Acute and Chronic Illness

Research topics on nursing care of acute illness range from sleep-wake patterns of preterm infants in the neonatal intensive care unit to the biobehavioral factors affecting recovery after a myocardial infarction. Nursing studies of chronic illness address pain assessment and management, stress, orientation and cognitive dysfunction, and adaptation to decreased functional status (Hester, et al., 1990). They also address symptom management for diverse diseases and conditions such as fatigue, dyspnea, nausea and vomiting, anxiety, cognitive impairment, and sleep disturbances, as well as symptoms of specific diseases (McCorkle et al., 1994).

There is a renewed focus in nursing research on the application of state-of-the-art biological and behavioral theory and measurement to the clinical problems patients experience with illness and medical treatment. For example, one such study is measuring the effects of self-management biofeedback therapy on the frequency of complex ventricular ectopia, events of sudden cardiac arrest, survival rate, and enhanced heart rate variability in subjects after an episode of sudden cardiac arrest (Cowan et al., 1991). Other studies are investigating factors related to breast cancer, colorectal cancer, and depression after stroke. Investigators are combining data across studies in the areas of depression and biological immune responses (Johnston et al., in press; Tax et al., in press).

Nursing studies also examine the effectiveness of nursing procedures, such as open versus closed endotracheal suctioning. They compare different modes of oxygen delivery to patients with chronic lung disease and develop accurate tests for confirming correct nasogastric tube placement at the bedside (Rudy et al., 1991). Other procedures being investigated include feeding and handling of infants in the neonatal intensive care units, wound healing of decubiti, and behavioral strategies to maintain the functional independence of cognitively impaired nursing home residents.

Nursing research holds great promise for increasing the effectiveness of patient care and improving the quality of life for patients and their families. New discoveries enhance the potential for new and effective approaches to nursing.

Health Promotion and Disease Prevention

Nursing studies of health promotion and disease prevention examine ways in which behavioral change can be effected to improve quality of life and encourage avoidance of health risks across the life span. Descriptive and correlational studies have predominated in the past, exploring such variables as mental health in postpartum mothers, neurometric measures of premenstrual syndrome, weight management, fatigue, exercise regimens, and perimenopausal phenomena (Shaver et al., 1992). Studies of intervention programs such as educational programs for schoolage children are also conducted.

Most health problems are complex and are linked to behavior and lifestyle. They require multidisciplinary approaches that combine knowledge from the biological, environmental, and behavioral sciences. Nurse investigators are seeking ways to tap into the extraordinary advances in the basic biological and behavioral sciences to better understand how healthy behaviors are established and maintained. For example, nurse researchers investigate positive and negative health behaviors in childhood and early adolescence and their linkage to individual, family, social, biological, and environmental factors. They work with colleagues in the biological sciences to test interventions such as exercise and counseling.

Women's health is another area of expanding interest for nursing research, including childbearing, nutrition, exercise, normal developmental processes, and stress and adaptation to life transitions (Woods et al., 1993). The large studies on women's health issues initiated by NIH will provide additional opportunities for nurse researchers to study the biological, behavioral, and social factors that contribute to health and disease and to test interventions that will promote health and prevent disease.

Systems of Care

Nurse researchers are evaluating the clinical context in which health care is provided, the process of nursing care, and organizational factors that affect patient outcomes and quality of care delivery. For example, the cardiovascular effects of noise and light have been studied in neonatal intensive care units and coronary care units. Other studies have documented the cost effectiveness of nurse-coordinated care from the hospital into the home for high-risk populations such as very-low-birth-weight infants, women with high risk pregnancies, and frail older people (Brooten et al., 1986).

A unique and challenging area of research is the exploration of bioethical issues in health care delivery. There is a tremendous need for empirical studies of treatment decisions, especially as they relate to advanced medical technologies and access to innovative therapies.

A major challenge for nurse investigators is the identification and measurement of interventions and clinical endpoints of nursing care that are cost effective. New modes of health care delivery and financing will continue to exert pressures to develop measures of care that can monitor appropriateness and quality of care. To answer research questions related to these issues, nurse investigators often collaborate with researchers in health services research and other disciplines.

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