Does Nursing Science Exist?

A
View from Seattle
Margaret Heitkemper, RN,
PhD, FAAN
Elizabeth Sterling Soule
Chair in Nursing
University of Washington

University of Bergen
University of Bristol
University of California,
San Diego
University of Illinois,
Urbana-Champaign
University of Leeds
University of
Manchester
Nanjing University
University of Oslo
Pennsylvania State
University

University of Sheffield
University of
Southampton
University of Sydney
University of Toronto
Universiteit Utrecht
University of
Washington, Seattle
University of
Wisconsin, Madison
University of York
Zheijang University

Task at Hand
To open a dialogue about
international nursing
science
To focus on mutual interests
To consider multi-site
studies
To enhance graduate
student education

Trying to summarize our dialogue to date and/or create

vision for the future is like trying to drink from a firehose

WUN: Nursing
Contributing to the national and
international health research agenda
Impacting health policy
Ensuring the next generation of
nurse scientists
Modeling scientific behavior
How can we utilize the framework of
WUN to provide nursing research
leadership?

Our National Agendas

National

Institutes of
Health (NIH)

Predictive
Personalized
Pre-emptive
Participatory

On-Going Dialogue
Chronic Illness/Chronic Disorders
End of Life Care
Health Promotion
Self Management
Health Disparities
Methodologies
Mentorship of the next
generation

Chronic Illness
By the 1990s, chronic disease
had superseded
communicable diseases as the
leading cause of death in all
parts of the world except subSaharan Africa & Middle East.
Chronic diseases will be the
predominant global source of
morbidity, death, and disease
during the 21st century.

http://www.cdc.gov/pcd/issues/2007/apr/07_00.24.htm

Disability
Approximately 1800 US
troops are now suffering from
traumatic brain injuries
caused by penetrating
wounds. 30% of those who
are engaged in active combat
for 4 months or longer are at
risk for disabling neurological
disorders from IEDs. (Washington
Post 4/8/07)

World Prevalence of IBS

Canada
12%

US
1020%

Sweden 13%
Belgium 8% Denmark 7%
UK 22%
Netherlands 9% China 23%
France 20%
Germany 12%
Spain 13%

Japan 25%

Nigeria 30%
Australia 12%
New Zealand 17%

End of Life Research

EOLispoorlyunderstood,leavingmany
tostrugglethroughthislifeevent.
inolderadultsneedingEOLcare
warrantsresearchinfrastructure&
resources.
CurrentEOLinterventionsneed
validation.
Subgroups(race,ethnicity,culture,
gender,age,disease)experienceEOL
caredifferently.
Enhancedcommunicationamong
patients,families,&providersiscrucial
tohighqualityEOLcare.

State of the Science (NIH,

12/04)

Health Promotion

We will discover, in the next 10 or 15 years,

hundreds of genes that predispose to disease
we will be able to take a snippet of blood, analyze
the genes and write out a health history for that
person what would happen in his or her life
without interventions. By so doing, we can move
into a preventive mode, by knowing what is likely
to happen and how to prevent it. Whats created
is an opportunity to extend the life span by 10 to
30 productive and creative years. Leroy Hood,
September, 2002

The Challenge will be to enhance the quality of those

extra years

If I had known how long I was going to live, I

would have taken better care of myself

Eubie Blake (1883-1983)

The obesity epidemic is

even beginning to affect

children, whose obesity rates
have doubled in the past two
decades (NIH)

Linked with Type 2 diabetes, heart

disease, cancer, arthritis, liver
disease, body image disturbance,
social discrimination
Does obesity speed the aging
process?

Obesity Trends* Among U.S. Adults

(*BMI 30, or about 30 lbs overweight for 54 person)

1991

1996

2005

2005
2003

No Data

<10%

10%14%

65% of Americans
overweight or obese
31% meet criteria for obese
Disproportionately affects
minorities & those with low
SES

15%19%

20%24%

25%

Health Promotion
Screening: breast cancer,
colorectal cancer
But is there equal access?
Decision-making
But do the providers or
familys beliefs match the
patients
Managing symptoms
During & after treatment
Survivorship
Family support

Self Management: Patient-Centered

Care

My view you know is that

the ultimate destination
of all nursing is the
nursing of the sick in their
own homesI look to the
abolition of hospitals and
workhouse infirmaries.
But no use to talk about
the year 2000. F. Nightingale

Self Management
Diet,

exercise, self-monitoring
Adherence
Delivery mode: telephone, webbased
For whom do they work best?
BIOLOGY
CULTURE
SOCIOECONOMIC STATUS

Why and How Interventions Work

Miaskowski & Dodd (UCSF) examining
characteristics of those who respond to a
psychoeducational intervention for cancer pain
management to those who dont
Is it dose (number of minutes/hours)?
Or duration?
Or patient baseline characteristics?
Which component?

