SigridLadores,PhD,RN,PNP,CNEPhilippineNursesAssocia1onofAmerica
38thNa1onalConven1on–July23-30,2017
TheResearchEnterprise:DrivenbytheIndividual’sPassiontoFindAnswerstoHealth-RelatedQues1ons
Objec1ves
Bytheendofthispresenta1on,theaudiencewillbeableto…..
Describethejourneyofpursuingaresearch-focused
doctorate.
Discussthemilestonesof
researchincys1cfibrosis.
HighlightresearchconductedbyFilipinonursescien1sts.
PhDvs.DNP
PhD
• Researchcareer• Developingnursingknowledge
• Leadershipexperienceinareaofsustainedresearchfunding
• Accesstoresearchse[ngsandresources
• Outcome:Developmentofnewknowledgeandscholarlyproducts
DNP
• Prac1cecareer• Improvingpa1entcareoutcomes
• Leadershipexperienceinroleandpopula1onprac1ce
• Accesstodiverseprac1cese[ngs
• Outcome:Healthcareimprovementviaprac1ceandpolicychange
PhDvs.DNP
2015-2016:• Studentsenrolledin
DNPprogramsincreasedfrom21,995to22,289
• DNPgraduatesincreasedfrom4,100to4,855
SinceDNPmovementbeganin2004:• EnrollmentinPhD
programshasincreasedby53.8%.
PhD
• ProgramofStudy:74totalcreditsCourseNumber CourseName
NUR751Q** PhilosophicalFounda1onsofScience
NUR753Q NursingasaScien1ficDiscipline
NRM750Q** Founda1onsofQuan1ta1veResearch
NUR755Q** Cri1calAnalysesofTheories,ModelsandFrameworks
NRM780Q** Applica1onofResearchDesignPrinciplesI
NRM798QL ResearchImmersion NRM752Q** ResponsibleConductofResearch
NST778Q** DataManagement NUR742Q** Wri1ngaCareerDevelopmentGrant
Proposal NST758Q** Inferen1alSta1s1csI NRM798QL ResearchImmersion Elec1ve Substan1veCore
NUR760Q Scien1ficDissemina1on
NRM781Q** Quan1ta1veMeasurement NST779Q** Sta1s1calModeling1LinearModels
NRM782Q** Applica1onofResearchDesignPrinciples
NUR758Q** ResearchandHealthPolicy
NRM783Q** Founda1onsofQualita1veResearch
NST780Q** Sta1s1calModelingII–TopicsinMul1variateAnalysis
NUR797Q** Wri1ngtheDisserta1on
Elec1ve Substan1veCore
NUR799Q Disserta1on
NUR799Q Disserta1on
PhD
• WhatdoyoudowithaPhD?– Focusonresearch– Academicfaculty– Becomeprimaryinves1gatoronresearchgrants
– Academicleadershipposi1ons– Directorsofresearchinhealthsystems
– Conductresearchthatinfluencesprac1ce
CommonPhDJobTitles
ChiefNurseResearcher
DirectorofNursingResearch
AssociateProfessor
ResearchPosi1onwithGovernmentOrganiza1ons
ex:CDC
DNP• WhatdoyoudowithaDNP?– Focusonnursingprac1ce– Formulateandinterpretevidence-basedprac1ce– Healthpolicydevelopment– Advancedclinicalprac1ce– Informa1ontechnology– Educator– Directorofclinicalnursingathealthfacili1es– Useresearchtoadvancenursingprac1ce
CommonDNPJobTitlesVicepresidentforNursingandClinicalServices
ProgramDirector
VicePresidentforPa1ent
Care
ChiefExecu1veOfficerHealthOfficer
CommissionerofHealth
QualityImprovement
Director
NeedforFilipinoNurses
• DemographicSurveyofFilipinoAmericanNurses:– 3.7%hadamastersinhealthcare
– 12.3%hadanMSN– 0.6%hadaPhDorEdD
PassionBehindDoctoralDegree
Vision:Tobestengagetheneedsofstudentsand
society
Passion:Helpfuturestudentsandcolleagues
developtheirvisiontobe
engagedaspublicintellectualsin
theirresearchandteaching
Ac9on:Committoac1onandchanceof
failingpubliclytoensure
accountability
PassionBehindDoctoralDegree
• Welearnfromourfailuresandwilleventuallysucceed
• Wemusthavecouragetotakerisks• Iftheworkwedomajers,wewillbedeterminedtodoitsuccessfully
• Facultyencouragementeestodeveloppassionfortheirworkthatsustainsalifelongcommitment
CommonStrugglesofaPhDStudent
Applica'onprocess:
• References• Wri1ngsample• Iden1fyingpoten1alresearchinterestandmentor
Roletransi'on:
• Expertcliniciantonovicestudent
• Learningtothinkcri1cally
• Changesworldview• Socializa1onintoacademiaandresearch
• Work/lifebalance
CommonStrugglesofaPhDStudent
• FinancialimplicaConsFull'mestudent• Cannotworkfull1me• Payfor9credithours(~$5,000persemester)• Takesapproximately3-4years
Part'mestudent• Canworkfull1me• Payfor6credithours(~$2,500persemester)• Takesapproximately5-6years
LessonsLearnedasPhDStudent
Resilience
Perseverance
Learntoadaptto"scien1ficwri1ng"
Abilitytotakeconstruc1vecri1cism
WhatisTenureandTenureTrack?
