Educating future nursing scientists: Recommendations for integrating omics content in PhD programs

Impact of a Professional Development Course for Doctoral Nurses and Students on Genomic Conceptual Knowledge and Competencies

BACKGROUND

Universally, nurses' limited educational opportunities to expand their genomic literacy may have implications on patient care management, research, and training.

PURPOSE

To evaluate the impact of a self-paced online course on genomic knowledge and competency acquisition in a sample of nurses possessing a doctoral degree and doctoral students.

METHODS

Pre- and postcourse data were collected using the "Genomic Nursing Concept Inventory" (GNCI) (N = 129) and a self-report survey based on the Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees (N = 131).

RESULTS

GNCI scores in all 4 topical categories and in 9 of the 16 domains significantly improved. All Genetic Competency scores significantly improved. Significant correlations were observed between Genetic Competency self-ratings and GNCI scores precourse and change of scores.

CONCLUSIONS

The positive outcomes should encourage the development of more accessible educational opportunities for nurses and other healthcare professionals to improve genomic literacy and competency.

Current State of Genomics in Nursing: A Scoping Review of Healthcare Provider Oriented (Clinical and Educational) Outcomes (2012-2022)

In the 20 years since the initial sequencing of the human genome, genomics has become increasingly relevant to nursing. We sought to chart the current state of genomics in nursing by conducting a systematic scoping review of the literature in four databases (2012-2022). The included articles were categorized according to the Cochrane Collaboration outcome domains/sub-domains, and thematic analysis was employed to identify key topical areas to summarize the state of the science. Of 8532 retrieved articles, we identified 232 eligible articles. The articles primarily reported descriptive studies from the United States and other high-income countries (191/232, 82%). More than half (126/232, 54.3%) aligned with the "healthcare provider oriented outcomes" outcome domain. Three times as many articles related to the "knowledge and understanding" sub-domain compared to the "consultation process" subdomain (96 vs. 30). Five key areas of focus were identified, including "nursing practice" (50/126, 40%), "genetic counseling and screening" (29/126, 23%), "specialist nursing" (21/126, 17%), "nurse preparatory education" (17/126, 13%), and "pharmacogenomics" (9/126, 7%). Only 42/126 (33%) articles reported interventional studies. To further integrate genomics into nursing, study findings indicate there is a need to move beyond descriptive work on knowledge and understanding to focus on interventional studies and implementation of genomics into nursing practice.

[Status Quo and Prospects of Research on Precision Nursing of Life-Cycle Health and Disease]

With the changing lifestyle and spectrum of diseases among Chinese people, the life-cycle approach to health has been given national strategic importance. Over the past decade, global nursing researchers have gradually started to pay more attention to the research related to precision nursing at different stages of the life cycle. Researchers have applied multi-omics to explore the pathogenesis and novel biomarkers of relevant symptoms in tumor patients or patients with chronic diseases in order to manage symptoms with better precision. However, systematic theories of precision nursing of life-cycle health and disease have not yet been developed, and the research field and its implications still need to be continuously expanded and innovated. In the nursing discipline, the advantages of interdisciplinary integration should be given full play and the precise and effective resolution of life-cycle health problems should be taken as its goal. Through accurately defining key quantitative objective indicators of nursing care, the nursing discipline will be able to achieve early identification of life-cycle health problems, clarify the occurrence and patterns of change in life-cycle health problems, and gain a better understanding of the regulatory mechanisms. Precise and effective nursing-related technologies and products of non-medication and non-surgery nature should be developed to achieve better precision in nursing interventions, thereby effectively promoting recovery from diseases and improving the overall health of the people.

Research focused doctoral nursing education in the 21st century: Curriculum, evaluation, and postdoctoral considerations

The AACN position statement on The Research-Focused Doctoral Program in Nursing: Pathways to Excellence was revised in 2022 by an AACN Task Force charged with creating a new vision for the PhD and similar programs in nursing. This document, which was informed by hundreds of academic nursing stakeholders, yields expectations and recommendations for PhD program curriculum, program evaluation, post-doctoral competencies, and resources. Results of an AACN 2021 survey indicated increased enrollment in PhD programs 2017-2000. Fifteen percent of students were enrolled in BSN-PhD, programs, 70 % of schools reported external review, and overall average time to degree completion was 5 years. Considerations for the education for the research doctorate include development of curriculum that fosters the scholarship of discovery and scientific inquiry and implements systematic evaluation of program outcomes while advancing postdoctoral competencies and resources, including the post-doctoral fellowship. Comprehensive assessment of the PhD program promotes ongoing program analysis and quality. Postdoctoral fellowships advance the science of nursing via the creation of a culture and workforce for nursing research. Successful postdoctoral programs have mentors, resources, and infrastructure to adequately enable the fellow to progress in their line of inquiry and develop as an investigator.

