The nursing role in the delivery of genetic services

Nursing and genetics: applying the American Nurses Association's Code of Ethics

A professional code of ethics is essential for behaviors to be reinforced in any discipline. The American Nurses Association (ANA) has established a code of ethics for nurses to use as a framework for making ethical decisions with all aspects of health care delivered to the public. With the explosion of genetic discoveries, nurses and clients are facing new ethical dilemmas. It is important for nurses to understand how to use the ANA Code of Ethics when faced with the many complexities of ethical issues involving genetics and health care. This article illustrates how the ANA Code of Ethics can be applied in nursing practice to establish professional behaviors related to ethical issues and genetics.

Education for genetics and nursing practice

Genetic factors influence the risk for disease, selection of treatments, and overall health of persons throughout the life span. Nurses in critical care practice participate in assessing genetic risks for disease, implementing treatments, educating people about genetic aspects of health and disease, supporting the client's abilities to cope with the information, and assisting the individual and family to make health-related decisions involving genetic information. Opportunities for critical care nurses to become knowledgeable about genetic aspects of critical care nursing exist through academic courses, continuing education, and summer institutes. Recently, new guidelines for the genetic education of nurses have been developed. However, genetic education opportunities are not available to all nurses throughout the United States. Genetic nursing education programs based on guidelines for integration of genetic knowledge into professional nursing practice are needed.

The role of the nurse in cancer genetics

Knowledge gained from the Human Genome Project and related genetic research is already impacting clinical oncology nursing practice. Because cancer is now understood to be a genetic disease, changes in the traditional approaches to prevention, diagnosis, and therapeutic management of cancer are becoming increasingly genetically based. Therefore, to ensure competency in oncology nursing practice at all levels, nurses must incorporate an understanding of the underlying biology of carcinogenesis and the molecular rationale underlying strategies to prevent, diagnose, and treat cancer.

Genomic-based health care in nursing: a bidirectional approach to bringing genetics into nursing's body of knowledge

Nurses can expect to become partners with patients and their families as genomic-based health care brings decisions involving gene-based diagnostics and therapeutics into commonplace practice. All health professionals need genetic literacy to continue competence in clinical practice in the future. This article explores the efforts nursing has undertaken during the past decade to integrate human and clinical genetics into practice and scholarship. Genetics nursing education literature in the second half of the 20th century was analyzed. A focused survey of 15 genetics nurses and nursing leaders regarding key national initiatives, genetics research training programs, and genetics education models was conducted. Nursing has taken a bidirectional approach (through grass roots and top-down initiatives) to implementing change and advancing genetics in nursing practice, research, and education. For optimal leadership in genetics education for nursing and other disciplines, bidirectional efforts must continue and concentrate on bringing genetics into clinical practice and scholarship as genomic-based health care spreads worldwide. Evidence of nursing's interdisciplinary leadership is recognized. Recommendations and strategies for continued nursing leadership and programs that build on previous work are presented.

The role and practice of the genetic nurse: report of the AGNC Working Party

The role of the genetic nurse has evolved historically with the emergence of clinical genetics in the field of health care. During 1994, a Practice Working Party was convened by the Genetic Nurses and Social Workers Association in response to discussion about the role of the nurse within and between regional genetics centres. The Working Party conducted a study of the current nursing practice and attitudes of nurses and clinicians to the nursing role, as a basis for future discussion and planning for educational needs. This paper describes the role of the genetic nurse within the United Kingdom and offers suggestions for assessment of competency. Strong themes emerging from respondents' comments include the need and desire for multi-professional team work, and it is apparent that most respondents felt the families' needs would best be served by a skilful combination of medical and nursing input, rather than adherence to traditional roles.

Evolution of the nursing role in genetics

The role of the nurse in the delivery of genetic counseling services initially was developed by nurses working in multidisciplinary teams serving the developmentally disabled and mentally retarded. Both the characteristics of the role and the need for didactic content and clinical experiences were well articulated as early as the early to mid-1960s. Since that time, many nurses have published their interpretations of the role in light of their individual practice and the state of the art. The basic elements of case finding and referral, explaining the process of genetic evaluation and counseling to families, constructing a family pedigree, assisting the family in gathering records and documentation, clarifying genetic information, and providing long-term management assistance remain basically the same. What changes is the information available and the population to which the information may be applied. Prenatal diagnosis and the identification of individuals at risk for common disorders are two good examples of change based on emerging scientific information.

Wilms' tumor: a paradigm, a parallel, and a puzzle

Wilms' tumor, a childhood tumor of the kidney, parallels retinoblastoma in several ways. Both malignancies occur in the very young, involve paired organs, arise from embryonal cells, can develop unilaterally or bilaterally, and can occur in hereditary and non-hereditary forms. However, Wilms' tumor rarely occurs in family clusters and may involve the loss of function of multiple genes.