50 Years of Excellence in Discovery
Innovative Research Results in Improved Patient Care
Nursing research advances nursing practices that are most effective in improving health and health care systems; therefore, research is a necessity for the profession and for excellence in patient care. The American Association of Colleges of Nursing defines scholarship in nursing as “those activities that systematically advance the teaching, research, and practice of nursing through rigorous inquiry that is significant to the profession, is creative, can be documented, can be replicated or elaborated; and can be peer-reviewed through various methods.”
Through the Office of Nursing Research and Scholarship and the faculty Committee on Scholarship, the School of Nursing supports the scholarship of teaching, discovery and practice/engagement. The school is an integral part of an internationally recognized academic health center that is a site for a funded Clinical Translational Science Award (CTSA), the Institute for Integration of Medicine and Science (IIMS). Interprofessional research collaborations are strongly supported and nurse scientists have been a part of the IIMS guiding group since its inception in 2008, with increasing leadership in interprofessional scientific teams.
Over the history of nursing and the nursing school, the pace and scope of research activities by faculty scientists and Ph.D. students have grown at a steady pace. With the demands for new nursing knowledge, the increase in the number of doctorally prepared faculty, the school’s commitment to this part of its mission, and success in securing funding, an impressive collection of research has been conducted.
Research came into focus at the school in 1988 with the establishment of the Office of Nursing Research initially led by Wealtha McGurn, Ph.D., RN (1988-1992). In 1993, the National Institute for Nursing Research within the National Institutes of Health was signed into being, giving nursing research full-fledged recognition by the nation’s government and the health research community. Subsequent associate deans built on this foundation, led by Barbara Holtzclaw, Ph.D., RN (1992 - 2000), and Carrie Jo Braden, Ph.D., RN (2000 - 2018).
Students are essential to the school’s discovery team, particularly through their Ph.D. dissertations. As part of a highly regarded research university in South Texas and one of the major academic health science centers in the nation, the School of Nursing is the leading school in this region to offer doctorate nursing degrees to build the scientific workforce for the profession. Since the Ph.D. program began, faculty have supported the completion of 76 original research dissertations by Ph.D. students. The themes of these studies reflect the school’s mission and priorities of our communities and nursing profession in developing science to guide practice. Nurse scientists have conducted research on health outcomes related to nutrition, infection prevention, stress, adaptation to illness, heart health, and pain management in various special populations. Their research has contributed to theory building and conceptual development as well as testing clinical interventions. Our nurse scientists also have studied ways the health care system can support nurse performance, improve patient safety, and advance information technology in care.
In addition to doctoral students conducting research, undergraduate nursing students may engage in research while earning their B.S.N. in the traditional track program. Since 2017, the Summer Undergraduate Nursing Research Immersion Experience (SUNRISE) program provides opportunities for undergraduate students in their fifth semester to participate in two, eight-week summer research sessions mentored by faculty members. Selection for the program is done through a competitive application and interview process. Students in the SUNRISE program are expected to make meaningful contributions to science with national presentations and inclusion in peer-reviewed publications. These students graduate with a B.S.N. with Research Distinction designation, indicating their commitment to enriching their nursing education with independent research and an added advantage in the job market and selection for graduate programs.
Since May 2018, the Office of Nursing Research and Scholarship—under the direction of Jing Wang, Ph.D., M.P.H., M.S.N., RN, FAAN, vice dean for research—promotes the school’s research mission and serves to advance nursing science and scholarship with resources to support faculty and students by providing a collaborative environment and comprehensive services. Resources include grant lifecycle support, editorial services support, intellectual property advising, and data storage and analysis advising.
CENTERS OF EXCELLENCE
Nursing research advances nursing knowledge. By strategically concentrating expertise and resources in centers of excellence, the school has provided focal points for high-priority health needs. These focal points historically have included the Academic Center for Evidence-Based Practice (ACE), the Center for Violence Prevention, and the Center for Community-Based Health Promotion with Women and Children.
