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8 Healthcare Research and Academic Writing (Part 2): Finding and Using Sources

T his chapter focuses on the strategies involved in gathering and integrating infor- mation in order to write the sort of research-oriented academic documents explored in chapter 7. The wider-ranging preliminary investigation into a subject

that occurs during the prewriting stage and helps you to narrow down from that subject to a topic, then from topic to thesis (or statement of purpose) gives way as the drafting stage progresses to a more concentrated and detailed engagement with source mate- rials, one that both shapes and is shaped by the developing focus and direction of your essay or report. Over the course of the research process, student writers may find themselves having to seek out answers to many important questions. Where do I look for sources, and how do I search for them effectively? How do I know if the sources I find are useful (or scholarly)? How do I get the information I want to use out of those sources and into my essay or report? What is appropriate documentation, and how (or why) am I supposed to do it? The goal of this chapter is to offer something by way of an answer to most, if not all of these.

FINDING SOURCES

Among the first things to consider as you undertake research for a particular assign- ment is what type of sources you are required to use. Is there an assigned limit with respect to number or type? If not, how many should you be aiming to employ in your paper and of what sort? First, consider the important contextual details of purpose and audience. Since you are writing something either to persuade a well-educated, expert reader (i.e., your instructor) or to inform that reader about your topic, the sources you marshal to the task of helping you address your audience most effectively need to be relevant, authoritative, and scholarly. A scholarly source refers to any research-based book, journal article, or essay written by someone with academic qualifications and affiliation, published by a reputable or university-associated press or in an academic journal, and searchable by way of your university or college library’s system of databases. Journal articles tend to take slight precedence over books with respect to perceived importance and quality, primarily due to the fact that journal articles represent the most current published research in a field, and currency is an especially desirable char- acteristic for a source in the health sciences (and the sciences generally).

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Scholarly sources can be categorized as either primar y or secondar y. A primary source is a first-hand account of something: an experiment, a course of research, an ongoing study. Lab reports and research articles constitute primary sources, as do dissertations and conference papers, published or otherwise. A secondary source consists of anything that draws upon, analyzes, and interprets primary material but doesn’t write up research of its own. Literature reviews, critical analysis essays, refer- ence works (e.g., dictionaries and encyclopedias), and textbooks like this one are examples. One possible strategy for moving from a general subject to a more specific topic during the prewriting stage is to focus initially on secondary sources only, seek- ing out things like review articles, which summarize the prevailing thinking on and discussion of a subject and therefore allow you to find out about some of the topics scholars have addressed. Once you have settled on one or two such possible topics for your own paper, shift your focus to primary sources that document research on those topics, and see what’s out there that engages and interests you the most (Hofmann, 2013). Note that the essay or report that you end up producing (by way of this method or any other) will most likely draw upon and cite both primary and secondary sources. However, some instructors may limit you to using one type or the other in a given assignment, most often primary.

Sometimes, assignment instructions might specify that you are to use only peer-reviewed sources in your paper. And indeed, being peer-reviewed is an important characteristic of the best, often most authoritative scholarly writing. As the condition of its publication, a peer-reviewed source has been rigorously vetted for quality by a group of experts in the subject area. It has been deemed credible and authoritative enough to make a contribution to the ongoing scholarly conversation and (potentially) to be used by other researchers as a source in the future. The peer-review process is a standard part of academic publishing, and it is a way of signalling to other academic readers that a book or essay or journal article has sufficient scholarly merit. Note that most databases now allow you to focus your search on peer-reviewed sources only. And if you are in doubt as to whether or not a book or a journal is peer-reviewed, read its publication details or a description of its editorial practice, either by following the link to that book or journal in your library’s catalogue (as in the screenshot below), or by going directly to the publisher’s website.

Searching in Databases

In terms of seeking out scholarly source material, the best places to go are the discipline- specific subscription databases available through your university or college library. For

Screenshot: Publication details for Journal of Nursing Management (Academic Search Complete, Western Libraries).

Chapter 8: Healthcare Research and Academic Writing (Part 2) 175

healthcare-related disciplines, some of the notable ones are AMED, CINAHL, Medline, ProQuest Nursing and Allied Health Source, PsycINFO, PubMed, and SCOPUS. A more widely available, general scholarly search tool such as Google Scholar is also a fi ne place to start, as is Academic Search Complete. Even a non–healthcare specifi c database like the MLA International Bibliography might prove useful, for some topics related to narrative medicine and healthcare communication in particular. Regardless of where you start or what search tools you employ, to fi nd sources eff ectively you need to be able to recast your topic as a set of searchable terms that you can then alter and adjust as need arises—need usually being determined by the number and quality (or lack thereof ) of the sources your search yields.

As an example, let’s imagine that you are asked to write a report on living with Parkinson’s disease. You decide in trying to narrow down to a possible topic that you want to look at some of the treatment options available to Parkinson’s patients, then go from there. What are the main concepts that inform your topic? How might those become workable search terms?

Look for nouns and noun phrases, and ignore function words (prepositions and conjunctions) and even verbs:

Treatment options for Parkinson’s patients. [Main concepts = Treatment options,

Parkinson’s (since “patients” seems redundant, considering the focus on treatment,

something that is necessarily patient-oriented)]

One strategy is to search each concept separately, then combine the searches. Here, however, since “treatment options” is imprecise and applicable to any sort of disease or ailment, you can anticipate getting an unmanageable number of sources, and that is an unproductive and discouraging way to start. Th us, search both of these terms together, using “AND” to link them. Note that you will have to put “treatment options” in quotation marks to ensure it gets searched as a phrase. Using the database PubMed to start, the combination of “treatment options” and “Parkinson’s” gets you 284 sources.

