Advancing the NIH Strategic Plan and Health Care Needs During the COVID-19 Pandemic



## Advancing the nih strategic plan and health care
Needs During the COVID-19 Pandemic Congress passed and the President signed the 2020 Coronavirus Aid, Relief, and the Economic Security (CARES) Act on March 27, incorporating several public health provisions, including $945 million for the National Institutes of Health (NIH). In the midst of a pandemic, resources must be mobilized quickly and effectively to help save lives. The race to develop therapeutics and a vaccine for COVID-19 and provide support to survivors to live with the potential long-term health consequences requires research and infrastructure. Nurses play critical roles in advancing public health in terms of disease prevention and wellness, supporting people through acute illness, managing long-term chronic consequences, addressing health inequities, and providing palliative care. Nowhere are these needs more evident than in the many health concerns that are emerging in the COVID-19 pandemic being experienced by diverse people across the lifespan and the world. As nurse scientists, we will continue to leverage our scientific knowledge and expertise to address these and other needs as they emerge.
In these uncertain times, science and facts must drive health care practice and policy, to include the care that nurses provide. The Council for Advancement of Nursing Science (CANS), dedicated to promoting better health through nursing science, is a national voice for nursing science that leverages the many strengths of our members to guide the work of our discipline and health policy, in collaboration with the American Academy of Nursing. Our work was recently exemplified in our response to a Request for Information (RFI) from the National Institutes of Health (NIH), seeking feedback on the proposed framework for the NIH-Wide Strategic Plan for Fiscal Years (FYs) 2021-2025.
The NIH Strategic Plan, approved by Congress every five years, is designed to guide how the NIH will "advance its mission to support research in pursuit of fundamental knowledge about the nature and behavior of living systems, and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability" (National Institute of Health, 2015). The NIH RFI sought feedback on the framework for the strategic plan including cross-cutting themes and overarching objectives. CANS and the Academy acted swiftly and decisively to prepare comments that directly relate to several of the current challenges with COVID-19, as well as the many other health challenges facing society.
We convened a series of calls and email communications with CANS leaders and experts, including myself; Robin Dail, PhD, RN, FAAN; Holli DeVon, PhD, RN, FAHA, FAAN; Ann Marie McCarthy, PhD, RN, FAAN; Rita Pickler, PhD, RN, PNP, APRN-BC, FAAN; Susan Rawl, PhD, RN, FAAN; and Therese Richmond, PhD, CRNP, FAAN, to evaluate the strategic plan draft and consider ways to bolster it to assure that it maximized its impact on the health of the population. We prepared and submitted our response with the collaboration of the Academy senior staff and board members. Our group of senior scientists reviewed the proposed cross-cutting themes included in the NIH framework: "Optimizing Data Science and the Development of Technologies and Tools." To safeguard our future, the wellness and safety of every individual, in any location, during all health stages is foundational. Innovation and emerging practices must be tested and advanced for heightened impact and improved outcomes.
[formula] Increasing [/formula]
To help increase the impact of the plan, we made two recommendations related to the cross-cutting themes:
Health equity, and the incredible impact of improving it for the nation, should be added as its own crosscutting theme. Increased access to not only health services, but also all the factors that affect the social determinants of health, will improve the health of a nation as a whole. This language is also in line with that used in the Healthy People 2030 Guidelines.
The framework also addresses the overarching objectives to guide NIH's work for the next five years. We recommended amending the following: We also requested that NIH provide some clarifying language around the word "cultivating." Like much of the scientific community, CANS has been monitoring and sharing concerns about the slow growth in the research workforce. This is a particular issue for the preparation of nurses with research doctorates and the diversity represented within, especially since individuals from diverse backgrounds represent the fastest growing group of the US population. In addressing this objective, we requested clarification about whether partnerships referred specifically, to NIH partnerships or external opportunities? We also suggested the need to address the areas of ethics, accountability, and the regulatory burdens faced by scientists.
In addition, we suggested more collaboration between the institutes at NIH and between the intraand extramural programs to avoid duplication in research areas and facilitate team science. Ways to promote public engagement in setting research priorities and in research itself should also be investigated.
The process of refining the NIH strategic plan will ultimately include the input of many stakeholders. As we await the final document, there are numerous innovations and research needs that are emerging and will require further study, especially as they pertain to the COVID-19 pandemic. The most obvious and acute need is for an effective vaccine and curative treatments. However, there are many other areas that are emerging and will likely be the focus of future research to inform practice and policy, to include research conducted by nurse scientists. Some examples are listed below. These are by no means meant to be exhaustive:
The COVID-19 pandemic has led to widespread use of telehealth due to the loosening of regulatory restrictions that help protect frontline healthcare providers, as well as patients, during emergencies (Centers for Medicare and Medicaid Services, 2020). However, much remains to be known about best practices and outcomes of this innovation in diverse populations with varying health care needs and differing levels of access to technology. Emerging evidence suggests that the COVID-19 pandemic disproportionately affects low income and minority group members. There is a need to better understand the social determinants for this inequity and to study ways to improve community health and policy to address this problem now and in the future. The shortage of personal protective equipment (PPE) is leading to the need for improved understanding of potential ways for recycling PPE (or new forms of PPE) to ensure the safety of health care providers and our patients. Emerging reports suggest that, similar to other survivors of critical illness, COVID-19 survivors who require critical care may have long term needs for rehabilitation, extending well beyond the acute care period. There is a need to know who is at highest risk for negative long-term outcomes, the nature and duration of these needs, and best ways to address them. Palliative care is a critically important service for people who are dying. The pandemic has been especially challenging, given the large number of people in need. Yet, the risk of infection has limited the ability of families to be present at the bedside. There is a need to evaluate the impact of this practice and ways to anticipate and address this problem in the future. Anxiety, trauma symptoms, and social isolation are increasingly common as the pandemic progresses. Research is needed to understand the trajectory and risk factors for these problems and ways to prevent long term negative health outcomes.
Nurses play a vital role in addressing health care needs and in developing health care innovations. In the spring of 1918, when the Spanish Flu (H1N1) first appeared in the United States, the country's nursing resources were already spread thin due to deployments associated with World War I. Despite these shortages, "excellent nursing care was the primary treatment for influenza. The disease was not well understood, and there were no antiviral medications to inhibit its progression or antibiotics to treat the complicating pneumonia that often followed" [bib_ref] Alert to the Necessities of the Emergency": U.S. Nursing during the 1918..., Keeling [/bib_ref]. As was the case 100 years ago, today we see our nurse colleagues stepping up to the challenge to serve our patients and protect the health of our nation.
As scientists, we know that nursing and health care, when supported by nursing science, make a tremendous impact on the health of the public. We look forward to seeing the 2021 NIH Strategic Plan and contributing to the important scientific work of advancing the health of individuals, families, communities, and society through the COVID-19 pandemic and beyond.
[table] Objective 3: Exemplifying and Promoting the Highest Level of Scientific Integrity, Public Accountability, and Social Responsibility in the Conduct of Science [/table]