A LITERATURE REVIEW ON THE INTEGRATION OF GENETICS AND

A LITERATURE REVIEW ON THE INTEGRATION OF GENETICS AND GENOMICS

EDUCATION IN UNDERGRADUATE AND GRADUATE NURSING CURRICULA

by

Sylvia Quevedo Garcia, BSN, RN

________________________

A Master’s Project Submitted to the Faculty of the

COLLEGE OF NURSING

In Partial Fulfillment of the Requirements For the Degree of

MASTER OF SCIENCE

In the Graduate College

THE UNIVERSITY OF ARIZONA

2 0 1 0

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STATEMENT BY AUTHOR

This master’s project has been submitted in partial fulfillment of requirements for an advanced degree at The University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library.

Brief quotations from this master’s project are allowable without special permission, provided that accurate acknowledgment of source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the head of the major department or the Dean of the Graduate College when in his or her judgment the proposed use of the material is in the interests of scholarship. In all other instances, however, permission must be obtained from the author.

SIGNED: Sylvia Quevedo Garcia

APPROVAL BY MASTER'S PROJECT DIRECTOR

This Master's Project has been approved on the date shown below:

Donna Velasquez, PhD, RN, FNP-BC, FAANP Date: Clinical Associate Professor

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ACKNOWLEDGMENTS

I would like to thank the members of my report committee Dr. Donna Velasquez, Dr. Karen Greco, and Dr. Lois Loescher for their feedback, support, and patience. I would also like to thank my family, especially my fiancé, for believing in me and encouraging me as I pursued my goal of obtaining my master’s degree. Finally, no words can describe my endless gratitude to my Heavenly Father, Who has infinitely blessed me and led me to where I am today.

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TABLE OF CONTENTS LIST OF FIGURES……………………………………………………………………………….5 LIST OF TABLES………………………………………………………………………………...6 ABSTRACT.....................................................................................................................................7

1. CHAPTER I INTRODUCTION.............................................................................................8 Genetic and Genomic Competencies for Nurses ..................................................9

Recommendations for Integrating Genetic and Genomic Competencies into Nursing Curricula ................................................................................................11

Statement of Problem............................................................................................................11 Significance...........................................................................................................................12 Purpose..................................................................................................................................12

2. CHAPTER II CONCEPTUAL FRAMEWORK ..................................................................14 The Learning Engagement Model.......................................................................14

The Diffusion of Innovation Theory .....................................................................16 Chapter Summary .................................................................................................................17

3. CHAPTER III METHODS...................................................................................................18 Literature Search ................................................................................................18

4. CHAPTER IV RESULTS & SYNTHESIS..........................................................................20

Articles Narratives ..............................................................................................25 Synthesis ...............................................................................................................................31

Aim 1: Teachings Strategies ................................................................................31 Aim 2: Barrier and Facilitators ............................................................................32 Aim 3: Evaluation Methods ...................................................................................33

Chapter Summary .................................................................................................................35 5. CHAPTER V DISCUSSION................................................................................................36 Aim 1: Teachings Strategies ................................................................................36 Aim 2: Barrier and Facilitators ............................................................................40 Aim 3: Evaluation Methods ...................................................................................41

Implications for Future Research..........................................................................................42 Strengths & Limitations of Project .......................................................................................42 Implications for Nursing & Healthcare.................................................................................42 Summary & Conclusion........................................................................................................43

APPENDIX A................................................................................................................................44 SUMMARY OF CONCENSUS PANEL (2008) AND NCHPEG (2007) COMPETENCIES...45 REFERENCES ..............................................................................................................................47

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LIST OF FIGURES

FIGURE 1. Learning Engagement Model .....................................................................................15

FIGURE 2. Flow diagram of the selection process for including articles in review.....................19

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LIST OF TABLES TABLE 1. Genetics and Genomics Teaching Strategies in Undergraduate and Graduate Nursing

Curriculums as Found In Current Literature..................................................................................21

TABLE 2. Teaching Strategies that Addressed or Further Hindered Barriers ..............................32

TABLE 3. Teaching Strategies that Supported Facilitators...........................................................33

TABLE 4. Learning Engagement Model Concept Met by Teaching Strategies Results...............37

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ABSTRACT

Problem & Significance: As genetic advances increasingly impact nursing care, nurses are expected to have the necessary knowledge to interpret genetic and genomic information and technology with translation into nursing care. In 2005 less than a third of all nursing programs in the United States included a genetics and genomics curriculum thread with no increase in genetic and genomic content over the previous nine years. With the 2006 and 2009 publications of the Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics and the inclusion of genetics and genomics in the current essentials for baccalaureate, master’s, and Doctor of Nursing Practice programs, nursing faculty are being expected to include genetics and genomics content in their nursing programs at all levels. Purpose: To explore teaching strategies and describe facilitators, barriers, and evaluation methods in genetics and genomics education in undergraduate and graduate nursing curricula. The use of the learning engagement model and the diffusion of innovation theory guided the project’s purpose and implications of findings. Search strategy: A search of the CINAHL, MEDLINE, and WEB OF SCIENCE databases, articles published in English from January 1999 through January 2009 used the key words ‘genomics OR genetics AND students AND nursing AND education.’ Documents were included if they described a single study or were review articles and were aimed at academic nursing education. Articles were limited to those that included specific strategies for teaching genetic and genomics education in undergraduate and graduate nursing. Excluded documents were those aimed at continuing education for practicing nurses; those concerning faculty knowledge and awareness, or patient education. Findings: Genetics and genomics teaching strategies include a variety of methods. However, there is a lack of evaluation methods to support the teaching effectiveness of these strategies. Barriers and facilitators were discussed within the documents found. Implications of findings: Although teaching strategies, barriers, and facilitators were found in the literature, further research is needed to evaluate the effectiveness of genetics and genomics teachings strategies to successfully implement genetics and genomics education in undergraduate and graduate nursing curricula.

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CHAPTER I INTRODUCTION

Since the completion of the human genome project in 2003, there has been an explosion

of knowledge that is changing how we assess, diagnose, and treat many illnesses and disorders.

Genetics refers to the study of single genes and their effects on relatively rare single gene

disorders. Genomics is the study of all the genes in the human genome together, including their

interactions with each other and the environment (Guttmacher & Collins, 2002). As genetic

testing and treatment increases, nurses are expected to have the necessary knowledge to help

interpret information, evaluate risks, and use appropriate services (Read, Dylis, Mott, &

Fairchild, 2004). Advanced practice nurses (APNs) must be literate in genetics to discuss the

heritability of certain health problems with patients, make appropriate referrals, share such

information with other nurses, and collaborate with other disciplines to treat patients with genetic

conditions (Beery, 2008; Horner, 2004).

The integration of genetics and genomics education in nursing academic curricula was

first recommended forty years ago, yet genetic content is deficient in nursing programs

nationwide (Hetteberg & Prows, 2004). In 2005, less than one third of all baccalaureate nursing

programs in the United States had curricula that included genetics and genomics content (Jenkins

& Calzone, 2007). Additionally, most nurses currently in practice have had little to no genetics

and genomics education. Nevertheless, genetic and genomic knowledge has key implications for

nurses in all roles and settings (Consensus Panel on Genetic/Genomic Nursing Competencies,

2009).

