Friday, 17 October 2014

Genetics in nursing: long overdue for a tipping point

Rita Pickler, Editor

We all know about the tipping point, described by Malcolm Gladwell as that moment when an idea crosses a threshold, tips, and spreads like wildfire (Malcolm Gladwell, The Tipping Point: How Little Things Can Make a Big Difference). The authors of the collected papers in the JAN’s latest virtual issue would argue that nursing is overdue for its tipping point in genetics education, genetic knowledge, genetic research and genetics in practice for the nursing profession. Advances in genetics have brought great benefit to humans, revealing the basis of health and illness, disease risk and treatment response. The progress in genetics and genomics can be applied to the entire spectrum of health care; we can all potentially benefit from what is known now and will be known in the future. And yet, a barrier to those benefits is nursing’s minimal involvement in the genetics knowledge explosion.

Nursing and genetics work share a focus on health promotion and disease prevention. Nursing clearly then has a place in genetics work. But nurses are woefully undereducated about even the most basic of genetics knowledge. Moreover, nursing educational programs have not followed the longstanding recommendations in both the US and Europe regarding essential genetics education and minimal genetics competencies needed in order for nurses to meet the needs of the public they serve. Further, despite a growing body of evidence about the contribution of genetics and genomics to health and illness, the evidence specific to outcomes of nursing practice provided by genetics competent nurses and the impact on the public’s health is very limited.

For people to benefit from the growing arsenal of genetic and genomic discoveries, nurses must be competent in obtaining comprehensive family histories. They need to help identify family members at risk for developing a genetically influenced condition or having a genetically influenced drug reaction. They need to understand the potential benefit or harm that may ensue from participating in genetics and genomic research. The public depends on nurses, the most trusted of health care providers, to help them make informed decisions about and understand the results of their genetic/genomic tests and therapies and to refer them, if they are at-risk to the most appropriate health care professionals and agencies. All of that requires knowledge and competence in using that knowledge.

More than that, qualified nurses need to be engaged in research about genetics and genomics Nurses are well poised to do the work of investigating the behavioral, social, and physiological benefits and risks for individuals and families who are asked to participate in genetics research or to use genetically engineered interventions. Moreover, nurses need to study the epigenetic effects of our own practices in order to understand the potentially long reaching effects of the care we give.

As providers of quality health care services, it is essential that nursing cross the threshold and embrace genetics knowledge, tip the balance from passive bystanders of genomic research to active participants in genetic discoveries and their application, and join other scientists and health care practitioners in ensuring that genetics knowledge is used wisely and well to improve health around the world. Yes, we are overdue for our tipping point. Perhaps the time is now.

The selection of papers in JAN’s Genetics Virtual Issue are available for view now on the JAN website. There readers will find papers about nursing’s current genetics competencies and abilities in applying genetics knowledge to care (Barnoy et al, 2009; Godino et al, 2012; Skirton et al, 2012), interesting efforts and strategies to improve genetics competencies within nursing curricula (Andrews et al, 2013; Kirk et al, 2013) and practice (Andrews et al, 2014), as well as papers that will educate readers about the breadth of genetics knowledge (Bancroft, 2010), newly emerged genomic tests (Prows et al, 2014), and future possibilities for genetics research in nursing science (Munro, 2014). The selection of papers reveals nursing’s gaps and also its potential to reach the genetics tipping point.

Andrews V, Tonkin E, Lancastle D, Kirk M (2013) Using the Diffusion of Innovations theory to understand the uptake of genetics in nursing practice: identifying the characteristics of genetic nurse adopters. Journal of Advanced Nursing DOI: 10.1111/jan.12255

Andrews V, Tonkin E, Lancastle D, Kirk M (2014) Identifying the characteristics of nurse opinion leaders to aid the integration of genetics in nursing practice. Journal of Advanced Nursing DOI: 10.1111/jan.12431

Bancroft EK (2010) Genetic testing for cancer predisposition and implications for nursing practice: narrative review. Journal of Advanced Nursing DOI: 10.1111/j.1365-2648.2010.05286.x

Barnoy S, Levy O, Bar-Tal Y (2010) Nurse or physician: whose recommendation influences the decision to take genetic tests more? Journal of Advanced Nursing DOI: 10.1111/j.1365-2648.2009.05239.x

Godino L, Turchetti D, Skirton H (2013) Knowledge of genetics and the role of the nurse in genetic health care: a survey of Italian nurses. Journal of Advanced Nursing DOI: 10.1111/j.1365-2648.2012.06103.x

Kirk M, Tonkin E, Skirton H (2013) An iterative consensus-building approach to revising a genetics/genomics competency framework for nurse education in the UK. Journal of Advanced Nursing DOI: 10.1111/jan.12207

Munro C (2014) Individual genetic and genomic variation: a new opportunity for personalized nursing interventions. Journal of Advanced Nursing DOI: 10.1111/jan.12552

Prows C, Tran G, Blosser B (2014) Whole exome or genome sequencing: Nurses need to prepare families for the possibilities. Journal of Advanced Nursing DOI: 10.1111/jan.12516

Skirton H, O’Connor A, Humphreys A (2012) Nurses’ competence in genetics: a mixed method systematic review. Journal of Advanced Nursing DOI: 10.1111/j.1365-2648.2012.06034.x

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