Nurses Need Physiology

How can you engage your Nursing Students in Anatomy & Physiology?

www.bls.gov

Patricia S. BowneBiology Department

Alverno Collegepat.bowne@alverno.edu

Success in A&P

difficultymotivation

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What Motivates Nursing Students?• Desire to become an RN, for:

– professional reward – opportunity to

• help others • be useful • provide human contact

“If nursing students are to retain their desire to be RNs it is important for the educator to create a curriculum that promotes student motivation and relates the education programme to their forthcoming profession.”

Stomberg, M. W., & Nilsson, K. (2010). Nursing Students’ Self-Graded Motivation to Complete their Programme of Study. The Open Nursing Journal, 4, 42–47. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043268/

The more removed a topic is from the student’s final goal, the harder it can be for the student to see the connection and maintain motivation.

Help others Be useful Provide human contact

Clinicals

Pathophysiology, Pharmacology

A & P

Nursing Theory

Nursing skills

Students used A&P outside of class for: N=39Interpret patient conditions 9Understand medical professionals* 12Communicate with professionals 3Interpret medical treatments/lab values 10Diagnose selves/family 10Explain to acquaintances/family 11Impress others/sound professional 4Understand material in other classes 4Practice teaching 1Haven’t used it yet 3

Millenbruch, J and P. Bowne (2008)* e.g. Dr House

• A&P is not used in concurrent classes, according to students.

• A&P content doesn’t appear in syllabus of concurrent classes

• A&P is most important as a foundational course for later nursing classes.

Millenbruch, J and P. Bowne (2008)

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?

If we want to improve their motivation, we need to be able to relate the material to their goals.

Mouse over images for sources

What do Nurses do?

• Don’t they just follow the doctor’s orders?

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Some Decisions Nurses Make:

• Assessment – How often? – What measurements?– What methods?– Significance of results

• Interventions– When to administer

allowed drugs– Other interventions

• Hygiene – How often? – What methods?

• Complications– Which are likely– When are they

developing– How to forestall them– When to call the

doctor

Nursing Decisions cont’d.

• Tests– In some settings nurses can order or even perform

lab tests– Significance of results

• Patient Education• Nursing hand-off– What to tell the next nurse?

• Collaboration– How to establish a ‘team’ relationship with doctors?

Communicating with doctors

“…four reviewed studies found that communication between [nurses and doctors] tends to be unclear and imprecise ... This resulted in delayed delivery of patient care and more frequent medical errors that ultimately jeopardized patients’ safety ”

Tang, C. J., Chan, S. W., Zhou, W. T., & Liaw, S. Y. (2013). Collaboration between hospital physicians and nurses: An integrated literature review. International Nursing Review, 60(3), 291–302.

“… Doctors valued the better information provided by experienced nurses”

“Doctors wanted to be given

enough clinical information to enable them to

prioritise calls and initial actions.”

“Nurses expressed frustration when

doctors … failed to acknowledge their concerns or take

them seriously ‘until they had some hard

evidence’ “

Weller, J. M., Barrow, M., & Gasquoine, S. (2011). Interprofessional collaboration among junior doctors and nurses in the hospital setting: Interprofessional collaboration. Medical Education, 45(5), 478–487. http://doi.org/10.1111/j.1365-2923.2010.03919.x

FAILURE TO RESCUE“inability of clinicians to save a patient's life by timely diagnosis and treatment when a complication develops”• failure to recognize clinical deterioration• failure to communicate and escalate concerns• failure to physically assess the patient• failure to diagnose and treat appropriately

Garvey, P. K. (2015). Failure to Rescue: The Nurse’s Impact. Medsurg Nursing, 24(3), 145–149.

Nursing to avoid Failure to Rescue:

• Need to recognize and interpret clinical cues• Need to alter monitoring of patient in

response to clinical cues• Need to decide when to call physician or rapid

response team• Need to explain the seriousness of the

situation in a way that convinces physicians

Hughes L, Mark B, 2004. Processes Contributing to Failure to Rescue in Acute Care Hospitals. Abstr AcademyHealth Meet. 2004; 21: abstract no. 1831. http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103624865.html

What does an A&P teacher know about

failure to rescue?

“early, subtle signs and symptoms often overlooked in clinical assessments… typically occur due to compensation for hypoxia or hypoperfusion”and may appear 48-72 hours before the adverse event

Garvey, P. K. (2015). Failure to Rescue: The Nurse’s Impact. Medsurg Nursing, 24(3), 145–149.

