Transitioning from Natural Science to Nursing Science

I recently graduated from Duke University’s Accelerated Bachelor of Science in Nursing program.  Remaining as evidence of the completion of my degree is an apartment full of nursing syllabi, PowerPoint lecture handouts, client care plans, course and clinical evaluations, and a plethora of journal articles covering every clinical issue from patient controlled analgesia algorithms to best practice recommendations in pediatric palliative care.  When preparing my extensive collection of coursework for file thirteen, I could not help to notice the transition I have experienced over the past sixteen months. 

Having previously majored in biology and chemistry (AKA the natural sciences), I remember being especially flustered by the relativity of nursing.  Laboratory science protocols are rather absolute. Few bench procedures leave room for deviation or innuendo.  Yet in the world of nursing, I constantly pressed my professors for ‘hard and fast answers’ (or proverbial What Would You Do’s clinical scenarios) I generally received the same three word response – “well it depends”! 

Early in the program, I could not help to question the competence of faculty who seemingly always uttered those three loathed words – “well it depends”.  Why wouldn’t I?  What professor with an exhaustive clinical career and several advanced degrees couldn’t answer my simple clinical question directly?  Now, or at least having graduated, I appreciate those solemn words.  Because now I know it really does depend. 

Consider, for instance, the client that presents to the emergency department with a Myocardial Infarction (or heart attack).  The literature suggests our priority nursing interventions are the administration of Morphine, Oxygen, Nitroglycerin, and Aspirin (and arguably a Beta Blocker).  Yet mindlessly administering morphine or nitroglycerine to all patients whom are experiencing an MI could prove disastrous. As some clients experiencing an MI already have low blood pressures, thus medications like morphine or nitroglycerine could further induce hypotension (low blood pressure) effectively exacerbating the client’s ischemia and likely resulting in greater myocardial cell death.  Similarly blindly administering oxygen in a client with chronic obstructive pulmonary disease who is also experiencing an MI could provoke respiratory suppression and yield respiratory arrest.

I’ve decided that nursing, unlike the natural sciences, provides little room for hard and fast answers.  The professional nurse must examine all clients holistically; critically considering the risks and the benefits; and selectively implement the interventions aimed best at maintaining health and treating illness or disease – a concept that admittedly sixteen months ago seemed very foreign to me.

Reflection: A Beginning to An End

During my short tenure as both an educator and as a nursing student, I have been encouraged to remain reflective.  Reflection, as it was explained to me, provides one with the ability to analyze the past with the intent to improve the future.  As an educator, I often reflected on the instructional strategies I had employed to convey abstract scientific theories and concepts to a diverse body of eight graders.  As a nursing student, reflection involved the recollection of conversations held and care provided to clients throughout the trajectory of their illness aimed at promoting recovery from disease and improving my clinical practice.  While the context for the reflection in these disciplines are polar opposites, the process and outcome are the identical: what could I have said/done to promote a ‘greater’ understanding or to provide a ‘higher’ level of nursing care?

This summer will be a period of a great reflection for me as well.  Following nursing boards (affectionately referred to as NCLEX) and a luxurious European vacation, I will begin preparing psychologically (and perhaps physiologically) for the highest level of academic preparation – doctoral education.  Yes, I have been selected to join the ranks of less than one percent of Americans; those who bravely pursue a doctoral degree.  And despite having initiated some of the curriculum; I realize the first year of doctoral education will be intense yet transformational experience that will consequently lead to the development of a new framework for the ‘next level’ of reflection.  The next three to four years will prepare me for a higher level of scientific inquiry and for the eventual role as a nurse scholar. 

The doctorate of philosophy, in most disciplines, is characterized as the terminal degree program.  Given this definition, one might infer that the possessor of the Doctorate of Philosophy is the reservoir of all knowledge in their respective discipline.  I, however, believe that doctoral education culminates in a bearer whom: is inquiring, who can innately design studies, critically interpret findings, draw appropriate conclusions and who is skilled in disseminating findings.  Essentially, doctoral education prepares the scholar to initiate the acquisition of knowledge.  Thus I will continue to reflect with each paper written; with each journal article read; with each research symposium I attend; and with each presentation I offer….I will remain reflective! Because, in my humble opinion, reflection is necessary to eventually obtain perfection.