A roadmap for social determinants of health and biological nursing research in the National Institute of Nursing Research 2022-2026 Strategic Plan: Optimizing health and advancing health equity using antiracist framing.

BACKGROUND: Health equity is essential for improving the well-being of all individuals and groups, and research remains a critical element for understanding barriers to health equity. While considering how to best support research that acknowledges current health challenges, it is crucial to understand the role of social justice frameworks within health equity research and the contributions of minoritized researchers. Additionally, there should be an increased understanding of the influence of social determinants of health on biological mechanisms. PURPOSE: Biological health equity research seeks to understand and address health disparities among historically excluded populations. DISCUSSION: While there are examples of studies in this area led by minoritized researchers, some individuals and groups remain understudied due to underfunding. Research within minoritized populations must be prioritized to authentically achieve health equity. Furthermore, there should be increased funding from National Institutes of Health to support minoritized researchers working in this area.

Advancing family science and health equity through the 2022-2026 National Institute of Nursing Research strategic plan.

BACKGROUND: Consistent with the National Institute of Nursing Research's mission of leading nursing research to address current health challenges, the new Strategic Plan identifies five research lenses: health equity, social determinants of health, population and community health, prevention and health promotion, and systems and models of care. Family research, central to nursing research and practice, is the cornerstone of social ecology and represents a critical intersection of social and structural determinants of health. PURPOSE: We argue why family health is essential to the 2022-2026 Strategic Plan and how the lenses can strengthen family research. METHODS: Drawing from collective expertise and existing literature in family research, sociology, psychology, and nursing science, the authors present a new conceptual model that integrates structural racism and heteropatriarchy to examine the salience of family structure statuses for family outcomes and discuss approaches to research design, empirical measurement, and interpretation in order to bring this new model into practice. DISCUSSION: The NINR Strategic Plan has the potential to dismantle structures that perpetuate racism and health inequity within and across family structures. An underaddressed research area under the new Strategic Plan relates to how social determinants of health influence and are influenced by families. CONCLUSION: We challenge all investigators, not just family scientists, to expand the scope of their research to conceptualize the role of family on health inequities.

Disability research must be a priority for nurses to advance health equity.

Disability results from an interplay between health conditions and environmental and personal factors. People with disabilities face substantial and ongoing health inequities; however, research to mitigate these inequalities is lacking. There is an urgent need for a better understanding of the multilevel factors that influence health outcomes in people with visible and invisible disabilities across all the lenses of the National Institute of Nursing Research strategic plan. Disability research must be a priority of nurses and the National Institute of Nursing Research to advance health equity for all.

DNP-PhD Collaboration in NINR-Funded Physical Activity Trials: A Series of Case Studies.

Collaboration between Doctor of Nursing Practice (DNP) scholars and Doctor of Philosophy (PhD) scholars is crucial to efficiently advance and disseminate nursing science. Also, DNP-PhD collaboration can help achieve priorities outlined in the recent National Institute of Nursing Research (NINR) Strategic Plan. The purpose of this series of case studies is to describe exemplars of ongoing DNP-PhD collaborations across three NINR-funded trials (1 completed, 2 ongoing) testing physical activity interventions for women at risk for cardiovascular disease. In our three physical activity intervention trials for women, we categorized examples of DNP-PhD collaboration by the four phases of the team-based research model (development, conceptualization, implementation, and translation). Across all three trials, DNP and PhD scholars contributed successfully to all phases of research in an iterative manner. Future work should focus on expanding DNP-PhD collaboration in behavioral trials, which can inform adapted, contemporary models of iterative DNP-PhD collaboration.

New Strategic Plan From the National Institute of Nursing Research.

JOGNN's new Editor in Chief discusses a strategic plan for nursing research.

A Concept Development for the Symptom Science Model 2.0.

