Genetics nursing

Last updated February 07, 2024

Genetics nursing is a nursing specialty that focuses on providing genetic healthcare to patients.

The integration of genetics into nursing began in the 1980s and has been a slow but important process in improving the quality of healthcare for patients receiving genetic and genomic based care from nurses. Modeling the United Kingdom, the United States critically established a set of essential competencies as a set of guidelines for registered nurses. Through the process of consensus the essential competencies were created by the steering committee, and provided the minimalist competency and scope of practice for registered nurses delivering genetic healthcare to patients.

The Nursing Code of Ethics and other ethical foundations were established for field of genetics nursing to provide regulations when ethical issues develop.^[1]

Background

Adopted from the early Christians in 30 AD, the term nurse was created from the Latin origin nutrire, which means to nurture or nourish. Establishing nursing as one of the oldest forms of healthcare and continues to be a growing field of medicine.^[2] Genetics, which is the study of inherited traits and their variation is a much more recent field of medicine. The experiments and theories of Gregor Mendel in the mid-19th century helped to introduce the field of genetics into medicine. Genomics is a subset of genetics that compares and analyzes genomes and how the genes interact with one another. Both genetics and genomics help to reveal how closely related we are to each other and to other species.^[3] This scientific study is ongoing and strives to interpret health, illness, disease risk, and treatment response. The progress in genetics and genomics is applicable to the entire spectrum of health care and all health professionals and as such to the entire nursing profession.^[4] Genetics and genomics are important to healthcare because it provides information in the diagnosis, treatment, and prevention of diseases and illnesses. Even though genetics has been a growing field of medicine since the mid-19th century, the process of integrating genomics into the nursing curriculum, National Council Licensure Examinations, continuing education, and certification was not highlighted until the 1980s.^[5] Genetics and genomics are fundamental to the nursing practice because the basis of genetics can recognize individuals at risk for certain illnesses and diseases, identify the risks of certain disease or illnesses when conceiving children, facilitate drug dosage or selection for certain illnesses or specific patients, and genetics promotes benefits in treatment of particular ailments.^[6]

However, it took twenty more years until the Health Recourses and Services Administration (HRSA) stressed the significance of incorporating genetics into nursing education.^[5] After HRSA's proposal, there was minor advancement and the development that was established contained a lot of inconsistency. The progress of integration continued to be slow and limited. By fall of 2005, only 30% of academic nursing programs contained a curriculum thread in genetics and genomics.^[5] One of the leading factors in the limited progress of genetics integration is the relevance to all nursing practice is not fully appreciated by many, and genetics is also seen by many nurses to be a subspecialty. Also state boards of nursing do not require competency in genomics and genetics as part of licensure and genetics and genomics are not considered in the evaluations of accrediting bodies. The extremely large size and variation of the nursing workforce provides an extra challenge in the many existing barriers needed to be overcome for genetics to be implemented.^[4] Some of the first successful training of genetic practices in the nursing workforce can be seen in the United Kingdom. The main aspect of the U.K.’s strategy was simplicity. They achieved this by constructing seven essential competencies that were applied to the entire nursing profession. In 2003, the U.K. National Health Service created the NHS National Genetics Education and Development Centre. The main functions of these programs were to enhance genetics education and to dispense materials and resources for educators of all genetic professions. The United States mirrored the efforts and ideas established in the U.K. and adopted similar methods and competencies. The U.S. National Human Genome Research Institute and the National Cancer Institute of the National Institutes of Health united to initiate strategies, training programs, committees, and define the competencies.^[5]

Competencies

Development

The genetic and genomic competencies are important to the practice of all nurses regardless of academic preparation, practice setting, role, or specialty.^[6] The competencies are significant because they establish a foundation and set of guidelines for the nursing workforce on administering the minimal amount of genetic and genomic based healthcare. Since the competencies would only reflect the minimalist amount of genetic and genomic based healthcare, they were specifically drawn up to focus on the scope of practice for registered nurses. This was done because a registered nurse is a general level of practice for nursing and requires that one has graduated from a college or university nursing program and has passed the NCLEX. The NCLEX is a national licensing exam that signifies minimal competency in practicing nursing if passed.^[5]^[6]^[7]

