TEACHING BIOCHEMISTRY TO NURSING STUDENTS

Rosa María Martínez-Espinosa

Agrochemistry and Biochemistry Department
University of Alicante

Abstract
Biochemistry is the study of chemical processes within and relating to living organisms. This field of
knowledge is considered one of the most difficult disciplines for students in the Higher Education Area.
Most of the Degrees and Bachelors programs related to Biology, Chemistry, Medicine, Biotechnology,
and Chemical Engineering contain at least one course focused on Biochemistry.
During the last few years, new Degree programmes focused on Nursing or Human Nutrition have been
designed and implemented in Spain and in most cases, those programs have been improved with the
addition of courses related to Biochemistry, mainly applied Biochemistry. In general, professors have
really appreciated this change, because Biochemistry offers the required knowledge to properly
understand important processes such as metabolic disorders, the theoretical principle under some
health care techniques, the assimilation of the nutrients, etc.
However, Nursing students have a negative perception about Biochemistry and most of them consider
that this subject is not necessary to become a qualified Nursing professional.
This article explores these issues and examines the role of Biochemistry teachers in changing the
Nursing students’ negative perception and helping them to develop a more positive attitude towards
studying and learning Clinical Biochemistry.
Keywords: Degree in Nursing, Biochemistry, first year-undergraduate.

1 INTRODUCTION.
In general, the old Degrees in Nursing in Spain (before Bologna Process was implemented) did not
include Biochemistry as a subject in the syllabus. In some of the old Degrees, Biochemistry was part of
a subject grouping Cellular Biology, Biochemistry and even Anatomy. Under those circumstances, it
was difficult, even impossible, for Biochemistry teachers to give complete information about Clinical
Biochemistry. Besides, Biochemistry has traditionally been viewed as a difficult course by Nursing
students.
Meetings and discussions between Biochemistry teachers involved in old Nursing Degrees pointed out
that most of students did not realise how important some aspects of Biochemistry are to properly
understand the human body, the development of diseases, etc. Nevertheless, prospective nurses need
to understand the fundamental principles of Biochemistry for different reasons:
- Physical health and growth depend on biochemical processes in the body (metabolic
pathways).
- Life-saving medications work through physiological reactions, and prescription doses must be
calculated carefully so as to yield therapeutic results and reduce potentially dangerous side effects.
For all the previous reasons, and in order to change Nursing students’ attitude towards Biochemistry, it
is important to ensure that Nursing students have a solid knowledge of basic/fundamental sciences such
as Biology and Chemistry [1,2]. Otherwise, students are not ready to follow the basic concepts required
to understand some of the biochemical processes taking place in human beings.
Besides, it is interesting to identify what prospective students already understand about Biochemistry
and their ability to make the necessary translations of biochemical concepts into the real world of clinical
practice.
According to several studies, the perception of its relevance to Nursing practice has been shown to
modify attitudes. As a start point to change the perceptions and attitudes of Nursing students towards
Biochemistry courses, it is important to identify the main Chemistry concepts that are relevant for pre-
Nursing students. After this identification, the next step to be done by teachers is to explain the concepts
in an applied clinical context. When teaching Biochemistry in that way, students understand a concept
much more easily because they recognize the relevance of the concept to Nursing practice. On the
other hand, teaching concepts with application to clinical practice increases motivation and offers
students a good experience in learning.
In the old Degree in Nursing at the University of Alicante, Biochemistry was just a part of a 9-credit
course grouping Cellular Biology, Biochemistry and Anatomy. The Biochemistry section was designed
mainly as theoretical lectures where basic Biochemistry concepts were explained (mainly all of those
related to biomolecules structure and physico-chemical properties). At that time, only two practical
lessons were carried out in the lab (mainly focused on clinical tests to quantify different metabolites in
blood or urine).
Bologna Process implementation in higher education gave the chance to review and modify different
aspects related to:
i) the way Degrees are organised
ii) teaching methods
iii) the timetable implemented for the academic courses, etc.
At that time, few Biochemistry teachers teaching this subject in Nursing at the University of Alicante
decided to design a new Biochemistry course completely orientated and adapted to Nursing students’
needs.

2 METHODOLOGY

2.1 Proposal of a Biochemistry course for Nursing:

To design a new course on Biochemistry for Nursing, more than 50 academic programmes of
Biochemistry courses for Health sciences and Nursing (from Spain and abroad) were taken into account.

2.2 Identification of knowledge deficiencies related to Biochemistry in

Nursing professionals:
In order to identify what is really important for Nursing professionals in terms of Biochemistry knowledge,
different interviews were organised (10) with Health Sciences professionals in charge of the Nursing
units at hospitals and outpatient clinics. On the other hand, different meetings with Nursing students (old
and new Degrees) have been carried out during the last 10 years to identify students’ attitudes toward
Biochemistry and knowledge deficiencies related to Biochemistry.

