Applying the NIEHS Translational Research Framework (NIEHS-TRF) to Map Clinical Environmental Health Research Trajectories

Abstract

Background:

There is a need for comprehensive planning tools and exemplars for clinical environmental health research programs. The National Institute of Environmental Health Sciences Translational Research Framework (NIEHS-TRF), as a comprehensive research activity mapping framework, promises to fill this gap in program planning and communication tools.

Objective:

The objective is a proof of concept demonstration to apply the NIEHS-TRF as a research project and career trajectory cartography framework.

Methods:

We utilized case series examples to apply the NIEHS-TRF as a project/career cartography framework. After a tailored research mission statement is clarified, the four step process in the NIEHS-TRF application includes 1) identifying research categories and activities (depicted visually by rings/nodes) that link to research program deliverables, 2) within each category (visual ring), linking specific works and program outcomes to activities (visual nodes), 3) coherently depicting visually as an overall map, and 4) developing recommended improvements for the NIEHS-TRF for research program cartography utility.

Results:

Successful mapping of a research project plan in a training grant application, a summary of an individual trajectory of research, and a community-initiated project was completed with mapping visualizations. The exercise facilitated purposeful planning and communication to describe common translational goals, progress, and targeted need for interdisciplinary collaboration.

Discussion:

Utilizing the NIEHS-TRF as a mapping tool for research program planning enabled unique insights into strengths, gaps, collaboration opportunities, and applications for environmental health nursing. This research project, career, and community-initiated research program trajectory mapping communication tool promises to accelerate impact and advancement through purposeful and clear planning for ongoing research activities along the translational continuum.

Introduction

Planning frameworks that clearly map individual projects and activities within an overall research program trajectory are essential to optimize and accelerate individual research careers and purposeful collaborations (Feetham & Doering, 2015). Cartography, by visually mapping the process framework of a trajectory, is a program development and evaluation management exercise that enhances communication with diverse stakeholders (Feetham & Doering, 2015; Wilson, Rosemberg, Visovatti, Munro-Kramer, & Feetham, 2017). Developing a clear visual depiction of activities and projects that map the past foundational work, current projects, short- and long-term planned proposals is called career cartography for clinician scientists, and promises to improve impact and translation for individual research (Feetham & Doering, 2015). There is a paucity of planning tools and exemplars for clinical environmental health research programs (Gehle, Crawford, & Hatcher, 2011; Miller, Valenti, Schettler, & Tencza, 2016; Woodruff & Sutton, 2011). Applying the National Institute of Environmental Health Sciences Translational Research Framework (NIEHS-TRF) as a career/portfolio cartography framework promises to fill this gap in research program planning tools. Here, we present three case examples for applying the NIEHS-TRF as career cartography for environmental health nursing research planning and communication.

Translational research has many definitions, most commonly characterizing a process where scientific ideas are continuously rendered throughout a spectrum of research activities, in phases, that integrate traditional bench and clinical settings or methods (Fort, Herr, Shaw, Gutzman, & Starren, 2017). Since the mid-1800’s application of germ theory, disciplinary boundaries between environmental health and the clinical sciences have resulted in narrowed paradigms of translational science applications (Gehle et al., 2011; Miller et al., 2016; Nash, 2006; Schenk, Corbett, Barbosa-Leiker, Postma, & Butterfield, 2016; Speaks, Thomas, & Thompson, 2012; Woodruff & Sutton, 2011; Zachek et al., 2015). Several translational research models either focus on clinical applications for individual patients, or are predicated on an underlying assumption that populations are engaged as patients in clinical healthcare systems (Dougherty & Conway, 2008; Sung et al., 2003; Westfall, Mold, & Fagnan, 2007; Woolf, 2008). While these models evolved to encompass public health and non-clinical outcomes, they remain patient-focused (Khoury et al., 2007; Trochim, Kane, Graham, & Pincus, 2011; Waldman & Terzic, 2010). The National Institute of Environmental Health Sciences (NIEHS) has translational research at the heart of its mission “to discover how the environment affects people… to promote healthier lives” and serves as one of three themes that form the basis of NIEHS’ current strategic plan (Collman et al., 2018; NIEHS, 2012). Although the NIEHS has a long history of funding programs to support and facilitate translational research, the organization’s scientists relied on clinical models of translational research to define, understand, and evaluate the environmental health translational research efforts (NIEHS, 2018a). NIEHS identified the need to broaden these models to encompass the full continuum of environmental exposure research relevant to well-being in the non-clinical community setting to testing the individual patient intervention in the clinical setting. This resulted in NIEHS adapting a translational research framework that included clinical translational research while making a place for environmental health science research (Pettibone et al., 2018).

