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Investigating the determinants of health: The role of nursing science
Council for the Advancement of Nursing Science
Investigating the determinants of health: The role of nursing science Nursing science plays a critical role in the health research enterprise, bridging the gaps between the bench, the research clinic, and communities and translating its findings to clinical care. Rather than focusing on any particular disease or condition, nursing science addresses the needs of individual patients, through patient- and family-centered care, with the goal of improving patients’ overall health and quality of life. This approach, combined with recognition of the broad environmental influences on health (e.g., community, society, biology) is gathering momentum across health care and health research disciplines. For example, the National Institutes of Health (NIH) Precision Medicine Initiative, launched by President Obama in January 2015, and the National Institutes of Health (2017) will enable a new era of investigation in which researchers, providers, and patients work together to develop individualized care. Similarly, the National Academy of Medicine is turning its attention to patient-centered health and patient empowerment with its Vital Directions for Health and Health Care (Dzau et al., 2016) initiative. In this same vein, the 2016 Council for the Advancement of Nursing Science State of the Science conference addressed the latest research involving the determinants of health, focusing on social, biological, and lifestyle factors. Kicking off a series of stimulating plenary talks on each subject, Dr. Paula Braveman (University of California, San Francisco), outlined the far-reaching influence of income, education, inequality, and social networks across the lifespan and across generations. Dr. Margaret Heitkemper (University of Washington) introduced opportunities for employing ‘omics in symptom science and understanding environmental effects on health, with an emphasis on inflammatory bowel syndrome. Dr. Margaret Grey (Yale University) described the impact of lifestyle, such as food choices, exercise, and coping strategies on health in the context of pediatric diabetes. Uncovering and managing determinants of health, including social factors, is a cornerstone of the National Institute of Nursing Research (NINR)’s history of supporting research on patient- and family-centered care. NINR has operationalized this research emphasis through concentration on four broad areas of study: symptom science, wellness, self-management, and end-of-life and palliative care. Central to investigation in each of these areas is recognition and inclusion of social factors in both study design and analysis.
Symptom Science Nursing science provides a unique perspective into both the biological and clinical features of symptoms and the negative side effects of treatments. New advances in genomics and other fields have allowed nurse scientists to better understand the debilitating symptoms of chronic conditions, such as pain, fatigue, and disordered sleep. In addition, nursing research is evaluating the influence of behavioral, environmental, and social factors in the manifestation of symptoms and their resolution. Throughout its history, NINR has supported research to develop improved, personalized strategies to treat and prevent the adverse symptoms of illness across diverse populations and settings that will facilitate clinical management of illness and lead to more productive lives.
Wellness NINR supports research to understand the physical, behavioral, and environmental causes of illness across health conditions, settings, the lifespan, and in minority and underserved populations. NINR-supported research has also assessed behaviors that lead to healthy lifestyle choices, explored many of the barriers to wellness and prevention strategies, and developed evidence-based interventions that promote wellness in the context of heterogeneous environmental factors and cultural diversity.
Self-Management Increased life expectancy and advances in life-sustaining treatments have resulted in greater numbers of people living with chronic conditions. Self-management has taken a more prominent role in chronic conditions as long-term care responsibilities are shifting from health care providers to the individuals, their families, and the communities where they live. NINR-supported research has helped individuals from diverse backgrounds and their families live with chronic illness by developing effective approaches to self-management that can improve quality of life while reducing the burden on caregivers and the health care system.
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Nurs Outlook xxx (2017) 1e3
End-of-Life and Palliative Care Facing serious advanced illness, living with progressive disabling function and diminishing independence, and addressing the continuum of end-of-life caredfrom early palliative care to later hospice and bereavement supportddemand a seamless, comprehensive, and integrated system of health service that reaches all communities, cultures, and practices. NINR is deeply involved in fostering the national dialogue to address the important and highly personal issues surrounding end-of-life care. NINR leads end-of-life research at the NIH and supports investigations in assisting individuals, families, and health care professionals in managing the symptoms of life-limiting conditions and planning for end-of-life decisions.
Technology and Training In addition, supporting advances in technology and training play a key role in advancing NINR’s efforts to expand the impact of nursing science. Innovative technologies play a critical role in advancing health care. Nursing science can foster the development of novel, culturally sensitive interventions that deliver tailored care and real-time health information to patients, families, clinicians, and communities. The development of a strong cadre of nurse scientists has been a primary goal of NINR since its establishment. To continue to leverage advancements in nursing science and improvements in health, it is essential that the scientific workforce of the future be dynamic, interdisciplinary, and diverse. NINR supports a wide range of activities, in both its extramural and intramural programs, to ensure excellence in the next generation of nurse scientists.