Th is is a fairly unmanageable number of sources to skim through, even just by look- ing at titles and reading abstracts where necessary. You might notice some common terms recurring in the titles and descriptions of the sources you turn up, and those can help you narrow your focus a little more, hopefully leading to at least slightly fewer results. One of the recurrent terms in this search pertaining to Parkinson’s treatment options is “brain stimulation.” What happens when that gets turned into a concept added to our search string?

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All of a sudden, you have reduced the number of sources considerably (from 284 to 40). Th ere is no reason that you can’t look at all 40 here in some detail before making a decision about whether or not you will have enough useful research to proceed with this particular topic, or whether you will have to alter your search again to broaden it a bit, perhaps generalizing the specifi c surgical intervention “brain stimulation” into the more inclusive category “brain surgery,” or perhaps adding a synonym: “Parkinson’s OR ‘movement disorders.’” Going the other way, if you want to focus things even more, you could make the third term “deep brain stimulation,” and/or you could apply some limits on source date and type (e.g., only within the last fi ve years, only peer-reviewed articles).

EVALUATING YOUR SOURCES

Regarding the amount of source material you end up employing in the course of putting together your essay or report, it matters much less than how useful and credible that source material is. And it is, in fact, possible to employ too many sources in a paper, especially when it is short. You defi nitely need to produce a document that comes across as very well informed and that looks like it is conforming to the basic expec- tations of scholarly writing—namely, that it will incorporate and appropriately cite published research. Th at said, you do not want to hand in something that reads wholly like a pastiche of other people’s words and ideas, with little or no evidence of any

Strategies for Skimming Journal Articles

In order to fi nd and gather information as effi - ciently as you can during the course of your research, you need to be able to assess quickly and accurately which sources are going to warrant closer attention. To do that, you have to know what information to look for in a journal article and where to fi nd it. Since the abstract provides a brief

summary of the article’s contents, start there, then skip down to the very end and see what the discus- sion and/or conclusion section says regarding key fi ndings and their signifi cance. If the article seems like it might be helpful to you, then go back and start at the beginning, reading the introduction and seizing on the research questions or hypoth- esis that defi nes the purpose of the study before making your fi nal decision as to usefulness.

Chapter 8: Healthcare Research and Academic Writing (Part 2) 177

distillation, framing, or analysis of those words/ideas on your part. Thinking gener- ally about differences between exposition and argument, per our discussion of those modes in the previous chapter, a report—being a more information-based type of writ- ing and one less outwardly indicative of your own ideas or opinions—may be likely to have a higher number and concentration of source citations than an essay. But that is certainly not always going to be the case. In the end, there is no particular amount of source material to have in mind when you are getting your research together. You need as many sources as you need to do whatever it is your essay or report is trying to do, however unhelpful that may sound. Quality always takes precedence over quantity.

But how do you assess the quality of a source? While not all peer-reviewed sources are going to be equally useful to you, in terms of overall authority and trustworthiness, there is usually little to question about a scholarly book or article. The problem tends to be with non-scholarly sources, particularly those you find online. And note that when we say online, we are referring to the “open” internet accessible to anyone, not to the “closed,” subscription-only databases that students are able to access through their campus libraries. It is a retrograde approach to think that student writers in particular will limit their research to academic databases alone or that only scholarly sources can be of use in academic writing. Though scholarly books and articles should certainly comprise the majority of the material upon which you draw in essays and reports, some well-chosen non-scholarly sources—newspaper or magazine articles, websites, blogs, wikis, social media postings—can have much to offer by way of usefully supple- menting your research material. Go back to the sample scholarly essay in chapter 7, and look at the way some of the ongoing conversation about healthcare wait times in Canadian media sources (e.g., the National Post and CBC News) is used to frame the argument regarding the benefits of adopting a two-tier system. Particularly if your topic is a timely, relevant one that has been subject to discussion in the media, some- times the most up-to-date information you can get will come from online sources.

Be sure, however, to think very critically about whether or not such sources have intrinsic value that recommends their inclusion in your paper—whether or not they seem to offer you something useful that your scholarly sources don’t. If an online source doesn’t provide anything new or salient with respect to information or offer an approach that might enhance your discussion, then you should not bother with it. But if and when you do consider using a source you find via Google (or Bing or another search engine), there are several questions you then need to pose in order to evalu- ate its potential merit:

■ Who or what is responsible for or behind the source? Is the site sponsored by an organization? Is it affiliated with an institution? If there is any corporate or institutional affiliation, what can you find out about the sponsor? Might there be some sort of political or professional bias inflecting the information or skewing its presentation? Are you being “sold” something, literally or figuratively? Is the site trying to get you to act or to buy something by relying heavily on appeals to pathos, perhaps presenting an especially rosy or particularly dire picture of things? Assuming there is a lack of objectivity as a function of the site’s personal, political, or professional investment in a

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topic, does that pose a problem? Remember that much of your ethos as an academic writer derives from the quality and authority of your sources, and in academic writing authority and objectivity are very closely related.

■ Who is the author? Is there one? What are his or her credentials? What is his or her ethos? Figuring out who wrote a scholarly book or article is never an issue, but figuring out the same with respect to an internet source can often be quite difficult. Not having an identified author isn’t necessarily a deal breaker, but you need to think very carefully about the source’s credibility on other grounds.

