Genomic-based health care in nursing: a bidirectional approach to bringing genetics into nursing's body of knowledge.

Nurses can expect to become partners with patients and their families as genomic-based health care brings decisions involving gene-based diagnostics and therapeutics into commonplace practice. All health professionals need genetic literacy to continue competence in clinical practice in the future. This article explores the efforts nursing has undertaken during the past decade to integrate human and clinical genetics into practice and scholarship. Genetics nursing education literature in the second half of the 20th century was analyzed. A focused survey of 15 genetics nurses and nursing leaders regarding key national initiatives, genetics research training programs, and genetics education models was conducted. Nursing has taken a bidirectional approach (through grass roots and top-down initiatives) to implementing change and advancing genetics in nursing practice, research, and education. For optimal leadership in genetics education for nursing and other disciplines, bidirectional efforts must continue and concentrate on bringing genetics into clinical practice and scholarship as genomic-based health care spreads worldwide. Evidence of nursing's interdisciplinary leadership is recognized. Recommendations and strategies for continued nursing leadership and programs that build on previous work are presented.     

Recommendations for educating nurses in genetics

With the ongoing and increasingly rapid pace of genetic discoveries, nurses must be able to incorporate genetic knowledge into their everyday practices of promoting the genetic health of individuals, families, and communities. Although development of genetic health knowledge is in its infancy, nurses are currently expected to integrate information about genetic risks, testing, and treatments for clients throughout the clients' entire lifespan. All nurses must have an understanding of the relationship between genetics and health to appropriately identify and address genetic concerns in their clients. To fulfill these roles, nurses need to improve their knowledge base in genetics. This article provides recommendations for genetics curriculum in continuing and entry-level nursing education programs. These recommendations are outcomes of a research project involving genetics nurse experts as well as nurses new to the area of genetics, and a consensus workshop of nursing faculty involved in curriculum changes subsequent to an intensive genetics continuing education program. Nursing educators are beginning to recognize the importance of education of all nurses about genetics. If, however, all educators do not accept this responsibility, nurses will be left behind in designing and offering health care for the 21st century.     

Knowledge, perceptions, and attitudes of advanced practice nursing students regarding medical genetics

PURPOSE: To describe the current medical genetic knowledge and perceptions of graduate advanced practice nursing (advanced practice nurse [APN]/nurse practitioner and nurse anesthetist) students using survey data for future integration of genetic topics, principles, and healthcare issues into curriculum. DATA SOURCES: Survey data of APNs' perceived knowledge of genetics and a review of the literature from past research studies of students and current articles from professional journals and organizations. Web sites were those of the National Coalition of Health Professions for Education in Genetics and National Institutes of Health, Human Genome Research Institute; professional organizations; and the authors' professional, clinical, and educational experiences. CONCLUSIONS: Most APN students perceived they had minimum knowledge and prior training regarding medical genetics. There is a need to integrate genetic concepts, principles, and medical conditions into advanced practice nursing curriculum and to provide clinical experiences in genetic conditions across the life span and throughout the health and illness spectrum. APN students have positive attitudes toward integrating genetics into graduate curricula. Potential methods for program integration include readings, small group discussion, standardized patients, and role-play as measures to increase information. IMPLICATIONS FOR PRACTICE: The National Coalition for Health Profession Education in Genetics, the American Nursing Association, and the American College of Nursing Education have recommended integration of genetics knowledge and skills into routine health care to provide effective interventions for individuals and families. However, previous research and data from this study have revealed that many nurses have minimal training in genetics. Advanced practice nurses must be knowledgeable on genetic principles, topics, and the ethical, legal, and social implications related to medical genetics to increase the ability to diagnose, prevent, and treat diseases and to provide effective care for individuals and families.     

