The effective use of genetic information in nursing began at a slow pace, but it has gradually gained pace. Research shows that it has increasingly enabled the provision of quality healthcare for patients, therefore giving them a reason to smile. However, there is also increasing criticism in regards to the use of gene therapy in the health sector. Medical practitioners have been accused of incompetence’s in dealing with gene technology at their place of work. This includes several other issues of genomic nursing that the public have complained about even with the improvement it has brought to healthcare sector. This paper incorporates an evidence-based practice on the knowledge of genomics and the need for such education among healthcare workers. The aim is to provide an evidence-based practice of genetics and gene therapy in the provision of quality healthcare to patients. The paper makes use of various academic and professional sources to back up the provided information.
Definitions of terms are integral to understanding genetics in healthcare among healthcare practitioners. This is because the term “genetics” seems to confuse, or has confused many individuals (Cowen & Moorhead, 2011). It is, therefore, advisable that the genetic language be disseminated to the public domain to ensure that nobody strains when it comes to explaining or understanding common terminologies. Below are some chosen unique genetic manipulation terminologies useful for nurses.
- Genes – These are some DNA sequence patterns that carry organisms’ hereditary characteristics.
- Genetics – It refers to the study of individual genes with particular focus on their inheritance impact. Genetics explains why certain conditions or traits pass through from a generation to another.
- Genomics – It is the full study of a set of genes as a group within the overall human genome. Environmental, cultural and psychosocial factors play a big part in genomics. In healthcare provision, genomics is integral in identifying pathways for screening, diagnosis and even treatment.
- Pedigrees – These are specific diagrams of family history that include trends of medical issues within the family. Pedigrees provide essential information that guides health practitioners in providing effective and quality healthcare.
- Technology – In health, technology is the innovation in healthcare functions to improve healthcare systems. Technology is vital in genetic diagnosis and handling of genetically associated information.
The above explanation of terms not only equips nurses with adequate information but also gives patients adequate knowhow on genetic information. Experts’ opinion suggests that the treatment process is made easier if all involved parties at least bear basic knowledge on genetics, therefore, enabling them to comply with prescription procedures and schedules leading to the provision of quality healthcare.
Role of health care providers in gene therapy
In gene therapy, healthcare providers take a bigger part of responsibility than patients. Upon educating patients about some of the terminologies as explained above, health professionals take control of everything thereafter. With application of evidence-based practice nurses must be critical with their decision making. They should always look to answer the question “Why” and provide evidence before diagnosing a patient. However, accurate diagnosis may not be possible unless a comprehensive dialogue is initiated between the patient and the medic (Edwards & Elwyn, 2009). An oral conversation will enable the healthcare provider to acquire information about the history, sequence and nature of the problem of the patient. The doctor/nurse will ask some key questions in the process such as the existence of similar symptoms in siblings or other relatives as well as how these symptoms were handled in the previous cases. After getting satisfactory information from this through oral conversation with the patient, the medic can then proceed to the next step.
Having noted any family related occurrence of a disease, the medic is more assured to perform an accurate diagnosis of the genetically related issue that the patient may be suffering from. However, even before this step, a pedigree diagram formulated from the oral observation will be helpful in identifying the genomics concerns. Then, with the assistance of technological devices, the initial stages of screening will be done attentively and carefully. If the medics identify and establish evidence of a genetic concern, he/she will be tasked with formulating some bases to analyze specific features of the issue. At this point, the patient may be highly concerned about the nature of the disease, especially when it emerges that siblings or other relatives could be possessing identical symptoms meaning that the problem is spread across the entire family (Feeny, 1988). The healthcare provider has a duty to take control of the issue matter and then ensure that the patient does not panic.
In the next step, the healthcare provider is expected to advance with genomics diagnosis to identify the real problem, cause, treatment and prevention measures. Evidence-Based Practice standards in nursing recommend a direction-setting in this step. After disclosing the information to the patient, it is ideal that their worry and panic is mitigated. This could be done by giving them assurance that everything will be fine and that the entire situation is under control. However, since the health issue is family related, the heath provider has to set up policies in making sure that the whole family is well advised about the disease. The family has the right to know the truth about the genomic situation to enable them to prepare to assist each other in advance. The healthcare provider will only guide them in observing a restricted routine at the same time helping them counter the problem through their skill.
