Today’s climate of evidence-based practice requires accessing current literature. Yet nursing campuses around the world struggle to acquire and maintain sufficient current reference materials. Today’s climate of evidence-based practice requires accessing current literature. Yet nursing campuses around the world struggle to acquire and maintain sufficient current reference materials. Given these conditions, the culture of evidence-based practice is difficult to achieve. In developing countries, reference collections are often decades out of date. In developed countries, smaller hospitals, private colleges, and other institutions often do not have budgets to purchase large datasets of journals and may lack access to other current information as well. Unfortunately, even large universities have seen significant cuts in library budgets due to recent economic challenges (White & Creaser, 2007). The economic downturn has resulted in publishers increasing journal prices (Van Orsdel & Born, 2009). Given these conditions, information access is, and will continue to be, a global problem. The guiding characteristic of Open Access (OA) material is that it may be accessed via the web without charge. This offers practitioners and educators worldwide a higher level of information currency and competency.

...many nurses are not aware of the Open Access issues, benefits, and resources that exist. The advent of electronic publishing has greatly enhanced the ability to disseminate scholarly information around the world. A related movement, one that is just as powerful, is the Open Access movement. This movement has already changed the landscape of information access and acquisition for other disciplines. Unfortunately, because this concept is relatively new, many nurses are not aware of the Open Access issues, benefits, and resources that exist. This article provides a brief orientation to the Open Access movement, introduces new terminology, discusses various publishing models, elucidates issues surrounding the choice to publish in OA journals, and outlines the benefits of participating in OA. It does this through the lenses of authors, developing countries, developed countries, institutions, and the science of nursing. A second article, 'Open Access Part II,' provides OA resources, and explains how clinicians and nurse educators can use these resources in their daily practice.

Open Access Movement

During the last decade the Open Access (OA) movement has taken hold, starting in the basic sciences followed by the health sciences. Open Access provides people ability to access information electronically by searching and linking to full-text, peer-reviewed materials without a fee in order to read or download, copy and distribute, or print the information (Bethesda Statement, 2003). More succinctly, “OA removes price barriers such as subscriptions, licensing fees, pay-per-view fees, and permission barriers such as copyright and licensing restrictions” (Suber, 2007, para. 1). If materials are published via the OA model, consumers can access them without having to pay subscription fees and can distribute the materials freely without needing to seek permission from copyright holders.

Open Access provides people ability to access information electronically by searching and linking to full-text, peer-reviewed materials without a fee in order to read or download, copy and distribute, or print the information. Scientists have long recognized that the impact of their research is modulated by limited access to their published work. With the advent of the Internet came the realization that research could be equally available to all, not just to the well financed. Complete historical reviews of the OA movement by Albert (2006), Harnad et al. (2008), and Suber (2006 and 2007) track the early conceptual development of OA in the 1990s and describe how the movement blossomed organizationally in the early 2000’s. Supported by institutional libraries and embraced by visionaries, scientists from multiple disciplines met during these periods to discuss the possibility of revolutionizing access to information. In the initial meetings a shift occurred in the understanding of how information should be published/distributed. Conference participants created initiatives, statements, and ground rules for the publishing and distribution of Open Access publications. Key policy statements were developed in rapid succession. These statements today are affectionately called the BBB (for the Budapest Initiative, the Bethesda Statement, and the Berlin Declaration).

In December 2001 human rights proponents gathered for the Open Society Institute meeting. During the meetings a suggestion was made to garner global support and create open information access within the scientific community (Budapest Open Access Initiative, 2001). A draft was created during that meeting, and formalized two months later, in February 2002 as the Budapest Initiative. The United States (US)- and the United Kingdom (UK)-based biomedical community convened in April 2003 and drafted a set of publishing principles guiding scientific dissemination. These principles were finalized and published in June 2003 as the Bethesda Statement. Four months later, in October 2003, the European scientific community responded with the Berlin Declaration, calling for support by European researchers to engage in Open Access.