BACKGROUND: The National Institute of Nursing Research developed the National Institutes of Health symptom science model (SSM) in 2015 as a parsimonious conceptual model to guide symptom science research. OBJECTIVES: This concept development paper synthesizes justifications to strengthen the original model. METHODS: A literature review was performed, discussions with symptom science content expert stakeholders were held, and opportunities for expanding the current model were identified. Concept elements for a revised conceptual model-the SSM 2.0-were developed. RESULTS: In addition to the four original concept elements (complex symptom presentation, phenotypic characterization, biobehavioral factors [previously biomarker discovery], and clinical applications), three new concept elements are proposed, including social determinants of health, patient-centered experience, and policy/population health. DISCUSSION: There have been several calls to revise the original SSM from the nursing scientific community to expand its utility to other healthcare settings. Incorporating three additional concept elements can facilitate a broader variety of translational nursing research symptom science collaborations and applications, support additional scientific domains for symptom science activities, and produce more translatable symptom science to a wider audience of nursing research scholars and stakeholders during recovery from the COVID-19 pandemic. The revised SSM 2.0 with newly incorporated social determinants of health, patient-centered experience, and policy/population health components now empowers nursing scientists and scholars to address specific symptom science public health challenges particularly faced by vulnerable and underserved populations.

Oncology Nursing Symptom Science: Overview of the NINR, ONS, and NCI Symptom Science Colloquium.

This article provides an overview of the process, development, and evaluation of the Symptom Science Colloquium sponsored by the National Institute of Nursing Research, Oncology Nursing Society (ONS), and National Cancer Institute. This colloquium was the first of its kind to leverage the common goals of these institutes to advance oncology symptom science. Specifically, this article will identify the goals of the agencies involved and synergy in forming this collaboration, review the ONS Research Agenda that provided the blueprint for the colloquium, and offer insights and lessons learned to be used for future planning. The colloquium engaged roughly 500 participants from all levels of clinical (RNs, advanced practice nurses), educational (undergraduate, master's, doctorate), and research (students, faculty, scientists) expertise. Six featured expert speakers and 115 poster presentations focused on the latest research in symptom science, cancer survivorship, palliative and end-of-life care, and hot topics (COVID-19, health disparities). Fourteen networking sessions fostered opportunities to engage with international experts. Special awards emphasized mentee-mentor relationships and exemplary midcareer faculty. Based on this emphasis, the authors provide themes from the successful award applications as exemplars. A summary of participant satisfaction and recommendations for future collaborations to enhance and advance oncology symptom science are provided.

National Institute of Nursing Research Grant Funding Recipients: Hispanic and Nurses of Color Are Lagging.

INTRODUCTION: National Institute of Health (NIH) stated in their strategic plan that a diverse research workforce is an important goal for the advancement of health care science; however, there is little evidence to show funding goes to National Institute of Nursing Research (NINR) minority nurse scientists. The study's aim was to determine NINR grant recipients' race/ethnicity, gender, and licensed nurse status. METHODS: A descriptive research design was used with NIH providing NINR award recipients' names and employing organizations. An online survey with questions about their gender, race, ethnicity, and being a licensed nurse was sent to 619 award recipients. RESULTS: Survey responses were collected from 135 NINR recipients receiving awards. Almost 50% NINR grant recipients were non-nurses. With licensed nurse recipients, White female was the dominate race and gender. Hispanic licensed nurses were 6.8% of the NINR grant recipients over the 3-year period. In addition, Asians and Blacks were the lowest race categories at 4.1% award percentage over the 3-year period. CONCLUSIONS: NIH strategic plan is for a diverse research workforce in order to advance health care science. NINR must lead the efforts to grow a diverse nursing workforce including Hispanic and underrepresented nurses in order to successfully compete in NINR grants and funding.

Federal funding of nursing research by the National Institutes of Health (NIH): 1993 to 2017.

BACKGROUND: There has been a dramatic increase in the number of doctoral programs (PhD and DNP) that prepare nurse research scientists and advanced practitioners since establishment of the National Institute of Nursing Research (NINR) at the National Institutes of Health (NIH) in 1985. PURPOSE: The purpose of this report is to examine the historical context of federal research funding to schools/colleges of nursing to determine if the NINR/NIH budget is adequate. METHOD: Data were extracted from the NIH RePORT/ER database from 1993 to 2017. Additional data were obtained from the American Association of Colleges of Nursing. A return on investment analysis for four landmark nursing studies is included. FINDINGS: The percent of the NINR budget awarded to schools/colleges of nursing peaked in 2005; since 2011, more funding to schools/colleges of nursing was received from all other NIH institutes combined, compared to NINR. The return on investment for four nursing research studies, ranged from $1:$202 to $1:$1,206, and far exceeds the Standard and Poor's 500 Index (S&P 500) of 10%. DISCUSSION: Federal funding of nursing research is inadequate and a chokepoint relative to the number of doctoral programs. We suggest the NINR budget would need to increase at least fivefold to over $763 million to adequately fund nursing science. The impact of inadequate funding on the discipline is discussed.

