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National Institute of Nursing Research (NINR)
The mission of the National Institute of Nursing Research (NINR) is to promote and improve the health of individuals, families, and communities. To achieve this mission, NINR supports and conducts clinical and basic research and research training on health and illness, research that spans and integrates the behavioral and biological sciences, and that develops the scientific basis for clinical practice. From premature infants in neonatal intensive care units, to adolescents living with diabetes, to elderly cancer survivors coping with pain, nursing research develops the science to help people strengthen the quality of their lives. Nursing science transcends the boundaries of disease and research disciplines to better understand the experiences of individuals and families living with illness and to develop personalized approaches that maximize health and well-being for individuals at all stages of life, across diverse populations and settings. NINR’s scientific programs encompass the following topics: symptom science, wellness, self-management of chronic conditions, end-of-life and palliative care, innovative technologies, and training nurse scientists.
The NINR Strategic Plan: An Overview
NINR’s Strategic Plan: Advancing Science, Improving Lives, focuses on areas of science in which the health needs are greatest, and in which NINR-supported research can have the largest impact.
It is organized around four areas of scientific focus: symptom science, wellness, self-management of chronic conditions, and end-of-life and palliative care. Two other areas, promoting innovation and developing the nurse scientists of the 21st century, are emphasized in all areas of NINR’s research programs.
The future research directions of these focus areas were shaped through the Innovative Questions (IQ) initiative, an initiative by NINR to encourage new thinking and creativity from the broader scientific community and general public. The innovative questions that emerged from the initiative are posted on the NINR website as a resource to all in the nursing science community.
The Plan is intended to be a living document, one which can be adapted as new opportunities and challenges arise.
November 20, 1985 — Public Law 99-158, the Health Research Extension Act of 1985, becomes law. Among other provisions, the law authorizes the National Center for Nursing Research (NCNR) to support research and training related to patient care at NIH.
April 18, 1986 — The U.S. Department of Health and Human Services (HHS) Secretary announces the establishment of NCNR at NIH.
April 1986–June 1987 — Dr. Doris Merritt, Special Assistant to the NIH Director, is appointed Acting Director of NCNR. NCNR’s initial budget is $16 million.
December 3, 1986 — The HHS Secretary appoints the first members of the NCNR Advisory Council.
February 17, 1987 — The NCNR Advisory Council holds its inaugural meeting.
June 1987–June 1994 — Dr. Ada Sue Hinshaw serves as the first Director of NCNR.
May 30, 1988 — The NCNR Advisory Council is renamed the National Advisory Council for Nursing Research.
1993 — NINR-funded researcher Dr. David Olds and colleagues establish that visits from home nurses significantly lower mothers' high blood pressure during pregnancy, result in better timing of subsequent pregnancies, and reduce abuse and neglect of children.
June 10, 1993 — P.L. 103-43, the NIH Revitalization Act of 1993, becomes law. Among other provisions, it elevates NCNR to an NIH Institute. As such, NCNR is re-designated the National Institute of Nursing Research (NINR).
June 14, 1993 — The HHS Secretary signs the Federal Register notice establishing the National Institute of Nursing Research (NINR).
July 1994–April 1995 — Dr. Suzanne Hurd serves as Acting Director of NINR.
1994 — NINR-funded researcher Dr. Loretta Sweet Jemmott tests several gender-appropriate, culturally sensitive interventions on hard-to-reach vulnerable populations and significantly reduces sexual risk behaviors for HIV. Her "Be Proud! Be Responsible!" intervention becomes the Centers for Disease Control and Prevention's model curriculum.
April 3, 1995 — Dr. Patricia A. Grady is appointed Director of NINR.
1997 — The NIH Director designates NINR as the lead NIH Institute to coordinate collaborative research on end-of-life care.
1998 — Building on research that showed risk for cardiovascular disease can begin at an early age, NINR-funded researcher Dr. Joanne Harrell demonstrates that a specially designed classroom educational program for elementary school children can significantly lower their cholesterol levels in just eight weeks. NINR-funded researcher Dr. Nancy Bergstrom, in a multi-site study, tests the Braden scale for risk of pressure sores and finds its predictive capability accurate. The scale is widely used in nursing homes and hospitals.
1999 — NINR-funded researcher Dr. Mary Naylor demonstrates that transitional care from hospital to home can significantly improve the health of older adult patients and substantially reduce patient days in hospitals, hospital readmissions, and health care costs. NINR-funded researcher Dr. Jon Levine establishes that gender plays a key role in pain relief, where women obtain satisfactory relief from kappa-opioids while men receive little benefit.
2000 — Dr. Margaret Grey reports that providing training in coping skills—such as social problem solving, communication, and conflict management—for young people with type 1 diabetes mellitus can significantly improve their quality of life.
Summer 2000 — NINR holds the first Summer Genetics Institute.
2002 — NINR funded researcher Dr. Linda Aiken demonstrates that hospital working conditions and adequacy of nurse staffing per patient can affect patients' recovery and that in hospitals where nurses have lower patient workloads, patients have substantially lower mortality rates.
April 2002 — NINR launches a free online training, "Developing Nurse Scientists" for students interested in the nursing research field.
2003 — NINR Director Dr. Patricia A. Grady is named co-chair of the Interdisciplinary Research component of the NIH Roadmap for Medical Research and co-chair of the NIH Pain Consortium.
2003 — NINR-funded researcher Dr. Martha Hill finds that interventions conducted at the community level by a multidisciplinary health care team reduce high blood pressure in young inner-city African-American males, who are typically underserved by the health care system. The study illustrates that culturally sensitive, successful interventions can be conducted for vulnerable populations and can help reduce health care disparities.
2004 — NINR Director Dr. Grady is named co-chair of the NIH Public Trust Initiative.
2004 — NINR launches a new pilot training project, the Graduate Partnerships Program in Biobehavioral Research.
December 2004 — NINR co-sponsors the NIH State-of-the-Science conference, Improving End-of-Life Care, bringing together almost 1,000 health care practitioners from around the world.
2005–2006 — NINR celebrates its 20th anniversary at NIH.