To begin the development of the competencies, the initial strategy of the U.S. National Human Genome Research Institute and the National Cancer Institute of the National Institutes of Health established the steering committee. It was composed of nurse leaders from a variety of professional nursing agencies, academic settings, and organizations. Two of the major nursing leaders, Jean Jenkins, RN, PhD, FAAN and Kathleen Calzone, RN, MSN, APNG, FAAN were chosen as the Co-Chairs of the committee. The committee's fundamental function was to generate a mechanism for establishing competencies by recognizing, examining, and comparing existing published competencies.^[5]^[6] The published competencies that were being examined targeted all health care professionals, specifically those practicing genetics, nurses with bachelor's degrees, and advanced practice nurses. After the published competencies were reviewed carefully, the developing of the essential competencies was produced in four phases called the process of consensus.

During phase I of the process of consensus, a subset of the committee was created to synthesize competencies from the documents under review that would apply to all registered nurses; then the steering committee reviewed, modified, and approved the recommended competencies.^[5] In 2005, nurse representatives of the National Coalition for Health Professional Education in Genetics also reviewed the proposed competencies and made modifications. Throughout phase II, the American Nursing Association published the competencies during a meeting in 2006 and requested judgment, thoughts, and comments from the public, specifically targeting the insight from the nursing community.^[5]^[6] The 10 comments that were received were recorded and evaluated and the majority of them showed support. Phase III consisted of establishing consensus on the final draft of the essential competencies by the steering committee and the consensus panel, which is also made up of a variety of nursing leaders in different organizations and settings.^[5] The steering committee also constructed strategies for integrating genetic and genomic information into education and practice such as the NCLEX exam, accreditation programs, certification processes, and nursing curriculum. In March 2006, phase IV occurred and consisted of endorsing the final document by the Nursing Organizations Alliance member organizations.^[6]

Essential Competencies

The essential competencies consists of two domains: professional responsibilities and professional practice. Under the professional responsibilities domain, all professional activities by registered nurses are required to fall within the confines of the Nursing: Scope and Standards of Practice produced by the American Nurses Association.^[6]

Also, competent nursing practice now requires the incorporation of genetic and genomic knowledge and skills in order to:

Recognize when one's own attitudes and values related to genetic and genomic science may affect care provided to clients.
Advocate for clients access to desired genetic/genomic services and/or resources including support groups.
Examine competency of practice on a regular basis, identifying areas of strength, as well as areas in which professional development related to genetics and genomics would be beneficial.
Incorporate genetic and genomic technologies and information into registered nurse practice.
Demonstrate 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.
Advocate for the rights of all clients for autonomous, informed genetic and genomic-related decision-making and voluntary action.^[5]

The competencies for the registered nurse, under the professional practice domain, includes: nursing assessment, which is the application and integration of genetic and genomic knowledge, identification, referral activities, and provision of education, care, and support.^[5]

Nursing Assessment for the registered nurse includes:

Demonstrates an understanding of the relationship of genetics and genomics to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness.
Demonstrates ability to elicit a minimum of three-generation family health history.
Constructs a pedigree from collected family history information using standardized symbols and terminology.
Collects personal, health, and developmental histories that consider genetic, environmental, and genomic influences and risks.
Conducts comprehensive health and physical assessments which incorporate knowledge about genetic, environmental, and genomic influences and risk factors.
Critically analyzes the history and physical assessment findings for genetic, environmental, and genomic influences and risk factors.
Assesses clients’ knowledge, perceptions, and responses to genetic and genomic information.
Develops a plan of care that incorporates genetic and genomic assessment information.^[5]

Identification for the registered nurse includes:

