of a study incudes the scientific, clinical, social, and political, and sometimes epistemological worlds to which it might contribute. All are worth considering for comment. A common first paragraph of a Discussion section is a description of how the findings support or contradict past reports. There is no obligation to mention every past report with which the results are congruent and every report with which they are not, even if all were cited in the Background. Better to provide a synthesis and summary of how the results should be judged, with citations as appropriate. If the results were congruent with all past reports, this can be stated simply and briefly. If this congruence is surprising, given improvements in the
T H E S E C L E A R T H E WI N D S H I E L D T O RE V E A L OUR P R O G R E SS
vehicle in the present study (e.g., stronger design, sample, or measures), those points are helpful. If a result contradicts past reports, authors can discuss the degree to which the finding is trustworthy (not
Accurately appraising what was learned from the study
threatened greatly by statistical or other error). Then they can discuss why that may have occurred and whether it is important as a step forward along the scientific path.
In an effective Discussion, the author takes a step back to show the
The scientific context of any research is complex and
reader the big picture of how far this study has moved knowledge
multifaceted. Deciding which aspects of the present study are
forward. To gain this view, readers need a wide-angle perspective of
important and helping readers understand that judgment is the
their present location on the map of the field. Readers are grateful
most challenging aspect of framing a Discussion. To give readers
when authors clearly and concisely depict how the results do or do
the broad view they need, authors can remind them of how the
not move the science forward. Readers’ confidence grows when the
present work fits into the major initiatives in the field. If the
Discussion provides a road map of where they are after this study,
present work was an exploratory side trip off the main highway of
in comparison to where they were before.
discovery, authors can remind readers of that main direction and
To provide this accurate appraisal, authors should remind
indicate the likelihood, if any, that the current project could offer
readers of the project’s overall goals, and the limits of the approach
an alternate route. If the effort led to a dead end, this is valuable
taken to reach them. Whether the goals were modest, such as to
to know. If the work makes a meaningful contribution to progress
validate an instrument or determine the opinions of a small target
down the main road, authors should depict this and justify it based
group, or grand, such as conducting a meta-analysis of the effects of
on the rigor of the present work. The typical study produces
a widely used clinical approach, authors should be transparent in
incremental progress. This is valuable, given the complexity of
their reporting of what was done and what they realistically could
knowledge development, but readers should be reminded to zoom
hope to achieve. To further stretch the roadmap metaphor,
out from the close-up map view and remember how far there is yet
providing a realistic picture of the present study helps readers
to go.
remember whether they are traveling in an old subcompact car with
From the scientific context, authors can move to the clinical and
many hungry children aboard or a sleek high-speed roadster without
social contexts and beyond. Maybe an exciting statistical discovery
passengers. The distance we can hope to travel in one vehicle is very
really has no impact at all on business as usual outside research. That is
different than in the other.
perfectly fine. On the other hand, If a study was designed to depict the
This reminder of the study vehicle can be as simple as starting
extent of a problem in a population not previously studied, test a less
with, for example, “This descriptive correlational study was adequately
expensive treatment that was found less effective, or try an approach
powered and with a sufficiently diverse sample to achieve its aims of
that was found effective but would be prohibitively expensive to use
determining statistical relationships between (conditions of interest)
in practice, those results should be placed in their social and clinical
and (outcome of interest). The findings may provide a new perspective
contexts. Similarly, the political context of results is important when
on (condition) and can serve as a step toward evaluating the potential
they indicate, for example, that prevailing health policies are doing
for an intervention to modify (condition of interest) in hope of creating
harm. A strong qualitative study can contribute to the epistemological
improvement in (outcome). Nonetheless, caution is needed in
context of care, when an objective clinical indicator of a health
interpreting the results, given the nature of the sample, measures,
problem is convincingly supplanted by an emotional or social view of
and design.” This type of Discussion opening helps readers step back
it from the experiencing subjects. Authors have the responsibility to
KEARNEY
|
3
recognize the big picture surrounding their research ventures and
make sense to recommend redoing the study with better measures
direct the reader to appreciate accurately the scale and significance of
and a larger or different sample. Perhaps the science has taken a new
the contribution.
direction in the meantime that is more feasible or profitable. Again, taking a step back to appraise the landscape enables the author to
Acknowledging limitations
guide the reader along the road.
