Anita O’Connor

Nurses’ competence in genetics: a mixed method systematic review

AIM   To ascertain the extent to which nurses are achieving the core competences in genetics appropriate for nursing practice. BACKGROUND   There is an increasing focus on genetics in nursing, and relevant core competences have been developed. However, it is unclear whether nurses are achieving these competences. DATA SOURCES   Four databases (CINAHL, Medline, The Allied and Complementary Medicine Database, and British Nursing Index) were searched. Hand searching of relevant reference lists and author names was also conducted. DESIGN Systematic review. REVIEW METHODS   The systematic review was undertaken using methods described by the Centre for Reviews and Dissemination (University of York, 2008). Research studies published in English between January 2000-January 2011 reporting data focussing on nurse competence in genetics were eligible for inclusion. Data were abstracted for inclusion in a table and subjected to thematic analysis: due to diversity of studies, a meta-analysis was not performed. RESULTS   Of 269 papers retrieved, 13 were eligible for inclusion. There were five main themes: knowledge, experience in using skills, ethical practice, perceived relevance, and confidence. Although the majority of participants believed genetics was relevant to their role, their knowledge of genetic concepts was generally poor; however, most studies measured self-reported knowledge rather than assessing actual knowledge. CONCLUSIONS   There is little evidence on this topic, but it does appear from the available evidence that nurses are not demonstrating the competences needed to offer holistic health care to people with genetic conditions. Pre- and post-registration programmes must be enhanced to include genetic health care.

Are health professionals ready for direct-to-consumer genetic and genomic testing?

Direct-to-consumer genetic and genomic tests have been offered for over a decade. With the reduction in the cost of sequencing, the options for consumers will increase, with subsequent pressure on health services to interpret data and integrate the results into healthcare management. However, indications are that health professionals are grossly unprepared to deal with requests for support from those who have undertaken direct-to-consumer genetic or genomic tests. While benefits may be derived from patient-driven investigations, distinction needs to be made between the mostly uncertain clinical utility of susceptibility testing and the potential benefits of a reliably interpreted sequencing result. It is essential that we develop strategies, including enhanced professional education, to cope with the potential impact on the health services, rather than ignoring these developments. There may also be implications for the future of genetic counseling, with potential changes in the current paradigm.

The Gen-Equip Project: evaluation and impact of genetics e-learning resources for primary care in six European languages

PurposeGenetic advances mean patients at risk of genetic conditions can be helped through testing, clinical screening, and preventive treatment, but they must first be identified to benefit. Ensuring quality of genetic care for patients requires genetic expertise in all health services, including primary care. To address an educational shortfall, a series of e-learning resources was developed in six languages to equip primary care professionals with genetic skills relevant for practice. The purpose of the study was to evaluate these resources using Kirkpatrick’s framework for educational outcomes.MethodsMixed methods (qualitative and quantitative) were used over four phases of the study.ResultsA high level of satisfaction with the resources was reported. Knowledge and skills improved significantly after using the education material. Participants reported changes in confidence and practice behavior, including family history taking, seeking advice from specialists and referring patients. The resources helped users to learn how to explain genetics. Many visited the resources repeatedly and some used them to educate colleagues or students.ConclusionGen-Equip modules are effective in improving genetic knowledge, skills, and attitudes for primary care professionals. They provide both continuing professional development and just-in-time learning for a potentially large global audience at a practical level.

Frameworks and quality measures used for debriefing in team-based simulation: a systematic review

Objectives The skill of the debriefer is known to be the strongest independent predictor of the quality of simulation encounters yet educators feel underprepared for this role. The aim of this review was to identify frameworks used for debriefing team-based simulations and measures used to assess debriefing quality. Methods We systematically searched PubMed, CINAHL, MedLine and Embase databases for simulation studies that evaluated a debriefing framework. Two reviewers evaluated study quality and retrieved information regarding study methods, debriefing framework, outcome measures and debriefing quality. Results A total of 676 papers published between January 2003 and December 2017 were identified using the search protocol. Following screening of abstracts, 37 full-text articles were assessed for eligibility, 26 studies met inclusion criteria for quality appraisal and 18 achieved a sufficiently high-quality score for inclusion in the evidence synthesis. A debriefing framework was used in all studies, mostly tailored to the study. Impact of the debrief was measured using satisfaction surveys (n=11) and/or participant performance (n=18). Three themes emerged from the data synthesis: selection and training of facilitators, debrief model and debrief assessment. There was little commonality across studies in terms of participants, experience of faculty and measures used. Conclusions A range of debriefing frameworks were used in these studies. Some key aspects of debrief for team-based simulation, such as facilitator training, the inclusion of a reaction phase and the impact of learner characteristics on debrief outcomes, have no or limited evidence and provide opportunities for future research particularly with interprofessional groups.