New concepts arising out of the OA movement included: article embargos, pre prints and post prints, self-archiving, and uploading raw data into institutional repositories. To facilitate the creation of, and to standardize repositories, two key organizations sprang up to help institutions create their own OA repositories. U.S.-based SPARC (Scholarly Publishing & Academic Resources Coalition), and U.K.-based SHERPA (Securing a Hybrid Environment for Research Preservation and Access) quickly formed to educate faculty about the important role institutional repositories play in facilitating Open Access. These two organizations also aimed to assist institutions in developing their own archival repository systems and to influence policy. SPARC and SHERPA have since expanded and set up offices in other countries.

Publishing Models

The presence of these mixed models indicates that publishers acknowledge the OA movement and are finding ways to be responsive, while retaining traditional avenues for generating revenue.  Although the Open Access publishing model has taken a firm hold, three other publishing models continue to exist. One is the historical, subscription-based system; two other models mix the concepts, and provide OA “options.” The mixed models include the hybrid, and the delayed-open-access model. The hybrid model is typically a subscription-based journal that offers authors the opportunity to turn their article into an Open Access article by paying an article processing charge (APC) prior to publishing it. This model makes it possible to have subscription-based articles and Open Access articles in the same digital journal issue. On the other hand, the delayed access model starts out as a subscription-based publication, but after a wait embargo of typically 6 months to 12 months, the article is released and is identified on the publisher’s website as OA. Publications from the delayed access model can also be automatically deposited in a central, open-access repository after the wait embargo is complete. The presence of these mixed models indicates that publishers acknowledge the OA movement and are finding ways to be responsive, while retaining traditional avenues for generating revenue. Figure 1 shows the different publishing models to disseminate scholarly work that are now available. Authors and potential authors must be aware of these different models in order to design publishing activities to align with their philosophical values of knowledge accessibility.

Considering the emphasis on achieving evidence-based practice, the global nursing community must...decide how best to participate to maximize the OA impact on the science of nursing. Most science-based disciplines have used the OA model for several years, but participation among healthcare publishers and authors remains minimal. Zuber (2008) analyzed OA library holdings from 83 U.S. institutions. He reported that the discipline with the highest percentage of Open Access journal holdings was engineering with 36%, followed by business at 15%, and physical science at 13%. Medicine was near the bottom at 3%. The OA movement is now firmly grounded in the digital landscape. Considering the emphasis on achieving evidence-based practice, the global nursing community must increase its awareness of the OA phenomenon, acknowledge the potential it has for increasing the dissemination of nursing knowledge globally, and decide how best to participate to maximize the OA impact on the science of nursing.

Open Access Issues

As with any new movement, there are advantages and disadvantages to consider. Four major issues related to OA include: peer review, author-related publication fees, copyright and licensing, and the related practice of author self-archiving. Table 1 provides specific details of the issues for each resource discussed.

Author-Related Publication Fees

Although nursing journals have generally not required article processing charges to publish in the traditional, subscription-based-journal model, in other disciplines it is common practice. Using the OA model, fees are essentially eliminated for the end user and are borne on the front end. These fees are called publication fees and can range from $600 to $1500. Publication fee requirements for OA journals can usually be found in the “Instructions for Authors." ”Happily, not all OA journals charge author-related publication fees. Less than half of the OA journals (47%) required publication fees (Kaufman-Wills Group, 2005). Shifting the cost of publication from the end user to the author should not be of concern however, since departments, schools, or universities will often subsidize or reimburse fees. Recent research in the UK, revealed that grants covered 41% of processing charges, while departmental indirect costs covered 15%, central administration covered 13%, and only 18% came from author’s own resources (SQW Consulting, 2008). In addition, various publishers have policies in place to reduce or waive charges if authors cannot pay the publication processing charges.