Readers are accustomed to seeing a section of the Discussion on limitations of the study’s scope, design, methods, and enactment—the study’s vehicle, its drivers, and the road conditions they encountered. Would this result have occurred under different conditions? Would I
Exercising caution in recommending change to clinicians
have taken so long to get home if I were in my fast new car at midnight,
RINAH articles are not required to include clinical recommendations,
and not on my old motor scooter in rush hour? The Discussion should
and clinicians are not our primary audience. Given the incremental
provide readers with interpretation of the results while taking all
nature of much research in nursing science and the great vulnerability
relevant context into account.
of patients whom nurses serve, recommendations for practice require
Certainly the study conditions must shape readers’ understanding
careful deliberation. Here, the assumption that association equals
of its contribution to progress, but if relegated to a section near the
causality is dangerous. The temptation is great to recommend
end, the reader may struggle to evaluate them. In my view, limitations
widespread adoption of a behavior that was found statistically related
are easier for readers to grasp when woven into the appraisal of the
to a health outcome and seems harmless. Unless experimental
study in its scientific context as described above than in a separate
evidence is adequate, it is better to be safe than sorry. A lesser risk
section. Specific limitations affect interpretation of specific findings,
but still worth mentioning is the common recommendation that an
and the author must help readers link them. The easiest way to do this
assessment measure only tested in research samples be used in clinical
is to present the degree of progress achieved, whether large, small, or
settings. Clinical studies are needed to establish its predictive validity
nonexistent, along with the reminder about the vehicle being used to
before it is put to widespread use. Nonetheless, many studies can
achieve it.
provide food for thought for clinicians. In some cases, one can sensitize clinicians to possibilities to consider and suggest they be alert for the
Providing concrete and justified recommendations for researchers
kind of definitive research still needed. The deliberation reflected in a Discussion section is an essential component of a fully considered piece of scientific work. Whether
A research journal like RINAH exists mainly to provide scientists with
they were driving a hugely expensive randomized controlled trial or a
building blocks of evidence that can be foundations for future studies.
tiny exploratory case study, the authors’ careful synthesis of where we
Realistic and thoughtful recommendations for further research in the
as readers were before this study, where we are now, and caveats on
area are very important. Authors may have recommendations for
how we got there are critically important for those who might seek to
design and methods or for questions or hypotheses. When the authors
use the report to guide next steps.
are the best positioned in the field to say where to go next, underreaching in research recommendations greatly diminishes the value of the article. To avoid over-reaching or under-reaching, authors must
Margaret H. Kearney
make a calm and clear-eyed appraisal of what was and was not
Editor
accomplished in the present study and whether to continue in this
University of Rochester
direction or head in another. If one’s perspective has shifted over the
Correspondence
course of the study, this insight is valuable and should be shared. After
Margaret H. Kearney, University of Rochester,
acknowledging weak measurements and an inadequate sample that
Rochester, New York.
made answering a research question impossible, it may not always
Email: [email protected]
|
Accepted: 4 May 2017
DOI: 10.1002/nur.21803
EDITORIAL
The Discussion Section Tells Us Where We Are K E Y W O R D S : publishing, research dissemination, scholarly communication, scholarly writing
In the Discussion section of a research report, the study’s results are
the Background is limited to the narrow question pursued in the study,
situated for the reader in the context of past and future research,
and almost all related literature is saved for the Discussion. Either way,
clinical evidence, and theory. The author must look forward and
when the Background has not provided the state of the science on
backward to demonstrate to what degree, if any, the present work has
which the present work was based, to learn of it later can frustrate an
moved the science forward, and where the field should go next. This
invested reader.
section may require more thought and effort than any other part of a manuscript. If science is a long and winding road, and research is how we move forward on that road, then the Discussion section should show the
Overplaying significance of findings, particularly when not significant
reader on a roadmap (or GPS system) how far we have moved after
Reviewers and editors are particularly unhappy when authors claim
the present study, if we have moved at all. Keeping this principle in
some kind of importance for findings that fail to reach the previously
mind, writers can craft accurate and useful Discussions.
identified indicator of statistical significance, are in fact only a very small contribution to the literature, or could have been predicted by someone familiar with the field. This occurs in both qualitative and
TH ESE O BS CU RE OU R LOCAT I ON O N T HE ROAD OF SCIENCE
quantitative reports. It conveys wishful thinking or naiveté at best, and deception at worst. Another version of this risk is claiming to have conducted the first study of its kind. This claim does not augment the importance of the contribution and cannot reliably be known,
Repeating the results
regardless of the level of expertise and seniority of the authors.