Who’s watching the patient?

The doctor is there at roundsThe nurses are in and out all day

The normal regulatory mechanisms are there 24/7

… if you can understand what they are saying about the patient

Gosh, do we teach anything about that?*

• Homeostasis • Negative feedback • BP = CO X PR• Baroreceptor reflex• SNS/PNS• RAAS• CRH

• ADH and thirst response

• Chemoreceptors • Acid-base balance• Ventilation • Hematocrit • Erythropoiesis

*rhetorical question

Example from Pathophysiology

• “Physical examination findings are variable and include fever, tachycardia, hypotension, severe abdominal tenderness, respiratory distress, and abdominal distension… Clinical findings such as thirst, poor urine output, progressive tachycardia, tachypnea, hypoxemia, agitation, confusion, a rising hematocrit level … are warning signs of impending severe disease.”

Porth, C.M. (2015) Essentials of Pathophysiology. Wolters Kluwer. P 749

In summary:

• What we teach is key for actual nursing practice and saving lives

• We do not need to teach different content in order to serve nursing students

• BUT they do not know how they will use what we’re teaching them

• So if we want them engaged, we need to help them make the connections.

• The good news: this is not hard to do.

Making A&P questions nurse-friendly• Patients, not principles

– “What might be going wrong with the patient?”– “What will the patient complain of?”– “How will you explain this to the patient?”

• Medical Setting– “You’re working in … ”– “What problem do you think might develop?”– “You observe … what does it make you worry about?”

• Team context– “The med student says … do you agree or not?”– “The aide reports … what will you do about it?”– “Why did the doctor order that test?”– “What will you tell the doctor?”Freestock photos, Public Domain

http://www.freestockphotos.biz/stockphoto/15413

For example:

• “List two of the four major factors that influence how much Oxygen diffuses into pulmonary blood per minute.” (Patton, K.T. and G.A. Thibodeau (2010). Anatomy & Physiology, Mosby. P. 816)

• “A 62-year-old man in respiratory distress is in the ER. His pulseox indicates a low blood O2 saturation. What are the major factors that might be influencing how much Oxygen diffuses into his pulmonary blood?”

• “How do slow, separate, autorhythmic contractions of cardiac muscle make it well suited to its role in pumping blood?” (p. 363)

• “Mrs. K has atrial fibrillation, a condition in which the atrial cardiac muscle cells are firing rapidly in an uncoordinated fashion. She doesn’t understand why her blood pressure is low, when her heart cells are beating faster than usual. How will you explain this to her?”

You try it:

• “What is the purpose of peristalsis?” (p. 884)

• “How does blood pressure affect filtration in the kidney?” (p. 959)

• “Name some effects of cortisol in the body.” (p. 562)

• “Relate stroke volume and heart rate to cardiac output.” (p. 675)

Freestockphotos, Public Domain. http://www.freestockphotos.biz/stockphoto/16249

Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational Levels of Hospital Nurses and Surgical Patient Mortality. JAMA : The Journal of the American Medical Association, 290(12), 1617–1623. http://doi.org/10.1001/jama.290.12.1617

Educated Nurses Save Lives

HAPS and Nursing Education … some resources to start with

• Covert, S. O. (2008) A Preliminary Survey on the Conceptual and Motivational Value of Using Specially Designed Clinical and Pharmacological Cases As Problem-Solving Tools in Physiology Dry Labs for Pre-Nursing Students. HAPS-ED 12(2): 25-26

• Cooper, S. and S. Ritter (2009) The Face of Nursing in the 21st Century. HAPS-ED 13(3): 13-15

• Bowne, P.S. and M.K.Feeney (2009) Nurses use physiology for … ? HAPS EDucator, 13(2): 5-6

• Jaffe, M (2009) Suture 101: Closing the Gap Between Basic Anatomical Knowledge and Clinical Application in the A&P Laboratory. HAPS-ED 14(1):22-24

• Bowne, P.S. and M.K.Feeney (2009) Nurses Use Physiology for ... Avoiding Failure to Rescue. HAPS-ED 14(1):36-38

• Levey, J. (2009) Understanding Baccalaureate Nursing Students’ Perceptions of Anatomy and Physiology. HAPS-ED 14(1):43-49