The iceberg of genomics: New perspectives in the use of genomics and epigenetics in oncology nursing clinical reasoning. A discursive paper

Building a Genomics-Informed Nursing Workforce: Recommendations for Oncology Nursing Practice and Beyond

BACKGROUND

Genomics is a foundational element of precision health and can be used to identify inherited cancers, cancer related risks, therapeutic decisions, and to address health disparities. However, there are structural barriers across the cancer care continuum, including an underprepared nursing workforce, long wait times for service, and inadequate policy infrastructure that limit equitable access to the benefits of genomic discoveries. These barriers have persisted for decades, yet they are modifiable. Two distinct waves of efforts to integrate genomics into nursing practice are analyzed. Drawing on research and observations during these waves, this discussion paper explores additional approaches to accelerate workforce development and health system transformation.

RESULTS

Three recommendations for a third wave of efforts to integrate genomics are explored. (1) Collaborate across the domains of nursing practice, professions, and sectors to reset priorities in response to emerging evidence, (2) Education in leadership, policy and practice for rapid scale-up of workforce and health system transformation, and (3) Create a research framework that generates evidence to guide nursing practice.

CONCLUSIONS

Preparing nurses to lead and practice at the forefront of innovation requires concerted efforts by nurses in all five domains of practice and can optimize health outcomes. Leveraging nursing as a global profession with new strategies can advance genomics-informed nursing.

Integrating genomics into Canadian oncology nursing policy: Insights from a comparative policy analysis

AIM

To learn from two jurisdictions with mature genomics-informed nursing policy infrastructure-the United States (US) and the United Kingdom (UK)-to inform policy development for genomics-informed oncology nursing practice and education in Canada.

DESIGN

Comparative document and policy analysis drawing on the 3i + E framework.

METHODS

We drew on the principles of a rapid review and identified academic literature, grey literature and nursing policy documents through a systematic search of two databases, a website search of national genomics nursing and oncology nursing organizations in the US and UK, and recommendations from subject matter experts on an international advisory committee. A total of 94 documents informed our analysis.

RESULTS

We found several types of policy documents guiding genomics-informed nursing practice and education in the US and UK. These included position statements, policy advocacy briefs, competencies, scope and standards of practice and education and curriculum frameworks. Examples of drivers that influenced policy development included nurses' values in aligning with evidence and meeting public expectations, strong nurse leaders, policy networks and shifting healthcare and policy landscapes.

CONCLUSION

Our analysis of nursing policy infrastructure in the US and UK provides a framework to guide policy recommendations to accelerate the integration of genomics into Canadian oncology nursing practice and education.

IMPLICATIONS FOR THE PROFESSION

Findings can assist Canadian oncology nurses in developing nursing policy infrastructure that supports full participation in safe and equitable genomics-informed oncology nursing practice and education within an interprofessional context.

IMPACT

This study informs Canadian policy development for genomics-informed oncology nursing education and practice. The experiences of other countries demonstrate that change is incremental, and investment from strong advocates and collaborators can accelerate the integration of genomics into nursing. Though this research focuses on oncology nursing, it may also inform other nursing practice contexts influenced by genomics.

Nursing strategies to address health disparities in genomics-informed care: a scoping review

OBJECTIVE

The objective of this review was to map the available global evidence on strategies that nurses can use to facilitate genomics-informed health care to address health disparities to inform the development of a research and action agenda.

INTRODUCTION

The integration of genomics into health care is improving patient outcomes through better prevention, diagnostics, and treatment; however, scholars have noted concerns with widening health disparities. Nurses work across the health system and can address health disparities from a clinical, research, education, policy, and leadership perspective. To do this, a comprehensive understanding of existing genomics-informed strategies is required.

INCLUSION CRITERIA

Published (qualitative, quantitative, mixed methods studies; systematic and literature reviews; and text and opinion papers) and unpublished (gray) literature that focused on genomics-informed nursing strategies to address health disparities over the past 10 years were included. No limitations were placed on language.

METHODS

The review was conducted in accordance with the JBI methodology for scoping reviews. A search was undertaken on May 25, 2023, across 5 databases: MEDLINE (Ovid), Embase, Cochrane Library (Ovid), APA PsycINFO (EBSCOhost), and CINAHL (EBSCOhost). Gray literature was searched through websites, including the International Society of Nurses in Genetics and the Global Genomics Nursing Alliance. Abstracts, titles, and full texts were screened by 2 or more independent reviewers. Data were extracted using a data extraction tool. The coded data were analyzed by 2 or more independent reviewers using conventional content analysis, and the summarized results are presented using descriptive statistics and evidence tables.

