Genetic Encoding

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated). Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings. Support your response with references from the professional nursing literature, less than or equal to five years old. Post 1: I chose genetically competent care for those with chronic illness. The article I chose is involves breast cancer and how the Oncotype DX Breast Reassurance Score Assay is beneficial in making treatment decisions for early-stage breast cancer patients. Current practice in determining prognosis for these patients include patient age at diagnosis, axillary node involvement, tumor size, histology, lymphatic/ vascular invasion, etc (Curtit et al., 2016). According to the article, these factors can help predict long term outcome of treatment. However, it also states that this system of identification does not work for early breast cancer patients that do not fit into either the low or high risk category. The article discusses how the Oncotype DX Breast Recurrence Score Assay takes in account 21 genes. According to Curtit et al. (2016), “the gene expression data are used to calculate a Recurrence result that is significantly associated with the 10-year risk of distant recurrence (95% confidence interval) in ER and HER2-negative patients, (p. 923). The nurse’s role in providing care to these patients consists largely of emotional support (Remmers et al., 2010).  However, as with any illnesses, it also requires self-education and competency about the disease. We have to be educated about the disease, treatment options, and testing process to be able to relate to, or be empathetic to, our patients. Ethical implications involving genetics are many. For example, although genetic testing is available, it does not mean that everyone wants to know if they carry a gene that can cause cancer. That being said, this can cause issues in decision making. For example, maybe the husband does not want the testing, but the wife does want the testing for her husband. Maybe the husband doesn’t want to know, but the wife thinks it’s important to know for the kids’ sake. These decisions can greatly effect treatment options and prognosis for the patient and family members (Beamer, 2017). There are also ethical issues involving gene editing. Is it ethical to alter genes at the sperm and egg level? Some say yes, others no. If it is allowed, will it be marketed as service you have to pay for? Is it ethical for some people to be able to pay for this, while others can’t afford it? Beamer, L. C. (2017). Ethics and genetics: examining a crossroads in nursing through a case study. Clinical Journal of Oncology Nursing, 21(6), 730–737. Curtit E, Mansi L, Maisonnette-Escot Y, Sautière JL, Pivot X. Prognostic and predictive indicators in early-stage breast cancer and the role of genomic profiling: focus on the oncotype DX® breast recurrence score assay. Eur J Surg Oncol. 2017 May;43(5):921-930. doi: 10.1016/j.ejso.2016.11.016. Epub 2016 Dec 14. PMID: 28087099. Remmers H, Holtgräwe M, Pinkert C. Stress and nursing care needs of women with breast cancer during primary treatment: a qualitative study. Eur J Oncol Nurs. 2010 Feb;14(1):11-6. doi: 10.1016/j.ejon.2009.07.002. Epub 2009 Sep 11. PMID: 19748314. Post2: The integration of genetic and genomic information in nursing clinical practice can result in improved outcomes in patient care. The focus of this post is on pharmacogenomics and its implications in the management of chronic mental illness. By definition, pharmacogenomics is the study of how a patient metabolizes pharmaceuticals based on said patient’s specific genetic make-up (Montgomery et al., 2017, 10). In the article, The Use of Pharmacogenetic Testing in Patients with Schizophrenia or Bipolar Disorder, Routhieaux et al. (2018) reviewed the findings of eighteen pharmacogenetic research studies to assess the impact of ethnicity, age, family history, and sex on the efficacy of psychotropic medications. Many of these studies recognized an association between an identified gene and the genetic predisposition to an illness or  response to a psychotropic medication. (Routhieaux et al., 2018, 299). The conclusion drawn from this review is that ongoing research and application of pharmacogenomics may help a patient achieve a positive therapeutic response early in the treatment process and avoid adverse effects or delays in symptom relief (Routhieaux et al., 2018, 300). The nurse plays an important role in the application of genetic and genomic information in the clinical setting. As part of the patient assessment, the nurse can develop a comprehensive medical history by identifiying conditions that the patient may have a genetic predisposition to. As an advocate and educator, these findings present opportunities for the nurse to assist a patient in obtaining a referral for genetic counseling, developing a plan to reduce personal risk factors, understanding early screening guidelines, and watching for the  signs and symptoms associated with the development of an identified health condition (Montgomery et al., 2017, 12). Although there appears to be multiple benefits to using genetic information in patient care,  there are still ethical implications that must be considered. The nurse is taught to respect the values, goals, and individuality of each patient that we come in contact with. Therefore, each patient has the right to refuse the testing that could provide the genetic information needed to determine which medication would best resolve one’s mental health symptoms. For example, patients with paranoia may demonstrate particular resistance to any type of testing that involves blood or sputum samples (Routhieaux et al., 2018, 301). Additionally, nurses must be aware of their own personal biases in order to provide the culturally competent care necessary to communicate effectively to  diverse populations. Bibliography Montgomery, S., Brouwer, W. A., Everett, P. C., Hassen, E., Lowe, T., McGreal, S. B., & Eggert, J. (2017, October). Genetics in the clinical setting: what nurses need to know to provide the best patient care. American Nurse Today, 12(10), 10-17. Routhieaux, M., Keels, J., & Tillery, E. E. (2018). The use of pharmacogenetic testing in patients with schizophrenia or bipolar disorder: A systematic review. Mental Health Clinician, 8(6), 294-302. 10.9740/mhc.2018.11.294

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