...it will be important to monitor nursing’s participation and track the growth of OA...research on this topic could be an important area of informatics research in nursing, as we increase our participation in the Open Access movement. The concept of paying to publish may be unpalatable to nurse authors. Although nursing journals have generally not required article processing charges to publish in the traditional, subscription-based-journal model, in other disciplines it is common practice. Authors submitting to basic science and natural science journals expect to pay a lump sum processing fee or variable sum “page charges” that can be as high as $5000 when publishing in subscription-based journals. The reader will note that the article processing charge (APC) for subscription-based journals is much higher than OA publication fees (BioMed Central, 2010). The traditional publishing system for basic sciences creates a pay-pay model for dissemination of scholarly information, by having authors pay to publish and readers pay to access. This situation unfortunately creates an information bias by hampering the ability of potential authors who are financially challenged to submit, and by hampering the ability of potential readers who are financially challenged to access important information. Since other disciplines are already accustomed to paying to publish, they have embraced OA more readily than the health sciences, such as medicine or nursing, which typically do not have processing charges related to publishing. Because many options are available to cover the costs and also create a more economical base for authors and consumers, schools of Nursing would do well to dialogue and begin establishing OA publication-charge policies. Readers are encouraged to consider the benefits derived when publishing in OA journals before discounting this venue for dissemination of scientific information.

As the number of OA nursing journals increase, it will be important to monitor nursing’s participation and track the growth of OA, regardless of whether the journal started out as an OA journal or transitioned to OA status. It would be helpful to authors, departments, and institutions, to determine the typical processing fees charged in nursing journals. This information would help authors plan when writing proposals for funding, help departments set policies for reimbursement, and help institutions plan budgets. The scarcity of research on this topic could be an important area of informatics research in nursing, as we increase our participation in the Open Access movement.

Peer Review Policies

Publications in the Open Access model still require peer review and/or quality control policies. Publications in the Open Access model still require peer review and/or quality control policies. With one exception, all the resources listed in Table 1 have extant peer review policies. Many use the traditional pre-publication, blind, peer review model, while the most recent OA resource uses an open post-publication peer review system, in which peers can comment/review the article in an open-forum format online, and in which consumers can read the comments, post their own comments regarding the quality of the work, and/or respond to the comments of others.

Licensing and Copyright Laws

Open Access does not imply there is no copyright attached to the open document; rather, in most cases the Creative Commons Attribution License (CCAL) model is used. Open Access does not imply there is no copyright attached to the open document; rather, in most cases the Creative Commons Attribution License (CCAL) model is used. Founded in 2001, the CCAL states users are free to share, adapt, or use the work as long as they give attribution in the manner specified by the author or licensor (Creative Commons Attribution License, 2010). In other words, use freely but do not plagiarize! The Attribution License is one of six codes under the Creative Commons License. Most of the resources presented in this article use the CCAL model for copyright and licensing. Copyright details can be seen in Table 1.

A second copyright model typically used for journal publication is called the U.S. Fair Use guidelines, Title 17, section 107, U.S. Code. It is a more restrictive model, and encourages users to gain permission from the copyright holder prior to use and acknowledgment of the source (U.S. Copyright Office, 2009). Reproduction of materials used in teaching and research are specifically mentioned as falling under the “fair use” guidelines. Subscription-based journals typically use this model for copyright and licensing and it is our most familiar model in nursing. Very few OA resources, however, have chosen to use this model. They use the CCAL model instead.

As OA publications continue to grow, users are faced with complying with more than one licensing model. Therefore, learning about CCAL licensing model, as well as the more familiar Fair Use guidelines, is not only prudent but also necessary. Another important point to be cognizant of is that even when publishers lift an article wait embargo, and place a subscription-based article in Open Access, the copyright (most likely the U.S. Fair Use guidelines) does not change. Therefore, users must not only differentiate between the two but know which of the guidelines applies to the article being used so as to not infringe on copyright.

Author Archiving Policies

...even if an author publishes in a journal that uses the traditional, subscription-based publishing model, or U.S. Fair Use guidelines, they may be able to self-archive the article in an institutional repository, and/or on a personal webpage, thus providing Open Access to the subscription-based article. Parallel with the OA movement, the issue of author archiving has also surfaced. When an author publishes in an OA journal, their article is automatically uploaded into any number of global OA repositories. However, what many authors are not aware of is that even if an author publishes in a journal that uses the traditional, subscription-based publishing model, or U.S. Fair Use guidelines, they may be able to self-archive the article in an institutional repository, and/or on a personal webpage, thus providing Open Access to the subscription-based article. Coleman (2007) found that varying levels of self-archiving is allowed by 90% of journals sampled from the Thompson-ISI list.