Identifies clients who may benefit from specific genetic and genomic information and/or services based on assessment data.
Identifies credible, accurate, appropriate and current genetic and genomic information, resources, services and/or technologies specific to given clients.
Identifies ethical, ethnic/ancestral, cultural, religious, legal, fiscal, and societal issues related to genetic and genomic information and technologies.
Defines issues that undermine the rights of all clients for autonomous, informed genetic and genomic-related decision-making and voluntary action.^[5]

Referral Activities for the registered nurse includes:

Facilitates referrals for specialized genetic and genomic services for clients as needed.^[5]

Provision of support, care, and education for the registered nurse includes:

Provides clients with interpretation of selective genetic and genomic information or services .
Provides clients with credible, accurate, appropriate and current genetic and genomic information, resources, services, and/or technologies that facilitate decision-making.
Uses health promotion and disease prevention practices to:
Considers genetic and genomic influences on personal and environmental risk factors.
Incorporates knowledge of genetic and/or genomic risk factors (e.g., a client with a genetic predisposition for high cholesterol who can benefit from a change in lifestyle that will decrease the likelihood that the genetic risk will be expressed) .
Uses genetic and genomic-based interventions and information to improve clients’ outcomes.
Collaborates with healthcare providers in providing genetic and genomic healthcare.
Collaborates with insurance providers and payers to facilitate reimbursement for genetic and genomic healthcare services.
Performs interventions and treatments appropriate to clients’ genetics and genomic healthcare needs.
Evaluates impact and effectiveness of genetic and genomic technology, information, interventions, and treatments on clients’ outcome.^[5]

Issues

Ethical

Ethics pertain to the ‘’rightness’’ and ‘’wrongness’’ of human actions, motives, and conduct. Complicated ethical issues in areas such as justice, privacy, and autonomy, tend to follow both the field of genetics and the field of nursing. Ethical problems and dilemmas arise daily in healthcare settings for both the patient and health care provider. For example, all patients and individuals have the right to receive equal health care regardless of gender, religious beliefs, status, or race. A Code of Ethics for Nursing was created by the American Nurses Association, which provides rules, regulations, and guidelines to follow when making a decision that is ethical based. These regulations were mainly established to help provide equal healthcare, protect the rights, safety, and privacy of the patient, and to hold nurses accountable for their actions and choices. Genetics can create ethical issues in nursing for a variety of different situations. Many scenarios, questions, and debates have been encountered such as what individuals can receive genetic testing or information? Who owns or controls the information received from the genetic test and how can the owner use that information? However, the code of ethics does not address genetics or genomics specifically, so ethical foundations were also established to help guide genetics into health care. The foundations provide a set of guidelines to understand and manage an ethical issue if one should arise, and to assist in the translation of genetics into the healthcare environment.^[8]^[9]

Related Research Articles

Bioethics is both a field of study and professional practice, interested in ethical issues related to health, including those emerging from advances in biology, medicine, and technologies. It proposes the discussion about moral discernment in society and it is often related to medical policy and practice, but also to broader questions as environment, well-being and public health. Bioethics is concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, theology and philosophy. It includes the study of values relating to primary care, other branches of medicine, ethical education in science, animal, and environmental ethics, and public health.

Genetic counseling is the process of investigating individuals and families affected by or at risk of genetic disorders to help them understand and adapt to the medical, psychological and familial implications of genetic contributions to disease. This field is considered necessary for the implementation of genomic medicine. The process integrates:

Telenursing refers to the use of information technology in the provision of nursing services whenever physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telemedicine, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, and telemonitoring. The field, however, is still being developed as the information on telenursing isn't comprehensive enough.

A licensed practical nurse (LPN), in much of the United States and Canada, is a nurse who cares for people who are sick, injured, convalescent, or disabled. In the United States, LPNs work under the direction of physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their jurisdiction.