2006 — NINR-funded researcher Dr. Bernadette Melnyk demonstrates that her Creating Opportunities for Parent Empowerment (COPE) program, which aims to support the parents of premature infants, results in improved knowledge and parenting behaviors, decreased parental stress, and shortened length of NICU stays by about four days, reducing health care costs associated with premature births by about $4,800 per infant. COPE has been adopted by hospitals and insurers throughout the United States.
2007 — NINR-funded researcher Dr. J. Randall Curtis and collaborators report that an intervention to improve communication between ICU clinicians and family members of dying patients significantly reduces feelings of stress, anxiety, depression, and other symptoms of post-traumatic stress disorder in the family members for up to three months after the loss of their loved one.
2008 — NINR Director, Dr. Patricia A. Grady, is named co-chair of the Science of Behavior Change NIH Roadmap/Common Fund Initiative.
2008 — First two NINR Graduate Partnerships Program fellows graduate.
2009 — NINR publishes an award-winning patient information brochure, “Palliative Care: The Relief You Need When You’re Experiencing the Symptoms of Serious Illness.”
2009 — NINR-funded researcher Dr. Pamela Mitchell reports that a behavioral intervention called Living Well with Stroke reduces the incidence of depression in stroke survivors, both immediately after treatment for stroke and at a one-year follow up.
2009 — Using the unprecedented additional funding made available through the American Recovery and Reinvestment Act (ARRA), NINR supports an additional $36 million in research in fiscal year 2009–2010. Projects supported under ARRA include a new research cooperative for palliative care science and multiple training opportunities to build the scientific workforce. Approximately 73 additional research grants are supported, along with multiple research and training supplements.
2010 — NINR intramural researcher Dr. Taura Barr identifies a gene panel useful for stroke diagnostics and outcome prediction as well as other neurological conditions such as traumatic brain injury.
NINR intramural researcher Dr. Wendy Henderson develops a device for collecting patient-reported outcomes related to pain called the "Gastrointestinal Pain Pointer," enabling a patient to describe the location, intensity, and subjective components of their pain on a graphic interface. These data are then captured electronically for quantification and comparison to later reports of pain.
2010 — NINR holds its first Methodologies Boot Camp, which focuses on pain research.
2010 — NINR releases its first history book, NINR: Bringing Science to Life.
2010 — U.S. Senate resolution, S. Res. 642, congratulates NINR on a quarter century of achievement in science and public service. The resolution is introduced by Senator Daniel Inouye (D-Hawaii) and co-sponsored by Senator Susan Collins (R-Maine).
May 2010 - The research of Drs. Rita Colwell, Anwar Huq, and colleagues shows that using readily available sari cloth to filter pond and river water successfully reduces the incidence of cholera by nearly half in a study conducted in Bangladesh.
2010–2011 — NINR celebrates its 25th anniversary at NIH with a series of scientific events.
2011 — NINR launches a new NINR Director's Lecture series, designed to bring the nation’s top nurse scientists to the NIH campus to share their work and interests with a transdisciplinary audience. Dr. Bernadette Melnyk presents the inaugural lecture on “COPE: Improving Outcomes for Premature Infants and Parents.”
January 2011 — NINR establishes a YouTube channel, “NINR News,” to post videos highlighting its events and trainings.
February 2011 —NINR-funded researcher Dr. Barbara J. Drew leads a team that develops a modified electrocardiogram technique that can quickly be administered by a paramedic with the results automatically transmitted to the hospital via cell phone, allowing hospital personnel additional time to prepare for the incoming patient, potentially leading to faster treatment and improved patient outcomes.
July 2011 — NINR-funded researcher Dr. Samuel Sia and colleagues develop a novel “lab-on-a-chip” device for rapidly detecting HIV. This lab-on-a-chip, or mCHIP, device uses microfluidics and nanoparticles to simultaneously detect HIV and syphilis antibodies in a small amount of human whole blood, in an accurate and repeatable manner, demonstrating that the mCHIP can accurately, rapidly, and cost-effectively detect clinically infectious diseases in resource-limited settings.
August 11–12, 2011 — NINR convenes a national summit on “The Science of Compassion: Future Directions in End-of-Life and Palliative Care,” attended by nearly 1,000 scientists, health care professionals, and public advocates.
October 13, 2011 — Bringing Science to Life: NINR Strategic Plan is released at NINR's 25th Anniversary Concluding Symposium.
November 2011 — NINR publishes the Spanish-language public education brochure: "Cuidados Paliativos: El alivio que necesita cuando tiene síntomas de una enfermedad grave" (Palliative Care: The Relief You Need When You're Experiencing the Symptoms of Serious Illness).
December 2011 — NINR-funded researcher Dr. David Dinges and collaborators study individuals with an alteration in a protein called catechol-O-methyltransferase (COMT), and find that this mutation could serve as a biomarker to predict individual differences in sleep physiology and further our understanding of the effects of sleep deprivation.
March 2012 — NINR launches the Video Grantsmanship Workshop series, designed to help pre- and post-doctoral students and early-career nurse scientists learn the basics of grantsmanship, on its YouTube channel and website.
April 2012 — NINR-supported researcher Dr. Marilyn Rantz finds that, in a trial of an early warning sensor system that alerts nurses to declining health, long-term care residents participating in the intervention demonstrate better functional measures (e.g., hand-grip; gait) than residents receiving usual care.
October 2012 — Dr. Jessica Gill joins NINR as one of the first Lasker Clinical Research Scholars, the premier clinical intramural training program at NIH. She has developed a novel line of research on the mechanisms underlying differential responses to combat trauma and traumatic brain injury.
April 2013 — NINR launches its Twitter account, @NINR.
June 2013 — NINR-supported researcher Dr. Marilyn Rantz and collaborators conduct research on the development of a sensor system for use in apartments in a senior living community. The sensors alert nurse-care coordinators and clinicians to alterations in a patient’s health before the appearance of clinical signs—knowledge that can help promote independent living for older adults.
August 2013 — NINR publishes “Building Momentum: The Science of End-of-Life and Palliative Care: A Review of Research Trends and Findings, 1997–2010.”
