Genetic discoveries and nursing implications for complex disease prevention and management

Global cardiovascular disease prevention: a call to action for nursing executive summary

The global epidemic of cardiovascular disease (CVD) calls for multidisciplinary and multiprofessional approaches to the management of this condition, with strategic emphasis on prevention, treatment, and control. In addition, there is increasing recognition that effective prevention and management of CVD requires a diverse workforce skilled in the social, environmental, and policy determinants of health. Nowhere are these approaches and strategies brought together and more closely aligned than in the field of preventive cardiovascular nursing. This executive summary of "Global Cardiovascular Prevention: A Call to Action for Nursing" includes key points from the 6 papers written by the Preventive Cardiovascular Nurses Association and published in July-August 2011 as a supplement to the Journal of Cardiovascular Nursing and the European Journal of Cardiovascular Nursing. This supplement addresses innovative efforts to stem the current global epidemic of CVD and emphasizes the need for effective team-based interventions for lifestyle and behavior changes across the life span. Social solutions, strategies for working with key players to develop interactive models, as well as coordinated multilevel policies, partnerships, and programs that are culturally relevant and context specific are examined. Such approaches are urgently needed to reduce death and disability from CVD in the United States and globally. Nurse leaders and other members of the healthcare team are well positioned internationally to meet these challenges.

Pharmacogenomics in the nursing literature: an integrative review

BACKGROUND

Pharmacogenomics is a rapidly growing component of personalized health care, and nurses must be competent to deliver genomic-focused nursing care.

METHODS

We conducted an integrative review of pharmacogenomics in the nursing literature. A comprehensive search of the nursing literature was conducted using the key words pharmacogenomics and pharmacogenetics. A total of 47 unique articles were included.

RESULTS

Articles represented mainly narrative reviews, with limited discussions of the implications for nursing practice, education, or research. As such, they provide limited direction for advancing either clinical practice or scientific inquiry.

CONCLUSIONS

This review serves as a call to action for more systematic and empirical publications addressing pharmacogenomics in nursing practice, education, and research. Nurses must be involved in and contribute to interdisciplinary conversations and burgeoning clinical practice initiatives related to pharmacogenomics.

Genetic counseling: a survey to explore knowledge and attitudes of Italian nurses and midwives

In the past, genetic services were delivered to a limited number of families with rare conditions. However, genomics is now being applied to both inherited and common diseases in a range of healthcare settings, and there is a greater need for nurses to understand the basic concepts of genetic health care. The aim of this cross-sectional survey was to explore the understanding and attitudes of Italian nurses toward genetic health care. A questionnaire was completed by 102 nurses and midwives (85% response rate). Of these, 61% believed that genetic counseling was only an informative and advisory process, and 53.9% could not specify to whom the counseling was aimed. When asked to identify nurses' role in genetic health care, 62% of the respondents believed they had no role, although 28% believed that nurses could provide information, support, and counseling. These findings indicate that nurses have only partial knowledge of the issues surrounding genetic health care. To prepare nurses for the post-genomic era, improved genetic education at the undergraduate and postgraduate levels is required.

Global cardiovascular disease prevention: a call to action for nursing: community-based and public health prevention initiatives

Policy changes are necessary to promote cardiovascular disease prevention. These will involve community-based and public health initiatives for primary and secondary prevention of cardiovascular disease. In this article, we discuss such interventions, community-based participatory research that has been conducted in this area, and implications for capacity building in genetics research. Finally, areas for future research in this area will be identified.

Searching for the noninvasive biomarker holy grail: are urine proteomics the answer?

Recently, biobehavioral nursing scientists have focused their attention on the search for biomarkers or biological signatures to identify patients at risk for various health problems and poor disease outcomes. In response to the national impetus for biomarker discovery, the measurement of biological fluids and tissues has become increasingly sophisticated. Urine proteomics, in particular, may hold great promise for biobehavioral focused nursing scientists for examination of symptom-and syndrome-related research questions. Urine proteins are easily accessible secreted proteins that provide direct and indirect windows into bodily functions. Advances in proteomics and biomarker discovery provide new opportunities to conduct research studies with banked and fresh urine to benefit diagnosis, prognosis, and evaluation of outcomes in various disease populations. This article provides a review of proteomics and a rationale for utilizing urine proteomics in biobehavioral research. It addresses as well some of the challenges involved in data collection and sample preparation.

