Journal of Nursing Education

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Teaching Biomedical Science

Linda Fagan Dubin, PhD

Abstract

The title of the Yale University School of Nursing (YSN) "Three-Year Master's Program for Non-Nurse College Graduates" is a cumbersome, yet descriptive one. In this era of declining jobs for college graduates, nurses are still in demand, and nursing is an essential profession in our health-oriented society. Whatbetterchoice for the philosophy or psychology graduate interested in the health sciences than a career in nursing! This is not to imply that such students were not previously motivated or exposed to nursing. The applicant pool is so great that good students with experience as nurses aides, family planning counselors, EKG technicians, etc., can be selected. The programs for non-nurse college graduates at Yale and Pace Universities,1'2 as well as the historic (1918) Vassar Training Camp for Nurses seem to have been fantastically successful.

The first year of the YSN program is a basic, introductory pre-speciaity year. Students take courses in science, nutrition, pharmacology and "Issues in Nursing." After a seven-week clinical "Introduction to Nursing," students have clinical practice for seven or eight weeks in each of the following specialities: medical/surgical, psychiatric, pediatrie, community health and maternal-newborn nursing. After the first year, which consists essentially of intensive courses in everything relevant to nursing, students enter one of the preelected specialty programs where they become assimilated with bachelor's degree nurses entering a two-year master's program (MSN). The specialty programs include medical/surgical nursing with oncology, cardiovascular, pulmonary and neurology-neurosurgery subspecialties); psychiatric-mental health nursing (including adult, child and psychiatric liaison specialties; pediatrie nursing (a pediatrie nurse practitioner program); maternal-newborn nursing (nurse-midwifery); and community health nursing (including a family nurse practitioner track).

To accomplish t he Three- Year Program's goal, the content of both baccalaureate program and master's programs in nursing must be condensed into three years. The scientific component is no exception. In some cases, candidates with degrees in the sciences have had courses equivalent to those in a nursing curriculum. But what about science for the formerart or history major? Ventura has shown that there is no difference between liberal arts and science graduates in their performance in an MSN program. (All do well.)

The following is a description of a firstyear course designed to provide the necessary scientific foundation for clinical practice: Biomedicai Science. The course is taught by a biologist who has endeavored to bring the fundamentals of cell biology, biochemistry, genetics, embryology, immunology, anatomy, and most of all, physiology, into a cohesive, concentrated exposure to the natural sciences relè van t to nursing. (Students who Kave had previous course work in these areas are granted full or partial waivers.) During the first year, students also take a Science Study Project, which gives two credits for remedial or advanced work, according to the needs of individual students, and a three-credit Seminar in Pathophysiology.

Biomedicai Science is an "integrated" science course. While it is true that the advantages and disadvantages of integration have been debated - in this "crash course," it is appropriate and essential to select from all the scientific disciplines not only what is relevant, but what may someday be relevant. Typically, in BSN programs, science courses a re "farmed out" to biology or chemistry depart men t s, where courses appropriately, but redundantly, begin with a review of basics and include material extraneous to the nursing major. Perhaps what is done here can only be done by a scientist incubated in a school of nursing and committed to the special needs of such a program. This approach may be successful at any level, given good students and an instructor with the right background and expertise.

The con ten t of Biomedical…

The title of the Yale University School of Nursing (YSN) "Three-Year Master's Program for Non-Nurse College Graduates" is a cumbersome, yet descriptive one. In this era of declining jobs for college graduates, nurses are still in demand, and nursing is an essential profession in our health-oriented society. Whatbetterchoice for the philosophy or psychology graduate interested in the health sciences than a career in nursing! This is not to imply that such students were not previously motivated or exposed to nursing. The applicant pool is so great that good students with experience as nurses aides, family planning counselors, EKG technicians, etc., can be selected. The programs for non-nurse college graduates at Yale and Pace Universities,1'2 as well as the historic (1918) Vassar Training Camp for Nurses seem to have been fantastically successful.