October 2013 — NINR-funded researcher Dr. Bernadette Melnyk and colleagues test a teacher-delivered, cognitive-behavioral skills-building intervention program (COPE-Healthy Lifestyles TEEN [Thinking, Emotions, Exercise, and Nutrition]), promoting healthy lifestyles which improve health behaviors, body mass index, social skills, severe depression, and academic performance in high school adolescents. They find multiple, immediate improvements that are sustained over time.
November 2013 — Dr. Ann Cashion is appointed Scientific Director for the NINR Division of Intramural Research.
December 2013 — Dr. Jessica Gill, a Lasker Clinical Research Scholar and NINR intramural investigator, and Dr. Ida Spruill, an NINR-supported extramural scientist, are selected to receive the Presidential Early Career Award for Scientists and Engineers (PECASE). The PECASE is the highest honor bestowed by the United States Government on science and engineering professionals in the early stages of their independent research careers.
The Office of End of Life and Palliative Care Research is established to support NINR’s leadership role in end-of-life and palliative care research. As the lead NIH Institute for end-of-life research, NINR supports research that explores interventions to manage the symptoms of advanced illness and in planning for end-of-life decisions.
2014 — NINR’s Director's Lecture becomes an annual series to bring the nation’s top nurse scientists to the NIH campus several times each year to share their work and interests with a transdisciplinary audience.
January 2014 — NINR launches the Palliative Care: Conversations Matter® campaign, which aims to increase the use of palliative care for children living with a serious illness. The campaign is initiated to raise awareness of and improve communication about pediatric palliative care.
February 2014 — NINR-funded scientist Dr. Linda Aiken and collaborators conduct a detailed analysis of patient outcomes associated with nurse staffing and education. Their study finds that increases in nurses’ workload increases the likelihood of in-hospital death within 30 days of admission. They also find that increases in the numbers of nurses on staff with bachelor’s degrees lowers the likelihood of patient death. The study underscores the potential risks to patients of cuts in nurse staffing levels and suggests that an increased emphasis on bachelor’s level education for nurses can reduce hospital deaths.
February 2014 — NINR-funded researcher Dr. Debra Moser and colleagues study heart failure patients, learning that symptoms of heart failure are consistent across cultures — a finding that is important for improving symptom recognition and acting early to avoid adverse outcomes.
March 2014 — NINR, the lead Institute for end-of-life research at NIH, develops a new web resource aimed at helping people address a sensitive subject — the end of life. The 13-chapter End of Life module is added to NIHSeniorHealth.gov, a health and wellness website for older adults.
June 2014 — NINR-funded researcher Dr. Hyekyun Rhee and an interdisciplinary team of researchers develop and test an automated device for asthma monitoring (ADAM), applying technology to help assess asthma symptoms objectively and accurately. The device is found to be a valid asthma monitoring tool, and is well-received by users. These results indicate that ADAM can improve self-management of asthma in adolescents.
July 2014 — A record number of nursing graduate students, faculty, and clinicians (nearly 100) participate in NINR’s first Big Data Symptoms Research Methodologies Boot Camp.
September 2014 — C-SPAN’s Washington Journal interviews NINR Director Dr. Patricia A. Grady, NIH Director Dr. Francis Collins, and NIDDK Director Dr. Griffin Rodgers about important and groundbreaking research taking place across the NIH.
October 2014 — NINR-supported scientist Dr. Linda Aiken receives the prestigious Gustav O. Lienhard Award from the Institute of Medicine.
2015 — As part of its Palliative Care: Conversations Matter® campaign, NINR releases pediatric palliative care materials for families. These materials include the brochure, “Palliative Care for Children: Support for the Whole Family When Your Child Is Living with a Serious Illness” available in English and Spanish, as well as a resource on finding support, a series of family stories, and an at-a-glance fact sheet.
January 12, 2015 —NINR hosts a briefing on the IOM report, "Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life."
May 2015 — Researcher Dr. Amy Abernethy and others in the NINR-supported Palliative Care Research Cooperative Group examine the safety of discontinuing statin therapy in patients with advanced, life-limiting illness. They find no significant differences in mortality between patients who have discontinued statin therapy and those who have not. Those patients who discontinue statins also report improved quality of life, and health care costs are reduced. These findings highlight the need for providers to have meaningful discussions with patients about treatment options and maximizing their quality of life.
August 2015 — NINR intramural researcher Dr. Jessica Gill leads a team, which discovers that a protein linked to short-term complications after traumatic brain injury (TBI), may also be responsible for long-term complications that can result from TBI. The researchers use a novel technology to measure levels of the protein, tau, in the blood months and years after military personnel had experienced TBI, and find that elevated tau levels are associated with chronic neurological symptoms, independent of other factors such as depression and post-traumatic stress disorder. This finding provides an insight into the underlying biology of TBI, and could help lead to new strategies for mitigating TBI’s debilitating symptoms.
November 2015 — NINR director Dr. Patricia A. Grady receives the 2015 American Association of Colleges of Nursing Policy Luminary Award. The award recognizes an outstanding nurse leader for achievement in nursing, research, and health care policy.
2015–2016 — NINR marks its 30th anniversary at NIH with a series of scientific events including the “Advancing Science, Improving Lives” scientific symposium.
August 2016 — NINR releases a series of videos that give an overview of opportunities and dilemmas often encountered by midcareer scientists as they work to develop a sponsored project into a successful and sustained program of research.
September 2016 — NINR holds its first Science and the Public Lecture. Ellen Goodman presents her talk, which describes The Conversation Project, a public health campaign and movement, that works to change the way people talk about, and prepare for their end-of-life care.
September 2016 — NINR releases its new Strategic Plan, "Advancing Science, Improving Lives: A Vision for Nursing Science." The blueprint for the Plan grew from the Institute’s 2011 Strategic Plan, past scientific accomplishments, and current research priorities.
October 2016 — NINR creates a LinkedIn page to provide information on NINR events, job openings, and funding and training opportunities.
November 2016 — NINR launches a “Stories of Discovery" web feature that puts a spotlight on programs of research from NINR-funded institutions around the country. The discoveries cross the spectrum of strategic priority areas including self-management, symptom science, and end-of-life care.
January 2017 — NINR intramural researcher Dr. Jessica Gill and colleagues find that the blood protein tau can be an important new clinical biomarker to better identify athletes who need more recovery time before safely returning to play after a sports-related concussion.
