More strategies for enhancing your message

AORN Journal, Jan, 2007 by Cynthia Saver

Readers absorb information through words and images. When used together, these two elements can increase the effectiveness of your article and enhance readers' retention of key points. Last month's column discussed tables and basic figures, such as line, pie, and bar graphs and how to submit them. Now that you have a handle on the basics, you can consider more intricate figures, as well as illustrations and photographs.

GRAPHS: BEYOND THE BASICS

Two types of two-axis graphs you might want to include in your menu of choices are histograms and scatter grams, also called scatter plots. You may want to consult a statistician or an experienced researcher to determine whether these graphs are appropriate for your article.

Use histograms (Figure 1) to show frequency distribution. To create this type of graph, divide the range of the variable into class intervals. These intervals are groups of data points for each variable, and each group is a range of values. Then use vertical bars to represent how often each class occurs. Each bar will have the same width, but the height will vary to reflect the frequency for each class interval. Unlike a simple bar graph, the bars in a histogram touch each other because the measurement is continuous (eg, the sequential months in Figure 1).

[FIGURE 1 OMITTED]

Histograms, which commonly are used to show the distribution of cases for quality improvement studies, easily point out the outliers and help identify data distribution trends. For example, in the figure, you can see a spike in the incidence of falls in March and April, which might lead you to reexamine reports for those months to detect patterns and external factors that could account for the change, such as unusually high staff vacancies in those months.

Choose a scattergram when you want to show whether two variables correlate. A straight regression line through the data points shows a linear (ie, strong) correlation (Figure 2). The independent variable is on the horizontal axis and the dependent variable is on the vertical axis. The correlation coefficient (eg, "R" in the figure) is a number between -1 and 1 that indicates the strength of the relationship between the two variables. A zero indicates no linear correlation.

[FIGURE 2 OMITTED]

ILLUSTRATIONS

Illustrations such as flowcharts, decision trees or algorithms, and drawings can clarify complex processes for readers. Use flowcharts to show a sequence of complex events or processes. For example, flowcharts are helpful in presenting steps in a research protocol and recruitment and retention of study participants (Figure 3).

[FIGURE 3 OMITTED]

A flowchart that shows decision points is commonly called an algorithm. Many nurses are familiar with the advanced cardiac life support algorithms. Each algorithm offers a decision tree for managing patients who have a serious cardiovascular problem. In an algorithm, a decision point usually is phrased as a question, followed by choices linked to the options for the answer, which is commonly "yes" or "no". An example of an algorithm is shown in Figure 4.

[FIGURE 4 OMITTED]

Drawings are ideal for depicting a device or how it works. Use them in tandem with the text to explain procedures. Figure 5, for example, shows the location of an intra-aortic balloon pump (IABP) catheter inside a patient and how it works. The authors of the article about IABP presented information in the text and used drawings to give the reader a visual image to emphasize the explanation. Be sure the explanation in your article matches the figure.

[FIGURE 5 OMITTED]

PHOTOGRAPHS

Photographs can replace many words of text, for example, when you discuss equipment, wound types, and physical outcomes. In Figure 6, the author uses a photograph to illustrate the advantages of using a custom cradle tray to hold specialty instruments. You can label elements in the photograph for additional clarification.

[FIGURE 6 OMITTED]

Most journals request that you submit high-resolution, digital photographs that you can send by e-mail or post on a journal's manuscript submission web site. If you submit hard copy photographs, make sure they are of good quality. Do not send Polaroid photographs because they are not of sufficient quality to print.

Submit close-up photographs that highlight the procedure or device, and be sure the image is well lit. Obtain permission from staff members, patients, or anyone else in the photograph in accordance with the journal's guidelines. Many journals, such as the AORN Journal, have a permission form you can use; otherwise, contact the media relations department of the organization where the photograph was taken for a release form, and submit a signed copy to the journal. It is best not to take photographs that identify patients, even if they sign a release form.

IMAGE CREATION

Be creative with illustrations and photographs. For instance, consider using a map to highlight the prevalence of obesity by state when writing about the increase in bariatric surgery. For an article on positioning, you might submit diagrams of the skin's layers to illustrate the changes that occur with pressure. Some journals have a graphics department that can help you create illustrations, so you do not have to be an artist.