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Home > RNJ > 2010 > July/August > The Rehabilitation Nursing Foundation Celebrates 20+ Years of Funded Research

The Rehabilitation Nursing Foundation Celebrates 20+ Years of Funded Research
Linda L. Pierce, PhD CNS RN CRRN FAHA Pamala D. Larsen, PhD RN CRRN FNGNA

The history and trajectory of the Rehabilitation Nursing Foundation (RNF), the research arm of the Association of Rehabilitation Nurses, is presented in this article. From 1988 through 2008, 52 RNF research grants have been awarded to 49 researchers. Since 1995, this research award program has been guided by the Rehabilitation Nursing Research Agenda. Funded studies have varied in focus from pediatrics to geriatrics, to specific chronic conditions, and to administrative and management issues, providing a basis for the development of rehabilitation nursing science. Strategies for successful RNF grant writing are also included in this article.

Florence Nightingale’s research during the 1850s on epidemiology and the detection of contagion marked the beginning of the process of discovery in nursing (Nightingale, 1859/1946). History notwithstanding, rehabilitation nursing research has a short chronology. What is known today as rehabilitation had its roots in the 20th century after World Wars I and II. For the first time, a large proportion of soldiers had survived wars with disabilities and chronic conditions (e.g., amputations and spine and head injuries) and lived into older adulthood. In the first issue of Nursing Research, an article on the adjustment of older adults with chronic illnesses who were receiving home care was published (Mack, 1952). Nearly 10 years elapsed before an article described a study more directly related to rehabilitation nursing; this article discussed the development of an objective measure of decubitus ulcers (Verhonick, 1961). In 1974, the Association of Rehabilitation Nurses (ARN) was founded, and in 1976 the first research article was published in the newly established ARN Journal (now known as Rehabilitation Nursing). The article’s authors, Donahue and Van Deusen (1976), focused on intermittent catheterization in neurogenic bladder rehabilitation. Two other research reports published in the journal that year focused on older adults and institutional care environments (Abdellah & Chow, 1976; Steels, 1976).

An increasing number of rehabilitation nurses have become involved in research. In 1993, of 8,000 ARN members, only 186 (2%) responded to a survey about their involvement in research. Among responding nurses, 41% reported they had no involvement in research (Hoeman, Dayhoff, & Thompson, 1997). In 2005, 30% of 6,000 ARN members (n = 1,701) were contacted by an e-mail survey, and 286 members (17%) responded. Among respondents, 20% reported they were researchers (Jacelon, Pierce, & Buhrer, 2007).

In 2008, 55 authors wrote 17 research-focused articles for Rehabilitation Nursing. This represents a 567% increase in published research (n = 3/17) and a 111% increase in the number of research authors (n = 5/55) in this journal today when compared to its first year of publication.

ARN and Research

ARN’s commitment to nursing research has not wavered since the early days of its history. The research arm of ARN, the Rehabilitation Nursing Institute, was established in 1976 (ARN, 2009a). The name was changed in 1986 to the Rehabilitation Nursing Foundation (RNF). Research is an integral part of ARN’s current strategic plan (ARN, 2009b). ARN’s goal is to be the global leader in building, disseminating, and translating the science of rehabilitation nursing into practice. To help meet that goal, RNF’s purpose is to advance practice by promoting, supporting, conducting, and disseminating research that has the potential to improve the quality of health care for people with disability or chronic illness (ARN, 2009a, 2009b).

RNF’s research grants program was established in 1988. Through this program, RNF has made funding available to both novice and seasoned researchers, totaling $40,000–$50,000 in recent years (ARN, 2009a). Since the RNF grant program’s inception, total monetary funding for research has exceeded $315,000. Table 1 highlights 52 funded research projects conducted by 49 researchers between 1988 and 2008 (ARN, 2009a).

Table 1

Table 1 part 2

The Rehabilitation Nursing Research Agenda

Since the mid 1990s, RNF research grant recipients’ studies have reflected the identified priorities of the Rehabilitation Nursing Research Agenda (RNRA; ARN, 2009a). In 1993, the RNF, under the direction of ARN, initiated a 2-year process to develop an agenda that identified the focus of rehabilitation nursing research (Gorden, Sawin, & Basta, 1996). Through a combination of quantitative (survey) and qualitative (focus group) research methods, Gorden and colleagues developed the RNRA, which outlined the critical issues to be studied to advance rehabilitation nursing practice. The broad range of issues, described by 25 clinical priorities and 20 contextual statements, was synthesized into five categories or areas. The categories included (1) nursing interventions, including management of symptoms to promote function in people with chronic illness and physical disability; (2) health promotion and prevention strategies to facilitate self-care and independence for people with or at risk for physical disability and chronic illness; (3) rehabilitation practices in the changing healthcare system; (4) community context of care for people with or at risk for physical disability or chronic illness to enhance quality of life; and (5) outcomes and costs influenced by rehabilitation nurses in multidisciplinary settings and across the continuum of care.

