Intensive and Critical Care Nursing (2004) 20, 59—61

Editorial

In our December 2003 Editorial, Carol Ball ourEditor, wrote concerning the process a manuscriptgoes through when it is submitted to our journal,including the process of review. At present Inten-sive and Critical Care Nursing employs double blindpeer review, this requires a large body of reviewer’sto ensure timely and appropriate review of submit-ted manuscripts. Novice reviewers often raise con-cerns about what is expected of them. Having spentmuch time in the past, reviewing papers and thenbeing unsure how to present my feedback, I thoughtit might be helpful to briefly present some of theissues surrounding peer review and also to presentsome of the helpful advice I have received from col-leagues, which have helped me as a reviewer andlatterly as assistant editor.

Why have a peer review process?

Peer review is expected to provide editors with awide body of knowledge gained from a group of ex-perts to ensure that published papers are:

• Consistent with the aims of the journal• Scientifically rigorous• Unbiased and generalisable• Accurate and easily readable

This process is to ensure that only valid data,observations and conclusions are presented inan appropriate format for the journals audience.Therefore a good reviewer should be both friendand adversary to the author/scientist (Reidenberg,2002). Nevertheless, there are two key criticismsof this process. Firstly, until recently there hasbeen little scientific rigour applied to the processof peer review. Secondly, most reviewers are un-trained in the process, giving their time voluntarilyand often on top of busy jobs.Over the past decade much attention has been

paid to the peer reviewing process (Godlee et al.,1998; White, 2003). Various suggestions have beenmade to improve this practice, which include openreview and the sharing of reviews between review-

ers (Smith, 2001; van Rooyen et al., 1998, 1999;Walsh et al., 2000).Burnard and Hannigan (2001) propose a move to-

wards standardisation of the reviewing process injournals of a particular discipline, to enable a com-parison of quality between these journals. Presentlya journal may reject a paper to find it published inanother journal, which might imply that peer re-view determines where a manuscript is published,rather than which papers are published (DeMaria,2002). Several authors suggest the need to provideguidance to reviewers in order to provide greateraccuracy, validity and appropriateness of publi-cations (Ammenwerth et al., 2003; Burnard andHannigan, 2001; Salasche, 1997).Opthof et al. (2002) demonstrate that while the

peer review process has its drawbacks, especiallywith regard to bias, this process remains the mosteffective way of identifying successful papers, asdemonstrated by future citations. While the evi-dence for open reviews or for sharing of reviewsbetween reviewers remains equivocal (Smith, 2001;van Rooyen et al., 1998, 1999; Walsh et al., 2000),our journal continues with double blind peer review,in an attempt to limit bias. However this is an areafor us to consider in the future.

Guidelines for reviewers

Reviewers for Intensive and Critical Care Nurs-ing are usually experts in the subject area and/orknowledgeable of the research methodologies em-ployed in the manuscript presented to them. Thereviewers are asked to use the following criteria tohelp them analyse the manuscript:

• Is the topic suitable for the journal?• Does the submission attempt to make a concep-tual advance?

• Does the submission present new research?• Is the methodology used appropriate?• Are the conclusions supported by the results?• Is the paper clearly written?

0964-3397/$ — see front matter © 2003 Elsevier Ltd. All rights reserved.doi:10.1016/j.iccn.2003.12.002

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Using these criteria, how do successful review-ers provide constructive feedback to the editor andpotential authors?

Knowing the journal and its audience

When reviewing a manuscript, it is as important ifnot more important for the reviewer to be familiarwith the journal and the readership just as the au-thor should be. The reviewer must be aware of theaims and scope of the journal, the type of papersusually published by the journal, the audience towhich that material is delivered and the academiclevel expected by the journal. It is common for re-viewers to also be authors and readers of that jour-nal; this where budding reviewers are recruited.

Knowing the market

Successful papers are those that fill a gap in themarket (Newell, 2000), developing our thinking ona particular subject. An example of this would beOutreach, initially readers looked for descriptivearticles to help them plan their service, howeverthere are now many of this type of article on themarket and more recently readers and editors havebeen looking for empirical manuscripts. As a resultthe reviewer must be familiar with this change inemphasis. There are various ways that an authorcan increase our knowledge base, develop our prac-tice and advance our thinking on a particular sub-ject. These include research reports which presentnew perspectives or seminal findings; systematic re-views providing an overview of the evidence andconclusions based on the compilation of publishedwork and discursive articles presented by authorswith an ability to question from different perspec-tives asking the reader to view a topic from anotherstandpoint. All of these require different skills fromthe reviewer, the most difficult often being thosethat present controversial views or findings, theseoften require the reviewer to take a step back fromtheir own viewpoints.

Knowing your own skill and limitations as areviewer

In deciding who might be suitable to review amanuscript for our journal, the editor will aimto find two reviewers with complimentary skills,however when necessary a third reviewer mightbe asked to review a particular methodology orstatistical analysis. As a reviewer it is importantto ensure the editor is aware of the areas your ex-pertise does and does not cover (Lee, 1995), this

enables them to choose whether to ask another re-viewer to comment on particular areas. Day et al.(2002) suggest the use of dedicated methodologicaland statistical reviewers, their study showed thatthese reviewers provided useful additional issuesthat were not raised by the regular reviewers.

