Bridge Between Two Cultures - J Chem Ed 2012

A Bridge between Two Cultures: Uncovering the Chemistry Concepts Relevant to the Nursing Clinical Practice

Corina E. Brown, Melissa L. M. Henry, Jack Barbera, and Richard M. Hyslop

Journal of Chemical Education 2012 89 (9), 1114-1121

DOI: 10.1021/ed200041x

The goal of this study is collect data on the relative relevance of topics of general, organic, and biological (GOB) chemistry to the clinical nursing practice.

The article begins by listing the factors that have the most impact on student success in GOB courses: instructor teaching style, cognitive load, academic skills, prior science background, mathematics abilities, and anxiety of failure.  They point out that information from studies like these can address to some extent instructor teaching style and cognitive load.

The researchers used the research methodology phenomenography to collect qualitative data from a group of experts on their perceptions of the relevance and applications of different chemistry topics to clinical nursing practice.  This methodology is “suitable for description of differences and similarities in participants’ opinions.  The experts are a diverse group of GOB Chemistry instructors, nursing educators, and nursing graduate students with 2-5 years of clinical experience.  The experts were interviewed and the verbatim transcripts were analyzed by at least three different people to look for patterns and identify categories of descriptions, using “no algorithm for the analysis of phenomenographic interviews, rather a series of iterations to distill the meaning by repeated reading of the transcripts”.

Based on key terms used in the participants’ responses (frequency of the terms “used”, “important”, “needed”, versus “needed for understanding” or “foundational” versus “not used” or “not important”), the researchers came up with the following three categories of their relevance and applications to clinical nursing practice:

·         Topics that are important have a direct application in the nursing clinical practice.

·         Topics that are foundational facilitate the understanding of the important topics, but are not directly important for nursing clinical practice.

·         Topics that are not important do not have a direct application or are not significant in nursing clinical practice.

The list of topics evaluated were divided into General Chemistry, Organic Chemistry, and Biological Chemistry.  Detailed data about the number of responses pertaining to the three categories above are given in the article. Summary of results based on the authors’ interpretation of data (additional data from responses):

General Chemistry

·         Important Topics

o   Acid-base-salt chemistry (including pH and buffers)

o   Measurements (useful for concentration and drug dosage calculations, metric system)

o   Solutions (osmotic pressure, osmolarity, concentration)

·         Foundational

o   Matter

o   Atomic structure

o   Periodic table

o   Ionic and covalent bonds

·         Chemical calculations (“”working with mole ratios and stoichiometry was considered as not important in nursing, although an understanding of moles and molecular weight is useful in calculating concentrations”)

·         Gases, liquids, and solids are intermediate between foundational and not important although special mention of allosteric binding of oxygen to hemoglobin “especially as it relates to the Bohr effect, metabolic acidosis, and oxygen perfusion in general” is suggested by both groups.

·         Nuclear Chemistry: all chemistry instructors considered this as non-important but 70% from the nursing culture (educators and graduate students) considered this as important. The authors summarized the nursing perspective as follows: “Even though nurses are not directly involved in taking an x-ray, they should be able to explain to the patients the basics of the procedure and what the effects of the radiation treatment are.”

Organic Chemistry

Topics in organic chemistry were perceived with the greatest disparity by the participants. The key finding that came out is that while the nursing perspective values understanding of functions, the chemistry educators’ perspective emphasized the importance of understanding structure as a pre-requisite for understanding function. Because there is no obvious groupings into the three main categories, the author presented a summary of responses per topic:

·         Hydrocarbons: foundational by most experts by unsaturated hydrocarbons with less relevance than saturated hydrocarbons.  “None of the nurse educators or nursing students could present a clinical application of saturated or unsaturated hydrocarbons.”

·         Alcohols, phenols, and ethers: mixed opinions, with about half considering these three not important.  Instructors consider alcohols as important to understanding carbohydrates and metabolic intermediates.

·         Aldehydes and ketones: the nursing perspective considers aldehydes and ketones as foundational or important in terms of metabolic by-products their connection to diseases such as diabetes, again function but not structure.

·         Carboxylic acids, esters, and amides: Nursing perspective considers these as foundation with amines as important or foundational. The chemical education perspective considers these important or foundational for understanding lipids, amino acids, and proteins.

The authors have the following recommendations on the basis of the responses: “The organic functional groups should be presented in connection with the structure and function of biomolecules, the nomenclature greatly simplified, and the connection of functional groups to properties, function, and metabolism of biomolecules and drugs well-emphasized.”

Biological Chemistry

There is a more consistent evaluation of topics in biological chemistry by both cultures, agreeing that all topics are important with the exception of nuclei acids. “Understanding enzymes and vitamins, carbohydrates and lipids, and proteins and their metabolism” was considered important by the experts.  75% of chemistry instructors considered nucleic acids as not important while 70% of the nursing educators and the graduate students consider it important, “especially in terms of function, such as replication and mutations”.  Furthermore, the latter group made specific mention of the importance of understanding metabolism including: “anaerobic metabolism of carbohydrates, glycolysis and ketone body production in understanding diabetes and metabolic acidosis in general, and the urea cycle, because it is connected with liver and brain disorders”. Biochemical energetics was considered important by both cultures but counting ATP’s was not considered important by the nursing group.

Table 4 lists the relevant topics that bubbled to the top from the participants’ responses.

Responses from the participants also indicate the following recommendation:

·         Elements that are potential electrolytes should be highlighted in the periodic table

·         Understanding cations and anions is important for understanding the role of electrolytes

·         Covalent bonds and polarity were important for understanding drugs and their excretion

·         Hydrogen bonds should be specially emphasized as they play an important role in structure, physical and chemical properties, and function of biomolecules.

·         “An understanding of metabolism will enable nurses to better understand implications and side effects of prescribed medications, provide more effective interventions in trouble-shooting situations, and ease in professional communications at the patient’s level of understanding.”

In conclusion, results from this study may help chemistry instructors meaningfully reduce the cognizant load factor for nursing chemistry students and with the recommendation to use example relevant to nursing practice help improve their teaching styles to encourage student success.