Department of Health and Human Services
National Institutes of Health
National Institute of Nursing Research
Minutes of the National Advisory Council for Nursing Research
September 14-15, 2010
The 72nd meeting of the National Advisory Council for Nursing Research (NACNR) was convened on Tuesday, September 14, 2010, at 1:00 p.m. in Wilson Hall, Building 1, National Institutes of Health (NIH), Bethesda, Maryland. The first day of the meeting was an open session and adjourned that same day at approximately 5:10 p.m. The closed session of the meeting, which included consideration of grant applications, was convened on Wednesday, September 15, 2010, at 9 a.m. and continued until adjournment at 12:15p.m. Dr. Patricia A. Grady, Chair, NACNR, presided over both sessions of the meeting.
I. CALL TO ORDER, OPENING REMARKS, COUNCIL PROCEDURES, AND RELATED MATTERS
Dr. Grady called the 72nd meeting of the NACNR to order, welcoming all Council members (including new Council members), visitors, and staff.
Conflict of Interest and Confidentiality Statement
Dr. Mary Kerr, Executive Secretary, NACNR, reminded attendees that the standard rules of conflict of interest applied throughout the Council meeting. Briefly, all closed session material is privileged, and all communications from investigators to Council members regarding any actions on applications being considered during the Council should be referred to National Institute of Nursing Research (NINR) staff. In addition, during either the open or the closed session of the meeting, Council members with a conflict of interest with respect to any topics or any application must excuse themselves from the room and sign a statement attesting to their absence during the discussion of that application. Dr. Kerr also reminded NACNR members of their status as special Federal employees while serving on the Council, and that the law prohibits the use of any funds to pay the salary or expenses of any Federal employee to lobby or otherwise influence state legislatures or Congress. Specific policies and procedures were reviewed in more detail at the beginning of the closed session and were available in Council notebooks.
Minutes of Previous NACNR Meeting
Standing Council members received a copy of the minutes of the May 18-19, 2010, NACNR meeting by electronic mail. A motion to accept the minutes of the May 18-19, 2010, Council meeting was proposed, seconded, and approved unanimously. Any comments, corrections, and changes to the May 2010 meeting minutes identified at a later time should be forwarded to Drs. Grady or Kerr. The approved minutes of each quarterly NACNR meeting become part of the Institute’s permanent record and are posted on the NINR Web Site (www.ninr.nih.gov).
Dates of Future Council Meetings
Dates of future meetings in 2011 and 2012 have been approved and confirmed. Council members were asked to confirm their calendars for these meeting dates and contact Drs. Grady or Kerr regarding any conflicts or expected absences.
January 18-19 (Tuesday-Wednesday)
May 17-18 (Tuesday-Wednesday)
September 20-21 (Tuesday-Wednesday)
January 17-18 (Tuesday-Wednesday)
May 15-16 (Tuesday-Wednesday)
September 18-19 (Tuesday-Wednesday)
II. REPORT OF THE DIRECTOR, NINR
—Dr. Patricia Grady, Director, NINR
The Director’s report focused on updates since the last Council meeting and on current and impending activities and initiatives related to the NIH and NINR budgets, the NIH overall, and the NINR.
Budget Update—Dr. Grady provided an update on the current status of appropriations and projections for the NINR budget. The Institute’s funding for fiscal year (FY) 2010 was $145.660 million and reflected an increase of 2.7 percent over the FY 2009 level of $141.879 million. The President’s proposed budget for FY 2011 is $150.198 million for the NINR, reflecting a 3.2 percent increase above the FY 2010 level. The Senate Appropriations bill includes $149.963 million for the NINR and represents a 3.0% increase from FY 2010. The proposed FY 2011 budget for the NIH overall is $32.007 billion, reflecting a 3.2 percent increase from FY 2010. Dr. Grady next reviewed NINR’s expenditures for FY 2009, which included: research program grants (RPGs) (74%), of which P01 grants comprise 1.6 percent; Centers (4%); research management and support (8%); training (6%); research and development (3%); intramural research (3%); and other research (2%).