The Academic Center for Evidence-Based Practice was the school’s first center of excellence authorized by the UT Health Executive Council. It was established in 2000 to advance cutting-edge evidence-based practice (EBP), research and education within an interprofessional context. As a national and global pioneer in EBP, founding Director Dr. Kathleen Stevens led the team to develop a suite of components that have proven to be foundational to the field: The Star Model of Knowledge Transformation, national consensus on essential competencies in EBP, the EBP Readiness Inventory, and the Summer Institute on Evidence-Based Quality Improvement. Through collaboration with the CTSA Institute for Integration of Medicine and Science (IIMS), South Texas Veterans Health Care System, ACE projects garnered $15 million over 15 years of research in quality and safety. In 2015, with EBP successfully integrated into education and practice and spreading globally, the goal of the EBP center was met and the goals advanced into a solely research focused center, the Improvement Science Research Network, an AHRQ Practice-Based Research Network that is part of the IIMS.
Center for Violence Prevention was also established in 2000 as an interdisciplinary effort among the School of Nursing, School of Medicine and the San Antonio Police Department; it was directed by Drs. Margaret Brackley, Gail Williams and Charles Mouton. The center’s goal was to understand the effects of violence on individuals, families, and communities in the South Texas region.
Center for Community-Based Health Promotion with Women and Children was established in 2001 under an endowment from Anita Thigpen Perry, M.S.N., Class of 1977, and former first lady of Texas (Gov. Rick Perry). This center uses an innovative model of community-based participatory research to address needs identified by the community. A key driver for the center is engaging marginalized and disenfranchised groups. Through sharing power, the center builds community capacity to advocate for community change, prepare young girls to seek and succeed in higher education, create a successful sexual and reproductive health program, and assist the recovery of homeless women. Janna Lesser, Ph.D., RN, professor and center director, leads the center that continues to provide rich opportunities combining care and research in serving these vulnerable populations.
Michigan En San Antonio (MESA) Center funded from September 2002 through July 2009 by the National Institute of Nursing represented a partnership with the University of Michigan School of Nursing that focused on research related to health disparities. Toni Villarruel, Ph.D., RN, FAAN, was the principle investigator from the University of Michigan College of Nursing and Carrie Jo Braden, Ph.D., RN, FAAN, was the principle investigator from UT Health San Antonio School of Nursing. Led by Dr. Braden, the Research Core of the Center supported 20 research studies from the school’s faculty and students. Ten of these studies focused on health promotion of vulnerable populations experiencing health disparities which included: families of persons at the end of life, Tap Pilam Coahuitecan Nation people, older Mexican American women, Black American breast feeding women, and young Native American Indian males. Nine of the studies focused on health restoration of vulnerable populations experiencing health disparities which included: elders diagnosed with dementia, community dwelling persons diagnosed with mental illness, older Hispanic women, children of mothers having experienced domestic violence, Hispanic teens in South Texas, incarcerated Latino youth, persons with spinal cord injury, Mexican American elders, and minority women federal offenders. One study assessed outcomes of Writing Center interventions with undergraduate nursing students who participated in a peer mentoring program to support student scholarly achievement. Forty publications and 39 presentations reported findings from these studies. The Mentoring Core led by Dr. Elizabeth Reifsnider (2002 – 2004) and Dr. Gail Williams (2005 – 2006) provided five formal research colloquia and weekly one-hour research scholars seminars across seven years of MESA Center support. Faculty and students from the two schools participated in exchange programs of research and other learning opportunities at the two sites. The MESA Center outcomes served as a basis for the RO1 (GM0088781), MESA: Mechanisms for Enhancing Scholarly Achievements funded by the National Institute of General Medical Science (Dr. Braden, principle investigator) that provided support for interdisciplinary graduate student research scholar participation in weekly research seminars from 2010 through 2016.
EMERGING SCIENTIFIC NEEDS
As goals in these centers were realized and needs were met, the achievements were incorporated into multiple aspects across the school. Additional centers of excellence are being evolved to address other emerging needs, including care of the aging and their caregivers, and connected health.
