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Walker T, Ersig AL, Dwyer AA, Kronk R, Snyder CT, Whitt K, Willis V. Integrating genomics and precision health knowledge into practice: A guide for nurse practitioners. J Am Assoc Nurse Pract 2024:01741002-990000000-00245. [PMID: 39235897 DOI: 10.1097/jxx.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/12/2024] [Indexed: 09/07/2024]
Abstract
ABSTRACT Nurse practitioners (NPs) are the fastest growing group of health care providers, with an increase of 8.5% over the past year and anticipated growth of more than 40% by 2031. Improving NPs' knowledge of how genes influence health enables them to assess, diagnose, and manage patients in all states of health in a safe, efficient, and competent manner. Nurse practitioners may also care for patients who obtain direct-to-consumer (DTC) genetic tests without provider oversight and share their results; improved knowledge of genetics can provide NPs with the information and resources needed to interpret and understand DTC test results. The literature indicates that NPs have limited understanding of basic genetic concepts and guidelines for prescribing drugs affected by genomic variability. As a result, NPs report low confidence in their ability to accurately interpret and apply genetic test results, which inhibits genomics-informed precision health care. This article provides resources and clinical recommendations for using the 2021 American Association of Colleges of Nursing Essentials and the American Nurses Association Essentials of Genomic Nursing to facilitate the integration of genomics into NP curricula and practice. These resources will help future and practicing NPs integrate genomics into practice and improve precision health care.
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Affiliation(s)
- Trina Walker
- Creighton University College of Nursing, Omaha, Nebraska
| | - Anne L Ersig
- University of Wisconsin-Madison School of Nursing, Madison Wisconsin
| | - Andrew A Dwyer
- Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Rebecca Kronk
- Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | - Cynthia T Snyder
- Georgia Center for Oncology Research and Education, Atlanta, Georgia
| | - Karen Whitt
- George Washington University School of Nursing, Washington, District of Columbia
| | - Valerie Willis
- Clinical Division, Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana
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Curtin M, Dickerson SS. An Evolutionary Concept Analysis of Precision Medicine, and Its Contribution to a Precision Health Model for Nursing Practice. ANS Adv Nurs Sci 2024; 47:E1-E19. [PMID: 36728719 DOI: 10.1097/ans.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Precision medicine is a new concept that has been routinely encountered in the literature for little more than a decade. With increasing use, it becomes crucial to understand the meaning of this concept as it is applied in various settings. An evolutionary concept analysis was conducted to develop an understanding of the essential features of precision medicine and its use. The analysis led to a comprehensive list of the antecedents, attributes, and consequences of precision medicine in multiple settings. With this understanding, precision medicine becomes part of the broader practice of precision health, an important process proposed by nursing scholars to provide complete, holistic care to our patients. A model for precision health is presented as a framework for care.
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Affiliation(s)
- Martha Curtin
- School of Nursing, University at Buffalo, State University of New York
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Dordunoo D, Limoges J, Chiu P, Puddester R, Carlsson L, Pike A. Genomics-informed nursing strategies and health equity: A scoping review protocol. PLoS One 2023; 18:e0295914. [PMID: 38100433 PMCID: PMC10723661 DOI: 10.1371/journal.pone.0295914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE The objective of this scoping review is to map the available evidence on strategies that nurses can use to facilitate genomics-informed healthcare to address health disparities. INTRODUCTION Advancements in genomics over the last two decades have led to an increase in the delivery of genomics-informed health care. Although the integration of genomics into health care services continues to enhance patient outcomes, access to genomic technologies is not equitable, exacerbating existing health disparities amongst certain populations. As the largest portion of the health workforce, nurses play a critical role in the delivery of equitable genomics-informed care. However, little is known about how nurses can help address health disparities within the context of genomics-informed health care. A review of the literature will provide the necessary foundation to identify promising practices, policy, and knowledge gaps for further areas of inquiry. INCLUSION CRITERIA We will include papers that explore strategies that nurses can undertake to facilitate genomics-informed care to address health disparities. METHODS This review will be conducted using JBI methodology for scoping reviews. We will search electronic databases including MEDLINE (OVID), EMBASE, Cochrane Library, PsychInfo, and CINAHL for quantitative and qualitative studies, systematic reviews and grey literature. Theses, books, and unavailable full-text papers will be excluded. The search will be limited to papers from 2013 and beyond. Two reviewers will screen titles and abstracts followed by full-text and disagreements will be resolved by a third reviewer. We will use a data extraction tool using Microsoft Excel and analyse data using descriptive statistics and conventional content analysis. Findings will be presented in the form of evidence tables and a narrative summary. We will report findings using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). DISCUSSION Genomics will continue to transform all aspects of health care across the wellness continuum from prevention, assessment, diagnosis, management, treatment, and palliative care. The identification of nursing strategies to address health disparities will build the foundation for policy and practice to ensure that the integration of genomic technologies benefits everyone.
