Year: 2022
Type: article
Abstract: As nurse scientists, we often get asked what our work has to do with nursing. Through this editorial, we are hoping to highlight the links between science and nursing, to show how our work directly relates to nursing, and to attract others with an interest in science in nursing. Personalized care is foundational to the art and science of nursing education, research and practice. Traditionally, nursing care is guided by the utilization of theoretical frameworks situated in the metaparadigms of nursing, person, health and environment (Fawcett, 1984). Nursing constitutes the actions, characteristics and attributes of the nurse to promote, maintain and restore the person's health. A person (patient) can represent the individual, family or community who are the recipients of nursing-based care. Health is the person's experience of wellness and well-being. Environment is the internal and external surroundings that influence the person (Fawcett, 1984). While the person's behavioural, biological and genetic traits in motion with the environment can influence overall well-being, the delivery of nursing-based care is essential in optimizing the health of the person. Thus, the art of nursing incorporates caring, creativity and intuitiveness in promoting, maintaining and restoring health (Peplau, 1988; Vega & Hayes, 2019). Whereas the science of nursing integrates systematic evidence through utilizing a variety of scientific approaches to answer important research questions that address existing knowledge gaps in our understanding of how to meet the health needs of the person (Peplau, 1988; Vega & Hayes, 2019). Health is multidimensional and consists of complex biobehavioral interactions which are influenced by the individual and environmental factors (Kang et al., 2010). Nurses are at the forefront of health care delivery and routinely address the health needs of patients. Thus, nursing research has been focused on comprehensive aspects that influence health and disease. Biobehavioral research is centred on exploring links among psychosocial, behavioural and biological factors in relation to health and health-related outcomes (Greenberger et al., 2007). Biological responses typically function as a mediator across various psychosocial, behavioural and environmental factors on health outcomes (Kang et al., 2010). For instance, exercise and nutrition are behavioural factors, which could be investigated on individual and interactive effects on health outcomes using a biobehavioral approach including the examination of important biomarkers. A biomarker is defined as characteristic that is measured as an indicator of normal biological processes, pathogenic processes or responses to an exposure or intervention, including therapeutic interventions (Biomarkers Definition Working Group, 2001). The types of biomarkers include molecular, histologic, radiographic or physiologic characteristics, which can be found in blood, tissue, saliva and other body fluids. Biomarkers are used for several purposes such as diagnostic detectors of disease and prognostic indicators to assess a person's response to treatment or intervention, or to elucidate potential mechanisms underlying factors of interest (Califf, 2018; Kang et al., 2010). Through biobehavioral research, the most sensitive and specific biomarkers can be identified in relation to the health outcome, which supports the development and evaluation of targeted interventions and personalized care. Therefore, the integration of biomarkers into nursing research and practice can advance nursing science. Basic science, also known as “fundamental science,” provides the essential building blocks to understand biological processes of living systems in relationship to health, disease, treatment and prevention (National Institute of General Medical Sciences, 2020). The nursing discipline is grounded in basic science principles that support the delivery of nursing-focused interventions (i.e., symptom management, nutrition, wound healing, restored mobility) to the person at the bedside and chairside across various health care settings. Over the past several decades, nursing science has begun to fuel innovative studies that examine the dynamic biological contributors to health and disease (Rudy & Grady, 2005). Therefore, the application of a comprehensive nurse-driven biobehavioral conceptual model provides a solid foundation for nursing research and practice. Casavant (2020) proposes the Nurse Role Integration Model, which describes relationships between the art and science of nursing in conjunction with centralized physiologic concepts. In this model, nurse scientists initiate investigations involving underlying pathophysiological mechanisms that facilitate widespread health policy changes to promote population health (Casavant, 2020). Many nurse researchers are placing greater focus on the biologic processes surrounding diseases at the cellular and molecular levels through the identification of biomarkers (Dekker et al., 2017; Ferranti et al., 2017; Hooke et al., 2021). Furthermore, nurses are utilizing biomarkers to accurately identify a person's health risk, evaluate the biological mechanisms that attribute to adverse clinical outcomes, and develop interventions that optimize health in various patient populations (Ielapi et al., 2020). In the oncology field, the Oncology Nursing Society is charging nurses to advance their knowledge in biomarker and genomic applications (ONS, n.d.). Through precision oncology, nurses can gain increased understanding about molecular mechanisms and tumour genomics to better educate their patients regarding personalized treatments. According to the National Cancer Institute ([NCI], n.d.), genomics refers to: “The study of the complete set of deoxyribonucleic acid ([DNA] including all of its genes) in a person or other organism.” Cancer genomics concentrates on the DNA of cancer cells to understand abnormalities by applying advanced technologies (Berger & Mardis, 2018). Genomic alterations can serve as biomarkers that directly inform practitioners and patients about important