1. Olson, DaiWai M.

Article Content

Yes! The Journal of Neuroscience Nursing (JNN) has published-and will publish-quality improvement (QI) and performance improvement (PI) projects. Granted, JNN intends to only publish articles that contribute to the body of knowledge surrounding neuroscience nursing. However, this is actually both a reasonable and achievable goal for any nurse engaged in QI or PI work.

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The JNN receives over 200 submissions each year and publishes roughly 30% of all submissions. The most common reason an article is rejected is that the content does not fit the aims of the journal. In other words, the article does not provide information about neuroscience nursing. Of the many QI and PI articles submitted to JNN, most are written by neuroscience teams with multidisciplinary author groups. Those with nurses as first or senior author are almost always certain to include neuroscience nursing content. So, why are so few accepted?


The most common reason that a QI article is rejected is that the authors do not match the purpose, methods, outcome, and conclusion. Some articles are rejected because they fail to use a design that suits the purpose of the project. Some are rejected because they measure outcomes not affected by the intervention. Some are rejected because the methods are not detailed such that another healthcare provider could replicate the intervention. A few are rejected because the authors do not wish to publish that their interventions did not improve the quality of care. Most are rejected because they did not demonstrate a true effect.


An example might help. Catheter-associated urinary tract infection (CAUTI) has been a frequent aim of QI since I started as a nurse in the early 1980s. A rather common QI project for CAUTI is something like: "We had a lot of CAUTI in year 1. We started a QI project that included multiple interventions at different times during year 2. By the end of year 2, our CAUTI rate went down." Even well written, submitting this project to JNN is likely to result in rejection. However, eliminating new interventions and measuring the results for another 2 years before submitting the results would likely be accepted, even if the results are that the QI project failed.


Sustainable change is elusive. Many of the QI and PI manuscripts submitted to JNN end their data collection shortly after the last month of an intervention. Administering a test 10 minutes after a teaching session tests memory, not knowledge. Assessing the outcome of a QI project immediately after the intervention tests efficacy, not effectiveness. The threshold for QI projects to contribute to the body of neuroscience nursing knowledge is that they must conclusively demonstrate that they either are effective in producing change or they are ineffective.


The JNN will publish both positive and negative outcome articles from QI and PI projects. However, please do yourself a favor and do not stop collecting data early. In my approximately 40 years, I have seen dozens of CAUTI QI projects, but we still have CAUTI. We need good data on QI and PI effectiveness. I know that there are nurses completing important QI projects that will help neuroscience nurses provide better care, and I encourage them to submit the findings from their high-quality QI projects to our journal.

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