Content Analysis of Dissertations for Examination of Priority Areas of Nursing Science

BACKGROUND

Based on current and future research priorities to inform Ph.D. education, emerging and priority areas were developed through the Idea Festival Advisory Committee of the Council for the Advancement of Nursing Science.

PURPOSE

The Purpose of this study was to examine the bibliographic, methodologic, study topic characteristics, and emerging and priority areas of two randomly selected samples of nursing doctoral dissertations from the Proquest Digital Dissertations and Theses database between January 2017 and September 2018.

METHODS

Using human- (N = 101) and computer-coding (N = 242), we analyzed text data using descriptive statistics and data visualization.

FINDINGS

Health behavior (32.7%) and quantitative sciences (17.8%) were the most common emerging and priority areas, and translation science and -omics/microbiome were absent. Health, practice, education, and leadership were four study topic themes.

DISCUSSION

This approach may serve as a metric for the state of Ph.D. nursing education. A replication study is recommended in three to five years.

Opportunities and challenges presented by recent pedagogical innovations in doctoral nursing education

The demand to expand the nurse scientist pipeline over the past decade has generated numerous pedagogical innovations in nursing doctoral education. A PhD nursing education summit was held at the University of Pennsylvania in October 2019 to discuss pedagogical innovations. The main pedagogical innovations discussed by Summit attendees included: 1) the expansion of both 3-year PhD programs and BSN to PhD programs; 2) changes in learning opportunities and curricula content; and 3) the role of postdoctoral fellowships. This overview examines the numerous opportunities and challenges generated by these innovations. Opportunities include producing scholars with research careers that are potentially longer than historically seen in the nursing profession, as well as the emergence of unique educational and mentoring opportunities both during and after doctoral studies. Challenges involve the impact condensed program timelines have had on both the content and delivery of curricula, as well as the research expertise and skillsets of nursing PhD program graduates. There is a need to conduct a national coordinated evaluation of PhD program using shared metrics in order to better evaluate the effect of these pedagogical innovations on the development of nurse scientists, and ultimately, the discipline.

Metabolomics Research Conducted by Nurse Scientists: A Systematic Scoping Review

Metabolomics, one of the newest omics, allows for investigation of holistic responses of living systems to myriad biological, behavioral, and environmental factors. Researcher use metabolomics to examine the underlying mechanisms of clinically observed phenotypes. However, these methods are complex, potentially impeding their uptake by scientists. In this scoping review, we summarize literature illustrating nurse scientists' use of metabolomics. Using electronic search methods, we identified metabolomics investigations conducted by nurse scientists and published in English-language journals between 1990 and November 2019. Of the studies included in the review (N = 30), 9 (30%) listed first and/or senior authors that were nurses. Studies were conducted predominantly in the United States and focused on a wide array of clinical conditions across the life span. The upward trend we note in the use of these methods by nurse scientists over the past 2 decades mirrors a similar trend across scientists of all backgrounds. A broad range of study designs were represented in the literature we reviewed, with the majority involving untargeted metabolomics (n = 16, 53.3%) used to generate hypotheses (n = 13, 76.7%) of potential metabolites and/or metabolic pathways as mechanisms of clinical conditions. Metabolomics methods match well with the unique perspective of nurse researchers, who seek to integrate the experiences of individuals to develop a scientific basis for clinical practice that emphasizes personalized approaches. Although small in number, metabolomics investigations by nurse scientists can serve as the foundation for robust programs of research to answer essential questions for nursing.

Nursing research priorities based on CINAHL database: A scoping review

Aim

To analyse nursing research based on the CINAHL database to identify research priorities for nursing.

Design

A scoping literature review was conducted. The CINAHL Plus (EBSCO) Full Text was searched between 2012-2018.

Methods

Out of 1522 original publications, 91 fulfilled the inclusion criteria. The Joanna Briggs Institute critical appraisal tools were applied. Data were analysed by a thematic analysis method.

