uring the past 15 years of working at Atlanta's Veteran Affairs Medical Center and Emory University Hospital, Associate Professor Kathy Parker has methodically developed the role of acute care nurse practitioner. Along the way, she's looked at, listened to, and learned from the best of instructors: the hundreds of patients she has cared for in that time. This bedside education inspired Parker to work her way up the academic ladder - culminating in a doctorate earned in 1990 - and to carve out a research career focused on investigating sleep disturbances in patients on chronic hemodialysis. "Over the years, I saw a pattern among the dialysis patients I cared for," she says. "Most would initially report sleep disturbances as a result of their renal disease, but once dialysis was initiated those symptoms would improve - for a while that is. Typically, we would see a return of sleep problems over time." A chronic inability to sleep well coupled with the trauma of dialysis itself can easily compromise a patients' health, recovery, and quality of life, Parker says. And this has important implications for nursing. "Sleep disturbances are very common in renal-failure patients, and recent studies have provided convincing evidence that poor sleep is not just a quality-of-life problem for these people - it can add another physiological burden to their disease. In day-to-day clinical nursing practice, however, issues of sleep quality are rarely addressed. Ultimately, I hope my work can bring attention to the importance of sleep and health, as well as the role of the nurse in assessing and managing sleep problems."

Kathy Parker, RN, PhD

arker's research has been well received both in terms of funding and publication. Like much of the cutting-edge research being conducted at the School of Nursing these days, hers is grounded in collaboration. Her evidence-based approach to practice - in which one observes and identifies a patient problem, like difficulty in sleeping, then goes in search of resources to address that problem - led her to sleep expert Donald Bliwise, PhD, director of Emory's Sleep Disorder Center. The two developed a series of studies designed to examine aspects of sleep regulation in dialysis patients, work which ultimately provided the basis for an $863,503 grant they received from the NIH's National Institute of Nursing Research. "We just finished the first year of data collection," Parker says, "and have begun analyzing the first wave of data." Additional data will be collected and analyzed every six months for the duration of the three-year study to look for trends that can help guide future research. Parker has also collaborated on several projects with researchers in Emory's Renal Division, receiving substantial support from them in the process, and has recently published work demonstrating the safety and efficacy of once-weekly low-dose erythropoeitin to combat the anemia of renal failure. This latest research - which indicates that a much lower dose of the drug, administered less frequently, is just as effective as the larger, more frequent dose called for by standard guidelines - has the potential to save the nation's Medicare system literally hundreds of millions of dollars if the findings are incorporated into mainstream dialysis procedures. In late August, Parker was also approved to begin a preliminary interventional study at Emory University Hospital's Clinical Research Center. That study - "Effects of Cool Dialysate on Sleep and Sleep Propensity in Chronic Hemodialysis Patients" - will last for one year, during which time Parker and her collaborators will collect data on the efficacy of using this particular intervention to improve sleep patterns among dialysis patients. If the initial findings are promising, and if outside funding is forthcoming, Parker plans to enlarge the study in the near future.

ertainly, when the School of Nursing's new doctoral program is in place, Kathy Parker's presence at Emory will be a great calling card for any PhD candidate interested in sleep physiology and circadian rhythms, or in the many other problematic symptoms of renal disease. For her part, Parker hopes so. "I look forward to having student colleagues here who are interested in these issues, not only to share what I've learned thus far but also to enhance my own learning." In the meantime, she says, she will keep herself busy not just with her research but also with her clinical role as a nurse practitioner in the Sleep Disorders Center. "Without my years of clinical work, and my years of interacting with professionals from other disciplines, I wouldn't be able to ask the right questions. And without the right questions, I certainly couldn't come up with the right answers."

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ome 200 people are expected to take part in "Pain and Sleep: A Critical Interface," an interdisciplinary conference to be held at Emory January 14-16. Continuing education credits will be awarded for the conference, which will be geared toward physicians, nurses, social workers, and allied health professionals. Sessions will include presentations on the commonalities of basic mechanisms of pain and sleep, sleep disturbances in specific pain syndromes, and pain management strategies. The planning committee for the event is comprised of several faculty with pain/sleep expertise: Dr. Lynn Lotas (neonatal sleep), Dr. Kathy Parker (sleep disorders in kidney dialysis patients), Dr. Deborah McGuire (cancer pain), and Dr. Marlene Walden (neonatal pain). Also on the committee are Emory neurologists Donald Bliwise (director of Emory's Sleep Disorder Center), David Rye (medical director of the Sleep Disorder Center), and David Hewitt. See the calendar entry for information on how to register.