Caring for families with a family history of cancer: why concerns about genetic predisposition are missing from the palliative agenda

Care of the family is integral to palliative care, but little attention has been paid to the way nurses, or other healthcare professionals, are responding to the needs of families who are concerned about whether their family history of cancer is associated with an inherited genetic predisposition. This paper discusses how palliative care nurses perceive the care needs of patients with a family history of cancer. Data were collected through recorded, semi-structured interviews with 10 nurses who had worked in specialist palliative care. The findings show that there are cogent arguments and concerns about raising the issue of an inherited genetic predisposition at the end of life (especially when the patient is close to death and there is a lack of knowledge about genetics). Nevertheless, exemplar cases are used to illustrate the reasons why it is important that nurses working in specialist palliative care settings are aware of the needs of this patient group. The paper highlights that nurses not only need an appropriate knowledge base but also an insight of what can be achieved when supporting patients with a family history of cancer.

The Development of a Spanish Language Instrument to Measure Genetic Knowledge of Diabetes Mellitus Type 2

Purpose: The purpose of this study was to develop a Spanish-language measure of genetic knowledge relevant to type 2 diabetes for use with members of the ethnically heterogeneous U.S. Latino community. Design: Review of the literature and expert content analysis guided initial instrument development. The instrument was pretested in three cognitive interview waves with 36 Latinos representative of Mexican, Central and South American, and Cuban heritage. Interview analysis indicated potential sources of response error and guided an iterative process of instrument refinement. Results: Difficulties associated with item interpretation, grammatical structure, and comprehension were identified. Analysis indicated that revisions improved item quality and enhanced cultural and linguistic appropriateness of the instrument. Conclusions: Field testing suggested initial validity of a Spanish-language instrument to measure genetic knowledge relative to type 2 diabetes. Implications for Practice: A Spanish-language measure of genetic knowledge can guide nursing interventions that support culturally appropriate integration of genetics into health care.

Ethical issues related to BRCA gene testing in orthodox Jewish women

Persons exhibiting mutations in two tumor suppressor genes, BRCA1 and BRCA2, have a greatly increased risk of developing breast and/or ovarian cancer. The incidence of BRCA gene mutation is very high in Ashkenazi Jewish women of European descent, and many issues can arise, particularly for observant Orthodox women, because of their genetic status. Their obligations under the Jewish code of ethics, referred to as Jewish law, with respect to the acceptability of various risk-reducing strategies, may be poorly understood. In this article the moral direction that Jewish law gives to women regarding testing, confidentiality, and other issues is explored. The intent is to broaden nurses' knowledge of how a particular religious tradition could impact on decision making around genetics testing, with the aim of enhancing their understanding of culturally sensitive ethical care.

Nurses' Professed Knowledge of Genetics and Genetic Counseling

All over the world, the increased awareness of the importance of early diagnosis of genetic diseases has given them priority in primary health care. However, more recent surveys indicate that genetics content is still lacking in nursing curricula. This survey aimed to measure the current status of primary care nurses' knowledge about genetics and genetic counseling, and the educational needs of nurses related to human genetics in the Denizli region of Turkey. This area in western Turkey has an 11.7% rate of consanguineous marriages; about 3.5% of the population are hemoglobinopathies carrier and 3.2% are thalassemia carriers. Data were collected on forms that aimed to obtain information about nurses' approaches to genetics and genetic counseling. A total of 86 of 106 nurses working in Denizli province returned the questionnaire (response rate of 81.1%). Phenylketonuria, at 61.5%, and Cooley's anemia, at 60.0%, were identified as the subjects these nurses were most knowledgeable about in terms of genetic disorders. A high percentage of nurses admitted they had insufficient knowledge about the genetic basis of diseases (96.4%), inheritance patterns (98.9%), ethical and legal issues (100.0%), genetic counseling (100.0%), gene testing (95.9%), and genetic engineering (97.9%). About 67% of nurses stated they would like to attend a training course on these subjects. As a result of this study a genetics course is planned for nurses so they can actively participate in the prevention and early diagnosis of genetic diseases.