Journal of Nursing Education

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Educational Innovation 

Promoting Integration of Genetics Core Competencies into Entry-Level Nursing Curricula

Catherine Y. Read, PhD, RN; Ann M. Dylis, PhD, RN; Sandra R. Mott, PhD, RNC; Nancy J. Fairchild, MS, RN, CAES

Abstract

Nurse educators must respond to the growing need to teach genetics content in undergraduate nursing curricula. Recently developed genetics core competencies can be used to guide curriculum assessment and planning. This article describes a 5-year effort to integrate genetics education into a baccalaureate nursing curriculum and provides the results of a curriculum survey based on published genetics core competencies.

Dr. Read is Assistant Professor, and Dr. Mott and Dr. Fairchild are Associate Professors, Boston College, William F. Connell School of Nursing, Chestnut Hill; and Dr. Dylis is Assistant Professor, Northeastern University, School of Nursing, Bouve College of Health Sciences, Boston, Massachusetts.

Address correspondence to Catherine Y. Read, PhD, RN, Assistant Professor, Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467; e-mail: readca@bc.edu.

Received: November 10, 2003
Accepted: March 05, 2004

Abstract

Nurse educators must respond to the growing need to teach genetics content in undergraduate nursing curricula. Recently developed genetics core competencies can be used to guide curriculum assessment and planning. This article describes a 5-year effort to integrate genetics education into a baccalaureate nursing curriculum and provides the results of a curriculum survey based on published genetics core competencies.

Dr. Read is Assistant Professor, and Dr. Mott and Dr. Fairchild are Associate Professors, Boston College, William F. Connell School of Nursing, Chestnut Hill; and Dr. Dylis is Assistant Professor, Northeastern University, School of Nursing, Bouve College of Health Sciences, Boston, Massachusetts.

Address correspondence to Catherine Y. Read, PhD, RN, Assistant Professor, Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467; e-mail: readca@bc.edu.

Received: November 10, 2003
Accepted: March 05, 2004

All nurses now need education related to genetics. Identification, referral, and support of clients with genetic concerns are no longer the sole responsibility of specialists. As the genetic components of disease become better understood and as genetically based diagnoses, screening tests, and therapies develop, clients need and expect nurses to help them interpret information, evaluate risks, and use services (International Society of Nurses in Genetics [ISONG] & American Nurses Association [ANA], 1998).

The principles of genetics are initially explored in middle or high school biology and expanded in science courses in schools of nursing. However, it is imperative that genetics also be integrated into nursing curricula. The historical practice of teaching genetics to nursing students solely in the context of maternal-child or human development courses must be abandoned. To prepare nurses who can “think genetically when approaching a clinical situation or problem that on the surface may not appear to be genetic,” (Lashley, 2000, p. 798) educators must seriously evaluate the adequacy of genetics content in every course.

In a recent position statement (Lea, 2002), the American Academy of Nursing recommended that nursing programs adopt the genetics core competencies developed by the National Coalition for Health Professional Education in Genetics (NCHPEG) (2001). These competencies represent the minimum knowledge, skills, and attitudes necessary for health care professionals from all disciplines to provide patient care that involves awareness of genetic issues and concerns. The American Medical Association, the National Human Genome Research Institute, and the ANA established the NCHPEG in 1996 to promote health care professional education and access to information about advances in human genetics.

Responding to an explosion of new scientific knowledge is a challenge, and schools of nursing must develop strategies for teaching genetics that will be effective in their particular curricula. Some experts promote requiring a separate human genetics course (Zamerowski, 2000). However, this may not be feasible in programs that integrate scientific content into nursing courses. Even when a separate genetics course is required, all nursing faculty bear the responsibility for teaching genetics content relevant to their course material or clinical setting, just as they do with pharmacology, pathophysiology, and nutrition. The implications of the genetics revolution permeate every aspect of nursing and must be introduced in the particular context of every nursing course.

