Writing for Nursing Research, An Essay on Style: Continuities
John Eric Bellquist
Nurse Author & Editor, 2021, 31(1), 4
In my previous article,1 I illustrated a model of writing sentences drawn from Joseph Williams’2 discussion of style, which I suggested might be useful in teaching and evaluating writing for nursing research. The model describes the successive iteration of given (familiar) and new information within sentences and from sentence to sentence, supporting an implicit contract between writer and reader.3
In the given–new model of sentence structure, each sentence begins with a context that the author and reader share, and each sentence concludes with new information, which also suggests how the next sentence will begin. As a result, the reader’s experience is never interrupted, so that consecutive sentences “flow.” As Williams recommends, “generally, use the beginning of your sentences to refer to what you have already mentioned or knowledge that you can assume you and your reader readily share”2, p. 64 This is the given information, which points toward the new information at the sentence’s end. You could also define this movement as a patterned sequence, as A–B, B–C, C–D, and so forth, where each pair of letters represents a sentence, and each letter after the first in a pair is new and then in the next sentence familiar. We can put this more generally: In formal academic writing, we write linearly, such that each sentence should prepare the reader for the next, resulting in a continuous, logical development. This is one way to achieve coherence in what we are saying and satisfy our readers’ expectations.
Some will object that such a practice is too mechanical. Indeed if every sentence simply matched the model as I have defined it so far, that might be so. But nothing is ever so simple. Williams says that the familiar given information should “generally” come at the sentence’s beginning, and in referring to the new information at the end of the sentence, he uses the word perhaps: it will be “perhaps the information that you will expand on in your next sentence.”2, p. 48 This is because the movement from sentence to sentence implicates many more patterns than a simple progression from familiar to new. Consider the following example, adapted from the World Health Organization’s Global Report on Diabetes:4
Worldwide in 2014, an estimated 422 million people had diabetes, for a prevalence of 8.5% among adults. In the Eastern Mediterranean, the prevalence was highest, at 13.7%; in Africa, it was lowest, 7.1%. From 1980 to 2014, in all regions, prevalence of diabetes increased; from country to country, it increased or at best remained the same.
This example begins with shared information (the world in 2014), followed by new information: the number of those with diabetes and the prevalence of diabetes among adults. But the next sentence does not start with adult prevalence. Instead it repeats the first sentence’s pattern more specifically. In two statements, the world is replaced by the geographical regions of the Eastern Mediterranean and Africa, and their respective prevalences follow. This second sentence thus reiterates the pattern of the first, moving twice from familiar to new information, but it does so by giving greater specificity and detail for both the familiar and the new. The third sentence repeats that pattern, beginning with the period from 1980 to 2014 instead of just 2014 and concluding with the increase in prevalence in all regions; after that, it narrows the focus once more to countries rather than regions, and it adds new information about the prevalence of diabetes in countries. Thus each sentence begins with shared, given information, and after the first sentence, each subsequent sentence begins by naming a subset of the first shared information. Applying our A–B formula, we might describe this pattern as A–B. A1–B1; A2–B2. A3–B3; A4–B4. In this example, the given–new structure is developed through stylistic parallelism.
Now for a published paragraph:
Prostate cancer is the most commonly diagnosed cancer in US men and the second leading cause of cancer death. It has been estimated that in 2018, approximately 165 000 US men will be diagnosed with prostate cancer and 29 000 men will die of prostate cancer. Prostate cancer incidence is 74% greater among African American than white men and is also relatively greater in men with vs men without a family history of prostate cancer.5
Here the authors go straight to the point; they are writing for their peers, and prostate cancer, a familiar disease, is the given information at the start. The subsequent new information is prostate cancer’s prevalence, presented in two ways without numbers: the frequency of prostate cancer diagnosis in US men and of prostate cancer as a cause of cancer death. The next sentence then reexamines the information in the first sentence, providing greater specificity in parallel: prostate cancer for 2018, and estimates for diagnoses and deaths in that year. Estimation echoes the preceding information about prostate cancer’s frequency, and together with the year 2018 it constitutes familiar information. The estimated numbers now become the new information, stated in parallel with the more general statements of prevalence for diagnosis and death in the opening sentence. The third sentence takes up prostate cancer’s incidence, this time for African American versus white men and for men with versus without a family history of the disease. Thus each sentence follows the given–new model, each one adding specificity, and all three sentences are parallel in style.
What happens when such sentence patterns are not followed carefully? Here is another published example:
The past two decades have seen extraordinary advances in our understanding of human immunodeficiency virus (HIV). The global scale-up of access to antiretroviral therapy (ART) for people living with HIV is perhaps the greatest of these advances. As of the end of 2017, more than 20 million of the world’s 37 million people with HIV were taking ART, often in the form of a single pill a day. Despite this major public health achievement, almost 2 million new infections continue to occur each year, leaving many countries, primarily in sub-Saharan Africa, with a daunting epidemic.6
The first sentence of this paragraph begins with a familiar context, the past 20 years. It then gives us new information: remarkable advances in our understanding of HIV. The second sentence then begins by referring to “the global scale-up of access” to ART. But is this “scale-up” an advance in our “understanding”? An increase in access is certainly an advance, but not in scientific knowledge. The “global scale-up” does not accurately echo the new information at the end of the preceding sentence. Nevertheless, the second sentence concludes with the claim that the global scale-up is one of those advances after all. But the advances are not new information. So, as readers, we are returned, inaccurately and redundantly, to the information at the end of the first sentence. Instead of proceeding from A to B (familiar to new) and from B to C (familiar to new), these sentences move from A to B, and from C back to B (new to familiar), rendering their meanings in a circle. Leaving aside the issue of access versus understanding, a better order of this material might read like this:
The past two decades have seen extraordinary advances in our understanding of human immunodeficiency virus (HIV). Perhaps the greatest of these advances is the global scale-up of access to antiretroviral therapy (ART) for people living with HIV.
