foumal of Advanced Nursing, 1995,22,405—406

Guest editorial

NURSING AND THE BIOLOGICAL SCIENCES

Nurses frequently claim that their practice is holistic Yet,to judge by the content of nursing publications and dieattitudes of many nurses and nurse teachers, there is con-siderable devaluing ofthe acqmsition and use of biologicalscience knowledge withm the nursing profession in theUmted Kmgdom (UK) (Tmobranski 1993) How can nurs-mg practice be holistic if the biolc^ical basis of health andillness and the biological component of nursmg inter-ventions are ignored or dismissed' Whilst the currentemphasis upon knowledge from the social sciences andpsychology is to be welcomed, holism can only beachieved if all areas of relevant knowledge are acquiredand used m a balanced way

The issue might be seen as one of only academic interest,but I would argue that it has important political impli-cations both for the present and the future As in manyother European countries, a major current concernamongst politicians m the UK is to cut the cost of healthcare Nursmg salaries consume over 40% of the totalBritish Nationai Health Service (NHS) budget Under suchcircumstances the replacement of professionai nurses byless expensive, less highly trained health care assistantsbecomes an attractive proposition To resist this, pro-fessional nurses need to prove their effectiveness, that theyprovide better value for money than health care assistants

Clearly, the role performed by nurses needs to be dis-tinctly different from that of health care assisteints andshould reflect the longer, more academic and rigorous edu-cation which they have undergone This can be demon-strated by a holistic approach, the use of holisticknowledge and the exercise of professionai judgementbased on broad but relevant knowledge It is the particularcombination of knowledge from the biological, psychologi-cal and social sciences, the ability to relate one eirea ofknowledge to another and to apply it to the particular prob-lem presented, which distinguishes the professionai fromthe nonprofessional A further distinctive characteristic ofthe professionai is the constant development of knowledgeand the evaluation of practice through research

If one IS to examme the areas of clinical practice mwhich the professionai nurse is highly valued by healthservice managers and doctors, we find that they are allareas in which the nurse shows special expertise bsised ona good deal of specialist knowledge (Wilson-Bamett 1995)Specialisms such as mtensive care, coronary care, thenurse practitioner in accident and emergency c£ire[Nursing Times 1994) and clinical nurse specialist rolessuch as m diabetes, incontinence, stoma therapy, breastcancer and community psychiatnc nursing, come readily

to mmd With the exception of community psychiatricnursing, these are all areas of practice where biologicalscience knowledge is as important as knowledge of mobv-ation, interpersonal interaction, family dynamics, and so

onNurses are increasingly being valued m the UK for their

ability to undertake actions which were, until fairlyrecently, the exclusive province of jumor hospital doctorsCjmically, it could be seen as mere expediency to take onthe performance of tasks discarded by the medical pro-fession However, there is no doubt that patients gam enor-mously from the interpersonal approach and the level ofskill brought by the nurse in carrymg out these inter-ventions Particularly where primary nursmg is practised,it IS clear that there is great benefit to the patients throughtheir own primary nurse taking on this extension of his/herrole Virtually without exception, this new area of workrequires biological knowledge as a basis for safe practiceAs examples, nurses are undertaking the treatment ofinjuries and ordenng X-rays m accident and emeigencydepartments, carrying out venous cannulation and admin-istering dmgs through IV cannulae

The balance of emplojmient of nurses within the BntishNHS IS changing More and more, nurses are beingemployed m the pnmary health care sector by generalpractitioners in order to carry out health education, to runscreening clinics and to carry out treatments Here yetagain, biological knowledge is an important basis forcompetence

Safety

Health service managers rightly give pnonty to the safetyof patients and clients for whom they are responsible ItIS m ensuring safe care in adult hospital and communitynursing and m child health nursing that biological scienceknowledge is particularly important Nurses should notonly base their practice upon sound biological knowledgebut should be seen and heard to do so This can onlyenhance their credibility with both patients and clients,not to mention their employers In the absence of a solidand explicit knowledge base for practice which is apparentto all It IS only too easy to make simplistic assumptionsabout the nature of nursing care Simplistic assumptionsare only too common amongst executives m the NHS andit IS these which lead to the view that anyone can performa nursing role with the minimum of trairung

Why IS It that biological science knowledge is apparentlyless valued by nurses than psychological or social scienceknowledge' Partly, this arose as a reaction against thealmost exclusive emphasis on anatomy, physiology.