3 RESULTS

3.1 Design of a Biochemistry course for Nursing:

After the analysis of more than 50 different Biochemistry courses for Health sciences and Nursing (most
of them from Spain, United kingdom, Italy and France) and after taking into account that most of the
subjects constituting the new Degrees at the University of Alicante are 6-credit courses (60 in-class
teaching hours), a Biochemistry course for Nursing was designed as summarised in Table 1:
 Table 1: Biochemistry learning plan. Degree in Nursing. University of Alicante

Teaching activity Methodology

LECTURES Theoretical classes (48 hours)

LABORATORY Practices to be done in the laboratory by the students

under supervision (12 hours)

TOTAL 60 hours

The aim of this course within the Degree context is to provide an overview about the nature and function
of the key biomolecules in the human body. In addition, this subject also determines the relationship
between the chemical, the molecular and the genetic basis of biological processes. Also, the course
includes basic content about the molecular alterations that cause the most common pathologies.
Throughout the history of this scientific discipline, biochemists have worked to uncover the fundamental
chemical and physical principles underlying the processes in living beings, and together with clinical
disciplines have elucidated the molecular mechanisms which cause many pathological conditions.
Therefore, this discipline sets out the basis for the need of knowledge to identify these processes and
to understand other subjects included in this Bachelor’s Degree as for example Pharmacology, Anatomy
and Physiology.
This subject/course has been designed as follows:
A total of forty eight lectures with no laboratory work involved are distributed as two/three lectures per
week in the first semester of the academic year (first course of the Degree). The course is divided into
4 sections (Introduction, Biomolecules, Metabolism and Molecular Biology) with nineteen units in total,
starting with Unit 1: Biochemistry and Molecular Biology definition (table 2).
In the first five weeks sufficient organic chemistry and general aspects of cell biology are introduced for
an understanding of the reactions of metabolism. After that, all details related to metabolism are
discussed in detail, and finally important aspects focused in clinical molecular biology are explained.
Clinical cases related to the lecture’s content have been added to the end of each lecture. Handouts
containing objectives for the lecture material and copies of slides to be shown in class have also been
prepared. These materials are given to the students before the beginning of each lecture.
Table 2: Theoretical contents organization. Biochemistry course. Degree in Nursing. University of
Alicante:

Section I: INTRODUCTION.
U1. Biochemistry and Molecular Biology definition.

Section II: BIOMOLECULES.
U2. Role of water in the organism. Mineral salt and trace elements.
Hydric and ionic balances. Pathologies.
U3. Proteins: structure and function.
U4. Enzymes and cofactors. Enzyme therapy and protein markers in
clinical.
U5. Structure and function of vitamins and coenzymes. Pathologies
related with excess or lack thereof.
U6. Carbohydrates: structure and function.
U7. Lipids: structure and function.
U8. Cell membranes. Transport across the membrane.
U9: Hormones and neurotransmitters.
 U10. Nucleotides and nucleic acids: structure and function.

Section III: METABOLISM. U11. Introduction to metabolism.

U12. Carbohydrates metabolism.
U13. Central metabolism.
U14. Glucose regulation and main associated diseases.
U15. Lipid metabolism.
U16: Protein and amino acid metabolism.

Section IV: MOLECULAR U17. Nucleotide metabolism.

BIOLOGY.
U18. Flow of genetic information.
U19. Clinic applications of molecular biology.

This theoretical programme summarised in table 2 is complemented with practical lessons at the
laboratory where the Nursing students carry out different common measurements and analyses related
to clinical Biochemistry. The students have 4 laboratory practices (3 hours each) where they work in the
lab to become more familiar with those methods and techniques usually used in clinical biochemistry
labs in hospitals. Table 3 summarises the practical programme designed for this course:

Table 3: Practical contents organization. Biochemistry course. Degree in Nursing. University of Alicante:

Lab Session 1 Determination and quantification of biomolecules

in urine.

Lab Session 2 Enzyme kinetics. Lactate dehydrogenase.

Lab Session 3 Cholesterol, HDL, TG identification in normal and

pathologic blood serum.

Lab Session 4 Escherichia coli DNA isolation and agarose gel

electrophoresis.