Now the familiar, given information comes first (A; the past two decades); the new information follows (B; extraordinary advances); and the subsequent given information (B; the greatest of the advances), which recalls the preceding new information, points to the new information that follows it (C; the global scale-up). These sentences now fit the iterative given–new model.
However, further improvement remains possible. When we begin a sentence with familiar information that derives from the end of the preceding sentence, it is best to avoid redundancy, so consider joining the two sentences, preserving the A–B, B–C sequence yet cutting superfluous words:
The past two decades have seen extraordinary advances in our understanding of human immunodeficiency virus (HIV), perhaps the greatest of which is the global scale-up of access to antiretroviral therapy (ART) for people living with HIV.
This in turn leads very well into the original third sentence, which begins in parallel with the first by specifying a year (the end of the two decades) and then provides more detail about the prevalence of ART:
As of the end of 2017, more than 20 million of the world’s 37 million people with HIV were taking ART, often in the form of a single pill a day.
So far, the revision reads as follows; how well does the final sentence fit?
The past two decades have seen extraordinary advances in our understanding of human immunodeficiency virus (HIV), perhaps the greatest of which is the global scale-up of access to antiretroviral therapy (ART) for people living with HIV. As of the end of 2017, more than 20 million of the world’s 37 million people with HIV were taking ART, often in the form of a single pill a day. Despite this major public health achievement, almost 2 million new infections continue to occur each year, leaving many countries, primarily in sub-Saharan Africa, with a daunting epidemic.
According to the given–new model, the phrase “this major public health achievement” does echo the preceding details about the scale-up of ART. But that now familiar achievement is negated by the word despite, which seems to reject the preceding information, so that the reader stumbles. Why? The answer is simple: We have words or phrases (e.g., and, but, however, therefore) to signal breaks or shifts in the sequence of given–new sentences and complement the flow of thought:
The past two decades have seen extraordinary advances in our understanding of human immunodeficiency virus (HIV), perhaps the greatest of which is the global scale-up of access to antiretroviral therapy (ART). As of the end of 2017, more than 20 million of the world’s 37 million people with HIV were taking ART, often in the form of a single pill a day. Nevertheless [However, Yet], despite this major public health achievement, almost 2 million new infections continue to occur each year, leaving many countries, primarily in sub-Saharan Africa, with a daunting epidemic.
By adding a single connecting word with the right logical implication at the start of the final sentence, we enable the reader to expect a contrast that continues to recognize the preceding new information as given but that will provide very surprising new information about it. This is yet another tool in the mechanics of style.
What, then, is the purpose of such a model of writing sentences? Presumably, the best writers write this way intuitively. Can the model be used consciously as a tactic while you write? Perhaps not. Yet once you have written a few sentences, a paragraph, or a longer document, you can use the model to diagnose your written work. If sentences, when read, present a sequential, continuous development according to the given–new pattern, they will better support the logical unfolding of your topic and thoughts. They will fulfill your—the author’s—contract with the reader. Nor is this approach entirely novel or unfamiliar: Every research article, structured as Background, Methods, Results, and Discussion, presents a logical sequence of sections that, like the given–new sentence structure, proceed from a shared context and point toward what comes next. The Background establishes the shared context. The Methods present how one addresses that shared context. The Results present the Method’s outcomes, and the Discussion evaluates the Method’s results and often concludes with recommendations for future research. Thus the scientific conversation continues, from sentence to sentence, from article section to article section, from study to study, and from research project to research project, looking forward but also looking back.
- Bellquist JE. Writing for nursing research: an essay on style. Beginnings. Nurs Auth Ed. 2021;31(1)3.
- Williams JM. Style: Toward clarity and grace. University of Chicago Press;1990.
- Kolln M, Gray, L. Rhetorical grammar: Grammatical choices, rhetorical effects. 8th ed. Pearson Education; 2018.
- World Health Organization. Global report on diabetes. 2016, http://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.pdf;jsessionid=8EB4FB5B8434A10F0895F8AEC9915DEE?sequence=1.
- Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J. Prostate-specific antigen-based screening for prostate cancer: Evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;319(18):1914–1931. https://doi.org/10.1001/jama.2018.3712
- Justman JE, Mugurungi O, El-Sadr, WM. HIV population surveys—bringing precision to the global response. N Engl J Med. 2018;378(20):1859–1861. https://doi.org/10.1056/NEJMp1801934
About the Author
John Eric Bellquist, PhD, serves as editor and as lecturer in writing for nursing research at the University of Texas at Austin School of Nursing. Formerly the managing editor for the journals of the Psychonomic Society, he has authored books as well. You can contact John at firstname.lastname@example.org.
Copyright 2021: The Author. May not be reproduced without permission.
Journal Complication Copyright 2021: John Wiley and Son Ltd.