The NIEHS-TRF identifies five major categories of translational research efforts (Figure 1), represented using a series of concentric rings (Pettibone et al., 2018). These categories from inner ring out include fundamental questions (which encompasses research drivers, experimental settings, and organisms), application and synthesis, implementation and adjustments, practice, and impacts. Nodes have been placed along each of these rings that describe the types of activities that might occur within each of these categories. Further, the framework reimagines the concept of basic research. Previous translational research frameworks considered basic research to be “scientific exploration that can reveal fundamental mechanisms of biology, disease or behavior” (National Center for Advancing Translational Sciences, 2018). The NIEHS-TRF instead frames this category as the Fundamental Questions category, which incorporates three concepts: research drivers or questions, experimental setting, and organism (Pettibone et al., 2018). This adaption allows for a more nuanced categorization of the fundamental science and clinical advances that are required for making significant environmental health impacts. Last, the framework provides a comprehensive paradigm by incorporating previous concepts (e.g. translational phases T0–T4) that defined translation as research that bridges from one translational category to another and make the connections between basic, bench science studies and policy, environmental exposure, and practice changes possible (Drolet & Lorenzi, 2011). The NIEHS-TRF builds on this bridging concept by positing that movement from ring to ring or node to node within a ring are recognized as a translational research bridge. This characteristic of the framework reflects the nuance of the evolution of fundamental research as it moves through a variety of phases that require different questions, methods, tools, and training.

Figure 1.

The NIEHS-TRF for Career Cartography

Reproduced from Environmental Health Perspectives with permission from the author: Pettibone, K. G., Balshaw, D. M., Dilworth, C., Drew, C. H., Hall, J. E., Heacock, M., … Collman, G. W. (2018). Expanding the Concept of Translational Research: Making a Place for Environmental Health Sciences. Environ Health Perspect, 126(7), 074501. doi:10.1289/ehp3657

This article examines three clinical research examples from the field of environmental health nursing through the lens of the NIEHS-TRF, demonstrating the application of a novel clinical research cartography method using the NIEHS-TRF (Pettibone et al., 2018). The first case study demonstrates how the framework can be used to plan a research effort, the second and third case studies describe completed research projects in an individual career portfolio and a community-initiated research project.

Methods

As a proof of concept demonstration, we utilized a series of case study examples to apply the NIEHS-TRF as a career/portfolio cartography framework (Feetham & Doering, 2015; Pettibone et al., 2018). Career cartography, as program planning, begins with an overarching mission statement. This statement should communicate the envisioned destination for the scientific trajectory (Feetham & Doering, 2015). The four step practice/policy processes in the NIEHS-TRF application to this tailored research mission statement includes 1) identifying translational categories and activities (visual rings/nodes) that link to research program deliverables, 2) within each ring, link specific works and program outcomes to nodes, 3) coherently depict visually as an overall map, and 4) develop recommended improvements for the NIEHS-TRF for program cartography utility.

Step 1. The first step, identifying rings/nodes that link to research program deliverables, can be accomplished through several iterative approaches. The user can circle each node that relates to his/her program of research (Figure 1). The user may also alternate colors to depict completed, current, and planned research projects. Alternately, NIEHS has developed checklists with criteria for each ring/node criteria to utilize, which is publicly available on the website (NIEHS, 2018b).

Step 2. Next, within each category (visual ring), the user maps their work or program outcomes to the activity within that category (visual nodes). As described in the introduction, The NIEHS-TRF identifies five major categories of translational research efforts the categories from inner ring out are: 1) fundamental questions, 2) application and synthesis, 3) implementation and adjustments, 4) practice, and 5) impacts. This step begins with collecting the publications, presentations, and scholarly activities for the individual scholar or program members. Alternately, for individual project research planning, the aims and approaches are specified. For individual career cartography, the research program goal statement, curriculum vitae, and current proposals compose the materials for review. A program portfolio review may involve reported outcome metrics or a review of the published literature, funded proposals, and a survey of current activities of the researcher or research team. Each of these program outcomes becomes a source of qualitative or quantitative data.