■ What is the nature and quality of the information presented? Are citations provided? Frequently, they won’t be, which can make accuracy difficult to discern. Importantly, though, does the information have intrinsic merit? Does it present information not available elsewhere and/or does it present that information in a way that other (scholarly) sources can’t or don’t? Is it multimedia dependent, for example? That’s one of the important, potentially productive ways an online source might differ from a print source. The other, as we have noted, is in terms of currency. Is the source more up-to-date than anything else you’ve come across? Remember that the very thing that can make the information in an online source so useful—its potential timeliness— also speaks to one of the most problematic things about online sources in terms of authority, namely that they are inherently unstable and prone to alteration in ways that print sources are not.

One other thing to note: before evaluating any online source, try to parse the URL back to the homepage first, in the same way you would want to assess a book in its entirety by starting back at the beginning—with the author note, blurb, table of contents, intro- duction—not just picking it up in medias res (in the middle of things). You need to get the full picture of any source at issue in order to assess it fairly and in a fully informed manner.

USING SOURCES: AVOIDING PLAGIARISM

What does it mean to plagiarize, and why is it so important to understand what is at stake in plagiarism, with a view to avoiding it at all costs in your academic writing? Plagiarism is academic dishonesty that entails taking credit for someone else’s intel- lectual property, whether intentionally or not. Determining just what constitutes the intellectual property of another, however, can sometimes be tricky. The useful definition of plagiarism provided by the American Psychological Association (APA) publication manual—perhaps the most authoritative source on correct procedures for academic writing, particularly for those in healthcare fields—acknowledges the occa- sionally murky nature of intellectual property ownership in a passage that cautions against presenting

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the work of another as if it were [your] own work. This can extend to ideas as well as written words. If authors model a study after one done by someone else, the originating author should be given credit. If the rationale for a study was suggested in the Discussion section of someone else’s article, the person should be given credit. Given the free exchange of ideas, which is very important to the health of intellectual discourse, authors may not know where an idea for a study originated. If authors do know, however, they should acknowledge the source; this includes personal communications. (2010, p. 16)

Essentially, the intellectual property of others encompasses any words, ideas, and even inspiration you draw from things you have read (or people you have spoken to) in the course of preparing to write a document. In order to avoid plagiarism, you are required to acknowledge any and all of the sources you draw upon by citing your debt to them appropriately within your essay or report, using a standard citation style (such as APA), and also providing full bibliographic details in a list of references.

The practice of citing sources throughout your researched writing is referred to as documentation. When in doubt as to whether or not you should cite a particu- lar source, the very fact that you are at least thinking on some level that you need to should be reason enough to cite it. Though overciting is possible (since sources of material considered standard information within a particular field of study—major historical facts such as dates, or facts readily available in a wide variety of reference works—need not be acknowledged), it is by far the lesser of two evils when the other option is unintentional plagiarism. So be vigilant about citing anything you think you need to. Following good academic procedure is never wrong, nor is being a fair person who gives credit where it is due.

Most colleges and universities use some sort of plagiarism-checking program, such as Turnitin, and these have made the detection of problems with integrating and docu- menting sources virtually effortless. In our experience, the majority of student writers who have any sort of issue with source acknowledgement or incorporation do not know- ingly take credit for someone else’s work with malicious intent. Instead, they usually plagiarize unintentionally due to one (or both) of two possible issues: they lack sufficient familiarity with their research material or knowledge of how to incorporate research into their writing; they have been too careless in taking notes from their sources (by failing, perhaps, to distinguish between direct quotations and their own paraphrase, or by not copying down correct page numbers). Students can help to prevent careless- ness that results from haste by planning ahead and giving themselves sufficient time for the prewriting processes of rhetorical situation assessment and information gath- ering. Problems that arise out of a lack of knowledge or of comfort with using sources, however, can really only be addressed by learning the correct techniques for incorpo- rating and acknowledging your research and by practising those techniques. To recall the preamble to our overview of grammar, punctuation, and style in chapter 6, prac- tice makes permanent when it comes to the fundamentals of clear, effective writing. The same can be said for the basics of effective source citation and documentation.

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Summary

Information drawn from research sources can be integrated into your essay or report in only three ways. You can summarize it, paraphrase it, or quote it directly. In all instances, the information being drawn from elsewhere must be documented via in-text citation (and corresponding bibliographic entry). A summary distills key ideas from a source and condenses material presented at much greater length in the origi- nal into perhaps a paragraph or less in your paper, depending of course on the length and complexity of the original material being summarized. In the previous chapter, we discussed summary in a couple of different contexts: in an article review, as the means of providing the necessary context for your critical analysis; and in the literature review portion of a formal report, which offers an overview of the relevant contempo- rary and historical research published on your topic. There are two other particular academic writing contexts wherein effective summary is absolutely essential: abstracts and annotated bibliographies.

Abstracts precede scholarly research articles in all disciplines, and they are a standard component in most types of report. As we mentioned earlier in this chapter, abstracts provide an important heuristic for readers, since they offer a brief but accu- rate summary of an article or report’s contents in a single paragraph (approximately 300 words or fewer in the case of research articles, 150 or fewer for most lab reports). One of the keys to writing an effective abstract is to save it for the very end, after your article or report has been completed. That way, writing the abstract will truly be a summative, backward-looking exercise. You will presumably have arrived at a better sense of what it is you actually accomplish in your article or report and/or in the course of the research it discusses. There is actually quite a lot riding on a being able to write a clear, effective abstract, since readers will very often determine whether or not your work is interesting or worth reading solely on the basis of the abstract.