Authors can learn about publisher archiving policies in one of two ways. Authors can check the copyright transfer agreement (CTA) that they are asked to sign when a manuscript is accepted for publication. This CTA may specify the archival restrictions. Authors can also go to a website that tracks this information. One such tracking website was developed at the University of Nottingham in the UK. This SHERPA/RoMEO project created a color coding system for journals in order to differentiate the levels of archiving rights (SHERPA Project, 2006). Using the SHERPA/RoMEO website ‘Browse’ function, an author can search for a journal and find out the archiving policy by checking the color code. The intent of the SHERPA/RoMEO directory is to assist authors in determining publisher policies on archiving. Unfortunately, the color classification scheme seems to be based on random color assignment, rather than an already established color order, e.g. rainbow order, so there is no intuitiveness to the classification system. Nevertheless, policies range from being very restrictive (no archiving allowed) to unrestricted (archiving of preprints and postprints allowed). Table 2 delineates the differences between preprints, postprints, reprints, and published versions.

...although publishers establish archiving policies, authors can negotiate the level of archiving with the publisher. It is important to realize, however, that although publishers establish archiving policies, authors can negotiate the level of archiving with the publisher. Troll Covey (2009) has strongly suggested that addenda be attached to the Copyright Transfer Agreement (CTA) giving the author the right to self-archive and to provide Open Access to their work. Figure 2 shows the different archiving policies displayed along a continuum from most restrictive to least restrictive.

Recent studies from the US and the UK show that 45% to 50% of faculty have self-archived at least one article (Swan, 2005; Troll Covey, 2009); unfortunately, over one-third (36%) of authors did not even know this was an option. Morris (2009) found that publishers are more liberal than is generally assumed as far as transfer of copyright is concerned. This finding supports research conducted by Harnad, Carr, Swan, Sale, and Bosc (2009) who documented that 90% of journals allow and/or encourage some form of self-archiving. These details indicate that even though publishers allow authors to self-archive, the scholarly community does not know about self-archiving or is simply not taking advantage of this opportunity (a conclusion documented in 2007 by Harnad).

...even though publishers allow authors to self-archive, the scholarly community does not know about self-archiving or is simply not taking advantage of this opportunity... Nurse authors must continue to seek efficient and effective ways to disseminate their articles so as to reach as large an audience as possible. The recent development of self-archiving has challenged the traditional system of subscription-based-journal licensing and copyright, and causes these journals to compete with free, full-text, open-access journals. In response the majority of publishers have created a system whereby authors can self-archive, regardless of the journal status regarding Open Access. Currently Open Access publishers, as well as subscription-based publishers, usually have policies regarding self-archiving. Authors need to be aware of these policies so as to derive the maximum benefit of increased citation advantage, while not infringing on copyright licenses.

Open Access Benefits

There is a growing body of evidence indicating clear benefits of publishing in OA journals. This is the case both when developing and developed countries use OA resources and when institutions archive OA materials. Being aware of all research done on a certain topic will impact networking and increase connectedness at a global scale.

Author-Related Benefits of Open Access

Publishing in OA venues results in wider dissemination and quicker citing by other authors, thereby increasing the impact factor (Antelman, 2004; Harnad et al., 2008; Lawrence, 2001; McVeigh, 2004). Of note, Hajjem, Harnad, and Gingras (2005) found that articles from OA journals were cited anywhere from 36% to 176% more frequently than articles in non-OA journals. Eysenbach (2006) also documented that OA articles had both increased citation rates and were cited earlier in time. Additionally, Wagner’s (2010) findings supported the hypothesis of citation advantage. Wagner found 39 studies showing a citation advantage for OA publications, and only 7 studies that concluded there was no advantage over traditional publication. Citation frequency plays an important role in the calculation of the Institute for Scientific Information (ISI) Web of Science impact factor.