Innovations in United States genetics nursing: Practice and research

Aim: Clinical and research applications from human genome discoveries are growing and creating both opportunities and challenges to the integration of genetic concepts into practice and research. Nurses have a long history of caring for individuals, families, and groups with genetic conditions. In the past two decades, a small group of nurses in the USA have used a variety of strategies to further develop the field of genetics nursing. In this paper we identify innovative approaches to identifying genetics‐related nursing roles and opportunities, as well as successful collaborative efforts beyond nursing to address the emerging health and societal challenges related to human genetics discoveries. Methods: The information presented here comes from a variety of sources where the authors or genetics nurses directly participated, including: (i) a systematic literature review of genetics nursing; (ii) a comprehensive research study of models of delivering clinical genetics services and the roles of health professionals; and (iii) participation in numerous national research, planning, programmatic, and advisory groups involved with clinical genetics‐related health services, research, education, and public policy. Results: Genetics nurses in the US have developed innovative responses to genetics‐related challenges within and beyond the profession of nursing. These include: (i) establishing an organization for nurses in genetics and gaining formal recognition of genetics as a specialty of nursing; (ii) defining the scope of genetics nursing practice and developing a new genetics nursing credential; (iii) establishing a multiprofessional genetics education coalition and defining genetic competency for health‐care practice; (iv) creating new clinical practice roles for nurses that integrate emerging genetics concepts and skills into diverse clinical practice areas; (v) expanding nursing involvement in genetics‐related research; and (vi) participation in high‐level genetics advisory groups. Conclusions: The US experience shows that nurses have made substantial progress in expanding their involvement in genetic services through visionary leadership, innovative approaches to challenges, establishing support with nurse colleagues, and engaging in multiprofessional efforts. The most important first step is developing a supportive environment for nurse advancement. In the US, the genetics nurses’ organization known as the International Society of Nurses in Genetics (ISONG) has provided this base.     

Genetic discoveries and nursing implications for complex disease prevention and management.

The purpose of this article is to examine the management of patients with complex diseases, in light of recent genetic discoveries, and to explore how these genetic discoveries will impact nursing practice and nursing research. The nursing science processes discussed are not comprehensive of all nursing practice but, instead, are concentrated in areas where genetics will have the greatest influence. Advances in genetic science will revolutionize our approach to patients and to health care in the prevention, diagnosis, and treatment of disease, raising many issues for nursing research and practice. As the scope of genetics expands to encompass multifactorial disease processes, a continuing reexamination of the knowledge base is required for nursing practice, with incorporation of genetic knowledge into the repertoire of every nurse, and with advanced knowledge for nurses who select specialty roles in the genetics area. This article explores the impact of this revolution on nursing science and practice as well as the opportunities for nursing science and practice to participate fully in this revolution. Because of the high proportion of the population at risk for complex diseases and because nurses are occupied every day in the prevention, assessment, treatment, and therapeutic intervention of patients with such diseases in practice and research, there is great opportunity for nurses to improve health care through the application (nursing practice) and discovery (nursing research) of genetic knowledge.     

Education for genetics and nursing practice

Genetic factors influence the risk for disease, selection of treatments, and overall health of persons throughout the life span. Nurses in critical care practice participate in assessing genetic risks for disease, implementing treatments, educating people about genetic aspects of health and disease, supporting the client's abilities to cope with the information, and assisting the individual and family to make health-related decisions involving genetic information. Opportunities for critical care nurses to become knowledgeable about genetic aspects of critical care nursing exist through academic courses, continuing education, and summer institutes. Recently, new guidelines for the genetic education of nurses have been developed. However, genetic education opportunities are not available to all nurses throughout the United States. Genetic nursing education programs based on guidelines for integration of genetic knowledge into professional nursing practice are needed.     

Advancing genetic nursing knowledge

Although genetic discoveries affect nursing education, practice, and research, the use of genetic principles in research design and methodologies is a recent approach in nursing science. This article describes results of a needs assessment to identify barriers and strategies to overcome problems encountered by nurse scholars in the integration of genetic principles into nursing investigations. A Delphi survey was conducted with attendees at a nursing genetics research consensus meeting. Understanding genetics, need for sensitive measures, limited resources, and difficulties in networking were major themes identified as barriers. Key strategies include educational preparation, appropriate research methods, institutional support, and research collaboration. Nurses must understand genetics in order to participate in knowledge discovery regarding relationships between genetics, health, and nursing. Integration of genetic concepts into nursing science requires development of collegial relationships among nursing researchers, as well as with those in genetics and related disciplines.     

