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Katherine Alford: Nursing Science Helps The Bedside Nurse

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Author: GSBS | Category: Final Words... | Nursing Science (Ph.D.) | June 13, 2017

Your name, program, mentor name.

I’m Katherine Alford, I completed the Ph.D. in Nursing Science degree with Dr. Sara L. Gill as my mentor.

When did you realize you were passionate about science?

My passion for science developed gradually. I wanted to be a nurse, a teacher, or a journalist. I chose nursing as a career due to the influence of an aunt who was a nurse, and I was able to do all three. I appreciate looking for patterns in the environment or in what I read. I like asking questions and forming conclusions based on observations which are essentially what being a researcher is about.

Please tell me about yourself, why did you pick UT Health Science Center, and your program.

My lifelong mentors encouraged me to pursue a Ph.D. I chose UT Health San Antonio because of the UT brand and the school’s research excellence. I also wanted to serve the San Antonio community and UT Health San Antonio facilitates that opportunity

Tell me about your research. Why are you passionate about your research topic? How did you first become interested in it?

My undergraduate senior thesis was about Adherence to the Five Rights of Medication Administration among students nurses so early on I was interested in medication administration work. I knew when my doctoral studies began that I wanted to have an end product that would help the bedside nurse. One of the best ways to do that was by studying nursing work. If nurses define and describe in full what their work entails, it will prevent others from interpreting the work for them. Workarounds are a part of that work.

It is my belief that workarounds need to be made visible so it can be properly studied. Nurses come to work every day to help and care for patients, not to engage in subversive, error-prone activities that will endanger the lives of patients. I served on a variety of interprofessional committees where other healthcare, and non-healthcare professionals would freely mention performing a workaround to accomplish a goal or meet a policy requirement. However, in the nursing world; it is considered taboo to speak about workarounds. If nurses are considered the most ethical profession in the United States, why do nurses perform workarounds? And why can’t nurses speak about workarounds?

What do you want the public to know about your research? Why is your topic important?

That workarounds are a part of nursing work and workarounds does not always result in a safety breach or originate from a system failure. One of the findings from my study was nurses performed workarounds as a clinical judgment due to past experiences which can be tacit or due to an inherent time knowing – the time it would take to complete a procedure would be an example. Workarounds were often performed due to a motivation to assist the patient. It was not about nurses choosing a shortcut rather than the proper procedure. 

If nurses cannot speak out about workarounds and the decision making involved in the process, then health care would miss out on important organizational learning. Nurses should be able to freely talk about workarounds and the realities that occur in the workplace. If nurses talk about the workaround issue and define it, nurses and healthcare leaders will be able to come up with solutions to the root cause of why the workaround was needed in the first place. Because nursing work is complex and often involve collaboration and care coordination, workarounds are a means of accomplishing goals among interprofessional team members. 

In any complex setting, emergencies will happen and workarounds will take place. Nursing leaders should engage the bedside nursing staff on discussions about workarounds. The discussions should also include coaching nurses about workarounds that could cause patient safety errors and workarounds needed to facilitate workflow. If we remain silent about workarounds or attempt to sweep workarounds “under the rug,” it will not benefit the patients and will be detrimental not only to patient safety but nursing safety. It’s time to “roll back the rug” and face the issues.

What was your best memory during graduate school or what did you learn?

 I think my struggles in graduate school made me a stronger person. In anything, you take the good with the bad and that creates a fuller experience. One of the best memories I had was being the Principal Investigator for a pilot study that eventually informed my dissertation’s research questions. This was an ethnographic study that included performing participant observations, writing field notes, coding the field notes, and semi-structured interviews. I presented the findings of this pilot in a poster presentation at the Qualitative Health Research Conference, Montreal B.C. I met other qualitative researchers in that conference and learned the latest trends in qualitative research. UT School of Nursing helped me supplement what I learned in class by providing travel support to conferences. The best memories in graduate school came from the wonderful people I met along the way. 

I met my dissertation’s external committee member during one of these conferences – Dr. Bonnie Jennings. Dr. Jennings was awesome and invested in my growth as an independent researcher. I also had the best dissertation committee! I am indebted to all of them. In addition to formal classes, I supplemented learning by attending classes from other universities for my cognate requirement. I completed a Certification in Qualitative Research Methods from the Summer Institute in Qualitative Research from the University of North Carolina, Chapel Hill. My study was a Mixed Methods study and going to University of Michigan Mixed Methods Research and Scholarship Conference helped me write my dissertation.

What do you like to do outside of graduate school?

Outside of graduate school, I have a full-time job in Quality Management at the South Texas VA. My Quality Management family gave me a home outside nursing. I love data analytics, leading process improvement teams, planning programs, and implementing projects. I like interacting with bedside staff nurses and the Veterans. I feel privileged to serve our Nation’s Veterans. Most of my studying was done in the “wee hours of the morning" and the weekends and on some days, I was sleep deprived. I find myself napping and catching up on sleep on the weekends post dissertation defense. ☺ I also enjoy spending time with my family and reading classic books.

What’s next?

I enjoy quality improvement, research, team and implementation science. If there is a career field that would enable me to function in these, it would be the best job! I am writing the results of my dissertation and I have targeted several journals for publication. I am considering grants and postdoctoral fellowships in patient safety, quality improvement, advanced methodologies such as big data analytics, and health services research.



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