In an annotated bibliography, full bibliographic information for sources is accom- panied by brief descriptions (usually three to five sentences at most) that summarize the content and offer some sort of evaluative commentary that speaks to the relevance and overall quality of the source (including its potential limitations or shortcomings). Here are a couple of examples of annotated bibliography entries for sources used in the sample scholarly essay with which our previous chapter concludes.

Flood, C. M., & Haugan, A. (2010). Is Canada odd? A comparison of European and Canadian approaches to choice and regulation of the public/private divide in health care. Health Economics, Policy and Law, 5, 319–41. doi: 10.1017/ S1744133110000046

Flood and Haugan investigate the ongoing debate over allowing a privatized healthcare option into the Canadian system by way of the famous Chaoulli case from 2005, which asked if it was constitutional for the Quebec government to ban private insurance for medically necessary care in the face of long wait times. Flood and Haugan describe the shortcomings of and failures within this case, such as what steps were neglected and what was overlooked. They utilize six major features

Chapter 8: Healthcare Research and Academic Writing (Part 2) 181

of Canadian healthcare legislation and use this information to draw comparisons between five European countries. The Chaoulli case is a strong case study to utilize within my research because it brought healthcare issues to the forefront of national discussions and debates and highlighted the inefficiencies and inadequacies within the Canadian healthcare system. Although this case took place in Quebec under the Quebec Health Insurance Act, its information is still very applicable to Canada as a whole. The comparative analysis between countries provides insight on how Canada’s system can be improved and where shortcomings lie. Although this comparison is generally useful, not all of the conclusions made by the authors are applicable to the Canadian system due to cultural, structural, and political differences between countries.

Johnson, A. P., & Stuart, H. (2009). Health services research in Canada. In R. Mullner (Ed.), Encyclopedia of health services research. (pp. 559–65). Thousand Oaks: SAGE Publications.

Johnson and Stuart begin their essay by providing a brief historical overview of Canada’s healthcare system and its main goals and objectives, focusing on the idea of health information as well as health service research within Canada. This focus is important as it gives a substantial background as to why and how policies and infrastructures have been implemented within Canada, and explores the continuous developments research institutes and governments have been making in order to stay informed and make decisions based on qualified and substantiated research. This is a useful source because it provides an informative history of the Canadian healthcare system. It also describes how and why research is so important and the effects it has on policy makers, which in turn influences how health care is provided to citizens. While this article does not specifically focus on the two-tiered healthcare model within Canada, it still offers research that suggests how such a model might affect the delivery of care.

Annotated bibliographies may be assigned to take the place of literature review compo- nents or to provide a snapshot of your research in progress as you begin to move from prewriting to the drafting stage. In the latter case, the annotation can provide helpful notes that allow you to remember what you thought about a source in relation to your particular piece of writing (as in the first example above). Regardless of their specifics, all annotated bibliographies are impelled by the same important concern a literature review has of demonstrating some broad knowledge of what has been published on your topic and helping you to situate the place of your essay or report within an ongo- ing scholarly discussion.

To write an effective summary of any sort, you need to be very familiar with the source you are using. Read it over thoroughly, then (in a process akin to critical read- ing) go back over it slowly—or over the particular portion of the document you want to summarize—taking time to identify the key ideas by underlining or highlighting them. After that, try articulating the relevant points in brief, wholly in your own words. And when you have done that to your satisfaction, try combining those rewritten points

Some annotations may demonstrate a reflective aspect in

offering some sense of how or why a

particular source fits into the writer’s essay

or report.

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together in a more condensed and concise manner. Go back and check your draft summary against the original to ensure both that you have covered all the ideas and that you have done so in language and syntax different from the source.

Paraphrase

In paraphrasing, you follow more closely the author’s presentation of material (in terms of length and detail) than you do when summarizing, but you still cast things in your own words. While summary is useful for providing your reader with a broad- strokes overview of a source, paraphrase is better for a closer engagement with, or more focused use of, your primary or secondary research materials. If you want to present an author’s argument or an aspect of her position in a manner and at a length more akin to the original, but you don’t deem the original’s words striking or interesting enough to be worth quoting directly, then paraphrase. As with summary, though, when you paraphrase, it is not enough that your version differs from the original at the level of diction; you need to strive for structural (grammatical and syntactical) difference too in order to avoid plagiarism. Also like summary, any paraphrase you include must be cited accordingly, with author’s name and source date. Note that APA style does not demand that you include a page number in your citations of summary or paraphrase, even though a paraphrase in particular will necessarily seize on a portion of the original that is found on a specific page or couple of pages, something that won’t necessarily be the case with summary. Still, according to the APA manual, when making reference to a point of content from another work by way of paraphrase, “you are encouraged”—but not required—“to provide a page or paragraph number especially when it would help an interested reader locate the relevant passage in a long or complex work” (p. 171).

Because paraphrase entails something more like a one-to-one relationship with your source in terms of length, you need to be wary of the strong potential to produce a version of a passage that is not sufficiently distinct from the original in all ways. Remember that effective paraphrase involves rewriting entirely: not merely chang- ing words but reframing how ideas are conveyed with respect to grammar and syntax. The following example illustrates an attempt to paraphrase part of chapter 3’s descrip- tion of the benefits of attentive listening that falls short by focusing too much on the particulars of diction and not doing enough to recast the original passage on a broader structural level.

Original passage:

“Many patients, even routine users of the healthcare system or those who have

developed prolonged professional relationships with their physicians, home care

nurses, therapists, dentists, or any type of healthcare provider, are not surprisingly

often intimidated during interviews or assessment and may be reluctant to make

self-disclosures. It is therefore imperative that practitioners take the time to critically

absorb all dimensions of a patient’s narrative, and allow the patient to self-edit with the

understanding that the process is more confession than interrogation.”

