National Institute of Nursing Research (NINR)

Mission

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 topics such as:

  • Exploring the mechanisms underlying symptoms of illness and developing personalized treatments that address these mechanisms through symptom science research;
  • Enhancing wellness by understanding the physical, behavioral, and environmental causes of illness and developing culturally tailored interventions to prevent illness and promote health;
  • Helping individuals with chronic conditions better understand and manage these conditions by engaging individuals as active participants in their own health;
  • Providing caregivers with better tools for fulfilling their caregiving responsibilities and maintaining their own quality of life;
  • Developing palliative care strategies to help individuals and families manage symptoms of life-limiting conditions and plan for end-of-life decisions;
  • Using innovative technologies to develop novel interventions that deliver personalized care and real-time health information to patients, families, and health care providers; and
  • Promoting the development of an innovative, multidisciplinary, and diverse nursing science workforce through a variety of training programs and mechanisms.

NINR also places great emphasis on research training to cultivate the next generation of nurse scientists. NINR-supported opportunities for research training are available for students beginning their research careers, as well as for scientists seeking to expand their research expertise. Among these opportunities, NINR provides support for trainees from underrepresented and disadvantaged backgrounds.

NINR fosters collaborations with many other disciplines in areas of mutual interest such as long-term care for older adults, the special needs of women across the lifespan, genetics and genomics, biobehavioral aspects of the prevention and treatment of infectious diseases, and the impact of environmental influences on risk factors for chronic illnesses, among many others.

The NINR Strategic Plan: An Overview

Released in October 2011, Bringing Science to Life: NINR Strategic Plan, describes NINR’s approach for advancing the "science of health." It seeks to leverage 25 years of nursing science accomplishments to pave the way for future discoveries in scientific areas that have the greatest potential to impact the health of the nation. Developed with the input of scientists, clinicians, experts in health care and public policy, members of the public, and other stakeholders, the plan also provides a vision for the next quarter century of nursing science achievements. NINR’s research supports the science of health, which encompasses the investigation of multiple health determinants — including psychological, physiological, genomic, environmental, familial, societal, and cultural factors. This focus is based on the premise that individuals would benefit from being actively involved in maintaining their own health through the prevention of disease and self-management of illness.

To advance the science of health, NINR supports research to:

  • Enhance health promotion and disease prevention;
  • Improve quality of life by managing symptoms of acute and chronic illness;
  • Improve palliative and end-of-life care;
  • Enhance innovation in science and practice; and
  • Develop the next generation of nurse scientists.
  • In 2016, NINR will release a new Strategic Plan, coinciding with the commemoration of the Institute’s 30th Anniversary. The plan will describe priority areas of research in which it is anticipated that NINR support can have the most impact on improving health and quality of life in the next 10–20 years. The plan is intended to be a flexible, living document. As new science and new opportunities emerge, and as new health challenges arise, NINR will regularly seek to reassess and adapt its research strategies to meet these needs and opportunities.

NINR’s Innovative Questions Initiative

In fall 2013, NINR launched the Innovative Questions (IQ) Initiative, the next step in implementing NINR’s Strategic Plan. IQ was an interactive, collaborative initiative designed to stimulate a dialogue among the scientific community, professional organizations, and the public. NINR gathered thoughts and ideas that would encourage new thinking and creativity in nursing science, explore unanswered questions, promote results-oriented research, and guide the science over the next 5 to 10 years.

The initiative consisted of two components: NINR’s IQ Workshops and the IQ Website. The IQ Workshop series brought together leading scientists to identify innovative questions that could stimulate novel research in nursing science. On the IQ Website, members of the scientific community and the general public contributed their own innovative questions, and commented on the ideas submitted by others.

The questions developed through the IQ initiative have been released to the scientific community through the NINR website. NINR hopes that these questions will serve as a valuable resource to the entire nurse scientist community, from experienced investigators to trainees, in considering future directions for their own programs of research. These questions will also serve to provide the larger community with a better understanding of the potential and importance of nursing science.

