Ways of Knowing: A Guide to the Journals a Clinical Discipline Needs?

When I say I am the editor of RINAH, some scholars respond with remarks like these. Their message is that research-focused journals like RINAH are more selective and therefore better than other journals. Early in my time as Editor, I was privately flattered. As time went on, however, my thinking has changed. RINAH has provided a trustworthy venue for dissemination of highly controlled, meticulously executed research for 37 years, and research evidence is essential for describing, evaluating, and improving practice, but “research-only” journals like RINAH are insufficient for knowledge development and communication in a discipline like nursing. I now believe that diversity of journals and journal content is essential to professional communication within and among the many communities of nursing practice and thought.

Hundreds and hundreds of journals are published that are relevant to nursing as a discipline. A curmudgeon might grouse that proliferation of nursing journals only lowers the quality of the material that appears in print. This hypothetical complaint is based on the assumptions of my first commentator above, that all manuscripts are of the same kind, and all journals are of the same kind, so authors should use only a journal quality ranking of some kind to find a journal in which even a faulty manuscript can be accepted. Yes, poor writing, bad logic, and weak research do make it into print, in nursing and other fields, but I think nursing authors are more discriminating than my straw-man curmudgeon assumes, and they should be.

All journals are not of the same kind, which is good. Authors in nursing need many journals. In a small or developing country, a single journal may serve as the mouthpiece and communication venue for all of nursing. In more developed regions, journals focus more narrowly on certain types and activities of nursing practice, from home health nursing to critical inquiry to peri-anesthesia care. Some journals are owned by professional nursing associations; these typically promote members' interests and share association news as well as publishing peer-reviewed articles of interest to members. There are journals for nurses' ideas and observations on trends and issues, journals on nursing history or theory, journals that focus on ethics in nursing, journals on case management, journals on self-care, and journals on caring itself. Some topics, such as cancer nursing, intensive care nursing, or maternal–child nursing, are of such interest that publishers compete within them. In addition, there are journals on creative nursing, humor in nursing, Christian nursing, journals for Black and Hispanic nurses, and on and on.

All manuscripts are not of the same kind, which also is good. RINAH's content is very homogeneous. We do not publish clinical case studies, observations, opinions, narratives, philosophical or ethical treatises, poetry, visual art, or policy statements, except as editorials or letters to the editor. However, all these kinds of publications appear regularly as peer-reviewed articles in other journals. Most journals publish several types of articles, ranging from original research, to clinical reminiscences, to policy recommendations, to refreshers on basic principles of good nursing care, to applications of research in current clinical practice.

Remember Carper's (1978) “Fundamental patterns of knowing in nursing?” While the four forms of expertise she outlined are neither all-inclusive nor mutually exclusive, they can be a useful way to think about the kinds of journals nurses need to read and the kinds of content nurses can be encouraged to write.

Empirics were identified by Carper (1978) as the science of nursing. Research articles, research reviews and meta-analyses, and research-only journals such as RINAH fill this niche. Empirical knowledge from nursing and related health disciplines is essential and highly prized as a source of evidence for broad-scale policies and practices. Rigorous research requires specialized expertise to produce, write, review, read, and apply. A relatively small percentage of nurses have this expertise. They are busy supporting journals such as this one, for which I am grateful. But their expertise is not all that nursing needs. Carper questioned nursing's reliance on factual knowledge as the only trustworthy form. It is difficult to uncover or foster new insights and perspectives when a discipline relies exclusively on verifiable principles deduced from empirics.

Esthetics were conceptualized as the art of nursing (Carper, 1978). Art is expressive rather than merely descriptive, involving a subjective expression of something imagined or experienced, bringing previously unrelated observations into a new pattern or whole. Esthetic knowing in nursing can be mediated by empathy, as nurses perceive and creatively respond to patients' needs. The unanalyzed perception that is art can be difficult to capture in words, but journals in nursing, medicine, and other clinical disciplines do publish narratives, poems, and visual art that reflect this creative perception of patterns. Patient care exemplars and narratives of insights gained from uniquely challenging patients can be the most engaging reading in a clinical journal.

Personal knowledge was for Carper (1978) the most difficult to teach and perhaps also to write about. Personal knowledge is recognizing and using one's own selfhood in interactions for the benefit of patients. It can only be acquired by accumulating interpersonal experiences over time. Effective use of personal knowledge might be observable and describable to a limited extent, such as when influential leaders and highly effective practitioners are profiled by others who have seen them in action over a period of years. Such profiles were more common in the early years of nursing publications but now are too rare. I see them mainly in appreciations of influential association members in association journals, and in journals from developing nations where the personal influence of a single individual has moved the profession forward. Let us pay more attention to nurses with deep personal knowledge who use it to make a difference!

Ethical knowing, Carper's (1978) fourth category, is the awareness and judicious simultaneous application, in actions on behalf of the patient, of the discipline's moral codes, the norms and priorities of the institution and of society, and the values of the nurse. To Carper, value judgments are particular to situations and circumstances and can only be evaluated with a full awareness of a given context. How is ethical knowing reflected in nursing journals? Perhaps in narratives on “my most difficult patient” or “how I have grown over time.” Clinical journals of many kinds publish these pieces, but like personal knowledge they may be devalued because to appreciate the correctness of an ethical decision, “you had to be there,” as the saying goes. As a new nurse reading RN or AJN, these articles had much more impact on my practice than refreshers on chest tubes or pain scales. More exemplars of challenging personal decisions in nursing are needed.

Nurses, educators, and publishers must use and promote journals that disseminate all these kinds of nursing know-how. First, let us find criteria by which to judge nursing journals beyond selectivity, impact factor, or proportion of research content. Do we fully appreciate the array of journals in the field and the varieties of content they provide? Do we value our own non-empiric ways of knowing enough to put pen to paper (or fingers to keyboard), capture this knowledge in narrative, and share it in publications?

Clinicians and clinical faculty are ideally positioned to write about ways of knowing revealed in patient care. As faculty researchers, our readings generally focus on research, but students in nursing should be directed to readings beyond research reports and should be supported to write about other kinds of knowing as their clinical experience grows. I am not calling for watercolors or poetry in nursing curricula, but new nurses learn from clinical experts as well as from reading research. We can hone students' and our own sensitivity to what expertise looks like and how it can be captured in print, with the hope that these clinicians of tomorrow will contribute the clinically grounded knowledge on which we depend.

We need a variety of journals in institutional libraries. I do not underestimate the budget challenges faced by libraries, but nurses must find their way to the decision-making table when library collections are at risk. In a parallel step, those of us who are faculty need to expand our course readings beyond research evidence. Nursing programs already are tightly packed, but ways of knowing beyond empirics are not optional in nursing practice. Nurses need to be self-aware, perceptive, and ethical, as well as informed by research.

When does a paper by a nurse or about nursing belong in one of the rainbow of nursing journals depicted above, and when is it of broader interest beyond nursing? In a future editorial, I will share thoughts on how to select a journal for submission of a research paper, perhaps the most common question I field as Editor. In the meantime, I urge you to give thought to the diversity of journals and take full advantage of the knowledge this literature has to offer.