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Discovering data patterns: From the platoon to pressure injuries

A U.S. Navy poster hung in the nursing school at the University of Illinois Chicago and beckoned students to join the military. Jenny Alderden noticed the enticing hospital destinations in Italy and the United Kingdom and thought to herself: “‘I would like to do that, and I don’t have money for school.’”

Since the Navy will pay for nursing school, Alderden joined up in the year 2000.

Jenny Alderden stands in front of a medical transport helicopter.
Jenny Alderden is now an associate professor at the School of Nursing.

“Then obviously in 2001 the world changed, so my military career ended up being a lot different than what I had imagined,” she said.

Alderden first served as a fixed-wing critical care air transport nurse out of Okinawa, Japan, meaning she performed her nursing duties while transporting patients in an airplane.

At the height of the U.S. troop surge to Iraq in 2006, she deployed to Al Anbar. Here she served as a helicopter flight nurse, as well as the senior nurse of a shock trauma platoon.

“[It was] incredibly chaotic, because [the U.S.] had our war and our objectives, but there was also a massive civil war going on in Iraq,” Alderden said. “It was a very unstable, very violent, very brutal place at that time.”

She had already planned to get out of the military when she returned stateside and pursue her master’s degree. Her original goal was to become an expert clinician.

“I had thought that I wanted to be this really crackerjack critical care nurse,” she said, “But my experience in deployment really changed my focus and my perspective in the sense that we just saw so much massive amounts of human suffering.”

“So I instead started to focus on wounds, which are not sexy,” she said, laughing. “For my master’s thesis, I just read a bunch of charts.”

Finding ways to ease human suffering

Alderden studied wounds at the University of Washington in pursuit of her master’s in nursing. She searched for patterns in the data of patients with pressure injuries.

“We used to think that pressure injuries are mostly caused by not repositioning the patient,” Alderden said. But her master’s research data told a different story: “It’s really circulation,” she said. The trauma patients who were part of her study helped her see the problem was sometimes a lack of quality oxygen delivered to the skin and underlying tissues.

Pressure injuries (also known as pressure ulcers or bedsores) are areas of opening or damage on one’s skin. They often occur on a bedridden person’s heel or sacrum, and are therefore “hugely limiting in terms of quality of life. They’re painful and embarrassing,” Alderden said.

“But I feel passionate about my research because I think pressure injuries are a place where we can ease human suffering, at least to some degree.”

Another reason Alderden pursued pressure injuries research is because it’s an understudied topic and very nursing-driven.

“Lots of things that we study in healthcare, physicians are the ones that write the orders,” Alderden said. “But pressure injuries tend to be really within the domain of nursing, which is something that I like.”

She also enjoys working with data. As anyone who’s been to a healthcare facility in the last century knows, staff constantly input patient data into computerized electronic health records.

Jenny Alderden stands in a flight suit next to another flight nurse by their helicopter.
Alderden spent some of her time deployed with the Navy serving as a helicopter flight nurse.

“I love taking that data and actually using it to try to identify patterns or identify ways that we can help patients have better outcomes,” Alderden said.

But Alderden has the Navy to thank for her first experience with data patterns.

Data patterns from deployment

Similar to the practices of healthcare facilities we know, the nurses in the shock trauma platoon constantly recorded patient data while deployed in Iraq. During her time there, Alderden saw several patients all in a row come in with nearly identical fatal gunshot wounds. Then she received a call from a nurse scientist at the Pentagon asking about the pattern; apparently their platoon wasn’t alone.

“Everybody that was in our region was seeing these specific gunshot wounds,” Alderden said.

Alderden talked to a gunnery sergeant about the pattern in order to learn context for the injury. He mentioned a tactic that the squads would do while on patrol; they realized it was unintentionally making squads vulnerable to this kind of injury. So the squads changed tactics.

Later on they discovered there was a skilled sniper in the area who specialized in those particular shots. Changing tactics – in response to a pattern – ended up preventing these injuries and saving lives.

“I thought that was fascinating,” Alderden said. “The idea that data in the individual means nothing, but in aggregate you can sometimes see patterns that weren’t obvious to you that can really make a real difference.”

What story does the data tell?

Alderden went on to develop her skills in aggregate data research while earning her doctorate at the University of Utah. Now, she hopes to bring that same fascination with data into her teaching as an associate professor at Boise State.

Associate professors Jenny Alderden and Lucy Zhao with their research poster about postoperative delirium risk factors.
Alderden (left) and associate professor Lucy Zhao presented their work at a nursing conference this past spring. They collaborated with St. Luke’s Center for Excellence to conduct research focusing on nursing care for older adults using a national dataset.

Often nurses spend so much time entering data in electronic health records, “yet we don’t think of that as a tool that can give us [something] back,” Alderden said.

“When we work with a lot of data, we need to understand the context of the data-generation process,” she said. “We need to know the story behind how those data were produced in order to make sure we interpret them right. So I think of what I do as a lot of trying to elucidate the story in the data.”

Alderden sees her research as a mix of math, computer science and storytelling with data.

“Technically it’s not [qualitative], but I think that the line between qualitative and quantitative is a little bit artificial,” she said. “Those are very unnecessary and arbitrary distinctions because we’re all kind of doing the same thing.”

The research process is all about finding meaning – and in Alderden’s case, the story – in whatever subject is being researched. She wants to help students see how data is a “tool for telling the story about the patient.”

“There’s two sides of the same coin,” she said, “And using data to tell a story is, in my opinion, one of the best uses for data.”