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NNRA PROCESS 

The mandate of the National Center for Nursing Research (NCNR) -- to advance nursing care by 

building a strong scientific base for nursing practice--fits well with the mission of the National 

Institutes of Health (NIH) to improve the health of the people of the United States through research. 

In 1986, when the NCNR was a new component of the NIH, the highest priority was to establish the 

organization. Once the NCNR was firmly established, the development of a long-range plan to guide 

allocation of resources became paramount. 

The National Nursing Research Agenda (NNRA) is the priority-setting component of NCNR's longrange planning effort, but priorities also result from recommendations from other sources. For 

example, the priority area "Nursing Resources and the Quality of Patient Care" was the result of a 

congressional mandate in response to the acute nursing shortage in the United States. Another area of 

special interest, bioethics, answered a need perceived by NCNR and NIH staff. In that case, the 

NCNR invited a small interdisciplinary group of experts in bioethics to a workshop. This workshop 

resulted in a report (NCNR, 1990a) upon which a small program in bioethics and clinical decision 

making is now based. However, this series of NNRA reports addresses only the priorities identified 

through the NNRA. 

Planning is vitally important not only in the development of NCNR's programs, and in the optimal 

allocation of its resources, but also in ensuring that NCNR's programs are in harmony with the 

mission, programs, and planning process of the NIH and the United States Public Health Service 

(USPHS). 

The objectives of the NNRA are to: 

z Provide structure for selecting scientific opportunities and initiatives. 

z Promote depth in developing a knowledge base for nursing practice. 

z Provide direction for nursing research within the discipline. 

The process used by the NCNR is modeled on the five-year planning effort of the National Eye 

Institute (NEI), which, in the early 1980s, brought together a number of expert panels to address 

research needs and opportunities related to eye diseases (National Eye Institute, 1983). 

Collaboration 

The process used for development of the NNRA requires collaboration between the NCNR and three 

groups: the National Advisory Council for Nursing Research (NACNR); the nursing research 

community; and members of other disciplines both within and outside of NIH and USPHS. 

The National Advisory Council for Nursing Research (NACNR) 

The NACNR participates in the NNRA largely through its NNRA Subcommittee. That subcommittee 

was established by the NCNR Director in September 1987 to provide policy direction to all efforts 

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addressed under the auspices of the NNRA. The subcommittee is co-chaired by the Director of the 

NCNR and a nurse member of the NACNR, and its members are drawn from both the senior NCNR 

staff and the members of the NACNR. This innovative committee structure expresses NCNR's 

philosophy of collaboration, symbolizing a partnership between the NCNR and its constituencies. 

The Nursing Research Community 

NCNR's philosophy is that the nursing research community must have primary responsibility for the 

defining of priorities in nursing science. This collaboration has taken three forms: 

z In the very early stages of NNRA development, the literature was reviewed to assess prioritysetting efforts by nursing organizations in the United States. This review resulted in a paper 

called "A Working Paper on Nursing Research Priorities" (NCNR, 1988a). In addition, general 

and specialized nursing organizations were asked about any priority-setting work they had done 

that had not yet been published. The 10 new responses to this request resulted in a companion 

working paper, entitled "Update to the Working Paper on Nursing Research Priorities" (NCNR, 

1988b). These two papers were used as background information for NNRA participants. A third 

paper in this series, based on more recent information from nursing organizations, is in 

progress. 

z In January 1988, the NCNR convened a two-day invitational conference, entitled "Conference 

on Research Priorities in Nursing Science (CORP)," to broadly delineate nursing research 

priorities for the NCNR. Approximately 50 nurse scientists with research expertise related to a 

broad array of nursing practice specialties participated in this conference, which is discussed in 

more detail below. 

z Each priority area recommended by the CORP participants and finalized by the NNRA 

Subcommittee is refined by a "Priority Expert Panel" (PEP), a group of nurse and non-nurse 

scientists. The work of the panels is also discussed below. 