NINR funding dedicated to sexual and gender minority health: 1987-2018.

BACKGROUND: Despite multiple federal initiatives and calls to action, nursing literature on the health of sexual and gender minority (SGM) populations remains sparse. Low levels of funding for SGM-focused research may be a factor. PURPOSE: To examine the proportion and focus of National Institute of Nursing Research (NINR)-funded projects that address SGM health, the number and type of publications arising from that funding, and the reach of those publications over time. METHODS: NINR-funded grants focused on SGM research and bibliometrics of resultant publications were identified using multiple search strategies in NIH RePORTER and PubMed and Scopus, respectively. FINDINGS: Since 1987, NINR has funded 25 projects addressing the health of SGM populations. Pre-doctoral fellowship funding resulted in more publications in nursing journals than research grant funding. DISCUSSION: There are clear differences in patterns of funding for fellowships and research grants with corresponding differences in publications and impact on the nursing literature.

National Institute of Health (NIH) funding patterns in Schools of Nursing: Who is funding nursing science research and who is conducting research at Schools of Nursing?

BACKGROUND: Developing the next generation of nurse researchers must be a priority to advance the discipline's science. A comprehensive description of the current federally-funded research is useful for understanding the research enterprise in Schools of Nursing. PURPOSE: To describe the past 5 years of National Institute of Health (NIH) funding patterns in US Schools of Nursing. METHOD: Data were extracted from NIH RePORTER for years 2014-2018. The total number of award types (F, K, R, U, P and T) granted to a School of Nursing in the US was summarized and organized by Institute. Grants were then characterized according to whether the Principal Investigator had a nursing degree (yes or no). Finally, the total funding from each NIH Institute/Center that was awarded to a School of Nursing was assessed. FINDINGS: Nearly 50% of the National Institute of Nursing Research's (NINR) extramural budget is awarded through grants to Schools of Nursing in the US. NINR funds 80% of training grants and >70% of Center grants, which support the education and infrastructure for research, respectively, at Schools of Nursing. Among top ranked research-intensive Schools of Nursing, awards to non-nurse Principal Investigators (PIs) averaged 34.5% across all years. The percentage of NIH funds awarded to non-nurse PIs ranged from 0% at 3 Schools to as high as 97% at 1 School of Nursing. Over the past 5 years, the following Institutes have consistently been the largest funders (total dollars) to Schools of Nursing: NINR, National Institute of Aging, National Institute of Minority and Health Disparities, National Cancer Institute and National Institute of Child Health and Human Development. CONCLUSION: These findings highlight the current funding streams for Schools of Nursing as well as opportunities for expansion. Preparing a cadre of nurse scientists who can generate new knowledge to advance our health care is critical to the success of our profession and to ensuring the health of the people for whom we provide care.

Collaborative Framework to Advance Symptom Science: An Intramural Perspective.

PURPOSE: To describe the collaborative framework used by National Institute of Nursing Research (NINR) investigators to advance symptom science and to provide a research exemplar. MODEL: The National Institutes of Health (NIH) Symptom Science Model (SSM) was developed to guide symptom science researchers to understand the molecular underpinnings of symptoms using innovative "omics" approaches. The process begins with a review of the literature to understand the state of the science of the symptoms of interest and is followed by cross-sectional, case-controlled, or longitudinal studies to identify potential biological correlates of these symptoms. The final steps include validation of these potential symptom biomarkers using multidisciplinary, collaborative, preclinical experiments, and proof-of-concept clinical trials. RESEARCH EXEMPLAR: Using the NIH SSM as a guide, the identification of biologic correlates of symptoms using omics and bioinformatic strategies depends on determining the distinct phenotype of the symptoms of interest. The identified biologic correlates of these symptoms are then validated for their functional relevance using in vitro and ex vivo experiments, or through proof-of-concept clinical trials. NINR investigators observed that activation of specific receptors in neural networks can trigger inflammation-related fatigue development and predispose patients to develop chronicity of symptoms. Specifically targeting these neural receptors can reduce symptom intensity. CONCLUSIONS: Through using the NIH SSM as a guide, NINR investigators quickly generate data and discoveries that significantly advance symptom science by simultaneously collaborating with multiple experts and core laboratories to identify more correlates and validate their functional relevance in order to further understand the biological underpinnings of the symptoms of interest. CLINICAL RELEVANCE: The collaborative framework used by NINR investigators as guided by the NIH SSM identifies functionally relevant clinical markers that can explain the biological underpinnings of symptoms and can be targeted to optimize symptom management.