Nursing assessment is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status by a licensed Registered Nurse. Nursing assessment is the first step in the nursing process. A section of the nursing assessment may be delegated to certified nurses aides. Vitals and EKG's may be delegated to certified nurses aides or nursing techs. It differs from a medical diagnosis. In some instances, the nursing assessment is very broad in scope and in other cases it may focus on one body system or mental health. Nursing assessment is used to identify current and future patient care needs. It incorporates the recognition of normal versus abnormal body physiology. Prompt recognition of pertinent changes along with the skill of critical thinking allows the nurse to identify and prioritize appropriate interventions. An assessment format may already be in place to be used at specific facilities and in specific circumstances.

A nursing care plan provides direction on the type of nursing care the individual/family/community may need. The main focus of a nursing care plan is to facilitate standardised, evidence-based and holistic care. Nursing care plans have been used for quite a number of years for human purposes and are now also getting used in the veterinary profession. A care plan includes the following components: assessment, diagnosis, expected outcomes, interventions, rationale and evaluation.

In the United States, a Certified Nurse-Midwife (CNM) is a nurse midwife who exceeds the International Confederation of Midwives' essential competencies for a midwife and is also an advanced practice registered nurse, having completed registered nursing and midwifery education leading to practice as a nurse midwife and credentialing as a Certified Nurse-Midwife. CNMs provide care of women across their lifespan, including pregnancy and the postpartum period, and well woman care and birth control. Certified Nurse-Midwives are recognized by the International Confederation of Midwives as a type of midwife in the U.S.

The National Council Licensure Examination (NCLEX) is a nationwide examination for the licensing of nurses in the United States, Canada, and Australia since 1982, 2015, and 2020, respectively. There are two types: the NCLEX-RN and the NCLEX-PN. After graduating from a school of nursing, one takes the NCLEX exam to receive a nursing license. A nursing license gives an individual the permission to practice nursing, granted by the state where they met the requirements.

Home health is a nursing specialty in which nurses provide multidimensional home care to patients of all ages. Home health care is a cost efficient way to deliver quality care in the convenience of the client's home. Home health nurses create care plans to achieve goals based on the client's diagnosis. These plans can include preventive, therapeutic, and rehabilitative actions. Home health nurses also supervise certified nursing assistants. The professional nursing organization for home health nurses is the Home Healthcare Nurses Association (HHNA). Home health care is intended for clients that are well enough to be discharged home, but still require skilled nursing personnel to assess, initiate and oversee nursing interventions.

A clinical nurse specialist (CNS) is an advanced practice nurse who can provide advice related to specific conditions or treatment pathways. According to the International Council of Nurses (ICN), an Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice.

Health information management (HIM) is information management applied to health and health care. It is the practice of analyzing and protecting digital and traditional medical information vital to providing quality patient care. With the widespread computerization of health records, traditional (paper-based) records are being replaced with electronic health records (EHRs). The tools of health informatics and health information technology are continually improving to bring greater efficiency to information management in the health care sector.

A family nurse practitioner (FNP) provides continuing and comprehensive healthcare for the individual and family across all ages, genders, diseases, and body systems. Primary care emphasizes the holistic nature of health and it is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion.

Evidence-based nursing (EBN) is an approach to making quality decisions and providing nursing care based upon personal clinical expertise in combination with the most current, relevant research available on the topic. This approach is using evidence-based practice (EBP) as a foundation. EBN implements the most up to date methods of providing care, which have been proven through appraisal of high quality studies and statistically significant research findings. The goal of EBN is to improve the health and safety of patients while also providing care in a cost-effective manner to improve the outcomes for both the patient and the healthcare system. EBN is a process founded on the collection, interpretation, appraisal, and integration of valid, clinically significant, and applicable research. The evidence used to change practice or make a clinical decision can be separated into seven levels of evidence that differ in type of study and level of quality. To properly implement EBN, the knowledge of the nurse, the patient's preferences, and multiple studies of evidence must all be collaborated and utilized in order to produce an appropriate solution to the task at hand. These skills are taught in modern nursing education and also as a part of professional training.

Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses can be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialties with differing levels of prescription authority. Nurses comprise the largest component of most healthcare environments; but there is evidence of international shortages of qualified nurses. Nurses collaborate with other healthcare providers such as physicians, nurse practitioners, physical therapists, and psychologists. There is a distinction between nurses and nurse practitioners; in the U.S., the latter are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications unlike the former. They practice independently in a variety of settings in more than half of the United States. Since the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.

Nurses in Canada practise in a wide variety of settings, with various levels of training and experience. They provide evidence-based care and educate their patients about health and disease.

Unlicensed assistive personnel (UAP) are paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs). UAPs also provide bedside care—including basic nursing procedures—all under the supervision of a registered nurse, licensed practical nurse or other health care professional. UAPs must demonstrate their ability and competence before gaining any expanded responsibilities in a clinical setting. While providing this care, UAPs offer compassion and patience and are part of the patient's healthcare support system. Communication between UAPs and registered nurses (RNs) is key as they are working together in their patients' best interests. The scope of care UAPs are responsible for is delegated by RNs or other clinical licensed professionals.

Holistic nursing is a way of treating and taking care of the patient as a whole body, which involves physical, social, environmental, psychological, cultural and religious factors. There are many theories that support the importance of nurses approaching the patient holistically and education on this is there to support the goal of holistic nursing. The important skill to be used in holistic nursing would be communicating skills with patients and other practitioners. This emphasizes that patients being treated would be treated not only in their body but also their mind and spirit.. Holistic nursing is a nursing speciality concerning the integration of one's mind, body, and spirit with his or her environment. This speciality has a theoretical basis in a few grand nursing theories, most notably the science of unitary human beings, as published by Martha E. Rogers in An Introduction to the Theoretical Basis of Nursing, and the mid-range theory Empowered Holistic Nursing Education, as published by Dr. Katie Love. Holistic nursing has gained recognition by the American Nurses Association (ANA) as a nursing specialty with a defined scope of practice and standards. Holistic nursing focuses on the mind, body, and spirit working together as a whole and how spiritual awareness in nursing can help heal illness. Holistic medicine focuses on maintaining optimum well-being and preventing rather than just treating disease.

A pediatric nurse practitioner (PNP) is a nurse practitioner who specializes in care for newborns, infants, toddlers, pre-schoolers, school-aged children, adolescents, and young adults. Nurse practitioners have an in-depth knowledge and experience in pediatric healthcare including well childcare, and prevention/management of common pediatric acute illnesses and chronic conditions. This care is provided to support optimal health of children within the context of their family, community, and environmental setting. In order to be a pediatric nurse practitioner one must be compassionate, resourceful, good at communicating and have good attention to detail.

An adult-gerontology nurse practitioner (AGNP) is a nurse practitioner that specializes in continuing and comprehensive healthcare for adults across the lifespan from adolescence to old age.

Cultural competence in healthcare refers to the ability for healthcare professionals to demonstrate cultural competence toward patients with diverse values, beliefs, and feelings. This process includes consideration of the individual social, cultural, and psychological needs of patients for effective cross-cultural communication with their health care providers. The goal of cultural competence in health care is to reduce health disparities and to provide optimal care to patients regardless of their race, gender, ethnic background, native languages spoken, and religious or cultural beliefs. Cultural competency training is important in health care fields where human interaction is common, including medicine, nursing, allied health, mental health, social work, pharmacy, oral health, and public health fields.