Important Events in NINR History

November 10, 1985 — Public Law 99-158, the Health Research Extension Act of 1985, became law. Among other provisions, the law authorized 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 announced the establishment of NCNR at NIH.

April 1986–June 1987 — Dr. Dorris Merritt, Special Assistant to the NIH Director, appointed Acting Director of NCNR. NCNR’s initial budget was $16 million.

December 3, 1986 — The HHS Secretary appointed the first members of the NCNR Advisory Council.

February 17, 1987 — The NCNR Advisory Council held its inaugural meeting.

June 1987–June 1994 — Dr. Ada Sue Hinshaw served as the first Director of NCNR.

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

1992 — NINR-funded researcher Dr. David Olds established that visits from home nurses significantly lowered mothers' high blood pressure during pregnancy, resulted in better timing of subsequent pregnancies, and reduced abuse and neglect of children.

June 10, 1993 — P.L. 103-43, the NIH Revitalization Act of 1993, became law. Among other provisions, it elevated NCNR to a NIH Institute. As such, NCNR was re-designated the National Institute of Nursing Research (NINR).

June 14, 1993 — The HHS Secretary signed the Federal Register notice establishing the National Institute of Nursing Research (NINR).

July 1994–April 1995 — Dr. Suzanne Hurd served as Acting Director of NINR.

1994 — NINR-funded researcher Dr. Loretta Sweet Jemmott tested several gender-appropriate, culturally sensitive interventions on hard-to-reach vulnerable populations and significantly reduced sexual risk behaviors for HIV. Her "Be Proud! Be Responsible!" intervention became the Centers for Disease Control and Prevention's model curriculum.

April 3, 1995 — Dr. Patricia A. Grady was appointed Director of NINR.

1997 — The NIH Director designated 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 demonstrated that a specially designed classroom educational program for elementary school children could significantly lower their cholesterol levels in just eight weeks. NINR-funded researcher Dr. Nancy Bergstrom, in a multi-site study, tested the Braden scale for risk of pressure sores and found its predictive capability accurate. The scale is now widely used in nursing homes and hospitals.

1999 — NINR-funded researcher Dr. Mary Naylor demonstrated that transitional care from hospital to home could 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 established that gender plays a key role in pain relief, where women obtained satisfactory relief from kappa-opioids while men received little benefit.

Summer 2000 — NINR held the first Summer Genetics Institute.

2002 — NINR funded researcher Dr. Linda Aiken demonstrated 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 launched a free online training, "Developing Nurse Scientists" for students interested in the nursing research field.

2003 — NINR Director Dr. Patricia A. Grady 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 found that interventions conducted at the community level by a multidisciplinary health care team reduced high blood pressure in young inner-city African-American males, who are typically underserved by the health care system. The study illustrated that culturally sensitive, successful interventions can be conducted for vulnerable populations and can help reduce health care disparities.

2004 — NINR Director Dr. Grady named co-chair of NIH Public Trust Initiative.

2004 — NINR launched a new pilot training project, the Graduate Partnerships Program in Biobehavioral Research.

December 2004 — NINR co-sponsored 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 celebrated its 20th anniversary at NIH.

2006 — NINR-funded researcher Dr. Bernadette Melnyk demonstrated that her Creating Opportunities for Parent Empowerment (COPE) program, which aims to support the parents of premature infants, resulted 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 reported that an intervention to improve communication between ICU clinicians and family members of dying patients significantly reduced 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, named co-chair of the Science of Behavior Change NIH Roadmap/Common Fund Initiative.

2008 — First two NINR Graduate Partnerships Program fellows graduated.

2009 — NINR published 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 reported that a behavioral intervention called Living Well with Stroke reduced 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 supported an additional $36 million in research in fiscal year 2009–2010. Projects supported under ARRA included a new research cooperative for palliative care science and multiple training opportunities to build the scientific workforce. Approximately 73 additional research grants were supported, along with multiple research and training supplements.