The RNF evaluated and revised the RNRA in 2005. The evaluation and revision process was described in detail in two articles by Jacelon, Pierce, and Buhrer (2006, 2007). To summarize the process, the Cumulative Index to Nursing and Allied Health Literature database from January 1995 and December 2004 was searched for publications identified as research in ARN’s two journals, Rehabilitation Nursing and Rehabilitation Nursing Research (which ceased publication in 1996). The search identified 203 research articles in these journals that disseminated the findings of a variety of research endeavors and supported the RNRA. Another part of this evaluation process revealed that RNF grant recipients had published their studies in a variety of nursing and interdisciplinary journals including Cancer; Cancer Practice: A Multidisciplinary Journal of Cancer Care; Cancer Nursing; Journal of Christian Nursing; Journal of Cultural Diversity; Journal of Neuroscience Nursing; Journal of Nursing Scholarship; Nursing Research; Oncology Nursing Forum; Qualitative Health Research; Research in Nursing & Health; Topics in Stroke Rehabilitation; and Western Journal of Nursing Research (Jacelon et al., 2006).

The revised 2005 RNRA (Table 2) consists of 19 statements of research priorities grouped into four categories: nursing and nursing-led interdisciplinary interventions to promote function in people of all ages with disability and/or chronic health problems, experience of disability and/or chronic health problems for individuals and families across the lifespan, rehabilitation in the changing healthcare system, and the rehabilitation nursing profession (ARN, 2005). This agenda, widely disseminated both within ARN and throughout the nursing and rehabilitation professions, will drive rehabilitation nursing research for the next 10 years (Jacelon et al., 2007).

Table 2

Opportunities for RNF Funding

RNF encourages nurse researchers to consider the RNRA when planning their research activities. Quantitative or qualitative research proposals that address clinical practice or educational or administrative dimensions of rehabilitation nursing are accepted for review for RNF grants. The principal investigator for the research project must be a registered nurse who is active in rehabilitation or who demonstrates interest in or has made significant contributions to rehabilitation nursing. Membership in ARN is not required, and graduate student researchers are eligible for funding (ARN, 2009a).

RNF offers $30,000 in the form of three research grants. The New Investigator Grant provides up to $10,000 for projects by nurses who are novice researchers. Up to two grants are awarded to recipients who are designated RNF Research Fellows. Research Fellows are more established researchers who are on a path to establish or expand a line of research. These Fellows are encouraged to serve as mentors to novice researchers by participating in research consultation sessions for interested researchers at the annual ARN conference and by serving as Web-based consultants listed on the research section of the ARN Web site (ARN, 2009a).

RNF’s history of awarding corporate-funded grants began in 2000 with Aventis (formerly known as Rhone-Poulenc Rorer Pharmaceuticals) and in 2001 with Mentor Corporation. Aventis pledged $20,000 and Mentor Corporation pledged $15,000 annually for 3 years of grant funding. With corporation reorganizations and mergers, these grants ceased to exist after 2004 and 2003, respectively (K. Nason, personal communication, January 29, 2009).

RNF currently cosponsors two grants with other professional nursing organizations. Established in 1998, the Sigma Theta Tau International/RNF grant offers $4,500 for one nursing research project related to rehabilitation nursing. The principal investigator for this grant must have a master of science degree in nursing. Launched in 2009, the Oncology Nursing Society Foundation/RNF grant provides $10,000 for one research project that advances rehabilitation nursing for patients with cancer (ARN 2009a).

All research proposals are reviewed by members of the ARN Research Grant Committee and members of an appointed peer-review panel that assists the committee. Proposals are rated according to predetermined weighted criteria established by the committee that follow published guidelines for proposal submission. Upon this review, the Research Grant Committee chair recommends the proposals selected to receive funding to the RNF Board of Trustees (ARN, 2009a).