We utilized the Framework Method (Gale, Heath, Cameron, Rashid, & Redwood, 2013) to review the publications, presentations, proposals, and other program outcomes. After the initial review to familiarize ourselves with the documents, each project was systematically coded in a deductive approach using the existing categories and activities defined in the NIEHS-TRF as qualitative codes (NIEHS, 2018b).

Step 3. The third step was to modify the NIEHS-TRF figure categories and activities (rings and nodes) to a custom visualization of the program trajectory. We used the translational research story template to facilitate the visualization of categories, activities, and milestones (Pettibone et al., 2018). During this process of charting the parts into a whole framework (Gale et al., 2013), the user iteratively identifies redundancy and inconsistency that requires revisiting step 2. This third step is, therefore, often accomplished in an iterative process with step 2 until a comprehensive program trajectory is depicted. Because one of the purposes of the cartography is to clearly and succinctly communicate with diverse stakeholders, this step also involves using feedback to inform edits or revisions to previous maps. For individual career cartography, peer and/or mentor feedback is expected at this step.

Step 4. The last step, once the theory has been utilized and applied, was to evaluate the NIEHS-TRF. The researcher who has engaged in the intellectual labor of Framework application is well positioned to engage in scholarly dialogue regarding potential improvements and revisions. Evaluating the adequacy, clarity, consistency, complexity, scope, significance, and criticism enables best-practice evolution of the new model to amplify the utility and ongoing model uptake (Meleis, 2018).

We applied these methods to three scenarios: 1) planning a research effort in a training grant funding application of one of the authors, 2) describing completed research projects in an individual research trajectory of one of the authors, and 3) relaying an ongoing community-requested research project. The materials and methods used for these three cases were individual publications, funding, and policy documents as listed on a curriculum vitae.

Results

The case studies demonstrate how each step is applied to use the framework for: (1) early career project planning, (2) career trajectory communication, and (3) progress in a community-initiated research project. Translational categories are italicized, activities are capitalized, and both categories and activities are depicted in the corresponding figures.

Early Career Project Planning

The first case study involves an early career scientist planning for a career development training grant (Figure 2). In Step 1, the early career investigator began the planning process by identifying where her research interests correspond and intersect with the current NIEHS strategic plan. The investigator identified Theme Two of the NIEHS Strategic Plan 2018–2023 as center to her research efforts. Theme Two of the Strategic Plan is focused on Promoting the Translation of Data to Knowledge to Action to ensure that research efforts are directed towards improving people’s health and maintains that stakeholder communities are an essential asset in this work.

Figure 2.

Early Career Project Planning: Increase Environmental Health Literacy Among Under-Represented Populations

Using the NIEHS-TRF, she reviewed her completed postdoctoral work on radon, secondhand smoke and report-back strategies to identify the most appropriate nodes and rings for these completed research efforts (Butler, Huntington-Moskos, Rayens, Wiggins, & Hahn, 2019; Hahn, Huntington-Moskos et al., 2019; Hahn, Wiggings, et al., 2019; Huntington-Moskos, Rayens, Hall, & Hahn, 2016; Huntington-Moskos, Rayens, Wiggins, & Hahn, 2016; Huntington-Moskos, Turner-Henson, & Rice, 2014; Rodgriguez et al., 2016). This step allowed her to understand how her previous work connects to activities (nodes) within a translational category (ring) as well as the potential for activities that bridged to additional translational categories. She noted that this work, guided by her postdoctoral mentor, lay firmly in the Implementation and Adjustment category as it examined the indoor air testing behaviors in the home environment. As she set out to develop a new grant proposal and training plan, the stated overarching research goal was to develop an independent program of research focused on the implementation of report-back strategies with adolescents to prevent asthma exacerbations and support asthma self-management. The training plan focused on the report-back process, which is defined as the sharing research findings with participants, noting comprehension, knowledge attainment, and resulting behavior change (Goho, 2016). Identifying the appropriate translational research categories and activities in Step 1 allowed her to consider any external factors (i.e. fundability and impact) that may influence the proposed work along with her own passion and internal motivators. In Step 2, she noted that her postdoctoral research contributions were focused mainly on an adult population; thus, the adolescent focus of the proposed grant would require a move to the Application and Synthesis category. This category highlights research works completed in predictable setting to gain a deeper understanding of a process or effect. Intervention pilot testing and tool testing with an adolescent sample would be required before larger implementation work could begin.

