Background
Experimental animals are used for a wide range of scientific research (e.g., new drugs and vaccines development, safety assessment of chemical products) and for education [
1,
2]. They are necessary to meet the needs of society regarding health problems, food control and environmental toxicity.
The use of experimental animals has been the subject of very complex ethical debates for a long time, leading to legal regulations for its protection in different countries. Directive 2010/63/EU [
3] regulates their use in research and teaching in the European Union countries and, in the introduction section, it is indicated that “
while it is desirable to replace the use of live animals in procedures by other methods not entailing the use of live animals, the use of live animals continues to be necessary to protect human and animal health and the environment”. Thus, experimental animal testing is required prior to the approval of new drugs and vaccines.
Although initially nursing knowledge does not seem to be related to animal experimentation, nursing research covers a wide range of topics related to human health, and experimental animals can provide a wealth of information that may then be applied to human beings. Nurses may provide a discipline-specific focus on animal studies, and improve the pertinency of these studies for nursing practice [
4]. Thus, it is necessary to raise awareness and promote the application of animal experimentation in various fields of nursing research, as a way to expand the body of nursing knowledge applicable to the same conditions in humans, and to develop nursing interventions [
5].
In this sense, a small but increasing number of nurse researchers have used animals for decades to study diseases [
6], and to find solutions for patient care questions. Nevertheless, its use in nursing research is still controversial, as it is under debate whether all studies carried out by nurses (including those developed with animal models) should be based on nursing conceptual frameworks, and the extent to which this type of research may contribute to nursing knowledge [
7‐
9]. As Page [
9] noted, the nursing discipline should embrace animal research as an integral component of its own research.
The use of experimental animals in the University education is small compared to those employed for research purposes, and it has decreased considerably in recent years [
10‐
12], mainly because they have been replaced by other alternative proposals [
13‐
16]. To advance in the development of alternative methods, collaboration between professional fields is essential. Interprofessional education has been defined by the World Health Organization (WHO) as “
occurring when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes” [
17]. It has been identified as a key element in the education of health professions students [
18], and incorporated into accreditation and competency standards for several health professions [
19,
20]. Pharmacology is a core science course required by multiple health professions [
21] in which interdisciplinary collaboration can be integrated, to give students early interprofessional experiences. One of the activities described in this paper is the result of the collaboration between the teachers of the Pharmacology course (Degree in Nursing) and those of Computer Architecture (Degree in Computer Science) with the purpose of increasing students’ motivation and interest in the corresponding subject contents. With this goal in mind, the teachers and students of Computer Architecture programmed the ability of artificial vision and movement in several robots as an alternative method to simulate mice.
In the experience described in the present study, the experimental evaluation of a psychotropic drug, promazine, has served as the basis for analyzing the use of experimental animals in education and research, the ethical and legal aspects of this use, and the importance of interdisciplinary collaboration to achieve alternative methods with Pharmacology students of the Degree in Nursing. In Spain, Pharmacology is a compulsory course of the Degree in Nursing. In this subject, students are provided with knowledge about the actions and properties of drugs so that they can be used with safety and in optimal conditions. Experimental Pharmacology is of great importance within this science, and for this reason we have implemented a practical class focused on the knowledge about the use of experimental animals and the alternative methods employed in pharmacological research. It is necessary for the students to know the importance of the search for alternative methods to replace experimental animals without prejudice to scientific progress [
22,
23] and, at the same time, the inability to fully assess some drugs such as psychotropics by using only alternative methods. In their near future, nursing students will become responsible for the handling and administration of medications, as well as for the monitoring of the drug’s effects, and it is important that they have a global vision of all these aspects, including how efficacy and safety of drugs have been characterized previously to be used in humans and how pharmacological data have been obtained from experimental models. Moreover, it is expected that more and more nurses lead or collaborate in research studies in which experimental animals are employed.
Thus, the aim of this study was to assess the perceptions and attitudes of the nursing students enrolled in a Pharmacology course on the use of experimental animals and the possibilities of implementing alternative methods, by comparing the experience carried out for two academic years. For this purpose, we conducted a two-session practical class, in which an interdisciplinary collaboration has also been developed.
Results
First session: analysis of the legislation for the protection of experimental animals and evaluation of the neuroleptic effect of promazine in mice
As described previously, in this first session the legislation for the protection of experimental animals was explained. After the analysis of regulations, a discussion was established with the students. They concluded that it was necessary to develop alternative methods for replacing experimental animals when possible and if not, to make an appropriate use of them. The knowledge acquired, especially the importance of the three Rs (Replacement, Reduction and Refinement), were then applied in those experimental procedures carried out with the mice.