Chapter 8: Healthcare Research and Academic Writing (Part 2) 183

Ineffective paraphrase:

Lots of patients, even those who regularly seek medical care or who have fostered close

relationships with their doctors, nurses, physiotherapists, or other sorts of healthcare

practitioners over an extended period of time, are still wary of revealing personal

information in the context of being assessed or examined. Healthcare professionals

must thus be patient and vigilant about taking in all aspects of their patients’ personal

stories; they need to give patients the freedom to self-edit, due to what needs to be seen

as the confessional nature of provider-patient interactions.

With perhaps the exception of the rather distinctive term self-edit, this paraphrase does a decent job of staying away from the language used in the original. Certain key words—patients, for example, or practitioners—necessarily have to be used, and it isn’t even an issue that assessment in the original gets rendered as the participle assessed, and confession closely informs the paraphrase’s confessional nature. The problem is that, on the whole, this attempt at paraphrase only consists of swapping out the origi- nal words with synonyms. No attempt at all is made to restructure or rewrite anything. Aside from the troubling fact that it reads in relation to the original as if it were composed by someone who had a thesaurus open next to him, the paraphrase here problemat- ically reproduces a couple of structural elements quite characteristic of the original. Specifically, it retains the list of various practitioners in the first sentence, and it artic- ulates the logical relationship between the sentences in the very same way the source does, merely swapping out one conjunctive adverb (therefore) for another (thus) that serves the same function. And, of course, it is also noteworthy that no attempt at docu- mentation is made either.

How might a more effective paraphrase of the same passage look? Here is one possibility:

Healthcare practitioners must learn to listen carefully and thoughtfully to their

patients’ stories and, as a result of the often-intimidating nature of the clinical

environment, be attuned to the importance of allowing patients to disclose personal

details on their own terms (Arntfield & Johnston, 2016).

While a bit shorter than the original (which is fine), in recasting the source as one sentence instead of two, the paraphrase here makes it easier to ensure there is struc- tural difference. The first sentence of the original, which makes the point about the negative effects the intimidating nature of provider–patient interviews can have, gets relegated to a prepositional phrase within the main clause, and in turn, the original’s seeming focus on the patient (as the subject of the first sentence) is changed to a focus on the practitioner. All told, this paraphrase distinguishes itself from its source in terms of both the language it uses to convey the main idea and the grammatical construc- tion it employs. What’s more, a correctly formatted parenthetical citation is included at the end, as it should be, to acknowledge the writer’s debt to the original.

As with summary, in order to paraphrase effectively you need to have much more than a passing familiarity with your source material; indeed, you need to know it fully

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and well, with respect to its diction, syntax, and style as well as its relevant details of content. Some student writers feel that it is counterintuitive to think that the more they immerse themselves in the nuances of the source they want to incorporate into their essay or report, the less likely they will be to plagiarize it unknowingly. Often, the approach seems to be that keeping a more healthy distance from your sources will prevent any accidental overlap between the words or style of the original and your own. Nothing actually bears that out, however, and it is always better to get as familiar with your sources as you can, something you can really only do if you allow yourself suffi- cient time during the prewriting stage and after to gather, read, annotate, and revisit your research materials.

Direct Quotation

Quote directly from a source in moderation. That is, do it only when the exact words of the original seem especially important or telling; when the author says something more succinctly, elegantly, and interestingly than you ever could; when you want to employ the words of an authority to lend support to your points; and/or when the orig- inal passage warrants closer analysis in your essay or report. Outside these scenarios, your default setting as an academic writer should be to paraphrase or summarize. Obviously, any and all words taken directly from a source need to be set off in quotation marks, and a citation that includes a page number needs to be provided. A quotation may be introduced into your writing by way of a signal phrase, which is a reference in the body of your paper to the source of the quoted material that follows. When a signal phrase is employed, the parenthetical source citation in APA style need only include the page number, since name and date have already been given.

According to Bonk (2015), “beginning writers should understand that mechanics are just

another set of tools for writers to use when conveying information to audiences” (p. 101).

Signal phrases can also be used to introduce summary or paraphrase, and they can be particularly useful rhetorically if the material you want to introduce comes from a noted authority whose name is recognizable to the reader. Effective academic writers will always strive for variety in how their incorporated sources get introduced through- out, however, employing signal phrases only sometimes.

In terms of mechanics, there are a few things worth pausing over when it comes to quotations. First, any quotation you include needs to blend seamlessly into your writ- ing. While we know that the main clause-colon-quotation construction is a perfectly acceptable way to introduce and incorporate quoted material, stylistically it is the least sophisticated and most mechanical. When you integrate a quotation into your prose effectively, you should be able to read aloud the sentence of which it is part without being able to discern by ear (possible presence of a signal phrase aside) where the quoted author’s words begin and where your own words end.

It goes without saying that “Among the key steps that healthcare writers must take is

citing sources for information used within documents” (Bonk, 2015, p. 68).

Chapter 8: Healthcare Research and Academic Writing (Part 2) 185

Bonk’s suggestion that acknowledging one’s debt to source materials “not only displays

respect for others’ work but also can protect writers from lawsuits regarding copyright

infringement” (p. 68) usefully frames documentation as both a moral and legal

imperative.

As both of these examples demonstrate, well-integrated quotations should not compro- mise the grammatical integrity of your writing. And note that, unlike the citations for paraphrase or summary, which occur right before the nearest punctuation mark after the paraphrased/summarized source material, citations for direct quotations go imme- diately after the end of the quote in APA style.

