The Program for Research in Military Nursing: Progress and Future Direction

Committee on Military Nursing Research

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.
1996



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--> The Program for Research in Military Nursing: Progress and Future Direction Committee on Military Nursing Research INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1996

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--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, NW Washington, DC 20418 NOTICE: The project that is the subject of the report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Science, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competencies and with regard for appropriate balance. The report, The Program for Research in Military Nursing: Progress and Future Direction, has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute of Medicine acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this project was provided by the Department of Defense through the Uniformed Services University of the Health Sciences, Contract No. MDA905-95-C-0023. The opinions or conclusions expressed herein do not, however, necessarily reflect those of the Uniformed Services University of the Health Sciences or the Department of Defense. Library of Congress Catalog Card Number: 96-68833 International Standard Book Number: 0-309-05490-7 The Program for Research in Military Nursing: Progress and Future Direction and its companion volume are available for sale from the National Academy Press , 2101 Constitution Avenue, N.W., Lock Box 285, Washington, D.C. 20055. Call 800/624-6242 or 202/334-3313 (in the Washington Metropolitan area). The published report and its companion volume Military Nursing Research: Bibliographies (which is available in electronic or printed form) are also available from: Director, REA Uniformed Services University of the Health Sciences 4301 Jones Bridge Road Bethesda, MD 20814 Copyright 1996 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

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--> COMMITTEE ON MILITARY NURSING RESEARCH RUTH McCORKLE* (Chair), School of Nursing, University of Pennsylvania, Philadelphia GERALDENE FELTON (Cochair), College of Nursing, University of Iowa, Iowa City LINDA BURNES BOLTON, Nursing Research and Development, Cedars-Sinai Medical Center, Los Angeles, California PETER I. BUERHAUS, Harvard Nursing Research Institute, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts MARIE COWAN, Office of Nursing Research, School of Nursing, University of Washington, Seattle SARA FRY, School of Nursing, Boston College, Chestnut Hill, Massachusetts VICKI STOVER HERTZBERG, Department of Biostatistics, The Rollins School of Public Health, Emory University, Atlanta, Georgia EUGENE A. HILDRETH,* The Reading Hospital and Medical Center, University of Pennsylvania, Reading HAZEL W. JOHNSON-BROWN (retired December 1995), Center for Health Policy, College of Nursing and Health Science, George Mason University, Fairfax, Virginia CAROL LEDBETTER, School of Nursing, The University of Texas at Houston Health Science Center SUSAN LEEMAN,† Department of Pharmacology and Experimental Therapeutics, School of Medicine, Boston University, Massachusetts KATHLEEN ANN LONG, College of Nursing, University of Florida, Gainesville SHARON SEARLS MAILEY, School of Nursing, Georgetown University, Washington, D.C. HAL MORGENSTERN, Department of Epidemiology, School of Public Health, University of California at Los Angeles BARBARA REDMAN, School of Nursing, University of Connecticut, Storrs JEAN M. REEDER, The Hospital for Sick Children, Toronto, Canada BONNIE ROGERS, Occupational Health Nursing Program, School of Public Health, University of North Carolina at Chapel Hill DAVID D. SCHNAKENBERG, American Society for Clinical Nutrition, Incorporated, Bethesda, Maryland LEE SECHREST, Department of Psychology, University of Arizona, Tucson CHRISTINE SULLIVAN, Bixby Medical Center, Adrian, Michigan *   Member of the Institute of Medicine †   Member of the National Academy of Sciences

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--> Study Staff ALLISON A. YATES, Division Director CAROL W. SUITOR, Study Director MARY I. POOS, Senior Program Officer GEORGE DAVATELIS, Program Officer YVETTE J. BENJAMIN, Research Associate SHEILA MOATS, Research Associate DIANE R. JOHNSON, Project Assistant GAIL E. SPEARS, Administrative Assistant JAMAINE L. TINKER, Financial Associate, September 1995–March 1996 CARLOS GABRIEL, Financial Associate, April 1996–present

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--> Preface High-quality nursing care is essential to obtain favorable patient outcomes. Military nursing research has the capacity to prevent health problems, improve patient care, and contribute to appropriate and desirable outcomes that are cost-effective in many situations. In the last 45 years, considerable progress has been made in wide-ranging applications of research in military nursing. Unarguably, however, further evolution and programs of military nursing research will depend on enhanced scholarly inquiry by military nurses and on the dissemination and application of research results. This report concerns the purpose and need for military nursing research and for the congressionally funded program that supports such research. In September 1995, the advisory group for the TriService Nursing Research Program asked the Institute of Medicine to establish a committee of experts to review its military nursing research program and make recommendations for management, funding, allocation of resources, and identification of program goals. A 20-member multidisciplinary group that excluded active-duty military personnel was organized, representing a range of knowledge and views regarding the practice of nursing, nursing research, and the place of nursing research in the military. Some initial unifying characteristics of the group included its knowledge of the scientific process and of scientific and programmatic review. In less than 5 years, the TriService Nursing Research Program has grown in maturity and sophistication and has played a significant role in producing capable researchers. The program's advisory group members are aware, however, of the need to strengthen the program and create a mechanism to ensure the development of a cadre of military nurse researchers. As the Institute of Medicine committee proceeded with its work, it became clear that there is a compelling need for research in a variety of areas that are