The first year of the YSN program is a basic, introductory pre-speciaity year. Students take courses in science, nutrition, pharmacology and "Issues in Nursing." After a seven-week clinical "Introduction to Nursing," students have clinical practice for seven or eight weeks in each of the following specialities: medical/surgical, psychiatric, pediatrie, community health and maternal-newborn nursing. After the first year, which consists essentially of intensive courses in everything relevant to nursing, students enter one of the preelected specialty programs where they become assimilated with bachelor's degree nurses entering a two-year master's program (MSN). The specialty programs include medical/surgical nursing with oncology, cardiovascular, pulmonary and neurology-neurosurgery subspecialties); psychiatric-mental health nursing (including adult, child and psychiatric liaison specialties; pediatrie nursing (a pediatrie nurse practitioner program); maternal-newborn nursing (nurse-midwifery); and community health nursing (including a family nurse practitioner track).

To accomplish t he Three- Year Program's goal, the content of both baccalaureate program and master's programs in nursing must be condensed into three years. The scientific component is no exception. In some cases, candidates with degrees in the sciences have had courses equivalent to those in a nursing curriculum. But what about science for the formerart or history major? Ventura has shown that there is no difference between liberal arts and science graduates in their performance in an MSN program. (All do well.)

The following is a description of a firstyear course designed to provide the necessary scientific foundation for clinical practice: Biomedicai Science. The course is taught by a biologist who has endeavored to bring the fundamentals of cell biology, biochemistry, genetics, embryology, immunology, anatomy, and most of all, physiology, into a cohesive, concentrated exposure to the natural sciences relè van t to nursing. (Students who Kave had previous course work in these areas are granted full or partial waivers.) During the first year, students also take a Science Study Project, which gives two credits for remedial or advanced work, according to the needs of individual students, and a three-credit Seminar in Pathophysiology.

Biomedicai Science is an "integrated" science course. While it is true that the advantages and disadvantages of integration have been debated - in this "crash course," it is appropriate and essential to select from all the scientific disciplines not only what is relevant, but what may someday be relevant. Typically, in BSN programs, science courses a re "farmed out" to biology or chemistry depart men t s, where courses appropriately, but redundantly, begin with a review of basics and include material extraneous to the nursing major. Perhaps what is done here can only be done by a scientist incubated in a school of nursing and committed to the special needs of such a program. This approach may be successful at any level, given good students and an instructor with the right background and expertise.

The con ten t of Biomedical Science emerges in about 92 hours of lecture, supplemented with laboratory exercises on an ad hoc basis. The student is first introduced to the structural and biochemical aspects of the cell and the concept that most, if not all, diseases are actually manifestations of disordered subcellular structure and metabolism. When one reflects on the fact that renalglomeruliof diabetics show thickened "basement membranes" and that lysosomes participate in the inflammatory response, one may appreciate why this is necessary. The students may still be around when the "cellular treatment of disease" comes to pass, as it already has for cancer.

Cellular chemistry lecture ma te rialgi ves the definitions and significance of major classes of molecules in all cells: fluid and electrolytes, nucleic acids, proteins, carbohydrates, and lipids. General descriptions of protein and Iipid syntheses set the stage for understanding formation of the protein hormone insulin and the steroid (Iipid) hormones testosterone and estrogen, as well as of the steroid vitamin D. Later lectures pick up on some of the details of specific hormone biosynthesis, functions, and dysfunction. The lecture on protein synthesis and function expands in to a twohour discussion of serum enzyme activity, isoenzymes, and enzymatic de terminations routinely done a t Vale Ne w Ha ven Hospital. The last presented to high light the need for such knowledge in the diagnosis of disease, e.g., myocardial infarction.

The patterns and principles of general and molecular human genetics are presented in the context of genetic diagnosis, counseling, and prevention of gene tic problems. The inheritance of blood groups leads to the discussion of potential fetal-maternal or transfusion incompatibilities. Sickle cell anemia is one example given of a molecular genetic disease (not to ignore the fact that all genetic disease has a molecular basis). Techniques available for detection of genetic disease, including amniocentesis, Ba rr body determination, and karyotype analysis are described, since nurses may often become involved in educating patients when such tests are indicated.

