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Reimagining Nursing Research: One Year Later

Friday, July 28, 2017

It’s been more than a year since the Duke University School of Nursing (DUSON) Center for Nursing Research implemented a new structure and launched Research Areas of Excellence: Precision Health, Population Health and Chronic Illness, Clinical Innovation and Methods and Analytics.                                         

“Creating the research areas of excellence was part of our strategic planning initiative,” said Marilyn Hockenberry, PhD, RN, PPCNP-BC, FAAN, associate dean for Research Affairs. “These are areas where we want to invest and grow. And these opportunities for growth come at a time when our nursing research has ranked higher than ever with more than $6.4 million in funds from the National Institutes of Health in 2016.”

The Center for Nursing Research's supportive infrastructure and efforts to target research clusters of excellence has fostered an environment that strenghtened research capabilities. Faculty have been awarded funds for studies that will advance health outcomes across the lifespan.

Precision Health

Research within Precision Health is broad and includes investigations that are predictive, preventative, personalized and participatory in nature, while concentrating on improving health outcomes and reducing health disparities. Faculty research include biomarkers, omics approaches to health care, clinical implementation and utility and phenotypic and genotypic health characterizations.

Karin Reuter-Rice, PhD, CPNP-AC, FCCM, FAAN, associate professor, was awarded funding for two research projects. The first, entitled “Collecting and Aggregating Omic and Environmental Data in Pediatric Traumatic Brain Injury: A Pilot Study” and the second, “Aggregating and Visualizing Environmental Biological, Physiological, and Outcome Data in Acute Pediatric Traumatic Brain Injury.” Both projects examine our understanding of an individual’s environment and the brain’s biological response to an injury, which allows the development of strategies to support a child’s brain recovery. 

Reuter-Rice’s research looks at how a child’s genetic makeup, their body’s biologic response to the brain injury and how the hospital environment affects their brain’s recovery.

Both studies allow Reuter-Rice to track a group of sensors that monitor the hospital room environment and collect the sensor data as well as the biologic markers and brain flow ultrasounds to better understand the brain’s response to the injury. Findings from these studies can improve the outcomes of children with TBI by one day developing personalized medicine treatments that promote recovery.

Individuals living with chronic disease such as diabetes often need ongoing support and expert advice, which are not always easy to find in the health care system. Health coaching and online communities may be ways to give people the ongoing support that they need when they need it.

Allison Vorderstrasse, DNSc, APRN, CNE, FAAN, associate professor, uses technologies such as online gaming sites to help people prevent or live better with diabetes. In her study, “Diabetes Self-Management & Support LIVE (Learning in Virtual Environments),” an online community on a gaming platform provides people access to diabetes information, diabetes educators for classes and questions, and interactive games to test and develop diabetes management knowledge and skills.

In her second study, “Genetic Risk Testing & Health Coaching for T2D and CHD,” Vorderstrasse uses genetic testing to influence health behaviors or risk factors over time and/or a health coach by phone to allow patients to focus on their own health and life priorities.

Findings from both studies will help determine what next steps would be most effective in using tools like these in care settings for patients with chronic diseases.

Population Health and Chronic Illness

The goal of the population health and chronic illness area is to improve group outcomes, identify health patterns and pinpoint policies and interventions that link those outcomes and patterns. This work centers on disease within populations, including HIV, sickle cell and cancer, as well as disease by age group – neonatal, children and adolescents and older adults.

In her study “Addressing Tobacco Use Disparities in Older Adults through an Innovative Mobile Phone Intervention: Testing the Feasibility of the Textto4gotobacco Intervention,”  Devon Noonan, PhD, MPH, FNP-BC, associate professor, concentrates on developing health behavior change interventions that work to decrease cancer risk in underserved populations.

The study focuses on tobacco cessation in rural older adults and test the feasibility and acceptability of delivering support messages and personalized smoking reduction plans to help them quit.

In another Population Health research study, Cheryl Rodgers, PhD, RN, CPNP, CPON, assistant professor, and Hockenberry, have identified three essential factors that guide the development of a Parent Educational Discharge Support Strategies intervention study entitled “A Nurse-led Parent Educational Discharge Support Strategies (PEDSS) for Children Newly Diagnosed with Cancer.”