© 1995 Blackwell Science Ltd 4 0 5

Guest editonal

microbiology, pharmacology and pathology m nursingeducation in the past This was coupled not only with analmost total exclusion of psychology and social sciencehut even nursing itself as a suhject for study assumed littleimportance in the cumculum With the recognition of theimportance of the study of these other subjects, some ofthe subjects already m the cumculum had to he curtailedto make room for the new areas of knowledge To a largeextent, the biological sciences have been greatly affectedby this (Courtenay 1991)

Today m the UK, with the implementation of the Project2000 nurse education recommendations there is the tend-ency, withm the first part of the course, for the new entrantto the profession to treat nursmg as if it were a homo-geneous whole, through a common core cumculumHowever, the nursing care of people with mental healthproblems demands much less biological science knowl-edge than the other hranches of nursing, (Dawson 1994)This IS true also ofthe nursing care of people with learningdifficulties In trjnmg to provide knowledge for such dispar-ate areas of practice there is a danger that one fails theneeds of all Indeed, there has been cnticism that thecommon foundation programme ignores the needs of thosewishing to specialize m the care of people with mentalhealth problems (Jowett et al 1994)

It IS also the case that the teaching of biological sciencesIS seen as problematic, both by teachers and students(Courtenay 1991, Tmobranski 1993) With the increasingemphasis being placed on graduate status for nurse teach-ers, many have opted to read subjects such as education,sociology, social policy and psychology Few have takendegrees m the biological sciences Thus there are compara-tively few nurse teachers who can teach these subjects inany depth Frequently the solution has been to employmainstream biology graduates to teach nurses Whilstmany of these not only have expertise in their subjectmatter but also are superb teachers, only too frequentlythey lack the ability to apply their knowledge to the clini-cal work for which the knowledge is hemg taught This isleft for the students to do themselves

Nursing students seem to find the acquisition of the fac-tual knowledge required by the biological sciences difficultenough, without them having to know these facts so wellthat they can recall them and apply them withm the newand frequently stressful real-life clinical situation m whichthey leam and consolidate their practical skills Ideallynurse teachers or senior clinical staff would help themwith the application of biological science knowledgeHowever, this is prohlematic for nurse teachers, as alreadystated There is also much evidence that nurse teachersfind It difficult to engage in clinical teaching (BaiUie 1994)

As for trained nurses who act as mentors m the clmicalareas, there is much evidence to suggest that they do nothave the knowledge m an exphcit enough form to teachin an applied way, even if there was enough time m whichto do so The evidence is that the existing biological sci-ence knowledge base of trained nurses undertakmg highereducation is problematic The problems for students canonly be perpetuated if new cohorts of qualified nursescannot articulate the relevance of biological science as abasis of nursing care

What action is needed to remedy the situation' No readyanswer sprmgs to mmd but learmng matenal whichincluded examples of the application and use of the hio-logical sciences for practice would be helpful The knowl-edge hase used by clinical nurse specialists could providea rich source of such examples Another possibility is forthose teachers who successfully teach biological sciencesto nurses to share their expertise widely with other teach-ers Perhaps successful teachers of other health pro-fessionals who use hiological science as a basis for practicewould also be willing to share examples of good practice'Over and above this, however, the nursing profession as awhole must show that it values biological science knowl-edge m its application to nursing practice

Margaret ClarkeRGN RNT BSc MPhil

Ementus Professor of Nursing Studies,University of Hull

References

Bailhe L (1994) Nurse teachers' feelmgs about participating inclinical practice an exploratory study fournal of AdvancedNursing 20, 150-159

Courtenay M (1991) A study of the teaching and learning of thebiological sciences in nurse education foumal of AdvancedNursing 16, 1110-1116

Dawson P J (1994) Contra biology a polemic foumal ofAdvanced Nursing 20, 1094-1103

Jowett S , Walton I & Payne S (1994) Challenges to Change mNurse Education A Study of the Implementation of P 2000National FoundaUon for Educational Research, Slongh,Berkshire

Nursing Times (1994) Nurse practitioners are 'highly valued' saysstudy (news item) Nursing Times 90(49), 6

Tmobranski P H (1993) Biological sciences and the nursmg cur-riculum a challenge for educationalists foumal of AdvancedNursmg 18, 493-499

Wilson-Bamett J (1995) Specialism in nursing effectiveness andmaximization of benefit (editorial) foumal of AdvancedNursing 21, 1-2

406 © 1995 Blackwell Science Ltd, foumal of Advanced Nursing, 22, 405-406