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clinical conditions associated with the need for long-term care among people

aged 65 'and over. Such conditions include, among others, oxygen deficit associated with chronic respiratory disease, impaired mobility, urinary

incontinence, and cognitive dysfunction.

The Nursing Center supports several

studies concerned with interventions for these conditions. An NCNR grantee is

investigating the effective delivery of supplemental oxygen to patients who

require continuous oxygen therapy from a portable oxygen device.

In this

study, comparisons among three methods for providing supplemental oxygen are

based on measures obtained during exercise performed at home. Early findings

indicate that oxygen delivery through a tube in the neck is clearly better than through a nasal tube. These findings have important implications for

management of respiratory conditions.

Another study is underway to determine the effect of a family-based intervention on the cognitive stimulation of patients with Alzheimer's disease. Effects on the well-being of their caregivers and caregiver-patient interactions are also being observed. A technique to provide cognitive stimulation is being taught to caregivers, who then use the technique with their patients every day at home. Preliminary data show trends toward

improvement or maintenance in the treatment group and decreased cognitive

functioning in the control group. Other early results indicate a trend toward improved family interaction in the experimental caregiver group.

As numbers of rural residents of the United States have become proportionately smaller, their vulnerability to illness, disability, and poor pregnancy outcomes has increased. Research is needed to determine the health

status of these individuals, their health-care requirements, and effective

methods of delivering health care to them. NCNR is supporting two projects in

a special initiative to study health care needs in rural and minority populations. One is designed to improve birth outcomes through improved

prenatal care to Native Americans and Hispanics living in rural communities in

Oregon. The other is evaluating interventions for providing prenatal care to Hawaiian, Filipino, and Japanese women living in a rural district of Hawaii.

These projects are intended to provide models of culturally sensitive,

affordable, and cost-effective prenatal care for minority women in rural

communities. With its focus on vulnerable populations, the rural health

initiative is also a valuable means of addressing minority health issues.

In the area of women's health, the NCNR supports a broad range of

studies, including investigations of predictors of pregnancy complications for women of lower socioeconomic status, factors that influence women's decisions

about estrogen replacement therapy, recovery in older women after hip

fractures and heart attacks, and attitudes toward breast cancer, breast self

examination practices, and mammography. In addition, the NCNR supports a

Center for Women's Health Research at the University of Washington for the

study of women's health concerns across the life span.

The NCNR is continuing to oversee the development of its major long-range

planning initiative, the National Nursing Research Agenda. Two priority areas of this Research Agenda have been implemented as planned for fiscal years 1990

and 1991.

The current focus of research in the first area, HIV Infection:

Prevention and Care, is the management of symptoms at various stages of the

disease. In addition, the Nursing Center's Collaborative Intramural Research

Program is conducting a study of the type, severity, and causes of nutrition

related symptoms and problems in individuals with HIV infection, such as

unintentional weight loss and decreased appetite.

In the second area to be implemented, Low Birthweight: Mothers and

Infants, current program emphasis is two-fold:

(1) the prevention of low

birthweight through attention to maternal factors and (2) the special care requirements of the low-birthweight infant. Of the remaining research agenda areas, Long-Term Care for Older Adults and Symptom Management are in the final phases of development for program initiation in fiscal years 1991 and 1992. The areas of Health Promotion: Children and Adolescents and Technology

Dependency Across the Lifespan are just beginning to be developed.

Research training continues to be the focus of major program development. In order to further enhance nursing research, the NCNR is striving to develop a strong cadre of well-prepared nurse investigators. Special emphasis has been placed on increasing the number of trainees, building postdoctoral programs, and supporting more research intensive environments for training and

career development.

Increasing the numbers of our minority colleagues in the research arena

also remains a major priority of the Nursing Center. Several strategies have been employed, including special supplemental awards to increase the numbers of minority investigators in ongoing research and to provide additional training opportunities. The number of minority investigators in research

training has increased substantially over the past four years.

Mr. Chairman, the FY 1992 budget request for this Center is $43,747,000. I will be pleased to answer any questions that you may have.

BIOGRAPHICAL SKETCH OF DR. ADA SUE HINSHAW

May 20, 1939. Arkansas City, Kansas.

Education:

B.S., University of Kansas, Lawrence, Kansas, 1961;
M.S.N., Yale University, New Haven, Connecticut, 1963;
M.A., University of Arizona, Tucson, Arizona, 1973;
Ph.D., University of Arizona, Tucson, Arizona, 1975.

Professional History: 1963-1965, Instructor and Chairperson,
Maternity Nursing Section, University of Kansas, Lawrence,
Kansas. 1966-1967, Assistant Professor, School of Nursing.
University of California, San Francisco, California, 1968-1971,
Administrative Coordinator, First Year Undergraduate Program,
School of Nursing, University of California, San Francisco,
California. 1971-1975, Masters' and doctoral studies, University
of Arizona, Tucson, Arizona. 1975-1987, Llaison Position:
Director of Nursing Research, University Medical Center, Tucson,
Arizona and Professor and Director of Research, College of
Nursing, University of Arizona, Tucson, Arizona. 1987 - Present,
Director, National Center for Nursing Research, National
Institutes of Health.

