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Methods

The Institute of Medicine study process was initiated with the formation of the Committee on Military Nursing Research—an expert multidisciplinary committee. The committee process included extensive information gathering; examination of TriService Nursing Research Program (TSNR Program) materials and materials from the chief of the Army Nurse Corps and the directors of the Navy and Air Force Nurse Corps; examination of research citations and abstracts; and discussions of various aspects of the three military Nurse Corps and the TSNR Program with representatives of each. Committee deliberations directed the acquisition of information, and recommendations are based on the collective opinion of the expert committee.

Composition of the Committee

In order to identify experts in all relevant fields of nursing and in related health sciences, nominations were solicited from a wide array of individuals and organizations: Institute of Medicine members and staff; members of the National Academy of Sciences; the TriService Nursing Research Group (TSNR Group); U.S. Public Health Service; American Academy of Nursing; American Nurses Association; American Association of Occupational Health Nurses; National Association of Hispanic Nurses; the National Black Nurses Association; the National Association of Pediatric Nurse Associates and Practitioners; the Association of Women's Health, Obstetric and Neonatal Nurses; the American Association of Critical Care Nursing; the Retired Army Nurse Corps Association; and the Society of Retired Air Force Nurses.



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--> 2 Methods The Institute of Medicine study process was initiated with the formation of the Committee on Military Nursing Research—an expert multidisciplinary committee. The committee process included extensive information gathering; examination of TriService Nursing Research Program (TSNR Program) materials and materials from the chief of the Army Nurse Corps and the directors of the Navy and Air Force Nurse Corps; examination of research citations and abstracts; and discussions of various aspects of the three military Nurse Corps and the TSNR Program with representatives of each. Committee deliberations directed the acquisition of information, and recommendations are based on the collective opinion of the expert committee. Composition of the Committee In order to identify experts in all relevant fields of nursing and in related health sciences, nominations were solicited from a wide array of individuals and organizations: Institute of Medicine members and staff; members of the National Academy of Sciences; the TriService Nursing Research Group (TSNR Group); U.S. Public Health Service; American Academy of Nursing; American Nurses Association; American Association of Occupational Health Nurses; National Association of Hispanic Nurses; the National Black Nurses Association; the National Association of Pediatric Nurse Associates and Practitioners; the Association of Women's Health, Obstetric and Neonatal Nurses; the American Association of Critical Care Nursing; the Retired Army Nurse Corps Association; and the Society of Retired Air Force Nurses.

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--> Nominations were also sought from prominent researchers in academic health centers around the country and from military service members. The Institute of Medicine's final selection of committee members from this extensive list of nominees ensured representation of the various fields of nursing; related fields such as epidemiology, biostatistics, nutrition, physiology, and health policy; and the three branches of the armed forces. The nine committee members who have experience in the military are reserve, retired, or former members of the armed forces. Information Gathering To assist the committee in its evaluation of the TSNR Program, extensive information was gathered in three areas: (1) program history and support for the program, including federal legislation; (2) program administration, implementation, and products; and (3) relevant published and current nursing research. The committee as a whole advised project staff on general parameters for information gathering, whereas each of the committee's three working groups (administrative/structure, process, and outcome) provided detailed guidance concerning types of information needed to prepare letters of inquiry, data collection forms, and questionnaires. History and Support for the Program The committee reviewed the legislation authorizing the program in fiscal year (FY) 1996 and the appropriations history of the program beginning with its initiation in FY 1992. The committee recognized that military nurses work in a unique environment and that frequently the success of efforts to obtain funding and carry out a coherent research program depends on balance with other commitments; therefore, it sought additional information from the three military service branches. In particular, it requested information concerning the history of military nursing research, opportunities for military nurses for advanced educational preparation, research opportunities, number of positions requiring nurses with advanced degrees, and the importance of nursing research to their overall mission. Information was requested from the chief of the Army Nurse Corps and the directors of the Navy and Air Force Nurse Corps; the chiefs of the Army, Navy, and Air Force Reserves Nurse Commands; and the chiefs of the Army and Air Force National Guard. Current members of the TSNR Group provided the committee with a description of the program and its goals, historical information, and responses to specific questions. Information on the history of the program was also sought from past members of the TSNR Group and from the published literature.