February 2017 — NINR releases an interactive timeline that highlights significant accomplishments, discoveries, and initiatives over NINR’s 30-year history.
March 2017 — An early integrated palliative and oncology care intervention developed by Dr. Jennifer S. Temel and colleagues finds that patients receiving the intervention are more likely to have discussed their preferences in end-of-life care with clinicians and to report that knowing their prognoses was helpful in decision-making. The study’s findings indicate a significant positive impact of discussions with palliative care clinicians on patients with incurable cancer.
April 2017 — The NINR Intramural Research Program holds a scientific symposium, “Symptom Science Research: A Path to Precision Health,” highlighting Intramural’s scientific advances and collaborations across the NIH and other organizations.
August 2017 — NINR and its partners host “The Science of Caregiving: Bringing Voices Together” Summit. The Summit provides perspectives across the spectrum of caregiving, including the importance of caregiving across the lifespan as well as current and future directions for research to improve the health of patients and caregivers.
January 2018 — Dr. Ann Cashion serves as Acting Deputy Director of NINR.
March 2018 — Research led by Dr. Paul Macey, discovers connections between obstructive sleep apnea (OSA) symptoms and thinning of the brain’s cerebral cortex. The study also discovers differences in these brain changes among men and women, which might explain why women are more likely than men to have cognitive symptoms like depression, insomnia, and anxiety when experiencing OSA.
August 31, 2018 — After 23 years of service, Dr. Patricia A. Grady retires as director of NINR.
September 2018 — Dr. Ann Cashion serves as Acting Director of NINR.
November 10, 1985 — Public Law 99-158, the Health and Research Extension Act of 1985, becomes law. Among other provisions, the law authorizes the National Center for Nursing Research (NCNR) to support research and research training related to patient care at NIH.
1986 — A series of continuing resolutions (P.L. 99-500, P.L. 99-599) establishes NCNR as a separate NIH appropriation.
June 10, 1993 — P.L. 103-43, the NIH Revitalization Act of 1993, becomes law. Among other provisions, it elevates NCNR to a NIH Institute. As such, NCNR is re-designated the National Institute of Nursing Research (NINR).
2010 — U.S. Senate resolution, S. Res. 642, congratulates NINR on a quarter century of achievement in science and public service. The resolution is introduced by Senator Daniel Inouye (D-Hawaii) and cosponsored by Senator Susan Collins (R-Maine).
Ann Cashion, PhD, RN, FAAN, is Acting Director of the National Institute of Nursing Research (NINR) and Scientific Director of the NINR Division of Intramural Research. She is a well-known scientist and leader in the field of nursing science with expertise in genetic markers that predict clinical outcomes.
From 2011-2013, Dr. Cashion served as the Senior Advisor to the Office of the Director and Acting Scientific Director before being appointed Scientific Director in November 2013. Dr. Cashion was named NINR Acting Deputy Director in January 2018.
As lead investigator of NINR’s Genomic and Clinical Biomarkers Lab, she uses the NIH Symptom Science Model to identify biomarkers to predict “at-risk” populations and guide therapeutic management for multiple health outcomes.
Prior to her appointment at NINR, Dr. Cashion was professor and chair of the Department of Acute and Chronic Care in the College of Nursing, University of Tennessee Health Science Center (UTHSC). She joined the faculty in 2000, shortly after earning her doctorate at UTHSC. Also, in 2000 Dr. Cashion participated in the inaugural NINR Summer Genetics Institute (SGI). Drawn by the idea of incorporating genetics and genomics into her research, she credits the SGI with changing the trajectory of her career.
During her tenure at UTHSC, Dr. Cashion researched early biomarkers of acute rejection in recipients of pancreas transplantations. She also shared her expertise, mentoring numerous doctoral students on how to incorporate genomics into their programs of research and chairing an NIH Integrated Review Group Study Section for training applications.
Prior to her work as a nurse scientist, Dr. Cashion practiced as a critical care nurse and clinical nurse specialist for nearly two decades in Little Rock, Arkansas.
Currently, Dr. Cashion serves as a member of the National Academies of Sciences, Engineering, and Medicine Roundtable on Genomics and Precision Health. She was previously on the Board of Directors for the Alumni Association of the Robert Wood Johnson Executive Nurse Fellows program, served as co-chair of the Genetics Expert Panel for the American Academy of Nursing, and served as Communication Chair of the Centers for Disease Control and Prevention-sponsored GAPPNet (Genetic Applications in Practice and Prevention Network).
Dr. Cashion has served as President of the International Society of Nurses in Genetics (ISONG) and received the ISONG Founder’s Award in recognition of outstanding genetics research and scholarship. She was one of 20 nurses selected for the 2005 Robert Wood Johnson Executive Nurse Fellow program, and one of 10 featured nurse scientists on the Johnson and Johnson Nurse Scientists’ video. She has presented and published numerous times on her research findings related to transplantation and genetics.
Dr. Cashion received her BSN from the University of North Carolina at Chapel Hill, her MNSc from the University of Arkansas for Medical Sciences campus, and her PhD from the University of Tennessee Health Science Center.
|Name||In Office from||To|
|Doris H. Merritt (Acting)||April 18, 1986||June 1987|
|Ada Sue Hinshaw||June 6, 1987||June 30, 1994|
|Suzanne S. Hurd (Acting)||July 1, 1994||April 2, 1995|
|Patricia A. Grady||April 3, 1995||August 31, 2018|
|Ann Cashion (Acting)||September 1, 2018||Present|
Division of Extramural Science Programs (formerly Division of Extramural Activities)
The Division of Extramural Science Programs (DESP) serves NINR’s extramural research community and NINR by overseeing policy and management for grants and contracts to support NINR research and training. DESP also performs other specialized functions for the Institute such as overseeing a nationwide Research Centers program.
DESP consists of three offices:
- Office of Extramural Programs
- Office of End-of-Life and Palliative Care Research
- Office of Extramural Research Administration
The Office of Extramural Programs (OEP) manages NINR funding for projects at research institutions across the country and internationally. A major 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 NINR’s science areas.
