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Biologically-Based Nursing ResearchBiologically-Based Nursing Research

Leslie Kramer Pejic, Ph.D., C.N.S., R.N.Leslie Kramer Pejic, Ph.D., C.N.S., R.N.

April 11, 2008April 11, 2008

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Nursing is “the diagnosis of human Nursing is “the diagnosis of human

responsesresponses to actual or potential health to actual or potential health

problems.” problems.” (American Nurses’ Association)(American Nurses’ Association)

What is Nursing?

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Human Response Viewed From Human Response Viewed From Four PerspectivesFour Perspectives

• Physiological regulatory responsesPhysiological regulatory responses

• Pathophysiological responsesPathophysiological responses

• Experiential responsesExperiential responses

• Behavioral responsesBehavioral responses

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Human Response ModelHuman Response Model

These perspectives are used in other disciplines; however, nursing science synthesizes These perspectives are used in other disciplines; however, nursing science synthesizes

them explicitly considering their linkages in clarifying human them explicitly considering their linkages in clarifying human response phenomenaresponse phenomena..

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Memory Deficits From Memory Deficits From StressorsStressors

STROKESTROKEEPILEPSYEPILEPSYPARKINSON’S DISEASEPARKINSON’S DISEASEALZHEIMER’S DISEASEALZHEIMER’S DISEASECARDIAC DARRESTCARDIAC DARRESTHYPOGLYCEMIAHYPOGLYCEMIAALCOHOLISMALCOHOLISMHUNTINGTON’S DISEASEHUNTINGTON’S DISEASE

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Memory DeficitsMemory Deficits

Neurodegeneration in the hippocampusNeurodegeneration in the hippocampus

StressStress receptors very prevalent in receptors very prevalent in

hippocampushippocampus

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EINSTEINEINSTEIN

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Human HippocampusHuman Hippocampus

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Subfields of The HippocampusSubfields of The Hippocampus

HippocampusHippocampus

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Layers of The CA1 and Dentate Layers of The CA1 and Dentate Gyrus of The HippocampusGyrus of The Hippocampus

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BCO Model of Memory DisorderBCO Model of Memory Disorder

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Balance of Stress ReceptorsBalance of Stress Receptors

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Think Outside The Box!Think Outside The Box!

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Apoptosis of Neuron

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Apoptosis of NEURON and GLIAApoptosis of NEURON and GLIA

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Biologically-based Nursing Research Biologically-based Nursing Research Training ObjectivesTraining Objectives

1.1. Apply theories and methods of theApply theories and methods of the

biological sciences in the identification biological sciences in the identification

of problems arising from human of problems arising from human

responsesresponses to acute and chronic to acute and chronic

diseases (diseases (stressorsstressors))

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OBJECTIVES continuedOBJECTIVES continued

2. Integrate theories and methods of the 2. Integrate theories and methods of the

basic sciences, nursing, and related basic sciences, nursing, and related

theories regarding humantheories regarding human response response to to

acute and chronic illnesses acute and chronic illnesses (stressors)(stressors)

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OBJECTIVES continuedOBJECTIVES continued

3. Demonstrate skill in the biologic approaches to 3. Demonstrate skill in the biologic approaches to

measurement.measurement.

4. Demonstrate proficiency in design, data 4. Demonstrate proficiency in design, data

generation and analysis of biologically-based generation and analysis of biologically-based

nursing researchnursing research

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Examples Of Biologic ResearchExamples Of Biologic Research

• Neurologic impact of diabetesNeurologic impact of diabetes

• Nutrition and gut mobilityNutrition and gut mobility

• Gender differences in cardiac functionGender differences in cardiac function

• Mechanisms of wound healingMechanisms of wound healing

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Translational ResearchTranslational Research(Bench To Bedside)(Bench To Bedside)

Effective translation of new knowledge, Effective translation of new knowledge, mechanisms and techniques generated mechanisms and techniques generated by advances in basic science research by advances in basic science research

into new approaches for the prevention, into new approaches for the prevention, diagnosis and treatment of diseasediagnosis and treatment of disease

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Translational Neuroscience Translational Neuroscience AccomplishmentsAccomplishments

•Retinitis pigmentosa: gene therapyRetinitis pigmentosa: gene therapy

•Parkinson’s disease: deep brain stimulationParkinson’s disease: deep brain stimulation

•Stroke: cooling brain, TPA for clotsStroke: cooling brain, TPA for clots

•Depression, bipolar disorder and Depression, bipolar disorder and

schizophrenia: pharmacologyschizophrenia: pharmacology

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Magnetic Resonance Imaging Magnetic Resonance Imaging (MRI)(MRI)

• Tesla discovered the Tesla discovered the rotating magnetic field in rotating magnetic field in 1882. 1882. (Invented the radio)(Invented the radio)• In 1956, the “In 1956, the “Tesla UnitTesla Unit” ” was proclaimed as unit of was proclaimed as unit of measurement of the strength measurement of the strength of a magnetic field. of a magnetic field. • All MRI’s are calibrated in All MRI’s are calibrated in Tesla Units.Tesla Units.• The strongest MRI is 9.4 The strongest MRI is 9.4 Tesla units.Tesla units.

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Molecular ImagingMolecular Imaging

1.1. Measuring neurotransmittersMeasuring neurotransmitters• GABAGABA• GLUTAMATEGLUTAMATE

2.2. Quantifying blood-brain permeabilityQuantifying blood-brain permeability

3.3. Observing brain activation and perfusionObserving brain activation and perfusion

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Practice-based Evidence for Practice-based Evidence for Clinical Practice ImprovementClinical Practice Improvement

Examines three sets of factors and the Examines three sets of factors and the interaction among them:interaction among them:

•PATIENT PATIENT ((CASE MIX CLASSIFICATION ; SEVERITY OF CASE MIX CLASSIFICATION ; SEVERITY OF ILLNESS)ILLNESS)

•PROCESS (TREATMENTS, INTERVENTIONS, PROCESS (TREATMENTS, INTERVENTIONS, MEDICATIONS)MEDICATIONS)

•OUTCOMES (CLINICAL, COST, LENGTH OF STAY)OUTCOMES (CLINICAL, COST, LENGTH OF STAY)

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PBE: Effectiveness ResearchPBE: Effectiveness Research (Attention To Details Of The (Attention To Details Of The Process Of Care)Process Of Care)

1.1. ANSWERS THE QUESTION: does a ANSWERS THE QUESTION: does a treatment work under usual conditions of care?treatment work under usual conditions of care?

2. SEEKS TO IDENTIFY NATURAL VARIATION 2. SEEKS TO IDENTIFY NATURAL VARIATION IN THE POPULATION AND DETERMINE IN THE POPULATION AND DETERMINE

HOW INTERVENTIONS AFFECT HOW INTERVENTIONS AFFECT DIFFERENT POPULATIONSDIFFERENT POPULATIONS

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PBEPBE

Creates a comprehensive, complex databases, Creates a comprehensive, complex databases, that include detailed patient-specific descriptions, that include detailed patient-specific descriptions,

severity-of-illness measures, and severity-of-illness measures, and characterizations of treatments for large samples characterizations of treatments for large samples

of patients.of patients.

(examples; stroke rehabilitation, sepsis evaluations for infants with (examples; stroke rehabilitation, sepsis evaluations for infants with bronchiolitis, pressure ulcers)bronchiolitis, pressure ulcers)

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Biologically-Based Nursing Biologically-Based Nursing ResearchResearch

1.1. Bench to bedsideBench to bedside

2.2. Bedside to benchBedside to bench

3.3. Bedside to communityBedside to community