In a 2- to 3-page, double-spaced paper, describe three conclusions you have drawn from the findings in this study, taking into consideration the limitations of the study

Research in Nursing & Health, 2009, 32, 241–242

EDITORIAL

Thoughts on the End of the Article: The Implications for Nursing Practice

Keywords: nursing research; implications for nursing practice

Many years ago, as the deadline for my dissertation defense was fast approaching, all but the Discussion Section was complete. I was confident that I was all but done. To my chagrin, I discovered that writing the Discussion Section was perhaps the most difficult part of the whole enterprise. Articulating relevant and meaningful conclusions based on one’s data involves con- siderable thought and careful critique of how the actual findings fit with the literature reviewed in making a case for the study, the conceptual framework, the original hypotheses or research questions, and the broader knowledge in the area. For reports of nursing research, this critique further involves drawing inferences from the data not only for nursing scholarship, but also for nursing practice. Yet, perhaps because of deadlines or because they seem obvious to us, it is the thoughtful presentation of this section, the nursing implications, which often is given short shrift in preparing a manuscript.

The focus of nursing scholarship is diverse, thus, the nursing implications of a data set may not relate directly to clinical practice, but instead to other arenas of nursing science, such as education, health care policy, or systems management. Nevertheless, because nursing is a clinical dis- cipline, there is an implicit expectation that the findings from a study will be interpreted in terms of the ultimate, if not the immediate, relevance to practice. The importance of adequately addressing nursing implications has been stressed in editorials by many nursing journal editors (e.g., Gennaro, 2008; Hegyvary, 2007), and many journals require a separate labeled section devoted to nursing implications. Accordingly, evaluating the nursing implications is a focus for manuscript reviewers, and as Gennaro noted, reviewers can be unforgiving when authors do not make those implications explicit.

Given the limitations inherent in the psycho- social and behavioral nature of much nursing research, the first issue for articulating the nursing

implications is at what point an author is justified in drawing conclusions about practice applica- tions versus constraining the discussion to what needs further study before application is appro- priate. In the form of the difference between statistical and clinical significance, this issue has been dealt with at length in the literature (e.g., Beyea & Nicoll, 1997), and more recently, in terms of the level of evidence required for translating findings into practice (Jennings & Loan, 2001; Melnyk, 2004; Rycroft-Malone et al., 2004).

There are several other issues for presenting the nursing implications that also are important, as they have to do with their utility. As authors, we take our obligation to interpret results in terms of the relevance for nursing practice seriously, but at times, too seriously. This is manifest in the frequency with which the nursing implications are phrased as imperatives: ‘‘The findings indicate that nurses should. . .,’’ ‘‘The results make clear that nurses must. . .,’’ ‘‘In light of these findings, nurses have to. . .,’’ and even, ‘‘It is imperative that nurses take action to. . .’’ Although the degree of confidence in the data implied by imperative terminology is seldom warranted, quite often the findings are critically reviewed, limitations acknowledged, and the need for further study delineated, yet the implications framed as impera- tives.

One presentation issue pertains to generality with respect to the topic of study. The implications as written frequently are too general or formulaic to be of either scholarly interest or clinical use. For example, social support is a heavily studied variable both in nursing and other disciplines, and has been for many years. Assessment of social support would be an expected standard of nursing practice in most arenas where it is relevant to the target population. Thus, nursing implications phrased generally as ‘‘Nurses must assess families/patients for social support’’ fall short of providing creative new ideas for practice.

*Associate Editor, Research in Nursing & Health. Published online 11 March 2009 in Wiley InterScience

(www.interscience.wiley.com). DOI: 10.1002/nur.20324

� 2009 Wiley Periodicals, Inc.

A second issue is practicality. It is tempting to be overly enthusiastic about the clinical implications of one’s findings and thus fail to tailor them to what nurses in the current health care system could be expected to implement or even to promote as reasonable goals for practice. For example, suggesting that ‘‘All patients must be assessed via a home visit for adequacy of social support,’’ or ‘‘It is imperative that a team approach involving all relevant disciplines be used,’’ may be unrealistic. Thoughtful analysis of the conditions under which proposed implementation might be feasible (e.g., level of administrative support, or ability to change hierarchical patterns of influence among disciplines) would add depth and meaning to the nursing implications.

A third issue for presentation is practice setting applicability. The nursing implications frequently are phrased rhetorically as ‘‘Nurses are in an ideal position to. . .’’ This itself is more than just a rhetorical issue because nursing is so diverse, its settings so varied, the nature of practice so wide ranging. Although the focus of the manuscript usually implies for which nurses or practice settings the results pertain, the suggested nursing implications will be more credible and useful if the ‘ideal’ is either abandoned in favor of reality or anchored in the concrete, that is: For what kinds of nurses? Because of what skills or roles? In what categories of practice? In what types of locations/ institutions? Under what conditions?

These reflections have their own implications, in this case for nurse scholars as both authors and reviewers. They suggest that the goals of nursing

science will be best served if as authors we allow ample time during manuscript development for thinking through how to give realistic meaning to the nursing implications of our findings, and if as reviewers we support this process by critiquing not only generalizability, but also aspects of general- ity, practicality, and applicability.

Patricia T. Becker* Helen Denne Schulte Professor

of Nursing University of Wisconsin-Madison

School of Nursing Madison, WI 53792-2455

REFERENCES

Beyea, S.C., & Nicoll, L.H. (1997). An overview of statistical and clinical significance in nursing research. AORN Journal, 65, 1128 – 1130.

Gennaro, S. (2008). Sing of significance. Journal of Nursing Scholarship, 40, 99.

Hegyvary, S. (2007). To make a difference. Journal of Nursing Scholarship, 39, 1 – 2.

Jennings, B.M., & Loan, L.A. (2001). Misconceptions among nurses about evidence-based practice. Journal of Nursing Scholarship, 33, 121 – 127.

Melnyk, B.M. (2004). Integrating levels of evidence into clinical decision making. Pediatric Nursing, 30, 323 – 325.

Rycroft-Malone, J., Seers, K., Titchen, A., Harvey, G., Kitson, A., & McCormack, B. (2004). What counts as evidence in evidence-based practice? Journal of Advanced Nursing, 47, 81 – 90.

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