A Reason for Higher Education in Nursing (and anywhere)

 This week's nursing topic is, "Is Nursing a Profession?" There are interesting criteria that constitute a definition of "profession," of which there are three: medicine, legal, clergy. 

One of the criteria is extensive education. According to my reading materials, the most common degree held by nurses is a 2-year associates degree (which I hold.) 

One of the concepts being examined this week is whether or not a more extensive education is warranted or merited. That is, versus work and life experience. This has me thinking.

Here's my hypothesis: while one can learn much from those around them at work and from life experience, those exposures are local to the individual learner. On the other hand, when one receives a more formal education, the exposure is to a more worldly set of ideas and experiences and includes opportunities to practice with frequent feedback to each trial. 

Does exposure to more worldly materials and ideas make a better nurse? 

It reminds me a little of how Wife and I talk to our kids about the importance of good grade in reference to their effect on choice of college: getting good grades does not mean you are required to go to colleges that have higher academic standards of entry; it means that more doors are open to you. 

In that way, the exposure to concepts developed and published from a wide sample of geography and time does not mean that they are definitively of greater value than the experiences from life and exposure to work; it is that the individual has more resources to pull from when confronted by the situations typical and atypical to the occupation. 

And that is with the lean toward the skill aspect of nursing (hands-on activity.) We also have to consider the intellectual sides of nursing, which include interdisciplinary communication and patient education. I can tell you with great anecdotal certainty that neither of those are skills inherent to the average individual - to communicate clearly and to teach others. There are always outliers, but most people need honing of those skills with practice in both speaking and writing. 

Here's an example: the formation of a formal argument. It is one thing to be able to discuss a topic with another person. It is quite another to have learned to express the opinion or position in a format that is logical and difficult to refute because it includes logical rationale and supportive evidence. And how does that fit into nursing? If I have a patient who is resistant to a treatment, I am going to use the analytical skills developed from my BA in English to tell the patient the rationale and then express the evidence behind the rationale. This is all while advocating for patient autonomy: that the decision is in said patient's hands, and that they should make any refusal - or acceptance of treatment - based on being properly informed. AND, they need to be informed in a way that is understandable to that individual! 

If you're going to get most of that skill and ability from life and work experience, your life and work must include a lot of practice and trial-and-error that includes harsh analysis (akin to grades.) You need to know if your method works.

One can certainly "get by" and get better over time, but the formal education is dedicated to the specific outcome and provides feedback that is less consequential than that of the feedback of a life experience when you were wrong. An F is better than a death.  

G-tube patient education (for use in any education that is part of a skill the patient will need to perform)

I recently was educating a patient about caring for their g-tube, which is a feeding tube surgically placed through the abdomen to the stomach in order to bypass the mouth and esophagus. 

Recently, I was told by a doctor that the tube had to be in place for a minimum of 6 weeks.

However, some patients regain their swallowing ability and, in turn, lose the need for the tube before the time when it is medically safe to remove.  The tube still needs to be maintained to prevent pathogens from forming inside the tube as well as from the opening in the abdomen.

Something that I did well: showed the patient the materials, then explained the procedure.

Materials:

• foam non-stick pad to place between the plastic circle that keeps the tube from retracting into the abdomen
• wet and dry washcloths
• basin with soap and water
• 2 washcloths (one for wet, one to dry)
• scissors
• marker
• graduated cylinder filled with at least 50 mL tap water
• piston syringe

Processes:

• date the foam barrier and cut out a hole for the tube and a slit to slide it into place
• how to clean and dry around the hole in the abdomen
• how much water to suck into the piston
• How to kink the tube to prevent backflow
• Insert the piston syringe and flush the tube.
• Put everything back in place

The patient was uncomfortable with looking at the hole where the tube is.

Didn't want to touch or clean it.

Didn't want to flush the tube.

What I should have done:

Give the patient duplicate supplies to handle as I'm handling each

Ask after each step if they wanted to perform the task on themself. No judgment if declined.

One of the challenges is that the patient does not know what it will feel like to push water out of the piston, or if the hole cut in the foam barrier is the right size and they don't want to mess up on themself (just like we, as nurses, don't want to make a mistake on a patient.)

The other challenge is disturbed body image. By exposing the patient to the change slowly and non-judgmentally several times, the patient has time to get used to the change and gain comfort and confidence. Then, adding repeated exposure to the materials for maintenance, the patient will eventually be capable - if not enthusiastic - about performing the task on their own.

We can apply the same principles to any number of skills that a patient may require; injections and wound care are two other skills that come to mind.

The goal, after all, is to promote the patient's independence and autonomy.