Content area
Background:
With the exponential development of genetic and genomic (GG) knowledge and technology comes a great responsibility for nurses to be prepared to educate and support their clients; however, educational gaps in nursing curricula are common. This article describes the process and results of assessing GG content in a Doctor of Nursing Practice-Family Nurse Practitioner (DNP-FNP) program and the approach to addressing the identified gaps.
Method:
A DNP-FNP curriculum was reviewed to identify GG gaps.
Results:
Eleven GG gaps were identified. Interactive case studies were incorporated into the DNP-FNP program, addressing seven of the gaps. Students appreciated the applicability of the GG content to their future practices.
Conclusion:
Nurse educators must evaluate their curricula and develop a plan to incorporate GG content for graduate students. Online case studies provide a simple way to address GG gaps and increase GG knowledge for both graduate nursing students and faculty.
Genetic and genomic (GG) knowledge and technology have grown exponentially in the past two decades. From 2012 to 2022, nearly 52,000 new genetic tests became available for use in the United States (Halbisen & Lu, 2023). In 2019, it was estimated that 100 million people would have used direct-to-consumer (DTC) genetic testing by the end of 2021 (Regalado, 2019).
With the availability of more rapid and affordable genome sequencing and DTC genetic testing comes a great responsibility for nurses to be prepared to educate and support their clients to make evidence-based, personalized health care decisions. In 2012, the American Nurses Association and the International Society of Nurses in Genetics released Essential Genetic and Genomic Competencies for Nurses With Graduate Degrees, which provided 38 competencies for nurses prepared at the master's and doctoral level, including advanced practice registered nurses (APRNs) (Greco et al., 2012). These competencies provide structure for graduate level nurses to incorporate GG into their clinical practice and should guide master's and doctoral level nursing faculty as they prepare APRNs to provide comprehensive, client-centered care (Greco et al., 2012).
Despite the need for GG education and the availability of these graduate level competencies, graduate nursing faculty and students have low levels of both self-perceived and objectively measured GG knowledge (Connors et al., 2022; Sharoff, 2017). Sharoff (2017) found that while most nurse educators and graduate nursing students believed that GG content is important for nurses to know, the majority of both educator and student respondents had limited self-perceived knowledge of several GG-related topics. Of all of the respondents (53 nurse educators and 31 APRN students), more than 75% reported a lack of confidence in teaching or explaining basic GG topics to students and clients (Sharoff, 2017).
Similarly, Connors and colleagues (2022) reported most graduate nursing faculty and graduate nursing students had fair to poor perceived proficiency in GG and did not feel prepared to integrate GG into their clinical practice. Connors et al. (2022) used the Genomics Nursing Concept Inventory (GNCI) to test the objective GG-related knowledge of both faculty and students. The GNCI is a 31-item multiple choice assessment measuring knowledge about foundational concepts of GG related to nursing and is scored as a percentage of correct answers out of 100% (Ward et al., 2014). The median total percent correct score on the GNCI was 48.4% for faculty (N = 33) and 54.8% for students (N = 82) (Connors et al., 2022).
Both self-perceived and objectively measured knowledge about GG in nurse educators and students are low. Nursing faculty must educate themselves and integrate GG content into graduate nursing education to ensure that APRNs have the knowledge and confidence they need to help clients make informed decisions about their health. Because of this imperative, two graduate nursing faculty leaders and an administrator at a public university in the Midwest started integrating GG content into a Doctor of Nursing Practice (DNP) family nurse practitioner (FNP) program. This article describes the process of assessing the GG content in a DNP-FNP program and reports the approach that was used to address identified GG curricular gaps.
