Academic journal article Nursing Education Perspectives

Preparing Nurses for a 21st Century Role in Genomics-Based Health Care

Academic journal article Nursing Education Perspectives

Preparing Nurses for a 21st Century Role in Genomics-Based Health Care

Article excerpt

ABSTRACT Advances in genomic research are changing the nature and focus of health care. All health professionals must be prepared with new knowledge and skill competencies to meet the social and scientific demands of clinical practice. Nurses can expect to take on new practice roles that involve family history assessments, screening, and case coordination for clients receiving genetic testing and gene-based therapies. The authors report on successful initiatives since 1995 resulting from efforts of national organizations to advance the diffusion of genetic knowledge and genomics in nursing education and practice. Recommendations to strengthen these developments, along with strategies for nursing leadership in carving a new role, that of Genomics Nurse Case Coordinator, are presented.

Genomics can no longer be viewed as an optional luxury in nursing education. Francis Collins, MD, PhD, head of the National Human Genome Research Institute at the National Institutes of Health, alerts health care providers that every day, new advances bring genomics more fully into mainstream medicine (1,2). Here are a few examples:

1. The American Medical Association (AMA) recently put forth a statement that "the family tree has become the most important genetic test of all" (3). The AMA urges all individuals to create their own medical family tree to save their health, and even their lives. As stated succinctly by the AMA president-elect, "This...is the drumroll before the explosion" (3). The unprecedented avalanche of genetic information and technology expected in health care delivery will lead to careful evaluation of family histories by astute providers as a routine and expected first line of action.

2. The American College of Obstetrics and Gynecology now recommends that all couples planning pregnancy or seeking prenatal care be offered cystic fibrosis (CF) carrier screening (4). This recommendation has significant ramifications for the public and for health care providers nationwide, and it will create the need for major programmatic and budgetary shifts in private and public health services. As a new community standard of care, it will have an impact on every childbearing couple, as well as on persons homozygous for CF mutations that cause adult conditions such as male infertility and chronic sinusitis. The complex nature of this screening test is sure to involve the investigation of false-negative and false-positive findings and generate the need for careful counseling and support services.

3. The use of a gene test to screen for colorectal cancer is a prime example of genetics in primary care. A recent study used the APC gene mutation to test stool samples for early signs of colorectal cancer. Results showed that this method identified 60 percent of individuals with relatively early colorectal tumors, thereby suggesting a new noninvasive approach for early detection (5).

4. A recent report in the New York Times told of a couple's use of preimplantation genetic diagnosis (PGD) to select a healthy embryo in order to avoid the birth of a child carrying a gene for an early-onset form of Alzheimer's disease (6). The report highlighted the ethical and legal questions attached to the selection of genetically healthy offspring. Providers caring for patients with Alzheimer's and many other conditions are likely to be asked about the possibility of using PGD to avoid passing deleterious genes to future children.

The Genomics Nurse Case Coordinator Genomics is defined as the branch of genetics that studies the combined influences of multiple genes and their molecular functions that result in states of health and illness (7). Today, as professionals are challenged to create new nursing practice roles in the provision of 21st century genomic health care, leadership and innovation in nursing education and clinical practice are required more than ever.

To provide a level of genomics-based health care that will meet increasing social and scientific demands, all nurses will need to incorporate three key aspects of genomics into practice. …

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