Genetics nursing

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]

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]

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]