2010 — NINR intramural researcher Dr. Taura Barr identified a gene panel useful for stroke diagnostics and outcome prediction as well as other neurological conditions such as traumatic brain injury. Her work may lead to the development of bedside tests for assessment of the extent of brain injury and to guide individualized therapeutics. NINR intramural researcher Dr. Wendy Henderson developed 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 were then captured electronically for quantification and comparison to later reports of pain.

2010 — NINR held the first Methodologies Boot Camp, which focused on pain research.

2010 — First NINR history book released: NINR: Bringing Science to Life.

2010 — U.S. Senate resolution, S. Res. 642, congratulated NINR on a quarter century of achievement in science and public service. The resolution was introduced by Senator Daniel Inouye (D-Hawaii) and co-sponsored by Senator Susan Collins (R-Maine).

2010–2011 — NINR celebrated its 25th anniversary at NIH with a series of scientific events.

2011 — NINR launched 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 presented the inaugural lecture on “COPE: Improving Outcomes for Premature Infants and Parents.”

January 2011 — NINR established a YouTube channel, “NINR News,” to post videos highlighting its events and trainings.

February 2011 —NINR-funded researcher Dr. Barbara J. Drew led a team that developed 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 developed 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 convened 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, 2011Bringing Science to Life: NINR Strategic Plan released at NINR's 25th Anniversary Concluding Symposium.

November 2011 — NINR published 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 studied individuals with an alteration in a protein called catechol-O-methyltransferase (COMT), and found 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 launched 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 found that, in a trial of an early warning sensor system that alerts nurses to declining health, long-term care residents participating in the intervention demonstrated better functional measures (e.g., hand-grip; gait) than did residents receiving usual care.

October 2012 — Dr. Jessica Gill joined 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 2013NINR Twitter account (link is external) launched.

June 2013 — NINR-supported researcher Dr. Marilyn Rantz and collaborators conducted 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 published “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 tested a teacher-delivered intervention program (COPE-Healthy Lifestyles TEEN [Thinking, Emotions, Exercise, and Nutrition]) promoting healthy lifestyles improved health behaviors, body mass index, social skills, severe depression, and academic performance in high school adolescents. They found multiple, immediate improvements that were sustained over time using a teacher-delivered, cognitive-behavioral skills-building intervention program incorporated into a high school health education class.

November 2013 — Dr. Ann Cashion appointed Scientific Director for the NINR Division of Intramural Research.

November 2013 — NINR launched its Innovative Questions Initiative, the next step in the implementation of NINR’s Strategic Plan. (PDF) The IQ initiative consisted of two components, a series of workshops, and a public website.

The workshops, which began in November of 2013 and continued through June of 2014, focused on wellness and personalized health strategies, self-management for individuals with chronic illness, end-of-life and palliative care, and technology in health. The workshops brought together leading scientists and interdisciplinary experts to identify and refine innovative research questions for each topic through a consensus-building discussion format.

On NINR’s IQ website, members of the scientific community, professional organizations, and the general public were given the opportunity to submit innovative research questions directly to NINR, and to comment on questions submitted by others.

December 2013Dr. Jessica Gill, a Lasker Clinical Research Scholar and NINR intramural investigator, and Dr. Ida Spruill (link is external), an NINR-supported extramural scientist, were 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 was established in December 2013 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 annual 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 launched the Palliative Care: Conversations Matter® campaign, which aims to increase the use of palliative care for children living with a serious illness. The campaign was initiated to raise awareness of and improve communication about pediatric palliative care.

February 2014 — NINR-funded scientist Dr. Linda Aiken and collaborators conducted a detailed analysis of patient outcomes associated with nurse staffing and education. Their study found that increases in nurses’ workload increased the likelihood of in-hospital death within 30 days of admission. They also found that increases in the numbers of nurses on staff with bachelor’s degrees lowered 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 could reduce hospital deaths.

