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A Dynamic Duo

An engineer and nurse collaborate in the classroom and on research projects.


Shanina Knighton, PhD, RN, an instructor and KL2 Scholar with a primary appointment in the Frances Payne Bolton School of Nursing Colin Drummond, a professor and assistant chair of the Department of Biomedical Engineering

Graduate students at Case Western Reserve University who enroll in the BioDesign course to learn about medical device innovations are co-taught by two experts: Colin Drummond, a professor and assistant chair of the Department of Biomedical Engineering, and Shanina Knighton, PhD, RN, an instructor and KL2 Scholar with a primary appointment in the Frances Payne Bolton School of Nursing. At first glance, it may seem odd that a nurse teaches an engineering course about inventing and implementing new medical devices and instruments. But one of the main purposes of the class is to examine how innovations can address unmet clinical needs – something that Knighton became quite familiar with as a bedside nurse.

“Shanina and I come from two different places, and we arrive at BioDesign to teach together,” says Drummond. “Shanina has experience working on the frontlines in healthcare, so she can provide feedback and perspective that really enriches the classroom.”

Knighton has been teaching BioDesign alongside Drummond since 2016 as an adjunct faculty member and is the first nurse to have an appointment in the Case School of Engineering. It’s a natural fit for the nurse, who is a problem-solver with research interests in infection control and the use of technology for self-management of elderly and disabled patients. She came to Case Western Reserve University in 2013 for her doctorate degree in nursing to pursue those interests and further develop her idea for a novel patient hand-cleaning system.

“I was attracted to Case because the university is focused on innovation,” says Knighton. “Former Dean Mary Kerr told me about an awesome engineer named Colin Drummond, who had an appointment in nursing at the time, who could help push forward entrepreneurial endeavors.” She and Drummond hit it off right away, and for the past seven years they have collaborated on a multitude of fronts, from research projects to instructing and mentoring students.


A Commitment to Patient Hand Hygiene

Knighton’s first interaction with Drummond was as a student in the BioDesign course she now co-instructs. She was the only nurse in a class of mostly engineering and medical students. Knighton thrived in the course, which included lots of interactive, hands-on projects. It also featured a pitch competition to investors, where Knighton presented the patient hand-cleaning system that ultimately became the focus of her dissertation research.

Knighton’s interest in patient hand hygiene began as a clinical nurse on a pre/post-surgical care unit, where she worked for seven years. Informed by infection prevention theories from two influential nurse pioneers – Florence Nightingale and Virginia Henderson – Knighton recognized gaps in knowledge surrounding patient self-management of hand hygiene. She proposed using verbal electronic audio reminders, in conjunction with a patient hand hygiene bundle, to increase independent hand hygiene practices in older adults in acute care settings.

Impressed with the pitch, Drummond suggested that Knighton submit her business plan to the Galen/Brien Holder-Vision Graduate School Business Plan Competition held by the School of Engineering. She did so and won third place.

Drummond shared news of Knighton’s winning entry with leaders of the Frances Payne Bolton School of Nursing. “That really put me on the radar with the nursing school, getting recognition for something beyond being a nurse,” recalls Knighton. “From there on out, things took off. I did more pitch competitions and collaborated more with Colin.”


Research Expands into New Areas

The crux of Knighton’s research for her dissertation – creating an easier way for patients to clean their hands – escalated into broader work in design, development and evaluation of technology-based interventions that she continues today as a KL2 Scholar. Funded by the Clinical and Translational Science Collaborative (CTSC), KL2 Scholars are trained and mentored to conduct team-based, multidisciplinary, patient-oriented clinical research. It aligns perfectly with Knighton’s mission.

A quick glance at just a few of the projects Knighton has worked on recently with Drummond reveals her commitment to multidisciplinary work. Between 2018 and 2019, she served as co-principal investigator on an Industrial Internet of Things grant from the Institute for Smart, Secure and Connected Systems (ISSACS) at Case Western Reserve University to establish an infrastructure to engage older adults as partners to determine their unmet needs and simplify care. Drummond was a collaborator on the grant.


Drummond and Knighton during a working session for the CTSC Pilot Award to create a virtual assistant system to enhance patient self-medication outcomes


Earlier this year, Knighton and Drummond wrapped up work on a CTSC Pilot Award to create a virtual assistant system to enhance patient self-medication outcomes. Drummond was the principal investigator and Knighton the co-principal investigator. “My role on the team was to help develop patient and nurse clinical needs for voice algorithms to detect medication use and potential adverse medication interactions,” says Knighton.