Grant-Writing Strategies

RNF’s strategies for success in writing grant applications (“Tips: Guide to Writing a Research Proposal”) are posted on the ARN Web site at www.rehabnurse.org/pdf/RNFTips.pdf. People with little or no experience writing research proposals, as well as seasoned researchers, may find these tips helpful in preparing the RNF grant application. In Section 1 of this document, strategies for success include questions for researchers to consider when preparing the application. Questions include (1) What do you want to do, how much will it cost, and how much time will it take? (2) How does your proposed study relate to the RNRA? (3) What has already been done in the topic area of your study? and (4) Why should you, rather than someone else, pursue this research study? Section 2 contains an outline and explanation for parts of a research proposal from cover page and abstract through methods, budget, and appendices for consent forms and measurement instruments. Numerous strategies are discussed in Section 3 to deal with short application deadlines. One strategy is to pay special attention to the abstract, because it provides initial information about a study that reviewers read and it must capture their attention. Common reasons for proposal rejection are highlighted in Section 4. Assuming that funds are available, the success of the RNF proposal will depend on the quality of the study itself and its presentation in the proposal. In Section 5, other proposal development tools are listed, including Web pages such as Writing a Grant Proposal from the Center for Participatory Change (www.cpcwnc.org/Toolbox/writinggrants.html) and the Guide for Proposal Writing from the National Science Foundation (www.nsf.gov/publications/pub_summ.jsp?ods_key=nsf04016; ARN, 2009a). The RNF grant program is competitive, and this guide represents just one strategy for preparing a research proposal.

When writing grant applications, researchers also may benefit by consulting professional colleagues who are knowledgeable in funded research processes. Members of the ARN Research Special Interest Group, university faculty colleagues, directors of research, or members of grant departments may provide direction in grant writing. In addition, the ARN Web site includes a list of researchers who have received the RNF Research Fellow award. These rehabilitation nurses, with their research focus and research methods identified, are available to answer general research proposal questions by electronic mail. In addition, at the annual ARN educational conference, RNF representatives are available to discuss areas of research interest and procedures for the application process. Also, a staff member at the ARN office is available to answer questions related to the application process and review deadlines for the application (ARN, 2009a). Valuable assistance in substantive and administrative matters related to grant applications is available.

From Novice to Expert Researchers

Rehabilitation nurses are making progress toward recognition as nurse scientists who focus on areas of identified research within clinical, educational, or administrative dimensions of practice (Table 1). Mary Catherine Gebhardt, PhD, serves as one example of a novice researcher funded by RNF. Gebhardt, a certified rehabilitation registered nurse (CRRN) and an assistant professor at Georgia State University, examined the perceptions of recovery from acquired brain injury using qualitative methodology. Her 2006 RNF-funded project as a new investigator looked at the hopes and expectations of caregivers who care for those with acquired brain injury. This project built upon her previous work examining rehabilitation nurses who provide spiritual care as part of holistic care (M. C. Gebhardt, personal communication, April 6, 2009).

Cynthia Jacelon, PhD, is an associate professor at the School of Nursing, University of Massachusetts, Amherst, MA. She is a CRRN whose research areas include dignity, functional ability, and chronic diseases of older adults. Jacelon received funding from the joint Sigma Theta Tau International/RNF Award. Her qualitative work, through participant diaries and unstructured interviews, identified themes in the daily lives of community-dwelling older adults with chronic health problems. As these older adults tried to maintain balance between their health, activity, attitude, autonomy, and relationships, different client strategies were used, which Jacelon identified in her work. This study continued her previous research on the dignity and integrity of older adults (C. Jacelon, personal communication, April 6, 2009).

Well-funded and published researchers have had early beginnings with RNF-funded grants. Two stellar researchers with early initial RNF awards include Alexa Stuifbergen, PhD RN FAAN, and Kathleen Sawin, DNS CPNP FAAN. Stuifbergen, associate dean for research and professor at the University of Texas–Austin, School of Nursing, has been involved in research related to health promotion for people with disabilities for more than 20 years. Her grants and research projects studying health promotion in adults with chronic disabling conditions (multiple sclerosis, postpolio syndrome, and fibromyalgia) have been funded for more than $9.4 million by the National Institute of Nursing Research, the Center for Medical Rehabilitation Research, the National Institute of Child Health and Human Development, and the Office of Research on Women’s Health at the National Institutes of Health (A. Stuifbergen, personal communication, April 6, 2009). Stuifbergen received an RNF New Investigator Grant in 1989 for her study “Health-Promoting Knowledge, Attitudes, and Behaviors of Adults with Disabilities.”

