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{{short description|Nursing specialty}}
'''Genetics nursing''' is a [[nursing]] specialty that focuses on providing [[Genetics|genetic]] healthcare to patients.

The integration of genetics into nursing began in the 1980s and has been a slow but important process in improving the quality of healthcare for patients receiving [[Genetics|genetic]] and [[genomic]] based care from nurses. Modeling the United Kingdom, the United States critically established a set of essential competencies as a set of guidelines for [[registered nurses]]. Through the process of consensus the essential competencies were created by the steering committee, and provided the minimalist competency and scope of practice for [[registered nurses]] delivering [[Genetics|genetic]] healthcare to patients.

The Nursing Code of Ethics and other ethical foundations were established for field of genetics nursing to provide regulations when ethical issues develop.<ref>{{cite journal | vauthors = Zahedi F, Sanjari M, Aala M, Peymani M, Aramesh K, Parsapour A, Maddah SB, Cheraghi M, Mirzabeigi G, Larijani B, Dastgerdi MV | title = The code of ethics for nurses | journal = Iranian Journal of Public Health | volume = 42 | issue = Supple1 | pages = 1–8 | date = 2013 | pmid = 23865008 | pmc = 3712593 }}</ref>

==Background==

Adopted from the early Christians in 30 AD, the term [[nurse]] was created from the Latin origin nutrire, which means to nurture or nourish. Establishing [[nursing]] as one of the oldest forms of healthcare and continues to be a growing field of medicine.<ref name="nursing history">{{cite book|last=Egenes|first=Karen J. | name-list-style = vanc |title=History of Nursing|publisher=Jones and Bartlett Publishers|pages=1–20|url=http://www.jblearning.com/samples/0763752258/52258_ch01_roux.pdf}}</ref> [[Genetics]], which is the study of inherited traits and their variation is a much more recent field of medicine. The experiments and theories of [[Gregor Mendel]] in the mid-19th century helped to introduce the field of [[genetics]] into medicine. [[Genomics]] is a subset of [[genetics]] that compares and analyzes [[genomes]] and how the genes interact with one another. Both [[genetics]] and [[genomics]] help to reveal how closely related we are to each other and to other species.<ref name="Human Genetics">{{cite book|last=Lewis|first=Ricki | name-list-style = vanc |title=Human Genetics Concepts and Applications|year=2012|publisher=McGraw-Hill|location=New York, Ny|isbn=9780073525303|pages=2}}</ref> This scientific study is ongoing and strives to interpret health, illness, disease risk, and treatment response. The progress in [[genetics]] and [[genomics]] is applicable to the entire spectrum of health care and all health professionals and as such to the entire [[nursing]] profession.<ref name="transforming health care">{{cite journal | vauthors = Calzone KA, Cashion A, Feetham S, Jenkins J, Prows CA, Williams JK, Wung SF | title = Nurses transforming health care using genetics and genomics | journal = Nursing Outlook | volume = 58 | issue = 1 | pages = 26–35 | date = January–February 2010 | pmid = 20113752 | pmc = 2835985 | doi = 10.1016/j.outlook.2009.05.001 }}</ref> [[Genetics]] and [[genomics]] are important to healthcare because it provides information in the diagnosis, treatment, and prevention of diseases and illnesses. Even though [[genetics]] has been a growing field of medicine since the mid-19th century, the process of integrating [[genomics]] into the nursing curriculum, National Council Licensure Examinations, continuing education, and certification was not highlighted until the 1980s.<ref name="Establishing competencies">{{cite journal | vauthors = Jenkins J, Calzone KA | title = Establishing the essential nursing competencies for genetics and genomics | journal = Journal of Nursing Scholarship | volume = 39 | issue = 1 | pages = 10–6 | date = August 2006 | pmid = 17393960 | doi = 10.1111/j.1547-5069.2007.00137.x | pmc = 10461169 }}</ref> [[Genetics]] and [[genomics]] are fundamental to the [[nursing]] practice because the basis of [[genetics]] can recognize individuals at risk for certain illnesses and diseases, identify the risks of certain disease or illnesses when conceiving children, facilitate drug dosage or selection for certain illnesses or specific patients, and [[genetics]] promotes benefits in treatment of particular ailments.<ref name=competencies />