Families and genetics: Bridging the gap between knowledge and practice

The Human Genome Project (HGP) and news of genetic breakthroughs are pervasive to most of our lives today. Yet how many of us have had formal education in genetics? When and how do we integrate this knowledge into our clinical practice? This article discusses the relevance of genetics to newborn and infant nursing practice and how new genetic knowledge affects patients and their families. Approaches to educating clinicians about genetics within the context of the family are described, as newborn and infant nurses emphasize the family in their daily work and frequently work with children and families with genetic diagnoses. Education and research from the University of Illinois at Chicago College of Nursing are used as examples to describe the integration of genetics into the practice of nurses caring for newborns, infants, and their families. Copyright 2002, Elsevier Science (USA). All rights reserved.     

Nursing in genetics: current and emerging issues for practice and education

This article focuses on genetics as a dynamic, rapidly expanding health care arena, offering nurses from all specialty areas new career opportunities. Community issues are examined, and the need for nursing research in genetics is identified. A synopsis of a recent national meeting that explored practice changes and the resulting implications for advanced education for nurses in genetics is discussed. Certification remains a controversial issue. Consensus is reached concerning the need to include genetic knowledge at the baccalaureate level. A panel discussion by students and recent graduates describes existing programs in nursing that offer a genetic specialty.     

An historical perspective on genetic care

The outcomes of genetic research endeavors have the potential to transform health care with significant implications for both providers and consumers of clinical services. Professional and public integration of genetics knowledge is key to successful utilization of genetics information. This article will provide an overview of genetics including a historical perspective, examples of genetic health care, the nursing perspective, and ethical considerations and challenges. New scientific explanations for health, disease, responsiveness to treatment, and design of options for care may create personal and professional dilemmas. Nurses have a responsibility to become active participants in confronting the demands resulting from this new knowledge for education, practice, and policy. The purpose of this article is to provide a foundation from which the profession of nursing can build to enhance current skills and knowledge about genetics to prepare for this transformation in health care.     

Genetic education,knowledge and experiences between nurses and physicians in primary care in Brazil: A cross‐sectional study

Recent advances in genomics and related technologies have the potential to improve health care throughout the world. In this cross‐sectional study, we examine genetics education, knowledge, and genetics‐related experiences among the nurses and physicians who provide primary care in a Brazilian city. Fifty‐four healthcare professionals from family health units participated in the study (response rate: 90%). Data were collected using a structured 36‐item questionnaire divided into five axes: sociodemographic data and academic background; genetics education; genetics knowledge; genetics‐related experiences in family practice; and knowledge regarding the National Policy for Comprehensive Care in Clinical Genetics in the Unified Health System. Although most participants (85.2%) acknowledged receiving some genetic content during their undergraduate education, the majority (77.8%) advised that they did not feel prepared to deliver genomics‐based health care in primary care. The results suggest that nurses and physicians often lack the knowledge to provide genomics‐based health care in primary care. Therefore, continuing education in genetics/genomics should be provided to primary healthcare professionals in order to enhance family practice and compliance with national policies.     

Neonatal nursing and the genetics revolution!

Discoveries from the Human Genome Project are having a significant impact on the way we look at genetic makeup, health, and disease. As a result of this new knowledge, changes will be made in how diseases are treated and how nurses work with patients and their families. The National Coalition for Health Professionals Education in Genetics was formed to strengthen baseline knowledge in genetics of nurses and other health professionals. For neonatal nurses, this is an extremely important area that will become more and more critical to care as genetics knowledge continues to rapidly expand. Neonatal nurses must be knowledgeable about genetics, genetic testing, and the use and possible misuse of genetic information. This article describes the impact of genetics on neonatal care.     

Legal issues associated with genetics

With the evolution of genetic research, legal issues have emerged related to the health care delivery industry and the protection of patient information. The use of genetics or genetic enhancement expands the role of the nurse and also brings a new perspective to the nurse-patient relationship. Nurses now must discern their role in relation to patient privacy and confidentiality. In addition to reviewing the ethical and legal dilemmas of registered nurses in clinical practice, the nursing profession must review the level of responsibility appropriate when using genetic and or experimental treatments, especially when the nurse is not the primary care provider or the leader of the research team. Nurses will have to delve into privacy and confidentiality issues associated with genetic research. Although little case law exists on the relationship of nursing to genetic research and treatments, the implications of experimental research and policy associated with genetics must be analyzed to better understand their impact on the scope of nursing practice.     