Quoted material may be modified slightly, so long as its meaning is not affected. Use an ellipsis (...) to indicate where something has been omitted in order to condense the quotation. What remains still needs to work grammatically. Remember that any material omitted from a quotation must be unnecessary to your reader’s understand- ing of what that quotation is attempting to say or accomplish, and it cannot be essential to the tone or intent of the original.

As Hofmann (2013) describes, “Reading and understanding ... research papers is mainly

a matter of experience and knowledge of the specific vocabulary of a field” (p. 146).

The original quotation refers to “Reading and understanding primary articles or research papers,” but the writer here has decided to omit the first term to address the specific needs of her paper: “primary articles” is not used elsewhere in her document, and the quotation is being employed in a passage that addresses research papers specifically. Since the original links “primary articles” and “research papers” together with the coor- dinating conjunction “or,” the suggestion is that they are interchangeable terms; the same things are required to read either of them effectively. As such, omitting the first term does nothing to alter the original’s meaning or intent, but it renders the quota- tion more usefully focused and concise while still maintaining grammatical integrity.

To add something to a quotation, employ square brackets ([ ]). As with material omitted when quoting a source, added material cannot change or distort the origi- nal meaning. You should alter quotations by way of addition only sparingly, ensuring that each time you do it is either to provide necessary context, to explain a confusing or unclear reference, or to make a sentence work better grammatically with your own writing (by, for example, changing tense for consistency).

Bonk (2015) notes how one “typical [organizational] strategy for simple situations is

chronology: describing how a process occurs in time” (p. 44).

In this example, what the writer deems to be an important detail of context and clarifi- cation is added. The original quotation from Writing for Today’s Healthcare Audiences comes from a chapter dealing with ways of organizing information in healthcare docu- ments, but the writer uses the quotation in a way that doesn’t necessarily make that context as apparent as it might, so he introduces the modifier “organizational” to ensure the reader knows just what sort of strategy is being referred to. He is erring on the side

Part III: Fundamentals of Successful Healthcare Writing186

of caution here, since precision and clarity should always be what guide a writer’s deci- sions. The addition of a single clarifying word adds little to the original quotation in terms of length and does nothing to undermine sentence grammar or alter meaning.

Lastly, when a quotation is long—40 words or more in APA style—it cannot be integrated into the body of your text and must instead be offset or blocked. When quotations are offset, they must begin on a new line, indented from the left margin the distance of a normal paragraph indent (approximately half an inch). Contrary to what many student writers seem to think, each line of the offset quotation will extend to the right margin, then start again on the next line at the same half-inch distance from the left as the previous. The text of such quotations should be in the same font and of the same size as the text elsewhere in your paper, and uniform double-spacing must be maintained. It is also the case that offset quotations need not be enclosed in quotation marks, since the block formatting itself provides a sufficient visual signal to the reader that the material is being taken directly from a source. Obviously, a paren- thetical citation is still required at the end, but the punctuation will occur before that citation, not after. Writers should strive to avoid quoting at length, if possible, as too many block quotations—even one or two in a short paper—can affect ethos adversely by making the writer look lazy.

DOCUMENTING SOURCES: APA STYLE

APA (American Psychological Association) style, the documentation style employed by and referred to throughout this book, is used in most health and social science disci- plines. Like the other primary North American documentation style—that of the Modern Language Association (MLA), which is employed in arts and humanities disciplines such as English—APA style employs in-text parenthetical citations that are keyed to an alphabetized list of bibliographic entries, called “References” in APA, “Works Cited” in MLA. The expectations a documentation style has regarding the form and content of citations can tell us about what aspects of a research source a particular discipline values most and wants to emphasize. APA citations always include the date of publi- cation in addition to the author’s name, and the suggestion therein is that disciplines using this style put emphasis on both the source and the currency of the information: who or where it comes from and how contemporary and thus (in theory) how rele- vant it is. Certainly, in healthcare-related fields, providing the most recent research you can is key. Focusing where possible on sources that fall within a three-year window from the present is a good place to start. Many university and college writers will have access to citation management software—such as EndNote, Mendeley, RefWorks, or Zotero—that will compile in-text citations and bibliographic entries for their research sources according to whatever style they are using. Such programs are not infallible, however, and errors of formatting and organization do occur. Students need always to review any auto-generated documentation very carefully.

We have discussed already in this chapter, and provided examples that illustrate, some differences between summary/paraphrase and quotation with respect to cita- tion form and location. It is not our intent to provide a comprehensive discussion and

Chapter 8: Healthcare Research and Academic Writing (Part 2) 187

analysis of APA style, in all of its detail and frequent complexity. When asking any ques- tions regarding specific points of formatting, citation mechanics, or “References” list construction, writers should always first go directly to the source by consulting the APA Publication Manual in addition to the APA’s very useful website (www.apastyle.org), where the most up to date information about and ongoing discussions of APA style can be found. What follows here is meant to provide only a very brief rundown focused on some of the more common points of confusion or misunderstanding with respect to in-text citations, bibliographic entries, and document format. For each topic, relevant section numbers from the sixth edition of the APA manual are provided to facilitate more detailed review and discussion.

1. APA In-text Citations

To review the basic formats of in-text citations, go back over the examples in our sections on paraphrase and direct quotation. See also “Table 6.1: Basic Citation Styles” in the APA manual (6th edition).

PROBLEM SOLUTION RELEVANT SECTION

IN APA MANUAL

Source has no author

Cite using shortened version of the title (since the title will be in the author position for the References entry), followed by date.