HHS, NIH, and NINR News—Dr. Grady reported on news items of interest within the Department of Health and Human Services (HHS), NIH, and NINR communities. The HHS has announced new initiatives totaling $250 million to strengthen the primary health care workforce, including: training additional nursing workforce ($30 million), training health professionals ($96 million), and home visiting programs to improve the well-being of children and families ($88 million). The National Prevention, Health Promotion, and Public Health Council has been established by Executive Order. Dr. Donald Berwick has been appointed Administrator of the Centers for Medicare and Medicaid Services (CMS).
Dr. Grady informed members about recent senior NIH appointments. Dr. Lawrence A. Tabak is now the Principal Deputy Director of the NIH; Dr. Sally Rockey is Deputy Director for Extramural Research; Dr. Alan Guttmacher is Director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Dr. Robert Kaplan is Director of the Office of Behavioral and Social Sciences Research (OBSSR); and Dr. James Anderson is Director of the NIH Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI).
In other NIH news, Dr. Grady reported that the Clinical and Translational Science Awards (CTSA) Program has been expanded to include nine additional institutions that will receive $355 million over 5 years; the intent of the expansion is to bridge laboratory discoveries to patient treatments. Dr. Margaret Hamburg, U.S. Food and Drug Administration (FDA) Administrator, and Dr. Francis Collins, NIH Director, are co-developing strategies to accelerate the road to personalized medicine, including through early identification of promising therapies and expediting the translation of research from the laboratory to patients. This is the 10-year anniversary of the Human Genome Project. Dr. Collins recently published an article on “Cancer in America: The Cancer You Can Beat” in Parade magazine that featured the importance of screening for colon cancer.
Dr. Grady noted that the NIH is supporting the Network on Inequality, Complexity, and Health (NICH), which aims to identify more successful strategies to help reduce health disparities. Information about the NIH grant review process is now available through two videos about the peer review process and tips for grant applicants. She encouraged Council members to consider the recent Request for Applications (RFAs) released by the NIH Basic Behavioral and Social Science Opportunity Network (OppNet). OppNet also is hosting a meeting on expanding opportunities in basic behavioral and social science research on October 28-29, 2010. The NIH intramural research program is recruiting Earl Stadtman Investigators, particularly in the areas of sensory biology and the neurosciences, symptoms research, systems biology, stem cells, infectious diseases, and bioinformatics. Dr. Grady expressed sorrow at the recent passing of renowned scientist Dr. Robert N. Butler, who served as the first Director of the National Institute on Aging.
Dr. Grady congratulated Council member Dr. Marion Broome on her induction into The Sigma Theta Tau International Nurse Researcher Hall of Fame. She also expressed congratulations to intramural NINR investigators Drs. Jessica Gill and Taura Barr on recent publications and academic appointments; they will continue to serve as NINR guest scientists. The NINR awarded funds from the NIH Office of the Director’s (OD) Evaluation Set-Aside Program to support a study of the nature and extent of end-of-life (EOL) and palliative care (PC) science conducted from 1997 through 2010; this activity will help review NINR’s portfolio, build the NINR program, and reach out to the nursing research community across the country. In addition, an EOL and PC special interest group has been started/formed on the NIH Campus. Recent publications on EOL and other nursing research areas include: communicating EOL treatment preferences (Dr. Susan Hickman, Indiana University and Oregon Health and Science University in American Geriatrics Society); implications of the California nurse staffing mandate for other states (Dr. Linda Allen, University of Pennsylvania School of Nursing in HSR); and Centers for Disease Control and Prevention (CDC)-supported, evidence-based programs to prevent teenage pregnancy (Drs. Loretta Sweet Jemmott, Deborah Koniak-Griffin, and Antonia Villarruel). Dr. Grady said that applications for the NINR 2011 Graduate Partnerships Program (GPP) are due January 3, 2011.
