1 Biologically-Based Nursing Research Leslie Kramer Pejic, Ph.D., C.N.S., R.N. April 11, 2008

2 Nursing is “the diagnosis of human responses to actual or potential health problems.” (American Nurses’ Association) What is Nursing?

3 Human Response Viewed From Four Perspectives Physiological regulatory responsesPhysiological regulatory responses Pathophysiological responsesPathophysiological responses Experiential responsesExperiential responses Behavioral responsesBehavioral responses

4 Human Response Model These perspectives are used in other disciplines; however, nursing science synthesizes them explicitly considering their linkages in clarifying human response phenomena.

5 Memory Deficits From Stressors STROKE STROKE EPILEPSY EPILEPSY PARKINSON’S DISEASE PARKINSON’S DISEASE ALZHEIMER’S DISEASE ALZHEIMER’S DISEASE CARDIAC DARREST CARDIAC DARREST HYPOGLYCEMIA HYPOGLYCEMIA ALCOHOLISM ALCOHOLISM HUNTINGTON’S DISEASE HUNTINGTON’S DISEASE

6 Memory Deficits  Neurodegeneration in the hippocampus  Stress receptors very prevalent in hippocampus

7 EINSTEIN

8 Human Hippocampus

9 Subfields of The Hippocampus Hippocampus

10 Layers of The CA1 and Dentate Gyrus of The Hippocampus

11 BCO Model of Memory Disorder

12 Balance of Stress Receptors

13 Think Outside The Box!

14 Apoptosis of Neuron

15 Apoptosis of NEURON and GLIA

16 Biologically-based Nursing Research Training Objectives 1. Apply theories and methods of the biological sciences in the identification of problems arising from human responses to acute and chronic diseases (stressors)

17 OBJECTIVES continued 2. Integrate theories and methods of the basic sciences, nursing, and related theories regarding human response to acute and chronic illnesses (stressors)

18 OBJECTIVES continued 3. Demonstrate skill in the biologic approaches to measurement. 4. Demonstrate proficiency in design, data generation and analysis of biologically-based nursing research

19 Examples 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

20 Translational Research (Bench To Bedside) Effective translation of new knowledge, mechanisms and techniques generated by advances in basic science research into new approaches for the prevention, diagnosis and treatment of disease

21 Translational Neuroscience Accomplishments 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 schizophrenia: pharmacologyDepression, bipolar disorder and schizophrenia: pharmacology

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

23 Molecular Imaging 1.Measuring neurotransmitters GABAGABA GLUTAMATEGLUTAMATE 2.Quantifying blood-brain permeability 3.Observing brain activation and perfusion

24 Practice-based Evidence for Clinical Practice Improvement Examines three sets of factors and the interaction among them: PATIENT ( CASE MIX CLASSIFICATION ; SEVERITY OF ILLNESS)PATIENT ( CASE MIX CLASSIFICATION ; SEVERITY OF ILLNESS) PROCESS (TREATMENTS, INTERVENTIONS, MEDICATIONS)PROCESS (TREATMENTS, INTERVENTIONS, MEDICATIONS) OUTCOMES (CLINICAL, COST, LENGTH OF STAY)OUTCOMES (CLINICAL, COST, LENGTH OF STAY)

25 PBE: Effectiveness Research (Attention To Details Of The Process Of Care) 1.ANSWERS THE QUESTION: does a treatment work under usual conditions of care? 2. SEEKS TO IDENTIFY NATURAL VARIATION IN THE POPULATION AND DETERMINE HOW INTERVENTIONS AFFECT DIFFERENT POPULATIONS

26 PBE Creates a comprehensive, complex databases, that include detailed patient-specific descriptions, severity-of-illness measures, and characterizations of treatments for large samples of patients. (examples; stroke rehabilitation, sepsis evaluations for infants with bronchiolitis, pressure ulcers)

27 Biologically-Based Nursing Research 1.Bench to bedside 2.Bedside to bench 3.Bedside to community