Publishing in OA venues results in wider dissemination and quicker citing by other authors, thereby increasing the impact factor...articles from OA journals were cited anywhere from 36% to 176% more frequently than articles in non-OA journals. Although it is hard to argue with documented higher citation advantage, there is some controversy over the perceived resultant higher ‘impact factor’ associated with Open Access. Because OA articles are available in multiple search engines, (e.g., Google Scholar, PubMed Central, and BioMed Central), multiple avenues increase the ability of end users to find articles. Wren (2005) has cautioned the scientific community about the apparent higher impact factors, and has asserted that the effect of Open Access on raising the impact factor is artificial due to electronic article duplication in multiple electronic repositories and to self-promotion (self-archiving) rather than an effect of the Open Access movement. However, the main premise still holds true: if a full-text article is more accessible and can be found in multiple locations, scholars will be more likely to find and reference this article in their work compared with an article that can be found only at one source and is only available for a fee. This conclusion is supported by the research of Xia, Myers, and Wilhoite (2011). In summary, the use of OA will allow more scholars to have access to scientific work and will contribute to a greater impact factor for OA journals than the use of single repositories using subscription-based access.

Benefits to the Global Science of Nursing

...as OA grows, an unlimited number of medical and nursing journals can be searched and accessed, increasing the overall depth of research. Traditionally, achieving a global representation of nursing knowledge has been unattainable because fee-based databases search a limited number of journals in each country. The earliest official published statement on Open Access, namely the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities (2003), stated that the power of the Internet, coupled with OA, “now offers the chance to constitute a global and interactive representation of human knowledge (para. 1).” Mark and Shearer (2006) have acknowledged that removing existing economic barriers can increase the amount of information available to the global scientific community. In the future, as OA grows, an unlimited number of medical and nursing journals can be searched and accessed, increasing the overall depth of research.

Fee-based research database services limit awareness of research in the science of nursing that is being conducted nationally as well as globally. Not even all of the U.S. nursing journals are included in common research database services such as EbscoHost, the Cumulative Index to Nursing and Allied health Literature (CINAHL), and OVID. Additionally none of the non-U.S.-based OA nursing journals were included, again limiting the availability of research findings. Unawareness creates replication of research without verification; it creates silos or pods of research. With full participation in OA, the whole body of nursing knowledge could be globally available and promote the rapid growth and maturation of our science. Without it, pods of knowledge will continue to exist nationally and globally. Universal access could increase networking, nursing research alliances, and implementation of new and improved treatments. Completed research from multiple countries could be combined to develop much needed Nursing Systematic Reviews, Clinical Practice Guidelines, Critically Appraised Topics, or Best Evidence Topics. This would contribute to clinical practice being more closely aligned with the goals of the evidence-based-practice movement

Benefits to Developing Countries

...traditional fee-for-information is generally out of reach for nurses in half of the world. Due to economic disparities, many institutions and researchers in developing countries simply do not have the fiscal resources to purchase multiple articles from a fee-based repository on a routine basis. Out of 209 countries around the world, 103 (49%) fall into the category of a ‘developing country’ with an average income of less than $935 for low economies or less than $3705 for lower middle economies (The World Bank, 2009). Therefore, traditional fee-for-information is generally out of reach for nurses in half of the world. They are not able to access and use a broad range of current information or implement evidence-based practice. OA provides the resources needed so that those with access to the web can stay abreast of evidence-based-nursing practice.

Benefits to Developed Countries

Although developed countries have better access to the Internet...some institutions in developed countries are challenged to pay for fee-based research database services. OA should not be considered a resource solely for developing countries because subscription-based information can also be difficult to obtain by institutions in developed countries where institutional financial challenges limit information access. For example, a small private college in Japan, in a country considered highly developed and with average incomes slightly higher than the US, can only afford to pay for a service that allows two individuals to search a limited number of electronic journals at any given time. Smaller hospitals in the US also face fiscal limitations. Although developed countries have better access to the Internet and may take more advantage of the benefits of increased access to information, some institutions in developed countries are challenged to pay for fee-based research database services. Clearly then, Open Access has added benefits for all nurses, regardless of the status of their national economy.