NINR Outreach—Ms. Melissa Barrett, NINR Communications Director, reported on recent presentations by the NINR leadership, including Dr. Grady’s presentations in August: on “Celebrating 25 Years of Supporting Excellence in Nursing Research” at the Forum on Health Care Leadership; on “Improving Health Equity in a Diverse World” at the 12th Pan American Nurse Colloquium in Brazil; and to Alaskan citizens, including the Southcentral Foundation. Dr. Grady published an article on “Translational Research and Nursing Science” in Nursing Outlook (May/June 2010). The NIH American Recovery and Reinvestment Act (ARRA) Web page featured a story about NINR support to Dr. Deborah Koniak-Griffin, who provided high school students with valuable hands-on research experience about health issues among rural populations.
The NINR participated in the “Science in the Cinema” event with the screening of the film “My Sister’s Keeper”; Dr. Pamela Hinds, Director, Nursing Research, Children’s National Medical Center, provided commentary and led an interactive question-and-answer session following the showing. The NINR is celebrating its 25th anniversary, starting with 2010 scientific symposium on “Bringing Science to Life” on September 10, 2010. Celebratory events throughout the next year include: Grand Rounds (November 2010), the NINR Director’s lecture (January 2011), the NINR-NIH Clinical Center Joint Conference (May 2011), Science in the Cinema (summer 2011), and 2011 Scientific Symposium (Fall 2011). Council Members were invited to visit the NINR Web Site (www.ninr.nih.gov) for additional information about these events and other NINR news.
III. UPDATE ON HEALTH DISPARITIES—
Dr. Paul Cotton, NINR
Dr. Cotton described NINR’s efforts to reduce health disparities. The Institute’s mission is to promote and improve the health of individuals, families, communities, and populations, through clinical and basic research that encompasses health promotion and disease prevention, quality of life (QOL), health disparities, and EOL. Community-based practice research (CBPR) was introduced in the mid-1990s in the social sciences, and in 2003 the Institute of Medicine (IOM) issued a report that included a recommendation for the incorporation of CBPR in the public health arena. Practitioners primarily employ four CBPR models—ignored, placed, informed, participatory—with the goal of ensuring that communities are equal partners in research activities. The NIH definition of CBPR invites participation, in contrast to the Kellogg Foundation’s definition, which mandates participation. This collaborative approach to research focuses on social change to improve community health and eliminate health disparities, builds mutual trust and respect between scientific researchers and local communities, and has produced valid, reliable results.
The NINR has supported CBPR since 1996, with an initiative on community-based strategies to reduce health risk. Other select NINR research over the years has included: community partner interventions to reduce health disparities (2002); collaboration with other NIH Institutes and Centers (IC) in community-based research individual investigator grants (R01/R21) (2005); and CBPR in underserved populations (2008) and in behavioral and social science research (2010). In addition, the NINR has funded several initiatives through the NIH Public Trust Initiative supporting CBPR research through small grants that foster collaboration with community partners to reduce health disparities. These include:
- Collaborations between the University of South Carolina (Dr. Jeanette Andrews) and the Charleston Trident Urban League (Mr. Otha Meadows) to develop partnership readiness to ascertain that the community had the capability to deal with CBPR.
- A co-study by the Montana State University and Center for Asbestos Related Disease (CARD) to determine the research environment at Libby, MT, which was designated a Superfund site by the U.S. Environmental Protection Agency (EPA) in 2002.
- Research by the University of California, San Francisco (Dr. C. Chesla) to improve the management of type 2 diabetes in Chinese immigrants and address a cultural program for disease management.
- Work by the University of Florida (Dr. Sharon Kneipp) in collaboration with the State of Florida to reduce health disparities through temporary assistance for needy families, with the aim of improving the cultural relevance and efficacy of the State’s welfare transition and clinical health programs.