With the emergence of precision healthcare, genomics and personal monitoring options for exposure assessment, the early career investigator focused on the Tool Testing activity in the Application & Synthesis category to develop a project focused on Tool Validation among adolescents with asthma for an adolescent-led data collection. Completing this proposed work incorporating tool testing and an intervention pilot study with adolescents with asthma would set the stage for movement into the Implementation & Adjustment category as a promising career trajectory. In addition, the development of a feasibility study with an adolescent sample to examine health disparities (e.g. asthma outcomes among adolescents in communities of color) in the Application & Synthesis category would allow for the future planning of a larger, investigator-led study. The plan for such a larger study housed in the Implementation & Adjustment category could yield potential external funding and meet public health demands, thus striving to reach the Impact category of the NIEHS-TRF.

In Step 3, the early career investigator set out to visually depict the proposed feasibility work to imagine and contemplate the potential of multiple paths and different research trajectory options for the future. The career development training plan, identified with the assistance of the NIEHS-TRF, could now be mapped as a multi-year process and assisted the early career investigator in articulating her path to independence. Step 3 also facilitated the brainstorming process to identify potential collaborations with colleagues from the disciplines of engineering, economics, epidemiology, and specialists in Geographic Information Systems (GIS). In the evaluation of different paths and trajectories (Step 4), she considered the possibility of pursuing additional training in genomics. This led to the consideration for mentoring with established bioethicists as the emerging science of precision healthcare and how its accompanying technologies (i.e. Clustered Regularly Interspaced Short Palindromic Repeats, also known as CRISPR) brings up many ethical questions that need to be thoughtfully considered and thoroughly studied.

Through this career mapping process, this early career investigator contemplated ways in which collaborations might increase the public health impact, by seeking to partner with community agencies for the development of community-engaged research. She conceptualized this collaboration within the Impact category, with the philosophy that incorporating the community perspective early in research efforts will increase the potential for the effective real world translation of research. The cartography results (Step 3) of her application of the NIEHS-TRF is depicted in Figure 2. For feedback on the model (Step 4), the early career investigator can continue to refer back to this NIEHS-TRF career cartography effort to continue the pursuit of next steps for greater impact. A specific node in the Practice ring specifically for ethics is recommended.