Tenure:• Provideselevatedlevelofjobsecurity
• Enhancedlevelofprotec1onforacademicfreedom
TenureTrack:• Proba1onaryperiodlas1ng~5-7years.
• Scholarship,service,andteachingareevaluatedbyanoversightcommijee.
• Promo1onisvotedonbythecommijee.
CommonStrugglesofNewTenure-TrackAssistantProfessor
• Whatdoestenuretrackentail?– Mee1ngthemissionoftheuniversityandschoolofnursing:• Educa1on• Scholarship• Service
– Grantfundingtosupportresearch– Achievingwork-lifebalance– Beingaprofessional
Cys1cFibrosis:Background
• 1989:CFgenediscoveredbyTsui,Riordan,Collins,andtheircolleagues.
• Survival:
1990:31.9years
Now:49.7years
Cys1cFibrosis:Overview
Cys1cFibrosis
Autosomalrecessive
Abnormalchloridetransportacrosscellmembranes
Thickenedsecre1ons
Createsextensivetreatmentregimen
TreatmentsCon1nued
• Airwayclearance:Chestphysiotherapy(manualorvest).
• Inhaledmedica'ons:givenvianebulizer.
• Pancrea'cenzymes:takenwitheverymealtoimproveabsorp1on
• 2015:CFTRmodulatorstocorrectfunc1onofdefec1veproteincreatedbytheCFgene.
Cys1cFibrosisMilestones
1962:median
survivalagereaches10
years
1989:CFgene
discovered
1993:Pulmozymeapprovedtothinmucusinlungs
1997:Tobramycinapprovedthat
reduceshospitalstaysandimproveslungfunc1on
2002:azithromycinimproveslung
health
2003:3-D
structureofCFTRprotein
discovered
Cys1cFibrosisMilestones
2006:Ivacasor
entersclinicaltrialsand
targetsCFTRprotein
2012:FDA
approvesKalydecofor
G551Dmuta1onto
treatunderlyingcauseofCF
2015:FDAapprovesOrkambifor
doubleF508delmuta1on
2016:Cys1cFibrosisFounda1onmaintainsapipelineofpoten1altherapiestotargetCFinhopesforacure
EmergentIssuesinCFResearch
• TreatmentsforraremutaConsthatwillnotbenefitfromfirst-generaConCFTRmodulators– Cys1cFibrosisFounda1onlaunchednewNonsenseandRareMuta1onsTherapeu1csIni1a1ve
– UABandSouthernResearchareusingascreeningprocesstofindtherapiesforthesegene1cmuta1ons
EmergentIssuesinCFResearch
• Addressingmentalhealth– PeoplewithCFandtheirparentsare2-31mesmorelikelythanthegeneralpopula1ontohavedepression,anxietyorboth
– CFFdevelopedthefirstprac1ceguidelinesfordepressionandanxietyin2015
– Dataonfollow-upwillbeinthe2016CFFannualreport
“Thereisnohealthwithoutmentalhealth”
-Cys9cFibrosisFounda9on
EmergentIssuesinCFResearch
• FerClityandpregnancyinwomenwithCF– NumberofCFwomenwhobecamepregnanthasdoubledinthelast20years.
– Inarecentstudy,32.8%ofwomenunderstoodhowCFaffectsfer1lity
– Lifeexpectancynowinthe40’s– Educa1onandpregnancyplanningwithcareteamisimpera1ve.
EmergentIssuesinCFResearch
• LungTransplantaCon– Canextendandimprovelife– Requiresextensiveevalua1on– Morethan50%liveatleast5yearspost-transplant
– Risks:• Rejec1on• Infec1ons• Cancer• Sideeffectsofimmunosuppressivedrugs
CurrentResearch:CFFDrugPipeline
RestoreCFTRFunc1on
• 2drugsalreadyreachedpa1ents
• 7inphase2clinicaltrials
• 2inphase1clinicaltrials
MucociliaryClearance
• 2drugsalreadyreachedpa1ents
• 1inphase3clinicaltrials
• 4inphase2clinicaltrials
• 1inphase1clinicaltrials
An1-inflammatory
• 1drugalreadyreachedpa1ents
• 3inphase2clinicaltrials
• 1inphase1clinicaltrials
An1-Infec1ve
• 4drugsalreadyreachedpa1ents
• 4inphase2clinicaltrials
• 1inphase1clinicaltrials
Nutri1onal-GI
• 3drugsalreadyreachedpa1ents
• 1inphase3clinicaltrials
• 1inphase2clinicaltrials
FilipinoNurseScien1sts
MarlonGarzoSaria,PhD,RN,AOCNS®,FAAN
KarenMeneses,PhD,RN,FAAN
JosephD.Tariman,PhD,RN,ANP-BC,FAAN
MarlonGarzoSaria,PhD,RN,AOCNS®,FAAN
• ResearchInterest:– Effectofcancerandcancer-relatedtoxici1esonpa1entoutcomes
– Impactofcaregiverburdenoncaregiverwell-beingoutcomes,pa1enthealthoutcomes,andhealthcareu1liza1onoutcomes
• Whythisarea?– Oncologynurse– WorkswithaPhysicianScien1st
”Iwanttohelppa1entsandfamiliesastheyliveeverydayoftheirliveswith
cancer.”
