The power of Open Access (OA) is that it equalizes and levels scholarly information around the globe...The Open Access movement has the potential to erase the scientific knowledge disparity that exists today. In the summer and fall of 2008 I taught evidence-based practice concepts to the nursing faculty at the National University in Paraguay while on sabbatical as a Fulbright Scholar. In Paraguay the nursing library was small, most books were 10 to 20 years old, and journal issues were incomplete. Although the nursing program subscribed to an online research database service (comparable to Ovid or EbscoHost), they could afford only the basic package and had access to only a small number of key nursing and medical journals. They struggled to obtain and keep abreast of current information. Today Open Access to scholarly materials allows them to enlarge their base of information without incurring additional costs.

The power of Open Access (OA) is that it equalizes and levels scholarly information around the globe. In the traditional publishing model, those who can afford to buy the scientific information ‘have,’ and those who cannot afford to buy scientific information ‘have not.’ In the new publishing paradigm of Open Access, if the material is published in OA, anyone can access the information for free, and copy, distribute, display, and transmit the work as long as they give proper attribution to the author (Bethesda Statement on Open Access Publishing, 2003).

In the new publishing paradigm of Open Access, if the material is published in OA, anyone can access the information for free, and copy, distribute, display, and transmit the work as long as they give proper attribution to the author. The Open Access movement has the potential to erase the scientific knowledge disparity that exists today. Nurses need to be aware of and understand this movement so as to have confidence in their web-based searches because open access resources will likely be included in their search findings. For example, Google Scholar™ gives preference to Open Access pdf articles and sends crawlers to find first those articles in Open Access repositories before listing other articles (Google Scholar, 2011). Combining OA resources with subscription-based databases makes a larger amount of scholarly material readily available.

OJIN’s two-part series on Open Access attempts to increase knowledge of and participation in this very important movement. The first article, “Open Access Part I: The Movement, the Issues, and the Benefits,” introduces the concept of Open Access, addresses issues related to peer review, author-related publication fees, copyright changes, and policies on self-archiving of published manuscripts; the benefits to authors, institutions, and the global science of nursing are identified. The present article builds on Part I. In this article I outline the structure of Open Access publishing and explain how the compiled resources are divided into one of two basic categories, specifically a third party repository, or a combined publisher and repository. Following this discussion I offer suggestions for using the OA resources in classrooms and clinical areas and discuss potential research projects that illustrate the use of OA. It is important to realize that because the OA movement has worldwide participation, it is a truly universal resource for scholars. Nurses around the world will want to remain aware of the expansion of knowledge that is occurring as a result of Open Access.

Open Access Structure

OA resources can be divided into two basic categories. Some OA resources function only as a global repository of journals published elsewhere. Others combine functions and both serve as OA publisher and offer their own, proprietary repository. In this latter category, resources can be further broken down into journal publishers and single topic publishers. Some resources deal only with materials in the English language, while others include multiple languages, thus enhancing global utility. Of significance, a few OA resources use the digital format of electronic publishing to full advantage and now feature nontraditional formats for scholarly work such as media, videos, and clinical summaries. The Table provides a summary of the websites for OA resources, classifies each resource according to its function, clarifies the format, and identifies the main features of the resource that are useful for the teaching/learning environment. The various OA resources described below offer differing advantages.

Global Repository

...publishers from many countries register their journals in these repositories and the new content is automatically uploaded to the global repository each month, thus providing a global collection of scholarly articles and text. Global repositories collect Open Access journals and offer the advantage of search capabilities so that clinicians and educators can find a precise journal or a particular volume/issue. To be efficient in using a global repository, clinicians and educators must have the citation already identified. However, one can simply browse a recently released journal issue in a global repository. This resource parallels traditional methods of looking up journal information in the library stacks. The main advantage of knowing about this type of resource is that publishers from many countries register their journals in these repositories and the new content is automatically uploaded to the global repository each month, thus providing a global collection of scholarly articles and text. The global repositories in this category include the Directory of Open Access Journals, Free Medical Journals, and PubMed Central. Nurses can benefit from these repositories since they are easy to use, free to access, and offer journals published in many languages. Each of these global repositories is described below.

Directory of Open Access Journals (DOAJ). A global repository and significant contributor to the OA movement, DOAJ was created in Sweden by Lund University Libraries in partnership with the National Library of Sweden, EBSCO Publishing, the Open Society Institute (OSI), and the International Network for the Availability of Scientific Publications (INASP). The DOAJ directory does not specialize solely in health-related journals, but is a repository of all the open access journals published around the world that have a quality control system in place (DOAJ, 2007). This resource is useful for any liberal arts college or university.