Results

A strong emphasis should be put on development and evaluation of nursing theories and, in addition, randomized controlled trial studies, meta-synthesis, experimental and intervention studies are needed in nursing research. Development of competencies and skills in the nursing profession ought to be studied more extensively and research should be focused on variety fields of nursing practice.

Genomics education in nursing in Hong Kong, Taiwan and Mainland China

AIM

To identify issues and challenges of genomics education in Hong Kong, Taiwan and Mainland China.

BACKGROUND

The use of genetics/genomics in health care, such as genetic testing, pharmacogenomics and tumour profiling in the context of cancer, is increasing. The rapid application of genetics/genomics in clinical practice requires healthcare providers to be competent to practise genetics-related patient care.

SOURCES OF EVIDENCE

We reviewed current practices in genomics education in nursing in Hong Kong, Taiwan and Mainland China, including the opportunities for nurses to advance their knowledge and recommendations to incorporate genomics education in the nursing curriculum in these regions.

FINDINGS

While many citizens and health professionals recognize the importance of new and exciting research areas of genomics/genetics, there are still many gaps in the translation of genetic/genomic medicine into clinical practice. There is also a similar lack of genetics professionals in China.

CONCLUSION

Hong Kong, Taiwan and Mainland China face challenges in promoting genetic education in nursing. A strategic approach in a coordinated effort ineffectively translating genomic knowledge into healthcare practice should be established in these three regions.

IMPLICATIONS FOR NURSING AND POLICY

Nursing educators in Hong Kong, Taiwan and Mainland China should link with the international nursing community (e.g. Global Genomics Nursing Alliance) and form closer networks to improve education in the area of genetics and genomics. From a policy level, genomics education is suggested to be incorporated in nursing curriculum to enhance nurses' competency in incorporating genetics/genomics service into patient care.

Beyond the Helix: Ethical, Legal, and Social Implications in Genomics

OBJECTIVE

To review ethical, legal, and social implications of genomics, a ground-breaking science that when applied improves cancer care outcomes.

DATA SOURCES

PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library, consensus statements, and professional guidelines.

CONCLUSION

Ethical, legal, and social domains of genomics are not fully delineated. Areas needing further discussion and policies include return of findings, informed consent, electronic health records, and data resources and sharing.

IMPLICATIONS FOR NURSING PRACTICE

All nurses need a basic understanding of the ethical, legal, and social implications of genomics.

Establishing the Genomic Knowledge Matrix for Nursing Science

PURPOSE

To establish the knowledge needed to integrate the multiple branches of omics into nursing research to accelerate achieving the research recommendations of the Genomic Nursing Science Blueprint.

METHODS

The creation of the Genomic Knowledge Matrix occurred in three phases. In phase 1, the Omics Nursing Science and Education Network (ONSEN) Education Workgroup completed an evidence, bioinformatics, and technology review to inform the components of the Matrix. The ONSEN Advisory Panel then reviewed and integrated revisions. Phase 3 solicited targeted public comment focused on education and research experts, and applicable revisions were made.

FINDINGS

The Genomic Knowledge Matrix establishes the following content areas: cellular and molecular biology, system physiology, microbiology, and translational bioinformatics as the minimum required preparation for nurse scientists to understand omics and to integrate this knowledge into research. The Matrix also establishes levels of understanding needed to function based on the role of the nurse scientist.

CONCLUSIONS

The Genomic Knowledge Matrix addresses knowledge important for nurse scientists to integrate genomics into their research. Building on prior recommendations and existing genomic competencies, the Matrix was designed to present key knowledge elements critical to understand omics that underpin health and disease. Knowledge depth varies based on the research role.

CLINICAL RELEVANCE

The Genomic Knowledge Matrix provides the vital guidance for training nurse scientists in the integration of genomics. The flexibility of the Matrix also provides guidance to inform fundamental genomic content needed in core science content in undergraduate and graduate level nursing curricula.

Nursing genetics and genomics: The International Society of Nurses in Genetics (ISONG) survey

BACKGROUND

The International Society of Nursing in Genetics (ISONG) fosters scientific and professional development in the discovery, interpretation, and application of genomic information in nursing research, education, and clinical practice.

OBJECTIVES

Assess genomic-related activities of ISONG members in research, education and practice, and competencies to serve as global leaders in genomics.

