Integration of Genomics in Cancer Care

Prognostic uncertainty in multiple sclerosis: A concept analysis

AIM

To report an analysis of the concept of prognostic uncertainty in patients with multiple sclerosis (MS).

BACKGROUND

The complexity and ambiguity involved in a diagnosis of MS lead to the occurrence of prognostic uncertainty among patients. A concept analysis is presented that analyses what prognostic uncertainty means to those experiencing the transition between relapsing-remitting multiple sclerosis and secondary progressive multiple sclerosis.

DESIGN

Concept analysis.

DATA SOURCES

PubMed, Ovid Medline, Cumulative Index for Nursing and Allied Health Literature databases were searched for literature published within the last 10 years using combinations of the terms prognostic and diagnostic uncertainty, and multiple sclerosis along with archival referencing.

METHODS

The Walker and Avant method was used to analyse the concept of prognostic uncertainty in patients with MS.

RESULTS

The defining attributes identified that provide additional context to prognostic uncertainty are illness uncertainty, intolerance of uncertainty and progressive dwindling. Related, contrary, model and borderline cases are presented to further discuss the application of the key attributes to the concept.

CONCLUSION

There are limited data on prognostic uncertainty and multiple sclerosis; however, patients and physicians express uncertainty in understanding one's disease trajectory and determining when a patient with relapsing-remitting multiple sclerosis has entered the secondary progressive multiple sclerosis disease course leading to ineffective communication and frustration.

RELEVANCE TO CLINICAL PRACTICE

Genetics and genomics have the potential to provide a prognostic factor for addressing the concept of uncertainty as it relates to persons with multiple sclerosis. Moving beyond the concept analysis, a case is made for nurse involvement in genetic and genomic research to conduct trials, translate, and apply these findings to clinical practice and nursing curricula, addressing the uncertainty experienced by those afflicted with chronic illnesses, such as multiple sclerosis.

Genetics and Genomics Teaching in Nursing Programs in a Latin American Country

Although the importance of genetics and genomics in nursing education has been widely recognized, surveys carried out in several countries show that these subjects are still limited in nursing undergraduate programs. In Latin America, the teaching of genetics and genomics in nursing programs has never been previously documented. Considering this scenario, we aimed to investigate how genetics and genomics have been taught in undergraduate nursing programs in Brazil. A total of 138 undergraduate nursing program coordinators and 49 faculty members were recruited to participate in this cross-sectional study. After IRB approval, data were collected using an online survey, covering curriculum design, faculty credentials, genetics and/or genomics teaching, as well as their impressions regarding the document "Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics". Genetics is taught in most of the investigated courses (67.3%), mainly by biologists (77.6%), with master's degree (83.7%), and with the syllabus mainly focused on molecular biology. More instructors agreed with Competency 2 (C2) which refers to advocating for clients' access to desired genetic/genomic services and/or resources including support groups as well as C23 which refer to using health promotion/disease prevention practices that incorporate knowledge of genetic and genomic risk factors, than coordinators. That is, the participants' type of appointment (instructors vs. coordinators) had a significant effect on their agreement level with competencies C2 (χ2 = 6.23, p = 0.041) and C23 (χ2 = 9.36, p = 0.007). Overall, a higher number of participants with both master's and Ph.D. degrees significantly agreed with competencies C2, C4, which refer to incorporating genetic and genomic technologies and information into registered nurse practice, and C5-demonstrating in practice the importance of tailoring genetic and genomic information and services to clients based on their culture, religion, knowledge level, literacy, and preferred language, when compared to those with Ph.D. only, and those with a master's degree only (χ2 = 8.73, p = 0.033; χ2 = 8.61, p = 0.033; χ2 = 8.61, p = 0.033, respectively). Our results support reflections on ways to prepare the nursing workforce to deliver personalized nursing care. Additionally, they can be an aid in establishing guidelines for the undergraduate nursing curricula in Brazil and in other Portuguese-speaking countries, as well as in Latin America.

How American Nurses Association Code of Ethics informs genetic/genomic nursing

Members of the Ethics and Public Policy Committee of the International Society of Nurses in Genetics prepared this article to assist nurses in interpreting the American Nurses Association (2015) Code of Ethics for Nurses with Interpretive Statements (Code) within the context of genetics/genomics. The Code explicates the nursing profession's norms and responsibilities in managing ethical issues. The nearly ubiquitous application of genetic/genomic technologies in healthcare poses unique ethical challenges for nursing. Therefore, authors conducted literature searches that drew from various professional resources to elucidate implications of the code in genetic/genomic nursing practice, education, research, and public policy. We contend that the revised Code coupled with the application of genomic technologies to healthcare creates moral obligations for nurses to continually refresh their knowledge and capacities to translate genetic/genomic research into evidence-based practice, assure the ethical conduct of scientific inquiry, and continually develop or revise national/international guidelines that protect the rights of individuals and populations within the context of genetics/genomics. Thus, nurses have an ethical responsibility to remain knowledgeable about advances in genetics/genomics and incorporate emergent evidence into their work.