...[DOAJ] now provides scholars the opportunity to access almost 6500 scientific journals from a variety of sciences, including health sciences. The project, which began in 2003, now provides scholars the opportunity to access almost 6500 scientific journals from a variety of sciences, including health sciences. When browsing by subject, the ‘Health Sciences’ category appears, displaying over 441 medical journals, approximately 163 public health journals, and more than 36 nursing journals. Only journals that publish primary research or summaries of research are included in this repository. Unfortunately, DOAJ allows journals to ask the ‘searcher’ for registration information before accessing their articles, thus slowing down the reader’s access to the journal. Access can be achieved by either clicking on the journal name that is underlined and linked, or clicking the DOAJ box to the right of the name, which gives access through a different path. One can search a specific journal, or a topic within DOAJ by using key words, a feature that makes this repository a powerful tool to find and access free information.

Monitoring key journals monthly for one’s personally targeted information is an extremely valuable tool for monitoring global research on a particular topic. Free Medical Journals (FMJ). The second repository in this category is called Free Medical Journals (FMJ). As the name implies, this resource collects only health-related research and scholarly journals. The website includes a database of more than 2,226 full-text medical journals in four languages. FMJ is a consortium that promotes free access to highly acclaimed journals, e.g., JAMA, Scientific American, Lancet, Johns Hopkins, and Annals of Internal Medicine, for the medical community worldwide.  One can get a sense of the quality of journals included in this website by perusing the titles that can be sorted by topic or impact factor, or else alphabetized. An added feature of FMJ is that it offers links to almost 400 free medical books, as well as medical podcasts in English. About half the journals are available without charge immediately after publication, while others are free after a wait embargo of typically 6 to12 months. Although searching by journal title is the most efficient way to find a journal in FMJ, one can also search for journals by using the ‘sorting’ feature, and by specifying criteria by which to sort, such as by ‘language,’ ‘specialty,’ or ‘impact factor.’  Journals in multiple languages add to the desirability and usefulness of this website. The Free Medical Journals site offers an automated service that sends a monthly update of user-specified journals from their global sampling. Monitoring key journals monthly for one’s personally targeted information is an extremely valuable tool for monitoring global research on a particular topic. Of caution however, is that the Google™ search box inside this website is confusing--it goes back out to Google and searches on the entire web. It is not a useful tool to use inside FMJ and therefore should not be used.

...PubMed Central houses only single articles published elsewhere. Because of the ‘article’ approach, searches in PMC can be done using key words. PubMed Central (PMC). Whereas the previous two resources contain entire journals, PubMed Central houses only single articles published elsewhere. Because of the ‘article’ approach, searches in PMC can be done using key words. PubMed Central, sponsored by the United States (U. S.) National Library of Medicine (NLM) and the U.S. National Institutes of Health (NIH), provides an open access archival system that focuses on biomedical journals (National Center for Biotechnology Information, 2011). Recent U.S. legislation requires that findings from all NIH-sponsored research be deposited in the PubMed Central database (NIH Public Access Policy, 2008). This policy applies to articles accepted for publication after April 7, 2008. In order to be in compliance with this federally mandated policy, PubMed Central uses two methods for collecting articles. In the first method, articles are automatically uploaded to PMC by publishers who have a contract with PMC to do so. In the second method, authors choosing to publish their NIH-sponsored research articles in journals that do not have an agreement with PMC manually upload the final pdf copy of the published article to the PMC repository themselves. Therefore, authors must be aware of journal archiving policies when submitting a manuscript to a journal, if their manuscript resulted from NIH funding. More importantly, if a journal does not allow archiving in PMC due to a restrictive copyright transfer agreement (CTA), the author should not submit NIH-funded research manuscripts to that journal. My first article, Part I, “Open Access Part I: The Movement, the Issues, and the Benefits,” reviewed the journal color coding system used to alert authors as to publisher policies on archiving.

It is exciting to recognize there is reciprocal agreement between national PMCs—articles deposited in one PMC are transferred to the other PMCs and vice versa. This action increases the accessibility and availability of research articles from around the world. Interestingly, several other governments have now begun sponsoring their own PMC open repositories, including the United Kingdom PMC and PMC Canada. It is exciting to recognize there is reciprocal agreement between national PMCs—articles deposited in one PMC are transferred to the other PMCs and vice versa. This action increases the accessibility and availability of research articles from around the world. Research that was once unattainable because of proprietary research database services is now becoming accessible because of reciprocal agreements between PMCs around the globe. It is important to point out that other published articles, those not based on government- sponsored research, can also be uploaded to PMC (PMC FAQs, 2011). By uploading published materials into open access, authors not only increase the PMC database of available research, but also increase accessibility to their publications. An important point to remember is that because PMC collects articles from a variety of journals, the copyright also varies from the more restrictive U.S. Fair Use guidelines to the less restrictive Creative Commons Attribution License (also described in detail in Part I of this series). Although PubMed Central functions as a global repository of research articles, it currently only houses materials in English, whereas the previously mentioned resources have journals in other languages. PubMed Central recognizes this limitation and has future plans to work in collaboration with other national agencies, to expand the repository by adding journals in other languages (PMC FAQs, 2011).