Method
Educating Faculty and Administrative Leaders
The process of increasing personal knowledge and integrating GG content into the DNP-FNP program started with the project administrator and two faculty leaders enrolling in the Translation and Integration of Genomics is Essential to Doctoral Nursing (TIGER) Program. The TIGER Program is a year-long educational course for doctoral nursing faculty focused on improving the GG knowledge of doctoral nurses by integrating GG content into doctoral nursing education (Vanderbilt University School of Nursing, 2024). This program is offered yearly and is currently funded by the National Human Genome Research Institute (NHGRI) of the National Institutes of Health (NIH). As part of the TIGER Program, the administrator and faculty leaders collaborated to develop overall goals and a plan to identify and address GG gaps in the DNP-FNP curriculum. Overarching goals for the project were to (1) assess the GG content included in the DNP-FNP program to identify GG gaps; (2) develop a plan to integrate key GG principles into the doctoral nursing curriculum to address GG gaps; and (3) incorporate GG learning activities throughout the curriculum to increase doctoral nursing students' knowledge about GG.
Identifying and Mapping GG Gaps
To identify gaps in the curriculum, faculty leaders emailed all DNP-FNP faculty, including an explanation of why they were being contacted and what would be done with the information they supplied. Faculty leaders requested information about the courses DNP-FNP faculty taught, including whether they covered any GG topics in their courses, and if so, which specific content areas were covered, how the content was taught (lecture, activity, etc.), and how much total time was spent on GG content. Faculty leaders collected the information on a spreadsheet, matching the course and faculty with the GG content that was covered in the individual courses. Next, faculty leaders reviewed the GG content covered across the DNP-FNP courses, then compared this content to the competencies in the Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees (Greco et al., 2012). Eleven competency gaps were identified.
Addressing the GG Gaps
After identifying the 11 GG competency gaps, faculty leaders emailed DNP-FNP faculty with resources to help support the integration of additional GG content throughout the curriculum. Essential Genetic and Genomic Competencies for Nurses With Graduate Degrees (Greco et al., 2012) and Essentials of Medical Genetics for Nursing and Health Professionals: An Interprofessional Approach (Gunder McClary, 2018) were shared with faculty as guiding documents to provide rationale and context to expand GG in the curriculum. The Jackson Laboratory (2024) learning portal website was shared with faculty to provide expert-developed case studies targeted toward graduate nurses and health care providers. Project leaders also provided faculty with suggestions for which Jackson Laboratory case studies could be integrated into specific courses throughout the DNP-FNP program.
Over two semesters, six Jackson Laboratory (2024) case studies were added as assignments in two FNP clinical courses, addressing seven of the 11 identified gaps. The Jackson Laboratory case studies are interactive and require learners to complete a preassessment, watch short client videos on the topic, review several client-based case studies, and complete a postassessment with evaluation. Additional corresponding resources and guidelines were provided related to each case study topic. One of the case studies incorporated by faculty was titled, “Exploring Pharmacogenomic Testing.” This case study addressed the following competency gaps: (1) ordering, interpretation, and management of genetic tests; (2) client education, informed consent, and anticipatory guidance; (3) pharmacogenomics; (4) translation and application of GG-related research; and (5) precision health.
These case studies were easily integrated into the FNP courses by sharing the links for the case studies with students and did not require a significant time commitment or expert level of knowledge from faculty. To reinforce the GG content addressed in the case studies, the topics were covered during in-person didactic lecture, and course faculty facilitated class discussions about the GG case studies and lecture topics. Additionally, new test questions about GG topics covered through lecture and case studies were added to the course examinations.
Results
Facilitators for Integration of GG
Faculty preparedness is a significant barrier to integrating GG into practice (Connors et al., 2022). A major facilitator for this initiative was the opportunity for the authors to participate in the TIGER Program to learn about the latest developments in GG and implications for nursing practice and education. This empowered the authors with knowledge, accessible and affordable resources, and camaraderie to incorporate GG into the curriculum. Creation of goals and plans to achieve those goals, laid out on a timeline, provided urgency and motivation to keep the team focused. A collaborative team approach, with participation from both faculty leaders and an administrator with curricular and administrative expertise, ensured various stakeholders were informed and in agreement with the curricular update. Logistically, the small number of faculty members in the FNP program allowed for timely communication and facilitation. Although integrating GG into the curriculum amid the active curricular revisions to address the updated Essentials (American Association of Colleges of Nursing, 2021) seemed overwhelming, the authors were able to take advantage of the momentum of the existing curricular revisions to motivate and support faculty in their efforts to incorporate GG content.