This article briefly summarizes the history of genetics in nursing education, describes ongoing efforts to promote the integration of genetics content in our baccalaureate curriculum, and presents the NCHPEG competencies as they were used in a curriculum survey conducted at the Boston College William F. Connell School of Nursing (BCSON).

Genetics and Nursing Education: A 40-Year Historical Perspective

Brantl and Esslinger advocated for the inclusion of genetics in nursing curricula as early as 1962. However, there was a generally slow response to this call on the part of nurse educators (Scanlon & Fibison, 1995; Williams & Lessick, 2001). Subsequent studies in the 1970s and 1980s documented the limited human genetics knowledge of nursing students and professional nurses (Cohen, 1979), and noted minimal curricular attention to genetics-related topics (Mertens, Hendrix, & Morris, 1984; Monsen, 1984). Compared to the findings of Monsen (1984), a 1999 study by Hetteberg, Prows, Deets, Monsen, and Kenner found that the number of undergraduate nursing programs offering genetics content had increased, but the mean hours of that content had actually decreased.

As a way to promote education of nurses and to delineate the role of nurses in genetics, ISONG collaborated with the ANA to publish a Statement on the Scope and Standards of Genetics Clinical Nursing Practice (1998). In addition, many nurses have participated in or responded to interdisciplinary efforts to promote education in the field of genetics, including the development of the NCHPEG criteria (Jenkins, 2002; Lashley, 2001; Lea, 2002). Others have advocated specific strategies and resources that could be used by nursing faculty to increase genetics content (Lashley, 1999, 2000; Lea & Monsen, 2003; Williams, Prows, & Lea, 2000).

Continuing education providers are making efforts to promote genetics education for practicing nurses and nursing faculty (Cincinnati Children’s Hospital Medical Center, 1999; Jenkins, Prows, Dimond, Monsen, & Williams, 2001; Lea & Lawson, 2000) who may have received inadequate genetics content in their nursing programs. Genetics content in basic RN preparatory programs has not been specifically required by state boards of nursing in the past (Monsen et al., 2000). However, the National Council Licensure Examination (NCLEX-RN®) Detailed Test Plan (Brown, Wendt, & Crowell, 2001) now lists performing a genetic history and providing genetic counseling as nursing activities related to health and wellness. Entry-level nursing programs are responding to the call for increased genetics education by developing new courses, requiring genetics courses as part of basic science preparation, or integrating genetics content throughout the curriculum (Lashley, 2000; Zamerowski, 2000). At BCSON, integration of genetics content throughout the curriculum has been a goal for several years, with the recent efforts spearheaded by an ad-hoc Genetics Interest Group.

The “5-Year Plan” (1998–2003): Genetics at BCSON

The process began in the late 1990s when data were gathered to evaluate the presence and extent of genetics content in the existing curriculum. Lashley’s (1999) guidelines for recommended genetics content served as the basis for evaluation of the results. Survey results revealed that genetics was mentioned in most courses but in a limited way. When these findings were presented at the annual evaluation meeting, the faculty agreed that increased integration of genetics content should be a goal. A faculty development workshop on genetics was planned for the following year.

As the Human Genome Project neared completion in 2001, BCSON faculty members were well aware of the gene-environment interactions that affected health and illness, the relevance of genetics-based therapies, and the complexities of the ethical, legal, and social issues surrounding genetics information. However, to ensure continued interest and updated information in courses, an ad-hoc Genetics Interest Group, composed of representatives from all departments, was formed.

The Genetics Interest Group collected and disseminated articles about genetics in nursing education, provided consultation to faculty, presented guest lectures on genetics topics in several courses, attended and presented at genetics conferences, participated in genetics programs at other area nursing schools, updated the school’s genetics resources and bulletin board, conducted research related to genetics, and published journal articles on genetics topics. To familiarize faculty with the recently published NCHPEG competencies and to evaluate how well our integrated genetics curriculum was addressing them, the Genetics Interest Group incorporated the competencies into a survey instrument in 2002–2003. The results are included in the Table and described in the following section.

