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Question. The NIGMS has established a senior level position in order to more effectively plan and meet the emerging needs of the minority community through its existing or anticipated program. Since the NCRR's 1992 portfolio includes a number of activities that impact on the minority community (RCMI, construction for minority institutions, Minority High School Apprenticeship Program, and the Minority Clinical Associate Physicians Program), do you envision a similar administrative structure within your organization?

Answer. The minority programs of the NCRR are very different in their mission, scope, recipient communities and mechanisms of support. Because of these differences, each of the programs is under the management of a separate program director. Each of the Program Directors reports to the Deputy Director for Extramural Research Resources who coordinates them. By having direct access to the top level of management of the Center, the program directors of the various activities are able to maximize the potential for each program without the need for an additional layer of management.


Question. Since the 1992 president's budget request has zeroed out the BRSG Program, are there contingency plans such as reprogramming funds to meet this need?

Answer. There are no plans to reprogram funds into the BRSG Program at this time.

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Senator HARKIN. Dr. Hinshaw, the committee is pleased to have you with us again today to represent the National Center for Nursing Research.

Your budget request is for $43.7 million, which is $4 million or 10 percent more than last year. The first funding provided for the nursing center was $20 million in 1987. The budget has more than doubled since then. The number of research project grant applications reviewed for the center has also more than doubled from 160 in 1987 to an estimated 354 for 1991.

Dr. Hinshaw, I would be pleased to hear your statement at this time. Please proceed.

Dr. HINSHAW. Thank you, Senator. It is an honor to appear before you again to discuss the programs of the National Center for Nursing Research, the current state of knowledge for nursing practice, and the challenges that are facing us in terms of patient care. In its fifth year, the NCNR has shown substantial progress in the establishment of productive programs of research and training, in important preliminary findings achieved by our grantees, and also in continued planning for growth and expansion. Clusters of studies are now being assembled in areas central to nursing practice, such as prevention and care of low birthweight infants, symptom assessment and management, long-term care of older individuals, and health promotion across many aspects of the lifespan.


Four program areas are being proposed for a major development in 1992. First, long-term care requirements of older persons, a priority of the National Nursing Research Agenda, will stress nursing interventions and strategies that facilitate the maintenance of sound health and increase the older person's ability to maintain a high degree of well-being and to maintain themselves in the community rather than a nursing facility. The second area for major development is symptom management. Our research will initially focus on acute pain assessment and management in vulnerable populations. Acute pain is one of the four symptoms identified in the National Nursing Research Agenda. Interest in this area of research is shared with other NIH components, and we are seeking opportunities for collaboration.

The third area of expansion will involve the intramural program. Growth will be in the area of health-related quality of life. It is an initiative of high priority for us. Intramural scientists will develop

methodologies for the comprehensive study and evaluation of health-related quality of life.

The intramural program also conducts research on symptoms and side effects of treatments faced by individuals with HIV infection. Examples include muscle wasting, compliance issues, nausea, and fatigue.

The fourth area of expansion, health promotion among children and adolescents, is also a designated priority of the National Nursing Research Agenda. This will address dominant, preventable health problems in emerging lifestyles related to diet, physical activity, alcohol and smoking, and sexual behavior to achieve healthpromoting behavior changes in children and adolescents. We judge that if we would intervene at an earlier age, one might have a better opportunity to achieve health-promoting behaviors. We know how difficult it is at our age to try to maintain diets or to quit smoking. It would be better to start very early in life as lifestyles are emerging, to achieve these health-promoting behaviors.

Other areas of research are currently undergoing substantial program development. They include nursing interventions and women's health. In this area we stress midlife health issues and longitudinal studies of health and disease across the context of a woman's life.

An initiative on low birthweight has resulted in a cluster of studies. This will continue to be expanded. About 9 percent of our portfolio is currently in this area of study. This initiative targets studies that look both at care of the premature infant within the neonatal ICU's and studies which provide prenatal care in the community in a culturally sensitive way. I would be glad to speak to several of those studies later if you would like.

Rural health is another major focus for us, thanks to the directive and the encouragement of the Senate from the last 2 years. In addition, two task forces are being established which will advise us on policies regarding native American health care issues and on the issues of rural health.


I was also interested in the earlier points that you made about research training, because as a rapidly growing research discipline, a strong emphasis has been placed on establishing a cadre of wellprepared nurse investigators. Approximately 11 percent of our budget is invested in nurse research training, which is comparable to about 4 percent that is invested by NIH overall in biomedical research training. We have placed extra emphasis and dollars_in order to expand the cadre of well-prepared nurse investigators. We are building post-doctoral programs supporting research intensive environments for training, and also creating training opportunities for our minority colleagues.

The fiscal year 1992 budget request for the National Center for Nursing Research is $43,747,000.

I would be pleased to answer any questions that you may have. [The statement follows:]


Mr. Chairman, I am honored to appear before you again to discuss the programs of the National Center for Nursing Research, the current state of knowledge for nursing practice, the challenges facing us in patient care, and the promotion of health in this country.

As the Center moves into its fifth year, our efforts show substantial progress in the establishment of productive programs of research and training, in important preliminary findings achieved by our grantees, and in continued planning for growth and expansion. Clusters of studies are being assembled in areas central to nursing care and practice--low birthweight, symptom management, long-term care of the elderly, and health promotion across the life span. The following are examples of very promising research:

A group of NCNR grantees has developed an instrument called the NEECHAM Scale to assess problems with information processing in older patients. confusion, defined as a disturbance in information processing, is an extremely serious condition that frequently develops in older people during


Confusion increases the complexity of treatment, is associated with increased mortality and complications, and results in medical

and nursing interventions that have associated risks, such as sedation,

Preliminary findings from comparisons with three other commonly used clinical assessment tools indicate that the NEECHAM Scale is more sensitive to early or mild disturbances in information processing. addition, this tool can be used at the bedside with minimal stress on the patient. The ability to detect confusion at a very early stage and to identify specific patterns in confusion development are prerequisites to prevention, early intervention, and effective management of this condition among older hospital patients.

restraints, and catheters.



In another NCNR-supported study, researchers are investigating a common problem among low birthweight infants--compromised breathing from immature lungs. These infants require mechanical assistance to help them breathe, along with suctioning to clear air passages. Early results from this study suggest that turning the infant's head during the suctioning procedure does not improve the outcome and may actually be harmful. Data also suggest that repeated passes with the suction tube are not beneficial and can decrease the

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