Genomics for Health in Preconception and Prenatal Periods

PURPOSE: To review and report changes in genomic-based knowledge and care during the preconception and prenatal periods. DESIGN: Integrative review of relevant medical and nursing literature. FINDINGS: Client education and counseling are needed to understand genomic information and provide guidance in interpreting this information and making decisions. The factors that influence decision-making about testing and acting on test results constitute a complex process that has not been well studied. Family history is an important tool for obtaining genomic information and can assist women and families in understanding risk preconceptionally and prenatally. Genomic research has enhanced understanding of the mechanisms of birth defects such as neural tube defect and will likely provide research opportunities to better understand complex perinatal outcomes such as preterm birth. CONCLUSIONS: Research, education, advocacy, and anticipatory guidance are needed as women and families obtain more genetic and genomic information before and during pregnancy. All nurses will be involved in helping patients use genetic and genomic information to understand risk and to develop strategies to modify risk, and in translating the expanding array of genomic information to improve birth outcomes.     

Nursing Leadership in Genomics for Health and Society

PURPOSE: This article is part of the series regarding genomics and nursing practice, science, education, and policy. Issues in genetic testing, genetic information and the lessons learned through applications of genetic and genomic science are analyzed and discussed. FRAMEWORK: Scientists, scholars, and members of the public have articulated a vision to guide genomics research and scholarship. The three overarching themes of this conceptual framework are genomes to biology, genomes to health, and genomes to society. CONCLUSIONS: Nurses can promote the use of genomic research technologies and information in the context of health, biology, and society, as well as in nursing research, practice, education, and policy.     

Promoting Children''s Health Through Understanding of Genetics and Genomics

PURPOSE: To describe the effects of genetics and genomics on children's health care. ORGANIZING CONSTRUCT: The breakthroughs in the Human Genome Project have great potential for disease prediction, treatment, and prevention in the health care of children with chronic health conditions. Most childhood conditions based on a single gene are influenced by a complex interaction of genetic and environmental factors. METHODS: A review of the literature was conducted to determine the most common childhood diseases linked to genetic causes. FINDINGS: Two examples were selected to depict how a health professional would use genetic knowledge to provide holistic health promotion and disease prevention. CONCLUSIONS: Knowledge of the interaction of the genetic profile coupled with a person's lifestyle, work environment, and family context provide a more holistic picture of a person's health profile. The clinical implications are that this knowledge will provide opportunities for health professionals to advise families on individualized treatment options or to tailor health promotion to future disease states based on genes and their interaction with the environment.     

The Electronic Health Record

This paper reports findings from a survey of 239 psychiatric nursing staff. This study aimed to investigate how often psychiatric nursing staff participates in clinical supervision and any possible associations among individual and workplace factors in relation to participation.

The survey findings are followed by a prospective longitudinal registration of participants in clinical supervision. The registration revealed that participation varies considerably and large numbers of the staff may not participate in clinical supervision at all. Characteristics of the workplace, including organisational location, work shift, and work-environmental factors, are related to participation and, consequently, may affect the outcome of clinical supervision.     

The Increasing Role of Genetics and Genomics in Women's Health

Genetic and genomic testing are a clinical reality in health care today. Persons at risk for disease or who are simply curious about their genomes can have them analyzed. An individual's genome is a function of ancestry, family history and personal health and environmental exposures. Clinical and pharmacologic information can be obtained through genomic analysis. Genomic testing can be done by health care providers but some results can now be obtained through direct‐to‐consumer tests. Many ethical questions are being raised regarding genomic testing. Nurses can provide more optimal care by understanding the process of genomic testing as well as the implications of the results.     

Electronic Health Records and Privacy

The Center for Epidemiological Studies-Depression (CES-D) Scale's 20-item version is well-validated and reliable for detecting depressive symptoms in adolescents in community samples. A shortened version, CES-D 10 has not been validated with adolescents, but has demonstrated strong psychometrics in other populations. The purpose of this study was to test the factorial validity and internal consistency of the CES-D 10 in adolescents. Using data from 156 adolescents in a previous community-based study, we tested three models of the underlying factors of the CES-D 10 using Structural Equation Modeling (SEM) based on factor models validated in other populations. A two-factor model comprised of depressive affect and positive affect was found to be the model that best fits the data (RMSEA = 0.016, CFI = 0.98, GFI = 0.95, AIC = 97.43, BIC = 191.98). These findings are consistent with other studies in adults and provide initial support for the use of the CES-D 10 as a depression screen for adolescents in the community. The utility of a brief screen for adolescents in the community is high, given that many adolescents do not know they need help or are reluctant to seek help. The CES-D 10 could be used as a depression screen for adolescents at a population level and in health clinics.     

Implementation of a Postoperative Electronic Health Record Alert for Cardiac Implantable Electronic Device Patients

PurposeApproximately 2% of surgical patients have an existing cardiac implantable electronic device (CIED). Perioperative device reprogramming requires postoperative care to ensure that device settings are restored. Electronic health record (EHR) alerts have been shown to improve communication between providers and decrease time to necessary interventions in other areas of medicine. The aim of this quality improvement project was to create an EHR alert for postoperative CIED patients who require device reprogramming to help clinicians track, remember, and document the timely and safe restoration of device settings.DesignThis project used a pre-post observational design.MethodsThis project was conducted at a major academic medical center using a pre-post observational design. To prevent anesthesia providers from closing an encounter in the EHR before postoperative restoration of device settings, an alert was developed and embedded within the intraoperative EHR to track preoperative device reprogramming, and alert anesthesia providers to perform and document postoperative restoration of safe settings.FindingsThe postimplementation group (n = 272) had fewer unknown or undocumented preoperative CIED interventions (12.9% vs 30.9%), a 7.3% shorter device suspension time (median = 165 minutes vs 178 minutes), 6.8% improvement in documentation of postoperative re-enabling of device therapies (78.8% vs 72.0%), and a 72.48% decrease in length of stay (median = 625 hours vs 172 hours) when compared with the preimplementation group (n = 132).ConclusionElectronic prompts effectively captured patients who received preoperative CIED reprogramming and provided a process for reprogramming devices to safe settings, both significant steps in preventing negative patient outcomes associated with undocumented CIED interventions. Perioperative CIED documentation improved, and length of stay decreased after project implementation.     

Meaningful Use of Electronic Health Records

The concerns on patient safety and quality improvement in health care are increasing. There is growing use of technology in health care, particularly use of the electronic health record (EHR). As this occurs, the health care system is transforming. The federal government has become involved in EHR implementation, encouraging improved health care. The Centers for Medicare & Medicaid Services are implementing the Meaningful Use (MU) Incentive Program for Medicare- and Medicaid-eligible providers. As EHR implementation and MU Programs grow, it is important for the nurse practitioner (NP) to be aware of the MU Program. As NPs become engaged in using EHRs, MU will have an impact on changing health care systems and implications related to clinical practice and improved outcomes.     

Electronic Medical Records and Electronic Health Records: Overview for Nurse Practitioners

Electronic medical records (EMRs) and electronic health records (EHRs) have become essential systems by which nurse practitioners (NPs) communicate vital patient information to other members of the health care team as well as to patients. In this article we examine the important distinctions between EMRs and EHRs; review the genesis of these types of records; summarize applicable provisions of the Health Insurance Portability and Accountability Act from a recent legal case centered around NP utilization of EMRs and EHRs; address open patient access to medical information; and examine threats to security. Suggestions are offered on ways in which NPs can safeguard confidential patient information.