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Genomic nurse scientists are at the intersection of human genomics research and the science of health. As the potential health benefits of precision medicine are considered, it is timely to reflect on nursing science's contributions to advancing the understanding of genomic aspects of health. During the decade of the 1990s, genetics was recognized as an essential component of nursing science (Lashley, 1997; Pesut, 1999), but was not yet a prominent focus of nursing research. Over the past two decades, the National Institute of Nursing Research (NINR) has identified the importance of the basic, behavioral, and social science aspects that influence health across populations, communities, and healthcare settings (NINR, 2011; Sigmon, Grady, & Amende, 1997). Also, during this period, the NINR has maintained an emphasis on the integration of behavior and biology (Grady, 2006). The current NINR Strategic Plan (NINR, 2011) continues this emphasis with its focus on investigation of multiple determinants of health, including genomics.During this same time period, a trajectory of genomics research was mapped (Green, Guyer, & National Human Genome Research Institute, 2011) in which the progression of genomic science moved from understanding the structure of the genome, through understanding the biology of genomes and disease, to advancing the science of medicine and improving the effectiveness of healthcare. Phases of clinical translation of genomic discovery to improve health include genome-based discovery, evidence-based recommendations, incorporation into the healthcare system, and evaluation of impact on health of populations (Khoury, Gwinn, Bowen, & Dotson, 2012). This trajectory of genomic science research also includes discovery of biology of diseases and symptoms, as well as examination of nursing interventions tailored for clients based on genomic variations (Munro, 2015). The dissemination and implementation phase addresses how to enable application of best evidence to improve healthcare outcomes (Eccles & Mittman, 2006). An awareness of genomic aspects of emerging areas of science was identified by the Council for the Advancement of Nursing Science (CANS) Idea Festival Committee (Henly et al., 2015) as a priority in its report on implications for PhD education. New healthcare policies will be needed to enable translation of genomic discoveries into health care (Institute of Medicine, 2014, 2015). Elements of the Precision Medicine Initiative (www.whitehouse.gov/precisionmedicine) are consistent with a nursing science agenda, as described in the NINR Strategic Plan (NINR, 2011), that includes a focus on innovation, as well as health promotion, disease prevention, and advancing quality of life. Further, the future of symptom science is envisioned as including knowledge development regarding genomic and context factors influencing symptom development and expression (Corwin et al., 2014).An invitational workshop at the National Institutes of Health (NIH) produced the Genomic Nursing Science Blueprint (hereafter referred to as the Blueprint), which identified crucial genomics problems relevant to health (https://www.ninr.nih.gov/sites/www.ninr.nih.gov/files/ jnu_12007_Rev_EV.pdf; Calzone et al., 2013). The systematic evidence review, key stakeholder testimony, and main meeting generated the listing of research topics that were then mapped into the NINR Strategic Plan, which contains themes of symptom science, wellness, self-management, and end-of-life and palliative care. The Blueprint contains four components: health promotion and disease prevention, advancing quality of life, innovation, and training, plus a fifth category of cross-cutting themes (e.g., health disparity and policy). In August 2013, a genomic nursing science workshop was convened by the NINR and the Office of Rare Diseases Research, National Center for Advancing Translational Sciences, to consider research topics that address behavioral and social sciences, as well as the biological aspects of genomic nursing science (Tully & Grady, 2015). …

Purpose: To describe characteristics and professional roles of genetics nurses in advanced practice. Design: A cross-sectional descriptive survey administered in 2004 as one component of a comprehensive study of genetic services and the health workforce. The sample was 211 U.S. members of the International Society of Nurses in Genetics. Methods: The survey included demographic characteristics, education, credentials, professional roles, and attitudes about genetic healthcare issues. Findings: The majority of respondents had master's degrees and many had earned doctorates in nursing (20%) or other fields (12%). Thirty-one percent were certified as nurse practitioners; 57% provided direct patient care, with the largest percentage working in genetics (26%) or oncology (22%) settings. Over one-third were educators and 19% conducted genome-related research. Conclusions: Genetics nurses in advanced practice in the US focus on both genomic discoveries and clinical health care through the application of genomic knowledge into health care, research, and nursing education.

Purpose: Analyze ethics, public policy, and education issues that arise in the United States (US) and the United Kingdom (UK) when genomic information acquired as a result of genetic testing is introduced into healthcare services. Organizing Construct: Priorities in the Ethical, Legal, and Social Issues Research Program include privacy, integration of genetic services into clinical health care, and educational preparation of the nursing workforce. These constructs are used to examine health policies in the US and UK, and professional interactions of individuals and families with healthcare providers. Findings: Individual, family, and societal goals may conflict with current healthcare practices and policies when genetic testing is done. Current health policies do not fully address these concerns. Unresolved issues include protection of privacy of individuals while considering genetic information needs of family members, determination of appropriate monitoring of genetic tests, addressing genetic healthcare discrepancies, and assuring appropriate nursing workforce preparation. Conclusions: Introduction of genetic testing into health care requires that providers are knowledgeable regarding ethical, policy, and practice issues in order to minimize risk for harm, protect the rights of individuals and families, and consider societal context in the management of genetic test results. Understanding of these issues is a component of genetic nursing competency that must be addressed at all levels of nursing education.

Purpose:To review international efforts to incorporate genetics content into nursing education curricula. Organizing Framework:A discussion of the progress in nursing education programs in selected countries to educate students for genomics-based health care. Information is based on review of the literature and curriculum change efforts by the authors. Conclusions:The lack of agreed-upon minimum competencies impedes efforts to educate nurses for genomics-based health care. Nationally and internationally recognized documents are useful for collaborative efforts to establish minimal competencies in knowledge, skills, and attitudes for nurses with basic and advanced education. Curriculum change that incorporates minimum competencies will require nursing faculty to improve their knowledge base in genomics-based health care. Partnerships among nurses in different countries are needed for successful genomics education programs for faculty.

Purpose: Faculty knowledge of genomics, learner competencies, and program requirements for nursing education are described to assist educators in introducing genomic information into nursing undergraduate, graduate, postgraduate, and continuing education programs regardless of geographic location. Selected programs in the United States and the United Kingdom are described to illustrate successful approaches used by nursing faculty to enhance their genomic knowledge in order to increase application of genetic and genomic content within nursing education curricula. Organizing Construct: Nursing education guidelines and nursing competencies provide benchmarks for educators in planning genetic and genomic curriculum content and expected learner outcomes. Methods: Elements within competencies from the United States and the United Kingdom are reviewed to provide the framework for faculty knowledge. Strategies to address development of faculty knowledge and expertise are suggested. Continuing education faculty development programs and strategies to develop doctorally prepared nurse scientists who will educate future students in the profession are described. Conclusions: Multiple faculty who are prepared to implement education on genetic and genomic topics are needed at all levels of nursing education. Faculty networking and application of genomic principles to nursing are key elements for sustaining nursing education to produce a nursing workforce that can apply essential genomic knowledge. Clinical Relevance: There is an urgent need to offer genomics in accessible and effective education for nursing practice to optimize health outcomes regardless of geographic location.