Nursing Planning

hello and welcome. i am dr. patricia grady, director of thenational institute of nursing research at the national institutes of health and it's mypleasure to provide you an overview of the national institute of nursing research. this presentation will provide you withinformation about the important role the national institute of nursingresearch or ninr plays in advancing health. ninr occupies a unique positionwithin the national institutes of health, with a focus on research toadvance clinical practice. i will start by setting the context for howthe national institute of nursing research,

or ninr, fits within the nih; i'll thenprovide some background on ninr's history, mission, and strategic plan; i'lldescribe ninr's research and leadership, and our commitment tolifelong learning and training; finally, i'll share with you our visionof the future and plans for moving nursing science forward. the national institutes of health, or nih,is the premiere health research entity in the united states. the nih mission is to seek fundamentalknowledge about the nature and behavior of living systems and the applicationof that knowledge to enhance health,

lengthen life, and reduceillness and disability. the ninr is one of 27 institutesand centers that comprise the nih. each institute or center has its ownmission and specific research agenda, typically focused around a particulardisease or group of related diseases - like the national cancerinstitute or the national heart, lung and blood institute. ninr is unique among the nih institutes andi'll provide some specific examples of the ways in which ninr's research agenda isdifferent from the other institutes and centers at the nih.

before i talk about ourresearch agenda, though, let me give you a brief overview ofninr's history as shown on this timeline. congress authorized the creation of thenational center for nursing research at nih in 1985. in 1993, the national center for nursingresearch became the national institute of nursing research through legislation. the impetus for creating thecenter, and later the institute, came from the findings of two studies. the first was a 1983 report by the instituteof medicine that recommended that nursing

research be included in the mainstreamof biomedical and behavioral science. the second was a 1984 nih task forcestudy that determined that nursing research activities are directlyrelevant to the nih mission. i have had the good fortune ofbeing the director of ninr since 1995. during that time, the ninr budget has morethan doubled and there has been a significant increase in the number of research andtraining grants awarded by the institute. since our inception we have emphasizeddeveloping an evidence base for care and translating research advancesinto tangible health outcomes. the mission of ninr is to promoteand improve the health of individuals,

families, and communities. we accomplish this mission bysupporting and facilitating research; collaborating with colleagues across thenih and with public and private organizations that arealigned with our mission. nursing science occupies a uniqueand significant place within the nih community - that is guiding thenation's nursing science research agenda, with a focus on the science of health. this focus sets ninr apart fromother nih institutes and centers. the science of healthincludes, but is not limited to,

research that covers thelifespan through the end of life; encompasses the spectrum of caresettings; and includes the individual, the family and the community. ninr is implementing its strategic plan withan emphasis on four scientific focus areas: symptom science - promotingpersonalized health strategies; wellness - promoting healthand preventing illness; self-management - improving quality oflife for individuals with chronic illness, and end-of-life and palliativecare - the science of compassion. ninr also promotes technological innovationand the training of the next generation of

nurse scientists, both of which cutacross our scientific focus areas. ninr sponsors a variety of activities andprojects that foster nursing research and leadership. ninr-supported research directlyimpacts health and influences care. let me provide some examples of researchoutcomes from each of our scientific focus areas. ninr's symptom scienceportfolio covers the lifespan, including neonates. newborns in the neonatal intensive care unitoften experience some painful procedures in

the course of monitoring and treatment. studies show neonatesare able to perceive pain. however, if the newborns are notclearly expressing signs of pain, caregivers rely solely on the newborn'salertness and their ability to react to painful experiences. with ninr support, dr. danilyn angeles fromloma linda university measured biochemical reactions to pain from skin tape removal. dr. angeles and her colleagues identified anelevated plasma indicator of pain upon tape removal in these newbornscompared to that of the control group.