February 2014 — NINR-funded researcher Dr. Debra Moser and colleagues studied 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, lead institute for end-of-life research at NIH, developed a new web resource aimed at helping people address a sensitive subject — the end of life. The 13-chapter End of Life module was 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 developed and tested an automated device for asthma monitoring (ADAM), applying technology to help assess asthma symptoms objectively and accurately. The device was found to be a valid asthma monitoring tool, and was 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) participated in NINR’s first Big Data Symptoms Research Methodologies Boot Camp.

September 2014 — C-SPAN’s Washington Journal interviewed 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 received 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.

May 2015 — Researcher Dr. Amy Abernethy and others in the NINR-supported Palliative Care Research Cooperative Group examined the safety of discontinuing statin therapy in patients with advanced, life-limiting illness. They found no significant differences in mortality between patients who had discontinued statin therapy and those who had not. Those patients who discontinued statins also reported improved quality of life, and health care costs were 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 lead a team which discovered 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 used a novel technology to measure levels of the protein, tau, in the blood months and years after military personnel had experienced TBI, and found 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.

September 2015 — NINR launches new precision medicine web page, in support of President Obama’s Precision Medicine Initiative.

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.

December 2015 — NINR launches a new web page highlighting the Institute’s support of advances in data science to promote and improve the health of individuals, families, and communities

2015–2016 — NINR celebrates its 30th anniversary at NIH with a series of scientific events.

NINR Legislative Chronology

November 10, 1985 — Public Law 99-158, the Health and Research Extension Act of 1985, became law. Among other provisions, the law authorized 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) established NCNR as a separate NIH appropriation.

June 10, 1993 — P.L. 103-43, the NIH Revitalization Act of 1993, became law. Among other provisions, it elevated NCNR to a NIH Institute. As such, NCNR was re-designated the National Institute of Nursing Research (NINR).

2010 — U.S. Senate resolution, S. Res. 642, congratulated NINR on a quarter century of achievement in science and public service. The resolution was introduced by Senator Daniel Inouye (D-Hawaii) and cosponsored by Senator Susan Collins (R-Maine).

Biographical Sketch of NINR Director Patricia A. Grady, Ph.D., R.N.

Research Investigator Workshop NINR director Dr. Patricia A. Grady addresses the NIH Partners in Research investigator workshop, October 2009. Dr. Howard K. Koh, Assistant Secretary for Health in the U.S. Department of Health and Human Services, also spoke at this workshop.

Dr. Patricia A. Grady has served as NINR Director since 1995. An internationally recognized researcher, Dr. Grady's scientific focus has been primarily in stroke, with emphasis on arterial stenosis and cerebral ischemia.

Dr. Grady joined NIH in 1988 as an extramural research program administrator in the National Institute of Neurological Disorders and Stroke (NINDS) in the areas of stroke and brain imaging. From 1993 to 1995, Dr. Grady served as NINDS Deputy Director and Acting Director. Before beginning her service at NIH, Dr. Grady held several academic positions and served concurrently on the faculties of the University of Maryland School of Nursing and School of Medicine.

Dr. Grady has authored or co-authored numerous articles and papers on hypertension, cerebrovascular permeability, vascular stress, and cerebral edema. She is an editorial board member of the major stroke journals. Dr. Grady lectures and speaks on a wide range of topics, including future directions in nursing research, developments in the neurological sciences, and federal research opportunities.

After earning her undergraduate degree in nursing from Georgetown University, Dr. Grady pursued her graduate education at the University of Maryland, receiving a master’s degree from the School of Nursing and a doctorate in physiology from the School of Medicine. She was elected to the Institute of Medicine and is a fellow of the American Stroke Association. Dr. Grady is a member of the Society for Neuroscience, the American Academy of Nursing, and the American Neurological Association.

Dr. Grady has been recognized with many prestigious honors and awards — including numerous honorary degrees — for her leadership and scientific accomplishments. She was named a Visionary Pioneer by the University of Maryland School of Nursing, and received the American Association of Colleges of Nursing’s 2015 Policy Luminary Award. Dr. Grady has also been honored with the Centennial Achievement Medal from Georgetown University School of Nursing and Health Sciences; the Second Century Award for Excellence in Health Care from the Columbia University School of Nursing; the Discover Award from the Arizona State University’s College of Nursing and Health Innovation; and the Sterling Award from the University of California, Los Angeles School of Nursing.