In the practical class with experimental animals, students could clearly see the differences in mice behavior and test times after saline or promazine administration. In the academic year 2019–20, the students watched the live practical session and took part in it with the teacher, whereas in year 2020–21 individual results of the previous year were given to the students after having watched the video produced by their teachers. Thus, in both years the students could analyze the data obtained for the two groups of animals, and calculate the means and standard deviations for each test. The students were able to see that the mice injected with promazine were not able to pass either the chimney or the traction test (only 5 and 2% of the animals did, respectively) compared to those that received saline (96 and 98% passed correctly, Chi-square test, p ≤ 0.05). In the evasion test, most of the mice with promazine were not able to cross the line drawn, while mice with saline did it on a mean of 23 ± 6.5 times (vs. 2.0 ± 1.9 times in promazine group, t test, p ≤ 0.05). Finally, in the maze test most of the mice with promazine were not able to cross the line or enter the labyrinth, whereas mice with saline reached the end of the maze in only 3.5 ± 1.3 min.
Second session: presentation of an alternative method with interdisciplinary collaboration and assessment of students’ opinion
Maze test was used in this session to emphasize the difficulty of finding an alternative method (robots) to completely replace mice in the evaluation of promazine effects. Students could watch in the video recorded by the students of the Computer Architecture course that the 10 mice reached the goal in a mean time similar to the obtained by the mice in the previous practical class (3.3 ± 1.1 minutes). Regarding robots, 6 out of the 10 programmed reached the goal, but the mean time needed was higher than for mice (4.1 ± 1.4 minutes). Only one robot reached the goal in less time than mice (35 seconds).
After watching the video, all the students attending the practical class completed voluntarily the questionnaires. Thus, the response rate was 100% both years (100 and 90 students in academic years 2019–20 and 2020–21, respectively). Most of them were women with an age of around 19 years, and had previously studied high school (Table
1).
Table 1
Sociodemographic characteristics of the sample
Age (years) (mean ± SD) | 19.3 ± 1.03 | 19.5 ± 1.82 |
Gender |
Women | 74 (74%) | 74 (82%) |
Men | 26 (26%) | 16 (18%) |
Previous studies |
High school | 92 (92%) | 81 (90%) |
Vocational training | 8 (8%) | 9 (10%) |
The medians and interquartile ranges calculated for each question in the first part of the questionnaire are shown in Table
2. In year 2019–20, the students found the practical class very interesting. Their motivation for learning about the use of experimental animals to assess or develop new drugs had also improved. On the other hand, they were able to better understand the concept of the three Rs, and the importance of the research in alternative techniques for learning Pharmacology. In year 2020–21, scores were slightly lower, although students positively evaluated the practical class and its content as well as in 2019–20. In this latter year, three new items were added (no. 10 to 12), and from the answers provided by the participants it can be inferred that nursing students believed that it was important for them to acquire knowledge on the use of experimental animals in Pharmacology, and that they would not ban their use to assess new drugs. Significant differences were found in scores provided by students from both academic years for questions no. 1, 2, 7 and 8.
Table 2
Results obtained in the survey (session 1) employed to assess students’ opinion
1. I have found the class interesting | 5 (1) | 4 (1) | 0.000 a
|
2. My motivation for learning about the use of experimental animals in the study and development of drugs has increased | 4 (1) | 3 (1) | 0.013 a
|
3. It has been a useful tool for learning Pharmacology | 4 (1) | 4 (1) | 0.778 |
4. It has increased my knowledge about the use of experimental animals in the study and development of drugs | 4 (1) | 4 (1) | 0.909 |
5. It has helped me to know how to value the use of experimental animals in Pharmacology | 4 (1) | 4 (1) | 0.952 |
6. It has been useful for me to know the legislation on experimental animals | 4 (1) | 4 (1) | 0.077 |
7. It has helped me to understand the concept and the importance of the practical application of the three Rs (Replacement, Reduction and Refinement) | 4 (1) | 4 (1) | 0.023 a
|
8. I consider important the research in alternative techniques for learning Pharmacology | 5 (1) | 4 (1) | 0.021 a
|
9. I consider interesting the interdisciplinary collaboration in the teaching of Pharmacology | 4 (1) | 4 (1) | 0.782 |
10. I would have liked to be able to do the practice with mice, instead of watching a video | – | 5 (1) | |
11. As a nursing student I do not need to know the use of experimental animals in Pharmacology | – | 2 (1) | |
12. If I could legislate, I would ban the use of experimental animals in the research of new drugs | – | 2 (1) | |
The four open-ended questions in part 2 allowed the students to give their opinion about the advantages and disadvantages of using experimental animals (mice) or an alternative method (robots). Table
3 includes those comments made by the students in the second part of the survey. Opinions were coded by the teachers taking into account the most frequently expressed ideas in the answers.