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--> exclusive to the military and that these studies are best carried out by military nursing personnel. In particular, military nursing research focuses on health maintenance of military personnel and their beneficiaries, advancing the practice of military nursing in support of mission readiness and deployment, and enhancing delivery systems to improve clinical outcomes. The committee met with both active-duty and reserve personnel from the three military Nurse Corps (U.S. Army, Air Force, and Navy), who described their research and the resources available to implement, complete, and evaluate their work. We found a group of professional men and women, committed to the advancement of military nursing, who assumed responsibility for studying problems encountered in their practice over and above their regular and demanding job assignments. The steps that the committee took to educate itself about the unique aspects of military nursing research broadened members' views and made it clear that the Army, Air Force, and Navy Nurse Corps are in need of continued support through the TriService Nursing Research Program, especially in the form of ongoing financial backing and mentoring to continue important and necessary research activities. The chair, cochair, and the committee extend appreciation for the staff and support provided by the Institute of Medicine. In particular, we would like to thank Kenneth I. Shine, Institute of Medicine president; Karen Hein, executive officer; and Allison A. Yates, division director, who were instrumental in initiating the study. We especially appreciate the diligent work of Carol W. Suitor, study director, and the assistance of Mary I. Poos and George Davatelis, program officers. We are also appreciative of the work of research associates Yvette J. Benjamin and Sheila Moats, and project assistant Diane R. Johnson. The experience of convening with the committee has been rewarding and inspiring for all involved. Despite our diverse backgrounds, at the conclusion of deliberations, we are all left with an appreciation and understanding of the need for a rigorous military nursing research program. The committee felt strongly that this report should be instructive to the TriService Nursing Research Group so that recommendations could be implemented easily in a timely fashion. Despite many substantial obstacles that have confronted the TriService Nursing Research Program, we were all impressed with the Corps Chief's and Director's vision for military nursing and the fact that scientific advancement has progressed steadily. It is the sentiment of the committee that with continued funding and commitment to support research and research positions, the possibilities for productivity among military nurse researchers are promising and constitute a worthy investment of the military's time and resources. RUTH McCORKLE, CHAIR GERALDENE FELTON, COCHAIR

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--> Contents Summary   1     Findings   2     Research Premises   3     Conclusions   4     Major Recommendations   5     Other Recommendations   6 1 Introduction and Background   11     Overview   11     History of Military Nursing Research   17     The TriService Nursing Research Program   19     Summary   21     References   21 2 Methods   25     Composition of the Committee   25     Information Gathering   26     Research Premises   28     Summary   29 3 Military Nursing Research   31     Nursing Research Resources in the Military   31     Published and Current Research Relevant to Military Nursing   37     Studies Funded by the TriService Nursing Research Program   43     Research Dissemination and Utilization   48

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-->     Summary   49     References   49 4 Program Execution   51     General Program Administration   52     Request for Proposals   55     Grant Review Process   58     Research Training   64     Program Monitoring and Evaluation   66     Summary   73     References   75 5 Conclusions and Recommendations   77     Conclusions   78     Major Recommendations   80     Recommendations to Develop and Sustain a Military Nursing Scientific Community   80     Other Recommendations   83     References   93 Acronyms   95 Appendixes     Appendix A Questionnaire and Results Summary for Funded Applicants   97 Appendix B Questionnaire and Results Summary for Unfunded Applicants   105 Appendix C Goals for the TriService Nursing Research Program Agreed upon by the Corps Chief and Directors   111 Appendix D TriService Nursing Research Program Awards, FY 1992–1995   113

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--> List of Tables and Boxes TABLES 3-1   Total Military Nurse Corps Officers, by Component, Educational Preparation, and Service,   35 3-2   Databases Searched for Published Research Relevant to Military Nursing,   39 3-3   Categorization of Military Nursing Research Articles Retrieved from Database Searches for Journal Articles, Technical Reports, and Dissertation Abstracts,   40 3-4   TriService Nursing Research Program Grant Awards, FY 1992–1993, by Priority Area, Total Number of Awards, and Amounts,   44 3-5   TriService Nursing Research Program Grant Awards, FY 1994, by Priority Area, Number of Awards, and Amounts,   44 3-6   TriService Nursing Research Program Grant Awards, FY 1995, by Priority Area, Number of Awards, and Amounts,   45 3-7   Synthesis of TriService Nursing Research Program Grant Awards, FY 1992–1995, by Research Category, Number of Awards, and Amounts,   46 3-8   Numbers of Funded TriService Nursing Research Program Projects by Study Characteristics,   47 4-1   Evolution of TriService Nursing Research Program Eligibilities and Requirements, FY 1992–1996,   56 4-2   Number of Proposals Funded by and Submitted to the TriService Nursing Research Program, FY 1992–1995, by Service and Component,   69 4-3   Proposals Submitted and Awarded, and Funding Requested and Awarded, for the TriService Nursing Research Program, FY 1992–1995,   69

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--> 4-4   Academic Achievement of Grant Recipients in the TriService Nursing Research Program, FY 1992–1995,   70 4-5   Summary of Key Parameters of Grant Recipients and Their Studies for the TriService Nursing Research Group,   71 BOXES 4-1   Subcontractor Services for the TriService Nursing Research Program, FY 1996,   54 5-1   Recommended Elements of Ongoing Monitoring and Evaluation of the TriService Nursing Research Program,   87