Because of the newness of the NIH Public Access policy, the impact has not been fully realized yet here in the US; however the potential is palpable. As the PMC repository grows, the availability of free, full-text information to scientists worldwide will increase.

Publisher and Own Repository

The second category in the OA model is the combined publisher and repository. In this category publishers typically produce either journals or single articles, and then house these online resources on their own website. An advantage of this type of resource is that in addition to offering a journal browse feature, an internal search engine also allows searching by key words, so that users can either browse a newly issued journal, or find articles on a specific topic. This feature increases efficiency and makes these resources a ‘one stop’ shopping experience. This combined OA category includes two sub-categories, namely the journal publisher and own repository and the topical publisher and own repository. With the advent of electronic publishing, alternate publishing formats are surfacing—the last two resources discussed in this section, i.e., eMedicine and WebmedCentral depart the most from the traditional publishing format, thus expanding our experience of electronic publishing.

Journal Publisher and Own Repository. Three resources can be identified in this section; they are the Bentham Open Series, Public Library of Science (PLoS), and BioMed Central resources. Because all three publishers limit their repository holdings to only the journals they publish, the sources are limited; even though OA has been in existence for 10 years, some of these journals have been started only within the last few years. It is important, however, to know about these resources because they can act not only as sources of information, but also as avenues for publishing. The publishers in this category circulate only resources written in English.

Bentham Open. Bentham Open is an OA publisher that produces more than 250 journals using the STM (science, technology, and medicine) model. Bentham Open, which offers full-text, free articles online is not to be confused with Bentham Science Publishers, the parent company that publishes subscription, fee-based journals as well. Bentham Open is known for their ‘Open’ series, including the Open Nursing Journal. Although Bentham Open publishes hundreds of journals, at this time only 17 journals are indexed in PubMed Central, of which the Open Nursing Journal is one. To be indexed in PubMed Central, certain qualifications and a track record must be demonstrated. Bentham Open requires a publishing fee, to be paid either by the author or the author’s institution, when an article is published. Looking for journals by subject is an efficient way to search within this website. The search box at the bottom of the left hand side does not provide help and should not be used.

BioMed Central (BMC). BioMed Central, based in the United Kingdom, is an early participant in the OA publishing business. BMC publishes over 215 peer-reviewed, open access journals focusing on the sciences, technology, and medicine (STM model). BioMed Central features the journal series called BMC (e.g., BMC Nursing), and covers many specialties in the health sciences. They report that 32% of their authors have chosen to publish in the BMC journals because of their open access policy (BMC, 2011). Once published by BioMed Central, journal articles are automatically transferred to the U.K. Pub Med Central (PMC) repository, which is then deposited into the U.S. PMC repository. In addition, authors retain copyright of the published article, and are encouraged to self-archive in their own institutional repository.

Although articles can be accessed for free, to take advantage of other services, BioMed Central requires free registration. Users can conduct and save searches from the BMC internal search engine, customize fields for automatic email notification of new articles in BMC published journals, or submit manuscripts to a BMC Journal. The topical alert feature makes BMC very desirable for busy clinicians who don’t have access to free, full-text information from other avenues. Clinicians can review the computer generated email notification and chose which articles to download using a simple click of the mouse.

Public Library of Science (PLoS). Created in 2003, PLoS publishing responded rapidly to the OA movement and now publishes seven OA journals. PLoS journals focus on basic science and medical literature, making PLoS a potential journal in which nurse researchers can publish their health-related research. Journals published by PLoS include:  PLoS One, PLoS Biology, PLoS Medicine, PLoS Computational Biology, PLoS Genetics, PLoS Pathogens, and PLoS Neglected Tropical Diseases. Although ‘PLoS Nursing’ unfortunately does not exist, the other PLoS journals do cover basic sciences and healthcare research, therefore nurses should not discount this PLoS as an information resource that offers foundational knowledge to support physiology content.

