Genetic Testing and Nursing Reflection

This past two weeks have been really helpful for deepening my understanding of how nursing practice can have a direct impact on population health as well as improving individual health outcomes. Week one was particularly challenging as we addressed the principles of genetics, from the basic structures of DNA and RNA, to their functions in the body and throughout the life span. I had learned about replication, transcription, and translation earlier in biology classes, but this course material was presented at a higher level of learning. Also, this week’s material showed how I would apply this knowledge to practice, such as by analyzing cellular and chromosomal events with the goal of helping patients make informed decisions. We continued our learning about inheritance and genetics in the second week. This week proved particularly illuminating because of the interface between genetic testing and bioethics. Screening and diagnosis are poignant ethical issues when it comes to reproductive rights, access to technologies linked to wealth disparities, and also issues related to patient autonomy. It is also important to consider the limitations of genetic testing (Lea, Williams & Donohue, 2005). Therefore, it was helpful to think more deeply and critically about how I might someday become more involved in public policy or advocacy related to genetic testing. I believe that genomic testing has tremendous benefits for improving patient outcomes and for promoting overall population health goals.
Our focus shifted somewhat during weeks three and four. We learned about some of the prevailing models nurses can use to create multigenerational family health histories, going beyond the genogram. We also learned about the range of physical assessments that take into account risk factors and exposure to environmental toxins. The complex interactions between genetics and environment is something that all nurses must contemplate at some point, and I feel more empowered and competent now delivering care within the evidence-based practice model. I believe it is critical to start offering genomics testing whenever possible, expanding funding in these critical areas of research.
One of the most salient ways nature and nurture interact in human health is with nutrition. We all know people whose lives are spent dedicated to healthy eating but who still develop disease, and vice-versa, the people who treat their bodies poorly their entire lives but who live to be a long age. Nutrition certainly does influence health, but the role genetics play in this equation is also important. Applying epidemiological concepts in this unit helped me to reframe my understanding of population health, especially with regards to how socioeconomic class and culture can also impact health outcomes. The implications of this knowledge for nursing practice are clear.
Weeks six through eight continued our learning about population health and epidemiology, via different population and subject areas. In week six, we considered the aging population and demands for new treatments, medications, and technologies that may be diverting funding unnecessarily. This gave rise to heated ethical debates, and should continue to inform healthcare policy. Similarly, we considered the ethical issues related to providing costly services to patients with chronic but preventable diseases. There are no easy answers to these types of ethical dilemmas, other than to propose a more complete overhaul of the healthcare system.
Finally, we returned to our overarching conversation about the ethical, legal, financial, and social issues that are related to genomics, genome technologies, and genetic interventions. Medical privacy, access, and informed choice were all subjects we thought deeply on (National Human Genome Research Institute, n.d). As nurses, we are committed to promoting quality of care in our daily dealing with patients but also to promoting sensible health policies and serving as patient advocates. These eight weeks have solidified my commitment to n ethically informed model of nurse leadership.



References
Lea, D.H., Williams, J. & Donohue, M.P. (2005). Ethical issues in genetic testing. Journal of Midwifery and Women’s Health 50(3): 234-240.
National Human Genome Research Institute (n..d). Issues in genetics. https://www.genome.gov/10000006/issues-in-genetics/