 The ISCCPEG Nursing Genomics Project Group has convened a group of experts to create a set of frequently asked questions for nurses at three levels of practice. Entry level nurses, advanced practice nurses who are nurse practitioners, and advanced practice nurses who are nurse educators. The following video will expand upon six of those answers, two from each FAQ in the series. We hope that you enjoy learning more about these areas of nursing genomics. Please share your thoughts in the comments thread of this video. Entry level nurses, why is genomics important for nurses and in which practice settings can it be used? This is a great question because genomics is just so very important for nurses for many reasons. Genomics is a rapidly developing science and we're already seeing improvements from the use of genomics in various sectors, including our health, environment and the economy. In healthcare, we see genomic knowledge from bench science being translated into direct clinical care with improvements in the screening, diagnosis, treatment and prevention of disease. Improvements in health related to the incorporation of genomics can be seen at individual, family, community and population levels. The integration of genomics into healthcare has led to the development of a new approach to care called precision healthcare. Precision healthcare combines a person's unique genomic information with other relevant biological, social, environmental and behavioral determinants of health to develop a care plan tailored to the individual. Genomics can sometimes seem like it is outside the scope of practice for nurses. However, with this shift to precision healthcare approach in clinical care, nurses should consider genomics to be fundamental to nursing. Nurses should be reassured that not only is genomics not outside their scope of practice, but the precision healthcare is very similar to the personalized care approach historically taken by nurses. Precision healthcare combines the holistic approach to care embedded in personalized care with an individual's unique genomic information. Vital aspects of precision healthcare that are already foundational to the personalized care nurses provide include advocacy, equity, access, ethics, patient autonomy, patient education and family relationships. Nurses can take small steps to learn about how genomics can be integrated into their current practice. One example is by learning what genomic factors to ask about and be aware of when obtaining a family history. A family history that includes this information is commonly referred to as the most cost effective genetic tests and can be crucial to appropriate and timely diagnosis and risk assessment. It is vital that nurses integrate genomics into their nursing practice and increase their capacity to provide precision healthcare because nurses are the largest group of healthcare of the healthcare workforce and spend the most time with patients and their families. No other group can make as big an impact on the accessibility quality and effectiveness of precision healthcare. Nurses are key members of the healthcare team and need to have foundational genomics knowledge to help with the team approach to precision healthcare. Additionally, nurses can and should be leaders in precision healthcare. Parallels between personalized nursing care and precision healthcare make this an area with many opportunities for leadership from nurses. Nursing's voice is critical to ensuring a holistic person and family centered approach to the implementation delivery and evaluation of precision healthcare. I'm so excited for the future of nursing as more and more nurses integrate genomics into their practice. In terms of which nursing practice settings genomics can be used in to reference an Oscar winning movie genomics can be used in every nursing role every setting all at once. As we learn about how health outcomes are influenced by genomic variations, as well as interactions between the genome and the environment, we are seeing applications of genomics that are relevant across the lifespan and in all practice settings. Nurses need to be prepared to integrate genomics into the nursing process, including gathering important information about the patient's environment. And nurses in all practice settings need to be prepared to provide patient education and be patient advocates in this new precision healthcare era. Nurse practitioners. What is the role of a nurse practitioner as it relates to genetics and genomics? Nurse practitioners are critical to providing genomics informed care to individuals, families and communities. As advanced practice providers, how nurse practitioners integrate genetics and genomics into their role builds on what registered nurses do. The nurse practitioner scope of practice related to genetics and genomics includes assessing, diagnosing and creating care plans based on precision health principles, ordering genetic tests and providing pre and post test counseling, providing individual and family risk information, and following risk based screening guidelines. Genetics and genomics informed care also includes taking and continually updating a comprehensive family history to identify those at increased risk and ensure they receive appropriate care. Based on the information they collect, nurse practitioners can provide genetic counseling to educate individuals and families, refer them to genetic counselors, if necessary, and implement tailored screening approaches for those at increased risk. Nurse practitioners are key members of the healthcare team and are critical to implementing precision healthcare for all. They should work with