The Office of End-of-Life and Palliative Care Research (OEPCR) coordinates and supports ongoing NINR and NIH research efforts in end-of-life and palliative care science. As the lead NIH Institute for end-of-life research, NINR supports science to assist individuals, families, and health care professionals in managing the symptoms of advanced life-limiting conditions and planning for end-of-life decisions.
Ongoing NINR efforts in EOLPC science include:
- Stimulation of EOLPC research initiatives;
- Creation of opportunities for collaborative activities;
- Facilitation of interdisciplinary EOLPC science;
- Identification of opportunities for science to inform policy and practice; and
- Coordination of the development, implementation, and evaluation of EOLPC research in direct collaboration with other NIH Institutes and Centers, federal research agencies, and outside constituencies.
To learn more about the Institute’s history in this area, see “NINR’s Leadership on End-of-Life Research and Palliative Care” below.
The Office of Extramural Research Administration (OERA) provides leadership and advice on implementing and coordinating extramural research, training and career development, grant program operations, and policies. OERA staff members are assigned in three major areas: the Grants Management Branch, the Research Policy and Analysis Branch, and the Scientific Review Branch.
Scientific Review Branch (SRB) - The SRB provides policy direction and coordination for the planning and execution of initial scientific and technical reviews conducted within the NINR.
Grants Management Branch (GMB) - The GMB branch is the central point of contact for all business-related activities associated with the negotiation, award, and administration of grants and cooperative agreements within NINR.
Research Policy and Analysis Branch (RPAB) – The RPAB provides leadership related to extramural research policy, including serving as a resource for policy interpretation, implementation, and communication for NINR staff and the scientific community.
National Advisory Council for Nursing Research
The National Advisory Council for Nursing Research provides a second level of review of grant applications, and recommends to the Institute Director which applications should be approved and considered for funding. These recommendations are based not only on considerations of scientific merit, but also on the relevance of the proposed project to NINR’s programs and priorities. Funding decisions are ultimately made by the Institute. In addition, the Council reviews the Institute’s extramural programs and also makes recommendations about its intramural research activities.
Research Centers Program
The Division of Extramural Science Programs maintains oversight of a nationwide Research Centers program. The Research Centers program is designed to increase research capability and expand the research of nurse scientists working on multiple projects by promoting collaboration between groups and across institutions, through the use of shared resources and expertise. These settings promote the development of skilled new investigators dedicated to interdisciplinary research. The collaborative approach to research typified in the Research Centers has been found to be valuable in producing outcomes that transform the results of research into current practice settings. The NINR Research Centers represent a continuum of institutional research programs at different stages of development, each with unique needs and potential. They are funded through the following grant mechanisms:
- Exploratory Center (P20) grants target schools of nursing to build research teams of the future and fund new programs, expand or modify existing resources, and conduct pilot studies to explore various approaches to the development of interdisciplinary programs that offer potential solutions to problems of special significance to the mission of the NINR. The P20 may lead to Center sustainability and/or the ability to be funded through other specialized or comprehensive grants.
- Centers of Excellence (P30) grants are designed for institutions with demonstrated research success, support interdisciplinary collaborative research programs among established investigators in specific areas of basic and/or clinical research of strategic interest to NINR. The purpose of the NINR P30 Centers is to: (1) develop sustainable interdisciplinary, biobehavioral research capacity for scientists conducting nursing research by establishing centralized research resources and a research infrastructure; (2) advance the Center’s thematic science area through complementary, synergistic research activities; and (3) enable pilot project research that will lead to new and independent investigator research.
In 2016, NINR supported a total of 16 Centers. Of these, six new 2016 NINR-funded Centers aim to develop sustainable interdisciplinary biobehavioral research programs for nurse scientists conducting research into the self-management of symptoms. All of the NINR Research Centers will enable support for the development of research infrastructures and centralized resources in support of independent nursing research programs. They will also serve to advance NINR’s goals of expanding research capacity, promoting sustainability, and increasing training opportunities.
Extramural Research Training and Career Development
NINR offers a range of extramural training awards and opportunities.
The Ruth L. Kirschstein National Research Service Awards (NRSA) are given to individual fellowship applicants selected for award as a result of national competition for research training in specified health-related areas. NIH awards NRSA individual postdoctoral fellowships (F32) to the most promising applicants to support full-time research training related to the mission of the NIH awarding components. Some specialized individual predoctoral fellowships (F31) and senior fellowships (F33) are also provided. The NINR T32 award program enables institutions with schools of nursing to make NRSA awards to individuals, who are nurse scientists, for pre-and postdoctoral research training in acute and chronic illness across the lifespan, focusing on health promotion, disease prevention, health disparities, HIV/AIDS, aging, caregiving, management of symptoms, self-management, and care at the end of life.
Career Development Awards
NINR supports several career development awards funded through the K01, K23, K24, and K99R/00 mechanisms.
For postdoctoral and established investigators, the K01 Mentored Research Scientist Development Award provides for a period of additional mentored research experience with an expert mentor as a way to gain expertise in an area new to the candidate or that would demonstrably enhance the candidate’s scientific career. For nurse scientists with a clinical focus who are performing patient-oriented research, NINR encourages research in the areas of symptom management, pulmonary, critical care, trauma, reproductive health, genetics, epigenetics, behavioral research, incorporation of advanced technology and end-of-life and palliative care using the K23 mechanism.
NINR participates in the NIH Pathway to Independence (PI) Award, which offers another excellent opportunity for highly promising, postdoctoral research scientists. This award uses the combination K99/R00 funding mechanism and is designed to facilitate receipt of an R01 award earlier in an investigator's research career. The PI Award provides up to 5 years of support consisting of two phases: 1–2 years of mentored support (K99), followed by up to 3 years of independent support for career transition (R00), contingent on securing a tenure-track research position. Previously funded NINR topics range from interventions to improve cognitive impairment in older adults with heart failure; to discovering biomarkers of pulmonary infection in the critically ill, to understanding access to hospice care. Award recipients are expected to compete successfully for independent R01 support from NIH during the career transition (R00) period.
Other career development awards offered by NINR’s Office of Extramural Programs include the Midcareer Investigator Award in Patient-Oriented Research (K24).