One histology lecture tunes the class into the com mon denomina tors of anatomy and prepares them for the "systems" approach that follows. The systems begin with the cardiovascular system after a three-hour presentation on the histology and physiology of muscle. After all, the heart isa muscle. Understanding i t requires a thorough familiarity with the electrolyte and energy needs for muscle function. The principles of electrocardiograph^ and the physics of blood pressure and flow dynamics arc given in an abridged form. Students are able to read or draw simple EKC tracings and know the factors influencing altered pressure and flow. For the audiophile, cardiac auscultation and the significance of heart sounds is enhanced using segments of a Merck, Sharpe, and Dohme recording. We view the film, "Disorders of the Heart Beat" from Wyeth Film Library with its accompanying brochure, an easy animated survey of cardiac arrhythmias and conduction defects.

Blood components are viewed biochemically, morphologically, and physiologically from maturation in the bone marrow to the peripheral blood. The red blood cell is dissected from the biosynthesis of hemoglobin and altered molecular forms, such as HbS (sickle cell anemia) to the degradation products bilirubin and iron. Etiologies of various anemias and the associated erythrocyte changes are compared. Leukocyte function is outlined, supplemented with a marvelous film showing the phagocytic action of neutrophils and eosinophils (courtesy of Dr. M. Farquhar, Yale School of Medicine). Comments on megakaryocytes, platelets, and blood clotting briefly cover synthesisand deficiences of clot ting factors. Students study peripheral and bone marrow smears microscopically and do hematocrits in the laboratory. We even do some population studies by tabulating frequency of blood types (ABO and Rh) in the class.

Two to three hours are barely sufficient to cover the expanding field of immunology. The historical concepts of humoral and cellular immunity are brought curren t by our understanding of B- and T- lymphocyte sensitization, maturation, and function. That B-cells fight bacteria and T-cells fight tumors (among other things), and that their cooperation and competitive efforts sometimes save and sometimes fail, are points of focus. The molecular structure of antibodies (immunoglobulins) and the different classes of immunoglobulins (e.g., IgG, IgM, the allergic type IgE) are given in terms of the relationships of structure to the role in immune responses.

Respiratory, renal, and gastrointestinal physiology are presented in a traditional way. But the multidisciplinary approach (molecular, cellular, biochemical, anatomical, physiological) is not abandoned. For example, the fine structure of the renal glomerulus and its alteration in some renal diseases are essential components of the discussions of that marveJous organ, the kidney. The liver (especially its synthetic properties} is a focal point of the gastrointestinal system since there are so many manifestations of liver disorder, especially common in an era of alcohol and drug abuse.

Approximately six weeks (24 lecture hours) are devoted to the study of the nervous system. A laboratory session featuring dissection of sheep brains and observations on half of a human brain facilitates the learning of anatomical terms. After an introduction to the nervous system and the neuron, two or three hours are spent on the synapse, describing and classifying neurotransmitters. Since so many pharmacologie agents and psychotropic drugs mimic or moderate neurotransmitter action, this is essential, particularly for the potential psychiatric nurse.

Surprisingly, retrospective comments from former students have indicated that a high point of the neurological component is the learning of the cranial nerves. (Student s must memorize them - appropriate mnemonics suggested). An old but useful film on the "Essentials of the Neurological Exam" (Smith, KIine and French, 1962, available from the American Medical Association) shows students the application of their efforts which they apparently put into practice the following year in their courses in Physical Diagnosis.

The functions of the autonomie and limbic systems, and of the cerebral cortex are explored. Our growing understanding of hemispheric specialization (the instructor's research interest) is not neglected. What the spinal cord does alone, and what spinal cord injuries do are, of course, areas of relevance to the medical/ surgical or rehabilitation nurse. The ear and auditory physiology, as well a s nerve and conduction deafness, are presented briefly, but at least three hours are spent on t he eye and vision. The eye is, of course, a complex organ. Common defects such as myopia and hyperopia related to its anatomy are covered. Exciting major breakthroughs in sensory physiology have yielded information on the cortical processing of visual information, which cannot be kept from students.