DESIGN

Cross-sectional survey (21-items) assessing genomic-related training, knowledge, and practice.

SETTINGS

An email invitation included a link to the anonymous online survey.

PARTICIPANTS

All ISONG members (n = 350 globally) were invited to partake.

METHODS

Descriptive statistics and Wilcoxon Rank Sum Test for between-group comparisons.

RESULTS

Respondents (n = 231, 66%), were mostly Caucasian, female, with a master's degree or higher. Approximately 70% wanted to incorporate genomics in research, teaching, and practice. More than half reported high genomic competency, and over 95% reported that genomics is relevant the next 5 years.

CONCLUSIONS

Findings provide a foundation for developing additional educational programs for an international nursing workforce in genomics.

Developing and Sustaining a Career as a Transdisciplinary Nurse Scientist

PURPOSE

The purpose of this article is to provide an overview of strategies to build and sustain a career as a nurse scientist. This article examines how to integrate technologies and precision approaches into clinical practice, research, and education of the next generation of nursing scholars.

DESIGN

This article presents information for shaping a sustainable transdisciplinary career. Programs of research that utilize self-management to improve quality of life are discussed throughout the article. The ongoing National Institute of Nursing Research-funded (R01 grant) iPhone Helping Evaluate Atrial Fibrillation Rhythm through Technology (iHEART) study is the first prospective, randomized controlled trial to evaluate whether electrocardiographic monitoring with the AliveCor™ device in the real-world setting will improve the time to detection and treatment of recurrent atrial fibrillation over a 6-month period as compared to usual cardiac care.

METHODS

Opportunities to sustain a career as a nurse scientist and build programs of transdisciplinary research are identified. These opportunities are focused within the area of research and precision medicine.

FINDINGS

Nurse scientists have the potential and ability to shape their careers and become essential members of transdisciplinary partnerships. Exposure to clinical research, expert mentorship, and diverse training opportunities in different areas are essential to ensure that contributions to nursing science are visible through publications and presentations as well as through securing grant funding to develop and maintain programs of research.

CONCLUSIONS

Transcending boundaries and different disciplines, nurses are essential members of many diverse teams.

CLINICAL RELEVANCE

Nurse scientists are strengthening research approaches, clinical care, and communication and improving health outcomes while also building and shaping the next generation of nurse scientists.

Improving -Omics-Based Research and Precision Health in Minority Populations: Recommendations for Nurse Scientists

PURPOSE

The purpose of this article is to provide an overview of the role of nurse scientists in -omics-based research and to promote discussion around the conduct of -omics-based nursing research in minority communities. Nurses are advocates, educators, practitioners, scientists, and researchers, and are crucial to the design and successful implementation of -omics studies, particularly including minority communities. The contribution of nursing in this area of research is crucial to reducing health disparities.

METHODS

In this article, challenges in the conduct of -omics-based research in minority communities are discussed, and recommendations for improving diversity among nurse scientists, study participants, and utilization of training and continuing education programs in -omics are provided.

FINDINGS AND CONCLUSIONS

Many opportunities exist for nurses to increase their knowledge in -omics and to continue to build the ranks of nurse scientists as leaders in -omics-based research. In order to work successfully with communities of color, nurse scientists must advocate for participation in the Precision Medicine Initiative, improve representation of nurse faculty of color, and increase utilization of training programs in -omics and lead such initiatives.

CLINICAL RELEVANCE

All nursing care has the potential to be affected by the era of -omics and precision health. By taking an inclusive approach to diversity in nursing and -omics research, nurses will be well placed to be leaders in reducing health disparities through research, practice, and education.

Biological determinants of health: Genes, microbes, and metabolism exemplars of nursing science

BACKGROUND

Increasingly, nurse scientists are incorporating "omics" measures (e.g., genomics, transcriptomics, proteomics, and metabolomics) in studies of biologic determinants of health and behavior. The role of omics in nursing science can be conceptualized in several ways: (a) as a portfolio of biological measures (biomarkers) to monitor individual risk, (b) as a set of combined data elements that can generate new knowledge based on large and complex patient data sets, (c) as baseline information that promotes health education and potentially personalized interventions, and (d) as a platform to understand how environmental parameters (e.g., diet) interact with the individual's physiology.

PURPOSE

In this article, we provide exemplars of nursing scientists who use omics to better understand specific health conditions.