References

↑ Zahedi F, Sanjari M, Aala M, Peymani M, Aramesh K, Parsapour A, Maddah SB, Cheraghi M, Mirzabeigi G, Larijani B, Dastgerdi MV (2013). "The code of ethics for nurses". Iranian Journal of Public Health. 42 (Supple1): 1–8. PMC 3712593 . PMID 23865008.
↑ Egenes KJ. History of Nursing (PDF). Jones and Bartlett Publishers. pp. 1–20.
↑ Lewis R (2012). Human Genetics Concepts and Applications. New York, Ny: McGraw-Hill. p. 2. ISBN 9780073525303.
1 2 Calzone KA, Cashion A, Feetham S, Jenkins J, Prows CA, Williams JK, Wung SF (January–February 2010). "Nurses transforming health care using genetics and genomics". Nursing Outlook. 58 (1): 26–35. doi:10.1016/j.outlook.2009.05.001. PMC 2835985 . PMID 20113752.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Jenkins J, Calzone KA (August 2006). "Establishing the essential nursing competencies for genetics and genomics". Journal of Nursing Scholarship. 39 (1): 10–6. doi:10.1111/j.1547-5069.2007.00137.x. PMC 10461169 . PMID 17393960.
1 2 3 4 5 6 7 Consensus (2009). Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators (PDF) (2nd ed.). Silver Spring, MD: American Nurses Association. pp. 11–14. ISBN 978-1-55810-263-7.
↑ "Oxford Dictionaries". Oxford University Press. Archived from the original on February 24, 2013. Retrieved 22 February 2013.
↑ Badzek L, Henaghan M, Turner M, Monsen R (March 2013). "Ethical, legal, and social issues in the translation of genomics into health care". Journal of Nursing Scholarship. 45 (1): 15–24. doi:10.1111/jnu.12000. PMID 23369261.
↑ Lea D (31 January 2008). "Genetic and Genomic Healthcare: Ethical Issues of Importance to Nurses". Online Journal of Issues in Nursing. 13. doi:10.3912/OJIN.Vol13No01Man04. S2CID 68813628 . Retrieved 23 February 2013.

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[1] Zahedi F, Sanjari M, Aala M, Peymani M, Aramesh K, Parsapour A, Maddah SB, Cheraghi M, Mirzabeigi G, Larijani B, Dastgerdi MV (2013). "The code of ethics for nurses". Iranian Journal of Public Health. 42 (Supple1): 1–8. PMC 3712593 . PMID 23865008.

[nursing_history-2] Egenes KJ. History of Nursing (PDF). Jones and Bartlett Publishers. pp. 1–20.

[Human_Genetics-3] Lewis R (2012). Human Genetics Concepts and Applications. New York, Ny: McGraw-Hill. p. 2. ISBN 9780073525303.

[transforming_health_care-4] 1 2 Calzone KA, Cashion A, Feetham S, Jenkins J, Prows CA, Williams JK, Wung SF (January–February 2010). "Nurses transforming health care using genetics and genomics". Nursing Outlook. 58 (1): 26–35. doi:10.1016/j.outlook.2009.05.001. PMC 2835985 . PMID 20113752.

[Establishing_competencies-5] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Jenkins J, Calzone KA (August 2006). "Establishing the essential nursing competencies for genetics and genomics". Journal of Nursing Scholarship. 39 (1): 10–6. doi:10.1111/j.1547-5069.2007.00137.x. PMC 10461169 . PMID 17393960.

[competencies-6] 1 2 3 4 5 6 7 Consensus (2009). Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators (PDF) (2nd ed.). Silver Spring, MD: American Nurses Association. pp. 11–14. ISBN 978-1-55810-263-7.

[oxford-7] "Oxford Dictionaries". Oxford University Press. Archived from the original on February 24, 2013. Retrieved 22 February 2013.

[ethics-8] Badzek L, Henaghan M, Turner M, Monsen R (March 2013). "Ethical, legal, and social issues in the translation of genomics into health care". Journal of Nursing Scholarship. 45 (1): 15–24. doi:10.1111/jnu.12000. PMID 23369261.

[online_journal-9] Lea D (31 January 2008). "Genetic and Genomic Healthcare: Ethical Issues of Importance to Nurses". Online Journal of Issues in Nursing. 13. doi:10.3912/OJIN.Vol13No01Man04. S2CID 68813628 . Retrieved 23 February 2013.

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