A Short History of Anti-pathophysiologicalism

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by jmqphd jmqphd Member

The college system in which I teach is calling a multi-campus-wide curriculum meeting. Rumor has it that the "bigs" want to tone down the pathophysiology in our Med-Surg Curriculum. I'm old. I've been around nursing for a long time and this is same song second verse. Been there, seen that. Here we go again. Good grief.

In the beginning there were diploma schools with their "materia medica" designed and often taught by doctors. Then, the world of nurses rose up, and BEHOLD...

There were baccalaureate programs offering a new degree... the BSN. Nurses finally had the respect of all creatures on the earth... having their own academic major, their own departments... Lo, even their own "Schools of Nursing" with their own deans and everything!

But, vanity of vanities... this meant nurses had to have their "own unique body of knowledge". (Whatever that meant.) So across all the face of the earth, there assembled the prophet(esses) of nursing dogma, speaking their wisdom in dreams and visions. The Nightingale's song gave way to the mysteries of the metatheorist, the describers of professions, the analyzers of cultures, Middling and Grand theorists, researchers of nursing research and educators of nursing educators. The doctoral dissertations went forth and multiplied across the land and prospered mightily.

Then, in the fullness of days the Tower of Nursing Babel was brought low by the plagues of patient care. All the world's symposia on taxonomies and competencies, the hours of faculty lounge blather, and scholarship on body aura and therapeutic non-touch could not add one minute to the span of life for one hypoxic patient, one septic grandmother, or one shattered trauma victim.

Then did the theorizers, researchers, and educators protest. The laws of life and death were too burdensome! Giving due worship to physiological reality would be like unto the ways of the malefactors of the medical model. Far be it from nurses to become hand-maids once again! "We will not have these men to rule over us!" Thus the researchers and theorizers and educators spake unto each other and proclaimed nursing to be a religion of the right brain, the intuitive and feminine mind. Woe unto those who came to the font of nursing with their left-brain-logic and hard science blasphemy. The defenders of the nursing temple would rise up! and deny tenure to all who would violate even the least of the Grand Theories or feminist principles that ruled supreme.

But, alas, having sold their birthright for a bowl of philosophical pottage they increasingly turned to Pharm D's, Microbiologists, Biochemists and Physiologists (or those among their sisters who spake these foreign tongues) to educate their youth.

Eyes they have, but they see not. Ears have they, but they hear not.

classicdame

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator. 2 Articles; 7,255 Posts

ok - a nice diatribe. But I bet the real reason is not enough time, space and money to do it all.

JeanettePNP

JeanettePNP, MSN, RN, NP

Specializes in Pediatric Pulmonology and Allergy. Has 8 years experience. 1 Article; 1,863 Posts

ok - a nice diatribe. But I bet the real reason is not enough time, space and money to do it all.

So what should be cut to make room for it? Let's see. "The Nursing Process" is indispensable, as is a class on "Current Issues in Nursing" and "Professional Nursing Development." Oh! I know! We can cut those pesky patho and pharm classes that so clutter up the nursing curriculum, so long as we make sure the REALLY important stuff is covered.

jmqphd

jmqphd

212 Posts

There is no way to prove this. It's just my deep seated suspicion based upon 40 years of observation.

I think the biggest problem with teaching pathophys (and to a similar degree pharmacology) is that it is really hard. It is hard for students to grasp. Not only do they have to learn disease processes, but then learn how one pathological process circles around and overlaps and influences other processes. And it's predicated upon knowing some tough basic science material! Just hard. No argument from me. It always was and it always will be. Heck... it's hard for medical students to get and they have way more preparation than nursing students.

And because it's hard students whine and complain and even (yes) cry. I am not a hard person. I have a soul and I do not like to feel that I might be crushing someone's dream. I hate it.

So, if it's tough on students, and tough on me (and I'm a true-believer) how hard and unpleasant is it on the "powers-that-be"? They are catching bloody you-know-what from 10's to 100's of students (not to mention parents.)

Consequently, more credit hours spent on "group dynamics", "nursing as a social force", "nursing theory", "health care economics and priorities" (the list is endless... add your own...) begin to look more and more attractive.

Oh, good lord... the tears! Don't you just feel like you're strangling a puppy?

jmqphd :yeah:

I think you are exactly right.

