Particular emphasis is placed on subsets of the population who have special health problems and needs such as older people, women and minorities, and residents of rural areas. Research seeks to discover how cultural and ethnic identity affect behavior and differences in risk patterns and to determine the influence of socioeconomic status, geographic location, and other factors on health-related attitudes, decisions, and behaviors.

NINR's intramural investigations center on managing symptoms of chronic illness such as the nutritional changes, myopathy, and fatigue that occur during treatment for HIV disease. Other studies, which focus on quality of life as an outcome of chronic illness, are being conducted in caregivers of persons with Alzheimer's disease and in persons with AIDS.

NINR fosters collaborations with many other disciplines in areas of mutual interest such as long-term care for at-risk older people, genetic testing and counseling, behavioral aspects of tuberculosis, the special needs of women with physical disabilities, and environmental influences on risk factors related to chronic illness.

The institute also supports comprehensive research training and career development programs to prepare individuals with requisite interdisciplinary skills to conduct nursing research.

April 18, 1986--Health and Human Services Secretary Otis R. Bowen, M.D., announced the establishment of NCNR at NIH.

December 3, 1986--Members of the NCNR Advisory Council were appointed by the HHS secretary.

February 17, 1987--The first meeting of the NCNR Advisory Council was held.

May 30, 1988--NCNR Advisory Council was renamed the National Advisory Council for Nursing Research.

June 10, 1993--P.L. 103-43, the NIH Revitalization Act of 1993, became law. Among other provision, it changed the center to an NIH institute.

June 14, 1993--DHHS Secretary Donna Shalala signed the Federal Register notice establishing the National Institute of Nursing Research.

1986--A series of continuing resolutions (P.L. 99-500, P.L. 99-599) established NCNR as a separate NIH appropriation.

June 10, 1993--NCNR was redesignated as an NIH institute under a provision in P.L. 103-43, the NIH Revitalization Act of 1993.

Dr. Grady became the institute's second director on April 3, 1995. She earned her bachelor of science degreee in nursing from Georgetown University in Washington, D.C. She received her master's degree in nursing and her doctorate in physiology from the University of Maryland School of Medicine.

Her scientific research has been primarily in stroke, including arterial stenosis, cerebrovascular permeability, cerebral edema and hypertension. Before coming to NIH, she served on the faculty of the University of Maryland School of Medicine. During that time, she was also a member of the faculty of the university's School of Nursing.

In 1988 Dr. Grady came to NIH as a program administrator for NINDS's extramural research programs related to stroke and brain imaging. While there, she served on NIH's Task Force for Medical Rehabilitation Research. In 1992, she assumed the responsibilities of NINDS assistant director. In 1993 she served as acting director and subsequently was appointed deputy director of NINDS until becoming NINR director in 1995.

A member of many scientific organizations, including the Society for Neuroscience and the American Academy of Neurology, she is a fellow of the American Heart Association Stroke Council and was recently elected a member of the American Neurological Association. Internationally known in the field of stroke research, she reviews major journals and speaks on neurological sciences, nursing research and federal research opportunities.

In August 1995 Dr. Grady received the PHS Superior Service Award for her exceptional leadership as NINDS acting director. She is also a recipient of the NIH Merit Award. She was selected as the 1995 Excellence in Nursing Lecturer by the Council on Cardiovascular Nurses of the American Heart Association. In 1996 she received the Rozella M. Schlotfeldt Distinguished Lecture Award from the Frances Payne Bolton School of Nursing, Case Western Reserve University, and an honorary degree of doctor of public service from the University of Maryland.

The NINR extramural program invites investigator-initiated applications containing innovative ideas and sound methodology in all aspects of nursing research consistent with the institute mission. A program priority is the integration of biological and behavioral research. Three dimensions--promoting health and preventing disease, managing the symptoms and disability of illness, and improving the environments in which care is delivered--cut across the following six areas.

• Research in chronic conditions, including arthritis, diabetes, and urinary incontinence, and in long-term care and caregiving.

• Research in health and risk behaviors, including studies of women's health developmental transitions such as adolescence and menopause and health and behavior research such as studies of smoking cessation.

• Research in cardiopulmonary health, including prevention and care of individuals with cardiac or respiratory conditions. This area also includes research in critical care, trauma, wound healing, and organ transplantation.

• Research in neurofunction and brain disorders, including pain management, sleep disorders, symptom management in persons with brain disorders such as Alzheimer's disease, and rehabilitation following brain and spinal cord injury. This also includes research on patient care in acute care settings.

• Research in immune and neoplastic diseases, including symptoms primarily associated with cancer and AIDS such as fatigue, nausea and vomiting, and cachexia. Prevention research on specific risk factors is also included.

• Research in reproductive and infant health, including prevention of premature labor, reduction of health-risk factors during pregnancy, delivery of prenatal care, care of neonates, infant growth and development, and fertility issues.

NINR's priority is to fund investigator-initiated research. To assure depth in certain scientific areas, however, the institute collaborated with the National Advisory Council for Nursing Research and nursing scientific community to develop the National Nursing Research Agenda. Initial areas for special focus in 1989-1994 were low birth weight: mothers and infants HIV infection: prevention and care long-term care for older patients symptom management of pain nursing informatics support for patient care and health promotion for children and adolescents.

Areas identified for 1995-1999 are:
• Community based nursing models to examine nursing strategies designed to promote health and reduce risks of disease and disabilities from chronic conditions, particularly among rural, underserved, and minority populations.

• Effectiveness of nursing interventions in HIV/AIDS to evaluate biobehavioral nursing interventions to foster health promoting behaviors of individuals at risk for HIV/AIDS, and to ameliorate the effects of illness in those already infected.

• Cognitive impairment--develop and test biobehavioral and environmental approaches to remedy cognitive impairment and to examine prevention strategies that target those at risk.

• Living with chronic illness--test interventions that increase individual and family adaptation to chronic illness.

• Biobehavioral factors related to immunocompetence--identify biobehavioral factors and test interventions that promote immunocompetence.

Research Training and Career Development

This activity assures that there will be an adequate cadre of well-trained nurse scientists to meet future research needs. This is accomplished through national research service awards consisting of predoctoral and postdoctoralindividual and institutional support, as well as senior fellowships for experienced investigators.

For career development, NINR offers a "Mentored Research Scientist Development Award--Nursing," which is available to doctorally prepared students who need a mentored research experience with an expert sponsor as a way to gain expertise in an area new to the candidate or would demonstrably enhance the candidate's scientific career.

Intramural Division

NINR's growing Division of Intramural Research develops and conducts clinical research that contributes to scientific knowledge for nursing practice and health care. It also provides research training opportunities for nurse scientists.

The Clinical Therapeutics Laboratorystudies the biophysiologic and behavioral basis for and the effectiveness of clinical therapeutics relevant to nursing practice and health care. Ongoing investigations study the prevention, detection, and treatment of symptoms and side effects occurring during HIV infection and its treatment, such as fatigue, nutritional problems, and muscle weakness. Another series of CTL studies in aging individuals focus on treatment of another symptom, incontinence.

The Laboratory for the Study of Human Responses to Health and Illness studies quality of life and adaptation. Investigations focus on people's responses to illness and disability, as well as health promotion. Ongoing longitudinal investigations are conducted on the predictors of burdens and quality of life of caregivers of Alzheimer's disease patients, as well as the psychophysio-logic predictors of quality of life of HIV-infected people. Another study is investigating how to more accurately measure and improve the functional status of people with chronic illnesses.

Investigators are in the process of developing protocols for a new Clinical Ethics Laboratory.