The issue of ‘internationality‘ currently vexes many people, not least editors of scholarly journals and those who assess the quality of research in the various research assessment exercises that are taking place around the world (Tierney 2005, Watson 2005a,b). A previous JCN editorial (Watson 2006) has already alluded to JCN as an international journal and it is one of our stated aims to be international: ‘The Journal of Clinical Nursing is an international scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing and midwifery practice’. This claim of international as a label for JCN is due to the majority of papers coming from outside the UK. Additionally, having manuscripts reviewed internationally, inviting international responses to key published articles, and having co-editors from around the globe are editorial tactics for JCN that strengthen this claim. However, while the journal may be described as international in the above aspects, the issue addressed here and, as usual, inviting comment for publication in these pages, is what makes an individual paper international.
There are a number of possible criteria, such as coming from a country other than the one where the journal is published; however, every paper is derived from some country and does this automatically make papers from the UK non-international for JCN? Authorship from more than one country is another possible criterion but, of course, this cannot apply to every paper that is published and might be manipulated by the gratuitous inclusion of multinational authors. Research across national boundaries is a clear indication of international activity but, again, this is not possible for every paper that is published and research carried out in more than one country is not, necessarily, a virtue in itself. However, these types of studies for which outcomes could be compared across borders would be very helpful in establishing an evidence base for international health issues. Trends within countries that may be dependent on culture or ethnicity, as independent from phenotype, could be discerned. In this era of globalization, critical issues of health disparities among nations could be more easily identified with international solutions posited, rather than more narrowly defined national goals. Researchers in different countries doing similar-focused studies could submit manuscripts reporting their discrete studies seeking ‘companion’ publication in an edition of JCN, although the incidence of this would probably be minimal.
At the other end of the spectrum, if internationality implies the criterion of research being of an international standard, this does not help us much as those involved in the UK Research Assessment Exercise may testify. In this exercise, being replicated around the world, international research constitutes work that is a primary reference in its field. It is unlikely and unreasonable to expect that every paper published in JCN will contain research of the above standard. Moreover, how will we know the extent to which a piece of work becomes a reference point at all until it is published?
It is easy to propose the impossible and the unattainable but the challenge remains of deciding what makes a paper international so that authors and reviewers may be guided. Surely, the main criterion is the international relevance, within its field, of a study: the extent to which its relevance for any reader can be gauged. This is enhanced by authors clearly and fully stating the context of the study so that transferability of the substantive findings to other contexts can be adequately evaluated. Although the country may differ, the context may not be so different. For instance, research into responses to a health condition by people of one ethnic origin in one country may be similar for that group in another country.
‘Relevance’ itself can be a relativist criterion. Whilst a study of renal nursing is less likely to be relevant to a cardiac nurse and a study in Hong Kong is less likely to be relevant in the UK, it is also possible that the above studies are relevant to a wider audience – clinically and internationally – as they may address fundamental issues in clinical nursing such as patient-centred care, communication or pain relief. The skill for authors is to see beyond the immediate substantive relevance of their paper, thereby making it relevant to as wide an audience as possible. A manuscript may require a stated limitation that the study's narrow or limiting context prevents global generalizability of the substantive results, but could emphasize parts of the findings that may be applicable. Additionally, when listing recommendations for further research, suggestions should be given for future studies that could extend knowledge for global application. In this way, therefore, a small study in one area of one country can be brought to the attention of nurses and midwives worldwide and, provided that it is presented properly, then any possible relevance internationally may be gleaned.
Some inclusions that will enhance the possibility that relevance is achieved can be suggested. The easiest way to do this is to make sure that the appropriate literature has been reviewed and referred to in the paper. If the study is in one country and only refers to literature in that country, when it is known that similar studies have taken place in other parts of the world, then the study is not international. The reported literature review should not only justify the study, but also embed the study in pertinent global knowledge. This also requires specification of the country in which cited studies have been conducted. If the study is unique to one country and, in the unlikely event that no international literature exists, then this must be clearly stated and the means whereby this was established must be explained – an oft-used criterion for methods reviewing research systematically. In fact, JCN encourages systematic reviews on issues that are becoming pandemic, such as causes for the rising rates of obesity or suicide. With this broader view, gaps within the science can be identified and internationally relevant research emerges.
Because of parochial writing, studies are often of limited appeal outside the country from which they originate. For example, writing from a UK perspective, it is of limited value to people outside the UK if an author refers to health service policies such as Agenda for Change or even National Service Frameworks and practices such as clinical governance, or from a US perspective, discussing the goals of Health for People 2010, if these are not familiar to readers in other countries. A few words of explanation about what these policies or national goals mean, the defining of country-specific or culture-specific words, and what a specific practice is will raise the level of the writing from the parochial to the international with minimal effort. If possible, comparison with similar concepts using nomenclature common to other parts of the world can stimulate interest from the wider readership.
Clearly, none of the above is a panacea for getting your paper published in JCN. However, addressing the above removes at least one barrier to the review process. In many ways, the above are quite superficial steps to make your paper international. In addition, the standard of writing has to be high and the use of English has to be good –JCN is an international journal published in English. After initial scanning, papers are frequently returned to authors whose first language is not English, with the request that they have a native English speaker read and review their paper prior to re-submission. It is not sufficient to have someone simply fluent in English – as many of the authors are – as a native English speaker is required. Unfortunately, while all manuscripts and proofs are meticulously edited, we cannot provide a translation service or even a service in improving the use of English in papers where it is sufficiently poor as to make aspects of the paper incomprehensible.
Finally, what makes a paper truly international is the standard of scholarship that it displays; the best written paper with attention to an international audience will not be published if it is not coherent, consistent, methodologically sound and does not make a contribution to the field of knowledge of nursing or midwifery.