Choose one of the following subtopics: Pharmacogenomics and chronic illnesses Genomics in patient assessment Genetically competent care for those with chronic illnesses Diss2.do

PROVIDING GENETIC NURSING CARE TO PATIENTS WITH CHRONIC ILLNESSES

There are several chronic health problems with genetic/genomic components that plague the population. These health problems are very difficult and challenging diseases to manage. Evidenced-based nursing practice must include genetic and genomic information when planning patient care. Nurses, through their knowledge and support, play an important role in positive patient outcomes when managing the challenges of these genetically linked diseases.

For this Discussion, you will consider applications of various topics to genetics and genomics. Review the Resources focusing on the application of genetics and genomics to nursing

Choose one of the following subtopics:

· Pharmacogenomics and chronic illnesses

· Genomics in patient assessment

· Genetically competent care for those with chronic illnesses

Locate at least one scholarly journal article that discusses your subtopic.

Resources:

Required Readings

· Coleman, B., Calzone, K. A., Jenkins, J., Paniagua, C., Rivera, R., Hong, O. S., Spruill, I., & Bonham, V. (2014).  Multi-ethnic minority nurses’ knowledge and practice of genetics and genomicsLinks to an external site. .  Journal of Nursing Scholarship, 46(4), 235-244. http://doi.org/10.1111/jnu.12083

· Gaskin, D. J., Thorpe, R. J., McGinty, E. E., Bower, K., Rohde, C., Young, J. H., LaVeist, T. A., & Dubay, L. (2014).  Disparities in diabetes: The nexus of race, poverty, and placeLinks to an external site. . American  Journal of Public Health, 104(1), 2147–2155. http://doi.org/ 10.2105/AJPH.2013.301420

· Mehrian-Shai, R., & Reichardt, J. V. (2015).  Genomics is changing personal healthcare and medicine: The dawn of IPH (individualized preventive healthcare)Links to an external site. .  Human Genomics, 9, 29. http://doi.org/10.1186/s40246-015-0052-0

· Plavskin, A. (2016).  Genetics and genomics of pathogens: Fighting infections with genome-sequencingLinks to an external site. .  MEDSURG Nursing, 25(2), 91-96.  

· Shaw, R. J., McDuffie, J. R., Hendrix, C. C., Edie, A., Lindsey-Davis, L., Nagi, A., Kosinski, A. S., & Williams, J. W (2014).  Effects of nurse-managed protocols in the outpatient management of adults with chronic conditionsLinks to an external site. .  Annals of Internal Medicine, 161(2), 113–121. http://doi.org/10.7326/M13-2567

· International Society of Nurses in GeneticsLinks to an external site. . (n.d.). http://www.isong.org/

· American Nurses Association. (n.d.).  Genetics and personalized medicine Links to an external site. . http://www.nursingworld.org/genetics

Personalized prescriptions | Russ Altman | TEDxStanford – YouTube

Jennifer Doudna: How CRISPR lets us edit our DNA | TED Talk

Ruby Wax: What's so funny about mental illness? | TED Talk

Respond to the following:

· Identify your subtopic and provide a brief summary of your journal article on how this topic relates to nursing practice.

· What is the nurse’s role in providing care in relation to your subtopic and the overarching theme of advocacy?

· What ethical implications should be considered with regard to genetics and genomics for nursing practice? Why?

Support your response with references from the professional nursing literature.

Note: Post a 3-paragraph (at least 350 words) response. Be sure to use  evidence Links to an external site.,   in-text citations Links to an external site. , and  essay-levelLinks to an external site.  writing skills, including the use of  transitional materialLinks to an external site.  and  organizational framesLinks to an external site. . Use the writing resources and the Discussion Rubric to develop your post.

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond with a comment that asks for clarification, provides support for, or contributes additional information to  two or more of your colleagues’ postings.

Post a Discussion entry on  three different days of the week. Refer to the Discussion Rubric.

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Zain Marie Kamara

Subtopic: Genetically competent care for those with chronic illnesses 

Utilizing genetic information to guide medical decisions is known as genetically competent care. For those with chronic illnesses, this can include genetic testing to identify the specific genetic mutations that are causing their condition and use that information to develop targeted treatments. It can also involve genetic counseling to help patients and their families understand their risk of acquiring specific disorders, and to make educated decisions regarding testing and treatment. Additionally, genetically competent care can allow healthcare providers to identify potential drug interactions or adverse responses that may be particular to a patient's genetic makeup. 

In the Medical surgical units, this is an important topic due to the wide variety of patient conditions we are exposed to and have to treat on a daily basis. Understanding the patient’s genetics will help limit polypharmacy, decrease adverse medication interactions, and help manage the patient’s other comorbidities while treating the primary illness. The first step in this approach will be to assess the number of providers and if this type of field is growing in demand. To learn more about how to accomplish this, I found an article that tries to inform public policy development and present possible solutions for improving access to genetic services (Maiese, et al., 2019). The study was conducted using a 16-question electronic survey that was distributed to members of the American College of Medical Genetics and Genomics Member Directory, regional collaborative partners, listservs from national partners, and social media. The researchers were able to obtain 924 responses from these genetic professionals and providers. In conclusion, researchers found that although the number of patients interested in this type of practice is increasing, the number of geneticists has not (Maiese et al., 2019).      

