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As a nurse practitioner, Lorraine Frazier, DSN, NP, RN, thought it odd that every patient with hypertension received the same meds and the same advice to reduce stress and sodium intake. But when she later saw in clinical practice that a variety of treatments could work, it piqued her curiosity. "It wasn’t cut-and-dried. High blood pressure wasn’t black and white. Today in medicine we often use a blanket approach. I always ask why. My goal is to understand the treatment for hypertension and hypertension itself," Frazier said. "I’ve always found cardiovascular patients fascinating. As a nurse, you see a lot of high blood pressure. I wanted to do a better job of treating it." Frazier knew she wanted to be a nurse as a child. She followed a linear path to a doctorate, driven by her thirst for more knowledge. Research
for the future Funding for nursing research has blossomed in recent years because of the broader range of topics, such as patient and family outcomes, said Daniel O’Neal, MA, RN, chief of the Office of Science Policy and Public Liaison at the National Institute of Nursing Research in Bethesda, Md. Most studies pay particular attention to people with special health needs, such as women, minorities, the elderly, residents of rural areas and the economically disadvantaged. "The research we do makes a difference in people’s lives, and they tell Congress," O’Neal said. During the past five years, the amount of grant money pouring out from the institute has more than doubled, from about $50 million to $104 million, O’Neal said. Most often, the scientific knowledge gleaned from nursing research greatly improves clinical practice. The findings from nursing researchers also fill academic journals. Thirst
for knowledge At a summer institute last year, she immersed herself in genetics at the NIH in Bethesda. While she works with an interdisciplinary team during the postdoc, Frazier would like to lay the groundwork that allows nurses a voice in influencing future policy-making on genetic research. Her research focuses on the sympathetic nervous system’s role in hypertension. She’s also investigating the part that genetic susceptibility plays in the development of high blood pressure. Another component of her research relates to how alpha-blockers affect hypertension. The overarching study will look at the effects of four different drug groups on hypertension, Frazier said. "We know now that approximately 30 percent of hypertension is genetic. But the treatment for the remaining 70 percent will vary by patient. Giving hypertension patients the same meds and telling them to reduce stress and sodium isn’t working," Frazier said. "I see myself as a clinical bridge. I understand the clinical piece and the cellular piece, and I think that’s important," Frazier said. She’d recommend research to any nurse with a passion for knowledge. "It depends on your interest and stage of life. I always ask why; I always read the journal articles. I used to wonder about treatments I’d just read about." A nurse researcher has an edge, Frazier said, because a nurse will be concerned about intervention. A geneticist who hasn’t ever seen a patient doesn’t think about what might help, she said. Opportunity also plays a part. In rural Oklahoma, Frazier lived nowhere near a doctoral program. But when she moved to Houston, she jumped at the chance to earn a doctorate and to continue her research with the postdoc. "I do it because I’m interested and passionate. I enjoy the research. Period. I’m invested," Frazier said. "I’m constantly thinking about my research. It gets more interesting the more I learn, and the complexity of genetics adds a lot of depth to it." Rewarding
combination "Questions come from patients. What’s wonderful is that you can conduct research on solutions and take that back to the patients." At the beginning of her career, Janson noticed how hard it was for patients to live with chronic lung disease. They told her that clinicians, physicians and nurses weren’t offering treatment for chronic shortness of breath. The medical approach at the time was more, ‘You have chronic lung disease—you’ll just have to live with it,’ " Janson said. After she went back to school for a doctorate, Janson designed and carried out a research study to reveal how patients with chronic lung disease were coping on their own. In other studies, she tested interventions. In a desensitization intervention, she and other researchers taught patients to walk and exercise during an attack of shortness of breath and how to breathe to modify the perception of the sensation. In another study, Janson sought to teach people with asthma to use a peak flow meter at home. Measuring airflow obstruction that way indicated to them whether they needed urgent care or could take care of themselves at home. An
ominous sign "That 7 percent doesn’t sound like a lot, but when you consider that these children probably will go on to develop Type 2 diabetes within 10 years, it’s frightening," Harrell said. In another study Harrell co-authored, she and other researchers found that activity levels for children in the third through 10th grades varied based on gender and race. The researchers found that girls were more sedentary than boys and that African-American children reported fewer vigorous activities than other races. The authors concluded that physical education curricula and other activities for school-age children should allow for those differences. "In addition, we found that the children got progressively less active as they got older. Some nurses don’t think it’s nursing research if you’re doing school-based ‘well children’ studies, but it’s primary health promotion. That’s an integral part of nursing practice," Harrell said. More
interventions "[A staff nurse] came up with that idea because she saw patients were nervous about starting treatment," said Terry Throckmorton, Ph.D., RN, director of nursing research at M.D. Anderson. The hospital’s research council supports this, said Marlene Cohen, Ph.D., RN, the John H. Dunn Sr. Distinguished Professor in oncology nursing at the UT-Houston HSC School of Nursing. Cohen, who has a joint role as director of applied nursing research at M.D. Anderson, developed and conducts a Nursing Research Fellowship, a program that gives clinical nurses a chance to learn research and earn course credit for the UT-Houston HSC School of Nursing’s master’s level research course. They also learn about a variety of disciplines within oncology research. In addition, they work as a team with Cohen to carry out research projects. "While
staff nurses are not For the past decade, Cohen’s research has focused on patients’ perceptions of cancer, with the goal of finding more effective interventions. A study she co-authored with Janice Phillips, Ph.D., RN, in 1999, for example, found that African-American women still hold misconceptions about the causes of breast cancer and fatalistic perspectives about breast cancer outcomes. In interviews with 26 African-American women from three employment groups, Cohen and her colleagues found that fear was the primary reason women did not undergo breast cancer screening. Unemployed and service-sector women thought breast cancer stemmed from violence, while teachers felt it arose from injury and sex. The women also said breast cancer is seldom discussed within the African-American community, which creates the impression that it is a disease more common to Caucasian women. Cohen and her colleagues concluded that future research should address the roles of pain, fear and fatalism in order to encourage screening, and that nurses should customize their interventions based on African-American women’s socioeconomic status. Cohen’s work represents the cutting edge of nursing scholarship: interdisciplinary research. She’s now studying symptoms experienced by blood and marrow transplantation patients with a team of clinicians and researchers that includes physicians, psychologists, a social worker, a dietitian and other nurses. The findings of researchers such as Frazier and Cohen can end up as required reading not just for nursing students, but physicians in training, too. Frazier sees the borders breaking down between health care professionals, thanks in part to research trends. "As nurses become interested in the physiological aspects [of health care], physicians are becoming interested in the social aspects of health care," Frazier said. "We’re sort of meeting in the middle." Nursing research can be an important draw for the profession, Janson said. Young people with an abiding sense of curiosity and a desire to teach can find a home in doctoral research for nursing, she said. The National Institute of Nursing Research, only too aware of the nursing shortage, said in a statement, "We must focus on developing the next generation of nurse researchers. To ensure that the cadre of nurse research-ers is maintained and expanded, we will continue to support the continuum of research training needs, from attracting nurses to the field of research to providing pre- and postdoctoral training and research opportunities." "[Research] is a different journey but it’s a good one," Frazier said. "Nursing allows you to take different journeys at different times in your life." -Ed
Frauenheim contributed to this article. |
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