Evolution of the National Institute of Nursing Research logic model for center sustainability.

BACKGROUND: Logic models are tools to evaluate the effectiveness of programs. In 2013, the National Institute of Nursing Research (NINR) Logic Model for Center Sustainability was developed. PURPOSE: The purpose of this paper is to describe the process of revision and implementation of the NINR Logic Model across a continuum of NINR Exploratory Centers and Centers of Excellence. METHODS: The process for incorporating common data elements for symptom, self-management, biomarker science and precision health in the logic model is outlined. Information about the NINR Logic Model was gleaned from the National Institutes of Health Reporter, annual NINR Center Directors meetings, and from individual Center Directors. FINDINGS: Centers utilized the model for funding applications and to guide Core administration, evaluation, Center sustainability, and/or other Center metrics. DISCUSSION: The revised NINR Logic Model for Center Sustainability can be a useful tool for planning and implementing center activities for center impact and sustainability.

Establishing the Genomic Knowledge Matrix for Nursing Science.

PURPOSE: To establish the knowledge needed to integrate the multiple branches of omics into nursing research to accelerate achieving the research recommendations of the Genomic Nursing Science Blueprint. METHODS: The creation of the Genomic Knowledge Matrix occurred in three phases. In phase 1, the Omics Nursing Science and Education Network (ONSEN) Education Workgroup completed an evidence, bioinformatics, and technology review to inform the components of the Matrix. The ONSEN Advisory Panel then reviewed and integrated revisions. Phase 3 solicited targeted public comment focused on education and research experts, and applicable revisions were made. FINDINGS: The Genomic Knowledge Matrix establishes the following content areas: cellular and molecular biology, system physiology, microbiology, and translational bioinformatics as the minimum required preparation for nurse scientists to understand omics and to integrate this knowledge into research. The Matrix also establishes levels of understanding needed to function based on the role of the nurse scientist. CONCLUSIONS: The Genomic Knowledge Matrix addresses knowledge important for nurse scientists to integrate genomics into their research. Building on prior recommendations and existing genomic competencies, the Matrix was designed to present key knowledge elements critical to understand omics that underpin health and disease. Knowledge depth varies based on the research role. CLINICAL RELEVANCE: The Genomic Knowledge Matrix provides the vital guidance for training nurse scientists in the integration of genomics. The flexibility of the Matrix also provides guidance to inform fundamental genomic content needed in core science content in undergraduate and graduate level nursing curricula.

Omics research ethics considerations.

BACKGROUND: Pending revisions to the Common Rule include topics consistent with respect for persons, justice, and beneficence for research subjects in studies using omics technologies and are relevant to omics research. PURPOSE: Synthesize trends in bioethics, precision health, and omics nursing science for novice and experienced nursing scholars from which to consider bioethics questions. METHODS: Review topics addressed in the National Institute of Nursing Research (NINR) strategic plan, Common Rule pending revisions, and publications regarding human subjects protection policies. DISCUSSION: Omics research involves decisions regarding understandable informed consent, broad consent, data sharing, trust, equal benefit, equal access, societal variables, privacy, data security, and return of findings to participants. CONCLUSION: Principles of respect for persons, justice, and beneficence as articulated in the Belmont report and reflected in the American Nurses Association (ANA) Code of Ethics provide guidance for human subjects protection procedures to advance omics and nursing science.

Pragmatic clinical trials at the National Institute of Nursing Research.

BACKGROUND: Pragmatic clinical trials are used to test the efficacy of interventions in a real-world clinical practice setting. PURPOSE: The purpose of this article was to summarize the presentation given at the Council on Advancement of Nursing Science 2017 Meeting. METHODS: Key science focus areas of the National Institute of Nursing Research (NINR) and the National Institutes of Health (NIH) guidelines relevant to pragmatic clinical trials were reviewed. DISCUSSION: The NIH supports some large-scale pragmatic trials and NINR participates in two of them. Generally, the NINR supports small-scale pragmatic trials that are a mission fit with the NINR. Now pragmatic trials are subject to the new NIH clinical trial requirements. CONCLUSION: Investigators must respond to a specific clinical trial announcement and use the new clinical trial application forms. The NINR program staff are a valuable resource to answer questions that investigators may have regarding their pragmatic clinical trial proposal.