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Genetic and Genomic Competencies for Nurses

In 2001, the National Coalition for Health Professional Education in Genetics (NCHPEG)

developed core competencies that represented the minimum requirements for health care

professionals to provide patient care involving genetic issues and concerns. These competencies

were revised and streamlined in 2007 (NCHPEG, 2007). A number of genetics and genomics

competencies for nurses are now in existence and many have overlapping recommendations.

Greco & Salveson (2009) recently summarized genetics and genomics nursing competencies

common among five published consensus recommendations: the Essential Nursing

Competencies and Curricula Guidelines for Genetics and Genomics, Jenkins’ (1999) dissertation

work on the research-based genetic competencies, the Genetics Program for Nursing Faculty’s

consensus conference for curriculum and genetics education of nurses, the Genomic

Competencies for the Public Health Workforce, and NCHPEG (2007) competencies (Consensus

Panel, 2009; Prows, 1999; Centers for Disease Control and Prevention, 2001).

In 2004, the American Academy of Nursing first recommended that these competencies

be part of nursing programs (Read et al., 2004). Since then, the American Association of

Colleges of Nursing (AACN) has added recommendations for genetics/genomics content to The

Essentials of Baccalaureate Education for Professional Nursing Practice (2008), stating that all

baccalaureate graduates should be prepared to “recognize the relationship of genetics and

genomics to health, prevention, screening, diagnostics, prognostics, selection of treatment, and

monitoring of treatment effectiveness, using a constructed pedigree from collected family history

information as well as standardized symbols and terminology”(p. 30). Although not finalized, in

their most recent draft of the Essentials of Master’s Education in Nursing, the AACN proposed

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to include increased genetics and genomics content (AACN, February 17, 2010). Genomics is

considered “foundational” for nursing practice at the doctoral level (AACN, 2006).

The Essential Nursing Competencies and Curricula Guidelines for Genetics and

Genomics (Consensus Panel, 2006, 2009), have had a significant impact on recent efforts to

increase genetics and genomics into undergraduate nursing programs. An independent panel of

nursing leaders from a variety of practice settings developed essential competencies to establish

a basis for educating the nursing profession on genetic and genomic nursing care. This panel

intended that the essential competencies be added to current nursing practice standards,

regardless of academic preparation and practice setting (Consensus Panel, 2009). The summary

of these competencies is to demonstrate “an understanding of the relationship of genetics and

genomics to health, prevention, screening, diagnostics, prognostics, selection of treatment, and

monitoring of treatment effectiveness” (Consensus Panel, 2009, p. 19). Furthermore, the

consensus panel has compiled a checklist to help faculty integrate genetic and genomic education

into nursing curricula (Hetteberg & Prows, 2004). In 2008, this panel conducted a working

meeting to review genetics and genomics education materials to compile a toolkit for nursing

faculty that would serve as a resource to faculty to prepare all levels of nurses in integrating

genetics and genomics advances into nursing practice (Jenkins, 2008). These essential

competencies, along with the AACN essentials are the driving force to implement genetic and

genomic education in undergraduate nursing curricula, as well as in the nursing workforce.

These essential competencies, as summarized in Appendix A, are endorsed by about 50 national

nursing organizations.

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Recommendations for Integrating Genetic and Genomic Competencies into Nursing Curricula

The Consensus Panel (2009) recommends the following activities for integrating the

aforementioned competencies into the nursing profession and nursing curricula, both

undergraduate and graduate:

• Inclusion of genetics and genomics content into NCLEX and specialty certification

exams.

• Develop a national initiative to educate practicing nurses on genetics and genomics,

similar to the one in place in the UK.

• Include genetics and genomics into accreditation standards for nursing programs.

• Add genetic and genomic content to existing course objectives, lectures, assignments,

and exams.

• Develop an elective genetics and genomics nursing course that can be transitioned into

a required course, collaborating with interdisciplinary colleagues to design courses and

curricula.

Statement of Problem

In 2005, less than one third of all baccalaureate nursing programs in the United States had

curricula that included genetics and genomics content, which demonstrates that the nursing

profession in not yet fully competent in this area (Jenkins & Calzone, 2007). In the past, lack of

specific competencies was viewed as the primary barrier to providing genetics and genomics

content in nursing curricula (Prows et al., 2005). This is no longer the issues as there are

numerous, well constructed guidelines outlining necessary competencies. However, while there

are now well developed competencies with specific recommendations that genetics and

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genomics content be included at all levels of professional nursing education, there is a paucity of

literature describing specific strategies for incorporating such content into nursing curriculums.

Significance

The next step in implementing the genetics and genomics competencies, which are

clearly established, is to commit nursing leaders and academic faculty to curriculum changes that

will permanently incorporate genetic and genomic information. Today’s nursing curricula are

dense and the integration of genetics and genomics is a challenge (Consensus Panel, 2009).

Therefore, effective teaching strategies must be available to integrate such content in a manner

that will be successful, permanent and ultimately result in nurses who are able to provide

competent genetic and genomic care.

Purpose

Although the AACN recommended that genetics and genomics content be included at all

levels of professional nursing education and competencies have been identified, there are few

guidelines about which strategies are most effective for teaching this content. The primary

purpose of this project was to explore strategies used to teach genetics and genomics content in

undergraduate and graduate nursing programs and to identify facilitators and barriers. A

secondary aim was to examine the effectiveness of the teaching strategies.

Aims:

1) To describe strategies used to teach genetics and genomics content in undergraduate

and graduate nursing programs.

2) To discuss barriers and facilitators of including genetics and genomics content in

undergraduate and graduate nursing programs.

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3) To describe how the identified teaching strategies were evaluated.

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CHAPTER II CONCEPTUAL FRAMEWORK

Two conceptual frameworks were used to guide this project: The Learning Engagement

Model (Guthrie &Wigfield, 2000) and the Diffusion of Innovation theory (Rogers, 1995). The

learning engagement model includes foundational concepts for adult learning that can be used to

provide a framework for strategies used to teach genomics and genetics content. The diffusion of

innovation theory was used to explore barriers and facilitators that need to be addressed in order

to successfully integrate the content.

The Learning Engagement Model

Adult learners vary in previous knowledge and learning styles. Thus, an effective

instructor must implement teaching strategies that keep students interested, meet students’

learning needs, and can objectively evaluate the effectiveness of such strategies (Seibert, 2008).

Content expertise is essential, especially when teaching complex and rapidly changing content

such as genetics and genomics. This expertise must be accompanied by the ability to

communicate the content using small chunks of information that are presented in innovative

ways and target visual and auditory learning needs (Seibert).

Effective teaching strategies include expert knowledge, theatrics, and instructional

strategy. Guthrie and Wigfield’s (2000) learning engagement model shown in Figure 1 can help

frame the basics of effective teaching strategies. To address the purpose of this project, the point

of interest in this model is the outer ring, which includes foundational teaching strategies used to

help students achieve knowledge acquisition and learning outcomes.

