G. A. Takacs, W. N. Bigler, W. A. Burns. and E. B. Stockham Rochester Institute of Technology Rochester. New York 14623
I Continuing Education Programs in I Chemistry for Clinicians and Nurses
During 1972, there were approximately 250,000 students in training for allied health and nursing professions in the United States and the majority of these (213,000) were in nursing programs. Most of these students are required to complete successfully a t least one chemistry course. A few recent innovations in the field of chemical education have attempted to make these chemistry courses as relevant as possible to the chosen professional careers of the students ( 1 , 2 ) .However, frequently these students graduate (having completed only chemistry courses designed for science majors or contemporary chemistry courses designed for liberal art students) with little understanding of the role of chemistry in their fields. In addition, practicing health professionals may recognize their deficiencies in chemistry and find a need for continuing education programs which directly relate to their work situation. It is with this in mind, that two continuing education programs in chemistry were developed; one for nurses and the other for medical lahoratory personnel. Concern over professional ohsolescence has created both a need and demand for continuing education programs within the health professions. The National Advisory Commission on Health Manpower, in 1967, recommended that professional associations and governmental regulatory agencies take immediate steps to establish systems designed to assist practitioners to maintain continuing competence (3). In 1971, the HEW Report on Licensure and Related Health Personnel Credentialing (4) cited professional ohsolescence as a major basis for its recommendation that consideration he given to replacement of the present system of individual licenswe with that of institutional licensure. The Professional Standards Review Organization (PSRO) Law of 1972 mandated peer review and evaluation of health services delivered by the various health professional personnel and health care facilities and agencies. This law has had the effect of increasing the demand by health professionals for continuing education programs. Since the PSRO Law became effective the health profession's organizations have been planning continuing education program philosophies and objectives, criteria, guidelines, recording mechanisms, etc., in order to meet some of the requirements of this legislation. For example, the American Society for Medical Technology has developed their Professional Acknowledgement for Continuing Education (PACE) program which is a voluntary program (5). The PACE program does not affect the participants status with employers or with the Registry. On the other hand, the American Nurses Association has developed their Continuing Education Recognition Program with the individual State Nurses' Associations deciding their own policies and procedures. The American Journal of Nursing has recently reported on the status of the various state programs (6). Two other reports on continuing education for nurses in Kentucky and Kansas (7) and five north central states of Montana, North Dakota, Minnesota, Wisconsin, and Michigan (8)have been published. The first step taken in implementing our continuing education programs was to determine the needs and interests of nurses and medical laboratory personnel in our Genesee Valley region of western New York. In order to obtain this information, survey questionnaires were designed, in con-
sultation with local health professionals, and sent to health personnel in 29 regional hospitals. Questionnaires were mailed out to 305 medical lahoratory personnel and 785 nurses and the percentages returned were 62 and 52%, res~ectivelv.The averaee survev indicated that - res~ondent . cbntinuiig e d u c a t i ~ n b r o ~ r a mshould s he offered once a week (1-2 hours) for several weeks durine the evenine of a weekday. There was a distinct that t h e p r o mams be offered in the fall or svrina . - rather than winter. In the survey for medical laboratory personnel, a question was asked to determine the most desirable field of concentration in clinical chemistry which should be presented. The following results were obtained in the order of decreasing importance: instrumentation and automation, enzymes, electrophoresis, making solutions and basic calculations, flame photometry, and quality control. By far, the most popular chemistry topic in the nursing survey was Princi~ l e sof Bodv Fluid and Electrolvte Balance. Other frequently selected chemistry topics were: Biochemistry for Nurses. Review of Chemistrv for Nurses. and Isotones and ~ a d i o a c t i v iin t ~Medicine. T o assist in evaluating the results of these questionnaires and, more importantly in developing and planning the proa a m s . Advisorv Committees were formed for each of the two areas of concentration. Each Committee consisted of four memhers from the Rochester Institute of Technology (RIT) and five local health professionals, either nurses, clinical chemists, or medical technologists. These health professionals made excellent suggestions about the content emphasis for the programs, the best time for the offerings, and possihle instructors for each program. The Extended Services Division of RIT had the responsibility for such things as: publicizing the programs, organizing the registration of participants, fee collecting, hudget reporting, and informing participants of classroom location. A staff member from Extended Services participated on each advisory committee. One program in each area was developed and offered on one weekday per week from 7-9 p.m. for five weeks. These programs were titled "Acid-Base and Electrolyte Syndromes" and "Clinical Chemistry Instrumentation and Automation." For each of the two programs, 1000 brochures were mailed out to the respondees of the questionnaires, memhers of two local organizations of nurses and medical laboratory personnel, and the personnel offices of area health facilities. Advertisements were also placed in local newspapers. Both programs were filled to a predetermined maximum enrollment. Table 1shows the course outline of the nursing program. The first session of this program consisted of a ggneral review of concentrations, buffers, p H , and electrolytes and was presented by a faculty member of our Department of Chemistry. The four other sessions were given by four nurse educators who had special expertise in the individual lecture topics. The program content, organization, and coordination were formulated entirely by the instructors. Each lecturer attempted to relate the chemistry and physiology presented directly to nursing care and procedures. The programmed instruction text Regulation of Fluid and Electrolyte Balance by Reed and Shepard (9) was recommended reading material. One Continuing Education Unit Volume 53, Number 7. July 1976 / 451
Table 1.
