A med student’s background in nursing informs her award-winning research to help pulmonary embolism patients.
Last fall, Christiana Prucnal ScM’21 MD’21, BSN, won the Joukowsky Student Award for Scholarly Excellence for her summer research project. How she got to that moment isn’t exactly the most straightforward of paths.
Prucnal earned her nursing degree from Loyola University in Chicago in 2012. “I was drawn to nursing because I could work closely with people and offer help to those in need. Everything about medicine fascinated me, and although I considered pre-medicine, I could not fathom entering such a long education period without first knowing more of what it would be like,” she says.
After graduating, she worked as a cardiac nurse at Northwestern Memorial Hospital in Chicago and then an emergency department nurse at Massachusetts General Hospital (MGH). With a few years of medical training, mentoring, and research experience under her belt, she decided she wanted to train as a physician after all. She completed a post-baccalaureate at Northwestern and applied to medical school.
Now at Brown, Prucnal’s research focuses on critically ill patients, driven by her desire to provide better care and informed by her work as a night shift nurse in the ED. “As a new nurse working the night shift with little other help, responding to an acutely ill, rapidly deteriorating patient could feel terrifying,” she says. “This made me want to learn everything I possibly could for those patients.”
For many patients, recovery after illness was slowed by social determinants of health, such as unstable housing and inequitable legal support, which Prucnal hopes to study as a student in the Primary Care-Population Medicine Program.
Prucnal’s award-winning study, which she began at MGH, examined unfractionated heparin, which is one of the most common medicines given for acute blood clots in the lungs (pulmonary embolism, or PE). The drug is often administered to patients with high-risk PEs. When someone has a clot, it can grow and rapidly become life-threatening. Heparin helps to prevent these clots from getting bigger and stops new clots from forming.
“The project had additional relevance for me because I knew firsthand that the administration of unfractionated heparin is a relatively nursing-intensive process with frequent blood testing and dose adjustment,” Prucnal says. Once a patient is on the drug, every six hours nurses must perform blood tests in order to see if the dosing is in the effective and therapeutic range. She wanted to know whether this difficult and error-prone process could be improved.
“Ultimately, we found that the medication has much more variability than once thought and traditional dosing guidelines need to be re-evaluated,” Prucnal says. Judges were impressed by the clinical relevance of the project and the fact that it had a large sample size of patients, which means the results were stronger.
Besides her research, Prucnal is passionate about providing hands-on learning experiences for her peers. Last semester, inspired by her work experience, she led the preclinical elective “Practical Skills in EMS and Disaster Response,” with Maia Dinsmore MD’21 and Ken Williams, MD, professor of emergency medicine. The bulk of the class focused on teaching practical first-responder skills. They also partnered with the Providence Fire Department so med students could ride along with paramedic crews.
Prucnal still works part time as an ED nurse at MGH. In her limited free time she loves to be outdoors by the water, hiking, or running. She continues to volunteer with the medical team for the Chicago Marathon every year—one of the few days she loves waking up at 4 a.m.
“I’m so fortunate to study and do work that I love. Every time I work a shift at the hospital, I see things I just learned about in my medical school classes,” Prucnal says. “It makes learning that much more rewarding.”