Nursing practice plays a significant role in delivering genetically competent care for individuals with chronic illnesses. Nurses are responsible for assessing patients' genetic risk factors, obtaining informed consent for genetic testing, interpreting test results, and teaching patients about their genetic information (Kilkku, & Halkoaho, 2022). Nurses must also advocate for patients by ensuring that their genetic information is kept confidential, offering emotional support, and addressing any worries or misconceptions that patients may have regarding genetics and genomics. 

Ethical problems connected to genetics and genomics in nursing practice include difficulties related to privacy, informed consent, and access to care. Patients' genetic information must be kept private and only disclosed to those who need to know. They must also seek informed consent from patients before performing genetic tests and provide patients with appropriate information to make educated decisions about testing and treatment (Samuel et al., 2017). Aware of the possibility of genetic discrimination, nurses must also stand out for patients' rights to equitable access to healthcare, regardless of their genetic makeup. 

 References:

Kilkku, N., & Halkoaho, A. (2022). Informed consent, genomic research, and mental health: A integrative review. Nursing ethics, 29(4), 973–987. https://doi.org/10.1177/09697330211066573 

Maiese, D. R., Keehn, A., Lyon, M., Flannery, D., Watson, M., & Working Groups of the National Coordinating Center for Seven Regional Genetics Service Collaboratives (2019). Current conditions in medical genetics practice. Genetics in medicine : official journal of the American College of Medical Genetics, 21(8), 1874–1877.  https://doi.org/10.1038/s41436-018-0417-6Links to an external site.  

Samuel, G.N., Dheensa, S., Farsides, B., et al. Healthcare professionals’ and patients’ perspectives on consent to clinical genetic testing: moving towards a more relational approach. BMC Med Ethics 18, 47 (2017). https://doi.org/10.1186/s12910-017-0207-8 

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Octavia Henry

Pharmacogenomics and chronic disorders were most interesting while considering the topics for this week. I looked up the phrase in several literature sources because I was unfamiliar with it. I discovered that pharmacogenomics is the study of a patient's response to medication depending on their genes by combining genetics and pharmacology ( What Oncology Nurses Need to Know About Pharmacogenomics, n.d.). Having a more individualized, targeted therapy for patients may help lower total expenses, which makes this a crucial idea given the rising cost of healthcare. Mehrian-Shai & Reichardt discovered a significant increase in cost as we approach the end of life, suggesting that a personal preventive approach may be helpful toward a more sustainable future.

In the field of cardiology, there are several chronic illnesses that we help manage daily, so I looked specifically for articles related to them. I was able to find a fascinating article that comprises pharmacogenomics and hypertension. This study aimed to review current hypertensive drugs, their effectiveness, and what's to come (Oliveira-Paula et al., 2019). The most commonly utilized medications used to treat hypertension are diuretics, beta-blockers, ACE inhibitors, and calcium channel blockers, and these groups were the ones selected. Although we already identified that certain medications are maybe less effective in specific races, this study looked specifically into genetic polymorphisms and blood pressure responses for each group of drugs identified earlier. Overall, the study identified several inconsistencies in the findings but supported the idea that the review comprises valuable genetic information for future research in pharmacogenomics and hypertension (Oliveira-Paula et al., 2019).

I believe this topic is essential in my practice because nurses are also knowledgeable in pharmacology and understand what meds can be suggested because they might work better for the patient. Part of being a good advocate as a nurse for your patient is, at times, offering different options because working as a team and bouncing off ideas may help the patient achieve better results, especially when managing a chronic disease, and so many options might have been used already.

The first thing that comes to mind about the ethical implications of genetic testing has to do with access. Like many healthcare things, new therapies/ procedures such as genetic testing are expensive. Although there are currently online options, those results are sent straight to the client without any provider to review the results. This provides a high risk for misinterpretation of results, privacy, and security concerns (Beery & Smith, 2011). And, if in our days so many patients base their requests based on Google searches, one can imagine what not controlled results of genetic testing can lead to.

References

Beery, T., & Smith, C. R. (2011). Genetics/genomics advances to influence care for patients with chronic disease.  Rehabilitation Nursing,  36(2), 54–59.  https://doi.org/10.1002/j.2048-7940.2011.tb00066.xLinks to an external site.

Mehrian-Shai, R., & Reichardt, J. V. (2015). Genomics is changing personal healthcare and medicine: The dawn of iph (individualized preventive healthcare).  Human Genomics,  9(1).  https://doi.org/10.1186/s40246-015-0052-0Links to an external site.

Oliveira-Paula, G. H., Pereira, S. C., Tanus-Santos, J. E., & Lacchini, R. (2019). <p>pharmacogenomics and hypertension: Current insights</p>.  Pharmacogenomics and Personalized Medicine,  Volume 12, 341–359.  https://doi.org/10.2147/pgpm.s230201Links to an external site.

What oncology nurses need to know about pharmacogenomics. (n.d.). ONS Voice.  https://voice.ons.org/news-and-views/what-oncology-nurses-need-to-know-about-pharmacogenomics#:~:text=Dodson%20explained%20why%20every%20oncology%20nurse%20needs%20to,likely%20to%20have%20an%20adverse%20drug%20reaction%20%28ADR%29.Links to an external site.

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