7.02

Source has more than two authors

Three to five authors: cite all the names the first time, subsequent to that just the first author and “et al.” (Latin et alia: and others). Use first author’s name and “et al.” for every citation if there are six or more authors.

6.12

More than one source from the same author

Year of publication should distinguish between sources, but if all are from the same year, use lower case letters in addition to date (e.g., 2012a, 2012b, ...).

6.16

Source has a corporate author

Cite using name of corporation (or association, agency, etc.) plus date.

6.13

Source has no date Use “n.d.” instead of date. 6.28

Source has no page numbers

Use what you can. If there are paragraph numbers, use those (preceded by “para.”). If there are section headings, use the titles or shortened titles of those. Also, remember that you really only have to provide page numbers when you are quoting.

6.05

Part III: Fundamentals of Successful Healthcare Writing188

PROBLEM SOLUTION RELEVANT SECTION

IN APA MANUAL

Source is personal communication

Use communicator’s name, followed by “personal communication,” then the date as exactly as possible (e.g., June 29, 2015).

6.20

Source is social media

If paraphrase or quotation is of material readers can’t access (due to privacy settings or because it was a PM), cite as personal communication above. If content is publicly accessible, then cite author and date, per usual.

6.20, 6.31, APA website’s style

blog (http://blog. apastyle.org/

apastyle/2013/10/ how-to-cite-social- media-in-apa-style.

html)

2. APA References Entries

Below are some sample References page entries to model, covering the basic sorts of print and online sources you are likely to encounter in the course of your research. Remember that whatever appears in the author position of a reference entry must also be what appears as part of the corresponding in-text citation, whether as a signal phrase or as the first portion of a full parenthetical citation. As well, all sources cited in-text must have a References entry (and vice versa).

Fierlbeck, K. (2011). Health care in Canada: a citizen’s guide to policy and politics. Toronto: University of Toronto Press. [Book]

Flood, C. M., & Haugan, A. (2010). Is Canada odd? A comparison of European and Canadian approaches to choice and regulation of the public/private divide in health care. Health Economics, Policy and Law, 5, 319–41. doi: 10.1017/ S1744133110000046 [Journal article with Digital Object Identifier (doi)]

Johnson, A. P., & Stuart, H. (2009). Health services research in Canada. In R. Mullner (Ed.), Encyclopedia of health services research. (pp. 559–65). Thousand Oaks: SAGE Publications. [Chapter in an edited book/entry in a reference work]

Kheiriddin, T. (2012, June 28). Think two-tier health care would be a disaster? Ask a Swede. National Post. Retrieved from http://www.nationalpost.com/index.html [Online newspaper article]

Chapter 8: Healthcare Research and Academic Writing (Part 2) 189

PROBLEM SOLUTION RELEVANT SECTION

Source has no author

Use the title of the work in the author position, alphabetized by the first letter (excluding the, a/an).

7.02

Source has multiple authors

Include every author’s name in entry (last name, initial) up to seven; after the sixth author, use an ellipsis (...) followed by the last author’s name.

7.01

More than one source from the same author

Single author entries by the same author are listed chronologically, earliest publication date first. Where publication dates are the same, alphabetize by title of work and put a letter (a, b, c) after the year to correspond with how those works will be cited in-text (see above). Multiple author entries in which the same author is listed first are alphabetized according to last name of the second author.

6.25

Source has no date

Use “n.d.” in parenthesis instead of date. 6.28

Source is an e-book

Enter as you would a print book with “Retrieved from” and URL taking the place of the publishing information. Retrieval statement is replaced by doi, where applicable.

7.02

Source is personal communication

Not applicable: cite in-text only. 6.20

Source is a movie or a TV show

For a movie, follow book entry format, with producer’s and director’s name in author position, each with their function in parentheses: (Producer). Title of the movie goes in italics, studio takes the place of publishing house. For TV shows, follow the entry format for a book chapter (above), but put the scriptwriter and director in the author position, and the producer in the editor position, labelling each function as in a movie entry. Title of the episode takes the place of the essay title, and the title of show itself is italicized, like the book title. Broadcasting corporation takes the place of publishing house.

7.07

Part III: Fundamentals of Successful Healthcare Writing190

PROBLEM SOLUTION RELEVANT SECTION

Source is social media

If cited as personal communication, no References entry is required. If not cited as personal communication, however, entry must provide author, date, title, and URL. If both real and screen names are known, provide screen name in square brackets; if only screen name is known, use it without brackets. For title, provide the page name or post caption, followed by content format in square brackets (e.g., [tweet]).

6.20, 6.31, APA website’s style

blog (http://blog. apastyle.org/

apastyle/2013/10/ how-to-cite-social- media-in-apa-style.

html)

Quotation marks vs. italics

Use quotation marks only for citing the titles of short works—essays, articles, chapters—in the body of your paper. In the list of references, those titles go in a regular font face, with no quotation marks. Italics are used for titles of longer works (e.g., books, journals, magazines, newspapers), both in-text and in your references.

4.21, 6.15

3. APA Document Format

For an example of APA formatting specifics in practice, see the sample student paper below.

COMPONENT EXPECTATION RELEVANT SECTION

Running head Use abbreviated version of title, maximum 50 characters, all uppercase; locate in upper left corner on all pages (including title page).

8.03 (and Fig. 2.1)

Title page Include title, running head (per above), author name, author note, institution, page number (1).

8.03 (and Fig. 2.1)

References list Uniformly double-space, make each entry hanging (or reverse) indented.

2.11

Page numbers Locate in upper right corner, use Arabic numerals (i.e., 1, 2, ...).