Many authors begin the Discussion by summarizing the study’s results. This is rarely necessary. Although the author may have produced the results many months ago and believe that reminders are needed,
Downplaying or ignoring significance of findings when lessons can be learned
the reader has just read them in the preceding section. If the results were extremely complex and occupied many pages of text, it may be helpful to clarify the most important findings, as discussed later, but in a terse manuscript, it is frustrating for readers to re-read what they
On the other hand, authors may be so close to their work that they fail to see a contribution to the larger understanding in the field that is worthy of discussion. Pointing out lessons learned from a failed intervention or lack of support for a hypothesized relationship may
have just read.
enable others to avoid pursuing the same path. By the same token, an atypical or unexpected finding may hold the key to an important new
Introducing new results
direction. When the relevance of the present work to the larger field is
To emphasize a point or explain a puzzling outcome, authors may offer
not accurately portrayed, readers may doubt the authors’ depth of
findings from an aspect of the project that was not described in the
familiarity with the field.
methods or results sections. This irritates readers who thought they already had been given an understanding of the project as a whole and do not have enough information to evaluate the credibility of
Over-reaching or under-reaching in suggesting future research or clinical applications
the new data. Over-reaching is much more common than under-reaching. Authors
Introducing literature that was needed earlier
may see this content as required, or feel an obligation to provide some kind of useful recommendations in return for their own and others’
Perhaps most commonly when a study is a multi-year project, the
investment in the study. One example of over-reaching is presuming
Background section of the report may have reflected only what was
causality based on statistical association. When the recommendations
known at the outset of the project. In some journals’ stylistic traditions,
are to conduct studies for which a foundation does not exist or use
Res Nurs Health. 2017;9999:1–3.
wileyonlinelibrary.com/journal/nur
© 2017 Wiley Periodicals, Inc.
|
1
2
KEARNEY
|
clinical practices that were not actually tested, reviewers and editors
from the minute facts of the results just presented and readies them to
worry a great deal, because readers who skipped the method section
learn what can be gained from these results in the context of the
or lack training to understand it may take unsound recommendations
study’s purpose, design, and methods.
at face value. Even when work is clearly groundbreaking and important, readers should beware when the author indicates that
Effectively placing results in context
they “must” change an approach or adopt a practice. One study is rarely sufficient evidence on which to base a change. On the other extreme, when authors offer no implications of their work for future research or practice, reviewers and editors may question the authors’ familiarity with the pressing issues of the discipline. This can occur when the authors are not immersed in the study’s field, as when social scientists study nursing practice because they have access to data but are not immersed in the literature of the discipline.
The context of a study incudes the scientific, clinical, social, and political, and sometimes epistemological worlds to which it might contribute. All are worth considering for comment. A common first paragraph of a Discussion section is a description of how the findings support or contradict past reports. There is no obligation to mention every past report with which the results are congruent and every report with which they are not, even if all were cited in the Background. Better to provide a synthesis and summary of how the results should be judged, with citations as appropriate. If the results were congruent with all past reports, this can be stated simply and briefly. If this congruence is surprising, given improvements in the
T H E S E C L E A R T H E WI N D S H I E L D T O RE V E A L OUR P R O G R E SS
vehicle in the present study (e.g., stronger design, sample, or measures), those points are helpful. If a result contradicts past reports, authors can discuss the degree to which the finding is trustworthy (not
Accurately appraising what was learned from the study
threatened greatly by statistical or other error). Then they can discuss why that may have occurred and whether it is important as a step forward along the scientific path.
In an effective Discussion, the author takes a step back to show the
The scientific context of any research is complex and
reader the big picture of how far this study has moved knowledge
multifaceted. Deciding which aspects of the present study are
forward. To gain this view, readers need a wide-angle perspective of
important and helping readers understand that judgment is the
their present location on the map of the field. Readers are grateful
most challenging aspect of framing a Discussion. To give readers
when authors clearly and concisely depict how the results do or do
the broad view they need, authors can remind them of how the
not move the science forward. Readers’ confidence grows when the
present work fits into the major initiatives in the field. If the
Discussion provides a road map of where they are after this study,
present work was an exploratory side trip off the main highway of
in comparison to where they were before.
discovery, authors can remind readers of that main direction and
To provide this accurate appraisal, authors should remind
indicate the likelihood, if any, that the current project could offer
readers of the project’s overall goals, and the limits of the approach
an alternate route. If the effort led to a dead end, this is valuable
taken to reach them. Whether the goals were modest, such as to
to know. If the work makes a meaningful contribution to progress
validate an instrument or determine the opinions of a small target
down the main road, authors should depict this and justify it based
group, or grand, such as conducting a meta-analysis of the effects of
on the rigor of the present work. The typical study produces
a widely used clinical approach, authors should be transparent in
incremental progress. This is valuable, given the complexity of
their reporting of what was done and what they realistically could
knowledge development, but readers should be reminded to zoom
hope to achieve. To further stretch the roadmap metaphor,
out from the close-up map view and remember how far there is yet
providing a realistic picture of the present study helps readers
to go.
