NINR developed a research framework that takes advantage of what makes the Institute unique by focusing on a holistic, contextualized approach to optimizing health for all people, rather than on specific diseases, life stages, or research topics. The framework builds on the strengths of nursing research, spans the intersection of health care and public health, and encompasses the clinical and community settings where nurses engage in prevention, treatment, and care—including hospitals and clinics, schools and workplaces, homes and long-term care facilities, justice settings, and throughout the community. The framework encourages research that informs practice and policy, and improves health and quality of life for all people, their families and communities, and the society in which they live.
NINR’s research framework includes guiding principles and research lenses that promote innovative and rigorous multilevel study designs that look upstream, midstream, and downstream to discover solutions to the nation’s most pressing and persistent health challenges.
Figure 1. Nursing Research Through NINR’s Research Lenses
NINR’s guiding principles describe the qualities that investigators should emphasize in all NINR-supported research. In considering awards for funding, the extent to which studies reflect these principles will factor into our decisions.
NINR will prioritize research that:
- tackles today’s pressing health challenges and stimulates discoveries to prepare for, prevent, or address tomorrow’s challenges;
- discovers solutions across clinical, community, and policy settings to optimize health for individuals, families, communities, and populations;
- advances equity by removing structural barriers from research, cultivating diversity in perspectives and ideas, and fostering inclusion and accessibility in designing, conducting, and participating in research; and
- is innovative, develops or applies the most rigorous methods, and has the potential for the greatest impact on health.
NINR identified five complementary and synergistic research lenses that best leverage the strengths of nursing research and promote multilevel approaches, cross-disciplinary and -sectoral collaboration, and community engagement in research. The research lenses are health equity, social determinants of health, population and community health, prevention and health promotion, and systems and models of care. Nursing research is well positioned to address each of these research lenses because of nursing’s expertise in biological, behavioral, social, and public health sciences and long-standing values of social justice, holism, and collaboration.
NINR believes that the application of these lenses to nursing research will lead to scientific discoveries that contend with pressing and persistent health challenges and positively impact practice and policy in the many settings in which nurses work. It is important to note that the lenses are not research topics, but rather perspectives through which to consider the full spectrum of nursing research topics that encompass health and illness within the context of people’s lived experiences. These lenses allow nursing research to examine new topics while also allowing nurse scientists to take a different look at long-standing areas of interest (Table 1).
Table 1. Current NINR Funding Levels for Long-Standing Areas of Interest
| Area of Interest* | Percent of Budget | NIH Rank as a Percent of Budget |
|---|---|---|
| Clinical Research | 78% | 1st |
| Behavioral and Social Sciences Research | 60% | 2nd |
| Prevention | 43% | 3rd |
| Health Disparities | 34% | 2nd |
| Social Determinants of Health | 26% | 3rd |
| Training** | 22% | 2nd |
| Women’s Health | 20% | 4th |
*Funding categories are not mutually exclusive
** National Research Service Awards (Fs/Ts)
Recognizing that definitions for the concepts presented in the research lenses continue to evolve as evidence emerges using cutting-edge methodologies that improve our understanding of them, NINR offers its perspective for each of the research lenses-rather than a definition-for the purpose of providing guidance to investigators.
NINR-supported researchers have the flexibility to apply a single lens or a combination of lenses in their study designs and training programs. NINR encourages researchers to view the health equity and social determinants of health lenses as primary foci through which to consider the population and community health, prevention and health promotion, and systems and models of care lenses (Figure 1).
There are many examples of pressing and persistent health challenges that could be viewed through NINR’s research lenses. Although far from comprehensive, and not intended to guide research proposals, the examples below illustrate just a few of our Nation’s pressing challenges that require urgent solutions:
- People who are Hispanic, Black, and American Indian or Alaska Native are nearly twice as likely to die from COVID-19 as people who are White. [KFF]
- 1 in 5 adults in the United States report experience with discrimination in the health care system and nearly three-quarters of those that experience it report more than one experience. [JAMA]
- In the United States, 6 in 10 adults have one chronic disease, and 4 in 10 have two or more. Chronic diseases are the leading drivers of the nation’s $3.8 trillion in annual health care costs. [CDC]
- People of color face higher rates of diabetes, obesity, stroke, heart disease, and cancer than people who are white. For example, the percentage of U.S. adults who are diagnosed with diabetes is much higher for people who are American Indian or Alaska Native (14.5%), Black (12.1%), or Hispanic/Latino (11.8%) than for those who are White (7.4%). [CDC]
- U.S. women who are pregnant or have recently given birth die by homicide at more than twice the rate of death from bleeding or placental disorders. [Nature]
- Black-majority neighborhoods have a lower life expectancy than the national average by approximately 4.1 years. [Brookings]
- Nearly half of adults with disabilities get no aerobic physical activity, an important protective health behavior to avoid chronic diseases, and are three times more likely to have heart disease, stroke, diabetes, or cancer than adults without disabilities. [CDC]
- Residents of neighborhoods with fewer fresh produce sources and plentiful fast-food restaurants and convenience stores have a higher risk of obesity and diabetes. [HHS]
- Nearly half of adolescents who identify as gay, lesbian, or bisexual seriously considered attempting suicide during COVID-19. [CDC]
- Black individuals are 22% less likely than White individuals to receive any pain medication for similar painful conditions. [PubMed]
- Research-focused doctoral programs in nursing consist of predominately female (89.1%) and White (71.7%) students, and percentages of students who are Black (8.1%) or Hispanic/Latino (9%) are not representative of the U.S. population. [AACN]
HEALTH EQUITY: Reduce and Ultimately Eliminate the Systemic and Structural Inequities That Place Some at an Unfair, Unjust, and Avoidable Disadvantage in Attaining Their Full Health Potential. NINR’s perspective on health equity
NINR recognizes that health equity refers to a state in which every person has a fair and just opportunity to attain their full health potential. Inequities are rooted in systemic and structural factors, including historical and contemporary laws, systems, values, and institutions, that limit access to power, opportunities, and resources for socially and economically disadvantaged groups. Structural and systemic factors, including structural racism, create obstacles to health and can lead to persistent health inequities.