Professional Organizations: American Academy of Nursing,
American Nurses' Association (ANA), ANA Council of Nurse
Researchers, Arizona Nurses' Association, Sigma Xi, Western
Society for Research in Nursing, Sigma Theta Tau, National
Academies of Practice, Institute of Medicine

Honors. Awards: Kay Schilter Award, University of Kansas School
of Nursing, 1961. Lucille Petry Leone Award, National League for
Nursing, 1971. Wolanin Geriatric Nursing Research Award, .
University of Arizona College of Nursing, 1978. Sigma Theta Tau,
Beta Mu Chapter, Award for Excellence in Nursing Education, 1980.
Alumni of the Year Award, University of Kansas School of Nursing,
1981. Distinguished Alumni Award, Yale University School of
Nursing, 1981. Nurse Scientist of the Year Award, American
Nurses' Association, 1985. Elizabeth McWilliams Miller Award for
Excellence in Research, Sigma Theta Tau International, 1987.
Doctor of Science Degree, University of Maryland, 1988. Doctor
of Science Degree, Medical College of Ohio, 1988. Doctor of
Science Degree, Marquette University, 1990. Alumni Achievement
Award, University of Arizona, 1990.

RESEARCH TRAINING
Senator HARKIN. Thank you very much, Dr. Hinshaw.
I had a question about rural health, but you covered that.
Let me ask you about research trainees.
Dr. HINSHAW. Yes.

Senator HARKIN. You are showing a decrease of 12 research training slots for the first time after several years of growth. The 1992 request is again for 245 research training slots or the same number as last year. The Institute of Medicine recommended we fund 320 slots for 1991.

What is happening here? Is this an area that is no longer a priority for your Institute?

Dr. HINSHAW. It's a very high area of priority for us. Our difficulty is we are also faced with an award rate of approximately 11.3 percent for competing research project grants in this next year.

Senator HARKIN. At what rate?

Dr. HINSHAW. It's 11.3 percent in fiscal year 1992. And because of this we are making some very hard choices around how to distribute our moneys.

Senator HARKIN. What was the Institute of Medicine's recommendation for this year? The same, 320?

Dr. HINSHAW. The recommendation was 320 for 1990. We did not have a further recommendation from the latest report, so we do not have updated numbers.

WOMEN'S HEALTH Senator HARKIN. Dr. Hinshaw, we understand the nursing center has a sizeable portfolio of studies about women's health. You mentioned some of these in your opening statement. I do not want to go back over that again. I would just emphasize the need for that and encourage you in that direction.

Again, do you see this as a growing area that your Institute will be involved in?

Dr. HINSHAW. Yes; very much so. We are looking at what other initiatives we can take in this particular area. We have about 20 percent of our portfolio that is currently in women's health.

Senator HARKIN. It's 20 percent now?

Dr. HINSHAW. About 20 percent which is in issues of women's health, and it is much broader than just the reproductive type of issues that one often sees with women's health. We are looking particularly at older women, at midlife and menopausal issues. So, it is a widespread type of program. We would see that continuing.

Senator HARKIN. Thank you very much, Dr. Hinshaw.
Dr. HINSHAW. Surely.

QUESTIONS SUBMITTED BY THE SUBCOMMITTEE Senator HARKIN. Thank you very much. There will be some additional questions which will be submitted for your response in the record.

[The following questions were not asked at the hearing, but were submitted to the Institute for response subsequent to the hearing:]

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QUESTIONS SUBMITTED BY THE SUBCOMMITTEE

RURAL HEALTH

Question. For this fiscal year the Committee provided an increase of $1,500,000 "... to support the establishment of a rural health care research agenda for vulnerable populations." Please tell the Committee what you are doing to implement this initiative.

Answer. Recognizing that those residing in rural areas have increased vulnerability to illness, disability, and poor pregnancy outcomes, NCNR has announced to the scientific community the initiation of a research program targeted to improving the health and well being of vulnerable populations in rural areas. Included in these vulnerable groups are those who have a chronic illness, those who may become disabled due to health threatening behaviors, childbearing women, infants, children, adolescents, and persons over 65 years of age. It is anticipated that initial clinical studies will focus on more clearly determining the health needs of these populations, developing intervention strategies for improving health and maintaining wellness, and evaluating nursing practice models designed to provide effective interdisciplinary health care to these populations.

This new research program builds on NCNR's previous experience with a special initiative implemented in FY 1990 to establish and evaluate community-based nursing practice models designed to provide health care to minority groups living in rural areas. This research demonstration initiative, co-sponsored with the Division of Nursing, Health Resources and Services Administration, and the Agency for Health Care Policy and Research, resulted in three studies being funded, two by NCNR. The NCNR studies focus on improving prenatal care and pregnancy outcomes among Native American, Hispanic, and Pacific Island women and their infants. The specific Pacific Island groups are Hawaiian, Filipino and Japanese women living in rural Hawaii.

In addition to the new research program, NCNR will actively assist investigators in rural areas with the technical aspects of the grants process, so they can develop better grant applications related to those areas of research relevant to rural populations. NCNR staff are working with investigators from the Appalachian region to plan a technical assistance workshop that will be held in West Virginia. NCNR staff will also participate in a rural health, workshop for the upper Midwest to be held in North Dakota in April. There are regional nursing research conferences held throughout the year in which NCNR staff participate, and at each of these, NCNR staff will be discussing the rural health research program.

NATIONAL NURSING RESEARCH AGENDA

Question. The two research focus areas included in the National Nursing Research agenda which are scheduled to be implemented in 1992 are: 1) Long term care for the elderly, and 2) Management of pain. How much of your 1992 funding request do you expect to make available for these two initiatives?

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