this biochemical method provides an objectiveand accurate way to measure the presence and degree of pain felt by newborns and may allowproviders to optimize pain relief treatment for neonates. another example of symptom science isthe characterization of symptom clusters. symptom clusters are symptoms thatoccur together and are interrelated. the characterization of clusters of symptomsis being pursued by several research teams with the idea that treatments designedfor groups of symptoms may provide better outcomes than targetingindividual symptoms themselves. in this study of patients with breast cancer,ninr-supported nurse scientist dr. andrea

barsevick analyzed changes in a cluster offive symptoms over the course of treatment (cognitive disturbance,fatigue, insomnia, pain, and depressed mood.) the treatmentincluded chemotherapy and radiation therapy. these symptoms varied inintensity across the treatment course. understanding the psychological andbiological mechanisms contributing to these symptom patterns can guide clinicians inthe development of personalized treatment interventions and canimprove patient outcomes. an example from the scientific focus area ofwellness is the work of dr. deborah gross and her colleagues.

these investigators recognized an unmet needfor high-quality early childcare programs that promote health in communitieswith high levels of poverty. with ninr support, dr.gross designed, tested, and further refiined theinnovative "chicago parent program, in partnership with parents of youngchildren in low-income communities. the program successfully promoted healthybehaviors and reduced risky behaviors among young children and their families. today, the chicago parent program is beingdelivered in 16 states and in head-start programs in chicago,baltimore, and new york city.

dr. gross and her colleagues have continuedthis work at johns hopkins university having conducted trainingprograms for over 200 teachers, health professionals,community workers, and parents. another example of the impact of ninr-fundedresearch is a series of evidence-based interventions that advancethe science of wellness. dr. loretta sweet jemmott and her colleaguesat the university of pennsylvania have reduced hiv/aids risk behaviors in diversepopulations of adolescents through their "be proud! be responsible!"

and "sister to sister" programs. partnering withcommunity-based organizations, including churches, clinics, and schools,dr. jemmott and her team have effectively translated and disseminated her researchinto prevention programs and her research has changed public policy related to hivrisk reduction interventions in community settings. adapting dr. jemmott's work, a ucla-basedteam led by dr. deborah koniak-griffin developed an effective program addressinghiv/aids and pregnancy risk behaviors in adolescent mothers, and later in hiv positivecouples seeking to have healthy pregnancies.

this program uses unique community-basedparticipatory research methods to maximize utility, effectiveness, and dissemination. the "cuidate!" program developed by dr. antoniavillarruel also builds on dr. jemmott's work, and focuses on adolescent latinos. these programs are models for effectivecommunity-based approaches to wellness interventions. in fact, the cdc has endorsed thesefour ninr-funded programs as best evidence examples of rigorous, community-engagedapproaches to reduce rates of teen pregnancy

and sexually transmitted diseases. another scientific focus area isself-management to improve quality of life. one example of ninr-supported self-managementresearch is the cope teen program that was developed and tested by dr. bernadette melnykat the ohio state university college of nursing. this school-basedintervention addresses obesity, social skills, and mentalhealth concerns in adolescents. the intervention includes education andcognitive behavioral skills development, as well as a variety of physical activities.

teens showed improved healthbehaviors and social skills, less depression, and better academicperformance at the end of the intervention program. the improved outcomes were also sustained sixmonths after completing the program with the cope teens retaining a significantlylower body mass index (bmi) and maintaining healthier weights relative tocontrol group participants. this program was presented by teachers aspart of the health education curricula in high school settings. therefore, the cope teenintervention is a model of a feasible,

cost-effective, andsustainable self-management program. today, cope teen has been implemented inseveral state schools at a minimal cost per student and has been adapted into afreshman-level college course at the ohio state university. a program for adults iscurrently under development. other ninr-funded self-managementprogram focus on: surviving cancer, in which patients and their families areassuming a greater role in managing follow-up care. self-management may act as amodel of care where providers,

patients, and families enter partnershipsto manage care across all aspects of cancer treatment. living with diabetes, where self-managementrequires patients to integrate numerous new activities into their daily life. identification of obstaclesto diabetes self-management, such as literacy, is vital, especiallyin diverse and vulnerable populations. internet intervention programs arebeing tested to reach teens with diabetes, allowing them to manage their healthmore independently and improving outcomes. in addition, our researchers are contributingto the science of self-management for other