Benefits to Institutions

As well as being a tangible indicator of scholarly productivity, institutional repositories also increase visibility, prestige, and perception of public value. Academic institutions involved in the OA movement provide a critical link for accessibility; they can now develop their own ‘institutional repository.’ An institutional repository serves as an indicator of the scholarly output of the institution. Prior to OA, housing published work in a private repository was not feasible. For the last eight years, it has been a reality. Institutional repositories typically house pre-publication prints (preprints); post-publication prints (postprints); publisher-allowed, portable-document-format (pdf), full-text articles; and other scholarly works by their faculty. As well as being a tangible indicator of scholarly productivity, institutional repositories also increase visibility, prestige, and perception of public value (Crow, 2002).

Troll Covey (2009) found that even if there was an institutional repository, some departments practiced self-archiving, while other departments did not. Hence, authors may be at an institution that has an established repository and not even know it. Two global registries provide a list of institutional repositories. Both repositories track all the institutions that have established repositories and provide data charts, as well as text, for each institutional repository. One, called the “Directory of Open Access Repositories” (Open DOAR) is found at www.opendoar.org/. The second, called the “Registry of Open Access Repositories” (ROAR), can be seen at http://roar.eprints.org/ . While there are too many examples to list here, the reader can view these websites to get a sense of the global participation, and to check and determine whether a particular institution has a repository. A third valuable resource is the ‘Repository 66’ map. This resource combines the information from the above-mentioned repository databases and provides a visual, world-map representation of where institutional repositories exist (http://maps.repository66.org/). The most concentrated areas with institutional repositories include Southern and Central Europe, the Eastern half of the US, and Japan.

In this era of state, regional, and national accrediting bodies requiring data to demonstrate achievement of the institutional mission statements, an institutional repository can be an extremely useful tool to demonstrate scholarly output to site visitors. Basically, institutional repositories provide all stakeholders with the ability to assess the institutional accomplishments and intellectual output. It is beneficial to institutions to invest time and effort in setting up and running a repository.

Summary

It is time for the nursing scientific community to convene and declare its intentions regarding participation in the Open Access movement. Over the last decade, many changes have occurred in electronic publishing. These changes and associated publishing issues require nurse educators and nurse clinicians to not only be aware of, but also know how to navigate new publishing models and create policies supportive of these new models. We, as nurses, must become involved in these changes so we do not miss out on the associated benefits personally, institutionally, and globally. Ten years ago, the scientific community gathered together and created statements, initiatives, and declarations. It is time for the nursing scientific community to convene and declare its intentions regarding participation in the Open Access movement. As the saying goes, to not decide is to decide (Harvey Cox). The potential to create a single body of knowledge accessible to all nurses is both exciting and urgently necessary.     

Author

Jan M. Nick, PhD, RNC-OB, CNE, ANEF
E-mail: jnick@llu.edu

Dr. Nick holds a dual appointment as faculty member in both the School of Nursing at Saniku Gakuin College (Japan) and at Loma Linda University (California). She teaches Obstetric and Neonatal Nursing, Clinical Nursing Research, and Nursing Informatics. Dr. Nick chaired the nursing technology committee for eight years. She conducts faculty development seminars on evidence-based practice and open access resources internationally. Dr. Nick is a strong supporter of OA and seeks to further the open access movement. She is also a Health Resources and Services Administration (HRSA) Health Information Technology Scholar and completed the Emerging Learning and Integrated Technologies Education (ELITE) Advanced Informatics Program by University of Pittsburgh. While Dr. Nick was in Paraguay as a Fulbright Scholar, she learned how powerful Open Access is to those who do not have the fiscal resources to obtain sufficient evidence to guide their practice. Dr. Nick received her BS in Nursing from Pacific Union College in Angwin, CA, her MS in Nursing from the University of Oklahoma in Oklahoma City, and her PhD in Nursing from Texas Woman’s University in Denton, TX.