Barriers to Integration of GG
A multitude of changes occurring in nursing academe beyond the release of the Essentials (American Association of Colleges of Nursing, 2021), such as the updated National Organization of Nurse Practitioner Faculties National Task Force Standards (National Task Force, 2022) and the launch of the Next Generation NCLEX® by the National Council of State Boards of Nursing, presented challenges. Faculty, especially those teaching across undergraduate and graduate programs, were already feeling the burden of change and had limited time for professional development related to GG topics. To promote efficiency, project leaders used established workflows, previously scheduled meetings, and existing professional development structures. Planned and unplanned changes to personnel and roles in the institution led to minor delays. Close communication and mutual support among the authors were key to perseverance.
Discussion
Despite a few barriers, faculty were able to easily incorporate several freely available Jackson Laboratory (2024) case studies into the curriculum and reinforce the GG topics through in-person lectures and discussions, addressing more than half of the identified GG gaps in just two courses of the DNP-FNP program. In informal verbal feedback to course faculty, students overwhelmingly voiced satisfaction with the addition of the case studies, specifically appreciating the straightforward nature of the cases and their applicability to practice. To address the remaining gaps, faculty leaders planned to organize additional faculty development, share GG-related resources more widely with both undergraduate and graduate faculty, and work to embed more GG-related content throughout the DNP-FNP program through lecture, case studies, and guest speakers.
Conclusion
Nurse educators must evaluate their curricula and develop a plan to incorporate GG content for graduate students. A multitude of evidence-based resources exist that nurse educators can use to guide this process (Table A, available in the online version of this article), including those mentioned in this article. Essential Genetic and Genomic Competencies for Nurses With Graduate Degrees (Greco et al., 2012) can be used as a guiding document to help determine strengths and gaps in the curriculum. Well-designed education interventions, such as the Jackson Laboratory (2024) case studies, provide high-quality, evidence-based tools to address GG gaps and increase GG knowledge for both graduate nursing students and faculty. As health care becomes more complex and knowledge about GG continues to expand, graduate-prepared nurses must integrate genomics into their practices to support their clients in making well-informed decisions about their health and to improve health care outcomes for all.
| Essential Genetic and Genomic Competencies for Nurses With Graduate Degrees (Greco et al., 2012) |
| Essentials of Medical Genetics for Nursing and Health Professionals: An Interprofessional Approach (Gunder McClary, 2018) |
| From Testing to Targeted Treatments (FT3) |
| Genetic Alliance |
| Global Genetics and Genomics Community (G3C) |
| Global Genomics Nursing Alliance (G2NA) |
| International Society of Nurses in Genetics (ISONG) |
| ISONG Genomics Education Resources Repository |
| The Jackson Laboratory Learning Portal |
| Method for Introducing a New Competency: Genomics (MINC) |
| National Human Genome Research Institute (NHGRI) |
| TIGER: Translation and Integration of Genomics Is Essential to Doctoral Nursing (Vanderbilt School of Nursing) |
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From Illinois State University Mennonite College of Nursing, Normal, Illinois (JS, KC); and University of Wisconsin Oshkosh College of Nursing, Oshkosh, Wisconsin (SYC).
Funding: This project was supported in part by the National Human Genome Research Institutes of Health under Award Number R25HG011018. This work was also supported by the Vanderbilt University School of Nursing Translation and Integration of Genomics is Essential to Doctoral Nursing Program, paid to Jessica Sullivan.
Disclaimer: The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.
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