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Figure 1. Learning Engagement Model

These teaching strategies include:

1. Teacher Involvement: Students are often more motivated to learn if they feel that their teacher

has a personal investment in them.

2. Autonomy Support: Autonomy allows students to become very passionate about a topic. Some

ways to support autonomy include offering students a choice of textbooks or asking them to

write a paper on a category of genetic disorder that interests them.

3. Collaboration: Collaboration creates a unique environment that fosters discovery, increases

communication and improves motivation, all of which enhances learning.

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4. Real world interaction: Learning improves if new knowledge is connected with a clinical

encounter.

5. Strategy instruction: Strategy instruction is teaching students how to link complex concepts

together, rather than rote memorization to enhance learning.

6. Reward and praise: Public recognition is highly motivating; it doesn’t matter how experienced

the student or what level the learner.

7. Interesting texts: Refers to all types of learning materials to include websites, interactive disks,

and simulation activities. Asking students to locate web-based resources serves two purposes; (a)

they learn to critically analyze Internet resources and (b) genetic information gathered from the

Internet is much more likely to be current than information gleaned from a book.

(Seibert, 2008).

The Diffusion of Innovation Theory

Roger’s (1995) Diffusion of Innovation Theory states that the diffusion of new ideas

involve an idea, practice, or object perceived as new by an individual or unit which must be

communicated through certain channels over a period of time to potential adopters of the

innovation. The adoption of an innovation depends on its relative advantage, compatibility,

complexity, triability, and observability, which are the five stages of the theory and provide a

theoretical framework when implementing change (Rogers). Successful change depends, in part,

on addressing barriers and using facilitators to make change. For the purpose of this project,

Roger’s stages of relative advantage and triability are the two stages that will serve as a

framework in addressing barriers and facilitators in implementing teaching strategies (Horner et

al., 2004). The relative advantage of an innovation in the diffusion of innovation theory is the

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persuasion stage that requires that those implementing the innovation and who have already

adopted the innovation provide feedback to potential decision-makers. This stage can be applied

to the barrier that must be overcome in the process of implementing teaching strategies (Horner

et al). Potential decision-makers, such as faculty, must receive feedback from other faculty that

have implemented specific teaching strategies in order to persuade the adoption of such

strategies. Once the relative advantage of an innovation is presented, triability can follow, which

involves evaluating the effectiveness of an innovation (Horner et al., 2004). Evaluation of

teaching strategies facilitates their further adoption. This stage, along with the persuasion stage

can be used as a framework to addressing barriers and facilitators in the implementation of

teaching strategies.

Chapter Summary

This chapter described the two conceptual frameworks used to guide this project. The

Learning Engagement Model by Guthrie & Wigfield (2000) was used to organize specific

concept on teaching strategies from the literature including: teacher involvement, autonomy

support, collaboration, real world interaction, strategy instruction, reward and praise, and

interesting texts. The Diffusion of Innovation theory by Rogers (1995) was used to examine

barriers and facilitators to integrating genetics and genomics content into nursing curricula

within the context of the persuasion and confirmation stages outlined in this theory.

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CHAPTER III METHODS

This chapter covers the author’s search strategy to find current genetics and genomics

teaching strategies in undergraduate and graduate nursing curriculums.

Literature Search

In January 2009, October 2009, and January 2010, a systematic literature search was

performed using CINAHL, Medline, and Web of Science to identify documents meeting the

following inclusion criteria: articles including genetics and genomics teaching strategies within

nursing published in English from January 1999 to present. Since this project is at a master’s

level, it is usually standard to obtain documents for the previous ten years plus any classic

documents related to the literature review topic (Burns & Grove, 2009). Since the author’s

original search began in January 2009, the search went back to January 1999. Search terms

included genomics OR genetics AND students AND nursing AND education. Documents were

included if they described a single study or were review articles and were aimed at academic

nursing education. Articles were limited to those that included specific strategies for teaching

genetic and genomics education in undergraduate and graduate nursing. Excluded documents

were those outside academic nursing education, including continuing education for practicing

nurses; those concerning faculty knowledge and awareness, or patient education. Documents that

served as news announcements, conference reports, or editorials on general nursing education

were also excluded.

In total, 135 documents met the search criteria (Figure 2). Results were at first limited to

articles concerning undergraduate nursing, which only yielded four articles so this project was

expanded to include graduate nursing to expand available teaching strategies discussed in the

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literature. Six articles found in the initial search results were not retrievable through the

databases or interlibrary document loans. From the 129 retrievable documents, 10 documents

described specific genetics and genomics teaching strategies for undergraduate and graduate

nursing, while the rest discussed the importance of teaching such content but did not describe

teaching methods and/or were not aimed at undergraduate and graduate nursing. Subsequently,

one of the author’s project committee member found an additional article that met search criteria

which was then included for a total of 11 documents reviewed for this project.

Initial search – 135 articles generated for possible inclusion

129 articles found on-line and in-library- titles and abstracts read

6 articles not retrievable

119 articles eliminated (see exclusion criteria)

10 articles met inclusion criteria and were included for review

1 additional article found by author’s committee member and included for review

A total of 11 articles met inclusion criteria and were included for review

Figure 2. Flow diagram of the selection process for including articles in review

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CHAPTER IV RESULTS & SYNTHESIS

The results pertaining to genetics and genomics teaching strategies found in the literature

review are presented in Table 1. Each key document is presented in terms of purpose, sample

setting, teaching strategies, findings, barriers and facilitators to the teaching strategies, and

evaluation methods. These headings are general categories designed by the author to help

analyze and compare each document in a consistent manner. These categories also address the

aims of this project, which are to explore teaching strategies, identify barrier and facilitators, and

review evaluation methods of such strategies. A synthesis of these aims was subsequently done

to identify consistencies and gaps across the documents reviewed.

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Table 1. Genetics and Genomics Teaching Strategies in Undergraduate and Graduate Nursing Curriculums as Found In Current

Literature

Source Purpose/ Study Aims

Sample Setting Teaching Strategies Key Findings Barriers/ Facilitators to Incorporating

Strategies

Evaluation Methods

Cook, 2003 Review genetics competencies, and describe examples of nursing programs that include genetics

Various US nursing programs, undergraduate and graduate levels

A three-course subspecialty in genetics for APNs, including didactic and clinical components; a genetic counseling focus in a master’s level pediatric program; a summer institute in genetics and an online semester-long program for nurse educators; and a master’s level major and minor in genetics for APN students

None discussed None discussed None

Cragun et al., 2005

Development and evaluation of a short-term genetics educational intervention

Nursing and dietetic students at a Midwestern research university

Self-directed, web-based tutorial and an in-class lecture with case-based problems

Increased knowledge from pretest to posttest for all participants, with a 66% retention rate for nursing students. A majority of participants (% not stated) enjoyed the educational intervention, with the lecture rating higher (76%) than the tutorial. More than 2/3

Barriers: Faculty’s uncertainty about students’ genetics knowledge, time diverted from existing content. Facilitators: Self-tutorial to allow students to learn at their own pace, and reviewing curriculum may help better fit of genetic

In-class pretest/ posttest to test knowledge retention; questionnaires to assess participant like/dislike of intervention

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Strategies

Evaluation Methods

participants stated case studies helped them apply the knowledge learned to clinical situations.

content in existing courses or allow for the development of an additional course.

