Expanding RN Scope of Knowledge-Genetics/Genomics: The New Frontier

Single center experience developing sustainable genetics clinical care: a model to address workforce challenges in medical genetics

PURPOSE OF REVIEW

The national workforce shortage in genetics is being evaluated in order to identify a sustainable solution to the increasing demand for genomic services. An innovative solution to the short term needs is to integrate advanced practice providers (APPs) and embed genetic counselors into both outpatient and inpatient specialty care. Incorporating APPs into a genetic service is not unique in itself, but the method of implementation at Medical College of Wisconsin (MCW) was, at the time, unchartered.

RECENT FINDINGS

There are >100 vacancies for board certified medical geneticists across the nation, training programs are not enrolling sufficient trainees to meet demand and more than a third of the current workforce plan to retire within the next 10 years.

SUMMARY

The integration of advanced practice providers (nurse practitioners, midwives, physician assistants etc.) into both primary and specialty care has been an evolving practice since the mid-1900s and incorporating APPs into a genetic service was not unique in itself but the method of implementation was new at that time. This is a model to successfully develop a clinical practice model around a team-based structure incorporating nurse clinicians, advanced practice providers, genetic counselors, nutritionists, and physicians into an academic clinical genetics practice.

Current State of Genomics in Nursing: A Scoping Review of Healthcare Provider Oriented (Clinical and Educational) Outcomes (2012-2022)

In the 20 years since the initial sequencing of the human genome, genomics has become increasingly relevant to nursing. We sought to chart the current state of genomics in nursing by conducting a systematic scoping review of the literature in four databases (2012-2022). The included articles were categorized according to the Cochrane Collaboration outcome domains/sub-domains, and thematic analysis was employed to identify key topical areas to summarize the state of the science. Of 8532 retrieved articles, we identified 232 eligible articles. The articles primarily reported descriptive studies from the United States and other high-income countries (191/232, 82%). More than half (126/232, 54.3%) aligned with the "healthcare provider oriented outcomes" outcome domain. Three times as many articles related to the "knowledge and understanding" sub-domain compared to the "consultation process" subdomain (96 vs. 30). Five key areas of focus were identified, including "nursing practice" (50/126, 40%), "genetic counseling and screening" (29/126, 23%), "specialist nursing" (21/126, 17%), "nurse preparatory education" (17/126, 13%), and "pharmacogenomics" (9/126, 7%). Only 42/126 (33%) articles reported interventional studies. To further integrate genomics into nursing, study findings indicate there is a need to move beyond descriptive work on knowledge and understanding to focus on interventional studies and implementation of genomics into nursing practice.

Genetics and genomics knowledge and competency of Chinese nurses based on the theory of diffusion of innovation: A descriptive cross-sectional study

Background

Nurses are responsible for providing genetics and genomics health care services, including disease risk assessment, medical referrals, and advocating for communities and individuals who probably benefit from genomics and genetics services.

Objective

This study aimed to investigate Chinese nurses' understanding and previous training in genomics and genetics. Additionally, we aimed to understand the degree to which Chinese nurses use genomics and genetics knowledge in their daily practice and to assess the learning needs regarding genomics and genetics.

Method

This study utilized the design of a descriptive cross-sectional study. From January 18 to March 15, 2022, 406 registered nurses from the Shandong province of China working in clinical institutions and with good English proficiency were recruited as study subjects. Nurses' demographic data and data related to genetic knowledge and competency were collected using the Genetics and Genomics Nursing Practice Survey (GGNPS) questionnaire. Kruskal Wallis and Mann-Whitney-U tests were utilized to investigate the descriptive statistics and non-normally distributed data.

Results

There are 406 nurses from Shandong Province, China participated in the study. Among them, BSN degrees accounted for 83.7%. Female nurses accounted for 96.8%, and 40% are clinical nurses. Among such nurses, 65.5% reported that genetics was involved in their nursing courses, and 56.2% planned to study more knowledge associated with genetics. The mean knowledge score was 7.35 (out of 12). Nurses' gender, primary role, genomics education, and experience caring for patients with common diseases influenced nurses' scores on genetic and genomics knowledge.

Conclusion

The genomics knowledge and competency of Chinese nurses need to be further improved. Incorporating genomics into the standard nursing curriculum can effectively reduce the knowledge gap. Simultaneously, it is also necessary to improve the attention of senior nurses and nursing managers to genomics nursing and improve the clinical practice environment.