Increasing importance of genetics in nursing

ObjectivesTo examine the empirical literature related to the incorporation of genetic research and genetic competency needed by the nurse in practice.DesignLiterature review.Data SourcesThis article will explore published research within the past seven years of 2008–2015 that address the need for the increased incorporation of genetic content in nursing practice in addition to the need for the nurse to effectively screen the patient at risk of a genetic disorder. This literature review specifically focuses on the inadequacy of nurses in addressing genomic health compromise and serving as advocates for patients and families facing genetic disorders.MethodsA review of the literature published from 2008 to 2015 related to the incorporation of genetics in nursing practice and the role of the nurse as a patient advocate for families facing genetic disorders with resulting genomic health compromise.ResultsThe research exposes the lack of adequate preparation of nurses to incorporate and utilize the recent advances in genomic healthcare. Practicing nurses lack understating and skill in the application of genetics and genomic technologies to patient care. The nursing profession, including nursing academia, need to enhance the integration of genetic and genomic content into nursing curriculum and practice.ConclusionPracticing nurses are inadequately prepared to apply genetic advancements in screening at risk patients and addressing the needs of the patient or family facing a genomic health compromise.     

Canadian nursing in the genomic era: a call for leadership

With developments in genomics, there is an urgent need for Canadian nurses in all settings to be informed and involved in the incorporation of this new knowledge into healthcare. The purpose of this paper was to synthesize the literature on genetic nursing roles to provide a foundation for Canadian nursing leaders as they take on the challenges of nursing in the genomic era. A comprehensive review of 98 articles published between 1994 and 2004 revealed strong support for genetic nursing roles and recommendations for levels of genetic nursing practice. The few studies on genetic nursing roles suggested that nurses and other health professionals support the integration of genomics into nursing practice. Issues that need to be addressed related to nursing practice, education and research are offered to engage nursing leaders in advocating for the incorporation of genomics into nursing in Canada.     

Genetics in nursing education

The discoveries stimulated by the human genome project have changed the way health and disease are thought about. In practice, health care professionals are responsible for the application of this knowledge. Guiding principles regarding genetics and health care lead to the knowledge nurses need, roles for nurses in relation to genetics, what knowledge is needed in nursing curricula, how to include the relevant information, and suggested approaches for inclusion despite barriers.     

Interdisciplinary practice, education, and research: the expanding role of the occupational health nurse.

The nurses' roles are changing and expanding along with the changing health care system. Occupational health and environmental health nurses are in key positions to coordinate and direct interdisciplinary practice, education, and research. Occupational and environmental health nurses have a broad knowledge base in which they deal with employers, employees, stakeholders in communities, different governmental organizations, and families. Interdisciplinary collaboration is a way to find possible solutions to meet the needs of the work force, their families, communities, and the global community. Nurses must educate the different disciplines about their worth in collaborative interdisciplinary practice, education, and research. No single discipline can help individuals reach their full level of well-being. Interdisciplinary practice, education, and research should be encouraged for nurses to provide the best care for individuals in need of health care.     

Genetics education in the nursing profession: literature review

AIM: This paper reports a literature review exploring genetics education for nursing professionals. The aim was to contribute to the debate about the future direction of such education. BACKGROUND: Advances in genetics science and technology have profound implications for health care and the growing importance and relevance of genetics for everyday nursing practice is increasingly recognized. METHOD: A search was conducted in February 2005 using the CINAHL and Google Scholar databases and the keywords nurse, midwife, health visitor, education and genetics. Papers were included if they were published in English between 1994 and 2005 and included empirical data about genetics education in nursing. In addition, attempts were made to access the grey literature, with requests for information on research, for example, to members of the Association of Genetic Nurses and Counsellors and searches of relevant websites. FINDINGS: Agreement on the relevance of genetics for nursing practice is extensive. Empirical evidence of the learning needs of practitioners highlights widespread deficits in knowledge and skills, and low confidence levels. Provision of nursing education in genetics is patchy and insubstantial across a number of countries, further hampered by lack of strategic development. Significant progress has been made in the identification of learning outcomes for nurses. Research on the delivery of genetics education is limited, but the role of skills-based training, use of clinical scenarios, and importance of assessment have all been identified as factors that can promote learning. CONCLUSION: Whilst areas of good performance were revealed, many studies identified gaps in professional competence and/or education. New initiatives are underway to support genetics education and its integration into professional practice, but further research is needed on the most effective forms of educational delivery, and an international collaborative approach to this should be considered.