Topical Publisher and Own Repository. Two resources, eMedicine, and WebmedCentral are examples of electronic publishing using a new format. This type of OA publisher does not focus on the traditional journal, volume, and issue format held over by the printed journal model, but rather, takes full advantage of electronic publishing possibilities and publishes single papers. An exciting feature of the resources in this category is that of author-produced videos that are also published online. Repositories in this category are exclusive publishers and include access only to their own publications and media.

eMedicine. Sponsored by U.S. based WebMD, and created for medical personnel, eMedicine publishes over 6500 clinical topics; eMedicine is the reference portion of Medscape and focuses on information regarding diseases, procedures, and anatomy. The benefit of this resource is that it offers free, full-text, clinical information for all specialties in a concise format, making it extremely useful for nurse clinicians and educators. The advantage of this resource is the completeness, currency, and practicality of the information it includes. Authors use a template, and each topic covers pathophysiology, frequency of the disease, mortality/morbidity, the differential diagnoses and workup, treatment and medication, and recommended follow-ups. Although the topical articles use the medical model, the information can be applied to nursing models of care. The creation of a parallel eNursing that focuses on nursing diagnoses and nursing treatments is urgently needed. The potential for unifying the science and practice of evidence-based nursing with this type of OA resource is thrilling to ponder.

WebmedCentral. The newest of the OA resources, WebmedCentral, published their first articles in August 2010. WebmedCentral publishes topics rather than journals and lists the articles by the month and year published. An exciting aspect of this resource is the ability to submit videos on medical topics as well as original manuscripts, thus expanding the concept of scholarly publications for the OA community. Searches can be done by article or by subject. Another innovative feature is WebmedCentral’s model which eliminates pre-publication peer review, and uses a post-publication peer review that occurs in an open forum. The intent of this maverick design is to achieve rapid dissemination, increase author accountability, and improve transparency of the review process. Once published, each submission is linked, so readers can read the reviewer’s comments, as well as contribute their own comments. Reviewers evaluate and score articles using a template. The reviewer must also answer questions about competing interests, expertise in the area, and if the review was by invitation from the author(s). Reviewer comments, scores, and statements on reviewer qualifications and competing interests are displayed following the article. This publishing model is too new to evaluate, but it definitely breaks new ground. At this time, WebmedCentral is indexed in Google Scholar, but not in PubMed.

Use of Open Access Resources in Classroom and Practice Settings

Constraints, such as traditional publishing models, financial limitations, national rather than global databases, and restricted search engines all contribute to the current situation of information silos. Constraints, such as traditional publishing models, financial limitations, national rather than global databases, and restricted search engines all contribute to the current situation of information silos. These conditions have made it difficult to keep abreast of global research. Electronic publishing has changed the landscape for dissemination of scholarly information, and now Open Access has the ability to encourage globalization of scholarly work, facilitate lifelong-learning habits, enhance distribution, impact informatics curriculum, support active learning, and provide many opportunities for research.

OA supports the trend towards academic globalization. Academic institutions are aligning with schools of nursing in other countries. Institutions now offer exchange programs, faculty development seminars, and off-campus and/or distance learning programs internationally. Their faculty should also be aware of the global and multilingual resources currently available. Because of my familiarity with OA resources, I introduced English OA resources to nurses in the Philippines, Spanish OA resources to a South American university, and French OA resources to medical and nursing faculty and students in Africa last year. None of these healthcare personnel had ever heard of the OA movement, nor were they aware of the free, scholarly resources available. Providing them with Open Access resources lifted their financial burden and increased their ability to access information online, a benefit that will ultimately facilitate their adoption of evidence-based practice. The simple act of increasing access to scholarly resources can impact teaching content, student learning, clinical practice, and ultimately patient care outcomes. These experiences underscored for me the impact OA offers to international healthcare providers who struggle to have access to current information and research on practice issues. In essence, OA offers the potential for ‘equalizing’ information acquisition around the world.

The simple act of increasing access to scholarly resources can impact teaching content, student learning, clinical practice, and ultimately patient care outcomes. Nurse educators spend time teaching students how to use and access their institution’s subscription-based, library databases during their programs of study. But when students finish their college tenure, and do not have access to this institutional library, how can they access information to continue lifelong learning? Nurse educators do a disservice to students by not orienting students while in school to free resources that they will be able to access after graduation, when they may take position in agencies with limited library resources. By teaching students where to go to find all types of resources, free or subscription based, nurse educators give students tools to use that will last a lifetime.