The NINR has participated in numerous NIH CBPR activities, including the Leap into Community Assistance Workshop and other meetings. The next steps in promoting CBPR and health disparities include: increasing partnerships with CDC and the Agency for Healthcare Research and Quality to involve interested persons in these agencies in CBPR; increasing utilization of CBPR with CTSA information; continuing to develop multidisciplinary CBPR applications; and considering multi-agency Program Announcements.
IV. USE OF INTERACTIVE CULTURALLY SENSITIVE TECHNIQUES TO IMPROVE PRIMARY HEALTH PRACTICES—
Dr. Usha Menon, Pamela Kidd Distinguished Professor, Arizona State University College of Nursing, and Visiting Scientist, Mayo Clinic Cancer Center
Dr. Menon described how interactive and culturally sensitive techniques can be used to improve primary health practices. Whereas targeted health education is appropriate for newsletters, has a lower cost, and is easier to adapt for various groups, tailored health education addresses variables with increased within-group variance, can be personalized to individual beliefs and knowledge, and is customizable to characteristics that are unique to a specific person. Tailored messages also are more likely to be remembered and considered relevant; health promotion messages may be tailored to a combination of beliefs, knowledge, and state of readiness.
Health education programs can be targeted based on culture through various stratagems, such as peripheral, evidential, linguistic, constituent-involving, or sociocultural strategies. Cultural leveraging involves proactive identification of areas in which a cultural intervention can improve behaviors, implementation of the solution, invocation of principles of cultural competence, and the potential to operate at multiple levels throughout the health care delivery process. Culture is broadly defined beyond simply language and race, encompassing practices, products, philosophies, or environments as vehicles that facilitate behavior change of patients and practitioners. Race and ethnicity frequently are used as proxies for culture. Cultural leveraging incorporates transdisciplinary research, a multi-lens approach, relevant components of theoretical frameworks, and an emphasis on changeable factors. Guiding principles for the development of tailored messages cover demographics, language, health literacy, delivery medium, and the person delivering the message, with particular attention paid to within-group differences and single-person or committee-method translation. The Interactive Colorectal Cancer (CRC) Screening in Primary Care Study employs tailored message techniques in determining and addressing perceptions about colon cancer, considering the differential impact of tailoring and motivational interviewing interventions by race and gender. The study found that the group that received tailored education achieved the highest levels of CRC screening and was 2.2 times more likely to complete post-intervention screening than the control group.
V. REPORT OF DECEMBER RETREAT 2009—
Dr. Marion Broome, Dean and Distinguished Professor, School of Nursing, Indiana University
Dr. Broome presented a report on the December 2009 NINR retreat in December 2009. The retreat included several Council members, 10 NINR Program Directors, and other NINR staff. The goals of the retreat were to identify scientific gaps and opportunities relative to the mission of the NINR and develop a list of concepts that have the potential to move nursing science forward. Pre-concepts concerning NINR’s emphasis areas—EOL, QOL, health disparities, and health promotion and disease prevention—were discussed, including public health relevance, current science advances, and gaps and opportunities. In reviewing the pre-concepts, the balance of the NINR portfolio and areas of success and challenges were considered, as well as NINR’s inherent strengths, opportunities for new collaborations, and the best contract mechanisms to use. Dr. Broome reported that the concepts chosen were vetted at the NINR June 2010 Senior Retreat and presented at the September 2010 Council meeting; they may form the basis of FY 2011 initiatives and stimulate science advances in FY 2012. Dr. Broome explained that concept development is a 24-month process, and that presenting the concepts to Council ensures that NINR initiatives remain congruent with its Strategic Plan. The December 2009 retreat formalizes the 2-year process, and the initiatives will be developed and published in FY 2011, with grants awarded in FY 2011 and 2012.
VI. PRESENTATION OF CONCEPTS—
Dr. Yvonne Bryan, Director, Division of Extramural Activities, NINR
Council members reviewed and discussed 12 new concepts during the September 2010 NACNR meeting.