8.03 (and Fig. 2.1)

Line spacing Uniformly double-space throughout, even block quotations.

8.03

Chapter 8: Healthcare Research and Academic Writing (Part 2) 191

Example: APA Formatted Student Report (Title page, first page, References)

Running Head: EMBRYONIC STEM CELL THERAPY FOR TYPE-1 DIABETES 1

Embryonic Stem Cell Therapy for Type-1 Diabetes Alexa Buxton

Western University

EMBRYONIC STEM CELL THERAPY FOR TYPE-1 DIABETES 2

Embryonic Stem Cell Therapy for Type-1 Diabetes Diabetes mellitus is a chronic disease that affects approximately 346 million people worldwide (World Health Organization, 2014). There are multiple types of diabetes, but the focus of this report will be type-1, or insulin-dependent diabetes. Type-1 diabetes is most often caused by an autoimmune attack by the body in which the insulin-producing cells of the pancreas called

in high blood glucose levels, and these high glucose levels in turn damage blood vessels and

diabetics must receive synthetic insulin through subcutaneous injection or pump (Franz, 2008).

secreted by the pancreas. Normal functioning beta cells produce the exact amount of insulin necessary to balance the blood glucose levels; however, synthetic insulin is administered by the patient him- or herself and, therefore, will never be as accurate in dosage (Slack, 2014). To date, there is no cure for type-1 diabetes. As this report explores, however, there have been several

from the Harvard Stem Cell Institute that may promise a cure in the near future. Historically, the main focus of diabetes research has been on islet transplantation—a

procedure that involves the transplantation of beta cells taken from the pancreases of deceased

EMBRYONIC STEM CELL THERAPY FOR TYPE-1 DIABETES 7

References Ahmad, S. (2013). Diabetes: An Old Disease, a New Insight. doi: 10.1007/978-1-4614-5441-0 Engelking, C. (2014). Stem cell breakthrough puts type 1 diabetes cure in reach. Discover.

Retrieved from http://blogs.discovermagazine.com/d-brief/2014/10/10/stem-cell -breakthrough-type-1-diabetes-cure-in-reach/#.VHIm4ItU3ww

Paddock, C. (2014). Type 1 diabetes breakthrough as stem cells make billions of human insulin cells. Medical News Today. Retrieved from http://www.medicalnewstoday.com/ articles/283739.php

Pagliuca, F. W., Millman, J. R., Gurtler, M., Segel, M., Van Dervort, A., Ryu, J. H., … Melton, D. (2014). � Cell, 159(2), 428–39. doi: 10.1016/j.cell.2014.09.040

Slack, J. (2014). Stem cell therapy for diabetes. [Weblog post]. Retrieved from http://blog.oup .com/

Stanekzai, J., Isenovic, E.R., & Mousa, S.A. (2012). Treatment option for diabetes: Potential role of stem cells. Diabetes Research and Clinical Practice, 98(3), 361–68. doi: 10.1016/j. dibres.2012.09.010.

Stem Cell Network. (2012). Type 1 diabetes. Retrieved from http://www.stemcellnetwork.ca /index.php?page=type-1-diabetes#escs

Preceded by “Running Head” only on title page; only the

capitalized version of the title thereafter. Full report title is

used for running head since it is fewer than 50 total characters.

12-point Times New Roman font. Title should be centred,

mid-way down the page.

Title is repeated on the first page, centred, double spaced

above first line of text.

1-inch margins all around. Note too that all text is left ragged

(unjustified) on the right, which facilitates ease of reading.

No additional space is required between paragraphs. Even if

headings are used, the text should remain uniformly

double-spaced.

Format for citing an ebook with a doi.

Journal article with more than seven authors.

Format for citing a blog post.

Part III: Fundamentals of Successful Healthcare Writing192

CHAPTER SUMMARY

By this point, you should be able to:

■ Distinguish between primary and secondary sources, as well as between scholarly and non-scholarly sources. Additionally, you should be able to assess online sources for their relative quality and develop functional search terms out of a topic.

■ Define plagiarism and understand what constitutes another’s intellectual property. You should also understand what documentation is, what is at stake in summarizing and how to do it effectively.

■ Recognize the difference between paraphrase and summary, as well as between effective and ineffective paraphrase. You should also be able to recognize what is at stake in quoting directly and why you would choose to quote rather than paraphrase. And you should be able to alter quotations correctly when needed in addition to knowing how and when to offset them.

■ Create both appropriate APA style in-text citations and correctly formatted References page entries for a variety of source types. You should also be able to format an essay or report correctly according to APA expectations.

Some self-check or class discussion exercises you might want to try include the following:

■ Choose a broad, healthcare-related subject that interests you, and develop from it a couple of different possible topics. Then, break each of those topics into concepts, develop search terms from those concepts, and plug those terms into an academic database. Compare the results of one topic’s search to the other’s, and think about which topic would be a more viable, productive one were you actually to write an essay or report. After that, choose a couple of other databases and repeat the same searches. Are your results the same? Play around with your search parameters in each database to familiarize yourself with the various search features available.

■ Write three annotated bibliography entries from sources you found doing the previous exercise, or do so using sources you find online. Ensure that your entries are all formatted according to the expectations of APA style.

■ Find an academic article that interests you—perhaps again using the search terms you created for the first exercise—and read it carefully. Then summarize it. After that, paraphrase a key portion, and then quote from that same portion. Try writing a sentence that includes a quotation and employs a signal phrase, then one without. Include proper in-text citations for each, as well as for your summary/paraphrase. Think about the differences in citation content, and consider the reasons for those differences.