Danz, 2004 To increase genetics content in an associate’s degree in nursing (ADN) curriculum

ADN nursing students and faculty at Delaware Technical Community College

Design and integrate genetics content into a maternal-newborn course, provide professional development for faculty, and establish a genetics focus group based on ISONG and NCHPEG competencies

The genetics focus group successfully made recommendations to implement genetics content into course content and should be continued as strategy to enhance the further integration of genetics content. Genetics content in the maternal-newborn course was readily accepted by students and enhanced the assignments; 85% passing rate on content exam. Faculty voiced readiness to learn more about genetics and suggested that a genetics molecular biology course be offered as an elective.

Barriers: Difficulty in obtaining genetics clinical placement for students and faculty concerns regarding time and curriculum content change. Facilitators: Creating a genetics focus group and faculty committee to address barriers.

Author’s narrative of meetings and subsequent recommendations for future planning; Faculty interviews on familiarity with nursing programs that offer genetics content, if genetic content is already incorporated into their own courses, faculty willingness to learn genetics, and their opinion on incorporating a separate course vs. integrating genetics into existing courses; passing rate for course.

Gresty, Skirton, &

Development of an online resource

Students, nurses, and

Online resource containing genetics case

User feedback on online resource was

Facilitator: E-learning to integrate

Comment feedback on online resource via

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Strategies

Evaluation Methods

Evenden, 2007

for health professionals

midwives at an institution in the UK

studies, available free to health professionals and students using it adjunct to a bioscience course

positive but effectiveness not measured. Participants strongly supported using the Internet as a resource for genetics information provided in small pieces.

genetics content into student curricula and in the practitioner population. No barriers discussed.

phone, e-mail, resource site, and verbal

Horner, Abel, Taylor, &

Sands, 2004

To present a theoretical perspective of change employed in incorporating genetics into a nursing program as an elective course

52 undergraduate and 12 graduate nursing students

Undergraduate and graduate nursing elective courses were created and included content on basic genetics, patterns of inheritance, pedigree construction, genetic testing, assessment, ethical, legal, and social issues, pharmacogenomics, and various health problems with a genetic basis

The innovation diffusion theory was successful as a guide for implementing a genetics course in the nursing curriculum

Barriers: Perceiving that the course will be beneficial and will properly fit with the school’s philosophy and mission, complexity of course implementation. Facilitators: Opportunities to test the course prior to adopting it, and envisioning how the course will benefit students and eventually patients.

Course evaluation rated on a 5.0 scale (score 1 = and score 5 = not defined in document). The mean quality rating after its first completion was 4.8 for the undergraduate course and 4.9 for the graduate course.

Horner, 2004 Describe a genetics course in advanced clinical nursing practice

APN students; unspecified setting

The 3-credit course offered over a long semester included a didactic component with concepts, research findings, and clinical applications. Self-

The formal paper allowed students synthesize literature on a genetic topic. One student published his/her formal paper.

None discussed None

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Strategies

Evaluation Methods

assessments, case studies, video vignettes, and a formal paper with presentation were employed. Students were required to obtain web-based resources nearly every class.

Kirk, 2000 Genetics educational and ethical considerations in teaching

Nurses & midwives in the UK

Reflection with story telling, discussion and debate, and narratives.

The literature on teaching ethics can serve as a model on teaching genetics in regards to strategies. Genetics education should be taught at the undergraduate level as an integrative discipline rather than as a science.

Barriers: Genetics content will compete for curriculum space with other content; perceived low status of genetic science; lack of scientific literacy of students and faculty. Facilitator: Revise existing courses to integrate genetics content without extending current curriculum.

None

Lashley, 2000 Suggestions for including genetic content in nursing curricula

Nursing programs; unspecified

Include genetic content into pre-requisite courses such as biology, microbiology, sociology, ethics, and pharmacology. In nursing courses, integrate genetic content into a research course,

Pre-requisite courses can provide a foundation for defining genetics and how it can be used in treating disease. Nursing courses can build on the foundation by

Barriers: Faculty’s lack of knowledge and not perceiving genetic content as important. Facilitators: Faculty education, expanding on existing curriculum

None

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Strategies

Evaluation Methods

statistics, trends/issues, health and physical assessment, medical-surgical nursing, community and public health nursing, maternal-child nursing, and psychiatric mental health nursing courses.

applying genetics knowledge when teaching how to obtain a health history, teach and refer patients, and to understand the genetic contribution when caring for patients.

content, identifying resources, and providing contemporary examples to illustrate the importance of genetics.

Newcomb & Riddlesperger

, 2007

Using improvisational theater to teach ethical and social aspects of genetics

Undergraduate nursing students at a private liberal arts university in southwest US with little to no knowledge of ethical and social issues related to genetics

Case study presented to students, characters assigned, play presented by students followed by a debriefing session on genetics issues in play

Role-playing allowed students to learn and apply genetics-related concepts

Barriers: Time, space, and faculty resources. No facilitators discussed.

Faculty observation of student interactions during role-playing and debriefing session; blank comment cards offered to participants afterwards

Warren & Alley, 2005

Effectiveness of genetics case study learning strategy

Online course for FNP students

Genetics case study and related discussion questions presented in course

Thoughtful discussion resulted from case study learning strategy. Although midterm and final test questions were administered based on the case study, findings from such were not discussed.

None discussed Review of discussion postings and midterm and final test questions related to case study with no specific measures provided

Williams, 2002

Recommendations to add genetics

None specified Integrate genetic content in existing core and

None discussed Barrier: Most instructional

None

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Strategies

Evaluation Methods

content to nursing practice, including basic and graduate nursing education

elective nursing courses; faculty use of curriculum modules to include specific genetics concepts and using guest lecturers such as advanced practice nurses specialized in genetics and/or families with genetic healthcare experiences; web-based courses; CD-ROM genetics modules; post-Master’s certification in genetics; the Summer Genetics Institute for doctoral scholars; a human genetics course.

material available tends to lack a focus on caring for patients with complex chronic genetic illnesses or those in the acute phases of such. No facilitators discussed.

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Articles Narratives

Article I: Cook (2003) reviewed genetics competencies and provided examples of

current nursing programs that include genetics content. The examples described in this

document include subspecialties in genetics for advanced practice nurses acquired

through a three-credit course, and a genetics major and minor. Another described strategy

is a summer genetics institute and an online program for nurse educators. Since this was a

review of current strategies in place, no key finding or evaluation methods were

discussed. Also, barriers and facilitators to strategies were not discussed.

Article II: Cragun et al. (2005) described the development of a short-term genetics

educational intervention and its evaluation. The intervention was a self-directed, web-

based tutorial accompanied by an in-class lecture that included case-based problems. The

participants were nursing and dietetic students enrolled at a research university.