METHODS

We highlight various ongoing nursing research investigations incorporating omics technologies to study chronic pain vulnerability, risk for a pain-related condition, cardiometabolic complications associated with pregnancy, and as biomarkers of response to a dietary intervention.

DISCUSSION

Omics technologies add an important dimension to nursing science across many foci of investigation. However, there are also challenges and opportunities for nurse scientists who consider using omics in their research.

CONCLUSION

The integration of omics holds promise for increasing the impact of nursing research and practice on population health outcomes.

Genome Sequencing Technologies and Nursing: What Are the Roles of Nurses and Nurse Scientists?

BACKGROUND

Advances in DNA sequencing technology have resulted in an abundance of personalized data with challenging clinical utility and meaning for clinicians. This wealth of data has potential to dramatically impact the quality of healthcare. Nurses are at the focal point in educating patients regarding relevant healthcare needs; therefore, an understanding of sequencing technology and utilizing these data are critical.

AIM

The objective of this study was to explicate the role of nurses and nurse scientists as integral members of healthcare teams in improving understanding of DNA sequencing data and translational genomics for patients.

APPROACH

A history of the nurse role in newborn screening is used as an exemplar.

DISCUSSION

This study serves as an exemplar on how genome sequencing has been utilized in nursing science and incorporates linkages of other omics approaches used by nurses that are included in this special issue. This special issue showcased nurse scientists conducting multi-omic research from various methods, including targeted candidate genes, pharmacogenomics, proteomics, epigenomics, and the microbiome. From this vantage point, we provide an overview of the roles of nurse scientists in genome sequencing research and provide recommendations for the best utilization of nurses and nurse scientists related to genome sequencing.

Again, What Is Nursing Science?

This article again asks, What is nursing science? Who knows? Who cares? The author describes the threat to the survival of nursing science grounded in nursing frameworks and theories. This threat is magnified by the proposal of the Council for the Advancement of Nursing Science (CANS) to change the curricula of PhD education. The aim of CANS is to prepare nurse scientists for lifelong competitive careers in interdisciplinary research, often focused on funding priorities of the National Institute of Nursing Research (NINR). Curricula would include preparation for conducting research in topics such as omics, e-science, translation science, biobehavioral science, symptom science, and team science. How can this be nursing science? It is argued that this focus might obliterate nursing’s discipline-specific phenomenon of concern, the human-universe-health process.

Maternal Interleukin Genotypes Are Associated With NICU Outcomes Among Low-Birth-Weight Infants

BACKGROUND

Maternal interleukin (IL) single nucleotide polymorphisms (SNPs) are associated with obstetrical outcomes. Conversely, infant SNPs are associated with subsequent neonatal intensive care unit (NICU) outcomes. Little is known about relationships between maternal SNPs and neonatal outcomes.

PURPOSE

To examine the relationships between maternal IL genotypes and neonatal outcomes.

METHODS

An ancillary study was conducted among mothers ( N = 63) who delivered very low-birth-weight infants ( N = 74). Maternal DNA was extracted from breast milk and genotyped. Outcomes included fecal calprotectin, length of stay, scores for neonatal acute physiology with perinatal extension (SNAPPE-II), weight gain, oxygen needs, necrotizing enterocolitis, intraventricular hemorrhage, sepsis, retinopathy of prematurity, blood transfusions, and feeding intolerance. Multivariate analyses examined the relationships between maternal IL SNPs and outcomes, controlling for gestational age and the ratio of maternal milk to total milk.

RESULTS

Absence of a minor allele in 2 IL6 SNPs was associated with fecal calprotectin ( p = .0222, p = .0429), length of stay ( p = .0158), SNAPPE-II ( p = .0497), weight gain ( p = .0272), and days on oxygen ( p = .0316). IL6 genotype GG (rs1800795) was associated with length of stay ( p = .0034) and calprotectin ( p = .0213). Minor-allele absence in 2 IL10 SNPs was associated with days on oxygen ( p = .0320). There were associations between IL10 genotype TT (rs1800871) and calprotectin ( p = .0270) and between IL10 genotypes AA (rs1800872 and rs1800896) and calprotectin ( p = .0158, p = .0045).

CONCLUSION

Maternal IL SNPs are associated with NICU outcomes. A potential clinical application includes an antenatal risk profile to identify neonatal needs.