Physiology and Pharmacology for Nursing Practice Essay
Physiology and Pharmacology for Nursing Practice Essay
The assortment of processes by which the body controls the internal environment making it constant is jointly known as homeostasis. In a bid to ensure that the body’s internal environment is stable, the conditions of the body must be continually monitored and adjusted through homeostatic regulation (Lenford and Johnson, 2015). It engages the receptor, the control center, and the effector.
The receptor detects information about changes that occur in the environment (Norris & Carr, 2013). They then send the information to the control centers, which interpret the information as either being below or above the homeostatic range (Clancy & McVicar, 2009). The control centers send commands to the effectors that correct the disturbance by either opposing or enhancing a stimulus thus reinstating homeostasis (Clancy & McVicar, 2009). This is a continuous process to ensure the continuity and maintenance of homeostasis. Physiology and Pharmacology for Nursing Practice Essay. An example is where the temperature receptors in the skin detect a change in temperature; communicate this to the control centers which are in the brain, then to the effectors in the blood vessels and sweat glands facilitating the required adjustments (Lenford and Johnson, 2015).
When disturbances in the physiological balance occur, the system reacts to two forms of feedback. These include the positive and negative feedback. The majority of the homeostatic control mechanisms operate on the principle of negative feedback (Lenford and Johnson, 2015). It involves the system responding so as to reverse the direction of the change. An example of this principle is blood sugar regulation in the body. An increase in blood glucose higher than the homeostatic range triggers the processes that reduce it. Still, when blood glucose levels are below homeostatic range, the processes that increase the glucose levels will be triggered. Both instances result in the blood sugar level being maintained at a constant level
The overall aim of the study was to explore health care students´ understanding of core concepts in pharmacology.Physiology and Pharmacology for Nursing Practice Essay.
Method
An interview study was conducted among twelve students in their final semester of the medical program (n = 4), the nursing program (n = 4), and the specialist nursing program in primary health care (n = 4) from two Swedish universities. The participants were individually presented with two pharmacological clinically relevant written patient cases, which they were to analyze and propose a solution to. Participants were allowed to use the Swedish national drug formulary. Immediately thereafter the students were interviewed about their assessments. The interviews were audio-recorded and transcribed verbatim. A thematic analysis was used to identify units of meaning in each interview. The units were organized into three clusters: pharmacodynamics, pharmacokinetics, and drug interactions. Subsequent procedure consisted of scoring the quality of students´ understanding of core concepts. Non-parametric statistics were employed.
Results
The study participants were in general able to define pharmacological concepts, but showed less ability to discuss the meaning of the concepts in depth and to implement these in a clinical context. The participants found it easier to grasp concepts related to pharmacodynamics than pharmacokinetics and drug interactions.
Conclusion
These results indicate that education aiming to prepare future health care professionals for understanding of more complex pharmacological reasoning and decision-making needs to be more focused and effective.
Background
Pharmacotherapy is a cornerstone in the treatment of many diseases and consequently a large proportion of the population is prescribed or self-medicates with pharmaceuticals [1]. Although a variable response to medications has long been acknowledged, drug therapy has generally employed a broad treatment approach to a heterogeneous group of patients instead of a unique treatment approach to an individual patient.Physiology and Pharmacology for Nursing Practice Essay. Today the current opinion is, however, that pharmacotherapy should as far as possible be adjusted for each patient [2]. Thus, in the health care setting, more focus should be attributed to the monitoring and fine-tuning of drug treatment and to communicate pharmacological issues with individual patients.
During their pharmacological studies health care students (future physicians, nurses, and specialist nurses in primary health care, henceforth denoted “the students”) are exposed to generalized knowledge, which they must later put into context. The latter step has proven hard to master, thus hampering the students’ abilities to identify and handle complex medication treatments and, in the end, make qualified judgments and communicate these with patients [3]. Students often struggle when it comes to understanding the subject of pharmacology. It requires, among other things, that chemical, physiological and mathematical thinking are integrated. Because different groups of health care personnel have different skills and roles, overall understanding and communicative skills in pharmacokinetics/pharmacodynamics are essential to avoid the risk of incorrect use of medicines [4].
