This week, I chose the subtopic of genomics in patient assessment, but the journal article also falls under the subtopic of genetically competent care for those with chronic illness. This week’s article focuses on the fact that in 2006, the American Nurses Association (ANA) created important competencies for all RNs, but over half of the nurses in practice receive no pre-licensure education on genetics and genomics (G/G) competencies. The article subsequently describes the current utilization of G/G nursing competencies in the acute setting in hospitals and the nurses’ perceptions of them (Newcomb et al., 2019).
The completion of the Human Genome Project has broadened the opportunities for the prevention, diagnosis and management of many diseases resulting in more demands for genetic services. The increasing demands are utilizing nongenetic health professionals to take family histories, conduct family history assessments, interpret results of genetic tests, provide G/G education, and advocate for patient referrals for genetic evaluations. For non-genetic nurses, mostly staff nurses, keeping up with genetic advancements is difficult partially because of the lack of genomic competencies, skills and confidence in integrating G/G into patient education and assessments. Because of the increasing demands of bedside nursing and the education involved to maintain staff nurse competencies, little attention is paid to G/G assessment competencies and patient education (Talwar, et al., 2017).
Clinical performance for nurses is usually evaluated using competencies that compare nurses’ current work performance with previously established standards of performance. Competencies should reflect the current realities in practice, connecting to performance improvement data and is ever changing. That being said, clinical nurses are expected to master many competencies directly related to their work specific environment, and there are some universal competencies, regardless of practice setting. NURS 4005 NURS 4006: Topics in Clinical Nursing
The ANA created a new set of essential G/G competencies because they usually have a disease or health disorder component. However, most clinical nurses are age 34 and over, with the average age being 48 years old. Many currently practicing nurses who attended nursing school immediately after high school or those who graduated before 2006, received no education about the G/G competencies in their prelicensure programs, but currently, there is very little empirical evidence of that clinical nurses are actually using these competencies. This journal takes a quick look at 10 hospitals over a four -week period and assess in a 38-item questionnaire and direct observation of the EMR to assess for evidence of RN documentation of G/G related care activities (Newcomb, et al., 2019).
While nurses with a graduate degree tended to report more significant competency performance, bedside nurses performed less if any and generally didn’t report any continuing education focusing on G/G. Only six components were performed by most of the respondents in the study with two of them being more concrete activities such as collecting health histories and conducting a physical exam with G/G in mind. Obtaining a family history has been taught as a nursing fundamental for decades, but the ANA suggests going back three generations, which was rarely performed (Newcomb, et al., 2019).
Medical management of chronic illness consumes 75% of money spent on healthcare in the United States making accessible, high quality care a major concern (Shaw, et al., 2014). With the vast amount of ever improving advances in personal monitors, smart phones, watches, and the plethora of data on the internet, many conditions can be identified early, but an ethical issue remains of misuse of information or patients who may manipulate data to get information or push for a diagnosis of an illness that may not actually be appropriate. Genome sequencing is getting more affordable, allowing for the identification of risks that in some cases can be mitigated if not eliminated completely. However sometimes, more information can cause more ethical dilemmas and complicates decision making because genome sequencing is accurate in some case but can be just a predictor in other cases (Mehrian-Shai, et al.,2015).
Yearly competencies added to the multiple online and in person education for nurses both inpatient and outpatient settings, would be a great step towards obtaining pertinent data and increasing nurse confidence related to the education and integration of G/G. Much of this education should include the ethical complications of more advanced G/G testing. Also, a brief understanding of the role genetics plays in the treatment and prevention of disease should be reviewed each year to help bridge the gap for nurses who need a reminder of competencies and those who didn’t receive it in nursing school prior to actual nursing practice.
Mehrian-Shai, R., & Reichardt, J. K. V. (2015). Genomics is changing personal healthcare and medicine: the dawn of iPH (individualized preventive healthcare). Human Genomics, 9, 29. https://doi-org.ezp.waldenulibrary.org/10.1186/s40246-015-0052-0
Newcomb, P., Behand, D., SLEUTEL, M., WALSH, J., BALDWIN, K., & LOCKWOOD, S. (2019). Are genetics/genomics competencies essential for all clinical nurses? Nursing, 49(7), 54–60. https://doi-org.ezp.waldenulibrary.org/10.1097/01.nurse.0000554278.87676.ad NURS 4005 NURS 4006: Topics in Clinical Nursing
Shaw, R. J., McDuffie, J. R., Hendrix, C. C., Edie, A., Lindsey-Davis, L., Nagi, A., Kosinski, A. S., & Williams, J. W., Jr. (2014). Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis. Annals of Internal Medicine, 161(2), 113–121. https://doi-org.ezp.waldenulibrary.org/10.7326/M13-2567
Talwar, D., Tseng, T.-S., Foster, M., Xu, L., & Chen, L.-S. (2017). Genetics/genomics education for nongenetic health professionals: a systematic literature review. Genetics in Medicine : Official Journal of the American College of Medical Genetics, 19(7), 725–732. https://doi-org.ezp.waldenulibrary.org/10.1038/gim.2016.156 NURS 4005 NURS 4006: Topics in Clinical Nursing