Non-Nurse Scientists 

Non-nurse scientists play a significant role in the development of the NNRA. Some who are members 

of the NACNR participate by virtue of their membership in the NACNR and/or in its NNRA 

Subcommittee. Others who are scientists in areas of NCNR priorities participate as full-fledged 

members of PEPs, which play a vital role in the development of the NNRA. 

The Process of NNRA Development 

The NNRA encompasses a number of components, most notably the Conferences on Research 

Priorities in Nursing Science (CORP) and the Priority Expert Panels (PEPs). 

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Conference on Research Priorities (CORP) 

The first CORP, which took place on January 27-29, 1988, in Bethesda, Maryland, marked the formal 

beginning of NNRA development. Its purpose was to delineate the broad nursing research priority 

areas for the NNRA. Approximately 50 nurse scientists with different areas of expertise participated. 

Participants were keenly aware of the historic importance of the task they were chosen to carry out, 

and their excitement about the challenge was palpable. 

The conference began with a plenary session. Dr. Kathryn Barnard, a nurse scientist from the 

University of Washington, presented a paper entitled "Nursing Research Priorities: Today and 

Tomorrow," and Dr. David Evans, Professor in the Departments of Philosophy and Computer Science 

at Carnegie Mellon University, addressed the group about "Alternative Models for the Organization of

Knowledge." In the following days, the conferees met in working groups to delineate the major 

priority areas in nursing science. 

Participants were asked to choose priorities on the basis of a set of criteria developed by the NNRA 

Subcommittee. A priority area should: 

z Be on the cutting edge of science. 

z Have high potential for nursing research to influence/resolve a health care or systems problem 

or phenomenon. 

z Represent a major current and/or future societal need. 

z Represent a costly health care burden for patients and/or the delivery system. 

In delineating priorities, participants were asked to consider a number of dimensions, such as: the 

population group; individual, family, or community focus; biomedical and behavioral parameters; and 

the availability of nurse scientists to do the research. 

To develop the priorities, the 50 nurse scientists were first divided into eight homogeneous working 

groups: two each for acute illness, chronic illness, health promotion/disease prevention, and nursing 

systems. Participants were then divided into eight heterogeneous cross-content groups whose task 

was to make choices among, and/or synthesize the priorities identified by the homogenous groups. 

Tough choices, based on where nursing can make the strongest contribution to the health care needs 

of society, had to be made to arrive at the most critical areas of research to be developed first. To 

develop the recommendations further, the groups met again in homogeneous and then again in 

heterogeneous groups. In between, an all-participant session allowed groups to report the findings to 

the total conference. The conference ended with each group presenting their major priorities for 

nursing research to the assembled participants. The resulting material served as the raw data on which 

further refinement was based. 

Final Delineation of Priorities. Final delineation of the priorities was accomplished by the NNRA 

Subcommittee in February 1988. Subcommittee members used the priority information provided by 

the CORP groups to analyze, synthesize, and distill the CORP's broad priorities into a set of more 

specific priority statements. A dilemma was that the set of priorities could not, of course, encompass 

the total scope of nursing research. 

The NNRA Subcommittee used a set of criteria for selecting and focusing the priority areas: 

z Existing knowledge base/scientific development. 

z Points of opportunity (influence due to access/ control). 

z Value to society. 

z Potential cost savings. 

z Scientific personnel available. 

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z Areas of low emphasis by other NIH institutes. 

Seven priority areas that were in harmony with the NIH and USPHS missions emerged (Hinshaw, 

Heinrich, & Bloch, 1988). The wording of the priorities has undergone some refinement since their 

publication in the 1988 editorial. The list presented here is a more recent version (NCNR, 1991). This 

set of priorities was approved for further development and implementation at the June 1988 meeting 

of the NACNR. 

z Low Birthweight: Mothers and Infants. Research related to: preconceptional and prenatal 

nursing care, with a focus on pre-venting the delivery of preterm or growth-retarded infants; 

care of low birthweight infants in the acute care setting, with a focus on prevention of 

complications; and models of care delivery after discharge from the institution. 