Individual Research Trajectory

In the second case example, the NIEHS-TRF was applied to an individual research trajectory. The overarching statement for the completed work was the multi-level measurement and reduction of airborne pollutants with emergency effects on respiratory and sense organs. Using news media reports related to research translation, along with a standard curriculum vitae with publications and funded grants, the researcher identified at least one activity within each of the five translational research categories in Step 1. This reflected a purposeful and extensive transdisciplinary philosophy and collaborations (Castner, Klingman, Sullivan, Xu, & Titus, 2016). In Step 2, the research linked specific dissemination products to the translational research categories and activities as follows, with corresponding numbers depicted in Figure 3. Group and Population (#1 in Figure 3) research was completed to ascertain what environmental exposures were related to community member sense organ and odor symptoms, as well as efforts to develop time-related epidemiology indicators in the Fundamental Questions category (Castner, 2016). Three research activities were performed in the Application & Synthesis category. Tool Development/Testing (#2a in Figure 3) research involved activity tracker sleep patterns in women with asthma, novel smartphone compatible formaldehyde detection system and peak flow meter devices with corresponding software (Castner, Mammen, et al., 2018; Natarajan, Castner, & Titus, 2016; Szyszkowicz, Kousha, Castner, & Dales, 2018; Zhang et al., 2018). Method Testing & Pilot Intervention (two projects, #2b-c in Figure 3) using novel data science models were developed to measure environmental exposures and predict asthma outcomes at both the individual and population level (Castner, 2016; Castner et al., 2018). Implementation & Adjustment category research included Validation/Optimal Use Testing (#3a in Figure 3) of the Air Quality Health Index (Kousha & Castner, 2016) and Risk Assessment (#3b in Figure 3) of population-level emergency department utilization associated with ambient air pollutants (Szyszkowicz, Kousha, & Castner, 2016; Szyszkowicz et al., 2018). Three projects in the Practice category advanced Clinical Practice (#4a in Figure 3) to reduce environmental exposures as triggers (Castner, Gittere, & Seo, 2015; Castner & Polivka, 2018), Research Practice (#4b in Figure 3) for nurses in device development (Castner, Sullivan, Titus, & Klingman, 2016), and Policy (#4c in Figure 3) that ranged from an Emergency Nurses Association resolution on climate change to an evidence synthesis to recommend specific air pollutant levels for the Environmental Protection Agency Administrator. In the Impact category, activities included a Change in Environmental Exposures (#5 in Figure 3) with the reduction of emissions from a factory in violation of the Resource Conservation and Recovery and Clean Air Acts (Castner, Guo, & Yin, 2018). Further unpublished works addressed in vivo, ex vivo, and additional group and population data science indicator development. In addition to current work, the researcher created a cohesive visual depiction (Step 3, which generated Figure 3). This enabled the researcher to clearly envision long-term activities, as well as justify the adequate foundation for the next steps in the independent research trajectory. After using the framework to map out this project, the researcher identified a potential improvement in the NIEHS-TRF model (Step 4). Although the NIEHS criteria checklist recognizes the development of novel devices as part of mechanistic understanding work within the Fundamental Questions category, the framework itself does not include a node for this activity. Clarifying this activity in the NIEHS-TRF visual graphic (Figure 1) would facilitate the recognition of this critical activity in project planning.

Figure 3.

Research Trajectory: Multi-level Measurement and Reduction of Airborne Pollutants with Emergency Effects on Respiratory and Sense Organs

Note: VOC=Volatile Organic Compound. CBPR=Community Based Participatory Research.

Community-Initiated Project Planning

The overarching mission statement in the third case scenario was to provide and translate objective evidence of the environmental hazards in a community, increase community member understanding of local environmental hazards and health effects, and utilize these data to communicate with policymakers. The local context for this case scenario is as follows. Step 1: A nurse scientist was approached by the community members of Uniontown, Alabama, to investigate possible environmental exposures in the area. Uniontown has about 2,400 citizens (more than 91% African American), with high numbers of single, unemployed, and disabled individuals and a median household income of $14,605 (Amiri, 2016). Uniontown is the home for a landfill that holds more than four million tons of coal ash that were brought to this area from Tennessee after the coal ash dike at Tennessee Valley Authority (TVA) Kingston fossil plants was ruptured in 2008. Uniontown residents were also exposed to a waste treatment spray field (Amiri, 2017). Thirty-four percent of Lowndes County residents, a county close to Uniontown, Alabama, tested positive for one species of hookworm (Pathak, 2017).

Step 2: The nurse scientist co-developed the research question and approached key informant community members in an informal setting who were concerned about coal ash exposures and a failed sewage treatment system (Milestone 1, Fundamental Questions: Population/Human/Observation) (Harkness, Sulkin, & Vengosh, 2016; Lombardi, 2015; Pracheil et al., 2016; Project Earth, 2017). Step 3: By using the NIEHS-TRF, the nurse scientist was able to design a multistage community based participatory research (CBPR) (Amiri & Zhao, 2019). The NIEHS-TRF was modified to reflect the community project contents (Figure 4). The research team focused data collection on heavy metal groundwater contamination from coal ash (Pathak, 2017). After finding elevated lead levels and traces of arsenic in the environmental samples (Amiri & Zhao, 2019), the investigators designed and implemented community educational workshop interventions (Milestone 2, Practice, Clinical, and Public Health Practice). The educational sessions disseminated the environmental sample results, health effects of lead, blood lead screening referrals, actions to reduce exposure to lead, and hookworm infection information. In addition, free water purifiers were distributed (Milestone 3: Practice, Individual Behaviors).

Figure 4.

