Shaping Nursing Science and Improving Health: The Michigan Legacy

Prologue

The University of Michigan’s School of Nursing celebrates its 125th year in 2016. We began as a training school for nurses in 1891 and later became a collegiate program in 1941. We celebrate many achievements and a global impact. But this volume addresses a particular focus, that of the University of Michigan School of Nursing’s early and impressive leadership, which is to say, the development and impact of research on the discipline of nursing since the launch of the Doctor of Philosophy program in 1975.

Historical archives of the School of Nursing show a memo dated January 30, 1973, from the research faculty to the graduate faculty recommending the launch of a doctoral program in clinical nursing research. In that document, the research faculty note: “We are proposing that we train nurses to be sophisticated researchers. We think that there is a demonstrated need for extensive clinical research in nursing. Nursing practice must be founded on a solid knowledge base that says that certain interventions have predictable outcomes for certain kinds of people in certain settings” (University of Michigan, School of Nursing, 1973). This framework set the course for both efficacy studies in clinical research and the much later focus on implementation and effectiveness science approaches that aim to determine the “predictability of outcomes” in “certain settings.” The clinical nursing research directive was established at a time when most of the researchers in the discipline were not nurses. The School of Nursing was one of the pioneers in undertaking clinical nursing research, which would ultimately become the major focus of the national nursing research community.

The School of Nursing was one of the first programs in the country to launch a Doctor of Philosophy program, approved by the Rackham Graduate School on November 27, 1974, and the Regents of the University of Michigan in March 1975 (University of Michigan, Board of Regents, 1975). The proposal for the PhD occurred during a time when many schools of nursing were launching Doctor of Nursing (DN) or Doctor of Nursing Science (DNSc) programs as alternatives to the traditional research degree, the PhD. The University of Michigan’s School of Nursing PhD program launched in Fall 1975, and our first graduate, Marcia DeCann Andersen, graduated in Spring 1978. In 1981, to expand and strengthen the doctoral program as well as facilitate faculty in their research agendas, President Harold Shapiro recruited Dr. Rhetaugh Dumas, then deputy director of the National Institute of Mental Health, to be dean of the School of Nursing and to build a research-intensive environment. She established a research infrastructure with an associate dean for research, a research office with staff, and research awards for faculty. She also recruited the first endowed chair for a recognized nurse researcher. Since then, the number of endowed professorships has been increased to encourage and facilitate research within our faculty.

The chapters of this volume are organized into sections representing the overall thrust of our faculty and alumni work since the inception of the Doctor of Philosophy. The major themes of this work include biobehavioral studies, health promotion and risk reduction, women’s health, nursing and health care systems, and nursing leadership. A current underlying all the research is the global context in which our faculty and students consider the health care issues of interest. Biobehavioral research focuses on the interface and interaction of human biological and behavioral systems that influence health and illness. The human responses that underlie both the maintenance of health and the occurrence and management of diseases were an early emphasis of the school’s research program.

The authors of Chapters 1 through 4 provide illustrations of basic research, including using animal models, as well as research in humans as individuals and as groups. Focus on cancer, cardiopulmonary disease, and cognitive functioning were prevailing concerns as the faculty and students grappled with contemporary issues in managing these rapidly escalating chronic conditions.

Health promotion and risk reduction have been a prevailing priority for the faculty since the beginning of our research enterprise. The emphasis crosses the life-span from children and adolescents to older adults. Nola Pender, internationally renowned for her development of the health promotion model (Pender, 1982) has been a major influencer on several cohorts of faculty and students. Sally Lusk led our emphasis on occupational health and has had sustained influence over decades of occupational health research. Another major thread has been an enduring focus on primary care. As the role of nurse practitioners expanded across the country, our faculty and students developed the research base related to models and practice in primary care.

Women’s health and health care has also been a major thrust since the early days of the school’s research. From basic research to pelvic floor functioning and child birth issues, to issues encountered later in life, the women’s health faculty has built a body of knowledge related to women’s reproductive health and psychosocial health as well. Many studies have developed methods to reduce complications at birth and have also evaluated new models of mother/infant care in other countries and continents.

Another area of research has been women’s and adolescent girl’s mental health. Research on the effects of posttraumatic stress experienced early in life on later parenting has resulted in an international collaboration among women’s health researchers in England, Australia, and our school. Other faculty members have investigated the factors related to drug use and abuse in adolescents and adults—­an area of emphasis that also has international collaborators.

With the appointment in 1977 of Lillian Simms as director of Nursing Health Services Administration, a lineage of health services research was initiated. The program attracted Kellogg funding and groups of international students to the new master’s program. Originally a small group of investigators, the program in health services research expanded with key faculty recruitments of individuals with interests in leadership, systems, health care quality and safety, and interprofessional communications. Faculty recruitment expanded areas of emphasis to keep the school at the cutting edge of health care evolution. A major thread of the research has also been methodologies, such as implementation and effectiveness science, to understand the effect of interventions on individuals, groups, and systems. Most recently, the expansion into clinical informatics, health informatics, and the use of “big data” to understand population health and systems is setting the pace for future research and discovery. Finally, the impact PhD graduates have had on national leadership and the evolution of the field is illustrated in Chapters 11 and 12.

Faculty members have been highly successful in obtaining funding and resources for their research programs. The primary sources have been through the competitive programs of the federal government, such as the institutes and centers of the National Institutes of Health and the Agency for Healthcare Research and Quality. Faculty members have been very creative in obtaining funding for their research through foundations and other nongovernmental sources.

The chapters in this volume represent the work of only a small group of our PhD faculty and alumni. The goal of this publication is to provide a glimpse of the impact of our collective research and the concomitant development of our programs of research at the School through the stories of our faculty members and the lineages that they created through their students, building on the early research foundations. “Impact” is the word we use to describe the evolving and growing body of knowledge created by our first research faculty, expanded by their students and continued in a trajectory that today stand as substantial bodies of evidence driving science and care in the United States and around the globe.

I thank the University of Michigan School of Nursing 125th Anniversary Committee for the inception of this volume and the dedication of its editor, Dr. Shaké Ketefian, and the many authors who contributed. Understanding our history is a necessary foundation to launching the future. It is our hope at the School of Nursing that this volume inspires others to boldly advance the science that will transform the future of health care.