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--> Various representatives of the military participated in open sessions at each of the three committee meetings to share information about the history and goals of the program, the place of nursing research in the military, and unique aspects of military nursing. These individuals included the present and past program administrator, members of the TSNR Group, the chief and directors of the three Nurse Corps or their representatives, and selected TSNR Program grant recipients. In addition, the committee received a briefing on unique aspects of military nursing. Program Administration, Implementation, and Products The administrator of the TSNR Program provided extensive access to program materials. The committee reviewed the abstracts written by principal investigators for all proposals submitted (both funded and unfunded), the Request for Proposal (RFP) announcements for each of the five program years, the guidelines for peer review panels, the specifications to grant awardees for reporting requirements, reports field by the program administrator following completion of proposal evaluations by the Scientific Review Panels, and monographs of final reports. In addition, the committee was provided access to the curricula vitae of members of the Scientific Review Panels, copies of two background books for the TSNR Program-sponsored grants-writing workshops, and an outline of administrative services to be provided for the TSNR Program by a subcontractor. Among the materials were summaries of total applications received and applications funded for each of the four years of the program, FY 1992–1995; summaries of grants awarded by service branch plus summaries of grants awarded to senior and new investigators in 1995; and summaries of total dollars requested and total dollars awarded. This information is discussed in Chapter 4. Project staff abstracted such information as highest educational degree of the principal investigator, requests for no-cost extensions, evidence of transfers, and availability of interim and final reports; and summaries of these data were prepared (see Chapter 4). A total of five TSNR Program grantees, who represented each branch of the military Nurse Corps, gave presentations that addressed the competitive grant process, the value of comments received from the scientific review panel, the use of contact people, grants-writing workshops, funding strategies, support from the commanding officer, and other topics pertinent to the awarding of grants and the conduct of their research. With detailed guidance from the committee, staff prepared two questionnaires (Appendixes A and B), slight modifications of which were used to obtain information by telephone from random samples of nine grantees and nine unfunded grant applicants. Summaries of responses to those questionnaires

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--> are presented in Appendixes A and B and incorporated into the committee's analyses as appropriate. Current and Published Research With guidance from the committee, project staff conducted searches of selected on-line databases to identify research articles related to military nursing and to obtain information on the types of nursing research currently being funded. The search of the published literature was purposely limited to articles on nursing topics that are peculiar to the military or studies that were known to involve military populations. This eliminated a large body of published nursing research that is applicable to both the civilian and the military populations. More detail on the search process is provided in Chapter 3. Research Premises In the course of its deliberations, the committee agreed that the following premises concerning research would lay a foundation for its conclusions and recommendations: The quality of research is best enhanced by a rigorous system of peer review. The peer review of scientific merit must remain separate from policy decisions related to program management. In general, progress in science is best served by investigator-initiated research. Research requires extensive and increasingly demanding preparation to meet rigorous standards for the production and integration of knowledge. Research, education, and practice go hand in hand. Strongly focused programs of research are increasingly essential to meet strategic needs for knowledge production and utilization in response to the health needs of military beneficiaries. Programs of research are successful when they build on strengths. The development of programs of research requires a critical mass of individuals with the appropriate credentials to be scientists. Because of the nature of the questions that must be answered in nursing research, multidisciplinary research teams with varied skills and perspectives are essential. Research programs benefit from a stable infrastructure for the setting and reviewing of priorities, administration of grants, development of information systems, consultation, and other services and activities.

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--> Summary The multidisciplinary Institute of Medicine committee reviewed a broad range of materials and sought historical, current, and future-oriented perspectives on military nursing, the military nursing research base, and the infrastructure of military nursing research. A set of premises about research was adopted for use during deliberations. Chapters 3 and 4 provide summaries of the data examined by the committee and the analysis that undergirds the recommendations appearing in Chapter 5.

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