Interactions between simultaneously used drugs are common causes of undesirable drug-induced events in patients [5] such as adverse drug effects, insufficient efficacy or even drug intoxications. These effects might be explained by the prescriber’s limited knowledge of integrated pharmacology resulting in an inability to customize a drug’s pharmacokinetic or pharmacodynamics properties to a patient’s specific conditions [6, 7]. Apart from inter-professional communication and understanding which are crucial, if the healthcare professional does not have adequate pharmacokinetic and pharmacodynamic insights, trustworthy information may not be given to the patient. On the other hand if the physician/nurse is fully aware of the pharmacology of the prescribed drugs and the patient still does not understand, the explanation might be drawn from inadequacies in the communication. Physiology and Pharmacology for Nursing Practice Essay.
Finally, even though the different disciplines have separate roles within the health care setting, inter-professional communication is required to maintain the quality of care. The outcomes required to obtain the “Degree of Bachelor of Science in Nursing” (Nurse), “Postgraduate Diploma in Specialist Nursing: Primary Health Care” and “Degree of Master of Science in Medicine” (physician) are specified in Swedish law [8]. Here, it is clearly stated that all three professions are required, to master relevant aspects of drugs and drug treatments. For instance, a graduated nurse shall “demonstrate the ability to manage pharmaceuticals appropriately and also to inform patients of the effects and side-effects of pharmaceuticals” as well as to “demonstrate the ability to apply his or her knowledge to deal with different situations, phenomena and issues on the basis of the needs of individuals and groups”. Furthermore, graduated specialist nurses in primary health care, who have (limited) prescription rights, shall “demonstrate the ability to observe and assess complex care, habilitation and rehabilitation needs in patients”. The requirements for medical graduates are that they should “demonstrate the ability to initiate and undertake health promotion and preventive measures in the health care services for both individuals and groups of patients” and “demonstrate the ability to integrate and apply knowledge critically and systematically and also to analyze and assess complex phenomena, issues and situations” (translations from The Swedish Council for Higher Education; https://www.uhr.se/en/start/laws-and-regulations/Laws-and-regulations/The-Higher-Education-Ordinance/Annex-2/; accessed 2015-02-18). Thus, while some differences between the three cohorts studied regarding the depth of expertise obtained during their training may be present, the competences needed to deal with the cases presented could be expected from all three student groups.
The overall aim of the current study was to explore health care students’ understanding of core concepts in pharmacology. Physiology and Pharmacology for Nursing Practice Essay. Specifically the following questions were asked: 1. How do students undertaking nursing and medical educations understand core concepts of pharmacokinetics, pharmacodynamics and drug interactions? 2. How do the students adapt their pharmacological knowledge and apply the understanding of the core concepts of pharmacokinetics, pharmacodynamics and drug interactions when presented with two clinically relevant patient cases? (Fig. 1).
The two patient cases that were presented to the interviewees for discussion. Case A The patient is prescribed omeprazole (a proton pump inhibitor) in combination with the prodrug clopidogrel, an inhibitor of platelet aggregation (P2Y12 purinoceptor antagonist). Since clopidogrel is activated by an enzyme (CYP2C19) that is inhibited by omeprazole possible effects of an interaction may appear, which should be considered by the interviewed. Case B The patient is prescribed acetylsalicylic acid (at a low dose) because of cardiovascular events. The patient wants it to be replaced by another non-steroid, anti-inflammatory drug (NSAID) or paracetamol (acetaminophen). Physiology and Pharmacology for Nursing Practice Essay. The discussion of this case requires the understanding of the mechanism of action of NSAIDs (reversible and irreversible cyclooxygenase binding) and its relevance for the dosage
Methods
Study subjects
Twelve students in their final semester from the medical program, henceforth abbreviated DOC, nursing program (RN), and the specialist nursing program in primary health care (PHCN), were recruited to the study; four students from each category from two medical schools in Southern Sweden (Table 1). There was no intention to compare the performance of students from the different universities. The spread of backgrounds was intended to give a qualitative variation of the answers given. Students were asked to voluntarily sign up for participation in the study. All interviewees gave their informed consent prior to their inclusion in the study. The current study does not involve any handling of sensitive personal data or clinical procedures and therefore no ethical review is required by law in Sweden according to the Act (2003:460) concerning the Ethical Review. The project therefore complies fully with current applicable Swedish legal rules and ethical guidelines including the Helsinki declaration.