Courses at BCSON that Address NCHPEG (2001) Core Competencies (N = 20 Required Science and Nursing Courses)Courses at BCSON that Address NCHPEG (2001) Core Competencies (N = 20 Required Science and Nursing Courses)

Table:

Courses at BCSON that Address NCHPEG (2001) Core Competencies (N = 20 Required Science and Nursing Courses)

Faculty Survey of Inclusion of NCHPEG Competencies in Undergraduate Courses

Lead course faculty for the 20 required science and nursing courses at BCSON were asked to complete a survey about inclusion of genetics content in their courses. The survey items consisted of the NCHPEG competencies listed in the Table. We excluded nine competencies that the NCHPEG identified as relevant for health care professionals who provide direct genetics counseling services to their clients, since these would not apply to entry-level nurses.

Faculty were asked to indicate whether each competency was addressed (even if only partially) or not addressed in their course. Comments were encouraged, and faculty were asked to provide examples of how each competency was addressed in their course. The number of faculty who reported that each competency was addressed is reported in the Table. A 100% response rate was achieved. It should be noted that faculty teaching clinical courses were also surveyed. Although most instructors reported that the competencies were not addressed, their comments indicated that clinical situations often gave rise to discussions about genetics topics.

The results of this survey suggest that genetics is integrated into the nursing curriculum at BCSON. The NCHPEG competencies addressed by the largest number of courses (50% or more) included genetics terminology, how identification of genetic variations facilitates clinical care, the importance of family history in client assessment, and the need to protect client privacy, autonomy, and cultural identity. The competencies addressed by the fewest courses (20% or less) included indications for a referral to a genetics specialist, the history of misuse of genetics information, and ways to access and disseminate current information about genetics and related policy issues.

Faculty comments about how the NCHPEG competencies are addressed in the courses provided a more detailed look at how genetics is integrated throughout the curriculum. For example, molecular genetics is taught in anatomy and physiology and is later reinforced in nursing courses. All nursing courses address the genetic aspects of common conditions such as cancer, cardiovascular disease, diabetes, schizophrenia, Alzheimer’s disease, and inherited pediatric disorders. Students in health assessment take a genetics history, and prenatal screening and diagnosis is covered in depth in maternity nursing. Culturally competent nursing care is an important thread throughout the curriculum that often stimulates discussion of genetic variations. The interactions between genes and environment are stressed throughout the curriculum, as are the dilemmas faced by clients, families, and communities regarding genetics-related issues.

Following completion of the survey, the results were discussed at a meeting that included the entire BCSON faculty. In addition, the results with the compiled comments were discussed in greater detail by the undergraduate curriculum committee. In the survey summary, the Genetics Interest Group identified areas that were adequately covered and made the following suggestions:

  • Continue to develop own knowledge base in genetics and incorporate principles wherever possible.
  • Select course texts that include genetics content.
  • Supplement texts with readings about the genetic aspects of course content.
  • Use genetics resources on the Internet and resource people within the school and local community.
  • Select clinical experiences that demonstrate genetics concerns.

Where Do We Go From Here?

Faculty must overcome the fear of not knowing enough about genetics, and nursing programs must acknowledge that genetics has become an essential basic science of the discipline. Nurses must know how to identify genetics issues, how and when to refer clients to specialists, and how to provide basic support and counseling using up-to-date resources. These competencies should be addressed throughout entry-level curricula by faculty who can acknowledge that genetics is an emerging field that requires ongoing learning.

Successful integration of genetics content throughout an entry-level nursing program is clearly a multi-faceted endeavor. An individual or department should convene an interest group and set realistic goals. Ideally, an interest group would include faculty from all nursing specialty areas and science courses. It is not necessary for those individuals to be experts in all aspects of genetics, since there is current nursing literature available to help decipher the complexities of genetics concepts and provide templates for genetics education.