Most OA materials are published under the Creative Commons Attribution License (CCAL) copyright, so restrictions regarding the copying, distribution, and transmittal have been lifted, as long as attribution is given to the author(s) through appropriate referencing. For clinicians, this makes it easier to distribute information to colleagues without having to get permission from the publisher. For faculty gathering course packs, not having to struggle to obtain copyright permissions in time for the start of the academic session may pique their interest in using articles from OA journals rather than subscription-based journals that typically use U.S. Fair Use Guidelines which prohibit copying unless permission is granted.

By teaching students where to go to find all types of resources, free or subscription based, nurse educators give students tools to use that will last a lifetime. Professional organizations and policy makers now indicate today’s nurses need information literacy content in the curriculum (American Association of Colleges of Nursing, 2006, 2008; National Council of State Boards of Nursing Licensure Examination 2010; National League for Nursing Position Statement, 2008; Quality and Safety Education for Nurses, 2005). Knowing how and where to acquire evidence-based information is a key skill in the information sciences; these concepts should be included in a free-standing informatics course, research course, or woven throughout the curriculum. Additionally, hospital clinicians and administrators can be alert to this as a potential continuing education topic for their hospital or clinic. They can invite knowledgeable speakers to come and orient staff to this movement.

Increasing knowledge and forming attitudes related to Open Access is necessary but not sufficient for today’s student population. Open Access skills also need to be developed. This can be achieved by creating active learning environments in the classroom. Nurse educators can take advantage of students’ beginning knowledge of Open Access and help them refine their search skills by having students use these resources ‘live’ in the classroom. In addition to developing search skills, these activities can also help students and practicing nurses develop clinical reasoning, team building, and verbal communication skills. Strategies include having students conduct search contests using a ‘single citation’ approach. For example, having the learner document all the places they can find a given reference, either in global repositories, such as DOAJ, FMJ, or PMC, or in institutional repositories, will provide valuable opportunities for students to understand how repositories work. Using a ‘topics’ approach by dividing the learners into groups or teams and having them search for the most recent article on a specific topic at an OA publisher website, such as BioMed Central, PLoS, eMedicine, or WebmedCentral, allows for refinement of search skills, as these resources are clinically focused and offer internal search tools. The next step could be to have the students do a group project that involves answering clinical questions, thus providing opportunities for critical thinking and clinical reasoning. Requiring students to present their findings to the class develops verbal communication skills. These group or team exercises are prime opportunities for implementing team building skills.

Work is needed to identify nursing’s current awareness of OA, determine attitudes regarding OA as a viable knowledge resource, and tract submission rates of manuscripts in OA journals as an indicator of publication strategy. Finally, because there are relatively few OA nursing journals, nursing information science is an extremely fertile area for research. Work is needed to identify nursing’s current awareness of OA, determine attitudes regarding OA as a viable knowledge resource, and tract submission rates of manuscripts in OA journals as an indicator of publication strategy. It would be instructive to track yearly changes in OA article publication rates, and monitor the growth in the number of OA nursing journals that occurs over time. Additional areas of needed research include evaluating publication speed of OA vs. subscription-based manuscripts, determining access and download differences between the two models, and determining the impact of publishing in OA journals compared with similar indicators from other disciplines. Comparing OA repositories, such as DOAJ, FMJ, and PMC, to determine duplication of journals or articles would help to better understand the value added for each of the repositories. Determining OA search frequency in the clinical setting and correlating this usage with patient outcomes offers an exciting research opportunity as well. An additional area of research would be to monitor author processing charges in OA nursing journals and compare the charges with the processing charges of subscription-based journals. This information is needed so that authors and institutions can plan for appropriate, evidence-based reimbursement schedules when writing these costs in to grant proposals, as funding agencies are now aware of and willing to pay publication costs.

Conclusion

Due to the advent of electronic publishing, a new access model has been created by the scientific community. Free access to scientific resources has become a reality, and more journals are being added daily to the OA repositories. Information access is a necessity in today’s environment of evidence-based practice. In the past, the need to pay for journal subscriptions created difficulties for those with limited resources, causing many hospitals and nursing programs to use outdated materials. Due to the advent of electronic publishing, a new access model has been created by the scientific community. Free access to scientific resources has become a reality, and more journals are being added daily to the OA repositories. Governments now mandate open access to research findings from government-funded research. This increased access to evidence-based information empowers nurses and unifies our body of nursing knowledge.

The future of nursing science is exciting, due in part to the opportunity to shift the science of nursing from separate ‘national’ efforts to a truly global knowledge base. We now have a system that can eliminate the various pods of knowledge. It is critical for nursing professionals to engage in the OA movement, address the issues, create additional resources, and develop evidence-based data on a global scale. In so doing, nurses, the science of nursing, and our patients will reap many benefits.

Author

Jan 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.