However, it took twenty more years until the Health Recourses and Services Administration (HRSA) stressed the significance of incorporating [[genetics]] into [[nursing]] education.<ref name="Establishing competencies" /> After HRSA's proposal, there was minor advancement and the development that was established contained a lot of inconsistency. The progress of integration continued to be slow and limited. By fall of 2005, only 30% of academic nursing programs contained a curriculum thread in [[genetics]] and [[genomics]].<ref name="Establishing competencies" /> One of the leading factors in the limited progress of [[genetics]] integration is the relevance to all nursing practice is not fully appreciated by many, and [[genetics]] is also seen by many nurses to be a [[subspecialty]]. Also state boards of [[nursing]] do not require competency in [[genomics]] and [[genetics]] as part of [[licensure]] and [[genetics]] and [[genomics]] are not considered in the evaluations of accrediting bodies. The extremely large size and variation of the nursing workforce provides an extra challenge in the many existing barriers needed to be overcome for [[genetics]] to be implemented.<ref name="transforming health care" /> Some of the first successful training of genetic practices in the nursing workforce can be seen in the [[United Kingdom]]. The main aspect of the [[U.K.]]’s strategy was simplicity. They achieved this by constructing seven essential competencies that were applied to the entire nursing profession. In 2003, the U.K. National Health Service created the NHS National Genetics Education and Development Centre. The main functions of these programs were to enhance [[genetics]] education and to dispense materials and resources for educators of all [[Genetics|genetic]] professions. The [[United States]] mirrored the efforts and ideas established in the [[U.K.]] and adopted similar methods and competencies. The [[U.S.]] National Human Genome Research Institute and the National Cancer Institute of the National Institutes of Health united to initiate strategies, training programs, committees, and define the competencies.<ref name="Establishing competencies" />

==Competencies==

===Development===
The [[Genetics|genetic]] and [[genomic]] competencies are important to the practice of all [[nurses]] regardless of academic preparation, practice setting, role, or specialty.<ref name=competencies>{{cite book|last=Consensus|title=Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators|edition=2nd|year=2009|publisher=American Nurses Association|location=Silver Spring, MD|isbn=978-1-55810-263-7|pages=11–14|url=http://www.genome.gov/Pages/Careers/HealthProfessionalEducation/geneticscompetency.pdf}}</ref> The competencies are significant because they establish a foundation and set of guidelines for the nursing workforce on administering the minimal amount of [[Genetics|genetic]] and [[genomic]] based healthcare. Since the competencies would only reflect the minimalist amount of [[Genetics|genetic]] and [[genomic]] based healthcare, they were specifically drawn up to focus on the scope of practice for [[registered nurses]]. This was done because a [[registered nurse]] is a general level of practice for nursing and requires that one has graduated from a college or university nursing program and has passed the [[NCLEX]]. The [[NCLEX]] is a national licensing exam that signifies minimal competency in practicing nursing if passed.<ref name="Establishing competencies" /><ref name=competencies /><ref name=oxford>{{cite web|title=Oxford Dictionaries|url=http://oxforddictionaries.com/us/definition/american_english/registered%2Bnurse|archive-url=https://web.archive.org/web/20130224041546/http://oxforddictionaries.com/us/definition/american_english/registered+nurse|url-status=dead|archive-date=February 24, 2013|publisher=Oxford University Press|access-date=22 February 2013}}</ref>

To begin the development of the competencies, the initial strategy of the U.S. [[National Human Genome Research Institute]] and the [[National Cancer Institute]] of the [[National Institutes of Health]] established the steering committee. It was composed of nurse leaders from a variety of professional nursing agencies, academic settings, and organizations. Two of the major nursing leaders, Jean Jenkins, RN, PhD, FAAN and Kathleen Calzone, RN, MSN, APNG, FAAN were chosen as the Co-Chairs of the committee. The committee's fundamental function was to generate a mechanism for establishing competencies by recognizing, examining, and comparing existing published competencies.<ref name="Establishing competencies" /><ref name=competencies /> The published competencies that were being examined targeted all health care professionals, specifically those practicing [[genetics]], nurses with bachelor's degrees, and [[advanced practice nurses]]. After the published competencies were reviewed carefully, the developing of the essential competencies was produced in four phases called the process of consensus.

