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page 1 | page 2 | page 3 | page 4 | page 5 | page 6 | page 7 | page 8 | page 9 | page 10 | page 11 | table of contents | references | test Implications for Practice As more is learned about the contribution of genetics to health and disease, nursing roles will expand in the delivery of genetic health care in all settings. An ISONG committee developed a document in collaboration with the American Nurses Association that outlines the scope and standards of genetics clinical nursing practice (ISONG, 1998). The scope of genetics nursing practice is described as basic and advanced. Genetics nursing practice at the basic level includes assessment to identify risk factors, planning of care, interventions such as information or services, and evaluation of the client for referral to genetic services. Advanced nurses who practice in genetics provide genetic counseling, case management, consultation, and evaluation of clients, families, resources, or programs. This document further defines education and experience required by the nurse to adequately integrate genetics into practice. Genetics-related nursing practice includes care of patients who have genetic conditions, individuals who may be predisposed to develop or to pass on a genetic condition, or persons seeking information or referral for additional genetic services (Lea, Jenkins & Francomano,1998). All components of the nursing process offer opportunities for the nurse to identify genetic information that may be helpful to the care of individual patients and families. Examples include: assessment of family and reproductive history to identify the potential of high risk for an illness (i.e. colon cancer); screening; diagnosis; health teaching; counseling; testing; and intervention. Nurses will continually be challenged to delineate the role they assume in offering genetics services in conjunction with other genetics specialists and tailored to their specialty setting. The Oncology Nursing Society developed two position statements that specify the role of the oncology nurse in cancer genetic counseling which offer examples of such tailoring (ONS, 1997a; ONS, 1997b). Continuing efforts will need to address what aspects of genetics all nurses will need to integrate into their practice. Recognition of administrators within nursing schools, health care facilities, and funding agencies of the importance of genetics will be an important factor to the integration of genetics into the nursing role. Once administrators recognize that all health care settings will be impacted by these discoveries, enhanced availability of access to quality services will be a goal. Provision of collaborative teams to offer services in diverse settings will require an economic investment to prepare and support staff to offer cost effective and efficient care. Economic investments in educational preparation, allocation of human resources, and space to offer new models of care that focus on wellness counseling, diagnostics, and ethical considerations is needed now. Ethical considerations are an example of such an application area for genetics, which will have implications for all.
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