- Diabetes Self Care within the Social and Physical Environment (Dr. Kathleen Potempa, discussant)
- Determinants of Health To Prevent Obesity in Latina Women and Their Children (Dr. Marion Broome, discussant)
- School Environmental Exposures in Child Health Outcomes (Dr. Kevin Frick, discussant)
- Dynamic Interactions: Youth and Information and Communication Technology To Promote Sustainable Health Behaviors (Dr. Barbara Guthrie, discussant)
- Personalized Genomics for Symptom Management (Dr. Janet Williams, discussant)
- Late Effects in Chronic Illness: Evaluation of Mechanisms and Biobehavioral Interventions (Dr. Elaine Larson, discussant)
- Health Care Needs Research and Programs for Children and Youth in Disaster (Dr. Stan Finkelstein, discussant)
- Methods To Improve the Design and Evaluation of Behavioral Intervention Studies of Caregivers of Persons with Dementia (Dr. Dowling, discussant)
- End-of-Life Research in Life-Ending Illness: Advanced Heart Failure and Palliative Care Research (Dr. Jean McSweeney, discussant)
- Acute Life Threatening Illness: Preparation for End of Life (Dr. Gail Stuart, discussant)
- Pain Management: Sickle Cell Disease (Captain Maggie Richards, discussant)
- HIV/AIDS Stigma and Disclosure in the Older Population (Dr. Marla Salmon, discussant)
- STAR Program Strategic Plan (Dr. King Udall, discussant)
VI. UPDATE OF STRATEGIC PLAN—
Dr. Barbara Guthrie, Associate Professor, School of Nursing, Yale University
Dr. Guthrie presented the status of the NINR Strategic Plan for 2011-2016 (hereafter referred to as the Strategic Plan). The mission of the NINR is to advance nursing science by promoting and improving the health of individuals, families, communities, and populations through basic and clinical research and research training. This update is timely because current trends include an increased focus on the full spectrum of health care (i.e., prevention, promotion, and intervention), as well as expansion of health care coverage and rapid advances in technology and genomic science. In addition, significant changes have occurred in demographics, and there are increased demands on nursing for effective interventions that improve health outcomes. These trends are aligned closely with nursing science. The Strategic Plan will continue to invest in discoveries that contribute to nursing science and develop new health care strategies that benefit individuals, families, and communities throughout the United States.
Dr. Guthrie reviewed the strategic planning process to date. She then reminded Council members that NINR’s aim is to invest in research that will advance health promotion and disease prevention, improve QOL by managing symptoms of chronic illness, improve EOL and palliative care, enhance innovation in nursing research, and develop the next generation of nurse scientists. Premises are that individuals are active participants in their own health and should be actively involved in the management of illness and prevention of disease.
The Institute’s emphasis in health promotion research includes the study of the behavior of systems, understanding behavioral patterns and sustainable behavioral changes, models for lifelong preventive care, strategies to improve health literacy, translation of scientific advances, and interdisciplinary and community partnerships. The increase of knowledge and the development of new strategies are primary aims for NINR’s support of QOL and symptom management research, particularly regarding biological mechanism associated with symptoms and symptom clusters, reduction of symptom risk or impact on QOL, management of symptoms, and clinical effectiveness and outcomes research. The focus in EOL and palliative care research is to increase knowledge in the field, including the impact on caregivers and the effect of the shortage of health care workers as well as to develop interventions for chronically ill individuals and create new communication strategies among EOL stakeholders. Innovative initiatives also are important, including creative application of technologies and informatics, telehealth strategies, community collaboration on prevention models, global partnerships, better health for underserved community groups, and generation of best practices. The NINR is committed to the development of a strong cadre of nurse investigators and training of scientists; strategies to support this goal include models of trans-institutional learning and inter-professional training, rapid advancement to scientific investigator, recruitment of nurse investigators from underrepresented communities, increased research knowledge of faculty and students, and the education and development of a diverse workforce.