During phase I of the process of consensus, a subset of the committee was created to synthesize competencies from the documents under review that would apply to all registered nurses; then the steering committee reviewed, modified, and approved the recommended competencies.<ref name="Establishing competencies" /> In 2005, nurse representatives of the National Coalition for Health Professional Education in Genetics also reviewed the proposed competencies and made modifications. Throughout phase II, the American Nursing Association published the competencies during a meeting in 2006 and requested judgment, thoughts, and comments from the public, specifically targeting the insight from the nursing community.<ref name="Establishing competencies" /><ref name=competencies /> The 10 comments that were received were recorded and evaluated and the majority of them showed support. Phase III consisted of establishing consensus on the final draft of the essential competencies by the steering committee and the consensus panel, which is also made up of a variety of nursing leaders in different organizations and settings.<ref name="Establishing competencies" /> The steering committee also constructed strategies for integrating [[Genetics|genetic]] and [[genomic]] information into education and practice such as the [[NCLEX]] exam, accreditation programs, certification processes, and nursing curriculum. In March 2006, phase IV occurred and consisted of endorsing the final document by the Nursing Organizations Alliance member organizations.<ref name=competencies />

===Essential Competencies===
The essential competencies consists of two domains: professional responsibilities and professional practice. Under the professional responsibilities domain, all professional activities by [[registered nurses]] are required to fall within the confines of the ''Nursing: Scope and Standards of Practice'' produced by the [[American Nurses Association]].<ref name=competencies />

Also, competent nursing practice now requires the incorporation of [[Genetics|genetic]] and [[genomic]] knowledge and skills in order to:
* Recognize when one's own attitudes and values related to [[Genetics|genetic]] and [[genomic]] science may affect care provided to clients.
* Advocate for clients access to desired [[Genetics|genetic]]/[[genomic]] services and/or resources including support groups.
* Examine competency of practice on a regular basis, identifying areas of strength, as well as areas in which professional development related to [[genetics]] and [[genomics]] would be beneficial.
* Incorporate [[Genetics|genetic]] and [[genomic]] technologies and information into [[registered nurse]] practice.
* Demonstrate in practice the importance of tailoring [[Genetics|genetic]] and [[genomic]] information and services to clients based on their culture, religion, knowledge level, literacy and preferred language.
* Advocate for the rights of all clients for autonomous, informed [[Genetics|genetic]] and [[genomic]]-related decision-making and voluntary action.<ref name="Establishing competencies" />

The competencies for the [[registered nurse]], under the professional practice domain, includes: [[nursing assessment]], which is the application and integration of [[Genetics|genetic]] and [[genomic]] knowledge, identification, referral activities, and provision of education, care, and support.<ref name="Establishing competencies" />