A survey of genetics content in courses, including basic science courses, is an easy way to promote the genetics agenda and obtain information about omissions or duplications of content. Dissemination of the survey results involves the entire faculty and stimulates discussions about how to overcome the barriers of lack of time and knowledge. The NCHPEG competencies were co-authored by nurses and provide a logical format for curriculum evaluation and development. Using these competencies as a guideline is one way to help health care professionals identify the knowledge required to effectively care for clients with genetic concerns.

References

  • Brantl, V.M & Esslinger, P.N. (1962). Genetics implications for the nursing curriculum. Nursing Forum, 1(2), 90–100. doi:10.1111/j.1744-6198.1962.tb00109.x [CrossRef]
  • Brown, P.A., Wendt, A. & Crowell, M.J. (2001). National Council detailed test plan for the NCLEX-RN® examination. Chicago: National Council of State Boards of Nursing.
  • Cincinnati Children’s Hospital Medical Center (1999). GPNF suggestions/strategies. Retrieved October 10, 2003, from http://www.cincinnatichildrens.org/ed/clinical/gpnf/curriculum/recommend/used-strategies
  • Cohen, F. (1979). Genetic knowledge possessed by American nurses and nursing students. Journal of Advanced Nursing, 4, 493–501. doi:10.1111/j.1365-2648.1979.tb00883.x [CrossRef]
  • Hetteberg, C.G., Prows, C.A., Deets, C., Monsen, R. & Kenner, C.A. (1999). National survey of genetics content in basic nursing preparatory programs in the United States. Nursing Outlook, 47, 168–174. doi:10.1016/S0029-6554(99)90092-1 [CrossRef]
  • International Society of Nurses in Genetics & American Nurses Association. (1998). Statement on the scope and standards of genetics clinical nursing practice. Washington, DC: American Nurses Association.
  • Jenkins, J. (2002). Genetics competency: New direction for nursing. AACN Clinical Issues, 13, 486–491. doi:10.1097/00044067-200211000-00002 [CrossRef]
  • Jenkins, J.F., Prows, C., Dimond, E., Monsen, R. & Williams, J. (2001). Recommendations for educating nurses in genetics. Journal of Professional Nursing, 17, 283–290. doi:10.1053/jpnu.2001.28186 [CrossRef]
  • Lashley, F.R. (1999). Integrating genetics content in undergraduate nursing programs. Biological Research for Nursing, 1, 113–118. doi:10.1177/109980049900100208 [CrossRef]
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  • Lea, D.H. (2002). Position statement: Integrating genetics competencies into baccalaureate and advanced nursing education. Nursing Outlook, 50, 168–169. doi:10.1067/mno.2002.127296 [CrossRef]
  • Lea, D.H. & Lawson, M.T. (2000). A practice-based genetics curriculum for nurse educators: An innovative approach to integrating human genetics into nursing curricula. Journal of Nursing Education, 39, 418–427.
  • Lea, D.H. & Monsen, R.B. (2003). Preparing nurses for a 21st century role in genomics-based health care. Nursing Education Perspectives, 24, 75–80.
  • Mertens, T.R., Hendrix, J.R. & Morris, M.M. (1984). Nursing educators: Perceptions of the curricular role of human genetics/bioethics. Journal of Nursing Education, 23, 98–104.
  • Monsen, R.B. (1984). Genetics in basic nursing program curricula: A national survey. Maternal Child Nursing Journal, 13, 177–185.
  • Monsen, R.B., Anderson, G., New, F., Ledbetter, S., Frazier, L.G. & Smith, M.E. et al. (2000). Nursing education and genetics: Miles to go before we sleep. Nursing and Health Care Perspectives, 21, 34–37.
  • National Coalition for Health Professional Education in Genetics. (2001). Committee report: Recommendations of core competencies in genetics essential for all health care professionals. Genetics & Medicine, 3, 155–158. doi:10.1097/00125817-200103000-00011 [CrossRef]
  • Scanlon, C. & Fibison, W. (1995). Managing genetic information: Implications for nursing practice. Washington, DC: American Nurses Association.
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  • Zamerowski, S.T. (2000). A model for integrating genetics into nursing education. Nursing and Health Care Perspectives, 21, 298–304.