A recipient of the NIH Merit Award and the Public Health Service Superior Service Award for her exceptional leadership, Dr. Grady has been named among the 100 Most Powerful Women in Washington by Washingtonian Magazine.

NINR Directors

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 Present

Major Programs

Division of Extramural Science Programs (formerly Division of Extramural Activities)

The Division of Extramural Science Programs (DESP) leads NINR’s extramural program functions, grants management, and scientific review. DESP staff recommend priorities for new science initiatives; coordinate review of research training and career development awards; conduct analyses of the nursing science reviewed through the Center for Scientific Review; make recommendations to the NINR Director regarding science priorities; and manage the non-programmatic areas of grants administration (e.g., second-level review by the National Advisory Council for Nursing Research). The staff of DESP maintain awareness of critical advances in nursing science, emergent scientific areas of emphasis, and research activities throughout the NIH, across the nation, and internationally.

DESP is comprised 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 is divided into two branches. Each branch has two sections that reflect the scientific themes that flow from NINR’s strategic plan:

  • Symptom Science and Self-Management: Promoting Personalized Health Strategies and Improving Quality of Life for Individuals with Chronic Conditions
  • Wellness and Technology and Training: Promoting Health and Preventing Illness and Enhancing Technology to Improve Health and to Promote Innovative Strategies for Nurse Scientists

The Office of End of Life and Palliative Care Research (OEPCR) was established to support NINR’s leadership role in end-of-life and palliative care (EOLPC) research. 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.

OEPCR is unique in that it encompasses both science and policy functions. 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 is divided into four branches:

  • Scientific Review Branch - Responsible for coordinating the NINR standing study section that reviews training and career development awards. Responsibilities of this branch Include:
    • Meeting management and issuing of summary statements.
    • Coordinating the special emphasis panels to review applications submitted in response to NINR-sponsored funding opportunities such as Requests for Applications and some Program Announcements.
  • Grants Management Branch - Responsible for all business-related activities associated with the negotiation, award, and administration of grants and cooperative agreements for NINR. This branch works with grantee business officials, principal investigators, NIH staff, and NINR program staff to:
    • Review, negotiate, and administer NINR-funded grants.
    • Work closely with NINR program staff to interpret grant policies as they pertain to the grants award process.
  • Council Operations Branch - Responsible for coordinating logistics for meetings of the National Advisory Council for Nursing Research (NACNR) and other meetings hosted by NINR.
  • Research Policy and Analysis Branch - Responsible for supporting DESP with program functions and policy implementation and for using databases to analyze portfolios. Example activities include:
    • Monitoring the Guide Publication System for funding announcements published by other Institutes and Centers that may be of interest to NINR
    • Executing policy changes that have been approved through the Extramural Program Management Committee.

Research Centers Program

The Office of Extramural Programs maintains oversight of a nationwide Research Centers program. The Research Centers program is designed to increase research capability and expand the science of investigators 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 results that transform the results of research into current practice settings. NINR-funded Centers bring together scientists, students, and interdisciplinary collaborators with similar research interests to focus on investigations, such as symptom and self-management science in chronic conditions. They also serve to advance NINR’s goals of building research infrastructure, expanding research capacity, promoting sustainability, and increasing training opportunities. The focus of currently funded centers includes building the science of self-management in palliative care and chronic conditions such as pain, sleep disturbances, cardiovascular conditions, fatigue, and cognitive affective disorders.

