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.
