An RWJF Nurse Faculty Scholar Attacks Health Disparities With Research

    • December 8, 2011

The challenge. High blood pressure affects about one-third of all African American women—a significantly higher rate than for Caucasian or Latino women. It is a serious health condition that can lead to stroke, heart disease, kidney failure and other health problems.

While lifestyle factors, such as diet, overweight and inactivity contribute to the risk of high blood pressure, genetics also plays a role. Research by Robert Wood Johnson Foundation Nurse Faculty Scholar Jacquelyn Taylor, PhD, PNP-BC, RN, found that the children of parents with high blood pressure are at high risk for getting the disease. Taylor wanted to develop nursing interventions for these children to prevent and reduce their risk of high blood pressure later in life.

An early experience with nurses. Having cancer at age six is bound to be a life-altering event. For Taylor, it was doubly so, because the experience set her on a career path she never would have imagined for herself.

At the University of Michigan Hospital, Taylor was cared for by able and compassionate nurses—one was African American. "When my parents weren't there, she was there with me," Taylor recalled. "If I was afraid, she calmed me down. It was not just for treatment or injections. She was able to help me realize that in the end, it would be okay."

In the working-class town of Inkster, Mich., where Taylor grew up, she had encountered few African American professionals. After her hospital experience, "I was interested in nursing from that time on. I thought, if she could do it—be a nurse—so could I."

Discovering basic science. Taylor went to nursing school at Wayne State University in Detroit, where she was introduced to basic science research through the Minority Biomedical Research Support program. After four years in the lab studying high blood pressure in rats, she was hooked on research, and continued on at Wayne State to get her master's and doctoral degrees in nursing.

"I knew I wanted the mixture of basic science research and clinical practice," Taylor said. "As a nurse practitioner, I have both. We are the ones diagnosing and treating people with chronic health conditions in the primary care setting. On the other side, we can also be in the lab looking at some of the mechanisms that underlie many of the diseases we see clinically."

Though her specialty was pediatric nursing, Taylor also amassed graduate credits in molecular genetics while participating in the Summer Genetics Institute sponsored by the National Institute of Nursing Research. Realizing that she wanted to do research across the lifespan, Taylor accepted a post-doctoral position at the Institute of Gerontology at Wayne State.

Studying high blood pressure in African American women. While at Wayne State, she received her first pilot grant to study the genetic warning signs of high blood pressure among three generations of African American women.

After accepting a faculty position at the University of Michigan, Taylor was awarded a K award through the National Heart Lung and Blood Institute to continue her research. This time she used data from a large National Institutes of Health (NIH) epidemiological study of the genetics of high blood pressure in African American women. (K awards are designed to develop independent researchers. They provide three to five years of partial salary support and limited research funding and contain both a training and a research plan. The goal is to prepare researchers to apply for R01 funding by the end of their award period.)

"I wanted to look at some of the basic physiological underpinnings that may predict high blood pressure in the African American population," Taylor said. "The question is, where do we get this information about factors that lead to chronic disease and how do we translate that basic information into clinical interventions for diseases like hypertension?"

After additional training in cardiovascular genetic epidemiology at Washington University in St. Louis, Taylor joined the faculty at the Yale School of Nursing. Still within 10 years of receiving her PhD, she met the criteria for the Robert Wood Johnson Foundation Nurse Faculty Scholars program. She was accepted into the first cohort in 2008. The program seeks to create the next generation of national leaders in academic nursing through career development awards to outstanding junior faculty. For more information, see Progress Report.

"I was pleased and surprised to get the grant," she said. "It is like a K award, but provides more programs on leadership. The staff of RWJF Nurse Faculty Scholars, the advisory board and the mentors help prepare you to become a leader in nursing."

For more on Taylor's research with African American women, click here.

Research expands internationally. Taylor's research on health conditions of African American women has taken an international turn. She replicated her Detroit study with a study of three generations of West African women. The results were surprising—perhaps even game-shifting.

She found that some of the same genetic factors that influenced the development of high blood pressure in the U.S. sample were present in the West African sample, even in young African women and children who appeared to be at low risk for high blood pressure.

Diet and lifestyle appeared to be less important than genetics. The West Africans were mostly malnourished or undernourished, eating grains and corn and a little meat when they could get it. The Americans were largely overweight and obese, with diets high in cholesterol. This work can be found in an article that is available as an e-publication ahead of print in Biological Research for Nursing. Abstract available online.

