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Genetics: A ‘Refocus’ on Client Care

It’s almost hard to believe but a focus on the genetic composition of a patient in terms of their treatment and recovery is not as far away as we think. In 2014 the American Nurses Association actually added the concept genetics/genomics to their Nursing Informatics: Scope and Standard of Practice  (McCormick & Calzone, 2016). These standards state that informatics nurses must be able to “incorporate genetic and genomic technologies and informatics into practice” (McCormick & Calzone, 2016). They also state that informatics nurses must “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” (McCormick & Calzone, 2016).

In fact, the Canadian Nurses Association and Ontario Genomics together hold workshops to discuss the implications of genomics to nursing practice including parenting and child development, cancer screening and treatment, and cardiovascular risk management (Limoges & Carisson, 2020). Assessing a patient’s genetic profile will give us a look into their risk for developing disease, recommended screening and prevention strategies and treatment decisions (Leach et al., 2016).

What This Means for Nurses

To support this genetic ‘refocus’ on client care nurses must be competent in obtaining comprehensive family histories including identifying family members at risk for developing a genomic influenced condition and/or a genomic influenced drug reaction (Calzone et al., 2010; Limoges & Carisson, 2020). Having these assessment skills has the potential to help patients prevent adult onset disorders and consequential morbidity and mortality (Calzone et al., 2010). Nurses will also need to help patients make informed decisions about genetic tests and therapies and assist them in understanding their results (Calzone et al., 2010). Nurses can play an important role in addressing the gaps in the public’s knowledge on genetics (Kawasaki et al., 2021). Nurses must also refer at-risk people to appropriate health care professionals and agencies for specialized genetic care (Calzone et al., 2010).

Genetic Counselling

Ethical Issues

As the focus of genetic composition becomes more and more common, nurses may run into potential ethical issues. With scientific breakthroughs happening daily, nurses may be faced with more questions than answers (Huddleston, 2013). Although a patient’s genomics belongs to them, it is also relevant to the family as they share approximately 50% of that genomic background (Huddleston, 2013). As Huddleston (2013) states a family may do  a genome workup on their baby. What happens if they incidentally find out that their baby has a BRCA1 variant? This genetic variant is solely related to the onset of breast cancer as an adult (Huddleston, 2013). Do the parents have the right to know or should  the child have the right to choose whether or not they want to know the finding as they get older? Should the mother be told as it could affect her health as well? She may also want to be tested to see if she has the genomic variant. Ethical and legal genetic frameworks will need to be developed as healthcare continues to grow.

References

Calzone, K. A., Cashion, A., Feetham, S., Jenkins, J., Prows, C. A., Williams, J. K., & Wung, S. F. (2010). Nurses transforming health care using genetics and genomics. Nursing Outlook, 58(1), 26–35. https://doi.org/10.1016/j.outlook.2009.05.001

Huddleston, K (2013, December 23). Ethics: The challenge of ethical, legal, ad social implications (ELSI) in genomic nursing. OJIN: The Online Journal of Issues in Nursing, 19(1). DOI: 10.3912/OJIN.Vol19No01EthCol01 

Kawasaki, H., Kawasaki, M., Iki, T. & Matsuyama, R. (2021). Genetics education program to help public health nurses improve their knowledge and enhance communities’ genetic literacy: a pilot study. BMC Nursing, 20(1), 1–13. https://doi-org.ezproxy.loyno.edu/10.1186/s12912-021-00549-8 

Leach, V., Tonkin, E., Lancastle, D., & Kirk, M. (2016). A strategy for implementing genomics into nursing practice informed by three behaviour change theories. International Journal of Nursing Practice, 22(3), 307-315. Doi:10.111.ijn.12431

Limoges, J. & Carisson, L. (2020, October 26). Nurses poised to play key role in advancing precision care through genetics and genomics. Canadian Nurse. https://canadian-nurse.com/en/articles/issues/2020/october-2020/nurses-poised-to-play-key-role-in-advancing-precision-care-through-genetics-and-genomics 
McCormick, K. A., & Calzone, K. A. (2016). The impact of genomics on health outcomes, quality, and safety. Nursing Management, 47(4), 23–26. https://doi.org/10.1097/01.NUMA.0000481844.50047.ee

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