One of the newest initiatives is to build a center for connected health. Dr. Wang, holder of the Hugh Roy Cullen Professorship in Nursing, is leveraging mobile technologies to combine her interest in elderly patient care and their wish to stay in their own homes as they age. The new Center on Smart and Connected Health Technologies was launched in the spring of 2019 to offer faculty and students a collaborative space to research technologies that health care professionals, patients, families and caregivers can use to meet the needs of the growing senior population.
The school’s 2018 Strategic Plan prioritizes research in interprofessional teams focusing on health promotion, health risk, care coordination, advocacy and disease management across the life span. The plan also includes expansion of health services research to transform population health and health care systems through studies of dissemination, implementation and economic aspects of care. Importantly, nurse scientists are leading and collaborating in universitywide interprofessional research initiatives to build strong science in elder care in order to achieve patient safety.
Nurse scientists have been at the table from the inception of the school’s Clinical and Translational Science Award applications to support the Institute for Integration of Medicine and Science. These NIH/CTSA awards provide research infrastructure for interprofessional research to move research into practice and promote academic-practice partnerships around scientifically driven health care transformation.
Themes in nursing research have reflected social concerns. With the surge in concern over adverse medical events (such as infections caught during health care episodes), patients, families and health care workers are innovating solutions. The school was part of the founding of the Louise Batz Patient Safety Foundation, a heartfelt response to a daughter’s loss of her mother due to a preventable medical error. Professor Emeritus Brenda Jackson, Ph.D., M.S.N., RN, and Professor Stevens serve on the Batz Foundation Medical Advisory Board and continue to support the family’s advocacy for patient safety through development of the Batz Guide, which is used by patients and families to guard against medication errors. In addition to the hard copy version, the Batz Guide is being tested as a mobile app.
IT SAFETY RESEARCH
Concerns over patient safety also arise from newly created sources related to information technology (IT). While full of benefits, the internet brings with it new vulnerabilities. Funded through the San Antonio Life Sciences Institute (a collaboration between UT Health and UTSA), Azizeh Sowan, Ph.D., M.S.N., associate professor/research, and her team are developing protection of patient-support devices against invasion by ransom ware. This malware invades the technological devices used in respiratory ventilators, IV pumps and heart monitors, blocking their use or misinforming clinicians. The offenders demand a ransom to release the devices back to normal functioning. Dr. Sowan’s research holds promise for developing strategies to mitigate such threats.
Nurse scientists are key collaborators in UT Health research focused on health issues faced by the elderly. Assistant Professor Carolyn E.Z. Pickering, Ph.D., RN, received a Rising STAR Award from the UT System, a first for the School of Nursing. She is using the $250,000 grant to develop a community research collaboratory to accommodate the unique needs of persons with dementia and their caregivers and better support their participation in research. The collaboratory accommodates clinical services and serves as the site for experimental learning and interdisciplinary education. Dr. Pickering’s research program is a key component of the new Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases.
Carole White, Ph.D., RN, Nancy Smith Hurd President’s Chair in Geriatric Nursing and Aging Studies, is providing essential nursing perspectives through the Caring for the Caregiver program, which focuses on caregivers of people with Alzheimer’s and other dementias. This program is dedicated to improving the quality of life for family caregivers and those they care for with evidence-based services, support, education and research with value on the caregiver’s health, skills and resilience. The team is committed to research to identify effective interventions to address the strain and burden associated with caregiving and to translation of the evidence-based practices for caregivers into routine care. The program offers educational training for each stage of care, hands-on skills training, support groups by health care professionals, and a website directory identifying resources for care and information.
TRENDS IN RESEARCH
Nursing research conducted by the school’s faculty has been greatly influenced by the articulated needs of local, regional and national issues. Often, the health needs of the public are expressed in the priorities articulated by funding entities, such as the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality.
Over its history, the School of Nursing has conducted research on the national goals of better health care, better health outcomes, better value and better workplace environment (the “quadruple aim”). Faculty scientists and students have responded to these research needs by conducting studies that uncover best practices.
Our nurse scientists have conducted research on health outcomes related to nutrition, infection prevention, stress, adaptation to illness, and pain management in children, adults, the elderly and special populations. These researchers also have studied the ways the health care system can support nurse performance, improve patient safety, and advance information technology in care. This discovery and research is improving lives and making a difference.