NINR offers a video-based grantsmanship workshop via its YouTube channel and the NINR website. The workshop’s seven modules are geared to pre- and post-doctoral students and early-career nurse scientists. NINR also offers a Developing Nurse Scientists course. This free online training provides an introduction to research grantsmanship for new doctoral graduates and early career scientists.
In 2016, NINR released a series of videos titled, “Building and Sustaining a Scholarly Career." The videos provide an overview of opportunities and dilemmas often encountered by midcareer scientists as they work to develop a sponsored project into a successful and sustained program of research (POR). Senior and midcareer scientists and an NINR program officer discuss significant guideposts, useful strategies, and lessons learned.
Division of Intramural Research
NINR maintains a robust intramural program on the NIH campus in Bethesda, Maryland, dedicated to conducting basic and clinical research on the interactions among molecular mechanisms underlying a single symptom or cluster of symptoms and environmental influences on individual health outcomes. The Division of Intramural Research (DIR) program encompasses the individual variability inherent in symptoms associated with digestive disorders, cancer-related fatigue, traumatic brain injury, congenital muscle disease, and post-traumatic stress disorders as well as clinical interventions to alleviate these symptoms.
NINR's laboratories leverage the benefits of the highly collaborative research environment of the NIH intramural research community, where scientific partnerships are readily established, and the nursing science community can take full advantage of resources, infrastructure, and mentoring opportunities available at NIH. The DIR consists of the Office of the Scientific Director and three branches: Tissue Injury, Symptom Management, and Biobehavioral.
Tissue Injury Branch
The Tissue Injury Branch conducts clinical and laboratory-based studies on the mechanisms of tissue injury. These studies include the identification of molecular targets and pathways activated in response to cellular damage to provide greater understanding of the pathophysiology associated with tissue injury and identify novel targets for therapeutic intervention.
The Tissue Injury Branch currently consists of two units: Brain Injury and Neuromuscular Symptoms.
- The Brain Injury Unit examines the risks for neurological and behavioral symptoms following traumatic brain injuries (TBIs) and concussions through blood-based biomarkers. The research is focused on identifying biomarkers in military personnel, athletes, and civilians to improve the clinical care provided to individuals with brain injuries and concussion. The goal of this research area is to develop and improve monitoring and intervention methods to prevent the risks posed from brain injuries, and to improve the care of these individuals if they develop chronic neurological or behavioral symptoms and deficits.
The Neuromuscular Symptoms Unit investigates effective ways to measure and treat symptoms of congenital muscle disease, particularly ryanodine receptor 1-related myopathies (RYR1-RM). Many congenital muscle diseases have no FDA-approved treatments and are associated with severe morbidity and mortality. The unit completed a formal natural history study and double blind, randomized control trial in RYR1-RM. The unit also studies pathomechanisms behind associated symptoms, such as muscle weakness, hypotonia, and fatigue.
Symptom Management Branch
The Symptom Management Branch is dedicated to improving the understanding of the underlying biological mechanisms of a range of symptoms, their effect on patients, and the biological and behavioral basis for how patients respond to interventions.
The Symptom Management Branch consists of two units: Genomic and Clinical Biomarkers and Symptom Biology.
- The Genomic and Clinical Biomarkers Unit conducts research to discover biomarkers within an environmental and clinical context, to predict patient outcomes and guide therapies specifically in solid-organ transplant recipients, but also expanding to other diseases/disorders and patient populations. For solid organ transplant recipients, the goal is to discover biomarkers that will identify those patients most at risk for weight gain, and, that can be used to provide personalized strategies to prevent weight gain and resulting co-morbidities (e.g., diabetes and cardiovascular disease). In addition, the Genomic and Clinical Biomarkers Unit seeks to identify underlying molecular and biologic pathways that contribute to poor outcomes.
- The Symptoms Biology Unit examines the nature and causes of fatigue, in relation to cancer and its treatments. The purpose is to understand and identify bio-behavioral mechanisms of fatigue in order to develop more effective ways to manage it and, as a result, improve patient outcomes.
The Biobehavioral Branch supports research into the interplay of behavioral, biological, and environmental determinants of health and wellness across populations. The Biobehavioral Branch consists of the Digestive Disorders Unit and the Sensory Science and Metabolism Unit.
- The Digestive Disorders Unit focuses on improving the understanding of the mechanisms involved in symptom distress related to digestive disorders, specifically the biobehavioral relationships between inflammation and patient symptoms. The long-term goal of this research is to identify genetic or other biologic/physiologic factors to improve diagnoses and predict patient-related clinical outcomes.
- The Sensory Science and Metabolism Unit focuses on understanding the integral process underlying the primary senses—principally chemosensation. The goal is to understand the fundamental molecular, behavioral, and neural mechanisms associated with chemosensory symptoms (taste and smell alterations) in metabolic conditions such as type 2 diabetes, obesity, and related comorbidities.
Intramural Research Training and Career Development
NINR is committed to developing the next generation of nurse scientists and provides research training through several mechanisms. Summer internships allow for an intensive 8-week research experience within the DIR and accept students from many levels — from high school to medical school students. Post-baccalaureate training positions are available that allow BSN-prepared nurses and other science-focused BS graduates interested in exploring a research career in nursing or other science disciplines to spend a year engaged in biomedical investigation in DIR laboratories. Pre-doctoral fellows are supported through the Graduate Partnerships Program, and postdoctoral fellowships bring Ph.D.-prepared nurse scientists to perform research in the DIR and to hone their skills in basic and clinical research.
NINR also offers mentored research support to post-doctoral intramural investigators via the K99 mechanism. Known as the Pathway to Independence Award, it is designed to facilitate transition of the postdoctoral scientist to independent, tenure-track researcher. It also enables receipt of an R01 award earlier in an investigator's research career.
The DIR supports the Graduate Partnerships Program (GPP). The NINR GPP is a doctoral fellowship training program that coordinates training and funding for PhD students attending a school of nursing. The program combines the academic environment of a university with the breadth and depth of research resources available at NIH. The goal is to encourage and support the training of nursing doctoral students who are motivated to undertake careers in basic or clinical research. Students complete all required coursework at their academic institution. They then have up to 3 years to complete dissertation research within NIH’s Intramural Research Programs in Bethesda, Maryland.