Management of Incidental Findings from Genetic Tests: Perspectives of Ethics Committee Members

New genomic technologies, whilst allowing comprehensive and cost-effective access to disease-causing mutations, also increase the possibility of incidental findings unrelated to the original research question. These findings may have health, reproductive or familial implications for the research participant concerned. There are diverse opinions regarding the obligations of researchers and appropriate management strategies regarding how or whether to return this information to research participants. As the empirical data on which these arguments are based is still fairly limited, we undertook a qualitative study, using a thematic analysis approach, to explore the topic further. We interviewed members of UK NHS research ethics committees to ascertain their experiences regarding genetic incidental findings, as well as their opinions regarding future challenges and management. The interviews were transcribed, coded and analysed for common themes. Three themes emerged; facilitating participant consent, supporting the validity of consent, and risks and rights. Ethics committee members were aware of the issues raised by genetic incidental findings despite limited practical experience in the projects they have assessed. There was no consensus as to how information should be presented to potential participants during recruitment for research involving genome-wide technologies, or whether blanket or checklist-based consent was most useful. Participants also discussed the difficulties in balancing the rights and obligations of research participants, their families, researchers and clinicians when considering the return of incidental findings. Some supported overruling patient consent in order to return clinically actionable incidental findings. In the absence of national guidance on these issues, the lack of consensus evident in this study could potentially lead to disparity between research ethics committees in the way genetic research studies are appraised. A wider discussion on the suitability of the current informed consent model for complex genomic research may also be required.

0087 Team Work And Attitudes To Ipl In Students Undertaking Interprofessional Simulation

Background Interprofessional learning (IPL) can improve attitudes and awareness of other professionals’ roles and may improve patient outcomes. Simulation is increasingly used for IPL and specific learning outcomes have been developed. This study aimed to measure undergraduates’ attitudes to IPL, before and after, and team performance during, interprofessional simulation sessions. Methodology Final year students (50 medical, 47 nursing), in groups of 7 to 12, completed the KidSIM ATTITUDES tool1 before and after participating in a simulation session. Groups were divided into two mixed (medical/nursing) teams. One team undertook a 20 min scenario while the second team observed and scored their performance using the Team Emergency Assessment Measure (TEAM).2 These roles were reversed for the second scenario. Reliability of both instruments was assessed by Cronbach’s Alpha. We assessed pre-post changes in ATTITUDES scores using paired-sample tests. The association of student demographic factors with ATTITUDES score changes and TEAM ratings was investigated using ANOVA. Results The ATTITUDES scale showed good reliability (Cronbach’s α = 0.92). Total ATTITUDES scores showed a significant pre-post increase (paired t-test, p = 0.020) as did 25 of the 30 items (Wilcoxon rank sum test, p < 0.05). Total score increase was greater for those without prior team based learning experience (p = 0.011) and for White and Asian students (p = 0.007, p = 0.003) but did not vary with students’ course, gender, prior IPL experience or session attended. Reliability of the TEAM score within small-group scenarios was moderate to good (Cronbach’s α = 0.57–0.92). TEAM global score was unrelated to students’ course, gender, ethnicity and age but was significantly lower in the first of the two scenarios (p = 0.001). Conclusions and recommendations Simulation-based interprofessional education improved attitudes to IPL in final year nursing and medical students. Observing and rating peers may improve students’ teamwork skills. Funded through a Collaborative Teaching Development Grant awarded by the Higher Education Academy. References Sigalet et al. The KidSIM ATTITUDES questionnaire provides a reliable and construct valid measure of student perceptions of and attitudes toward IPE, teamwork, and simulation as a learning modality. Sim Healthcare 2012;7:353–358 Cooper et al. Team Emergency Assessment Measure (TEAM) is a reliable and valid instrument designed to measure emergency resuscitation team performance. Resuscitation 2010;81(4):446–52 Cronbach L. Coefficient alpha and the internal structure of tests. Psychometrika 1951;16:297–334