NINR Strategic Plan: A vision for nursing science The latest NINR Strategic Plan: Advancing Science, Improving Lives (National Institute of Nursing Research, 2016) sets the stage for research that will have a significant impact on the health of the American people. This strategic plan seeks to build on NINR’s four scientific focus areas. In continuing to advance symptom science, NINR will support basic, clinical, and biobehavioral research to promote personalized health strategies for symptom management. In this context, there will be particular focus on symptoms in multiple chronic conditions, integration of biomarkers with phenotypic indicators, and utilization of “omics” science. The NINR Intramural Research Program is guiding its biobehavioral research through its NIH Symptom
Science Model (NIH-SSM). The model begins with the identification of a symptom or complex group of symptoms, which is then characterized into a phenotype with biological and clinical data, followed by the application of genomic and other discovery methodologies to illuminate biomarker targets for therapeutic and clinical interventions. NINR is also developing a trans-NIH Symptom Science Center to implement the NIH-SSM in promoting biomarker discoveries that can be translated into clinical practice to eliminate or reduce symptom burden and engage patients and families in care. The Symptom Science Center will provide a hub where collaborative teams of interdisciplinary intramural, and subsequently extramural, investigators can address symptom research challenges. NINR’s ongoing support of research on the determinants of health and behaviors that lead to healthy lifestyle choices will contribute to innovative approaches to advance health and wellness. Findings from these studies can inform the health promotion and disease prevention activities of public and private entities. Wellness research will also strengthen the scientific foundation for efforts to improve health outcomes and reduce the burden of illness on patients and families. NINR’s commitment to the science of selfmanagement focuses on enhancing healthy behaviors and adherence to treatment, promoting functional status across conditions, improving health outcomes, maintaining quality of life, and limiting disabilities by using pragmatic approaches to assess outcomes. NINR will also continue supporting research to guide individuals from diverse, multicultural backgrounds and their families in personalizing self-management skills and tools. NINR’s research in end-of-life and palliative care will aim to optimize individuals’ and caregivers’ health and well-being and to facilitate decision-making and ongoing, personalized conversations about end-of-life care preferences. Other priorities in this area include the development of strategies aligning care with individual and family-centered goals and preferences throughout the trajectory of illness. The accelerating availability and accessibility of cutting-edge technologies provide nursing science with an ideal opportunity for improving health and preventing illness in diverse and underserved populations across the lifespan. NINR encourages research programs that develop and refine technologies to improve symptom risk assessment and identify potential interventions. In addition, NINR will maintain its foundational commitment to supporting a diverse and innovative workforce, with the goal of launching the next generation of investigators and enhancing overall research capacity in strategically important areas of research. These efforts will continue to provide awards to promote earlier entry into research careers, expand the interdisciplinary backgrounds of new investigators, and improve the abilities of mid-career investigators. NINR-supported investigators will lead the development of novel approaches across health care
Nurs Outlook xxx (2017) 1e3
disciplines to identify effective methodologies and strategies that promote health equity and point the way toward resolving health disparities. To strengthen these goals, NINR will enhance its efforts to support nurse educators to foster a new generation of scholars. NINR’s strategic plan is a dynamic document. Through periodic reviews and evaluations of the Institute’s research activities, as well as ongoing analysis of pressing health care needs, it will guide NINR’s efforts to identify determinants of health and to develop interventions that lead to improved health outcomes and quality of life for all.