Through the DIR, NINR sponsors the Summer Genetics Institute (SGI), an intensive research training program held at NIH and administered by the Foundation for Advanced Education in the Sciences (FAES) as one of its Biotechnology Specialty programs. The SGI provides a foundation in molecular genetics for use in research and clinical practice and features both lecture and hands-on laboratory training. The purpose of the SGI is to increase the research capability among nursing graduate students and faculty, and to develop and expand the basis for clinical practice in genetics among clinicians. The program awards 8 hours of graduate-level college credit. SGI graduates are making a difference in their communities in many ways. They are successfully building programs of research in genetics related to nursing (e.g., genetic components involved in organ transplantation outcomes, epigenetic signatures related to cardiovascular disease, genetic factors contributing to high blood pressure, gene-to-gene and gene-environment interactions in childhood asthma); disseminating findings through publications and scientific conference presentations; and integrating genetics content into nursing school curricula across the country.
The NINR Symptom Research Methodologies Series is a 1-week intensive research training “boot camp” at the NIH in Bethesda, Maryland. The purpose is to increase the research capability of graduate students, faculty, and clinicians. Sponsored by NINR and administered by FAES, NINR’s boot camp has focused on topics on topics including pain, fatigue, sleep, and data science. The topic for 2018 was, “Precision Health: Smart Technologies, Smart Health.” The boot camp features lectures by distinguished guest speakers, classroom discussion, and hands-on training.
DIR also participates in the NIH Lasker Clinical Research Scholar program. The Lasker Scholar program supports a small number of exceptional clinical researchers in the early stages of their careers to promote their development to fully independent scientists. The program combines a period of research experience as a tenure-track Principal Investigator in the DIR with an opportunity for additional years of independent financial support, either within the DIR or at an extramural research institution.
NINR Leadership in End-of-Life Research and Palliative Care
In recent years, many factors have converged to increase public and professional interest in issues surrounding care at the end of life.
The 1997 report from the Institute of Medicine (IOM), Approaching Death: Improving Care at the End of Life, found widespread dissatisfaction with end-of-life care and many gaps in our scientific knowledge of this phase of life. That same year, NINR sponsored a workshop on the symptoms of terminal illness and the NIH Director designated NINR as the lead NIH Institute for end-of-life research. The 2014 IOM report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, and the current 2018 National Academies of Sciences Roundtable on Quality Care for People with Serious Illness, further reiterated the importance of end-of-life and palliative care science.
As the lead NIH Institute for end-of-life research, NINR supports science to assist individuals, families, and health care professionals in managing the symptoms of life-limiting conditions and planning for end-of-life decisions. NINR also recognizes that high-quality, evidence-based palliative care is a critical component of maintaining quality of life at any stage of illness, not just at the end of life. Activities in this area address issues such as: relieving symptoms and suffering and understanding decision-making by patients, caregivers, and providers.
In December 2004, NINR co-sponsored the NIH State of the Science conference, Improving End-of-Life Care. This conference served to evaluate the current state of the science in end-of-life care and to determine future directions for research. It also highlighted the interactions among patients, caregivers, and the health system, and their effects on outcomes. The consensus statement from this conference is available here.
The Palliative Care Research Cooperative Group (PCRC) was established in 2010 with foundational support from NINR to develop scientifically based methods in the conduct of palliative care multi-site clinical trials that lead to meaningful evidence for improving quality of life for patients with advanced and/or potentially life-limiting illnesses, and their caregivers — including family members and providers of care. The network creates a community of palliative care scientists and clinical trial specialists who can engage in research discovery. As of January 2018, PCRC includes over 400 members and over 100 clinical trial research sites. More information on PCRC is available here.
NINR recognizes palliative care as a critical component of high-quality, evidence-based health care that improves the quality of life for those suffering from the symptoms of serious illness. In 2009, NINR released a patient information brochure entitled: "Palliative Care: The Relief You Need When You're Experiencing the Symptoms of Serious Illness." In 2011, it released the Spanish version: “Cuidados Paliativos: El alivio que necesita cuando tiene síntomas de una enfermedad grave.” Both brochures were updated in 2018 and are copyright free, so they may be downloaded and reproduced without charge.
In August 2011, NINR co-sponsored the three-day national summit, The Science of Compassion: Future Directions in End-of-Life and Palliative Care. The summit examined the state of research and clinical practice in end-of-life and palliative care and provided an opportunity for scientists, health care professionals, and public advocates to come together to catalyze and shape the future research agenda for this critical scientific area. The executive summary from the summit is available here.
In 2013, NINR published Building Momentum: The Science of End-of-Life and Palliative Care: A Review of Research Trends and Funding, 1997–2010. This report looked at the trends in end-of-life and palliative care (EOLPC) research publications over the past 14 years, including federal research awards, funding patterns, and the contributions of public and private investments in EOLPC science. The report’s focus addresses the 1997 Institute of Medicine recommendations for the scientific community to strengthen the research landscape, foster new evidence, and define and implement priorities for increasing the knowledge base for EOLPC. The key findings of the report not only summarized the state of EOLPC research, but also identified gaps that future research efforts could address. The publication is available here.
Also in 2013, NINR established The Office of End-of-Life and Palliative Care Research (OEPCR) to support NINR’s leadership role in end-of-life and palliative care research at NIH. OEPCR coordinates and supports ongoing NINR and NIH research efforts in end-of-life and palliative care (EOL PC) science, including: stimulation of end of life and palliative care research initiatives; creation of opportunities for collaborative activities; facilitation of interdisciplinary EOL PC science; and identification of opportunities for science to inform policy and practice. A major program priority is to coordinate the development, implementation and evaluation of end-of-life and palliative care research in direct collaboration with other NIH Institutes and Centers, federal research agencies and outside constituencies. More information on OEPCR is available here.
In 2014, NINR launched its Palliative Care: Conversations Matter™ campaign to encourage early and ongoing conversations between families and health care providers about pediatric palliative care. The campaign emphasizes that palliative care works along with other treatments to enhance quality of life for children of any age living with a broad range of serious illnesses. It strives to break the common association between palliative care and hospice care, stressing that palliative care is appropriate throughout illness — not just at the end of life.