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

Introducing a new competency into nursing practice requires the support of nursing leadership. A knowledge survey was used to assess nurses' knowledge following a yearlong genomics education initiative. Findings indicate that nurses benefit from repeated exposure to genetics-related content. Recommendations from this study include development and implementation of strategies that can be used to prepare nurses at all levels for the application of genetics and genomics. Clinical nurses with knowledge of genetics will be able to implement evidence-based interventions to manage acute and chronic illnesses. These nurses will then be able to engage patients more fully, thereby helping them to understand the relationship of genetics to healthy outcomes.

Non-pharmacological interventions to manage fatigue and psychological stress in children and adolescents with cancer: an integrative review

Cancer-related fatigue (CRF) is the most stressful and prevalent symptom in paediatric oncology patients. This integrative review aimed to identify, analyse and synthesise the evidence of non-pharmacological intervention studies to manage fatigue and psychological stress in a paediatric population with cancer. Eight electronic databases were used for the search: PubMed, Web of Science, CINAHL, LILACS, EMBASE, SCOPUS, PsycINFO and the Cochrane Library. Initially, 273 articles were found; after the exclusion of repeated articles, reading of the titles, abstracts and the full articles, a final sample of nine articles was obtained. The articles were grouped into five categories: physical exercise, healing touch, music therapy, therapeutic massage, nursing interventions and health education. Among the nine studies, six showed statistical significance regarding the fatigue and/or stress levels, showing that the use of the interventions led to symptoms decrease. The most frequently tested intervention was programmed physical exercises. It is suggested that these interventions are complementary to conventional treatment and that their use can indicate an improvement in CRF and psychological stress.

Holistic Nursing in the Genetic/Genomic Era

Holistic nursing practice is an ever-evolving transformative process with core values that require continued growth, professional leadership, and advocacy. Holistic nurses are required to stay current with all new required competencies, such as the Core Competencies in Genetics for Health Professional, and, as such, be adept at translating scientific evidence relating to genetics/genomics in the clinical setting. Knowledge of genetics/genomics in relation to nursing practice, policy, utilization, and research influence nurses' responsibilities. In addition to holistic nursing competencies, the holistic nurse must have basic knowledge and skills to integrate genetics/genomics aspects. It is important for holistic nurses to enhance their overall knowledge foundation, skills, and attitudes about genetics to prepare for the transformation in health care that is already underway. Holistic nurses can provide an important perspective to the application of genetics and genomics, focusing on health promotion, caring, and understanding the relationship between caring and families, community, and society. Yet there may be a lack of genetic and genomic knowledge to fully participate in the current genomic era. This article will explore the required core competencies for all health care professionals, share linkage of holistic nurses in practice with genetic/genomic conditions, and provide resources to further one's knowledge base.

Cancer genetics and genomics: essentials for oncology nurses

Cancer genetics and genomics are rapidly evolving, with new discoveries emerging in genetic mutations, variants, genomic sequencing, risk-reduction methods, and targeted therapies. To educate patients and families, state-of-the-art care requires nurses to understand terminology, scientific and technological advances, and pharmacogenomics. Clinical application of cancer genetics and genomics involves working in interdisciplinary teams to properly identify patient risk through assessing family history, facilitating genetic testing and counseling services, applying risk-reduction methods, and administering and monitoring targeted therapies.

Pharmacogenomics in the nursing literature: an integrative review

BACKGROUND

Pharmacogenomics is a rapidly growing component of personalized health care, and nurses must be competent to deliver genomic-focused nursing care.

METHODS

We conducted an integrative review of pharmacogenomics in the nursing literature. A comprehensive search of the nursing literature was conducted using the key words pharmacogenomics and pharmacogenetics. A total of 47 unique articles were included.

RESULTS

Articles represented mainly narrative reviews, with limited discussions of the implications for nursing practice, education, or research. As such, they provide limited direction for advancing either clinical practice or scientific inquiry.

CONCLUSIONS

This review serves as a call to action for more systematic and empirical publications addressing pharmacogenomics in nursing practice, education, and research. Nurses must be involved in and contribute to interdisciplinary conversations and burgeoning clinical practice initiatives related to pharmacogenomics.

An overview of epigenetics in nursing

Epigenetic changes to the genome are biochemical alterations to the DNA that do not change an individual's genome but do change and influence gene expression. The nursing profession is qualified to conduct and integrate epigenetic-focused nursing research into practice. This article discusses current epigenetic nursing research, provides an overview of how epigenetic research relates to nursing practice, makes recommendations, and provides epigenetic online resources for nursing research. An overview of major epigenetic studies in nursing (specific to childbirth studies, preeclampsia, metabolic syndrome, immunotherapy cancer, and pain) is provided, with recommendations on next steps.