The three factors will establish a framework to guide future development of educational tools for parents of other pediatric specialties that provide care to children with illness-related distress. These factors are:

  1. significant variation in what cancer care providers believe is essential for discharge teaching and how much information should be provided;
  2. common symptoms associated with all types of childhood cancer treatments that should be included in discharge education;
  3. and parents of children newly diagnoses with cancer want concise and consistent information on providing care for their child at home,

Children newly diagnosed with cancer experience multiple distressing symptoms including physical and emotional symptoms. Parents who are expected to assume responsibility after the initial hospitalization, are often overwhelmed with information and are apprehensive about caring for their child at home.

Clinical Innovation

In order to substantively advance the quality of health care, alternative types of care and care delivery must be considered. These alternatives include the implementation of new models of care, devices and technologies, as well as improved methods of interactions between patients and medical personnel that produce cost-effective improvements in clinical health outcomes.

Eun-Ok Im, PhD, MPH, RN, CNS, FAAN, DUSON Mary T. Champagne Professor of Nursing, has developed several technology-based information and coaching/support programs for diverse populations. In her study, “To Enhance Breast Cancer Survivorship of Asian Americans,” she will test if the efficacy of technology-based information can enhance women’s breast cancer survivorship experience.

The program, which can be accessible by computer, mobile tablet and mobile phone, can determine health outcomes such as needs for help, psychological and physical symptoms and quality of life for Asian American breast cancer survivors.

Findings from the study will provide directions for implementing the program into various health care settings which is subsequently expected to improve the quality of life and health outcomes of the patients.

Type 2 diabetes is a serious problem in the United States and self-management is critical to control the disease. Current methods for collecting and disseminating patient information are largely ineffective at improving health.

Ryan Shaw, PhD, RN, associate professor, works with faculty at Duke Schools of Nursing, Medicine and Engineering to integrate mobile technologies into first-generation care delivery systems. This study will use mobile health technologies to identify strategies that help patients and health care professionals use patient-generated data to help patients better self-manage and overcome challenges with diabetes.

These mobile technologies afford researchers, clinicians and patients a rich stream of real-time information about the patient’s biophysical and behavioral health in everyday environments. 

Methods and Analytics

Few schools of nursing have tackled research in ways that focus on cutting-edge methodologies. This fourth research area of excellence focuses on the promotion and use of these methodologies such as score analysis, sequential multiple assignment randomized trials (SMART) design, data visualization or mixed-method observational studies in research design and complex data analysis. The Methods and Analytics team also hopes to initiate investigation into the development of such methods themselves that are applicable to nursing science inquires.

DUSON’s faculty routinely use these approaches to develop and apply cutting-edge methodologies, models and analytics for research. Wei Pan, PhD, associate professor, is a nationally known methodologist in causal inference and propensity score analysis. He has published and presented numerous scholarly papers on propensity score methods, as well as organized and taught professional development courses on this subject at national conventions of major professional associations.

Another project that represents the Methods and Analytics area of excellence is the “Reducing Health Disparities in SMI, Rural and Minority Populations” study led by Elizabeth Merwin, PhD, RN, FAAN, executive vice-dean.

Using big data and innovative analytics, Merwin’s project addresses the effects of disability and comorbid mental illness in Medicare recipients under the age of 65 years old, and will be compared to individuals over the age of 65. The study will examine self-care capacity and its relationship to health status in a national database. In addition, it will examine selected illness trajectories and health outcomes, community capacity to support health, the quality of health care and the intersecting effects of gender, race and rurality.

Results from the project will inform the development of interventions and policies to improve access to care, quality of care and health outcomes such as length of life or mortality as well as to indicate needed changes in practice.

In a year’s time, the Center for Nursing Research and its four research areas of excellence have changed the way DUSON approaches research. The Center offers faculty, staff and students an unparalleled research experience that opens more interdisciplinary doors and paves the way for nursing research to impact and shape health care decisions and actions at all levels.

Visit nursing.duke.edu/research to learn more about the Center for Nursing Research.