their colleagues to incorporate genetics and genomics into clinical care. These colleagues include other healthcare professionals who may be able to provide genomics related information and guidance. Although some nurse practitioners in practice may have received limited content on genomics during their graduate education, there are widely available resources to support lifelong learning, including local genomics experts, continuing education courses and webinars. Nurse practitioners should use these resources to support integration of genomics into their practice. Because of their involvement in every aspect of patient care, nurse practitioners play an extremely important role in implementing genomics informed precision healthcare for all. Nurse practitioners. How can nurse practitioners be prepared to respond when patients share DTC results? Consumers who have undergone some type of direct to consumer genetic test or DTC testing is expected to surpass 100 million very soon. DTC genetic tests are readily available, often marketed as gifts for family or friends, and can be purchased quickly online. Patients bringing DTC genetic test results to primary care providers, such as nurse practitioners, has and will become more frequent. Nurse practitioners should be aware of what these results mean, where to go for assistance, and recommendations for next steps. Patients trust their healthcare team and are counting on you for the most sound and educated advice. In these cases, it's up to you to remain knowledgeable about how to interpret these results, as well as keeping an updated list of genetic specialists who may be able to help you. There are nurse practitioners with clinical genomics nurse credentials, or those who may be working in a genetics clinic. Additionally, there are physicians who work as clinical geneticists, as well as genetic counselors to name a few. While DTC genetic tests can provide details about ancestry, traits, and some health risks, they do not test for all known variants that can be disease causing. This means they should not be used to rule out or screen for a particular condition. Even if the DTC genetic test results show an abnormality that may be clinical actionable, these results typically need to be confirmed with a clinical genetic test. While DTC tests look at some genomic information, clinical genetic tests are more comprehensive and are based upon current genomic information known for a certain disorder. Due to this, DTC genetic test results should not be used for clinical decision making. It is important to communicate with patients about the risks of a false sense of security if the results in fact come back normal. As mentioned, all known variants are typically not tested, which means that the patient may still be at risk and patients should really understand this. For instance, if a DTC genetic test result identifies a single gene high risk variant, such as those we see with the BRCA gene variants for breast cancer, clinical genetic testing should be initiated and or referral or further discussion with a genetic specialist should occur. In the meantime, it's your duty as a nurse practitioner to maintain and update a thorough family history. And then depending on the results of the clinical test, patients, family members and close relatives should be educated about their risk and offered any screenings, treatments or other interventions as indicated. For patients with a low risk variant or one considered to be multifactorial involving genetics plus the environment, such as with type 2 diabetes, the provider should be prepared to explain that this may indicate increased risk for condition, but does not mean that they have or will even get the condition. Patient education in this case should focus on lifestyle management, as well as ongoing screenings. However, DTC genetic testing has been approved for a few variants for medication management via pharmacogenomics tests that are FDA approved do not need to be confirmed with a clinical genetic test. Currently, there are just a few medications for which this is approved. However, one caveat here again is that patients may not be tested for all known genetic information and may only get results for a handful of the variants that are known for drug metabolism specifically. You always want to remember your chemist, also known as your pharmacist, as someone to seek professional guidance from as well. With the increase in DTC genetic test access as well as the increased use, interpretation of these results will fall on nurse practitioners or other health care providers who are trusted to provide the most sound advice. In order to do this, nurse practitioners are expected to remain knowledgeable and up to date just as they would with any other clinical practice update in order to provide the best evidence-based care for every patient. Nurse educators, where is Genomics included in the American Association of Colleges of Nursing, AACN Essentials? So you want to know where Genomics is included in the Essentials. The American Association of Colleges of Nursing, the AACN, released a new version of the Essentials document in 2021. And the Essentials document is intended to provide a framework for the preparation of nurses at four-year colleges with specific guidance about developing and revising nursing curricula at specific degree levels. A very important document for academic nurse educators. So to answer the question, where is Genomics included in the Essentials? It's everywhere in the Essentials. Each one of the 10 domains includes competencies and sub-competencies for which Genomics-informed nursing has relevant and concrete applications. Genomics