A Researcher Who Still Talks to Nurses in their Own Language
Dawn Dowding, PhD
Dawn Dowding is a Professor of Nursing, and serves a joint appointment between Columbia Nursing and the Visiting Nurse Service of New York. Previously, Dowding served as Professor of Applied Health Research at the University of Leeds in her native United Kingdom. Her research focuses on the development of decision support tools and the evaluation of the effectiveness of such tools in clinical decision making. She received her PhD at the University of Surrey, and wrote her dissertation on how patient information is processed during nurse shift changes. Dowding also served as a Harkness Fellow in Health Care Policy and Practice at Kaiser Permanente in Oakland, California and as a member of the clinical editorial board of the Nursing Times, the UK-based weekly nursing magazine. At Columbia Nursing, she will teach evidence based practice to combined BS/MS students and is currently at work developing a research program across both organizations to improve patient outcomes at the VNSNY.
Q: What will your dual role with Columbia Nursing and VNSNY entail? What will your research focus on?
While it is still in its formative stage, the goal will be to provide the VNSNY nurses with access to a decision support system that can then be integrated into their practice to deliver better care. As a nurse scientist, I’m a bit unusual because I don’t focus on a particular client group, which is a perfect fit because the clients served by VNSNY come from several populations including frail elders, mothers with new babies, patients receiving hospice care at home, and other homebound patients.
Q: How has technology shaped the way nurses make decisions? In what ways can nurses and nurse scholars use this information to deliver better care?
Nurses often integrate evidence and research into their clinical decisions. For example, research I conducted demonstrated that when nurses used algorithms to arrive at a treatment plan for urinary incontinence in women, patient outcomes could improve. At Kaiser Permanente, when an electronic health record system (EHR) was introduced, pressure ulcer rates decreased. When clinicians are aware of how they make decisions, they can avoid traps based on habit. Computers don’t get tired or have a bad day. They do things consistently most of the time and enable nurses to make fewer mistakes.
Q: What are the major differences you have seen between the healthcare systems in the UK and in the US?
On many levels, caring for patients is quite similar on both sides of the Atlantic. It’s the surrounding environment that truly differs. Our use of EHRs in the UK is really patchy. In the US, you have a financial incentive to track patients and bill them using an electronic system. Since the National Health Service (NHS) doesn’t need to do that, EHRs are not used in most acute care settings as they are in the US.
Q: How does nursing education differ in the U.K. and the U.S.?
When it comes to nursing education, the U.S. often leads, and the U.K. follows. We’re a good few years away from moving towards doctoral level education for advanced practice nurses in the U.K.. At the University of Leeds, our program educated advanced practitioners from across the medical field, including nurses, physical therapists, radiologists, and the like. The nursing informatics community in the U.K.is tiny, so it’s a fantastic opportunity for me to work at Columbia Nursing where nursing informatics is so strong.
Q: What made you want to become a nurse?
I can’t remember a time when I didn’t want to be a nurse. My father was upset when I told him that it was my chosen career. At that time in the U.K. the entry level for nursing wasn’t at the bachelor’s level, we’ve only moved to the bachelor’s level a few years ago. So I did my nurse training and got a bachelor’s degree in psychology as a joint program. After I graduated, I worked as an acute care nurse in two London hospitals for two years, first in the admissions unit at St. Bartholomew’s Hospital, and then in the ICU at St. George’s Hospital.
In the ICU, most of my patients were very sick, and the majority died. It was a very difficult experience, and it influenced me to become a researcher so I could help improve patient outcomes. I realized that as a researcher I could provide evidence for beside nurses that would help their patients get better care, recover sooner, or make them more comfortable in their final days. I love being a nurse researcher, but I will never forget what it’s like caring for vulnerable people on the frontlines. I can still talk to nurses in their own language.