Friday, September 23, 2016

Reflections on NINR Symposium and 30th Anniversary Celebration

I was privileged to participate as the director of ceremonies at the National Institute of Nursing Research’s (NINR) closing symposium, which celebrated their 30th Anniversary. The symposium brought together presentations and dialogues, top eminent scientists in sleep research and findings that were supported by NINR. The event, which attracted more than 500 attendees (and was closed to more registrants), had two sleep research panels, a symptom science panel and a precision health omic science panel.

The panelists, who were moderated by Dr. David Dinges and Dr. Yvette Conley, discussed their scholarly trajectories and major findings from their research programs, their vision of progress in sleep research and their specific goals for advancing knowledge related to symptom and omic sciences. They also discussed how sleep influences, and is influenced by, health and wellbeing for individuals and populations, and ways by which sleep science reflects, and is congruent with, the overall mission of NINR, which is to promote and improve health and quality of life of individuals, families and communities through basic and clinical research that provides the scientific base for practice. The mission also includes the training of nurse scientists and preparing them for a life of scientific discoveries for the purpose of advancing nursing knowledge. Therefore, the panelists asserted also that it is imperative to give attention to translating sleep science to practice through developing best practices.

The symposium certainly exemplified the importance of this mission by highlighting how nursing science discoveries made a difference in people’s quality of life. It also demonstrated, rather effectively, through modeling, how NINR strategic goals foster and nurture the development of interdisciplinary teams. The panel members’ presentations, individually and collectively, reflected the richness of knowledge advanced by scientists who represented different fields and disciplines.

Moving forward in advancing sleep science, it is imperative to give attention to translating the evidence produced through their work. Research findings and recommendations should bridge the research and practice gaps. Best practices for management of sleep by professionals, as well as practices for self-management of sleep by people, should be developed by scientists and clinicians. Continued research is also needed to establish the benchmarks for healthy sleep quantitatively (7 hours?) and qualitatively? Research translated and reflected in policies is imperative as well, such as policies that affect working hours, school/education hours and care giving hours. Considering knowledge that emanates from the many sleep research findings about circadian rhythms and sleep-wake cycles, and what are the best and most congruent start times for shift workers and for schools, are just a couple of questions with answers that should lead to policy changes.

The panelists also spoke about the need for research focusing on outcomes of disturbed and insufficient sleep, particularly on special populations such as adolescents and the elderly, on management of chronic diseases, on developing and testing cognitive, behavioral and pharmaceutical interventions, and on developing tool boxes that include neurological, biological, cultural and social determinants. The panelists also advocated for advancing community and population based research and interventions. The expanse of technology, such as apps, wearable sleep trackers and watches, computer programs and other innovations to record, monitor or induce sleep, should drive future research. Technology and its use should drive research as determinants of healthy habits and outcomes, and as tools of communication between health professionals.

It was also suggested that these extraordinary sleep specialists, as well as others, may insure that the science produced reflects the diversity in this country and the different lifestyles imposed by race, culture, heritage, education and socioeconomic backgrounds.

With the agreement between 72 countries in confirming the United Nations 17 Sustainable Development Goals (SDGs) which encompass 169 targets, it behooves all scientists to be aware of these 2015-2030 goals, to value them, to critically consider connecting their work with them, and to consider ways by which they contribute to achieving them through their science. Sleep is vital for human health, and if the SDGs attainment by 2030 is mandated for the developed and developing countries, then it is imperative for every scientist and every professional organization to monitor and ensure progress toward attaining these goals.

Furthermore, sleep scientists are urged to consider how their science is being driven by competing or integrated theories that reflect determinants of health which include biological, genetic and sociocultural factors. I challenge sleep researchers to take responsibility for integrating findings by developing middle-range theories of sleep determinants and best practices for managing healthy sleep. Situation-specific theories may be a vehicle to better represent specific populations (underrepresented minorities and economic, cultural, gender and age differences) and more limited sets of variables.

A very stimulating and inspiring symposium about sleep symptom science, omic science and precision health in celebration of the 30th Anniversary of NINR.

Thursday, September 22, 2016

Our theoretical Future: Fifth Generation Nurse Theorists

I recently completed revising the 6th edition of the award winning book Theoretical Nursing: Development and Progress that I first wrote and published in 1985. In revising and updating this (more than) 600 page book, I considered the influence of the 21st century global context, and the many transitions that our discipline has undergone, from its practice beginning, to its current influential scholarly era, to the theoretical progress of the discipline.

In this edition, I celebrate the tremendous progress made in nursing theory and in the well-established theoretical foundations of our discipline, and I provide the rationale to challenge some of the myths and biases which may derail its continuous progress in the future. These myths may influence the nature of education provided to students, which focusses more on practice and research support while minimizing the value and the significance of theory. These views may promote atheoretical dialogues, decrease philosophical discourses, ignore the importance of value clarifications and/or the need for questioning assumptions that guide practice. Some of the early silo producing dichotomization of practice, research and theory is still lingering and is not benefitting the 21st century which is focused on collaboration and integration.

In this new edition, I hope readers will sense an urgency in pausing to celebrate our theoretical past and in reclaiming our theoretical future, and in the need to promote discussions, dialogues and debates about what is at stake if we do not groom the next generation of scholars for advancing theory. What is needed is a serious investment in members of future generations who will combine the skills of integrating knowledge and expertise and the ability to articulate findings in coherent theoretical dialogues which provide the language and the voice to influence health care policies for quality care.

In this edition, readers are encouraged to address some threats that may slow down progress and to transform these threats into opportunities for future progress. Among these threats are the potential loss of a nursing identity and nursing voice in the process of becoming more interprofessional. Another threat is in developing theories guided by recent revolutions in the sciences without reflecting the goals and the mission of the discipline of nursing. Another threat is for becoming entrepreneurs by utilizing dynamic and innovative technology, which may lead to reductionist approaches to caring. Finally, the threats of developing theories that do not reflect population diversity and a more global focus to populations may limit the development of culturally appropriate practices and models of care. These threats can only be mitigated by anticipating them, deliberately dialoging about population and environment issues and transforming them into opportunities.

Moving forward, jump restarting theoretical dialogues is a must. It requires an investment by all members of the discipline in fostering and nurturing the development and the sustainability of a disciplinary identity and in providing opportunities to revisit our theoretical heritage. It also requires investing in advancing the development integrated knowledge.

Therefore, the book promotes the reviewing of, and learning from, our history while considering current progress and discoveries, as well as paying particular attention to social and cultural transitions that are occurring globally. It is through all that, that we can envision a future of creativity and innovation to ensure a sustainable healthy future. With the attention the profession of nursing is receiving globally through the many national and international commissions and reports, and the science that nurses developed which provides evidence for practice, the discipline of nursing is poised for a fifth dimension for knowledge development. This fifth dimension addresses and integrates practice, theory, research, education and policies. Through this fifth dimension, members of the profession will be making a major impact on health care by investing in developing and supporting creative fifth generation theorists.  Fifth generation theorists are those who are well groomed and prepared to create population responsive health policies. These are policies to prevent illness, promote wellness, decrease disparities and enhance access to health care through innovative strategies. Fifth generation theorists use the theories to exert their strong voices to affect changes in health care policies that are designed to increase equitable and just access to quality health care. 

I am hoping that by reviewing and using this (600 plus page) edition, educators, researchers, students, clinicians and policy makers will be inspired to challenge the myths about the lack of importance of theories in developing research programs, in guiding practice and in empowering nurses’ voices. The book also provides an extensive updated list of historical and current theory resources.

Theoretical Nursing: Development and Progress
Wolters Kluwer publication date scheduled for January 2017