Karen Daley, RN, PhD, MPH, FAAN, president of the American Nurses Association, summed up the importance of the National Institute of Nursing Research this way: “No one is in a better position to ask the right questions than nurse researchers and their colleagues in nursing practice.”
Daley was a keynote speaker at “Bringing Science to Life: A Healthier Tomorrow,” a symposium that took place in October in Washington, D.C., and capped off a yearlong celebration of the NINR’s 25th anniversary.
The NINR, one of 27 institutes and centers comprising the National Institutes of Health, has spent the past quarter-century funding research to help advance the practice of nursing and healthcare as a whole.
Keynote speaker Michael Gottesman, MD, deputy director for intramural research at the NIH, noted the NINR is the only one of the 27 branches that “cuts across all diseases, all stages of life, all organ systems. This is a strength, but some people have questioned with such a broad mission and lack of focus, what really is nursing research? Over its 25 years, the Nursing Institute has answered this question both forcefully and convincingly.”
Gottesman said NINR-supported researchers strive to answer fundamental questions for nurses working in the field, such as: “How can we prevent disease? How can we improve management of chronic illness, especially management of debilitating symptoms? How can we develop new strategies for treating or preventing diseases that are culturally relevant at a time of increasing population diversity and overt health disparities? How can we accelerate translation of research discoveries into clinical practice and home- and community-based use? How do we develop a future workforce that is responsive to the increased research and clinical demands of modern medicine?”
On the cutting edge
Several presentations during the symposium highlighted work that has taken place in recent years.
NINR director Patricia Grady, RN, PhD, FAAN, noted research by Mary Naylor, RN, PhD, FAAN, of the University of Pennsylvania in Philadelphia, on the concept of transitional care. The research “demonstrated that transitional care improves outcomes, including enhancing quality of life and reducing hospital readmissions while substantially reducing healthcare costs,” Grady said.
Those findings were disseminated to Congress and major health insurers, and as a result “transitional care has emerged as one of the prominent themes in healthcare reform in the Affordable Care Act,” Grady said.
Sandra Dunbar, RN, DSN, FAAN, FAHA, associate dean for academic advancement at Emory University in Atlanta, presented research on the development and testing of interventions to improve medication adherence in patients with heart failure, including those who have both heart failure and diabetes.
According to speakers at the symposium, this research gets to the core of one of the challenges facing the healthcare system: how to treat people who have multiple chronic conditions. Among Medicare patients, two-thirds have at least two chronic conditions, said keynote speaker Anand K. Parekh, MD, MPH, deputy assistant secretary for health at the U.S. Department of Health and Human Services.
“The populations that we are all trying to help and care for don’t just have diabetes or arthritis or COPD,” Parekh said. “They have three, four, five, six, seven, eight or nine concurrent conditions. We know this matters because the research and literature tell us mortality increases, functional status declines [and] unnecessary hospitalizations, readmissions, adverse drug events, conflicting medical advice, duplicative procedures and hospital-acquired infections all increase. And on the cost side of the equation, it’s the same way.”
J. Randall Curtis, MD, MPH, professor at the University of Washington, showcased clinical research on understanding and evaluating clinician-family communication in the ICU. In previous surveys, families of ICU patients rated the communication skills of ICU clinicians as more important than clinical skills.
Curtis said the outcome of his study was not what he envisioned, with no effect of his study team’s research-based intervention on nurse-assessed quality of dying and death in the ICU or on family-rated satisfaction or ICU time to death.
“It’s not what we were hoping for,” Curtis said, but the results provided valuable lessons and helped frame future studies of ways to improve a family’s experience in the ICU.
Clinical research is “not for the faint of heart,” Martha A.Q. Curley, RN, PhD, FAAN, professor at the University of Pennsylvania School of Nursing, said at the end of her presentation on the evolution of sedation practices in pediatric critical care.
“It’s not for those who are squeamish, who want to avoid a challenge and who fear failure, because you will fail without a doubt,” she said. “But clinical research is all about providing the best care that we can to patients and their families.”
Few such sources of advice are available to RNs thinking about branching out into research. “Nursing researchers can appreciate that there aren’t too many places where nurses who are interested in research can get the appropriate training,” Gottesman said.
One NINR-sponsored program that can help fill the void, Gottesman and Grady said, is the Summer Genetics Institute, a tuition-free, month-long intensive research training program that takes place at the NIH headquarters in Bethesda, Md. The program provides participants with a foundation in molecular genetics for use in research and clinical practice, with goals of increasing the research capability among graduate students and faculty and expanding clinical practice in genetics among clinicians.
“Nurses in particular are going to be on the front lines in dealing with genetic counseling,” Gottesman said. “Their patients will hear about genetic disorders and mutations and so on, and will really turn to nurses to provide information and knowledge that can enable them to make important decisions in their lives.”
Daley said associations such as the ANA can increase the relevance of nursing research through their advocacy work.
“It is essential that healthcare systems invest in structures and processes that engender translation and utilization of nursing research to the benefit of patients,” Daley said. “It should become the norm that nurses in practice are supported in their efforts to translate evidence into practice and to partner with researchers to generate the important questions for improving care delivery.
“It is imperative early in nurses’ education, training and careers that nursing science comes to be understood as an accessible and necessary tool to advance the care of patients. We also must create cultures in which nurses view themselves as integral partners in bringing attention to the critical issues and questions that will improve patient outcomes.”
Eye on the future
During her opening remarks, Grady announced the implementation of a new five-year strategic plan for the NINR. Although the plan technically covers the next five years, Grady said she thinks the major themes will remain relevant for NINR’s next 25 years.
The five cornerstones of the strategic plan (www.ninr.nih.gov/AboutNINR/NINRMissionandStrategicPlan) are health promotion and disease prevention, symptom management to advance quality of life, palliative and end-of-life care, innovation and the training of nurse scientists. These broad areas represent pivotal research needs in the coming years.
Grady said NINR-supported research can become “the stories of health and healthcare in the 21st century.” She noted rising rates of obesity and chronic illness, health inequities among racial and ethnic groups and financial pressures on the country’s healthcare system are among the serious challenges that warrant fresh solutions.
“The demand for creative ideas, interdisciplinary scientific approaches and a talented cohort of investigators at all career levels from diverse backgrounds has never been greater,” Grady said.
• Nick Hut is news editor.