z HIV Infection: Prevention and Care. Study of: ethical issues; prevention of transmission; 

physiological and psychosocial factors; and issues relating to delivery of care to people with 

HIV infection or AIDS. 

z Long-term Care for Older Adults. Research focuses on both the older adult and the family, and 

includes: clinical problems encountered in the long-term care of older adults in institutions or in 

the community, and issues related to the delivery of long-term care services, such as continuity 

of care and transitions across clinical settings. 

z Symptom Management: Pain. Research concentrates on the development of effective 

assessment measures and intervention strate-gies for pain and other symptoms associated with 

acute and chronic illness, with an emphasis on bio-psycho-social parameters. 

z Nursing Informatics: Enhancing Patient Care. This area of research is designed to strengthen 

patient care. Priorities will be selected from research into the collection, organization, 

processing, and dissemination of information for clinical practice, including the design and 

development of databases, classification systems, computer models, and expert systems. 

z Health Promotion for Older Children and Adolescents. This area focuses on under-standing 

health behaviors in childhood and adolescence, a critical developmental period, and on testing 

theory-based interventions to facilitate health-enhancing behavior patterns and to reduce healthcompromising ones. 

z Technology Dependency across the Life-span. This research addresses technology used to 

support or replace lost function of body organs or systems when technology is an essential 

element in the treatment of chronic disease. Included are the study of individual and family 

responses, prevention of complications, bioethical issues, and demand for resources. 

Priority Expert Panels (PEPs) 

Although the NNRA Subcommittee delineated these seven broad priority areas using the CORP data, 

the responsibility to refine them is in the hands of multidisciplinary panels of scientists formed around 

each priority area. They are called "Priority Expert Panels" or "PEPs." Through this very concentrated 

effort, the nursing research community, along with colleagues from related disciplines, takes major 

responsibility to recommend very specific priorities for NCNR funding. 

Participants. The multidisciplinary nature of the PEPs is integral to the NCNR's philosophy to build 

collaborative relationships across NIH and the broad scientific community. Each PEP is composed of 

approximately seven senior nurse scientists and three senior scientists from disciplines related to the 

area under consideration. In addition, PEPs generally include a member of the National Advisory 

Council for Nursing Research, at least two NCNR staff members, representatives from other 

government agencies with related interests who serve as consultants and collaborators, and 

consultants from the public and private sector, as needed. 

As an example, the PEP entitled "HIV Infection--Prevention and Care" included six nurse scientists, 

one of whom served as chairperson; two physicians; one nurse scientist from the NACNR; four 

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NCNR intramural and extramural staff members; and one staff representative from each of the 

following five USPHS research programs: National Institute of Allergy and Infectious Diseases, NIH; 

National Institute of Child Health and Human Development, NIH; National Institute of Mental Health 

in the Alcohol, Drug Abuse, and Mental Health Administration; Centers for Disease Control; and 

Agency for Health Care Policy and Research. In addition, the PEP used eight consultants, of whom 

seven were nurse scientists and one was a staff member of the Office for Protection from Research 

Risks at NIH (NCNR, 1990b). 

Process. The general pattern of the PEP process has been for PEPs to meet three or four times over 

the span of a year or two to: assess, critique, and report the state of the science in the PEP's area of 

interest; delineate the gaps in the research base and note the research needs and opportunities; and 

make recommendations for specific priority areas for NCNR research and research training funding. 

The work of the PEPs is both time-consuming and demanding. It is time-consuming largely because 

the report must be drafted and redrafted between meetings. It is demanding because PEP members 

encounter many challenges. For example, they must survey the multidisciplinary state of the science 

in fields as extensive as low birthweight or long-term care, and they must narrow the focus to areas 

where nursing research can make the most significant and possibly a unique contribution. Further, 

making choices among multiple, favored, and competing areas of nursing research interest is difficult 

for a group, but that is the crux of the priority-setting process. If a PEP's recommendations were so 

broad as to encompass all possible research endeavors in its area, the purpose of the undertaking, 

namely the development of depth in science, would not be accomplished. 