Participants completed pretests, posttests, pre-questionnaires, and post-questionnaires.

Pre and posttests tested students’ genetics knowledge, while the questionnaires sought

information on attitudes towards genetics education and evaluative feedback on the

teaching strategies presented. Key findings of this intervention included a 66% retention

rate for nursing participants and a preference of the in-class lecture over the self-directed

tutorial by 76%. The questionnaire also revealed that two-thirds of participants thought

the case studies included in the lecture helped them apply genetics knowledge to clinical

situations. Barriers to this intervention were faculty’s uncertainty about students’ existing

genetics knowledge, time required for the intervention that diverted from existing

content, and a lack of suggestions for including genetics content into existing content.

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Facilitators to these barriers included a self-tutorial to allow student to learn at their own

pace and not take time away from existing curriculum content. However, the authors

stated that a review of curriculum could also facilitate a fit of genetic content into

existing content or allow for the development of an additional genetics course.

Article III: Danz (2004) aimed to increased genetics content in an ADN curriculum

by designing and implementing genetic content in a maternal-newborn course to increase

genetic knowledge of faculty and students. ISONG standards and NCHPEG

competencies guided this study, in which a genetics focus group was formed to make

recommendations to implement genetics content within the nursing curriculum. Genetics

content was successfully implemented into the maternal-newborn course, which the

author reported to be readily accepted by students.

The evaluation methods used in this study included the maternal-newborn course

passing rate for the genetic content implemented as assessed by a 50-question exam that

resulted in an average grade of eighty-five percent, and the author’s own evaluative

narrative of the implementation process (Danz, 2004). In addition, faculty members were

interviewed about the inclusion of genetics content in the courses they taught, familiarity

they had with other nursing programs that offered genetics content, their willingness to

learn genetics, and their opinion on incorporating a separate genetic course vs. integrating

content into existing content. The barriers identified in this study were difficulty in

obtaining genetics clinical placement for students and faculty concerns regarding time

spent on teaching new content and curriculum changes regarding this new content. These

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barriers were addressed by creating a genetics focus group and a faculty committee to

discuss these barriers.

Article IV: Gresty, Skirton, & Evenden (2007) developed an online resource for

health professionals, which included nurses and midwives, and students taking a

bioscience course at an institution in the UK. This online resource was made available

free of charge and contained genetics case studies on various topics.

The effectiveness of these case studies were not evaluated, although informal self-

report feedback was collected via phone, e-mail, the resource site itself, and verbally

(Gresty et al., 2007). The comments received were reported as positive and users of the

online resource site supported the use of the Internet as a resource to learn genetics in

small pieces. Although no barriers were discussed here, the authors stated that facilitators

to integrating genetics into student programs included e-learning methods such as this

resource (Gresty et al.).

Article V: Horner, Abel, Taylor, & Sands (2004) used Roger’s (1995) diffusion of

innovation theory as a framework to guide the incorporation of a genetics elective course

into a nursing program. These undergraduate and graduate nursing elective courses taught

basic genetics, patterns of inheritance, pedigree construction, genetic testing,

pharmacogenomics, genetic-based diseases and disorders, genetic assessment, and

ethical/legal/social issues related to genetics. These courses were created following the

diffusion of innovation theory stages, which the authors stated were a successful guide in

the implementation of such content.

30

Identified barriers included faculty and students who did not perceive that the

content would be beneficial, faculty concern that the courses would not fit the school’s

philosophy and mission, and the complexity of implementing the course (Horner et al.,

2004). Facilitators discussed included providing opportunities to test the course prior to

permanently adopting it into the curriculum, and helping faculty and student envision it

benefits. This teaching strategy was evaluated using a 5.0 scale course evaluation,

resulting in a mean quality rating of 4.8 for the undergraduate course and 4.9 for the

graduate course.

Article VI: Horner (2004) described a 3-credit genetics course for APN students in

an unspecified setting. This semester-long course was composed of didactic content,

research findings, and clinical applications of concepts. Teaching strategies included self-

assessments, case studies, video vignettes, and a formal paper and presentation done by

each student. In addition, students were required to access web-based resources every

class period. Horner concluded that this course was effective in that the formal paper

allowed student to synthesize literature on various genetic topics. While no barriers,

facilitators, or evaluation methods were discussed, it was noted that the formal paper was

deemed a successful teaching strategy since one of the students went on to publish his/her

paper.

Article VII: Kirk (2000) examined educational and ethical considerations in

teaching genetics to nurses and midwives in the UK. The author reviewed current

curricula through a survey of all diploma-level nursing programs in the UK asking for

opinions on the impact of genetics on health and education. More specifically, this

31

questionnaire asked for information on the provision for genetics education in each

program and the program’s attitude towards genetics. This survey revealed several

barriers to the implementation of genetics content, including the perception that genetics

content will compete for curriculum space with other content; a perceived low status of

genetic science; and a lack of scientific literacy of students and faculty. Kirk’s

recommendations included that genetics teaching strategies include story telling,

discussion, debate, and narratives. The author stated that the literature found on teaching

ethics can serve as a model to teach genetics, being taught at the undergraduate level as

an integrative discipline. Kirk’s overall recommendation to address barriers was to revise

existing courses to integrate genetics content without extending current curriculum.

Article VIII: Lashley (2000) explored ways of including genetic content in nursing

programs. Suggested strategies include adding genetic content to pre-requisite science

courses and existing nursing courses. The rationale for these suggested strategies is that

genetic content included in pre-requisite courses can provide a foundation for defining

genetics and the applicability in treating disease. This foundation can then be applied to

nursing care learned in existing nursing courses. Barriers to these strategies include

faculty’s lack of genetics knowledge and lack of perceiving such knowledge as

important. Facilitators to these include education faculty and providing resources to help

expand current curriculum content. Stressing the importance of genetics using

contemporary examples can also help bring awareness to faculty. Since this was not a

study or an intervention, no evaluation methods were discussed.

32

Article IX: Newcomb and Riddlesperger (2007) used improvisational theater to

teach ethical and social aspects of genetics to undergraduate nursing students at a private

university who had little to no genetics knowledge. A case study was presented to

students and characters were assigned. Students acted out the case study, and concluded

with a debriefing session on the genetics issues presented in the case study. Through

faculty observation of the interactions between the students during the improvisational

acting of the case study and debriefing session, the authors concluded that role-playing

allowed students to learn and apply genetics-related concepts. Although mastery of

content was not tested, blank comment cards were provided to participants, all of which

were described as positive. Barriers noted by the authors were time allotted to do this

intervention again, physical space needed for the intervention, and faculty needed to

serve as facilitators were not discussed.

Article X: Warren and Alley (2005) reviewed the effectiveness of an online course

for family nurse practitioners students that included a genetics case study with discussion

questions. Four discussion questions were included in the discussion and student response

was described as thoughtful, although no specific measures were provided. Also, midterm

and final test questions related to the case study were included in the course but results

from these were not included in this document. Barriers and facilitators were not

discussed.