Table 3
Opinions given by the students on advantages/disadvantages of mice/robots use (academic years 2019–20/2020–21)
Advantages | Knowledge of reality (78%/80%) Reliability (67%/69%) Similar to humans (51%/56%) | Avoids the use of animals (65%/73%) Animals do not suffer (61%/58%) Scientific progress (48%/60%) |
Disadvantages | Potential damage to the mouse (92%/89%) Wide variations in responses (71%/69%) | You do not see the real effect (91%/93%) High cost (72%/63%) Difficult to program (54%/68%) |
The answers given showed that students believed that the knowledge of reality was the main advantage of the use of mice. As for robots, they avoided the use of animals. On the other hand, the main disadvantage for the use of mice was the potential damage that they could potentially cause by handling or injecting saline/promazine (even if they had carried out the procedure correctly), and for robots, that it was more difficult to evaluate the real effect of a drug.
Discussion
A pedagogically effective approach should involve a variety of teaching strategies. The results of our study indicate that different learning strategies can be integrated in a coherent way, and that this implementation had a clear positive impact on the engagement of our nursing students with the scientific and ethical aspects on the use of animal experimentation.
The use of experimental animals for scientific or educational purposes always generates an intense debate [
26]. Main concerns about their use are related to their welfare (causing them pain, distress, suffering, lasting harm or even death) and to the failure of animal models to adequately represent human disease. Most scientists agree that animal research should be permitted as long as it is carried out for good reason, using human conditions as much as possible, if there are no viable alternatives and under strict regulation [
1,
2,
27].
As explained before, procedures used to evaluate promazine effects are considered as not harmful according to Directive 2010/63/EU [
3], and they would be a good basis to explain the regulations on animal protection, highlighting the aspects related to animal replacement. Various alternative methods to the use of experimental animals in research and education have been suggested and accepted worldwide [
28‐
30].
Measurement of students’ opinion is a way to evaluate educational programs [
31‐
33]. As can be seen in Table
2, the scores of the different questions in part 1 were near 4 points, indicating that our students rated the activity positively. The median scores of 5 for items 1 (“I found the class interesting”) and 8 (“I consider important the use of alternative techniques for learning Pharmacology”), suggest that the practical class achieved its goals in the academic year 2019–20. In year 2020–21, the highest score was obtained in item 10 (“I would have liked to be able to do the practice with mice, instead of watching on a video”, 5 points), which may be influenced by the health emergency lived by the students, including the perception of the urgent need to develop a new drug or a vaccine against COVID-19 [
34‐
36]. These results indicate that students prefer to do the practice themselves instead of watching a video, and that they are interested in this topic, not rejecting the use of experimental animals. Other studies have revealed that male students seemed to be more positive toward animal use in research [
37,
38]. However, we have not been able to compare students’ attitudes by gender due to the low number of male students enrolled in this Degree.
In a survey carried out among students of different degrees, most of them found animal research as morally acceptable, with a 78% of acceptance among nursing undergraduates. Moreover, they believed that this type of research played a significant role in treating human diseases [
38]. Nevertheless, in the study of Elhaji and Basheti [
33] 49.5% students refused to handle animals, being phobia the main reason to explain this rejection.
The opinions provided by the students in the second part of the survey (Table
3) revealed that, similarly to other authors [
10,
27,
39], students considered “causing them pain” as the main concern for the use of live animals, even though they were assured that the procedure was correctly carried out. Similar concerns were reported by other authors [
40,
41]. Our students believed that the use of alternative methods (robots) would avoid animal suffering. Thus, the practical experience implemented has been successful in making the students see the intrinsic value of experimental animals, and that they should be always treated as sentient creatures, restricting procedures in which they are used to those that ultimately benefit human or animal health [
3].