"This is pretty astonishing," Taylor said. "If we can identify early on that these women are at risk for high blood pressure, we can begin to think about interventions prior to onset, to prevent them from even developing the disease like their mothers and grandmothers."

Leadership opportunities: thinking outside the box. Developing leadership skills is as important as conducting research for RWJF Nurse Faculty Scholars. Each works with three mentors—one within their own school of nursing, one outside the nursing discipline in their area of research and one who is an established national leader in nursing. Each of these has played a role in fostering Taylor's leadership skills.

Taylor's in-house mentor, Margaret Grey, DrPH, RN, dean of the Yale School of Nursing and a leading researcher in pediatric nursing, influenced her to think outside the box in pursuing leadership opportunities. Her national mentor, Martha Hill, PhD, RN, dean at Johns Hopkins School of Nursing, further instructed her to look for ways to contribute outside of the nursing field.

Taylor became national representative for congenital genetic conditions for the National Association of Pediatric Nurse Practitioners in 2010. "I would not have thought about doing this as a junior faculty had it not been for Nurse Faculty Scholars," she said. She also became a member of the American Heart Association (AHA). She was an invited speaker and gave a lecture at the scientific sessions of the AHA's annual meeting in 2010 and has published in the Journal of Hypertension, an AHA publication.

Taylor partly credits the scholars program with her promotion to associate professor at Yale in July 2010. "Nurse Faculty Scholars provided me 60 percent time for research, which allowed me to publish a lot of the data I had, and to mentor other students and faculty," Taylor said. "It allowed me to move the research and some service initiatives forward, while still maintaining a presence in the classroom."

Taylor is one of nine nurse faculty scholars that have been accepted as a fellow in the American Academy of Nursing, the most prestigious honor in the nursing profession. Taylor was inducted October 15, 2011 at the national meeting in Washington. Taylor sees fellowship in the academy as an excellent platform for advancing policy in the area of health care disparities, both locally and on the national and international level.

Encouraging young people to choose academia. For Taylor, the pathway from Inkster, Mich., to Yale was long but it's one that she believes other young people from her hometown can follow. The past few summers, Taylor has been Yale's liaison to the Ivy League Academy, a program that introduces top students to the nation's elite colleges and universities. As Yale's liaison, she has been giving tours of the campus to students from Inkster High and neighboring Michigan high schools.

"Coming from disadvantaged backgrounds, they may not think it is a possibility, even if they have the aptitude," Taylor said. "We talk to students one on one and show them that Yale University has successful minority faculty and other resources if they decide to come."

Whether or not the students choose Yale, Taylor wants minority youth to have the experience she had in that hospital room when she was six—meeting an African American professional and thinking 'that could be me.'

RWJF perspective. The Robert Wood Johnson Foundation Nurse Faculty Scholars program offers three-year career development awards to outstanding junior faculty. By providing mentorship, leadership training, and salary and research support to young faculty, the program aims to create the next generation of national leaders in academic nursing and to strengthen the academic productivity and overall excellence of nursing schools.

The program has admitted 54 scholars in four cohorts—15 each in 2008 and 2009, and 12 each in 2010 and 2011. The scholars represent 44 U.S. colleges and universities.

RWJF Program Officer Maryjoan Madden, PhD, RN, notes, "Nurse Faculty Scholars is a very important program within RWJF's Human Capital Portfolio where we are focusing on workforce issues, leadership and diversity within the health care professions. There is a shortage of nursing faculty and through this program we are creating a cadre of leaders in academic nursing who will teach the next generation of nurses.

"This is a relatively young program for us—we have just graduated our first cohort. The overall effects will not be known for many years, but already the quality and productivity of the scholars is obvious. As one indicator, nine scholars have been elected to the American Academy of Nursing, the most prestigious honor in nursing. Achieving this milestone so early in their careers is a tribute to their skills as researchers, nurse scientists, and teachers—and to the mentoring and leadership development the program has provided.

"Although much of our focus is on enhancing the leadership capability of the individual scholar, we know that scholars benefit the university in terms of research dollars, prestige and influence," said Madden. "That's one reason we have tried to reach beyond the tier-one research universities. By choosing scholars from schools that are not research-intensive, we can help develop the rest of the faculty and strengthen the school."