The 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 feasibility 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 NIH. The purpose of NINR P20 Centers is to plan and build new research teams in interdisciplinary, biobehavioral research for scientists. In addition, NINR P20 Centers seek to plan and build new research infrastructures with emerging research programs, helping them to expand their early research efforts, centralize resources, strengthen research capabilities, and increase productivity to generate new research.
  • 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 NINR P30 Centers of Excellence is for the sustainability and enhancement of interdisciplinary, biobehavioral research for scientists conducting interdisciplinary research. In addition, these Centers of Excellence enable support for the development of research infrastructures and centralized resources in support of research programs. The goal is to have NINR P30 Centers that will be successful in their efforts to develop sustainable interdisciplinary, biobehavioral research capacity for scientists conducting nursing research by establishing centralized research resources and a research infrastructure; advance the Center’s thematic science area through complementary, synergistic research activities; and enable feasibility research that will develop into new programs of research and independent investigator research applications.

Extramural Research Training and Career Development

NINR offers a range of extramural training awards and opportunities.

Fellowships

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 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/00mechanisms.

For postdoctoral and established investigators, the K01 Mentored Research Scientist Development Award provides for a period of additional mentored research experience with an expert sponsor as a way to gain expertise in an area new to the candidate or that would demonstrably enhance the candidate’s scientific career.

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, followed by up to 3 years of independent support for career transition, 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 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.

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, cardiovascular related disorders, 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 three units: Brain Injury, Vascular Biology, and Neuromuscular Symptoms.

  • The Brain Injury Unit examines the risks for post-concussive syndrome and post-traumatic stress disorder (PTSD) following a traumatic brain injury (TBI). This unit’s research seeks to design screening methods to approximate psychological and neurological risks following TBI and interventions to mitigate risks and treat early symptoms.
  • The Vascular Biology Unit focuses on dietary factors and nutrients that are associated with the development of cardiovascular disease and symptoms, the role of nutrition interventions, and personalized nutrition based on individual genomic profiles.
  • The Neuromuscular Symptoms Unit focuses on the measurement and treatment of symptoms associated with various forms of congenital muscle disease, including Collagen 6 Related Myopathy, LAMA2 Related Muscular Dystrophy, and RYR1 Congenital Myopathy. The measures, many of which are now validated, are being implemented in interventional trials in an effort to find treatments for patients with congenital muscle disease.

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 three units: Genomic and Clinical Biomarkers, Symptom Biology, and Cardiovascular Symptoms.

  • 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. This unit will eventually expand to encompass other diseases/disorders and patient populations.
  • The Symptoms Biology Unit examines the nature and causes of symptoms like fatigue in specific conditions, such as cancer. This unit pursues investigations to understand the co-occurrence of symptoms, in order to describe distinct and shared functional pathways that can explain the biological underpinnings of a specific symptom to identify potential therapeutic targets.
  • The Cardiovascular Symptoms Unit focuses on vasculoprotective nutritional interventions that may improve risk factor profiles and prevent heart disease. Additional research will target individuals at high risk for heart disease and personalize therapeutic strategies..

Biobehavioral Branch

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 Clinical Neuroscience Unit.

  • The Digestive Disorders Unit seeks to understand the mechanisms involved in symptom distress related to digestive disorders, specifically the biobehavioral relationships between inflammation and patient symptoms, in order to identify genetic or other biologic/physiologic factors that predict patient-related clinical outcomes. Additionally, the unit focuses on the microbiome and chronic stress’ effects on the brain-gut axis.
  • The Clinical Neuroscience Unit examines the influence of circadian rhythms on symptoms such as pain and fatigue across conditions and populations. Research includes studies examining genomic profiles to illuminate the determinants of sleep and circadian rhythm in prostate cancer patients prior to, and throughout, the treatment process.

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 2016 is, “Precision Health: From ‘Omics’ to Data Science.” 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.

The flyer “NINR Training Opportunities (PDF)” provides an overview of both the extramural and intramural training programs offered by NINR.

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 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 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 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 providers who can engage in research discovery. As of December 2015, PCRC includes 168 members over 69 organizational 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."(PDF-15.5 MB) (PDF) In 2011, it released the Spanish version: “Cuidados Paliativos: El alivio que necesita cuando tiene síntomas de una enfermedad grave.” Both brochures are copyright free and 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 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 materials are free and can be downloaded or requested by e-mailing info@ninr.nih.gov(link sends e-mail).

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.

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.

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

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 April 15, 2016