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Affiliation(s)
- Dzifa Dordunoo
- University of Victoria, School of Nursing, Director, Centre for Evidence informed Nursing and Health Care: JBI Centre of Excellence, Victoria, Canada
| | - Jacqueline Limoges
- Athabasca University, Chair, Ontario Cancer Research Ethics Board, Toronto, Canada
| | | | - Rebecca Puddester
- Memorial University of Newfoundland, Faculty of Nursing, St. John’s, Canada
| | | | - April Pike
- Memorial University of Newfoundland, Faculty of Nursing, St. John’s, Canada
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Puddester R, Limoges J, Dewell S, Maddigan J, Carlsson L, Pike A. The Canadian Landscape of Genetics and Genomics in Nursing: A Policy Document Analysis. Can J Nurs Res 2023; 55:494-509. [PMID: 36850071 PMCID: PMC10619171 DOI: 10.1177/08445621231159164] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Genetics and genomics (GG) are transforming approaches to healthcare in Canada and around the globe. Canadian nurses must be prepared to integrate GG in their practice, but modest research in this area suggests that Canadian nurses have limited GG competency. Countries that have integrated GG across nursing provided guidance to nurses about the practice implications of GG through regional nursing policy documents. These documents propelled action to integrate GG across nursing. Little is known about the GG content in the nursing policy document infrastructure in Canada. PURPOSE This study aimed to examine the guidance for GG-informed nursing practice as provided by Canadian nursing organizations in official professional documents. METHODS Qualitative document analysis was used. A hybrid inductive/deductive analysis approach was used to analyze findings within the diffusion of innovation theory framework. RESULTS There is an overall lack of depth and breadth of Canadian nursing documents that include content related to GG. Of the (n = 37) documents analyzed, four themes were generated including (a) GG guidance in nursing education; (b) regulators' requirements for foundational GG knowledge, (c) Canadian Nurses Association (CNA) as an early catalyst to GG integration; and (d) early adopters in speciality practice. CONCLUSION There are opportunities to enhance the guidance available to Canadian nurses for the application of GG, through documents of nursing professional associations, nursing education accreditation organizations, and regulatory bodies. Findings suggest oncology and perinatal nurses are the early adopters which is an important consideration in future strategies to implement GG into Canadian nursing.
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Affiliation(s)
- Rebecca Puddester
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jacqueline Limoges
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada
| | - Sarah Dewell
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Joy Maddigan
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Lindsay Carlsson
- Drug Development Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - April Pike
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
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Ray M, Wallace MK, Grayson SC, Cummings MH, Davis JA, Scott J, Belcher SM, Davis TS, Conley YP. Epigenomic Links Between Social Determinants of Health and Symptoms: A Scoping Review. Biol Res Nurs 2023; 25:404-416. [PMID: 36537264 PMCID: PMC10404910 DOI: 10.1177/10998004221147300] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Social determinants of health (SDoH) impact health and wellness. The link between SDoH and adverse health outcomes, including symptom occurrence and severity, may be explained by an individual's physiologic response to one or more SDoH. One potential mechanism underlying this physiologic response linking SDoH and symptoms is the dynamic epigenome. The purpose of this scoping review of the literature was to examine differential susceptibility for symptoms by identifying and summarizing research linking SDoH and symptoms through epigenomic mechanisms. PubMed was searched to identify empirical research where at least one SDoH was an independent or dependent variable, at least one symptom was investigated, and the investigation included an epigenomic measure. Of the 484 articles initially retrieved, after thorough vetting, 41 articles met eligibility. The most studied symptom was depressive symptoms followed by anxiety, cognitive function, sleep dysfunction, and pain. The most frequently studied SDoH were: 1) stress, particularly early life stress and acculturative stress; and 2) trauma, predominantly childhood trauma. DNA methylation and telomere length were the most studied epigenomic measures. Four genes (SLC6A4, BDNF, NR3C1, OXTR) had evidence from multiple studies and across methodological approaches linking SDoH to symptoms. This review supports the inclusion of epigenomic approaches to better understand the link between SDoH and symptoms and provides evidence that SDoH impact telomere length and the methylation of genes involved in neurotransmitter signaling, neuronal survival, behavior, inflammation and stress response.