A Scoping Review: Do instruments measuring genomic competence in nursing incorporate ethics?

AIM

To explore the instruments used in measuring genomic competence in nursing. The objective was to understand how ethical issues are reflected in the instruments.

DESIGN

A scoping review.

METHODS

A systematically conducted scoping review was conducted by using CINAHL Complete and Medline databases covering the years from January 2010 to January 2022. Two authors inspected potentially eligible papers and assessed their quality independently using the critical appraisal tools of Joanna Briggs Institute. Twenty-five articles were eligible including 19 different instruments. Included articles answered the research question: "How ethical issues are reflected in instruments measuring genomic competence in nursing?" The inductive thematic analysis was used in this review.

RESULTS

Descriptions of ethical themes were unstructured in the scoped articles and instruments. Not all genomic competence instruments covered ethical aspects. Only three studies asked direct questions by using the word ethics or its derivates, including confidentiality in solving ethical problems, familiarity with the ethical aspects of genetic counselling and ability to identify ethical issues. Thirteen articles included ethics-related themes encompassing knowledge, skills, concerns, advantages and disadvantages.

Genetics and genomic competency of Turkish nurses: A descriptive cross-sectional study

BACKGROUND

Nurses have essential roles in genetic related healthcare, including risk assessment, referring individuals to genetics services, advocating for and educating individual, families, and communities who might benefit from genetic services.

OBJECTIVE

To determine the genetics and genomic competency of Turkish nurses.

DESIGN

A descriptive cross sectional research design was used to collect data.

SETTING

Totally 385 nurses working in clinical or academic settings in Turkey were recruited between 20 January and 20 April 2020.

METHODS

Data were collected using socio-demographic characteristics form and Genetics and Genomics in Nursing Practice Survey on 20 January-20 April 2020. Descriptive statistics, Kruskal Wallis, and Mann-Whitney U tests were used for data analyses.

RESULTS

A total of 385 nurses participated in this study. Most, 44.9% had a BSN degree, 42.1% were clinical nurses. Of the nurses, 34.5% reported that they had genetics included in their nursing curriculum, and 74.0% intended to learn more about genetics. The mean knowledge score was 9.36/12. Gender, primary role of nurses, and whether to see patients actively in practice were the factors effecting knowledge score of nurses in genetic and genomics.

CONCLUSIONS

Turkish nurses' genomics skills need additional development and integration of genomics to the nursing curriculum can be effective to decrease their knowledge gaps. Clinical nurses' genomic competency should improve to increase the nursing care quality.

Current status and future directions of U.S. genomic nursing health care policy

BACKGROUND

As genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing's holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care.

PURPOSE

To examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation.

METHODS

We conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health.

FINDINGS

Genomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed.

DISCUSSION

Nine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas.

CONCLUSIONS

To advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.

Hereditary Breast and Hereditary Ovarian Cancer: Implications for the Oncology Nurse

OBJECTIVES

To review heredity cancer syndromes involving the breasts, ovaries, or breast and ovaries. To recommend useful professional and patient resources on cancer genetics. A case study of germline BRCA genetic testing after allogeneic bone marrow transplant is presented.

DATA SOURCES

National guidelines, evidence-based summaries, peer-reviewed studies, editorials, and professional Web sites.

CONCLUSION

Advancing genetic/genomic technology in oncology has led to a renaissance of information about hereditary cancer syndromes.

IMPLICATIONS FOR NURSING PRACTICE

Nursing competence in genetics/genomics is necessary to provide evidence-based, personalized care for individuals with cancer. Resources are available to help nurses provide quality cancer genetic informed care.

Genomics Education: Knowledge of Nurses Across the Profession and Integration Into Practice

BACKGROUND

Since the completion of the Human Genome Project in 2003, the implications of genetics and genomics for health and illness have become clearer. All nurses, at all levels and across all specialties, must have a basic understanding of genetics and genomics to provide appropriate care. 
.

OBJECTIVES

This article provides an overview of the integration of genetics and genomics into nursing education, as well as continued barriers to nursing knowledge of genetics and genomics.
.

METHODS

A literature review was conducted using CINAHL®, PubMed, ProQuest, and Google Scholar. Databases were reviewed for literature published from January 1962 to November 2017.
.

FINDINGS

Although genetic and genomic education has been integrated into undergraduate and graduate nursing curricula, a gap exists in this knowledge among student nurses, practicing nurses, and nursing faculty.