Therapeutic Gap

Implementation

Evidence Based Practice

Creating Opportunities for Parent

Empowerment (COPE)
Evidence-Based Practice is the
search for and critical appraisal
of the "best evidence" to answer
challenging clinical questions;
single studies with strong clinical
practice applications; or
evidence-based strategies to
improve practice so that the
highest quality, up-to-date care
can be provided to children and
their families. (Melnyk, 2006)
Will it take 17 years to implement?

Disparities in
sepsis incidence

Disparities in
health care
access

Seattle Times 4/10/07

Disparities
Is it biological,
environmental,
acculturation?

Womens Health
In 1871 Holbrook wrote that . . . It
appears that the process of
childbearing is essentially necessary to
the physical health and long life, the
mental happiness, the development of
the affections and whole character of
the women. Women exist for the sake
of the womb.

Methods
International
data sets
Statistical
models
Biobehavioral
measures

Methods

Vasomotor Symptoms by
Menopausal Transition Stage &
CYP 19 - 11r

Can we determine who is

most likely to develop
symptoms?
Or benefit from treatment?
Can we target therapies based
on genetic markers?

Woods, Mitchell et al., 2006

Serotonin Reuptake Transporter Protein (SERT) &

Depression in Patients with Irritable Bowel
Syndrome

High Risk (s/s homozygotes or STin2.9 allele carriers); Low Risk (carriers of at
least one l allele plus STin2.10 or STin2.12). Jarrett et al. (in press)

Similar work with stroke patients to determine who is at risk for

depression (Mitchell, Kirkness)

Treatment Effectiveness
Those with the
l/l allele most
likely improve
( quality of life)
with in-person
cognitive
behavioral
therapy (CBT)

OCC:

3 6 mo

.5

0.0

95% CI A8D

-.5

TREATGRP
-1.0
Usual Care
-1.5
Telephone CSM

-2.0

In-Person CSM

-2.5
N=

23

21

s/l, s/s

SERT2

22

10

12

l/l

14

Questions

Ethical considerations
Who and when
Conditions for which no cure is available
Quality of life

Decision-making
Resource allocation

Health services impact

Storefront Technology

Challenges
How

can technology be used to

provide interventions & enhance
outcomes
What is the impact of increasing
technology on outcomes (patient
safety, reduction of clinical errors,
enhance patient satisfaction)?

Preparing the Next Generation

The need to dramatically increase,

even double, the number of nurse
scientists is acute, especially at
earlier points in their careers.
Recommendations:
need to enhance the productivity of each
investigators study for nursing practice & for
shaping health policy
increase the number of nurse investigators to
respond to the investigator and faculty
shortages
Emphasize the need for research training with
strong research-intensive environments.
National Research Council of the National Academies, 2005

Louis Pasteur (in regard to making observations)

chance favors the prepared mind.
Line drawing of
Louis Pasteur drawn
by David Wood from
Genentech, Inc.
Graphics Dept.

Does Nursing Science Exist?

The Discipline of Nursing

is characterized by a
unique perspective, a distinct
way of viewing all
phenomena, which ultimately
defines the limits and nature
of its inquiry. Donaldson &
Crowley, Nursing Outlook, 1978

Dorothy

Professional Perspective

The nursing profession abounds with problems of

concern to it. Why, then, does it not also abound
with inquiry research on these problems? ( 1969)
As nursing gropes for its maturity, it is coming to
recognize its responsibility as a profession to
search for and to build a broader and sounder
knowledge base for its professional practice.
Marge Batey Communicating Nursing Research

Societal Mandate

in deciding future
directions for nursing
research and science, it
better fits nursings societal
mandate to have as the
highest priority the
understanding and improving
the health status of those
whom we serve. S.

Donaldson, J. Professional Nursing,

2003

Sociocultural/Environment
al
Behavioral/Psychological
Organ Systems
Cellular
Molecular
(NIH, 2000)

Interdisciplinary Health Research

the development of scientific

knowledge in nursing depends on
research-oriented individuals who
are capable of both collaboration
and competition in the search for
new ideas. To date, nurses in
research have demonstrated
considerable proficiency in the art
of collaboration
Communicating Nursing Research, 1973

But are we leading these

interdisciplinary research efforts?

Jeanne
Benoliel

Are we prepared.
To

out expose or share our work

outside the discipline?
To develop new therapeutics that
blend the biological with social
and spiritual domains of health?
To consider ourselves
contributors in the broader arena
of health research.

Does nursing science exist?

Is it nursing research or is it
health research?