is referred specifically several times in the document, but you won't always find the elements related to Genomics simply by clicking and entering a search on genetics or genomics. I'll give you just a couple of examples. So the first domain in the Essentials document talks about foundational knowledge that nurses need to practice. And the competency 1.2A states that entry-level nursing education should enable nurses to apply or employ knowledge from nursing science as well as natural, physical and social sciences to build an understanding of human experience and nursing practice. Advanced practice nurses need to take this idea one step further, and in sub-competency 1.2F, it's noted that they should be able to synthesize this knowledge from nursing and other disciplines. Notice that in these two sub-competencies, the word genomics or genetics does not appear. However, biology is one of the natural sciences, and the study of genomics is essential for understanding the fundamental biological processes that make up human physiology, anatomy, including growth development, and the maintenance of homeostasis. Domain 2 is another example. Domain 2 of the Essentials document focuses on person-centered care with applications to individuals and families. What gets more genomic than that? One of the sub-competencies in this domain discusses the importance of being able to apply individualized information, specifically genomic information for the delivery of personalized healthcare. Both entry-level and advanced practice nurses must understand that personalized or precision healthcare is taking into account individual risk levels, screening decisions, and treatment plans. For example, if a woman has a lifetime risk for breast cancer that exceeds 20%, guidelines recommend that she receive annual screening MRI in addition to mammography. The Nursing Genomics Project Work Group from ISCCPEG has developed a frequently asked questions page, and on that page, we provide a table that maps a few important nursing learning objectives and activities that will help nurse educators teach students the application of genomics-informed nursing care. So final answer, nursing genomics is everywhere in the Essentials. Nurse Educators. How can genomic competency be assessed? It's my opportunity to provide some additional information on how we, as nursing educators, can assess genomic competencies. With the publication of the new Essentials by the American Association of Colleges on Nursing, our profession is moving towards a new model of competency-based education. Competencies are the knowledge, skills, attitudes, and behaviors that contribute to a nurse's performance. Transitioning to this new model presents an ideal time to ensure nursing students have the foundational genomic competencies needed to enter the practice environment. In nursing education, we must also consider the novice-to-expert model developed by Dr. Patricia Benner. Assessment of genomic competency acquisition can also be viewed through the same five levels of proficiency, novice, advanced beginner, competent, proficient, and expert. Teaching and assessment strategies for each of these stages can be scaffolded to help students gain skills and knowledge as they progress through each stage. Let me illustrate how we can map course objectives to the AACN Essentials domain of person-centered care while keeping in mind levels of proficiency as students demonstrate competency attainment. Gerald is a second-year nursing student who is taking his first clinical course, health assessment. In this course, students must show competency by utilizing interviewing skills and assessment skills to elicit a comprehensive health history. At the novice level, Gerald was able to identify and gather essential components of a person's individual health history. Meanwhile, Sophia is in her fourth and final year of her undergraduate nursing program and enrolled in a leadership course where students must apply strategies for increased collaborative practices. At a competent level, Sophia was able to obtain a full patient and family health history and discern a relative hereditary risk. She was then able to advocate for genetic counseling for this family. Monique is a family nurse practitioner student about to graduate and take her licensure exam. Monique is enrolled in the transitioning to advanced practice course. One course objective requires students to evaluate healthcare clinical process and practice problems and identify possible solutions. Monique works alongside her preceptor in a rural clinic located in parts of Appalachia. Most of their patients hesitate to obtain genetic testing when warranted. Monique demonstrates expert communication skills to gain trust and develop a variety of modalities to improve the genomic literacy of the patients that she serves. Whether your school of nursing has a concentrated genomic course or genetics and genomic information is threaded throughout the curriculum. These examples identify ways that genomic competency skills can be observed and assessed in the clinical setting. As you can see, competencies mature over time and become more sophisticated with ongoing practice. Within the classroom, we can also assess proficiency levels for baseline and advancing competency attainment through case studies, simulation activities, and even validated assessment tools. See other FAQs in this section for more details on resources and ideas on ways to map and assess genomic competencies within this new model. And I encourage you to explore all the FAQs that encompass rich information for practicing nurses just entering the field or have an advanced degree.