Importance of nursing education

Nurses across the country have just received the latest publications of their state nurses associations. The mission statement of these associations is “to promote the professional and educational advancement of nurses and the highest standards of nursing practice.” One piece in mine discussed changes to the Nursing Practice Act being considered by the Board of Nursing. The proposals would require BSN degrees for nurses — bachelor degrees from university programs taught by Ph.D. level instructors — in order to increase the quality of nursing education and clinical practice.

Turn the page of the publication. Just before the continuing education course offerings — including courses in energy medicine (35.8 hours of CE credits), Chi Net Tsang (21 CE hours) and homeopathy (7.5 CE hours) — were two articles written by a Ph.D. nurse from the Center for American Nurses. They example information young nursing students encounter.

More precisely, they provide an illustration of how alternative modalities have sacrificed science-based education in nursing school curriculums.

The Center for American Nurses is a coalition of 40 state nursing associations representing more than 49,000 nurses, formed in 2003. This professional nursing organization lobbies on public policy issues and says it educates and empowers nurses to advocate for themselves and patients, offering “evidence-based solutions and powerful tools to navigate workplace challenges, optimize patient outcomes and maximize career benefits.” Its newest resource center provides Continuing Nursing Education modules accredited and approved via the American Nurses’ Credentialing Center’s Commission on Accreditation. It also provides Focus on Health Articles to state nursing association publications.

Vermont nurses, for example, just read in their state publication:

Vitality or Life Energy: The Heart of Wellness

This month’s discussion of wellness will emphasize the notion of our health energies: i.e., vital energy, life force, Chi or Qi, élan vital, or vitality... Health energy, conceptualized by Western thought as vitality, may be characterized as liveliness or an abundant physical and mental energy usually combined with a wholehearted and joyous approach to situations and activities. Vitality, a positive subjective feeling of aliveness and well-being, has been hypothesized to “reflect organismic well-being and thus should co-vary with both psychological and somatic factors that impact the energy available to the self”... Eastern healing modalities, such as Traditional Chinese Medicine (TCM) where meridian theory/acupuncture are rooted, call this vitality or life energy, Qi or Chi. Qi fills the whole cosmos; it is seen as the origin of all life and things which are infused with this invisible life resource. Qi is often characterized as “the one essential thing” and is central to health and healing...

The author, Susan Vorce Crocker, Ph.D., RN, goes on to talk about energy modalities in nursing, as introduced by Krieger and Rodgers, in nursing theory and therapeutic touch. The background on these nonscience modalities and their adoption into university nursing curriculums was covered here; with follow-ups on alternative modalities in medical and nursing education here, here, here, here, and most recently here. She went on to advise nurses:

So what approaches might we consider to restore and sustain vitality? Reiki, healing touch, therapeutic touch, many types of physical movement, any type of massage/body work, and a diversity of spiritual meditative practices offer approaches to invigorating our inner energies for well-being and healing. Qigong, Tai Chi, and yoga are also modalities that address your whole-person energies. These offer more than the usual “fuel in the tank” and “calorie burning or low carb/low trans fat” diet and exercise programs that most of us fail to enjoy. Check them out! What else might you consider as you seek to maintain and nourish your vitality?

The second article that appeared in our professional nursing publications was on “living” water:

Hydration: Living Water as a Nutrient for Health and Wellness

This month we will take a few moments and assess our utilization of a basic element to our physical wellness – water... It is recommended that each person drink at least 8 glasses of water daily to maintain health...

In making water recommendations for nursing professionals, she quotes directly from a consumer magazine renowned for promoting unsubstantiated theories and/or methods. Quackwatch and the National Council Against Health Fraud have long had Prevention Magazine on the nonrecommended list of sources for health information, and specifically caution that it “should be avoided by persons seeking high-quality information on which to base a health-related decision.” She writes:

Consider the following thoughts as you assess the status of water as a nutrient for health in your life. McVeigh in Prevention offers these tips on water consumption and our health:

• For energy: First thing in the morning (12 ounces); your body loses fluid stores overnight, which can make your mind foggy. Starting your day with water might keep you from seeking out coffee or caffeinated tea—or help you cut back.

• For craving control: 30 minutes before meals (12 ounces). Whenever you’re feeling a craving, drink first. Still hungry? Have a balanced snack or healthy meal...

As if these urban legends weren’t enough, she went on to repeat nearly every other myth of water: that most of us are dehydrated and can’t trust our thirst, that the solvents released by caffeine cause more water loss and dehydration, that tap water isn’t safe to drink because of chemicals and contaminates, and that even mild dehydration is to blame for many illnesses. For this section, a key reference she used was a nutritional healing book by authors whose unsound and potentially harmful claims have been used by supplement products seized by the FDA over the years. As reviewed in a consumer protection article by Dr. Stephen Barrett, M.D., its authors have used hair analysis and cytotoxic testing to recommend supplements, more than 30 different products for some conditions.

Ms Crocker continues:

...even mild dehydration impairs a number of important facets of cognitive function — concentration, alertness, and short-term memory. They maintain that despite our knowledge about the importance of water for human health, it is unknown what the optimum level is for water consumption. We only know dehydration has occurred when the symptoms begin to escalate (i.e. low blood pressure, tachycardia, constipation, decline in alertness, headaches, increased tiredness etc.). By the time we notice as healthy adults, we are most likely already dehydrated. Further complicating our investigations of water are recent issues surrounding the purity of our water supplies. There are concerns about contaminants: debates over chemical additives (chlorine, fluoride)...

Note: Because these water recommendations have become part of employer wellness programs and the online health information being given to employees and consumers from such sources as Mayo Clinic, we’ll devote a post on the evidence for 8 glasses of water a day and other beliefs about water for those who’ve missed the latest research.

These are troubling examples of university degrees not arming nurses with science-based critical thinking skills. Even more worrisome, no degreed professional at state nursing associations saw anything amiss in these educational articles. Nor was anyone able to research the medical literature and fact check, or differentiate credible sources and credible information from quackery, before sending the information to 49,000+ nurses. If nurse educators and leaders don’t do science, who’s helping to ensure patients are being given accurate health information and that clinical care is evidence-based?

© 2008 Sandy Szwarc