By Debra Wood, RN, contributor
Scientists are continuing to find genetic connections to common illnesses such as cancer, heart disease, diabetes and asthma. Some treatments already vary depending on a patient’s genetic makeup and research is now underway to further tailor care according to genetic profiles.
“Genetics and genomics, eventually, will streamline care and the options we offer patients, and hopefully, offer more benefit,” said Jean F. Jenkins PhD, RN, FAAN, senior clinical advisor to the director of the National Human Genome Research Institute, at the National Institutes of Health in Bethesda, Maryland.
Oncology researchers have already begun to alter plans of care based on a person’s genetic makeup. Jenkins personally underwent cancer therapy determined by her genes when treated for lymphoma.
Jenkins expects identification of genetic risk factors for major diseases, such as hypertension and diabetes, will come soon. Tailoring drugs to a person’s genetic code, called pharmacogenmics, is also becoming more prevalent in the treatment of depression.
“Nurses should educate themselves about genetics and genomics to offer better care for their patients,” Jenkins said. “They can also refer their patients to a genetics specialist who can help customize their care.”
Jean F. Jenkins PhD, RN, FAAN, said all nurses need to become competent in understanding and utilizing genetic and genomic information in their practice.
Jenkins, Kathleen Calzone, RN, MSN, APNG, FAAN, of the National Cancer Institute, and a consensus panel drafted Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics, published in 2005. They included in the document information that nurses can use to become competent in understanding and utilizing genetic and genomic information in their practice.
The paper defines genetics as the study of individual genes and their impact on relatively rare single gene disorders. Genomics is defined as the study of all the genes in the human genome together, including their interactions with each other, the environment and the influence of other psychosocial and cultural factors.
The National Institute of Nursing Research offers a two-month Summer Genetics Institute, providing nurses with opportunities to learn more about molecular genetics in research and clinical practice.
Monica Polk, RN, BSN, clinical project manager genetic studies in dementia and ophthalmology at the Miami Institute of Human Genomics at the University of Miami School of Medicine, began working in genetic laboratory science with a microbiology degree and later returned to school to obtain a nursing degree in the university’s accelerated BSN program, with a goal of continuing her research career but with more patient interaction.
Currently, she obtains family histories and assesses participants taking part in genetic studies, performing neurological testing, drawing blood for laboratory studies and evaluating their medications’ neurological and systemic effects. Her dementia research aims to figure out what possible genetic factors cause some patients with Alzheimer’s disease to develop the condition early or late and what might affect its progression.
“Eventually that should translate into the development of new drugs, new exams and new treatments that can be done,” Polk said.
Polk tells participants that results may not benefit them but rather future generations. Although she does not see the direct effect of her actions, she takes satisfaction in changing outcomes in the years ahead.
“This is something that will be the forefront of medicine in the next few years,” Polk said. “We are only starting to tap the beginning of what nurses can do in research.”
Recognizing the need to educate nurses and other health professionals about genetics, Clemson University School of Nursing in Columbia, South Carolina, has launched the country’s first interdisciplinary Ph.D. in health care genetics program. Students will have the opportunity to focus on one of three specialty areas: interventional, working with patients with genetic syndromes, bench science and policy and ethics.
Two nurses and a chemical engineer have already begun the program.
Julie Eggert, PhD, GNP-BC, AOCN, doctoral program coordinator for the Clemson School of Nursing, said the university hopes the program also will help to alleviate the nursing faculty shortage. It already has attracted nurse faculty to Clemson.
“Nursing curriculum really needs to have the genetics component enhanced,” Eggert said. “Our graduates will be able to incorporate it into curriculum and into patient care.”
Graduates will also be prepared to work in industry or hospitals.
“As we learn more about genetics, I think we will see departments of genetics within hospitals, instead of just physicians and genetic counselors,” Eggert says. “There is so much about illness and wellness that is affected by genetics.”
Eggert highlighted the knowledge that people can react differently to medication based on their genetic makeup. For instance, some patients may have more or less toxicity to chemotherapy or may not metabolize codeine to morphine. In the past, health professionals often labeled the latter group as drug seekers, because they kept saying the medication they received had not helped and asked for relief.
“People are seeing the revolution of genetics as an exciting opportunity, from the perspective of contributing to the knowledge and taking that knowledge and making a difference,” Eggert said.
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