Courses at BCSON that Address NCHPEG (2001) Core Competencies (N = 20 Required Science and Nursing Courses)

NCHPEG Competency n (%)
KNOWLEDGE—All health professionals should understand:
Basic human genetics terminology. 10 (50)
The basic patterns of biological inheritance and variation, within both families and populations. 9 (45)
How identification of disease-associated genetic variations facilitates development of prevention, diagnosis, and treatment options. 12 (60)
The importance of family history (minimum three generations) in assessing predisposition to disease. 11 (55)
The role of genetic factors in maintaining health and preventing disease. 9 (45)
The difference between clinical diagnosis of disease and identification of genetic predisposition to disease (i.e., genetic variation is not strictly correlated with disease manifestation). 9 (45)
The role of behavioral, social, and environmental factors (e.g., lifestyle, socioeconomic factors, pollutants) to modify or influence genetics in the manifestation of disease. 9 (45)
The influence of ethnoculture and economics in the prevalence and diagnosis of genetic disease. 9 (45)
The influence of ethnicity, culture, related health beliefs, and economics in clients’ ability to use genetic information and services. 9 (45)
The potential physical and/or psychosocial benefits, limitations, and risks of genetic information for individuals, family members, and communities. 8 (40)
The range of genetic approaches to treatment of disease (i.e., prevention, pharmacogenomics/prescription of drugs to match individual genetic profiles, gene-based drugs, gene therapy). 7 (35)
The resources available to assist clients seeking genetic information or services, including the types of genetics professionals available and their diverse responsibilities. 8 (40)
The components of the genetic-counseling process and the indications for referral to genetic specialists. 3 (15)
The indications for genetic testing and/or gene-based interventions. 8 (40)
The ethical, legal, and social issues related to genetic testing and recording of genetic information (e.g., privacy, the potential for genetic discrimination in health insurance and employment). 9 (45)
The history of misuse of human genetic information (i.e., eugenics). 4 (20)
One’s own professional role in the referral to genetics services, or provision, follow up, and quality review of genetic services. 6 (30)
SKILLS—All health professionals should be able to:
Gather genetic family history information, including an appropriate multigenerational family history. 8 (40)
Identify clients who would benefit from genetic services. 8 (40)
Explain basic concepts of probability and disease susceptibility, and the influence of genetic factors in maintenance of health and development of disease. 10 (50)
Seek assistance from and make referrals to appropriate genetics experts and peer support resources. 5 (25)
Obtain credible, current information about genetics for self, clients, and colleagues. 5 (25)
Use new information technologies effectively to obtain current information about genetics. 4 (20)
Educate others about client-focused policy issues. 4 (20)
Participate in professional and public education about genetics. 1 (5)
ATTITUDES—All health professionals should:
Recognize philosophical, theological, cultural, and ethical perspectives influencing use of genetic information and services. 9 (45)
Appreciate the sensitivity of genetic information and the need for privacy and confidentiality. 12 (60)
Recognize the importance of delivering genetic education and counseling fairly, accurately, and without coercion or personal bias. 7 (35)
Appreciate the importance of sensitivity in tailoring information and services to clients’ cultures, knowledge, and language levels. 11 (55)
Seek coordination and collaboration with interdisciplinary team of health care professionals. 7 (35)
Speak out on issues that undermine clients’ rights to informed decision making and voluntary action. 10 (50)
Recognize the limitations of their own genetics expertise. 6 (30)
Demonstrate willingness to update genetics knowledge at frequent intervals. 8 (40)
Recognize when personal values and biases with regard to ethical, social, cultural, religious, and ethnic issues may affect or interfere with care provided to clients. 11 (55)
Support client-focused policies. 8 (40)

10.3928/01484834-20040801-02

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