Table 1
Describing participating students; primary healthcare nurse students (PHCN), medical students (DOC) and nurse students (RN)
| Future profession | Student number |
|---|---|
| PHCN | 1, 2, 3, 4 |
| DOC | 5, 6, 7, 12 |
| RN | 10, 11, 13, 14 |
Case introduction
The students were individually presented with two written cases describing patients treated with a combination of drugs. The cases were designed to imitate common health care provider-patient interactions. This allows the students to analyze the problems and to apply their pharmacological knowledge, acquired from their respective educations, in combination with their information collecting skills. Thereby, the depth of the understanding of the posed problems (Fig. 1) would be revealed. The first case mainly addressed drug problems related to pharmacodynamic issues, while the second was directed towards pharmacokinetic-related problems.Physiology and Pharmacology for Nursing Practice Essay. The present paper focuses on the students’ understanding and ability to articulate the pharmacological concepts pharmacodynamics, pharmacokinetics and drug interactions. In a paper we recently published, we investigated and problematized the pharmacological communication within the same setting [9]. The study participants did not have access to the internet and the only tool provided was a hardcopy of FASS, the Swedish national drug formulary which provides healthcare professionals with detailed information about approved pharmaceuticals. During 30 min (15 min per case) the student was expected to identify the pharmacological problems and find possible solutions. Immediately thereafter, the students discussed the cases for approximately 30 min individually with an interviewer (MR). The interviews were semi-structured. All interviewees were presented with the same patient cases and asked the same opening questions (Fig. 1) to clarify the meaning of the answers. The intention was to explore the interviewees´ understanding of the cases given. In the conversation following the opening questions the student´s understanding of the concepts of pharmacokinetics, pharmacodynamics and drug interactions were elicited. All interviews were audio-recorded and subsequently transcribed into text. Drugs were referred to primarily by brand names, rather than generic names, because of the structure of the FASS drug formulary.
Interview analysis
A thematic analysis was used [10] for identifying and analyzing patterns or themes in the interviews. The method allows for working with both a deductive and inductive approach to the data. The inductive approach (i.e. without trying to fit into a predefined coding frame) and the deductive approach (i.e. driven by our analytic interest) were used iteratively. The analysis consisted of identifying units of meaning which are coherent and distinct meanings embedded within the interviews [11]. A unit of meaning may consist of one word or several sentences. The units were organized in three thematic clusters: pharmacodynamics, pharmacokinetics, and drug interactions. In a subsequent analysis the quality of the extracted units of meaning were rated with scores 1–10 (Fig. 2). Physiology and Pharmacology for Nursing Practice Essay.Two of the authors (GT and MR), independently, assessed each unit of meaning in all interviews. The analysis was iterative, and the findings were reviewed and discussed in order to reach agreement in understanding of the data.
In the analysis of unites of meaning the quality of each unit was awarded a score from 1–10. The figure displays the competences expected on each level
Statistics
Non-parametric statistics was used and Kruskal-Wallis analysis was employed when three groups were compared.
Results
All 12 students completed the study. When analyzing the units of meaning a great variation in students´ answers was observed with regard to the interpretation of the task, the elaboration and the quality of the reflections.Physiology and Pharmacology for Nursing Practice Essay. Results of the quality assessment of units of meaning are graphically presented in Fig. 3. Each student´s result, including number and quality of statements (scores 1–10), is displayed in Table 2. Below quotes are organized to exemplify, in the first part, variation in quality of reflections and then to illustrate the understanding of the core concepts: pharmacodynamics; pharmacokinetics; and drug interactions.