references
National Institutes of Health. (2017). The All of Us Research Program. Retrieved from https://allofus.nih.gov National Institute of Nursing Research. (2016). NINR Strategic Plan Retrieved from https://www.ninr.nih.gov/sites/www.ninr.nih. gov/files/NINR_StratPlan2016_reduced.pdf
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Dzau, V. J., McClellan, M., Burke, S., Coye, M. J., Daschle, T. A., Diaz, A., & Zerhouni, E. (2016). Vital Directions for Health and Health Care: A policy initiative of the National Academy of Medicine. Retrieved from https://nam.edu/initiatives/vital-directionsfor-health-and-health-care/
Patricia A. Grady, PhD, RN, FAAN National Academy of Medicine Washington, DC Corresponding author: Patricia A. Grady, National Academy of Medicine, 500 5th St. NW, Washington, DC 20001. E-mail address: [email protected] Available online xxx 0029-6554/$ e see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.outlook.2017.04.010
Investigating the determinants of health: The role of nursing science Nursing science plays a critical role in the health research enterprise, bridging the gaps between the bench, the research clinic, and communities and translating its findings to clinical care. Rather than focusing on any particular disease or condition, nursing science addresses the needs of individual patients, through patient- and family-centered care, with the goal of improving patients’ overall health and quality of life. This approach, combined with recognition of the broad environmental influences on health (e.g., community, society, biology) is gathering momentum across health care and health research disciplines. For example, the National Institutes of Health (NIH) Precision Medicine Initiative, launched by President Obama in January 2015, and the National Institutes of Health (2017) will enable a new era of investigation in which researchers, providers, and patients work together to develop individualized care. Similarly, the National Academy of Medicine is turning its attention to patient-centered health and patient empowerment with its Vital Directions for Health and Health Care (Dzau et al., 2016) initiative. In this same vein, the 2016 Council for the Advancement of Nursing Science State of the Science conference addressed the latest research involving the determinants of health, focusing on social, biological, and lifestyle factors. Kicking off a series of stimulating plenary talks on each subject, Dr. Paula Braveman (University of California, San Francisco), outlined the far-reaching influence of income, education, inequality, and social networks across the lifespan and across generations. Dr. Margaret Heitkemper (University of Washington) introduced opportunities for employing ‘omics in symptom science and understanding environmental effects on health, with an emphasis on inflammatory bowel syndrome. Dr. Margaret Grey (Yale University) described the impact of lifestyle, such as food choices, exercise, and coping strategies on health in the context of pediatric diabetes. Uncovering and managing determinants of health, including social factors, is a cornerstone of the National Institute of Nursing Research (NINR)’s history of supporting research on patient- and family-centered care. NINR has operationalized this research emphasis through concentration on four broad areas of study: symptom science, wellness, self-management, and end-of-life and palliative care. Central to investigation in each of these areas is recognition and inclusion of social factors in both study design and analysis.
Symptom Science Nursing science provides a unique perspective into both the biological and clinical features of symptoms and the negative side effects of treatments. New advances in genomics and other fields have allowed nurse scientists to better understand the debilitating symptoms of chronic conditions, such as pain, fatigue, and disordered sleep. In addition, nursing research is evaluating the influence of behavioral, environmental, and social factors in the manifestation of symptoms and their resolution. Throughout its history, NINR has supported research to develop improved, personalized strategies to treat and prevent the adverse symptoms of illness across diverse populations and settings that will facilitate clinical management of illness and lead to more productive lives.
Wellness NINR supports research to understand the physical, behavioral, and environmental causes of illness across health conditions, settings, the lifespan, and in minority and underserved populations. NINR-supported research has also assessed behaviors that lead to healthy lifestyle choices, explored many of the barriers to wellness and prevention strategies, and developed evidence-based interventions that promote wellness in the context of heterogeneous environmental factors and cultural diversity.
Self-Management Increased life expectancy and advances in life-sustaining treatments have resulted in greater numbers of people living with chronic conditions. Self-management has taken a more prominent role in chronic conditions as long-term care responsibilities are shifting from health care providers to the individuals, their families, and the communities where they live. NINR-supported research has helped individuals from diverse backgrounds and their families live with chronic illness by developing effective approaches to self-management that can improve quality of life while reducing the burden on caregivers and the health care system.
2
Nurs Outlook xxx (2017) 1e3
End-of-Life and Palliative Care Facing serious advanced illness, living with progressive disabling function and diminishing independence, and addressing the continuum of end-of-life caredfrom early palliative care to later hospice and bereavement supportddemand a seamless, comprehensive, and integrated system of health service that reaches all communities, cultures, and practices. NINR is deeply involved in fostering the national dialogue to address the important and highly personal issues surrounding end-of-life care. NINR leads end-of-life research at the NIH and supports investigations in assisting individuals, families, and health care professionals in managing the symptoms of life-limiting conditions and planning for end-of-life decisions.
Technology and Training In addition, supporting advances in technology and training play a key role in advancing NINR’s efforts to expand the impact of nursing science. Innovative technologies play a critical role in advancing health care. Nursing science can foster the development of novel, culturally sensitive interventions that deliver tailored care and real-time health information to patients, families, clinicians, and communities. The development of a strong cadre of nurse scientists has been a primary goal of NINR since its establishment. To continue to leverage advancements in nursing science and improvements in health, it is essential that the scientific workforce of the future be dynamic, interdisciplinary, and diverse. NINR supports a wide range of activities, in both its extramural and intramural programs, to ensure excellence in the next generation of nurse scientists.