Community Initiated Project Planning: Coal Ash Exposures and Failed Sewage Treatment System

Step 3 continues: The investigators communicated the following to policymakers: 1) the community experience with and concern about the failed sewage system, 2) results of the research team’s water testing, and 3) translation of the related and existing evidence on hookworm infection incidence. This information was shared with Environmental Protection Agency staff, the Alabama governor, state representatives, and members of U.S. Congress (Milestone 4: Practice/Policy). Further, the research team educated the community on how to approach the policymakers with this evidence (Amiri & Zhao, 2019). Subsequently, 23 million dollars was secured for repairing the failed sewage system in the community (Richard Shelby: United States Senator for Alabama, 2018). Once the sewage system has been repaired, the team plans to conduct more environmental sampling and monitor the population for changes in hookworm infection incidence (milestone 5: Impact, Change in Population Outcomes and Environmental Exposures). In this case, the NIEHS-TRF met all the requirements of the project, and step 4 was not implemented.

Discussion

We present three case examples for applying the NIEHS-TRF for research cartography planning and communication. Cartography means to map and, in this instance, we used the framework to generate a coherent career map of the past foundation, current activities, and planned near and long-term trajectories.

NIEHS created several tools to facilitate the use of the framework by the research community. The Translational Research Story Template is a worksheet that can be used to outline the core components of a translational research story. The Translational Research Framework Criteria Checklist, adapted from a checklist created by Surkis and colleagues (2016) can be used to classify specific activities within each translational research category. Blank templates can be used to plan, map, and illustrate the trajectory of the research project and are helpful for preparing presentations or other visualizations of clinical translational research projects. These resources, as well as links to translational research related publications and examples of translational research stories told using the framework are available at www.niehs.nih.gov/translation.

Early Career Research Planning

In our first case application, we identified that for an early career investigator, conceptualizing an entire research career trajectory, or even planning next steps, can provoke feelings of uncertainty or being overwhelmed. The NIEHS-TRF clearly depicts the various options for early career planning of a unique research trajectory, and can allow the researcher to visualize a proposed path as it relates to: (1) research efforts of colleagues (including identifying potential collaborators) and (2) achieving real-world impact with improvements in human health. As a tool for mentors of early career researchers, and early career researchers planning for training grants and preparing their promotion and tenure package the cartography exercise with the framework promises to ease career planning and transition stressors by providing additional clarity to planned activities and collaborative relationships. In this instance, visioning movement between the translational research categories and activities was particularly useful for identifying additional skills and training needs that were not previously apparent to the researcher.

In addition to deciding and planning next steps, the early career investigator must be able to articulate a clear rationale for the research direction chosen. Further, we found that identifying connections and possible paths forward is important to consider, both in terms of content knowledge and also population and methods used. This type of iterative systems thinking may take practice and mentorship involvement. In a similar fashion, the NIEHS-TRF provides a guide for building an effective team of colleagues representing different yet complementary disciplines and skill sets. Using the NIEHS-TRF, an early career investigator should strive to think broadly regarding the colleagues and disciplines that could contribute to quality research findings.

Individual Research Trajectory Cartography

In the second case application, the NIEHS-TRF was applied to an individual research trajectory. Because of a habit and preference for highly transdisciplinary work, this research trajectory was often difficult to communicate succinctly using traditional models or single-disciplinary boundaries. The under-representation of nurse scientists in environmental health exacerbated the ability to communicate the research activities as intentional, purposeful and planned in a cogent overarching trajectory. The breadth of the framework, inclusive of clinical research, enabled an unparalleled usefulness to depict, plan, and evaluate a nursing research trajectory with an environmental health focus. However, this theoretical breadth does increase the complexity of the theory for project planning, compared to the NIH/NINR (National Institute of Nursing Research) Symptom Science model’s notable use and uptake for planning nursing research focus and projects (Cashion, Gill, Hawes, Henderson, & Saligan, 2016; Cashion & Grady, 2015; Castner et al., 2019). Grappling with the teleology, or use of consequences rather than properties or dimensions, is evident in both the constructive critique and application of this theory, which may provide additional opportunities for improvement (Meleis, 2018). Further, this application revealed either a consideration for tautology (needless repetition) or past research projects that spanned multiple translational research categories and activities (nodes and rings) with possible redundancy since several projects could have been depicted as bridging various rings and nodes. Continued exemplars of model application with potential iterative refinements will aide to clarify these elements of theory critique for the scientific community. In our research team and collaboration, the NIEHS-TRF resonated as filling an unmet need for a translational research framework as a shared mental model to accelerate, communicate, plan and evaluate an environmental health nursing research career trajectory.