Nursing research through the health equity lens
Nursing research is intended to improve health and well-being for all. Thus, nursing research is urgently needed that recognizes that, as a nation, we must work collectively to address inequities that prevent people from attaining their full health potential. Research through this lens builds on NINR’s ongoing investment in this area-34% of NINR’s budget focuses on research to eliminate health disparities-and aims to improve health outcomes through structural interventions that remove obstacles to health equity among disadvantaged groups by increasing availability and accessibility of resources and altering social and institutional norms.
SOCIAL DETERMINANTS OF HEALTH: Identify Effective Approaches to Improve Health and Quality of Life by Addressing the Conditions in Which People Are Born, Live, Learn, Work, Play, and Age.NINR’s perspective on social determinants of health
NINR considers social determinants of health as the conditions in which people are born, live, learn, work, play, and age that affect health and quality of life for individuals and populations. Social determinants of health include community conditions (e.g., job opportunities, school quality, transportation systems, social cohesion, and green space) and individual and family social and economic circumstances (e.g., income, educational attainment, social isolation, traumatic experiences, nutrition security, and housing) that can have positive or negative influences on health. Social determinants also include structural factors and can lead to persistent health inequities.
Nursing research through the social determinants of health lens
Nursing research is needed that identifies and develops interventions delivered at the right place and the right time to target social determinants of health, building on NINR’s ongoing investment in this area-26% of NINR’s budget focuses on social determinants of health. Research through this lens aims to discover creative solutions powerful enough to address upstream and midstream causes of positive and negative health outcomes and that identifies how to limit exposure to adverse social and economic conditions and circumstances and susceptibility to biological embedding of social determinants over the life course and across generations.
POPULATION AND COMMUNITY HEALTH: Address Critical Health Challenges at a Macro Level That Persistently Affect Groups of People With Shared Characteristics. NINR’s perspective on population and community health
NINR views population health as referring to health and well-being of groups of individuals with one or more shared characteristic (e.g., demographics, cultures, health conditions, life stages, social affiliations, and places) and the distribution of outcomes within and across groups. As a subset of population health, community health refers to health and well-being among those connected by place, such as neighborhoods, towns, cities, counties, or tribal jurisdictions.
Nursing research through the population and community health lens
Nursing research is needed that uses etiologic, applied, and translational approaches to identify risk and protective factors and improve health outcomes for populations and communities. Research through this lens investigates the etiology of variations in population and community health, tests and evaluates planned and natural experiments of macro-level interventions, and utilizes community action and partnerships in the many settings in which nurses work.
PREVENTION AND HEALTH PROMOTION: Prevent Disease and Promote Health Through the Continuum of Prevention-From Primordial to Tertiary. NINR’s perspective on prevention and health promotion
NINR considers prevention as actions taken to reduce risk of disease, disability, or injury along a continuum-from primordial prevention that targets underlying risks, to tertiary prevention that aims to reduce symptoms, severity, and progression. Health promotion includes but is not limited to efforts to facilitate healthy behaviors that reduce risk, improve health, manage disease, and enhance well-being. NINR recognizes that effective prevention and health promotion efforts aim to eliminate health inequities by accounting for the social, environmental, behavioral, psychosocial, and biological factors that affect risk.
Nursing research through the prevention and health promotion lens
Nursing research is needed that considers not only how to prevent disease and promote health, but how to also prevent inequities in disease burden, health outcomes, and well-being based on the broad range of factors at multiple levels that increase or mitigate risk. Research through this lens identifies the mechanisms through which interventions work and builds on NINR’s ongoing investment in this area-for example, 43% of NINR’s budget supports research on prevention.
SYSTEMS AND MODELS OF CARE: Address Clinical, Organizational, and Policy Challenges Through New Systems and Models of Care. NINR’s perspective on systems and models of care
NINR recognizes the need for innovative systems and models of care that are comprised of coalitions and partnerships that span clinical and community settings and address social factors and needs for populations and individuals. NINR strongly encourages nurse-led systems and models of care that consider how to leverage the public’s trust in and the expertise of the nursing workforce; employ policy and organizational solutions informed by the on-the-ground experiences of nurses; and focus on health-promoting care that encompasses the whole person in the context of their lives and living conditions, before, during, and after their points of care.
Nursing research through the systems and models of care lens
Nursing research is needed to inform the development, dissemination, and implementation of new, organized systems and models of care. Research through this lens explores solutions that grapple with systems-level challenges, such as coordinating care and integrating data across clinical and community settings, testing models of contextualized care, and understanding the impacts of organizational practices and policy on quality of care and its outcomes.