Sawinis professor and joint research chair in the nursing of children, Children’s Hospital of Wisconsin and University of Wisconsin-Milwaukee College of Nursing. Sawin has a particular interest in adolescents, women with disabilities, and the transition to young adulthood for those with chronic conditions. Her research has addressed health, adaptation, self-management, and quality-of-life outcomes in those with disabilities and their families as well as the risk and protective factors (individual, family, and environmental) associated with these outcomes. Her studies have investigated adolescents and young adults with spina bifida, spinal-cord injury, diabetes, cancer, and epilepsy as well as young-adult women with cerebral palsy and spinal-cord injury (K. Sawin, personal communication, April 6, 2009). Sawin received an RNF New Investigator Award in 1988 for her study “Developmental Competence in Adolescents with an Acquired Disability.”

Conclusion

The science of rehabilitation nursing is growing with the assistance of RNF funding and the RNRA. The four high-priority research areas of this agenda provide guidelines to researchers. Although one area of this agenda does not take precedence over another, the ARN-envisioned strategic goal is “to reshape health care by integrating rehabilitation nursing concepts into care for all people” (ARN, 2009b). It makes sense to designate the third priority area from the RNRA, “rehabilitation in the changing healthcare system” (ARN, 2009a), as high priority, particularly as the current healthcare system undergoes change.

Through funding from RNF for the past 20+ years, both new and seasoned researchers have been able to add to nursing science through publications and presentations of their research that expand nursing knowledge. Let’s celebrate the past work of our funded researchers and look to the future for continued advancement of rehabilitation nursing knowledge.

About the Authors

Linda L. Pierce, PhD CNS RN CRRN FAHA, is a professor at University of Toledo in Toledo, OH. She also was Rehabilitation Nursing Foundation Chair between 2006 and 2008. Address correspondence to her at l.pierce@utoledo.edu.

Pamala D. Larsen, PhD RN CRRN FNGNA, is an associate dean and professor at Fay W. Whitney School of Nursing, University of Wyoming, in Laramie, WY, and is 2008–2010 Rehabilitation Nursing Foundation Chair. Address correspondence to her at plarsen3@ix.netcom.com.

References

Abdellah, F., & Chow, R. (1976). The long-term care facility improvement campaign: The PACE Project. ARN Journal, 1(6), 3–4.

Association of Rehabilitation Nurses. (2005). The rehabilitation nursing research agenda. Retrieved January 28, 2009, from www.rehabnurse.org/research/researchagenda.html.

Association of Rehabilitation Nurses. (2009a). Research. Retrieved January 28, 2009, from www.rehabnurse.org.

Association of Rehabilitation Nurses. (2009b). Strategic plan. Retrieved June 2, 2009, from www.rehabnurse.org/about/vision.html.

Donahue, P., & Van Deusen, A. (1976). Intermittent catheterization in neurogenic bladder rehabilitation. ARN Journal, 1(2), 8–11.

Gorden, D. L., Sawin, K. J., & Basta, S. M. (1996). Developing research priorities for rehabilitation nursing. Rehabilitation Nursing Research, 5(2), 60–66.

Hoeman, S. P., Dayhoff, N. E., & Thompson, T. C. (1993). The initial RNF research survey: Rehabilitation nursing research interests of ARN members. Rehabilitation Nursing, 18(1), 40–42.

Jacelon, C., Pierce, L., & Buhrer, R. (2006). Evaluation of the research agenda for rehabilitation nursing. Rehabilitation Nursing, 31(6), 242–248.

Jacelon, C., Pierce, L., & Buhrer, R. (2007). Revision of the rehabilitation nursing research agenda. Rehabilitation Nursing, 32(1), 23–30.

Mack, M. J. (1952). The personal adjustment of chronically ill old people under home care. Nursing Research, 1(1), 9–31.

Nightingale, F. (1859/1946). Notes on nursing: What it is and what it is not. Philadelphia: Lippincott.

Steels, M. M. (1976). Perceptual style and the adaptation of the aged to the hospital environment. ARN Journal, 1(5), 9–14.

Verhonick, P. J. (1961). Decubitus ulcer observations measured objectively. Nursing Research, 10, 211–218.