Article XI: Williams (2002) recommended various teaching strategies to add

genetic content to the nursing profession, including basic and graduate nursing education.

These recommendations included the integration of genetic content into existing core and

33

elective nursing courses, faculty use of curriculum genetics modules and genetics expert

guest lecturers, web-based courses, CD-ROM modules, and a human genetics course.

Additionally, Williams recommended the creation of post-Master’s certification in

genetics and attendance at the Summer Genetics Institute geared towards doctoral

scholars. One barrier discussed by the author was that most instructional materials

covering genetics content lacks focus on caring for patients with complex chronic genetic

illnesses. No facilitators or evaluation methods were discussed.

Synthesis

A systematic review of the literature, such as this project, needs to critically

appraise documents to judge the strengths, weaknesses, meaning, and significance of

these (Burns & Grove, 2009). This project reviewed literature that was a mixture of

reviews and quantitative and qualitative studies. Below, a synthesis of the results is

presented within the project’s aims: teachings strategies, barriers and facilitators, and

evaluation methods.

Aim 1: Teaching Strategies

Case studies, including story telling, narratives, and role-playing were teaching

strategies discussed in six of the eleven key documents (Cragun et al., 2005; Gresty et al.,

2007; Horner, 2004; Kirk, 2000; Newcomb & Riddlesperger, 2007; Warren & Alley,

2005). The use of the Internet, online resources, and CD-ROM module were discussed in

five of the key documents (Cook, 2003; Cragun et al.; Gresty et al.; Horner; Williams,

2002). Eight documents discussed various course integration strategies such as the use of

34

guest lecturers, video vignettes, course clinical placement, and the creation of genetics

courses (Cook; Cragun et al.; Danz, 2004; Horner et al., 2004; Horner; Lashley, 2000;

Warren & Alley; Williams).

There were two strengths in the findings of this review. One was that using a

variety of teaching strategies was preferable to using just one. Only Gresty et al., (2007)

focused on only one teaching strategy, whereas the other authors described the use of

multiple strategies. The second strength of the findings was that eight out of the eleven

documents presented teaching strategies based on examples of current programs. For

example, Cook (2003) reviewed the importance of genetics competencies and at the same

time provided examples of current teaching strategies in place across nursing programs in

the US. Kirk (2000), Lashley (2000), and Williams (2002) provided suggestions for

teaching strategies but did not provide studies to support the methods. The variety of

teaching strategies, along with examples of application strengthened this literature review

by illustrating options for teaching genetics and genomics content.

A weakness found in these teaching strategies was a lack of theoretical

frameworks guiding their use. Only Horner et al., (2004) used Roger’s (1995) diffusion

of innovation theory to guide their study.

Aim 2: Barriers and Facilitators

Seven key documents discussed barriers and facilitators to the implementation of

genetics and genomics teaching strategies. Barriers (Table 2), included a lack of time in

already busy curricula, faculty and student lack of knowledge and perceived lack of

importance of genetics and genomics, difficulty in obtaining genetics clinical placement,

35

and a lack of focus on teaching how to care for patients with chronic complex genetic

illnesses (Cragun et al., 2005; Danz, 2004; Horner et al., 2004; Kirk, 2000; Lashley,

2000; Williams, 2002).

Table 2. Teaching Strategies that Addressed or Further Hindered Barriers

Barrier Teaching Strategies that Addressed Barrier

Teaching Strategies that Further Hindered Barrier

Lack of curriculum space • Self-directed tutorial (Cragun et al., 2005).

• Online genetics resource (Gresty et al., 2007).

• Self-assessments (Horner, 2004).

• Improvisational theater (Newcomb & Riddlesperger, 2007).

• Integrating genetics content into existing courses and/or creating new courses (Cook, 2003; Cragun et al., 2005; Danz, 2004; Horner et al., 2004; Horner, 2004;, Kirk, 2000; Lashley, 2000; Warren & Alley, 2005; Williams, 2002).

Lack of faculty genetics/genomics knowledge

• Professional faculty development (Danz, 2004).

• Use of guest lecturers (Williams, 2002).


None found within results.

Lack of perceived importance of genetics/genomics

• Genetics focus group (Danz, 2004).


Difficulty obtaining genetics clinical placement

None found within results. None found within results.

Lack of focus on teaching how to care for patients with complex chronic genetic diseases

None found within results. None found within results.

Suggested solutions to enhance integration of genetics/genomics content included

revising curricula, implementing self-paced and/or online tutorials, creating committees

to address barriers, envisioning the benefits of genetics education, providing

36

contemporary examples of genetics and genomics to illustrate their importance, testing a

genetics course prior to adopting it into a curriculum, and faculty education (Cragun et

al.; Danz; Gresty et al., 2007; Horner et al.; Kirk; Lashley) (Table 3).

Table 3. Teaching Strategies that Supported Facilitators

Facilitator Teaching Strategies that Support Facilitator Self-tutorial/E-learning • Self-directed, web-based tutorial (Cragun et al., 2005).

• Online resource (Gresty et al., 2007). • Self-assessments (Horner, 2004). • CD-ROM modules (Williams, 2002).

Curriculum revision • Genetics focus group and faculty committee to address barriers (Danz, 2004).

Envisioning benefits of genetics course/Providing contemporary examples of genetics and genomics to illustrate importance

• Clinical applications within a course (Horner, 2004). • Narratives (Kirk, 2000). • Case studies (Cragun et al., 2005; Gresty et al., 2007;

Horner; Newcomb & Riddlesperger, 2007; Warren & Alley, 2005).

• Use of genetics experts and families with genetic conditions (Williams, 2002).

Testing a genetics course prior to integration into curriculum


Faculty education • Faculty development (Danz, 2004). • Curriculum genetics modules (Williams, 2002).

Some of the teaching strategies discussed in the key documents either addressed

identified barriers or created more barriers. For example, a barrier frequently cited was

the lack of time in already dense curriculums. The self-directed, web-based tutorial

described by Cragun et al., (2005) addresses the barrier of time diverted from other

required content to teach genetics and genomics. On the other hand, Newcomb and

Riddlesperger (2007) tested the teaching strategy of improvisational theater, which lasted

a few hours and required specific room space. Therefore, the teaching strategies found in

this literature review served as both a strength and a weakness in addressing or impeding

37

discussed barriers. While some strategies served as facilitators, others created further

barriers. On the other hand, teaching strategies found in this literature review supported

some of the facilitators discussed (Table 3).

Aim 3: Evaluation Methods

Of the strategies discussed in the eleven articles, only six were evaluated using

quantitative or qualitative methods (Cragun et al., 2005; Danz, 2004; Gresty et al., 2007;

Horner et al., 2004; Newcomb & Riddlesperger, 2007; Warren & Alley, 2005). Two of

these six documents included quantitative evaluation methods, in the form of a course

evaluation scale given as a pretest and posttest (Cragun et al.; Horner et al.). These

quantitative measures were helpful in identifying knowledge retention rates and assigned

a numerical value to a uniform course evaluation. The remaining evaluation methods

were subjective feedback in terms of open ended responses, observation, and authors’

self-report of the success of a teaching strategy (Danz; Gresty et al.; Newcomb &

Riddlesperger; Warren & Alley).

