Genomics FAQ for Entry-level Nurses

Clinical care is increasingly focusing on precision health. Precision healthcare refers to care that is delivered based upon the understanding of a person’s unique genomic information combined with lifestyle and social, economic, cultural, and environmental contexts and how these influence well-being and health outcomes. Over half of the world’s healthcare workforce are nurses. No other profession interfaces more directly with patients and for longer periods of time than nurses.

Nurses are trained to:

• Care for the whole person and consider the influence of biopsychosocial interactions on health outcomes.
   
• Care for patients of all ages on a continuum of health and illness that is influenced by genomics and the environment.
   
• Obtain a family history to assist with early screening detection of genetic conditions or health habits that may affect a patient’s genome.
   
• Help families find answers to rare and common conditions by directing them to valid sources of information.
   
• Educate patients and families about genomics-informed targeted interventions for cancer, infections, and pharmacotherapy.

Genomics plays a role in every aspect of nursing, which includes providing one-on-one care, treating entire populations, teaching the next generation of nurses, or making discoveries in the lab.

Genomics is used in all practice settings across all aspects of nursing care, including educating patients and families, administering medications, advocating for health promotion and disease prevention and interpreting family histories.

Settings where nurses use or provide genomics-informed care to patients of all ages, families, and communities include but are not limited to:

• Primary care.
   
• Pediatric and adult outpatient clinics.
   
• Specialty clinics.
   
• Subspecialty clinics.
   
• Prenatal and reproductive centers.
   
• Inpatient settings.
   
• Case management.
   
• Community outreach clinics.

Examples of how nurses apply genomics in practice:

• Record and interpret a comprehensive family history to identify risk for heritable genetic conditions.
   
• Understand the genomic basis for certain health conditions and the associated prognosis.
   
• Recognize newborn risk for morbidity and mortality based upon identified genetic conditions.
   
• Identify risk for asymptomatic individuals with high risk for hereditary cancers.
   
• Advocate for interventions based upon individual genetic needs.
   
• Facilitate screening and follow up for individuals with known genetic conditions.
   
• Encourage genetic testing for at-risk family members.
   
• Obtain and verify informed consent.
   
• Ensure understanding of all risks, benefits, and limitations for genetic testing and/or research.
   
• Use current credible information to answer questions about genomic information or services and assess for understanding.
   
• Identify at-risk populations.
   
• Form empathetic relationships to support individuals and families at risk for or affected by genetic conditions.
   
• Educate individuals, families, and communities about the role of genomics in medication response.
   
• Discuss and educate about the function of new genomics-based vaccine.

Nurses’ ethical responsibilities are outlined in the Code of Ethics for Nurses. Parts of this code have a direct connection to genomics.

Self-determination: Patients have both the moral and legal right to control what will be done with and to their bodies. Nurses can talk to patients about benefits, burdens and available options of testing and treatment plans.
 

Primacy of the patient’s interest: Nurses must understand and protect the uniqueness, worth and dignity of each patient under their care. Each patient must be given the opportunity to play an active role in planning and carrying out care.
 

Protection of rights of privacy and confidentiality: Privacy is the right to control access to and disclosure or nondisclosure of personal information, including genomic information.

Resources for keeping up to date on genomic advances include websites with detailed repositories of genomic education materials, and email subscriptions.

• GenomeEd: a repository of high-quality genomic resources for interprofessional members of the healthcare team and educators. This repository is supported by the National Human Genome Research Institute (NHGRI). The resources are vetted by an interprofessional panel and reviewed every three years.
   
• International Society of Nurses in Genetics (ISONG) Repository: a collection of educational resources for nurses and healthcare providers that cover a range of genomic topics. The resources are systematically reviewed and updated every six months.
   
• Global Genetics/Genomics Community (GC3): a set of unfolding, interactive genomic case studies that allows participants to interview patients and make recommendations.
   
• National Human Genome Research Institute (NHGRI): option to subscribe to get updates on learning opportunities and new scientific discoveries.
   
• National Coordinating Center for the Regional Genetics Networks (NCC): an assortment of education modules, evidence-based practice guidelines and genetics policy information. There is an option to subscribe to free newsletters.
   
• Jackson Laboratories Education & Courses: a collection of online clinical and continuing education modules about various topics related to precision health.
   
• Jackson Laboratories Online Minicourses: minicourses on a variety of genomic topics.
   
• Learn Genetics: multiple interactive and video resources on a variety of topics, including genetics, evolution, cell biology, and human health. Some topics include virtual labs or instructions for conducting experiments at home (e.g., extract DNA).

Nurses practice from a holistic viewpoint. Nurses consider patients, families and communities within their contexts.

• Genomics must be considered in context, including patients’ genomic information, clinical presentation and the environments in which they live.
   
• Nurses consider ethical, legal and social issues for individuals and families.
   

Nurses have a central position in the healthcare team and interact the most with patients.

• Nurses are central to interdisciplinary communication and coordination.
   
• Nurses translate and relay concerns of patients and family members to the healthcare team.

Nurses have an optimal skillset to apply genomics in all practice settings and roles. Nurses apply genomics principles at the bedside, in the community, in policy and research.

• Nurses are skilled at obtaining individual and family histories to provide critical information for genomics-informed care.
   
• Nurses obtain and analyze data from physical assessments, individual and family histories, laboratory tests and other sources.
   
• Nurses plan and implement interventions central to genomics-informed care.
   
• Nurses champion patient education and are experts at translating complex topics into lay terms.
   
• Nurses are ethical practitioners prepared to advocate for patient needs.