Dr. Kerr explained that this is an interim report and that the Strategic Plan is expected to be posted on the NINR Web Site in January 2011 for public comment. Dr. Grady encouraged Council members to submit comments regarding the Strategic Plan to Dr. Kerr.
Following this update, Dr. Grady thanked participants and attendees for their time and interest and adjourned the open session of the meeting.
This portion of the meeting was closed to the public in accordance with the determination that this session was concerned with matters exempt from mandatory disclosure under Sections 552b(c)(4) and 552b(c)(6), Title 5, U.S. Code, and Section 10(d) of the Federal Advisory Committee Act, as amended (5, USC Appendix 2). Members absented themselves from the meeting during discussion of and voting on applications from their own institutions or other applications in which there was a potential conflict of interest, real or apparent. Members were asked to sign a statement to this effect.
REVIEW OF APPLICATIONS
The members of the NACNR considered 143 research and training grant applications on which NINR was the primary Institute; these applications requested a total of $39,348,261 (direct costs year 01). The Council also considered 593 applications on which another Institute/Center was primary and NINR was secondary; these applications requested a total of $228,038,660 (direct costs year 01). The Council concurred with the IRG recommendations on these 736 applications.
The 72nd meeting of the NACNR was adjourned at 12:15pm on September 15, 2010.
I hereby certify that the foregoing minutes are accurate and complete.
Patricia A. Grady, Ph.D., R.N., F.A.A.N
National Advisory Council for Nursing Research
Mary E. Kerr, Ph.D., R.N., F.A.A.N.
National Advisory Council for Nursing Research
Dr. Patricia A. Grady, Chair
Dr. Mary E. Kerr, Executive Secretary
Dr. Marion Broome
Dr. Stan Finkelstein
Dr. Everette Freeman
Dr. Kevin Frick
Dr. Barbara Guthrie
Dr. Diana Lake (teleconference)
Dr. Elaine Larson
Dr. Jean McSweeney
Dr. Kathleen Potempa
Dr. Susan Reinhard
Capt. Maggie Richard, Ex Officio
Dr. Gail Stuart
Dr. King Udall
Dr. Janet Williams
FEDERAL EMPLOYEES PRESENT
Dr. David Banks, NINR/NIH
Ms. Melissa Barrett, NINR/NIH
Dr. Yvonne Bryan, NINR/NIH
Dr. Paul Cotton, NINR/NIH
Dr. Ray Dionne, NINR/NIH
Dr. Chris Hafner-Eaton, NINR/NIH
Ms. Crystal Esler, NINR/NIH
Ms. Ana Ferreira, NINR/NIH
Dr. John Grason, NINR/NIH
Dr. Kevin Green, NINR/NIH
Dr. Rebecca Hawes, NINR/NIH
Dr. Jeanette Hosseini, NINR/NIH
Dr. Karen Huss, NINR/NIH
Mr. Doug Hussey, NINR/NIH
Ms. Deborah Jennings, NINR/NIH
Ms. Ellie Johnson, NINR/NIH
Dr. Weiqun Li, NINR/NIH
Dr. Yujing Liu, NINR/NIH
Dr. Susan Marden, NINR/NIH
Ms. Angela Marshall, NINR/NIH
Ms. Mary Murray, NINR/NIH
Ms. Brandis O’Neal, NINR/NIH
Mr. Chip Rose, NINR/NIH
Dr. Denise Russo, NINR/NIH
Ms. Candice Scott, NINR/NIH
Ms. Cheryl Stevens, NINR/NIH
Dr. Chelvi Thyagarajan, NINR/NIH
Dr. Xenia Tigno, NINR/NIH
Dr. Lois Tully, NINR/NIH
Dr. Linda Weglicki, NINR/NIH
Mr. Kevin Wilson, NINR/NIH
Dr. Marie Zeimetz, NINR/NIH