Previous experiences teaching Biochemistry to Nursing students (old Degrees) stated that including
clinical cases and organizing the topics from the simplest to the more complex concepts is the best
option to reach the following objectives and competences:
- To give an overview of the concept of Biochemistry and Molecular Biology and to set the
axioms of molecular logic of the cells.
- To describe the physical and chemical properties of water as the most abundant molecule in
the body. To know the diseases associated with alterations in the water and ion metabolism.
- To know the pH concept and its physiological implication.
- To distinguish levels of protein structure, and to analyse the three dimensional structure of
these biomolecules.
- To establish the relationship between the structure and the function of proteins as the main
molecular machinery for the development of cellular and intercellular physiological functions.
- To describe the role of blood proteins and their alterations in certain pathologies.
- To know the characteristics of biological catalysts, their functions in the body and the most
common pathological conditions related to alteration of enzymes.
- To understand the meaning of the kinetic parameters of an enzyme.
 - To understand the basis of enzyme therapy and protein markers.
- To identify the main characteristics of carbohydrates and the diseases related with their
metabolism.
- To describe lipids composition, their function in the human body and their properties in the cell
membranes.
- To establish the nature of different transport mechanisms through membranes.
- To differentiate the structure and function of hormones and neurotransmitters.
- To recognise the basis of signal transduction cascades.
- To know the nature and function of nucleic acids.
- To explain the denaturation and renaturation process of nucleic acids.
- To know the characteristics of telomeres in the lineal eukaryotic chromosomes.
- To describe the concept of mutation and to enumerate the DNA repair mechanisms. To explain
the pathologies related to genetic material.
- To explain the general concepts of nucleic acid metabolism.
- To describe the characteristics of the genetic code in detail.
- To study the clinic applications of molecular biology.
- To know the role of the ATP in the energetic metabolism.
- To understand the concept of metabolism and the main mechanism involved in its regulation.
- To understand the principal pathways related to glucose and other monosaccharides and their
regulation.
- To know the role that the TCA cycle plays in the interconnection between different
metabolisms.
- To be familiar with the cellular respiration and oxidative processes that produce energy.
- To get an overview of lipid metabolism.
- To learn the process by which the lipid produces energy, which the body uses to carry out its
metabolic functions.
- To get an overview of the metabolism of nitrogen compounds: amino acids, nucleotides and
urea.
- To connect the metabolism pathologies with common diseases.
- To recognise biomolecules for their use in the clinical diagnosis and monitoring of diseases
- To use the findings of scientific research in Biochemistry and Molecular Biology for the
interpretation of pathological disorders.
- To be able to interpret, process and synthesise data and information in Biochemistry and
Molecular Biology.

3.2 Changing Nursing students’ attitudes towards Biochemistry:

It was quite obvious that the majority of students are anxious and apprehensive toward Biochemistry.
Meetings with Nursing students at the University of Alicante when the old Degrees were running showed
that this negative attitude toward Biochemistry is due to different aspects:
- They don’t have basic knowledge of neither chemistry nor biology.
- They have knowledge about basic chemistry and biology but those topics are not fresh in their minds.
- Some students attribute their apprehension to experiences in general chemistry and/or to comments
they have heard from other students regarding the difficulty of biochemistry.
- Some students have the perception that Biochemistry is only explained from a theoretical point of view
because this field of knowledge is not really linked with clinical applications.
The main challenge introduced in the Biochemistry course designed for the new Degree is the increase
of hours for laboratory practices and the increase of discussions about clinical cases. The Biochemistry
course described in the previous section was implemented for the first time in 2010-2011 at the
University of Alicante. After 4 years, it is possible to see positive changes in terms of students’ attitudes
toward Biochemistry. Now, Nursing students think that the Biochemistry course is probably one of the
hardest in the Degree in Nursing but they realize how important Biochemistry concepts are to
understand much better what they are doing when injecting an antibiotic or another chemical compound
or when they have to apply oxygen at an specific flow, for example.

4 CONCLUSION
Most researchers and educators for health professionals point out the close relationship that exists
between the practical disciplines and the basic sciences. In Nursing, a significant amount of knowledge
essential for professional practice is derived from the basic sciences such as biology or chemistry. To
many students aiming to be health professionals, however, the relevance of some of these basic science
courses to their education toward professional practice is far from clear. The aim of the new approach
described here as well as in other studies [3, 4] is to satisfy any doubts that the student may have
regarding the relevance of Biochemistry to Nursing. The study showed that attitudes of Nursing students
towards a course such as Biochemistry can be changed by demonstrating the relevance to their future
profession. As soon as their attitude becomes more positive, their academic performance is positively
affected too.

REFERENCES

[1] Brown, C. E., Henry, M., Barbera, J., Hyslop, R. M. (2012). A Bridge Between Two Cultures:
Uncovering the Chemistry Concepts Relevant to the Nursing Clinical Practice. Journal of Chemical
Education 89, pp. 1114−1121.

[2] Siegel, M. A., Ranney, M.A (2003). Developing the Changes in Attitude about the Relevance of
Science (CARS) Questionnaire and Assessing Two High School Science Classes. Journal of Research
in Science Teaching 40, pp. 757-775.

[3] Thornton, T. (1997). Attitudes towards the relevance of biological, behavioural and social sciences
in Nursing education. Journal of Advanced Nursing 26, pp. 180-186.
[4] Ahmed, M.S. (1981) A new approach to teaching biochemistry to Nursing students. Biochemical
Education 9, pp. 19-20.