Acid-Bare and E l e c t r o l v t e Syndromes
Renal F u n c t i o n a n d Regulation Reabsorption, active and facilitated transport, renal hormone$. renal f u n c t i o n tests, acute renal failure, d i u r e t i c s a n d hypertensive agents. M e t a b o l i c Disturbances of cia- are Balance Selected h o r m o n a l and n u t r i t i o n a l disorders including diabetes m e l l i t u r and diabetes inripidus. E l e c t r o l y t e and F l u i d Balance Syndromes Burns, inflammation, dehydration, m o c k , cardiac arrhythmias. R e l p i r a t o r y F u n c t i o n and pH Regulation T r a n r o o r t o f o x w e n and carbon dioxide. emohvsema. .o u l m o n a r y e m b o l i r m , b u l m o n a r y edema, hypkrve&liation.
.
was awarded t o the 95 participants of this program. The offering in Clinical Chemistry (Table 2) was taught and planned by five experienced clinical laboratory personnel. The lectures were specifically designed to illustrate the application of chemical instrumentation and automation to a clinical laboratory. A final examination was given in this program and one quarter credit was awarded hy RIT to the 38 attendees who successfully completed the ten hours of participation. At the last session for each program, the participants were eiven the o.~.~ o r t u n ito t vexmess in writine both nositive and negative comments about the offerings. Suggestions for imorovements and Dossihle t o ~ i c sfor future nrograms were'requested in-the course evhuation form. 'The participants of the clinical chemistry program reacted positively to the lectures being presented by practicing clinical chemists: however, thev disliked the lack of ~ractical "hands on" work with i&ruments. Some of the nurses indicated that more work related information should he stressed rather than fundamental hackround knowledge.
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452 / Journal of Chemical Education
T a b l e 2.
Clinical C h e m i n r v I n s t r u m e n t a t i o n and A u t o m a t i o n
Smgle ann M u l l channel A J t o a n a l y l e r r A n e x a m nalnon of the tneury of a ~ t o a n a l y z e r s ,t h e r cnem r t r l e r a n d c m c d a .m . mallon ut m. 1. ohar c screenam. E n z y m e Analysis T h e a u t o m a t i o n of enzyme analysis, including t w o p o i n t and k i n e t i c Dracedurer and a dircusrion o f their clinical application. R a d i o i r o t o p e Measurements T h e m e a r u r e m e n t r o f beta and gamma e m i t t i n g radioisotopes and t h e impact o f their technique u p o n clinical chemistry. "STAT" A n a l y r e r A n e x a m i n a t i o n o f t h e t y p e of analyses required for emergency needs, t h e necessary inrtrumentation, q u a l i t y control, and application. A t o m i c A b r o r P t i o n a n d Gar L i q u i d Chromatography T h e measurement o f trace metals b y a t o m i c absorption and drugs b y gar l i q u i d chromatography; t h e o r y of instrumentation and clinical a w l i c a t i o n .
Several nurses preferred a single course instructor rather than several coordinated instructors. Some evaluations of both programs suggested that two sections he offered-one a t a more basic level than the other. More discussion time was desired and it was also proposed that improvements in the promams might ~ossiblvbe achieved hv more detailed study OF fewer topics: Literature Clted (1) Stenitski, C. L.,and Sean, C. T., J. CHEM. EDUC.. 52.226 (19751. (2) Report of the Mt Holyah Conference: New Directions for Tmditional Curriculum, J. CHEM. EDUC..SO,25 (1973). (31 Report on the National Advisory Commission on Health Manpower, Volume I.U.S. Go* Printing Office. Washingon, D.C., 1967. (41 Report on Lieenswe and Meted Health Personnel Credentiaiing, U.S. Depsrtment of Health Educationand Welfare, Washington, D.C.,1971. (51 Arnwicnn Sociofylor Medico1Teehnolagy (ASMTI N e w , (December. 1970. (6) Amsr J. o/Nurring, 74,878. (1974). M.,Amer J ofNursing, 73,1912 (1973). (71 Farni, P.R., and Bolte, I. (81 Cwper. S.S., and Byrns. H. H.. "A Plan for Continuing Education in Nuraing: Five North Central States," Department of Nursing, University of Winconsin-Extendon, Madison, Wisconain.January. 1973. (9) Reed, G. M.. and Sheppsrd, V. F., "Repistion of Fluid and Eieetrolm Belance:A Pmgrsmmed Instructian in Physioloki for Nunos," W. B. Saunders Co.. Philadelphia,Pe., 1971.
