A Penn State College of Nursing researcher works with colleagues at other universities and academic medical centers to identify genetic and hormonal links to depression and eating disorders in adolescents.

Another faculty member in the college holds a dual appointment in biobehavioral health, and investigates how such factors as stress, age and gender affect wound healing.

A postdoctoral fellow in nursing works with researchers in computer science and engineering to develop mobile apps that will help improve cognitive functioning in older adults.

All are examples of the interdisciplinary, collaborative nature of research conducted in the College of Nursing.

Nursing relies on evidence developed from research to support best practices that in turn promote quality health outcomes. The concept of evidence-based nursing dates back to the 1850s and Florence Nightingale, whose focus on hygiene and sanitation during the Crimean War resulted in fundamental environmental reforms that led to decreased mortality among soldiers injured in battle.

"Our mission is to improve the health of all people in Pennsylvania, the nation and the world, and every research project we do contributes to that mission in some way," says Janice Penrod, professor of nursing and director of the college's Center for Nursing Research. "Before we can change practice, we need to understand human behaviors in response to illness. Through the discovery of new knowledge, we contribute to nursing science in ways that will change how nurses care for their patients -- and ultimately affect health outcomes for those patients."

A Holistic Approach

What sets nursing research apart from research in other health-related disciplines, explains Penrod, is its use of the biopsychosocial model -- a holistic approach that considers environmental and behavioral factors (rather than purely biological ones) in the context of health and disease.

"Our work is not limited to the biology of illness," she says. "We focus on the illness experience: the whole person, patterns of care, and the family surrounding that person as they live through the process of caring for a loved one."

Penrod points to several examples.

Ann Kolanowski, Elouise Ross Eberly Professor of Nursing, and Donna Fick, Distinguished Professor of Nursing, are developing nonpharmacological interventions for the challenging behaviors of older adults in long-term care settings -- particularly those with dementia-related disorders. One outcome of their research is a "toolkit" that contains strategies for nursing home staff to manage these behaviors.

"Their work sets new patterns for the care of older adults, helping to decrease use of potentially harmful medications and promote quality of life during the final years," Penrod says. "Nurses are becoming aware of interventions that can save lives and help caregivers cope more effectively."

Other researchers are developing strategies to support families through the stress of caring for a dying loved one. Faculty members Judith Hupcey and Lisa Kitko look at the experiences of heart patients with a left ventricular assist device (LVAD) and their caregivers during the transition to the terminal phase of heart failure.

"Too often, the needs of the family are not addressed," Penrod says. "We're finding ways for clinicians to understand these needs and provide care to both patient and family across the course of life-limiting illnesses."

In a recently completed study, Assistant Professor Amy Sawyer assessed the risks involved when individuals with sleep apnea do not adhere to prescribed CPAP therapy.

"We're becoming more aware of the devastating effects of sleep disorders and the need to treat them," Penrod notes. "Understanding why many patients choose not to comply with their treatment recommendations is the first step to designing more appropriate treatment."

An Evolving Focus

Nursing research at Penn State has evolved from the program's beginning in 1964, when the Department of Nursing was created. A graduate program was established in 1973 with an emphasis on educating nurses for advanced practice. Soon, however, the emphasis shifted to nursing theory as a basis for practice.

"Historically, this was a time of growth in the nursing field," Penrod says. "Theories were developed to establish the science of nursing on which the discipline is based. So our graduate program began to infuse theory-based practice into education, and even contributed to several prominent nursing theories still in use today -- for example, the Health as Expanding Consciousness theory pioneered by Margaret Newman."

In the 1990s, the then–School of Nursing received its first federally funded research project grant from the National Institute of Nursing Research.

But it was after the arrival of Paula Milone-Nuzzo as dean in the early 2000s that the school's current research direction began to take shape. A project/grants administrator was hired in 2006, and the Center for Nursing Research was officially launched in 2011 under Penrod's leadership.

"Our vibrant research enterprise is part of what attracts quality students and faculty and ultimately improves the care provided to patients in the health care system," Milone-Nuzzo says. "The research conducted by our faculty members makes a significant difference in the lives of people across the life span."

Research support increased steadily. By 2011 Penn State ranked 17th among nursing schools nationwide in funding from the National Institutes of Health -- up from 93rd as recently as 2004. The College of Nursing also receives research funding from the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, and the John A. Hartford Foundation, which funds the Hartford Center of Geriatric Nursing Excellence at Penn State, one of only eight such centers in the nation.

Interdisciplinary Collaboration

Collaboration among disciplines is key to translating research into practice, says Penrod, noting that it takes an average of 17 years for just 14 percent of scientific discoveries to enter day-to-day practice.

"It's crucial that scientists work together to get new knowledge out to clinicians and communities," she says. "Penn State, with faculty and community linkages across the state, is an excellent venue for this."

To this end, the College of Nursing has built partnerships with the University's Clinical and Translational Science Institute (CTSI) to disseminate research more rapidly. In March, the two units introduced a new initiative to expand health research activities to Penn State campuses across the state, creating a community-based research network.

"We want to do research in the communities we serve, because we want to change the quality of our citizens' lives in the direction of greater health and well-being," Milone-Nuzzo says.

"Traditionally, research has been relegated exclusively to tenured research faculty, but that is changing," Penrod explains. "Under the new model, every nurse has a responsibility to become active in research that will change the practice of nursing and improve the health of the nation. Roles will vary, but the responsibility will be shared."

As noted, nursing-related research extends across many academic disciplines at Penn State. Sawyer is working with Vittaldas Prabhu, professor of industrial engineering, to develop a prototype for a "sleep health hub" to collect and analyze real-time data from patients being treated for sleep disorders. Nikki Hill, a Claire M. Fagin Fellow in the Hartford Center, enlisted two Schreyer Scholars from the Department of Computer Science and Engineering to translate her theories on the use of mobile apps to assess mild cognitive impairment into a testable product.

The past 50 years have witnessed tremendous growth and change for Penn State nursing, but as the program enters its second half-century, one thing will remain unchanged, according to Milone-Nuzzo: "The translation of nursing science from the bench to the bedside and, ultimately, to the community will continue to be the hallmark of our research."