In controlling the genomic situation of the victim’s family, nurses are expected to demonstrate a high level of competence. This entails incorporating the learned knowledge with individual skills to provide a safe ground where patient can feel comfortable and assured that everything is being done for them. Here, the issue of ethical and professional behavior is fundamental. Even with the realization that the patient can completely rely on the nurse for help, their condition is not to be taken for granted in any way (Forrester & Griffiths, 2010). A continuous guide and moral support in dealing with the genomic issue will win the hearts of the family hence give an easy time for the healthcare provider to achieve their treatment goal or objective.
The safety of patients is fundamental in any nursing practice. For genetic manipulation, safety procedures are always outlined to act as a guide for participants in the process of administering treatment or therapy. In genetic associated diagnosis, safety is a primary element, but how safe it the technology that handles genomics. Straight away from the diagnosis to the treatment of genetic diseases, Evidence-Based Practice recommends medical practitioners to be guided by operational routine safety measures. For instance, nurses are expected to observe restricted movement among patients diagnosed with such genetic complexions while on treatment schedules (Lu, Chen, Lu & Guan, 2010). Nurses are also a source of reference for patients who in one way, or another may need help. Research has shown that a lot of medical failures happen due to lack of observation of safety measures resulting to ineffective and inadequate treatment standards. When medical practitioners carry the responsibility of instilling safety routines, such incidences are likely to be eliminated. This would render the healthcare environment very ideal in the treatment of genetic related complications.
It is however not only the nurses or health care providers who should be concerned about safety; safety is also a responsibility for patients themselves. Healthcare objectives can never be fully realized if the task entirely lies within one party. While being diagnosed with certain complications, the patient is expected to cooperate in initiating change procedures and appropriately deal with immergences. Normally, a doctor/nurse will give some directions to the patient, including safety dictations. For example, when asked to give information that would lead to effective medication, the patient should not give false details that would compromise the safety of the medication process. When such a case happens, the whole genetic medication process will no doubt be of limited effect. Safety has been explained to be the cause of many flaws in the health sector and specifically in genetic processes (Monsen & American Nurses Association 2009). Therefore, it is advisable to install a safety guided health care environment so as to improve the outcomes of genetic associated medication and treatment processes.
Legal and Ethical issues
Ethical and legal issues are vital in administering genomic diagnosis and treatment. Healthcare providers have a well-defined professional conduct to guide their execution of duties at the work place. Evidence-Based practice identifies several cases of flawed behavior and breach of the code of ethics. In genomics, the most common cases of ethical concerns arise from the issue of privacy. When a genomic patient visits a health center, they trust that their health information is always in safe hands. This is because personal health matters are private issues only discussed between a health care provider and the patient, and it is by no means an issue to be discussed in public (Prows & Saldaña, 2009). The reverse, however becomes the surprising truth since many medical practitioners have disclosed patient genomic information to the public.
The other ethical concern is the extent and manner in which genomic patient receive diagnosis. It is evident that health providers have exercised bias in providing health care. In genetic treatment, bias is normally experienced in the diagnosis. Health providers tend to favor some individuals and compromise their services to others even though it is expected that every patient is treated fairly. This is a growing challenge in the health care sector. The major cause for this condition could be the existence of limited resources in handling a big number of patients. Genomic patients continue to rise in number with the increase of the world population while resources remain the same or even become limited (Strecker et al., 2002). A strain for attention could be credited with bringing about the incidences of corruption and unfair treatment at the health center. Collective effort in the health sector is needed to curb this ill-intentioned practice.
Another issue of legal and ethics is the nature in which health care providers work in administering the genomic treatment. Research provides adequate evidence that majority of public health premises are poorly managed. This means that medical practitioners work in poor environments that do not motivate them to execute their duties effectively. This defines the gap between public hospitals and privately managed hospitals. Infrastructural development is highly needed to provide a peace of mind among health practitioners. No one can give their best without the necessary motivation and systems fail due to lack of positive reinforcement (Wiggins & Middleton, 2013). The situation is even worse especially in a healthcare environment where nurses handle sensitive conditions of genomic patients. In fact, there are cases where medical works have contracted some of the infections from the patients that they are handling. Unless something is done to address this issue, it will always remain to be a bigger challenge in the health sector.