remember whether they are traveling in an old subcompact car with
From the scientific context, authors can move to the clinical and
many hungry children aboard or a sleek high-speed roadster without
social contexts and beyond. Maybe an exciting statistical discovery
passengers. The distance we can hope to travel in one vehicle is very
really has no impact at all on business as usual outside research. That is
different than in the other.
perfectly fine. On the other hand, If a study was designed to depict the
This reminder of the study vehicle can be as simple as starting
extent of a problem in a population not previously studied, test a less
with, for example, “This descriptive correlational study was adequately
expensive treatment that was found less effective, or try an approach
powered and with a sufficiently diverse sample to achieve its aims of
that was found effective but would be prohibitively expensive to use
determining statistical relationships between (conditions of interest)
in practice, those results should be placed in their social and clinical
and (outcome of interest). The findings may provide a new perspective
contexts. Similarly, the political context of results is important when
on (condition) and can serve as a step toward evaluating the potential
they indicate, for example, that prevailing health policies are doing
for an intervention to modify (condition of interest) in hope of creating
harm. A strong qualitative study can contribute to the epistemological
improvement in (outcome). Nonetheless, caution is needed in
context of care, when an objective clinical indicator of a health
interpreting the results, given the nature of the sample, measures,
problem is convincingly supplanted by an emotional or social view of
and design.” This type of Discussion opening helps readers step back
it from the experiencing subjects. Authors have the responsibility to
KEARNEY
|
3
recognize the big picture surrounding their research ventures and
make sense to recommend redoing the study with better measures
direct the reader to appreciate accurately the scale and significance of
and a larger or different sample. Perhaps the science has taken a new
the contribution.
direction in the meantime that is more feasible or profitable. Again, taking a step back to appraise the landscape enables the author to
Acknowledging limitations
guide the reader along the road.
Readers are accustomed to seeing a section of the Discussion on limitations of the study’s scope, design, methods, and enactment—the study’s vehicle, its drivers, and the road conditions they encountered. Would this result have occurred under different conditions? Would I
Exercising caution in recommending change to clinicians
have taken so long to get home if I were in my fast new car at midnight,
RINAH articles are not required to include clinical recommendations,
and not on my old motor scooter in rush hour? The Discussion should
and clinicians are not our primary audience. Given the incremental
provide readers with interpretation of the results while taking all
nature of much research in nursing science and the great vulnerability
relevant context into account.
of patients whom nurses serve, recommendations for practice require
Certainly the study conditions must shape readers’ understanding
careful deliberation. Here, the assumption that association equals
of its contribution to progress, but if relegated to a section near the
causality is dangerous. The temptation is great to recommend
end, the reader may struggle to evaluate them. In my view, limitations
widespread adoption of a behavior that was found statistically related
are easier for readers to grasp when woven into the appraisal of the
to a health outcome and seems harmless. Unless experimental
study in its scientific context as described above than in a separate
evidence is adequate, it is better to be safe than sorry. A lesser risk
section. Specific limitations affect interpretation of specific findings,
but still worth mentioning is the common recommendation that an
and the author must help readers link them. The easiest way to do this
assessment measure only tested in research samples be used in clinical
is to present the degree of progress achieved, whether large, small, or
settings. Clinical studies are needed to establish its predictive validity
nonexistent, along with the reminder about the vehicle being used to
before it is put to widespread use. Nonetheless, many studies can
achieve it.
provide food for thought for clinicians. In some cases, one can sensitize clinicians to possibilities to consider and suggest they be alert for the
Providing concrete and justified recommendations for researchers
kind of definitive research still needed. The deliberation reflected in a Discussion section is an essential component of a fully considered piece of scientific work. Whether
A research journal like RINAH exists mainly to provide scientists with
they were driving a hugely expensive randomized controlled trial or a
building blocks of evidence that can be foundations for future studies.
tiny exploratory case study, the authors’ careful synthesis of where we
Realistic and thoughtful recommendations for further research in the
as readers were before this study, where we are now, and caveats on
area are very important. Authors may have recommendations for
how we got there are critically important for those who might seek to
design and methods or for questions or hypotheses. When the authors
use the report to guide next steps.
are the best positioned in the field to say where to go next, underreaching in research recommendations greatly diminishes the value of the article. To avoid over-reaching or under-reaching, authors must
Margaret H. Kearney
make a calm and clear-eyed appraisal of what was and was not
Editor
accomplished in the present study and whether to continue in this
University of Rochester
direction or head in another. If one’s perspective has shifted over the
Correspondence
course of the study, this insight is valuable and should be shared. After
Margaret H. Kearney, University of Rochester,
acknowledging weak measurements and an inadequate sample that
Rochester, New York.
made answering a research question impossible, it may not always
Email: [email protected]