One of her latest endeavors is a multidisciplinary project including biomedical engineers, electrical engineers and physicians to develop a wearable sensor for COVID-19. When used in tandem with predictive platforms, users of wearable devices could be alerted when changes in their physiological metrics match those associated with COVID-19 symptoms. A review of the work, which is spearheaded by Dhruv Seshardi, a doctoral candidate in bioelectronics and data analytics at Case Western Reserve University, was published in June in Frontiers in Digital Health.


Understanding the ‘Systems View’ of Medicine

Knighton’s body of work, particularly in relation to the importance of hand hygiene, has proved timely this year. “We are in the middle of a pandemic, and something from the 1800s is becoming news,” she says. “People should clean their hands!”

Drummond applauds Knighton’s efforts in infection control. “Shanina has been on a decade-long journey about hand hygiene,” he says. “She knows it’s the right thing , and she has shown great resiliency in finding funding sources that support her strategy, not subordinating to somebody else’s strategy.”

They both assert that the work is not simply about hand hygiene, but about its place within a larger context. Older patients may be afraid or unable to get up and clean their hands. Not only can that cause infection, but it can also contribute to immobility, which in turn can lead to frustration, depression, further inactivity, muscle atrophy and risk of falls. “Western medicine encourages us to focus on one piece of the problem, but not within the context of the bigger picture,” says Knighton.

Understanding the big picture – the systems view – makes the collaboration between Knighton and Drummond crucial. As a nurse, she has invaluable clinical insight and day-to-day experience using many products designed by biomedical engineers. Drummond “knows the market and has the eye of an engineer,” she says.

But Drummond isn’t your average biomedical engineer. Prior to joining the BME Department in 2015, he had a short stint in Case Western Reserve University’s School of Nursing because of his expertise in informatics. “That year had such a profound impact on me,” he says. “I ended up really understanding the nursing perspective.” Afterward, he enrolled in continuing education nursing classes that led to frontline clinical work, underscoring the practical relevance of his research activity.

Drummond’s respect for nursing stems from his theory on care versus cure. “A lot of my biomedical engineering colleagues are working on cures for illnesses, diseases and medical conditions,” he says. “My bias on the translational side is to focus on patient care, and that’s what brought me to nursing.”

Knighton praises Drummond’s patient-centered focus. “When you talk to Colin, it’s not like talking to a regular engineer who wants to solve a problem,” she says. “He brings a more humanized approach. He thinks about the patient.”


Nurse/Engineer Partnerships Make Sense

Drummond acknowledges the importance of partnering with physicians on solutions such as diagnostic tools and therapeutics. But for his projects, focused on the care continuum, teaming with nurses like Knighton is crucial. “Nurses come up with the patient care plan for the day, provide the ongoing care and educate the patient,” he says. “The nurse is closer to many of the tools that are needed for care than physicians, so it’s natural for nurses to have innovative ideas.”

To help ensure that future biomedical engineers understand the valuable input nurses can provide, Knighton has mentored more than three dozen students, many in the department’s Senior Design class. As a KL2 Scholar, she says her goal is to “create an engineering/nursing pedagogy by taking the biomedical underpinnings and applying them to nursing in a practical manner.”

Knighton’s work on the hand hygiene system for older adults demonstrates the validity of this framework. In May, she received a UL1 Pilot Award from NIH’s National Center for Advancing Translational Sciences to further develop the system. “We hope to have a viable prototype sometime this winter to start trialing inside clinical settings,” she says.

Drummond and Knighton exemplify the quintessential relationship between interdisciplinary professionals. Spend an hour with the two researchers, and it’s easy to see why they’ve successfully teamed up on so many projects. The passionate conversation moves seamlessly from details about current research to big picture thinking about the healthcare landscape. But it all boils down to one objective – improving patient care.

“The engineer wants to make sure devices function and have all the necessary bells and whistles. The nurse wants to know how they fit into her workflow and facilitate patient care,” says Knighton. “We are all trying to solve the same problem, and sometimes viewing the issue through a different lens allows us to create innovative solutions.”


Many people have contributed to Shanina Knighton’s success along the way. While they could not all be mentioned in this article, she would like to acknowledge her gratitude to following for their mentorship and expertise: Patricia Higgins, Associate Professor in the Frances Payne Bolton School of Nursing; Curtis Donskey, Professor in the School of Medicine; Mary Dolansky, Sarah C. Hirsh Professor at the Frances Payne Bolton School of Nursing; Kurt Stange, Distinguished University Professor; David Aron, Professor in the School of Medicine and Director of Program Research and Education at the Louis Stokes Cleveland VA Medical Center; and Robin Jump, Assistant Professor in the Department of Medicine Division of Infectious Diseases & HIV Medicine Department of Educational Programs in Clinical Research, Louis Stokes Cleveland VA Medical Center.