And I don't think it should be "toned down" aka "dumbed down".

steph

Edited by Spidey's mom

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education. Has 35 years experience. 9,051 Posts

Nursing Faculty - PLEASE hold firm!!! We (on the service end) have more than enough work to do with new grads... I can't even imagine having to remediate basic pathophys also. Have Mercy.

jmqphd

jmqphd

212 Posts

Huzzah! Just graded final Care Plans for this term (it counts for 5% of their grade and none of them can afford to lose those points!). They all are starting to get it. I know they had 12 weeks to learn the patho on their patient. But the point is with some help, they were actually putting it together. One student did a great job care planning for a prisoner with Hep B and toxic megacolon. One had a patient with hepato-pulmonary syndrome, terrible hypo-albuminemia/pancytopenia and an awful cellulitis. Two students had patients with pelvic tumors that had caused ureteral blockage and hydronephrosis. Another had a patient with bad COPD and hepatic encephalopathy...

Even the student whose first draft was a disaster... I saved his for last and was shocked! I had to award him an 88%. He even had the labs figured out. Cool!

And they are so proud when they realize they understand what's going on with their patients. (At least the one they've sweated bullets over.)

I also did clinical evaluations on my other group. One passed by the skin of her teeth, but had improved so much in her last 3 weeks I couldn't fail her. With a good mentor, I think she'll be OK and she is great on paper so I am sure she'll pass her NCLEX

Of my 14, 2 will have to repeat the term because of test grades. But after seeing their care plans, I think it will click for them next time around. (A student I failed last semester is one of the top 6 out of 27 and doing GREAT in clinical.)

Oh, I am so glad this semester is winding down!

msn10

msn10

Specializes in cardiac, ICU, education. Has 18 years experience. 560 Posts

Heck... it's hard for medical students to get and they have way more preparation than nursing students.

Yes, and can you see the new RN who was able to take the "dumbed down" version of pathophysiology talking with the MD who was required to take the real one someday?

I have nightmares about sending my young students out into the nursing units unprepared to collaborate with the professionals with the "real degrees." I can envision them running down the hallways crying from ridicule and bullying. Please, universities and colleges, don't take anymore away from them, they need all the support we can give them.

jmqphd

jmqphd

212 Posts

So we are being flown to a meeting in another city for a system wide meeting and sure as the world... the plan is to excise the word pathophysiology out of our "essential elements" by which we categorize our objectives. They (whoever "they" are) seem to think it's too "medical". So we have to surrender that word from our vocabulary.

Are you ready for what they want us to use in place of it? Knowledge and Science. Maybe it's just me, but I think it's stupid. Knowledge or what? I know a lot about every Opera Verdi ever composed. I know a lot about the American Civil War. Maybe the science part is economics or finance, or calculus or sociology.

Can I buy a book for my class called "Book of Science and Knowledge and Stuff" I know there are some excellent pathophysiology books out there, but we will not be using them because someone among the "higher-ups" decided we don't teach patho. The students aren't stupid. They steal the pathophysiology books out of the library. They know where the straight scoop is.

It's very disheartening.

Moogie

Moogie

Specializes in Gerontology, nursing education. 1 Article; 1,796 Posts

OP, I wanted you to see this quote from one of the student forums. It may give you a glimmer of hope for the next generation.

etiology: where it comes from

pathphys: what it does

HOW does the infection affect the pt? What does C. diff do to the intestines? How does it do it? What do the bacilli do, specifically, that causes the s/sx of C. diff infection? Pathophys is pretty much about the cascade of things that happen. It's cool!

Here's the URL of the thread: https://allnurses.com/nursing-student-assistance/etiology-vs-pathophysiology-554585.html#post5022645

JaneyW

JaneyW

Specializes in Perinatal, Education. Has 9 years experience. 640 Posts

Pathophys is sooo cool! I am constantly telling my students that if you understand the physiology and pathophysiology on your patient you will not make mistakes because you will have a deeper understanding of why you are doing what you are doing. How can that not be important? And here I am a lowly ADN instructor when the hospitals are starting to decide they only want BSN new grads with all the better knowledge---AGH!!!

ImThatGuy, BSN, RN

2,139 Posts

I honestly don't even think our pathophysiology course is in depth enough especially when the instructor says "we're going to keep this simple, on a basic level." Why? I love the science much more so than any modicum of patient interaction. I'm definitely not right-brained.

Frankly, because I'd always heard that nursing school was "so hard" I just assumed it'd deal a lot more with physio, patho, micro, and pharm than it really does. I'm actually disappointed.

Go forth and spread your scientific seed. I used to teach bio, chem, and A&P. Only for one year though. Can't toot my horn that much though. Found arresting people to be a laughably enjoyable career instead. I'm with you.