Campaign resources include materials and a website with information for health care providers, families, and caregivers. The materials for families, available in English and Spanish, include a brochure, at-a-glance fact sheet, finding support resource card, a series of family stories, and an animated video. The materials for providers consist of a series of video vignettes and a customizable tear-off pad (available in English and Spanish), which includes tips for health care providers, answers to common questions about palliative care, and customizable patient education sheets designed to guide the provider’s discussion with the patient and his/her parent or caregiver. The campaign website provides outreach items such as web banners, web badges, newsletter articles, an infographic, and social media postings. The materials are free and can be downloaded (www.ninr.nih.gov/conversationsmatter) or requested by e-mailing firstname.lastname@example.org.
Also in 2014, NINR launched a new public education resource, the End of Life module on the NIHSeniorHealth website, to address the common but sometimes sensitive issues faced by the dying and their caregivers. The module describes the physical, mental, and emotional needs of people nearing the end of life, and suggests ways to maintain their quality of life, such as hospice and home care. It also addresses the often complex practical concerns that can attend death, including financial issues, advance directives, caregiver support, and more. Information on pain management, types and places of EOL care, paying for EOL care, what to do when the end comes, coping with grief, and research efforts may also be found.
In June 2015, NINR hosted a briefing on the IOM report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The briefing reviewed the recommendations, explored possible next steps and barriers to implementation, and provided an opportunity for stakeholder groups to discuss the impact of this report in regard to end-of-life and palliative care research.
Also in June 2015, NINR and the NIH National Center for Advancing Translational Sciences/Office of Rare Diseases Research co-sponsored the workshop, The Spectrum of Caregiving and Palliative Care in Serious, Advanced Rare Diseases, which brought together a community of experts in palliative care, pediatrics and adolescent care, oncology, and neurology to examine key priorities and research questions about knowledge gaps in palliative care and caregiving for those affected by rare diseases. The workshop highlighted the need for research focused on the palliative needs of caregivers and families of those facing advanced rare diseases, since most rare disorders have intensive, long-trajectories of Illness. A subsequent workshop proceeding and NINR funding opportunity announcement addressing the research gaps identified in this workshop were published in 2016.
In October 2015, the NINR-funded U24 Palliative Care Research Cooperative (PCRC) Group held a morning session of its bi-annual membership meeting at the NIH campus. Approximately 50 PCRC members were present. Attendees from NIH ICs and Offices included: NINR, NIA, NCI, NICHD, NIMHD, NCATS ORDR, the CRC, and NHLBI. HHS Federal Agencies or Offices attending included ACL/AoA, HRSA, AHRQ, CMS, CMMI and the HHS Office of Minority Health. Professional organizations supporting end-of-life and palliative care science attending included the American Cancer Society and the Pew Charitable Trusts. The PCRC provided an overview of the PCRC infrastructure, mission, and goals by the PCRC leadership as well as current examples of PCRC research capacity and initiatives.
In May 2016, NINR was invited to participate in a meeting at the National Academy of Medicine in Washington, DC, to assess national progress toward recommendations from the 2014 report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life and to characterize progress, identify barriers, and collectively determine priority action items. In July 2016, NINR received an official appointment as a representative on a new Roundtable on Quality Care for People with Serious Illness at the National Academies of Sciences, Engineering and Medicine. Through public workshops and expert meetings, the roundtable will work over three years to advance priorities identified by the Dying in America report.
NINR and Trans-NIH Initiatives
NINR plays an active role in several trans-NIH initiatives, including the:
- NIH Pain Consortium
- NIH Neuroscience Blueprint
- NIH Science of Behavior Change Roadmap/Common Fund initiative
- NIH Basic Behavioral and Social Science Opportunity Network (OppNet)
- NIH Health Care Systems Research Collaboratory Work Group
- NIH Big Data to Knowledge (BD2K) initiative
- NIH All of Us Research Program
- NIH Environmental Influences on Child Health Outcomes (ECHO) Study
NINR is a key member of the NIH Pain Consortium, for which Dr. Grady serves on the Executive Committee. The consortium promotes collaboration among the many NIH Institutes and Centers that conduct or fund pain research. NINR is also a member of the NIH Neuroscience Blueprint, which is designed to develop resources (i.e., people, tools, methods, knowledge bases) for the advancement of research in neuroscience. NINR’s involvement in these areas opens further avenues of research to NINR-supported investigators.
NINR is a co-sponsor of the Science of Behavior Change (SOBC) Roadmap/Common Fund initiative, and Dr. Grady serves as a co-chair of the SOBC initiatives working group. As one of the top priorities for NIH-wide research efforts, advancing the science of behavior change is focused on developing new and innovative approaches to enhance health-related behavior change.
In 2009, NIH launched the Basic Behavioral and Social Science Opportunity Network (OppNet), a trans-NIH initiative to expand the agency’s funding of basic behavioral and social sciences research (b-BSSR). Basic-BSSR studies mechanisms and processes that influence behavior at the individual, group, community, and population level. Research results lead to new approaches for reducing risky behaviors and improving the adoption of healthy practices. All NIH Institutes and Centers (ICs) share the mission of supporting b-BSSR. Representatives for NINR are involved in the OppNet Steering Committee, the Executive and Coordinating Committees, and other working groups and initiatives. OppNet has developed a plan for focused multi-year programs across ICs to advance priority b-BSSR topics, such as the impact of culture on health and well-being and multisensory processing.
NINR is a member of the NIH Common Fund’s Health Care Systems Research Collaboratory (HSC), the goal of which is to strengthen national capacity to implement cost-effective, large-scale research studies that engage health care delivery organizations as research partners. One of the Collaboratory’s initiatives seeks to stimulate pragmatic clinical trials for multiple chronic conditions. NINR is participating with the National Institute on Aging in an NIH HSC UH2/UH3 pragmatic trial to evaluate the effectiveness of advance care planning video decision support tools in the nursing home setting across two large health care systems nationwide. This work has the potential to improve the palliative and end-of-life care provided to millions of older Americans in nursing homes and enable future pragmatic trials in this setting.
For more information about NINR, nursing science, and research training opportunities, please visit the NINR website at: www.ninr.nih.gov.
This page last reviewed on October 1, 2018