Nursing Assessment for the [[registered nurse]] includes:
* Demonstrates an understanding of the relationship of [[genetics]] and [[genomics]] to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness.
* Demonstrates ability to elicit a minimum of three-generation family health history.
* Constructs a [[pedigree chart|pedigree]] from collected family history information using standardized symbols and terminology.
* Collects personal, health, and developmental histories that consider [[Genetics|genetic]], environmental, and [[genomic]] influences and risks.
* Conducts comprehensive health and physical assessments which incorporate knowledge about [[Genetics|genetic]], environmental, and [[genomic]] influences and risk factors.
* Critically analyzes the history and physical assessment findings for [[Genetics|genetic]], environmental, and [[genomic]] influences and risk factors.
* Assesses clients’ knowledge, perceptions, and responses to [[Genetics|genetic]] and [[genomic]] information.
* Develops a plan of care that incorporates [[Genetics|genetic]] and [[genomic]] assessment information.<ref name="Establishing competencies" />
Identification for the [[registered nurse]] includes:
* Identifies clients who may benefit from specific [[Genetics|genetic]] and [[genomic]] information and/or services based on assessment data.
* Identifies credible, accurate, appropriate and current [[Genetics|genetic]] and [[genomic]] information, resources, services and/or technologies specific to given clients.
* Identifies ethical, ethnic/ancestral, cultural, religious, legal, fiscal, and societal issues related to [[Genetics|genetic]] and [[genomic]] information and technologies.
* Defines issues that undermine the rights of all clients for autonomous, informed [[Genetics|genetic]] and [[genomic]]-related decision-making and voluntary action.<ref name="Establishing competencies" />
Referral Activities for the [[registered nurse]] includes:
* Facilitates referrals for specialized [[Genetics|genetic]] and [[genomic]] services for clients as needed.<ref name="Establishing competencies" />
Provision of support, care, and education for the [[registered nurse]] includes:
* Provides clients with interpretation of selective [[Genetics|genetic]] and [[genomic]] information or services .
* Provides clients with credible, accurate, appropriate and current [[Genetics|genetic]] and [[genomic]] information, resources, services, and/or technologies that facilitate decision-making.
* Uses health promotion and disease prevention practices to:
* Considers [[Genetics|genetic]] and [[genomic]] influences on personal and environmental risk factors.
* Incorporates knowledge of [[Genetics|genetic]] and/or [[genomic]] risk factors (e.g., a client with a [[Genetics|genetic]] predisposition for high cholesterol who can benefit from a change in lifestyle that will decrease the likelihood that the [[Genetics|genetic]] risk will be expressed) .
* Uses [[Genetics|genetic]] and [[genomic]]-based interventions and information to improve clients’ outcomes.
* Collaborates with healthcare providers in providing [[Genetics|genetic]] and [[genomic]] healthcare.
* Collaborates with insurance providers and payers to facilitate reimbursement for [[Genetics|genetic]] and [[genomic]] healthcare services.
* Performs interventions and treatments appropriate to clients’ [[genetics]] and [[genomic]] healthcare needs.
* Evaluates impact and effectiveness of [[Genetics|genetic]] and [[genomic]] technology, information, interventions, and treatments on clients’ outcome.<ref name="Establishing competencies"
/>

==Issues==

===Ethical===

[[Ethics]] pertain to the ‘’rightness’’ and ‘’wrongness’’ of human actions, motives, and conduct. Complicated ethical issues in areas such as justice, privacy, and autonomy, tend to follow both the field of [[genetics]] and the field of [[nursing]]. Ethical problems and dilemmas arise daily in healthcare settings for both the patient and health care provider. For example, all patients and individuals have the right to receive equal health care regardless of gender, religious beliefs, status, or race. A Code of Ethics for Nursing was created by the American Nurses Association, which provides rules, regulations, and guidelines to follow when making a decision that is ethical based. These regulations were mainly established to help provide equal healthcare, protect the rights, safety, and privacy of the patient, and to hold [[nurses]] accountable for their actions and choices. [[Genetics]] can create ethical issues in nursing for a variety of different situations. Many scenarios, questions, and debates have been encountered such as what individuals can receive [[Genetics|genetic]] testing or information? Who owns or controls the information received from the genetic test and how can the owner use that information? However, the code of [[ethics]] does not address [[genetics]] or [[genomics]] specifically, so ethical foundations were also established to help guide [[genetics]] into health care. The foundations provide a set of guidelines to understand and manage an ethical issue if one should arise, and to assist in the translation of [[genetics]] into the healthcare environment.<ref name=ethics>{{cite journal | vauthors = Badzek L, Henaghan M, Turner M, Monsen R | title = Ethical, legal, and social issues in the translation of genomics into health care | journal = Journal of Nursing Scholarship | volume = 45 | issue = 1 | pages = 15–24 | date = March 2013 | pmid = 23369261 | doi = 10.1111/jnu.12000 | doi-access = }}</ref><ref name="online journal">{{cite journal|last=Lea|first=Dale| name-list-style = vanc |title=Genetic and Genomic Healthcare: Ethical Issues of Importance to Nurses|journal=Online Journal of Issues in Nursing|date=31 January 2008|volume=13|doi=10.3912/OJIN.Vol13No01Man04|s2cid=68813628|url=http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/GeneticandGenomicHealthcare.html|access-date=23 February 2013|url-access=subscription}}</ref>

== References ==

{{Reflist}}

[[Category:Genetics]]
[[Category:Nursing specialties]]

Genetics nursing - История изменений

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