NINR Strategic Plan: A vision for nursing science The latest NINR Strategic Plan: Advancing Science, Improving Lives (National Institute of Nursing Research, 2016) sets the stage for research that will have a significant impact on the health of the American people. This strategic plan seeks to build on NINR’s four scientific focus areas. In continuing to advance symptom science, NINR will support basic, clinical, and biobehavioral research to promote personalized health strategies for symptom management. In this context, there will be particular focus on symptoms in multiple chronic conditions, integration of biomarkers with phenotypic indicators, and utilization of “omics” science. The NINR Intramural Research Program is guiding its biobehavioral research through its NIH Symptom
Science Model (NIH-SSM). The model begins with the identification of a symptom or complex group of symptoms, which is then characterized into a phenotype with biological and clinical data, followed by the application of genomic and other discovery methodologies to illuminate biomarker targets for therapeutic and clinical interventions. NINR is also developing a trans-NIH Symptom Science Center to implement the NIH-SSM in promoting biomarker discoveries that can be translated into clinical practice to eliminate or reduce symptom burden and engage patients and families in care. The Symptom Science Center will provide a hub where collaborative teams of interdisciplinary intramural, and subsequently extramural, investigators can address symptom research challenges. NINR’s ongoing support of research on the determinants of health and behaviors that lead to healthy lifestyle choices will contribute to innovative approaches to advance health and wellness. Findings from these studies can inform the health promotion and disease prevention activities of public and private entities. Wellness research will also strengthen the scientific foundation for efforts to improve health outcomes and reduce the burden of illness on patients and families. NINR’s commitment to the science of selfmanagement focuses on enhancing healthy behaviors and adherence to treatment, promoting functional status across conditions, improving health outcomes, maintaining quality of life, and limiting disabilities by using pragmatic approaches to assess outcomes. NINR will also continue supporting research to guide individuals from diverse, multicultural backgrounds and their families in personalizing self-management skills and tools. NINR’s research in end-of-life and palliative care will aim to optimize individuals’ and caregivers’ health and well-being and to facilitate decision-making and ongoing, personalized conversations about end-of-life care preferences. Other priorities in this area include the development of strategies aligning care with individual and family-centered goals and preferences throughout the trajectory of illness. The accelerating availability and accessibility of cutting-edge technologies provide nursing science with an ideal opportunity for improving health and preventing illness in diverse and underserved populations across the lifespan. NINR encourages research programs that develop and refine technologies to improve symptom risk assessment and identify potential interventions. In addition, NINR will maintain its foundational commitment to supporting a diverse and innovative workforce, with the goal of launching the next generation of investigators and enhancing overall research capacity in strategically important areas of research. These efforts will continue to provide awards to promote earlier entry into research careers, expand the interdisciplinary backgrounds of new investigators, and improve the abilities of mid-career investigators. NINR-supported investigators will lead the development of novel approaches across health care
Nurs Outlook xxx (2017) 1e3
disciplines to identify effective methodologies and strategies that promote health equity and point the way toward resolving health disparities. To strengthen these goals, NINR will enhance its efforts to support nurse educators to foster a new generation of scholars. NINR’s strategic plan is a dynamic document. Through periodic reviews and evaluations of the Institute’s research activities, as well as ongoing analysis of pressing health care needs, it will guide NINR’s efforts to identify determinants of health and to develop interventions that lead to improved health outcomes and quality of life for all.
references
National Institutes of Health. (2017). The All of Us Research Program. Retrieved from https://allofus.nih.gov National Institute of Nursing Research. (2016). NINR Strategic Plan Retrieved from https://www.ninr.nih.gov/sites/www.ninr.nih. gov/files/NINR_StratPlan2016_reduced.pdf
3
Dzau, V. J., McClellan, M., Burke, S., Coye, M. J., Daschle, T. A., Diaz, A., & Zerhouni, E. (2016). Vital Directions for Health and Health Care: A policy initiative of the National Academy of Medicine. Retrieved from https://nam.edu/initiatives/vital-directionsfor-health-and-health-care/
Patricia A. Grady, PhD, RN, FAAN National Academy of Medicine Washington, DC Corresponding author: Patricia A. Grady, National Academy of Medicine, 500 5th St. NW, Washington, DC 20001. E-mail address: [email protected] Available online xxx 0029-6554/$ e see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.outlook.2017.04.010