May 21, 2008 — University of Virginia doctoral nursing student Michael P. Cary Jr. is dedicated to nursing research that helps the elderly and to achieving his goal of becoming a nurse educator.
Thanks to a Johnson & Johnson/American Association of Colleges of Nursing Minority Nurse Faculty Scholars Award, one of five given nationally for the first time this year, Cary will be able to continue that pursuit. The scholarships are designed to help address the nation's shortage of nurse educators and are awarded in association with Johnson & Johnson's Campaign for Nursing's Future, which was launched in September 2007.
The scholarship will allow Cary, who is in the second year of the School of Nursing's Ph.D. program, to continue his education and to develop his career as an academic researcher, he said. The scholarship is awarded for one year with the possibility of renewal predicated on meeting goals set by the scholar.
One of the benefits of the scholarship is attendance at national conferences such as the one on faculty development, which Cary attended during the spring semester in Nashville, Tenn. The event, geared to the development of new faculty members, was "inspirational," Cary said. It also provided time to network with the other scholarship winners and faculty and deans from other schools.
U.Va. Nursing School Dean Jeanette Lancaster is Cary's scholarship mentor. Cary meets with Lancaster on a monthly basis and "asks millions of questions" related to leadership and setting goals, he said. The scholarship and opportunity to work with Lancaster, a leader in promoting nursing education and an advocate on the state and national levels for solutions to the nursing student and nursing faculty shortages and past president of ACCN "helps me to develop my professional goal of securing a position in academia," Cary said.
"It is a pleasure to work with Michael who is in the B.S.N. to Ph.D. program, and has a wife and baby so he has many competing demands on his time and attention. However, he has an eagerness to learn, grow and develop. My task is to help him craft his career while he has other mentors working with him on the important research he is doing," Lancaster said.
The scholarship also affords Cary the opportunity to explore his chosen field of geriatric-related research. The goal of a current research project is to evaluate and suggest ways to improve patient safety related to falls in hospitals. Cary is collaborating on the project with Gregory J. Gerling, U.Va. assistant professor of systems and information engineering. Cary and Gerling developed the idea for the project, "An Engineering Work Analysis Applied to Patient Falls in the Nursing Domain," after Cary took Gerling's fall 2007 class on human computer interaction.
Gerling, who had done some small studies related to falls, suggested to Cary that there was potential for research in this area.
"Gerling is looking at the problem through an engineering lens, and I am looking at it through a nursing lens," Cary said of the collaboration.
The two researchers are applying systems engineering techniques to understand the complexity of the health care system and identify problems related to patient falls. Specifically, they are using a cognitive work analysis, a systematic approach that seeks to identify workers' constraints, such as time constraints and patient load, to reduce workplace error and improve productivity, by identifying and analyzing the interplay between nurses, the patient, the environment and workflow. "The system in which care is provided affects the work of nurses and clinical processes, both of which influence the patient, the nurse and organization," Cary said. Through the analysis of the work domain of nurses, Cary and Gerling hope to identify ways to reduce the occurrence of falls in patients during hospitalization.
"We are observing the care delivery system being utilized, the workflow of the nurses, the communication structures on the unit, the physical layout of the unit, the type and availability of equipment, and the system for documenting care and patient status as they relate to fall precaution measures," Cary said. Through the analysis, Cary will develop a hierarchy of areas that impact patient falls and fall-related injuries and develop interventions to prevent falls. "With the data collected, we can suggest to the administration multidisciplinary interventions that target risk factors in reducing the occurrence of patient falls and other potentially safety-sensitive areas," Cary added.
"Michael really understands what it is like to be a nurse. He understands the various and often conflicting pressures on nurses — that they have to track everything about a group of patients each day while it is constantly changing," Gerling said.
"He is great in questioning rationale for taking an approach or using one method over another. What his questioning does is to make me think very hard about why we are using that method. Likewise, I may strongly question if in fact a nursing work process needs to be set up that way. Our work is better as a result."
The research is timely. Over the past 10 years there has been a surge in patient safety research, according to Cary. Last August the Senate passed the Safety of Seniors Act of 2007, a bill to expand and intensify programs with respect to research and related activities concerning elder falls. "Patient safety and falls particularly are one of many adverse events that are preventable," he said.
This research fits in nicely with Cary's interest in geriatrics, which he developed in his undergraduate studies at James Madison University. Through an elective gerontology class, Cary spent time visiting with an elderly gentleman for a few hours each week.
"He was very insightful and introduced me to some of the problems of long-term care and other health issues they deal with. I knew from then that I wanted to work with elderly and issues related to their care," Cary said.