shared clinical decisions that guide the overall cancer management. Genomic biomarkers provide information about cancer cells detected inside tumours, organs and body fluids based on an individual's unique genetics characteristics that can foster improvements in cancer screening, diagnosis, prognosis and treatment (Malone et al., 2020). For instance, specific genes have been identified that predict lung cancer and glioblastoma, which allow practitioners to stratify patients who are at higher risk for progressive disease and poor response to treatment (Sheng et al., 2020). Another area of utilizing biomarkers in research and clinical practice is ageing. Ageing is a biological process of degeneration, underpinned by alterations within molecular pathways, which result in systemic pathologies of organism. Ageing is one of the highest risk factors among certain types of chronic diseases and functional decline. An effective measure of biological age could be used to predict health outcomes, e.g. physical function, cognition, morbidity and mortality (Kudryashova, et al., 2020). Most chronic diseases have long latent periods that precede symptoms manifestation. Hence, early interventions can be delivered before the first clinical symptom or onset of chronic diseases if biological ageing is monitored. Ageing is associated with dysregulation of the immune system, which leads to chronic systemic low-grade inflammation. Circulating proinflammatory mediators, such as cytokines (interleukin [IL]-6, IL-8, IL-1 beta, TNF-alpha) and acute phase C-reactive protein produced in liver in response to inflammation are promising biomarkers of ageing (Kudryashova, et al., 2020). Altered metabolism is a major change in ageing. Glucose update and oxidation are often reduced in later stage of life with the progression of peripheral insulin resistance, particularly in skeletal muscle and adipose tissue, which can lead to weight loss and frailty in the older adults (Rivero-Segura, et al., 2020). Metabolic biomarkers, such as glycated haemoglobin HbA1c, glucose, lactate, polyunsaturated fatty acids, total fatty acids and albumin, have the potential to be used to assist clinical decision-making for the practitioners. Non-invasive biomarkers in ageing have been developed in the recent years. A decrease in the elasticity of skin and subdermal fat can be monitored by photographic imaging, and 3D facial imaging is able to predict biological age with a high level of accuracy (Kudryashova, et al., 2020). In addition, bone health can be measured by dual-energy X-ray absorptiometry (DEXA) to predict the risk of osteoporosis or fracture, which are highly prevalent among ageing population. Although the significance and advantages of using biobehavioral approach in nursing research have been clearly recognized for years, the progress has been slow (Kang et al., 2010). National Institute of Nursing Research (NINR) conducted a study involving 31 nurse scientists with a track record of NINR-supported funding who employed biological techniques and measurements in their research studies. The common themes reported by these nurse scientists were working with mentors who are experts in basic science, nursing, medical disciplines, recognizing the importance of small grants (e.g. Sigma Nursing, support from the university) at the beginning of their research careers, conducting cellular studies of direct relevance to clinical practice, bridging the two worlds of nursing and basic science together to contribute to nursing science (Rudy & Grady, 2005). Nevertheless, most of the nurse scientists reported tension between biological and nursing research, not only within the discipline of nursing but also from health science investigators who are not aware that nurses could conduct biological-related research. However, they stated that the best defence against criticism was evidence of procuring successful peer-reviewed external funding and supportive colleagues (Rudy & Grady, 2005). Challenges to implementing biological investigations in nursing research could be due to the costly laboratory facilities and equipment, lack of expertise in biological research, and lack of mentoring in the initial setting up of the lab and conducting the research (Kang et al., 2010; Rudy & Grady, 2005). So in answer to the question, ‘what does this have to do with nursing?’, we argue that more nurse scientists need to be equipped with training and resources for biological investigations to design the experiments and to monitor the quality of data processing and interpretation (Ferranti et al., 2017). To address the gap between biological and nursing research, academicians are advocating for integration of laboratory preparation into doctoral training to meet the increasing need for the preparation of nurse scientists to become skilled in conducting biological research (Calzone et al., 2013; Williams et al., 2016). NINR's effort on promoting the omics in nursing research through Omics Nursing Science and Education Network (ONSEN) website, provides a gateway to omics educational resources and collaboration among nurse scientists (https://www.ninr.nih.gov/researchandfunding/onsen). It is crucial that nurses develop interdisciplinary collaborations with experts in basic science. Nurse scientists have an important role in interdisciplinary partnerships to (1) anchor the scientific inquiries unique to the holistic nursing perspective and clinical practice; (2) evaluate complexities of biobehavioral research design with expansion on psychosocial factors and biomarkers and (3) reconcile statistical data in the context of clinical implications for patients (Kang et al., 2010). VXW, DEM: Study concept and design, Acquisition of data, Analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content. We would like to thank Professor Debra Jackson for her valuable advice. The authors declare no conflicts of interest.
Source: Journal of Advanced Nursing
DOI: 10.1111/jan.15541
Authors: Vivien Xi Wu, Diane E. Mahoney
Institutions: National University of Singapore, University of Kansas
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4312067068