A three-week (12 hours) introduction to endocrinology exposes students to the molecular classes of hormones and their mechanisms of action (as far as is presently known). Pituitary, adrenal, and thyroid function and their feedback relationships through the hypo t ha Im us of the brain with its releasing (or inhibiting) factors are given. The clinical picture of specific hormone dysfunctions is only briefly, but certainly, touched upon, is is the physiologic interpretation of laboratory tests.

Talking about hormones and hypothalmic/hypophyseal control leads naturally to the reproductive systems and their endocrine functions. Male and female anatomy are given and the gametogenic (exocrine) functions also presented. Many students elect the maternal-newborn (nurse-midwifery! specialty where they will learn about the female reproductive system in greater detail.

Reproductive systems and gametogenesis lead naturally to fertilization and the embryo. Embryology lectures (about three hours! begin with the cellular events of fertilization and a very brief overview of organ formation. Cardiac and neural tube formation aregivenasthe basis of congenital malformations, such as septal defects and spina bifida respectively. Mechanisms of embryogenesis, including cell death as in the formation of the digits, are included. The course lee tures close on the developing organism.

Additional laboratory experiences include "bone lab" (featuring skeletons, skulls, and disarticulated bones) and microbiology. Students must memorize on their own, but we offer practical experience in Cram staining of bacteria, innoculation and plate streaking techniques and interpretation, and antibiotic sensitivity testing. Specimens are ob tai ned from throat swabs, vaginal smears, or any other source the students themselves can provide.

The reader may be wondering what textbook accompanies this rather eclectic approach to the scientific principles of nursing. Needless Io say, there is no one book that serves. A basic not-too-simple, not- too-hard anatomy and physiology textbook8'" is recommended and a short list of additional reference books"1'16 is provided. Handouts prepared by the instructor, supplementary reading of introduction to Biochemistry, and selected Scientific American articles are helpful.

The above description of the Biomedical Science course is meaningless unless teaching in this integrated, concentrated manner works. It seems to succeed, at least with this highly selected group of students. They have scored well in the National League for Nursing (NLN) achievement examinations in Anatomy and Physiology, and Microbiology: in the last four years, 52% of these first-year students have scored above the 90th percentile of degree students in one or both exams, including those who have taken the Biomedical Science course and those who have been exempt (40%). Scores of most of the Biomédical Science students are not significantly different from those who have previously had several science coursesand, therefore, received waivers. A correlation between NLN achievement test scores and State Board test scores has been reported.18 What may be learned from the relative success of this course? It confirms the feeling that bright, highly motivated, hardworking students do well in most educational settings, and particularly in one aimed at their intellectual level. They can learn material in concentrated form and build upon it.

This approach may be even more appropriate at the BSN level, at which students especially need help in observing the relationships of the various scientific disciplines to nursing. Students' application of the principles of natural and physical science to nursing practice should be catalyzed, and their ability to interpret health phenomena in this con text fostered. A teacher with experience, perspective, and - most of all - knowledge of scientific principles is required. As preparation for the course just described, the instructor, a FhD in biology, audited classes at the Yale School of Medicine (including Laboratory Medicine, Biochemical Basis of Disease, and Pathology! and consulted with colleagues in the Yale Schools of Nursing and Medicine, in addition to doing the traditional relevant reading.

The Biomedical Science course has evolved over the five years the Three-Year Program has been in existence. Student feedback is very positive. Students graduating from the program have obtained good positions and seem to be functioning well in them. (Two alumnae are now on the Yale School of Nursing faculty.) Biomedical Science has made a contribution to their careers and to the knowledgable and scholarly practice of nursing.

Acknowledgments

The author expresses appreciation to A. Slavinsky for suggesting this article, to D. Diers and A. Slavinsky for helpful comments on earlier draft s, and top. Moore for "magical" secretarial assistance.

References

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10.3928/0148-4834-19820501-08

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