To assist the PEPs to make such choices, the NCNR staff reviewed and expanded the criteria used for 

the CORP participants, as follows: 

z An area that represents a major current or future health care need. 

z An area on the cutting edge of science, with potential to contribute significantly to the 

development of new knowledge. 

z An area that constitutes an opportunity for nursing to make a unique contribution to basic 

research, or an area which constitutes a unique opportunity for nursing practice research 

because the knowledge base is adequate. 

z An area with potential for nursing research to make a unique contribution in the resolution of a 

health care or system problem or phenomenon. 

z An area that represents a costly health care burden for patients and/or the delivery system, with 

potential for health care cost savings. 

z An area in which an adequate number of nurse scientists is available, or which is promising for 

training. 

z An area of concern to nursing that receives minimal attention from other NIH components or 

other Department of Health and Human Services agencies. 

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Six of the seven projected panels have been convened to date. Although a tremendous amount of 

effort on the part of panel members and NCNR staff charged with guiding the priority setting 

enterprise is required, both PEP members and staff have noted the excitement and challenge of this 

endeavor. One panel report has been published (NCNR, 1990b), and the rest are in various stages of 

development. 

Summary 

Setting priorities for nursing research is not a new idea in nursing. For example, Oberst published 

priorities in cancer nursing research as early as 1978 (Oberst, 1978). It is, however, the first time that 

the Federal Government has proposed and implemented priorities for nursing research funding. 

The recommendations of the first PEP panels have already formed the basis of requests for 

applications (RFAs) and program announcements (PAs), focusing the use of a portion of NCNR funds 

on specific priority areas. The recommendations have also been used by the NCNR staff to identify 

opportunities for joint initiatives with other NIH institutes and centers to expand funding and 

collaborative opportunities. They have also been applied within NCNR's intramural program. The 

remaining resources are allocated flexibly to support investigator-initiated projects and projects 

related to emerging societal needs. 

A timetable has been developed by the NNRA Subcommittee to phase in priorities over several years. 

This timetable has been disseminated to the nurse scientist community through publications, speeches, 

and consultation. 

References 

Hinshaw, A.S., Heinrich, J., & Bloch, D. (1988). 

Evolving clinical nursing research priorities: A national 

endeavor. Journal of Professional Nursing, 4(6), 398, 

458-459. 

National Center for Nursing Research (NCNR). (1988a). 

A working paper on nursing research priorities. 

(Unpublished paper available from the NCNR, NIH, 

Building 31, Room 5B03, Bethesda, MD 20892, USA). 

National Center for Nursing Research (NCNR). (1988b). 

Update to the working paper on nursing research 

priorities. (Unpublished paper available from the NCNR, 

NIH, Building 31, Room 5B03, Bethesda, MD 20892, 

USA). 

National Center for Nursing Research (NCNR). (1990a). 

Bioethics and clinical practice: Examining research 

outcomes and methods. Proceedings of an invitational 

workshop. Bethesda, MD: National Center for Nursing Research, National Institutes of Health, U.S. 

Public Health Service, U.S. Department of Health and Human Services. 

National Center for Nursing Research (NCNR). (1990b). HIV infection: Prevention and care

(National Nursing Research Agenda: Volume 2). (NIH Publication No. 90-2417). Bethesda, MD: 

National Institutes of Health, U.S. Public Health Service, U.S. Department of Health and Human 

Services. 

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National Center for Nursing Research (NCNR). (1991). National Nursing Research Agenda. 

(Unpublished document available from the NCNR, NIH, Building 31, Room 5B03, Bethesda, MD 

20892, USA). 

National Eye Institute. (1983). Vision research: A national plan--1983-1987 (NIH Publication Nos. 

83-2469 to 83-2476). Bethesda, MD: National Eye Institute, National Institutes of Health. 

Oberst, M.T. (1978). Priorities in cancer nursing research. Cancer Nursing, 1(4), 281-290. 

 

TABLE OF CONTENTS CHAPTER 3

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