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Affiliation(s)
- Mitali Ray
- Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | | | - Susan C. Grayson
- Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Meredith H. Cummings
- Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jessica A. Davis
- Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jewel Scott
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Sarah M. Belcher
- Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Tara S. Davis
- Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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吴 俊, 周 伟, 王 伟, 尚 少. [Latest Findings in Key Research Areas of Precision Nursing for Chronic Diseases in Older Adults]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:731-735. [PMID: 37545065 PMCID: PMC10442624 DOI: 10.12182/20230760507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Indexed: 08/08/2023]
Abstract
The advent of the era of biomedical big data has helped promote the development of precision nursing. Precision nursing for chronic diseases in older adults is an interdisciplinary research field in which accurate individualized data are utilized to carry out early screening and health management of older adult populations at high risk for chronic diseases and early intervention of diseases, which plays an important role in improving the prognosis of diseases and the health level of the older adult population. Herein, we introduced the concept of precision nursing, and discussed the latest research findings in the key areas of precision nursing for chronic diseases in older adults, including precision symptom management in cancer patients and precision nursing in older patients with multimorbidity. At present, research concerning precise symptom management of cancer patients is mainly focused on prediction modelling for risks of symptoms, longitudinal change trajectories, core symptom identification, etc. Investigations in the precise nursing of cancer patients are conducted in the following areas, risk prediction, the timing of interventions, and intervention targets. Research on precision nursing for multimorbidity is mainly focused on assessment of chronic disease multimorbidity, multimorbidity pattern recognition, and health management of multimorbidity. We also discussed potential opportunities and challenges of precision nursing in the future, in order to provide a scientific basis for the improving the practice and theories of precision nursing. In the future, precision nursing will play an ever more important role in uncovering pathogenic information, the diagnosis and treatment of diseases, the health of the research population, and the promotion of medical research.
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Affiliation(s)
- 俊慧 吴
- 北京大学护理学院 (北京 100191)School of Nursing, Peking University, Beijing 100191, China
| | - 伟娇 周
- 北京大学护理学院 (北京 100191)School of Nursing, Peking University, Beijing 100191, China
| | - 伟轩 王
- 北京大学护理学院 (北京 100191)School of Nursing, Peking University, Beijing 100191, China
| | - 少梅 尚
- 北京大学护理学院 (北京 100191)School of Nursing, Peking University, Beijing 100191, China
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Dewell S, Ginn C, Benzies K, Seneviratne C. Nursing student and faculty attitudes about a potential genomics-informed undergraduate curriculum. Int J Nurs Educ Scholarsh 2021; 18:ijnes-2020-0109. [PMID: 34380187 DOI: 10.1515/ijnes-2020-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 07/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore attitudes about adding genomic content to an undergraduate nursing curriculum. Genomic knowledge is essential to nursing education, but challenges exist for curriculum innovation. Few countries have guiding documents from national nursing organizations on genomic competencies for practice or education. Information on attitudes about genomics may provide guidance for curriculum development. METHODS Nineteen undergraduate nursing students and two faculty from a school of nursing with two sites in western Canada participated. Five focus groups and four interviews were conducted using a semi-structured focus group guide. Data were analysed using thematic analysis. Coding was inductive. RESULTS Characteristics of participants, eight key themes, and four future focal areas were identified to guide future research and curriculum development. CONCLUSIONS Global development of genomics-informed curricula will require a focus on increasing knowledge, defining scope and role, increasing visibility of role models, and preparing to implement precision health.
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Affiliation(s)
- Sarah Dewell
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Carla Ginn
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
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Fawaz M. Role of nurses in precision health. Nurs Outlook 2021; 69:937-940. [PMID: 33745686 DOI: 10.1016/j.outlook.2021.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/23/2021] [Accepted: 01/30/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Mirna Fawaz
- Nursing Department, Faculty of Health Sciences, Beirut Arab University, BEY, Lebanon.
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