The lack of quantitative methods to adequately evaluate the effectiveness of

teaching strategies discussed in this literature review is a weakness. Cragun et al. (2005)

was the only study that tested the relationship between the teaching strategies and

students’ retention of content. Other documents were reviews or suggestions of teaching

strategies already in place or qualitative studies that subjectively described the

implementation of a teaching strategy. These weaknesses may somewhat devalue the

worth of these teaching strategies, as a lack of theoretical rationale and objective data

may impeded further implementation of these strategies.

38

Chapter Summary

The results of this literature review provided a variety of teaching strategies that

can be used in genetics and genomics education in nursing curricula. Barriers and

facilitators to integrating genetics and genomics education provided various

considerations to address in the implementation of teaching strategies. While some

barriers were addressed by the teaching strategies presented, there was little discussion

about how to address the barriers. Facilitators were also addressed by some of the

teaching strategies. Few teaching strategies were evaluated and this deficiency presents a

gap in the literature.

39

CHAPTER V DISCUSSION

This chapter discusses the results of the literature review in connection to the

frameworks used to guide this project: the learning engagement model and the diffusion

of innovation theory (Guthrie & Wigfield, 2000; Rogers, 1995). This discussion is

divided into the project’s aims: teaching strategies, barriers and facilitators, and

evaluation methods. The author’s recommendations for further research, the project’s

strengths and limitations, implications for nursing and healthcare, and a conclusion

follow.

Aim 1: Teaching Strategies

Strategies used to teach genetic and genomic content were organized using the

learning engagement model, which includes foundational teaching strategy concepts that

were used to identify strengths and gaps of the teaching strategies found in the literature

to teach genetics and genomics in undergraduate and graduate nursing curricula (Guthrie

&Wigfield, 2000). Table 4 summarizes what concepts were met by the teaching strategies

identified in the key documents and identifies those concepts not met.

40

Table 4. Learning Engagement Model Concept Met by Teaching Strategies Results

Guthrie & Wigfield’s Teaching Strategy Concept Undergraduate and Graduate Genetics and Genomics Teaching Strategies as Found in the

Literature Teacher Involvement • Didactic component of a genetics APN

course (Cook, 2003). • In-class lecture (Cragun et al., 2005). • Genetic focus group and integration of

genetic content into maternal-newborn course (Danz, 2004).

• Undergraduate and graduate genetics course (Horner et al., 2004).

• Integration of genetics into existing science and nursing courses; human genetics course (Lashley, 2000; Williams, 2002).

Autonomy Support • Self-directed web-based tutorial (Cragun et al., 2005).


• Self-assessment, access to web-based resources, and formal paper on students’ genetic topic of choice (Horner, 2004).

• CD-ROM module (Williams, 2002). Collaboration • Genetics focus group (Danz, 2004).

• Discussion and debate (Kirk, 2000). • Improvisational theater (Newcomb &

Riddlesperger, 2007). • Discussion based on genetics case study

(Warren & Alley, 2005). • Summer Genetics Institute (Williams, 2002).

Real world interaction • Clinical component of a genetics APN course (Cook, 2003).

• Expert guest lecturers and families with genetic healthcare experiences (Williams, 2002).

Strategy instruction None

Reward and praise • Formal paper presentation (Horner, 2004).

Interesting texts • CD-ROM module (Williams, 2002). • Web-based tutorial (Cragun et al., 2005). • Online genetics resource (Gresty et al.,

2007). • Web-based resources (Horner, 2004).

Although most of the genetics teaching strategies met one or more teaching

strategy concepts, there were two teaching strategy concepts that were under-addressed.

41

One, the concept of strategy instruction refers to teaching students how to link complex

concepts together to improve learning, as opposed to rote memorization (Seibert, 2008).

None of the teaching strategies found in the literature here specifically described how a

specific teaching modality was able to help students link complex genetics/genomics

concepts together. Perhaps a more thorough evaluation of such teaching strategies can

identify the presence or lack of this teaching strategy concept. The second concept that

was under-addressed was reward and praise, which refers to motivating students through

public recognition (Seibert). Although Horner (2004) mentioned that the presentation of a

formal paper on a genetic topic reinforced learning, it was only implied that public

recognition took place for those that presented and for the one student that eventually

published such paper.

The teaching strategies found in the key documents targeted auditory and visual

learners. These strategies also could be taught in short or long-term sessions. Most

importantly, the teaching strategies fulfilled most of the concepts as outlined by the

learning engagement model, which in turn can help students achieve knowledge

acquisition and learning outcomes in a successful manner (Guthrie & Wigfield, 2000).

Teaching strategies identified in this literature review are supported by work by

Maradiegue et al. (2005). These authors surveyed graduate nursing students about

effective ways of teaching genetics education to nursing students and found that problem

sets or case studies, current literature, small group discussions, standardized patients, and

role-playing are preferred. These teaching strategies address the concepts addressed in

Table 4 in that case studies, clinical scenarios and role-playing allow for real world

42

application and represent innovative alternatives to traditional text instructions, including

current literature. Small group discussions and role-playing facilitate collaboration and

autonomy, both key concepts for effective learning.

Aim 2: Barriers and Facilitators

It is evident that while some barriers were addressed and/or made worse by the

teaching strategies found in the literature, others were simply mentioned but not

correlated to any specific teaching strategy (Table 2). Nevertheless, several teaching

strategies served as facilitators to these barriers. For example, the barrier of the lack of

perceived importance of genetics and genomics as identified by Lashley (2000) fits the

barrier concept described in the persuasion stage of Roger’s (1995) diffusion of

innovation theory. This barrier requires that those faculty who already see genetics and

genomics education as important provide feedback to those lacking such insight. Danz

(2004) proposed and tested that a genetics focus group that could provide

recommendations to enhance the integration of genetics and genomics content into

nursing curricula, thus partly addressing the faculty persuasion needed to deem such

content important and eventually adopt it.

The facilitators presented in Table 3, along with their supporting teaching strategies

relate to Rogers’ (1995) stage of presenting the relative advantage of an innovation.

Presenting the identified facilitators with corresponding and existing teaching strategies

can provide feedback to potential decision-makers in adopting genetics and genomics

content into nursing curricula. Although no teaching strategies found in the results

specifically corresponded with the facilitator of testing a genetics course prior to its

43

integration into a curriculum, other facilitators and the teaching strategies that support

them can serve as trial implementations of genetics and genomics content. As previously

discussed, triability involves evaluating the effectiveness of an innovation, which can

further facilitate its adoption (Horner et al., 2004). Therefore, the use of these identified

facilitators and their corresponding teaching strategies can serve as a template to persuade

integration of genetics and genomics content into nursing curriculums and allow for

potential decision-makers to test some of these strategies.