Presenting your feedback

In order to present your feedback in a clear and con-cisemanner it is helpful to provide a summary of themain aspects of the paper, this enables the author toidentify how effectively they have communicatedthe key messages of their work to the reviewer, areflection perhaps, of how their manuscript may bereceived by the audience. A summary is also help-ful to the editor if reviewers have conflicting opin-ions, as it should provide some context to thoseopinions. The summary should end with a generaloverall impression including the key strengths of themanuscript.Following the summary it is helpful to both the

author and editor for required revisions to be pre-sented as bulleted action points, where possiblemaking reference to the area of the manuscript,i.e. page 1, para 2, line 3. This ensures the re-visions are understandable and do-able. Clearlyassigned points allow the author to reply wherethey may disagree with the reviewers commentsand wish to provide an argument to remain withthe original presentation. The reviewer may beable to make suggestions as to how the revisionmight be approached, for example, if an area ofdiscussion needs to be developed, it can be helpfulto make suggestions as to how this can be achievedor provide explicit references which can be ob-tained subsequently by the author. Tables, figuresand diagrams are often provided with manuscripts,when reviewing it is easy to overlook these, as werequire them to be at the end of the manuscript.Take a moment to consider whether they add valueby illustrating a point in the text and that they arecorrectly labelled and made reference to withinthe text.

Is the paper clearly written

As important as the content is, the style of writingwill dictate whether the audience reads it. Althougha reviewer is not expected to correct spellings andgrammar, it does help if a comment can be madein this area, such as ‘the paper flows logically’ orconversely ‘I found it difficult to understand thepoint the author is trying to make’. In the latter it ishelpful to suggest an alternative structure either forthe whole paper or more usually, for the particular

Editorial 61

section. Where there are just the odd ‘typos’ orspelling mistakes, highlighting these can make theauthors revisions speedier, preventing the need forthe author or the editor trawling the text for onemistake!Finally, having completed your review, go back

to the reviewing criteria and ask whether youhave been able to provide comment against all thepoints. This is a good time to provide feedback onareas such as ‘Are the conclusions supported bythe results?’ as you will have read and re-read themanuscript several times by this point. If you areunable to provide feedback on a particular area, itis helpful to highlight that for the editor.Reviewing is an increasingly time consuming ac-

tivity for nurses (Emden, 1996), however, it is alsoimmensely rewarding. We would never question theneed for new or novice critical care nurses to re-quire a period of supervision and mentoring and Iassume that we all do this and gain from this ex-perience. Such are the rewards of reviewing; weshould be encouraging our colleagues to presenttheir work, thus reviewing for publication shouldbecome part of our mentoring role.A useful source of information for budding re-

viewers is ‘Editorial Peer Review: Its Strengths andWeaknesses’ by Ann C. Weller, Medford, NJ, Else-vier.

References

Ammenwerth E, Wolff A, Knaup P, Ulmer H, Skonetzki, Van Be-mmel J, et al. Developing and evaluating criteria to helpreviewers of biomedical informatics manuscripts: a casereport. J Am Med Inf Assoc. E-publication, 2003 June 4,www.jamia.org.

Burnard P, Hannigan B. Reviewing the review process: towardsgood practice in the peer review of manuscripts submittedto nursing journals. Nurse Educ Today 2001;21:238—42.

Day F, Schriger D, Todd C, Wears R. The use of dedi-cated methodological and statistical reviewers for peer re-view: a content analysis of comments to authors madeby methodological and regular reviewers. Ann Emerg Med2002;40(3):329—33.

DeMaria A. Peer review: better than the alternatives. J Am CollCardiol 2002;40(5):1017—8.

Emden C. Manuscript reviewing: too long a concealed form ofscholarship? Nurs Enquiry 1996;3:195—9.

Godlee F, Gale C, Martyn C. Effect on the quality of peer re-view of blinding reviewers and asking them to sign theirreports: a randomised controlled trial. J Am Med Assoc1998;280(3):237—40.

Lee A. Reviewing a manuscript for publication. J Operat Manage1995;13:87—92.

Newell R. Writing academic papers: the clinical effectivenessin nursing experience. Clin Effect Nurs 2000;4:93—8.

Opthof T, Ruben C, Janse. The significance of the peer reviewprocess against the background of bias: priority ratings ofreviewers and editors and the prediction of citation, therole of geographical bias. Cardiovasc Res 2002;56:339—46.

Reidenberg J. Improving peer review: a guide for reviewers ofbiomedical research. Clin Pharmacol Ther 2002;72(5):469—73.

Salasche S. How to ‘‘peer review’’: a medical journalmanuscript. Dermatol Surg 1997;23(6):423—8.

Smith R. Medical editor lambasts journals and editors. Br MedJ 2001;323:651.

van Rooyen S, Godlee F, Evans S, Black N, Smith R. Effect ofblinding and unmasking on the quality of peer review. J AmMed Assoc 1998;280:234—7.

van Rooyen S, Godlee F, Evans S, Black N, Smith R. Effect of openpeer review on quality of reviews and on reviewers’ recom-mendations: a randomised trial. Br Med J 1999;318:23—7.

Walsh E, Rooney M, Appleby L, Wilkinson G. Open peer review:a randomised controlled trial. Br J Psychiatry 2000;176:47—51.

White S. Little evidence for effectiveness of scientific peerreview. Br Med J 2003;326:241.

Deborah Dawson(-Assistant Editor ICCN)

E-mail address:deborah.dawson@stgeorges.nhs.uk (D. Dawson)