• PhD• Ge[ngcommissionedasairforceofficer
• Induc1onasFellowofAmericanAcademyofNursing
• SecretaryofOncologyNursingSociety• AssociateEditorforClinicalJournalofOncologyNursing
Top5professionalachievements
“Ge[ngmyPhDshowedmethat
perseverancetrumpstalent.”
MarlonGarzoSaria,PhD,RN,AOCNS®,FAAN
• Adviceaboutpursuingagraduatedegree:– Justdoit– Lifealwayshasdemandsthatwillbeareasonnottogobacktoschool
– Ifyouwantit,youshoulddoit
“Wallsaretheretokeepthosewhodonotreallywantwhatisontheinsideout.”
MarlonGarzoSaria,PhD,RN,AOCNS®,FAAN
KarenMeneses,PhD,RN,FAAN
• ResearchInterest:– Breastcancersurvivorship-dispari1esresearch
– Grewfromclinicalprac1cewithcancersurvivors
”Ihavebeenanursesincedinosaursroamedtheearth”
KarenMeneses,PhD,RN,FAAN
• Topprofessionalachievements:– Dis1nguishedFacultyLecturer– MaraMogensenMemorialLectureship
• Adviceaboutpursuingagraduatedegree:– Justdoit.
“Filipino
nursesarethebest!”
JosephD.Tariman,PhD,RN,ANP-BC,FAAN
• ResearchInterest:– Shareddecisionmaking– Mul1plemyelomatherapies– Sideeffectsmanagement
• Whythisarea?– Nurseprac11onerfor15yearsspecializinginmyeloma
– LedresearchteamofmyelomaprogramatNorthwesternUniversity
JosephD.Tariman,PhD,RN,ANP-BC,FAAN
• Topprofessionalachievements:– 2013:SpeakeratPNAAannualconference– Chair:AnnualMyelomaNursingConferencefor7consecu1veyears
– 2013:PlenaryspeakerforInterna1onalMyelomaNursingconference
• Adviceaboutpursuingagraduatedegree:“Stop
hesita9ng!Enrollingrad
school.“
References
• Elborn,J.S.,Shale,D.J.,&Brijon,J.R.(1991).Cys1cfibrosis:currentsurvivalandpopula1ones1matestotheyear2000.Thorax,46(12),881-885.
• hjp://www.aacn.nche.edu/dnp/ContrastGrid.pdf• hjps://www.cff.org/What-is-CF/About-Cys1c-Fibrosis/• hjps://www.cff.org/Research/About-Our-Research/Research-Milestones/• hjp://www.nature.com/news/2009/080709/full/460164a.html• hjps://www.cff.org/About-Us/Assets/2015-Annual-Report.pdf• hjp://web.a.ebscohost.com.ezproxy3.lhl.uab.edu/ehost/pdfviewer/pdfviewer?
sid=90657e0d-914e-429b-ba90-3d36236b05fd%40sessionmgr4006&vid=2&hid=4209• hjp://files.eric.ed.gov/fulltext/ED471502.pdf• hjps://www.cff.org/Life-With-CF/Treatments-and-Therapies/Lung-Transplanta1on/What-to-
Consider-Regarding-a-Lung-Transplant/Weighing-the-Benefits-and-Risks/• hjp://www.cys1cfibrosis.ca/about-cf/living-with-cys1c-fibrosis/complica1ons• hjps://www.cff.org/trials/pipeline• hjp://www.aacn.nche.edu/dnp/dnp-tool-kit-sec1on-1• MacKenzie,T.,Gifford,A.H.,Sabadosa,K.A.,Quinton,H.B.,Knapp,E.A.,Goss,C.H.,&Marshall,
B.C.(2014).Longevityofpa1entswithcys1cfibrosisin2000to2010andbeyond:survivalanalysisofthecys1cfibrosisfounda1onpa1entregistry.Annalsofinternalmedicine,161(4),233-241.
• Marx,J.L.(1989).Thecys1cfibrosisgeneisfound.Science,245(4921),923-926.