Aim 3: Evaluation Methods

A gap identified in the results was a lack of evaluation methods evident in five

articles (Cook, 2003; Horner, 2004; Kirk, 2000; Lashley, 2000; Williams, 2002). Of the

six articles containing evaluation methods, only two used evaluation methods based on a

numerical scale and calculated percentage, which were useful in analyzing retention rates

of a teaching strategy and translating self-reported course evaluation into an objective

number (Cragun et al., 2005; Horner et al., 2004). The remaining evaluation methods

included author summaries, open-ended faculty interviews, and open-ended feedback

(Danz, 2004; Gresty et al., 2007; Newcomb & Riddlesperger, 2007; Warren & Alley,

2005). Although these remaining evaluation methods were useful in providing an initial

sense of participant like or dislike of the different teaching strategies, the effectiveness of

these strategies was not measured. The lack of evaluation methods impedes the fifth stage

of the diffusion of innovation theory which evaluates the effectiveness of an innovation

to further the adoption of it (Horner et al.). If the teaching strategies found in the

literature are to be widely adopted across nursing curricula, the strategies must be

44

rigorously evaluated for effectiveness in terms of participant satisfaction, knowledge

retention and applicability. This is significant because the lack of evaluation methods

may play a key role in assessing the availability, reliability, validity, and practicality in

integrating these into undergraduate and graduate nursing curricula. Implications of this

gap are to measure genetics and genomics teaching strategies consistently and with

methods that can concretely assess their effectiveness. Objective evaluation of the

teaching strategies found in the literature review can aid comparisons of the effectiveness

of these strategies and facilitate implementation. Future adopters of these strategies will

be able to implement those that have proven to be most effective and be able to expect

similar results.

Implications for Future Research

The lack of evaluation methods was the most apparent gap in this literature review.

Future research of genetics and genomics teaching strategies need to be thoroughly

evaluated to add significance to the findings and their applicability. Additionally, the

cost-benefit implications of these teaching strategies must be evaluated.

Within the key documents, only a few strategies were experimental, thus

implicating the need for more rigorous research designs. Additionally, research in this

area should be guided by a framework to enable the researcher to connect findings to

nursing’s existing body of knowledge (Burns & Grove, 2009).

The barriers discussed in the key documents need to be addressed prior to

implementing teaching strategies in genetics and genomics. Separate research needs to be

focused on addressing barriers to integrating genetics and genomics content into nursing

45

curricula. At the same time, research on new or existing teaching strategies need to

include accompanying barriers along with recommendations for addressing those

barriers. Facilitators need to have proven effectiveness in addressing barriers of teaching

strategies or their implementation. Suggested facilitators can be individually tested to

assess their validity and reliability.

Strengths & Limitations of Project

The strengths of this project included the use of a medical librarian to extensively

research the available literature on the project’s purpose. The author met with a medical

librarian on two separate occasions to streamline search methods and systematically find

key documents based on the inclusion and exclusion criteria of this project. Another

strength was the use of two theoretical frameworks to guide the project. The use of these

frameworks guided the discussion of the results and allowed for further inquiry. A

limitation of this project was the use of three search databases. Although these databases

include extensive materials, perhaps the use of additional databases would have resulted

in more documents addressing the purpose of this project.

Implications for Nursing & Healthcare

Genetics and genomics competencies for nurses are clearly established so it is

now time to make necessary changes in undergraduate and graduate nursing curricula to

integrate genetic and genomic information. There are many barriers to integrating new

content into nursing curricula but there are also facilitators and a variety of teaching

strategies to help face this challenge. Effective teaching strategies must be identified and

tested to integrate genetics and genomics content in a manner that will be successful,

46

permanent and properly prepare nurses to provide competent genetic and genomic care.

The project’s limitation of finding so few documents on undergraduate and graduate

nursing teaching strategies on genetics and genomics is evident that research and

application of genetics and genomics is still insufficient in nursing and must be promptly

addressed to meet current competencies.

Summary & Conclusion

Through a systematic review, this project identified genetics and genomics

teaching strategies for undergraduate and graduate education as found in the literature.

Barriers and facilitators to the integration of genetics and genomics education were also

identified, along with evaluation methods presented in the literature. A variety of

teaching strategies were found, although documents were few. Barriers and facilitators

were discussed in some of these documents, and evaluation methods were present in few.

The greatest gap found in this review was the lack of evaluation of these teaching

strategies, which leaves ample room for future research to identify effective teaching

strategies. The frameworks used in this project, the learning engagement model and the

diffusion of innovation theory, allowed the author to correlate findings in a meaningful

manner that guided further inquiry into future research, implications for nursing and

healthcare, and the significance to the body of nursing. This project served to identify

current teaching strategies in genetics and genomics education in nursing curricula and

stress the need to further research strategies that will help effectively and permanently

establish genetics and genomics content at all levels of nursing education.

47

APPENDIX A

48

SUMMARY OF CONCENSUS PANEL (2008) AND NCHPEG (2007) COMPETENCIES

Knowledge Practice Ethics

Examine competency of practice on a regular basis, identifying areas of strength, as well as areas in which professional development related to genetics and genomics would be beneficial

Identifies clients who may benefit from specific genetic and genomic information and/or services based on assessment data

Recognize when one’s own attitudes and values related to genetic and genomic science may affect care provided to clients

One’s professional role in the referral to or provision of genetics services, and in follow-up for those services

Identifies credible, accurate, appropriate, and current genetic and genomic information, resources, services, and/or technologies specific to given clients

Advocate for clients’ access to desired genetic/genomic services and/or resources including support groups

The various factors that influence the client’s ability to use genetic information and services

Demonstrate in practice the importance of tailoring genetic and genomic information and services to clients based on their culture, religion, knowledge level, literacy, and preferred language and assesses clients’ knowledge, perceptions, and responses to genetic and genomic information

Advocate for the rights of all clients for autonomous, informed genetic- and genomic-related decision-making and voluntary action

The potential physical and/or psychosocial benefits, limitations, and risks of genetic information for individuals, family members, and communities

Demonstrates ability to elicit a minimum of three-generation family health history information

Assure that the informed-consent process for genetic testing includes appropriate information about the potential risks, benefits, and limitations of the test in question

The ethical, legal and social issues related to genetic testing and recording of genetic information

Collects and critically analyzes personal, health, and developmental histories that consider genetic, environmental, and genomic influences and risks

Appreciate the sensitivity of genetic information and the need for privacy and confidentiality

Understand the relationship of genetics and genomics to

Develops a plan of care that incorporates genetic and

49

health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness

genomic assessment information, using and evaluating genetic- and genomic-based interventions and information to improve clients’ outcomes

Basic human genetics terminology and the basic patterns of biological inheritance and variation, both within families and within populations

Collaborates with healthcare providers in providing genetic and genomic health care and with insurance providers/payers to facilitate reimbursement for genetic and genomic healthcare services

How identification of disease-associated genetic variations facilitates development of prevention, diagnosis, and treatment options

Performs interventions/treatments appropriate to clients’ genetic and genomic healthcare needs

The interaction of genetic, environmental, and behavioral factors in predisposition to disease, onset of disease, response to treatment, and maintenance of health

Explain effectively the reasons for and benefits of genetic services

50

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