Community-Initiated Project Planning

The NIEHS-TRF was applied to map collective activities and potential collaborations inherent to civic engagement, citizen science, and CBPR methods. The applied framework figure may enhance communication with community members and other stake holders such as legislators to depict the bridges between the traditional scientific work, community engagement, policy, and population level change. In our case series, communication activities within the NIEHS-TRF framework, as part of CBPR, resulted in multi-million dollar built environment funding changes and enhanced capacity to communicate with policymakers. Specific communication activities included presenting in grassroots environmental organizations, media interviews, professional organization committees, global health organization liaisons, and meetings with policymakers at the local, state, and federal level. These resulting changes include the 23 million dollar grant for repairing the failed sewage system in Alabama (Richard Shelby: United States Senator for Alabama, 2018), closure of a polluting factory in Tonawanda, New York, and removal of a traffic toll barrier in Western New York (Blazonis, 2017). Enhanced capacity to communicate with policymakers is evidenced in our professional organization’s public comment and our research studies utilized as part of the 2019 United States Federal Register notices by the Environmental Protection Agency for 1) The Integrated Science Assessment for Ozone and Related Photochemical Oxidants (Docket EPA-HQ-ORD-2018–0274/FRL-10000–35-ORD), 2) Release of Draft Policy Assessment for the Ozone National Ambient Air Quality Standards (Docket EPA-HQ-OAR-2018-0279/ FRL-10001–31-OAR), and 3) Release of a Draft Document Related to the Review of the National Ambient Air Quality Standards for Particulate Matter (Docket EPA-HQ-OAR-2015-0072/ FRL-9998-63-OAR).

Strengths and Weaknesses in Career Cartography Application of the NIEHS-TRF

We found the major strength of the NIEHS-TRF was the substantial ease of use and enhanced clarity for prospective project and next step planning. The model filled an unmet need and gap in the literature to plan and communicate a clinical environmental health research trajectory. The model’s strengths also included the comprehensiveness in spanning the translational continuum, and integrating both clinical and environmental exposure science processes. The model uniquely provides conceptual bridges from one translational category to another in order to communicate the connections between basic, bench science studies of environmental exposure, to practice changes and impact (Drolet & Lorenzi, 2011). While the Symptom Science Model with Environmental Health is also an important shared mental model for specific symptom clusters, phenotypes, biomarkers, and individual clinical interventions for environmental health nurse scientists, the NIEHS-TRF was uniquely useful for mapping a project or career trajectory with a breadth that spanned more than one level of the translational continuum (Castner et al., 2019). We identified several opportunities for improvement, or weaknesses, in the NIEHS-TRF theoretical model’s application to environmental health nursing. First, the Fundamental Questions concept in the model excluded the development of novel technology and devices. Second, a specific node for ethics in the Practice Ring would enhance the relevance for nurse researchers. Overall, we found the NIEHS-TRF was more difficult to retrospectively, compared to prospectively, apply to a research trajectory or program portfolio as several individual projects may have spanned multiple categories and activities (rings and nodes). However, the iterative reflection and opportunity to use the NIEHS-TRF as a unifying communication tool provided unique insights and enabled the team to conceptualize retrospective work in new ways. Last, it is still unclear if the NIEHS-TRF is superior to other administrative organizational development and change models, such as a logic model, for the planning and evaluation of multiple researcher’s aggregate trajectories.

Conclusion

The NIEHS-TRF deserves further attention as a unifying model for program planning, including individual research projects, career trajectories, and administrative programs. The model can serve as a map for early career investigators to articulate their research path forward, state how their scholarly work will build and how to justify the inclusion of essential interdisciplinary team members. Finally, the framework holds great potential to support translational science leading to impact that results in systems change. Purposeful planning and communication guided by the NIEHS-TRF will lead to the advancement of translational goals through interdisciplinary collaboration.