The humane use of experimental animals is of vital importance to understand the mechanisms of health and disease, as well as to develop therapies and promote health. As other authors, we believe that bioscientists’ formation should include, in addition to scientific knowledge, a thorough evaluation of the moral implications of scientific research [
42]. An increasing number of nurse researchers use animals to find solutions that can be later applied to patients. The experience described may be also seen as a first training step to provide nurses with the skills necessary to become nurse bioscientists, giving them a more visible role in basic and traslational research. However, although there is much work to be done to translate the animal research to the nursing practice, it is important for nursing students to know the research with animals used to develop new drugs and vaccines that they will be responsible for administering.
Regarding the use of the robots as an alternative method, simulation resources have been used in Pharmacology teaching for several years to help students understand difficult contents, and to demonstrate its application in clinical situations [
21,
43]. The purpose of using robots was to highlight the importance not only of the replacement of experimental animals but also of interdisciplinarity. The development of these methods needs an interdisciplinar collaboration and many times computers are used to help in this task.
In this sense, interprofessional education has been identified as an essential element in the education of health professions students [
21,
44]. This is an ongoing process, and it is necessary to learn how to work side-by-side, dealing with different aspects of a single problem, with the insights and methodologies from a variety of disciplines, and a broader perspective in relation to health practice. Students should be taught that no single discipline can claim the ownership of a topic. Recently, the American Association of Colleges of Nursing Position Statement on interdisciplinary education and practice aims to educate nursing students in such a way that promotes joint interdisciplinary planning, decision-making, and goal setting [
45].
The interdisciplinary collaboration carried out has served to convey to the students how hard it is to design an alternative method to an experimental animal (robot) in which the actions of a psychic depressor on its motor activity can be assayed. Nursing students not only appreciated the difficulty of simulating the behavior of a living being, but also the importance of the interdisciplinary collaboration and the limitations and difficulties of developing these methods [
26,
46‐
48]. Together with their teachers, students came to the conclusion that, in the future, computer professionals could implement software to simulate different situations of central nervous system affectation caused by stimulant or depressant drugs with the advice of Health Sciences professionals like them.
Regarding the robots employed in the activity, the teachers of the Architecture Computers course chose the Mindstorms RCX ones as they accept a good variety of programming languages and they were especially designed for educational purposes [
49‐
51]. As recommended by the teachers of the Computers Architecture course, we explained that robots did not know the right way, and they should explore like mice: choosing a path to get to an intersection and turning back to test another option if the path chosen is wrong. As it occurs at each intersection, the complexity of the algorithm grows rapidly [
50]. The implemented activity served our students to verify that at the present time, alternative methods cannot completely replace experimental animals in the evaluation of new drugs, and that it is necessary to use them in some phases, always ensuring a high level of protection for animals [
22,
23]. In a future, properly programmed robots or other in silico options could be used in the experimental assessment of a drug acting on the central nervous system. Our students found that it would be possible to simulate the behavior of a mouse under the effects of psychotropics but with intense programming work [
52].
Although the survey offers insight on the perceptions of students about the use of experimental animals and alternative methods, it is not exempt from limitations. In this sense, the study was conducted in only one course (Pharmacology) and using in both academic years one cohort of undergraduate students. Moreover, students may have been, in some way, directed toward one type of response or another taking into account the information provided from the teachers.
Further studies are needed to evaluate the knowledge that nursing students have on this topic when they are in higher courses, once they have taken other subjects and developed part of their practical activity in hospitals and health centers. On the other hand, the improvement of the robot described, or other in silico possibilities, would make possible to simulate the action of other drugs, which in turn would help to reinforce the interdisciplinary activity of Informatics and Nursing.
Conclusions
The alternative method to experimental animals designed for the teaching of Pharmacology practices, with the collaboration of the teachers and students of a different discipline (Computers Architecture), was useful for the students to understand and better accept the employment of experimental animals in biomedical research and education, as well as to know the legislation applied in the protection of animals. The development of this teaching experience demonstrates the importance of interdisciplinary collaboration in education, and the need of strengthening it from the beginning of nursing education. Moreover, as part of this educational experience has been carried out online under pandemic, we have seen that students prefer face-to-face practical activities and to do the practice themselves.
The results of our study reveal that it is possible to design and carry out interdisciplinary and active strategies to draw students’ attention to a certain topic. The challenge of developing a new and original teaching tool is an unusual situation for students, which leads them to find answers that are not in the textbooks, improving their creativity and interest in the topic developed in the class. We believe that the use of experimental animals and alternative methods has been successful in achieving the goals initially set. This teaching proposal can be applied in any classroom, of any country, with the only change of the corresponding legislation, to reinforce students’ skills and confidence with regard to animal experimentation.
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