chronic conditions such as asthma,arthritis, inflammatory bowel syndrome (ibs), and chronic obstructivepulmonary disease (copd). as the lead institute forend-of-life research at nih, ninr supports research that exploresinterventions to manage the symptoms of advanced illness and planfor end-of-life decisions. improving communicationbetween patients, family members, and health care professionalsis a critical area of study. at the university of washington, dr. j. randall curtis and his colleagues aredeveloping interventions to improve

communication between family members andhealth care professionals about palliative and end-of-life care. dr. curtis's studies include the use of a"communication facilitator" in the icu to help clinicians meetfamilies' needs for communication. he has also tested an educationalskills-building program to help clinicians improve their communication skillsduring sensitive end-of-life situations. his work shows that factors such as lengthof stay in the icu affect family members' satisfaction with care, that improvingcommunication about end-of-life care reduces stress, anxiety, anddepression in family members,

and that better outcomes were associatedwith physicians following standardized communication guidelines with family members. another ninr-supported investigator, dr.susan hickman from indiana university and the oregon health & science university, hasfocused on communicating patient wishes to health care professionals. the physician orders forlife-sustaining treatment, or polst, program consists of a standardizedform on which patient preferences are indicated for such measures ascardiopulmonary resuscitation (cpr), pain relief, and tube feeding.

she found that nursing facility residentswith polst forms were less likely to receive unwanted life sustaining treatmentwhen compared to those with traditional do-not-resuscitate (dnr) orders. these findings underscore the importance ofidentifying effective ways to communicate individual preferences for life-sustainingcare and can be implemented by health care professionals to help individuals make moreinformed choices about the type and level of end-of-life care they prefer. ninr is also translating the science ofpalliative and end-of-life care through a pediatric palliative care campaign and anend-of-life module on the nih senior health

website, reflecting ninr'sresearch efforts in this critical area, and our commitment to ensuring that ourresearch makes a difference to those in need. ninr's pediatric palliative care:conversations matter campaign is raising awareness of and improving communicationabout pediatric palliative care and aims to increase the use of palliative care forchildren living with serious illnesses. to develop the campaign, ninr broughttogether parents and palliative care clinicians, scientists, and professionals toidentify what was needed to improve the care of seriously ill children. the campaign offers materials designed tohelp health care providers begin palliative

care conversations withpediatric patients and their families, following diagnosis andthroughout the illness, to meet their changing needs. the nihseniorhealth.gov website conveyshealth and wellness information for older adults and their caregivers,including topics such as exercise, diet, long-term care, drugs andmanagement of common diseases. ninr developed a module for the seniorhealth website that addresses end-of-life. the end-of-life moduledescribes the physical, mental, and emotional needs of people nearingthe end of life and suggests ways to maintain

quality of life, such ashospice and home care. it also addresses the often complexpractical concerns that can attend death, including financialissues, advance directives, caregiver support, and more. the end-of-life module was describedin a new york times blog as "candid and comprehensive...andwell-designed for older users". recognizing a major technologygap in health care diagnostics, ninr's investment in innovation is helpingtechnology to gain a larger role in health ninr provided support to dr. samuel siaand his colleagues for investigations into

portable, point-of-care diagnostics. through ninr's small businesstechnology transfer program, an interdisciplinary team of investigatorsat columbia university developed and tested a portable, point-of-care, "lab-on-a-chip"diagnostic device - the mchip. the mchip is designed to detecthiv and associated co-infections, such as syphilis and herpes, whichsignificantly increase the transmission of hiv. notably, the mchip requires <1 microliterof blood to simultaneously detect hiv and syphilis and does not requireuser interpretation of the signal,

making it possible to perform these testswith ease and accuracy in remote locations and with low cost. the mchip has the potential to simultaneouslydetect a host of other diseases. i encourage you to view dr. sia's video atthe youtube nature video channel where he describes this research, andhis vision for its translation. a link to it is shown on this slide. another example of investment in innovationis ninr's leading role in the funding of science to support and facilitate publichealth priorities such as the reduction of so-called "never events"-healthcare errors that should "never" occur.