RESULTS

In total, we screened 818 records and 31 were included in the review. The most common years of publication were 2019 (n=5, 16%), 2020 (n=5, 16%), and 2021 (n=5, 16%). Most papers came from the United States (n=25, 81%) followed by the Netherlands (n=3, 10%), United Kingdom (n=1, 3%), Tanzania (n=1, 3%), and written from a global perspective (n=1, 3%). Nearly half the papers discussed cancer-related conditions (n=14, 45%) and most of the others did not specify a disease or condition (n=12, 39%). In terms of population, nurse clinicians were mentioned the most frequently (n=16, 52%) followed by nurse researchers, scholars, or scientists (n=8, 26%). The patient population varied, with African American patients or communities (n=7, 23%) and racial or ethnic minorities (n=6, 19%) discussed most frequently. The majority of equity issues focused on inequitable access to genetic and genomics health services among ethnic and racial groups (n=14, 45%), individuals with lower educational attainment or health literacy (n=6, 19%), individuals with lower socioeconomic status (n=3, 10%), migrants (n=3, 10%), individuals with lack of insurance coverage (n=2, 6%), individuals living in rural or remote areas (n=1, 3%), and individuals of older age (n=1, 3%). Root causes contributing to health disparity issues varied at the patient, provider, and system levels. Strategies were grouped into 2 categories: those to prepare the nursing workforce and those nurses can implement in practice. We further categorized the strategies by domains of practice, including clinical practice, education, research, policy advocacy, and leadership. Papers that mentioned strategies focused on preparing the nursing workforce were largely related to the education domain (n=16, 52%), while papers that mentioned strategies that nurses can implement were mostly related to clinical practice (n=19, 61%).

CONCLUSIONS

Nurses in all domains of practice can draw on the identified strategies to address health disparities related to genomics in health care. We found a notable lack of intervention and evaluation studies exploring the impact on health and equity outcomes. Additional research informed by implementation science that measures health outcomes is needed to identify best practices.

SUPPLEMENTAL DIGITAL CONTENT

A French-language version of the abstract of this review is available: http://links.lww.com/SRX/A65 .

Developing leadership competencies for genomics integration through globally networked learning and education

Aim

To describe the implementation and evaluation of an education strategy called the globally networked learning-genomics (GNL-G) used in Master's courses in Canada and Finland. The study focused on the feasibility and effectiveness of GNL-G in developing leadership competencies for integrating genomics into practice.

Methods

Interpretive description qualitative methodology was used to explore how GNL-G, global exchanges and assignments standardized with the Assessment of Strategies to Integrate Genomics in Nursing (ASIGN) tool influenced competency development. The Reporting Item Standards for Education and its Evaluation in Genomics (RISE2 Genomics) framework guided the design, implementation, evaluation, and reporting of GNL-G. Data included one-to-one interviews, written assignments, and reflections.

Results

Interviews and assignment data from three cohorts of students for a total of ten Canadian and 11 Finnish master's students participated in this study. The ASIGN Tool played a crucial role in facilitating students' analysis of their practice context and the development of leadership strategies. Participation in GNL-G enhanced students' confidence to lead efforts to integrate genomics, irrespective of their genomics expertise. Engagement with global peers emphasized the importance of incorporating equity, ethics, and social justice into leadership strategies for genomics integration.

Conclusion

The GNL-G strategy enhanced leadership competencies for genomics integration in graduate students from Canada and Finland. The ASIGN Tool and global peer collaboration highlight the importance of innovative educational methods in preparing leaders for the complexities of genomics in healthcare.

The relevance of the contribution of psychoneuroendocrinoimmunology and psychology of reasoning and decision making to nursing science: A discursive paper

AIM

Patients' death or adverse events appear to be associated with poor healthcare decision-making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem-related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision-making (PRDM) to support a new nursing theoretical frame.

DESIGN

Discursive paper.

METHOD

This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections.

CONCLUSION

Nursing recognizes the patient-nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections.

IMPACT ON NURSING PRACTICE

A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement in the design or writing of this discursive article.