Graphic overview of the results of the quality of units of meaning (score 1–10 and median). Results related to the core concepts of pharmacology; pharmacokinetics, pharmacodynamics and drug interactions, subdivided by groups of future health care professionals, i.e. primary healthcare nurse students (PHCN; ●), medical students (DOC; ■) and nurse students (RN; ▲). n = Number of units of meanings expressed by each category of future professionals. All participants contributed in each case
Table 2
Number of units of meaning (UM) expressed per student on the subjects kinetics, dynamics, and drug interaction.Physiology and Pharmacology for Nursing Practice Essay. In addition, the median score value per student on respective subject is presented
| PHCN | UM | Score | DOC | UM | Score | RN | UM | Score |
|---|---|---|---|---|---|---|---|---|
| student | (n) | median | student | (n) | median | student | (n) | median |
| Kinetics | ||||||||
| 1 | 4 | 5.25 | 7 | 4 | 4.75 | 13 | 3 | 1 |
| 2 | 6 | 1 | 12 | 3 | 9 | 14 | 4 | 1.25 |
| 3 | 3 | 3 | 5 | 3 | 6.5 | 10 | 4 | 3.5 |
| 4 | 12 | 2 | 6 | 3 | 1.5 | 11 | 6 | 4.25 |
| Dynamics | ||||||||
| 1 | 5 | 4.5 | 6 | 8 | 3.5 | 13 | 4 | 6 |
| 2 | 4 | 2.75 | 7 | 5 | 7 | 14 | 4 | 4.5 |
| 3 | 6 | 5 | 12 | 3 | 6.5 | 10 | 5 | 5 |
| 4 | 13 | 5 | 5 | 2 | 4.5 | 11 | 8 | 5 |
| Interaction | ||||||||
| 1 | 8 | 5.75 | 7 | 2 | 6 | 13 | 3 | 1.5 |
| 2 | 4 | 4 | 12 | 2 | 4.25 | 14 | 6 | 4 |
| 3 | 5 | 3.5 | 5 | 4 | 1.25 | 10 | 1 | 2.5 |
| 4 | 7 | 3.5 | 6 | 6 | 2 | 11 | 3 | 5 |
Although most students were able to define terms like half-life, clearance, distribution volume etc. within the cases, a number of units of meaning revealed an insufficient understanding even regarding such important terminology. The following two quotes illustrate their uncertainty:
“Half-life? Well, that’s tricky. I don’t know if I remember exactly what sort of stuff that is, ‘cause I failed that topic on the exam last time…..” (Student No. 2)
and
“I: What do you include into the concept metabolite?
R: It is probably the way it acts…” (Student No. 11)
Such statements are in contrast to the discussion by other students where they merge and interpret pharmacodynamic and pharmacokinetic information in order to explain the situation of the patient.
ORDER A PLAGIARISM-FREE PAPER NOW
“Among other things that CYP2C19 was the common denominator… both go via the CYP450 system but… it is metabolising if you consider these CYPs, and that in FASS they specifically dissuades from combining omeprazole and Plavix (clopidogrel) treatments. It has been observed that as much as 45 % of the active aggregation is inhibited, well, Plavix is inhibited.” (Student No. 12)
The overall evaluation of the units of meaning shows that the students used the pharmacodynamic information at a more advanced level than statements regarding pharmacokinetics and drug interactions. In the latter cases, the participants more often made just a simple definition of the words. Generally, the students tended to stress the pharmacodynamic topics of the patient cases over the pharmacokinetic or interaction issues. When comparing the median scores reached per pharmacokinetic (PK), pharmacodynamic (PD), and interaction (I) units of meaning within each professional category, pharmacodynamic units of meaning reached the highest scores for all students; significantly for PHCN (median values: PK 2; PD 5; I 4; P = 0.002) and RN students (PK 1.5; PD 5; I 3.5; P = 0.04). For DOC students, however, pharmacodynamic and pharmacokinetic units scored equal whereas units regarding interactions scored lower (PK 5.5; PD 5.5; I 3.2; P = 0.01). Physiology and Pharmacology for Nursing Practice Essay. Further, when median scores for pharmacokinetic, pharmacodynamic, and interaction units of meaning were compared between the professional categories, DOC scored significantly higher for pharmacokinetics than did PHCN or RN (PHCN 2; DOC 5.5; RN 1.5; P = 0.005). No differences were seen between the students for pharmacodynamics or drug interactions. Finally, in a comparison of median scores reached per core pharmacological concept, pharmacodynamics reached the highest scores, regardless of profession (PK 2.5; PD 5; I 3.5; P = 0.002). For example, in spite of omeprazole and clopidogrel interacting at a metabolic level, this was usually not mentioned even though the efficacy of clopidogrel was discussed. Physiology and Pharmacology for Nursing Practice Essay.