an operating room nurse, sharon morris,in partnership with other colleagues, proposed a research program that would applytechnology to prevent the "never event" of foreign objects remaining inpatients following surgery; something which can cause seriouspost-op complications or death. this research proved remarkably successful,and resulted in an fda approved medical device, now referred to asthe "smartsponge system". the smartsponge system has been awarded the"seal of recognition" from the association of perioperative registered nurses (aorn),and is helping to improve patient safety, enhance quality of care, and save livesin operating rooms around our nation.

these are just a few examples of the waysin which nursing science is leading change. nursing science is critical tothe health research enterprise, bridging the gaps between thebench, the research clinic, and communities. rather than focusing on anyparticular disease or condition, nursing science addresses the care needsof individual patients: on improving their overall health and quality of life. nurse scientists occupy pivotal positions inthe transformation of health care where they are essential leaders and participantsin inter-disciplinary team science,

working in partnershipwith physicians, engineers, environmental scientists,information technology specialists, and others in designing and testinginterventions for a broad range of health care issues. as leaders in the research community, nursescientists must keep pace with the latest techniques, initiatives,and innovations in science. for example, the nurse scientist of thefuture must be well versed in big data, genomics, and the latestclinical trial methodologies, including pragmatic trials.

in order for nurse scientists to be wellversed in these leading edge techniques and methodologies, ninr supports lifelonglearning and helping to train the next generation of nurse scientists. ninr is committed to training the nextgeneration of nurse scientists who will advance science to promote andimprove the health of individuals, these include both extramural (outsideof nih) and intramural (at nih) training opportunities. ninr extramural training opportunitiesinclude fellowships and career development awards.

fellowship training opportunities areavailable for the extramural community at universities, medical centers, and hospitals. these include the national research serviceawards (nrsa) that enable scientists to be trained to conduct independentnursing research and to collaborate in interdisciplinary research throughindividual and institutional predoctoral, postdoctoral, and senior fellowships. career development awards supported by ninrprovide support for independent investigators during the early andtransition stages of their careers. intramural ninr training opportunitiesinclude: the graduate partnership program in

collaboration with universities, thatprovides phd nursing students research training opportunities across nih includingthe ninr intramural research program; the summer genetics instituteoffering graduate students, faculty, and clinicians a foundation inmolecular genetics appropriate for use in research and clinical practice;and the methodologies boot camp, part of a series of ninr symptom researchmethodologies courses designed to increase the research capacity ofgraduate students and faculty. so, as you can see ninr-funded scienceis making a significant impact on health outcomes for the nation.

so what is ninr's vision of the futureand how do we plan to move nursing science forward? the innovative questions (or iq) initiativeis our latest and most interactive program which engages ourcommunity, and provides you, your colleagues and the public a chance tohelp shape the future of nursing science. this initiative is intended to stimulate adialogue among the scientific community, professional organizations, and the publicto develop questions that will point the way forward. we are looking for ideas that will enhancenew thinking and creativity in nursing

science, explore unanswered questions,promote innovative research that is results-oriented, and guide thescience over the next 5 to 10 years. the initiative consists of two components: aseries of workshops and an iq website: the iq workshops are bringing together scientiststo identify and discuss innovative questions that have not yet been asked or answered. the iq website is designed to promotecommunity dialogue by providing a venue where members of the scientificcommunity, professional organizations, and the general public cancontribute their own innovative questions. the website also allows people to commenton the questions that have been submitted.

we encourage you to visit this website;you can link to it from the ninr homepage. please tell your colleagues to do thesame and help us spread the word about this initiative. we want to hear your thoughtsand questions about accelerating progress in nursing science and where we canmost impact the health of the nation. in closing, i hope this brief overview ofninr has been helpful in introducing you to our programs. the challenges and opportunities thatlay before us are plentiful and complex, but i am confident that, together, throughour mutual support of nursing research, we will advance health care and improvehealth outcomes for all of our citizens.

thank you.