Mandatory genomic screening is the perfect way to identify a family with a gene issue. However, there has been limited public mandatory screening in recent times. This is because stakeholders argue that some family health secrets revealed through screenings may be undermined by interested parties. Again, this raises a legal concern about the practice since clinical professional standards protects patients’ health information. The major claim is that most public health systems are never at any one instant ready to handle such tasks (Kreps, 2008). Newborn screening on the public front has not been implemented for the benefit of public health, and unless one visits a health center, they are not protected from genomics whatsoever. This means that an individual could live with a genomic complication without their any knowledge or awareness of its existence. They will only become aware of the problem after their visit to a health center or when they become sick.
It could be very possible for health providers to conduct mandatory genomic screening with the help of technology. Unlike the ancient days when people had difficult routines when it came to seeking and getting adequate medical prognosis and attention, technology has removed a lot of burdens. Utilization of a single screening device in checking many people efficiently and effectively has been rendered possible by technological advancement. As a matter of fact, a single nurse can attend very many patients at a relatively short time. Therefore, conducting genomic screening, especially for newborn babies can be carried out without the use of extensive efforts. Technology has reduced the cost of healthcare systems in many areas and screening could even help out greatly in cutting the cost of providing medical services. When a child is screened in advance and a young age, controlling his/her health condition will be easier and effective as compared to when screened only after they visit a health center due to sickness.
As discussed above, genetics’ roles in health care provides a platform where medics can exercise effective and efficient service delivery. Evidence-Based Practice acknowledges the way technology backs up the quest to quality healthcare system. The role of nurses among other stakeholders in the medical fraternity is integral towards the success and the achievement of equitable and flawless healthcare system. Nurses’ task in diagnosis, prevention and treatment of genomic diseases should be accompanied with a sense of personal responsibility in order to eradicate ethical and safety concerns that have always compromised the health sector. It is no doubt that the health of the public will be in safe hands when everybody carries out their duties responsibly and in a professional manner.
Cowen, P. S., & Moorhead, S. (2011). Current issues in nursing. St. Louis, MO: Mosby Elsevier.
Edwards, A., & Elwyn, G. (2009). Shared decision-making in health care: Achieving evidence-based patient choice. Oxford: Oxford University Press.
Feeny, D. (1988). Health Technology in Ontario: Report to the Ontario Health Review Panel.
Forrester, K., & Griffiths, D. (2010). Essentials of Law for Health Professionals(2nd ed.). London: Elsevier Health Sciences APAC.
Kreps, G. L. (2008). Applying Weick's model of organizing to health care and health promotion: Highlighting the central role of health communication. Journal of Genetic health.
Lu, H., Chen, H., Chen, H., Lu, L., & Guan, H. (2010). Genetic regulatory network analysis for Myoc based on genetical genomics approach. Journal of nursing health. doi:10.1109/BMEI.2010.5639531
Monsen, R. B., & American Nurses Association. (2009). Genetics and ethics in health care: New questions in the age of genomic health. Silver Spring, MD: American Nurses Association.
Prows, C. A., & Saldaña, S. N. (2009). Nurses' Genetic/Genomics Competencies when Medication Therapy is Guided by Pharmacogenetic Testing: Children with Mental Health Disorders as an Exemplar. Journal of Pediatric Nursing. doi:10.1016/j.pedn.2008.02.033
Strecker, M. N., Williams, A. J., Bondy, M., Johnston, D. A., & Northrup, H. (2002). Knowledge and Attitudes of Hispanic Women and Their Health Care Providers about Breast Cancer Risk Factors and Screening. Community Genetics. doi:10.1159/000066685
Wiggins, J., & Middleton, A. (2013). Getting the message across: Communication with diverse populations in clinical genetics. Oxford: Oxford University Press.